Renee is a 27-year-old female who has come to group therapy while incarcerated in the city jail. She was arrested for vagrancy because she was sleeping in her car. She could not post bail and was sentenced to 14 days in jail. During group she contributes that none of this is her fault. Her mother is totally evil because she would not let Alexa stay in the family home. She has some other family but they are all jerks because they won’t help her. Alexa’s friend Melanie is the absolute best person in the world, but she can’t help because her boss fired her for no reason. Alexa has a history of arrests for buying illegal drugs and for prostitution. The last time she was in jail her sentence was extended for 30 days because she got into a fight with another inmate and beat her up so badly she had to be admitted to the hospital for 6 days. The PMHNP considers which of the following personality disorders?

A. Histrionic
B. Narcissistic
C. Borderline
D. Schizoid
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YouTube: https://www.youtube.com/watch?v=qDhZKym5gn8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=15

Mrs. Maxwell is a 75-year-old patient with neurocognitive disorder due to Alzheimer’s disease. She lives with her son and his wife and generally does very well with her day-to-day activities. The family understand the importance of routine and Mrs. Maxwell maintains a regular schedule of activities including her meals, timed toileting, and recreational activities. Which of the following behaviors should prompt an immediate depression screening for Mrs. Maxwell?

A. An acute change in mental status

B. Angry verbal outbursts that seem unwarranted

C. Death of her best friend

D. An unplanned weight loss despite consistent oral intake
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YouTube: https://www.youtube.com/watch?v=ZDngVJdU_YA&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=14

M.T. is a 39-year-old female being seen by the PMHNP for a major depressive disorder. She is being managed with SNRI therapy in combination with cognitive behavioral therapy, but is having difficulty achieving remission. Her husband is becoming very frustrated. He wants to be supportive, but does not understand why she is so depressed. Two years ago she had an episode of depression when her sister died in an accident, but after 6 month of treatment she seemed to return to normal. Her husband says “she has nothing to be depressed about.” In trying to help M.T.’s husband understand the disease process, the PMHNP discusses with him that:

A. The physiologic stress accompanying her first episode of depression may have produced changes in brain biology that makes her susceptible to subsequent episodes without an external trigger.

B. The pharmacotherapy required to achieve remission with her first episode resulted in neuroplastic changes that increased her likelihood of experiencing additional depressive episodes

C. The scientific literature suggests that the loss of a sibling is the life event most closely associated with recurrent episodes of major depressive disorder throughout adulthood

D. Response to pharmacotherapy often takes a minimum of 8 weeks and M.T. is much more likely to achieve remission if her husband can continue to provide the necessary support throughout her remission period.
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YouTube: https://www.youtube.com/watch?v=TWL9C9qKr84&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=12