NUR 670 Psychiatric Mental Health Nurse Practitioner Integration

Course Description
NUR 670 is the capstone integration course of the Psychiatric Mental Health Nurse Practitioner (PMHNP) graduate program. This course synthesizes and applies the theoretical knowledge, clinical reasoning, pharmacological expertise, and advanced practice competencies developed throughout the program. Students integrate evidence-based psychiatric assessment, diagnosis, and treatment across the full lifespan — from pediatric populations through older adults — within a variety of supervised clinical settings including outpatient psychiatry, inpatient units, community mental health centers, integrated behavioral health clinics, and specialty programs.
The course is structured around 15 weekly modules, each combining lecture content, scholarly discussion, and a practical assignment. Clinical practicum hours run concurrently, allowing students to immediately apply classroom learning in supervised patient care environments. A strong emphasis is placed on cultural humility, mental health equity, trauma-informed care, interprofessional collaboration, and the PMHNP’s emerging role as a leader and advocate in the broader healthcare system.
Upon successful completion of this course, graduates will be prepared to sit for national PMHNP board certification (ANCC PMHNP-BC or AANPCB PMHNP-C) and to practice independently or collaboratively as fully competent psychiatric mental health nurse practitioners.

Course Objectives
Upon completion of NUR 670, the student will be able to:
1. Conduct comprehensive psychiatric evaluations using the biopsychosocial model, DSM-5-TR criteria, and culturally sensitive assessment tools across the lifespan.
2. Formulate evidence-based, person-centered treatment plans integrating pharmacotherapy, psychotherapy, and community resources for diverse psychiatric populations.
3. Prescribe psychotropic medications safely and effectively, demonstrating knowledge of pharmacodynamics, pharmacokinetics, monitoring, and patient education.
4. Perform evidence-based suicide risk assessments and implement crisis intervention strategies including safety planning and appropriate level of care determination.
5. Apply trauma-informed care principles in all clinical encounters and recognize the impact of adverse childhood experiences on adult mental health.
6. Demonstrate competence in the assessment and integrated treatment of substance use disorders, including MOUD prescribing for opioid use disorder.
7. Analyze mental health disparities affecting marginalized populations and demonstrate advocacy skills at the clinical, organizational, and policy levels.
8. Apply quality improvement and evidence-based practice frameworks to identify clinical gaps and implement systematic improvements in psychiatric care.
9. Demonstrate readiness for PMHNP board certification and autonomous practice through professional portfolio development and clinical reflection.
10. Collaborate effectively with interprofessional healthcare teams to coordinate comprehensive, recovery-oriented psychiatric care.

Required Texts & Resources
• Sadock, B. J., Sadock, V. A., & Ruiz, P. (2024). Kaplan & Sadock’s Synopsis of Psychiatry (12th ed.). Wolters Kluwer.
• Stahl, S. M. (2021). Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (5th ed.). Cambridge University Press.
• American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text revision; DSM-5-TR). APA Publishing.
• Wheeler, K. (Ed.). (2022). Psychotherapy for the Advanced Practice Psychiatric Nurse: A How-To Guide for Evidence-Based Practice (3rd ed.). Springer Publishing.
• Epocrates or UpToDate — Clinical decision support access (student subscription required)
• Current APA, NICE, CANMAT, VA/DoD, and SAMHSA clinical practice guidelines (available open access online)

Grading & Evaluation
Assessment Component Weight Points
Weekly Assignments (15 × 40 pts) 40% 600
Weekly Discussion Posts (15 × 20 pts) 20% 300
Comprehensive Clinical Portfolio (Capstone) 20% 300
Clinical Practicum Evaluation (Preceptor) 15% 225
Professional Participation & Engagement 5% 75
TOTAL 100% 1,500

A: 93–100% C+: 77–79%
A-: 90–92% C: 73–76%
B+: 87–89% C-: 70–72%
B: 83–86% D: 60–69%
B-: 80–82% F: Below 60%

Weekly Course Content
The following 15 modules constitute the complete weekly content guide for NUR 670. Each module includes detailed lecture content and learning objectives, three scholarly discussion questions, and a graded assignment with full instructions.
 
WEEK 1 | FOUNDATIONS OF PMHNP PRACTICE

▌ LECTURE NOTES & CORE CONTENT
• Overview of the Psychiatric Mental Health Nurse Practitioner role: scope, standards, and competencies
• Historical evolution of psychiatric nursing and advanced practice roles
• Review of the American Nurses Association (ANA) Scope and Standards of Practice for PMHNP
• Ethical frameworks in psychiatric care: autonomy, beneficence, non-maleficence, and justice
• Introduction to evidence-based practice (EBP) in psychiatric settings
• Federal and state regulatory requirements: licensure, credentialing, and collaborative practice agreements
• Telehealth in psychiatric practice: current landscape and regulatory considerations

▌ WEEKLY DISCUSSION QUESTIONS
Discussion 1: Reflect on a clinical experience where ethical principles came into conflict in psychiatric care. How did you or the care team navigate this dilemma? What would you do differently as a PMHNP?

Discussion 2: The scope of PMHNP practice varies significantly by state. Compare your state’s collaborative practice requirements to those of two other states. What are the implications for patient access to care?

Discussion 3: How do you envision integrating telehealth into your future PMHNP practice? What are the benefits, limitations, and ethical responsibilities unique to remote psychiatric care?

▌ WEEKLY ASSIGNMENT
Assignment Title PMHNP Professional Philosophy Statement
Description Compose a 3–4 page personal philosophy of practice statement that articulates your vision for your role as a PMHNP. Address your core values, how you will approach ethical challenges, your commitment to evidence-based practice, and how you plan to advocate for mental health equity. Include a brief self-assessment of your current clinical competencies and areas for growth during this integration experience.
Submission Format APA 7th edition, 3–4 pages excluding title and reference pages
Due Date End of Week 1 (Sunday, 11:59 PM)

 
WEEK 2 | PSYCHIATRIC ASSESSMENT & DIAGNOSIS ACROSS THE LIFESPAN

▌ LECTURE NOTES & CORE CONTENT
• Comprehensive psychiatric evaluation: components and structure of the mental status examination (MSE)
• Biopsychosocial model in psychiatric assessment and its clinical application
• DSM-5-TR diagnostic criteria: navigating differential diagnosis in complex presentations
• Cultural formulation interview (CFI) and culturally responsive diagnostic practice
• Screening tools and validated instruments: PHQ-9, GAD-7, PCL-5, CAGE-AID, MMSE, BPRS, and others
• Pediatric and adolescent psychiatric assessment: developmental considerations and tools (CRAFFT, SCARED, MASC)
• Geriatric psychiatric assessment: distinguishing dementia, depression, and delirium (the 3 Ds)
• Documentation standards for psychiatric evaluations in electronic health records (EHR)

▌ WEEKLY DISCUSSION QUESTIONS
Discussion 1: A 72-year-old patient presents with acute confusion, agitation, and apparent auditory hallucinations. How do you differentiate delirium, dementia, and late-onset psychosis? What assessment tools would you use and why?

Discussion 2: The Cultural Formulation Interview is recommended by the DSM-5-TR but is inconsistently used in clinical practice. What barriers exist to its adoption, and how would you integrate it into your PMHNP practice?

Discussion 3: Discuss the limitations of standardized screening tools in diverse populations. How might you adapt your assessment approach for a patient with limited English proficiency or low health literacy?

▌ WEEKLY ASSIGNMENT
Assignment Title Comprehensive Psychiatric Case Evaluation
Description Using a de-identified patient from your clinical practicum, complete a full written psychiatric evaluation including: chief complaint, history of present illness, psychiatric and medical history, medication reconciliation, psychosocial and developmental history, MSE, cultural formulation, risk assessment, DSM-5-TR diagnosis with differential, and a problem list. Justify your diagnostic conclusions with reference to DSM-5-TR criteria and at least 3 peer-reviewed sources.
Submission Format Structured clinical format, 5–7 pages, APA 7th edition references
Due Date End of Week 2 (Sunday, 11:59 PM)

 
WEEK 3 | PSYCHOPHARMACOLOGY I: ANTIDEPRESSANTS & ANXIOLYTICS

▌ LECTURE NOTES & CORE CONTENT
• Neurotransmitter systems: serotonin, norepinephrine, dopamine, GABA — mechanisms relevant to psychiatric pharmacotherapy
• SSRIs and SNRIs: pharmacodynamics, pharmacokinetics, clinical indications, adverse effects, and drug interactions
• Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs): when and how to use legacy agents
• Novel antidepressants: mirtazapine, bupropion, vilazodone, vortioxetine, and esketamine (Spravato)
• Benzodiazepines: appropriate use, risks of dependence, and safe prescribing practices
• Buspirone and hydroxyzine for anxiety: non-habit-forming alternatives
• Pharmacogenomics in psychiatric prescribing: CYP450 system and clinical decision-making
• Managing antidepressant side effects, discontinuation syndrome, and serotonin syndrome
• Prescribing for vulnerable populations: pregnancy (FDA safety categories), lactation, and older adults

▌ WEEKLY DISCUSSION QUESTIONS
Discussion 1: A 35-year-old woman with MDD and comorbid generalized anxiety is 8 weeks pregnant and requesting medication. How do you approach the risk-benefit discussion? What agents would you consider and why?

Discussion 2: Pharmacogenomic testing is increasingly available but not universally covered by insurance. Debate whether PMHNPs should routinely order these tests. What are the ethical, clinical, and economic considerations?

Discussion 3: A patient on sertraline 150 mg presents with worsening depression after 10 weeks. Walk through your clinical decision-making: Do you increase the dose, augment, or switch? Justify using current evidence-based guidelines.

▌ WEEKLY ASSIGNMENT
Assignment Title Psychopharmacology Treatment Plan
Description Develop a comprehensive, evidence-based pharmacological treatment plan for a patient with a primary mood or anxiety disorder. Include: rationale for agent selection, starting and target dose, monitoring parameters (labs, vital signs, side effects), patient education, a safety plan if indicated, and a 3-month follow-up schedule. Support all prescribing decisions with current clinical practice guidelines (e.g., APA, NICE, CANMAT) and at least 5 peer-reviewed sources.
Submission Format Clinical format with APA 7th edition references, 4–5 pages
Due Date End of Week 3 (Sunday, 11:59 PM)

 
WEEK 4 | PSYCHOPHARMACOLOGY II: ANTIPSYCHOTICS, MOOD STABILIZERS & STIMULANTS

▌ LECTURE NOTES & CORE CONTENT
• First-generation antipsychotics (FGAs): dopamine D2 blockade, EPS, and tardive dyskinesia risk
• Second-generation antipsychotics (SGAs): receptor profiles, metabolic risks, and comparative efficacy
• Long-acting injectable antipsychotics (LAIs): indications, clinical benefits, and administration protocols
• Clozapine prescribing: indications for treatment-resistant schizophrenia, REMS program, and hematological monitoring
• Mood stabilizers: lithium (therapeutic window, toxicity, monitoring), valproate, lamotrigine, and carbamazepine
• ADHD pharmacotherapy: stimulants (methylphenidate, amphetamines), non-stimulants (atomoxetine, guanfacine, viloxazine), and DEA scheduling
• Antipsychotic polypharmacy: evidence, risks, and best practices for minimizing combinations
• Metabolic monitoring protocols: AIMS test, fasting glucose, lipids, weight, waist circumference

▌ WEEKLY DISCUSSION QUESTIONS
Discussion 1: Clozapine is considered the gold standard for treatment-resistant schizophrenia, yet it is severely underutilized. What are the barriers to clozapine prescribing, and how could PMHNPs help address the ‘clozapine gap’?

Discussion 2: A parent insists their 7-year-old child with ADHD should not receive stimulant medication due to fear of addiction and stunted growth. How do you counsel this family? What does the evidence say about long-term stimulant use in children?

Discussion 3: Your patient on risperidone 4 mg/day has gained 18 lbs in 4 months and has a new fasting glucose of 112 mg/dL. Outline your clinical response, including medication adjustment options and metabolic management strategies.

▌ WEEKLY ASSIGNMENT
Assignment Title Antipsychotic Medication Management Case Study
Description Select a patient (real or composite) with schizophrenia spectrum disorder or bipolar disorder with psychotic features. Write a detailed medication management case study covering: current regimen analysis, AIMS assessment result, metabolic monitoring data, medication adherence barriers, an evidence-based optimization plan, and a shared decision-making narrative. Include a patient education handout as an appendix.
Submission Format Case study format, 5–6 pages + appendix, APA 7th edition
Due Date End of Week 4 (Sunday, 11:59 PM)

 
WEEK 5 | EVIDENCE-BASED PSYCHOTHERAPY IN PMHNP PRACTICE

▌ LECTURE NOTES & CORE CONTENT
• Role of the PMHNP in psychotherapy: scope of practice, collaborative models, and integration with pharmacotherapy
• Cognitive Behavioral Therapy (CBT): principles, applications, and evidence for depression, anxiety, and PTSD
• Dialectical Behavior Therapy (DBT): theory, skills modules, and use in borderline personality disorder and suicidality
• Motivational Interviewing (MI): core techniques (OARS) and clinical applications in substance use and medication adherence
• Trauma-Focused CBT (TF-CBT) and EMDR for trauma and PTSD
• Acceptance and Commitment Therapy (ACT): psychological flexibility and the hexaflex model
• Brief solution-focused therapy techniques applicable within 30-minute medication management visits
• Group therapy modalities and their applications in psychiatric settings
• Psychotherapy documentation: progress notes, goal tracking, and treatment plan updates

▌ WEEKLY DISCUSSION QUESTIONS
Discussion 1: Many PMHNPs provide only medication management due to time constraints. How can brief therapy techniques (MI, CBT principles, psychoeducation) be meaningfully integrated into a 30-minute follow-up visit?

Discussion 2: DBT was originally developed for borderline personality disorder. Review the evidence for its application to other populations (adolescents, eating disorders, substance use). Should PMHNPs have basic DBT skill training? Why or why not?

Discussion 3: A patient with PTSD is resistant to trauma-focused therapy but agrees to medication. How do you navigate this? What is the evidence for combined pharmacotherapy and psychotherapy versus medication alone in PTSD?

▌ WEEKLY ASSIGNMENT
Assignment Title Psychotherapy Modality Analysis and Application
Description Select ONE evidence-based psychotherapy modality (CBT, DBT, MI, ACT, TF-CBT, or EMDR). Write an analysis paper that covers: theoretical foundations, core techniques, the current evidence base (including at least 2 RCTs), populations best suited for this modality, how a PMHNP can apply key principles within medication management appointments, and a sample 15-minute session vignette demonstrating the technique.
Submission Format APA 7th edition, 5–6 pages
Due Date End of Week 5 (Sunday, 11:59 PM)

 
WEEK 6 | TRAUMA-INFORMED CARE & PTSD MANAGEMENT

▌ LECTURE NOTES & CORE CONTENT
• Neurobiology of trauma: HPA axis dysregulation, amygdala hyperreactivity, and prefrontal cortex impairment
• ACEs (Adverse Childhood Experiences) study: impact on adult mental and physical health
• DSM-5-TR PTSD diagnostic criteria and complex PTSD (ICD-11)
• Trauma-informed care (TIC) principles: safety, trustworthiness, peer support, collaboration, empowerment, cultural humility
• Universal precautions in trauma screening: primary care and psychiatric settings
• Pharmacological management of PTSD: sertraline, paroxetine (FDA-approved), prazosin, propranolol, and emerging agents
• Evidence-based psychotherapies for PTSD: Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), EMDR
• Trauma in special populations: veterans, refugees, survivors of IPV, childhood sexual abuse, and medical trauma
• Secondary traumatic stress and vicarious trauma in PMHNP providers

▌ WEEKLY DISCUSSION QUESTIONS
Discussion 1: Complex PTSD (CPTSD) is recognized in ICD-11 but not DSM-5-TR. How does this diagnostic gap affect clinical practice, reimbursement, and research in the United States? How would you approach diagnosing and treating a patient whose presentation aligns with CPTSD?

Discussion 2: A refugee patient from a war-affected country presents with hypervigilance, nightmares, and emotional numbing. She refuses to discuss the trauma events but is seeking help for sleep disturbance. How do you implement trauma-informed care without forcing disclosure?

Discussion 3: Prazosin is commonly used off-label for PTSD nightmares, yet recent RCT data (Aurora trial) raised questions about its efficacy. Critically analyze the evidence and explain how you would approach this prescribing decision.

▌ WEEKLY ASSIGNMENT
Assignment Title Trauma-Informed Practice Protocol
Description Develop a clinical protocol for implementing trauma-informed care in your practicum setting (or a hypothetical outpatient psychiatric clinic). The protocol should include: a trauma screening workflow, communication standards for staff, environmental safety recommendations, clinical decision pathways for acute trauma disclosure, a patient resource list, and a PMHNP self-care plan to address vicarious trauma. Include an evidence-based rationale for all components.
Submission Format Protocol format with APA 7th edition references, 5–7 pages
Due Date End of Week 6 (Sunday, 11:59 PM)

 
WEEK 7 | SUICIDE RISK ASSESSMENT & CRISIS INTERVENTION

▌ LECTURE NOTES & CORE CONTENT
• Epidemiology of suicide: national statistics, demographic patterns, and disparities
• Neurobiological and psychological models of suicidal behavior: IPT (Joiner), Cry of Pain model, and fluid vulnerability theory
• Comprehensive suicide risk assessment: risk factors, protective factors, warning signs, and acute precipitants
• Validated assessment tools: Columbia Suicide Severity Rating Scale (C-SSRS), PHQ-9 item 9, SBQ-R, and ASQ
• Safety planning: Stanley-Brown Safety Planning Intervention (SPI) — step-by-step implementation
• Means restriction counseling: firearms, medications, and other lethal means
• Levels of care decisions: outpatient, intensive outpatient (IOP), partial hospitalization (PHP), inpatient psychiatric
• Psychiatric emergency management: involuntary holds (5150/Baker Act), crisis stabilization units
• Post-attempt follow-up and zero suicide framework in health systems
• Documentation of suicide risk assessments and clinical reasoning

▌ WEEKLY DISCUSSION QUESTIONS
Discussion 1: You conduct a safety planning intervention with a patient who reveals firearms in the home but refuses to remove them. How do you proceed clinically, legally, and ethically? What resources and laws apply in your state?

Discussion 2: The Zero Suicide Framework calls for systematic, evidence-based suicide care across health systems. What are the key components of this model, and how can PMHNPs be champions of its implementation in their practice settings?

Discussion 3: Critically evaluate the evidence for psychiatric hospitalization as a suicide prevention intervention. When is hospitalization clinically indicated versus potentially harmful? How do you make this determination?

▌ WEEKLY ASSIGNMENT
Assignment Title Suicide Risk Assessment & Safety Planning Simulation
Description Complete a written simulation exercise in which you: (1) conduct a structured suicide risk assessment using the C-SSRS framework for a provided clinical vignette, (2) determine and justify a level of care recommendation, (3) complete a full Stanley-Brown Safety Planning Intervention for the patient, (4) write a clinical progress note documenting your assessment and reasoning, and (5) reflect on two personal strategies for managing countertransference when working with suicidal patients.
Submission Format Structured clinical format, 5–6 pages, APA 7th edition
Due Date End of Week 7 (Sunday, 11:59 PM)

 
WEEK 8 | SUBSTANCE USE DISORDERS: ASSESSMENT & INTEGRATED TREATMENT

▌ LECTURE NOTES & CORE CONTENT
• Neuroscience of addiction: reward pathway, dopamine dysregulation, and neuroplasticity
• DSM-5-TR substance use disorder criteria: mild, moderate, severe specifiers
• Screening tools: AUDIT, DAST-10, CAGE-AID, ASSIST, and brief intervention models (SBIRT)
• Opioid Use Disorder (OUD): FDA-approved medications — buprenorphine/naloxone (MAT/MOUD), extended-release naltrexone (Vivitrol), and methadone
• X-waiver elimination (DATA 2000 amendment): current DEA requirements for buprenorphine prescribing
• Alcohol Use Disorder (AUD): detoxification management (CIWA-Ar), naltrexone, acamprosate, disulfiram
• Stimulant and cannabis use disorders: limited pharmacotherapy options and behavioral interventions
• Tobacco cessation: varenicline, bupropion, NRT combinations
• Co-occurring disorders (COD): integrated treatment models for SUD and psychiatric comorbidity
• Harm reduction philosophy: syringe exchanges, naloxone distribution, and fentanyl test strips

▌ WEEKLY DISCUSSION QUESTIONS
Discussion 1: The X-waiver requirement for buprenorphine prescribing was eliminated in 2023. How has this changed or has the potential to change opioid use disorder treatment access? What ongoing barriers remain for PMHNPs prescribing MOUD?

Discussion 2: A patient with schizophrenia and severe alcohol use disorder presents requesting help. He refuses abstinence-based treatment but is open to harm reduction. How do you structure a PMHNP treatment plan that addresses both conditions using an integrated, harm reduction framework?

Discussion 3: There is ongoing debate about whether cannabis is a ‘gateway drug’ and whether medical cannabis has a role in psychiatric treatment. Review the current evidence and discuss your clinical stance on patients who use cannabis medicinally for anxiety or PTSD.

▌ WEEKLY ASSIGNMENT
Assignment Title MOUD Treatment Plan: Opioid Use Disorder Case
Description Develop a comprehensive MOUD (Medication for Opioid Use Disorder) treatment plan for a provided OUD patient case. Include: DSM-5-TR diagnosis with severity, CIWA/COWS assessment if applicable, buprenorphine induction protocol with dosing schedule, urine drug screen monitoring plan, psychosocial support referrals, naloxone prescription and education, a patient agreement, and a 6-month follow-up framework. Integrate evidence from at least 5 peer-reviewed sources and relevant SAMHSA guidelines.
Submission Format Clinical plan format with APA 7th edition references, 5–7 pages
Due Date End of Week 8 (Sunday, 11:59 PM)

 
WEEK 9 | CHILD & ADOLESCENT PSYCHIATRY

▌ LECTURE NOTES & CORE CONTENT
• Normal neurodevelopment: cognitive, emotional, and social milestones from infancy through adolescence
• ADHD: updated DSM-5-TR criteria, combined/inattentive/hyperactive presentations, and lifespan considerations
• Autism Spectrum Disorder (ASD): screening (M-CHAT-R), diagnosis, and pharmacological management of associated symptoms
• Pediatric mood disorders: major depressive disorder, disruptive mood dysregulation disorder (DMDD), and early-onset bipolar disorder
• Anxiety disorders in children: separation anxiety, social anxiety, selective mutism, and school refusal
• Pediatric OCD: ERP therapy and pharmacology (fluvoxamine, sertraline)
• Eating disorders: anorexia nervosa, bulimia nervosa, ARFID, and PMHNP’s role in the treatment team
• Trauma in children: TF-CBT, Parent-Child Interaction Therapy (PCIT), and child-specific safety planning
• Assent, consent, and confidentiality with minors: HIPAA, FERPA, and state law considerations
• Psychotropic medication in children: black box warnings, FDA pediatric labeling, and off-label prescribing

▌ WEEKLY DISCUSSION QUESTIONS
Discussion 1: Black box warnings on antidepressants in children and adolescents have led to decreased prescribing, yet some researchers argue this has been associated with increased suicide rates. Analyze the evidence on both sides and discuss how you would counsel a parent of a 15-year-old with MDD about SSRI treatment.

Discussion 2: A 12-year-old patient with ASD and moderate intellectual disability presents with severe self-injurious behavior. His parents are requesting risperidone. How do you approach this consultation, including the informed consent/assent process, target symptom identification, and monitoring plan?

Discussion 3: School-based mental health services are increasingly integrated into pediatric care. As a PMHNP, how can you collaborate with school counselors, psychologists, and teachers as part of a wraparound care model for a child with ADHD and anxiety?

▌ WEEKLY ASSIGNMENT
Assignment Title Pediatric Psychiatric Case Presentation
Description Prepare a comprehensive pediatric psychiatric case presentation for a child or adolescent patient from your practicum (de-identified). The presentation should include: developmental and family history, school and social functioning, diagnostic formulation (DSM-5-TR), review of all psychotropic medications with pediatric evidence summary, psychotherapy recommendations, family psychoeducation plan, school accommodation suggestions (504/IEP considerations), and an ethical reflection on prescribing in this population.
Submission Format Case presentation format, 6–8 pages, APA 7th edition
Due Date End of Week 9 (Sunday, 11:59 PM)

 
WEEK 10 | GERIATRIC PSYCHIATRY & NEUROCOGNITIVE DISORDERS

▌ LECTURE NOTES & CORE CONTENT
• Aging and brain changes: neuroplasticity, cognitive reserve, and normal vs. pathological aging
• Mild Cognitive Impairment (MCI): diagnosis, conversion risk to dementia, and clinical monitoring
• Alzheimer’s disease: diagnostic criteria (NIA-AA), biomarkers, and pharmacotherapy (cholinesterase inhibitors, memantine, lecanemab)
• Non-Alzheimer’s dementias: Lewy body, frontotemporal, vascular, and mixed presentations
• Late-life depression: clinical differences from midlife depression, underdiagnosis, and treatment considerations
• Late-life anxiety, psychosis, and bipolar disorder: diagnostic challenges and age-appropriate pharmacotherapy
• Behavioral and Psychological Symptoms of Dementia (BPSD): non-pharmacological first-line approaches and judicious pharmacotherapy
• Polypharmacy and Beers Criteria: identifying potentially inappropriate medications in older adults
• Capacity assessment and surrogate decision-making in dementia
• Caregiver burden, family dynamics, and end-of-life psychiatric care

▌ WEEKLY DISCUSSION QUESTIONS
Discussion 1: The FDA approved lecanemab (Leqembi) for early Alzheimer’s disease. Critically evaluate the clinical trial evidence, safety concerns (ARIA), cost, and accessibility. How would you counsel a patient and family considering this treatment?

Discussion 2: Antipsychotics carry an FDA black box warning for use in elderly patients with dementia-related psychosis due to increased mortality risk. Yet BPSD can cause significant suffering and caregiver strain. How do you navigate this clinical dilemma, and what is your decision-making framework?

Discussion 3: An 80-year-old woman with moderate Alzheimer’s disease can no longer live independently. Her family is conflicted about nursing home placement versus in-home care. As her PMHNP, what is your role in this decision, and how do you assess and support caregiver mental health?

▌ WEEKLY ASSIGNMENT
Assignment Title Geriatric Psychiatry Medication Review & Care Plan
Description Conduct a Beers Criteria-based medication review for a geriatric psychiatric patient (real or composite) taking 5 or more medications. Identify all potentially inappropriate medications, provide evidence-based recommendations for deprescribing or substitution, develop an updated psychiatric medication plan using age-appropriate agents and doses, and write a family/caregiver education summary. Include a capacity assessment note if applicable.
Submission Format Clinical plan format, 5–6 pages, APA 7th edition
Due Date End of Week 10 (Sunday, 11:59 PM)

 
WEEK 11 | SCHIZOPHRENIA SPECTRUM & BIPOLAR DISORDER

▌ LECTURE NOTES & CORE CONTENT
• Schizophrenia: neurodevelopmental model, dopamine hypothesis, and updated understanding of glutamatergic dysfunction
• DSM-5-TR criteria for schizophrenia, schizoaffective disorder, brief psychotic disorder, and delusional disorder
• Positive, negative, and cognitive symptom domains: clinical assessment and treatment targets
• First-episode psychosis (FEP): coordinated specialty care (CSC), early intervention, and the RAISE study
• Antipsychotic selection in schizophrenia: efficacy, tolerability, and individualizing therapy
• Treatment-resistant schizophrenia (TRS): defining, identifying, and transitioning to clozapine
• Bipolar I and II: DSM-5-TR criteria, mixed features specifier, and cyclothymia
• Acute mania management: lithium, valproate, antipsychotics, and hospitalization criteria
• Bipolar depression: the challenge of diagnosis and treatment (quetiapine, lurasidone, lamotrigine)
• Maintenance therapy in bipolar disorder: preventing relapse and lithium’s anti-suicidal properties

▌ WEEKLY DISCUSSION QUESTIONS
Discussion 1: A 22-year-old college student presents with a first episode of psychosis. He is scared and his parents want him hospitalized. He is not a danger to self or others. How do you decide between outpatient coordinated specialty care and inpatient admission? What evidence supports your decision?

Discussion 2: Lithium remains the most evidence-based mood stabilizer for bipolar disorder and has anti-suicidal properties. Yet it is underused, largely due to fears about toxicity. How would you present lithium to a newly diagnosed bipolar patient? What monitoring do you implement?

Discussion 3: A patient with bipolar II disorder on lamotrigine 200 mg/day presents with a depressive episode. She refuses quetiapine due to weight gain in the past. Walk through your evidence-based options for treating bipolar II depression without quetiapine.

▌ WEEKLY ASSIGNMENT
Assignment Title First-Episode Psychosis Care Coordination Plan
Description Design a coordinated specialty care (CSC) plan for a young adult (18–30 years old) presenting with first-episode psychosis. The plan must include: psychiatric evaluation and DSM-5-TR formulation, antipsychotic selection rationale, supported employment/education referral, individual therapy recommendation (CBT-p), family education plan (psychoeducation), peer support integration, 12-month medication monitoring schedule, and relapse prevention planning. Reference the RAISE study and current SAMHSA CSC guidelines.
Submission Format Care plan format, 6–7 pages, APA 7th edition
Due Date End of Week 11 (Sunday, 11:59 PM)

 
WEEK 12 | MENTAL HEALTH EQUITY, ADVOCACY & POPULATION HEALTH

▌ LECTURE NOTES & CORE CONTENT
• Social determinants of mental health: poverty, housing instability, food insecurity, discrimination, and incarceration
• Mental health disparities: race, ethnicity, gender identity, sexual orientation, and rurality
• Structural racism in psychiatry: historical abuses, diagnostic bias, and inequities in access and treatment
• LGBTQ+ affirming care: gender dysphoria, minority stress model, and mental health in sexual minority populations
• Immigrant and refugee mental health: acculturation stress, detention trauma, and culturally responsive care
• Health policy and advocacy: mental health parity (MHPAEA), IMD exclusion, and community mental health funding
• Integrated behavioral health: co-locating psychiatric and primary care services
• Incarceration and mental illness: the criminalization of mental health and diversion programs
• PMHNP as public health advocate: participating in policy, community education, and systems change

▌ WEEKLY DISCUSSION QUESTIONS
Discussion 1: Black Americans are significantly less likely to receive antidepressant treatment and more likely to be diagnosed with schizophrenia compared to white Americans with similar symptom presentations. What are the root causes of these disparities, and what concrete actions can you take as an individual PMHNP to address them?

Discussion 2: The Mental Health Parity and Addiction Equity Act (MHPAEA) requires equal coverage for mental health and medical benefits. In practice, parity is often violated. How can PMHNPs support patients in advocating for their insurance coverage rights, and what systemic advocacy can the profession undertake?

Discussion 3: A transgender patient presents for anxiety management but discloses that her primary source of distress is her employer’s refusal to use her correct pronouns. How do you address this clinically? What is the role of the PMHNP in affirming care beyond prescribing?

▌ WEEKLY ASSIGNMENT
Assignment Title Mental Health Equity Advocacy Project
Description Identify a specific mental health disparity affecting a population in your practicum community. Write an evidence-based advocacy paper that: (1) describes the disparity and its root causes using a social determinants framework, (2) reviews 5 peer-reviewed studies documenting the disparity, (3) proposes three actionable interventions at the clinical, organizational, and policy levels, and (4) includes a one-page advocacy letter to a policymaker (senator, state representative, or health department official) requesting a specific change. Appendix the letter separately.
Submission Format APA 7th edition, 6–8 pages + appendix
Due Date End of Week 12 (Sunday, 11:59 PM)

 
WEEK 13 | PRACTICE MANAGEMENT, LEADERSHIP & INTERPROFESSIONAL COLLABORATION

▌ LECTURE NOTES & CORE CONTENT
• PMHNP business models: solo private practice, group practice, community mental health, telehealth platforms
• Credentialing and privileging: hospital, outpatient, and telehealth requirements
• Billing and coding: CPT codes for psychiatric evaluation (90792), psychotherapy add-ons (90833/90836/90838), and E&M codes
• Medicare and Medicaid reimbursement in mental health: incident-to billing and supervision requirements
• Malpractice insurance: occurrence vs. claims-made policies, risk management, and documentation as protection
• Supervision, consultation, and collaborative practice agreements: navigating state-specific requirements
• Interprofessional collaboration: working with psychiatrists, psychologists, social workers, counselors, and primary care
• Leadership in psychiatric settings: quality improvement, committee participation, and change management
• Burnout, compassion fatigue, and provider wellness: evidence-based self-care for PMHNPs
• Transition to practice: job searching, contract negotiation, and professional development planning

▌ WEEKLY DISCUSSION QUESTIONS
Discussion 1: You are considering opening a private telehealth PMHNP practice in your state. What are the key legal, regulatory, billing, and ethical considerations you must address before launching? What does a sustainable business model look like?

Discussion 2: Psychiatric nurse practitioners and psychiatrists sometimes experience role conflict and interprofessional tension. How do you envision building a collaborative, respectful relationship with physician colleagues? What does effective interprofessional collaboration look like in your ideal practice environment?

Discussion 3: Burnout among psychiatric providers is alarmingly high. Analyze the systemic factors contributing to PMHNP burnout and discuss both individual self-care strategies and organizational changes that healthcare systems should implement to protect provider wellness.

▌ WEEKLY ASSIGNMENT
Assignment Title PMHNP Business & Professional Development Plan
Description Create a professional development and career launch plan for your first year as a PMHNP. Include: (1) a target practice setting description with rationale, (2) a credentialing and licensure timeline checklist, (3) a billing and coding reference guide for your top 5 most common visit types, (4) a one-page contract negotiation guide covering salary benchmarks (referencing AANP or AMGA survey data), benefits, and red flags, (5) a professional organization membership plan, and (6) a 12-month CE and competency maintenance plan.
Submission Format Professional portfolio format, 6–8 pages, APA 7th edition references
Due Date End of Week 13 (Sunday, 11:59 PM)

 
WEEK 14 | QUALITY IMPROVEMENT, EBP & RESEARCH IN PMHNP PRACTICE

▌ LECTURE NOTES & CORE CONTENT
• Evidence-based practice (EBP) models: Iowa Model, PARIHS framework, and ACE Star Model
• Levels of evidence: systematic reviews, RCTs, cohort studies, and expert consensus
• PICO(T) framework: formulating answerable clinical questions
• Critical appraisal of psychiatric research: assessing bias, validity, and applicability
• Quality improvement (QI) methodologies: Plan-Do-Study-Act (PDSA), Lean, and Six Sigma in psychiatric settings
• Implementation science: bridging the gap between evidence and clinical practice
• Clinical practice guidelines (CPGs): APA, NICE, CANMAT, VA/DoD — how to critically evaluate and apply
• Patient-centered outcomes research (PCOR) and shared decision-making tools in psychiatry
• Health informatics and EHR optimization for psychiatric practice
• Publishing and disseminating PMHNP clinical scholarship: journals, posters, and conference presentations

▌ WEEKLY DISCUSSION QUESTIONS
Discussion 1: Using the PICO(T) framework, formulate a clinical question based on a gap in care you have observed in your practicum. Identify the highest level of evidence currently available to answer your question and appraise one key study using a validated tool (e.g., CASP checklist).

Discussion 2: QI projects differ from research in important ways. A colleague wants to implement a new depression screening protocol in your clinic and conduct a QI project to evaluate its impact. Does this require IRB approval? How would you design this project using the PDSA cycle?

Discussion 3: Clinical practice guidelines often lag behind emerging evidence. Describe a situation in which a current CPG recommendation may be outdated or inconsistent with recent research. How do you navigate clinical decision-making when guidelines conflict with newer data?

▌ WEEKLY ASSIGNMENT
Assignment Title Quality Improvement Proposal
Description Design a QI project proposal addressing a clinical problem identified during your practicum. The proposal must include: a problem statement with baseline data, a PICO(T) question, a literature review (5+ sources), a chosen QI methodology (PDSA or Lean), specific measurable aims (SMART goals), a workflow diagram of the proposed change, a data collection plan, key stakeholders and their roles, anticipated barriers and mitigation strategies, and an evaluation timeline. IRB versus QI determination must be addressed.
Submission Format QI proposal format, 6–8 pages with workflow diagram, APA 7th edition
Due Date End of Week 14 (Sunday, 11:59 PM)

 
WEEK 15 | INTEGRATION, REFLECTION & TRANSITION TO PMHNP PRACTICE

▌ LECTURE NOTES & CORE CONTENT
• Synthesis of PMHNP competencies: NTF domains — direct care, consultation, systems leadership, collaboration, coaching, and research
• Board certification examination preparation: ANCC PMHNP-BC vs. AANPCB PMHNP-C — eligibility, content, and strategies
• Prescriptive authority: DEA registration, state controlled substance licenses, and prescribing safety
• Continuing competency requirements: CE credits, pharmacology requirements, and recertification cycles
• Professional identity formation: transitioning from RN to PMHNP — role clarity and confidence
• Emerging trends in psychiatry: precision psychiatry, digital mental health tools, neuromodulation (TMS, ECT, ketamine)
• Reflection on clinical practicum: growth areas, challenging cases, and unresolved clinical questions
• Mentorship and peer support networks for new PMHNPs
• Legacy project presentations: sharing course work and clinical insights with peers

▌ WEEKLY DISCUSSION QUESTIONS
Discussion 1: Looking back on your integration experience, identify the three most significant clinical or professional growth moments. How have these experiences shaped your identity as a PMHNP? What specific competencies feel most developed, and where do you still feel uncertain?

Discussion 2: Digital mental health apps (Woebot, BetterHelp, NOCD, etc.) are increasingly used by patients. How should PMHNPs evaluate and engage with these tools? What questions should you ask patients who present using these platforms, and how do you integrate digital interventions into your clinical practice?

Discussion 3: Write a letter to your future self to be opened one year after you begin PMHNP practice. What promises do you make to yourself regarding patient care, professional development, advocacy, and self-care?

▌ WEEKLY ASSIGNMENT
Assignment Title Comprehensive Clinical Portfolio & Capstone Reflection
Description Submit a final comprehensive clinical portfolio and reflective capstone document. The portfolio must include: (1) a reflective narrative (4–5 pages) synthesizing your PMHNP competency development across the semester, identifying growth, challenges, and your clinical philosophy as it has evolved; (2) a curated table of 10 clinical cases seen during practicum with anonymized summaries, diagnosis, intervention, and key learning; (3) a personal clinical framework diagram depicting how you integrate assessment, diagnosis, pharmacotherapy, therapy, and advocacy; (4) a 5-year professional development roadmap; and (5) a final self-assessment against NONPF PMHNP competencies with evidence from your practicum. This is a signature assignment evaluated by the faculty and practicum preceptor.
Submission Format Portfolio format, 12–15 pages total, APA 7th edition
Due Date End of Week 15 (Sunday, 11:59 PM) — Signature Assignment

 
Course Policies
Academic Integrity
All submitted work must represent the student’s own original scholarship. The use of generative AI to complete assignments is prohibited unless explicitly authorized by the course faculty. All writing will be evaluated for authenticity. Any instance of plagiarism, contract cheating, or academic dishonesty will result in a grade of zero for the assignment and may result in program dismissal per university policy.
Clinical Practicum Requirements
Students must complete a minimum of 250 supervised clinical hours with a board-certified PMHNP or psychiatrist preceptor. Clinical hours must be documented in the clinical tracking system (Typhon or equivalent) and signed by the preceptor weekly. Students must maintain current BLS, HIPAA training, immunization records, malpractice insurance, and background clearance throughout the practicum period. Any safety concern in the clinical setting must be reported to the faculty supervisor immediately.
Confidentiality in Written Work
All case studies, clinical vignettes, and patient-related assignments must be de-identified in accordance with HIPAA regulations. Do not use real patient names, dates of birth, medical record numbers, or any other protected health information. Faculty are mandatory reporters and may be obligated to report disclosures of patient harm or safety concerns identified in student work.
Disability Accommodations
Students requiring academic accommodations must contact the Office of Accessibility Services prior to the start of the semester. Once accommodation documentation is received, the faculty will implement all approved accommodations. Students are encouraged to reach out proactively if any barrier to learning is identified.
Mental Health & Wellness
The content of this course includes traumatic, distressing, and emotionally challenging clinical material. Students are encouraged to prioritize their own mental health and to access available support services including the university counseling center, employee assistance programs (EAP), and peer support networks. Faculty are available to discuss workload concerns and to connect students with resources as needed. Seeking help is a sign of strength and a model for the patients you will serve.

NUR 670 — Psychiatric Mental Health Nurse Practitioner Integration
“The work of healing minds begins with the courage to understand them.”