The PMHNP is performing a follow-up visit on a 41-year-old female who is being treated for obsessive-compulsive disorder. She has been seeing an exposure-response therapist for over six months, and approximately two months ago both patient and the therapist felt that pharmacotherapy should be considered. The patient was started on fluoxetine and was rapidly titrated up to 40 mg day two months ago. Today in follow-up the patient’s Y-BOCS score is 23, as compared to a 24 when she started her medication 2 months ago. Subjectively she feels distinct improvement. She still loses time to both her obsessive thoughts and occasionally her husband has to pick her up and carry her from bed to living room because of her obsession about touching the floor. But, she feels encouraged and genuinely feels as though things are better.

The appropriate course of action today would be to do which of the following?

A. Increase her fluoxetine to 60 mg day

B. Change her SSRI to fluvoxamine rapidly tapering to 300 mg/day

C. Continue the current plan of care and follow-up in one month

D. Discuss with her a change of therapeutic modality to EMDR.

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YouTube: https://www.youtube.com/watch?v=UIuwwA5N63I&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=144

The PMHNP is reviewing the results of a comprehensive new patient assessment and notes that the result of the patient health questionnaire (PHQ)-9 is a 7. Knowing that the sensitivity of this screening tool is 90% for a score of 8 or more, the PMHNP recognizes that the likelihood that the patient is having a major depressive episode is:

A. 10%

B. 15%

C. 85%

D. 90%

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YouTube: https://www.youtube.com/watch?v=iK87yMniCNY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=143

J.T. is a 38-year-old male patient who presents for assessment and treatment of substance use disorder. He has a long history of chronic alcohol use, typically drinking a 6-pack of beer every evening. According to his primary care provider his physical examination and laboratory studies are all within normal limits and there are no documented medical conditions.

He admits that he personally does not truly believe he has substance use problem, but his wife does like the fact that he drinks, and they argue about it often. He loves his wife and does not want to argue, but he enjoys his beer and feels strongly that it is not hurting anything when he drinks. He thinks she is being unreasonable.

The PMHNP recognizes that he is at what point in the change process?

A. Precontemplative

B. Focusing

C. Unfreezing

D. Planning