A 67-year old previously healthy male patient with a history of well-controlled Type I diabetes mellitus and hypertension is brought to the emergency department by his son for active confusion and irritability that began several days ago. The patient has a history of bipolar II which has been treated successfully with lurasidone for a number of years. The diagnosis based on these findings is

A 48-year-old man is evaluated for excessive daytime sleepiness. His overnight polysomnography is normal. During multiple sleep latency testing (MSLT), he falls asleep within 4 minutes on average and enters REM sleep during two of the nap trials. He reports no history of cataplexy. CSF hypocretin levels are normal. Which diagnosis is most appropriate?

The mother of an 8 year old male currently diagnosed with ADHD accompanies the child to appointment with PMHNP. He has been taking methylphenidate ER 18 mg every day. The mother recently started a new job and has concerns that the patient has become increasingly angry, impulsive and irritable over the last 4 weeks, pushing his younger brother and threatening to hit mother if she takes his tablet away. He is not falling asleep until very late and consistently wakes up irritable. Mother is concerned that the child needs medication for bipolar disorder because he is happy one minute and then mad as soon as he doesn’t get his way. Mother says, “He’s just like his estranged biological father”. After contacting the school staff and reviewing behavior checklists returned by teachers, it is clear there are no major behavioral concerns at school, only mild impulsivity and distractibility during the initial portion of each day. Which of the following recommendations by the PMHNP reflects contingency management?

A 78 year old male sees an APRN in the outpatient mental health clinic accompanied by his 44 year old son. Routine workup by the PCP was negative. The patient has had a progressive decline in health and memory loss and can no longer perform ADLs. He has a hand tremor, is anxious and forgets to take his medications. He does not sleep well and often wanders around the house at night; he has left the stove turned on multiple times after cooking. The father has been living with his son for the past several months and the son reports noticing the gradual memory problems several years ago, but it recently increased after the death of the patient’s wife. The patient denies suicidal or homicidal thoughts. There is no evidence of delusions or hallucinations. Which of the following best fits this scenario?

Which of the following is not an accurate statement about Nightmare Disorder?

Which of the following is true about narcolepsy

A 49-year-old woman with obesity and COPD reports chronic morning headaches and nonrestorative sleep. PSG shows sustained oxygen desaturation during sleep and elevated CO₂ levels, but no significant apnea or hypopnea events. What is the most likely diagnosis?

A 74 year old man accompanied by his worried wife with concerns for possible dementia is seen in the office.  He retired from his work as a family practice physician four months ago and his wife notes decline in his memory and cognitive functioning since that time.  He seemed sharp and his practice was going well when he retired.  In the appointment, the patient was unkempt and unshaved.  He looked at the floor much of the time and answered most questions slowly with “I don’t know” if he responded at all.  No confabulation or response to internal stimuli was observed.  He typically stays in bed much of the day reading or sleeping and has lost weight. Inattentiveness and forgetfulness are assessed during the MSE. The best treatment recommendation is __________________ with a two week follow up appointment.

An 76-year old female seen by the APRN for an initial psychiatric interview is accompanied by her daughter who provides much of the history. The patient’s memory has progressively declined over the past four or five years and she started several small kitchen fires over the past month because she forgets to turn off the stove after cooking. She has increasing difficulty organizing and completing even simple tasks. Her muscle strength and balance are intact; gait is steady; no tremors. She is able to recall two of three items immediately, none after 5 minutes of interposed tasks. She has become increasingly disoriented and confused in the evening and through the night so has moved in temporarily with her daughter. The most evidence-based treatment recommendation is 

A 48-year-old man is evaluated for excessive daytime sleepiness. His overnight polysomnography is normal. During multiple sleep latency testing (MSLT), he falls asleep within 4 minutes on average and enters REM sleep during two of the nap trials. He reports no history of cataplexy. CSF hypocretin levels are normal. Which diagnosis is most appropriate?