When managing a patient in the stabilization phase of schizophrenia primary goals and process include which of the following?

A. Self-management skills

B. Supported employment

C. Assertive community treatment

D. Minimizing stress and supporting recovery

A 50 -year-old female patient has been followed by the PMHNP for over 6 years for a diagnosis of major depressive disorder, recurrent. The patient has achieved a successful remission on sertraline, 75 mg daily. Today presents complaining of an acute onset depressed mood, tearful days, and difficulty concentrating for the last month. It has become a problem at work, and her boss has suggested that she might need to take some time off to “take care of her problem.” Further discussion reveals that the patient learned last month that her husband is having an affair with a coworker. She is so distraught and consumed that she cannot fulfill her work responsibilities and she has completely cut herself off socially from friends and family.

The PMHNP suggests that the next best step in her care should include which of the following?

A. Increasing her sertraline to 100 mg daily

B. A referral to psychotherapy

C. A referral to couples counseling

D. Changing her pharmacotherapy to an SNRI

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YouTube: https://www.youtube.com/watch?v=I1kYlCdi7cg&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=110

A 48-year-old patient who reports a diagnosis of obsessive-compulsive disorder has transferred to your care after moving from out of state. You are unable to obtain medical records and must rely on the patient for information. During the initial appointment the patient says reports a very stressful home life. She has a school-aged daughter with severe chronic illness who requires 24-7 total care, as well as some other stressors related to her other children and finances. The patient says that for several years she has been in exposure-response therapy with intermittent, inconsistent improvement, and took fluvoxamine 300 mg daily which seemed to help for a while but then stopped. Her primary symptom presentation is related to obsessive thoughts, although there is a strong chronic anxiety and depressive component. The obsessive thought patterns are markedly worse when there is a stressful life event, and she has had periods of relief when things are calmer at home.

Which of the following aspects of her history is a favorable prognostic indicator?

A. Precipitating triggers

B. Reported history of treatment

C. Presence of children in the home

D. Lack of comorbid compulsions

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YouTube: https://www.youtube.com/watch?v=5ovzvLVpBrc&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=109