AANPCB PMHNP-C cheat sheet

Mental status exam components: appearance, behavior, speech, mood/affect, thought process, thought content, perception, cognition, insight, judgment.

C-SSRS stratifies suicide risk by ideation severity, intent, plan, and behavior; ask directly about ideation, plan, means, and prior attempts.

AUDIT-C positive screen: score ≥4 in men, ≥3 in women; CAGE is brief but less sensitive for binge or mild use.

PHQ-9 scores: 5-9 mild, 10-14 moderate, 15-19 moderately severe, ≥20 severe; item 9 flags suicidality.

GAD-7 scores: 5-9 mild, 10-14 moderate, ≥15 severe anxiety; ≥10 is a common treatment threshold.

Delirium screening (CAM) requires acute onset/fluctuation plus inattention, with either disorganized thinking or altered consciousness.

SIGECAPS mnemonic screens major depression: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicide.

Standard adult drink = 14 g ethanol (12 oz beer, 5 oz wine, 1.5 oz distilled spirits); heavy drinking exceeds 4/day or 14/week for men.

Major depressive disorder requires ≥5 of 9 symptoms for ≥2 weeks, including depressed mood or anhedonia, causing impairment.

Manic episode: elevated/irritable mood plus increased energy for ≥1 week (or hospitalization), with ≥3 of 7 criteria (4 if irritable).

Hypomania is ≥4 consecutive days, clearly different from baseline, without marked impairment, psychosis, or hospitalization.

Schizophrenia requires ≥2 of: delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behavior, negative symptoms; ≥1 must be delusions, hallucinations, or disorganized speech.

ADHD in adults requires ≥5 symptoms of inattention and/or hyperactivity-impulsivity present before age 12, in ≥2 settings.

GAD requires excessive worry for ≥6 months, difficult to control, with ≥3 of 6 symptoms (restlessness, fatigue, concentration, irritability, tension, sleep).

PTSD requires ≥1 intrusion, ≥1 avoidance, ≥2 negative cognition/mood, ≥2 arousal/reactivity symptoms, lasting >1 month.

Panic attack is a discrete surge peaking within minutes with ≥4 of 13 symptoms; panic disorder adds ≥1 month of worry or behavior change.

SSRIs are first-line for depression and anxiety; start low, titrate after 4-6 weeks, and allow 4-8 weeks for full response.

Serotonin syndrome triad: mental status change, autonomic hyperactivity, neuromuscular abnormalities (clonus, hyperreflexia); stop serotonergic agents.

Bupropion lowers seizure threshold and is contraindicated in bulimia, anorexia nervosa, and seizure disorders; no serotonergic sexual dysfunction.

Lithium monitoring: trough level 0.6-1.2 mEq/L, check renal function, thyroid, calcium, and levels 5 days after dose change.

Metabolic monitoring for antipsychotics: baseline weight/BMI, waist, BP, fasting glucose or A1c, and lipids, then periodically.

Benzodiazepines are short-term adjuncts; avoid in substance use disorder and in older adults (Beers criteria) due to falls and delirium.

First-line pharmacotherapy for opioid use disorder is buprenorphine or methadone; naltrexone is an alternative after detoxification.

Psychotherapy with strong evidence: CBT for depression/anxiety, exposure-based therapy for OCD/PTSD, DBT for borderline personality disorder.

Depression response is ≥50% reduction in symptom scale score; remission is PHQ-9 <5 or near-absent symptoms.

If no response after 4-8 weeks at adequate SSRI dose, verify adherence and diagnosis before switching or augmenting.

Naranjo or similar causality scales estimate likelihood that a symptom is an adverse drug reaction (score ≥9 definite, 5-8 probable).

QTc >500 ms or increase >60 ms from baseline warrants stopping or changing the QT-prolonging antipsychotic.

Clozapine requires ANC monitoring: weekly for 6 months, then every 2 weeks for 6 months, then every 4 weeks.

Thyroid and CBC should be rechecked periodically on lithium; tremor, polyuria, and weight gain signal toxicity or adverse effects.

Screen for treatment-emergent suicidality, activation, or mania after starting an antidepressant, especially in youth and young adults.

Relapse prevention: continue antidepressants ≥6-12 months after remission; longer if recurrent episodes.