NR607 Week 3 Questions With Complete
Solutions
________ in treatment-resistant cases. Correct
Answers clozapine
-Patients should be offered a clozapine trial if they
have a partial or non-response to two antipsychotic
trials, assuming those antipsychotic trials are an
adequate dose and duration (four to eight weeks)
___________ is FDA approved for tx of tardive
dyskinesia Correct Answers Valbenazine
(Ingrezza)
AIMS Correct Answers Abnormal Involuntary
Movement Scale
-12 questions
-5 point rating scale
• range from none to severe
Akathisia Correct Answers -The subjective feeling
of restlessness with a compelling urge to move
-May include repetitive movements:
• finger tapping, rocking, crossing/uncrossing legs
-Onset is usually within four weeks of starting or
increasing medication
-Management may include:
• discontinuing or reducing the antipsychotic dose
• switching to alternative antipsychotics
• beta-blockers
,• benzodiazepines
• anticholinergics
• Mirtazapine may be used at a low dose
Antidepressants Correct Answers SSRIs
-inhibit 5-HT reuptake
SNRIs
-inhibit 5-HT reuptake
-inhibit NE reuptake (↑ energy, focus)
-increase DA in prefrontal cortex (↑ cognition)
NDRIs
-inhibit DA reuptake (↑alertness, motivation)
-inhibit NE reuptake (↑energy)
antipsychotic medications are often effective in
managing _________ symptoms of schizophrenia
Correct Answers positive
Bettina is a 24-year-old who presents to the mental
health clinic after a referral from her primary care
provider. She endorses symptoms of depression
that began "when I was still in college," including
excessive sleepiness, withdrawal from social
activities, the guilt associated with "leaving my
friends hanging," and anhedonia. Bettina states
that she saw a counselor through the college
health service, which helped her symptoms
somewhat, but she was unable to continue with
,counseling after graduation two years ago. She
made an appointment with her primary care
provider to discuss medications for depressive
symptoms and was prescribed citalopram 20 mg
daily. After six weeks on the medication, she did
not experience relief of symptoms and returned to
the provider at which time her dose was increased
to 40 mg daily. She had a follow-up appointment
with the provider six months later, at which time
she was prescr Correct Answers continue current
medications and add aripiprazole 2 mg daily
Rationale: The most appropriate treatment for
Bettina is to continue her current medications and
add aripiprazole 2 mg daily. According to the
STAR*D guidelines, the client may choose to
remain on the current medications and add an
atypical antipsychotic medication such as
aripiprazole. Alternatively, the client may choose to
discontinue current medications and start a
tricyclic or tetracyclic antidepressant. The client
may also choose to begin therapy. Inpatient
admission is not indicated for this client.
Carlos is a 25-year-old who was admitted to the
inpatient psychiatric unit after a nonfatal suicide
attempt. He has a history of major depressive
disorder which was initially diagnosed when he was
22, at which time he was started on sertraline 50
mg and then increased to sertraline 100 mg. Carlos
, attempted suicide approximately four months after
beginning the sertraline. At that time, he was
referred for psychotherapy and prescribed
aripiprazole 5 mg in addition to sertraline. Carlos
states that while his symptoms of depression
improved after starting the aripiprazole, they never
completely disappeared. He endorses frequent
thoughts of dying but states "Most of the time,
they are just thoughts of not being here anymore-
they aren't active thoughts of killing myself."
Carlos states that he attempted suicide by
overdosing on his medications after his girlfriend
broke up with him. Currently, he endorses active
sui Correct Answers prescribe electroconvulsive
therapy
Rationale: The most appropriate management
strategy for Carlos is electroconvulsive therapy.
Since Carlos is experiencing active suicidal
thoughts, electroconvulsive therapy may be the
best treatment option at this time. Carlos's
symptoms have been resistant to multiple
medications; increasing dosages is not the best
option, especially since Carlos attempted to
overdose on his medications. Neither a suicide
contract nor one-to-one observations will provide
symptom relief.
conducting the Cornell Scale for Depression in
Dementia Correct Answers
Solutions
________ in treatment-resistant cases. Correct
Answers clozapine
-Patients should be offered a clozapine trial if they
have a partial or non-response to two antipsychotic
trials, assuming those antipsychotic trials are an
adequate dose and duration (four to eight weeks)
___________ is FDA approved for tx of tardive
dyskinesia Correct Answers Valbenazine
(Ingrezza)
AIMS Correct Answers Abnormal Involuntary
Movement Scale
-12 questions
-5 point rating scale
• range from none to severe
Akathisia Correct Answers -The subjective feeling
of restlessness with a compelling urge to move
-May include repetitive movements:
• finger tapping, rocking, crossing/uncrossing legs
-Onset is usually within four weeks of starting or
increasing medication
-Management may include:
• discontinuing or reducing the antipsychotic dose
• switching to alternative antipsychotics
• beta-blockers
,• benzodiazepines
• anticholinergics
• Mirtazapine may be used at a low dose
Antidepressants Correct Answers SSRIs
-inhibit 5-HT reuptake
SNRIs
-inhibit 5-HT reuptake
-inhibit NE reuptake (↑ energy, focus)
-increase DA in prefrontal cortex (↑ cognition)
NDRIs
-inhibit DA reuptake (↑alertness, motivation)
-inhibit NE reuptake (↑energy)
antipsychotic medications are often effective in
managing _________ symptoms of schizophrenia
Correct Answers positive
Bettina is a 24-year-old who presents to the mental
health clinic after a referral from her primary care
provider. She endorses symptoms of depression
that began "when I was still in college," including
excessive sleepiness, withdrawal from social
activities, the guilt associated with "leaving my
friends hanging," and anhedonia. Bettina states
that she saw a counselor through the college
health service, which helped her symptoms
somewhat, but she was unable to continue with
,counseling after graduation two years ago. She
made an appointment with her primary care
provider to discuss medications for depressive
symptoms and was prescribed citalopram 20 mg
daily. After six weeks on the medication, she did
not experience relief of symptoms and returned to
the provider at which time her dose was increased
to 40 mg daily. She had a follow-up appointment
with the provider six months later, at which time
she was prescr Correct Answers continue current
medications and add aripiprazole 2 mg daily
Rationale: The most appropriate treatment for
Bettina is to continue her current medications and
add aripiprazole 2 mg daily. According to the
STAR*D guidelines, the client may choose to
remain on the current medications and add an
atypical antipsychotic medication such as
aripiprazole. Alternatively, the client may choose to
discontinue current medications and start a
tricyclic or tetracyclic antidepressant. The client
may also choose to begin therapy. Inpatient
admission is not indicated for this client.
Carlos is a 25-year-old who was admitted to the
inpatient psychiatric unit after a nonfatal suicide
attempt. He has a history of major depressive
disorder which was initially diagnosed when he was
22, at which time he was started on sertraline 50
mg and then increased to sertraline 100 mg. Carlos
, attempted suicide approximately four months after
beginning the sertraline. At that time, he was
referred for psychotherapy and prescribed
aripiprazole 5 mg in addition to sertraline. Carlos
states that while his symptoms of depression
improved after starting the aripiprazole, they never
completely disappeared. He endorses frequent
thoughts of dying but states "Most of the time,
they are just thoughts of not being here anymore-
they aren't active thoughts of killing myself."
Carlos states that he attempted suicide by
overdosing on his medications after his girlfriend
broke up with him. Currently, he endorses active
sui Correct Answers prescribe electroconvulsive
therapy
Rationale: The most appropriate management
strategy for Carlos is electroconvulsive therapy.
Since Carlos is experiencing active suicidal
thoughts, electroconvulsive therapy may be the
best treatment option at this time. Carlos's
symptoms have been resistant to multiple
medications; increasing dosages is not the best
option, especially since Carlos attempted to
overdose on his medications. Neither a suicide
contract nor one-to-one observations will provide
symptom relief.
conducting the Cornell Scale for Depression in
Dementia Correct Answers
