ANCC Certification PMHNP Exam with Complete Solutions

Mood Disorders - Most common psych illnesses Primary characteristic is persistent disturbance in mood - Major Depressive Disorder Often occurs without precipitating event - MDD Object loss theory - Fairbairn, Winnicott & guntrip Aggression turned inward theory of MDD - Freud Cognitive Theory - Beck Learned Helplessness-Hopelessness Theory - Seligman Genetic predisposition - Strong genetic load for depression for child of depressed parent -having 3 fold increase in lifetime risk of MDD & 40% chance of depressive episode before age 18. Endocrine dysfunction Theory - Probably related to etiology of MDD Sleep disturbances, appetite disturbances, libido disturbances, lethargy, anhedonia are neurovegitative symptoms that are related to functions of the - Hypothalamus and pituitary gland secretions Endocrine dysfunction and pregnancy - A high incidence of postpartum mood disturbances is suggested with this Hypothalamic-pituitary-adrenal axis (HPA) - A theory of MDD, may be a result of an abnormal stress response related to dysregulation of this system HPA axis - Controls the physiological response to stress and is composed of interconnective feedback pathways between the hypothalamus, pituitary gland, and adrenal gland. Hypothalamus releases - corticotropin-releasing hormone (CRH) Adrenocorticotropin hormone (ACTH) - Released by pituitary in response to CRH by hypothalamus Cortisol - Released by adrenal glands in response to ACTH by pituitary gland Hyperactivity of the HPA axis - Demonstrated to be present in individuals with MDD. May also have elevated cortisol levels Elevated cortisol levels - Over time damages the CNS by altering neurotransmission and electrical signal conduction. Cortisol over time can cause changes in size and function of brain tissue Dexamethasone suppression test (DST) - Not commonly used in clinical practice for screening of depression as it is too non specific. Hypovolemic hippocampus and hypovolemic prefrontal cortex-limbic striatal regions - Abnormalities demonstrated by neuroimaging in individuals with chronic and severe depression Brain damage, including that from stroke and trauma - Depression is a acommon comorbidity in individuals who have experienced these events What is the Chronobiological theory of MDD - Desynchronization of the circadian rhythms produces the symptom constellation collectively called MDD Circadian rhythms control these biological processes that are frequent problems with depressed individuals - Sleep-rest cycle disturbances * Increased cortisol secretions * REM abnormalities Increased emotional reactivity Frequent waking More intensified dreaming Diurnal variations to circadian-related behaviors Decreased arousal and energy levels Decreased activity patterns * Incidence of MDD - 5% of U.S. population ages 18 and older each year. About 9.9 million Americans Most common psychiatric illness seen in primary care practices; only 50% of people receive treatment - MDD 25% women, 12% men - Risk during reproductive years Risk of MDD is ________ for both genders below puberty and after menopause - equal MDD is (greater) or (lesser) source of morbidity for women than other illnesses. - Greater Fifteen percent (15%) - Of people with MDD will commit suicide