The FNP Review

Mastering Psychiatry for FNP Boards: High-Yield Concepts You Can't Miss

Psychiatry · 5 min read · August 6, 2026

Mastering Psychiatry for FNP Boards: High-Yield Concepts You Can't Miss

As you prepare for your Family Nurse Practitioner (FNP) certification exam, whether it's the AANP or ANCC, psychiatry can feel like a vast and overwhelming subject. But don't worry! We're here to break down the high-yield concepts and equip you with the knowledge to confidently tackle those mental health questions. Remember, the goal isn't to become a psychiatric mental health nurse practitioner (PMHNP), but to understand the primary care FNP's role in screening, diagnosing, and managing common psychiatric conditions.

Let's dive into the core areas you need to master.

1. Common Psychiatric Disorders: Diagnosis and Key Features

Your FNP board exam will focus on your ability to recognize and differentiate common psychiatric disorders seen in primary care. Think about how these conditions present across the lifespan and what your initial steps would be.

Depression

Depression is a pervasive mood disorder that you will frequently encounter. For boards, understand the diagnostic criteria for Major Depressive Disorder (MDD): at least five symptoms present during the same 2-week period, representing a change from previous functioning, with at least one symptom being depressed mood or anhedonia. Other common symptoms include changes in sleep, appetite, energy, concentration, psychomotor activity, feelings of worthlessness/guilt, and thoughts of death/suicide.

Clinical Pearl: Always screen for suicidal ideation in any patient presenting with depressive symptoms. Safety is paramount.

Anxiety Disorders

Anxiety disorders are another cornerstone of FNP practice. Focus on differentiating between Generalized Anxiety Disorder (GAD), Panic Disorder, and Social Anxiety Disorder.

  • GAD: Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities. Associated with three or more of the following six symptoms: restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance.
  • Panic Disorder: Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or discomfort that reaches a peak within minutes, accompanied by physical and/or cognitive symptoms (e.g., palpitations, sweating, trembling, shortness of breath, chest pain, dizziness, derealization, fear of losing control or dying).
  • Social Anxiety Disorder: Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others.

Bipolar Disorder

While often managed by specialists, FNPs need to recognize the signs of Bipolar I and Bipolar II disorder. The key differentiator is the presence of mania (Bipolar I) versus hypomania (Bipolar II).

  • Mania: A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day. Requires three or more specific symptoms (e.g., grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, increased activity, excessive involvement in pleasurable activities with high potential for painful consequences).
  • Hypomania: Similar symptoms to mania but less severe, lasting at least 4 consecutive days, and not causing marked impairment in social or occupational functioning or requiring hospitalization.

Board Tip: If a patient presents with depressive symptoms, always screen for a history of manic or hypomanic episodes before initiating antidepressant monotherapy, as this can precipitate a manic episode in an undiagnosed bipolar patient.

ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) is diagnosed in both children and adults. Understand the criteria for inattention and hyperactivity-impulsivity, and that symptoms must be present in two or more settings (e.g., home, school, work) and interfere with functioning.

2. Screening Tools and Initial Assessment

As an FNP, your role often begins with screening and initial assessment. Knowing which tools to use is crucial.

  • Depression: The PHQ-2 (Patient Health Questionnaire-2) is an initial screen, and if positive, follow up with the PHQ-9 for severity and diagnosis. The Beck Depression Inventory (BDI) is also widely used.
  • Anxiety: The GAD-7 (Generalized Anxiety Disorder 7-item scale) is a common screening tool.
  • Alcohol Use: The AUDIT-C (Alcohol Use Disorders Identification Test-Concise) or CAGE questionnaire are quick screens.
  • Substance Use: A thorough history is essential, along with screening tools like the DAST-10 (Drug Abuse Screening Test-10).

Clinical Pearl: Screening tools are not diagnostic on their own; they identify individuals who need further evaluation. Always confirm with a comprehensive history and mental status examination.

3. Pharmacologic Management Considerations

While complex cases may warrant referral, FNPs often initiate and manage psychotropic medications for common conditions. Focus on first-line agents, key side effects, and monitoring.

Antidepressants

  • SSRIs (Selective Serotonin Reuptake Inhibitors): First-line for depression and most anxiety disorders. Examples: fluoxetine, sertraline, escitalopram, citalopram, paroxetine. Common side effects include GI upset, sexual dysfunction, headache, insomnia/somnolence. Watch for Serotonin Syndrome (agitation, hyperreflexia, tremor, diaphoresis, diarrhea).
  • SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors): Venlafaxine, duloxetine. Can be useful for depression with neuropathic pain. Side effects similar to SSRIs, plus potential for increased blood pressure.
  • Atypical Antidepressants: Bupropion (Wellbutrin) is good for depression with low energy, less sexual dysfunction, but contraindicated in seizure disorders. Mirtazapine (Remeron) can help with insomnia and appetite stimulation.

Anxiolytics

  • SSRIs/SNRIs: First-line for chronic anxiety disorders due to their non-addictive nature.
  • Benzodiazepines: (e.g., lorazepam, alprazolam, clonazepam, diazepam) are effective for acute anxiety but carry risks of dependence and withdrawal. Use short-term and with caution, especially in older adults. Avoid in patients with a history of substance use disorder.

Mood Stabilizers

  • Lithium: Gold standard for bipolar disorder. Requires close monitoring of lithium levels, renal function, and thyroid function. Narrow therapeutic window. Side effects: tremor, polyuria, polydipsia, weight gain, GI upset.
  • Anticonvulsants: Valproic acid (Depakote), lamotrigine (Lamictal), carbamazepine (Tegretol). Each has specific side effects and monitoring requirements (e.g., liver function, CBC for valproic acid; SJS rash for lamotrigine).

Antipsychotics

  • First-generation (typical): Haloperidol, chlorpromazine. Higher risk of extrapyramidal symptoms (EPS) and tardive dyskinesia.
  • Second-generation (atypical): Risperidone, olanzapine, quetiapine, aripiprazole. Lower risk of EPS, but higher risk of metabolic side effects (weight gain, dyslipidemia, hyperglycemia). Often used for schizophrenia, bipolar disorder, and sometimes as augmentation for severe depression.

Geriatric Considerations

Older adults are more sensitive to medications due to changes in pharmacokinetics and pharmacodynamics. Always **