Jeffrey T. is a 27-year-old man who has presented for care after being required to do so by the county court. He was involved in a car accident, and while he was not at fault for the accident, routine blood alcohol screening revealed that he was driving while intoxicated. He is a bit resentful at being required to attend therapy; he is vocal that his driving was not impaired and that he can function normally even after drinking what others might consider excess amounts of alcohol. His wife confirms this; they both admit what began as one or two beers after work a few years ago has evolved to where he now drinks at least a 12 pack of beer nightly. Regardless, they both confirm that he never “seems drunk” and this does not interfere with his job or fulfilling his family functions. Jeffrey’s ability to function normally despite high blood alcohol is likely a result of:

A. Dependence

B. Abuse

C. Adaptation

D. Addiction
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YouTube: https://www.youtube.com/watch?v=stFQXo4XV6Y&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=19

Fletcher is a 29-year-old male referred for court-ordered counseling. He has a long history of repeated offenses including DUI, domestic violence, battery, and other violent acts that fortunately have not yet caused any serious injury or death to the victims. An interview with his wife reveals that for the last few years he has lied about almost everything; he is able to get hired for jobs because he is very engaging and likeable, and then invariably he gets fired because he misses work and doesn’t do his job properly when he is there. According to the wife, they have known each other since high school where Fletcher was very happy and well-adjusted. He was on the soccer team, liked by teachers, and never demonstrated the tendencies he does now. Apparently in college he got involved with a fraternity that was notorious for alcohol and drug abuse, and he started drinking heavily; it was “all downhill from there.” The PMHNP considers that:

A. History and symptoms are most consistent with antisocial personality disorder

B. Fletcher needs a neurological workup to include an EEG and assessment for neurological soft signs

C. Consistent with his symptoms Fletcher will likely respond well to a stress interview

D. It is likely that substance abuse is the underlying cause of symptoms and should be explored further
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YouTube: https://www.youtube.com/watch?v=GINQB976rx4&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=18

Mrs. Bowen is a 33-year-old female who presents as a new patient requesting medication for depression. She reports a long history of mood disorders on and off going back to adolescence. She is very articulate in describing her history and reports that neither sertraline nor fluoxetine “worked for her.” With respect to considering Mrs. Bowen’s medication history, the PMHNP knows that:

A. A SNRI will likely be the most appropriate choice if pharmacotherapy is indicated for this episode

B. This may be an inaccurate characterization as depressed patients tend to overemphasize negatives

C. In some circumstances patients will purposefully mischaracterize the efficacy of medications they feel were ineffective

D. Some forms of recurrent depression are best managed with nonpharmacologic strategies
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YouTube: https://www.youtube.com/watch?v=tkuR-oLi0S8&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=17