PMHNP Boards

PMHNP Boards Sleep circuit ventrolateral preoptic nucleus (VLPN) in hypothalamus inhibits the brainstem arousal nuclei Sleep stages Stage 1-4 are progressively deeper stages of non-REM sleep REM stage comes in cycles, 1st REM happens 80-100 min into sleep. REM cycles lengthen throughout sleep -stage 4 NREM decreases as we age more for men than women. -Less REM associated with organic brain dysfunctions. SLAP Suicide assessment: -Specific plan -Leathality of suicide method -Accessibility of means -Proximity of helping resources IS PATH WARM - suicide I-suicidal ideation S- substance abuse P-purposelessness A-Anger T-Trapped H-Hopeless W-withdrawl from social interactions A-Anxiety R-Recklessness M-Mood change DIGFAST Mania Assessment D = Distractibility and easy frustration I = Irresponsibility and erratic uninhibited behavior G = Grandiosity F = Flight of ideas A = Activity increased with weight loss and increased libido S = Sleep is decreased T = Talkativeness SIGECAPS S-sleep disoreder I-interest deficit (anhedonia) G-guilt (worthlessness, hopeless, regret) E-engery C-contration deficit A-appetite disorder P-psychomotor retardation S-suicidality DEPRESSION MSE areas "All Bad Subjects are Tough Troubled Characters" A-Appearance B-Behavior S-Speech A-Affect T-thought process T-Thought content C-cognition SLUMS 11 item congitive assessment: tests, short-term memory, calculations, naming, clock, geometery Yalom Group Therapy -Principle of universality: you are not alone in your probems. Mauhler Theory of object relations 0-2 mo. normal autism - no recognition of others 3-5 mo. symbiosis - primary caretaker extension of self 5-36 mo. separation from caretaker (4 substages) -differentiation 5-8 aware of others -Practicing 8-16 mobility starts explores -Reapproachent 16-25 aware of big world, emotional support from caretaker feuls learning -Object constancy 25-36 memory of caretaker assures child, love self by internalizing love of caretaker Albert Ellis Rational Emotive Therapy (RET) People's beliefs strongly affect their emotional functioning. Core Irrational Beliefs: Demandingness or Absolutism Demand for Love and Approval Demand for Success or Achievement Demand for Comfort Certain irrational beliefs make people feel depressed, anxious or angry and lead to self-defeating behaviors. It is important to use vigor or energy when disputing irrational beliefs. Disputing is not just a rational or cognitive method but also an emotional method of changing irrational beliefs into rational ones. Carl Rodgers Person Centered Therapy Unconditional Positive Regard "Humanistic" psychology Erickson Stages (8) 1. Trust vs Mistrust ; 0-1 2. autonomy vs shame & doubt: 2-3 3. initiative vs guilt; 4-6 4. Industry vs. inferiority; 7-12 5. Identity vs role confusion; 13-19 6. Intimacy vs Isolation; 20-34 7. generativity vs stagnation; 35-65 8. Integrity vs. despair; 65-death Trust vs Mistrust 0-18mo - develope trust in cartaker fail: difficulty receiving and giving Autonomy vs shame & doubt 18mo-3 - gain some self-control and will power, body control fail: lack of self-confidence and rage against one's self Initiative vs guilt 3-6 - indentify and direct one's activities Fail: feeling of inadequacy and guilt Industry vs. inferiority 6-12 - self-confidence and peer recognition Fail: low self-esteem and poor interpersonal relations Identity vs role confusion 12-20 - develpement of secure self indentity FAil: lack of direction and confidence in self Intimacy vs Isolation 20- can i love? Generativity vs stagnation 35-65 - can i make my life count? Integrity vs. despair 65-death - did my life matter? SUSPECT paranoid PD Spousal infidelity suspected Unforgiving (bears grudges) Suspicious Perceives attacks (and reacts quickly) Enemy or friend? (suspects associates and friends) Confiding in others is feared Threats perceived in benign events DISTANT Schizoid PD - 7.5% Detached or flattened affect Indifferent to criticism or praise Sexual experiences of little interest Tasks done solitarily Absence of close friends Neither desires nor enjoys close relationships Takes pleasure in few activities ME PARTICULAR Schizotypal PD- 3% Magical thinking Experiences unusual perceptions Paranoid ideation Eccentric behavior or appearance Constricted or inappropriate affect Unusual thinking or speech Lacks close friends Ideas of reference Anxiety in social situations Rule out psychotic or pervasive developmental disorders CORRUPT Antisocial PD - 0.2-3.3% Cannot conform to law Obligations ignored Reckless disregard for safety Remorseless Underhanded (deceitful) Planning insufficient (impulsive) Temper (irritable and aggressive) I DISPAIRR Borderline PD - 2% of pop; 75% female Disturbance of identity Emotionally labile Suicidal behavior Paranoia or dissociation Abandonment (fear of) Impulsive Relationships unstable Emptiness (feelings of) Rage (inappropriate) -Mauhler thought it was caused by issues in the reapproachment stage where baby learns that mom is an other and she will PRAISE ME Historionic PD - 1.84% Provocative or seductive behavior Relationships considered more intimate than they are Attention (need to be the center of) Influenced easily Style of speech (impressionistic, lacking detail) Emotions (rapidly shifting, shallow) Make up (physical appearance used to draw attention to self) Emotions exaggerated GRANDIOSE Narcissistic PD - 6.2% - 50-75% male Grandiose