PMHNP Certification Exam Review 2022 (Verified) 100% CORRECT

PMHNP Certification Exam Review 2022 (Verified) 100% CORRECT Tarasoff Principle - - -1976 - duty to warn victims of potential harm from client Deontological Theory - - -Ethical theory that states an action is judged a ...

PMHNP Certification Exam Review 2022 (Verified) 100% CORRECT Tarasoff Principle - - -1976 - duty to warn victims of potential harm from client Deontological Theory - - -Ethical theory that states an action is judged as good or bad based on the act itself regardless of the consequences Teleological Theory - - -Ethical theory that states an action is judged as good or bad based on the consequence or outcome Virtue ethics - - -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 - - -birth-1 year Erikson's developmental stage infancy developmental tasks - - -trust vs. mistrust Erikson's developmental stage infancy indications of developmental mastery - - -Ability to form meaningful relationships, hope about the future trust in others Erikson's developmental stage infancy indication of developmental failure - - -poor relationships, lack of future hope, suspicious of others Erikson's developmental stage early childhood age - - -1-3 yo Erikson's developmental stage early childhood developmental task - - -autonomy vs. shame and doubt Erikson's developmental stage early childhood indications of developmental mastery - - -self-control, self-esteem, willpowerErikson's developmental stage early childhood indications of developmental failure - - -poor self-control, low self esteem, self-doubt, lack of independence Erikson's developmental stage late childhood age - - -3-6yo Erikson's developmental stage late childhood developmental task - - -initiative vs guilt Erikson's developmental stage late childhood indications of developmental mastery - - -self-directed behavior, goal formation, sense of purpose Erikson's developmental stage late childhood indications of developmental failure - - -lack of selfinitiated behavior, lack of goal orientation Erikson's developmental stage school-age ages - - -6-12yo Erikson's developmental stage school-age developmental task - - -industry vs. inferiority Erikson's developmental stage school-age indications of developmental mastery - - -ability to work; sense of competency and achievement Erikson's developmental stage school-age indications of developmental failure - - -sense of inferiority, difficulty with working, learning Erikson's developmental stage adolescence ages - - -12-20yo Erikson's developmental stage adolescence developmental task - - -identity vs role confusion Erikson's developmental stage adolescence indications of developmental mastery - - -personal sense of identityErikson's developmental stage adolescence indications of developmental failure - - -identity confusion, poor self-identification in group settings Erikson's developmental stage early adulthood ages - - -20-35 years Erikson's developmental stage early adulthood developmental task - - -intimacy vs isolation Erikson's developmental stage early adulthood indications of developmental mastery - - -committed relationships, capacity to love Erikson's developmental stage early adulthood indications of developmental failure - - -emotional isolation, egocentrism Erikson's developmental stage middle adulthood ages - - -35-65 yo Erikson's developmental stage middle adulthood developmental task - - -generativity vs. self-absorption or stagnation Erikson's developmental stage middle adulthood indications of developmental mastery - - -ability to give time and talents to others, ability to care for others Erikson's developmental stage middle adulthood indications of developmental failure - - -selfabsorption, inability to row and change as a person, inability to care for others Erikson's developmental stage late adulthood age - - ->65yo Erikson's developmental stage late adulthood developmental task - - -integrity vs despair Erikson's developmental stage late adulthood indications of developmental mastery - - -fulfilment and comfort with life, willingness to face death, insight and balanced perspective on life's eventsErikson's developmental stage late adulthood indications of developmental failure - - -bitterness, sense of dissatisfaction with life, despair over impending death Psychodynamic (Psychoanalytic) Theory - - --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 - - -Even apparently meaningless, random, or accidental behavior is actually motivated by underlying unconscious mental content Intellectual disability typical age onset - - -infancy- usually evident at birth ADHD typical age onset - - -early childhood (per DSM by age 12) Schizophrenia typical age onset - - -18-25 for men 25-35 for women Major Depression typical age onset - - -late adolescence to young adulthood dementia typical age onset - - -most common after age 85 Freud's Id - - --contains primary drives or instincts -drives are largely unconscious-operates on the pleasure principle -"I want" pleasure principle - - -the id seeks immediate satisfaction freud's ego - - --rational mind, logical and abstract thinking -"I think, I evaluate" Freud's superego - - --sense of conscience or right vs wrong -develops around age 6 -"I should or ought" Freud's psychosexual stage of development oral stage age - - -0-18 months Freud's psychosexual stage of development oral stage primary means of discharging drives and achieving gratification - - -sucking, chewing, feeding, crying Freud's psychosexual stage of development oral stage psych disorder linked to failure of stage - - - schizophrenia, substance abuse, paranoia Freud's psychosexual stage of development anal stage age - - -18 months-3 years Freud's psychosexual stage of development anal stage primary means of discharging drives and achieving gratification - - -sphincter control, activities of expulsion and retention Freud's psychosexual stage of development anal stage psych disorder linked to failure of stage - - - depressive disorder Freud's psychosexual stage of development phallic stage age - - -3-6 yearsFreud's psychosexual stage of development phallic stage primary means of discharging drives and achieving gratification - - -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 - - -sexual identity disorders Freud's psychosexual stage of development latency stage age - - -6years-puberty Freud's psychosexual stage of development latency stage primary means of discharging drives and achieving gratification - - -peer relationships, learning, motor-skills development, socialization Freud's psychosexual stage of development latency stage psych disorder linked to failure of stage - - - inability to form social relationships Freud's psychosexual stage of development genital stage age - - -puberty forward Freud's psychosexual stage of development genital stage primary means of discharging drives and achieving gratification - - -integration and synthesis of behaviors from early stages, primary genitalbased sexuality Freud's psychosexual stage of development genital stage psych disorder linked to failure of sage - - - sexual perversion disorders Cognitive Theory - - --Piaget - four stages of development Piaget developmental stage sensorimotor age - - -birth-2 years Piaget developmental stage sensorimotor - - -the critical achievement of this stage is object permanence Piaget developmental stage preoperational age - - -2-7 yearsPiaget developmental stage preoperational - - -more extensive use of language and symbolism magical thinking Piaget developmental stage concrete operations age - - -7-12 years Piaget developmental stage concrete operations - - -child begins to use logic develops concepts of reversibility and conservation Piaget developmental stage formal operations age - - -12 years-adult Piaget developmental stage formal operations - - -ability to think abstractly thinking operates in a formal, logical manner interpersonal theory - - --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 - - -interpersonal theory total components of personality traits two drives for behavior in interpersonal theory - - --the drive for satisfaction -the drive for security Freud's defense mechanisms - - --denial -projection-regression -repression -reaction formation -rationalization -undoing -intellectualization -suppression -sublimation -altruism Hierarchy of needs - - --Maslow -survival -safety and security needs -love and belonging -self-esteem -self-actualizaiton Sullivan's stage of interpersonal development infancy age - - -birth-18 months Sullivan's stage of interpersonal development infancy developmental task - - -oral gratification, anxiety occurs for the first time Sullivan's stage of interpersonal development childhood age - - -18 months- 6 years Sullivan's stage of interpersonal development childhood developmental task - - -delayed gratification Sullivan's stage of interpersonal development juvenile age - - -6-9 years Sullivan's stage of interpersonal development juvenile developmental task - - -forming peer relationshipsSullivan's stage of interpersonal development preadolescence age - - -9-12 years Sullivan's stage of interpersonal development preadolescence developmental task - - -same-sex relationships Sullivan's stage of interpersonal development early adolescence age - - -12-14 years Sullivan's stage of interpersonal development early adolescence developmental task - - -opposite- sex relationships Sullivan's stage of interpersonal development late adolescence age - - -14-21 years Sullivan's stage of interpersonal development late adolescence developmental taks - - -self-identity developed Health Belief Model - - -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 - - -states that change such as in health bx occurs in 6 predictable stages -precontemplation -contemplation -preparation-action -maintenance motivational interviewing - - -miller and rollnick -focused, goal-directive therapy -motivation is elicited from the client -nonconfrontational, nonadversarial self-efficacy and social learning theory - - --albert bandura -behavior is the result of cognitive and environmental factors theory of cultural care - - --madeline Leininger -regardless of the culture, care is the unifying focus and the essence of nursing theory of self-care - - -Dorothy orem -self care therapeutic nurse-client relationship theory or interpersonal theory - - -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 - - --orientation -working phase (identification, exploration) -termination phase (resolution) caring theory - - -jean Watson caring is an essential component of nursingt test - - -assesses whether the means of two groups are statistically different from each other analysis of variance (ANOVA) - - -tests the difference among three or more groups pearson's r correlation - - -tests the relationship between two variables probability - - -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 - - -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 - - -structure, process, outcome process of quality improvement PDSA cycle - - -Plan Do Study Act monoamines - - --biogenic amines -dopamine -norepinephrine -epinephrine -serotonin dopamine - - --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 - - --mesocortical -mesolimbic -nigrostriatal -tuberoinfundibular norepinephrine - - --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 - - --catecholamine -produced by the adrenal glands -referred to as the adrenergic system serotonin - - --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 - - -glutamate, aspartate, gamma-aminobutyric acid (GABA), glycine glutamate - - --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 - - -another excitatory neurotransmitter -works with glutamate GABA - - -universal inhibitory neurotransmitter -site of action of benzos, alcohol, barbiturates, and other CNS depressants -GABAa and GABAb receptors glycine - - --another inhibitory neurotransmitter -works with GABA cholinergics - - -acetylcholine acetylcholine - - -synthesized by the basal nucleus of Meynert -precursors are acetylcoenzyme A and choline -nicotinic and muscarinic receptors neuropeptides - - --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 - - -thinking decision making reward-seeking behaviorfine muscle action integrated cognition dopamine symptoms of deficit - - -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 - - --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 - - -alertness focused attention orientation primes fight or flight learning memory norepinephrine symptoms of deficit - - --dullness, low energy, depressive affect -depression norepinephrine symptoms of excess - - --anxiety, hyper alertness, increase startle, paranoia, decreased appetite -anxiety serotonin general function - - -regulation of sleep pain perception mood statestemperature regulation of aggression libido precursor for melatonin serotonin symptoms of deficit - - -irritability, hostility, depression, sleep dysregulation, loss of appetite, loss of libido OCD, anxiety disorders, schizophrenia serotonin symptoms of excess - - -sedation, increased aggression, hallucinations (rare) acetylcholine general function - - -attention, memory, thirst, mood regulation, REM sleep, sexual behavior, muscle tone acetylcholine symptoms of deficit - - -lack of inhibition, decreased memory, euphoria, antisocial action, speech decrease, dry mouth, blurred vision, constipation alzheimers dx acetylcholine symptoms of excess - - -overinhibition, anxiety, depression, somatic complaints, selfconsciousness, drooling, EPS parkinsonian symptoms GABA general function - - -reduces arousal, reduces aggression, reduces anxiety, reduces excitation GABA symptoms of deficit - - -irritability, hostility, tension and worry, anxiety, seizure activity anxiety disorders GABA symptoms of excess - - -reduced cellular excitability sedation impaired memoryglutamate general function - - -memory, sustained automatic functions glutamate symptoms of deficit - - -poor memory, low energy, distractible learning difficulty, negative symptoms of schizophrenia glutamate symptoms of excess - - -kindling, seizures, anxiety or panic bipolar affective disorder, psychosis from ischemic neurotoxicity or excessive pruning peptides opioid type general function - - -modulate emotions, reward center function, consolidation of memory, modulate reactions to stress peptides opioid type symptoms of deficit - - -hypersensitivity to pain and stress decreased pleasure sensation dysphoria substance abuse peptides opioid type symptoms of excess - - -insensitivity to pain catatonic-like movement disturbance auditory hallucinations decreased memory structural imaging - - -provides evidence of size and shape of anatomical structure -computed tomography CT -Magnetic resonance imaging MRI computed tomography CT - - -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) - - -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 - - -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 - - -least expensive test convey info on electrical functioning of CNS Magnetoencephalography MEG - - -similar to EEG detects different electrical activities used in complementary fashion with EEG testing single photon emission computed tomography (SPECT) - - -information of cerebral blood flow limited available expensivepositron emission tomography PET - - -images of brain when positron-emitting radionuclei interact with an electron expensive combined structural and functional testing - - -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 - - -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 - - -20-25 overweight BMI - - -26-29 obese BMI - - -30-35 what to watch for if on psychtropics such as carbamazepine (Tegretol) or clozapine - - -elevated temp agranulocytosis steven Johnson syndrome med risk - - -carbamazepine or lamotrigine blurry vision side effect in psychotropics - - -anticholinergic side effect Seroquel may cause cataractswhat can both lithium and anorexia nervosa cause - - -peripheral edema Free thyroxine T4 normal levels - - -0.8-2.8ng/dL interfering factors of Free T4 - - -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 - - -lithium systemic effects of hypothyroidism - - -decreased T4 and increased TSH mimics symptoms of unipolar mood dx systemic effects of hyperthyroidism - - -increased T4 and decreased TSH may mimic symptoms of bipolar affective disorders interfering factors of calcium levels - - -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 - - -excitability interfering factors of magnesium levels - - -values can be increased by drugs such as antacids, laxatives containing mg, salicylates, and lithium interfering factors of ALT levels - - -values can be increased with Tylenol, allopurinol, aspirin, ampicillin, carbamazepine, cephalosporins, codeine, digitalis, indomethacin, heparin, isoniazid, methotrexate, methyldopa, oral contraceptives, phenothiazines, propranolol, tetracycline, and verapamilGGT is used to evaluate and monitor clients with what - - -known or suspected alcohol abuse levels rise even after ingestion of small amounts of alcohol primary preventions - - -aimed at decreasing the incidence (number of new cases) of mental disorders helping people avoid stressors or cope with them more adaptively secondary prevention - - -aimed at decreasing the prevalence (number of existing cases) of mental disorders early case finding screening prompt and effective tx tertiary prevention - - -aimed at decreasing the disability and severity of mental disorder rehabilitative services avoidance or postponement of complications drug steady state - - -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 - - -decrease the serum level of other drugs that are substrates of that enzyme possibly causing subtherapeutic drug levels CP450 inhibitors - - -bupropion clomipramine cimetidine clarithromycin fluoroquinolones grapefruitketoconazole nefazodone SSRIs CP450 inducers - - -carbamazepine hypericum/ st johns wort phenytoin phenobarbital tobacco enzyme inhibitors can - - -increase the serum level of other drugs that are substrates of that enzyme possibly causing toxic levels agonist effect - - -Drug binds to receptors and activates a biological response inverse agonist effect - - -Drug causes the opposite effect of agonist; binds to same receptor partial agonist effect - - -drug does not fully activate the receptors antagonist effect - - -Drug binds to the receptor but does not activate a biological response schedule 1 drugs - - -nonmedicinal substances high abuse potential used for research only not available by prescription heroin and marijuana typical antipsychotics - - -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 - - -clozapine (Clozaril) ziprasidone (Geodon) risperidone (Risperdal) quetiapine (Seroquel) olanzapine (Zyprexa) aripiprazole (abilify) paliperidone (Invega) iloperidone (fanapt) asenapine (saphris) lurasidone (luatuda) mood stabilizers - - -valproic acid (depakene) divalproex sodium (Depakote) lithium carbonate (eskalith, lithobid, lithonate, lithotabs) lamotrigine (lamictal) carbamazepine (tegretol) carbamazepine ER (equetro) oxcarbazepine (Trileptal; off label) Tricyclics - - -clomipramine (anafranil) amoxapine (asendin)amitriptyline (Elavil) desipramine (norpramin) nortripyline (pamelor) doxepin (sinequan) trimipramine (surmontil) imipramine e(tofranil) protriptyline (vivactil) Serotonin selective reuptake inhibitors SSRIs - - -citalopram (celexa) fluvoxamine (Luvox) paroxetine (paxil) paroxetine mesylate (pexeva) fluoxetine Prozac) sertraline (Zoloft) escitalopram (Lexapro) Monoamine oxidase inhibitors MAOIs - - -phenelzine (nardil) tranylcyprmie sulfate (parnate) selegiline transdermal (EMSAM) SNRIs and other agents - - -trazodone (Desyrel) venlafaxine (Effexor) desvenlafaxine (Pristiq) mirtazapine (Remeron) nefazodone (serzone) bupropion (Wellbutrin, Forfivo, Aplenzin) duloxetine (Cymbalta) vilazodone (viibryd) vortioxetine (brintellix)levomilnacipran (Fetzima) Benzodiazepines BNZs - - -lorazepam (Ativan) clonazepam (klonopin) chlordiazepoxide (Librium) oxazepam (serax) clorazepate (tranxene) alprazolam (xanex) anxiolytics - - -buspirone (buspar) other agents to tx anxiety dx - - -propranolol (Inderal) atenolol (Tenormin) stimulants - - -amphetamine/destroamphetamine (Adderall) dexmethylphenidate (focalin) dextroamphetamine (Dexedrine) methylphenidate (Ritalin) lisdexamfetamine dimesylate (Vyvanse) other ADHD and ADD agents - - -guanfacine (intuniv) clonidine (kapvay) atomoxetine (Strattera) antidepressants such as desipramine (norpramin), venlafaxine (Effexor), and bupropion (Wellbutrin) are also used schedule II drugs - - -medicinal drugs in current use high potential for abuse and dependency written script onlyno 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 - - -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 - - -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 - - -lowest abuse potential handled similar to noncontrolled drugs buprenorphine (buprenex), cheratussin (robitussin) with codeine, promethazine (Phenergan) with codeine, diphenoxylate/atropine (Lomotil) pregnancy category A - - -Controlled studies show no risk pregnancy category B - - -no evidence of risk to humans pregnancy category C - - -risk cannot be ruled out pregnancy category D - - -Positive evidence of isk Pregnancy category X - - -absolutely contraindicatedteratogenic risks of benzos - - -floppy baby syndrome cleft palate teratogenic risks of carbamazepine (tegretol) - - -neural tube defects teratogenic risks of lithium (Eskalith) - - -Epstein anomaly teratogenic risks of divalproex sodium (Depakote) - - -neural tube defects specifically spina bifida atrial septal defect cleft palate possible long term developmental deficits med that can induce depression - - -beta blockers steroids interferon isotretinoin (Accutane) some retroviral drugs antineoplastic drugs benzos progesterone meds that can induce mania - - -steroids disulfiram (Antabuse) isoniazid (INH) antidepressants in persons with BP meds that can cause false positives for amphetamines - - -stimulants WellbutrinProzac trazodone ranitidine nefazodone (serzone) nasal decongestants pseudoephedrine meds that can cause false positives for alcohol - - -valium meds that can cause false positives for benzos - - -zoloft meds that can cause false positives for cocaine - - -amoxicillin most antibiotics NSAIDS meds that can cause false positives for heroin or morphine - - -quinolones rifampin codeine poppy seeds meds that can cause false positives for methadone or PCP - - -OTC cough meds (Nyquil) dextromethorphan psychoanalytic therapy - - -Freud promotes change by development of greater insight and awareness of maladaptive defenses Cognitive therapy - - -Aaron Beck goal is to change clients irrational beliefs, faulty conceptions, and negative cognitive distortionsbehavioral therapy - - -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 - - -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 - - -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 - - -viktor frankl goal to live authentically and to focus on the present and on personal responsibility humanistic therpay - - -carl rogers person-centered therapy self directed growth and self actualization people are born with capacity to direct themselves toward self actualization interpersonal therapy - - -Gerald klerman and myrna Weissman evidence based therapy focus on interpersonal issues creating distress time limited, active, focus on the present and on interpersonal distresseye movement desensitization and reprocessing EMDR - - -Francine shapiro behavioral and exposure therapy PTSD goal to achieve adaptive resolution 3 phases of EMDR - - -desensitization phase installation phase body scan group phases - - -pregroup phase forming phase storming phase norming phase performing phase adjourning phase family systems therapy - - -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 - - -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 - - -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 memberoverall goal is growth rather than symptom reduction alone does not focus on particular techniques strategic therapy - - -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 - - -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 - - -used for ADHD, dyslexia, cognitive impairment, dementia, CVD, asthma, lupus, and rheumatoid arthritis interacts with warfarin Sam-e supplement - - -used for depression, osteoarthritis, and liver dx may cause hypomania, hyperactive muscle movements, and possible serotonin syndrome tryptophan supplement - - -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 - - -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 - - -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 dosesfish oil supplement - - -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 - - -menopausal symptoms PMS dysmenorrhea belladonna herbal use - - -anxiety catnip herbal use - - -sedation chamomile herbal use - - -sedation anxiety ginkgo herbal use - - -delirium, dementia, sexual dysfunction caused by SSRIs Ginseng herbal use - - -depression fatigue valerian herbal use - - -sedation MDD object loss theory - - --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 - - --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 - - --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 - - -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 - - -having a depressed parent is the single strongest predictor of depression MDD endocrine dysfunction theory - - -HPA axis result of abnormal stress response related to HPA dysregulation MDD abnormalities of neurotransmitter function theory - - -dysregulation of dopamine, serotonin, and norepinephrine MDD structural brain changes - - -hypovolemic hippocampushypovolemic prefrontal cortex-limbic striatal regions MDD chronobiological theory - - -desynchronization of circadian rhythms produces the symptoms constellation collectively called MDD DSM MDD diagnostic criteria - - --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 - - -increasing serotonin levels TCAs act on - - -elevating serotonin and norepinephrine levels MAOIs act on - - -elevating serotonin and norepinephrine levels SNRIs act on - - -inhibiting dual reuptake of norepinephrine and serotonin citalopram (celexa) - - --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) - - --SSRI -tablet -10-20mg/day -SE: somnolence, headache, sexual dysfunction, GI disturbances -prego C -Lact L2 fluoxetine (Prozac) - - --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) - - --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) - - --SSRI -tablet or liquid -20-60mg/day -SE: headache, GI disturbances, somnolence, sexual dysfunction -Prego D -Lact L2 -Discontinuation syndrome very common Sertraline (Zoloft) - - --SSRI -tablet -50-200mg/day -SE: sexual dysfunction, GI disturbances, somnolence, headache -Prego C -Lact L2 Vilazodone (Viibryd) - - --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) - - --TCA -tablet or IM -50-300mg/day -also used for chronic pain (particularly neuropathic pain), insomnia-Prego C -Lact L2 clomipramine (Anafranil) - - --TCA -Capsule -100-250mg/day -approved for OCD -250mg/day maximum d/t increased seizure risk -Prego C -Lact L2 Desipramine (Norpramine) - - --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) - - --TCA -Capsule or liquid -100-300mg/day -also used for insomnia -Prego C -Lact L5 AVOID imipramine (Tofranil) - - --TCA -Tablet, capsule, or IM -100-300mg/day -also used for enuresis and separation anxiety-Prego D -Lact L2 Nortriptyline (Pamelor) - - --TCA -capsule or liquid -50-150mg/day -also used for enuresis and ADHD -Prego D -Lact L2 Protriptyline (Vivactil) - - --TCA -tablet -15-60mg/day -Prego C -Lact inadequate data Trimipramine (Surmontil) - - --TCA -Capsule -100-300mg/day -Prego C -Lact inadequate data norepinephrine dopamine reuptake inhibitors NDRIs act on - - -reuptake of norepinephrine and dopamine Serotonin agonist and reuptake inhibitors SARIs act on - - -agonist of serotonin 5HT2 receptors and elevate serotonin levels Isocarboxazid (Marplan) - - --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) - - --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) - - --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) - - --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 - - -SSRIs second line drugs for treating MDD - - -TCAs TCA side effects - - --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 - - -dry m