Mental Health High-Yield: Depression, Anxiety, ADHD, and More for FNP Boards
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.
Depression: Screening, Diagnosis, and Treatment
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.
Anxiety Disorders: GAD, Panic Disorder, and PTSD
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, irritability, muscle tension, sleep disturbance. Screening tool: GAD-7. First-line treatment: SSRIs or SNRIs (same agents as depression), combined with cognitive behavioral therapy (CBT). Buspirone is an alternative non-benzodiazepine anxiolytic. Benzodiazepines are effective short-term but are not first-line due to dependence risk.
Panic Disorder: Recurrent unexpected panic attacks (discrete episodes of intense fear with physical symptoms: palpitations, sweating, trembling, shortness of breath, chest pain, dizziness, paresthesias, fear of dying or losing control) plus persistent worry about future attacks or significant behavioral change. First-line: SSRIs/SNRIs + CBT. Benzodiazepines can be used short-term during SSRI initiation.
PTSD: Exposure to actual or threatened death, serious injury, or sexual violence, followed by intrusion symptoms (flashbacks, nightmares), avoidance, negative alterations in cognition and mood, and hyperarousal, lasting more than 1 month. First-line pharmacotherapy: SSRIs (sertraline and paroxetine are FDA-approved for PTSD). Prazosin (an alpha-1 blocker) is used specifically for PTSD-related nightmares. First-line psychotherapy: trauma-focused CBT and EMDR (eye movement desensitization and reprocessing).
ADHD: Diagnosis and Treatment Across the Lifespan
Diagnosis: ADHD requires symptoms of inattention and/or hyperactivity-impulsivity that are present before age 12, occur in two or more settings, and cause significant functional impairment. The boards test that ADHD is a clinical diagnosis — there is no laboratory test or imaging study that confirms it. Rating scales (Vanderbilt, Conners) are used to gather information from parents and teachers.
Treatment in children: First-line is stimulant medication — methylphenidate (Ritalin, Concerta) or amphetamine salts (Adderall, Vyvanse). Behavioral therapy is recommended as first-line for children under 6 years (medication is second-line in this age group). Non-stimulant alternatives: atomoxetine (Strattera, an SNRI), guanfacine (Intuniv), clonidine (Kapvay).
Key side effects: Stimulants cause decreased appetite, insomnia, and growth suppression with long-term use (monitor height and weight). They are Schedule II controlled substances. Atomoxetine carries a black box warning for suicidal ideation in children and adolescents.
ADHD in adults: The same diagnostic criteria apply. Stimulants remain first-line. The boards test that ADHD often persists into adulthood and that comorbid depression and anxiety are common.
Bipolar Disorder: Recognition and the Lithium Pearls
Bipolar disorder is characterized by episodes of mania (or hypomania) and depression. The boards test recognition and the pharmacology of mood stabilizers.
Manic episode: Elevated or irritable mood lasting at least 1 week (or any duration if hospitalization is required), with 3 or more of: grandiosity, decreased need for sleep, pressured speech, racing thoughts, distractibility, increased goal-directed activity, and impulsive behavior. Hypomania is a less severe form lasting at least 4 days without causing marked impairment.
Treatment: Mood stabilizers are the cornerstone — lithium, valproate, and lamotrigine. Lithium is the gold standard for bipolar I and has the strongest evidence for suicide prevention. Valproate is preferred for rapid cycling and mixed episodes. Lamotrigine is preferred for bipolar depression.
Lithium toxicity is a high-yield board topic. The therapeutic range is 0.6–1.2 mEq/L. Toxicity occurs at levels >1.5 mEq/L. Early signs: tremor, nausea, diarrhea, polyuria. Severe toxicity: confusion, seizures, cardiac arrhythmias. Toxicity is precipitated by dehydration, NSAIDs, ACE inhibitors, and thiazide diuretics (all reduce lithium excretion). Treatment: hold lithium, IV fluids, hemodialysis for severe toxicity.
Schizophrenia: Positive vs. Negative Symptoms
Schizophrenia is characterized by positive symptoms (hallucinations, delusions, disorganized speech and behavior) and negative symptoms (flat affect, alogia, avolition, anhedonia, asociality). The boards test the distinction because the two symptom categories respond differently to treatment.
Treatment: Antipsychotics are the mainstay. First-generation (typical) antipsychotics (haloperidol, chlorpromazine) are effective for positive symptoms but cause significant extrapyramidal side effects (EPS): acute dystonia, akathisia, parkinsonism, and tardive dyskinesia (TD). Second-generation (atypical) antipsychotics (clozapine, risperidone, olanzapine, quetiapine, aripiprazole) have fewer EPS but cause metabolic syndrome (weight gain, hyperglycemia, dyslipidemia).
Clozapine is reserved for treatment-resistant schizophrenia due to the risk of agranulocytosis — patients must be enrolled in a REMS program and have regular CBC monitoring.
The Bottom Line
Mental health on the FNP boards rewards knowing your screening tools (PHQ-9, GAD-7), your first-line medications (SSRIs for depression, anxiety, PTSD; stimulants for ADHD; lithium for bipolar), and your safety protocols (suicidal ideation = emergency evaluation). Know serotonin syndrome. Know lithium toxicity. Know when to refer. Master these and mental health becomes one of your strongest sections.
→ Explore the FNP Board Review Book — every mental health topic covered with board-focused clinical pearls.