Mental Health High-Yield: What the FNP Boards Test Every Time
Clinical High-Yield · 9 min read · February 19, 2026
Why Mental Health Is Heavily Tested
Mental health conditions are among the most common presentations in primary care. Depression, anxiety, and ADHD are seen in virtually every primary care practice. The FNP boards reflect this reality — mental health questions appear frequently on both AANP and ANCC exams.
Here's the high-yield framework.
Depression: The Essentials
Diagnosis (DSM-5): 5 or more symptoms for ≥2 weeks, including depressed mood or anhedonia:
- Depressed mood
- Anhedonia (loss of interest/pleasure)
- Sleep changes (insomnia or hypersomnia)
- Energy changes (fatigue)
- Concentration difficulties
- Appetite/weight changes
- Psychomotor changes
- Worthlessness/guilt
- Suicidal ideation
First-line treatment: SSRIs (sertraline, escitalopram, fluoxetine)
Board pearls:
- Fluoxetine has the longest half-life (safest in overdose, best for non-adherent patients)
- Sertraline is preferred in pregnancy and elderly
- Bupropion: no sexual side effects, weight loss, contraindicated in seizure disorders and eating disorders
- Mirtazapine: weight gain, sedation, good for patients with insomnia and poor appetite
- TCAs: significant side effects, lethal in overdose — avoid as first-line
- MAOIs: multiple drug and food interactions — rarely used in primary care
When to refer: Psychotic features, bipolar disorder, treatment-resistant depression, active suicidal ideation with plan
Anxiety Disorders
GAD: Excessive worry ≥6 months. First-line: SSRIs/SNRIs + CBT. Buspirone is an option (no dependence risk). Benzodiazepines for short-term only.
Panic disorder: Recurrent unexpected panic attacks + anticipatory anxiety. First-line: SSRIs + CBT. Benzodiazepines for acute attacks only.
Social anxiety disorder: First-line: SSRIs/SNRIs + CBT. Beta-blockers (propranolol) for situational performance anxiety.
PTSD: First-line: SSRIs (sertraline, paroxetine FDA-approved). Prazosin for nightmares.
Bipolar Disorder
Key distinction: Bipolar I requires at least one manic episode (≥7 days, or any duration if hospitalized). Bipolar II requires hypomania + major depression.
Treatment:
- Mood stabilizers: Lithium (first-line, monitor levels, renal function, thyroid), valproate, lamotrigine (maintenance, not acute mania)
- Atypical antipsychotics: Quetiapine, olanzapine, aripiprazole
Board pearl: Antidepressants alone can trigger mania in bipolar disorder. Always screen for bipolar before starting an antidepressant.
Schizophrenia
Positive symptoms: Hallucinations, delusions, disorganized speech/behavior
Negative symptoms: Flat affect, alogia, avolition, anhedonia
Treatment: Antipsychotics (first-generation: haloperidol; second-generation: risperidone, quetiapine, olanzapine, clozapine for treatment-resistant)
Board pearl: Clozapine is reserved for treatment-resistant schizophrenia due to risk of agranulocytosis — requires regular WBC monitoring.
ADHD
Diagnosis: Symptoms present before age 12, in ≥2 settings, causing functional impairment
Treatment:
- First-line: Stimulants (methylphenidate, amphetamines)
- Non-stimulant alternatives: Atomoxetine, guanfacine, clonidine
- Adults: Same medications, but also consider bupropion
Board pearl: Stimulants are Schedule II controlled substances. Screen for cardiovascular risk before prescribing.