PMHNP certification Questions and answers.

CAGE items responses are scored either 1 or 0. A score 2 or higher is considered clinically significant OCD obsessive thoughts interfere with your daily life -are you concern about things being contaminated, keeping things in perfect order -do you feel driven to perform certain acts over and over again? -have unwanted images or thought that you cant seem to get out of your head layman's explanation of mental illness Abnormal functioning of neurotransmitters. Neuroanatomical differences have been found in some cases. -can arise from multiple sources, not a single or consistent cause has been established biomedical psychiatry mental illness is conceptualized as a disorder of the brain circuit caused by a complex interplay of genetic and environmental factor state-dependent learning when a memory is formed a new neural pathway is created. If the memory was formed under specific chemical conditions (on a drug, manic), then the pathway will be primed to work most effectively under these circumstances. -state-dependent learning in bipolar. Bipolar individuals in a depressed episode may not be able to recall details of manic episodes. Corroboration is needed. Assessment tools to screen for cognitive impairment -folstein mini-mental: perfect score is 30. <24 impairment. If only 9th grade education <17 Abnormal sodium levels -increased: dehydration, methyldopa, -decreased: SIADH, heart failure, nephrotic syndrome, hepatic disease. Abnormal Potassium levels Increased: amiloride, spirolactone, lithium, propranolol. Decreased alpha 1 antagonists -vasodilator and used for hypertension -raynauds -PTSD and GAD -benign prostatic hyperplasia (tamsulosin) -agonism: vasoconstrictor -trazadone and many antipsychotics ESR-erythrocyte sedimentation rate high values indicate autoimmune, malignancies, infections absolute neurophil count calculations total WBC x percentage of neurophil in differential=ANC Calcium -increased: >10.8 caused by hyperparathyroidism from tumor of renal disease, lithium PET vs. fMRI measures brain activity by associated changes in blood flow. Relies on fact that cerebral blood flow and neuronal activity are coupled. -In addition, PET has the advantage of being able to identify specific receptors associated with neurotransmitter through its ability to image radioactive ligands ELISA testing -first screen with ELISA. ELISA tests for HIV antibodies. Vast majority of HIV positive people have detectable antibodies by 3 months after exposure. Splitting the individual segregates experiences in to all-good or all-bad, with no room for ambiguity or ambivalence. displacement separation of emotion from it object of discontent and redirected to a less threatening and intimidating --example: displaced aggression- If expressing or dismay to the source of the anger could lead to negative consequences, we may rather than express our angry to a person or object that pose no threat. introjecion a process whereby an individual unconsciously incorporates the qualities of another person into his or her ego structure Gestalt Therapy emphasizes personal responsibility. Cultivate a greater self-awareness and mindfulness. -greater self-awareness of mind and body -chair technique: a role-playing exercise. The client is asked to adopt one role in one chair, and another in the other chair (e.g. plays parent and then plays child) Hyperprolactinemia and Risperidone -prolactin levels peak the first 6 to 8 weeks -returns to normal range in 3 t0 5 months -hyperprolactinemia is dose-dependent -osteopenia, amenorrhea, galactorrhea, gynecomastia -get baseline, repeat in two months. ask about nipple discharge, menstruation, sexual dysfunction. If the patient has elevated prolactin after 2 months but no symptoms, repeat test in two months. Antipsychotics that cause the most hypotension olanzapine, risperidone, quetiapine Rett Syndrome -more common in females--the mutation arises from the X chromosome. -onset before first birthday -loss of skills already acquired: speech and purposeful hand movement -delayed head growth, scoliosis, ataxia Tourettes -tics must be present for at least a year before diagnosis -must have motor and vocal tic -abnormalities in the basal ganglia andd dopamine system are implicated -First use guanfascine or clonidine. if doesnt work then use risperidone autism appears before the age of 3. Difficulty with communication -pervasive failure to form social relationships -problems with communication -ritualistic behaviors -stereotyped behavior -circumscribed range of interests paranoid personality disorder -guarded with others. interprets actions of others as threatening and deceptive. -Suspicious that others are out to attack his character or reputation -uses projection as predominant defense mechanism -more common in families of schizophrenics schizoid personality -disinterested in close relationships -appears indifferent to the praise or criticism of others schizotypical personality -More likely to have a positive family history of schizophrenia -magical thinking, ideas of reference.