Advertise on podcast: Deep Dive with Lindsay Hill, DNP, PMHNP - Psych NP Mentor - PMHNP Mentor

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! Valproate monitoring for PMHNPs: baseline labs, 50 to 125 mcg/mL levels, LFT and platelet checks, ammonia, and the pregnancy conversation, in one protocol. In this Deep Dive episode, two hosts walk through “Valproate Monitoring: A PMHNP Safety Protocol” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • Valproate's boxed warning covers three things: liver failure, harm to a developing baby, and pancreatitis. A blood level tells you about none of them. • Get liver tests, a CBC with platelets, weight, and a pregnancy test (when relevant) before the first dose. Ask about urea cycle and mitochondrial disorders. • In the acute mania trials, patients were dosed to a trough level of 50 to 125 mcg/mL. Platelet drops get more likely above 110 mcg/mL in women and 135 mcg/mL in men. • Most serious liver injury shows up in the first six months, so check labs often early. Check ammonia when a patient turns confused, sleepy, or starts vomiting, even if the level and LFTs are normal. • For patients who can become pregnant, valproate is a last-line choice. The FDA cites IQ scores 8 to 11 points lower in exposed children at age 6. • Valproate roughly doubles lamotrigine levels. Halve the lamotrigine titration when you combine them. Read the full article: https://psychnpfellowship.com/valproate-monitoring-protocol-pmhnp-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! A patient hands you FMLA or disability forms. What PMHNPs can certify, a 4-step script, and how to write function-based answers that hold up under review. In this Deep Dive episode, two hosts walk through “FMLA and Disability Forms: A PMHNP Confidence Script” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • Nurse practitioners count as FMLA health care providers when they work within their state's scope of practice, under 29 CFR 825.125. You can sign the form. • Social Security has accepted APRNs as acceptable medical sources for claims filed on or after March 27, 2017. But a statement that a patient is "disabled" or "can't work" gets no weight there. Describe function instead. • Use a 4-step script: clarify the form, check your data, agree on what's true, and set your policy on timing and fees. • "Not yet" is a legitimate answer on visit one. You can't certify what you haven't observed. • For ADA letters, the EEOC wants your relationship to the patient, the condition, the functional limits, and a suggested accommodation. It does not want the whole chart. Read the full article: https://psychnpfellowship.com/fmla-disability-paperwork-pmhnp-confidence-script-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! A PMHNP job interview is your one chance to see the schedule, support, and pay rules before you sign. Use these 12 questions to spot a burnout job early. In this Deep Dive episode, two hosts walk through “PMHNP Job Interview: 12 Questions to Ask Employers” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • A PMHNP job interview is a two-way evaluation. The 45 minutes you spend asking questions shape roughly 2,000 hours of work a year. • The schedule template (new-eval length, follow-up length, panel size, ramp-up) predicts burnout better than the salary number does. • Ask exactly who answers your clinical questions, how fast, and who handles prior authorizations, refills, and the inbox. • Ask how productivity is measured, what you are paid during ramp-up, and who pays for malpractice tail coverage. • Ask why the last NP left. A vague answer is data. • New grads have more leverage than they think: BLS projects 41% growth in NP jobs from 2025 to 2035. Read the full article: https://psychnpfellowship.com/pmhnp-job-interview-questions-to-ask-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! Serotonin syndrome or NMS? A PMHNP decision tree that uses onset timing, clonus vs rigidity, CK and first-hour steps to tell them apart and treat each safely. In this Deep Dive episode, two hosts walk through “Serotonin Syndrome vs NMS: A PMHNP Decision Tree” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • Serotonin syndrome moves in hours: most cases start within 6 hours of a serotonergic change and nearly all within 24. • NMS moves in days: it builds over one to three days, usually in the first two weeks after starting or raising a dopamine blocker. • The exam splits them: clonus and hyperreflexia (worst in the legs) point to serotonin toxicity; lead-pipe rigidity and slowed movement point to NMS. • CK of at least four times the upper limit of normal and fever above 38°C on two readings anchor the NMS consensus criteria. • First hour for both: stop every suspect drug, give fluids, cool, and use benzodiazepines. Cyproheptadine is for serotonin toxicity only. • Never add an antipsychotic to calm an agitated, febrile patient until NMS is ruled out. Read the full article: https://psychnpfellowship.com/serotonin-syndrome-vs-nms-pmhnp-decision-tree-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! A worried parent calls about your adult patient. Here is what HIPAA really allows, a 4-step phone script, and when patient safety lets PMHNPs share more. In this Deep Dive episode, two hosts walk through “Family Calls About a Patient: A PMHNP HIPAA Script” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • HIPAA never stops you from listening to a family member. You can take in everything they tell you and use it clinically. • Sharing is the part with rules. Under 45 CFR 164.510(b), a patient who is present and has capacity can agree out loud, decline to object, or let you reasonably infer they're fine with it. No signed form is required. • When the patient isn't available, use professional judgment and share only what is directly relevant to that person's role in care. • A serious and imminent threat to the patient or others allows disclosure to people who can lessen it, including family (45 CFR 164.512(j)). • Parents of minors, guardians of adults, and SUD records under 42 CFR Part 2 each follow different rules. State law can be stricter than HIPAA. • The script: listen first, neither confirm nor deny, document, then bring it back to the patient. Read the full article: https://psychnpfellowship.com/family-member-calls-patient-hipaa-pmhnp-script-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! The first US adult ADHD guidelines are due this fall, and the DEA telehealth deadline hits Dec 31. What PMHNPs should tighten in adult ADHD practice now. In this Deep Dive episode, two hosts walk through “First US Adult ADHD Guidelines: A PMHNP Prep Guide” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • APSARD's US Adult ADHD Guidelines, the first US clinical guidance written for adults, entered final review in August 2026 and are expected this fall. • Nurse practitioners are a named target audience. Stimulant prescriptions written by NPs and PAs for adults rose 110% from 2019 to 2022. • The guidelines cover screening and diagnosis, medication, and psychosocial care, and were built through a Delphi consensus process. No recommendations have been released yet. • DEA telehealth flexibilities for Schedule II stimulants run through December 31, 2026. A fifth extension or a final rule has not been announced. • The best prep is a chart that shows your reasoning: a structured diagnostic workup, collateral history, a cardiovascular baseline, PDMP checks, and misuse screening. Read the full article: https://psychnpfellowship.com/first-us-adult-adhd-guidelines-pmhnp-prep-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! PMHNP CE requirements for 2026: ANCC's 75 contact hours, the DEA's one-time 8-hour rule, and a 50-state table of APRN renewal hours and required topics. In this Deep Dive episode, two hosts walk through “PMHNP CE Requirements by State: 2026 Guide” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • A PMHNP answers to up to three CE authorities at once: the state board (RN and APRN licenses), the national certifying board (ANCC or AANPCB), and the DEA. • ANCC's PMHNP-BC renews every 5 years with 75 contact hours, 25 of them in pharmacology. AANPCB's PMHNP-C asks for 100 contact hours (25 pharmacology) plus 1,000 practice hours. • The DEA's 8-hour substance use disorder training under the MATE Act is a one-time attestation, made at your first DEA registration or renewal on or after June 27, 2023. • One CEU equals 10 contact hours, so "2.5 CEUs" is 25 hours. Pharmacology hours only count when the certificate designates them. • State rules swing widely: 21 of 51 jurisdictions in our table set their own pharmacology hours, and 39 require controlled substance, opioid or pain management training for prescribers. • ANCC's renewal handbook changes on February 1, 2027: every one of the 75 hours must be accredited or formally approved, and the 8 renewal categories become 3 pathways. Read the full article: https://psychnpfellowship.com/pmhnp-ce-requirements-by-state-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! Grad PLUS is gone and nursing lost professional-degree status, capping loans at $20,500 a year. What the RISE rule and court fight mean for PMHNPs in 2026. In this Deep Dive episode, two hosts walk through “PMHNP Student Loan Caps: What the RISE Rule Changes” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • Since July 1, 2026, new graduate borrowers are capped at $20,500 a year and $100,000 total in federal loans, and Grad PLUS is closed to new borrowers. • The Department of Education's RISE rule left NP and DNP programs out of the "professional degree" group that gets $50,000 a year and $200,000 total. • A federal court in Washington, D.C. partially blocked that definition on June 25, 2026, but the order is preliminary and can still be reversed. • The gap is $29,500 per year. Over a three-year PMHNP program, that is $88,500 a student may need to find somewhere else. • Practicing PMHNPs feel it too: a thinner new-grad pipeline, more preceptor requests, and tuition help showing up as a hiring perk. Read the full article: https://psychnpfellowship.com/pmhnp-student-loan-caps-rise-rule-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! PMHNP wRVU pay explained: 2026 work RVU values for 99214, 90833 and 90792, the math behind productivity bonuses, and the six contract clauses to get in writing. In this Deep Dive episode, two hosts walk through “PMHNP wRVU Pay: How Productivity Contracts Work” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • A wRVU (work relative value unit) is a fixed credit CMS assigns to each CPT code. Many employers pay PMHNPs a set dollar amount per wRVU above a yearly threshold. • In 2026, a 99214 follow-up earns 1.92 wRVUs. Add a documented 30-minute psychotherapy add-on (90833, 1.71 wRVUs) and the same visit earns 3.63, about 89% more credit. • wRVUs do not shrink when Medicare pays NPs 85% of the physician rate or when a patient has Medicaid. That makes wRVU pay safer than collections-based pay for many PMHNPs. • Behavioral health codes were exempt from the 2026 CMS efficiency adjustment, which cut work RVUs 2.5% on about 7,700 non-time-based codes. • Before signing, get six things in writing: the wRVU threshold, the dollar rate, the fee schedule year, a ramp-up guarantee, how add-ons are credited, and how unpaid work is handled. Read the full article: https://psychnpfellowship.com/pmhnp-wrvu-compensation-explained-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! A step-by-step PMHNP protocol for antipsychotic hyperprolactinemia: who to screen, the 4-lab workup, when to image, and when adding 5 mg aripiprazole works. In this Deep Dive episode, two hosts walk through “Antipsychotic Hyperprolactinemia: A PMHNP Protocol” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • Risperidone, paliperidone, and older high-potency antipsychotics raise prolactin the most; aripiprazole, brexpiprazole, cariprazine, quetiapine, and clozapine raise it the least. • Most patients will not bring it up. Ask every patient on an antipsychotic about periods, breast discharge, libido, and erections at baseline and at follow-up. • Before you blame the drug, check four things: a repeat prolactin, a pregnancy test, TSH, and kidney function. • Most medication-related elevations stay under about 100 ng/mL. Very high values, headaches, or vision changes call for pituitary imaging and an endocrine consult. • In a 2022 network meta-analysis, adding aripiprazole 5 mg was the only option that reliably lowered prolactin above 100 ng/mL. Recheck in about 4 weeks. • A high number with no symptoms usually does not need treatment, but long-term low estrogen or testosterone can thin bones. Read the full article: https://psychnpfellowship.com/antipsychotic-hyperprolactinemia-pmhnp-protocol-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! Seven states now restrict AI in mental health care, and Illinois's law names psychiatric APRNs but not physicians. Here's what PMHNPs can still use AI for. In this Deep Dive episode, two hosts walk through “AI Therapy Laws 2026: What PMHNPs Can Still Use AI For” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • Seven states now restrict AI in mental health care: Illinois and Nevada (2025), plus Colorado, Maine, Rhode Island, Tennessee and Vermont (2026). Utah and California regulate chatbots through disclosure and crisis rules instead. • Illinois's law names the licensed advanced practice psychiatric nurse and leaves physicians out. A PMHNP there is covered, and the psychiatrist down the hall is not. • Scheduling, billing, reminders and drafting notes are still allowed. The laws call this administrative and supplementary support. • Recording or transcribing a session for an AI scribe takes the patient's written, specific, revocable consent in Illinois. Patient consent can't make the banned uses legal. • Three uses are off limits: AI making therapeutic decisions on its own, AI holding therapeutic conversations with patients, and AI detecting emotions or mental states. • Illinois fines run up to $10,000 per violation, enforced by the state's professional licensing department. Read the full article: https://psychnpfellowship.com/ai-therapy-laws-2026-pmhnp-state-guide/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! The selegiline patch (EMSAM) is the MAOI with no diet rules at 6 mg. A PMHNP protocol for candidates, washouts, dosing, tyramine, and monitoring in TRD. In this Deep Dive episode, two hosts walk through “Selegiline Patch for TRD: A PMHNP Prescribing Protocol” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • The selegiline transdermal system (EMSAM) is an FDA-approved MAOI for adult major depressive disorder, and at 6 mg/24 hours it needs no tyramine diet. • A 2025 real-world cohort of 117 patients with treatment-resistant depression found the patch was 0.81 CGI-S points better than tricyclics and better tolerated than oral MAOIs, with no hypertensive crises or serotonin syndrome. • The washout is the dangerous part: about 1 week off most antidepressants, at least 5 weeks off fluoxetine, and 2 weeks after stopping the patch before starting a contraindicated drug. • Start and stay at 6 mg when you can. Going to 9 or 12 mg brings back the tyramine diet, starting the first day at the higher dose. • Expect skin reactions (24% vs. 12% on placebo) and insomnia (12% vs. 7%). Check orthostatic blood pressure at every visit. • Contraindicated under age 12 and not recommended ages 12 to 17. For adults 65 and older the recommended dose is 6 mg. Read the full article: https://psychnpfellowship.com/selegiline-patch-emsam-treatment-resistant-depression-pmhnp-2026/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! Light therapy works well beyond winter. A 2025 JAMA Psychiatry meta-analysis of 11 trials and 858 patients found 40.7% remission with bright light versus 23.5% with control in nonseasonal depression. Two hosts cover the standard dose — 10,000 lux from a UV-filtered box, 20 to 30 minutes in the early morning, 12 to 24 inches from the face — when it's reasonable to push to 60 minutes, and who shouldn't start without a conversation first. Full protocol: https://psychnpfellowship.com/bright-light-therapy-depression-pmhnp-protocol-2026/

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! Six states rewrote healthcare noncompete rules in 12 months. What PMHNPs should check, negotiate, and refuse in a 2026 job contract before they sign it. In this Deep Dive episode, two hosts walk through “PMHNP Noncompete Clauses: 2026 State Law Guide” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • Between August 2025 and July 2026, six states changed their rules on healthcare noncompetes: Colorado, Texas, Utah, Virginia, Tennessee and Maine. • Colorado, Utah and Virginia now void most new noncompetes for nurse practitioners. Maine bans them unless the clinician owns part of the practice. Texas still allows them but caps them at one year, a 5-mile radius and a required buyout. • Tennessee moved the other way for almost every PMHNP: a noncompete of two years or less is now presumed reasonable for anyone earning $70,000 or more. • None of these laws is retroactive. The date you sign (and in some states, the date you renew) decides which rules apply to you. • Several states that ban noncompetes still allow patient non-solicitation clauses, and in psychiatry those can cost you more than a radius does. • The FTC's nationwide ban never took effect, but in September 2025 the agency warned large healthcare employers that overbroad noncompetes can still draw enforcement. Read the full article: https://psychnpfellowship.com/pmhnp-noncompete-clause-2026-state-law-guide/ Explore the Psych NP Fellowship: https://psychnpfellowship.com/programs/ This content is for educational purposes and does not replace individualized clinical judgment or supervision.

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! SSRI-associated hyponatremia is a start-up problem. In Swedish registry data, the odds of hospitalization ran 29 times higher in week one, 2.1 times higher by week 13, and slightly below baseline after three months. Two hosts cover who needs a baseline sodium before you start or increase an SSRI or SNRI, why a dose increase restarts the clock, and the two-week recheck window that catches it. Monitoring protocol: https://psychnpfellowship.com/ssri-hyponatremia-sodium-monitoring-pmhnp-protocol-2026/