PMHNP-BC

The correct answer is D) The clinical picture is consistent with anorexia nervosa, restricting type. Major Depressive Disorder is diagnosed when ≥5 of 9 SIGECAPS criteria are present for ≥2 consecutive weeks, with at least depressed mood or anhedonia: Sleep changes, Interest loss, Guilt/worthlessness, Energy loss, Concentration difficulty, Appetite/weight changes, Psychomotor agitation or retardation, Suicidal ideation. The PHQ-9 is the standard screening and severity measure. Treatment follows a stepped care model: mild (psychotherapy alone or with medication), moderate (medication + psychotherapy), severe (medication required, consider ECT for treatment-resistant or psychotic features). First-line medications: SSRIs, SNRIs. STAR*D trial showed remission rates of ~37% with first antidepressant, cumulative ~67% after 4 adequate trials. Treatment-resistant depression (failure of ≥2 adequate trials) options include augmentation (lithium, thyroid hormone, aripiprazole), switching, combination therapy, ketamine/esketamine (Spravato), TMS, ECT, and VNS. In this clinical scenario, This 34-year-old woman presents with features consistent with major depressive disorder. The correct response (The clinical picture is consistent with anorexia nervosa, restricting type) reflects the most evidence-based approach to this presentation, integrating DSM-5 diagnostic criteria, current pharmacological guidelines, and established clinical best practices. Option A (Schizophrenia is the most likely diagnosis given the 6-month symptom duration) does not represent the most appropriate clinical response for the specific scenario described. Option B (Generalized anxiety disorder is suggested by persistent worry and somatic complaints) does not represent the most appropriate clinical response for the specific scenario described. Option C (Borderline personality disorder is suggested by the pattern of instability) does not represent the most appropriate clinical response for the specific scenario described. This question tests competency in Diagnosis, specifically Major Depressive Disorder, which is a core area of PMHNP certification examination content. The PMHNP must integrate pharmacological knowledge, diagnostic criteria, and clinical reasoning to arrive at safe, effective treatment decisions.