APEA PMHNP 3P Exam Prep (2026 Edition)
Psychiatry Part 1: Psychiatric Assessment &
Differential Diagnosis Questions with Answers &
Detailed Rationales
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Question 1:
A 24-year-old woman reports depressed mood, anhedonia, increased appetite, and
sleeping 12 hours per day for the past 3 weeks. She denies mania or psychosis.
Which specifier applies?
a. Melancholic features
b. Atypical features
c. Catatonic features
d. Peripartum onset
Rationale: Atypical features of major depressive disorder include increased
appetite, hypersomnia, leaden paralysis (heavy feeling in limbs), and rejection
sensitivity. This specifier is more common in early-onset depression. Melancholic
features involve early morning awakening, anorexia, and weight loss—the opposite
of this presentation.
Question 2:
A 32-year-old man presents with a 4-day history of elevated mood, decreased need
for sleep, grandiosity, and excessive spending. He has no prior episodes. What is
the most likely diagnosis?
a. Bipolar II disorder
b. Cyclothymic disorder
c. Bipolar I disorder, manic episode
d. Substance-induced mood disorder
Rationale: A manic episode requires symptoms lasting at least 7 days (or any
duration if hospitalization is required) with functional impairment. Bipolar II
requires hypomania (minimum 4 days) plus major depression. Cyclothymic
disorder involves chronic, fluctuating symptoms that do not meet full criteria.
,Question 3:
A 45-year-old woman reports recurrent panic attacks, worry about having more
attacks, and avoids public places. Symptoms present for 8 months. What is the
most likely diagnosis?
a. Panic disorder with agoraphobia
b. Generalized anxiety disorder
c. Social anxiety disorder
d. Specific phobia
Rationale: Panic disorder with agoraphobia is characterized by recurrent,
unexpected panic attacks followed by at least 1 month of persistent worry about
additional attacks or maladaptive behavioral changes related to the attacks.
Agoraphobia involves fear or avoidance of situations where escape might be
difficult.
Question 4:
A 28-year-old woman presents with depressed mood, anhedonia, and fatigue for 2
months. She reports that her symptoms are worse in the winter months and
improve in the summer. What is the most likely diagnosis?
a. Major depressive disorder with atypical features
b. Persistent depressive disorder
c. Major depressive disorder with seasonal pattern
d. Bipolar II disorder
Rationale: Seasonal pattern specifier applies when there is a regular temporal
relationship between the onset of major depressive episodes and a particular time
of year (e.g., fall/winter) with full remission occurring at a characteristic time of
year (e.g., spring).
Question 5:
A 55-year-old man with a history of major depressive disorder reports feeling
"empty" and having difficulty concentrating. He has gained 15 pounds over the
past 6 months. Which medication would be most appropriate as first-line
treatment?
,a. Bupropion
b. Sertraline
c. Venlafaxine
d. Phenelzine
Rationale: Sertraline is a first-line SSRI for major depressive disorder. SSRIs are
preferred due to their favorable side effect profile and safety. Bupropion may be
appropriate for patients with weight gain concerns, but SSRIs remain first-line.
Question 6:
A 42-year-old woman with a history of depression reports feeling hopeless, having
trouble sleeping, and experiencing suicidal thoughts. She has a plan to overdose on
her medications. What is the priority intervention?
a. Schedule a follow-up appointment in 1 week
b. Initiate immediate safety assessment and hospitalization
c. Increase her antidepressant dose
d. Refer her to outpatient therapy
Rationale: Suicidal ideation with a specific plan requires immediate intervention.
The priority is to ensure patient safety through a thorough risk assessment and, if
indicated, hospitalization. This is a psychiatric emergency.
Question 7:
A 60-year-old man with Parkinson's disease develops visual hallucinations of small
animals and children. He is alert and oriented. What is the most likely cause?
a. Lewy body dementia
b. Schizophrenia
c. Delirium
d. Parkinson's disease psychosis
Rationale: Visual hallucinations are common in Parkinson's disease, often
medication-induced (dopamine agonists) or part of the disease itself. Well-formed,
recurrent visual hallucinations in a patient with known Parkinson's disease, without
fluctuations or other features of Lewy body dementia initially, are consistent with
Parkinson's disease psychosis.
, Question 8:
A 16-year-old boy has a 2-year history of irritability, argumentative behavior, and
vindictiveness toward his parents. He does not have these behaviors at school or
with peers. What is the most likely diagnosis?
a. Conduct disorder
b. Oppositional defiant disorder
c. Intermittent explosive disorder
d. Attention-deficit/hyperactivity disorder
Rationale: Oppositional defiant disorder (ODD) is characterized by a pattern of
angry/irritable mood, argumentative/defiant behavior, and vindictiveness lasting at
least 6 months. The behaviors must occur outside of the sibling relationship and
cause significant impairment.
Question 9:
A 38-year-old woman reports depressed mood, anhedonia, and significant weight
loss over the past month. She reports early morning awakening and excessive guilt.
Which specifier applies?
a. Melancholic features
b. Atypical features
c. Catatonic features
d. Peripartum onset
Rationale: Melancholic features include loss of pleasure in all or almost all
activities, lack of reactivity to pleasurable stimuli, early morning awakening,
anorexia/weight loss, and excessive guilt. This is the opposite of atypical features.
Question 10:
A 30-year-old woman reports depressed mood, anhedonia, and fatigue for 2 years.
She states she has "never felt happy" and has had these symptoms most days for as
long as she can remember. What is the most likely diagnosis?
a. Major depressive disorder, recurrent
b. Adjustment disorder with depressed mood
Psychiatry Part 1: Psychiatric Assessment &
Differential Diagnosis Questions with Answers &
Detailed Rationales
Leave your honest rating⭐⭐⭐⭐⭐
Question 1:
A 24-year-old woman reports depressed mood, anhedonia, increased appetite, and
sleeping 12 hours per day for the past 3 weeks. She denies mania or psychosis.
Which specifier applies?
a. Melancholic features
b. Atypical features
c. Catatonic features
d. Peripartum onset
Rationale: Atypical features of major depressive disorder include increased
appetite, hypersomnia, leaden paralysis (heavy feeling in limbs), and rejection
sensitivity. This specifier is more common in early-onset depression. Melancholic
features involve early morning awakening, anorexia, and weight loss—the opposite
of this presentation.
Question 2:
A 32-year-old man presents with a 4-day history of elevated mood, decreased need
for sleep, grandiosity, and excessive spending. He has no prior episodes. What is
the most likely diagnosis?
a. Bipolar II disorder
b. Cyclothymic disorder
c. Bipolar I disorder, manic episode
d. Substance-induced mood disorder
Rationale: A manic episode requires symptoms lasting at least 7 days (or any
duration if hospitalization is required) with functional impairment. Bipolar II
requires hypomania (minimum 4 days) plus major depression. Cyclothymic
disorder involves chronic, fluctuating symptoms that do not meet full criteria.
,Question 3:
A 45-year-old woman reports recurrent panic attacks, worry about having more
attacks, and avoids public places. Symptoms present for 8 months. What is the
most likely diagnosis?
a. Panic disorder with agoraphobia
b. Generalized anxiety disorder
c. Social anxiety disorder
d. Specific phobia
Rationale: Panic disorder with agoraphobia is characterized by recurrent,
unexpected panic attacks followed by at least 1 month of persistent worry about
additional attacks or maladaptive behavioral changes related to the attacks.
Agoraphobia involves fear or avoidance of situations where escape might be
difficult.
Question 4:
A 28-year-old woman presents with depressed mood, anhedonia, and fatigue for 2
months. She reports that her symptoms are worse in the winter months and
improve in the summer. What is the most likely diagnosis?
a. Major depressive disorder with atypical features
b. Persistent depressive disorder
c. Major depressive disorder with seasonal pattern
d. Bipolar II disorder
Rationale: Seasonal pattern specifier applies when there is a regular temporal
relationship between the onset of major depressive episodes and a particular time
of year (e.g., fall/winter) with full remission occurring at a characteristic time of
year (e.g., spring).
Question 5:
A 55-year-old man with a history of major depressive disorder reports feeling
"empty" and having difficulty concentrating. He has gained 15 pounds over the
past 6 months. Which medication would be most appropriate as first-line
treatment?
,a. Bupropion
b. Sertraline
c. Venlafaxine
d. Phenelzine
Rationale: Sertraline is a first-line SSRI for major depressive disorder. SSRIs are
preferred due to their favorable side effect profile and safety. Bupropion may be
appropriate for patients with weight gain concerns, but SSRIs remain first-line.
Question 6:
A 42-year-old woman with a history of depression reports feeling hopeless, having
trouble sleeping, and experiencing suicidal thoughts. She has a plan to overdose on
her medications. What is the priority intervention?
a. Schedule a follow-up appointment in 1 week
b. Initiate immediate safety assessment and hospitalization
c. Increase her antidepressant dose
d. Refer her to outpatient therapy
Rationale: Suicidal ideation with a specific plan requires immediate intervention.
The priority is to ensure patient safety through a thorough risk assessment and, if
indicated, hospitalization. This is a psychiatric emergency.
Question 7:
A 60-year-old man with Parkinson's disease develops visual hallucinations of small
animals and children. He is alert and oriented. What is the most likely cause?
a. Lewy body dementia
b. Schizophrenia
c. Delirium
d. Parkinson's disease psychosis
Rationale: Visual hallucinations are common in Parkinson's disease, often
medication-induced (dopamine agonists) or part of the disease itself. Well-formed,
recurrent visual hallucinations in a patient with known Parkinson's disease, without
fluctuations or other features of Lewy body dementia initially, are consistent with
Parkinson's disease psychosis.
, Question 8:
A 16-year-old boy has a 2-year history of irritability, argumentative behavior, and
vindictiveness toward his parents. He does not have these behaviors at school or
with peers. What is the most likely diagnosis?
a. Conduct disorder
b. Oppositional defiant disorder
c. Intermittent explosive disorder
d. Attention-deficit/hyperactivity disorder
Rationale: Oppositional defiant disorder (ODD) is characterized by a pattern of
angry/irritable mood, argumentative/defiant behavior, and vindictiveness lasting at
least 6 months. The behaviors must occur outside of the sibling relationship and
cause significant impairment.
Question 9:
A 38-year-old woman reports depressed mood, anhedonia, and significant weight
loss over the past month. She reports early morning awakening and excessive guilt.
Which specifier applies?
a. Melancholic features
b. Atypical features
c. Catatonic features
d. Peripartum onset
Rationale: Melancholic features include loss of pleasure in all or almost all
activities, lack of reactivity to pleasurable stimuli, early morning awakening,
anorexia/weight loss, and excessive guilt. This is the opposite of atypical features.
Question 10:
A 30-year-old woman reports depressed mood, anhedonia, and fatigue for 2 years.
She states she has "never felt happy" and has had these symptoms most days for as
long as she can remember. What is the most likely diagnosis?
a. Major depressive disorder, recurrent
b. Adjustment disorder with depressed mood
