Exam 2: NU 664C/ NU 664C Study Guide (2025/2026 UPDATE) – Family Psychiatric Mental Health I | Question & Answer | 100% Verified Solutions (Regis)

…..DLDD Exam 2: NU 664C/ NU 664C Study Guide (2025/2026 UPDATE) – Family Psychiatric Mental Health I | Question & Answer | 100% Verified Solutions (Regis) Q. What is the role of the amygdala in fear? Answer Central to fear and emotional learning; hyperactivity linked to anxiety disorders and PTSD; modulated by prefrontal cortex and hippocampus. Q. Which brain areas show hyperactivity in OCD? Answer Orbitofrontal cortex, anterior cingulate cortex, caudate nucleus — overactive cortico-striatal-thalamo-cortical loop. Q. What is the prevalence of anxiety disorders in females vs males? Answer Approximately 2:1 female-to-male ratio. Q. Which neurotransmitters are altered in anxiety disorders? Answer ↓ GABA, ↓ Serotonin, ↑ Norepinephrine; ↑ Cortisol. Q. What are first-line treatments for most anxiety disorders? Answer CBT (especially exposure-based) + SSRIs or SNRIs. Q. What medication is useful for GAD but not effective for panic disorder? Answer Buspirone. Q. What is the treatment of choice for OCD? Answer CBT with exposure/response prevention (ERP) + SSRI (high dose) or Clomipramine. Q. What medication helps PTSD-related nightmares? Answer Prazosin. Q. How long must symptoms persist for GAD diagnosis? Answer ≥6 months of excessive worry + ≥3 physical symptoms (e.g., tension, restlessness). Q. How does acute stress disorder differ from PTSD? Answer Duration 1 month; PTSD ≥1 month. Q. What are key symptoms of somatic symptom disorder? Answer One or more somatic symptoms with excessive anxiety, thoughts, or behaviors for ≥6 months. Q. What defines conversion disorder? Answer Neurologic symptoms incompatible with medical findings; often stress-related. Q. What differentiates factitious disorder from malingering? Answer Factitious = internal gain (sick role); malingering = external gain. Q. What is illness anxiety disorder? Answer Preoccupation with having a serious illness despite minimal or no symptoms; ≥6 months. Q. Diagnostic criteria for MDD? Answer ≥5 SIGECAPS symptoms for ≥2 weeks, with depressed mood or anhedonia required. Q. How do depressive symptoms differ in children? Answer Irritability may replace sadness. Q. What are first-line treatments for MDD? Answer SSRIs or SNRIs + psychotherapy (CBT or IPT). Q. When is ECT indicated? Answer Severe, psychotic, or treatment-resistant depression; suicidal or catatonic patients. Q. What is the typical course of an adjustment disorder? Answer Develops within 3 months of stressor; resolves ≤6 months after stressor ends. Q. Duration criteria for dysthymia (PDD)? Answer ≥2 years in adults (≥1 year in children). Q. Cyclothymic disorder definition? Answer ≥2 years of numerous hypomanic and mild depressive symptoms not meeting full criteria. Q. Onset timing for postpartum depression? Answer Within 4 weeks of delivery (can extend up to 1 year). Q. Black box warning for antidepressants? Answer Increased suicidal ideation/behavior in patients 25 years old. Q. Major lithium side effects? Answer Tremor, GI upset, hypothyroidism, polyuria/polydipsia, renal toxicity; monitor levels, thyroid, and renal function. Q. Which antidepressant is safest in breastfeeding? Answer Sertraline. Q. Geriatric antidepressant considerations? Answer Start low, go slow; avoid TCAs and benzodiazepines; prefer sertraline, escitalopram, buspirone. Q. What are key suicide risk factors? Answer Male, elderly, previous attempt, hopelessness, chronic illness, access to lethal means. Q. Which age group has highest suicide completion rates? Answer Elderly men. Q. Which psychotherapies are evidence-based for depression and anxiety? Answer CBT and IPT. Q. Which therapy uses eye movements to reprocess trauma? Answer EMDR (Eye Movement Desensitization and Reprocessing). Q. Which therapy focuses on mindfulness and emotional regulation? Answer DBT (Dialectical Behavior Therapy). Q. What is an adequate antidepressant trial? Answer 6-8 weeks at a therapeutic dose.If partial response to antidepressant, what is next step? Optimize dose or augment with lithium or atypical antipsychotic. Q. If no response to antidepressant, what is next step? Answer Switch to a different antidepressant class. Q. Physiologic findings common in anxiety disorders? Answer Increased HR, BP, tremor, diaphoresis due to ↑ sympathetic activity. Q. Which neurotransmitter is most associated with social anxiety disorder? Answer Serotonin (↓ activity) Q. A 45 y/o man with severe major depression is on a high dose of an antidepressant but develops increased blood pressure. Which of the following medications is most likely the culprit? Answer Citalopram Mirtazapine Venlafaxine Nefazodone Q. Compared with unipolar depression, the depressed phase of bipolar disorder Answer carries a higher risk of suicide Q. Nikki is a 22 y/o female diagnosed with borderline personality disorder. Her symptoms are self-harm by cutting, binge-purge eating, and alcohol and prescription pill abuse. Which of the following therapies would be the best match for this type of client? Answer Dialectical Behavior Therapy because its goal is to increase self awareness. Q. One of the targets of Health People 2020 focuses the United States on which mental health promotion issue? Answer Reducing child and adolescent suicide Promoting deinstitutionalization Increasing social supports for the indigent Q. The primary function of a biopsychosocial case formulation is to Answer generate understanding of the person as a whole assess the maturity of the patient's defense mechanisms Determine the patient's level of social support Q. Which of the following characteristics are critical factors to evaluate in light of a client's potential for suicide? Answer Hopelessness and helplessness Q. Which of the following is a protective factor for the risk of suicide? Answer Having a sense of responsibility for one's spouse or children Having good social standing in the community Having an IQ over 120 Q. Which of the following PMHNP activities may contribute to successfully accomplishing the Health People 2020 goals? Answer Reach educators about suicide screening and prevention at the local high school Use the Beck Depression Inventory (BDI) i private practice Provide education to high school students and their parents about eating disorders Write a local senator about current NP practice restrictions Q. Which one of the following is a self-administered rating scale in psychiatry? Answer Beck Depression Inventory (BDI) Q. Women are twice as likely to become depressed but men are more at risk for suicide. Answer True Q. levels of anxiety Answer 1-normative, perceptual field broadened 2-normative, perceptual field mild narrow 3-pathological, VS changes 4-pathological, panic Q. ataque de nervios Answer a self-labeled syndrome found in Latinos in which they experience a mixture of anxiety, panic, depression, and anger Q. older adult anxiety symptoms Answer somatic concerns Q. DSM5 anxiety disorders Answer panic disorder agorabphobia social anxiety disorder generalized anxiety disorder selective mutism Q. fear vs anxiety Answer panic attacks are fear response fear is imminent threat anxiety is perceived/future 2 components of anxiety awareness of physiological sensations I.e. VS awareness of being nervous/frightened limbic system amygdala, hypothalamus, hippocampus thalamus mild anxiety eustress motivating normal ___% pts with GAD have 1 other psychiatric disorder 90% ____ of people with GAD also have ____ 2/3 also have MDD _____ is comorbid with BPD and body dysmorphic disorder social phobia medical conditions associated w/ anxiety migraines anemia IBS PUD RA asthma/COPD CVD endocrine disorders fear panic phobia is ____ part of brain amygdala center circuit worry apprehension expectations, obsessions is what part of brain cohticostraital thalamic circuit fear responses triggers what part of brain? amygdala limbic system role emotions learning social behavior prefrontal cortex executive funcitoning/decision making what is no longer considered anxiety disorders per DSM5? OCD/obsessive common vitamin deficiency in anxiety B12 meds that induce anxiety symptoms anticholinergics sympathomimetics withdrawal syndromes that mimic anxiety sx SSRI discontinuation syndrome most common anxiety disorder 12 separation anxiety disorder important to consider "normal development" separation anxiety duration 4 weeks in children 6 months in adults selective mutism essential feature will not initiate speech or reciprocate with others in social situations speak w/ immediate family members at home most common 5 YO duration 1 month separation anxiety essential feature excessive fear/anxiety focused on separation from home or attachment figures nightmares kidnapping,monsters, school avoidance, specific phobia essential feature immediate reaction linked to "phobic stimulus" can occur in presence in or anticipation of coding for specific phobia based on phobic stimulus. Give codes 1. animal 2. natural environment (heights, storms, water etc) 3. blood injection injury 4. situational (airplanes, elevators, small spaces) 5. other ____% of people will have more than one phobia 75% what to look for in children with specific phobia (difficult to assess) rule out normal fear I.e. afraid of dark -may "freeze, cry, tantrum" bc they don't understand avoidance of phobic stimulus social anxiety disorder 2 types 1. performance only 2. regular in all situations social anxiety essential feature fear/anxiety in social situations of being negatively scrutinized including fear of one's own responses I.e. excessive blushing self medication before event is common I.e. ETOH before event panic disorder essential feature recurrent, unexpected panic attacks and either fear of future attacks or modifying behavior to try and avoid future attacks (panic attacks alone is not criteria for panic attacks, must fear future or modify behavior to avoid" I.e. can't go to grocery store b/c what if I have a panic attack first panic attack features people often remembers typically occurs in situation of high stress associated with more medical visits than any other anxiety d/o will come to ER having "hear attack" if they don't know what's happening panic attack sx 1. heart attack sx in chest 2. fear of dying, dizzy, detached from self 3. trembling/shaking/chills/hot flashes 4. choking 5. numbness/tingling in fingers/toes 6. nausea/abdominal distress panic attack duraiton typically 30 mins can last up to an hr but rare peak within mins (0-10) agoraphobia essential features marked by ___ of 5 of the following situations: 2 of 5: 1. public transportation 2. open spaces 3. closed spaces 4. being in a crowd/standing in line 5. being outside of home alone frequent comorbidity of agoraphobia panic d/o used to be coded with panic d/o but now always coded separately most common agoraphobic stimulus in children adults 1. being outside the home (think of being lost) 2. standing in lines/being in a crowd (fear of falling or experiencing panic-like symptoms) GAD essential feature excessive anxiety and worry about a number of events or activities worry can "shift" and tends to be expansive "im a worrier, I was always a worrier" DSM5 GAD criteria ___ of 6 of the following symptoms for most days for ___ months 3 or more of the 6 for 6 months 1. restlessness "on edge" 2. easily fatigued 3. difficulty concentrating 4. irritability (common) 5. muscle tensions 6. sleep disturbance big component of GAD assessment psych/social/family history is huge acute onset with no family history and previously high functioning and no hx of worry then investigate substance use/other causes rare but common example of cause of panic attack symptoms pheochromocytoma ____ is common example of medical diagnosis causing GAD symptoms hyperthyroidism SCARED screening tool anxiety screening for pediatric population 40 questions 30 more specific for diagnosis GAD-7 over 2 weeks bothered by 7 symptoms rated 0-3 anxiety dx first line meds SSRIs buspar PRN hydroxyzine, clonidine, propranolol (performance social anxiety) treatments for specific symptoms 1. panic symptoms 2. general anxiety, excessive worries 1. biofeedback 2. CBT tarasoff principle duty to warn NY 2013 mental health declaration of human rights by CCHR mental health treatment standards and guiding principles of citizen's commission on human rights 1. right to full consent 2. no tx against your will 3. no denial of civil liberty by reason of psychiatric illness w/out fair jury trial 4. no hospitalizations bc of beliefs/practices standards by which human rights violations are investigated and exposed in psychiatry mental health declaration of human rights by CCHR rouse v cameron right to treatment and standard quality care occonnor v donaldson right to refuse treatment harmless mentally ill patients can't be hospitalized MA 51A DCF report of child abuse must be written w/in 48 hours child protective services (CPS) process when report is filed 1. report is "screened" 2. assigned a CPS response if report is "screened in"; determine reasonable cause to believe supported, unsupported reporter receives a letter from DCF of department response does DCF tell the family who made report of child abuse? not unless ordered by a court where to report elder abuse elder protective servies, 60 YO and older MA elder abuse hotline who to report abuse if under 60 disabled persons protection commission who do you call to report abuse of patient by nursing home/hospital staff? MA department of public health who to call to report rape/sexual assualt department of criminal justice/local police but don't include victim's name section 12 A 1/2 reporting rape/sexual assault by clinician treating victim describe general area where attack occurred Bupert case PA duty to warn case mother asserts provider knew of patient's intention to kill a neighbor and should have warned all the neighbors parens patriae doctrine that allows the state to step in and serve as a guardian for children, the mentally ill, the incompetent, the elderly, or disabled persons who are unable to care for themselves section 8 commitment to Bridgewater state hospital section 7 civil commitment section 12 criteria 3 day hospitalization of person's by reason of mental illness 1. imminent risk to harm self/others 2. substantial risk of physical harm to other persons manifested by homicidal/violent behavior 3. substantial risk of physical impariment/injury to person by evidence of impaired judgment Roger's guardian psychiatric med administration lawyer only appointed by probate/family court MPC 120 form form to file petition for guardianship of incapacitated person (Roger's) suicide rates increased by more than ___% in 25 states in 2018 30 ___% of individuals who died by suicide did not have known mental health condition 54 (male/firearm) ___% made healthcare visit week before suicide attempt and ___% the month before 38, 64 screening for suicide PHQ-9 SBQ-R: suicide behaviors questionnaire revised SAFE-T Suicide Assessment Five-step Evaluation and Triage 1. risk factors 2. protective factors 3. suicide inquiry 4. determine risk level 5. appropriate interventions 6. document who is at the highest risk of suicide? males over 85 YO 1. judge determines _____ 2. NP determines ____ 1. competency (legal concept) 2. capacity CDC most frequent suicide precipitants (top 5) 1. relationship problems 2. crisis in past or upcoming 2 weeks 3. problematic substance use 4. physical health problem 5. job/financial problems aspects of suicide inquiry assessment 1. ideation: frequency/intenisity in last 48h, month or ever 2. plan: time, location, availability, preparation 3. behaviors: past attempts, aborted attempts 4. intent: will they carry it out? explore ambivalence suicide intervention for medium risk level IOP program or partial program imminent risk is section 12 obvs SBQ-R cut off score suicide assessment risk, cut off score is 8 for psychiatric population 7 for general population SAD PERSONS Risk factors for Suicide Sex Age Depression Previous attempts Ethanol loss of Rational thinking Sickness Organized plan No social support Stated future intent how is disorganized thinking assessed? by speech patterns of clients I.e. tangental, circumstantial, word salad, loose association what is the cause of positive symptoms of schizophrenia? excessive dopamine in mesolimbic pathway what is the cause of negative symptoms of schizophrenia? decreased dopamine in mesocortical pathway routine monitoring for schizophrenia pts on AS meds A1C lipid profile BMI CBC height/weight brief psychotic disorder duration at least 1 day but less than 1 month "placeholder" schizophrenia diagnosis schizophreniform d/o 1 mo but less than 6 mo WIRED 'N MIRED Catatonia pneumonic waxy flexibility immobility/stupor refusal to eat/drink excitement deadpan staring negativism mutism impulsivity rigidity echolalia/echopraxia direct observation catatonia treatment amantadine or BZDs schizoaffective d/o criteria major mood episode concurrent w/ criterion A of schizophrenia delusions/hallucinations for 2 weeks or more in absence of mood episode tx with AS schizophrenia onset age men vs women men 18-25 women 25-30s most abused drug in patients with schizophrenia? alcohol dementia precox kraeplin/bueler schizophrenia theory chronic sx no fluctuating course blubber 4 A's associations affect autism ambivalence 5th A: accessory sx (hallucinations/delusions) who is Kurt Schneider and what is his contribution? coined Schneiderian sx of schizophrenia first rank sx (emphasized the positive sx) high risk schizophrenia births spring and early winter (viral exposure in utero) too much dopamine in what part of brain results in positive sx of schizophrenia? basal ganglia (movement and emotions, integrating sensory info); D2 receptors too little dopamine in what part of brain results in negative symptoms of schizophrenia? prefrontal cortex (executive functioning); D1 receptors biological abnormalities of brain in schizophrenia 1. reduced cerebral ventricles 2. reduced density of PFC, thalamus, cingulate gyrus 3. abnormal cell migration in hippocampus and PFC phencyclidine model of schizophrenia neurotransmitter hypothesis of too much glutamate schizophrenia is a developmental brain d/o involving specific pathways r/t _____ in brain prefrontal cortex _____ have protective effect in schizophrenia which could lead to delayed onset estrogen cyp3a4 AS meds quetiapine ziprasidone haldol treatment for akathisia inderal (BB) what causes EPS symptoms for FGA? dopamine blockade in nigrostrital dopamine pathway EPS sx dystonia psuedoparkinsonism akathisa akinesia (loss of voluntary movement) tardive dyskinesia symptoms involuntary movements of the facial muscles, tongue, and limbs; grimacing, tongue protrusion, lip smacking, lip puckering AIMS scale The National Institute of Mental Health (NIMH) developed the Abnormal Involuntary Movement Scale (AIMS) The AIMS is a brief test for the detection of Tardive Dyskinesia and other involuntary movements The AIMS Examines facial, oral extremity, and trunk movement EPS side effects are more common in what generation of AS? FGA but possible in SGA new tx for TD only ingrezza, doesn't work for any other sx of EPS what causes NMS? excessive dopamine-2 receptor blockage NMS -NMS is like S&M; -you get hot (hyperpyrexia) -stiff (increased muscle tone) -sweaty (diaphoresis) -BP, pulse, and respirations go up & -you start to drool NMS treatment Dantrolene D2 agonists (e.g., bromocriptine). For NMS, think FEVER: Fever Encephalopathy Vitals unstable Elevated enzymes Rigidity of muscles FGAs with highest weight gain clozapine olanzapine when do you initiate schizophrenia tx with clozapine? failure of at least 2 other meds refractory schizophrenia high risk for suicide goal BMI and weight circumference for men + women on FGAs BMI 25-29 MEN: under 32 inch waist women: under 40 inch waist Antipsychotics FDA approved for ages 13-17? risperidal and aripiprazole SGA's main risks weight gain/metabolic syndrome (CATIE study-43% develop metabolic syndrome) increased CV disease anticholinergic sedation why do SGA have lower risk for EPS side effects? dopamine has inverse relationship with acetylcholine, when serotonin is blocked in nigrostriatal pathway by SGA, dopamine increases which causes ACh to decrease (EPS are caused by increased ACh) DSM5 outline for cultural formulation categories 1. cultural identity of individual 2. cultural concept of distress 3. psychosocial stressors and cultural features of vulnerability and resilience 4. cultural features of the relationship between individual and clinician 5. overall cultural assessment CSF four domains of assessment 1. cultural perceptions of cause, context, support 2. cultural factors affecting self coping nd past help seeking 3. cultural factors affecting current help seeking 4. cultural definition of the problem cultural syndromes clusters of symptoms and attributions that tend to co-occur among individuals in specific cultural groups, communities, or contexts and that are recognized locally as coherent patterns of experience cultural idioms of distress terms or phrases used to describe suffering or distress within a given cultural context doesn't not involve specific symptoms I.e. "nerves" "depressed" but doesn't explain specifically how cultural explanations culturally recognized descriptions of what causes the symptoms, distress, or disorder 3 areas of cultural concepts of distress aka "culture bound syndromes" idioms of distress syndromes explanations why is it important to understand cultural concepts? 1. Understanding that some mental distress may have unique presentations that are cultural in origin can assist with mental health screening and help avoid misdiagnosis. 2. Cultural understanding of these symptoms can help build a therapeutic alliance with a patient. 3. While cultural concepts of distress alone do not indicate the presence of a diagnosable mental disorder, they do indicate vulnerable individuals or populations that could benefit from mental health promotion initiatives and other public health activities. socialization the lifelong process of social interaction through which individuals acquire a self-identity and the physical, mental, and social skills needed for survival in society -inherit customs, values, ideologies acculturation (n.) the modification of the social patterns, traits, or structures of one group or society by contact with those of another; the resultant blend -process of adopting a different culture of interest; assimilation is the actual adoption of new culture assimilation the social process of absorbing one cultural group into harmony with another individual loses nearly all aspects of previous culture segmented assimilation is when you belong and communicate with new and old culture ethnocentrism Belief in the superiority of one's nation or ethnic group. xenophobia a fear or hatred of foreigners or strangers dislike of people from other cultures/countries SAMSHA TIP core elements of cultural competence 1. cultural awareness 2. cultural knowledge 3. cultural knowledge of behavioral health (interventions/services effective for specific cultures) 4. cultural skill development 6 concepts of culture 1. beliefs/values 2. passed on heritage/history 3. similar socialization patterns 4. common communication/language 5. geographic location of residence 6. dress and food race a socially constructed category of people who share similar physical characteristics I.e. asian eye slits in non-asians not genetically based ethinicity is explicitly ______ phenomenon cultural ethnicity vs race ethnicity is based on shared values/beliefs and race is based on physical characteristics what is the outcome of acculturation? assimilation RESPECT pneumonic for culturally responsive attitude respect explanatory model sociocultural influence power empathy concerns/fears trust/therapeutic alliance which cultural group is least likely to have confidence in their medical practitioners? asians anxiety tx in children CBT clonidine guanfacine best med for panic d/o with comorbid depression? fluoxetine when should venlafaxine be used for GAD tx? muscle rigidity insomnia irritability most effective therapy for phobias? behavior therapy what is kyal? Cultural anxiety syndrome "wind attacks" Cambodian and asian neck soreness/tinnitus Ataque de nervios a self-labeled syndrome found in Latinos in which they experience a mixture of anxiety, panic, depression, and anger Hamilton Rating Scale for Anxiety (HAM-4) was developed in 1959 by Max Hamilton primarily as a means of assessing anxiety symptoms in people who were already diagnosed with anxiety disorders. it is not intended as a means of detecting or diagnosing anxiety, but is most useful in helping clinicians measure patient improvement over time. what labs rule out other causes of anxiety? CBC, thyroid, B12, chemistry (BMP) which BZDs have longer half lives? klonopin valium advantages of shorter half life BZDs? quicker onset action less daytime sedation insomnia tx increased risk of addiction xanax, Ativan schizophrenia rating scales brief psychiatric rating scale (BPRS) positive and negative symptoms scale (PANSS) panic attacks must be what to meet DSM5 criteria? out of the blue, unexpected otherwise may signify specific phobia