LMR - Georgette's (GRADED A) Georgette's PMHNP Certification Exam TESTBANK

What drugs should be avoided with Kava Kava? Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) Cultural Formulation Interview perform what 3 functions? Clarify meaning of illness Empower the patient Va ...

What drugs should be avoided with Kava Kava? Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) Cultural Formulation Interview perform what 3 functions? Clarify meaning of illness Empower the patient Validate symptoms within cultural context What does a cultural formulation interview do? cultural assessment What is the normal range for TSH? 0.5 - 5.0 mu/L What are lab values in Hyperthyroidism Decreased TSH Increased T4 and T3 What are labs in Hypothyroidism? Increased TSH Decreased T4 and T3 What are 5 primary symptoms of Hyperthyroidism? Heat intolerance Agitation, Anxiety, Irritability Tachycardia Mood swings Weight loss What are 4 primary symptoms of Hypothyroidism? Cold intolerance Lethargy Weight gain Decreased libido Hypothyroidism mimics symptoms of what psychiatric disorder? Depression Hyperthyroidism mimics symptoms of what psychiatric disorder? Mania Valproic acid produces what teratogenic effect? Spina bifida (neural tube defect) What is the primary organ where valproic acid is toxic? Liver (hepatoxicity) What are 4 signs of hepatoxicity? Abdominal pain in the URQ Reddish-brown urine Yellowing of the skin and sclera Fatigue Abdominal pain in the URQ, Reddish-brown urine, Yellowing of the skin and sclera, and Fatigue are signs of Hepatoxicity What is the therapeutic range for valproic acid? 50-125 mcg/ml What is a toxic level of valproic acid? >150 mcg/ml What are 4 signs of valproic acid toxicity? Disorientation Lethargy Respiratory depression Nausea/vomiting Disorientation, Lethargy, Respiratory depression, and Nausea/vomiting are symptoms of toxicity with what drug? Valproic acid With suspected toxicity with valproic acid, what labs should be drawn? DC drug Check drug level Obtain LFTs Obtain ammonia level What is the major side effect with Kava Kava? Liver damage What herbal supplement is sued for anxiety, stress, and insomnia? Kava Kava What are 5 symptoms of Stephen's Johnson Syndrome? Fever Body aches Severe red rash Peeling skin Facial and tongue swelling Severe red rash, Fever, Body aches, Peeling skin, and Facial and tongue swelling are symptoms of Stephen's Johnson Syndrome Which mood stabilizer causes the least weight gain? Lamotrigine (Lamictal) Which 3 SGAs cause the least weight gain? Lurasidone (Latuda) Aripiprazole (Abilify) Ziprasidone (Geodon) Which SGA is the least sedating? Aripiprazole (Abilify) What are 3 hallmark symptoms of delirium? Acute disturbance of LOC impaired cognition inattention Acute disturbance of LOC, cognition, and inattention are hallmark symptoms of Delirium How are agitation and psychotic symptoms treated in delirium? Low dose Haldol What 4 drugs can cause mania? Steroids Disulfiram (Antabuse) Isoniazid (INH) Antidepressants (in BPD) Steroids, Disulfiram (Antabuse), and Isoniazid (INH) can induce Mania What 6 drugs can induce depression? Steroids Beta blockers Interferon, Isotretinoin (Accutane) Retroviral drugs, Antineoplastic drugs Benzodiazepines Progesterone Steroids can induce what 3 psychiatric states? Mania Depression Psychosis What medication to treat acne cause cause birth defects? Isotretinoin (Accutane) What is the therapeutic range for lithium? 0.6-1.2 mEq/L What medication has a neuroprotective effect for bipolar disorder? Lithium What is the gold standard for treating manic episodes Lithium What mood stabilizer has anti-suicidal effects? Lithium What 5 labs should be drawn with lithium? Thyroid panel (TSH) Serum creatinine BUN Urinalysis HCG What is a normal SCr range? 0.6-1.2 mg/dL What is the normal range for BUN? 10-20 mg/dL When should you suspect kidney disease with a urinalysis? 4+ protein 4+ protein in the kidney suggests Kidney disease What are 7 side effects of lithium? Hypothyroidism Fine hand tremors Maculopapular rash GI upset (N/V/D, cramps, anorexia) Polyuria, polydipsia, diabetes insipidus T-wave inversions Leucocytosis What are 7 signs of lithium toxicity? Severe nausea, vomiting, diarrhea Confusion Drowsiness Muscle weakness Heart palpitations Coarse hand tremor Unsteadiness while standing or walking Which 3 drugs can increase lithium levels by decreasing renal clearance? NSAIDs (ibuprofen, indomethacin) Thiazides ACEI What is a toxic level of lithium? 1.5 mEq/L or higher At what level do you monitor lithium closely (but not discontinue)? 1.3 mEq/L or higher With suspected lithium toxicity, what do you do first? Lithium level (not VS) What is the appropriate action if lithium level is 1.5 mEq/L? DC lithium Check lithium level What 2 conditions can increase lithium levels? Dehydration Hyponatremia What birth defect can lithium cause? Ebstein anomaly (congenital heart defect) What 3 neurotransmitters are associated with ADHD? DNS What 3 parts of the brain are affected with ADHD? Frontal cortex Basal ganglia Reticular Activating System The Frontal cortex, Basal ganglia, Reticular Activating System are associated with which psychiatric disorder? ADHD Inattentive Type ADHD demonstrates abnormalities in which part of the brain? Prefrontal cortex What should be done before placing a patient on stimulants for ADHD (priority)? Cardiac history Excessive worry, apprehension, or anxiety about events or activities that occurs more days than not for a period of at least 6 months is GAD If a patient is receiving Haldol 5 mg PO bid, how much Haldol Decanoate should they receive? 20 x 10 mg = 200 mg (q month) What is the formula for converting oral Haldol to depot form? 20 x daily dose What does thought process assess? thoughts and ideas The way a patient organizes his thoughts and ideas is called Thought process A normal thought process is described as Logical Linear Coherent Goal-oriented Moving from thought to thought and never getting to the point is called Tangentiality ("goes on tangent") Providing unnecessary detail but eventually getting to the point is called Circumstantiality ("goes in circles") Themes that occupy a patient's thoughts and perceptual disturbances is called Thought content Thought content includes 3 items Suicidal ideation Homicidal ideation Hallucinations/Delusions Asking a patient to count backward from 100 by seven (serial 7s) measures 3 processes Concentration Attention Calculation Asking the year, season, date, month, and location measures Orientation Asking a patient to repeat "bed, bad, ball" measures Registration (ability to learn new material) Asking a patient to repeat objects 5 minutes later measures Recall (memory) Asking the patient who is the president of the US or governor of state is measuring Fund of Knowledge What is a simple test that can be administered in a minute or two to measure possible dementia? Clock Drawing Test Impairments in the clock drawing test (CDT) can be associated with damage to Right parietal lobe (right hemisphere) Hyperactivity of dopamine in the mesolimbic pathway modulates positive psychotic symptoms Decreased dopamine in the mesocortical pathway (dorsolateral prefrontal cortex) leads to what 2 symptoms? Negative symptoms Depressive symptoms The nigrostriatal pathway modulates motor movements Dopamine has what type of relationship with acetycholine Inverse Dopamine blockage in the nigrostriatal pathway leads to what 4 side effects? Acute dystonia Parkinsonism syndromes Akathisia Tardive dyskinesia Blocking the tuberoinfundibular pathway leads to Increased prolactin What are 5 symptoms of hyperprolactinemia? Amenorrhea Galactorrhea Sexual dysfunction Gynecomastia Osteoporosis (Long-term) What antipsychotic has the greatest effect on prolactin? Risperidone What is the black box warning for carbamazepine? Agranulocytosis What are 8 symptoms of aplastic anemia? Pallor Fatigue Headache Fever Nosebleeds Bleeding gums Skin rash SOB Pallor, Fatigue, Headache, Fever, Nosebleeds, Bleeding gums, Skin rash, and SOB are symptoms of Aplastic anemia What ethnic group is most susceptible to SJS with carbamazepine? Asians Having the HLA-B*1502 allele increases the risk for SJS Which ethic group is at most likely to have the HLA-B*1502 allele? Asians Asians are most likely to have what allele? HLA-B*1502 In which ethnic group must you screen for the HLA-B*1502 allele before initiating therapy? Asian Which 2 drugs have the highest likelihood of causing agranulocytosis? Clozaril Carbamazepine A sudden fever, chills, a sore throat, and weakness are symptoms of Agranulocytosis What are 4 symptoms of agranulocytosis A sudden fever Chills Sore throat Weakness At what ANC should clozapine be stopped (even if asymptomatic)? <1000 What is neutropenia? <2000 PMNs What is agranulocytosis? <500 ANC What does DIGFAST stand for? Distractibility Indiscretion Grandiosity FOI Activity increased Sleep decreased Talkativeness What are 5 neurological symptoms in Conversion Disorder? Blindness Mutism Paralysis Paresthesia (glove stocking syndrome) Seizures When do symptoms typically begin with Conversion Disorder? After a stressful experience (suddenly) What are 5 stressful events in a child's life that can cause adjustment disorder? Family move Parent divorce/separation Loss of pet Birth of sibling Sudden or chronic illness A child with an Adjustment Disorder with disturbances of conduct may have what symptoms? Not going to school, destroying property, driving recklessly, or fighting What is the required duration of behavior for a DSM-5 diagnosis of Oppositional Defiant Disorder (ODD)? 6 months How many symptoms must a child with Oppositional Defiant Disorder (ODD) display to meet DSM-5 criteria? 4 An enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior is characteristic of Oppositional Defiant Disorder (ODD) What is the mainstay treatment of Oppositional Defiant Disorder (ODD)? Therapy What is the primary therapy used to treat Oppositional Defiant Disorder (ODD)? Child and parent problem-solving skills training A repetitive and persistent pattern of behavior in which the rights of others or societal norms or rules are violated is what disorder? Conduct Disorder What are 3 characteristics of Conduct Disorder? Destruction of property Deceit or theft Lack of remorse What 2 factors differentiate Conduct Disorder from ODD? Severity Aggression What are 4 pharmacologic treatments for Conduct Disorder? Antipsychotics Mood stabilizers SSRIs Alpha agonists What is the mainstay treatment for Conduct Disorder? Therapy What type of therapy is used in the treatment of Conduct Disorder? Behavioral therapy What is Multisystemic family therapy? Home-based model for youth with serious antisocial and criminal offenses by empowering parents with resources and skills and reducing barriers to resources needed for effective management of youth What is the goal of multisystemic family therapy (MFT)? Reduce barriers to resources for youth with problematic behavior What type of therapy target's youth who present with serious antisocial behavior? Multisystemic family therapy What is the moderate range for MMSE 10-20 What is the moderate range for SLUM? 10-20 What is the moderate range for HAM-D? 14-18 What is the moderate range for PHQ-9 10-14 What is the moderate range for BDI? 19-29 What is the moderate range for HAM-A? 18-24 What is the moderate range for GAD-7 10-14 What is the moderate range for COWS? 13-24 If a patient's COWS score is between 5 - 12, what do you do? Administer clonidine If a patient's COWS score is between 13 - 24, what do you do? Administer buprenorphine (Suboxone) When do you administer clonidine on the COWS? mild symptoms (>7) When do you administer buprenorphine (Suboxone) on the COWS? moderate symptoms (13-24) What is a moderate range on the CIWA? 16-20 When do you administer prn benzodiazepine on the CIWA? Mild symptoms (8 or greater) When do you administer scheduled benzodiazepine on the CIWA? moderate symptoms (15 or higher) If a patient has severe depression (over 18 on HAM-D) (over 14 on PHQ-9) (over 29 on BDI), how do you treat it? Medication and/or therapy Assess for suicidal ideation If a patient has moderate depression (14 - 18 on HAM-D) (10 - 14 on PHQ-9) (19 - 29 on BDI), how do you treat it? Medication and/or therapy If a patient has mild depression (<14 on HAM-D) (<10 on PHQ-9) (<19 on BDI), how do you treat it? Therapy or nothing If a patient has mild anxiety (<18 on HAM-A) (<10 on GAD-7), how do you treat? Therapy or nothing If a patient has severe anxiety (>24 on HAM-A) (>14 on GAD-7) how do you treat? Medication and/or therapy If a patient has moderate anxiety (18-24 on HAM-A) (10 - 14 on GAD-7) how do you treat it? Medication and/or therapy What are 4 areas in the brain that can cause aggression, impulsivity, and difficulty with abstract thinking? Prefrontal cortex Amygdala Basal ganglia Hippocampus Abnormalities in the Prefrontal cortex, Amygdala, Basal ganglia, and Hippocampus can cause what 3 symptoms? Aggression Impulsivity Difficulty with abstract thinking What are 6 symptoms of NMS? Extreme muscular rigidity Mutism Elevated CPK (creatine phosphokinase) Myoglobinuria Leukocytosis Elevated LFTs Extreme muscular rigidity, Mutism, Elevated CPK (creatine phosphokinase), Myoglobinuria, Leukocytosis, and Elevated LFTs are symptoms of NMS What are 2 symptoms of Serotonin Syndrome? Hyperreflexia Myoclonic jerks Hyperreflexia and myoclonic jerks are symptoms of Serotonin Syndrome How do you treat NMS? DC antipsychotic Bromocriptine or Dantrolene What does Dantrolene treat in NMS? Muscle rigidity How do you treat Serotonin Syndrome? DC Antidepressant Cyproheptadine What combination medications increases the risk of Serotonin Syndrome multiple antidepressants (SSRI/SNRI/TCA/MOAI) When switching from an MAOI to SSRI/SNRI, how long should you wait? 2 weeks When switching from Prozac to an MAOI, how long should you wait? 5-6 weeks When switching from Prozac to any antidepressant (TCA, SNRA, or MAOI), how long should you wait? 5-6 weeks When switching from an SSRI/SNRI to a MAOI, how long should you wait? 2 weeks What is the function of compulsions in OCD? Reduce subjective anxiety level What is PANDAS? Pediatric Autoimmune Neuropsychiatric Disorder associated with streptococcal infections in children If a child has both intrusive thoughts and tics, his most likely diagnosis is OCD If a child has multiple tics both no ruminating thoughts, his diagnosis is most likely Tourette's What 2 neurotransmitters are associated with OCD? Serotonin Norepinephrine A childhood depressive disorder that is diagnosed in children older than 6 but younger than 18 is most likely DMDD A child with chronic dysregulated mood ("mood"), frequent intense temper outbursts, severe irritability, and anger is most likely to have what diagnosis? DMDD The age criteria for a DSM-5 diagnosis of Disruptive Mood Dysregulation Disorder (DMDD) is >6 and <18 (7-17 yrs.) A child who is chronically "moody" is most likely to have what diagnosis? DMDD What are 2 symptoms associated with lead poisoning? Developmental delay (learning difficulties) Pica (paint chips) also gastrointestinal Which 2 demographic characteristics are associated with lead poisoning? rural areas 1970's A child with developmental delay who eats things (such as paint chips) may have Lead poisoning What 4 assessments should be done in a patient receiving an antipsychotic that causes weight gain? BMI Hip-to-waist ratio Glucose Lipid panel Where is norepinephrine produced? Locus coeruleus Medullary reticular formation The neurotransmitter produced in the locus coeruleus and medullary reticular formation is Norepinephrine What neurotransmitter is produced in the raphe nuclei in the brainstem? Serotonin Serotonin is produced in raphe nuclei in the brainstem What neurotransmitter is produced in the substantia nigra, the ventral tegmental area (VTA), and the nucleus accumbens? Dopamine What 3 areas of the brain is dopamine produced? Substantia nigra Ventral tegmental area (VTA) Nucleus Accumbens Where is acetylcholine synthesized? Basal nucleus of Meynert The Basal nucleus of Meynert is the area where what neurotransmitter is produced? Acetycholine What is the function of the amygdala? Emotions (aggression, fear, anxiety) Emotions (aggression, fear, and anxiety) originate from what area of the brain? Amygdala What are 4 functions of the hippocampus? Emotions Stress Learning Memory Emotions, stress, learning, and memory are functions of what structure of the brain? Hippocampus What disorder is associated with persistent deficits in social communication and social interactions across multiple settings? Autism Spectrum Disorder What 3 neurotransmitters are associated with Autism Spectrum Disorder? Glutamate GABA Serotonin A child who does not respond when called by name may have Autism A child that has little or no eye contact may have Autism A child who likes to line up, stack, or organize objects and toys in on tidy rows may have Autism What theory claims that dysfunction of a particular neuron system may be a cause of poor social interaction and cognition in autism? Broken Mirror Theory What is the DSM-5 criteria for number of tics in Tourette's Disorder? Motor: 2 or more and Vocal: 1 or more (not necessarily at same time) What are the DSM-5 criteria for the duration of symptoms in Tourette's Disorder? >1 year What is the age criteria for a DSM-5 diagnosis of Tourette's Disorder? <18 yrs What is the pharmacological treatment of Tourette's Disorder? Antipsychotic (haloperidol, pimozide, aripiprazole*) What are the 3 primary neurotransmitters involved in Tourette's Disorder? DNS What are 11 risk factors for suicide? Previous suicide attempt 45 and older (55 for women) Divorced, single, or separated White (Caucasian) Living alone Psychiatric disorder Physical illness Substance abuse Family history of suicide Recent loss Male gender What age is a risk factor for suicide? 45 and older What gender is a risk factor for suicide? Male What race is a risk factor for suicide? White (Caucasian) What 4 demographic characteristics are risk factors for suicide? 45 and older Single White Male What are 5 physical characteristics of Anorexia Nervosa? Low BMI Amenorrhea Emaciation (abnormally thin) Bradycardia Hypotension Low BMI, Amenorrhea, Emaciation (abnormally thin), Bradycardia, and Hypotension are characteristics of what psychiatric disorder? Anorexia Nervosa What is the BMI in a patient with Bulimia Nervosa Normal range For a DSM-5 diagnosis of Acute Stress Disorder, what is the onset of symptoms? Within 4 weeks of traumatic event Intense anxiety and fear, helplessness, reexperiencing the event and avoidance behaviors within 4 weeks of a traumatic event is DSM-5 criteria for what disorder? Acute Stress Disorder What are the 3 hallmark symptoms of PTSD? Intrusive re-experiencing Increased arousal (hyperarousal) Avoidance of stimuli associated with trauma What are 3 pharmacological treatments for PTSD SSRIs TCAs Prazosin for nightmares What 2 nonpharmacologic treatments for PTSD? EMDR CBT What are the 12 components/symptoms of the COWS? Pulse Sweating Restlessness Pupil size Bone aches Running nose or tearing GI upset Yawning Tremors Anxiety/irritability Gooseflesh skin Dilated pupils Pulse, Sweating, Restlessness, Pupil size, Bone aches, Running nose or tearing, GI upset, Yawning, Tremors, Anxiety/irritability, Gooseflesh skin, and Dilated pupils are components of what scale? COWS What are the 9 components/symptoms of the CIWA Scale? Nausea/vomiting Tremor Sweats Anxiety Agitation Tactile disturbances Auditory disturbances Headaches Orientation Nausea/vomiting, Tremor, Sweats, Anxiety, Agitation, Tactile disturbances, Auditory disturbances, Headaches, and Orientation are components of which Scale CIWA What are 3 treatments for Alcohol Use Disorder? Acamprosate (Campral) Disulfiram (Antabuse) Naltrexone (Vivitrol, ReVia) Which agent for the treatment of Alcohol Use Disorder is not metabolized by the liver? Acamprosate (Campral) Installation of hope, universality, group cohesiveness, and altruism are therapeutic factors of what group therapy? Yalom What are 4 therapeutic factors in Yalom's Group Therapy? Instillation of hope Universality Group cohesiveness Altruism What is an approach to organizational change which focuses on strengths rather than weaknesses? Appreciative Inquiry What is appreciative inquiry? An approach to organizational change which focuses on strengths rather than weaknesses What are the 3 goals of Quality Improvement? Projects designed to improve systems, decrease cost, and improve productivity Projects designed to improve systems, decrease cost, and improve productivity are called Quality Improvement The process/strategy of Quality Improvement is called PDSA Cycle Plan Do Study Act The PDSA Cycle is The process/strategy of Quality Improvement The 4 components of Health Policy are Process Policy reform Policy environment Policy makers Process, Policy reform, Policy environment, and Policy makers are the 4 components of Health Policy What is 3-part "process" component of Health Policy? Formulation, Implementation, and Evaluation (FIE) Formulation, Implementation, and Evaluation (FIE) are The "process" component of Health Policy What is the "policy reform" component of Health Policy? Changes in programs and practices Changes in programs and practices in Health Policy is called Policy Reform What is the "policy environment" component of Health Policy? The arena the process takes place in (government, media, public) The arena the process takes place in (government, media, public) is what component of Health Policy? Policy environment What is the "policy makers" component of Health Policy? Key players and stake holders What component of Health Policy are Key players and stake holders? Policy Makers What is the first action when developing Health Policy? Assess/address organizational barriers and facilitators A treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life is called Recovery Model What is the Recovery Model? A treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life is called What is a nonlinear treatment approach? Not a step-by-step process, but one based on continual growth and occasional setbacks What are 3 characteristics of the Recovery Model? Learning from experience (e.g. relapse) Nonlinear Self-directed, Individualized and Person-Centered The treatment approach that emphasizes "learning from experience," nonlinear, and self-directed/individualized/person-centered? Recovery Model What is the SBIRT Screens for Substance Use Disorders Screening Brief Intervention Referral Treatment What instrument screens for Substance Use Disorders SBIRT Screening Brief Intervention Referral Treatment What is the Tarasoff Principle Duty to warn victim of imminent danger of homicidal patients What is the Duty to warn victim of imminent danger of homicidal patients? Tarasoff Principle An involuntarily committed patient who has not been found incompetent, absent an emergency, has a qualified right to refuse psychotropic medications (court case) Rennie vs. Klein Court Case What is the Rennie vs Klein Court Base? Pts have the right to refuse treatment and use an appeal process It is unconstitutional to commit a person involuntarily (for the longest time) who is not (imminently) dangerous to self or others. Which court case? Donalson vs. O'Connor Court Case What is the Donaldson vs. O'Connor court case? You cannot confine (commit a person involuntarily) who is not dangerous to self or others What are 4 key components of Strategic Therapy? Problem Focused, Symptoms focused Paradoxical directive/intervention (reverse psychology) Straight forward directive Reframe belief system The paradoxical directive, a technique to be used with caution, is used in which therapy? Strategic Which 3 techniques are used in Solution-Focused Therapy? Miracle Questions Exception-finding questions Scaling Questions Miracle Questions, Exception-finding questions, and Scaling Questions are used in which therapy? Solution-Focused Which therapy uses triangles/triangulation, an self-differentiation? Family Systems Therapy What are 3 characteristics of Family Systems Therapy ? Triangles/Triangulation Self-differentiation Genograms What are 3 characteristics of Structural Family Therapy? Hierarchies Boundaries Genograms Hierarchies, Boundaries, and Genograms are characteristics of what therapy? Structural Family Therapy Genograms are used in which 2 family therapies? Family system therapy Structural therapy What type of therapy should be performed when a patient presents with a cultural syndrome? Brief supportive therapy What type of therapy should be used in a patient who has just lost their job? Brief supportive therapy What is the most important concept in working with patients from different cultues? Respect What should you teach a patient interested in meditation? muscle relaxation How to Mexican American's view mental illness? An imbalance between an individuals' relationship with the world Which ethnic group views mental illness as an imbalance between an individuals' relationship with world? Native American Which ethnic group has the highest incidence of suicidal attempt and completion? Native American Cultural syndrome is A culturally expected response to a stressor A culturally expected response to a stressor is called Cultural Syndrome How should multicultural teaching be conducted? Ethnospecific If a patient is regularly taking Kava, what lab should you get? LFTs What is the key symptom in suspecting Stephen's Johnson Syndrome? Fever Which antipsychotic has the least weight gain? Ziprasidone (Geodon) Which SGA is the least sedating? Aripiprazole (Abilify) Which 3 antipsychotic causes weight gain? Quetiapine (Seroquel) Olanzapine (Zyprexa) Clozapine (Clozaril) What is the first action to take with a patient who is gaining weight from an SGA? nonpharmacologic nutritional counseling (diet) exercise CBT When should clozapine be discontinued? ANC < 1,000 (even if asymptomatic) One of your patients receiving psychiatric medication develops an infection. What do you consider? Agranulocytosis What antipsychotic is antisuicidal in schizophrenia? Clozapine When a young woman is suspected of a toxic dose of lithium, what lab should you obtain initially? HCG If a patient has signs/symptoms of lithium toxicity but you have no labs available, what do you do? DC lithium What is one of the most important teaching points you should make in a patient taking lithium? Stay hydrated A patient with what medical condition is at risk for lithium toxicity? Cardiac failure (hyponatremia) What is the key indicator for NMS? Extreme muscle rigidity - Increased CPK Extreme muscle rigidity and increased CPK is the key indicator of NMS What is the key indicator of Serotonin Syndrome? Muscle jerks (myoclonic) Muscle jerks (myoclonic) are the key indicator of Serotonin Syndrome If a depressed patient is taking a triptan for migraines, what should you prescribe for depression? Bupropion What is first line treatment for MDD? SSRIs What are the 2 antidepressants of choice in a depressed patient with cancer? Citalopram (Celexa) Escitalopram (Lexapro) What is the antidepressant of choice in a depressed patient with sexual dysfunction? Bupropion What is the antidepressant of choice in a depressed patient with decreased energy? Bupropion What are 3 treatments for depressed patients with neuropathic pain? SNRI (safety) TCA Gabapentin Which SSRI is most likely to cause insomnia? Fluoxetine (Prozac) What question is important to ask in the social history with a depressed patient? Alcohol intake (self-medicating) What BBW do all antidepressants have? Suicidal ideation (<24 yrs.) Suicidal ideation for children, adolescents, and young adults <24 years is a BBW with what medications? Antidepresssants What question should ask all adolescent patients at each visit? Self harm (frequency and severity) Which 2 groups is it especially important to ask about SI at each visit? Adolescence Schizophrenics Why do children have a decreased placebo response with antidepressants? Few evidence-based studies What is the onset of schizophrenia in males? 18-25 What is the onset of schizophrenia in females? 25-35 What question should ask schizophrenic patients at each visit? SI What is the most likely diagnosis in a patient with homicidal ideation? Antisocial Personality Disorder What would yo expect to see on an MRI/Pet scan in a patient with schizophrenia? All structures decreased except ventricles Which class of agents should be avoided in patients with schizophrenia? Stimulants (increased DA) Which 3 structures in the brain are associated with aggressive and impulsive behavior? Prefrontal cortex Amygdala Hippocampus What is Assertive Community Treatment (ACT)? Form of rehabilitation post hospitalization for SMI Case management approach Patients with SMI who are discharged from the hospital should be referred to Assertive Community Treatment (ACT) Can patients receive Assertive Community Treatment (ACT) while in the hospital? No Which services can be provided in the home for SMI patients? Assertive Community Treatment (ACT) What is the best treatment program for SMI patients with poor medication adherence? Assertive Community Treatment (ACT) Social skills training in a schizophrenic patient is what type of prevention? Tertiary What are 3 benefits of aerobic exercise in schizophrenic patients? Increased cognition Quality of Life Long-term health How do you convert oral Haldol to IM (depot form)? 20 x daily dose When converting oral Haldol to depo form, what the maximum dose should administer? >100 mg (administer weekly if necessary) What is a delusion? A firm belief despite contrary evidence A firm belief despite contrary evidence is delusion How often is Haldol Decanoate typically adminitered? monthly How do you conduct a MSE in a preschooler (3-5 yo) Clinical observation (listen/observe) What is thought content? SI/HI, plan What are the 5 components of the MMSE (Folstein's) Concentration/attention/calculation Orientation Registration/ability to learn new material Recall/memory Fund of Knowledge What pharmacologic characteristic makes SGA's unique? 5-HT2A antagonism What is responsible for the decreased incidence of EPS with SGAs? 5HT2-antagonism What antipsychotic should you give to a patient with their first psychotic episode? SGA (IM) Which 4 SGAs are available in IM form? Ziprasidone (Geodon) Olanzapine (Zyprexa) Aripiprazole (Abilify) Paliperidone (Invega) What agent other than antipsychotics increase prolactin? Metoclopramide (Reglan) What is a normal prolactin level in men? <20 What is a normal prolactin level in women? <25 What do you do if a patient is on olanzapine (Zyprexa) and stops smoking? Decrease olanzapine dose What effect does tobacco have on CYP450? 1A2 inducer What class of drugs are primarily inhibitors? Antibiotics How does erythromycin and clarithromycin affect CYP240? Inhibitors What do you do if a patient on carbamazepine is given an inhibitor? Decrease CBZ dose (avoid aplastic anemia) If a depressed patient is receiving a drug that is associated with depression, what do you do? Increase dose of antidepressant Addiction is associated with what 2 neurotransmitters? Dopamine GABA What 7 signs/symptoms are associated with stimulant abuse? Insomnia Tremors Irritability, Mood swings. Agitation, Anxiety CV (increased HR/BP, palpitations) A patient who c/o pain after eating, bloating and fullness, what do you suspect? Delayed gastric emptying from anorexia What 3 signs/symptoms do you expect with delayed gastric emptying in anorexia? Pain after eating Bloating Abdominal fullness What 2 classes of medications delay gastric emptying? H2 antagonists: Famotidine (Pepcid) PPIs: Omeprazole (Prilosec) What 2 classes of medications interfere with the absorption of psychiatric medications and should be spaced apart by 2 hours? Antacids PPIs: Omeprazole (Prilosec), Pantoprazole (Protonix) What is a common side effect of SSRIs in the older population Anxiety What is a paradoxical effect of benzodiazepines? Increased anxiety (avoid in future) What is apotosis? Cell death/neuronal loss What is the name for cell death/neuronal loss? apotosis What is the greatest risk factor for bipolar disorder? genetics (very heritable) What is the first question you ask with a patient with suspected bipolar disorder? family history What should you consider in a 45 yo patient that presents with manic symptoms? Medical condition At what age should you consider a patient with manic symptoms to be medically-induced 45 and older What are 2 differences between mania and hypomania? More severe Increased duration (7 days vs. 4 days) A patient that presents with grandiosity or exaggerated self-esteem is most likely to have Mania or hypomania A patient who is manic, irritable mood, and uncooperative is most likely to have what disorder? bipolar disorder What is a key symptom to consider in a patient you suspect of mania or hypomania? Grandiosity or exaggerated self esteem What is a hallmark feature of borderline personality disorder? Self-harming behavior (recurrent) Self-harming behavior (recurrent) is a key factor in which disorder? Borderline personality disorder What therapy in borderline personality disorder been shown to decrease suicidal ideation? DBT Who developed DBT? Marsha Linehan In DBT, diagnosis of borderline disorder requires activity? journaling/diary A patient with borderline personality disorder with symptoms of depressed mood and lability should be prescribed Valproic acid When should valproic acid be prescribed in a patient with borderline personality disorder? Depressed mood + lability A hospitalized patient with a reaction to a stressful event is most likely to have what diagnosis? Adjustment Disorder A child with a history of juvenile detention (e.g., fire setting, forced sex) is most likely to have what diagnosis? Conduct Disorder Is a child with ODD or Conduct Disorder more likely to need medication? Conduct Disorder If a child develops tics after beginning a stimulant, should he be diagnosed with Tourette's? No (tics caused by a substance is an exclusionary diagnosis) Are motor tics permanent? Not always What 3 neurotransmitters are involved with Tourette's? DNS What is factitious disorder imposed on another? Munchausen syndrome by proxy, caretakers make up or produce physical illnesses in the individual receiving care. Usually parent --> child What is required if you suspect a factitious disorder imposed on another (Munchausen syndrome)? Report to CPS Child abuse (duty to report) What is Factitious Disorder Faking illness to get medical attention or sympathy A patient who feigns illness to get sympathy or attention is most likely to have Factitious disorder A patient with factitious disorder is most likely to have what type of demographic? Unmarried healthcare worker What is malingering? Feigning illness for secondary gain ($) (not a psychiatric diagnosis) A patient who claims disability or worker's comp when there is no injury is most likely Malingering (not a psychiatric diagnosis) A child who has been neglected, abuse, or comes from a foster home, is most likely to have what diagnosis? Reactive Attachment Disorder A child who shows no emotion or is withdrawn may have what disorder? Reactive Attachment Disorder A disorder that presents like PTSD, but symptoms last less than a month is most likely to have Acute Stress Disorder What is the required duration for a DSM-5 diagnosis of GAD? 6 months How does a panic attack differ from Panic Disorder? acute, impending doom How does Panic Disorder differ from a panic attack? Chronic, recurrent, unexpected How do you treat a patient with panic disorder who is taking albuterol for asthma? SSRI or benzodiazepine (don't give beta blocker) What is the treatment of choice for acute symptoms of panic disorder? Beta blocker (not addictive) How do you treat test anxiety for maintenance therapy? SSRI How do you treat text anxiety acutely? Beta blocker Benzodiazepine What structure of the brain is involved with attention, executive function, and cognitive processes (working memory, problem solving) that affects ADHD? Dorsolateral prefrontal cortex Children with inattentive ADHD are most likely to have an abnormality in which part of the cortex? prefrontal Dysfunction of the prefrontal cortex is most likely in what type of ADHD? Inattentive What do you recommend to a mother of a child with ADHD as an aftercare plan on admission? Brief supportive therapy (not after dc) If a patient present with irritability, depression, and lability, which questionnaire do you administer? Mood Disorder Questionnaire (MDQ) When a patient presents with what 3 symptoms should you administer the Mood Disorder Questionnaire (MDQ)? Patient presents with irritability, depression, and lability What disorder resembles bipolar disorder in children (7 and 17 years)? Disruptive Mood Dysregulation Disorder (DMDD) A child with intense temper outbursts is most likely to have what DSM-5 diagnosis? Disruptive Mood Dysregulation Disorder (DMDD) What should assess initially in a child who presents with nightmares? If other family members have the same problem What are 2 key factors in the diagnosis of Autism Spectrum Disorder? Persistent deficits in social communication and social interaction across multiple settings A child with persistent deficits in social communication and social interaction across multiple settings is most likely to have what DSM-5 diagnosis? Autism A child that does not establish eye contact is likely to have autism spectrum disorder When is the only time you should give a benzodiazepine to a patient with delirium? Alcohol withdrawal A patient in alcohol withdrawal who develops delirium should be administered Benzodiazepine An older female has delirium and you suspect a UTI, what 2 labs should you order? UA C/S An older patient who has had mental decline (>1 year) with chronic irritability and personality changes should be assessed for Dementia What are 2 labs that should be obtained in an older patient suspected of having a metabolic cause of dementia? B12 Folic acid What is the initial treatment for a patient with dementia and psychosis? Nonpharmacologic treatment If a patient with dementia does not respond to nonpharmacologic treatment, what do you do? Administer SGA What type of dementia is HIV-related? Subcortical What are 3 early signs/symptoms of HIV-related dementia? Cognitive deficit Motor abnormalities (decreased coordination) Behavioral symptoms A patient who presents with a cognitive deficit, decreased coordination, and behavioral symptoms should be assessed for what type of dementia? HIV-related In a patient with suspected HIV-related dementia, what is your initial action? Obtain HIV test What is first-line pharmacologic treatment for a patient with HIV-related dementia? Antiretroviral treatment An older adult who has had cognitive impairment for over a year and who tries to answer (may not be able to) or confabulates is most likely to have a diagnosis of Dementia An older adult who has had cognitive impairment for less than 5 months and who answers your questions with "I don't know," most likely has a diagnosis of Depression (pseudodementia) An older patient who has symptoms of irritability, agitation, hallucinations, and delusions is most likely to have Depression (vs. dementia) What are 2 ways to determine whether an older person with decreased memory has depression or dementia? SLUMS, Mini-Cog onset of symptoms What screening instrument can hep differentiate dementia from pseudodementia (depression)? MMSE A patient with frontal lobe (Pick's) dementia is most likely to present with what 4 symptoms? Executive dysfunction Slurred speech (expressive aphasia) Language comprehension (receptive aphasia) Personality and behavior changes Social skills A patient who presents with difficulties with executive function, slurred speech, personality, and behavior changes, difficulties with language comprehension, and poor social skills is most likely to have what type of dementia? Frontotemporal (Pick's) A patient with visual hallucinations is most likely to have what type of demenetia? Lewy Body A patient with Lewy Body Dementia is most likely to have what presenting symptoms? Visual hallucinations A patient with damage to the anterior cingulate will demonstrate what 3 symptoms? Cognitive dysfunction (decision making) Lack of empathy Difficulty with impulse control and emotions A patient who presents with cognitive dysfunction (decision making), lack of empathy, and difficulty with impulse control and emotions is most likely to have damage in what brain structure? Anterior cingulate A patient with damage to the cerebellum will demonstrate what sign? Lack of balance A patient who has a lack of balance is most likely to have damage to what structure in the brain? Cerebellum What condition may cause pica (eating things that are not food - paint chips)? Lead poisoning What 5 neurotransmitters are associated with mood disorders? Dopamine Norepinephrine Serotonin GABA Glutamate What do do yo do when an infant is about to die? Give him to his parents to grieve What 2 activities should be encouraged with grieving patients? Family support Support groups (don't give prescriptive advice) What are 5 risk factors for osteoporosis? Smoking Caffeine Low calcium/vitamin D in diet Decreased weight Lack of weight bearing exercises Smoking, Caffeine, Low calcium/vitamin D in diet, Decreased weight, and Lack of weight bearing exercises are risk factors for Osteoporosis Is Interpersonal Therapy offered individually as well as in group therapy? Yes If a patient is reluctant to participate in group therapy, what do you do? Continue group therapy Start individual therapy Which is more effective - cognitive therapy or CBT? CBT What are 5 techniques used in behavioral therapy? Problem-solving Skills training Exposure therapy Role-playing/modeling Relaxation Problem-solving, Skills training, Exposure therapy, Roleplaying/modeling, and relaxation are techniques used in Behavioral Therapy What are 2 common techniques used in CBT? Cognitive restructuring Journaling Cognitive restructuring and journaling are common techniques used in CBT 2 key concepts of Humanistic (person-centered) therapy are Self-directed growth Self-actualization Self-directed growth and self-actualization are key concepts of what type of therapy? Humanistic (person-centered) Which therapy is based on the principle that each person has the potential to self-actualize and find meaning in life? Humanistic (person-centered) What is the best therapy for dealing with conflicts with others (e.g., spouse, co-workers)? Interpersonal therapy Interpersonal therapy is recommended in what situation? conflict and relationship (marital) problems How long does interpersonal therapy typically last? 12-16 weeks If a patient is noncompliant, what is a technique that is used in Strategic Therapy? Paradoxical directive/intervention When is a paradoxical directive/intervention given in Strategic Therapy? With a noncompliant member If a patient is compliant, what is a technique that is used in Strategic Therapy? Straight Forward Directive When is a Straight Forward Directive given in Strategic Therapy? When a member is compliant What type of therapy is a therapist using when he asks "what worked before when you had this problem" Solution-focused Meditation is a form of Muscle relaxation What 4 positive effects does physical activity have on children? Increased body image Increased resilience Improved relationships Decreased social anxiety How can a child's body image, resilience, relationships, and social anxiety be improved? Physical activity When may a closed-ended question (yes/no) be necessary rather than an opened-ended question? Children (when a narrative cannot be constructed) If a child does not respond or open or closed-ended questions, what to you do? talk to parents What therapeutic factor does open-ended questions instill? empathy If only the wife shows up for a couple appointment, what do you do? Reschedule the appointment A mother reports that her child was sodomized. What 2 things do you do? Contact CPS Crisis therapy A mother reports her 5-yo was raped by his 16 yo brother. What 2 things do you do? crisis therapy separate brothers What lab do you draw in a patient with rheumatoid arthritis ESR When is an ESR indicated? Patient with rheumatoid arthritis What does PICO stand for? P- Patient population of interest I - Intervention of interest C - Comparison of interest O - Outcome How do you provide evidenced-based care? Have access to current journals A baby with a shrill cry is likely to have Increased intracranial pressure A sign of increased intracranial pressure in a baby is shrill cry What do you tell a mother when she reports her preschool child is playing with his genitals? That is normal between 3-6 yrs old (Phallic stage) What do you tell an adolescent who is concerned about nipple swelling and tenderness and breast enlargement? This is normal between 9-16 yo. It will disappear within 6 mo. How do you treat decreased sexual drive in a older female patient? Testosterone (improves blood flow to pelvic region) Why are women more likely to get intoxicated and have alcohol-induced hepatotoxicity? Decreased alcohol dehydrogenase What are the 2 effects of decreased alcohol hydrogenase in women Increased intoxication Increased alcohol-induced hepatotoxicity What is the grasp/palmar reflex? infant grabs anything put into his or her hand What primitive reflex causes a newborn to grasp vigorously any object touching the palm or fingers or placed in the hand? Grasp/palmar reflex When does the palmar grasp reflex disappear? 5-6 months What is the moro (startle) reflex? Loud noise or sudden loss of support will cause infant to abduct/extend UE's and trunk followed by a return to flexion Infant reflex where a baby will startle in response to a loud sound or sudden movement is called Moro/startle reflex When does the Moro reflex disappear? 5-6 months What is the Babinski (Plantar) reflex? the big toe is extended and the other toes fan in response to the brushing of the sole of the foot When does the Babinski (Plantar) reflex disappear? 2 years What is the absorption rate of PDE-5 inhibitors (Viagra)? Rapid What 2 deficiencies are associated with macrocytic anemia? Folic acid B12 Folic acid deficiency creates what type of anemia? Macrocytic With normocytic, macrocytic anemia, what 3 labs do you obtain? B12, folic acid, Fe B12 deficiency creates what type of anemia? Macrocytic What deficiency is associated with microcytic anemia? Iron An iron deficiency causes what type of anemia? Microcytic Acute or chronic blood loss (GI bleeding, heaving menses) can cause what type of anemia? Normocytic Normocytic anemia is due to Chronic or acute blood loss (GI bleeding, menses) What is the BMI in a patient with Bulimia Nervosa? Normal When vital signs are not normal in a thin women, you suspect Anorexia nervosa You see a patient with suspected anorexia nervosa. What do you do? Refer out for medical evaluation If a patient with anorexia nervosa refuses to see a PCP, what do you do? Contact CPS If AN patient is medically unstable and parents refuse hospital treatment, what do you do? contact CPS What 2 conditions is acupuncture used? Pain Depression What alternative medicine treatment is used with pain and depression? Acupuncture Habeas Corpus Act Protects a patient from unlawful hospitalization (able to leave AMA) What act prevents a patient from unlawful hospitalization (can leave AMA)? Habeus corpus (usually max of 28 days) A patient presents with paresthesia, fatigue and asymmetric body movement of extremities. What do you suspect and what do you do? Disseminated Encephalomyelitis Neuro exam What is Disseminated Encephalomyelitis and what are 3 symptoms? Autoimmune viral infection - children Paresthesia Fatigue Asymmetric body movement of extremities If a patient is unable to remember events, how do you establish a diagnosis? Provide anchor (memorable events) to establish diagnosis How do you implement policy affecting NPs nationwide? Host online forum/give survey to obtain information (vs. letters) How do you implement policy coworkers are against? Tell them how the policy will increase quality of patient care What is the initial step in providing continuous improvement of Quality of Care in an outpatient setting? Create an instrument to monitor outcomes What will you see in a laboratory test in a patient with an autoimmune disease? Increased cytokine levels Increased cytokine levels on a laboratory test suggests what disease? autoimmune What are 2 ways to treat enuresis (night-time bedwetting)? Alarm clock Desmopressin (DDAVP) An alarm clock and Desmopressin (DDAVP) are 2 methods to treat Enuresis What is the mechanism of action of Desmopressin (DDAVP)? Decreases urine production (via antidiuretic hormone - vasopressin) When considering the relationship between receiving samples from a drug rep or sponsored education, what should consider and what should you do? Conflict of Interest Create policy to address COI A conflict of interest may occur in what 2 scenarios? Receiving samples of drug rep Attending an industry sponsored educational program What does a black box warning provide? Benefits and risks A patient calls because he read on the internet about a BBW on his medication. What do you do? You don't need to discontinue drug. Research benefits and risks What are 2 things you should do when you prescribe off-label? Document Provide full disclosure (risks/benefits) When you prescribe trazodone to a male patient, what should you do? Warn about priapism and document What are 3 risk factors for Sleep Apnea? Smoking Increase weight/obesity DM Smoking, increased weight/obesity, and DM are risk factors for what disorder? Sleep Apnea What is tolerance? Decreased effect with continuous use Decreased effect with continuous use results in Tolerance What is the goal or Reflective Practice? Improve practice What is Reflective Practice? Providing debriefing techniques, feedback to staff, and strategies to learn from experiences Providing debriefing techniques, feedback to staff and strategies to learn from experiences is called Reflective Practice If a patient has mild symptoms on the COWs, what should you do? Give clonidine or a muscle relaxant When should you administer clonidine or a muscle relaxant to a patient withdrawing from opiates? mild symptoms (8 or higher) If a patient scores 8 or more on the COWS during opiate withdrawal, what should you do? Administer clonidine or a muscle relaxant If a patient has moderate symptoms on the COWS what should you do? Administer buprenorphine/naloxone (Suboxone) When should you administer buprenorphine/naloxone (Suboxone) in a patient withdrawing from opiates? Moderate symptoms (13 or higher) If a patient scores 13 or higher on the COWS scale during opiate withdrawal, what do you do? Administer buprenorphine/naloxone (Suboxone) Why should methadone not be used to treat opiate withdrawal? Arrhythmias Which benzodiazepine is used most often to treat alcohol withdrawal? Diazepam (longer half-life) If a patient with liver dysfunction or hepatitis is undergoing alcohol withdrawal, what benzodiazepine should he receive? Lorazepam If a patient presents with opiate withdrawal, what should you do? Refer to residential center to administer protocol (don't initiate in outpatient setting) If a pregnant patient presents with opiate withdrawal, what do you do? Refer to residential center (not CPS) What are 4 symptoms/categories of alcohol withdrawal? CNS activation: Hand tremor, insomnia, psychomotor agitation, anxiety, seizures) Autonomic hyperactivity (sweating, increased HR/BP) N/V Hallucinations/illusions What do you suspect when a patient presents with CNS activation (hand tremor, insomnia, anxiety, psychomotor agitation, seizures) and Autonomic hyperactivity (sweating, increased HR, increased BP) and N/V and hallucinations/illusions? alcohol withdrawal What are 7 symptoms/categories of opioid withdrawal? Muscle cramps, Bony aches Diarrhea/abdominal cramps Rhinorrhea, Lacrimation Goosebumps Pupil dilation Increased BP/HR Yawning What do you suspect when a patient who presents with muscle cramps, bony aches, diarrhea/abdominal cramps, rhinorrhea, lacrimation, goosebumps, pupil dilation increased BP/HR and yawning? Opiate withdrawal What are Yalom's 10 therapeutic factors? Instillation of Hope Universality Altruism Increased development of socialization skills Imitative behaviors Interpersonal learning Group cohesiveness Catharsis Existential factors Corrective refocusing Instillation of Hope, Universality, Altruism, Increased development of socialization skills, Imitative behaviors, Interpersonal learning, Group cohesiveness, Catharsis, Existential factors, and Corrective refocusing are Therapeutic Factors which differentiate group therapy from individual therapy Experiencing optimism through observing the improvement of others in the group is which of Yalom's therapeutic factors? Instillation of Hope Sharing experiences/feelings in group clients realize they are not alone is which of Yalom's therapeutic factors? Universality Learning to give to others is which of Yalom's therapeutic factors? Altruism The "natural laboratory" is which of Yalom's therapeutic factors? Increased development of social skills Group members modeling their behavior after other members of group/therapist is which of Yalom's therapeutic factors? Imitative behavior Interacting with others to increase adaptive interpersonal relationships is which of Yalom's therapeutic factors? Interpersonal learning Developing a sense of belonging in the group is which of Yalom's therapeutic factors? Group cohesiveness Group members dealing with the meaning of their existence is which of Yalom's therapeutic factors? Existential factors Participants reexperience family conflicts in the group, which allows them to recognize and change behaviors that may be problematic is which of Yalom's Therapeutic Factors? Corrective refocusing Openly expressing their feelings which were previously suppressed is which of Yalom's Therapeutic Factors? Catharsis What is the key component of Appreciate Inquiry? Focusing on strength of the group Focusing on the strength of the group is key to what organizational change strategy? Appreciative Inquiry Who determines the Scope of Practice? State legislature (BON) (varies state to state) Who determines the Standard of Practice? ANA (doesn't change) What are 8 exceptions to confidentiality? (know all) Unconscious (to save a life) Intends to harm self/others Court order (subpoena, summons) Attorneys in litigation Insurance companies Mandatory reporting (diseases) Tarasoff (duty to warn) Child or elder abuse What are the 5 elements of informed consent? Nature and purpose of treatment/procedure Risks and benefits of treatment Risks and benefits of not undergoing treatment Alternative procedures or treatments Diagnosis and prognosis What are the 7 ethical principles? Justice Beneficence Nonmaleficence Fidelity Autonomy Veracity Respect Fairness (according to gender, orientation, or ethnicity) is what ethical principle? Justice "Doing no harm" to the patient is what ethical principle? Nonmaleficence Discontinuing a medication that causes side effects is an example of what ethical principle? Nonmaleficence Denying a benzodiazepine to a patient with a SUD is an example of what ethical principle? Nonmaleficence "Doing good" and promoting well-being is what ethical principle? Beneficence Giving a patient a medication to treat symptoms is an example of Beneficence Being true and loyal is what ethical principle? Fidelity "Telling the truth" is what ethical principle? Veracity Allowing the patient to "do for self" is what ethical principle? Autonomy A patient's right to refuse medication is an example of what ethical principle? Autonomy Treating everyone with equal respect is what ethical principle? Respect Collecting data or conducting a survey is an example of assessment What is an important role to play as a client advocate? reduce stigma What is the best way to reduce stigma? Education (esp. large audience) just culture A work environment that improves patient safety through continuous learning A work environment that improves patient safety through continuous learning is Just Culture Recovery Model A model that does not focus on mental illness, is nonlinear (occasional setbacks) and stresses learning from experience What treatment approach does not focus on mental illness, is nonlinear (occasional setbacks), and stresses learning from experience? Recovery Model A process or strategy of quality improvement is called PDSA Cycle Plan Do Study Act What is the PDSA cycle A quality improvement process or strategy What is an example of a Quality Improvement Project? Chart review What are the 4 components of health policy? Process Policy reform Policy environment Policy makers When implementing health policy, what is the first thing you do? Assess barriers and facilitators (prior to meeting with stakeholders) What is SBIRT Assessment? Screening, Brief Intervention, and Referral to Treatment for SUD What should you do before warning someone about harm (Tarisoff act)? Contact Board of Nursing A key component of Piaget's Sensorimotor stage is Object permanence Object permanence develops in which of Piaget's developmental stages? Sensorimotor What are 2 key components of Piaget's Preoperational Stage? Magical thinking Symbols and language According to Piaget, at what stage do children display magical thinking and use language and symbols more? Preoperational What is a key component of Piaget's Concrete Operations Stage? See things from other's perspectives (less egocentric) According to Piaget, during what stage do children see things from other's perspectives - less egocentric? Concrete operations What is the key component of Piaget's Formal Operations stage? Abstract logic (science projects, hypotheses) According to Erikson, what period (age) is the development of meaningful relationships important? Infancy (0 - 1 yr.) According to Erikson, what period (age) is self-control a key component? Early childhood (1 - 3 yrs.) According to Erikson, what period (age) is being a "self-starter" (self-directed) a key factor? Late childhood (3 - 6 yrs.) According to Erikson, what period (age) is competence important, especially with classmates? School age (6 - 12 yrs.) According to Erikson, what period (age) is personal sense of identity a key factor? Adolescence (12 - 20 yrs.) According to Erikson, what period (age) are committed relationships a key factor? Early adulthood (20 - 35 yrs.) According to Erikson, what period (age) is the ability to care for others important (e.g., parenting)? Middle adulthood (35 - 65 yrs.) According to Erikson, what period (age) does fulfillment and comfort with life occur? Late adulthood (>65) What 3 neurotransmitters are associated with ADHD? DNS What 3 neurotransmitters are associated with MDD? DNS (decreased) What 3 neurotransmitters are associated with Tourette's? DNS (especially DA) What 5 neurotransmitters are associated with bipolar disorder? DNS Glutamate (increased) GABA What 2 neurotransmitters are involved with Addictive Disorders? DA (decreased) GABA (decreased) What 2 neurotransmitters are involved with OCD? 5HT (decreased) NE (decreased) What 4 neurotransmitters are associated with schizophrenia? DA (increased) Glutamate (increased) GABA (decreased) 5HT (decreased) What 3 neurotransmitters are associated with Autism Spectrum Disorder? Glutamate (increased) GABA (decreased) 5HT (decreased) What neurotransmitters are associated with anxiety? NE (increased) 5HT (decreased) GABA (decreased) What neurotransmitters are associated with Alzheimer's? ACh (decreased) Glutamate (decreased) What neurotransmitters are associated with Parkinson's Disease? DA (decreased) ACh (Increased) What 4 psychiatric disorders have dysregulation of dopamine, norepinephrine, and serotonin (DNS)? ADHD MDD BPD Tourette's Which 5 psychiatric disorders have dysregulation of the GABA receptor? BPD Schizophrenia Autism SUD Anxiety What 4 psychiatric disorders have dysregulation of glutamate receptors? BPD Schizophrenia ASD Alzheimer's Which 2 psychiatric disorder have dysregulation of acetylcholine receptor? Alzheimer's Parkinson's What 3 disorders have dysregulation of glutamate and gabapentin? autism spectrum disorder bipolar disorder schizophrenia You are concerned a 5-yo child may be sexually abused. How do you conduct the interview? Interview child and parents separately if child can communicate You see a child playing with a toy in a sexual manner. What do you do? contact CPS What are the 2 most important aspects of interviewing an adolescent? Rapport Confidentiality (explain exceptions) How should an adolescent be interviewed separately form parents If an adolescent is dating someone the same age, do you need to tell the parents? No If an adolescent is dating someone of the same gender, do you need to tell the parents? No What should you ensure before discharging a patient from the hospital? Support system (safety) Should a patient be interviewed in a day room? No (not confidential) When do you draw a T3 or T4 If TSH is abnormal What symptom occurs with high levels of ammonia? confusion What 4 symptoms are similar with serotonin syndrome and NMS? Hyperthermia Diaphoresis Tachycardia Altered LOC Thoughts of self-harm are greatest in what 5 disorders (according to order) MDD BPD Alcohol use disorder Eating disorder schizophrenia What is a long-term side effect of the anti-emetic metoclopramide (Reglan)? TD Are oral contraceptives inducers or inhibitors? inducers A person with pressure speech is most likely to have bipolar disorder If you can identify why a person is depressed, what is their mostly likely diagnosis? Adjustment disorder with depressed mood Can tics be a normal behavior? yes What are the 2 primary deficits in Cortical Dementia? Language Memory Language and memory are the 2 primary deficits in which type of dementia? Cortical Motor and behavioral (depression, irritability, apathy) are the 2 primary deficits in which type of dementia? Subcortical What are the 2 primary deficits in Subcortical Dementia? Motor Behavioral (depression, irritability, apathy) What is the value of integrative medicine (E.g., ObGyn + PMHNP)? increased mental health access to those who need it most What is the most important factor in a child who is grieving? Intact family How do you treat a child who is grieving? Normalize grief and loss (don't tell them what to do/how to grieve) (responses vary) How do you apply your knowledge of a relationship between ADHD and substance abuse to practice? Screen ADHD patients for substance use Screen SUD patients for ADHD When you look up data about a patient in social media, what are you violating? patient's trust Prior to sending prescriptions to a pharmacy, what do you need to do? obtain patient consent If patient is unable to give consent, what do you do? assess for involuntary treatment (don't forcefully give medication) The ethical principle that is associated with preventing imminent danger to patient is? nonmaleficence The ethical principle that is associated with keeping promises is Fidelity Sending a patient to a crisis stabilization unit rather than a hospital is honoring what patient right? least restrictive environment You plan to teach the patient about their illness. What do do you do first? assess knowledge In what age groups should you obtain HCG? 12-51 Do you need to tell parents if an adolescent reports she is dating someone of the same age or gender? no What are normal prolactin levels for males and females? Male: <20 Female: <25 What 2 labs for a patient with suspected dementia due to anemia? B12, folic acid What 2 symptoms might you see in a patient with a frontal lobe tumor? social skill deficit inappropriate affect What is the term for a symptom caused by a medical treatment? How do you assess it? Iatrogenic, assess medical history If you refer a patient to a residential center for alcohol withdrawal, what can you provide them for symptom control? Hydroxyzine or buspirone (not benzodiazepine) What does perjury mean? Lying or withholding information under oath Which 2 parties can you not disclose information without the patient's consent? family member another provider What are 4 risk factors for sleep apnea? smoking obesity DM HTN