Whether you're days from testing or deep in the trenches of your clinical prep, this episode delivers three case-based psychopharm scenarios designed to sharpen your diagnostic edge and reinforce high-risk, high-yield content for the PMHNP board exam. These aren’t fluff. These are the cases you’ll wish you studied harder—until now.

We break down three real-world dilemmas disguised as board-style questions. From the sneaky presentation of a health-anxious patient with no symptoms to the estrogen-lamotrigine interaction that could tank your mood stabilizer’s effect, to the exact number of days you must wait before initiating an MAOI after stopping an SSRI—this episode gets straight to the clinical meat.

If you’ve ever felt unsure about the difference between illness anxiety disorder and somatic symptom disorder, or you’re fuzzy on UGT1A4 and why it matters, or if serotonin syndrome is still a little too theoretical—you need this episode.

• The underrecognized red flags of illness anxiety disorder, and how one word in a patient’s narrative can change the entire diagnosis.
• The board-critical difference between a patient having symptoms vs. fearing they’ll get them.
• A deep dive into lamotrigine’s metabolic vulnerability—and how estrogen triggers an enzyme that might be sabotaging your treatment plan.
• The exact washout protocol required when transitioning from SSRIs to MAOIs—and the potentially deadly reason why you never fudge the math.
• Why UGT1A4 matters: the phase II liver enzyme you didn’t realize could blow up your lamotrigine levels.

• 💡 Case-based learning that mirrors real ANCC PMHNP exam structure
• 📊 Realistic distractors and rationales that test your diagnostic discrimination
• 🧠 Deep integration of pharmacology and psychiatric reasoning
• 🚫 Zero spoilers—answers are discussed in-episode only
• 🧬 Tightly woven clinical pearls you’ll carry into practice
• 💥 Mini “board bombs” that will either detonate your recall—or cement it

• Psych NP board review
• Illness anxiety vs somatic symptom disorder
• Lamotrigine and estrogen interaction
• UGT1A4 lamotrigine metabolism
• Bipolar depression treatment interactions
• MAOI washout protocol
• Switching from SSRI to phenelzine
• Serotonin syndrome prevention
• High-yield psychopharmacology
• PMHNP clinical pearls podcast
• ANCC PMHNP exam prep
• Psych NP case studies podcast
• Psychiatric differential diagnosis
• SSRI MAOI contraindications

Want the full breakdown of serotonin syndrome cases, drug-switching cheat sheets, and exclusive flashcard packs for everything from UGT enzymes to tricky anxiety presentations? Join us on Patreon for extended content, board prep vaults, and one-on-one Q&A.

• Lamotrigine
• Paxil (paroxetine)
• Phenelzine (Nardil)
• Estrogen-containing oral contraceptives

This episode isn’t about cramming. It’s about clinically understanding the why behind every answer—and becoming the kind of psych NP who doesn’t just pass boards… but owns the room.

🎧 Listen now and sharpen your diagnostic sword.

13

Board Bombs: 3 Great Practice Psychiatric Nurse Practitioner Board Prep Questions

Pearls and Prep

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Managing PTSD and Nightmares: An In-Depth Case Study

In this episode of Pearls and Prep, the focus is on a mock patient named Marcus who has been suffering from PTSD-related nightmares after falling into a non-active volcano years ago. Despite being on Zoloft, Marcus continues to experience severe nightmares, impacting his quality of life. The script covers the importance of understanding a patient's pre-trauma mental health status, assessing other potential symptoms and comorbidities, and the role of various pharmacological treatments, including the use of prazosin. The episode emphasizes the necessity of comprehensive questioning, considering sleep patterns, substance use, and the wider impact of the trauma on daily life. Detailed guidance is offered on optimizing treatment plans and the value of trauma-informed care.

00:00 Introduction to Pearls and Prep

00:12 Meet Marcus: The Mock Patient

01:39 Understanding Marcus's Trauma

01:52 Assessing Mental Health History

04:55 Exploring Sleep Patterns and Nightmares

05:52 Substance Use and Hypervigilance

07:37 Impact of Trauma on Daily Life

10:08 Diagnosing PTSD and Treatment Options

20:44 The Role of Prazosin in Treating Nightmares

24:35 Optimizing Treatment and Final Thoughts

In our examination of Marcus's case, we elucidate the multifaceted nature of PTSD, particularly the role of nightmares in exacerbating his distress. The podcast articulates how Marcus's traumatic memories manifest as vivid and distressing nocturnal episodes, which severely impair his quality of life. We detail the pharmacological interventions available, specifically focusing on the utilization of SSRIs such as Zoloft, and introduce Prazosin as an adjunct treatment aimed at ameliorating the frequency and intensity of nightmares. Our discussion emphasizes the necessity of understanding Marcus's subjective experience with medication, fostering an open dialogue about its effects on his mental health. We advocate for a tailored treatment plan that not only addresses the pharmacological needs but also incorporates therapeutic modalities that can enhance emotional processing and resilience. The episode serves as a platform for dissecting the clinical nuances of PTSD management, encouraging practitioners to adopt a patient-centered approach that values empathy and comprehensive care.

Takeaways:

• The patient, Marcus, experiences severe nightmares stemming from a traumatic event involving a volcano, significantly impacting his quality of life.
• Understanding a patient's mental health history before a traumatic event is crucial for effective treatment and determining their baseline functioning.
• Exploring the patient's sleep patterns and the nature of their nightmares is essential in addressing the psychological impact of trauma.
• It is important to assess the role of medication, such as Zoloft, in managing PTSD symptoms and consider additional treatments if necessary.
• The use of Prazosin has shown promise in alleviating nightmares associated with PTSD by mitigating fear responses during REM sleep.
• A comprehensive approach includes evaluating comorbid conditions, such as substance use disorders, that may complicate the patient's treatment journey.

6

From Volcanoes to Nightmares: A Deep Dive on Prazosin

Pearls and Prep

pearlsandprep@mail.com

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Navigating Complex Diagnoses: A Case Study on OCD

In this episode of Pearls and Prep, the host presents a mock case study featuring 'Sarah,' a fictional patient struggling with academic performance, overwhelming anxiety, and obsessive-compulsive behaviors. The episode emphasizes the importance of gathering comprehensive information before jumping to a diagnosis, exploring potential differential diagnoses including ADHD, OCD, and generalized anxiety disorder. Detailed advice is provided on conducting a thorough mental status examination, assessing insight levels, ruling out psychosis, and prioritizing treatment interventions such as SSRIs and exposure response therapy. Additional resources and tools for enhanced practice, available through the Patreon membership, are also highlighted.

00:00 Introduction and Purpose of the Episode

00:42 Meet Sarah: The Case Study Begins

01:26 Exploring Sarah's Symptoms and Background

02:28 Differential Diagnosis: Beyond ADHD

04:10 OCD Indicators and Patient Interaction

06:05 Importance of Therapeutic Rapport

07:06 Assessing Bizarre Thoughts and OCD

09:11 Mental Status Exam and Differential Diagnosis

10:02 Quantifying Symptoms and OCD Diagnosis

11:07 Comorbidities and Treatment Considerations

25:56 SSRIs and Treatment Strategies for OCD

29:54 Conclusion and Final Thoughts

In a detailed exploration of psychiatric practice, the podcast introduces a mock case study involving a patient named Sarah, who grapples with significant academic and psychological challenges. Sarah's narrative reveals her struggles with obsessive-compulsive tendencies, particularly her compulsive hand-washing and prolonged showering, which she employs as coping mechanisms against her overwhelming anxiety related to germs and academic performance. The speakers emphasize the necessity of a comprehensive diagnostic framework that transcends simplistic categorizations, urging listeners to consider the interplay of various mental health conditions that may manifest in a patient like Sarah.

The discussion highlights the significance of critical questioning in clinical practice, as the speakers guide listeners through the process of discerning the underlying causes of Sarah's distress. They encourage practitioners to adopt a holistic view that considers both her potential ADHD and the pervasive effects of anxiety on her academic life. By illustrating the importance of thorough mental status examinations and the use of appropriate screening tools, the podcast reinforces the idea that effective psychiatric treatment requires a well-rounded understanding of the patient’s lived experience. The episode ultimately advocates for a compassionate approach in clinical interactions, reiterating the importance of making patients feel safe to share their innermost concerns, which can significantly enhance diagnostic clarity and treatment outcomes.

Takeaways:

• The podcast emphasizes the importance of gathering rich information before diagnosing a patient, as multiple factors can contribute to their symptoms.
• Sarah, the mock patient in the episode, presents with obsessive hand washing and bizarre thoughts, indicative of potential OCD symptoms.
• The speakers caution against jumping to conclusions about ADHD and stress the need for thorough questioning to understand the patient's true concerns.
• They highlight that SSRIs are a primary treatment option for OCD, but a comprehensive approach involving therapy is also essential for effective management.

Links referenced in this episode:

• patreon.com/pearlsandprep

4

The Intricacies of Diagnosing Anxiety Disorders

Pearls and Prep

pearlsandprep@mail.com...