Exam 1: NURS 663/ NURS663 (New 2026/ 2027 Update) Psychiatric Mental Health Diagnosis and Management II Review with Qs & As| 100% Correct| Grade A (Verified Answers) - Maryville

Exam 1: NURS 663/ NURS663 (New 2026/ 2027 Update) Psychiatric Mental Health Diagnosis and Management II Review with Qs & As| 100% Correct| Grade A (Verified Answers) - Maryville. Q. Bipolar one disorder DSM five criteria ANSWER Manic episode: 1+ week of a colon elevated, expansive or irritable mood and increase energy. 3+ symptoms from B: distractibility, indiscretion, irresponsible, grandiosity, flight of ideas, activity(Increase goal-orient), decreased need for sleep, talkativeness or pressured speech. Q. Bipolar two DSM five criteria ANSWER Hypo mania and major depressive disorder: hypo mania same as mania with decreased severity and duration and no functional impairment for episode of four or more days and no psychosis Q. Mixed episodes (bipolar) ANSWER Manic and depressive symptoms time by side usually with comorbid substance abuse increased risk of suicide and psychosis Q. rapid cycling ANSWER Four or more cycles per year no greater than a week well period Q. Cyclothymia DSM-V Criteria ANSWER Two or more years of mood cycling with dysthymia and hypo mania decreased intensity than bipolar disorder meets criteria for hypo mania but does not meet criteria for major depressive disorder Q. Dysthymia DSM five criteria ANSWER HE'S 2 SAD depressive symptoms lasting two or more years that is subsydromal characterized by hopelessness decreased energy, decrease self-esteem for two years, abnormal sleep, abnormal appetite impaired decision-making. Q. MAOÍ Mechanism of action generally ANSWER Catalyzes the deamination of monoamines intracellularly and MAO transport Reuptake extracellular monoamines Q. MAO-A Mechanism of action ANSWER MAO-A Oxidizes serotonin norepinephrine and epinephrine Q. MAO-B Mechanism of action ANSWER Oxidizes phenylalanine Q. MAO-A and MAO-B mechanism of action ANSWER Oxidizes dopamine non-preferentially Q. MAOs Neumonic -2 ANSWER Date with Tyra banks with wine and cheese in Maui— can cause hypertensive crisis related to tyramine from aged food. MAWIs= my arms weight increased= effective for atypical depression Q. MAOs adverse effects-6 ANSWER Hypertensive crisis, diet restriction, avoid meds, five week after Prozac, two week after other antidepressants, no other medications for two weeks after discontinuing Q. MAOs diet restriction-4 compounds ANSWER Tyrosine, high tyramine, tryptophan, phenylalanine Q. Tyrosine foods-10 ANSWER Aged cheese, aged wine, fava or broad bean pods, sauerkraut, soy sauce, tap or draft beer, overripe fruit, cured meat, spoiled food Q. MAOs drugs to avoid- 6 ANSWER Antidepressants, Dextromethorphan, stimulants, sympathomimetics, meperidine, disulfiram Q. MAOs side effects 11 ANSWER Increased weight, drowsy, dizzy, orthostatic hypotension, tremor, headache, dry mouth, constipation, change in sexual drive, peripheral Edema, sweating Q. Tricyclic mechanism of action ANSWER Inhibit 5HT2, norepinephrine, dopamine and reuptake slows. Amino group interferes with ASP - 98 in HSERT. Causing down regulation of receptors. Q. Tricyclic side effects ANSWER Anticholinergic effects (dry mouth, blurred vision, constipation, urine retention, impotence). Histamine effects (sedation, increased weight). Adrenergic alpha receptor (postural hypotension). Direct membrane effects (decrease seizure threshold and arrhythmias). 5HT2 receptor (increase weight and decrease anxiety). Q. Amitriptyline dosing/Class ANSWER Start at 25 to 50 mg per day, titrate 25 to 50 mg per day per week, Max dose is 300 mg per day/TCA Q. Names of tricyclics 10 ANSWER Amitriptyline, nortriptyline, clomipramine, imipramine, protriptyline, doxepin, amoxapine, desipramine, mapratiline, tripramine Q. Tricyclics are useful-2 ANSWER Pain, migraine Q. Tricyclics adverse effects-2 ANSWER Overdoses are cardiotoxic, high potency increases the risk of mania Q. Nortriptyline mnemonic ANSWER No-triptyline equals less sedation and hypotension Q. Tricyclics mnemonic-2 ANSWER Think car goes over tricycle to remember that an overdose is cardiotoxic. Do you remember mechanism think trans =serotonin and norepinephrine Chans= Na+ and Ca+ Ans= ACH and histamine Q. Clomipramine mnemonic/class ANSWER TCA- think comipramine for obsessive compulsive disorder Q. Imipramine- pneumonic and class ANSWER I'm peeingamine- nocturnal enuresis Q. Unilateral electrode in ECT indications ANSWER Typically first line because it has less cognitive side effects but has less efficacy Q. What is ECT? ANSWER The use of electrical shock current delivered to the brain to induce a seizure that treats depression. Goal is to reverse atrophy. Q. ECT is FDA approved for what ANSWER Bipolar disorder, schizophrenia, schizoaffective disorder, catatonia, neuroleptic malignant syndrome, treatment resistant refractory major depressive disorder Q. What is ECT schedule ANSWER Typically Monday Wednesday Friday for 6 to 12 sessions Q. Bilateral electrode placement in ECT indications ANSWER Classic placement increases cognitive side effects but has better efficacy. Reserved for urgency such as life-threatening depression profound distress and catatonia ECT side effects and Risks 8 Cognitive side effects such as memory loss, head, neck, jaw pain, nausea, myalgia's procedure is low risk What is vagus nerve stimulation It's an implant in the chest that stimulates the left Vegas nerve by Paul stations and it's controlled by an on off switch that is activated by a magnet How does vagus nerve stimulation work Stimulates the brain stem nuclei which changes serotonin in the limbic and cortical systems Vagal nerve stimulation side effects-4 Voice altered, breathlessness, neck pain, no cognitive side effects Vagus nerve stimulation is FDA approved for what in under investigation for what FDA approved for epilepsy and under investigation for major depressive disorder and bipolar disorder What is trans cranial magnetic stimulation Placement of rapid alternating magnets on scalp cause impulse to structures and is focused Goal of trans cranial magnetic stimulation Firing of neurons will alter pathology Trans cranial magnetic stimulation is FDA approved for and not approved for Approved for refractory treatment resistant depression It is not approved for bipolar disorder or schizophrenia What is cognitive therapy based on Negative thinking increase his depression vulnerability, this therapy challenges beliefs and assumptions related to depression Cognitive therapy indications 11 Depression, anxiety, PTSD, schizophrenia, phobia, OCD, bipolar disorder, sexual disorder, eating disorders, sleep disorders, substance abuse disorders Cognitive therapy interventions Automatic thought restructuring, provide evidence just prove beliefs, antidepressants plus cognitive behavioral therapy is greater than just antidepressants and anti-depressants are greater than just cognitive behavioral therapy in efficacy What is interpersonal therapy based on Based on the theory that depression Arises from problematic patterns and relationships Interpersonal therapy indications 5 Indicated for depression, grief, interpersonal dispute, role transitions, interpersonal skill deficits Interpersonal therapy interventions 3 Increase relationship awareness, increase interpersonal skills, communication analysis What is behavioral therapy based on Deficits in reinforcers like present activities and positive interpersonal contacts increased depression vulnerability Behavioral therapy interventions 3 Increase activity level, structure goalsetting, interpersonal skills training Dialectical behavioral therapy is based on Increasing emotional regulation Dialectical behavioral therapy Indications Borderline, bulimia, binge eating, PTSD, substance abuse Dialectical behavioral therapy interventions 4 Increase skills, mindful practice, monitoring/responding to crisis Involuntary commitment reasons Danger to self, danger to others, and self Neglect Are there main points of involuntary commitment 1. Mental illness/developmental disability or drug/alcohol dependence. 2. It is treatable. 3. It is related to the danger to self or others Broad categories of suicide risk factors Psychological disorder, Nuro biological factors, social factors, psychological factors Psychological disorders related to suicide Bipolar is greater than depression however 50% are depressed at time of suicide Neurobiological factors of suicide Decrease serotonin, hereditary, increase reaction of H PA system Social factors of suicide Economic recession, media reports of suicide, social isolation, decrease social belonging Psychological factors of suicide Decrease problem-solving and life satisfaction, increase hopelessness and impulsivity Suicidal ideation safety mnemonic DIOSMIO Detained, impatient, observe, sharp, medical clearance, injuries, or occult overdose Likelihood of attempt pneumonic Guns & ROSES recent attempt, ongoing thoughts, self harm, ethanol, substance abuse Capacity eval mnemonic CURBSID communicate, understand, risk, benefit, situation, impact, decision Likelihood of violence mnemonic PV'd MALES previous violence, male, adult, low intelligence, estranged, substance-abuse Causes of delirium mnemonic DIMTOP drugs, infection, metabolic derangement, trauma, oxygen deprivation, psychological Substances that increase the risk of violence with intoxication Pneumonic PISSE PCP, inhalants, stimulants, steroids, ethanol Visual hallucinations medical cause mnemonic Visual hallucinations from disease of the viscera Signs and symptoms that suggest abuse mnemonic TEN4 Over & OUT torso, ears, neck, less than four months of age, all over the body, observable pattern, unexposed Body part, timing Suspected child abuse mnemonic Fuzzy DETAIL details are fuzzy or vague, denied, evolving, tardy, absent, inconsistent, lacking Catatonia mnemonic Turns a man into a manikin referring to the state of purposeless stupor What is SIADH? syndrome of inappropriate antidiuretic hormone- increase ADH production equals more water retention in kidneys equals less serum sodium Medications thought to cause SIADH Carbamazepine, SSRI, amitriptyline, morphine Mood Disorder Questionnaire (MDQ) Screens for Bipolar Disorder- 13 questions based on bipolar DSM five criteria, screen every patient with depression MDQ Positive score Includes 7+ symptoms in question one, question two, moderate severe problem in question three Patient health questionnaire nine Screen all patients with depressive symptoms, nine question based on DSM five criteria for major depressive disorder Other causes of SIADH Medications, Traumatic brain injury, infections, cancer, hypothyroid SIADH dysfunction Decreased serum osmolality equals increased urine osmolality related to vasopressin in kidney malfunction Patient health questionnaire nine scores 0-4 equals minimal, 5-9 equals mild, 10-14 equals moderate, 15 or more is moderate or severe DSM five criteria for major depressive disorder Sad mood or anhedonia for two weeks or more, Plus for the following: sleep changes, cycle motor changes, appetite or weight change, decreased energy, guilt/worthless, difficulty concentrating/thinking/decisions, recurrent thought of suicide/death Major depressive disorder mnemonic SIGECAPs, Sleep, decrease interest, guilt, decreased energy, decreased concentration, how to say change, psycho motor agitation or retardation, suicide SIGECAPs, sleep, decrease interest, guilt, decreased energy, decreased concentration, how to say change, psycho motor agitation or retardation, suicide Medical conditions that look like mania or depression 4 Substance abuse, metabolic, infection, neurological, cerebrovascular Bipolar disorder brain structure mnemonic Let's live outrageously forget consequences equals left lateral orbital frontal cortex Differentiating bipolar II disorder mnemonic BP II Equals lower lows Mania often seen symptoms mnemonic MANIA more activity not inherently affective. Increase goal directed activity is seen more than elevated mood Depression assessment across the lifespan mnemonic Reactive PLANETS reactivity, polarity, lability, attributability, normalcy, episodic, treatment response, severity Anti-depressants adverse effects 4 Serotonin syndrome, mania shift, suicidal ideation, bleeding Don't use anti-depression's with what disorders Bipolar and borderline personality disorder Negative affective biased pneumonic NAB To nab the correct diagnosis and treatment. These patients don't see happiness like happy faces and if the treatment is working they will start to see that Atypical depression Mnemonic ATE typical increase eating, heaviness/Leaden paralysis/hypersomnia, rejection sensitivity Depression with psychotic features requires treatment with And anti-depressant and an antipsychotic Trazodone mnemonic TraZoBONE Z sleep aid, bone for priapism Venlafaxine mnemonic 2 Think fax because it is fast like a fax because it has rapid metabolism and discontinuation affects vENlafaxine Think hypertENsion like norepinephrine Duloxetine Mnemonic DUALoxetine for its door mechanism, and DULL oxetine because it can dull pain Mirtazapine mnemonic MEALtazipine- related to increased appetite/weight and sedation Bupropion mnemonic 4 Bu DA NE to remember neurotransmitters. Think butane lighter because it is hot like sex related to no sexual side effects and also think to decrease smoking for smoking cessation. Think BUproprion to remember not to give to those with BUlimia or others at risk for seizures related to decreasing the seizure threshold. You don't use bupropion on with other disorders Traumatic brain injury, seizure disorder, neurological disorder, those who have had brain surgery, disorders with electrolyte. Abnormalities (eating disorders, severe renal or gastrointestinal issues) Used cautiously in substance abusers related to abuse potential because of psychotic symptoms at high doses. Can increase anxiety irritability and agitation Bupropion dosing The 12 hour give 100 mg daily to start then increase 100 mg daily every three weeks to a max dose of 200 mg twice a day. The 24 hour start at 150 mg then increase 150 mg each day every week to a maximum of 450 mg per day Bupropion mechanism of action Like SSRI/SNRI, inhibits dopamine reuptake, an alpha three beta 4 nicotinic antagonist Bupropion side effects advantages and other uses 7 No sexual dysfunction, substance abuse especially nicotine, ADHD, increased energy, decreased appetite, good augmentation, low induction of mania Escitalopram adverse effects 2 QTc prolongation/SI escitalopram dosing Initial dose is 10 mg per day increase at 10 mg a day per week and the max dose is 30 mg a day Fluoxetine mnemonic FLUoxetine remember that the flu lasts 1 to 2 weeks which is related to the longer half-life of fluoxetine Fluoxetine interactions -Warfarin (flux can displace it) -St. John's wort (may cause Serotonin Syndrome) burn up and can overdose -Dabigatran P450 interactions are significant Sertraline mnemonic SQUIRTraline related to its adverse effects of increased diarrhea and the benefit of a safe while pregnancy and breast-feeding sertraline indication/benefits MDD, OCD, PMDD middle of the road antidepressant with no buildup Paroxetine adverse effects Withdrawal symptoms, more sedating, increase appetite Paroxetine mnemonic Think pair of oxen related to it works fast and has a short half-life Paroxetine Interactions Potent CYP 2D6 Inhibitor and substrate equals many interactions Paroxetine dosing Immediate release start at 20 mg per day and titrate 10 to 20 mg per day per week max dose is 50 mg per day, Extended release start at 25 mg per day increase by 12.5 mg per day each week to a max dose of 62.5 mg Anti-depressants side effects 10 Anhedonia, apathy, n/v, drowsy/dizzy, somnolence, headache, bruxism, vivid dreams, fatigue, change in sexual behavior. Antidepressant Mechanism on action Ser-438 residue determines potency (hSERT) SSRI (unk exact mech). sertraline dose Init 20mg/day, titrate 25-50mg/day every 1-2wk, max dose 200mg Fluoxetine indications Depression, d/c syndrome (give 20mg tab), for activation, noncompliance, and to decrease appetite Citalopram (Celexa) and Escitalopram (Lexapro) Pneumonic Think car seat for SEATalopram to remember to obtain an Electrocardiogram forQTC prolongation Carbamazepine treats First line and acute mania, acute/prophylaxis mania, anti-aggressive, rapid cycling, mix patience Carbamazepine labs Level range is 4-12, LFTs, CBC, EKG, multiple drug to drug interactions Carbamazepine dosing 100 milligrams a day initially then increase 200 mg per day everyone to four days to a max dose of 1.6 g per day Carbamazepine mnemonic CBZ Cranial nerve pain, bipolar disorder, seiZures. CarbamASIApine Do you remember that Asian dissent patients have an increased risk of Steven Johnson syndrome and are recommended to be screened Carbamazepine side effects Water retention, ataxia, n/v/d, rash, dizzy, sedation, confusion, transaminitis Carbamazepine adverse effects CNS, rash. Rarely SJS/toxic epidermal necrolysis. Black box warning for aplastic anemia, thrombocytopenia, leukopenia. Carbamazepine mechanism Block voltage-dependent sodium channels, anticholinergic, antidiuretic, antimania, anticonvulsant, antineuralgic, antiarrythmic Valproic Acid (Depakote) mnemonic ValproATE a folate PLaTe, folate linked to neural tube defects. Pancreatitis, Liver problems (hepatotoxic), Thrombocytopenia Valproate (Depakote) indications Mania (equal to Li), comorbid sub. Abuse/anxious, mixed patient, rapid cycling Valproate labs LFT, HCG, CBC, steady state 4-5 days-12hr after last dose check level/CBC/LFT again, target level 50-125 Valproate side effects Depakote. liver toxicity, bone marrow depression, nausea, vomiting, amenorrhea (cessation of menstruation), alopecia (excessive hair loss), sedation, tremor and increased weight Valproate Dosing Initially 500-750mg/day Titrate 250-500mg every 1-3days, Max mg/day Valproate adverse effects Steven-Johnson syndrome, toxic epidermal necrolysis, NTD, PLT dysfunction, transaminitis, thrombocytopenia Lithium indications manic episodes in bipolar disorder and maintenance for prevention of such episodes, decreased efficacy in depression symptoms Lithium mnemonic for SEs? LI: Leukocytosis (increased WBCs) T: Tremors/Thirst H: Hypothyroidism IU: Increased urine output M: Muscle weakness, mental disorders, memory loss Pregnancy: LIT for Low Implanted Tricuspid (Epstein's anomaly). Side Effects: LMNOP Lithium, Movement, Nephrotoxic, hypOthyroid, Pregnancy Lithium labs to monitor Li level- 0.6-1.2 after steady state of 5 days, 12 hr after dose, then at dose change or every 3 months, creatinine, HCG, TSH, CBC Lithium dosing Init 300-600mg/day titrate 300mg/day every 1-5 days to max 1800 mg/day (based on labs) Lithium side effects Hand tremor, polyuria/dypsia r/t ADH, thirst, muscle weakness, nausea, incoordination, acne, thyroid abnormal, dec. SZ threshold, non-sig leukocytosis, kidney fibrosis Init treatment acute mania and mnemonic Antipsychotic are quicker, Quietly Lifting Out Quitiepine, Lurazidone and Olanzapine Lamotrigine mnemonic LamotrITCHgine r/t rash (Steven-Johnson) LAMOtrigine lamb greater than lion (BP depression) Lamotrigine (Lamictal) indications epilepsy, seizures, BP depression Lamotrigine (Lamictal) dosing Init dose 25mg/day, increase 25mg/day every 2wks (faster equals increased risk of rash), max 400mg/day. (If stopped for 5 or more days start again at 25 mg/day Lamotrigine (Lamictal) labs LFT Lamotrigine (Lamictal) adverse effects Steven-Johnson, toxic epidermal necrolysis, blood dyscrasias Lamotrigine (Lamictal) interactions VPA increases dose by double slower titration required and Sertraline increases dose Lamotrigine (Lamictal) side effects Nausea, diplopia, dizziness, unsteadiness, HA Rash, SJS, Hematologic, liver failure, ataxia, sedation LAMOtrigine mechanism of action Na channel effect, possibly inhibits glutamate, weak affect on serotonin Disruptive Mood Dysregulation Disorder (DMDD) Chronic irritability, temper outbursts 3x/wk for 1yr, starts before 10, not diagnosed before 6 or after 18 Major Depressive Disorder (MDD) Sad, empty, or irritable mood affecting function, with specific subtypes and specifiers Persistent Depressive Disorder (PDD) 2 years of depressed mood, with specific symptoms Premenstrual Dysphoric Disorder (PMDD) Sad, anxiety, irritability, concentration, sleep, appetite changes before menses Substance/Medication Induced Depressive Disorder Depressive symptoms due to substance use or medical condition Patient Health Questionnaire-9 Rule of 5s. Mild, Moderate, Moderately Severe, Severe DMDD vs IED DMDD has persistent irritable mood, IED has angry outbursts without persistent irritable mood MDD Subtypes & Specifiers Anxious distress, melancholic features, atypical features, mixed features, peripartum onset, seasonal pattern Zung Self-rating Depression Scale Self-reported screening tool for depression 34 = normal, 50 = depressed Beck Depression Inventory II (BDI-II) Self-reported screening tool for depression with severity levels 0-13 minimal, 14-19 mild, 20-28 moderate, 29-63 severe Hamilton Rating Scale for Depression (HAM-D) Clinician-administered screening tool for depression with severity levels 10-13= mild, 14-17 = mild-tomoderate, 17 = moderate-to-severe MDD Development and Course Chronic and recurrent, recovery within 3mo's when treated, lower recurrence over time Substance-Induced Depressive Disorders Depressive symptoms due to substance use, categorized by type of substances Medical Conditions that can cause depression CVA, Parkinson's, hypothyroidism Recovery from a MDE begins within 3mo's of onset - 40% (when treated) • Within 1 year of onset - 80%; untreated depressive episode lasts 6-13mo's Recurrence of MDD lower over time as duration of remission increases • 25% - recurrence within first 6mo's after hospitalization • 30-50% - recurrence within 2 years • 50-75% - recurrence within 5 years MDD versus Bipolar Depression versus Dementia Depression Onset can be dated w/ precision Rapid progression Patients c/o cognitive loss Patients emphasize disability Strong sense of distress Nocturnal accentuation of symptoms uncommon Dementia verus Depression Dementia Onset can only be approximated Slow progression Patients don't c/o cognitive loss Patients conceal disability Patients often seem unconcerned Nocturnal accentuation of symptoms Dysthymic Disorder = 2years of symptoms (1yr in children) 2 months symptoms free Dysthymia Mneumonic HE'S 2 SAD Hopelessness Energy loss or fatigue Self-esteem is low 2 years minimum of depressed mood most of the day, for more days than not Sleep is increased or decreased Appetite is increased or decreased Decision-making or concentration is impaired PMDD (premenstrual dysphoric disorder) Present in the final week before onset of menses and improves w/i a few days after onset. PMDD DSM-5 Total of 5 symptoms with one or more symptoms in each category. Category A 1. Affective lability 2. Irritability or anger 3. Depressed mood 4. Anxiety, tension, feeling on edge Category B 1. Anhedonia 2. Difficulty Concentrating 3. Lethargy, fatigue 4. Change in appetite 5. Hypersomnia or insomnia 6. Overwhelmed 7. Physical sx: breast tenderness, joint or muscle pain, bloating, weight gain PMDD Diagnostic Markers 2 months of symptoms indicated by: 1. Daily Rating of Severity of Problems 2. Visual Analogue Scales of Premenstrual Mood Symptoms 3. Premenstrual Tension Syndrome Rating Scale which has a self-report and observer version PMDD Differential Dx PMS (not 5/11 symptoms) Dysmenorrhea Substance-induced depressive disorder 1. Prominent and persistent disturbance of mood indicated by depressed mood or anhedonia 2. Symptoms develop during or soon after substance intoxication or withdrawal 3. Substance is capable of producing the symptoms Common substances that cause depression 1. Amphetamine or cocaine withdrawal 2. Alcohol or sedative-hypnotic withdrawal Depression from Medical Condition 1. CVA 2. Huntington's 3. Parkinson's 4. TBI 5. Temporal lobe epilepsy 6. Cushings and hypothyroidism 7. Cancers Compare Depressive Disorders Trazodone precaution Priapism Wellbutrin precaution Lowers seizure threshold Celexa precautions QT prolongation Neuromodulary Treatments Neuromodulary Tx w/ Seizure Risk Neuromodulary Pros/Cons ECT Pros/Cons DBS and VNS Pros/Cons Therapies as Tx for Mood Disorders