PMHNP Comprehensive questions and
answers with solutions
AIMS - ANSWER Abnormal Involuntary Movement Scale for 8 and older
12 item tool to assess symptoms of tardive dyskinesia for patients taking antipsychotics
Rating 0-4, >2 to diagnose TD and reduce dose
BARS - ANSWER Barnes Akathisia Rating Scale for 8 and older
4 item tool to assess objective and subjective symptoms of akathisia with antipsychotics and/or
SSRIs
CRS-R - ANSWER Connors Rating Scales - Revised for 3-17
ADHD Parent (80 items) and Teacher Scales (59 items)
Low T-score of 61= mildly atypical; >70 = markedly atypical
Subscales for Oppositional Behaviors, Cognitive Problems, Hyperactivity, ADHD Index, Anxious-
Shy, Perfectionism, Social Problems, DSM-IV Subscales and Connors' Global Index
Vanderbilt ADHD Parent and Teacher - ANSWER 55 parent, 43 teacher items for 6-12
Initial assessment rates symptoms and impairment in academic and behavioral performance
ASRS-1 - ANSWER Adult ADHD Self-Report Scale, 16 and older
Two-part Screening
Part A: 6 questions, 4 symptoms suggest ADHD
Part B: 12 questions to clarify and quantify
AUDIT-C - ANSWER Alcohol Use Disorders Identification Test - Consumption, > 13
,Documents use and frequency in prior year
0-4, F >3 = positive, M >4 = positive, >8 = hazardous drinking
CAGE-AID - ANSWER IDs problem drinking or druging, 13 and older
(C=cut down, A=annoy, G=guilty, E=Eye-opener, AID=altered to include drugs
CRAFFT - ANSWER 6-item screen for alcohol or drugs in adolescents, 14-18
(C=car, R=relax, A=alone, F=forget, F= family or friends, T= trouble)
BAI - ANSWER Beck Anxiety Inventory, 17 and older
Assesses 21 symptoms of anxiety, 0-36 scores
HAM-A - ANSWER Hamilton Anxiety Scale, most commonly used
14 domains, 14=mild, 18-24= moderate, 25-30=severe
LSAS-CA - ANSWER Liebowitz Social Anxiety Scale-Child/Adolescent Version, 7 and older
24 items, social and performance
55-65=moderate social phobia, 65-80=marked, 80-95=severe, >95=very severe
MMSE - ANSWER Mini Mental Status Exam
30 items, 24-30= no cognitive impairment; 18-23=mild cognitive impairment; 0-17= severe
cognitive impairment
MOCA - ANSWER Montreal Cognitive Assessment
>26=normal, add point for <12th grade education
,SPMSQ - ANSWER Short Portable Mental Status Questionnaire
10 items, more than 3 incorrect indicates dementia
BDI-2 - ANSWER Beck Depression inventory, 13 and older
presence and impact of depressive symptoms
21 items, <10=normal; 11-17=mild depression; 18-23=moderate; 24+=severe
CCSD - ANSWER Cornell Scale for Depression in Dementia
19 items, <6=no significant depression; 8-17=probable major depression; >18=definite
depression
MDQ - ANSWER Mood Disorder Questionnaire
Screen for mania or hypomania
positive if 7 or more of 13 items in question #1 present and #2 is yes and #3 gets moderate or
serious problem response
YMRS - ANSWER Young Mania Rating Scale, 11 items (adult)
Range 0-60; adults with 12 or more=mania
CY-BOCS - ANSWER ...
YBOCS - ANSWER Yale-Brown Obsessive Compulsive Scale
10 items; age 14 and older
gold standard for OC symptoms
score indicates level of severity
BPRS - ANSWER Brief Psychiatric Rating Scale, 18 and older
, Assesses psychopathology (+, - and affective) with schizophrenia, not for screening or DX
PANSS - ANSWER Positive and Negative Syndrome Scale, 18 and older
measures changes in symptom intensity in psychosis and schizophrenia
Gold standard in studies of treatment efficacy
SPS - ANSWER Suicide Probability Scale, 13 and older
Rapid measure of suicide risk
higher score indicates greater risk
CIWA-Ar - ANSWER Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised
9 item symptom rating scale, max score 67; <10 does not warrant intervention
COWS - ANSWER Clinical Opiate Withdrawal Scale
Quantifies severity of withdrawal syndrome, guides dosing, monitors over time
Used for induction of Suboxone
5-12=mild; 13-24= moderate; 25-36=mod to severe; >36=severe
T4, FREE THYROXINE - ANSWER 0.8-2.8
Increased In Graves
Decreased In Hypothyroidism
TSH - ANSWER 2- 10 mu/l
Normal values can range from 0.4 - 4.0 mIU/L (milli-international units per liter),
Calcium, Ca++ - ANSWER 8.8-10.5
answers with solutions
AIMS - ANSWER Abnormal Involuntary Movement Scale for 8 and older
12 item tool to assess symptoms of tardive dyskinesia for patients taking antipsychotics
Rating 0-4, >2 to diagnose TD and reduce dose
BARS - ANSWER Barnes Akathisia Rating Scale for 8 and older
4 item tool to assess objective and subjective symptoms of akathisia with antipsychotics and/or
SSRIs
CRS-R - ANSWER Connors Rating Scales - Revised for 3-17
ADHD Parent (80 items) and Teacher Scales (59 items)
Low T-score of 61= mildly atypical; >70 = markedly atypical
Subscales for Oppositional Behaviors, Cognitive Problems, Hyperactivity, ADHD Index, Anxious-
Shy, Perfectionism, Social Problems, DSM-IV Subscales and Connors' Global Index
Vanderbilt ADHD Parent and Teacher - ANSWER 55 parent, 43 teacher items for 6-12
Initial assessment rates symptoms and impairment in academic and behavioral performance
ASRS-1 - ANSWER Adult ADHD Self-Report Scale, 16 and older
Two-part Screening
Part A: 6 questions, 4 symptoms suggest ADHD
Part B: 12 questions to clarify and quantify
AUDIT-C - ANSWER Alcohol Use Disorders Identification Test - Consumption, > 13
,Documents use and frequency in prior year
0-4, F >3 = positive, M >4 = positive, >8 = hazardous drinking
CAGE-AID - ANSWER IDs problem drinking or druging, 13 and older
(C=cut down, A=annoy, G=guilty, E=Eye-opener, AID=altered to include drugs
CRAFFT - ANSWER 6-item screen for alcohol or drugs in adolescents, 14-18
(C=car, R=relax, A=alone, F=forget, F= family or friends, T= trouble)
BAI - ANSWER Beck Anxiety Inventory, 17 and older
Assesses 21 symptoms of anxiety, 0-36 scores
HAM-A - ANSWER Hamilton Anxiety Scale, most commonly used
14 domains, 14=mild, 18-24= moderate, 25-30=severe
LSAS-CA - ANSWER Liebowitz Social Anxiety Scale-Child/Adolescent Version, 7 and older
24 items, social and performance
55-65=moderate social phobia, 65-80=marked, 80-95=severe, >95=very severe
MMSE - ANSWER Mini Mental Status Exam
30 items, 24-30= no cognitive impairment; 18-23=mild cognitive impairment; 0-17= severe
cognitive impairment
MOCA - ANSWER Montreal Cognitive Assessment
>26=normal, add point for <12th grade education
,SPMSQ - ANSWER Short Portable Mental Status Questionnaire
10 items, more than 3 incorrect indicates dementia
BDI-2 - ANSWER Beck Depression inventory, 13 and older
presence and impact of depressive symptoms
21 items, <10=normal; 11-17=mild depression; 18-23=moderate; 24+=severe
CCSD - ANSWER Cornell Scale for Depression in Dementia
19 items, <6=no significant depression; 8-17=probable major depression; >18=definite
depression
MDQ - ANSWER Mood Disorder Questionnaire
Screen for mania or hypomania
positive if 7 or more of 13 items in question #1 present and #2 is yes and #3 gets moderate or
serious problem response
YMRS - ANSWER Young Mania Rating Scale, 11 items (adult)
Range 0-60; adults with 12 or more=mania
CY-BOCS - ANSWER ...
YBOCS - ANSWER Yale-Brown Obsessive Compulsive Scale
10 items; age 14 and older
gold standard for OC symptoms
score indicates level of severity
BPRS - ANSWER Brief Psychiatric Rating Scale, 18 and older
, Assesses psychopathology (+, - and affective) with schizophrenia, not for screening or DX
PANSS - ANSWER Positive and Negative Syndrome Scale, 18 and older
measures changes in symptom intensity in psychosis and schizophrenia
Gold standard in studies of treatment efficacy
SPS - ANSWER Suicide Probability Scale, 13 and older
Rapid measure of suicide risk
higher score indicates greater risk
CIWA-Ar - ANSWER Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised
9 item symptom rating scale, max score 67; <10 does not warrant intervention
COWS - ANSWER Clinical Opiate Withdrawal Scale
Quantifies severity of withdrawal syndrome, guides dosing, monitors over time
Used for induction of Suboxone
5-12=mild; 13-24= moderate; 25-36=mod to severe; >36=severe
T4, FREE THYROXINE - ANSWER 0.8-2.8
Increased In Graves
Decreased In Hypothyroidism
TSH - ANSWER 2- 10 mu/l
Normal values can range from 0.4 - 4.0 mIU/L (milli-international units per liter),
Calcium, Ca++ - ANSWER 8.8-10.5
