Psychiatric Nurse Practitioner Assessment Spring 2022 (100% Verified)

Psychiatric Nurse Practitioner Assessment Spring 2022 (100% Verified) Explain the clinical signifcance of the Stystematic Treatment Enhancement Program for Bipolar Disorder: STEP-BD) - ✔✔As more contempts are tried wi ...

Psychiatric Nurse Practitioner Assessment Spring 2022 (100% Verified) Explain the clinical signifcance of the Stystematic Treatment Enhancement Program for Bipolar Disorder: STEP-BD) - ✔✔As more contempts are tried with SSRIs to relieve depressive symptoms, the client becomes more treatment resistant leading to poor outcomes. Explain the clinical significance of the Sequenced Treatment Alternative to Relieve Depression STAR D - ✔✔Strong behavioral therapy combined with medications lead to 30% better outcomes as compared to monotherapy or medication or therapy alone. Describe the mechanism of action of Typical Antipsychotics - ✔✔Blocking D2 receptors in the mesolimbic and mesocortical The Blocking D2 receptors in the mesolimbic and mesocortical tract - ✔✔tract reducing positive symptoms of psychosis, does effect the negative symptoms of the disorder, can create EPS symptoms in the nigro-striatal tract, Nigrostriatal - ✔✔involved with muscular movement Mesolimbic - ✔✔source of visual hallucinations and auditory hallucinations, Mesocortical - ✔✔mesocortical area holds affective symptoms, Second generation antipsychotics are pharmacology directed to - ✔✔blocking both D2 and 5HT receptors in the brain and also relieve the negative symptoms of psychosi down regulation blocking Alpha ! receptors - ✔✔Orthostatic hypotension and dizziness which comes down regulation of blocking Muscarinic and Histamine receptors - ✔✔Weight gain, dizzinessserontin down regulation in the gut - ✔✔constipation Neuroleptic malignant syndrome - ✔✔cause by increased medication changes or treatment naive patients What are notable side effects of Clozapine - ✔✔Induced by cigarette smoking which is through the 1A2 pathway Recommended dosing schedule for clozapine - ✔✔Start at 12.5 first day, then in divide doses of 25-50 mg/day up to 300-400 mg per day. Clozapine maxes - ✔✔Maximum dose is 900 mg per day. No single dose should exceed 450 mg Clozapine monitoring - ✔✔Need to register at the clozapine website as a provider Normal levels of WBCs > 3500 Normal levels of ANC > 2000 wbc - ✔✔WBC with differentials, Absolute Neutrophil Count Blood draws are done weekly for the first 6 months, then every other week for 6 months, then monthly Notable side effects of Risperidone - ✔✔Increase risk of seizure Contraindicated for pregnancy Increased prolactin Metabolic syndrome diagnostic criteria - ✔✔Combination of any three of the following Abdominal circumference > 37 in males > 31.5 in femaies Plus any two of the following: Elevated Triglycerides > 150 mg/dlHDL less than 40 mg/dl in men, 50 mg/dl in women Blood pressure >130/85, or receiving treatment for hypertension Fasting blood sugar >110 mg/dl or prior type of DM diagnosis A weight increase of 7% should prompt the provider - ✔✔to consider a different medication. Neuroleptic Malignant Syndrome criteria - ✔✔Within 2 weeks of beginning the medication or a significant medication increase / or present with abrupt withdrawal of levodopa or exposure to a dopamine agonist Classic triad: - ✔✔Hot, Stiff, and Out of it: includes extreme mental status change/confusion, extreme muscle rigidity, and extremem autonomic instability/hyperthermia: What is the appropriate treatment for Neuroleptic Malignant Syndrome - ✔✔Dantrolene bromocriptine to relieve rigidity How are TCA metabolized - ✔✔the 2D6 pathway The importance of TCA to be aware of: - ✔✔Toxicity causes heart block, torsade de pointes arrythmia or sudden death Monoamine Oxidase Inhibitor (MAOIs) concern for treatment - ✔✔Low tyramine diet including red wine, cheese, processed foods, causes a hypertensive crisis (high blood pressure) Buproprion - ✔✔Can lower the seizure threshold, should avoid in children and the elderly, NDRI class Fluoxetine (Prozac) - ✔✔Longer half life 36-40 hours Paroxetine (Paxil) - ✔✔known for withdrawl symptoms if not taken regular, short half-life, good for anxiety disordersCitalopram (Celexa) - ✔✔cardiac effect may require decreased doses (QT prolongation) do not go over 40 mg/day Trazodone - ✔✔Can cause priaprism Sertraline (Zoloft) - ✔✔Dose dependent, need to increase the dose Venlafaxine - ✔✔Elevated blood pressure Signs and symptoms of serotonin syndrome - ✔✔High serotonin levels can cause agitation, confusion, hallucinations, tachycardia, fever, anxiety, muscle rigidity, hyperreflexia, tremors, diarrha, hypo/hypertension Treatment for Serontonin Syndrome - ✔✔Withdraw from the SSRI, Stabilizing temperature, Use benzodiazepines for muscle relaxation, Beta-blocker for the tachycardia Notable side effects of Lithium - ✔✔Muscle weakness, tiredness, slurred speech, fine hand tremor, thirst nausea, diarrhea / vomiting Maintenance value for Lithium is - ✔✔0.8 to 1.0 When do you check the Lithium level - ✔✔Check serum level 12 hours after the last dose and after 5 days of steady dosing.What antipsychotic can not be used with Lithium - ✔✔Haldol, linked to mild encaphalopathy and mimics NMS Lithium is contraindicted in pregnancy- why - ✔✔causes Epstein anomaly, heart defect in the fetus Depakote is contraindicted in pregnancy- why - ✔✔Birth defects: spina bifida are found in this medication What over the counter pain relievers can be used with lithium - ✔✔aspirin and tylenol What over the counter pain reliever is contraindicated - ✔✔ibuprofen What diuretic should be avoided with the use of the Lithium - ✔✔Thiazides, but all diuretics should be monitored closely due to risk of toxicity What heart medicines are contraindicated with lithium - ✔✔calcium channel blocker are contraindicated with this mood stabilizer Notable side effect of depakote - ✔✔hair loss, alopecia ADHD medication targets - ✔✔accelerating "slow rate behaviors" such as paying attention and sitting still, Blocks the reuptake of the dopamine Stress Diathesis Model - ✔✔vulnerability, inheritted vulnerability when acted on by a stressor produces the disease/dysfunction Criteria for Generalized Anxiety Disorder (GAD) - ✔✔Present more days than not for 6 months Must have 3 or more symptoms causes impairmentCriteria for Panic Disorder - ✔✔Intense state, must have at least 4 of the symptoms: "I am going to die" palpatations, need to rule out a heart condition Phobias criteria - ✔✔intense, irrational, avoidance is persistent last 6 months, fear is out of proportion to the situation Obsessive/compulsive Disorder critieria - ✔✔Presence of obsessions, compulsions, or both, body dysmorphic falls into this category Major Depression stats - ✔✔Present in 3-5% of the population, Affects women more than men, Affects women when menstruating, Higher incidence in lower economic status, Single and divorced individuals Bipolar stats - ✔✔Affects men and women equally, Mania more common in men, Lower incidence in higher socioeconomic class Diagnostic for Season Affective Disorder - ✔✔Two episodes in 2 years of depression related to the season Onset of Major Depressive Disorder - ✔✔More than 50% experience depression before age 40, Peak hits at age 26. Depression in adolesence indicates a bi-polar disorder Later onset associated with antisocial/substance abuse Define the phases of treatment for Depression - ✔✔Goal is to achieve remissionAcute phase of depression is over when - ✔✔there have been 3 weeks of absence of sad mood and reduced interest And there are no more than the three following remaining symptoms - ✔✔insomnia, vegetative symptoms, appetite Define the continuation phase of Depression treatment - ✔✔Montior for early signs of relapse, meds 4- 9 months, with therapy recommended in conjunction Sustained remission - ✔✔it is gone, not just a response Response definition - ✔✔some symptoms such as vegetative symptoms are gone but other symptoms remain. ' Remission definition - ✔✔that all symptoms are gone for at least 3 weeks If remission is not achieved, what are the implications - ✔✔More significant psycho-social disability, Three times faster to relapse, Mild residual symptoms indicate an increase risk for relapse Define the maintenance phase of Depression treatment - ✔✔Prevent reoccurrence, 50-80% of the population will have a reoccurrance Increase risk of affective episodes such as mania or hypomania Define the discontinuation phase of Depression treatment - ✔✔12 months or longer with no symptoms before discontinuing medication What group poses the greatest risk for suicide? - ✔✔Bipolar disorderBipolar I prevalence in the population - ✔✔1%-1.5% of the population and is equal among men and women Bipolar II prevalence in the population - ✔✔0.5% of the population and is predominately female Define a manic episode - ✔✔distinct period last 7 days and hospitalization is necessary, STOP LISTENING HERE - ✔✔STOP LISTENING HERE Define a hypo-manic episode - ✔✔distinct period lasting 4 days, does not require hospitalization, but may be indicative of a mood disorder Defining factor of Bipolar II - ✔✔at least one hypomaniac episode Lithium bipolar profile - ✔✔Indicated for mania Lithium dosage 200-2400 mg/day Takes 5-10 days Blood level acute (0.8-1.5) Blood level maintenance (0.6-1.2) watch for side effects Valproic Acid (Depakene) / Divalproex (Depakote) bipolar profile - ✔✔Often used in addition to lithium Side effects are hair loss (use zinc and selenium supplements) Lamotrigine bipolar profile - ✔✔Typically given in dose packs when titrating Depakote interactions: the lamotrigine raises the level of depakote, do not exceed 200 mg of depakote, this should be avoidedIndicated for managing depression lamictal - ✔✔10% incidence of rash and can develop into Stevens-Johnson Syndrome 20% of the Asian population contain a gene that cannot metabolize this drug effectively, genetic testing is required Anorexia prevalence in the population is: - ✔✔0.9% and is more female than male 9:1, age of onset is 12 to 16 years of age (puberty) Hallmark features of anorexia - ✔✔starvation, amenorrhea is common but a diagnostic, can vomit and laxatives, but the main way is through starvation Bulemia hallmark feature - ✔✔use of vomiting an laxatives to control the weight is the primary way of weight loss rathar than restricting Personality disorders At least once a week for 3 months Metabolic syndrome in labs results Binge eating disorder hallmark feature - ✔✔Similar symptoms of other eating disorders but lack the vomiting or laxative to control the weight. The client is often over weight At least two binge episodes per week for 3 months Labs for eating disorder - ✔✔Fluid and electrolyte imbalances Inflammation ESR Cardiac (low potassium) leading cause of deathTSH imbalance Low sodium in bulemia Chloride (up in bulemia) CO2 is down Eating Disorder treatment in acute - ✔✔Restore electrolye balance Correct body disturbance Create healthy coping mechanisms In the treatment of an Eating disorders which are mainly treating - ✔✔The co-morbidity such as depression with SSRI, GAD with benzodiazepine Hospitalization is required for an eating disorder when: - ✔✔Weight loss is greater 30% or BMI is 16 Heart rate less than 50 beats per minute Altered mental status Orthostatic hypotension Suicidal Electrolyte imbalances Schizphrenia incidence and prevalence: - ✔✔The disorder affects 1.3% of the population and occurs equally among men and women. Onset happens in the early 20's for men and later 20's for women Schizophrenia suicide rates and healthcare costs - ✔✔It has the second highest suicide rate, bipolar is first. The disorder takes approximately 75% of the mental health dollars. the success rate of suicide is 5- 6% The four phases of Schizophrenia - ✔✔Premorbid: delayed motor mielstones, poor school perfromance, reduced concentration and motivation, depressent, sleep disturbance, bedwetting, social withdraw2 - ✔✔Prodromal: pecular behavior, speech is difficult, odd ideas, feeling of unreality, suspciciousness, deterioration in role functioning, beginning of psychosis 3 - ✔✔Acute: delusions, auditory, agresssion, agitation, catatonic, disorganized thinking, catatonic, 4 - ✔✔Stable or residual: similar to predisposing Schizophrenia genetics predisposing factors - ✔✔Has a 81% heritability 48% risk if the other twin has schizophrenia Fraternal twins and other siblings 9-17% Children of one parent 13% risk Child of two parents of schizophrenia 27-35% General population 1.3% Rating scales and assessment for Psychotic Disorder - ✔✔Brief Psychiatric Rating scale Positive and Negative Symptoms Scale Content of Thought regarding psychosis - ✔✔Delusions Religiosity Paranoia Magical thinking: posses magical powers Form of thought regarding pyschosis: terms - ✔✔Assoicative looseness Neologisms: made up words Concrete thinking: black and white thinking Clang association: sing-song words Word salad: words that are put together and do not make sense Circumstatntiality TagnentialityMutism Perseveration: repeat of a word, phrase, or gesture, desipte the absence ro cessation of the stium Form of thought regarding pyschosis: terms - ✔✔Assoicative looseness Neologisms: made up words Concrete thinking: black and white thinking Clang association: sing-song words Word salad: words that are put together and do not make sense cont - ✔✔Circumstatntiality Tagnentiality Mutism Perseveration: repeat of a word, phrase, or gesture, desipte the absence ro cessation of the stium Form of thought regarding pyschosis: terms - ✔✔Assoicative looseness Neologisms: made up words Concrete thinking: black and white thinking Clang association: sing-song words Word salad: words that are put together and do not make sense Circumstatntiality Tagnentiality Mutism Perseveration: repeat of a word, phrase, or gesture, desipte the absence ro cessation of the stium Form of thought regarding pyschosis: terms - ✔✔Assoicative looseness Neologisms: made up words Concrete thinking: black and white thinking Clang association: sing-song words