The PMHNP is evaluating a new client, a 31-year-old woman with a history of substance use disorder. She was recently sober for 9 months, but just experienced a relapse. The PMHNP should refer her to which form of therapy for relapse prevention?

Choice A reason: Smoking is a well-established risk factor for oral and oropharyngeal cancers, but its contribution to the increasing incidence has declined due to public health efforts and reduced smoking rates. It remains a significant cause but not the primary driver of the recent rise.

Choice B reason: Air pollution is associated with respiratory and cardiovascular diseases, but it is not a recognized major contributor to oropharyngeal cancers. There is no strong epidemiological link between air pollution and the rising incidence of these cancers.

Choice C reason: Human papillomavirus (HPV), particularly HPV-16, has emerged as the leading cause of the increasing incidence of oropharyngeal cancers, especially among younger adults who do not smoke. HPV-related cancers tend to affect the tonsils and base of the tongue and are biologically distinct from those caused by tobacco and alcohol.

Choice D reason: Alcohol is a known risk factor for oral cancers, especially when combined with tobacco use. However, like smoking, its role in the rising incidence is secondary to HPV, which has become the predominant etiological factor in recent years.

Choice A reason: Korsakoff’s syndrome is a chronic neuropsychiatric condition resulting from thiamine deficiency, most commonly associated with prolonged alcohol use. It is characterized by severe memory impairment, including both retrograde and anterograde amnesia, and confabulation—where the patient fills in memory gaps with fabricated stories. This clinical presentation matches the description provided.

Choice B reason: Lewy body dementia involves fluctuating cognition, visual hallucinations, and parkinsonian features. It does not typically present with confabulation or the specific memory deficits seen in Korsakoff’s syndrome.

Choice C reason: Delirium is an acute, fluctuating disturbance in attention and awareness, often reversible. It does not cause persistent amnesia or confabulation and is not consistent with the chronic nature of this patient’s symptoms.

Choice D reason: Kuru is a rare prion disease historically found in Papua New Guinea, associated with cannibalistic rituals. It presents with tremors and neurodegeneration but is not relevant to this case and does not involve confabulation or alcohol-related pathology.