PMHNP Actual Exam 2022/2023 Solved 100%

PMHNP Actual Exam 2022/2023 Solved 100% Autosomal Dominant - ANSWER Genetic inheritance, is more rare (i.e. Huntington's disease), is present in more than one generation. Autosomal Recessive - ANSWER Expressed in one generation, inherited from unaffected parent, is more common. CAGE Questionnaire - ANSWER For substance abuse, Cut, Annoyed, Guilty, Eye opener Suicidal Risk Assessment - ANSWER SLAP: Social support, Lethality, Access to means, Plan and previous attempts, & family history Suicidal Risk Assessment #2 ISPATHWARM - ANSWER ISPATHWARM: Ideation, Substance abuse, Purpose for living, Anxiety/agitation, Trapped feeling, Hopelessness, Withdrawing from friends, Anger with rage, Reckless in behaviors, Mood changes DepressionAssessment SIGECAPS - ANSWER SIGECAPS: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor retardation, Suicidality Mania Assessment DIGFAST - ANSWER DIGFAST: Distractibility, Indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep deficit, Talkativeness Mental Status Exam Components (All Borderline Subjects Are Tough Troubled Characters) - ANSWER Appearance, Behavior, Speech, Affect, Thought Process, Thought Content, Cognitive Examination Hamilton Depression Rating (HDRS) for very severe depression - ANSWER more than 23 Hamilton Depression Rating (HDRS) for severe depression - ANSWER 19-23 Hamilton Depression Rating (HDRS) for moderate depression - ANSWER 14-18 Hamilton Depression Rating (HDRS) for mild depression - ANSWER 8-13 Hamilton Depression Rating (HDRS) for no depression - ANSWER 0-7 Hamilton Anxiety Rating for moderate to severe anxiety - ANSWER 25-30 Hamilton Anxiety Rating for mild to moderate anxiety - ANSWER 18-24 Hamilton Anxiety Rating mild anxiety - ANSWER 17 General screening labs - ANSWER CBC, Chem, Thyroid, Hepatic, b12, folate, drug levels Lithium labs - ANSWER evaluate thyroid function, check creatinine clearance regularly Depakote labs - ANSWER check hepatic function Olfactory Nerve (On) - ANSWER CN I: Sensory: (test by smell- coffee, tea, non astringent smells) Optic Nerve (Old) - ANSWER CN II: Sensory- visual acuity test (confrontation method to assess visual fields) Oculomotor (Olympus) - ANSWER CN III: Motor- eye movement (follow penlight through six fields of gaze, test OD, OS individually) Trochlear Nerve (Towering) - ANSWER CN IV: Motor- eye movement (superior oblique-same test as oculomotor) Trigeminal Nerve (Tops) - ANSWER CN V: Both- superficial and deep structures of head and face, mastification/corneal reflex (test by show teeth) Abducens Nerve (A) - ANSWER CN VI: Motor- specific eye movements (test same as oculomotor) Facial Nerve (Fin) - ANSWER CN VII: Both- taste of anterior 2/3 of tongue, sensation in ear canal, facial movement (use salt/sugar for taste, evaluate corneal reflex, raise eyebrows, keep eyes closed, and resist attempt to open, puff cheeks) Acoustic Nerve (And) - ANSWER CN VIII: Sensory- Hearing/tickling watch and whisper (tuning fork with Rinne- positive as normal, when air conduction persists twice as long as bone conduction) Glossopharyngeal Nerve (German) - ANSWER CN IX: Both- Swallow, taste of posterior 1/3 of tongue, pain, touch, and temp of mucosa and pharynx (check for deviation of uvula to unaffected side) Vagus Nerve (Viewed) - ANSWER CN X: Both- Elevation of the uvula (swallow, have patient say aaah and check uvula elevation, gag reflex, and ability to swallow water) Accessory Nerve (A) - ANSWER CN XI: Motor- Innervates trapezius and sternocleidomastoid (shrug shoulders against resistance, turn head against hand on cheek) Hypoglossal (Hop) - ANSWER CN XII: Motor- motor of the tongue (push tongue against the inside of cheek, stick out tongue and check for fasciculation) Lithium therapeutic levels (acute mania) - ANSWER 0.6-1.2 mEq/L Lithium therapeutic levels (maintenance) - ANSWER 0.8-1.0 mEq/L Lithium adverse effect level - ANSWER 2 mEq/L 2.5 mEq/L = seizure, death Valproic acid therapeutic levels - ANSWER 50-120 ug/ml Sensitivity - ANSWER true positives (the degree to which those who have a disease screen positive) Specificity - ANSWER true negatives (the degree to which those who not have a disease test negative) Incidence - ANSWER frequency with which a disease appears in a population given the rate in which new cases occur during a specific time period Prevalence - ANSWER proportion of a population that is affected by a disease at a particular time Major cause of death for adolescents - ANSWER motor vehicle accident, suicide, accidents, homicide, malignancy, cv or congenital disease Major cause of death for young adults - ANSWER Motor vehicle accidents, homicide, suicide, injuries, heart disease, AIDS Major cause of death for middle age adult - ANSWER Heart disease, accidents, lung cancer, CVA, breast and colorectal cancer, COPD Major cause of death for elderly adults - ANSWER Heart disease, CVA, COPD, pneumonia and influenza Primary prevention - ANSWER measures to promote health prior to onset of problems (teaching) Secondary prevention - ANSWER focuses on early identification and treatment of existing problems (screening) Tertiary prevention - ANSWER rehabilitation and restoration of health Diagnosis of diabetes - ANSWER fasting BG 126 on 2 separate occasions random BG of 200 with s/s of diabetes oral glucose tolerance test 200 Total cholesterol recommendations - ANSWER 200 LDL recommendation - ANSWER 100, 70 goal HDL recommendation - ANSWER 40 men 50 women Triglycerides recommendation - ANSWER 150 Mitral stenosis - ANSWER loud first heart sound (s1) murmur, low pitched, mid diastolic, apical crescendo rumble Mitral regurgitation - ANSWER third heart sound (S3) with systolic murmur at 5th intercostal space midclavicular line (apex), may radiate to base or left axilla, musical, blowing, or high pitched Aortic stenosis - ANSWER systolic, "blowing", rough harsh murmur at second right ICS usually radiating to the neck Aortic regurgitation - ANSWER diastolic, "blowing" murmur at second left ICS S1 - ANSWER mitral/tricuspid (AV) valves closure S2 - ANSWER aortic/pulmonic (semilunar) valves closure systole - ANSWER period between S1 and S2 diastole - ANSWER period between S2 and S1 S3 - ANSWER "Kentucky", increased fluid states (CHF, pregnancy) S4 - ANSWER "Tennesse", stiff ventricular wall (MI, left ventricular hypertrophy, chronic hypertension) HIV window period - ANSWER immune system responding to viral presence in serum but virus hidden in lymphatic system Ego defense mechanisms - ANSWER compensation, denial, displacement, identification, intellectualization, introjection, isolation, projection, rationalization, regression, sublimation, suppression, undoing Transactional Analysis - ANSWER Eric Berne: description of what people do and say themselves and to each other Interpersonal Theory - ANSWER Harry Sack Sullivan, Peplau Interpersonal Theory: the bad me - ANSWER Develops in response to negative feedback, feelings of anxiety, discomfort, displeasure, and distress Interpersonal theory: the good me - ANSWER Develops in response to positive feedback, feelings, of pleasure, contentment, and gratification Interpersonal Theory: The not me - ANSWER Develops in response to intense anxiety, feelings of horror, dread, awe, loathing Gesalt Therapy - ANSWER Fredrick Perls: the whole is more important than the sum of it's parts (increased awareness of self and responsibility) Person-Centered Therapy - ANSWER Carl Rogers: Unconditional Positive Regard, genuineness, warmth accurate empathy, respect, permissiveness (development of selfdirection) Behavioral Therapy -ANSWER Pavlov (, Skinner, Bandura, Wolpe Understanding human behavior, scientific method Applied Behavioral Analysis - ANSWER direct extension of BF Skinner's radical baaviorism, Operant conditioning- all behavior result of consequences Neobehavioristic Mediational Stimulus Response - ANSWER S-R Model. Classical conditioning, based on research of Pavlov , Guthrie. Model of mediating and intervening variables that create consequence and affect behaviors. Social Cognitive Theory - ANSWER Pavlov's classic dog study, external stimulus events, external reinforcement, cognitive mediational processes Rational Emotive Therapy - ANSWER Albert Ellis. Neurosis is irrational thinking and behaving, emotional disturbances are rooted in childhood but continue through reindoctrination in the now Cognitive Behavioral Therapy - ANSWER Aaron Beck. How one thinks largely determines how one feels and behaves. Cognitive distortions created by certain pathologies like depression/anxiety crate systematic bias. Collaborative Empiricism - ANSWER Agreeing that something is the truth (therapist and client create collaboration to identify dysfunctional interpretations and try to modify them) Trauma Informed Care - ANSWER Goals are safety, awareness through mindfulness, managing physiological arousal. Narratives are constructed sometimes. Most commonly used: CBT and EMDR, and adjunctive body/energy work, group therapy. Avnet Report - ANSWER 1969: demonstrated efficacy of treatment with short-term therapy, paid for by commercial insurance (setting the foundation for 3rd party payment) Role of Psychiatric Nurse - ANSWER Peplau identified the 6 nursing sub-roles: mothersurrogate, technician, manager, socializing agent, health teacher, and counselor/psychotherapist Physical Conditions to Group Therapy - ANSWER no barriers between participants, 5- 10 participants, either open-ended or close-ended depending on the focus of group Yalom Principles - ANSWER Universality, Hope, Altruism (helping others), imparting information (education) , Corrective recapitulation of the primary family experience, Development of socializing techniques, Imitative behavior, cohesiveness, existential factors (direction in life, responsibility), catharsis, interpersonal learning, self understanding Autocratic Leadership - ANSWER "This is how it is" type. Leader focused, memers encouraged to adopt leader's ideas, member participation limited, low individual creativity, low cohesiveness, low productivity Democratic Leadership - ANSWER Most effective type. Member focused, group problem solving, unlimited member participation, encouraged creativity, high cohesiveness, high productivity Laissez-Faire Leadership - ANSWER Undetermined focus, no defined strategy, inconsistent member participation, creativity not addressed, low cohesiveness, low productivity Family Systems Theory - ANSWER Bowen. Usually there is an identified patient (the symptom barer within the family). Goal: coach families to develop more solid self to stand against anxiety, triangles, goal is differentiation. Focus on relationships and not individuals, use "I think" rather than "I feel". Therapy can occur without family. present. Triangles - ANSWER Family Systems Theory: building blocks of any emotional system. A person focuses on a different object, idea or person to manage anxiety between him/her and another person in the family. De-triangulating allows increased differentiation of self and decreased emotional reactivity. Emotional Reactivity -ANSWER Family Systems: To react without separating thoughts and feelings as individuals learn about the emotional processes in family- they can establish themselves as an individual with own beliefs within family. Cutoffs - ANSWER Family Systems: Immature separation of people from each other Fusion - ANSWER Family Systems: Ways that people borrow and lend a self to another Strategic Family Therapy - ANSWER Jay Haley: families inadvertently develop strategies to solve problems and the strategies become the problems. Therapist designs strategies for eliminating problematic behaviors, paradoxical interventions aimed at changing behaviors. Structural Family Therapy - ANSWER Minuchin: Structure, subsystems, boundaries. Families with diffuse boundaries (enmeshed) have more chaos, families with rigid boundaries (disengaged) have less emotional support. Goal: develop clearly defined generational boundaries, unified view on family issues, open communication. Keep hierarchy. Lazarus - ANSWER Theory of stress and coping. internal stress exceeds a persons resources and endangers wellbeing. Stress Diathesis Model: Watson - ANSWER Caring is central theme. Caring only effective when interpersonal (holistic), clients need holistic care enhancing humanism, health and quality of living. Erikson: Trust vs Mistrust - ANSWER infancy (birth to 18 mo), develop trust in primary caretaker and generalize to others. When fails child has difficulty receiving and giving. Erikson: Autonomy vs Shame and Doubt - ANSWER Early Childhood (18 mo- 3 years), gain some self- control and will power. When fails child lacks self- confidence and rage against ones self. Erikson: Initiative vs Guilt - ANSWER Later childhood (3 to 6 years), to identify and direct activities. When fails child has feelings of inadequacy and guilt. Erikson: Industry vs Inferiority - ANSWER School Age (6-12), self- condifence and peer recognition. When fails child has low self-esteem and poor interpersonal relations. Erikson: Identity vs Role confusion - ANSWER Adolescence (12-20 years), development of secure self-identity. When fails person lacks direction and confidence in self. Erikson: Intimacy vs Isolation - ANSWER Early Adulthood (20-39 years), development of close relationship with the other people. When fails the person has low self esteem, feelings of emotional isolation, loneliness, and depression. Erikson: Generativity vs Stagnation - ANSWER Adulthood (40-59 years), focusing on career and family, getting involved in the community. When fails person feels unproductive and alone in the world. Erikson: Integrity vs Despair - ANSWER Elderly adults (60 and over), looking back in life with satisfaction and few regrets. When fails the person have feelings of regrets, bitterness, and despair. Cognitive Theory - ANSWER Piaget: human intelligence is an extension of biological adaptation. Sensorimotor - ANSWER 0-2 years (reflecxive movements, understanding action and result, differentiate self from other objects, hold mental image) Preoperational - ANSWER 2-7 years (symbolic play, only present no clear understanding of time, non-contested respect for authority, can't distinguish fantasy from reality) Concrete operational - ANSWER 7-11 years (understanding of spatial relations, think about past and present, begins to value others) Formal operational - ANSWER 11-15 years (future thinking, abstract thinking, complex problem solving) Theory of Object Relations - ANSWER Margaret Mahler: normal autism (0-2 mo), symbiosis (3-5 mo), separation of individuation- separation of caretaker from self. Imprinting - ANSWER Lorenz: critical period after birth in which imprinting takes place, ethological studies (animal studies) Modern Cognitie Conditioning - ANSWER Bandura: learn by observing others, model observed behaviors, strengthened through reinforcement Pavlov - ANSWER Neural stimulus repeated, paired with unconditioned stimulus, results in learning John B. Watson - ANSWER conditioning, personality is outcome of conditioning experiences unique to child Operant conditioning - ANSWER Skinner- voluntary response depends on consequence Ecological Systems Model - ANSWER Urie Bronfenbrenner: ecological transitions or changes in an individual's role or setting affect development. DNA strands linked by what 4 nucleotide bases? - ANSWER adenine paired with thymine, guanine paired with cytosine Genotype - ANSWER Genetic code (trisomy 21) Phenotype - ANSWER human expression (down syndrome) Asian decent: FDA requirement to check prior to prescribing carbamazepine? - ANSWER HLA-B*1502 allele (due to Stevens-Johnson syndrome) IQ: mild retardation - ANSWER 50-55 to 70 IQ: moderate retardation - ANSWER 35-40 to 50-55 IQ: severe retardation - ANSWER 20-25 to 35-40 IQ profound retardation - ANSWER 20-25 Most common type of ADHD - ANSWER combined type Most common childhood disorder - ANSWER ADHD ADHD primary symptoms - ANSWER inattention, distractibility, impulsivity, hyperactivity ADHD comorbidities -ANSWER learning disabilities, anxiety, depression, ODD, CD Labs that can indicate med cause for hyperactivity - ANSWER hematocrit, lead levels, thyroid function Cluster A personality DO - ANSWER Paranoid, Schizoid, Schizotypal (Odd) Cluster B personality DO - ANSWER Borderline, Narcissistic, Antisocial, Histrionic (Angry) Cluster C personality DO - ANSWER Avoidant, Dependent, Obsessive-Compulsive (Anxious) Paranoid Personality DO - ANSWER More common in schizophrenic families. SUSPECT: Spousal infidelity suspected, Unforgiving, Suspicious of others, Perceive attacks, Everyone viewed as either friend or enemy, Confiding in others is feared, Threats perceived in benign events. Schizoid Personality DO - ANSWER More males (lacking nurturing in childhood). DISTANT: Detached, Indifferent to criticism or praise, Sexual experiences of little interest, Takes performed solitarily, Absence of close friends, Neither desires or enjoys closeness, Takes pleasure in few activities. Schizotypal Personality DO - ANSWER increased association in families with schizophrenia. ME PECULIAR: Magical thinking, Experiences unusual perceptions, Paranoid ideation, Eccentric behavior or appearance, Constricted or inappropriate affect, Unusual or odd thinking and speech, Lacks close friends, Ideas of reference, Anxiety in social settings, Rule our psychotic and pervasive development DO. Antisocial Personality DO - ANSWER 75% of people convicted of crimes have this, familial pattern. CORRUPT: Conformity to the law is lacking, Obligations ignored, Reckless disregard for safety of self or others, Remorse lacking, Underhanded, Planning insufficient, Temper. Borderline Personality DO - ANSWER Frequent hx of childhood abuse/sexual abuse. I DESPAIR: Identity disturbance, Disordered unstable affect with marked mood reactivity, Emptiness feelings, Suicidal behaviors, gestures, that are recurrent, Paranoid ideation under duress, Abandonment sense, Impulsivity, Rage that is inappropriate, Relationship instability with extremes of idealization and devaluation. Histrionic Personality DO - ANSWER PRAISE ME: Provocative, relationships overvalued, Attention seeking and uncomfortable when not, Influenced easily, Style of speech exaggerated without details, Emotions shallow and rapid shifting, Made-up in ways to draw attention, Emotions exaggerated. Narcissistic Personality DO - ANSWER often intelligent. SPEEECIAL: Special (believes in own uniqueness), Preoccupied with fantasies, Envious, Entitlement, Excessive admiration required, Conceited, Interpersonal exploitation, Arrogant, Lacks empathy. Avoidant Personality DO - ANSWER CRINGES: Certainty of being liked prerequisite for involvement, rejection sensitive and preoccupied, intimate relationships avoided, New relationships avoided, Gets around occupational work that involves interpersonal contact, Embarrassment potential prevents new activities, Self-view is one of inferiority, ineptness. Dependent Personality DO - ANSWER more common in women. RELIANCE: Reassurance required for decisions, expressing any disagreement is difficult, life responsibilities assumed by others, Initiating projects difficult, alone, nurturance needs excessive, companionship needed urgently at all times, exaggerated fears of being left to care for others. Obsessive Compulsive Personality DO - ANSWER LAW FIRMS: Loses the point of activities, ability to finish anything compromised by perfection, worthless objects overvalued and cherished, friendships excluded as work focus of life, inflexible and over conscientious, reluctant to delegate, miserly, stubborn. maturational Crisis - ANSWER transitional crisis, throughout the lifecycle, when old methods of coping no longer work Situational crisis - ANSWER from events (loss of others, change of employment, status of significant other, physical illness, suicide) Adventitious Crisis -ANSWER disasters (fires, earthquakes, riots, crimes of violence) Becks Cognitive Triad - ANSWER Individual holds negative view of self, individual evaluates ongoing events in negative way, individual misinterprets available data and assumes future holds no hope Highest risk group for suicide success - ANSWER older white men (widowed) Highest risk group for unpredictable suicide attempt - ANSWER teenage boys Thanatology - ANSWER the study of death, dying, grief 5 stages of grief - ANSWER Kubler/Ross: Denial, Anger, Bargaining, Depression, Acceptance 4 stages of grief for children - ANSWER Bolwby: numbness, disequilibrium, disorganization and despair, reorganization Comorbid with ADHD - ANSWER anxiety (25%), depression (25%), ODD (50%) Xenophobia - ANSWER fear of foreigners Value Orientation - ANSWER Present, past, future orientation (how the patient verbalizes pride in accomplishments and variety of aspects of self) Activity Orientation - ANSWER Measurable achievements (education, career, parenting), spontaneous being (satisfied with being self with or without accomplishments), emphasizing self-development in all aspects as integrated whole Human Nature Orientation - ANSWER View of humans as evil, requiring constant discipline or self-control, or as neutral (neither good or bad), view of humans as subject to environment with little control over destiny (in harmony with environment, master over nature) Relational Orientation - ANSWER Individualistic (more frequent interpersonal relationships with outsiders than with family), lineal (value group goals over individual, tendency toward succession), Collateral (focus on group goals and relationship with others) Family Roles - ANSWER Composition of family unit, family members roles, how member demonstrate affection toward each other, events and associated celebration, attitudes/beliefs toward marriage, divorce, child rearing, views regarding alcohol drugs, religion, special beliefs and practices regarding illness, death, birth Language Communication - ANSWER Language spoken in the home, how family members respect each other, special greetings, English language skills (interpreter?) Dietary Practices - ANSWER Food prep, food forbidden or required for special events, particular foods thought to cause of cure illness, periods of fasting Health Beliefs and Practices - ANSWER Definition of health, cause and history of present problem, perception of severity of problem, practices used to promote health, preventative practices, attitude toward illness/handicaps/disability/death, family members who make decisions regarding illness, demographic preference in health care provider, restrictions regarding modesty and special procedures American- European traits - ANSWER value on individual or object, knowledge based on proof, dichotomous reasoning, develop based on perceived need, future oriented, scientific casue, concrete cause of illness, written/hands on/visual resources, think they should be provided a pill, 5% poor metabolizers of 2c19 African-American traits - ANSWER value on developing/maintaining interpersonal relationships, knowledge through senses/affective means, reasonsing based on union of opposites, develop continuum with interconnection of all relationships over time, present oriented, unnatural caused cause illness, verbal communication/hands on, 19% poor metabolizers of 2C19 Asian traits - ANSWER value on balance within between individual and group relations, knowledge develops when striving for transcendence of mind/body, reasoning reflects separation of mind/body from physical environment, past and present oriented, natural cause disruption of connectedness cause illness, courteous, respectful, meditation, quiet observation and contemplation, Yin/yang (cancer is cold illness that needs hot treatment), 20% poor metabolizers of 2c19 Hispanic traits - ANSWER value on developing and maintaining interpersonal relationships, knowledge acquired through senses/affective means, reasoning based on union of opposites, develop continuum with interconnection of all relationships over time, present oriented, unnatural caused cause illness, verbal communication/hands on, hot and cold (childbirth is cold condition, requires hot treatment), 5% are poor metabolizers of 2c19 Screening Question for alcohol abuse/alcoholism - ANSWER on any single occasion during the past 3 months have you had more than drinks (men 4, women 3) containing alcohol? Who at risk for alcohol screening question - ANSWER if men consume over 14 drinks per week or 4 per day = risk if women consume over 7 drinks per week or 3 per day =risk (NIAAA) Neurobiological factors of substance abuse - ANSWER mesocorticolimbic dopamine systems originating in ventral tegmental area Withdrawal of substances involves... - ANSWER decrease in dopamine levels in nucleus accumbens Alcohol Withdrawal - ANSWER anxiety, irritability, agitation, tachycardia, hypertension, hallucinations, confusion, vomiting, diaphoresis, tremor Opioid Withdrawal - ANSWER Constricted pupils when using but dilated when withdrawling, lacrimation, rhinorrhea, piloerection, yawning, sneezing, anorexia, nausea/vomiting Alcohol delirium lab findings - ANSWER MCV (indicates long term heavy drinking) will be elevated, CDT (carbohydrate deficient transferrin), GGT (gamma glutamyl transferase) elevations r/t liver enzyme induction, AST (more sensitive than ALT) might be normal with heavy chronic drinking, ALT (elevations indicate liver injury/cell deathmay be normal in chronic heavy drinking), CBC-GI bleeding Alcohol hallucinations are different how? - ANSWER they are visual and tactile, not usually auditory Alcohol Withdrawal Treatment - ANSWER Thiamine 100 mg daily IM every 3 days to prevent Wernickes encephalopathy When to start CIWA - ANSWER when clients history indicates likelihood of withdrawal reaction, large amounts over long period of time, history of withdrawal symptoms, last drink within past 12 hours When to stop CIWA - ANSWER when score is less than 10 after 3 consecutive assessments Thought disorders due to elevated in with greatest change in tract. - ANSWER dopamine in basal ganglia with greatest change in mesocorical-mesolimbic tract. Depression may be due to decreased and . - ANSWER Serotonin and norepinephrine Bipolar disorder may be due to interactions between , , , , , . - ANSWER norepinephrine, dopamine, 5-HT, acetylcholine, GABA, and peptides. Anxiety disorders may be due to elevated and and decreased . - ANSWER elevated 5-HT and norepinephrine and decreased GABA. Frontal lobes LIMP - ANSWER Language Intelligence (cognitive function) Motor Personality Occipital lobes VIP - ANSWER visual input Parietal lobes VAST- ANSWER Visual special processing Association cortex Symbolic recognition Topographic sense Temporal lobes LAME - ANSWER Language Affective component of speech Memory Emotion Limbic system (found in temporal lobes) - ANSWER compromised of amygdala and hippocampus behavioral awareness, fear, social behavior, rage, sexual desire, appetite Thalamus - ANSWER relay station for synaptic input Hypothalamus - ANSWER regulates homeostatic functions, links nervous system and endocrine, regulates emotion and basic behavioral patterns Pituitary gland - ANSWER secretes hormones under influence of hypothalamus Basal nuclei/ganglia - ANSWER coordinates slow, sustained movements, suppressed useless patterns of movements Cerebellum - ANSWER maintains balance, enhances muscle tone, coordinates/helps plan skilled voluntary muscle activity Brain stem - ANSWER cardiovascular, respiratory, and digestive control centers, regulates muscle reflexes, involved in posture/equilibrium, receives/integrates input from spinal cord, activates cerebral cortex, sleep centers Dopamine - ANSWER excitatory, D2 and D4 most important. controls thoughts, emotions in frontal cortex, mesocortical tract (involved in attention, focus, and depression). Produced in substantia nigra and ventral tegmental area (precursor is tyrosine), removed from synaptic cleft by MAO enzymatic action Dopamine helps control complex movement in the path, which is also why when given a potent D2 blocker one can develop . - ANSWER nigrostriatal. one can develop extrapyramidal symptoms. symptoms in Schizophrenia. - ANSWER projecting to the nuculeus accumbens, elevated DA, positive symptoms DA influences the tuberoinfundibular path contolling secretion. -ANSWER prolactin nucleus accumbens - ANSWER part of limbic system involved in pleasurable behaviors Norepinephrine - ANSWER produced brainstem (pons) and locus coeruleus, projections everywhere, precursor to tyrosine, removed from synaptic cleft and returned to storage via an active reuptake process NE projections to frontal cortex influence - ANSWER influence attention, concentration (alpha 2 receptors) NE projections to limbic cortex influence - ANSWER emotions and energy NE projections into cerebellum influence - ANSWER tremors NE projections to brain stem - ANSWER affect blood pressure, and innervate the heart via beta-1 receptors NE projections innervate urinary via alpha 1 receptors causing - ANSWER urinary retention 5HT1A is - ANSWER somatodendritic and presynaptic 5HT1D is - ANSWER terminal autoreceptor and presynaptic 5HT is located primarily in with projections - ANSWER located in raphe nucleus, projections everywhere 5HT projections to frontal lobe - ANSWER mood and depression 5HT projections to basal ganglia - ANSWER 5HT2 especially controls movements, obsessions and compulsions 5HT projections to limbic area - ANSWER 5HT2A and 2C- anxiety and panic (enafranil, luvox) 5HT projections to hypothalamus - ANSWER 5HT3- appetite sleep (mirtazapine) 5HT projections to brainstem - ANSWER sleep centers regulated with 5HT2A postsynaptic receptors The mesolimbic pathway projecting to the is associated with DA and 5HT projections to spinal cord - ANSWER sexual response and gut 5HT projections to peripheral - ANSWER 5HT3, 5HT4, receptors in gut regulate appetite as well as GI motility GABA - ANSWER Amino acid, inhibitory, works to sedate, calm Acetylcholine - ANSWER Amino acid, synthesized by basal nucleus of Meynert, precursors are acetylcoenzyme A and choline, memory and cognition, held in balance with dopamine in substantia nigra 5HT - ANSWER an indole, produced in raphe nuclei of brainstem, precursor to tryptophan, removed from synaptic cleft and returned to storage via active reuptake process HPA axis - ANSWER hypothalamus pituitary adrenal axis: may be abnormal in individual with disorders of circadian rythym, stress, depression, comorbidity (diabetes, hyperlipidemia), hypothalamus releases CRH during stress and release of adrenocorticotropic hormone from ant. pituitary then releasing cortisol (causing increased belly fat, elevating BG, BP, suppressing immune) HPT axis - ANSWER hypothalamus pituitary thyroid axis: hypothalamus releases thyrotropin releasing hormone TRHthis acts on ant pituitary-- causing it to secrete thyroid stimulating hormone TSH TSH stimulates thyroid to synthesize T4 T4 is converted to T3 through hepatic path/brain HTP axis deficiencies lead to - ANSWER weight gain, depression, slow mentation, mental retardation (when occurs at birth) HTP axis excessive activity leads to - ANSWER anxiety, stress, hypermetabolic state HPG axis - ANSWER hypothalamus-pituitary-gonadal axis: hypothalamus releases gonadotropin releasing hormone GnRH acts on pituitary to cause secretion of FSH and LH FSH stimulates - ANSWER ovarian follicle development, estrogen secretion, sperm production LH stimulates - ANSWER estrogen and progresterone (in females), testosterone (in males) Stress activating the HPA axis can suppress the - ANSWER immune system 2C19 has reduced activity in - ANSWER Asians and caucasians 1A2 is inhibited by - ANSWER SSRI's (fluvoxamine), increasing theophylline cigarette smoking is an of 1A2 elimination of - ANSWER induces 1A2, increasing elimination of olanzapine 2D6 is most strongly inhibited by - ANSWER fluoxetine and paroxetine (elevated TCA levels when switching from TCA that depends on 2D6 for metabolism to SSRI) 3A4 is inhibited by . - ANSWER some SSRI's (nefazodone)- some benzo's will rise (alprazolam will rise when given fluoxetine) 3A4 is induced by . - ANSWER carbamazepine (oral contraceptive levels will decrease, and the level of carbamazepine itself) oral contraception in combination with lamotragine induce production of . - ANSWER glucuronidation enzyme 1A4. STEP-BD - ANSWER Systematic Treatment Enhancement Program for Bipolar typical antipsychotics bock D2 receptors in the and tracts - ANSWER mesocortical and mesolimbic Sedation and weight gain from antipsychotics is from - ANSWER H1 blockade orthostatic hypotension from antipsychotics is from - ANSWER alpha 1 receptor blockade increased prolactin from antipsychotics is from - ANSWER tuberoinfundibular tract blockade anticholinergic effects from antipsychotics is from - ANSWER MI (muscarinic) blockade Typical antipsychotic examples - ANSWER chlorpromazine (thorazine) thioridazine (Mellaril) Trifluoperazine (Stelazine) Perphenazine (Trilafon) Haloperidol (Haldol) Thiothixene (Navane) Chloprotixene (Taractan) Molidone (Moban) Loxipine (Loxitane) Atypical antipsycotics - ANSWER block D2 and 5HT Clozaril - ANSWER may cause agranulocytosis use 12.5 mg for 1st dose (there after, divided dose) Increase by 25 -50 mg per day as tolerated, to 300 - 400 mg per day (900 mg max per day) Clozaril monitoring - ANSWER weekly complete blood count for six months if WBC 3.5 get repeat CBC, absolute neutrophil if WBC 3.0 hold clozapine, absolute neutrophil if WBC 2.0 stop and monitor daily Risperidone - ANSWER may cause seizures, contraindicated in pregnancy, increased prolactin Examples of atypical antipsychotics - ANSWER clozapine (clozaril) risperidone (ridperdal) olanzapine (zyprexa) quetiapine (Seroquel) ziprasidone (Geodon) aripiprazole (abilify) Metabolic concerns with atypical antipsychotics - ANSWER metabolic syndrome (3 of the following): abdominal obesity elevated triglycerides HDL decreased increased BP increased fasting BG abdominal obesity - ANSWER 37 inches in males, 31.5 in women (for central and south americans) 35.5 in men and 31.5 in women in south Asians Neuroleptic Malignant Syndrome - ANSWER Life threatening (complication of antipsychotics). usually develops within first 2 weeks. can be seen in parkinsons with levodopa. S/S:HOT, STIFF, AND OUT OF IT (extreme mental status change, rigidity, autonomic instability, hyperthermia) Lab findings with Neuroleptic Malignant Syndrome - ANSWER elevated WBC, elevated creatinine phosphokinase, elevated myoglobin, iron deficiency, electromyography, increase in muscle fibers Patho of NMS - ANSWER central dopamine system, muscle membrane dysfunction, sympathetic nervous system Correlations for NMS - ANSWER dehydration, agitation, catatonia, mood disorders, dementia, rapid drug escalation, parenteral drugs, hyponatremia, young male, thyrotoxicosis, combining lithium and haldol Treatment for NMS - ANSWER Dantrolene, bromocriptine Examples of TCA's -ANSWER Amitriptiline (Elavil) Nortriptiline (Aventyl, pamelor) Desiparmine (Norpramin, pertfrane) Imipramine (Tofranil) Doxepin (Sinequan) Portriptyline (Vivactil) Amoxapine (Asendin) Trimipramine (Surmontil) Clomipramine (Anafranil) Tetracyclic antidepressant examples - ANSWER Maprotiline (Ludiomil) Mirtazapine (Remeron) MAOI examples - ANSWER Phenelzine (Nardil) Tranylcypromine (Parnate) Isocarboxazid (Marplan) Selegiline (Eldelpryl)- used for parkinsons SRI examples - ANSWER Nefazodone (Serzone) Trazodone (Desyrel) Bupropion (Wellbutrin) SNRI EXAMPLES - ANSWER Venlafazine (Effexor) Duloxetine (Cymbalta) Desvenlafaxine (Pristiq) NARI examples - ANSWER Reboxetine (Vestra) - not in US TCA's and Tetracyclics - ANSWER sedating, anticholingeric, cognitive impairment, memory loss, weight gain, maprotiline and mirtazapine can cause agranulocytosis MAOI's - ANSWER dizziness, vertigo, headache, insomnia, memory impairment, hypertensive crisis with thyamine rich foods and sympathomimetic drugs (MeperidineDemerol) SRI and SSRI's - ANSWER nervousness, insomnia, sedation (paroxetine), headache, sweating, dry mouth, teeth clenching, sexual dysfunction, nausea, weight gain with prolonge use Serotonin syndrome - ANSWER tachycardia, fever, anxiety, muscle rigidity Serotonin Syndrome risks - ANSWER use of more than 1 SSRI use of st johns wort with SSRI use of other antidepressants with SSRI use of SSRI + triptans (migraine meds) use of tramadol +SSRI's Serotonin Syndrome Treatment - ANSWER withdrawal from SSRI, benzo for muscle rigidity Lithium side effects - ANSWER muscle weakness, thirst, tiredness, slurred speech, diarrhea, vomiting, fine hand tremor Caution use with Lithium and - ANSWER Aspirin Ibuprofen- increase lithium Calcium Haldol Diuretics Check lithium levels... - ANSWER acute treatment twice a week chronic every 2 months 12 hrs after last dose-5 days after steady dosing Examples of Antiepileptics used for BP - ANSWER Carbamazapine (Tegretol) Gabapentin (Neurontin) Divalproex (Depakote) Primidone (Mysoline) Topiramate (Topamax) Lamotrigine (Lamictal) Contraindications ofAE use - ANSWER pregnancy, hepatic impairment, known hypersensitivity MMSE: attention/ calculation - ANSWER serial sevens, spell word backwards MMSE: orientation - ANSWER time: years, season, month, date, day place: name of place, floor, city MMSE: Registration - ANSWER Repeat 3 objects (apple, table, penny)- recall 5 min later MMSE: recall - ANSWER recall objects previously named MMSE: naming - ANSWER show pt items and have them name MMSE: repeat - ANSWER have them repeat words "no ifs and or butts" MMSE: 3 stage verbal command - ANSWER take paper in right hand, fold in half, put on floor MMSE: written command - ANSWER have patient write sentence with subject, verb, and logical progession of thought MMSE: intersecting pentagons - ANSWER copy intersecting pentagons on piece of paper MMSE: 25-30 - ANSWER normal MMSE: 21-24 - ANSWER mild cognitive impairment MMSE: 16-20 - ANSWER moderate cognitive impairment MMSE: less than 15 - ANSWER severe cognitive impairment MMSE: less than 24 - ANSWER possible indicator of dementia MOCA - ANSWER Montreal Cognitive Assessment and Short Portable Mental Status Questionnaire 26 or higher score is normal range (score is 0-30) FT4 normal values - ANSWER 0.8 -2.8 ng/dL TSH normal levels - ANSWER 0.4-0.5 mU/L Calcium normal levels - ANSWER 8.8-10.5 mg/dL Sodium normal levels - ANSWER 135-148 mEq/L Magnesium normal levels - ANSWER 1.3-2.1 mEq/L Chloride normal levels - ANSWER 98-106 mEq/L Potassium normal levels - ANSWER 3.5-5.1 mEq/L ALT normal levels - ANSWER 5-35 U/L (0-55) AST normal levels - ANSWER 5-40 U/L (0-50) GGT normal levels - ANSWER 10-38 IU/L WBC normal levels - ANSWER 4.5-11 thousand cells/mm3 Mean Corpuscular hemoglobin normal levels - ANSWER 26-34 pg/cell MCH concentrated normal levels - ANSWER 31-37% Hb/cell Mean Corpuscular volume MCV normal - ANSWER 80-100 fl Platelets normal levels - ANSWER 150-450 thousand/mm3 Albumin normal levels - ANSWER 3.5-5 g/dl RBC normal levels - ANSWER 3.8-5.1 million cells/mm3- w 4.3-5.7- m HCT normal levels - ANSWER 35-45%-w 39-49%-m HGB normal levels - ANSWER 13.5-17.5 g/dL m 12.0-16.0 w Free T3 normal levels - ANSWER 2.3-4.2 pg/ml Creatinine normal levels - ANSWER 0.7-1.3 mg/dL m 0.6-1.1 w Meds known to cause low sodium - ANSWER trileptal, citalopram Quetiapine use has increased risk for . - ANSWER cataracts stimulants block reuptake. - ANSWER DOPAMINE gold standard treatment for parkinsons is - ANSWER levodopa Acetylcholine antagonist examples - ANSWER Benztropine (Cogentin) Trihexyphenidyl (Artane) Amandtadine (Symmetrel) Selegiline (Eledepryl)- this is a MAOI Early treatment for parkinsons - ANSWER dopamine agonists (pramipexole, ropinole, pergolide) COMT inhibitor examples and use - ANSWER Tolcapone (Tamsar) Entacapone (Comtan) -help reduce levodopa drug induced dyskinesia Stress Diathesis Model: Lazarus - ANSWER Individual heritable vulnerability that when acted on by a stressor produces disease/dysfunction. General Adapatation Syndrome - ANSWER Hans Selye: An emotional or physiological change due to a perceived event or stressor. Fight or Flight Response - ANSWER Hypothalamus stimulates sympathetic NS SN stimulates adrenal medulla Adrenal medulla releases epinephrine and NE into blood Bio response to fight or flight - ANSWER dilated pupils (increased lacrimal secretion) increased respirations (dilation of bronchioles, pulmonary blood vessels) increased heart rate (increased contractility, output) decrease in GI motility and secretions, sphincter contracted Liver glycogenolysis/gluconeogenesis fat cells undergo lipolysis ureter motility increased secretion from sweat glands increased Sustained stress - ANSWER Hypothalamus stimulates pituitary gland releases adrenocorticotropic hormone and stimulates adrenal cortex release of mineralorticoids vasopressin, growth hormone, thyroid stimulating hormone, gonadatropins Primary Appraisal - ANSWER individual makes judgment of stressor and it's either irrelevant, pleasurable, or stressful to the person Secondary Appraisal - ANSWER assessment of coping Amok - ANSWER dissociative episode followed by violent aggression directed toward people or object (Culturally bound syndrome) Koro - ANSWER Fear that the penis will recede into the body and cause death (Culturally bound syndrome) Falling-out - ANSWER American culturally bound syndrome- individual collapses without reason Sutso - ANSWER Belief that the soul will leave the body after an illness (Culturally bound Syndrome) Alcohol Dependence Labs - ANSWER increased alkaline phosphate, increased triglycerides, increased GGT, increased amylase, increased lipase, and increased uric acid Excitatory response cause what type of chemical reactions - ANSWER depolarization (opening of sodium and calcium channels with ions going into cell) Broca's area - ANSWER speech (inferior frontal) Wernicke's area - ANSWER receptive language (temporal cortex) Dementia deterioration in intellectual functioning - ANSWER amnesia: memory dysfunction aphasia: language dysfunction apraxia: voluntary action dysfunction agnosia: perception and recognition disorganization Astrocytes - ANSWER Glial cells: provision of nutrients to the neurons, deactivations of some neurotransmitters integration with the blood brain barrier Oligodendrocytes - ANSWER Glial cells: facilitate conduction, form myelin sheath around axons Microglia - ANSWER Glial cells: remove cellular debris Inhibition at synapse - ANSWER Cl into cell and K out Trileptal and citalopram increase risk of developing low . - ANSWER sodium Delusions of reference - ANSWER other people's thoughts, words or actions refer to self Delusions of persecution - ANSWER other people have malevolent intentions toward self, or are conspiring against the person Religious Delusions - ANSWER Unrealistic special relationship with God Nihilistic Delusions - ANSWER Destruction of self, world, or body part Delusions of Grandiosity - ANSWER Special or gifted, powerful, or important without factual support what is typical for WBC with Lithium - ANSWER they become elevated AIMS tests: - ANSWER facial and oral movements extremity movements trunk movements severity of abnormal movements incapacitation due to movements awareness of movements problems with teeth or dentures? do they wear dentures? AIMS scoring - ANSWER A score of 2 in two or more movements OR a score of 3 or 4 in a single movement Trans-theoretical change model (Declamente) - ANSWER Precontemplation, contemplation, preparation, action, maintenance SBIRT - ANSWER Screening Brief Intervention Resource Training Patient Centered Counseling (5 A's) - ANSWER Assess, Advise, Agree,Assist, Arrange Primary Prevention - ANSWER Reducing Incidence Secondary Prevention - ANSWER Reducing Prevalence Tertiary Prevention - ANSWER Reducing Disability SCID - ANSWER An actual diagnostic instrument, correlated with the DSM (quantitative) Clock Drawing Score - ANSWER Scores 1-6 (higher the score the more cognitive impairment) 3 indicates cognitive deficit Validity - ANSWER extent to which a screening tool actually identifies the disorder in which it is used Reliability - ANSWER extent to which screen tool consistently identifies disorder for which it is used Geriatric Depression Scale - ANSWER 5 is suggestive of depression and warrants an evaluation 10 is almost always indicates depression PHQ-9 - ANSWER 5: mild depression 10: moderate depression 15: moderately severe depression 20: severe depression DAST - ANSWER 12= substance abuse problem Group Phases - ANSWER Tuftman: Storming, Norming, Performing, Adjourning Predictor of group therapy success? -ANSWER Cohesion Narrative therapy - ANSWER Michael White Solution Focused Therapy - ANSWER Shazer, O'Hanlon, Berg: rework present situation solutions that have worked previously (concept of miracle questions "if a miracle were to happen.. what would be different?" Pharmacokinetics - ANSWER movement of drugs within biological systems: absorption, distribution, metabolism, elimination Pharmacodynamics - ANSWER how a drug affects the body when someone is malnourished what happens to medications? - ANSWER they are less bound in the body because malnourishment causes decreased albumin (decreased binding of the drug) and more free unbound drug Steady State - ANSWER the among of drug administered is equal to the amount of drug eliminated within one dosing interval resulting in s plateau or constant serum drug level Half Life - ANSWER time required for serum plasma concentrations to decrease by one half Agonist - ANSWER Drugs which alter the physiology of a cell by binding to plasma membranes or intracellular receptors Partial agonist - ANSWER A drug which does not produce maximal effect even when all of the receptors are occupied Antagonists - ANSWER inhibit or block responses caused by agonists Competitive Antagonist - ANSWER competes with an agonist, high doses of an agonist can generally overcome antagonists Pilocarpine - ANSWER lowers intraocular pressure, lowers cholinergic load: useful when someone is in cholinergic crisis Yohimbine - ANSWER sexual stimulant, can lower blood pressure Verapamil - ANSWER Can increase levels of tegretol, buspar, and lithium through 34A inhibition Use potassium sparing diuretics in those who have - ANSWER Hep C, liver impairment Pyrimethamine (Daraprim) - ANSWER treatment of Malaria Leprosy treatment - ANSWER Clofazimine Lapsone Rifampin 2 brain centers associated with memory formation - ANSWER medial temporal lobe and basal forebrain