NR 547 Differential Dx Midterm Review – Questions with Correct and Verified Answers

NR 547 Differential Dx Midterm Review – Questions with Correct and Verified Answers Differential Dx - Correct Answer Diagnostic reasoning is the process of questioning one's thinking to determine if all possible avenues have been explored and if the conclusions that are drawn are based on evidence. This is a critical step for providers who are trying to uncover a cause, or diagnosis, for their clients' signs and symptoms. The provider's initial hypothesis is known as the differential diagnosis. The differential diagnosis, or differential, is a working list of potential problems that can be associated with the initial or chief complaint. Establishing a differential diagnosis is a critical step in providing safe, quality care. This evolving process of clinical reasoning and decision making involves examining the client's presentation, clinical data, and when appropriate, screening and diagnostic test results to distinguish one disease from another and arrive at the correct diagnosis. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)provides guidance for identifying psychiatric diagnosest History of Present Illness - Correct Answer How long have you been feeling this way? Did something happen in your life that may have triggered these emotions? How is this current situation impacting your life? The Psychiatric History - Correct Answer Have you ever been hospitalized for any mental health issues? Have you ever had counseling or psychotherapy? Have you ever taken medications for your mental health in the past? Are you currently on any medications for mental health or sleep? Medical History/Screening for General Medical Conditions - Correct Answer Do you have a primary care provider? Do you have any medical illnesses? Are you currently taking any medications or herbal supplements? Do you have any allergies to medications? Have you ever been hospitalized for any reason? Have you ever had surgery? Family Psychiatric History - Correct Answer Has any relative of yours ever been hospitalized for a mental health issue? Has any blood relative of yours ever been diagnosed with a mental health issue? Has any blood relative of yours had a history of seizures or dementia/Alzheimer's? Social and Developmental History - Correct Answer Tell me a little bit about your childhood and how you grew up. How was your experience in school when you were younger? Did you enjoy school? How do you support yourself with your finances? Do you have a good support system? Are you currently in a relationship? Where do you live? Who do you live with? What do you do in your free time? What activities do you enjoy? Which of the following should be included when providing client education about medication regimens? Select all that apply. - Correct Answer A)Explain how the medication targets the symptoms, specific benefits, and expected time course. (Correct answer) B)Identify potential side effects, duration of side effects, and adverse effects. (Correct answer) C)Explain the instructions, dosing, and special requirements. (Correct answer) D)Use teach-back methods to ensure client understanding. (Correct answer) Apply the Ask Suicide-Screening Questions (ASQ) Suicide Risk Screening Tool (Links to an external site.) to the scenario below. A 52-year-old client presents to the emergency department following a car accident. The emergency department (ED) physician is concerned that the client may have intentionally crashed her car and requests a stat PMHNP consult. In speaking with the PMHNP, the client describes persistent feelings of sadness and hopelessness. She states that she often wonders if her husband would be happier if she wasn't around anymore since she's never happy and sometimes thinks about what it would be like to just take a handful of sleeping pills and go to sleep forever. The client reports a previous suicide attempt when she was 16 but denies that she is considering killing herself right now. Based on the client's ASQ score, what is the most appropriate response? A) No action is necessary as the client is not - Correct Answer B)Provide a brief suicide safety assessment. Rationale: While the client's responses do not indicate a need for a stat full safety and mental health evaluation, the client requires a brief suicide safety assessment to determine whether a full mental health evaluation in necessary. It is also important to notify the client's physician or the clinician responsible for the client's care. Complete Blood Count - Correct Answer The CBC is a serum diagnostic test that measures red blood cells, white blood cells, hemoglobin, hematocrit, and platelets. The CBC includes a differential of the white blood cells. A CBC is often included as part of routine health screening or to obtain information related to specific conditions. In mental health, the CBC is used to rule out medical conditions that may present with symptoms that can be attributed to both medical and psychiatric diagnoses. For example, the CBC can help rule out anemia as a cause for depressive symptoms and fatigue or rule out infection as a cause of acute mental status changes. The CBC is also used to monitor certain treatment regimens. For example, some medications, such as clozapine, require routine analysis of absolute neutrophil count and platelet levels. Normal Range of: Red blood cells Hemoglobin Hematocrit Reticulocytes - Correct Answer Red blood cells: 4.5-6.0 million/microliter Hemoglobin: 12-18 grams/100 mL Hematocrit: 38%-48% Reticulocytes: 0%-1.5% Normal Range of? White blood cells (total): Neutrophils: Eosinophils: Basophils: Lymphocytes: Monocytes: Platelets: - Correct Answer White blood cells (total): 5000-10,000/microliter Neutrophils: 55%-70% Eosinophils: 1%-3% Basophils: 0.5%-1% Lymphocytes: 20%-35% Monocytes: 3%-8% Platelets: 150,000-300,000/microliter Comprehensive Metabolic Panel (CMP) - Correct Answer The CMP is another common blood test used to determine general health status. The CMP includes several tests that provide information about fluid and electrolyte balance as well as the status of the body's metabolism, liver function, and kidney function. In psychiatric care, the CMP may be used to rule out medical conditions that could cause symptoms such as changes in mood or cognition. The CMP is also used to monitor the effects of medications, such as antipsychotics, on liver function and glucose levels. Normal CMP Levels Electrolytes Sodium (Na+): Postassium (K+): Chloride (Cl-): Bicarbonate (HCO3-): - Correct Answer Normal CMP Levels Electrolytes Sodium (Na+): 136-145 mEq/L Postassium (K+): 3.5-5.0 mEq/L Chloride (Cl-): 95-105 mEq/L Bicarbonate (HCO3-): 22-28 mEq/L Normal CMP levels Misc. Calcium, serum (Ca 2+) Glucose, serum Fasting: 2-h postprandial: Cholesterol, serum: Total Protein Albumin - Correct Answer Calcium, serum (Ca 2+) 8.4-10.2 mg/dl Glucose, serum Fasting: 70-110 mg/dl; 2-h postprandial: <120mg/dl Cholesterol, serum: REC<200 mg/dl Total Protein 6.0-7.8 g/dl Albumin 3.5-5.5 g/dl Kidney Tests Creatinine, serum Urea nitrogen, serum (BUN) - Correct Answer Creatinine, serum 0.6-1.2mg/dl Urea nitrogen, serum (BUN) 7-18mg/dl Liver Tests Alanine aminotransferase (ALT), serum: Aspartate aminotransferase (AST), Bilirubin, serum (adult) Total//Direct: Phosphatase (alkaline), serum: - Correct Answer Liver Tests Alanine aminotransferase (ALT), serum: 8-20 U/L Aspartate aminotransferase (AST), serum: 8-20 U/L Bilirubin, serum (adult) Total//Direct: 0.1-1.0 mg/dl // 0.0-0.3 mg/dl Phosphatase (alkaline), serum: 20-70 U/L Normal TFT levels TSH: T3: T4: - Correct Answer Normal TFT levels TSH: 0.4-4.5 mIU/L T3: 100-200 ng/dL T4: 5-11 ug/dL Vitamin B12 Level - Correct Answer Providers may choose to check vitamin B12 levels. Deficiency of vitamin B12 can affect mood and other brain functions. Common psychiatric symptoms associated with B12 deficiency include depression, mania, psychotic symptoms, and cognitive impairment ( A normal vitamin B12 level is between 190-950 picograms/mL. Between 200-300/mL indicates a borderline level with a possible need for additional testing. Vitamin D Level - Correct Answer Vitamin D affects functions such as neurotransmission, neuroprotection, and neuroimmunomodulation. Studies have indicated a high prevalence of vitamin D deficiency in clients with psychiatric disorders such as schizophrenia, depression, seasonal affective disorder, and cognitive impairment (Cuomo et al., 2019). Symptoms of vitamin D deficiency include depression, irritability, anxiety, psychosis, and poor brain development. A vitamin D level can be measured via the 25-hydroxy vitamin D blood test. A normal level is between 20-50 ng/mL. A level less than 12 ng/mL indicates a deficiency. Toxicology Screen - Correct Answer When diagnosing psychiatric conditions, providers may use toxicology screenings to rule out substance use as a cause for symptoms. Toxicology screenings are also used before starting therapy involving controlled substances, to monitor medication adherence, and in the diagnosis of substance use disorder. Urinalysis (UA) - Correct Answer Urinary tract infections are associated with a variety of neuropsychiatric symptoms (Lee et al., 2019). When clients present with acute mental status changes, a urinalysis may be used to rule out a urinary tract infection as the cause. Toni is a 58-year-old who presents with fatigue. Her TSH is 6.3 mIU/L. A) Begin Treatment B) Refer - Correct Answer B) Refer Rationale: A TSH level >4.0 is indicative of hypothyroidism, which is associated with fatigue. A referral for treatment of hypothyroidism is required. Client can be reevaluated for fatigue if symptoms persist after hypothyroid treatment has been initiated, TSH levels are within normal limits. Leo is a 49-year-old who presents with fatigue. His hemoglobin is 15 g/dL and hematocrit is 42%. A) Begin Treatment B) Refer - Correct Answer A) Begin treatment. Rationale: The hemoglobin and hematocrit are within normal limits. This client's complaint of fatigue is not due to anemia. Begin treatment based on a complete evaluation. Terri is a 79-year old who presents with confusion. She has positive urine leukocyte esterase. A) Begin treatment B) Refer - Correct Answer B)Refer Rationale: A positive Urine Leukocyte Esterase indicates the presence of a urinary tract infection (UTI) , which may cause confusion. Refer this client for treatment of the UTI. Julio is a 66-year-old who presents with depression. His vitamin D level 11 ng/mL. A) Begin Treatment B) Refer - Correct Answer B) Refer Rationale: Vitamin D deficiency is associated with depressive symptoms. The PMHNP may refer or treat vitamin D deficiency depending on the level of comfort of the provider. Beth is a 24-year-old who presents with anxiety. Her T3 is 260 ng/dL. A) Begin Treatment B) Refer - Correct Answer B) Refer Rationale: Clients with hyperthyroidism have elevated T3 levels. Hyperthyroidism is associated with anxiety symptoms. Client can be reevaluated for anxiety once hyperthyroid treatment has been initiated and T3 levels are within normal limits. Fred is a 19-year-old who presents with psychosis. His vitamin B12 level is 900 picograms/mL. A) Begin Treatment B) Refer - Correct Answer A) Begin treatment Rationale: The B12 level is within normal limits. Treatment for symptoms of psychosis should be initiated. Ted is a 64-year-old who presents with confusion. His serum creatinine is 7.0 mg/dL and BUN is 32 A) Begin Treatment B) Refer - Correct Answer B) Refer Rationale: Elevated serum creatinine and BUN indicate a problem with kidney function, which could contribute to confusion. Social Determinants of Health (SDOH) - Correct Answer 1: Discrimination, racism, social exclusion 2: Adverse early life experiences 3: Poor education 4: Unemployment, underemployment, job insecurity 5: Poverty 6: Neighborhood deprivation 7: Food insecurity 8: Poor housing quality and housing instability Holistic Care: Culture, Values, and Health Beliefs - Correct Answer Holistic approaches to mental health care consider all aspects of the individual, not just the symptoms and diagnosis. A holistic approach not only addresses psychiatric and medical considerations, it recognizes that social, spiritual, lifestyle, and behavioral elements also impact mental health. Psychiatric symptoms may be secondary to environmental factors or life events. Clients' culture, values, and health beliefs may affect how mental health diagnoses are manifest or described and may impact treatment choices. Healing and rehabilitation are most likely to occur when providers address client needs holistically and involve clients in treatment planning. A commonly used method is the "SNAPPS" method, which follows a mnemonic consisting of six steps. This method is often used for client presentations to preceptors. The six steps includ - Correct Answer 1.Summarize the history and findings 2.Narrow the differential diagnosis to two or three possibilities 3.Analyze the differential by comparing and contrasting the possibilities 4.Probe the preceptor by asking questions about alternative approaches or uncertainties 5.Plan the management of the client's health issues 6.Select an issue from the case for self-directed learning What is the most common mental illness in the US? And what percentage does it affect adult and children? - Correct Answer Anxiety disorders are the most common mental illness in the United States. Anxiety impacts approximately 18% of the adult population and 25% of children ages 13-17 each year (Anxiety & Depression Association of America [ADAA], n.d.). People who experience anxiety have a higher incidence of work and school absenteeism and higher use of medical resources, such as emergency department and provider visits than the general population First line of Tx for Generalized anxiety disorder? - Correct Answer SSRIs SNRIs Buspirone Drug Therapy at least 12 months First line of Tx for Panic Disorder? - Correct Answer Paroxetine Sertraline Fluoxetine Drug therapy 6-9 months First line of Tx for Obsessive compulsive disorder - Correct Answer Fluoxetine Fluvoxamine Sertraline Paroxetine Clomipramine (TCA) Drug therapy for at least 1 year First line of Tx for Social anxiety disorder - Correct Answer Sertraline Paroxetine Drug therapy takes 4 weeks to see effects First line of Tx for Post-traumatic stress disorder - Correct Answer Paroxetine Sertraline Hamilton Rating Scale HAM-A scoring Mild, moderate, severe - Correct Answer 0 (not present) 4 (severe) Total score ranges from 0-56 <17: indicated mild severity 18-24: mild to moderate severity 25-30 moderate to severe What 14 questions are on HAM-A? - Correct Answer 1) Anxious mood 2) Tension 3) Fears 4) Insomnia 5) Intellectual 6) Depressed mood 7) somatic (muscular) 8) Somatic (sensory) 9) cardiovascular symptoms 10) Respiratory symptoms 11) gastrointestinal symptoms 12) Genitourinary symptoms 13) Autonomic symptoms 14) Behavior at interview Anxiety is usually comorbid with? - Correct Answer Depression, COPD, asthma, and diabetes Pt's with GAD show persistent, uncontrollable worrying that causes emotional distress and show symptoms on most days for a period of how long? - Correct Answer 6 months Pt's with anxiety often show increase activity in where? - Correct Answer Amygdala and prefrontal cortex Positron emission tomography (PET) scans show reduced what in pt's with anxiety? - Correct Answer Reduced serotonin binding What are risk factors for developing anxiety? - Correct Answer 1) family Hx 2) being female 3) recent life stressors 4) chronic physical illness 5) lack of support during childhood Increased brain activity in prefrontal cortex is a sign of? - Correct Answer Anxiety According to NIMH approximately ___% of US adults will experience GAD in the past year and approximately ____% of the US adults will experience GAD at some point in their lifetime - Correct Answer 3, 6 GAD is twice as common in ___________ than in __________ - Correct Answer Women, men How is GAD characterized by? - Correct Answer Persistent, uncontrollable worry about ordinary everyday situations Functional neuroimaging studies of GAD show? - Correct Answer Functional neuroimaging studies of GAD show increased activation of the amygdala and reduced activation in the prefrontal cortex, indicating heightened activation of the fear response with diminished capacity for reasoning GAD often presents with physical symptoms, including: - Correct Answer restlessness or edginess fatigue difficulty concentrating irritability muscle tension sleep disturbance Thyroid Function Tests - Correct Answer In psychiatric diagnosing, TFTs are used to rule out thyroid disorders as a cause for symptoms. Common symptoms related to thyroid disorders include anxiety, restlessness, depression, mood swings, sleeping difficulties, difficulties with concentration, short-term memory lapses, and lack of mental alertness. Social Anxiety Disorder - Correct Answer While it is common to feel nervous in some social situations, social anxiety disorder (also called social phobia) is a condition in which typical, everyday social interactions cause significant anxiety, self-consciousness, fear of embarrassment, or a feeling of being judged negatively by others. DSM-5 defines SAD - Correct Answer as an individual's fear of acting in a way that might cause judgment by others Anxiety leads to avoidance of social situations which disrupts an individual's relationships and daily routines. The anxiety is persistent, lasting greater than six months. What anxiety can become so severe that derealization, or a feeling of "spacing out"? - Correct Answer SAD What may individuals with SAD resort to? - Correct Answer Drugs or alcohol to reduce social inhibitions In the past year SAD has impacted approximately ____% of adults and _____% of adolescents - Correct Answer 7, 9 Risk Factors for SAD - Correct Answer HX of abuse or Neglect Close relative with SAD SAD causes distress in what kind of social situations? - Correct Answer Making small talk with other Meeting new people Performing in front of other (called performance anxiety) Greta who is clingy to her mom when meeting adults but does not have anxiety in peer setting. Would this meet DSM-5 criteria? - Correct Answer Greta displays anxiety when meeting adults in a social situation. Her anxiety is expressed as clinging to her mother and not speaking. The anxiety has been present for several years; however, Greta does not have anxiety in peer settings. Therefore, she does not meet DSM-5 criteria for social anxiety disorder Panic attacks - Correct Answer is a brief episode of acute anxiety during which an individual develops an intense fear of negative outcomes accompanied by a feeling of imminent danger. Panic attacks can be unpredictable, often occurring in familiar places where there are no apparent threats. The feelings are often accompanied by physiological symptoms. While symptoms typically peak within ten to twenty minutes, some may last for hours Physical symptoms of a panic attack include? - Correct Answer Palpitations, pounding heart, or accelerated heart rate Trembling or shaking Paresthesias (numbness or tingling sensations) Sensation of shortness of breath or smothering Derealization (feelings of unreality) or depersonalization (feeling detached from oneself) Feeling of choking Feeling of chest pain or discomfort Nausea or abdominal stress Feeling dizzy, unsteady, light-headed or faint Chills or heat sensations Panic disorder - Correct Answer occurs when a person experiences repeated panic attacks, usually accompanied by fears about future attacks. Anxiety about future attacks may lead to behavioral changes to avoid situations that might trigger attacks Fabrizia is a 27-year-old graphic designer who presents to the clinic two months after an emergency department visit for complaints of chest pain, palpitations, nausea, and dizziness. Her electrocardiogram (ECG) and cardiac enzyme panels showed no abnormalities. She states that the symptoms began while she was watching a movie with her boyfriend and lasted about 15 minutes. She has never experienced anything like this in the past, but since the episode, she has worried occasionally about the symptoms recurring, as her father died of a heart attack at age 45. Based on the DSM-5-TR, does Fabrizia meet diagnostic criteria for panic disorder? A) Yes B) No - Correct Answer B) No Rationale: Fabrizia meets diagnostic criteria for a panic attack, but not for panic disorder. During her panic attack, she reported having four cardinal symptoms associated with a panic attack. She has only had one panic attack, and although she has expressed worry about symptoms recurring, it is not persistent concern or worry. Phobia - Correct Answer phobia is an intense fear of a specific situation or object. The fear associated with a phobia is not in proportion to the actual danger associated with the situation or object. The prevalence of specific phobias is approximately 8%. Specific phobias often occur after experiencing or witnessing a traumatic event and typically develop in childhood. Clients who have specific phobias often fear more than one object or situation. Each specific phobia is diagnosed separately Ella is a 17-year-old who presents to the clinic with her mother. Her mom reports that Ella will not go to the basement in their home, and she is concerned about the behavior. During the interview, Ella confirms that even thinking about going to the basement causes her extreme anxiety because she knows that there are spiders in the basement. She has had her phone taken away in the past because she will not go to the basement to gather her laundry, but she states, "I will take the punishment because it is better than being around those spiders." She states she has been afraid of spiders for as long as she can remember Which of the following is the most appropriate ICD-10-CM code for Ella? 40.2 Specific phobias 40.218 Specific phobia - animal F40.298 Other specified phobia F40.9 Phobia, phobic - Correct Answer 40.218 Specific phobia - animal Rationale: Ella meets diagnostic criteria for F40.218 Specific Phobia: Animal. Agoraphobia - Correct Answer involves intense fear, anxiety, or panic out of proportion to the situation that occurs in two or more of the following specific scenarios: public transportation (bus) open spaces (parking lot or bridge) enclosed spaces (store, theater) standing in a crowd or line (crowd) being outside of their home Coping mechanism for agoraphobia - Correct Answer Although some clients with agoraphobia are completely homebound, many clients cope by actively avoiding situations that create anxiety; for instance, a person who fears public transportation may choose to live within walking distance to employment and shopping. Clients may be able to function better when a support person comes with them Sigourney is a 47-year-old who presents to the clinic with complaints of anxiety. She states that certain situations seem to trigger her anxiety, including using the subway, attending concerts and movies, and going to the corner bodega. She states that these types of situations make her fear that she will be trapped in the event of an emergency. To cope, she has been walking rather than using public transportation and using an online ordering app for grocery delivery. She has not been to a concert or movie theater in years and feels that she has lost some friends because of her reluctance to attend. Based on the DSM-5-TR, does Sigourney meet diagnostic criteria for agoraphobia? A) Yes B) No - Correct Answer A) Yes Rationale: Sigourney meets the following diagnostic criteria for agoraphobia: she has marked anxiety about using public transportation and being in enclosed spaces and crowds. She fears a situation because she worries about her ability to escape. She has changed her behaviors to avoid situations that cause her anxiety, and she has caused social impairment in her life. Adjustment Disorder with Anxiety - Correct Answer The DSM-5 classifies adjustment disorder as a trauma- and stressor-related disorder; however, symptoms of adjustment disorder with anxiety are similar to those found in anxiety disorders. Adjustment disorder with anxiety presents with nervousness, worry, or jitteriness. Adjustment disorder occurs in the presence of a specific and identifiable stressor. The distress experienced is out of proportion to the severity of the stressor. Adjustment Disorder with Anxiety examples - Correct Answer Examples of common stressors include loss of employment, getting married, a new disability, or a natural disaster. When does Adjustment Disorder with anxiety usually appear? - Correct Answer Symptoms begin within three months of the stressor and typically last no more than six months. Callie is an 18-year-old college student who reports to the healthcare provider that she feels anxious "about everything." Her restlessness and irritability have impacted her relationship with her significant other. She reports no significant past medical or mental health history. She states that her anxiety started about 8 months ago when she decided to transfer from her local community college to a large state university to pursue a law degree. During the law program's orientation attended by 300 students, she learned that only 100 students would be selected out of 300 applications for the fall admission. She began feeling inferior that she would not be one of the students accepted. She also started thinking about "plan B," assuming that her grades are not "good enough" to get her selected for the program. She told the PMHNP that she was preparing for the rejection because she does not measure-up to the other appli - Correct Answer A) generalized anxiety disorder Rationale: Callie has persistent symptoms of anxiety accompanied by restlessness and irritability. The thoughts are unrealistic since she has pre-determined that she is not good enough for the law program without evidence to support that feeling. She also compares herself to strangers where she automatically assumes that they are better prepared for the program than she is. She decides not to apply to the law program based on these unsubstantiated thoughts. Jeremy is a 44-year-old male who works as a department head for a local grocery store chain that is down-sizing due to economic reasons. Top level management has announced that there will be restructuring of the company where many of the employees are no longer deemed essential. Because of the automatic self-check-out systems, there is no longer the need to employ as many cashiers as possible. Jeremy has been given the task of notifying his employees of this major change in staffing. He plans to share these decisions at next week's staff meeting. From the moment Jeremy received this directive, he started to feel fearful of the possibility of announcing the decision to downsize as well as deciding on who would be eliminated. On the day of the staff meeting, his employees were present. As he started the staff meeting, he began to feel nausea. He even noticed his heart pounding. When he was questioned by an employee on - Correct Answer C) panic attack Rationale: Jeremy's anxiety is associated with a stressful situation (delivering the bad news) and a fear that something bad will happen (staff's reaction to the announcement). He experiences physical symptoms of heart pounding, nausea, dizziness, and inability to formulate an organized answer to the question. The setting is also in a familiar place among colleagues where no real threat exists. Sari is a 34-year-old female who is engaged to be married in one month. This will be her second marriage. She has been divorced for three years. Her fiancé, who is also divorced, has arranged for Sari to meet his three teenagers. Sari learns through a mutual friend of hers and the fiancé, that his teenagers, although hesitant, are willing to meet her. On the day of the arranged meeting, Sari is asked to arrive to the restaurant to meet the teens prior to the fiancé's arrival because he has been held up at a meeting. Sari agrees but starts to feel uneasy about it. She is concerned that they will not accept her because of her previous divorce and the fact that she is not their mother although they were willing to meet her. The closer she got to the restaurant, the more uneasy she felt to the point of disorientation. Just before entering the restaurant, she turned around and called her fiancé to inform him that her car - Correct Answer D) Social Anxiety Rationale: Sari feels like she will be judged by the teens because she is not their mother. She avoids the situation by creating an excuse for not meeting them at the restaurant. The feelings are unwarranted since the teens agreed to meet with Sari. Complete the case study below by utilizing the HAM-A scale. Rashard, a 54-year-old, presents for a walk-in visit with the PMHNP due to increased anxiety and requests an early refill of his clonazepam. He reports his brother died a week ago and he is very anxious. He has taken all the clonazepam #20 tabs that the PMHNP refilled 3 weeks earlier. The client understands that his benzodiazepine is to be used as needed and only for severe anxiety, but he said he used it all because he "just couldn't cope." He reveals that he was hospitalized after the death of his father 7 years ago and does not want that to happen again; he wants to avoid the hospital. Upon assessment, the client has difficulty sitting still, his leg is swinging continuously, and he taps his fingers; he is constantly shifting in his chair. His anxiety symptoms include feeling short of breath, heart racing, and some chest pain, "jumping out of his skin" - Correct Answer C) moderate to severe anxiety Rationale: The HAM-A is a clinician-rated anxiety screening tool. Based on Rashard's interview and examination, his positive findings score as follows: Anxious mood - 4 (daily worry, fearful anticipation) Tension- 4 (startle, tense, trembling daily) Fears- 3 (daily fear something will happen) Insomnia- 3 (nightly sleep issues) Intellectual- 2 (poor memory) Depressed mood- 3 (daily loss of interest, lack of pleasure) Cardiovascular symptoms- 3 (tachycardia, chest pain) Respiratory symptoms- 2 (pressure or constriction in chest, dyspnea) Behavior at interview- 3 (fidgeting, restlessness, or pacing) Rashard's total HAM-A screening score is 28, indicating moderate to severe anxiety. Which of the following medical conditions is likely to present with symptoms that mimic anxiety? A) hypothyroidism B)hyperthyroidism (C C)dysrhythmias (Correct answer) D) irritable bowel syndrome (Correct answer) E) anemia F) diabetes type 2 G)migraine headache (Correct answer) H) Covid-19 I) rheumatoid arthritis (Correct answer) J) menopause (Correct answer) - Correct Answer B)hyperthyroidism C)dysrhythmias D) irritable bowel syndrome G)migraine headache I) rheumatoid arthritis J) menopause Rationale: Medical conditions that commonly present with symptoms that mimic anxiety include endocrine disorders including hyperthyroidism and adrenal dysfunction cardiac disorders including angina and dysrhythmias, GI conditions including irritable bowel syndrome and GERD, inflammatory conditions including lupus and rheumatoid arthritis, neurological disorders including migraine headaches and seizures, and respiratory conditions including asthma and COPD. Changes in the menstrual cycle, including PMS and menopause, may also cause symptoms that mimic anxiety. Which of the following medications or substances commonly cause symptoms that mimic anxiety? A)bupropion B)nasal decongestants C)metoprolol D)levothyroxine E)Insulin F)albuterol G)cocaine H)alcohol I)caffeine J)morphine - Correct Answer A)bupropion (Correct answer) B)nasal decongestants (Correct answer) C)metoprolol (Correct answer) D)levothyroxine (Correct answer) F)albuterol (Correct answer) G) cocaine (Correct answer) H)alcohol (Correct answer) I)caffeine (Correct answer) Rationale: Medications with side effects mimicking anxiety disorder include nasal decongestants, antidepressant medications, synthetic thyroid hormones, beta-adrenergic agonists, and hormones such as androgens and estrogens. Substances with effects that may mimic anxiety include cocaine, ecstasy, marijuana, psychoactive compounds, and caffeine. What is the Tx of GAD ? - Correct Answer Pyschotherapy, medication, or both What is the most widely studied and efficacious form of Tx of GAD? - Correct Answer Serotonergic antidepressants in combinations with CBT If symptoms are severe of GAD what is the line of Tx? - Correct Answer Short course of a benzodiazepine at the beginning of treatment may be indicated Anxiolytic Pros vs Cons - Correct Answer PROS: ↓ adverse effects ↓ drug interactions CONS limited effectiveness Anxiolytic time to efficacy? - Correct Answer 2-4 weeks Anxiolytic agents? - Correct Answer Buspirone SSRIs/SNRIs Pros vs Cons - Correct Answer PROS: Highly effective CONS: ↑ drug interactions risk of hyponatremia SSRIs/ SNRIs time to efficacy? - Correct Answer Up to 6 months SSRIs/ SNRIs Agents - Correct Answer escilatopram (Lexapro) paroxetine (Paxil) duloxetine (Cymbalta) Benzodiazepines Pros vs Cons - Correct Answer PROS highly effective rapid onset can be used PRN CONS multiple adverse effects fall risk risk of misuse Benzodiazepines time to efficacy? - Correct Answer Immediate Benzodiazepines Agents - Correct Answer alprazolam (Xanax) clonazepam (Klonopin) Non pharmacologic Treatment of GAD - Correct Answer Some clients may consider complementary and alternative treatments. Treatments may include physical, cognitive, and spiritual activities aimed at decreasing anxiety. High-intensity aerobic exercise is a good complement to first-line therapy for GAD. Mindfulness-based stress reduction activities, such as meditation and yoga, have shown a reduction in symptoms of GAD Relaxation or meditation Art of music therapy Yoga or other exercise Acupuncture Prayer or spiritual counselling What is Silexan? - Correct Answer Is a branded extract of lavender. OTC in the US. Similar to CAM therapies Harold is a 32-year-old who presents to the clinic with complaints of fatigue, difficulty concentrating, and difficulty falling asleep at night. He states he worries about finances, his performance at work, and his relationship, and his worries have been "almost constant" for 8 months. He denies substance use and recently had a normal physical exam. He feels that his relationship is suffering due to his constant worry. Based on the DSM-5-TR, does Harold meet diagnostic criteria for generalized anxiety disorder? A) Yes B) No - Correct Answer A) Yes Rationale: Harold meets the following diagnostic criteria for generalized anxiety disorder: He has three symptoms associated with worry, including fatigue, difficulty concentrating, and sleep difficulties. He has experienced anxiety more days than not for over 6 months, and his worries are impacting his relationship. SAD treatment plan? - Correct Answer Not all clients with social anxiety disorder (SAD) require treatment. Young adults may experience benefits from learning about their disorder and reflecting on how the disorder impacts their personal life to make an educated decision about treatment options. Many clients diagnosed with SAD have experienced symptoms for years and have learned to navigate the symptoms at a functional level. Treatment for SAD is rarely an emergent situation. Treatment includes cognitive behavioral therapy, medications, or a combination of both. SAD medication treatment options? - Correct Answer Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) SAD is usually treated using anti-depressants. Benzodiazepines These psychoactive drugs are known for inducing calm. Monoamine oxidase inhibitors (MAOIs) This class of drugs are for clients who are able to undergo dietary and medication restrictions. SSRIs or SNRIs must be completely flushed from the system first. Performance- only SAD Tx for one or rarely recurring performance? - Correct Answer Beta blocker or Benzodiazepine 30-60 min before performance Performance-only SAD Tx for Recurring performances - Correct Answer 1) CBT 2) Beta blocker or Benzodiazepine 30-60 min before performance Panic disorder Tx plan - Correct Answer Exposure therapy Cognitive behavioral therapy Medications Combination of modalities Treatment may include exposure therapy, cognitive behavioral therapy, medications, or a combination of modalities. SSRIs are a safe, economical pharmacologic treatment for panic disorder. Benzodiazepines may be used in emergencies Obsessions vs compulsions - Correct Answer Obsessions: (intrusive or unwanted thoughts) "Did I forget to turn the stove off?" Fear of germs Continued thoughts of harming another person Compulsions: (repetitive behaviors in response of intrusive thoughts) Checking the lock on the door multiple times Taking several hours to eat a meal Counting Repetitive prayers OCD Tx options? - Correct Answer Pharmacotherapy, psychotherapy or combo Typical night dose of SSRI - common dosage fluoxetine 80mg What is Exposure and response prevention (ERP) - Correct Answer Is a specific CBT for clients with OCD. Provides exposure to obsessive thoughts and learned behaviors to choose not to complete a compulsive behavior Y-BOCS - Correct Answer Yale-brown Obsessive Compulsive Scale Chuck has checking compulsions that he performs occasionally. The compulsions slightly interfere with other activities, and he feels very anxious if he is interrupted in his compulsive activities. He does not feel that he has control over the compulsive actions. Based on his score, Chuck is likely to have a moderate case of OCD. Which initial medication would you select for Chuck? A) fluoxetine 80 mg B) fluoxetine 20 mg C)venlafaxine 75 mg D) venlafaxine 150 mg - Correct Answer B) fluoxetine 20mg, always start at the lowest dose and titrate as needed What should you monitor with clients who have OCD and anxiety disorders? - Correct Answer There is a higher incidence of SI and completion. Therefore monitor clients carefully during therapy and psychopharmacologic Tx The United States Food and Drug Administration (FDA) issued a black box warning for nine antidepressants related to an increased risk of suicide in children and adolescents. The medications include - Correct Answer citalopram, fluvoxamine, paroxetine, fluoxetine, sertraline, venlafaxine, mirtazapine, nefazodone, and bupropion. What is the most psychiatric disorder in people 60 and over - Correct Answer Anxiety Match the brain area with malfunctioning circuitry with the symptoms produced: Mesocortical and ventromedial prefrontal cortex - Correct Answer negative and affective symptoms Match the brain area with malfunctioning circuitry with the symptoms produced: Dorsolateral - Correct Answer cognitive symptoms Match the brain area with malfunctioning circuitry with the symptoms produced: Orbitofrontal and connections to the amygdala: - Correct Answer aggressive, impulsive symptoms Traditionally, schizophrenia and psychosis symptoms have been associated with a surplus of ____________, since medications that block dopamine, specifically D2, have been found to reduce the positive symptoms of schizophrenia - Correct Answer Dopamine positive symptoms - Correct Answer Hallucinations Delusions Thought disorder Hostility Excitability negative symptoms - Correct Answer Affective flattening Alogia Anhedonia Amotivation Asociality Alogia - Correct Answer A decrease in speech or speech content; a symptom of schizophrenia. Also known as poverty of speech. Anhedonia - Correct Answer inability to experience pleasure Amotivation - Correct Answer Describes when someone is not motivated to engage in an activity or behavior. Asociality - Correct Answer lack of interest in social interactions Anosognosia - Correct Answer A patient's inability to realize that he or she is ill, which is caused by the illness itself. Avolition - Correct Answer lack of motivation Depersonalization - Correct Answer a dissociative disorder characterized by persistent or recurrent feelings of detachment from one's mental processes or body catatonic schizophrenia - Correct Answer A type of schizophrenia marked by striking motor disturbances, ranging from muscular rigidity to random motor activity. lifeless, trance-like state with lack of response or movement Cognition Symptoms of Schizophrenia - Correct Answer Attention Working memory Verbal memory Visual memory Executive functioning Processing speed Social conditioning Affective symptoms of schizophrenia - Correct Answer Depression Anxiety Suicidality Motor Symptoms - Correct Answer Motor delay Dyscoordination EPS, e.g., Parkinsonism Dyskinesia Hallucinations - Correct Answer perceptual experiences in the absence of external stimuli Examples of hallucinations include: - Correct Answer Auditory: hearing things that are not there (may include command hallucinations in which voices direct the client to perform actions, often related to self-harm or violence towards others) Visual: seeing things that are not there Tactile: feeling sensations in the body in the absence of stimuli Olfactory: smelling things that are not there Gustatory: tasting things that are not there Delusions - Correct Answer fixed false, irrational beliefs persecution delusion - Correct Answer delusions related to being threatened, victimized, or spied on reference delusion - Correct Answer delusions related to receiving personal messages from tv, radio, or actions of others somatic delusions - Correct Answer elusions related to the body, including illness or the presence of foreign objects (e.g. Sometimes people believe there are objects in their bodies; for example they might think they are infested with insects.) grandeur delusion - Correct Answer delusions related to beliefs of special abilities or powers control delusion - Correct Answer delusions that actions and thoughts are controlled by others Thought disorder (schizophrenia) - Correct Answer disorganized, irrational thinking Examples of thought disorder include: - Correct Answer incoherent speech loose associations meaningless words perseveration disorganized behavior (schizophrenia) - Correct Answer acting in strange or unusual ways, including strange movement of limbs, bizarre speech, and inappropriate self-care, such as failing to dress properly or bathe Examples of disorganized behavior include: - Correct Answer childlike silliness unpredictable agitation inappropriate clothing for the weather poor hygiene schizophrenia are at risk of premature mortality due to co-occurring medical conditions that are often undiagnosed or undertreated - Correct Answer Common comorbidities include heart and liver disease and diabetes. Approximately half of the individuals with schizophrenia have co-occurring mental and/or behavioral health disorders (NIMH, n.d.). Those with schizophrenia are at increased risk for suicide At what age does schizophrenia typically first appear? - Correct Answer 25 What may precipitate symptoms of schizophrenia in those already vulnerable - Correct Answer Stressful life events, such as the loss of a loved one, the end of a relationship, abuse, or substance use Positive vs negative symptoms in schizophrenia - Correct Answer Positive symptoms tend to come and go throughout the illness while negative symptoms tend to be more stable throughout life. Cognitive symptoms impact a client's ability to function independently. positive vs negative symptoms - Correct Answer positive: something added (such as delusions, hallucinations, disorganized speech) negative: something removed (lack of emotion) Prodromal phase of schizophrenia - Correct Answer usually develop before the first psychotic episode over a few days to a few months and may persist for a year or more before the onset of overt psychotic symptoms Symptoms that occur in the prodromal phase of the illness - Correct Answer are typically negative and may be overlooked due to their similarity to other conditions, such as depression Clients may begin to show an interest in abstract ideas, philosophy, and occult or religious questions. Other prodromal signs and symptoms include noticeably strange behavior, abnormal affect, unusual speech, bizarre ideas, and odd perceptual experiences. The pattern of illness during the first _____ years after the diagnosis generally indicates the client's course. Each relapse leads to further decline in client functioning. - Correct Answer Five Over time, __________ symptoms tend to become less severe while _____________ symptoms may increase in severity - Correct Answer Positive; negative schizoaffective disorder - Correct Answer Psychotic disorder featuring symptoms of both schizophrenia and major mood disorder, such ad a bipolar disorder. Schizoaffective disorder is associated with? - Correct Answer Depression and often misdiagnosed at MDD. What is the diagnosis requirement of Schizoaffective disorder? - Correct Answer At least TWO psychotic episodes lasting 2 weeks or more. With one of these episodes must happen without depressive or manic symptoms Minh is a 19-year-old who presents to the emergency department after a suicide attempt. She is medically stable. She states that she has experienced auditory hallucinations for the past 3-4 weeks and "could not take them anymore." She also complains of depressed mood, loss of interest in activities, and feelings of hopelessness for the past few months. Her toxicology reports on admission were negative - Correct Answer Rationale: Minh presents with major depressive episode concurrent with hallucinations. This disturbance is not attributable to a substance. The most appropriate diagnosis for Minh is schizoaffective disorder depressive type F25.1. schizophreniform disorder - Correct Answer Psychotic disorder involving the symptoms of schizophrenia but lasting less than 6 months but more than 1 month. This condition is differentiated from schizophrenia based on the length if time symptoms have been present Holden is a 14-year-old who presents to the clinic with his parents. His mother notes that he has stopped showering, seems disinterested in activities in which he had previously engaged and in peer interaction, and echoes words that others have said. These behaviors have increased over the past two months. Holden's urine toxicology is negative. Based on the DSM-5-TR, does Holden meet diagnostic criteria for schizophreniform disorder? yes no unable to determine - Correct Answer no (Correct answer) Rationale: Holden's behaviors have lasted for at least one month, but less than six months. His behaviors are not attributable to a substance. Holden displays two of the five required symptoms for the diagnosis of schizophreniform disorder. He displays catatonic behavior with echolalia and has negative symptoms of asociality and avolition. He does not, however, display one of the three required behaviors for diagnosis: delusions, hallucinations, or disorganized speech. An alternate diagnosis should be considered. brief psychotic disorder - Correct Answer Psychotic disturbance involving delusions, hallucinations, or disorganized speech or behavior but lasting less than 1 month; often occurs in reaction to a stressor. Clients experience full remission with a full return to function Shelby is a 31-year-old who presents to the emergency department with her husband. She is 32 weeks pregnant. Her husband noted that a few days ago, she began having bizarre behaviors, including avoiding eye contact, exhibiting tangential speech, and expressing delusions that she is being followed and tracked by the CIA and that they are planning to steal her baby. Shelby has no medical or psychiatric history, and she is not on any medications. She has abstained from alcohol during pregnancy and does not use other drugs. Based on DMS-5-TR, does Shelby meet the criteria for brief psychotic disorder? yes no Unable to determine - Correct Answer Unable to determine (Correct answer) (Correct answer) Rationale: Shelby may meet diagnostic criteria for brief psychotic disorder (298.8) with peripartum onset, but a diagnosis cannot be confirmed at this time. Shelby exhibits delusions and disorganized speech. The symptoms cannot be better explained by another medical or psychiatric illness or substance. Shelby's symptoms began a few days ago. If symptoms resolve within one month, this is an appropriate diagnosis. If not, an alternate diagnosis should be considered. delusional disorder - Correct Answer Psychotic disorder featuring a persistent belief contrary to reality (delusion) but no other symptoms of schizophrenia.Delusional disorder involves a person having prominent delusions without hallucinations. Clients with delusional disorder tend to have false beliefs that involve real-life situations such as the belief that they are being followed or that others are plotting against them. Clients with delusional disorder often retain their personalities and are more functional socially and at work than with other psychotic disorders. Geoff is two days post-op from knee surgery. He has been awake, alert, oriented, and pleasant over the last few days and has shown no signs of mental distress. The surgical team asked for a psychiatric consult after Geoff became increasingly angry, argumentative, and agitated with nursing staff when he was offered a flu shot. Geoff states that he was given a flu shot against his will at work several years ago, and since then the government has been tracking him and listening in on private conversations. He states that taking another shot will "triple the power" of the surveillance. Upon follow-up, Geoff's wife confirms that he has held this belief for many years. He believes the same is true for other vaccines, but he does not hold other delusions. He has maintained employment, relationships, and social interactions. Based on the DSM-5-TR, does Geoff meet diagnostic criteria for delusional disorder? Yes No Unable to - Correct Answer yes (Correct answer) no unable to determine Rationale: Geoff has one belief that is irrational and fixed and has held the delusion for several years. His functioning is not impaired. He meets diagnostic criteria for delusional disorder (297.1), persecutory type. Scott is a 33-year-old who is currently without housing. He has been unable to adhere to his prescribed oral medication regimen. The PMHNP recommends a long-acting intramuscular form of medication. Scott is willing to try but would like to receive the medication at the community clinic near the shelter where he is staying. Which medication option is the least appropriate for Scott at this time? aripiprazole monohydrate olanzapine paliperidone palmitate risperidone - Correct Answer olanzapine (Correct answer) Rationale: Olanzapine must be given in a registered health care facility with available emergency medical services. The client receiving olanzapine must be monitored for 3 hours post-injection. Which of the following laboratory tests are indicated for a client who is taking olanzapine? BMI CBC HbA1C Lipid panel Kidney function tests - Correct Answer BMI (Correct answer) CBC HbA1C (Correct answer) Lipid panel (Correct answer) Kidney function tests Rationale: Monitoring should include fasting glucose or hemoglobin A1C, lipid profile, weight, and BMI at regular intervals during the first year of antipsychotic therapy and then annually. Which of the following tests are indicated for a client who is taking ziprasidone? CT scan ECG vital signs EEG - Correct Answer ECG (Correct answer) vital signs (Correct answer) Rationale: Ziprasidone may cause prolonged QT interval; clients who are prescribed this medication should have an ECG before taking the medication, at three months, and annually thereafter. The provider should also monitor pulse and blood pressure at each visit. Ziprasidone may cause orthostatic hypotension and subsequent tachycardia. A client has been on clozapine for 9 months. Absolute neutrophil counts (ANC) have consistently been less than 1500/microliter? At what frequency should a CBC be drawn? daily weekly every 2 weeks ( monthly - Correct Answer every 2 weeks (Correct answer) Rationale: With a normal baseline ANC, the CBC should be monitored weekly for 6 months; every 2 weeks for months 6-12; and monthly thereafter (Clozapine REMS, 201). catatonia - Correct Answer a state of unresponsiveness to one's outside environment, usually including muscle rigidity, staring, and inability to communicate Catatonia is a psychomotor syndrome that presents as a decreased reactivity to one's environment. Catatonia typically occurs in tandem with other medical or psychiatric disorders. It is most often associated with schizophrenia, affective disorders, autism, and infectious disease. Clinical signs of catatonia include immobility, mutism, withdrawal, refusing to eat, staring, negativism, posturing, and rigidity. Helmut is a 58-year-old who has a history of alcoholism and liver failure. He presents to the emergency department with his wife, who is concerned about recent changes in his behavior, including a decrease in mobility and verbal response. He will not follow instructions during the examination. Facial grimacing is noted. His physical exam is positive for ascites and asterixis. A CT scan shows no acute concerns. His blood ammonia level is elevated. Based on DSM-5-TR criteria, what is the most appropriate diagnosis for Helmut at this time? Fill in your answer and provide the appropriate ICD-10 code. - Correct Answer Answer with rationale: Helmut is experiencing signs and symptoms consistent with hepatic encephalopathy, including a negative CT scan, ascites, asterixis, and elevated blood ammonia level. He meets diagnostic criteria for catatonia as he has four symptoms: stupor, mutism, negativism, and grimacing. Based on the clinical presentation, an appropriate diagnosis for Helmut is hepatic encephalopathy (572.2) and catatonic disorder due to hepatic encephalopathy (293.89). Brief Psychiatric Rating Scale Links to an external site. - Correct Answer may be used to assess clients who present with symptoms of psychosis. The scale consists of 24 categories, each scored between 1-7. Although interpretation of the BPRS scale varies, scores may be broadly interpreted with higher numbers indicating more severe illness. The BPRS may be used over time to evaluate treatment. Positive and Negative Syndrome Scale - Correct Answer (PANSS) is a clinician-rated tool to identify and differentiate the presence of positive and negative symptoms of psychosis. The tool is commonly used in research settings. Clinician-Rated Dimensions of Psychosis Symptom Severity Scale - Correct Answer can help the provider to determine the degree of impairment from positive, negative, and cognitive symptoms. Each item is scored and interpreted independently. The tool may be used to monitor treatment success and the need for additional follow-up Which of the following medical conditions are likely to present with symptoms that mimic psychosis? - Correct Answer Medical conditions that commonly present with psychotic symptoms include Alzheimer's disease, Huntington disease, multiple sclerosis, brain tumors, head trauma, Creutzfeldt-Jakob disease, syphilis, viral encephalitis, hepatic encephalopathy, adrenal disorders, and vitamin B12 deficiency. Which of the following medications or substances commonly cause symptoms that mimic psychosis? Select all that apply. - Correct Answer Rationale: Medications with side effects mimicking psychosis include cephalosporins, penicillin, anticholinergics, steroids, amphetamines, cocaine, alcohol, marijuana, and hallucinogens. First line of pharmacologic psychosis tx - Correct Answer Antipsychotic medications are commonly used in the management of psychosis. Second-generation or atypical antipsychotics (SGA) are effective for the treatment of both positive and negative symptoms. SGAs are often the first-line treatment for psychotic disorders, especially for clients who will require long-term therapy, as SGAs have fewer side effects. Click through the activity below to learn more. Olanzapine (Zyprexa) - Correct Answer atypical antipsychotic olanzapine(Zyprexa) Indication: FDA approved for treatment of schizophrenia age 13 and older Special Comments: Best tolerated antipsychotic MEDICATION INTERACTS WITH SMOKING AND REQUIRES 30% INCREASED DOSAGE FOR CLIENTS WHO SMOKE Risk: High metabolic risk Highest risk for weight gain, blood dyscrasias, QT prolongation, cardiovascular disease, cerebrovascular effects, hyperglycemia, and hyperprolactinemia quetiapine (Seroquel) - Correct Answer Atypical antipsychotics Indication: Labeled use for schizophrenia ages 13 and older Risk: Moderate metabolic risk Low EPS risk Risk of orthostatic hypotension, blood dyscrasias (neutropenia, leukopenia, and agranulocytosis), QT prolongation, weight gain, and renal and hepatic impairment asenapine (Saphris) - Correct Answer Atypical antipsychotics Indication: FDA approved for schizophrenia ages 10 and older Special Comments: Available in sublingual and transdermal patch Risk: Low metabolic risk clozapine(Clozaril) - Correct Answer Atypical antipsychotics Indication: Approved for treatment resistant schizophrenia and chronic suicidal behavior in schizophrenia or schizoaffective disorder Not indicated in acute presentation of schizophrenia Special Comments: The Absolute Neutrophil Count (ANC) must be >1500/mm3 when used and requires initial and weekly monitoring of WBC, granulocyte, and neutrophil counts. Risk: High metabolic risk Highest risk for weight gain. Low EPS risk. Black box warning: may cause severe neutropenia Contraindicated in liver disease and hepatic failure Not a first-choice mediation for treating schizophrenia risperidone (Risperidol) - Correct Answer Atypical antipsychotics Indication: FDA approved for schizophrenia ages 13 and older Risk: Moderate metabolic risk Highest risk of hyperprolactinemia Risk of blood dyscrasias, QT prolongation, cardiovascular, and cerebrovascular effects paliperidone (Invega) - Correct Answer Atypical antipsychotics Indication: FDA approved for schizophrenia ages 12 and older Risk: Moderate metabolic risk ziprasidone (Geodon) - Correct Answer Atypical antipsychotics Indication: FDA approved for schizophrenia in ages 10 and older Special Comments: IM dosing in acute agitation associated with schizophrenia Risk: Low metabolic risk Lowest risk for weight gain Contraindicated in clients with QT, recent myocardial infarction, or uncompensated heart failure High incidence of rash/urticaria related to Stevens-Johnson syndrome and Drug Reaction with Eosinophilia and Systemic Syndrome (DRESS) lloperidone (Fanapt) - Correct Answer Atypical antipsychotics Indication: FDA approved for schizophrenia Risk: Moderate risk for weight gain Low risk for hyperlipidemia lurasidone (Latuda) - Correct Answer Atypical antipsychotics Indication: FDA approved for schizophrenia ages 13 and older Special Comments: Lurasidone (Latuda) should be taken with food, at least 350 calories, for maximum absorption. Risk: Low metabolic risk 2 dones and a rone - Correct Answer 2 dones and a rone The dones and rone more potently to the 5HT 2A receptor than to D2 or bine equally between the 2 receptors. These medications are less sedating and cause less weight gain, but have a higher risk for hyperprolactinemia and EPS. aripiprazole (Ability) - Correct Answer Atypical antipsychotics Indication: FDA approved for schizophrenia ages 13 and older Risk: Low metabolic risk Low risk for weight gain Low risk for orthostatic hypotension brexpiprazole(Rexulti) - Correct Answer Atypical antipsychotics Indication: FDA approved for schizophrenia Special Comments: Considered procognitive Risk: Low metabolic risk cariprazine (Vraylar) - Correct Answer Atypical antipsychotics Indication: FDA approved for schizophrenia Risk: Low metabolic risk Chlorpromazine - Correct Answer FGA: Chlorpromazine Potency: Low Additional Indications & Considerations: 2nd line due to QTc issues Mesoridazine - Correct Answer Typical Antipsychotic/Low Potency Thioridazine - Correct Answer low potency typical antipsychotic. Additional indications due to QTC issues Thiothixene - Correct Answer Typical Antipsychotic/medium Potency Fluphenazine - Correct Answer Typical Antipsychotic/High Potency Haloperidol - Correct Answer Typical Antipsychotic/High Potency Erica is a 24-year-old with a newly diagnosed schizophreniform disorder. She is a current smoker. She does not use alcohol or other drugs. She has no medical history. Which of the following would be the least appropriate initial medication for Erica? aripiprazole lurasidone olanzapine quetiapine - Correct Answer olanzapine (Correct answer) Rationale: Olanzapine requires up to 30% increased dosage for clients who smoke concurrently. Initiating a medication that does not interact with smoking is preferable. Tony is a 56-year-old who has recently been diagnosed with schizophrenia. He takes amiodarone for a history of cardiac dysrhythmias. He does not use alcohol or other drugs. He is a nonsmoker. Which of the following is the most appropriate medication for Tony? aripiprazole lurasidone quetiapine risperidone - Correct Answer risperidone (Correct answer) Rationale: Amiodarone is a moderate CYP3A4 inhibitor. Risperidone does not interact with CYP3A4 inhibitors or inducers. Jenny is a 22-year-old who has been prescribed aripiprazole 15 mg/day for the past 8 months. She has gained approximately 30 lbs. during treatment. Jenny's psychiatric symptoms have been managed well on aripiprazole and she has no other adverse effects. What is the most appropriate initial intervention for Jenny? switch to a different antipsychotic medication prescribe metformin refer to a bariatric specialist - Correct Answer prescribe metformin (Correct answer) Rationale: Prescribing metformin as an adjunct treatment to assist with weight loss associated with antipsychotics is appropriate. Jenny is well-managed on the current dose of aripiprazole; switching to a different medication is not indicated at this time. Referral to a bariatric specialist may be indicated if the client continues to gain weight but is not indicated as the most appropriate initial intervention.