Clinical High-Yield · 11 min read · April 28, 2026
Mental health is one of the highest-yield sections on the FNP boards — and one of the most straightforward once you understand what the boards are actually testing. They are not asking you to manage complex psychiatric cases. They are asking whether you can screen correctly, choose the right first-line medication, recognize contraindications, and know when a patient needs to be referred to psychiatry or admitted to a higher level of care.
Screening: The PHQ-9 is the standard screening tool for depression in primary care. A score of 5–9 indicates mild depression, 10–14 moderate, 15–19 moderately severe, and 20–27 severe. The PHQ-2 (the first two questions of the PHQ-9) is used as an initial screen. The USPSTF recommends screening all adults for depression, including pregnant and postpartum women.
Diagnosis: Major depressive disorder (MDD) requires 5 or more of the following symptoms for at least 2 weeks, with at least one being depressed mood or anhedonia: depressed mood, anhedonia (loss of interest or pleasure), weight change (>5% in a month), sleep disturbance (insomnia or hypersomnia), psychomotor agitation or retardation, fatigue, feelings of worthlessness or excessive guilt, difficulty concentrating, and recurrent thoughts of death or suicidal ideation.
Treatment: First-line pharmacotherapy is an SSRI or SNRI. The boards do not require you to choose between specific SSRIs — they are considered equivalent in efficacy. Know the side effect profiles: SSRIs cause sexual dysfunction, GI upset, and insomnia. SNRIs (venlafaxine, duloxetine) also increase blood pressure. Bupropion is an alternative that does not cause sexual dysfunction and is contraindicated in patients with seizure disorders or eating disorders (anorexia/bulimia). Mirtazapine causes sedation and weight gain — useful in patients with insomnia and poor appetite.
Board Pearl: Serotonin syndrome is a life-threatening emergency caused by excess serotonergic activity. The triad: altered mental status, autonomic instability (hyperthermia, tachycardia, diaphoresis), and neuromuscular abnormalities (clonus, hyperreflexia, tremor). The most common cause: combining an SSRI with another serotonergic agent (MAOIs, tramadol, linezolid, triptans, St. John's Wort). Treatment: discontinue the offending agents, supportive care, cyproheptadine for mild-moderate cases.
Suicidal ideation: The boards test that the correct response to active suicidal ideation with a plan and intent is not outpatient referral — it is emergency psychiatric evaluation. Document your assessment, remove access to lethal means (especially firearms), and involve the patient's support system.
Generalized Anxiety Disorder (GAD): Excessive, uncontrollable worry about multiple domains for at least 6 months, associated with 3 of the following: restlessness, fatigue, difficulty concentrating, irrita...