1. Collette is a 23-year-old female who presented for emergency care with her mother because her
behavior has become increasingly erratic and caused her to lose her job. Her mother reports
that she had never done anything like this in the past, but about 3 months ago, her boyfriend of
3 years broke up with her, and Collette began to express unrealistic beliefs that her boyfriend
wanted to drive her crazy and hurt her. A gentleman trying to hail a taxi accidentally bumped
into her this morning, and she started screaming that her ex-boyfriend had hired the man to
throw her into the street under a car. Collette is on a 2-week suspension from her job as a
restaurant server because she was combative to a customer— she accused him of colluding with
her ex-boyfriend to get her fired. After this morning's incident, her mother was so worried she
brought her to the emergency room. Her appearance is disheveled, she is clearly hyperalert and
is crying that her boyfriend must have converted her mother to work against her. Head imaging,
screening lab, and a toxicology screen are negative. A leading differential for Collette is:
a. Acute psychotic episode
Rationale: Collette's differential diagnosis is an acute psychotic episode, this disorder
causes abnormal ideas and perceptions. Two of the main symptoms are delusions and
hallucinations. Delusions are false beliefs, such as that someone is against them and
hallucinations are false perceptions, such as listening, or feeling something that does
not exist.
2. Jake and Laurie are a young married couple who have been referred to mental health counseling
because Jake is having disturbing sleep events. Laurie reports that on more than one occasion
she has awakened to find Jake having what appears to be a panic attack, but he doesn't seem to
realize it. When he finally wakes up, he is confused and doesn't really understand what
, happened, although he does have a sense of intense fear. This has happened twice in the last 2
weeks, and the last time Laurie heard him screaming. Jake is now a bit afraid to go to sleep and
as a result does not feel well the next day. The PMHNP recognizes that sleep terrors in adults:
a. Are often associated with trauma or psychiatric problems
3. Jack is a 27-year-old male who has a history of paranoid schizophrenia that first became
apparent approximately 10 years ago. He developed paranoid delusions and eventually
decompensated to the point that he required inpatient stabilization. At the time, he was started
on conventional antipsychotics, but due to intolerable adverse effects he was switched to
haloperidol. It worked well, but whenever he stopped taking it, symptoms would recur. After
several hospitalizations, he was stabilized. The neurophysiologic theory of schizophrenia
suggests that Jack's symptoms were a result of:
a. Increased dopamine activity in the mesolimbic pathway
4. Johanne is a 22-year-old female who is being treated for narcolepsy. She is attempting to
implement a regimen of forced daytime naps in an effort to manage her condition without
pharmacotherapy as she is generally averse to taking medications. While following Johanne, the
PMHNP should be alert to signs and symptoms of
a. Depression
5. Narcolepsy
a. A sleep disorder characterized by uncontrollable sleep attacks. The sufferer may lapse
directly into REM sleep, often at inopportune times.
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