PMHNP Certification Exam 1052 Questions with Verified Answers,100% CORRECT

PMHNP Certification Exam 1052 Questions with Verified Answers Taras off Principle - CORRECT ANSWER 1976 - duty to warn victims of potential harm from client Deontological Theory - CORRECT ANSWER Ethical theory that states an action is judged as good or bad based on the act itself regardless of the consequences Teleological Theory - CORRECT ANSWER Ethical theory that states an action is judged as good or bad based on the consequence or outcome Virtue ethics - CORRECT ANSWER ethical theory that states actions are chosen based on the moral virtues (eg. honesty, courage, compassion, wisdom, gratitude, self-respect) or the character of the person making the decision Erikson's developmental stage infancy age range - CORRECT ANSWER birth-1 year Erikson's developmental stage infancy developmental tasks - CORRECT ANSWER trust vs. mistrust Erikson's developmental stage infancy indications of developmental mastery - CORRECT ANSWER Ability to form meaningful relationships, hope about the future trust in others Erikson's developmental stage infancy indication of developmental failure - CORRECT ANSWER poor relationships, lack of future hope, suspicious of others Erikson's developmental stage early childhood age - CORRECT ANSWER 1-3 yo Erikson's developmental stage early childhood developmental task - CORRECT ANSWER autonomy vs. shame and doubt Erikson's developmental stage early childhood indications of developmental mastery - CORRECT ANSWER self-control, self-esteem, willpower Erikson's developmental stage early childhood indications of developmental failure - CORRECT ANSWER poor self-control, low self esteem, self-doubt, lack of independence Erikson's developmental stage late childhood age - CORRECT ANSWER 3-6yo Erikson's developmental stage late childhood developmental task - CORRECT ANSWER initiative vs guilt Erikson's developmental stage late childhood indications of developmental mastery - CORRECT ANSWER self-directed behavior, goal formation, sense of purpose Erikson's developmental stage late childhood indications of developmental failure - CORRECT ANSWER lack of self-initiated behavior, lack of goal orientation Erikson's developmental stage school-age ages - CORRECT ANSWER 6-12yo Erikson's developmental stage school-age developmental task - CORRECT ANSWER industry vs. inferiority Erikson's developmental stage school-age indications of developmental mastery - CORRECT ANSWER ability to work; sense of competency and achievement Erikson's developmental stage school-age indications of developmental failure - CORRECT ANSWER sense of inferiority, difficulty with working, learning Erikson's developmental stage adolescence ages - CORRECT ANSWER 12-20yo Erikson's developmental stage adolescence developmental task - CORRECT ANSWER identity vs role confusion Erikson's developmental stage adolescence indications of developmental mastery - CORRECT ANSWER personal sense of identity Erikson's developmental stage adolescence indications of developmental failure - CORRECT ANSWER identity confusion, poor self-identification in group settings Erikson's developmental stage early adulthood ages - CORRECT ANSWER 20-35 years Erikson's developmental stage early adulthood developmental task - CORRECT ANSWER intimacy vs isolation Erikson's developmental stage early adulthood indications of developmental mastery - CORRECT ANSWER committed relationships, capacity to love Erikson's developmental stage early adulthood indications of developmental failure - CORRECT ANSWER emotional isolation, egocentrism Erikson's developmental stage middle adulthood ages - CORRECT ANSWER 35-65 yo Erikson's developmental stage middle adulthood developmental task - CORRECT ANSWER generativity vs. self-absorption or stagnation Erikson's developmental stage middle adulthood indications of developmental mastery - CORRECT ANSWER ability to give time and talents to others, ability to care for others Erikson's developmental stage middle adulthood indications of developmental failure - CORRECT ANSWER self-absorption, inability to row and change as a person, inability to care for others Erikson's developmental stage late adulthood age - CORRECT ANSWER >65yo Erikson's developmental stage late adulthood developmental task - CORRECT ANSWER integrity vs despair Erikson's developmental stage late adulthood indications of developmental mastery - CORRECT ANSWER fulfilment and comfort with life, willingness to face death, insight and balanced perspective on life's events Erikson's developmental stage late adulthood indications of developmental failure - CORRECT ANSWER bitterness, sense of dissatisfaction with life, despair over impending death Psychodynamic (Psychoanalytic) Theory - CORRECT ANSWER -Sigmund Freud -all bx is purposeful and meaningful -principle of psychic determinism -most mental activity is unconscious -conscious behaviors and choices are affected by unconscious mental content -childhood experiences shape adult personality -instincts, urges, or fantasies function as drives that motivate thoughts, feelings, and bx -Id, Ego, Superego -conflict is experienced consciously as anxiety Principle of psychic determinism - CORRECT ANSWER Even apparently meaningless, random, or accidental behavior is actually motivated by underlying unconscious mental content Intellectual disability typical age onset - CORRECT ANSWER infancy- usually evident at birth ADHD typical age onset - CORRECT ANSWER early childhood (per DSM by age 12) Schizophrenia typical age onset - CORRECT ANSWER 18-25 for men 25-35 for women Major Depression typical age onset - CORRECT ANSWER late adolescence to young adulthood dementia typical age onset - CORRECT ANSWER most common after age 85 Freud's Id - CORRECT ANSWER -contains primary drives or instincts -drives are largely unconscious -operates on the pleasure principle -"I want" pleasure principle - CORRECT ANSWER the id seeks immediate satisfaction freud's ego - CORRECT ANSWER -rational mind, logical and abstract thinking -"I think, I evaluate" Freud's superego - CORRECT ANSWER -sense of conscience or right vs wrong -develops around age 6 -"I should or ought" Freud's psychosexual stage of development oral stage age - CORRECT ANSWER 0-18 months Freud's psychosexual stage of development oral stage primary means of discharging drives and achieving gratification - CORRECT ANSWER sucking, chewing, feeding, crying Freud's psychosexual stage of development oral stage psych disorder linked to failure of stage - CORRECT ANSWER schizophrenia, substance abuse, paranoia Freud's psychosexual stage of development anal stage age - CORRECT ANSWER 18 months-3 years Freud's psychosexual stage of development anal stage primary means of discharging drives and achieving gratification - CORRECT ANSWER sphincter control, activities of expulsion and retention Freud's psychosexual stage of development anal stage psych disorder linked to failure of stage - CORRECT ANSWER depressive disorder Freud's psychosexual stage of development phallic stage age - CORRECT ANSWER 3-6 years Freud's psychosexual stage of development phallic stage primary means of discharging drives and achieving gratification - CORRECT ANSWER exhibitionism, masturbation with focus on Oedipal conflict, castration anxiety, and female fear of lost maternal love Freud's psychosexual stage of development phallic stage psychiatric disorder linked to failure of stage - CORRECT ANSWER sexual identity disorders Freud's psychosexual stage of development latency stage age - CORRECT ANSWER 6years-puberty Freud's psychosexual stage of development latency stage primary means of discharging drives and achieving gratification - CORRECT ANSWER peer relationships, learning, motor-skills development, socialization Freud's psychosexual stage of development latency stage psych disorder linked to failure of stage - CORRECT ANSWER inability to form social relationships Freud's psychosexual stage of development genital stage age - CORRECT ANSWER puberty forward Freud's psychosexual stage of development genital stage primary means of discharging drives and achieving gratification - CORRECT ANSWER integration and synthesis of behaviors from early stages, primary genital-based sexuality Freud's psychosexual stage of development genital stage psych disorder linked to failure of sage - CORRECT ANSWER sexual perversion disorders Cognitive Theory - CORRECT ANSWER -Piaget - four stages of development Piaget developmental stage sensorimotor age - CORRECT ANSWER birth-2 years Piaget developmental stage sensorimotor - CORRECT ANSWER the critical achievement of this stage is object permanence Piaget developmental stage preoperational age - CORRECT ANSWER 2-7 years Piaget developmental stage preoperational - CORRECT ANSWER more extensive use of language and symbolism magical thinking Piaget developmental stage concrete operations age - CORRECT ANSWER 7-12 years Piaget developmental stage concrete operations - CORRECT ANSWER child begins to use logic develops concepts of reversibility and conservation Piaget developmental stage formal operations age - CORRECT ANSWER 12 years-adult Piaget developmental stage formal operations - CORRECT ANSWER ability to think abstractly thinking operates in a formal, logical manner interpersonal theory - CORRECT ANSWER -Harry Stack Sullivan -self-system -when the person's need for satisfaction and security is interfered with by the self system, mental illness occurs -humans experience anxiety and bx is directed toward relieving the anxiety, which then results in interpersonal security self system - CORRECT ANSWER interpersonal theory total components of personality traits two drives for behavior in interpersonal theory - CORRECT ANSWER -the drive for satisfaction -the drive for security Freud's defense mechanisms - CORRECT ANSWER -denial -projection -regression -repression -reaction formation -rationalization -undoing -intellectualization -suppression -sublimation -altruism Hierarchy of needs - CORRECT ANSWER -Maslow -survival -safety and security needs -love and belonging -self-esteem -self-actualizaiton Sullivan's stage of interpersonal development infancy age - CORRECT ANSWER birth-18 months Sullivan's stage of interpersonal development infancy developmental task - CORRECT ANSWER oral gratification, anxiety occurs for the first time Sullivan's stage of interpersonal development childhood age - CORRECT ANSWER 18 months- 6 years Sullivan's stage of interpersonal development childhood developmental task - CORRECT ANSWER delayed gratification Sullivan's stage of interpersonal development juvenile age - CORRECT ANSWER 6-9 years Sullivan's stage of interpersonal development juvenile developmental task - CORRECT ANSWER forming peer relationships Sullivan's stage of interpersonal development preadolescence age - CORRECT ANSWER 9-12 years Sullivan's stage of interpersonal development preadolescence developmental task - CORRECT ANSWER same-sex relationships Sullivan's stage of interpersonal development early adolescence age - CORRECT ANSWER 12-14 years Sullivan's stage of interpersonal development early adolescence developmental task - CORRECT ANSWER opposite- sex relationships Sullivan's stage of interpersonal development late adolescence age - CORRECT ANSWER 14-21 years Sullivan's stage of interpersonal development late adolescence developmental taks - CORRECT ANSWER self-identity developed Health Belief Model - CORRECT ANSWER Marshall Becker explains that healthy people do not always take advantage of screening or preventative programs because of certain variables: -perception of susceptibility -seriousness of illness -perceived benefits of tx -perceived barriers to change -expectations of efficacy transtheoretical model of change - CORRECT ANSWER states that change such as in health bx occurs in 6 predictable stages -precontemplation -contemplation -preparation -action -maintenance motivational interviewing - CORRECT ANSWER miller and rollnick -focused, goal-directive therapy -motivation is elicited from the client -nonconfrontational, nonadversarial self-efficacy and social learning theory - CORRECT ANSWER -albert bandura -behavior is the result of cognitive and environmental factors theory of cultural care - CORRECT ANSWER -madeline Leininger -regardless of the culture, care is the unifying focus and the essence of nursing theory of self-care - CORRECT ANSWER Dorothy orem -self care therapeutic nurse-client relationship theory or interpersonal theory - CORRECT ANSWER Hildegard Peplau -first significant psych nursing theory -sees nursing as an interpersonal process in which all interventions occur within the context of the nurse-client relationship phases of the nurse-client relationship - CORRECT ANSWER -orientation -working phase (identification, exploration) -termination phase (resolution) caring theory - CORRECT ANSWER jean Watson caring is an essential component of nursing t test - CORRECT ANSWER assesses whether the means of two groups are statistically different from each other analysis of variance (ANOVA) - CORRECT ANSWER tests the difference among three or more groups pearson's r correlation - CORRECT ANSWER tests the relationship between two variables probability - CORRECT ANSWER likelihood of an event occurring lies between 0 and 1 an impossible event has probability of 0 a certain event has a probability of 1 P value - CORRECT ANSWER aka level of significance describes the probability of a particular result occurring by change alone if P=0.1, there is a 1% probability of obtaining a result by chance alone Donabedian model - CORRECT ANSWER structure, process, outcome process of quality improvement PDSA cycle - CORRECT ANSWER Plan Do Study Act monoamines - CORRECT ANSWER -biogenic amines -dopamine -norepinephrine -epinephrine -serotonin dopamine - CORRECT ANSWER -catecholamine -produced in the substantia nigra and ventral tegmental area -precursor is tyrosine -removed from synaptic cleft by monoamine oxidase (MAO) enzyme action -D1-like and D2-like receptors four dopaminergic pathways - CORRECT ANSWER -mesocortical -mesolimbic -nigrostriatal -tuberoinfundibular norepinephrine - CORRECT ANSWER -catecholamine -produced in the locus ceruleus of the pons -precursor is tyrosine -major neurotransmitter implicated in mood, anxiety, and concentration disorders -Alpha 1 and 2 receptors epinephrine - CORRECT ANSWER -catecholamine -produced by the adrenal glands -referred to as the adrenergic system serotonin - CORRECT ANSWER -known as an indole -produced in the raphe nuclei of the brainstem -precursor is tryptophan -major neurotransmitter implicated in mood and anxiety disorders -5HT1a, 5HT1d, 5HT2, 5HT2a, 5HT3, 5HT4 receptors amino acids - CORRECT ANSWER glutamate, aspartate, gamma-aminobutyric acid (GABA), glycine glutamate - CORRECT ANSWER -universal excitatory neurotransmitter -major neurotransmitter involved in process of kindling (implicated in sz dx and bipolar dx) -imbalance implicated in mood dx and schizophrenia -AMPA and MNDA receptors aspartate - CORRECT ANSWER another excitatory neurotransmitter -works with glutamate GABA - CORRECT ANSWER universal inhibitory neurotransmitter -site of action of benzos, alcohol, barbiturates, and other CNS depressants -GABAa and GABAb receptors glycine - CORRECT ANSWER -another inhibitory neurotransmitter -works with GABA cholinergics - CORRECT ANSWER acetylcholine acetylcholine - CORRECT ANSWER synthesized by the basal nucleus of Meynert -precursors are acetylcoenzyme A and choline -nicotinic and muscarinic receptors neuropeptides - CORRECT ANSWER -nonopioid type (substance P, somatostatin) -opioid type (endorphins, enkephalines, dynorphins) -modulate pain -Decreased amount of neuropeptides is thought to cause substance abuse - opioid type receptors: mu, kappa, epsilon, delta, sigma dopamine general function - CORRECT ANSWER thinking decision making reward-seeking behavior fine muscle action integrated cognition dopamine symptoms of deficit - CORRECT ANSWER mild: pour impulse control, poor spatiality, lack of abstractive thought -severe: Parkinson's disease, endocrine alterations, movement disorders -substance abuse, anhedonia Dopamine symptoms of excess - CORRECT ANSWER -mild: improved creativity, improved ability for abstract thinking, improved executive functioning, improved spatiality -severe: disorganized thinking, loose association, tics, stereotypic bx -schizophrenia, psychosis norepinephrine general function - CORRECT ANSWER alertness focused attention orientation primes fight or flight learning memory norepinephrine symptoms of deficit - CORRECT ANSWER -dullness, low energy, depressive affect -depression norepinephrine symptoms of excess - CORRECT ANSWER -anxiety, hyper alertness, increase startle, paranoia, decreased appetite -anxiety serotonin general function - CORRECT ANSWER regulation of sleep pain perception mood states temperature regulation of aggression libido precursor for melatonin serotonin symptoms of deficit - CORRECT ANSWER irritability, hostility, depression, sleep dysregulation, loss of appetite, loss of libido OCD, anxiety disorders, schizophrenia serotonin symptoms of excess - CORRECT ANSWER sedation, increased aggression, hallucinations (rare) acetylcholine general function - CORRECT ANSWER attention, memory, thirst, mood regulation, REM sleep, sexual behavior, muscle tone acetylcholine symptoms of deficit - CORRECT ANSWER lack of inhibition, decreased memory, euphoria, antisocial action, speech decrease, dry mouth, blurred vision, constipation alzheimers dx acetylcholine symptoms of excess - CORRECT ANSWER overinhibition, anxiety, depression, somatic complaints, self-consciousness, drooling, EPS parkinsonian symptoms GABA general function - CORRECT ANSWER reduces arousal, reduces aggression, reduces anxiety, reduces excitation GABA symptoms of deficit - CORRECT ANSWER irritability, hostility, tension and worry, anxiety, seizure activity anxiety disorders GABA symptoms of excess - CORRECT ANSWER reduced cellular excitability sedation impaired memory glutamate general function - CORRECT ANSWER memory, sustained automatic functions glutamate symptoms of deficit - CORRECT ANSWER poor memory, low energy, distractible learning difficulty, negative symptoms of schizophrenia glutamate symptoms of excess - CORRECT ANSWER kindling, seizures, anxiety or panic bipolar affective disorder, psychosis from ischemic neurotoxicity or excessive pruning peptides opioid type general function - CORRECT ANSWER modulate emotions, reward center function, consolidation of memory, modulate reactions to stress peptides opioid type symptoms of deficit - CORRECT ANSWER hypersensitivity to pain and stress decreased pleasure sensation dysphoria substance abuse peptides opioid type symptoms of excess - CORRECT ANSWER insensitivity to pain catatonic-like movement disturbance auditory hallucinations decreased memory structural imaging - CORRECT ANSWER provides evidence of size and shape of anatomical structure -computed tomography CT -Magnetic resonance imaging MRI computed tomography CT - CORRECT ANSWER provides a three-dimensional view of the brain structures -differentiates structures based on density provides suggestive evidence of brain-based problems but not specific testing for psychiatric disorders -advantage: widely available, relatively inexpensive -disadvantage: lack of sensitivity, cannot differentiate white matter from gray mater; cannot view structures close to the bone tissue; underestimation of brain atrophy, inability to image sagittal and coronal views magnetic resonance imaging (MRI) - CORRECT ANSWER provides a series of 2D images that represent the brain -advantages: can view brain structures close to the skull and can separate white matter from gray matter; readily available; resolution of brain tissue superior to CT scanning -disadvantages: expensive, many contras to use, claustrophobia Functional imaging - CORRECT ANSWER measures function of areas of the brain and bases the resulting assessment on blood flow -may use radioactive pharmaceuticals to cross blood-brain barrier -mainly used for research -EEG and evoked potentials testing -magnetoencephalography MEG -single photon emission computed tomography SPECT -positron emission tomography PET EEG and evoked potentials testing - CORRECT ANSWER least expensive test convey info on electrical functioning of CNS Magnetoencephalography MEG - CORRECT ANSWER similar to EEG detects different electrical activities used in complementary fashion with EEG testing single photon emission computed tomography (SPECT) - CORRECT ANSWER information of cerebral blood flow limited available expensive positron emission tomography PET - CORRECT ANSWER images of brain when positron-emitting radionuclei interact with an electron expensive combined structural and functional testing - CORRECT ANSWER examine structure in conjunction with function mainly for research functional MRI fMRI 3D, event realted functional MRI 3fEMRI Fluorine magnetic spectroscopy Dopamine D2 receptor binding genetic testing FDA required in people of Asian descent - CORRECT ANSWER presence of HLA-B*1502 allel inherited variant of HLA-B gene prior to prescribing carbamazepine d/t risk of steven Johnson syndrome and toxic epidermal necrolysis TEN normal BMI - CORRECT ANSWER 20-25 overweight BMI - CORRECT ANSWER 26-29 obese BMI - CORRECT ANSWER 30-35 what to watch for if on psychtropics such as carbamazepine (Tegretol) or clozapine - CORRECT ANSWER elevated temp agranulocytosis steven Johnson syndrome med risk - CORRECT ANSWER carbamazepine or lamotrigine blurry vision side effect in psychotropics - CORRECT ANSWER anticholinergic side effect Seroquel may cause cataracts what can both lithium and anorexia nervosa cause - CORRECT ANSWER peripheral edema Free thyroxine T4 normal levels - CORRECT ANSWER 0.8-2.8ng/dL interfering factors of Free T4 - CORRECT ANSWER values can be increased during tx with heparin, aspirin, and propranolol values can be decreased during tx with furosemide (Lasix) or Methadone TSH values can be increased during therapy with what - CORRECT ANSWER lithium systemic effects of hypothyroidism - CORRECT ANSWER decreased T4 and increased TSH mimics symptoms of unipolar mood dx systemic effects of hyperthyroidism - CORRECT ANSWER increased T4 and decreased TSH may mimic symptoms of bipolar affective disorders interfering factors of calcium levels - CORRECT ANSWER values can be increased by excessive ingestion of milk or during tx with lithium, thiazide diuretics, alkaline antacids, or vitamin D -values can be decreased during tx with anticonvulsants, aspirin, calcitonin, corticosteroids, heparin, laxatives, diuretics, albuterol, and oral contraceptives magnesium is a cause of neuromuscular what - CORRECT ANSWER excitability interfering factors of magnesium levels - CORRECT ANSWER values can be increased by drugs such as antacids, laxatives containing mg, salicylates, and lithium interfering factors of ALT levels - CORRECT ANSWER values can be increased with Tylenol, allopurinol, aspirin, ampicillin, carbamazepine, cephalosporins, codeine, digitalis, indomethacin, heparin, isoniazid, methotrexate, methyldopa, oral contraceptives, phenothiazines, propranolol, tetracycline, and verapamil GGT is used to evaluate and monitor clients with what - CORRECT ANSWER known or suspected alcohol abuse levels rise even after ingestion of small amounts of alcohol primary preventions - CORRECT ANSWER aimed at decreasing the incidence (number of new cases) of mental disorders helping people avoid stressors or cope with them more adaptively secondary prevention - CORRECT ANSWER aimed at decreasing the prevalence (number of existing cases) of mental disorders early case finding screening prompt and effective tx tertiary prevention - CORRECT ANSWER aimed at decreasing the disability and severity of mental disorder rehabilitative services avoidance or postponement of complications drug steady state - CORRECT ANSWER drugs usually are administered once every half-life to achieve this it takes approx. 5 half lives to achieve a steady state and 5 half lives to completely eliminate a drug enzyme inducers can - CORRECT ANSWER decrease the serum level of other drugs that are substrates of that enzyme possibly causing subtherapeutic drug levels CP450 inhibitors - CORRECT ANSWER bupropion clomipramine cimetidine clarithromycin fluoroquinolones grapefruit ketoconazole nefazodone SSRIs CP450 inducers - CORRECT ANSWER carbamazepine hypericum/ st johns wort phenytoin phenobarbital tobacco enzyme inhibitors can - CORRECT ANSWER increase the serum level of other drugs that are substrates of that enzyme possibly causing toxic levels agonist effect - CORRECT ANSWER Drug binds to receptors and activates a biological response inverse agonist effect - CORRECT ANSWER Drug causes the opposite effect of agonist; binds to same receptor partial agonist effect - CORRECT ANSWER drug does not fully activate the receptors antagonist effect - CORRECT ANSWER Drug binds to the receptor but does not activate a biological response schedule 1 drugs - CORRECT ANSWER nonmedicinal substances high abuse potential used for research only not available by prescription heroin and marijuana typical antipsychotics - CORRECT ANSWER haloperidol (Haldol), haloperidol deconate (Haldol deconate) loxapine (loxitane) thioridazine (mallaril) thiothixene (navane) fluphenazine (prolixin), fluphenazine deconate (prolixin doconate) mesoridazine (serentil) trifluoperazine (stelazine) chlorpromazine (thorazine) perphenazine (trilafon) second generation antipsychotics - CORRECT ANSWER clozapine (Clozaril) ziprasidone (Geodon) risperidone (Risperdal) quetiapine (Seroquel) olanzapine (Zyprexa) aripiprazole (abilify) paliperidone (Invega) iloperidone (fanapt) asenapine (saphris) lurasidone (luatuda) mood stabilizers - CORRECT ANSWER valproic acid (depakene) divalproex sodium (Depakote) lithium carbonate (eskalith, lithobid, lithonate, lithotabs) lamotrigine (lamictal) carbamazepine (tegretol) carbamazepine ER (equetro) oxcarbazepine (Trileptal; off label) Tricyclics - CORRECT ANSWER clomipramine (anafranil) amoxapine (asendin) amitriptyline (Elavil) desipramine (norpramin) nortripyline (pamelor) doxepin (sinequan) trimipramine (surmontil) imipramine e(tofranil) protriptyline (vivactil) Serotonin selective reuptake inhibitors SSRIs - CORRECT ANSWER citalopram (celexa) fluvoxamine (Luvox) paroxetine (paxil) paroxetine mesylate (pexeva) fluoxetine Prozac) sertraline (Zoloft) escitalopram (Lexapro) Monoamine oxidase inhibitors MAOIs - CORRECT ANSWER phenelzine (nardil) tranylcyprmie sulfate (parnate) selegiline transdermal (EMSAM) SNRIs and other agents - CORRECT ANSWER trazodone (Desyrel) venlafaxine (Effexor) desvenlafaxine (Pristiq) mirtazapine (Remeron) nefazodone (serzone) bupropion (Wellbutrin, Forfivo, Aplenzin) duloxetine (Cymbalta) vilazodone (viibryd) vortioxetine (brintellix) levomilnacipran (Fetzima) Benzodiazepines BNZs - CORRECT ANSWER lorazepam (Ativan) clonazepam (klonopin) chlordiazepoxide (Librium) oxazepam (serax) clorazepate (tranxene) alprazolam (xanex) anxiolytics - CORRECT ANSWER buspirone (buspar) other agents to tx anxiety dx - CORRECT ANSWER propranolol (Inderal) atenolol (Tenormin) stimulants - CORRECT ANSWER amphetamine/destroamphetamine (Adderall) dexmethylphenidate (focalin) dextroamphetamine (Dexedrine) methylphenidate (Ritalin) lisdexamfetamine dimesylate (Vyvanse) other ADHD and ADD agents - CORRECT ANSWER guanfacine (intuniv) clonidine (kapvay) atomoxetine (Strattera) antidepressants such as desipramine (norpramin), venlafaxine (Effexor), and bupropion (Wellbutrin) are also used schedule II drugs - CORRECT ANSWER medicinal drugs in current use high potential for abuse and dependency written script only no telephone orders no refills on script morphine sulfate, codeine, fentanyl, methadone, hydromorphone (dilaudid), oxycodone (oxycontin, Percocet), hydrocodone (Vicodin etc), amphetamine salts, methylphenidate schedule III drugs - CORRECT ANSWER medicinal drugs with less abuse than II telephone orders if followed by written script prescription must renew Q6months refills limited to 5 appetite suppressants, butalbital, testosterone, buprenorphine/naloxone schedule IV drugs - CORRECT ANSWER medicinal drugs with less abuse than III dextropropoxyphene (Darvon), pentazocine (talwin), benzos, modafinil (Provigil), phenobarbital, zolpidem (ambien), eszopiclone (Lunesta), temazepam (Restoril), armodafinil (nuvigil) schedule V drugs - CORRECT ANSWER lowest abuse potential handled similar to noncontrolled drugs buprenorphine (buprenex), cheratussin (robitussin) with codeine, promethazine (Phenergan) with codeine, diphenoxylate/atropine (Lomotil) pregnancy category A - CORRECT ANSWER Controlled studies show no risk pregnancy category B - CORRECT ANSWER no evidence of risk to humans pregnancy category C - CORRECT ANSWER risk cannot be ruled out pregnancy category D - CORRECT ANSWER Positive evidence of isk Pregnancy category X - CORRECT ANSWER absolutely contraindicated teratogenic risks of benzos - CORRECT ANSWER floppy baby syndrome cleft palate teratogenic risks of carbamazepine (tegretol) - CORRECT ANSWER neural tube defects teratogenic risks of lithium (Eskalith) - CORRECT ANSWER Epstein anomaly teratogenic risks of divalproex sodium (Depakote) - CORRECT ANSWER neural tube defects specifically spina bifida atrial septal defect cleft palate possible long term developmental deficits med that can induce depression - CORRECT ANSWER beta blockers steroids interferon isotretinoin (Accutane) some retroviral drugs antineoplastic drugs benzos progesterone meds that can induce mania - CORRECT ANSWER steroids disulfiram (Antabuse) isoniazid (INH) antidepressants in persons with BP meds that can cause false positives for amphetamines - CORRECT ANSWER stimulants Wellbutrin Prozac trazodone ranitidine nefazodone (serzone) nasal decongestants pseudoephedrine meds that can cause false positives for alcohol - CORRECT ANSWER valium meds that can cause false positives for benzos - CORRECT ANSWER zoloft meds that can cause false positives for cocaine - CORRECT ANSWER amoxicillin most antibiotics NSAIDS meds that can cause false positives for heroin or morphine - CORRECT ANSWER quinolones rifampin codeine poppy seeds meds that can cause false positives for methadone or PCP - CORRECT ANSWER OTC cough meds (Nyquil) dextromethorphan psychoanalytic therapy - CORRECT ANSWER Freud promotes change by development of greater insight and awareness of maladaptive defenses Cognitive therapy - CORRECT ANSWER Aaron Beck goal is to change clients irrational beliefs, faulty conceptions, and negative cognitive distortions behavioral therapy - CORRECT ANSWER Arnold Lazarus focus on changing maladaptive bx by participating in active bx techniques such as exposure, relaxation, problem solving, and role playing Dialectical behavior therapy - CORRECT ANSWER Marsha Linehan focuses on emotional regulation, tolerance for distress, self management skills, interpersonal effectiveness, mindfulness, with an emphasis on treating therapy-interfering bx goals of DBT - CORRECT ANSWER decrease suicidal bx decreased therapy interfering bx decrease emotional reactivity decrease self invalidation decrease crisis-generating bx decrease passivity increase realistic decision making increase accurate communication of emotions and competencies existential therpay - CORRECT ANSWER viktor frankl goal to live authentically and to focus on the present and on personal responsibility humanistic therpay - CORRECT ANSWER carl rogers person-centered therapy self directed growth and self actualization people are born with capacity to direct themselves toward self actualization interpersonal therapy - CORRECT ANSWER Gerald klerman and myrna Weissman evidence based therapy focus on interpersonal issues creating distress time limited, active, focus on the present and on interpersonal distress eye movement desensitization and reprocessing EMDR - CORRECT ANSWER Francine shapiro behavioral and exposure therapy PTSD goal to achieve adaptive resolution 3 phases of EMDR - CORRECT ANSWER desensitization phase installation phase body scan group phases - CORRECT ANSWER pregroup phase forming phase storming phase norming phase performing phase adjourning phase family systems therapy - CORRECT ANSWER Murray Brown focus on chronic anxiety within families tx goal to increase familys awareness of each members function within the family and to incrase levels of self determination structural family therapy - CORRECT ANSWER Salvador minuchin main tx goal to produce structural change in the family organization to more effectively manage problems changing transactional patterns and family structure experiential therapy - CORRECT ANSWER virginia satir focus on being authentic, freedom of choice, human validation, and experiencing the moment tx goals to develop authentic, nurturing communication and increased self worth of each family member overall goal is growth rather than symptom reduction alone does not focus on particular techniques strategic therapy - CORRECT ANSWER jay haley tx goal to help family embers behave in ways that will not perpetuate the problem bx interventions are problem focused solution focused therapy - CORRECT ANSWER steve deshaer bill ohanlon and insoo berg focus to rework for the present situations that have worked previously tx goal is effective resolution of problems through cognitive problem solving and use of personal resources and strengths omega 3 fatty acid supplements - CORRECT ANSWER used for ADHD, dyslexia, cognitive impairment, dementia, CVD, asthma, lupus, and rheumatoid arthritis interacts with warfarin Sam-e supplement - CORRECT ANSWER used for depression, osteoarthritis, and liver dx may cause hypomania, hyperactive muscle movements, and possible serotonin syndrome tryptophan supplement - CORRECT ANSWER used for depression, obesity, insomnia, headaches, and fibromyalgia increased risk of serotonin syndrome with use of SSRIs, MAOIs, and st johns wort vitamin E supplement - CORRECT ANSWER used in enhancing immune system and protecting cells from effects of free radicals used for neurological dx, diabetes, and PMS interacts with warfarin, antiplatelet drugs, and statins increasing risk of rhabdomyolysis melatonin supplement - CORRECT ANSWER used for insomnia, jet lag, shift work, and cancer interacts with aspirin, NSAIDS, beta blockers, corticosteroids, valerian, kava kava, and alcohol can inhibit ovulation in large doses fish oil supplement - CORRECT ANSWER used for bipolar disorder, hypertension, lowering triglycerides, and decreasing blood clotting interacts with warfarin, aspirin, NSAIDs, garlic, and ginkgo may alter glucose regulation black cohosh herbal uses - CORRECT ANSWER menopausal symptoms PMS dysmenorrhea belladonna herbal use - CORRECT ANSWER anxiety catnip herbal use - CORRECT ANSWER sedation chamomile herbal use - CORRECT ANSWER sedation anxiety ginkgo herbal use - CORRECT ANSWER delirium, dementia, sexual dysfunction caused by SSRIs Ginseng herbal use - CORRECT ANSWER depression fatigue valerian herbal use - CORRECT ANSWER sedation MDD object loss theory - CORRECT ANSWER -early psychological developmental issues lay the foundation for depressive responses later in life -the accomplishment of the first stage of development in which the child is able to form relationships is normal -during the second stage of development, the child experiences traumatic separation from significant objects of attachment (usually a maternal object) MDD aggression turned inward theory - CORRECT ANSWER -Freud -assumes that early psychological developmental issues lay he foundation for depressive responses later in life -the accomplishment of the first stage of development in which the child is able to form relationships is normal -during the second stage of development, the child experiences the loss of the significant mothering person MDD cognitive theory - CORRECT ANSWER -Beck -represents cognitive diathesis- stress model in which developmental experiences sensitize a person to response to stressful life events in a depressed manner -assumes that people with a tendency to be depressed think about the world differently than nondepressed people and that depressed people are more negative and believe that bad tings are going to happen to them because of their own personal shortcomings and inadequacies MDD learned helplessness-hoplessness theory - CORRECT ANSWER Seligman -modified aspect of cognitive theory -a person becomes depressed due to perceptions of lack of control over life events and experiences -these perceptions are learned over time, especially as the person perceives others seeing him or her as inadequate MDD genetic predisposition theory - CORRECT ANSWER having a depressed parent is the single strongest predictor of depression MDD endocrine dysfunction theory - CORRECT ANSWER HPA axis result of abnormal stress response related to HPA dysregulation MDD abnormalities of neurotransmitter function theory - CORRECT ANSWER dysregulation of dopamine, serotonin, and norepinephrine MDD structural brain changes - CORRECT ANSWER hypovolemic hippocampus hypovolemic prefrontal cortex-limbic striatal regions MDD chronobiological theory - CORRECT ANSWER desynchronization of circadian rhythms produces the symptoms constellation collectively called MDD DSM MDD diagnostic criteria - CORRECT ANSWER -anhedonia or depressed mood or both -depressed mood most of the day, nearly every day, as indicated by subjective reports or observations of others (irritability in kids) -marked anhedonia in all or almost all ADLs -at least 3 or more significant symptoms present during the same 2 week period that represent a change in previous functioning -weight loss/gain of more than 5% of body weight -hypersomnia or insomnia nearly every day -psychomotor agitation or retardation -fatigue or loss of energy -self-deprecating comments or thoughts -feelings of worthlessness or excessive or inappropriate guilt nearly every day -decreased concentration and memory -symptoms that begin within 2 months of significant loss and do not persist beyond 2 months is bereavement not MDD SSRIs act on - CORRECT ANSWER increasing serotonin levels TCAs act on - CORRECT ANSWER elevating serotonin and norepinephrine levels MAOIs act on - CORRECT ANSWER elevating serotonin and norepinephrine levels SNRIs act on - CORRECT ANSWER inhibiting dual reuptake of norepinephrine and serotonin citalopram (celexa) - CORRECT ANSWER -SSRI -tablet -20-40mg/day -SE: sedation, sexual dysfunction, agitation, yawning, GI disturbances, wt gain -preg C -lact L2 -proglonged QTc interval in doses above 40mg (20mg in older adults) and in those susceptible to prolonged QTc escitalopram (Lexapro) - CORRECT ANSWER -SSRI -tablet -10-20mg/day -SE: somnolence, headache, sexual dysfunction, GI disturbances -prego C -Lact L2 fluoxetine (Prozac) - CORRECT ANSWER -SSRI -capsule, tablet, or liquid -20-80mg/day -SE: insomnia, headache, GI disturbances, sexual dysfunction -Long half-life -Prego C -Lact L2 -discontinuation syndrome unlikely fluvoxamine (Luvox) - CORRECT ANSWER -SSRI -tablet -100-300mg/day -SE: sedation, sexual dysfunction, agitation, GI disturbances -Doses above 150mg should generally be given BID -Prego C -Lact L2 Paroxetine (Paxil CR, Pexeva) - CORRECT ANSWER -SSRI -tablet or liquid -20-60mg/day -SE: headache, GI disturbances, somnolence, sexual dysfunction -Prego D -Lact L2 -Discontinuation syndrome very common Sertraline (Zoloft) - CORRECT ANSWER -SSRI -tablet -50-200mg/day -SE: sexual dysfunction, GI disturbances, somnolence, headache -Prego C -Lact L2 Vilazodone (Viibryd) - CORRECT ANSWER -Serotonin partial agonist reuptake inhibitor SPARI -tablet -20-40mg -SE: diarrhea, nausea, dry mouth, lower risk of sexual side effects -Prego C -Lact unknown, is excreted in breast milk Amitriptyline (Elavil) - CORRECT ANSWER -TCA -tablet or IM -50-300mg/day -also used for chronic pain (particularly neuropathic pain), insomnia -Prego C -Lact L2 clomipramine (Anafranil) - CORRECT ANSWER -TCA -Capsule -100-250mg/day -approved for OCD -250mg/day maximum d/t increased seizure risk -Prego C -Lact L2 Desipramine (Norpramine) - CORRECT ANSWER -TCA -tablet or capsule -100-300mg/day -also used for ADHD (off label for pediatric clients and for ADHD) -Prego C -Lact L2 Doxepin (Sinequan) - CORRECT ANSWER -TCA -Capsule or liquid -100-300mg/day -also used for insomnia -Prego C -Lact L5 AVOID imipramine (Tofranil) - CORRECT ANSWER -TCA -Tablet, capsule, or IM -100-300mg/day -also used for enuresis and separation anxiety -Prego D -Lact L2 Nortriptyline (Pamelor) - CORRECT ANSWER -TCA -capsule or liquid -50-150mg/day -also used for enuresis and ADHD -Prego D -Lact L2 Protriptyline (Vivactil) - CORRECT ANSWER -TCA -tablet -15-60mg/day -Prego C -Lact inadequate data Trimipramine (Surmontil) - CORRECT ANSWER -TCA -Capsule -100-300mg/day -Prego C -Lact inadequate data norepinephrine dopamine reuptake inhibitors NDRIs act on - CORRECT ANSWER reuptake of norepinephrine and dopamine Serotonin agonist and reuptake inhibitors SARIs act on - CORRECT ANSWER agonist of serotonin 5HT2 receptors and elevate serotonin levels Isocarboxazid (Marplan) - CORRECT ANSWER -MAOI -Tablet -20-60mg/day -also used for panic disorder, phobic disorders, selective mutism -CAUTION: high-tyramine diet; sympathomimetic agents -divided dosing BID and QID -Prego C -Lact inadequate info Phenelzine (Nardil) - CORRECT ANSWER -MAOI -Tablet -45-90mg/day -also used for panic disorder, phobic disorders, selective mutism -CAUTION: high-tyramine diet; sympathomimetic agents -divided dosing BID and QID -Prego C -Lact inadequate info Tranylcypromine (Parnate) - CORRECT ANSWER -MAOI -tablet -30-60mg/day -also used for panic disorder, phobic disorders, selective mutism -CAUTION: high-tyramine diet; sympathomimetic agents -divided dosing BID and QID -Prego C -Lact inadequate info Selegiline (EMSAM) - CORRECT ANSWER -MAOI -Transdermal patch -6-12mg -no dietary restrictions with 6mg dosage -may need higher dose to see antidepressant effect -Prego C -Lact L4 AVOID first line tx for first episode major depression with mild to mod symptoms - CORRECT ANSWER SSRIs second line drugs for treating MDD - CORRECT ANSWER TCAs TCA side effects - CORRECT ANSWER -anticholinergic -antiadrenergic -antihistaminergic -EKG changes and cardiac dyshrythmias possible -unsafe in many co-occurring disorder such as cardiac disease -significant discontinuation syndrome anticholinergic side effects - CORRECT ANSWER dry mouth blurred vision constipation memory problems from muscarinic receptor blockade antiadrenergic side effects - CORRECT ANSWER orthostatic hypothension from alpha 1 receptor blockade antihistaminergic side effects - CORRECT ANSWER sedation and weight gain from histamine receptor blockade TCA serum blood levels - CORRECT ANSWER well identified levels guide dosing particularly nortriptyline predicts toxicity combo of TCAs and MAOIs - CORRECT ANSWER lethal serotonin syndrome, hypertensive crisis, or both adhere to two week washout period (5 weeks for fluoxetine) before switching between the two classes of medications combo of TCA and SSRI - CORRECT ANSWER use caution SSRI can elevate TCA concentrations because of pharmacodynamic or pharmacokinetic interactions monitor TCA levels MAOIs - CORRECT ANSWER not first or second line d/t dangerous food/drug interactions MAOIS and tyramine - CORRECT ANSWER hypertensive crisis hypertensive crisis - CORRECT ANSWER life threatening and cannot be reversed unless more MAO is produced by the body sudden, explosive like headache, usually in occipital region elevated BP facial flushing palpitations pupillary dilation diaphoresis fever Hypertensive crisis and death occurring when MAOIs taken in conjunction with certain meds - CORRECT ANSWER meperidine decongestants TCAs atypical antipsychotics st johns wort l-tryptophan stimulants and other sympathomimetics asthma meds hypertensive crisis tx - CORRECT ANSWER d/c MAOI give phentolamine (binds with norepinephrine receptor sites, blocks norepinephrine) -stabilize fever Combo of MAOI and serotonergic agent - CORRECT ANSWER contra d/t serotonin syndrome risk Serotonin syndrome tx - CORRECT ANSWER -d/c offending agents -supportive tx of symptoms mild symptoms such as restlessness may d/c with removal of agent, close monitoring and judicious use of benzos -severe symptoms constitute a medical emergency necessitating hospitalization and tx such as cyproheptadine, anticonvulsants, and autonomic support clinically significant side effects of MAOIs include - CORRECT ANSWER insomnia hypertensive crisis weight gain anticholinergic side effects lightheadedness and dizziness sexual dysfunction Venlafaxine (Effexor, Effexor XR) - CORRECT ANSWER -SNRI -Capsule (XR), or tablet -75-375mg/day -XR 75-225mg/day -SE: diaphoresis, headache, dizziness, GI disturbances -can raise BP -QD for XR capsules -BID-TID dosing for tablets -full SNRI effect at doses at or above 150mg -safer in OD than TCAs -has significant discontinuation syndrome of stopped abruptly -Prego C -Lact L3 Duloxetine (Cymbalta) - CORRECT ANSWER -SNRI -Capsule -30-120mg/day -SE: dizziness, headache, GI disturbances -once daily dosing -can elevate BP -can elevate LFTs -has significant discontinuation syndrome if stopped abruptly -Prego C -Lact L3 Vortioxetine (Brintellix) - CORRECT ANSWER -5HT3 and 5HT7 antagonist -5HT 1A agonist -tablet 5, 10, 20mg -20mg QD -SE: nausea, diarrhea, dizziness -Prego C -Lact inadequate info Levomilnacipran (Fetzima) - CORRECT ANSWER -SNRI -tablet 20, 40, 80, 120mg -40-120mg QD -SE: N/V, constipation, sweating, palpitations, urinary hesitancy, hypertension, hypotension, decreased appetite -Prego C -Lact inadequate info Bupropion (Wellbutrin) - CORRECT ANSWER -NDRI -Tablet -150-450mg/day -SE: headache, nervousness, tremors, tachycardia, insomnia, decreased appetite -contra if client has sz dx, eating dx -SR offers BID dosing -XL offers QD dosing -can increase energy level -also used for ADHD and smoking cessation -Prego C -Lact L3 Bupropion SR/XL (Wellbutrin SR, XL) - CORRECT ANSWER -NDRI -SR 150-400mg/day -XL 150-450mg/day -caution with caffeine and in people with panic dx Mirtazapine (Remeron) - CORRECT ANSWER -alpha2/5HT2 antagonist -tablet -15-45/day -sedation, weight gain, increased cholesterol -inverse relationship between dosage and sedation -Prego C -Lactation L3 Nefazodone (Serzone) - CORRECT ANSWER -SARI -tablet -300-600mg/day -SE: headache, drowsiness, GI disturbances -must monitor LFTs -can cause liver failure -safer in OD than TCAs -QHS or BID dosing -potent P450 3A4 inhibitor -Prego C -Lact L4 AVOID Trazodone (Desyrel) - CORRECT ANSWER -SARI -Tablet -200-600mg/day -NE: sedation, nausea, headache, hypotension -safer in OD than TCAs -priapism possible -not well tolerated at antidepressant dosage d/t sedation -most commonly used as hypnotic at 50-200mg/HS -May prolong QTc interval -Prego B -Lact L2 Persistent Depressive Disorder (Dysthymia) - CORRECT ANSWER -chronically depressed mood that occurs for most of the day, more days than not, for at least 2 years -prominent presence of low self esteem, self criticism, and a perception of general incompetence compared to others -less common symptoms: alteration in appetite and sleep-rest patterns dysthymic disorder is associated with what - CORRECT ANSWER personality disorders period of symptoms required for dysthymia in kids vs adults - CORRECT ANSWER kids 1 year adults 2 years grief and bereavement develops when - CORRECT ANSWER within 3 months of stressor Greif and bereavement pharmacological management - CORRECT ANSWER if needed short term use of anti-anxiety agents such as Benzos if needed short term use of sleep-induction agents such as Benzos, nonbenzo hypnotic such as Zolpidem, TCA or other sedating antidepressants, antihistamines PMDD treatment - CORRECT ANSWER hormonal contraceptives SSRIs both Bipolar biological theories - CORRECT ANSWER -GABA deregulation -increased noradrenergic activity -voltage-gated ion channel abnormalities -abnormalities lead to abnormal balances of intracellular and extracellular levels of neurotransmitters, which then cause subsequent disruption of electric signal transmission in brain regions -kinding kindling - CORRECT ANSWER -process of neuronal membrane threshold sensitivity dysfunction -long-lasting, epileptogenic changes induced by daily subthreshold brain stimulation -brain becomes overly sensitive to electrical stimuli -neuronal misfiring occurs -process becomes automatic; neuronal firing occurs even without stimuli Bipolar diagnostic criteria - CORRECT ANSWER -period of abnormally or persistent elevated, expansive, or irritable mood lasting for at least 1 week -mood episode has rapid development and escalation of symptoms over a few days -often precipitated by significant environmental stressor -mood disturbance may result in brief psychotic symptoms -manic episodes last days to several months -briefer duration and ending more abruptly tan major depressive episodes -60% of people, a major depressive episode immediately precedes or follows a manic episode -persistent symptoms of mania -recurrent shifts on polarity -expansive or elevated mood symptoms Bipolar I - CORRECT ANSWER clinical history characterized by occurrence of 1 or more manic or mixed episodes Bipolar II - CORRECT ANSWER -Clinical hx characterized by occurrences of one or more major depressive episodes accompanied by at least 1 manic or hypomanic episode -recurrent shifts in polarity can occur more frequently-rapid cycling rapid cycling - CORRECT ANSWER -occurrence of 4 or more mood episodes during the previous 12 months -mood episodes are either major depressive or manic -other than occurring more frequently, mood episodes are same as nonrapid-cycling episodes -20% of people -most are women -identification is important -antidepressants may accelerate cycling -poorer prognosis mixed state - CORRECT ANSWER dysphoric hypomania lithium in BP - CORRECT ANSWER -gold standard for manic episodes -antisucidial effects -action unknown -rapid cycling rarely responds to monotherapy baseline labs prior to lithium initiatin - CORRECT ANSWER -Thyroid -Serum creatinine -BUN -Prego -ECG for pts over 50yo endocrine SE of lithium - CORRECT ANSWER weight gain impaired thyroid functioning CNS SE of lithium - CORRECT ANSWER fine hand tremors fatigue mental cloudiness headaches coarse hand tremors with toxicity nystagmus derm SE of lithium - CORRECT ANSWER maculopapular rash pruritus acne GI SE of lithium - CORRECT ANSWER GI upset diarrhea vomiting cramps anorexia renal SE of lithium - CORRECT ANSWER polyuria with related polydipsia diabetes insipidus edema microscopic tubular changes cardia SE of lithium - CORRECT ANSWER T-wave inversions dysrhythmias hem SE of lithium - CORRECT ANSWER leukocytosis carbamazepine in BP - CORRECT ANSWER -black box warning agranulocytosis and aplastic anemia valproic acid/divalproex sodium in BP - CORRECT ANSWER -black box warning for hepatotoxicity and pancreatitis Lamotrigine in BP - CORRECT ANSWER -black box warning for serious rash Lithium carbonate (Eskalith, Lithobid) - CORRECT ANSWER -1,200-2,400mg/day (acute) -900-1200mg/day (maintenance) -SE: common- nausea, fine hand tremors, increased urination and thirst -SE: toxicity- slurred speech, confusion, severe GI effect -establish standard treatment for BP -Prego D -Lact L3 -risk of hypothyroidism -avoid in prego, especially 1st trimester -monitoring of kidney function is essential -concurrent use of NSAIDs and angiotensin-converting enzyme inhibitors (ACEIs) may double lithium level carbamazepine (Tegretol) - CORRECT ANSWER -10-20mg/kg/day -6-12mcg/mL -SE: common- Nausea, dizziness, sedation, headache, dry mouth, constipation, skin rash -SE: rare- agranulocytosis/aplastic anemia, steven johnsons syndrome, particularly in Asians (screen for HLA-B 1502 allele before initiating) -hepatic enzyme inducer -monitor LFTs -alternative to lithium or valproic acid -Prego D -Lact L2 lithium therapeutic plasma level - CORRECT ANSWER 0.8-1.2mEq/L for Eskalith 0.6-1.2mEq/L for Lithobid carbamazepine therapeutic plasma level - CORRECT ANSWER 6-12 mcg/mL valproic acid (Depakene), divalproex sodium (Depakote) - CORRECT ANSWER -15-40mg/kg/day -SE: common- nausea, diarrhea, abdominal cramps, sedation, tremor -SE: rare- increased liver enzymes, steven Johnson's syndrome (unlike carbamazepine, divalproex does not carry screening directive for HLA-B 1502 antigen at this time) -Depakote minimizes GI effects -more effective than lithium for raid cycling and mixed Bipolar -Loading dose 20mg/kg -prego D -lact L2 Valproci acid/ divalproex sodium therapeutic plasma level - CORRECT ANSWER 50-125mcg/mL lamotrigine (Lamictal) - CORRECT ANSWER -25-600mg/day -blood monitoring not necessary -SE: common- dizziness, ataxia, somnolence, diplopia, nausea, headache, hepatotoxicity -SE: Rare- life threatening rashes including steven Johnsons syndrome (unlike carbamazepine, divalproex does not carry screening directive for HLA-B 1502 antigen at this time), leukopenia -indication for maintenance only -helps in depressive phase of Bipolar -titrate slowly -often used in combo with lithium, SGAs, and antidepressants lamictal dosing considerations - CORRECT ANSWER -titrate slowly: 25mg PO QD for 2 weeks, then 50mg PO QD for 2 weeks etc -concomitant use with divalproex may double lamotrigine level and should be factored into dosing -concomitant use with carbamazepine may increase metabolism and should be factored into dosing carbamazepine/ valproic acid/divalproex sodium lab monitoring - CORRECT ANSWER drawn 1 week after start 12 hour trough serum drug level CBC LFTs response to tx with lithium or anticonvulsant med is in - CORRECT ANSWER 1-2 weeks steven johnsons syndrome tx - CORRECT ANSWER stop offending agent supportive measures often in hospital burn unit adolescent manic episodes present differently than in adults - CORRECT ANSWER more psychotic features often associated with antisocial bx often associated with substance abuse prodromal period of significant bx problems (School truancy, failing grades) Bipolar follow up - CORRECT ANSWER initially seen weekly Bipolar rating scales - CORRECT ANSWER Young mania rating scale a daily mood chart cyclothymic disorder - CORRECT ANSWER -chronic, fluctuating mood dx with symptoms similar but less severe than BP -numerous periods of hypomanic and dysthymic symptoms -often regarded by others as temperamental, moody, unpredictable, inconsistent, and unreliable -no psychotic episodes ataques de nervios - CORRECT ANSWER -latino cultural syndrome -provoked by disruptions in family bonds -trembling, crying, screaming -in presence of others -relief after first line tx for children and teens with anxiety dx - CORRECT ANSWER psychotherapy anxiety psychodynamic theory - CORRECT ANSWER -freud -anxiety initially occurs in response to stimulation of birth and need of infant to adapt to changed environment -subsequent anxiety is from intrapsychic conflict -process of unconscious repression of sexual drive is at the core -conflict exists between instinctual needs of the id and the superego anxiety interpersonal theory - CORRECT ANSWER -henry stack Sullivan -humans are goal directed toward attainment of satisfaction and security needs that are normally met in interpersonal interactions -anxiety is when needs are unmet -interpersonal conflict anxiety neurobiological theory - CORRECT ANSWER -deficits in limbic system, midline brainstem area, sections of cortex -predispose to abnormal stress response, with hyperactivity of autonomic nervous system -problems with HPA axis -low levels of GABA neurotransmitters involved in suppressing the HPA axis - CORRECT ANSWER Serotonin GABA First line agents for chronic anxiety disorders - CORRECT ANSWER SSRIs acts on serotonin system and indirectly on GABA system Benzos - CORRECT ANSWER -potentiate effect of GABA -use is associated with Alzheimers -longer half lives are more useful for continuous, moderate to severe anxiety or as bridge meds while waiting for efficacy of SSRI (klonopin, valium) -shorter half lives require more frequent dosing and have more severe withdrawal and rebound anxiety (xanex, Ativan) TCAs in anxiety - CORRECT ANSWER effective but affect multiple receptors and have problematic side effect profiles Buspirone (Buspar) - CORRECT ANSWER -20-60mg/day -SE: dizziness, insomnia, tremors, akathisia, stomach upset, dry mouth -helpful adjunct for anxiety -not PRN Tiagabine (Gabitril) - CORRECT ANSWER -4-56mg/day -SE: dizziness, somnolence, stomach upset, tremors, dry mouth -helpful adjunct for anxiety , off label use Gabapentin (Neurontin) - CORRECT ANSWER -300-3600mg/day -SE: ataxia, decreased coordination, sedation, disequilibrium -used for anxiety, neuropathic pain, fibromyalgia, and as an anti-craving medication -off label use Propranolol (Inderal) - CORRECT ANSWER -10-20mg/day PRN -SE: bradycardia, hypotension -performance anxiety -off label use -usually adjunctive with other agent anxiety meds in children - CORRECT ANSWER -alpha agonists often used -clonidine (catapres) 0.003-0.01mg/kg/day off label -guanfacine (tenex) 0.015-0.05mg/kg/day off label standardized rating scales for anxiety disorders - CORRECT ANSWER -Zungs self rating anxiety scale -Hamilton rating scale for anxiety -yale-brown obsessive compulsive scale panic disorder diagnostic criteria - CORRECT ANSWER -discrete episode in which client experiences 4 or more symptoms having a sudden onset and peaking within 10 minutes of onset -after 1st attack, persistent concern over having another attack, worry over the consequences of initial attack, or a significant bx change related to attack -with high somatic sensations, clients are often sensitive to new somatic experiences or perceptions -often intolerant of or concerned with common side effects of medication tx for panic disorder, consider general medical disorder if - CORRECT ANSWER -first episode panic attack symptoms occur after 45yo -panic symptoms are atypical such as: vertigo, loss of consciousness, incontinence, headache, slurred speech, amnesic pattern after attacks Panic disorder pharm - CORRECT ANSWER - SSRIs -Benzos for short term symptom control or bridge med when starting antidepressant -buspar effective adjunct to antidepressant -other non-benzo anxiolytic meds as adjuncts agoraphobia diagnostic criteria - CORRECT ANSWER -presence of anxiety related to fear of developing panic-like symptoms -never met criteria for panic disorder -avoidant bx as a result of anxiety agoraphobia pharm - CORRECT ANSWER -SSRIs -benzos for short term use -beta blockers off label for discrete episodes of social anxiety specific phobias - CORRECT ANSWER phobic diagnosis should occur only when accompanied by significant functional impairment specific phobia pharm - CORRECT ANSWER SSRIs TCAs short term Benzos social anxiety disorder - CORRECT ANSWER diagnosed only if symptoms persist longer than 6 months do NOT feel better or experience decreased anxiety when accompanied by a trusted companion social anxiety disorder pharm - CORRECT ANSWER SSRIs Benzos for short term beta blockers for discrete episode relief GAD - CORRECT ANSWER -excessive worry, apprehension, anxiety about events or activities occurring more days than not for at least 6 months -symptoms worsen as life events stress the person GAD pharm - CORRECT ANSWER SSRIs Buspar Benzos PRN GAD non pharm - CORRECT ANSWER good candidates for therapy as single tx modality separation anxiety disorder occurs at what age - CORRECT ANSWER after age 4 OCD diagnostic crtieria - CORRECT ANSWER -presence of either obsessions or compulsions -person recognizing that the obsession or compulsion is excessive or unreasonable -causing marked distress, time consuming, or interferes with normal daily activity OCD pharm - CORRECT ANSWER -SSRIs (often need higher dosing ranges for adequate symptom control) -TCA (clomipramine) -SGAs (risperidone off label but have supportive data adjunctive with SSRI) OCD associated in children with what - CORRECT ANSWER group A beta-hemolytic streptococcal infections (scarlet fever, strep) PTSD acute - CORRECT ANSWER less than 3 months PTSD chronic - CORRECT ANSWER longer than 3 months PTSD delayed onset - CORRECT ANSWER at least 6 months between traumatic event and onset of symptoms PTSD diagnostic criteria - CORRECT ANSWER -1 month or longer -exposure to traumatic event -traumatic event persistently reexperienced in one or more ways -3 or more avoidance symptoms -2 or more increased arousal symptoms -causing significant distress or impairment in Activities of daily functioning -occur within 3 months of trauma -duration is highly variable (remit within 3 months in 50% cases, common waxing and waning) PTSD pharm - CORRECT ANSWER -SSRIs -TCAs -Benzos not recommended -antipsychotics useful during flashbacks -alpha agonists (prazosin) for nightmares off label dissociative disorders causes - CORRECT ANSWER -physical: seizures, migraines, psychedelic drugs, alcohol -psych: severe anxiety and traumatic stress Schizophrenia structural neurobiology - CORRECT ANSWER -enlarged ventricles -smaller frontal and temporal lobes -reduced symmetry in temporal, frontal, and occipital lobes -cortical atrophy -decreased cerebral blood flow -hippocampal and amygdala, thalamus reduction -widened cortical sulci -diffuse decrease in volume of white and gray matter schizophrenia neurochemical alterations - CORRECT ANSWER -excess dopamine in mesolimbic pathway -decreased dopamine in mesocortical pathway -excess glutamate -decreased gama-aminobytyric acid (GABA) -decreased serotonin schizophrenia demographics men - CORRECT ANSWER -onset 18-25 yo -tend to have more negative side effects -tend to have poorer prognosis, more hospitalizations, and less responsiveness to meds schizophrenia demographics in women - CORRECT ANSWER -onset 25-35 years -usually less premorbid dysfunction than men -usually experience more dysphoria than men -tend to have paranoid delusions and more hallucinations than men Schizophrenia diagnostic criteria - CORRECT ANSWER -2+ symptoms frequently present during 1 month period and at least 1 must be delusions, hallucinations, or disorganized speech -significant occupational/social impairment -duration at least 6 months what schizophrenia symptoms are most debilitating - CORRECT ANSWER negative symptoms negative schizophrenia symptoms - CORRECT ANSWER -less responsive to antipsychotics -better response to atypicals -caused by decrease dopamine in mesocortical pathway positive schizophrenia symptoms - CORRECT ANSWER -respond well to antipsychotics -excess or distortions of normal brain functioning -caused by increased dopamine in mesolimbic pathway schizophrenia presence of neurological nonlocalizing soft signs - CORRECT ANSWER -astereogonosis -twitches, tics, rapid eye blinking -dysdiadochokinesia - impaired fine motor movement -left-right confusion -mirroring schizophrenia presence of neuro