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 prese...