A 27-year-old patient presents for evaluation at the suggestion of his intimate partner who thinks he might have depression. During the initial evaluation the patient admits that he is often “down,” has a really hard time feeling happy even when really good things happen. He denies any particular precipitating factor and in retrospect thinks he has been like this for “years.” He denies any difficulty sleeping, although says he never really wakes up feeling “well-rested and ready to go.” His appetite is fine, he denies any thoughts of death, suicide or self-harm, and denies a sense of hopelessness about life.

He likes his job with a property management company, although he says it’s not especially exciting. He admits to generally having no mental or physical energy. Sometimes he wants to do things, but cannot get himself to do it. It is beginning to be a problem with his relationship, which is why he made the appointment. He has not medical conditions, takes no medications, and the rest of his history and ROS is within normal limits.

What is the most likely diagnosis?

A. Depressive mood due to substance use disorder

B. Adjustment disorder with depressed mood

C. Major depressive disorder, recurrent

D. Persistent depressive disorder

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YouTube: https://www.youtube.com/watch?v=WCrL3cdK4dM&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=107

The PMHNP is seeing a patient who has been struggling with a collection of anxiety and depressive symptoms. She is resistant to pharmacotherapy and prefers to begin with a psychotherapy approach. As it turns out, the primary source of her symptoms is that she is married to a spouse in the military and has had to move thousands of miles from home, friends and family.

An attempt to implement solution-focused therapy would include which of the following techniques?

A. Motivational interviewing

B. Cognitive restructuring

C. Social skills training

D. The miracle question

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YouTube: https://www.youtube.com/watch?v=60cxLyWFU4E&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=106

The PMHNP is interviewing a new patient, a 32-year-old single female who is presenting for evaluation of underlying anxiety. While collecting a social history the PMNP asks the patient if she has a boyfriend. The patient is uncomfortable with the question as she is lesbian and is now afraid that the PMHNP will not treat her fairly and with dignity.

The PMHNP is most likely demonstrating which of the following?

A. An appropriate approach to collecting social history

B. A manifestation of implicit bias

C. An overt implementation of her value system

D. A conscious disregard for alternative lifestyles

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YouTube: https://www.youtube.com/watch?v=6kyWMh95t18&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=105