Which patient is at highest risk for SI<\/p>\n\n\n\n
A. 30y\/o married AA female with previous SI attempt *1 risk factor<\/p>\n\n\n\n
B. 35 y\/o single Asian male with previous SI attempt *3 risk factors<\/p>\n\n\n\n
C. 38 y\/o single AA male who is a manager of a bank *2 risk factors<\/p>\n\n\n\n
D. 68 y\/o single white male with depression *5 risk factors (age, male, white, depression)<\/p>\n\n\n\n
D. 68 y\/o single white male with depression *5 risk factors (age, male, white, depression)<\/p>\n\n\n\n
Count the risk factors<\/p>\n\n\n\n
When interview teenagers (16 y\/o) that arrive with their parents what should you do?
interview them separately from parents.
-This helps Build therapeutic rapport with teens by telling them the info is confidential. Parents may be upset but remember you are advocating for the child.<\/p>\n\n\n\n
Which Ethnic group has the highest rate of suicide?
Native Americans<\/p>\n\n\n\n
Example A patient is being treated for schizophrenia with olanzapine. Which of the following is the most common side effect of olanzapine?
A. Increased waist circumference
B. EPS (not as common in atypical antipsychotics d\/t 5HT2A)-receptor antagonism
C. Increased Lipids
D. Metabolic Syndrome
D. Metabolic Syndrome (UMBRELLA ANSWER)<\/p>\n\n\n\n
Which antipsychotics have the least weight gain?
Latuda, Abilify, (also least sedating), Geodon-if patient has metabolic syndrome consider switching to one of the medications above. Or if the patient is overly sedated try switching to ABILIFY<\/p>\n\n\n\n
Which mood stabilizer have the least weight gain?
Lamictal
-But remember all mood stabilizers cause some weight gain<\/p>\n\n\n\n
When presented with a question about typical vs atypical antipsychotic the answer is usually to start of a
atypical<\/p>\n\n\n\n
A client presents with complains of changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. What is the neuroanatomical area of the brain that is responsible for the normal regulation of these functions?<\/p>\n\n\n\n
A. Thalamus<\/p>\n\n\n\n
B. Hypothalamus<\/p>\n\n\n\n
C. Limbic System<\/p>\n\n\n\n
D. Hippocampus<\/p>\n\n\n\n
Hypothalamus
A, B, & D are all part of the limbic system so you can rule that out<\/p>\n\n\n\n
When a patient is hesitant to participate in treatment you should encourage?
Bring a support person like a husband<\/p>\n\n\n\n
Thyroid-Stimulating hormone normal level
0.5-5.0 Mu\/L<\/p>\n\n\n\n
When T4 and T3 are high and TSH is low what is the diagnosis
HYPERTHYROIDISM, TSH secretion decreases: TSH LOW \u00e0 key symptoms HEAT INTOLERANCE<\/p>\n\n\n\n
Key symptoms of Heat Intolerance
Hyperthyroidism<\/p>\n\n\n\n
When T4 and T3 are Low and TSH is high what is the diagnosis
(HYPOTHYROIDISM) TSH secretion increased: TSH HIGH \u00e0 COLD INTERANCE<\/p>\n\n\n\n
Key symptoms of Cold Intolerance
Hypothyroidism<\/p>\n\n\n\n
Hyperthyroid can mimic
Mania<\/p>\n\n\n\n
Hypothyroid can mimic
Depression<\/p>\n\n\n\n
A patient on depakote complains of RUQ pain and has reddish\/brown urine
Hepatoxicity
-Check LFTs<\/p>\n\n\n\n
Signs of Depakote toxicity
Disorientation, confusion, lethargy<\/p>\n\n\n\n
You suspect depakote toxicity what do you do?
Check
-LFT
-Ammonia
-Depakote Level<\/p>\n\n\n\n
What herbal supplement can cause hepatoxicity?
Kava Kava<\/p>\n\n\n\n
When taking Kava Kava in combinations with other medications you should caution about
Risk of Hepatoxicity and Sedation<\/p>\n\n\n\n
TCAs carry a risk of
Hepatotoxicity<\/p>\n\n\n\n
Signs of Stevens-Johnson Syndrome
-fever, mouth pain, swelling, burning eyes, blisters, skin pain<\/p>\n\n\n\n
two psychotropics known to cause steven johnson syndrome
lamictal and tegretol<\/p>\n\n\n\n
What nationality is most suseptible of getting steven johnson?
Asians<\/p>\n\n\n\n
When treating asians with tegretal screen for?
HLAB-1502 Allele<\/p>\n\n\n\n
What two medications cause agranulocytosis?
Clozaril & Tegretal<\/p>\n\n\n\n
Agranulocytosis when to discontinue medication
Less than 1000<\/p>\n\n\n\n
When monitoring for agranulocytosis in patients look for s\/s of what?
Infection
-Fever, sore throat, fatigue, chills<\/p>\n\n\n\n
Before starting any mood stabilizer in a female of childbearing age be sure to check?
HCG<\/p>\n\n\n\n
Which two medications may decrease the risk of suicide?
clozaril and lithium<\/p>\n\n\n\n
Medications that increase lithium level
NSAID-ibuprofen, INDOCIN
THIAZIDES-hydrochlorithiazide ACE INHIBITORS-lisinopril<\/p>\n\n\n\n
Ace inhibitors are treatment of choice for?
Heart Failure<\/p>\n\n\n\n
Certain medications are known to increase lithium level, but HOW?
by reducing renal clearance<\/p>\n\n\n\n
When educating a patient about lithium teach them about
Hyponatremia
Dehydration-hot days, exercise<\/p>\n\n\n\n
Normal Lithium Level
0.6-1.2<\/p>\n\n\n\n
Lithium Toxicity
1.5 or above
Discontinue and re-order lithium level<\/p>\n\n\n\n
Lithium level of 1.4
Monitor for toxicity<\/p>\n\n\n\n
Labs before starting lithium
TSH, BUN, CREATININE, HCG, U\/A to check for presence of protein in the urine (4+ protein is concerning for renal impairment)\u00e04+ protein in urine=MONITOR FOR TOXICITY<\/p>\n\n\n\n
4+ protein in the urine of a patient on lithium
4+ protein is concerning for renal impairment<\/p>\n\n\n\n
4+ protein in urine=MONITOR FOR TOXICITY<\/p>\n\n\n\n
Lithium side effects
hypothyroid, leukocytosis, maculopapular rash, t-wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting, anorexia)<\/p>\n\n\n\n
-Some of these are also signs of toxicity<\/p>\n\n\n\n
Signs of lithium toxicity
confusion, ataxia, GI upset, palpitation, tremor<\/p>\n\n\n\n
NMS
muscle rigidity, mutism (because of muscle rigidity), increased CPK (caused by muscle contraction and muscle destruction), increase WBC, increased WBC, myoglobinuria (also from muscle destruction)<\/p>\n\n\n\n
Cherry colored urine in a patient that exercises a lot
test for myoglobinuria may be a sign of rhabdo<\/p>\n\n\n\n
Serotonin Syndrome
With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures.
-Treatment: cyproheptadine (5-HT2 receptor antagonist).<\/p>\n\n\n\n
Treatment for NMS
Stop Offending Medication<\/p>\n\n\n\n
-Dantrolene (muscle relaxer)<\/p>\n\n\n\n
-Bromocriptine (Dopamine D2 agonist).<\/p>\n\n\n\n
*In question focus on what they are asking for\u2026.dopamine agonist vs muscle relaxer<\/p>\n\n\n\n
Treatment for Serotonin Syndrome
Stop Med (1 or more SSRI, SSNRI, TCA, MOAI)<\/p>\n\n\n\n
-Cyproheptadine<\/p>\n\n\n\n
Triptans
Used for MIGRAINES<\/p>\n\n\n\n
-These meds increase serotonin<\/p>\n\n\n\n
example SUMATRIPTAN<\/p>\n\n\n\n
patient taking Prozac and started on sumatriptan<\/p>\n\n\n\n
-call PCP to ask them to switch the migraine med if patient already on SUMATRIPTAN do not start antidepressant without talking to PCP<\/p>\n\n\n\n
How long do you wait when switching between an SSRI to an MAOI?
2 weeks<\/p>\n\n\n\n
How long do you wait when switching between Prozac and MAOI?
5-6 weeks wash out period<\/p>\n\n\n\n
What is the first line treatment for depression and why?
SSRI-First line treatment for depression due to less risk of injury from OVERDOSE<\/p>\n\n\n\n
If a cancer patient has depression what should you consider?
Treating with a medication with minimal drug\/drug side effects like Lexapro<\/p>\n\n\n\n
Patient with depression worries about sexual dysfunction what would be the medication of choice?
Wellbutrin<\/p>\n\n\n\n
Primary symptoms of depression include fatigue and low energy what med would you chose?
Wellbutrin<\/p>\n\n\n\n
Wellbutrin is contraindicated in patients with
Seizures and anorexia<\/p>\n\n\n\n
Which medications are best for neuropathic pain?
SNRI
Gabapentin
TCA<\/p>\n\n\n\n
Secondary to the black box warning providers caring for patients on antidepressants should assess for?
Suicidality, frequency, and severity at EVERY appointment<\/p>\n\n\n\n
Which meds have the worse serotonin discontinuation syndrome
Those with short half lives
such as zoloft<\/p>\n\n\n\n
Symptoms of serotonin withdrawal syndrome
Fever, achiness, soreness, lethargy, fatigue, impaired memory, decreased concentration, GI UPSET<\/p>\n\n\n\n
Shits and Shivers<\/p>\n\n\n\n
Ages of onset for schizophrenia in males vs females
-MALES 18-25 years<\/p>\n\n\n\n
-FEMALE 25-35 years<\/p>\n\n\n\n
Schizophrenia increases the risk for
SUICIDE<\/p>\n\n\n\n
HIGH RISK OF SI in SCHIZOPHRENIA<\/em><\/p>\n\n\n\n Just having schizophrenia increases your risk of suicide.<\/p>\n\n\n\n MUST ASK ABOUT SI, EVERYTIME (frequency, severity of thoughts)<\/p>\n\n\n\n What increases the causes or increases the risk or schizophrenia -inadequate synapse formation,<\/p>\n\n\n\n -intrauterine insults such as maternal exposure to toxins, viral agents, maternal substance use, maternal illness, maternal malnutrition, fetal oxygen deprivation,<\/p>\n\n\n\n -first order relative (mom\/dad)<\/p>\n\n\n\n MRI or PET scan what is seen in schizophrenia -You will see VENTRICULAR ENLARGEMENT<\/p>\n\n\n\n Stimulants can potentiate the release of what neurotransmitter? Assertive Community Treatment (ACT) What level of prevention is ACT? What adjunctive treatment is important in schizophrenia Exercise for mental health patients can promote ACT is ideal for patients with a history of -Think about making the treatment convenient for them–>bringing it to their home<\/p>\n\n\n\n What diagnosis has the highest risk of Homicidality In the MMSE how do you test for abstraction? Thought Process-Tangential Circumstantial Mental Status-Thought Content includes Another name for MMSE How to assess concentration on MMSE Assess ability to learn new material Assess ability to recall Assess fund of knowledge What is a quick and easy way to assess for neurological issues If patient is unable to draw a clock this indicates mesolimbic pathway -Antagonism of D2 receptors in this pathway treats positive psychotic symptoms<\/p>\n\n\n\n mesocortical pathway Nigrostriatal Pathway -Dopamine blockade in this pathway can lead to increase acetylcholine levels<\/p>\n\n\n\n -Blockade of dopamine (D2) receptors in this pathway can lead to EPS, i.e dystonia, parkinsonian symptoms and akathisia<\/p>\n\n\n\n Low Dopamine in the nigrostriatal pathway increases which neurotransmitter Long-standing D2 blockade in the nigrostriatal pathway can lead to<\/p>\n\n\n\n tardrive dyskinesia<\/p>\n\n\n\n Tuberoinfundibular pathway -DECREASE DOPAMINE INCREASED PROLACTIN<\/p>\n\n\n\n Long-term hyperprolactinemia can be associated with what condition<\/p>\n\n\n\n osteoporosis<\/p>\n\n\n\n Normal Prolactin Level in Men Normal Prolactin Level in Women Which medication is the highest offender for increasing prolactin Acute Dystonia + Treatment -Treatment is IM COGENTIN + continue PO COGENTIN for several days<\/p>\n\n\n\n Akathisia + Treatment -First line Treatment is BETA-BLOCKERS like PROPANOLOL (Inderal)<\/p>\n\n\n\n -Second line treatment is COGENTIN<\/p>\n\n\n\n -Third line treatment is benzos<\/p>\n\n\n\n Beta-Blockers such as Inderal are contraindicated with what type of asthma medication akinesia\/bradykinesia + treatment PSEUDOPARKINSON or PARKINSONIAN + Treatment -Treatment COGENTIN<\/p>\n\n\n\n tardive dyskinesia + Treatment -Treatment DECREASE DOSE OF MED, DISCONTINUE MED, Switch to CLOZARIL, Switch to different med, VINPAT<\/p>\n\n\n\n Does Cogentin Treat TD Typical onset of TD What non-psych med can cause TD? InDucers CYP450<\/p>\n\n\n\n DECREASE<\/p>\n\n\n\n Carbamazepine<\/p>\n\n\n\n Rifampin<\/p>\n\n\n\n Alcoholics (chronic)<\/p>\n\n\n\n Phenytoin<\/p>\n\n\n\n Grisiofulvin<\/p>\n\n\n\n Phenobarb<\/p>\n\n\n\n Sulphonylureas<\/p>\n\n\n\n Crap GPS Induces me to Madness!<\/p>\n\n\n\n InhIbitors of CYP450<\/p>\n\n\n\n INCREASE<\/p>\n\n\n\n Ciprofloxacin Acute Etoh Crack Amigos<\/p>\n\n\n\n Erythromycin and Clarithromycin can cause Patient started on Clozaril or Zyprexa and two months later starts smoking<\/p>\n\n\n\n as a provider you know that the smoking can decrease the medication effectiveness<\/p>\n\n\n\n -Increase medication dose<\/p>\n\n\n\n Patient has been a chronic smoker and has been stable on Zyrexa but tells you that he recently quit smoking cold turkey Medications that cause mania -If a patient must take steroids, the provider should increase the mood stabilizer<\/p>\n\n\n\n Medications that cause depression -may need to increase antidepressant<\/p>\n\n\n\n Accutane (isotretinoin) Flonase Increase mood stabilizer to maintain stability, steroids can also trigger depression<\/p>\n\n\n\n Flonase can trigger mood instability but it can also cause an increase in patient is taking flonase while on antipsychotic but you find that the antipsychotic is ineffective it is likely because the flonase is exacerbating psychosis<\/p>\n\n\n\n -increase the dose of antipsychotic<\/p>\n\n\n\n Neurotransmitters involved in Addiction Symptoms of Stimulant Abuse<\/p>\n\n\n\n If an anorexic patient complains of pain or bloating after eating this may indicate Medications that delay gastric emptying Proton Pump Inhibitors (omeprazole & Protonix) -MUST WAIT TWO HOURS BEFORE TAKING ANTIPSYCHOTIC OR SSRI<\/p>\n\n\n\n When initiating an SSRI on an elderly patient you should advise about Paradoxical effect Apoptosis At age 45 and above the patient displays mania for first time what should be ruled out<\/p>\n\n\n\n MEDICAL CONDITION<\/p>\n\n\n\n Patient with bipolar disorder presents with depressed mood & emotional lability<\/p>\n\n\n\n Give Depakote<\/p>\n\n\n\n Hallmark sx of Borderline Personality Treatment for Borderline Personality Creator of DBT What activity is helpful in making a diagnosis of borderline personality Conversion Disorder Adjustment Disorder -Symptoms occur within 3 months of the stressor<\/p>\n\n\n\n If question states recently moved, recent death\u2026.THINK ADJUSTMENT<\/p>\n\n\n\n factitious disorder -Faking illness but NO MOTIVE BEHIND IT<\/p>\n\n\n\n Malingering Reactive Attachment -Withdrawn and shows no emotion towards caregiver<\/p>\n\n\n\n ODD -Family Therapy is mainstay<\/p>\n\n\n\n -Child management \/Parent management skills is the focus in therapy<\/p>\n\n\n\n -Positive reinforcement<\/p>\n\n\n\n -Boundary Setting<\/p>\n\n\n\n Conduct Disorder -May need meds and therapy<\/p>\n\n\n\n -Goal of therapy is to target MOOD & AGGRESSSION (mood stabilizers, antipsychotics, alpha agonists\/alpha 2 adrenergic receptor blockers such as guanfacine and clonidine)<\/p>\n\n\n\n -Monitor BP with guanfacine and clonidine<\/p>\n\n\n\n Acute Stress Disorder -heightened arousal, nightmares, flashbacks<\/p>\n\n\n\n -LESS THAN ONE MONTH<\/p>\n\n\n\n PTSD -3 HALLMARK SXS: intrusive re-experiencing of trauma, increased arousal, avoidance<\/p>\n\n\n\n -May also have NIGHTMARES\u00e0 GIVE PRAZOSIN<\/p>\n\n\n\n -Non-pharm tx of PTSD- EMDR, CBT<\/p>\n\n\n\n Panic attack vs Panic disorder (treatment) Panic Attack is ACUTE Feels like impending doom<\/p>\n\n\n\n Tourette’s Syndrome -TWO moto tics and ONE vocal tics<\/p>\n\n\n\n -LASTS more than ONE YEAR<\/p>\n\n\n\n -By age 18<\/p>\n\n\n\n CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL<\/strong><\/p>\n\n\n\n Child presents with one tic and the parent is worried Neurotransmitters involved in Tourettes Treatment for tourettes What type of medication can cause tics or exacerbate them Neurotransmitters involved in mood disorders Neurotransmitters involved in ADHD part of brain implicated in ADHD ADHD inattentive type is caused in what part of the brain dorsolateral prefrontal cortex Deficit in the _<\/strong> can lead to ADHD inattentive type Teacher reports that the stimulant only works for first few hours of class<\/p>\n\n\n\n medication has worn off too fast. Order multiple dosing throughout the day<\/p>\n\n\n\n When does the aftercare plan start If parents become anxious while you are educating about a new diagnosis what should you do -Parents may become anxious after a diagnosis of mental illness such as ADHD, stop teaching offer support because they will not absorb the education. Provide supportive therapy<\/p>\n\n\n\n Neurotransmitters involved in OCD A tic may also be a _<\/em> Facts about OCD -A tic may be a compulsion<\/p>\n\n\n\n -If first order relative has OCD the child\u2019s risk of developing OCD is increased<\/p>\n\n\n\n -Streptococcal infections increase risk of OCD<\/p>\n\n\n\n -Treatment SSRI-prozac, Zoloft, if adult you may also use TCA such as clomipramine<\/p>\n\n\n\n If question asks if the patient has Tourette\u2019s vs OCD listen for mention of streptococcal treatment this will trigger you to think OCD<\/p>\n\n\n\n DMDD -Irritability for no reason, sad, depressed mood, tantrums, crying, moody, always mad<\/p>\n\n\n\n If patient presents with irritability or labile mood and you need help further delineating symptoms Sleep Disorders are often _<\/strong> ask if someone in the family has a similar issue with sleep\u2026look for family patterns of sleep problems<\/p>\n\n\n\n GAD Delirium inattention<\/p>\n\n\n\n -Urinary Tract Infections are common cause for DELIRIUM always check UA<\/p>\n\n\n\n -Treatment is antipsychotics like HALDOL<\/p>\n\n\n\n Dementia -Mental decline in cognition, irritability, personality changes<\/p>\n\n\n\n -When asked questions they may try to answer or MAKE UP ANSWERS (confabulate)<\/p>\n\n\n\n Low levels of what labs may mimic dementia Cortical Dementia Subcortical Dementia HIV Dementia is a type of subcortical dementia<\/p>\n\n\n\n Early signs of HIV dementia COGNITIVE, MOTOR, BEHEAVIOR for example a patient with lack of coordination, unsteady gait<\/p>\n\n\n\n Treatment for HIV dementia Pseudo Dementia -Also assess onset of symptoms, pseudo dementia is more acute onset<\/p>\n\n\n\n -When asked questions they often say \u201cI DON\u2019T KNOW\u201d<\/p>\n\n\n\n Instruments to use to differentiate between dementia and pseudo dementia -Older individuals with depression may present with irritability and agitation<\/p>\n\n\n\n If question is asking you to differentiate between depression and dementia look at the amount of time that the symptoms have been present<\/p>\n\n\n\n hallmark of lewy body dementia Frontotemporal lobe Dementia -Hallmark is personality changes, language difficulties, poor impulse control, and behavioral changes<\/p>\n\n\n\n -May see slurred speech or difficulty getting words out<\/p>\n\n\n\n What lobe is associated with ability to understand what others are saying (comprehending speech) Neurotransmitters involved in Autism Autism When play they often like to line up their toys, stack them in tidy rows<\/p>\n\n\n\n Broken Mirror Theory of Autism Risk Factors for Autism Screening tools for Autism Where is Norepinephrine produced? Where is serotonin produced? Where is dopamine produced? Where is acetylcholine synthesized? Hippocampus Limbic System Amygdala function Thalamus function hypothalamus function anterior cingulate cortex Cerebellum signs of lead toxicity Hint home built before 1970\u2019s<\/p>\n\n\n\n TEST FOR LEAD<\/p>\n\n\n\n When caring for an infant that is about to die? Risk factors for osteoporosis Provide Education<\/p>\n\n\n\n If discharging a patient that is not following up with outpatient care, organize ways to help the patient get to the appointment REMEMBER STAY INVOLVED IN THE CARE<\/p>\n\n\n\n Assume you are doing group therapy and there is a patient that is not comfortable sharing but you are trying to promote interpersonal learning. What should you do?<\/p>\n\n\n\n Provide adjunctive individual session that will help facilitate group participation<\/p>\n\n\n\n Cognitive Therapy Replacing irrational or distortive thoughts with positive thoughts<\/p>\n\n\n\n Behavioral Therapy Humanistic Therapy Existential Therapy Why am I here, What is my purpose<\/p>\n\n\n\n Interpersonal Therapy –Used for people who have trouble interacting with others, relationship distress<\/p>\n\n\n\n -Marital conflict<\/p>\n\n\n\n -12-16 weeks (3-4 months)<\/p>\n\n\n\n EMDR Phases Installation Phase: Installs and increases strength of the positive thoughts that the patient has declared as a replacement<\/p>\n\n\n\n Body Scan: Visualize the trauma along with the positive thought and then scan ones body mentally to identify any tension within<\/p>\n\n\n\n Group therapy: Installation of hope Group therapy: Universality Group Therapy: Altruism Group Therapy: Imitative Behavior Group Therapy: Interpersonal learning Group Therapy: Group Cohesiveness Group Therapy: Catharsis Group Therapy: Existential Factors Group Therapy: Corrective Refocusing Group Phases Family Systems Therapy -a person’s problematic bx may serve a function for the family or be a symptoms of dysfunctional patterns<\/p>\n\n\n\n KEY WORDS*<\/p>\n\n\n\n Self-Differentiation, Triangulation,<\/p>\n\n\n\n Triangles<\/p>\n\n\n\n Structural Family Therapy -How, when, and who whom family members relate<\/p>\n\n\n\n KEY WORDS*<\/p>\n\n\n\n Mapping<\/p>\n\n\n\n Hierarchies<\/p>\n\n\n\n Boundaries<\/p>\n\n\n\n Strategic Therapy -Symptoms are a way to communicate metaphorically in a family<\/p>\n\n\n\n -Symptom focused<\/p>\n\n\n\n KEY WORDS*<\/p>\n\n\n\n Straightforward directive<\/p>\n\n\n\n Paradoxical directive (reverse psychology)<\/p>\n\n\n\n Reframing (you are not jealous of your sister you just care for her so much)<\/p>\n\n\n\n Solution Focused Therapy -EXCEPTION-BASED FINDING -SCALING QUESTIONS<\/p>\n\n\n\n Meditation If patient tells you something BEFORE you ASSESS- EXPRESS EMPATHY \u201cI\u2019m sorry this happened to you.\u201d<\/p>\n\n\n\n USE OPEN ENDED QUESTIONS unless talking to a child or someone that is unable to construct a narrative then use CLOSED ENDED or YES\/NO<\/p>\n\n\n\n PICOT If a patient has rheumatoid arthritis check Therapy session with husband and wife & only one shows up<\/p>\n\n\n\n Reschedule<\/p>\n\n\n\n A patient\u2019s mother calls and tells you that her son has been sodomized by their 15 year old brother<\/p>\n\n\n\n tell mother DO NOT LEAVE THE CHILD ALONE WITH THE BROTHER<\/p>\n\n\n\n -Provider calls CPS<\/p>\n\n\n\n -Arrange crisis therapy for family<\/p>\n\n\n\n Patient is moving out of state<\/p>\n\n\n\n if there is no imminent danger then provide enough medication for them to establish a new provider<\/p>\n\n\n\n Level 1 evidence Level 2 Evidence Shrill Cry Child between the ages of 3-6 masterbating Mom is concerned that her son age 10 has swelling in his chest and she is concerned he is developing breasts *reassure them that this is normal<\/p>\n\n\n\n Elderly female presents with decreased sex drive Sex Hormone-Testosterone is involved in sex drive<\/p>\n\n\n\n -MUST KNOW THAT WOMAN have TESTOSTERONE TOO<\/p>\n\n\n\n alcohol dehydrogenase -WOMAN HAVE LOWER ALCOHOL DEHYDROGENASE (metabolizes alcohol)<\/p>\n\n\n\n -This is why woman get drunk faster<\/p>\n\n\n\n -Lower levels of this enzyme may also cause a higher propensity to develop LIVER DISEASE<\/p>\n\n\n\n When OB wants to hire psych providers<\/p>\n\n\n\n they want to increase mental health access to those that need it the most<\/p>\n\n\n\n Normalizing grief and loss in children<\/p>\n\n\n\n Don\u2019t tell them what to do because grief responses vary<\/p>\n\n\n\n -i.e Don\u2019t tell them to stop working that is prescriptive advise<\/p>\n\n\n\n -With children the most important thing is to reinforce FAMILY support an supportive therapy such as group therapy so they can learn from other children who have experienced similar events<\/p>\n\n\n\n palmar grasp reflex Moro (startle) reflex Babinski reflex PDE-5 inhibitors Vardenafil (Levitra)<\/p>\n\n\n\n Tadalafil (Cialis)<\/p>\n\n\n\n RAPIDLY ABSORBED<\/p>\n\n\n\n Used for erectile disfunction<\/p>\n\n\n\n Difference between BMI in anorexia vs Bulemia Parent brings in 16-year-old with BMI 12, Pulse LOW, BP LOW and you determine the patient needs to be sent for medical evaluation but the parents refuse<\/p>\n\n\n\n Contact CPS<\/p>\n\n\n\n You read and article that says that most children with ADHD abuse substances\u2026<\/p>\n\n\n\n -To translate this information into practice what should you do?<\/p>\n\n\n\n -Screen ALL children for ADHD for SUBSTANCE USE<\/p>\n\n\n\n -OR Screen ALL children with SUBSTANCE USE for ADHD<\/p>\n\n\n\n accupuncture Habeas Corpus<\/p>\n\n\n\n legal concept that protects patients from unlawful hospitalization<\/p>\n\n\n\n -May be a reason to leave AMA<\/p>\n\n\n\n Disseminated Encephalomyelitis<\/p>\n\n\n\n inflammation of nervous system<\/p>\n\n\n\n -MUST DO NEURO EXAM<\/p>\n\n\n\n -EXAM: May present with ASSYMETRICAL BODY MOVEMENTS<\/p>\n\n\n\n Assume you are interviewing a patient and you want them to provide information in a specific timeline, but they are unable<\/p>\n\n\n\n TO help ask them specific questions which helps to ANCHOR their memory<\/p>\n\n\n\n Before you administer a medication, you must educate them about the medication but first you should assess<\/p>\n\n\n\n BUT FIRST ASSESS WHAT THEY KNOW ALREADY or WHAT THERE BELIEVES ARE ABOUT THE MEDICATION<\/p>\n\n\n\n Patient presents with iatrogenic effect -Don\u2019t assume that it is from the medication you prescribed<\/p>\n\n\n\n When trying to pass a policy and your co-workers are against it what should you do To promote a policy how do you get the word out there Working in outpatient setting and you want to ensure continuous improvement in quality of care.<\/p>\n\n\n\n -Create an instrument to monitor clinical outcomes (this helps to identify what you are doing right or wrong)<\/p>\n\n\n\n Autoimmune disease can lead to increased If a child is urinating the bed -If that doesn\u2019t work try DESMOSPRESSIN (decreased enuresis)<\/p>\n\n\n\n Are you allowed to look up a patient on social media? Assume you started a patient on a medication and they go home and find out that there is a black box warning on the medication that you were unaware of. They call with concerns\u2026<\/p>\n\n\n\n -First, go online and do your own research<\/p>\n\n\n\n -Research the RISK vs BENEFIT before you tell the patient to stop the medication<\/p>\n\n\n\n Risk factors for sleep apnea Tolerance PHQ-9<\/p>\n\n\n\n 5 mild depression Max score 27<\/p>\n\n\n\n HAM-D<\/p>\n\n\n\n 10 Mild HAM-A<\/p>\n\n\n\n 8 Mild Beck Depression Inventory (BDI) 14 Mild Max score 63<\/p>\n\n\n\n GAD-7 Scoring 5 Mild Anxiety Max score 21<\/p>\n\n\n\n COWS Consider Subutex or Suboxone at 13 or above<\/p>\n\n\n\n Remember Methadone is the LEAST safe option due to cardiac issues<\/p>\n\n\n\n CIWA Scores of 15 or above consider scheduled medications<\/p>\n\n\n\n Patient in alcohol withdrawal and you are choosing medication for CIWA, check what? if liver disease use ATIVAN because of short half life over VALIUM<\/p>\n\n\n\n REMEMBER DETOX SHOULD NOT OCCUR OUTPATIENT–>residential or inpatient is needed<\/em> especially if pregnant. REMEMBER SAFETY FIRST<\/p>\n\n\n\n Idealization This is often seen in grieving before acceptance of the loss<\/p>\n\n\n\n Appreciative Inquiry Example do not focus on what the employee does wrong focus on what they do well<\/p>\n\n\n\n Reflective Practice -After an incident–> Debrief<\/p>\n\n\n\n Assume you started the patient on an antidepressant and now they complain of insomnia<\/p>\n\n\n\n Conflict of interest between pharmaceutical companies and Nurse Practitioners i.e promises to sponsor NP loan forgiveness. You want to create a policy to address this. First you must examine\u2026<\/p>\n\n\n\n study the relationship between the industry provided samples and industry sponsored education<\/p>\n\n\n\n If a patient is involuntarily admitted can they still refuse medications? Scope of practice is determined by Scope of practice defines If you would like to perform ECT as an NP what should you review Standard of practice is determined by -Provides a way to judge nature of the care provided<\/p>\n\n\n\n The PMHNP is required by law to carry out care in accordance with what other reasonably prudent nurses would do in the same or similar circumstances. Thus, provision of high-quality care consistent with established standards is critical<\/p>\n\n\n\n Exceptions to Confidentiality -Insurance companies<\/p>\n\n\n\n -Giving information to attorneys involved in litigation<\/p>\n\n\n\n -Intent to harm self or others<\/p>\n\n\n\n -Meeting state of federal requirements for reporting disease states<\/p>\n\n\n\n -When the need for information outweighs the principle of confidentiality i.e unconscious patient and their life is at stake<\/p>\n\n\n\n Tarasoff principle may vary by state so you must check with your state board of nursing first\u2026it may not be your responsibility to notify<\/p>\n\n\n\n If you are taking care of a patient and during the process of interview she tells you that her husband just texted her that her husband is going to kill self<\/p>\n\n\n\n -Call the police, provide the address<\/p>\n\n\n\n informed consent -Ensure they understand the risks vs benefits<\/p>\n\n\n\n If patient is able to reiterate the risks vs benefits of procedure or treatment, they are able to give consent*<\/p>\n\n\n\n Example patient comes to the hospital, and they are unable to give consent i.e to sick to agree to treatment you must<\/p>\n\n\n\n assess need for involuntary treatment<\/p>\n\n\n\n Justice Nonmaleficence Beneficence Fidelity Veracity Autonomy New male patient has a 10 year history of substance abuse, depression, and anxiety. He is requesting Xanax. Which principle should the PMHNP employ moving forward?<\/p>\n\n\n\n A. Beneficence<\/p>\n\n\n\n B. Fidelity<\/p>\n\n\n\n C. Non-Maleficence<\/p>\n\n\n\n D. Veracity<\/p>\n\n\n\n C. Non-Maleficence<\/p>\n\n\n\n Do no harm, giving Xanax would endanger him secondary to the high abuse potential and imminent danger if he were to overdose on Xanax<\/em><\/p>\n\n\n\n If no history of substance use, then beneficence would be appropriate because the Xanax would help the anxiety<\/p>\n\n\n\n Acute agitation and anxiety vs acute agitation and psychosis<\/p>\n\n\n\n IM ordered IM antipsychotic for agit\/psychosis<\/p>\n\n\n\n Patients have the right to be treated in the Least The PMHNP is asked to consult with a local inpatient psychiatric facility to provide nursing staff development. After meeting with the administrator to identify the nature of the problem requiring the consultation, the PMHNP’s next step is to: 3 Interventions vs 1 Assessment<\/em> FIRST YOU NEED TO ASSESS FIRST<\/p>\n\n\n\n What is the best way to reduce stigma *THINK WIDEST AUDIENCE<\/p>\n\n\n\n Just Culture The PMHNP is concerned about access-to-care issues in the local community and wants to help develop health care policy to help patients access care more effectively. Remember strength in numbers but STAY INVOLVED i.e asking the manager just passes off<\/em><\/p>\n\n\n\n If a patient from a specific culture is refusing to accept any diagnosis of mental health disorders because of shame what could be done to address this barrier?<\/p>\n\n\n\n A. Educate the family<\/p>\n\n\n\n B. Political advocacy<\/p>\n\n\n\n C. Public Health Concern<\/p>\n\n\n\n D. Community education programs<\/p>\n\n\n\n D. Community education programs<\/p>\n\n\n\n *Narrow down to education A\/D\u2026then think WIDE NET =Community EDUCATION<\/p>\n\n\n\n A client with Biolar I disorder presents to your PMHNP office for a follow-up visit. During the visit the client informs you he no longer wants to be treated with medication. , and he does not have bipolar disorder, that was a misdiagnosis, He further informs you he stopped all his medications 2 months ago and is here to thank you for your care and tell you he no longer needs appointments. Understanding ethical conflict, you use which of the following ethical principles? Patient\u2019s have the right to self-determination<\/em><\/p>\n\n\n\n Recovery Model * RELAPSE IS A LEARNING OPPORTUNITY<\/p>\n\n\n\n -Treatment approach that does not focus on full symptom resolution but emphasizes on resilience and control over problems in life<\/p>\n\n\n\n -Self-Direction (do not tell them what to do)<\/p>\n\n\n\n -Individualized and Person-Centered<\/p>\n\n\n\n -Non-Linear, Recovery is not a step-by-step process, but one based on continual growth, occasional setbacks, and learning from experience<\/p>\n\n\n\n In counseling a 23 y\/o married Hispanic mother who brought her 4 year old son to the clinic for “mal de ojo” with symptoms of fitful sleep, diarrhea, vomiting, and fever the PMHNO; *In cultural questions remember RESPECT FIRST! Even before assessment<\/p>\n\n\n\n Quality Improvement<\/p>\n\n\n\n Projects designed to improve systems, decrease cost, and improve productivity<\/p>\n\n\n\n What is an example of a quality improvement process? Retrospective Chart Review is an example of a Quality Improvement Process<\/p>\n\n\n\n If they ask HOW the NP would do a quality Improvement Process the answer may be Plan, Do, Study, Act<\/p>\n\n\n\n The NP is responsible for initiating quality improvement at a community clinic. The effective strategy for evaluating the clients services is to<\/p>\n\n\n\n A. Chart review analysis<\/p>\n\n\n\n B. A root cause analysis<\/p>\n\n\n\n C. Plan DO Study Act<\/p>\n\n\n\n D. Failure effect mode analysis<\/p>\n\n\n\n C. Plan Do Study Act<\/p>\n\n\n\n SBIRT Erikson’s stages of psychosocial development<\/p>\n\n\n\n Piaget’s stages of cognitive development<\/p>\n\n\n\n Preoperational Stage includes Egocentric<\/p>\n\n\n\n Understand language<\/p>\n\n\n\n formal operational stage KEY WORD is LOGIC think like a scientist or do a science project you must be able to use logic ABSTRACT THINKING such as doing algebra<\/p>\n\n\n\n sensorimotor stage concrete operational stage Risk factors for suicide Women try more often. Men succeed more often.<\/p>\n\n\n\n A 72 year old female brought in by her husband with increasing forgetfulness, decreased activity, and decreased appetite for 2 months. She has a history of HTN and is being treated with Lisinopril. The exam is normal and the MMSE provides a score of 24 but she declines to answer some questions and needs to be urged to participate in the assessment. What is the likely diagnosis?<\/p>\n\n\n\n A. Alzheimer<\/p>\n\n\n\n B. Vascular Dementia<\/p>\n\n\n\n C. Depression<\/p>\n\n\n\n D. Medication Toxicity<\/p>\n\n\n\n C. Depression<\/p>\n\n\n\n *2 months=too soon for Alzheimer\u2019s, 24 is mild MMSE, HTN is not enough info to diagnose vascular dementia HALLMARKS FOR VASCULAR DEMENTIA are carotid bruits fundoscopic abnormalities and enlarged cardiac chambers, remember PSEUDO dementia is DEPRESSION<\/p>\n\n\n\n HALLMARKS FOR VASCULAR DEMENTIA<\/p>\n\n\n\n carotid bruits fundoscopic abnormalities and enlarged cardiac chambers,<\/p>\n\n\n\n Patient comes to the office, and you score them on HAM-D a 23 and you start an antidepressant on dose Xmg, 2 weeks later they score a 16 on the HAM-D. What would you do?<\/p>\n\n\n\n Leave the dose where it is<\/p>\n\n\n\n Patient is taking Zoloft 200mg and on the GAD 7 they score a 2, what do you do<\/p>\n\n\n\n Leave the dose where it is<\/p>\n\n\n\n Zung Depression Scale Scoring<\/p>\n\n\n\n 50 Mild 25-49 is NORMAL RANGE MMSE scoring 10 moderate<\/p>\n\n\n\n 20 mild<\/p>\n\n\n\n 25 Normal<\/p>\n<\/blockquote>\n\n\n\n Kids under 10 years old are severely challenging to teach<\/p>\n\n\n\n HIGHER THE BETTER!<\/p>\n\n\n\n Teratogenic Effects<\/p>\n\n\n\n Primary prevention Secondary Prevention Tertiary Prevention Pharmacokinetics Pharmacodynamics messenger RNA codes for Poor relationships, lack of future hope, suspicious of others indicates developmental failure of what stage Poor self-esteem, low self control, self-doubt, lack of independence indicates failure of what stage Lack of self-initiative, lack of goal orientation indicates failure of what stage sense of inferiority, difficulty with working\/learning indicates a failure of what stage identity confusion, poor self-identification in groups indicates failure of what stage emotional isolation, egocentrism indicates a failure of what stage self-absorption, inability to grow and change as a person, inability to care for others indicates a failure at what stage bitterness, sense of dissatisfaction with life, despair over impending death indicates failure of what stage<\/p>\n\n\n\n 65 y\/o integrity vs despair<\/p>\n<\/blockquote>\n\n\n\n agonist effect Inverse agonist effect partial agonist effect Antagonist effect Herbals that interact with warfarin Black Cohosh Bellandonna chamomile Ginko Ginseng Valerian Hypertensive crisis can occur when MAOI are taken with Microcytic anemia macrocytic anemia Labs: Folic Acid, B12, ESR\/CRP, HGB, MCV<\/p>\n\n\n\n 14 y\/o with no axillary hair and no period Two classes of cardiac meds that should not be used together Abnormal Trendelenburg Test too little acetylcholine 4 D’s Discover, Dream, Design, Destiny Cranial Nerve V WBC 1500-2000 How can you assess cranial nerve XII? First sign of metabolic syndrome Grade 2\/5 hoarse systolic heart murmur Ibuprofen + lithium Kleinfelter’s Syndrome Mental Health Parity Act what does nuchal rigidity indicate? Patient is on interferon and lexapro, as a provider you understand that Patient complains of neuropathic pain and neurontin is not working Patient is in hospital with no family and is failing cognitive test what should you do? Phases of policy making Rhett Syndrome Signs of fetal alcohol syndrome Tegretol side effects Telemedicine legal question? A person is seen wandering the streets for 2 days Medication used for serotonin syndrome Why? it is an H1 blocker but is also has serotonin receptor blocking activity. Specifically, it acts to block 5-HT1A and 5-HT2A receptors which are the ones responsible for serotonin syndrome<\/p>\n\n\n\n When to assess a patient in restraints? Why would you be concerned with immature reticulocytes? pharm treatment for agoraphobia Anorexia admission Criteria for hospitalization includes: ANOVA precontemplation stage Contemplation stage Preparation Stage Action Stage Maintanence stage These 3 meds cause BIG FREAKING PROBLEMS Boy tells you he wishes to be a girl and asks you not to tell the parents BRUISE on the padded part of his arms Can an advanced directive be revoked? How? Can you take Buspar during pregnancy? Carb and barb + Coumadin Who is in charge of the DEA? Common comorbidities of bipolar Conjunctival injection, munchies, psychomotor slowness? Diary Log Depakote and Disulfiram What 3 atypicals can be used with teens? Np wants to implement a certain policy in nursing. Phenycyclidine (PCP) can cause? Hildegard Peplau Patient acting out due to missing session what do you do? Patient on antidepressants for 3 weeks and attempted Suicide Patient shows symptoms of dizziness, tremors, sweating, What Medical Diagnosis Pearson’s r pincer grasp Problems in the parietal lobe can lead To promote resilience in a patient with schizophrenia that lives alone consider referral to Patient on Lithium and Depakote and has temp, right flank pain, brown urine. What do you do FIRST? Pt states “god did this to me.” Patient taking breathing treatment Albuterol\/Proventil p-value Reliability Stereogenesis Tagamet (cimetidine) Trazadone concerns Turner Syndrome To start your own firm as an NP and need to examine economic viability 3 CK muscle enzyme tests? What are the legal ramifications of treating someone without informed consent? Two important things to measure when prescribing Zyprexa What schedule of controlled substances are NPs allowed to prescribe? What crania nerve is affected when you ask the patient to shrug their shoulders? These medications are renally metabolized grapefruit juice How do Asians see HC providers? How do you protect from the evil eye? T-test Treatment for children with panic disorder What do BCP’s do to Lamictal? What does an increased retic count indicate What do you see in Labs with HIV dementia What is occuring in the adolescent brain? Indomethacin is a Tramadol Dissemination Sensitivity vs. Specificity *In medical diagnosis, testing sensitivity is the ability of a test to correctly identify those with the disease (true positive) whereas test specificity is the ability of the test to correctly identify those without the disease (true negative)<\/p>\n\n\n\n What is the purpose of HIPAA? DETROL interactions Yale-Brown Obsessive Compulsive Scale (Y-BOCS) If you want to decrease the use of seclusion who would be considered the primary change agent Rennie vs Klein<\/p>\n\n\n\n Roger vs. Oken ROGERS GUARDIAN<\/p>\n\n\n\n Donalson vs O’Connor Donalson was a patient hospitalized for 15 years<\/p>\n\n\n\n Dusty vs United States Durham vs King Riese vs St. Mary’s Hospital Stark Law There is a medication class that is contraindicated when a patient has tics. What is that class of medication? What action do you take if a patient reports being a victim of abuse. If you work inpatient, what do you do before discharging a patient who says they have been abused? If you work inpatient, is a safety contract sufficient to determine that you are releasing a patient into a safe home? Inpatient–for safety, where should the NP interview the patient and why? If a child comes into the office with their parents and say they have been abused, what action does the NP take? If a child comes into an appointment without their parents and plays with a toy in a sexual way, what action does the NP take? What is the cornerstone of building a therapeutic alliance with adolescents? Do we interview adolescents with their parents in the room? If an adolescent comes in with their parents, do you keep the parents and adolescent together or separate theme? Which ethnic group has the highest incidence of suicide and suicide attempts ? Native Americans believe in their healing stick. If a staff member tries to take it away, what should the NP do? If a patient wants a traditional healer to accompany them to an appointment, what does the NP have to do ? Which labs should be taken before treating for depression or mania? What is the normal range of TSH? Symptoms of hypothyroidism mimic which mental illness? Symptoms of hyperthyroidism mimic which mental illness? If TSH is low i.e. 0.4 or lower, what is happening to T4 an T3 and what condition does patient have? If TSH is high e.g. 7.0, what is happening to T4 an T3 and what condition does patient have? What are the symptoms of hyperthyroidism that can mimic mania? And what are other symptoms? Other symptoms are heat intolerance and tachycardia<\/p>\n\n\n\n What are symptoms of hypothyroidism that mimic depression? And what are other symptoms? And, cold intolerance<\/p>\n\n\n\n What is the Black Box warning for Depakote? What are physical side effects\/ dangers of Depakote (Divalproex)–for patient or fetus If a patient taking depakote has signs of hepatotoxicity what would those signs and symptoms be ? If patient taking depakote has signs of hepatotoxicity, what should the NP do? Signs of valproic acid toxicity? What action do we take at signs of valproic acid (Divalproex\/Depakote) toxicity? What are the signs and symptoms of pancreatitis tenderness when touching the abdomen What in mental illness is Kava (or Kava Kava) used for ? anxiety What is the major side effect of Kava? What do we monitor? Kava is contraindicated with which meds\/med classes? Benzos (CLonazepam\/Klonopin), (Lorazepam\/ Ativan),<\/p>\n\n\n\n phenobarbital (Donnatal)<\/p>\n\n\n\n Zolpidem (Ambien)<\/p>\n\n\n\n Lamictal and weight Lamictal and rash What are the symptoms of Stevens Johnson syndrome? Which antipsychotics cause the least weight gain? For patients taking antipsychotics that have caused weight gain, what routine labs do we check? Non-pharm treatment of antipsychotic induced weight gain (AIWG)–1st line This is first line treatment<\/p>\n\n\n\n Pharm intervention for Antipsychotic Induced Weight Gain Black Box Warning for Carbamazepine symptoms of Aplastic anemia If prescribing Carbamazepine for an Asian patient, what gene do you screen for ? ANC level that indicates NP should DC clozapine or Carbamazepine? What are signs of infection for which we should monitor patients on Clozapine or Carbamazepine to DC it? Lithium and neuroprotection What is the therapeutic range of Lithium At what Lithium level does lithium toxicity occur? Lithium is the gold standard for treating what? Lithium and suicide. What is the therapeutic range of depakote? What is the toxic range of depakote(valproic acid)? Necessary labs for Lithium Signs of lithium toxicity weakness, worsening tremor, mild ataxia, poor concentration and diarrhea.<\/p>\n\n\n\n With worsening toxicity, vomiting, the development of a gross tremor, slurred speech, confusion and lethargy emerge<\/p>\n\n\n\n When to DC Lithium with or without symptoms if 1.5 serum level –toxicity level<\/p>\n\n\n\n If creatinine or BUN are high because Lithium is processed through kidney<\/p>\n\n\n\n Preventative tests when prescribing antipsychotics to women If patient has 4+ protein in urine while on lithium what do we do ? What are side effects of Lithium? What do we do in cases of Lithium toxicity? What are some factors that can increase Lithium levels? What causes Neuroleptic Malignant Syndrome (NMS)? What are the symptoms of Neuroleptic Malignant syndrome (NMS)? Elevated CPK (happens due to muscle contraction and destruction)<\/p>\n\n\n\n Myoglobinuria What is the treatment for NMS? There are two with different MOAs:<\/p>\n\n\n\n Bromocriptine (Parlodel) which is a Dopamine (2) agonist<\/p>\n\n\n\n Dantrolene which is a Muscle Relaxant<\/p>\n\n\n\n What are the signs of both NMS and serotonin syndrome? What are the signs of Serotonin Syndrome? What causes serotonin syndrome? How do we treat Serotonin Syndrome? Cyproheptadine<\/p>\n\n\n\n When switching from an SSRI to an MAOI, how long wait before starting the MAOI? When switching from fluoxetine (Prozac) to MAOIs how long to wait before starting the MAOI? When switching from an MAOI to Prozac how long wait until start Prozac? Why the wait times for switching from between SSRIs and MAOIs? Due to risk of Serotonin Syndrome, which combination of meds to we avoid? If we see “regenerate” in answers related to serotonin, what do you do ?<\/p>\n\n\n\n eliminate. “Regenrate” is wrong answer<\/p>\n\n\n\n Why are SSRIs the 1st line antidepressants used in depression Serotonin Syndrome and triptans? Which antidepressant to do we give a patient who is depressed and has cancer? Which antidepressant to do we give a patient who is depressed and has neuropathic pain? What do we prescribe for patients in chronic neuropathic pain? antidepressants and sexual dysfunction Important info about Wellbutrin Patient depressed +Low energy +fatigue give Wellbutrin<\/p>\n\n\n\n Wellbutrin contraindicated in hx of seizures or eating d\/o = Wellbutrin increase seizure risk<\/p>\n\n\n\n Black Box Warning on all depressants and responsibiltity of NP assess for frequency and severity of these thoughts at every visit.<\/p>\n\n\n\n Alcohol and depression Prozac and Insomnia Mental illnesses that cause thoughts of self-harm mental illness most often associated with Homicidal ideation Placebo rate, children, antidepressants positive symptoms of schizophrenia Negative symptoms of schizophrenia age of onset of schizophrenia What is going on in brain of a schizophrenic that we see in an MRI\/PET scan? Everything else is decreasing in size What are the parts of the brain in which abnormalities or changes\/deficits cause agression, impulsitivity, and abstract thinking problems in schizophrenia? Medications for which schizophrenics have a low tolerability so they are not as neuroprotective for schizophrenics as they are for others Why should we not give stimulants to schizophrenics? Non-pharm management of schizophrenia What is ACT? If a schizophrenic has a long-term history of non-adherence what may they need for in home care? What level of care is social skills training for a schizophrenic? How does exercise help schizophrenics? A schizophrenic is taking oral Haldol and is at high risk of relapse (multiple hospitalizations), what should we do about administering medication Dosing for switching from oral Haldol to Haldol Decanoate 5 mg PO BID What is the dose limit of LAI Haldol that can be given in one week? same for 300 mg= 100 mg day one What is a delusion? If doing a MSE of preschooler(3-5y\/o), what is the most important approach to Components of a Mental Status Exam–what do you assess with thought process assessment? Components of a Mental Status Exam–what do you assess with thought content assessment? Mental status exam–when evaluating thought process or thought content, what are we evaluating? Are we evaluating organization of speech? NO, we are not evaluating organization of speech<\/p>\n\n\n\n The Folstein Mini Mental Status Examination is used with which population and for what ? What are some important components of the mini-mental status examination Orientation: Year, season, date, day, month, country, town, hospital, floor<\/p>\n\n\n\n Registration\/ability to learn new material: say names of three unrelated objects clearly and slolwy, ask patient to repeat immediately<\/p>\n\n\n\n Recall (memory): Ask patient if they can recall the three object words previously asked to remember 5 minutes after introducing the object words<\/p>\n\n\n\n Fund of knowledge: Who is president\/govenor<\/p>\n\n\n\n What is the purpose of the Clock drawing test ? If there are impairments on the CDT (Clock Drawing Test), which part of the brain may be damaged? What makes an antipsychotic atypical? Lower chance of EPS syndromes<\/p>\n\n\n\n Which type of antipsychotic for first psychotic episode? Dopamine Pathway: Mesocortical pathway relationship between dopamine and schizophrenic symptoms Nigrostriatal pathway of brain controls what ? Dopamine blockade in this pathway can lead to increase acetylcholine levels–increase salivation, teary eyes, diarrhea<\/p>\n\n\n\n Dopamine Pathway: Nigrostriatal pathway relationship between dopamine and EPS Long standing D2 blockade in the nigrostriatal pathway can lead to Tardive Dyskinesia.<\/p>\n\n\n\n Neurotransmitters and EPS EPS and metoclopramide How do you treat EPS except Tardive Dyskinesia? How do we treat Tardive Dyskinesia? Dopamine Pathway: Tuberoinfundibular pathway relationship between dopamine and physical symptoms Long term hyperprolactinemia can be associated with osteoporosis.<\/p>\n\n\n\n Normal prolactin levels impact of Cytocrome P450 enzyme CYP1A2 inducers on drugs metabolized on the pathway impact of Cytocrome P450 enzyme CYP1A2 inhibitors on drugs metabolized on the pathway Olanzapine (Zyprexa) and Clozapine are both metabolized on which enzyme? If a patient on olanzapine or clozapine stops smoking what do we do with the dose Which are more worrisome? Inhibitors or Inducers? Is Tegretol(carbamazapine) an Inducer or Inhibitor ? Are clarithromycin and erithromycin inducers or inhibitors? If a patient is taking tegretol (carbamazapine) and clarithromycin, tegretol an inducer and clarithromycin an inhibitor, what should an NP do? Medications that cause mania Medications that cause depression Steroids and psychosis Are flonase and prednisone steroids? When taking medications that cause mania and depression, how do you dose the antidepresant or antipsychotic? Neurotransmitters involved in addiction What causes pain in anorexics after eating? medications that can delay gastric emptying If a med decreases the absorption of psychotropic medications, what is the best way to take it? Some medications that decrease absorption of psychotropics? If a patient aged 65+ is given SSRIs, for what should we monitor them? What is a paradoxical effect of a medication? Heart issues and Geodon and Citalopram What is the maximum recommended dosage per day for Citalopram? What is the greatest risk factor for bipolar If a person’s first bipolar episode is after the age of 45, what is the likely cause? What are the symptoms of Mania? What is apoptosis Primary symptoms of Borderline Personality Disorder What is the only treatment for Borderline Personality Disorder? Who created DBT? What is the diagnostic process for borderline Medication for a pateint with borderline presenting with irritability, anger and self-harming behavior Specific Medication for a patient with borderline presenting with depressed mood, emotional lability, interpersonal problems, rejection sensitivity, aggresion, hostility What is conversion disorder? Treatment is therapy<\/p>\n\n\n\n What is an adjustment disorder? What are symptoms of adjustment disorder with mixed disturbance of emotion and conduct — A child has a mix of symptoms from anxiety, depression and conduct dysfunction–possible peer conflict, verbal altercations, insomnia, frequent crying<\/p>\n\n\n\n Differentiation between Adjustment disorder and MDD How do we treat Oppositional Defiant Disorder? Child and parent problem-solving skills training<\/p>\n\n\n\n In ODD therapy, if no parenting skills are developed, what can ODD turn into What are key symptoms of conduct disorder Lack of remorse for ill deeds done<\/p>\n\n\n\n Pharmacological treatment for conduct disorder Diagnosing Tourette Syndrome Tics are not caused by using a subtance or other medical condition<\/p>\n\n\n\n When children have motor tics are they rare and permanent ? Primary neurotransmitter involved in Tourette Syndrome Hyperactivity of Dopaminergic systems in brain can lead to Tourette’s<\/p>\n\n\n\n Pharmacological treatment of Tourette Syndrome What is acute stress disorder? What are hallmark symptoms of PTSD? Pharmacological management of PTSD Non-Pharmacological management of PTSD What are the phases of EMDR? Which parts of the brain are affected in ADHD? ADHD — age amphetamines are approved for Heart and ADHD meds There can be elevated heart rate and BP; increase risk of heart attack and stroke<\/p>\n\n\n\n ADHD — age methylphenidate are approved for ADHD– what does the dorsolateral prefrontal cortex control? Signs of stimulant abuse ADHD–If patient starts having symptoms again during the day, what does that indicate; what should be done? If parent is anxious or scared of child starting stimulants what should be done? What is OCD? Which autoimmune illness should be considered with sudden onset OCD symptoms in children? Differentiate OCD from Tourettes OCD = intrusive\/ persistent thoughts and tics<\/p>\n\n\n\n Factitious disorder Malingering factitious disorder imposed on another Reactive Attachment Disorder GAD (general anxiety disorder) Panic Attack Panic Disorder SSRIs for treatment of panic disorder Definition and Symptoms of DMDD (disruptive mood dysregulation disorder) Treatment for panic attacks Contraindications for propranolol Anorexia Nervosa symptoms Action if Anorexic with BMI less than 15? BMI of bulimia nervosa What is the non-pharm treatment for Oppositional Defiant Disorder?<\/p>\n\n\n\n If no parenting skills are developed what can ODD develop into? What are the primary symptoms of Conduct disorder What is the pharm treatment for conduct disorder? What are the defining symptoms of Tourette Syndrome\/Disorder<\/p>\n\n\n\n What is the expected permanence of children’s motor tics? What are the primary neurotransmitters involved in tourette’s syndrome? Hyperactivity of Dopaminergic systems in the brain can lead to Tourette’s<\/p>\n\n\n\n What is the primary pharm treatment for Tourette’s What are secondary pharm treatments for Tourette’s ? DSM-5 of Acute Stress Disorder Features include anxiety, insomnia, poor concentration, intense fear or helplessness, re-experiencing the event and avoidance behaviors–<\/p>\n\n\n\n It presents as PTSD but the onset of symptoms is less than PTSD<\/p>\n\n\n\n What is the minimum length of time that PTSD has to last? Hallmark symptoms of PTSD What is the pharm management of PTSD? What is primary important non-pharm treatment for PTSD? What are the different Non-pharm treatments for PTSD? CBT<\/p>\n\n\n\n What are the parts of the brain involved in ADHD? Basal ganglia<\/p>\n\n\n\n Abnormalities in reticular activating system<\/p>\n\n\n\n Frontal cortex<\/p>\n\n\n\n abnormalities in the Prefrontal cortex–inattentive type<\/p>\n\n\n\n Cardiology and ADHD stimulant If history or family hx of cardiac issues, get an ECG before starting.<\/p>\n\n\n\n What are the ages for amphetamines? what are the ages for methylphenidate? What are the ages for Alpha agonist or alpha 2 adrenergic receptors agonist? What are the ages for Strattera? Which aspect of ADHD does the Dorsolateral prefrontal cortex control? Signs of Stimulant Abuse If a patient is having ADHD symptoms during the day after having taken their stiumlant, what does that indicate and what should we do? We should consider an extended release<\/p>\n\n\n\n What to do if parent is really anxious or scared about Medication for their kid? Differentiate OCD from Tourettes Tourettes: Tics only<\/p>\n\n\n\n Symptoms of OCD What does PANDAS stand for and which mental illness’ acute onset may be an indication of having PANDAS? Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections<\/p>\n\n\n\n Malingering factitious disorder Reactive Attachment Disorder GAD Panic Attack Panic Disorder Treatment for Panic disorder SNRI–venlafaxine<\/p>\n\n\n\n Beta Blocker–this manages the elevated BP that occurs with a panic attack<\/p>\n\n\n\n Can also give benzos which aren’t as safe<\/p>\n\n\n\n Beta blockers can cause bronchospasms so they are contraindicated with DMDD–Disruptive mood dysregulation disorder Chronic dysregulated mood Hallmark symptoms of Anorexia Nervosa Amenorrhea BMI for Bulimia Nervosa if a patient has an irritable, depressed, labile mood, what is the first thing we should do ? When should we assess for nightmare disorder? Which neurotransmitters are affected in autism? What are the symptoms of autism? Broken mirror theory of autism If delirium is caused by ETOH or substance abuse what treatment can we give patient? What are often the causes of delirium in older people and what should we test them for? Dementia and which vitamins levels should be checked Differentiating between depression and dementia Also, in combination with memory issues, they have depression issues. Dementia memory decline happens over time i.e. over 12 months or longer<\/p>\n\n\n\n Pseudodementia Which parts of the brain are involved in Dementia Cortical: Language (aphasia) and memory impairments<\/p>\n\n\n\n Early signs of HIV dementia Lewy Body Disease symptom of importance for the test Pick’s disease Personality, behavioral, and language changes (slurred) in early stage<\/p>\n\n\n\n What meds treat HIV dementia? if patient has history of high risk behavior and HIV dementia symptoms, what should we do? Pharm treatment of psychosis and agitation in dementia? What does the amygdala control? What does the Hippocampus control? What does dopamine produced in the substantia nigra regulate? If you are taking care of a terminal infant what do you do with the parents? How should we speak of and refer about grief to children What is the most important factor in children’s healing from grief? mood disorder neurotransmitters What are most important risk factors for osteoporosis? What drugs should be avoided with Kava Kava? What is the normal range for TSH? What are lab values in Hyperthyroidism What are labs in Hypothyroidism? What are 5 primary symptoms of Hyperthyroidism? What are 4 primary symptoms of Hypothyroidism? Hypothyroidism mimics symptoms of what psychiatric disorder? Hyperthyroidism mimics symptoms of what psychiatric disorder? Valproic acid produces what teratogenic effect? What is the primary organ where valproic acid is toxic? What are 4 signs of hepatoxicity? Reddish-brown urine<\/p>\n\n\n\n Yellowing of the skin and sclera<\/p>\n\n\n\n Fatigue<\/p>\n\n\n\n What is the therapeutic range for valproic acid? What is a toxic level of valproic acid?<\/p>\n\n\n\n 150 mcg\/ml<\/p>\n<\/blockquote>\n\n\n\n What are 4 signs of valproic acid toxicity? A pt on Depakote C\/O Abdominal pain in the URQ and Reddish-brown urine. What do you suspect? What do you do? With suspected toxicity with valproic acid, what steps\/labs should be drawn? A pregnant pt is taking accutane, zyprexa and abilify; what med needs to be d\/c’d? What herbal supplement is used for anxiety, stress, and insomnia? What is the major side effect with Kava Kava? What are 5 symptoms of Stephen’s Johnson Syndrome? burning of mouth\/eyes -HY<\/p>\n\n\n\n Body aches<\/p>\n\n\n\n Severe red rash<\/p>\n\n\n\n Peeling skin<\/p>\n\n\n\n Facial and tongue swelling<\/p>\n\n\n\n Which mood stabilizer causes the least weight gain?<\/p>\n\n\n\n Lamotrigine (Lamictal)<\/p>\n\n\n\n Which 3 SGAs cause the least weight gain?<\/p>\n\n\n\n Lurasidone (Latuda) Which SGA is the least sedating? Your pt is taking Kava and you need to add an AS to manage their SCZ, which do you add? What are 2 hallmark symptoms of delirium? disturbance of LOC<\/p>\n\n\n\n impaired cognition<\/p>\n\n\n\n inattention<\/p>\n\n\n\n How are agitation and psychotic symptoms treated in delirium? 16 y\/o C\/O feeling funny after inhaling Acetone (nail polish remover). What is your action? What 4 drugs can cause mania? Steroids<\/p>\n\n\n\n Antidepressants (in BPD)<\/p>\n\n\n\n Isoniazid (INH)<\/p>\n\n\n\n Disulfiram (Antabuse)<\/p>\n\n\n\n What 6 drugs can induce depression? Steroids<\/p>\n\n\n\n Interferon,<\/p>\n\n\n\n Progesterone<\/p>\n\n\n\n Beta blockers<\/p>\n\n\n\n Accutane, (Isotretinoin)<\/p>\n\n\n\n Retroviral drugs, Antineoplastic drugs<\/p>\n\n\n\n Benzodiazepines<\/p>\n\n\n\n Steroids can induce what 3 psychiatric states? REMEMBER SAFETY FIRST; pt s\/p assault, 1st thing you do is_____. What is the therapeutic range for lithium? Many postpartum women have SI after delivery, yet they don’t have psych evals before leaving the hospital, what could a possible solution be? If collaborating with a provider who is not in the same clinic or hospital, the informed consent [does\/does not] apply? When discharging from inpatient you want [to fax\/print off-give to pt.] labs for the outpatient provider before pt discharge? Before referring a pt out or discharging them, it is good to ask yourself what question? What 3 things are MUST KNOWS about Lithium? the gold standard for treating manic episodes<\/p>\n\n\n\n the mood stabilizer w\/ anti-suicidal effects<\/p>\n\n\n\n What mood stabilizer has anti-suicidal effects? What 5 labs should be drawn with lithium? What is a normal SerumCr range? What is the normal range for BUN? When should you suspect kidney disease with a urinalysis? What are 7 side effects of lithium?<\/p>\n\n\n\n Hypothyroidism What are 7 signs of lithium toxicity?<\/p>\n\n\n\n Severe nausea, vomiting, diarrhea<\/p>\n\n\n\n Confusion<\/p>\n\n\n\n Drowsiness<\/p>\n\n\n\n Muscle weakness<\/p>\n\n\n\n Heart palpitations<\/p>\n\n\n\n Coarse hand tremor<\/p>\n\n\n\n Unsteadiness while standing or walking<\/p>\n\n\n\n Bold =must knows<\/p>\n\n\n\n Which 3 drugs can increase lithium levels by decreasing renal clearance? What is a toxic level of lithium? At what level do you monitor lithium closely With suspected lithium toxicity, what do you do first?<\/p>\n\n\n\n D\/C Li and draw Lithium level (not VS)<\/p>\n\n\n\n What is the appropriate action if lithium level is 1.5 mEq\/L? What 2 conditions can increase lithium levels? Take extra water to avoid dehydration<\/p>\n\n\n\n What birth defect can lithium cause? When working with adolescents, parents often feel they have a right to know what is going on with their child, but the teen has a right to confidentiality. This can create an When building a therapeutic alliance w\/ adolescents, it is important to stress [or they are in a relationship with someone much older (like 14 y\/o seeing a 30 y\/o)]<\/p>\n\n\n\n if an adolescent C\/O abuse, even if they make the claim in the presence of the parents, what should you do? What 3 neurotransmitters are associated with ADHD? The Frontal cortex, Basal ganglia, Reticular Activating System are associated with which psychiatric disorder? Inattentive Type ADHD demonstrates abnormalities in which part of the brain? What should be done before placing a patient on stimulants for ADHD (priority)? Excessive worry, apprehension, or anxiety about events or activities that occurs more days than not for a period of at least 6 months is if ADHD and tic both present, what is contraindicated? if a stimulant was tried and provided some but not enough benefit (helped, but not long enough) what can this mean? What are the lower age limits for stimulants for ADHD? When considering Clonidine or Guanfacine for a pt, the PMHNP knows? What does thought process assess? A normal thought process is described as Moving from thought to thought and never getting to the point is called Providing unnecessary detail but eventually getting to the point is called Themes that occupy a patient’s thoughts and perceptual disturbances is called Thought content includes 3 items Asking a patient to count backward from 100 by seven (serial 7s), or anything going backwards measures what? Asking the year, season, date, month, and location measures Asking a patient to repeat “bed, red, ball” measures Asking a patient to repeat objects 5 minutes later measures Asking the patient who is the president of the US or governor of state is measuring What is a simple test that can be administered in a minute or two to measure possible dementia? Impairments in the clock drawing test (CDT) can be associated with damage to Hyperactivity of dopamine in the mesolimbic pathway to the dorsolateral prefrontal cortex (DLPFC) modulates The safest drug switch strategy is to have a “washout period” of _<\/em><\/strong> half-lives between cessation of old med and the introduction of the new med.<\/p>\n\n\n\n 5 1\/2<\/p>\n\n\n\n Decreased dopamine in the mesocortical pathway (dorsolateral prefrontal cortex) leads to what 2 symptoms? The nigrostriatal pathway modulates Dopamine has what type of relationship with acetycholine Dopamine blockage in the nigrostriatal pathway leads to what 4 side effects? Blocking DA in the tuberoinfundibular pathway leads to What are 5 symptoms of hyperprolactinemia? What antipsychotic has the greatest effect on prolactin? What is the black box warning for carbamazepine? SJS in Asians (+) for HLA-B*1502 allele<\/p>\n\n\n\n What are 8 symptoms of aplastic anemia? In which ethnic group must you screen for the HLA-B1502 allele before initiating CBZ (Tegretol) therapy? Why is it necessary? Asians risk for SJS in Asians (+) for HLA-B<\/em>1502 allele<\/p>\n\n\n\n Which 2 drugs have the highest likelihood of causing agranulocytosis? A sudden fever, chills, a sore throat, and weakness are symptoms of At what ANC should clozapine be stopped (even if asymptomatic)? What is neutropenia? What is agranulocytosis? What does DIGFAST stand for? Indiscretion<\/p>\n\n\n\n Grandiosity<\/p>\n\n\n\n FOI<\/p>\n\n\n\n Activity increased<\/p>\n\n\n\n Sleep decreased<\/p>\n\n\n\n Talkativeness<\/p>\n\n\n\n What neurological symptoms might one see in Conversion Disorder? When do symptoms typically begin with Conversion Disorder? What are 5 stressful events in a child’s life that can cause adjustment disorder? A child with an Adjustment Disorder with disturbances of conduct may have what symptoms? What are some key sx of Oppositional Defiant Disorder (ODD)? What is the mainstay treatment of Oppositional Defiant Disorder (ODD)? What is the primary therapy used to treat Oppositional Defiant Disorder (ODD)? A repetitive and persistent pattern of behavior in which the rights of others or societal norms or rules are violated is what disorder if under age 18? What are 3 “hallmark” characteristics of Conduct Disorder? Destruction of property<\/p>\n\n\n\n Lack of remorse<\/p>\n\n\n\n What 2 factors differentiate Conduct Disorder from ODD? Aggression<\/p>\n\n\n\n What are 4 pharmacologic treatments for Conduct Disorder? –Antipsychotics<\/p>\n\n\n\n –Mood stabilizers<\/p>\n\n\n\n –SSRIs<\/p>\n\n\n\n –Alpha agonists (Clon. and Guan)<\/p>\n\n\n\n What type of therapy is used in the treatment of Conduct Disorder? What is the goal of multisystemic family therapy (MFT)? What is Multisystemic family therapy? helps to develop natural support systems<\/p>\n\n\n\n What is the range for MMSE? 25+ normal<\/p>\n\n\n\n 21-24 mild<\/p>\n\n\n\n 10-20 moderate<\/p>\n\n\n\n 0-9 severe<\/p>\n\n\n\n What is the range for SLUM? 27+ normal<\/p>\n\n\n\n 21-26 mild<\/p>\n\n\n\n <21 dementia<\/p>\n\n\n\n What is the range for HAM-D? 0-7 normal<\/p>\n\n\n\n 8 mild<\/p>\n\n\n\n 14 moderate<\/p>\n\n\n\n 19 mod-severe<\/p>\n<\/blockquote>\n\n\n\n 23+ severe<\/p>\n\n\n\n Just moderate 14-18<\/p>\n\n\n\n What is the moderate range for PHQ-9 0-4 normal<\/p>\n\n\n\n 5 mild<\/p>\n\n\n\n 10 moderate<\/p>\n\n\n\n 15 mod-severe<\/p>\n\n\n\n 20 severe<\/p>\n<\/blockquote>\n\n\n\n Just moderate 10-14<\/p>\n\n\n\n What is the moderate range for BDI? 0-9 normal<\/p>\n\n\n\n 10 mild<\/p>\n\n\n\n 19 moderate<\/p>\n\n\n\n 30 severe<\/p>\n<\/blockquote>\n\n\n\n Just moderate 19-29<\/p>\n\n\n\n What is the moderate range for HAM-A? 0-17 mild<\/p>\n\n\n\n 18 moderate<\/p>\n\n\n\n 25 severe<\/p>\n<\/blockquote>\n\n\n\n Just moderate 18-24<\/p>\n\n\n\n What is the moderate range for GAD-7 0-4 normal<\/p>\n\n\n\n 5 mild<\/p>\n\n\n\n 10 noderate<\/p>\n\n\n\n 15 severe<\/p>\n<\/blockquote>\n\n\n\n Just moderate 10-14<\/p>\n\n\n\n What is the moderate range for COWS? If a patient’s COWS score is between 5 – 12, what do you do? If a patient’s COWS score is between 13 – 24, what do you do? When do you administer clonidine on the COWS? When do you administer buprenorphine (Suboxone) on the COWS? What is a moderate range on the CIWA? When do you administer prn meds such as benzodiazepine or for N\/V\/D on the CIWA? When do you administer scheduled benzodiazepine +PRN’s on the CIWA? 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?<\/p>\n\n\n\n Medication and\/or therapy<\/p>\n\n\n\n Assess for suicidal ideation<\/p>\n\n\n\n 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?<\/p>\n\n\n\n Medication and\/or therapy<\/p>\n\n\n\n If a patient has mild depression (<14 on HAM-D) (<10 on PHQ-9) (<19 on BDI), how do you treat it?<\/p>\n\n\n\n Therapy or nothing<\/p>\n\n\n\n If a patient has mild anxiety (<18 on HAM-A) (<10 on GAD-7), how do you treat?<\/p>\n\n\n\n Therapy or nothing<\/p>\n\n\n\n If a patient has severe anxiety (>24 on HAM-A) (>14 on GAD-7) how do you treat?<\/p>\n\n\n\n Medication and\/or therapy<\/p>\n\n\n\n If a patient has moderate anxiety (18-24 on HAM-A) (10 – 14 on GAD-7) how do you treat it?<\/p>\n\n\n\n Medication and\/or therapy<\/p>\n\n\n\n What are 4 areas in the brain that can cause aggression, impulsivity, and difficulty with abstract thinking? Abnormalities in the Prefrontal cortex, Amygdala, Basal ganglia, and What are 6 symptoms of NMS? *Mutism<\/p>\n\n\n\n *Elevated labs CPK (creatine phosphokinase), LFT’s and WBC’s<\/p>\n\n\n\n Myoglobinuria<\/p>\n\n\n\n autonomic instability vBP, ^HR\/RR<\/p>\n\n\n\n Fever<\/p>\n\n\n\n *= top 3 ways to differ from SS<\/p>\n\n\n\n Elevated CPK (creatine phosphokinase) in NMS is caused from What are 2 differentiating symptoms (Key indicators) of Serotonin Syndrome? S\/S of serotonin syndrome include:<\/p>\n\n\n\n what are the 4 most often seen (in bold)?<\/p>\n\n\n\n \u201cShits and Shivers\u201d<\/p>\n\n\n\n \u00a7 Diarrhea (shits)<\/p>\n\n\n\n \u00a7 Shivering,<\/p>\n\n\n\n \u00a7 Hyperreflexia\/myoclonic jerks<\/p>\n\n\n\n \u00a7 Increased temperature<\/p>\n\n\n\n \u00a7 Vital sign instability<\/p>\n\n\n\n \u00a7 Encephalopathy<\/p>\n\n\n\n \u00a7 Restlessness\/anxiety<\/p>\n\n\n\n \u00a7 Sweating<\/p>\n\n\n\n How do you treat NMS? What does Dantrolene treat in NMS? How do you treat Serotonin Syndrome? Cyproheptadine: H1 antihistamine that acts to block<\/p>\n\n\n\n 5-HT1A and 5-HT2A receptors<\/p>\n\n\n\n What combination of medications increases the risk of Serotonin Syndrome? What herbal supplement also increases the risk? When switching from an MAOI to SSRI\/SNRI, how long should you wait? Why? for the MAO to regenerate (remember MAO-I deplete MAO)<\/p>\n\n\n\n When switching from Prozac to any antidepressant (TCA, SNRA, or MAOI), how long should you wait? When switching from an SSRI\/SNRI to a MAOI, how long should you wait? Why? What is the function of compulsions in OCD? What is PANDAS? When would you suspect PANDAS? new onset OCD sx- recent strep throat<\/p>\n\n\n\n If a child has both intrusive thoughts and tics, his most likely diagnosis is If a child has multiple tics (at least 2 motor and 1 vocal) for at least 1 yr, and no ruminating thoughts, his diagnosis is most likely? What 2 neurotransmitters are associated with OCD? vocal tics A child between 7-17 years with a chronic dysregulated mood (moody for no reason), frequent intense temper outbursts, severe irritability, and anger is most likely to have what diagnosis? What are some symptoms associated with lead poisoning? Pica (paint chips)<\/p>\n\n\n\n irritability<\/p>\n\n\n\n gastrointestinal sx<\/p>\n\n\n\n low weight<\/p>\n\n\n\n Which 2 demographic characteristics are associated with lead poisoning? A child with developmental delay who eats things (such as paint chips) may have What 4 assessments should be done in a patient receiving an antipsychotic that causes weight gain? Where is norepinephrine produced? Serotonin is produced in What 3 areas of the brain is dopamine produced? Where is acetylcholine synthesized? What is the function of the amygdala? What are 5 functions of the hippocampus? Stress<\/p>\n\n\n\n Learning<\/p>\n\n\n\n Motivation<\/p>\n\n\n\n Memory conversion ST to LT<\/p>\n\n\n\n BOLD =HY<\/p>\n\n\n\n What disorder is associated with persistent deficits in social communication and social interactions across multiple settings? A child who likes to line up, stack, or organize objects and toys in tidy rows, little or no eye contact and does not respond when called by name may have What theory claims that dysfunction of a particular neuron system may be a cause of the poor social interaction and cognition in autism? What is the age criteria for a DSM-5 diagnosis of Tourette’s Disorder? What is the pharmacological treatment of Tourette’s Disorder? What are the 3 primary neurotransmitters involved in Tourette’s Disorder? What is special about DA? What are 11 risk factors for suicide? 45 and older ( > 55 for women)<\/p>\n<\/blockquote>\n\n\n\n Male gender<\/p>\n\n\n\n Divorced, single, or separated<\/p>\n\n\n\n White (Caucasian)<\/p>\n\n\n\n Living alone<\/p>\n\n\n\n Psychiatric disorder<\/p>\n\n\n\n Physical illness<\/p>\n\n\n\n Substance abuse<\/p>\n\n\n\n Family history of suicide<\/p>\n\n\n\n Recent loss<\/p>\n\n\n\n bold (must knows)<\/p>\n\n\n\n What are 5 physical characteristics of Anorexia Nervosa? What is the BMI in a patient with Bulimia Nervosa 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? What are the 3 hallmark symptoms of PTSD? What are 3 pharmacological treatments for PTSD What 2 nonpharmacologic treatments for PTSD? CBT<\/p>\n\n\n\n What are the 12 components\/symptoms of the COWS? What are the 9 components\/symptoms of the CIWA Scale? What are 3 treatments for Alcohol Use Disorder? Which agent for the treatment of Alcohol Use Disorder is not metabolized by the liver? What to avoid while taking Acamprosate and for at least 2 weeks post use? What are 4 therapeutic factors in Yalom’s Group Therapy? What is an approach to organizational change which focuses on strengths rather than weaknesses? What are the 3 goals of Quality Improvement? The process\/strategy of Quality Improvement is called Plan<\/p>\n\n\n\n Do<\/p>\n\n\n\n Study<\/p>\n\n\n\n Act<\/p>\n\n\n\n Process, Policy reform, Policy environment, and Policy makers are the 4 components of Changes in programs and practices in Health Policy is called What is the “policy environment” component of Health Policy? What is the “policy makers” component of Health Policy? What is the first action when developing Health Policy?<\/p>\n\n\n\n Assess\/address organizational barriers and facilitators<\/p>\n\n\n\n A treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life is called<\/p>\n\n\n\n Recovery Model<\/p>\n\n\n\n What are 3 characteristics of the Recovery Model? Self-directed -pt is not told what to do<\/p>\n\n\n\n Individualized and Person-Centered-pt is the center of the therapy<\/p>\n\n\n\n What is the SBIRT, and what is it used for? Brief<\/p>\n\n\n\n Intervention<\/p>\n\n\n\n Referral<\/p>\n\n\n\n Treatment<\/p>\n\n\n\n Screens for Substance Use Disorders<\/p>\n\n\n\n What is the Tarasoff Principle What is the Rennie vs Klein Court case?<\/p>\n\n\n\n “Rennie’s Right to Refuse and appeal”<\/p>\n\n\n\n An involuntarily committed patient who has not been found incompetent, absent an emergency, has a qualified right to refuse psychotropic medications<\/p>\n\n\n\n What is the Donaldson vs. O’Connor court case?<\/p>\n\n\n\n “You can’t confine Donald”<\/p>\n\n\n\n You cannot confine (commit a person involuntarily) who is not imminently dangerous to self or others<\/p>\n\n\n\n What are 4 key components of Strategic Therapy? Paradoxical directive\/intervention (reverse psychology) when pt non-compliant<\/p>\n\n\n\n Straight forward directive- when pt compliant<\/p>\n\n\n\n Reframe belief system<\/p>\n\n\n\n Miracle Questions, Exception-finding questions, and Scaling Questions are used in which therapy? Which therapy uses triangles\/triangulation, and self-differentiation? The paradoxical directive, a technique to be used with caution, is used in which therapy? Hierarchies, Boundaries, and Genograms are characteristics of what therapy? Genograms are used in which 2 family therapies? What type of therapy should be performed when a patient presents with a cultural syndrome? What type of therapy should be used in a patient who has just lost their job? What is the most important concept in working with patients from different cultues? What should you teach a patient interested in meditation? Which ethnic group views mental illness as an imbalance between an individuals’ relationship with world? Which ethnic group has the highest incidence of suicidal attempt and completion?<\/p>\n\n\n\n Native American<\/p>\n\n\n\n A culturally expected response to a stressor is called How does the PMHNP perform health promotion education in a community setting with different ethnicities If a patient is regularly taking Kava, what lab should you get? Releasing information to a traditional healer Which antipsychotic has the least weight gain? If your patient doesn’t understand English, the PMHNP should NativeAmericans have healing sticks that can heal them of illnesses, if the patient is hospitalized inpatient, what should you do? Which SGA is the least sedating? Which 3 antipsychotic causes weight gain? Olanzapine (Zyprexa)<\/p>\n\n\n\n Clozapine (Clozaril)<\/p>\n\n\n\n What is the first action to take with a patient who is gaining weight from an SGA? nutritional counseling (diet)<\/p>\n\n\n\n exercise<\/p>\n\n\n\n CBT<\/p>\n\n\n\n When should clozapine be discontinued? One of your patients receiving psychiatric medication develops an infection. What do you consider? What antipsychotic is anti-suicidal in schizophrenia?<\/p>\n\n\n\n Clozapine<\/p>\n\n\n\n When a young woman is suspected of a toxic dose of lithium, what lab should you obtain initially? If a patient has signs\/symptoms of lithium toxicity but you have no labs available, what do you do? A patient with what medical condition is at risk for lithium toxicity? What are the key indicators for NMS? Increased CPK<\/p>\n\n\n\n If a depressed patient is taking a triptan for migraines, what should you prescribe for depression? What is first line treatment for MDD? Why? What are the 2 antidepressants of choice in a depressed patient with cancer? Why? What is the antidepressant of choice in a depressed patient with sexual dysfunction? What is the antidepressant of choice in a depressed patient with decreased energy? What are 3 treatments for depressed patients with neuropathic pain? TCA (think safety tho)<\/p>\n\n\n\n Gabapentin\/Pregabalin (alpha2 delta ligands)<\/p>\n\n\n\n BOLD = know<\/p>\n\n\n\n Which SSRI is most likely to cause insomnia? What question is important to ask in the social history with a depressed patient? Suicidal ideation for children, adolescents, and young adults <24 years is a BBW with what medications? What question should ask all adolescent patients at each visit? Which 2 groups is it especially important to ask about SI at each visit? Alpha 2 adrenergic receptor blockers (Clonidine and Guanfacine) have lower tolerability in patients with schizophrenia. What effects from these meds are limited in this population? Why do children have a decreased placebo response with antidepressants? What is the onset of schizophrenia in males? What is the onset of schizophrenia in females? What question should ask schizophrenic patients at each visit? What is the most likely diagnosis in a patient with homicidal ideation? What would yo expect to see on an MRI\/Pet scan in a patient with schizophrenia? Which class of agents should be avoided in patients with schizophrenia? Abnormalities, changes\/deficits in which structures of the brain are associated with aggressive and impulsive behavior ? What is Assertive Community Treatment (ACT)? Can patients receive Assertive Community Treatment (ACT) while in the hospital?<\/p>\n\n\n\n No; think “community” in ACT<\/p>\n\n\n\n What is the best treatment program for SMI patients with a long Hx of poor medication adherence? Social skills training in a schizophrenic patient is what type of prevention? What are 3 benefits of aerobic exercise in schizophrenic patients? mproves Quality of Life<\/p>\n\n\n\n improves Long-term health<\/p>\n\n\n\n What is a delusion? How often is Haldol Decanoate typically adminitered? If a patient is receiving Haldol 5 mg PO bid, how much Haldol Decanoate should they receive for the 1st month? When converting oral Haldol to depot form, what the maximum dose should administer at a time? How do you conduct a MSE in a preschooler (3-5 yo) What is included in thought content? What are the 5 components of the MMSE (Folstein’s) What pharmacologic characteristic makes SGA’s unique? What does this help prevent? What antipsychotic should you give to a patient with their first psychotic episode? IM Invega, Geodon or Abilify<\/p>\n\n\n\n increase risk for EPS (acute dystonia)<\/p>\n\n\n\n Which 4 SGAs are available in IM form? Olanzapine (Zyprexa)<\/p>\n\n\n\n Aripiprazole (Abilify)<\/p>\n\n\n\n Paliperidone (Invega)<\/p>\n\n\n\n What agent other than antipsychotics can increase prolactin and can cause TD?<\/p>\n\n\n\n Metoclopramide (Reglan)<\/p>\n\n\n\n What do you do if a patient is on olanzapine (Zyprexa) and stops smoking? What effect does tobacco have on CYP450? What class of drugs are primarily inhibitors? How does erythromycin and clarithromycin affect CYP450? What do you do if a patient on carbamazepine is given an inhibitor like erythromycin? If a depressed patient is receiving a drug that is associated with depression (like interferon), what do you do? What 7 signs\/symptoms are associated with stimulant abuse? A patient who c\/o pain after eating, bloating and fullness, what do you suspect? What 2 classes of medications delay gastric emptying? PPIs: Omeprazole (Prilosec)<\/p>\n\n\n\n What 2 classes of medications interfere with the absorption of psychiatric medications and should be spaced apart by 2 hours? What is a common side effect of SSRIs in the older population What is a paradoxical effect of benzodiazepines? What is apotosis? What is the greatest risk factor for bipolar disorder? fm Hx<\/p>\n\n\n\n What should you consider in a 45 y\/o patient that presents with manic symptoms? if a pt w\/ SCZ is controlled on Risperdal; but has been prescribed a steroid by the PCP, what might you need to do? What are 2 differences between mania and hypomania? A patient who is manic, irritable mood, and uncooperative is most likely to have what disorder? What are key symptoms to consider in a patient you suspect of mania or hypomania? What is a hallmark feature of borderline personality disorder? What therapy in borderline personality disorder been shown to decrease suicidal ideation? Who developed DBT? In DBT, diagnosis of borderline disorder requires activity? A patient with borderline personality disorder with symptoms of depressed mood, rejection sensitivity, and emotional lability should be prescribed?<\/p>\n\n\n\n A patient with borderline personality disorder with symptoms of irritability, anger, self-harm could be given? Lithium<\/p>\n\n\n\n A hospitalized patient with a reaction to a stressful event is most likely to have what diagnosis? A child with a history of juvenile detention (e.g., fire setting, forced sex) is most likely to have what diagnosis? Is a child with ODD or Conduct Disorder more likely to need medication? If a child develops tics after beginning a stimulant, should he be diagnosed with Tourette’s? Are motor tics permanent? What is factitious disorder imposed on another? What is required if you suspect a factitious disorder imposed on another (Munchausen syndrome)? What is Factitious Disorder A patient with factitious disorder is most likely to have what type of demographic? What is malingering? (not a psychiatric diagnosis)<\/p>\n\n\n\n A patient who claims disability or worker’s comp when there is no injury is most likely A child who has been neglected, abuse, or comes from a foster home, is most likely to have what diagnosis? A child who shows no emotion or is withdrawn may have what disorder? A disorder that presents like PTSD, but symptoms last less than a month is most likely to have How does a panic attack differ from Panic Disorder?<\/p>\n\n\n\n acute (peaks w\/in minutes), impending doom<\/p>\n\n\n\n How does Panic Disorder differ from a panic attack?<\/p>\n\n\n\n Chronic, recurrent, unexpected<\/p>\n\n\n\n How do you treat a patient with panic disorder who is taking albuterol for asthma?<\/p>\n\n\n\n SSRI or benzodiazepine<\/p>\n\n\n\n (don’t give beta blocker)<\/p>\n\n\n\n What is the treatment of choice for acute symptoms of panic disorder?<\/p>\n\n\n\n Beta blocker (not addictive)<\/p>\n\n\n\n How do you treat test anxiety for maintenance therapy? How do you treat text anxiety acutely? Benzodiazepine<\/p>\n\n\n\n What structure of the brain is involved with attention, executive function, planning and cognitive processes (working memory, problem solving) that affects ADHD? Children with inattentive ADHD are most likely to have an abnormality in which part of the cortex? What do you recommend to a mother of a child with ADHD as an aftercare plan on admission?<\/p>\n\n\n\n Brief supportive therapy (not after dc)<\/p>\n\n\n\n If a patient present with irritability, depression, and lability, which questionnaire do you administer? What disorder resembles bipolar disorder in children (7 and 17 years)? What should you assess initially in a child who presents with nightmares?<\/p>\n\n\n\n If other family members have the same problem<\/p>\n\n\n\n aftercare starts What are 2 key factors in the diagnosis of Autism Spectrum Disorder? A child that does not establish eye contact is likely to have When is the only time you should give a benzodiazepine to a patient with delirium? An older female has delirium and you suspect a UTI, what 2 labs should you order? An older patient who has had mental decline (>1 year) with chronic irritability and personality changes should be assessed for What are 2 labs that should be obtained in an older patient suspected of having a metabolic cause of dementia? What is the initial treatment for a patient with dementia and psychosis? If a patient with dementia does not respond to nonpharmacologic treatment, what do you do? What type of dementia is HIV-related? cortical or subcortical A patient who presents with a cognitive deficit, decreased coordination, and behavioral symptoms should be assessed for what type of dementia? In a patient with suspected HIV-related dementia, what is your initial action? What is first-line pharmacologic treatment for a patient with HIV-related dementia? 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 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 An older patient who has symptoms of irritability, agitation, hallucinations, and delusions is most likely to have What are 2 ways to determine whether an older person with decreased memory has depression or dementia? onset of symptoms<\/p>\n\n\n\n A patient who presents with difficulties with executive function (poor judgment), slurred speech, personality and behavior changes, difficulties with language comprehension, lack of empathy, and poor social skills is most likely to have what type of dementia? A patient with visual hallucinations is most likely to have what type of demenetia? 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? A patient with damage to the cerebellum will demonstrate what? What condition may cause pica (eating things that are not food – paint chips)? What 5 neurotransmitters are associated with mood disorders? What do you do when an infant is about to die? What 2 activities should be encouraged with grieving patients? Smoking, Caffeine, Low calcium\/vitamin D in diet, Decreased weight, long term prolactinemia is associated with? Is Interpersonal Therapy offered individually as well as in group therapy? If a patient is reluctant to participate in group therapy, what do you do? Which is more effective – cognitive therapy or CBT? Problem-solving, Skills training, Exposure therapy, Roleplaying\/modeling, and relaxation are techniques used in What are 2 common techniques used in CBT? Self-directed growth and self-actualization to find meaning in life are key concepts of what type of therapy? What is the best therapy for dealing with conflicts with others (e.g., spouse, co-workers)? How long does interpersonal therapy typically last? If a patient is noncompliant, what is a technique that is used in Strategic Therapy? What is the benefit of paradoxical directive If a patient is compliant, what is a technique that is used in Strategic Therapy? What type of therapy is a therapist using when he asks “what worked before when you had this problem” How can a child’s body image, resilience, relationships, and social anxiety be improved? When may a closed-ended question (yes\/no) be necessary rather than an opened-ended question? If a child does not respond or open or closed-ended questions, what to you do? What therapeutic factor does open-ended questions instill? Example of open ended questions If only the wife shows up for a couple appointment, what do you do? A mother reports that her child was sodomized. What 2 things do you do? A mother reports her 5-y\/o was raped by his 16 y\/o brother. What 2 things do you do? What lab do you draw in a patient with rheumatoid arthritis What does PICOT stand for? How do you provide evidenced-based care? A baby with a shrill cry is likely to have What do you tell a mother when she reports her preschool child is playing with their genitals? What do you tell an male adolescent who is concerned about nipple swelling and tenderness and breast enlargement? How do you treat decreased sexual drive in a older female patient? Why are women more likely to get intoxicated and have alcohol-induced hepatotoxicity? What primitive reflex causes a newborn to grasp vigorously any object touching the palm or fingers or placed in the hand? when does it go away? Infant reflex where a baby will startle in response to a loud sound or sudden movement is called______and it disappears by _<\/em><\/strong>? What is the Babinski (Plantar) reflex? When does the Babinski (Plantar) reflex disappear? What is the absorption rate of PDE-5 inhibitors (Viagra)? What 2 deficiencies are associated with With normocytic, macrocytic anemia, what 3 labs do you obtain? What deficiency is associated with microcytic anemia? Acute or chronic blood loss (GI bleeding, heaving menses) can cause what type of anemia? When vital signs are not normal in a thin women, you suspect You see a patient with suspected anorexia nervosa. What do you do? If a patient with anorexia nervosa refuses to see a PCP, what do you do? If AN patient is medically unstable and parents refuse hospital treatment, what do you do? What alternative medicine treatment is used with pain and depression? What act prevents a patient from unlawful hospitalization (can leave AMA)? A pedi patient presents with paresthesia, fatigue, unsteady gait, confusion, arm\/leg weakness and asymmetric body movement of extremities. What do you suspect and what do you do? If a patient is unable to remember events, how do you establish a diagnosis? How do you implement policy affecting NPs nationwide? How do you implement policy that coworkers are against? What is the initial step in providing continuous improvement of Quality of Care in an outpatient setting? What will you see in a laboratory test in a patient with an autoimmune disease? What are 2 ways to treat enuresis (night-time bedwetting)? What is the mechanism of action of Desmopressin (DDAVP)? When considering the relationship between receiving samples from a drug rep and sponsored education, what is there a concern for, and what should you do? A conflict of interest may occur in what 2 scenarios? A patient calls because he read on the internet about a BBW on his medication. What do you do? What are 2 things you should do when you prescribe off-label? When you prescribe trazodone to a male patient, what should you do? Smoking, increased weight\/obesity, and DM are risk factors for what disorder? What is tolerance? What is the goal or Reflective Practice? Providing debriefing techniques, feedback to staff and strategies to learn from experiences is called<\/p>\n\n\n\n Reflective Practice<\/p>\n\n\n\n If a patient has mild symptoms on the COWs, what should you do? If a patient scores 8 or more on the COWS during opiate withdrawal, what should you do? If a patient has moderate symptoms on the COWS what should you do? When should you administer buprenorphine\/naloxone (Suboxone) in a patient withdrawing from opiates? If a patient scores 13 or higher on the COWS scale during opiate withdrawal, what do you do? Why should methadone not be used to treat opiate withdrawal? Which benzodiazepine is used most often to treat alcohol withdrawal? If a patient with liver dysfunction or hepatitis is undergoing alcohol withdrawal, what benzodiazepine should he receive? If a patient presents with opiate withdrawal, what should you do? If a pregnant patient presents with opiate withdrawal, what do you do? What do you suspect when a patient presents with CNS activation (hand tremor, insomnia, anxiety, psychomotor agitation, seizures) and<\/p>\n\n\n\n Autonomic hyperactivity (sweating, increased HR, increased BP) and<\/p>\n\n\n\n N\/V and hallucinations\/illusions?<\/p>\n\n\n\n alcohol withdrawal<\/p>\n\n\n\n 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? adolescents have a right to confidentiality, but not Instillation of Hope, Universality, Altruism, Increased development of socialization skills, Imitative behaviors, Interpersonal learning, Group cohesiveness, Catharsis, Existential factors, and Corrective refocusing are<\/p>\n\n\n\n BOLD= focus on more<\/p>\n\n\n\n Therapeutic Factors which differentiate group therapy from individual therapy<\/p>\n\n\n\n Experiencing optimism through observing the improvement of others in the group is which of Yalom’s therapeutic factors?<\/p>\n\n\n\n Instillation of Hope<\/p>\n\n\n\n Learning to give to others is which of Yalom’s therapeutic factors?<\/p>\n\n\n\n Altruism<\/p>\n\n\n\n Sharing experiences\/feelings in group clients realize they are not alone is which of Yalom’s therapeutic factors?<\/p>\n\n\n\n Universality<\/p>\n\n\n\n The “natural laboratory” is which of Yalom’s therapeutic factors?<\/p>\n\n\n\n Increased development of social skills<\/p>\n\n\n\n Group members modeling their behavior after other members of group\/therapist is which of Yalom’s therapeutic factors?<\/p>\n\n\n\n Imitative behavior<\/p>\n\n\n\n Developing a sense of belonging in the group is which of Yalom’s therapeutic factors?<\/p>\n\n\n\n Group cohesiveness<\/p>\n\n\n\n Interacting with others to increase adaptive interpersonal relationships is which of Yalom’s therapeutic factors?<\/p>\n\n\n\n Interpersonal learning<\/p>\n\n\n\n Group members dealing with the meaning of their existence is which of Yalom’s therapeutic factors?<\/p>\n\n\n\n Existential factors<\/p>\n\n\n\n Participants reexperience family conflicts, allows them to recognize and change\/correct behaviors that may be problematic is which of Yalom’s Therapeutic Factors?<\/p>\n\n\n\n Corrective refocusing<\/p>\n\n\n\n Openly expressing their feelings which were previously suppressed is which of Yalom’s Therapeutic Factors?<\/p>\n\n\n\n Catharsis<\/p>\n\n\n\n Focusing on the strength of the group is key to what organizational change strategy?<\/p>\n\n\n\n Appreciative Inquiry<\/p>\n\n\n\n Who determines the Scope of Practice? Who determines the Standard of Practice?<\/p>\n\n\n\n ANA What are 8 exceptions to confidentiality? (know all) Intends to harm self\/others<\/p>\n\n\n\n Court order (subpoena, summons)<\/p>\n\n\n\n Attorneys in litigation<\/p>\n\n\n\n Insurance companies<\/p>\n\n\n\n Mandatory reporting (diseases)<\/p>\n\n\n\n Tarasoff (duty to warn)<\/p>\n\n\n\n Child or elder abuse<\/p>\n\n\n\n What are the 5 elements of informed consent? What are the 7 ethical principles? Fairness (according to gender, orientation, or ethnicity) is what ethical principle? Discontinuing a medication that causes side effects is an example of what ethical principle? Denying a benzodiazepine to a patient with a SUD is an example of what ethical principle? “Doing good” and promoting well-being is what ethical principle? Giving a patient a medication to treat symptoms is an example of Being true and loyal is what ethical principle? “Telling the truth” is what ethical principle? A patient’s right to refuse medication is an example of what ethical principle? Treating everyone with equal respect is what ethical principle? What are 2 important roles to perform as a client advocate? What is the best way to reduce stigma? A work environment that improves patient safety through continuous learning designing safe systems is<\/p>\n\n\n\n Just Culture<\/p>\n\n\n\n What treatment approach does not focus on mental illness, is nonlinear (occasional setbacks), and stresses learning from experience? In the recovery model, the clinician focuses less on the Dx and tries to focus\/foster the the pts __<\/em>? What is the PDSA cycle What is an example of a Quality Improvement Project? When implementing health policy, what is the first thing you do? What should you do before warning someone about harm (Tarisoff act)? A key component of Piaget’s Sensorimotor stage is Object permanence develops in which of Piaget’s developmental stages? What are 2 key components of Piaget’s Preoperational Stage? According to Piaget, at what stage do children display magical thinking and use language and symbols more?<\/p>\n\n\n\n Preoperational<\/p>\n\n\n\n What is a key component of Piaget’s Concrete Operations Stage? According to Piaget, during what stage do children see things from other’s perspectives – less egocentric?<\/p>\n\n\n\n Concrete operations<\/p>\n\n\n\n Conservation and reversibility occur during what stage per Piaget? What is the key component of Piaget’s Formal Operations stage? According to Erikson, what period (age) is the development of meaningful relationships important?<\/p>\n\n\n\n Infancy (0 – 1 yr.)<\/p>\n\n\n\n According to Erikson, what period (age) is self-control a key component?<\/p>\n\n\n\n Early childhood (1 – 3 yrs.)<\/p>\n\n\n\n According to Erikson, what period (age) is being a “self-starter” (self-directed) a key factor?<\/p>\n\n\n\n Late childhood (3 – 6 yrs.)<\/p>\n\n\n\n According to Erikson, what period (age) is personal sense of identity a key factor?<\/p>\n\n\n\n Adolescence (12 – 20 yrs.)<\/p>\n\n\n\n According to Erikson, what period (age) is competence important, especially with classmates?<\/p>\n\n\n\n School age (6 – 12 yrs.) Industry vs inferiority<\/p>\n\n\n\n According to Erikson, what period (age) are committed relationships a key factor?<\/p>\n\n\n\n Early adulthood (20 – 35 yrs.) intimacy vs isolation<\/p>\n\n\n\n According to Erikson, what period (age) is the ability to care for others important (e.g., parenting)?<\/p>\n\n\n\n Middle adulthood (35 – 65 yrs.) generativity vs stagnation<\/p>\n\n\n\n According to Erikson, what period (age) does fulfillment and comfort with life occur?<\/p>\n\n\n\n Late adulthood (>65) Integrity vs despair<\/p>\n\n\n\n What 3 neurotransmitters are associated with MDD? What 5 neurotransmitters are associated with bipolar disorder? What 2 neurotransmitters are involved with Addictive Disorders? What 2 neurotransmitters are involved with OCD? What 4 neurotransmitters are associated with schizophrenia? What 3 neurotransmitters are associated with Autism Spectrum Disorder? What neurotransmitters are associated with anxiety? What neurotransmitters are associated with Alzheimer’s? What neurotransmitters are associated with Parkinson’s Disease? What 4 psychiatric disorders have dysregulation of dopamine, norepinephrine, and serotonin (DNS)? Which 5 psychiatric disorders have dysregulation of the GABA receptor? What 4 psychiatric disorders have dysregulation of glutamate receptors? Which 2 psychiatric disorder have dysregulation of acetylcholine receptor? What 3 disorders have dysregulation of glutamate and gabapentin? You are concerned a 5-yo child may be sexually abused. How do you conduct the interview? You see a child playing with a toy in a sexual manner. What do you do? What are the 2 most important aspects of interviewing an adolescent? How should an adolescent be interviewed If an adolescent is dating someone the same age, do you need to tell the parents? If an adolescent is dating someone of the same gender, do you need to tell the parents? What should you ensure before discharging a patient from the hospital? Should a patient be interviewed in a day room? When do you draw a T3 or T4 What symptom occurs with high levels of ammonia? What 4 symptoms are similar with serotonin syndrome and NMS? Thoughts of self-harm are greatest in what 5 disorders (according to order) [I left this one\u2026but I’ve not heard of it ranked] Are oral contraceptives inducers or inhibitors? A person with pressured speech, no sleep and inflated self-esteem, may suspect If you can determine an identifying factor (an event) to why a person is depressed, what is their most likely diagnosis? Can tics be a normal behavior? Language and memory are the 2 primary deficits in which type of dementia? Motor and behavioral (depression, irritability, apathy) are the 2 primary deficits in which type of dementia? What is the value of integrative medicine (E.g., ObGyn + PMHNP)? What is the most important factor in a child who is grieving? How do you treat a child who is grieving? How do you apply your knowledge of a relationship between ADHD and substance abuse to practice? When you look up data about a patient in social media, what are you violating? Prior to sending prescriptions to a pharmacy, what do you need to do? If patient is unable to give consent, what do you do? The ethical principle that is associated with preventing imminent danger to patient is? Sending a patient to a crisis stabilization unit rather than a hospital is honoring what patient right? You plan to teach the patient about their illness. What do do you do first? In what age groups should you obtain HCG? What are normal prolactin levels for males and females? serotonin is implicated in what 2 areas? What 2 symptoms might you see in a patient with a frontal lobe tumor? What is the term for symptoms caused by a medical treatment or drug therapy? How do you assess it? If you refer a patient to a residential center for alcohol withdrawal, what can you provide them for symptom control? What does perjury mean? Which 2 parties can you not disclose information without the patient’s consent? As part of reflective practice, what strategy is used post event? When a medication error occurs, what is the first thing to assess per just culture? What cardiac SE is geodon (ziprasidone) known for? the max dose of Citalopram is 20mg\/day in the elderly client, why? Parkinson’s disease is caused by Pseudoparkinsonism In a trauma focused cognitive interview, what questions help build rapport? There are 3 phases to EMDR, they are\u2026 the goal of EMDR is Having the pt visualize the trauma, verbalize the negative thoughts or maladaptive beliefs; remain attentive to physical sensations while the also maintaining rhythmic eye movements is part of which EMDR Phase? Instructing the pt to block out negative thoughts, to breathe deeply, and verbalize what they are thinking, feeling, or imagining occurs during which EMDR Phase? Which EMDR phase closely resembles Cognitive Therapy and why? Having the pt visualize the trauma alongside the positive thought, then scan their body for tension is which EMDR phase? Why is this important to do? telemedicine\/telehealth legal issues include med errors<\/p>\n\n\n\n Jurisdictions<\/p>\n\n\n\n Authority over licensure<\/p>\n\n\n\n if the PMHNP want to change an old Tx for a newer way to Tx a condition, what should it be based on? How are rating scales best used? When deciding if a client is ready to move to a less intensive level of treatment (Inpt to PHP or PHP to IOP etc); what does the PMHNP look for? Signs they are ready: (+) coping skills, taking accountability<\/p>\n\n\n\n prevent\/promotion, classes, safety initiatives, education, classes, modifying environment is what level of prevention? screen-early detection, crisis hotlines, disaster is what level of prevention? treat- to prevent further deterioration, rehab, restoration, day treatment, social skills is what level of prevention? When questions ask for a priority action\u2026think about\u2026 If undecided on an answer due to high similarities, choose: What is the most common side effect of olanzapine\/zyprexa what is the difference between typical and atypical antipsychotics 1st psychotic break\u2026 two actions to take Three AP with least weight gain Always encourage interprofessional collaboration TSH High, then\u2026.t3\/t4 TSH low, then\u2026t3\/t4 cold\/hot sensitivity with t3\/t4 relationship What birth defect can be caused by depakote? What organ does depakote cause toxicity? and what sx would you expect to see? labs to run? kava kava is used to treat Rash and fever associated with tegretol, suspect<\/p>\n\n\n\n What allele is HLAB 1502 associated? what rare and dangerous side effects are associated with tegretol Sx’s of agranulocytosis if starting a woman on lithium what test should be done? why? adverse s\/e of lamictal\/lamotrigine labs to checke BEFORE starting on lithium What does protein in urine indicate best choice med for decreasing si in bipolar disorder. best choice med for si in schizophrenia best choice med for SI in borderline What medications will INCREASE Li levels Besides medications, what else can cause increased Li levels what type of tremors will you see with lithium toxicity? lithium can cause what other comorbidities? what is a defining characteristic of NMS vs SS Sx’s\/labs associated with NMS myoglobinuria\/rhabdo can cause cherry colored urine<\/p>\n\n\n\n Treatment for NMS and what each does Sx of SS treatment for SS how to best PREVENT SS Why are SSRIs considered the safest for use in depression antidepressant for cancer depressed patient presents with fatigue and low energy, consider: sexual s\/e with ssri? try\u2026 What medication must be avoided if client has seizure history or eating disorder? why? if client has depression and neuropathic pain What med class treats neuropathic pain well What medication class is good for depression with comorbid CA Black box warning on SSRI Required education for rx ssri what to ask when client is depressed (additional question) Sx’s of serotonin discontinuation syndrome What are some scenarios that place patients at risk of a hypertensive crisis? Sx of Hypertensive crisis Treatment for HTN Crisis age of onset for male \/ female schizophrenia schizophrenia has high rate of suicide what is the cause of schizophrenia on MRI \/PET schizonphrenia positive sx of schizophrenia caused by\u2026 positive sx of schizophrenia on a stimulant? What is ACT delusions, you respond how? how to assess mental abstraction assess thought process why? and potential findings MMSE thought content include MMSE\/ Folstein Test assesses? concentration\/attention\/calculation assessed how? Registration\/ability to learn new material assessed how? orientation is assessed by fund of knowledge assessed how? clock drawing assesses? First generation AP 2nd gen AP excess DA in mesolimbic pathway decreased DA in mesocoritcal pathway nigrostriatal pathway Tuberoinfundibular pathway what does high prolactin levels lead to which AP is most closely associated with hyperprolactinemia Male prolactin EPS caused by acute dystonia treatment of acute dystonia akathisia 1st line treatment for akathisia? And which population to AVOID use in? 2nd line? 3rd line? 2nd line: cogentin\/benztropine<\/p>\n\n\n\n 3rd line: benzos<\/p>\n\n\n\n akanesia treatment for akanesia Sx of akinesia Tardive dyskinesia (TD)\/timeframes Reglan (metoclopramide) and compazine (prochlorperazine) can both cause? what medication can worsen TD? Inducers inhibitors reglan and compazine can both cause Smoking and dosing of meds Antibiotics\/macroglides are INHIBITORS and greatly effect what medication what meds can cause mania what meds can cause depression if patient taking meds for a mood disorder and is on flonase or prednisone. What do you do with your dose of oxcarbazepine treating a patient with zoloft and starts taking interferon. what do you do with zoloft dosing? addiction neurotransmitters Gamma-aminobutyric acid main function Sx’s of stimulant abuse Pt with anorexia complains of pain after eating\/bloating\/fullness what meds can delay gastric empying? ANTACIDS \/PPI do what to psychotropic medications? advise client to take other meds 2 hours AFTER antacids\/PPI<\/p>\n\n\n\n Older adults and SSRIs for anxiety? Older adults and benzos? apoptosis BP1 pneumonic DIGFAST Borderline sx in regard to impulsivity Therapy for BPD\/goal\/founder Conversion Disorder (Functional Neurological Symptom Disorder) present with neuro sx: adjustment disorder (anxiety\/depressive\/mixed) factitious disorder Reactive Attachment Disorder ODD treatment for ODD<\/p>\n\n\n\n CD conduct disorder AGE 6-17 Treatment for CD Alpha agonist aka alpha 2 adrenergic receptor blockers (clonidin, guanfacine)<\/p>\n\n\n\n Family therapy<\/p>\n\n\n\n acute stress disorder Over 1 month is PTSD<\/p>\n\n\n\n PTSD cluster of sx nightmare trmt in ptsd PTSD treatment phases of EMDR Panic attack vs disorder disorder: chronic leads to feelings of impending doom Tourette dx criteria NT in tourette tics can be caused by what type of medication how do you treat a kid with tics for adhd guanfacine and clonidine are good choice for adhd in kid with tics Meds for tourettes are tics in kids normal brain region affected in adhd basal ganglia-<\/p>\n\n\n\n dorsolateral PFC–executive function, attention, cognitive processes (problem solving, working memory)<\/p>\n\n\n\n reticular activating<\/p>\n\n\n\n OCD NT’s Pandas DMDD (disruptive mood dysregulation disorder) moody for no reason IED (intermittent explosive disorder) violent irritibility, depression, labile mood\u2026utilize a________ nightmares in children can be genetic or psychological GAD (Generalized Anxiety Disorder) Autism Spectrum Disorder NTs impaired communication what two things do you have to have to diagnose adhd Do stimulants increase DA? P450 Inducer meds P450 inhibitor pneumonic for inducers 450 subtypes What NT are involved with OCD Trmt med for kid with ocd trmt med for adult with ocd GAD pneumonic Stages of change contemplation: acknowledges, but NOT YET ready to change. “i know heroin is killing me, but i have no time for rehab”\u2026 some self doubt<\/p>\n\n\n\n preparation: acknowledges issue, intends to eventually act. “Ive been thinking about rehab or buprenorphine, what do you think?” No action or behavioral modification yet\u2026 researching<\/p>\n\n\n\n action: behavioral change occurs. “I’m in inpatient rehab and I’m feeling much better!”<\/p>\n\n\n\n maintenance: effort made to sustain the change. “Ive been on buprenorphine for a year and I’m still doing well”<\/p>\n\n\n\n relapse: reversion to a previous stage\u2026 goes back to a prior stage to start over.<\/p>\n\n\n\n Autism hallmarks Broken mirror theory of autism-responsible for childs presentation of autism symptoms Risk factors for autism screeners for autism? ADOS-G: autism diagnostic observation schedule-generic<\/p>\n\n\n\n ASQ: ages and stages questionnaire<\/p>\n\n\n\n nightmares in children NT in Autism Spectrum disorder If patient presents with irritibility, personality changes, check their: if ? presents lack of coordination, slowing, motor symptoms, and apathy, depression, irritability think about this dx cortical dementia effects mostly\u2026 cognitive deficits pseudo dementia what disorder does a provider hear a lot of “I don’t know answers” aphasia is associated with which region of the brain visual hallucinations are associated with which type of dementia frontotemoporal dementia Signs of lead abuse TEST LEAD LEVELS<\/p>\n\n\n\n Components of the COW Scale anterior cingulate is responsible for what NE is produced in the locus ceruleus and the \u2026 SE is produced in the_________? And is involved in __<\/strong>? DA is produce in the substantia nigra and __<\/strong>? Acetylcholine is synthesized by the basal nucleus of _<\/strong>? NT in mood disorders risk factors for osteoporosis What is the hippocampus responsible for? Amygdala cerebellum anterior cingulate frontal lobe issues If you are caring for an infant that is dying and the parents are present, what action should you take osteoporosis can be prevented by a diet rich in what? and other ways to prevent Cognitive theory basics Humanistic therapy basics Behavioral therapy SKILLS SKILLS<\/p>\n\n\n\n interpersonal therapy (IPT) Family systems therapy structural family therapy strategic family therapy solution focused family therapy Appreciative inquiry if question answers give closed ended questions and one open ended question and all are appropriate, choose open ended because open ended questions promote the relationship therapy session with a couple and only one party shows up, what do you do? if someone has lost someone, ask them\u2026.? If client is moving to another state, how can you assist in not abruptly stopping medications? Sibling abuse 5yo sodomized by his 15yo borther reported to you. Inform parent to , and call<\/em><\/strong><\/em><\/strong>? suspect rheumatoid arthritis, check\u2026..? PICOT Level 1 evidence Level 2 evidence how do you continue to give evidence based care? Shrill cry in infant when do you start aftercare plan? masturbating is normal in what age range? Freud stage? normal for young boys to develop breast enlargement\/swelling\/tenderness. Usually goes away in\u2026.? sex drive is driven by what hormone? Testosterone decreases as we\u2026? if male or female c\/o dec sex drive, chec\u2026? Alcohol dehydrogenase best way to normalize the grieving process in children? do psychoeducation<\/p>\n\n\n\n do not give prescriptive advise<\/p>\n\n\n\n these reflexes go away at what age: what class of medications are PDE5? know diff between AN and BN Screen all adhd presentations for substance use<\/p>\n\n\n\n high risk for sub use in depression population recommend accupuncture for inform adolescents all info is confidential except what is habeus corpus substance induced psychosis has a very high rate of ? disseminated encephalomyelitis asymmetrical body movements<\/p>\n\n\n\n do a neuro exam<\/p>\n\n\n\n patient has a mood disorder. started depakote and been stable. BMI 25 now 30. eating alot of sweets and juices. recommendations? how can you help your client remember something by anchoring their memory. how do you do thta? ask what they know about medications before rxing polypharmacy can lead to adverse side effects iatrogenic tardive dys: caused by a med rx’d by a doc<\/p>\n\n\n\n post online forms to give responses to influence autoimmune diseases can lead to increased\u2026.? Desmopressin (DDAVP) guanfacine and clonidine is disliked by some patients due to? cannot look up patietns information on Social media treatment for nighttime wetting under 12yo? if addicts are still blamining others they are not ready for\u2026.? non compliant with medication? assess data before changing anything<\/p>\n\n\n\n if patient comes to your with concerns make sure you come to office or discuss by phone<\/p>\n\n\n\n documentation for off label use? do this\u2026. risk factors for sleep apnea what is macrocytic anemia MMSE high score means? if depression is “severe” assess for MMSE scale SLUM scale HAM D PHQ 9 Beck HAM A GAD COWs CIWA cows criteria ciwa etoh abuse treatment aversion therapy<\/p>\n\n\n\n naltrexone<\/p>\n\n\n\n idealization false positive screen for pcp rationalization intellectualization scope of practice standard of practice confidentiality exceptions to confidentiality intent to harm self or others<\/p>\n\n\n\n info given to atty in litigation<\/p>\n\n\n\n releasing records to insurance companies<\/p>\n\n\n\n answering court orders, subpoenas, summons<\/p>\n\n\n\n Meeting state requirements for mandatory reporting of dx of condition<\/p>\n\n\n\n informed consent in apt with dementia autonomy is: Rights of patient re environment just culture Recovery model quality improvement projects focus on\u2026 a retrospective chart review would be a type of\u2026. PDSA is a process reflective practice industry vs inferiority intimacy vs isolation piaget age 2-7 piaget 11 and up primary prevention example secondary prevention tertiary prevention Which patient is at highest risk for SI A. 30y\/o married AA female with previous SI attempt *1 risk factor B. 35 y\/o single Asian male with previous SI attempt *3 risk factors C. 38 y\/o single AA male who is a manager of a bank *2 risk factors D. 68 y\/o single white male […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-110852","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/110852","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=110852"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/110852\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=110852"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=110852"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=110852"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
excessive pruning of synapses<\/p>\n\n\n\n
EVERYTHING DECREASES EXCEPT VENTRICLES<\/p>\n\n\n\n
Dopamine which can worsen symptoms of schizophrenia<\/p>\n\n\n\n
a form of rehabilitation post hospitalization, in home treatment<\/p>\n\n\n\n
Tertiary<\/p>\n\n\n\n
-social skills training
-Exercise<\/p>\n\n\n\n
Cognition
Quality of Life
Long-term health<\/p>\n\n\n\n
Treatment non-compliance<\/p>\n\n\n\n
Antisocial<\/p>\n\n\n\n
proverb interpretation (everyone that lives in glass houses shouldn\u2019t throw stones) Are they able to think abstractly<\/p>\n\n\n\n
means that their response has nothing to do with the question<\/p>\n\n\n\n
means that their response goes in circles instead of getting to the point of the question<\/p>\n\n\n\n
SI\/HI\/AH\/VH<\/p>\n\n\n\n
Folstein Scale<\/p>\n\n\n\n
Serial 7s or perform an activity backwards i.e list the days of the week backwards<\/p>\n\n\n\n
repeat 3 words after me<\/p>\n\n\n\n
repeat 3 words after 5 minutes<\/p>\n\n\n\n
Who is the president<\/p>\n\n\n\n
Clock drawing test<\/p>\n\n\n\n
Problem with the right hemisphere, cerebrum, or parietal lobe<\/p>\n\n\n\n
Hyperactivity of dopamine in the this pathway mediates positive psychotic symptoms<\/p>\n\n\n\n
-Decreased dopamine in the this projection to the dorsolateral prefrontal cortex is postulated to be responsible for negative and depressive symptoms of schizophrenia<\/p>\n\n\n\n
-This pathway mediates motor movements<\/p>\n\n\n\n
-Dopamine has a reciprocal relationship with acetylcholine (Ach) (LOW DOPAMINE INCREASE Ach)<\/p>\n\n\n\n
-Blockade of D2 receptors in this pathway can lead to increase prolactin levels leading to hyperprolactinemia which clinically manifests as amenorrhea, galactorrhea, and sexual dysfunction, gynecomastia<\/p>\n\n\n\n
level less than 20ng\/ml<\/p>\n\n\n\n
less than 25ng\/ml<\/p>\n\n\n\n
Risperdal<\/p>\n\n\n\n
neck stiffness, muscle spasm of upper body especially neck\/face\/tongue<\/p>\n\n\n\n
may mimic anxiety, restlessness, can\u2019t sit still, rocking, pacing<\/p>\n\n\n\n
-DO NOT GIVE WITH BROCHODIALATOR such as ALBUTERAL this combination can cause bronchospasm<\/p>\n\n\n\n
A. difficulty initiating movement; slowness of movement
-Treatment Cogentin<\/p>\n\n\n\n
caused by dopamine blockade, results in muscle rigidity, mask like facial expression, may look blunted, pill rolling tremors in fingers, shuffling gait, motor slowing<\/p>\n\n\n\n
abnormal facial movements, grinding teeth, lip smacking, protruding tongue<\/p>\n\n\n\n
COGENTIN MAKES TD WORSE<\/p>\n\n\n\n
OCCURS 1-2 years TYPICALLY, but can be ACUTE ONSET ALSO<\/p>\n\n\n\n
REGLAN (Metoclopramide) can CAUSE Tardive Dyskinesia must educate patient that this med or the combination of this PLUS antipsychotic can increase risk of TD*** encourage them to discontinue reglan if TD develops<\/p>\n\n\n\n
Ritonavir
Amiodarone
Cimetidine
Ketoconazole<\/p>\n\n\n\n
Macrolides
INH
Grapefruit Juice
Omeprazole<\/p>\n\n\n\n
Increased tegretol levels<\/p>\n\n\n\n
as a provider you know that you must now decrease the dose of the antipyshcotic<\/p>\n\n\n\n
Steroids, Disulfiram (Antabuse), Isoniazid (INH), Antidepressants in persons with bipolar<\/p>\n\n\n\n
steroids, beta blockers, interferon, Accutane (isotrentinoin), some retroviral drugs, antineoplastic drugs, benzodiazepines, progesterone<\/p>\n\n\n\n
Can cause depression and birth defects<\/p>\n\n\n\n
As a provider you know that flonase is a STEROID so it may exacerbate mood symptoms<\/p>\n\n\n\n
Psychosis<\/p>\n\n\n\n
Dopamine and GABA<\/p>\n\n\n\n\n
delayed gastric emptying<\/p>\n\n\n\n
Omeprazole, ranitidine, famotidine<\/p>\n\n\n\n
Decrease absorption of antipsychotics & SSRI<\/p>\n\n\n\n
increased anxiety<\/p>\n\n\n\n
when meds cause the opposite effect than expected<\/p>\n\n\n\n
programmed cell death\/neuronal loss<\/p>\n\n\n\n
Recurrent self harm<\/p>\n\n\n\n
DBT<\/p>\n\n\n\n
Marsha Linehan<\/p>\n\n\n\n
Journaling or diary keeping<\/p>\n\n\n\n
STRESS leads to neurological symptoms such as seizures, paresthesia, blindness, mutism<\/p>\n\n\n\n
adjusting to a situation resulting in depression or anxiety or both or mixed disturbance of emotions and conduct (this type is more common in children: insomnia, peer conflict, verbal altercations, truancy, crying)<\/p>\n\n\n\n
when patients introduce foreign substances into their body or contaminate their food<\/p>\n\n\n\n
Faking illness for financial gain<\/p>\n\n\n\n
common in children in foster care, abuse from parents<\/p>\n\n\n\n
They deliberately annoy others, no aggression, defiance of authority<\/p>\n\n\n\n
violence, criminal, fire setting, killing animals, gang activity, +AGGRESSION, NO REMORSE<\/p>\n\n\n\n
similar to PTSD but the timeline differs<\/p>\n\n\n\n
-OVER ONE MONTH<\/p>\n\n\n\n
Panic attack = BZ
Panic disorder = SSRI<\/p>\n\n\n\n
Panic Disorder is CHRONIC<\/p>\n\n\n\n
Criteria for diagnosis<\/p>\n\n\n\n
CHILDREN MAY NORMALLY HAVE TICS so if they have one tic only THIS IS NORMAL<\/strong><\/p>\n\n\n\n
DNS: Dopamine, Norepinephrine, Serotonin<\/p>\n\n\n\n
Treatment: Haldol, Pimozide, Abilify, Guanfacine, clonidine<\/p>\n\n\n\n
Stimulants<\/p>\n\n\n\n
DNS: Dopamine, Norepinephrine, Serotonin + GABA<\/p>\n\n\n\n
DNS: Dopamine, Norepinephrine, Serotonin<\/p>\n\n\n\n
prefrontal cortex
basal ganglia
reticular activating system<\/p>\n\n\n\n
Prefrontal Cortex which is known to regulate ATTENTION and EXECUTIVE FUNCTION<\/p>\n\n\n\n
Attention
Executive Function
Cognition
Processing
Working Memory
Problem Solving<\/p>\n\n\n\n
Prefrontal Cortex<\/p>\n\n\n\n
on admission<\/p>\n\n\n\n
-Provide patient and parents information immediately don\u2019t wait till discharge<\/p>\n\n\n\n
serotonin, dopamine, glutamate & GABA<\/p>\n\n\n\n
Compulsion<\/p>\n\n\n\n
Obsession\/Compulsion<\/p>\n\n\n\n
6-17 years ONLY<\/p>\n\n\n\n
Administer MOOD QUESTIONAIRE
7\/13 Bipolar Diagnosis Likely<\/p>\n\n\n\n
So what should you assess if a parent reports that a child is having nightmares
GENETIC<\/p>\n\n\n\n
Worry, apprehension, fear must LAST ATLEAST 6 MONTHS<\/p>\n\n\n\n
-ACUTE (within hours to days) onset of disturbance of LOC, COGNITION,<\/p>\n\n\n\n
-Chronic and slow onset (months to years to develop)<\/p>\n\n\n\n
Vit B12 and Folic Acid<\/p>\n\n\n\n
Language and memory (aphasia and amnesia)<\/p>\n\n\n\n
Motor abnormalities\/Mood issues like apathy, depression, irritability<\/p>\n\n\n\n
subcortical form of dementia<\/p>\n\n\n\n
Antivirals<\/p>\n\n\n\n
Depression causes the memory issues, common in older adults<\/p>\n\n\n\n
-Use instrument to further screen out cognitive issues such as SLUMS, MOCHA, MMSE<\/p>\n\n\n\n
visual hallucinations<\/p>\n\n\n\n
PICKs Disease<\/p>\n\n\n\n
Temporal Lobe<\/p>\n\n\n\n
GABA, Glutamate, Serotonin<\/p>\n\n\n\n
a disorder that appears in childhood and is marked by deficient communication, social interaction, Poor eye contact, May not respond when you call their name, Stereotypical movement<\/p>\n\n\n\n
Explains that the child\u2019s presentation is caused by the mirror neuron i.e dysfunction in the mirror neuron<\/p>\n\n\n\n
Male gender, genetic loading, intellectual disability, parents ages, preterm<\/p>\n\n\n\n
ADOS-G (autism diagnostic observation schedule-genetic)
ASQ (ages and stages questionnaire)
M-CHAT (modified-checklist for autism-toddler)<\/p>\n\n\n\n
locus coeruleus and medullary reticular formation<\/p>\n\n\n\n
raphe nuclei<\/p>\n\n\n\n
substantia nigra, ventral tegmental area, nucleaus accumbens<\/p>\n\n\n\n
Basal nucleus of Meynert<\/p>\n\n\n\n
a neural center located in the limbic system; helps process memory and manage stress<\/p>\n\n\n\n
The limbic system is the part of the brain involved in our behavioral and emotional responses, especially when it comes to behaviors we need for survival: feeding, reproduction and caring for our young, and fight or flight responses.
-Hippocampus
-Amygdala
-Hypothalamus
-Thalamus<\/p>\n\n\n\n
Responsible for the response and memory of emotions, especially fear<\/p>\n\n\n\n
relay station for sensory impulses, pain<\/p>\n\n\n\n
homeostasis, temperature, thirst, appetite, sex drive, sleep cycle, emotions<\/p>\n\n\n\n\n
brain region that regulates cognitive function, decision making, empathy, impulse control, and emotions<\/p>\n\n\n\n
Balance and coordination<\/p>\n\n\n\n
developmental delay, learning diff., irritability, loss of appetite, weight loss, sluggishness, fatigue, abdominal pain, vomiting, constipation, hearing loss, seizures, eating non-food items PICA<\/p>\n\n\n\n
GIVE THE BABY TO THE PARENTS and allow them to grieve<\/p>\n\n\n\n
Age
smoking
caffeine
lack of exercise
diet lacking calcium and vit D<\/p>\n\n\n\n
-Aaron Beck<\/p>\n\n\n\n
-Arnold Lazarus
focuses on changing behavior by identifying problem behaviors, replacing them with appropriate behaviors
-Exposure
-Relaxation
-Skills training
-Role Playing<\/p>\n\n\n\n
-Carl Rogers
person-centered therapy
-Self-actualization
-Self-Directive Growth
-Everyone has the potential to actualize and find meaning in life<\/p>\n\n\n\n
Victor Frankl -an insight therapy that focuses on the elemental problems of existence, such as death, meaning, choice, and responsibility, emphasized making courageous life choices.
-Emphasizes accepting freedom and making responsible choices
-Focus on the present<\/p>\n\n\n\n
Gerald Kierman & Myrna Weissman<\/p>\n\n\n\n
Desensitization Phase: visualize the trauma, verbalize negative thoughts but remain attentive to physical sensations<\/p>\n\n\n\n
participants develop hope for creating a different life; they gain hope from others<\/p>\n\n\n\n
people have similar problems, thoughts, and feelings and they are NOT ALONE<\/p>\n\n\n\n
sharing of oneself with another and helping another<\/p>\n\n\n\n
Patients can increase their skills by imitating the bx of others<\/p>\n\n\n\n
interacting with others increases adaptive interpersonal relationships<\/p>\n\n\n\n
Patients develop an attraction to the group and other members as well as a sense of belonging<\/p>\n\n\n\n
Patients openly express their feelings which were previously suppressed<\/p>\n\n\n\n
Groups enable participants to deal with the mean of their own existance<\/p>\n\n\n\n
Participants reexperience family conflicts in the group, which allows them to recognize and change behaviors that may be problematic<\/p>\n\n\n\n
forming, storming, norming, performing, adjourning<\/p>\n\n\n\n
Murray Bowen<\/p>\n\n\n\n
Salvador Minuchin<\/p>\n\n\n\n
Jay Haley<\/p>\n\n\n\n
-MIRACLE QUESTIONS<\/p>\n\n\n\n
if teaching about meditation must tell them about MUSCLE RELAXATION<\/p>\n\n\n\n
P: Population
I: Intervention
C: Comparison
O: Outcome
T: Time<\/p>\n\n\n\n
ESR<\/p>\n\n\n\n
systematic reviews of random control trials (RCTs) or Meta-analysis or RCT-highest internal validity due to randomizations
At least (2)<\/p>\n\n\n\n
systematic reviews of cohort studies
-little bias because the subjects are identified prior to outcome – randomization is lost<\/p>\n\n\n\n
Intracranial pressure<\/p>\n\n\n\n
Normal to play with genitals (PHALLIC STAGE) NORMAL do not assume they have been abused*<\/p>\n\n\n\n
Young boys ages 9-16 years old often have NORMAL BREAST ENLARGEMENT which disappears within 6 months<\/p>\n\n\n\n
Check Testosterone level<\/p>\n\n\n\n
an enzyme active in the stomach and the liver that metabolizes alcohol<\/p>\n\n\n\n
normal up to 5-6 months
If older baby still has this reflex->refer to specialist<\/p>\n\n\n\n
Normal till 5-6 months
If present past normal range->refer to specialist
If not present within the normal age->Xray may be a sign of a broken bone, nerve injury, or spinal injury<\/p>\n\n\n\n
Normal up to 2 years
If present past normal range->refer to specialist<\/p>\n\n\n\n
Sildenafil (Viagra)<\/p>\n\n\n\n
Anorexia-Low BMI
Bulemia-Normal BMI<\/p>\n\n\n\n
used for pain and depression<\/p>\n\n\n\n
assess ALL the medications that the patient is taking<\/p>\n\n\n\n
educate them on how the policy will benefit patient care<\/p>\n\n\n\n
Think most FEASIBLE option with WIDE net or audiance<\/p>\n\n\n\n
Cytokine level<\/p>\n\n\n\n
-Teach parents to use alarm clock to wake up to urinate (NON PHARM FIRST)<\/p>\n\n\n\n
No it violates their trust<\/p>\n\n\n\n
excessive weight, obesity, diabetes, smoking<\/p>\n\n\n\n
you need higher doses of the medication in order for the medication to be effective<\/p>\n\n\n\n\n
10 moderate
15 moderately severe
20 severe<\/p>\n<\/blockquote>\n\n\n\n\n
14 Moderate
17 Severe<\/p>\n<\/blockquote>\n\n\n\n\n
15 Moderate
24 Severe<\/p>\n<\/blockquote>\n\n\n\n
0-13 Subclinical<\/p>\n\n\n\n\n
20 Moderate
29 Severe
40 EXTREME<\/p>\n<\/blockquote>\n\n\n\n
0-4: Minimal Anxiety<\/p>\n\n\n\n\n
10 Moderate Anxiety
15 Severe Anxiety<\/p>\n<\/blockquote>\n\n\n\n
Medicate with PRNS at score of 7 or above<\/p>\n\n\n\n
Begin PRN medication at 8 or above<\/p>\n\n\n\n
LFT<\/p>\n\n\n\n
Seeing someone else as perfect, ideal, or more worthy than everyone else<\/p>\n\n\n\n
is an approach to organizational change which focuses on strengths rather than on weakness<\/p>\n\n\n\n
Links theory to practice with a goal of correcting practices that are incorrect. Example Debriefing after a restraint to find out what went wrong or what went right DEBFRIEFING MAY BE A KEY WORD<\/p>\n\n\n\n\n
they can still refuse medications, UNLESS it is an emergency or if the court determines they must take medications<\/p>\n\n\n\n
State board of Nursing<\/p>\n\n\n\n
NP roles and actions
-Varies broadly state to state<\/p>\n\n\n\n
The state scope of practice standards to see if it is allowed and what certification is needed<\/p>\n\n\n\n
ANA<\/p>\n\n\n\n
-Answering court orders, subpoenas, or summonses *high yield (if you don\u2019t release or lie about knowing this is PERJURY)<\/p>\n\n\n\n
1976 – duty to warn victims of potential harm from client<\/p>\n\n\n\n
-Communication process between the provider and client that results in client\u2019s acceptance or rejection of proposed treatment<\/p>\n\n\n\n
doing what is fair, fairness in all aspects of care<\/p>\n\n\n\n
do no harm<\/p>\n\n\n\n
doing good\/promoting well-being<\/p>\n\n\n\n
being true and loyal<\/p>\n\n\n\n
telling the truth, patients have the right to know the truth about their treatment<\/p>\n\n\n\n
doing for self (right to self-determination)<\/p>\n\n\n\n
IM ativan for agit\/anx<\/p>\n\n\n\n
Restrictive Setting<\/p>\n\n\n\n
A. Create interdisciplinary teaching team
B. Develop Outcome measures
C. Market the educational plan
D. Utilize a survey to assess the educational needs of the staff
D. Utilize a survey to assess the educational needs of the staff<\/p>\n\n\n\n
THROUGH EDUCATION<\/p>\n\n\n\n
individuals are continually learning, designing safety systems, and managing behavioral choices<\/p>\n\n\n\n
A. Asking the clinical manager to explore options for access
B. Organizing a political protest
C. Working with the local chapter of the nurses professional association
D. Writing letters to the editor of the local newspaper
C. Working with the local chapter of the nurses professional association<\/p>\n\n\n\n
A. Autonomy
B. Nonmaleficence
C. Justice
D. Beneficence
A. Autonomy<\/p>\n\n\n\n
A. Identifies what steps the mother has already tried in caring for the child
B. Explain that the symptoms are viral infection
C. Educates about importance of fluid electrolyte imbalance
D. Respects the mother’s understanding of the child’s illness
A. Respects the mother\u2019s understanding of the child\u2019s illness<\/p>\n\n\n\n
Plan, Do, Study, Act<\/p>\n\n\n\n
Screening, Brief Intervention, and Referral to Treatment<\/p>\n\n\n\n\n
\n
\n
2-7 y.o- MAGICAL THINKING IS NORMAL, if they believe that monsters can fly this is NORMAL<\/p>\n\n\n\n
12+ y\/o during which people begin to think logically about abstract concepts<\/p>\n\n\n\n
in Piaget’s theory, the stage (from birth to about 2 years of age) during which infants know the world mostly in terms of their sensory impressions and motor activities
Object permanance<\/p>\n\n\n\n
in Piaget’s theory, the stage of cognitive development (from about 6 or 7 to 11 years of age) during which children gain the mental operations that enable them to think logically about concrete events
i.e finding similarities in objects, grouping things<\/p>\n\n\n\n
Sex (Male),
Age (Teenager or Elderly),
Depression,
Previous Attempt, Ethanol or Drug Use, Loss of rational thinking, Sickness (medical illness),
3 or more prescription medications,
Organized plan,
No spouse (divorced, widowed, or single especially if childless). Social support lacking.
WHITE<\/p>\n\n\n\n\n
60 Moderate
70 Severe<\/p>\n<\/blockquote>\n\n\n\n
100 is max score<\/p>\n\n\n\n
0-10 severe<\/p>\n\n\n\n\n
\n
Efforts to prevent an injury or illness from ever occurring.
-Education
-Safety Initiatives
-Modifying environment<\/p>\n\n\n\n
Efforts to limit the effects of an injury or illness that you cannot completely prevent.
-Early findings
-Screening
-Prompt and effective treatment
Example: Crisis hotline, disaster response<\/p>\n\n\n\n
-aims to prevent the long-term consequences of a chronic illness or disability and to support optimal functioning
-Rehab Services
-Day treatment
-Case management
-Social Skills training<\/p>\n\n\n\n
what the body does to the drug<\/p>\n\n\n\n
what the drug does to the body<\/p>\n\n\n\n
amino acids<\/p>\n\n\n\n
infancy, trust vs mistrust<\/p>\n\n\n\n
early childhood 1-3, autonomy vs shame and doubt<\/p>\n\n\n\n
Late childhood 3-6 y\/o initiative vs guilt<\/p>\n\n\n\n
school age 6-12 y\/o industry vs inferiority<\/p>\n\n\n\n
adolescence 12-20 y\/o identity vs inferiority<\/p>\n\n\n\n
early adulthood 20-35 y\/o intimacy vs isolation<\/p>\n\n\n\n
middle adulthood 35-65 y\/o generativity vs stagnation<\/p>\n\n\n\n\n
Drug binds to receptors and activates a biological response<\/p>\n\n\n\n
Drug causes the opposite effect of agonist<\/p>\n\n\n\n
Drug does not fully activate the receptors<\/p>\n\n\n\n
Drug binds to the receptor but does not activate a biological response<\/p>\n\n\n\n
Vitamin E
Omega-3<\/p>\n\n\n\n
herbal used for menopause<\/p>\n\n\n\n
herbal used for anxiety<\/p>\n\n\n\n
herbal used for sedation and anxiety<\/p>\n\n\n\n
Herbal used to treat memory, dementia, & sexual dysfunction from SSRIs<\/p>\n\n\n\n
Herbal product used for stress reduction, fatigue, and depression<\/p>\n\n\n\n
herbal used for sedation<\/p>\n\n\n\n
Meperidine
Decongestants
TCAs
Atypical Antipsychotics
St.Johns wart
L-Tryptophan
Stimulants
Asthma meds<\/p>\n\n\n\n
iron deficiency<\/p>\n\n\n\n
due to folate or vitamin B12 deficiency<\/p>\n\n\n\n
Normal tanner stage, start by 16<\/p>\n\n\n\n
ACES and ARBS (angiotensin receptor blocker)
Together can cause renal dysfunction<\/p>\n\n\n\n
Hip disease, refer child out, assessed during head to toe<\/p>\n\n\n\n
too much acetylcholine
Alzheimer’s
Parkinson’s and EPS<\/p>\n\n\n\n
Appreciative Inquiry<\/p>\n\n\n\n
Trigeminal
Clenched Teeth<\/p>\n\n\n\n
Biweekly labs
Less than 1000 Stop<\/p>\n\n\n\n
Ask patient to stick out their tongue<\/p>\n\n\n\n
large waist circumference<\/p>\n\n\n\n
aortic stenosis<\/p>\n\n\n\n
increases the serum level of lithium up to double<\/p>\n\n\n\n
male with more than one X chromosome (XXY)
-Decreased sperm, fertility issues<\/p>\n\n\n\n
forbids health plans from placing lifetime or annual limits on mental health coverage that are less generous than those placed on medical or surgical benefits<\/p>\n\n\n\n
meningitis<\/p>\n\n\n\n
interferon can increase depression therefore you may have to increase the lexapro<\/p>\n\n\n\n
Try Lyrica (pregabalin) its absorbed quickly and the maximum rate of absorption is 3x of Neurontin<\/p>\n\n\n\n
MRI
Tox Screen<\/p>\n\n\n\n
formulation, implementation, evaluation<\/p>\n\n\n\n
a rare disorder found virtually exclusively in girls, is a neurodevelopmental disorder in which the child usually develops normally until about 6 to 18 months of age at which characteristics of the syndrome emerge; characteristics include: hypotonia (loss of muscle tone), reduced eye contact, decelerated head growth, and disinterest in play activities<\/p>\n\n\n\n
small head, smooth palpebral fissure, inner epicanthal folds, thin upper lip<\/p>\n\n\n\n
Aplastic anemia, agranulocytosis, steven johnsons, hyponatremia. Watch with cipro and erythro<\/p>\n\n\n\n
Licensing Jurisdiction for the NP must be considered<\/p>\n\n\n\n
Delirium<\/p>\n\n\n\n
Cyproheptadine<\/p>\n\n\n\n
initially within 1 hour; then 8 hours<\/p>\n\n\n\n
Reticulocytes are involved in conditions affecting RBCs such as anemia.
-Low reticulocytes may be seen is iron def. anemia, pernicious anemia, folic acid deficiency, and aplastic anemia<\/p>\n\n\n\n
short term benzo, SSRI, SNRI, TCA, or beta-blocker off label<\/p>\n\n\n\n
weight loss over 30% over 6 months
severe hypothermia temp less than 96.8
HR less than 40
BP less than 70
Hypokalemia less than 3mEq\/L
BMI<16<\/p>\n\n\n\n
ANalysis Of VAriance – btwn means of 3 or more groups
An inferential statistical test for comparing the means of three or more groups<\/p>\n\n\n\n
stage of change in which people are unwilling to change their behavior<\/p>\n\n\n\n
person is considering making a change, aware that there is a problem but is not quite committed to changing<\/p>\n\n\n\n
Person has made the decision to change, is ready for action<\/p>\n\n\n\n
Person is engaging in specific, overt actions to change<\/p>\n\n\n\n
The person is engaging in behaviors to prevent relapse<\/p>\n\n\n\n
Strong inhibitors of 2D6
Bupropion, Fluoxetine, Paxil<\/p>\n\n\n\n
Don’t tell<\/p>\n\n\n\n
Say I see you have bruises on your arm
may I Ask what happened<\/p>\n\n\n\n
Yes
at any time<\/p>\n\n\n\n
Category B – ok if really needed.<\/p>\n\n\n\n
Strong Inducers of 3A4 can decrease INR<\/p>\n\n\n\n
State and Federal<\/p>\n\n\n\n
anxiety, alcohol, substance use<\/p>\n\n\n\n
Marijuana intoxication<\/p>\n\n\n\n
CBT<\/p>\n\n\n\n
increases INR<\/p>\n\n\n\n
Zyprexa, Abilify, Seroquel – low doses<\/p>\n\n\n\n\n
start with nurse manager<\/p>\n\n\n\n
Nystagmus<\/p>\n\n\n\n
Theory of Interpersonal Relations
Nurse as therapeutic tool
-Care for the person as well as the illness
-Patients are PEOPLE not DIAGNOSES<\/p>\n\n\n\n
You relate to childhood abandonment and talk about it with the patient<\/p>\n\n\n\n
stop the medication immediately<\/p>\n\n\n\n
hypoglycemia<\/p>\n\n\n\n
a statistic that measures the direction and strength of the linear relation between two variables that have been measured on an interval or ratio scale<\/p>\n\n\n\n
9 months<\/p>\n\n\n\n
Sensory-perceptual disturbances and agnosia(inability to perceive objects)
R-L confusion
Difficulty writing (agraphia)
Aphasia(difficulty of language)<\/p>\n\n\n\n
-ACT
-Peer support<\/p>\n\n\n\n
Check LFT
If fine then check creatinine<\/p>\n\n\n\n
Assess spiritual needs first<\/p>\n\n\n\n
Do not take MAOI or TCA<\/p>\n\n\n\n
The probability of results of the experiment being attributed to chance.<\/p>\n\n\n\n
consistency of measurement<\/p>\n\n\n\n
identify an object without sight
i.e dice in hand<\/p>\n\n\n\n
H2 receptor antagonist (antacid)
Increases benzo
Increases coumadin<\/p>\n\n\n\n
EKG-QT prolongation
Priapism
Glaucoma<\/p>\n\n\n\n
A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted.
-Delayed puberty
-Amenorrhea
-Web neck, osteoporosis, lymphedema
-poor social skills<\/p>\n\n\n\n
Show Revenue and expenses<\/p>\n\n\n\n
CKMM, CKBB, CKMB (normal 0.3 mmcg\/L)<\/p>\n\n\n\n
The same as they are with informed consent
-Respect
-Beneficence
-Justice<\/p>\n\n\n\n
Waist circumference
Lipids<\/p>\n\n\n\n
II-V<\/p>\n\n\n\n
XI (11) Spinal Accessory<\/p>\n\n\n\n
Gabapentin
Campral
Lithium<\/p>\n\n\n\n
inhibitor that can reduce the absorption of the drug by 47% therefore the drug blood levels will be increased
-Decrease dose of drug<\/p>\n\n\n\n
As in a position of authority.
Expect to give instructions and help make decisions<\/p>\n\n\n\n
Red ribbon on an infant
Amulet for adults<\/p>\n\n\n\n
assesses whether the means of two groups are statistically different from each other<\/p>\n\n\n\n
clonidine
guanfacine<\/p>\n\n\n\n
Inducer – will lower dose of Lamictal<\/p>\n\n\n\n
Bone marrow disorder or Vitamin Deficiency
Normal Range 0.5-1.5<\/p>\n\n\n\n
CD4 <200
Viral Load is high
<20% get it with antiretroviral treatment<\/p>\n\n\n\n
Dendritic pruning
Emotions are controlled by amygdala
Prefrontal Cortex is still not fully developed (may be why young boys are risk takers)<\/p>\n\n\n\n
NSAID- WATCH WITH LITHIUM<\/p>\n\n\n\n
Highly serotonergic<\/p>\n\n\n\n
the act of spreading widely
-publication-highest level
-Presenting at national conference
-Journal club<\/p>\n\n\n\n
sensitivity – how well a test identifies truly ill people (True positive)
specificity – how well a test identifies truly well people (True negative)<\/p>\n\n\n\n
National standards for electronic HC transactions
-National ID for providers, health plans and employers.
-Not SIMPLY Confidentiality.<\/p>\n\n\n\n
Topamax
KCL
Zonegran<\/p>\n\n\n\n
OCD
0-7 subclinical
8-15 Mild
16-23 Moderate
24-31 Severe
32-40 Extreme<\/p>\n\n\n\n
Unit staff<\/p>\n\n\n\n\n
Until court orders it
“due process”<\/li>\n<\/ul>\n\n\n\n
determined that patients have an absolute right to refuse treatment, but a guardian may authorize their treatment.<\/p>\n\n\n\n
Confinement
-It is unconstitutional to commit a person involuntarily who is not imminently dangerous to self or others<\/p>\n\n\n\n
incompetent to stand trial<\/p>\n\n\n\n
Insanity defense<\/p>\n\n\n\n
7\/8 8B ruling says that there should be court determination of incompetence for involuntary committed mental persons to receive antipsychotic medications<\/p>\n\n\n\n
Prohibits physicians or their family members who own health care facilities from referring patients to those entities if the federal government, under Medicare or Medicaid, will pay for treatment.<\/p>\n\n\n\n
Stimulants –often used for ADHD<\/p>\n\n\n\n
Safety first!
Provide patient with an environment of safety and reassure them of their safety in the clinic\/hospital.<\/p>\n\n\n\n
Make sure the patient will be safe.<\/p>\n\n\n\n
No. A safety contract is not enough. The NP has to confirm that the patient is going to be safe for themselves or their environment is safe.<\/p>\n\n\n\n
Safety is more important than privacy. In an office with a door open or partially open. The day room would be a breach of confidentiality and a closed door or in their room would give the patient access to harming the NP.<\/p>\n\n\n\n
interview the child separately from the parents THEN report to CPS<\/p>\n\n\n\n
This makes the NP suspect abuse so initial action is to immediately report to CPS.<\/p>\n\n\n\n
Confidentiality with the explanation that confidentiality must be broken if they are a danger to self or others<\/p>\n\n\n\n
No because the adolescent may have info that they want kept confidential from their parents.<\/p>\n\n\n\n
Separate them and speak to adolescent alone because the adolescent has a right to confidentiality.<\/p>\n\n\n\n
Native American<\/p>\n\n\n\n
Educate the staff member in cultural competency and sensitivity.<\/p>\n\n\n\n
Get consent from the patient and allow the traditional healer to attend as well. With permission from the patient, you can include the healer in the care plan as follow up.<\/p>\n\n\n\n
TSH<\/p>\n\n\n\n
0.5-5.0 mu\/L<\/p>\n\n\n\n
Depression<\/p>\n\n\n\n
Mania<\/p>\n\n\n\n
T4 and T3 will be high and patient will have hyperthyroidism<\/p>\n\n\n\n
T4 and T3 will be low and patient will have hypothyroidism.<\/p>\n\n\n\n
agitation, anxiety, irritability, mood swings, weight loss.<\/p>\n\n\n\n
lethargy, weight gain, decreased libido.<\/p>\n\n\n\n
Pancreatitis<\/p>\n\n\n\n
Spina bifida in fetuses
Hepatotoxicity<\/p>\n\n\n\n
Abdominal pain in upper right quadrant of abdomen
Reddish brown urine
Yellowing of the skin and whites of eyes
Fatigue<\/p>\n\n\n\n
A liver function test –check AST and ALT levels<\/p>\n\n\n\n
Disorientation
lethargy
Respiratory depression
Nausea\/vomiting<\/p>\n\n\n\n
Dc medication and check depakote levels, do a LFT and check ammonia levels<\/p>\n\n\n\n
upper adbominal pain
abdominal pain that radiates to patient’s back<\/p>\n\n\n\n
fever
rapid pulse
nausea
vomiting
oily stools<\/p>\n\n\n\n
Kava Calms<\/p>\n\n\n\n
stress
insomnia<\/p>\n\n\n\n
Liver damage
We monitor patient for RUQ pain and do LFTs<\/p>\n\n\n\n
Xanax (Alprazolam)
CNS depressants\/ sedative medications<\/p>\n\n\n\n
Lamictal is the mood stabilizer that causes the least weight gain<\/p>\n\n\n\n
Can cause Stevens Johnson<\/p>\n\n\n\n
Body aches, red rash, peeling skin, facial and tongue swelling<\/p>\n\n\n\n
ZAL
Ziprasodone (Geodon)
Aripriprazole (Abilify)
Lurasidone (Latuda)<\/p>\n\n\n\n
bmi
hip-to-waist ratio
glucose
lipid panel<\/p>\n\n\n\n
Exercise and nutritional counseling<\/p>\n\n\n\n
Switch to antipsychotic with lower potential for weight gain: ZAL<\/p>\n\n\n\n
agranulocytosis, aplastic anemia, Stevens –Johnson syndrome<\/p>\n\n\n\n
pallor
fatigue
HA
fever
nosebleeds
bleeding gums
skin rash
SOB<\/p>\n\n\n\n
HLA-B* 1502 allele is highly associated with Carbamazepine-induced Stevens-Johnson syndrome<\/p>\n\n\n\n
An ANC less than 1000 mm3 whether patient is showing signs of infection or not.<\/p>\n\n\n\n
Sudden fever
Chills
sore throat
weakness<\/p>\n\n\n\n
Lithium is neuroprotective treatment of choice for bipolar disorder– can protect nerve cells from damage.<\/p>\n\n\n\n
0.6-1.2 mEq\/L<\/p>\n\n\n\n
1.5 mEq\/L or higher<\/p>\n\n\n\n
Mania<\/p>\n\n\n\n
Lithium is the only mood stabilizer with evidence of anti-suicidal effects in bipolar<\/p>\n\n\n\n
50-125 micrograms (ug\/ml)<\/p>\n\n\n\n
150 microgrms (ug\/ml)<\/p>\n\n\n\n
TSH
Serum creatinine
BUN
Urinalysis
HCG for females age 12-51<\/p>\n\n\n\n
In mild lithium toxicity, symptoms include WATCAD–Weakness, Ataxia, Tremor, Concentration poorness and Diarrhea.<\/p>\n\n\n\n
serum level of 1.3 or 1.4 and signs of Lithium toxicity.<\/p>\n\n\n\n
Take HCG test\/ aka pregnancy test before placing any woman on antipsychotic -for females of age 12-51.<\/p>\n\n\n\n
Monitor closely for lithium toxicity<\/p>\n\n\n\n
hypothyroidism, ebstein anomaly, and nephrogenic diabetes insipidus, fine hand tremors, Maculopapular rash, GI upset(Diarrhea, vomiting, cramps, anorexia), polyuria, polydispsia, T-wave inversions, Leukocytosis (increased WBCs)<\/p>\n\n\n\n
DC Li and check serum Li levels<\/p>\n\n\n\n
Kidney disease or drugs that reduce renal clearance
NSAIDS(ibuprofen, Indocin)
Thiazides (hydrochlorothiazide)
ACE inhibitors
Medications used for cardiac failure (lisinopril)
Dehydration
Hyponatremia (low sodium levels)<\/p>\n\n\n\n
Antipsychotics<\/p>\n\n\n\n
Extreme musclular rigidity
Mutism<\/p>\n\n\n\n
Elevated WBCs(leukocytosis)
Elevated LFTs<\/p>\n\n\n\n
DC the antipsychotic and treat with:<\/p>\n\n\n\n
Hyperthermia
Tachycardia
Diaphoresis
Altered level of consciousness<\/p>\n\n\n\n
Hyperreflexia
Myoclonic jerks<\/p>\n\n\n\n
SSRIs\/SNRIs\/TCAs\/MAOIs<\/p>\n\n\n\n
DC the offending agent and treat with<\/p>\n\n\n\n
wait 14 days<\/p>\n\n\n\n
5-6 weeks<\/p>\n\n\n\n
wait 2 weeks<\/p>\n\n\n\n
need a washout period of 5 half-lives between cessation of previous drug and introduction of new drug. This is the time it takes for the medication to degenerate out of the system<\/p>\n\n\n\n
Combinations of SSRIs and SNRIs or TCAs or MAOIs or St. John’s Wort<\/p>\n\n\n\n
because they are safer in cases of overdose<\/p>\n\n\n\n
Triptans can cause serotonin syndrome so no triptans (for migraines) or sumatriptan (imitrex)<\/p>\n\n\n\n
Citalopram or escitalopram because lower incidence of drug-drug interaction.<\/p>\n\n\n\n
SNRI or TCA
An SNRI is safer<\/p>\n\n\n\n
Alpha 2 Delta Ligands= Gabapentin and Pregabalin (Lyrica)<\/p>\n\n\n\n
SSRIs\/SNRIs can cause sexual dysfunction<\/p>\n\n\n\n
NDRIs do not cause sexual dysfunction = Wellbutrin<\/p>\n\n\n\n
increase thoughts of self-harm in adolescents.<\/p>\n\n\n\n
If patient is depressed, assess alcohol intake because some patients use alcohol to self-medicate and this can become a barrier to treatment<\/p>\n\n\n\n
Prozac can cause insomnia; encourage pt to take Prozac in the morning<\/p>\n\n\n\n
Depression
bipolar
alcohol abuse
eating disorder
schizophrenia<\/p>\n\n\n\n
Antisocial personality disorder<\/p>\n\n\n\n
few experimental studies exist that investigate the placebo effect of antidepressants in children and adolescent (When compared to adults, children with depression have a reduced placebo representation in studies but a higher placebo rate).<\/p>\n\n\n\n
\u2022Hallucination, Delusion, Loose association
\u2022Ideas of reference (paranoia\/ paranoid delusions)
\u2022Agitated and bizarre behavior<\/p>\n\n\n\n
\u2022Avolition – Asociality (Hygiene, Work)
\u2022Anhedonia – Asociality (Interest, Relationship)
\u2022Blunted affect
\u2022Paucity of thought<\/p>\n\n\n\n
18-25 males
25-35 in females<\/p>\n\n\n\n
Ventricular enlargement<\/p>\n\n\n\n
–Different lobes
–Different parts of limbic system
–Cerebral blood flow<\/p>\n\n\n\n
prefrontal cortex
amygdala
basal ganglia
hippocampus
limbic regions<\/p>\n\n\n\n
Alpha 2 adrenergic receptor agonist (guanfacine and clonidine)<\/p>\n\n\n\n
Because stimulants can potentiate dopamine release<\/p>\n\n\n\n
manualized group therapy and assertive community treatment (ACT)<\/p>\n\n\n\n
ACT is a form of rehabilitation post-hospitalization<\/p>\n\n\n\n
Referral to case management team so a nurse can go to their home and administer their medication. And, referral to aerobic exercise program<\/p>\n\n\n\n
Tertiary<\/p>\n\n\n\n
Improve cognition
Improve quality of life
Improve long term health<\/p>\n\n\n\n
switch to intramuscular Haldol<\/p>\n\n\n\n
20 X the total daily oral doses=Decanoate dose–example:<\/p>\n\n\n\n
LAI–20 X 10 mg = 200 mg<\/p>\n\n\n\n
100 mg
If they need 200 mg then give 100 mg on day one and come back in 5-7 days for another 100 mg;<\/p>\n\n\n\n
5-7 days for second 100 mg
and 5-7 days for third 100 mg<\/p>\n\n\n\n
Firm belief maintained despite evidence to the contrary.<\/p>\n\n\n\n
listen and observe cues\u2014depends on clinical observation<\/p>\n\n\n\n
Assess the organization of the patient’s thoughts and ideas.<\/p>\n\n\n\n
Refers to the themes that occupy the patient’s thoughts and perceptual disturbances. Ex:
Suicidal ideations
homicidal ideations
SI or HI plan
visual hallucinations
auditory hallucinations<\/p>\n\n\n\n
We are evaluting thoughts and ideas<\/p>\n\n\n\n
Adults–to assess cognitive decline<\/p>\n\n\n\n
Concentration\/attention\/ calculation–examples: count backward from 100 by 7s<\/p>\n\n\n\n
Very quick way to screen for possible dementia– takes 1-2 minutes to complete<\/p>\n\n\n\n
right parietal lobe i.e. the right hemisphere of the brains<\/p>\n\n\n\n
Atypical antipsychotics have both dopamine and 5HT2A receptor antagonism<\/p>\n\n\n\n
Atypical antipsychotic that can be administered IM like Invegga, Geodon or Abilify.<\/p>\n\n\n\n
Meso–not major depression but meso depression + other negative symptoms
decreased dopamine in the mesocortical pathway is thought to be responsible for negative and depressive symptoms of schizophrenia<\/p>\n\n\n\n
Nigrostriatal pathway mediates motor movements<\/p>\n\n\n\n
Blockade of dopamine receptors in the nigrostriatal pathways can lead to EPs e.g. acute dystonia, parkinsonism, and akathisia<\/p>\n\n\n\n
Increased acetylcholine and decreased dopamine can cause EPS’<\/p>\n\n\n\n
Metoclopramide (Reglan) can cause EPS like Tardive dyskinesia and parkinsonism<\/p>\n\n\n\n
Benztropine<\/p>\n\n\n\n
stop\/decrease meds, switch to new anti psych that doesn’t cause tardive dyskinesia (possibly clozapine)<\/p>\n\n\n\n
Blockade of D2 receptors in this pathway can lead to increased prolactin levels leading to hyperprolactinemia which clinically manifests as amenorrhea, galactorrhea (Risperidone), sexual dysfunction, and gynecomastia.<\/p>\n\n\n\n
Men–less than 20 ng\/ml
Women — less than 25 ng\/ml<\/p>\n\n\n\n
decrease serum levels of drugs that are substrates of CYP1A2 enzymes which causes subtherapeutic drug levels<\/p>\n\n\n\n
Increase serum levels possibly causing toxic levels of drug<\/p>\n\n\n\n
Cytochrome P450 Enzyme CYP1A2<\/p>\n\n\n\n
Decrease the dose because smoking is an inducer and it is no longer decreasing the serum levels of the drug.<\/p>\n\n\n\n
Inhibitors because they can cause toxic levels of a drug in the body.<\/p>\n\n\n\n
Inducer<\/p>\n\n\n\n
Inhibitors<\/p>\n\n\n\n
Decrease the tegretol (carbamazapine) to avoid the inhibitors causing a toxic level of tegretol in the blood<\/p>\n\n\n\n
Steroids
Disulfram (Antabuse)
Isoniazid(INH)
Antidepressants in persons with bipolar<\/p>\n\n\n\n
Steroids
Beta blockeres
Interferon
Isotretinoin (Accutane)
Some retroviral drugs
Antineoplastic drugs
benzodiazepines
progesterone<\/p>\n\n\n\n
Steroids can cause psychosis<\/p>\n\n\n\n
Yes<\/p>\n\n\n\n
Increase the dose.<\/p>\n\n\n\n
Dopamine and GABA<\/p>\n\n\n\n
Delayed gastric emptying<\/p>\n\n\n\n
Ranitidine–Antihistamine and Antacid
Famotidine–Antihistamine and Antacid
Omeprazole–proton pump inhibitor<\/p>\n\n\n\n
Take 2 hours apart<\/p>\n\n\n\n
Antacids
PPIs like Protonix, Omeprazole<\/p>\n\n\n\n
monitor for increased anxiety<\/p>\n\n\n\n
when medication causes opposite effect for which is was prescribed. Avoid giving in the future<\/p>\n\n\n\n
Geodon and Citalopram can cause QT prolongation<\/p>\n\n\n\n
40 mg
for those 65+– 20 mg<\/p>\n\n\n\n
multigenerational bipolar<\/p>\n\n\n\n
A medical condition like a stroke<\/p>\n\n\n\n
Distractability
Insomnia
Grandiosity
Flight of ideas
Agitation\/Activity increase
Sexual indiscretions (or other pleasurable activity)
Talkativeness
DIG FAST<\/p>\n\n\n\n
programmed cell death<\/p>\n\n\n\n
self-harming behavior
recurrent suicidal behavior<\/p>\n\n\n\n
DBT–decreases suicidality in Borderlines<\/p>\n\n\n\n
Marsha Linehan<\/p>\n\n\n\n
use their journals\/diaries to help diagnose borderlines<\/p>\n\n\n\n
Lithium<\/p>\n\n\n\n
Depakote<\/p>\n\n\n\n
a mental condition–usually begining suddenly after a stressful experience– in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation<\/p>\n\n\n\n
An unhealthy or excessive response to an event or change within 3 months of it happening<\/p>\n\n\n\n
with depressed mood — feelings of sadness, decreased interest, sleep disturbance, appetite changes<\/p>\n\n\n\n
Adjustment disorder has a specific cause.<\/p>\n\n\n\n
Family therapy with emphasis on child management skills; teaching parents about positive reinforcement and boundary settings.<\/p>\n\n\n\n
Conduct Disorder<\/p>\n\n\n\n
Aggression toward people or animals and property.<\/p>\n\n\n\n
Targets mood and aggression–treat with antipsychotics, mood stabilizers, SSRIs and alpha agonists (Clonidine and guanfacine)<\/p>\n\n\n\n
At least 2 motor tics and at least 1 vocal tic have been present, not necessarily at the same time–for more than a year<\/p>\n\n\n\n
No. Children’s tics are common and often temporary<\/p>\n\n\n\n
Dopamine, Norepinephrine, serotonin (DNS)<\/p>\n\n\n\n
Clonidine (Catapres or Kapvay) or Guanfacine (Intuniv)<\/p>\n\n\n\n
Psychiatric diagnosis that may occur in patients within 4 weeks after a traumatic event Features include anxiety, insomnia, re-experiencing, avoidance behaviors–basically PTSD symptoms but duration of symptoms is less than a month. (PTSD has to last at least one month)<\/p>\n\n\n\n
Intrusive re-experiencing
Increased arousal (hyperarousal)
Avoidance of stimuli associated with trauma<\/p>\n\n\n\n
SSRIs, TCAs, Prazosin for nightmares<\/p>\n\n\n\n
EMDR (preferred over CBT)
CBT<\/p>\n\n\n\n
Desensitization phase
Installation phase
body scan phase<\/p>\n\n\n\n
Frontal cortex
Basal ganglia
Abnormalities in prefrontal cortex–inattentive
Abnormalities of reticular activating system<\/p>\n\n\n\n
children age 3 to adult<\/p>\n\n\n\n
Assess cardiac hx before beginning stimulants.<\/p>\n\n\n\n
children age 6 to adult<\/p>\n\n\n\n
Executive function
Cognitive process such as planning, working memory
Problem solving
How to direct and maintain attention to a task<\/p>\n\n\n\n
Insomnia
Tremors
Increased BP
Heart palpitations<\/p>\n\n\n\n
Medication has been cleared by the body; consider an extended release dose.<\/p>\n\n\n\n
address their anxiety\u2014give them some support before continuing with psychoedcation<\/p>\n\n\n\n
Presence of anxiety-provoking obsessions (recurrent and persistent thoughts, impulses, or images) or compulsions (for example motor tics) that function to reduce the person’s subjective anxiety level<\/p>\n\n\n\n
PANDAS–Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.<\/p>\n\n\n\n
Tourettes= tics only<\/p>\n\n\n\n
Condition in which a person presents with physical or mental illness symptoms that are induced.<\/p>\n\n\n\n
symptoms are faked for secodary gain such as avoiding work or prison<\/p>\n\n\n\n
a condition in which one person induces illness symptoms in someone else<\/p>\n\n\n\n
product of severely dysfunctional early relationships between principle caregiver and child —- results when caregiver disregards child’s physical\/emotional needs–> behavioral\/interpersonal problems later in life (fearful\/inhibited\/withdrawn\/apathetic\/shows no emotion towards caregivers\/ disruptive\/disorganized)<\/p>\n\n\n\n
excessive worry for at least 6 months<\/p>\n\n\n\n
surge of intense fear or discomfort that reaches a peak within minutes as well as a sense of impending doom<\/p>\n\n\n\n
diagnosis given when patient experiences recurrent panic attacks without apparent triggers<\/p>\n\n\n\n
fluoxetine
Paroxetine
Sertraline
Venlafaxine<\/p>\n\n\n\n
Childhood (<18) depressive disorder that includes
Chronic dysregulated mood (“moody”)
Frequent intense temper outburts\/temper tantrums
Severe irritability
Anger<\/p>\n\n\n\n
Betablocker like propranolol.<\/p>\n\n\n\n
Can cause bronchospasms so contraindicated in patients using bronchodilators like albuterol<\/p>\n\n\n\n
Low BMI (<15)
Amenorrhea
Emaciation
Bradycardia
Hypotension<\/p>\n\n\n\n
Refer for hospitalization. If parent refuses, report to CPS<\/p>\n\n\n\n
Usually in normal range<\/p>\n\n\n\n\n
CD-conduct disorder<\/p>\n\n\n\n
Aggression towards human and animals and lack of remorse<\/p>\n\n\n\n
Meds that target mood and aggression:<\/p>\n\n\n\n\n
\n
They are fairly common and can be temporary.<\/p>\n\n\n\n
DNS= Dopamine, Norepinephrine, Serotonin<\/p>\n\n\n\n
Clonidine (Catapres, Kapvay)
Guanfacine (Intuniv)<\/p>\n\n\n\n
Atypical Antipsychotic
Haldol, Pimozide, Aripiprazole<\/p>\n\n\n\n
Acute stress disorder occurs within 4 weeks of traumatic event.<\/p>\n\n\n\n
One month<\/p>\n\n\n\n
Intrusive re-experiencing
Increased arousal
Avoidance of stimuli associated with the trumatic event<\/p>\n\n\n\n
Prazosin for nightmares
SSRIs
TCAs<\/p>\n\n\n\n
EMDR<\/p>\n\n\n\n
EMDR<\/p>\n\n\n\n
BAFaP<\/p>\n\n\n\n
Assess cardiac history before placing patient on stimulants as they can cause elevated heart rate and bP and increase risk of Heart attack and stroke<\/p>\n\n\n\n
3 and up<\/p>\n\n\n\n
Ages 6 and older<\/p>\n\n\n\n
Age 6 and up<\/p>\n\n\n\n
Ages 6 and up<\/p>\n\n\n\n
Executive function<\/p>\n\n\n\n
Insomnia
tremors
increased blood pressure and HR
Heart palpitations<\/p>\n\n\n\n
Indicates the medication has been cleared by the body<\/p>\n\n\n\n
Address their anxiety–support them then continue with psychoeducation<\/p>\n\n\n\n
OCD–intrusive\/persistent thoughts and tics<\/p>\n\n\n\n
presence of anxiety provoking obsessions–recurrent and persistent thoughts, impulses, or images or compulsions for example motor tics that funtion to reduce the person’s subjective anxiety level<\/p>\n\n\n\n
Should be considered in all children with sudden onset OCD symptoms<\/p>\n\n\n\n
Deliberate faking of a physical or psychological disorder motivated by secondary gain.<\/p>\n\n\n\n
Condition in which a person does things to make themselves sick when they are not organically sick<\/p>\n\n\n\n
in children, a pattern of inhibited, withdrawn, apathetic behavior toward adult caregivers and show no emotion towards caregivers.
The product of a severely dysfuntional early relationship between the principal caregiver and the child<\/p>\n\n\n\n
General Anxiety Disorder:
excessive worry for at least 6 months<\/p>\n\n\n\n
Abrupt surge of intense fear of discomfort that reaches a peak within minutes; a variety of psychological and physical symptoms including a sense of impending doom<\/p>\n\n\n\n
Patient experiences recurrent unexpected panic attacks<\/p>\n\n\n\n
Fluoxetine
Paroxetine
sertraline<\/p>\n\n\n\n
bronchodilators like albuterol<\/p>\n\n\n\n
Childhood depressive and mood disorder–diagnosis age 6-17<\/p>\n\n\n\n
Frequent intense temper outbursts\/ temper tantrums<\/p>\n\n\n\n
Low BMI (15 or less than 15)<\/p>\n\n\n\n
Emaciation
Bradycardia
Hypotension<\/p>\n\n\n\n
BMI usually in normal range<\/p>\n\n\n\n
Administer the mood questionnaire<\/p>\n\n\n\n
if pt reports a nightmare and parents or other family members have nightmares<\/p>\n\n\n\n
Glutamate, GABA, Serotonin<\/p>\n\n\n\n
Persistent deficits in social communication and social interaction
No response when called by name
Nonverbal communication
Little or no eye contact
often like to line up, stack, or organize objects and toys in long, tidy rows<\/p>\n\n\n\n
Claims that dysfunction of the mirror neuron system may be the cause of poor social interaction and cognition<\/p>\n\n\n\n
Benzos<\/p>\n\n\n\n
Infections
We should do a urinalysis with culture and sensitivity<\/p>\n\n\n\n
Progressive mental decline; personality changes occur, irritability
Check Vit B12 and Folic Acid levels<\/p>\n\n\n\n
with depression it is acute onset of memory problems like happening over 5 months.<\/p>\n\n\n\n
“I do not know” responses are commonly depression. In dementia, patient often confabulates answers–will not say “I do not know”<\/p>\n\n\n\n
Primary diagnosis is depression
acute onset of memory problems like happening over 5 months<\/p>\n\n\n\n
subcortical–motor symptoms: lack of coordination, tremors, ataxia, dystonia<\/p>\n\n\n\n
Cognitive decline
motor abnormalities
behavioral abnormalities<\/p>\n\n\n\n
Presents with recurrent visual hallucinations<\/p>\n\n\n\n
AKA frontotemporal dementia\/frontal lobe dementia<\/p>\n\n\n\n
Antiretrovirals<\/p>\n\n\n\n
give them an HIV test<\/p>\n\n\n\n
atypical antipsychotics<\/p>\n\n\n\n
aggression
fear
anxiety
emotions<\/p>\n\n\n\n
emotions
stress
learning
memory<\/p>\n\n\n\n
motor movements<\/p>\n\n\n\n
give infant to parents and allow them to grieve for their loss<\/p>\n\n\n\n
Normalize grief and loss in children\u2014psychoeducation on grief responses; group therapy
Grief responses vary so do not tell a patient or family how they should grieve<\/p>\n\n\n\n
an intact family so they can adapt easily<\/p>\n\n\n\n
DNS (dopamine, nor, serotonin+ GABA+ Glutamate )<\/p>\n\n\n\n
Smoking
Caffeine
Lack of weight bearing exercises
Lack of dietary calcium and vitamin D<\/p>\n\n\n\n
Alprazolam
CNS depressants (e.g., phenobarbital, zolpidem)<\/p>\n\n\n\n
0.5 – 5.0 mu\/L<\/p>\n\n\n\n
Decreased TSH
Increased T4 and T3<\/p>\n\n\n\n
Increased TSH
Decreased T4 and T3<\/p>\n\n\n\n
Heat intolerance
Agitation, Anxiety, Irritability
Tachycardia
Mood swings
Weight loss<\/p>\n\n\n\n
Cold intolerance
Lethargy
Weight gain
Decreased libido<\/p>\n\n\n\n
Depression<\/p>\n\n\n\n
Mania<\/p>\n\n\n\n
Spina bifida (neural tube defect)<\/p>\n\n\n\n
Liver (hepatoxicity)<\/p>\n\n\n\n
Abdominal pain in the URQ<\/p>\n\n\n\n
50-125 mcg\/ml<\/p>\n\n\n\n\n
Disorientation
Lethargy
Respiratory depression
Nausea\/vomiting<\/p>\n\n\n\n
Hepatotoxicity; hold med, draw LFT’s (priority), DVP level<\/p>\n\n\n\n
D\/C drug
Check drug level
Obtain LFTs
Obtain ammonia level<\/p>\n\n\n\n
Accutane (used for acne; Causes birth Defects!!!)<\/p>\n\n\n\n
Kava Kava
liver damage<\/p>\n\n\n\n
Fever -Key sx to suspect SJS; high yield (HY)<\/p>\n\n\n\n
Aripiprazole (Abilify)
Ziprasidone (Geodon)<\/p>\n\n\n\n
Aripiprazole (Abilify)<\/p>\n\n\n\n
Aripiprazole (least sedating)<\/p>\n\n\n\n
Acute onset<\/p>\n\n\n\n
Low dose Haldol (QTc check first)<\/p>\n\n\n\n
Do UDS; chances are they may be abusing other substances<\/p>\n\n\n\n
“SAID”<\/p>\n\n\n\n
“SIP BARB”<\/p>\n\n\n\n
Mania
Depression
Psychosis<\/p>\n\n\n\n
What is the best environment to interview this pt in?
reassure safety, provide environment of safety
private area with door open\/partially open<\/p>\n\n\n\n
0.6-1.2 mEq\/L<\/p>\n\n\n\n
collaborating care between psych and OBGYN to provide the best care for that pt<\/p>\n\n\n\n
Does not, ie pt will need to sign consent for labs\/ chart to be sent<\/p>\n\n\n\n
fax; so the new provider has them for follow-up appointment<\/p>\n\n\n\n
is there something that I could do for this patient first?<\/p>\n\n\n\n
has neuroprotective effect for bipolar disorder<\/p>\n\n\n\n
Lithium<\/p>\n\n\n\n
Thyroid panel (TSH)
Serum creatinine
BUN
Urinalysis
HCG<\/p>\n\n\n\n
0.6-1.2 mg\/dL<\/p>\n\n\n\n
10-20 mg\/dL<\/p>\n\n\n\n
4+ protein; if pt on Lithium–>monitor closely toxicity<\/p>\n\n\n\n
Fine hand tremors
Maculopapular rash
GI upset (N\/V\/D, cramps, anorexia)
Polyuria, polydipsia, diabetes insipidus
T-wave inversions
Leucocytosis<\/p>\n\n\n\n
NSAIDs (ibuprofen, indomethacin)
Thiazides
ACE-I<\/p>\n\n\n\n
1.5 mEq\/L or higher<\/p>\n\n\n\n
(but not discontinue)?
1.3 -1.4 mEq\/L or higher<\/p>\n\n\n\n
D\/C lithium
Check lithium level<\/p>\n\n\n\n
If this pt is going on a hike, what would you recommend ?
Dehydration
Hyponatremia<\/p>\n\n\n\n
Ebstein anomaly (congenital heart defect)<\/p>\n\n\n\n
Ethical dilemma<\/p>\n\n\n\n
confidentiality;
what they say remains confidential unless they are wanting to harm self\/ someone else,
<\/p>\n\n\n
interview the teen w\/o the parents; call CPS<\/p>\n\n\n\n
DA, NE, 5HT aka serotonin –>(DNS)<\/p>\n\n\n\n
ADHD<\/p>\n\n\n\n
Prefrontal cortex<\/p>\n\n\n\n
Cardiac history<\/p>\n\n\n\n
GAD<\/p>\n\n\n\n
Stimulants<\/p>\n\n\n\n
the medication has been cleared from the body<\/p>\n\n\n\n
AMPH = 3yrs MPH = 6yrs<\/p>\n\n\n\n
Clonidine is more sedating than Guanfacine;
Guanfacine lasts longer than Clonidine<\/p>\n\n\n\n
thoughts and ideas<\/p>\n\n\n\n
Logical
Linear
Coherent
Goal-oriented<\/p>\n\n\n\n
Tangentiality (“goes on tangent”)<\/p>\n\n\n\n
Circumstantiality (“goes in circles”)<\/p>\n\n\n\n
Thought content<\/p>\n\n\n\n
Suicidal ideation
Homicidal ideation
Hallucinations\/Delusions<\/p>\n\n\n\n
Concentration
Attention<\/p>\n\n\n\n
Orientation<\/p>\n\n\n\n
Registration (ability to learn new material)<\/p>\n\n\n\n
Recall (memory)<\/p>\n\n\n\n
Fund of Knowledge<\/p>\n\n\n\n
Clock Drawing Test<\/p>\n\n\n\n
Right parietal lobe (right hemisphere)<\/p>\n\n\n\n
positive psychotic symptoms<\/p>\n\n\n\n
Negative symptoms: affect, anhedonia, asociality, alogia, apathy, avolition,
Depressive symptoms<\/p>\n\n\n\n
motor movements<\/p>\n\n\n\n
Inverse<\/p>\n\n\n\n
Acute dystonia: stiff neck, muscle spasms neck\/back, painful
Parkinsonism syndromes
Akathisia
Tardive dyskinesia<\/p>\n\n\n\n
Increased prolactin<\/p>\n\n\n\n
Amenorrhea
Galactorrhea
Sexual dysfunction
Gynecomastia
Osteoporosis (Long-term)<\/p>\n\n\n\n
Risperidone<\/p>\n\n\n\n
Agranulocytosis and<\/p>\n\n\n\n
Pallor
Fatigue
Headache
Fever
Nosebleeds
Bleeding gums
Skin rash
SOB<\/p>\n\n\n\n
Clozaril
Carbamazepine<\/p>\n\n\n\n
Agranulocytosis<\/p>\n\n\n\n
<1000<\/p>\n\n\n\n
<2000 PMNs or WBC <2000<\/p>\n\n\n\n
<500 ANC<\/p>\n\n\n\n
Distractibility<\/p>\n\n\n\n
Blindness
Mutism
Paralysis
Paresthesia (glove stocking syndrome)
Seizures<\/p>\n\n\n\n
After a stressful experience (suddenly)<\/p>\n\n\n\n
Family move
Parent divorce\/separation
Loss of pet
Birth of sibling
Sudden or chronic illness<\/p>\n\n\n\n
Not going to school, destroying property, driving recklessly, or fighting<\/p>\n\n\n\n
NOT aggressive (key difference vs CD)
loses temper easily
annoys others
angry\/resentful
argues with authority
easily annoyed
blames others
spiteful
refuses to comply with rules\/requests from authority figures<\/p>\n\n\n\n
Therapy, individual and family<\/p>\n\n\n\n
Child and parent problem-solving skills training, boundary setting<\/p>\n\n\n\n
Conduct Disorder<\/p>\n\n\n\n
aggression<\/p>\n\n\n\n
Severity<\/p>\n\n\n\n
Things to target mood and aggression<\/p>\n\n\n\n
Behavioral therapy\/ problem solving skills<\/p>\n\n\n\n
Reduce barriers to resources for youth with problematic behavior<\/p>\n\n\n\n
Home-based model for youth (12-17) with serious antisocial problematic bx and criminal offenses by empowering parents with resources and skills and reducing barriers to resources that prevent families from accessing services needed for effective management of youth<\/p>\n\n\n\n
score 0-30. Higher the better<\/p>\n\n\n\n
score 0-30 Higher the better<\/p>\n\n\n\n
range 0-76<\/p>\n\n\n\n\n
range 0-27<\/p>\n\n\n\n\n
range 0-63<\/p>\n\n\n\n\n
0-56<\/p>\n\n\n\n\n
range 0-23<\/p>\n\n\n\n\n
13-24<\/p>\n\n\n\n
Administer clonidine (mild score)<\/p>\n\n\n\n
Administer buprenorphine (Suboxone) (moderate score)<\/p>\n\n\n\n
Definitely at score of >7; prior to that (scores 5-6) it can be given<\/p>\n\n\n\n
moderate symptoms (13-24)<\/p>\n\n\n\n
16-20<\/p>\n\n\n\n
Mild symptoms (8 or greater)<\/p>\n\n\n\n
moderate symptoms (15 or higher)<\/p>\n\n\n\n
Prefrontal cortex
Amygdala
Basal ganglia
Hippocampus<\/p>\n\n\n\n
Hippocampus can cause what 3 symptoms?
Aggression
Impulsivity
Difficulty with abstract thinking<\/p>\n\n\n\n
*Extreme muscular rigidity<\/p>\n\n\n\n
muscle contraction and destruction<\/p>\n\n\n\n
Hyperreflexia
Myoclonic jerks<\/p>\n\n\n\n
DC offending agent
Bromocriptine or
Dantrolene<\/p>\n\n\n\n
Muscle rigidity<\/p>\n\n\n\n
DC offending agent<\/p>\n\n\n\n
What class of migraine medications raises the risk?
multiple antidepressants (SSRI\/SNRI\/TCA\/MOAI)
St John’s wort –> with any of the above AD classes
Triptans –> with any of the above AD classes<\/p>\n\n\n\n
2 weeks;<\/p>\n\n\n\n
5-6 weeks<\/p>\n\n\n\n
2 weeks; for the SSRI to degenerate<\/p>\n\n\n\n
Reduce subjective anxiety level<\/p>\n\n\n\n
Pediatric Autoimmune Neuropsychiatric Disorder associated with streptococcal infections in children<\/p>\n\n\n\n
OCD<\/p>\n\n\n\n
Tourette’s, NOTE: (the tics do not necessarily have to occur at same time)<\/p>\n\n\n\n
Serotonin
Norepinephrine<\/p>\n\n\n\n
can include coughing, grunting, throat clearing, sniffling, or making sudden, vocal outbursts<\/p>\n\n\n\n
DMDD<\/p>\n\n\n\n
Developmental delay (learning difficulties)<\/p>\n\n\n\n
rural areas
houses built in 1970’s (lead was in the paint)<\/p>\n\n\n\n
Lead poisoning<\/p>\n\n\n\n
BMI
Hip-to-waist ratio (waist circumference)
Glucose
Lipid panel<\/p>\n\n\n\n
Locus coeruleus
Medullary reticular formation<\/p>\n\n\n\n
raphe nuclei in the brainstem<\/p>\n\n\n\n
Substantia nigra
Ventral tegmental area (VTA)
Nucleus Accumbens<\/p>\n\n\n\n
Basal nucleus of Meynert<\/p>\n\n\n\n
Emotional memories (aggression, fear, anxiety, rage [think amygdala], stress)<\/p>\n\n\n\n
Emotions<\/p>\n\n\n\n
Autism Spectrum Disorder<\/p>\n\n\n\n
Autism<\/p>\n\n\n\n
Broken Mirror Theory<\/p>\n\n\n\n
tics appeared before age 18 yrs<\/p>\n\n\n\n
Antipsychotic
(haloperidol, pimozide, aripiprazole*)<\/p>\n\n\n\n
DA, NE, 5HT or (DNS)
hyperactivity of DA can lead to tourettes<\/p>\n\n\n\n
Previous suicide attempt<\/p>\n\n\n\n\n
Low BMI (below 18.5 is underweight)
Amenorrhea
Emaciation (abnormally thin)
Bradycardia
Hypotension<\/p>\n\n\n\n
Normal range (18.5-24.9)<\/p>\n\n\n\n
Acute Stress Disorder<\/p>\n\n\n\n
Intrusive re-experiencing of the trauma
Increased arousal (hyperarousal)
Avoidance of stimuli associated with trauma<\/p>\n\n\n\n
SSRIs
TCAs
Prazosin for nightmares<\/p>\n\n\n\n
EMDR<\/p>\n\n\n\n
Pulse
Sweating
Restlessness
Pupil size
Bone aches
Running nose or tearing
GI upset
Yawning
Tremors
Anxiety\/irritability
Gooseflesh skin<\/p>\n\n\n\n
Nausea\/vomiting
Tremor
Sweats
Anxiety
Agitation
Tactile disturbances
Auditory disturbances
Headaches
Orientation<\/p>\n\n\n\n
Acamprosate (Campral)
Disulfiram (Antabuse)
Naltrexone (Vivitrol, ReVia)<\/p>\n\n\n\n
Acamprosate (Campral)<\/p>\n\n\n\n
anything with ETOH, mouthwash, aftershave, vinegars, perfume, cough\/cold meds<\/p>\n\n\n\n
Instillation of hope
Universality
Group cohesiveness
Altruism<\/p>\n\n\n\n
Appreciative Inquiry<\/p>\n\n\n\n
Projects designed to
–improve systems,
–decrease cost,
–improve productivity<\/p>\n\n\n\n
PDSA Cycle<\/p>\n\n\n\n
Health Policy<\/p>\n\n\n\n
Policy Reform<\/p>\n\n\n\n
The arena the process takes place in (government, media, public)<\/p>\n\n\n\n
Key players and stake holders<\/p>\n\n\n\n
Nonlinear recovery, continual growth and occasional setbacks; Learning from experience (e.g. relapse)<\/p>\n\n\n\n
Screening<\/p>\n\n\n\n
Duty to warn victim of imminent danger of homicidal patients\u2026varies by state<\/p>\n\n\n\n
Problem and Symptom focused<\/p>\n\n\n\n
Solution-Focused therapy<\/p>\n\n\n\n
Family Systems Therapy<\/p>\n\n\n\n
Strategic Therapy<\/p>\n\n\n\n
Structural Family Therapy<\/p>\n\n\n\n
Family system therapy
Structural therapy<\/p>\n\n\n\n
Brief supportive therapy<\/p>\n\n\n\n
Brief supportive therapy<\/p>\n\n\n\n
Respect<\/p>\n\n\n\n
muscle relaxation<\/p>\n\n\n\n
Native American<\/p>\n\n\n\n
Cultural Syndrome<\/p>\n\n\n\n
provide multi-cultural teaching\/education by using ethno-specific assessment parameters<\/p>\n\n\n\n
LFTs<\/p>\n\n\n\n
is okay after you get clearance for informed consent<\/p>\n\n\n\n
Ziprasidone (Geodon)<\/p>\n\n\n\n
get a translator\/interpreter for them so they can understand you and know you are culturally competent<\/p>\n\n\n\n
inform\/educate the staff members of cultural competency\/sensitivity re: the healing stick, the healing stick doesn\u2019t need to be taken away (make accommodations for the patient )<\/p>\n\n\n\n
Aripiprazole (Abilify)<\/p>\n\n\n\n
Quetiapine (Seroquel)<\/p>\n\n\n\n
nonpharmacologic<\/p>\n\n\n\n
ANC < 1,000 (even if asymptomatic)<\/p>\n\n\n\n
Agranulocytosis<\/p>\n\n\n\n
HCG<\/p>\n\n\n\n
DC lithium<\/p>\n\n\n\n
Cardiac failure (hyponatremia)<\/p>\n\n\n\n
Extreme muscle rigidity<\/p>\n\n\n\n
Bupropion<\/p>\n\n\n\n
SSRIs
Safer in OD<\/p>\n\n\n\n
Citalopram (Celexa)
Escitalopram (Lexapro)
less risk for Drug-Drug Interaction<\/p>\n\n\n\n
Bupropion<\/p>\n\n\n\n
Bupropion<\/p>\n\n\n\n
SNRI<\/p>\n\n\n\n
Fluoxetine (Prozac)<\/p>\n\n\n\n
Alcohol intake (self-medicating)<\/p>\n\n\n\n
all Antidepressants<\/p>\n\n\n\n
Self harm (frequency and severity)<\/p>\n\n\n\n
Adolescence
Schizophrenics<\/p>\n\n\n\n
the neuroprotective effects<\/p>\n\n\n\n
Few evidence-based studies<\/p>\n\n\n\n
18-25<\/p>\n\n\n\n
25-35<\/p>\n\n\n\n
SI<\/p>\n\n\n\n
Antisocial Personality Disorder<\/p>\n\n\n\n
All structures decreased EXCEPT Ventricles, they are enlarged<\/p>\n\n\n\n
Stimulants (will increase DA)<\/p>\n\n\n\n
Prefrontal cortex
Amygdala
Hippocampus
Basal ganglia
limbic Regions<\/p>\n\n\n\n
Form of rehabilitation post hospitalization for Severe Mental Illness (SMI)
Case management approach
24\/7 services<\/p>\n\n\n\n
Assertive Community Treatment (ACT)<\/p>\n\n\n\n
Tertiary<\/p>\n\n\n\n
Increased cognition<\/p>\n\n\n\n
A firm belief despite contrary evidence
Ex: Church members are part of a cult<\/p>\n\n\n\n
monthly<\/p>\n\n\n\n
20 x [total daily dose] = first month dose
What is their maintenance dose?
20 x 10 mg = 200 mg (first month)
Maintenance: 10-15 x previous daily oral dose<\/p>\n\n\n\n
100 mg R\/T adverse SE;
then 5-7 days later then give an additional 100 mg<\/p>\n\n\n\n
Clinical observation (listen\/observe)<\/p>\n\n\n\n
SI\/HI, plan<\/p>\n\n\n\n
Concentration\/attention\/calculation
Orientation
Registration\/ability to learn new material
Recall\/memory
Fund of Knowledge<\/p>\n\n\n\n
5-HT2A receptor antagonism
EPS<\/p>\n\n\n\n
If they are a harm to themselves or others how should it be administered?
What is the risk of this type of administration?
SGA<\/p>\n\n\n\n
Ziprasidone (Geodon)<\/p>\n\n\n\n
Decrease olanzapine dose (he stopped the inducer)<\/p>\n\n\n\n
1A2 inducer<\/p>\n\n\n\n
Antibiotics<\/p>\n\n\n\n
Inhibitors<\/p>\n\n\n\n
Decrease CBZ dose
(avoid aplastic anemia)<\/p>\n\n\n\n
Increase dose of antidepressant<\/p>\n\n\n\n
Insomnia
Tremors
Irritability,
Mood swings.
Agitation,
Anxiety
CV (increased HR\/BP, palpitations)<\/p>\n\n\n\n
Delayed gastric emptying from anorexia<\/p>\n\n\n\n
H2 antagonists: Famotidine (Pepcid)<\/p>\n\n\n\n
Antacids
PPIs: Omeprazole (Prilosec), Pantoprazole (Protonix)<\/p>\n\n\n\n
Anxiety<\/p>\n\n\n\n
Increased anxiety
(avoid in future)<\/p>\n\n\n\n
Cell death\/neuronal loss<\/p>\n\n\n\n
What is the first question you ask with a patient with suspected bipolar disorder?
genetics (very heritable)<\/p>\n\n\n\n
Medical condition<\/p>\n\n\n\n
increase the anti-psychotic<\/p>\n\n\n\n
More severe
Increased duration (7 days vs. 4 days)<\/p>\n\n\n\n
bipolar disorder<\/p>\n\n\n\n
Grandiosity or exaggerated self esteem
lack of sleep (and not tired)
talkativeness or pressured speech<\/p>\n\n\n\n
Self-harming behavior (recurrent)<\/p>\n\n\n\n
DBT<\/p>\n\n\n\n
Marsha Linehan<\/p>\n\n\n\n
journaling\/diary<\/p>\n\n\n\n
Valproic acid\/Depakote\/DVP<\/p>\n\n\n\n
Adjustment Disorder<\/p>\n\n\n\n
Conduct Disorder<\/p>\n\n\n\n
Conduct Disorder<\/p>\n\n\n\n
No
(tics caused by a substance is an exclusionary diagnosis)<\/p>\n\n\n\n
Not always<\/p>\n\n\n\n
Munchausen syndrome by proxy, caretakers make up or produce physical illnesses in the individual receiving care. Usually parent –> child<\/p>\n\n\n\n
Report to CPS
Child abuse (duty to report)<\/p>\n\n\n\n
Faking illness to get medical attention or sympathy<\/p>\n\n\n\n
Unmarried healthcare worker<\/p>\n\n\n\n
Feigning illness for secondary gain ($)<\/p>\n\n\n\n
Malingering (not a psychiatric diagnosis)<\/p>\n\n\n\n
Reactive Attachment Disorder<\/p>\n\n\n\n
Reactive Attachment Disorder<\/p>\n\n\n\n
Acute Stress Disorder<\/p>\n\n\n\n
SSRI<\/p>\n\n\n\n
Beta blocker<\/p>\n\n\n\n
Dorsolateral prefrontal cortex<\/p>\n\n\n\n
prefrontal<\/p>\n\n\n\n
Mood Disorder Questionnaire (MDQ)<\/p>\n\n\n\n
Disruptive Mood Dysregulation Disorder (DMDD)<\/p>\n\n\n\n
upon admission<\/p>\n\n\n\n
Persistent deficits in social communication and social interaction across multiple settings<\/p>\n\n\n\n
autism spectrum disorder<\/p>\n\n\n\n
Alcohol or substance withdrawal<\/p>\n\n\n\n
UA
C\/S<\/p>\n\n\n\n
Dementia<\/p>\n\n\n\n
B12
Folic acid<\/p>\n\n\n\n
Nonpharmacologic treatment<\/p>\n\n\n\n
Administer SGA<\/p>\n\n\n\n
Subcortical<\/p>\n\n\n\n
HIV-related<\/p>\n\n\n\n
Obtain HIV test<\/p>\n\n\n\n
Antiretroviral treatment<\/p>\n\n\n\n
Dementia<\/p>\n\n\n\n
Depression (pseudodementia)<\/p>\n\n\n\n
Depression (vs. dementia)<\/p>\n\n\n\n
screening tools (SLUMS, Mini-Cog, MMSE)<\/p>\n\n\n\n
Frontotemporal (Pick’s)<\/p>\n\n\n\n
Lewy Body<\/p>\n\n\n\n
Anterior cingulate<\/p>\n\n\n\n
Lack of balance<\/p>\n\n\n\n
Lead poisoning<\/p>\n\n\n\n
Dopamine
Norepinephrine
Serotonin
GABA
Glutamate<\/p>\n\n\n\n
Give him to his parents to grieve<\/p>\n\n\n\n
Family support
Support groups
(don’t give prescriptive advice)<\/p>\n\n\n\n
and Lack of weight bearing exercises are risk factors for
Osteoporosis<\/p>\n\n\n\n
Osteoporosis<\/p>\n\n\n\n
Yes<\/p>\n\n\n\n
Continue group therapy
Start individual therapy<\/p>\n\n\n\n
CBT<\/p>\n\n\n\n
Behavioral Therapy<\/p>\n\n\n\n
Cognitive restructuring
Journaling<\/p>\n\n\n\n
Humanistic (person-centered)<\/p>\n\n\n\n
Interpersonal therapy<\/p>\n\n\n\n
12-16 weeks<\/p>\n\n\n\n
Paradoxical directive\/intervention<\/p>\n\n\n\n
Promote self-awareness (ie med adherence or fear of failure)<\/p>\n\n\n\n
Straight Forward Directive<\/p>\n\n\n\n
Solution-focused therapy<\/p>\n\n\n\n
Physical activity<\/p>\n\n\n\n
Children
(when a narrative cannot be constructed)<\/p>\n\n\n\n
talk to parents<\/p>\n\n\n\n
empathy<\/p>\n\n\n\n
How did you fall?
Why do you think you are feeling sad?
Tell me more<\/p>\n\n\n\n
Reschedule the appointment<\/p>\n\n\n\n
Contact CPS
Crisis therapy<\/p>\n\n\n\n
crisis therapy
separate brothers<\/p>\n\n\n\n
ESR<\/p>\n\n\n\n
P- Patient population of interest
I – Intervention of interest
C – Comparison of interest
O – Outcome
T – Time<\/p>\n\n\n\n
Have access to current journals<\/p>\n\n\n\n
Increased intracranial pressure<\/p>\n\n\n\n
That is normal between 3-6 yrs old (Phallic stage)<\/p>\n\n\n\n
This is normal between 9-16 yo.
It will disappear within 6 mo.<\/p>\n\n\n\n
Testosterone
(improves blood flow to pelvic region)<\/p>\n\n\n\n
Decreased alcohol dehydrogenase<\/p>\n\n\n\n
Grasp\/palmar reflex; disappears by 5-6 mons<\/p>\n\n\n\n
Moro\/startle reflex; disappears by 5-6 mons<\/p>\n\n\n\n
the big toe is extended and the other toes fan in response to the brushing of the sole of the foot
disappears at 2 yrs<\/p>\n\n\n\n
Rapid absorption<\/p>\n\n\n\n
macrocytic anemia?
Folic acid
B12<\/p>\n\n\n\n
B12, folic acid, Ferritin(iron)<\/p>\n\n\n\n
Iron<\/p>\n\n\n\n
Normocytic<\/p>\n\n\n\n
Anorexia nervosa<\/p>\n\n\n\n
Refer out for medical evaluation<\/p>\n\n\n\n
Contact CPS<\/p>\n\n\n\n
contact CPS<\/p>\n\n\n\n
Acupuncture<\/p>\n\n\n\n
Habeus corpus
(usually max of 28 days)<\/p>\n\n\n\n
Disseminated Encephalomyelitis
Neuro exam<\/p>\n\n\n\n
Provide anchor (memorable events) to establish diagnosis<\/p>\n\n\n\n
Host online forum\/give survey to obtain information (vs. letters)<\/p>\n\n\n\n
Tell them how the policy will increase quality of patient care<\/p>\n\n\n\n
Create an instrument to monitor outcomes<\/p>\n\n\n\n
Increased cytokine levels<\/p>\n\n\n\n
Alarm clock
Desmopressin (DDAVP)<\/p>\n\n\n\n
Decreases urine production
(via antidiuretic hormone – vasopressin)<\/p>\n\n\n\n
Conflict of Interest
Create policy to address COI<\/p>\n\n\n\n
Receiving samples of drug rep
Attending an industry sponsored educational program<\/p>\n\n\n\n
You don’t need to discontinue drug.
Research benefits and risks<\/p>\n\n\n\n
Document
Provide full disclosure (risks\/benefits)<\/p>\n\n\n\n
Warn about priapism and document<\/p>\n\n\n\n
Sleep Apnea<\/p>\n\n\n\n
Decreased effect with continuous use<\/p>\n\n\n\n
Improve practice<\/p>\n\n\n\n
Give clonidine or a muscle relaxant<\/p>\n\n\n\n
Administer clonidine or a muscle relaxant<\/p>\n\n\n\n
Administer buprenorphine\/naloxone (Suboxone)<\/p>\n\n\n\n
Moderate symptoms (13 or higher)<\/p>\n\n\n\n
Administer buprenorphine\/naloxone (Suboxone)<\/p>\n\n\n\n
Arrhythmias<\/p>\n\n\n\n
Diazepam (longer half-life)<\/p>\n\n\n\n
Lorazepam<\/p>\n\n\n\n
Refer to residential center to administer protocol (don’t initiate in outpatient setting)<\/p>\n\n\n\n
Refer to residential center (not CPS)<\/p>\n\n\n\n
Opiate withdrawal<\/p>\n\n\n\n
privacy<\/p>\n\n\n\n
State legislature (BON)
(varies state to state)<\/p>\n\n\n\n
(doesn’t change)<\/p>\n\n\n\n
Unconscious (to save a life)<\/p>\n\n\n\n
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<\/p>\n\n\n\n
Justice
Beneficence
Nonmaleficence
Fidelity
Autonomy
Veracity
Respect<\/p>\n\n\n\n
Justice<\/p>\n\n\n\n
Nonmaleficence<\/p>\n\n\n\n
Nonmaleficence<\/p>\n\n\n\n
Beneficence<\/p>\n\n\n\n
Beneficence<\/p>\n\n\n\n
Fidelity<\/p>\n\n\n\n
Veracity<\/p>\n\n\n\n
Autonomy<\/p>\n\n\n\n
Respect<\/p>\n\n\n\n
support the client’s best interest while respecting family’s role
reduce stigma of Mental illness<\/p>\n\n\n\n
Education (esp. large audience)<\/p>\n\n\n\n
Recovery Model<\/p>\n\n\n\n
interests, abilities and dreams<\/p>\n\n\n\n
A quality improvement process or strategy<\/p>\n\n\n\n
RETROSPECTIVE Chart review<\/p>\n\n\n\n
Assess barriers and facilitators
(prior to meeting with stakeholders)<\/p>\n\n\n\n
Contact Board of Nursing<\/p>\n\n\n\n
Object permanence<\/p>\n\n\n\n
Sensorimotor<\/p>\n\n\n\n
Magical thinking
Symbols and language
thoughts of monsters being real, if they think of someone getting hurt and it happens, they think they caused it.<\/p>\n\n\n\n
See things from other’s perspectives (less egocentric)
develops concepts of
–conservation: clay is always clay
–reversibility: water to ice turns back to water<\/p>\n\n\n\n
Concrete<\/p>\n\n\n\n
Abstract logic (science projects, hypotheses)<\/p>\n\n\n\n
DNS (all decreased)<\/p>\n\n\n\n
DNS
Glutamate (increased)
GABA<\/p>\n\n\n\n
DA (decreased)
GABA (decreased)<\/p>\n\n\n\n
5HT (decreased)
NE (decreased)<\/p>\n\n\n\n
DA (increased)
Glutamate (increased)
GABA (decreased)
5HT (decreased)<\/p>\n\n\n\n
Glutamate (increased)
GABA (decreased)
5HT (decreased)<\/p>\n\n\n\n
NE (increased)
5HT (decreased)
GABA (decreased)<\/p>\n\n\n\n
ACh (decreased)
Glutamate (decreased)<\/p>\n\n\n\n
DA (decreased)
ACh (Increased)<\/p>\n\n\n\n
ADHD
MDD
BPD
Tourette’s<\/p>\n\n\n\n
BPD
Schizophrenia
Autism
SUD
Anxiety<\/p>\n\n\n\n
BPD
Schizophrenia
ASD
Alzheimer’s<\/p>\n\n\n\n
Alzheimer’s
Parkinson’s<\/p>\n\n\n\n
autism spectrum disorder
bipolar disorder
schizophrenia<\/p>\n\n\n\n
Interview child and parents separately if child can communicate<\/p>\n\n\n\n
contact CPS<\/p>\n\n\n\n
Rapport
Confidentiality (explain exceptions)<\/p>\n\n\n\n
separately form parents<\/p>\n\n\n\n
No<\/p>\n\n\n\n
No<\/p>\n\n\n\n
can they stay safe and cope effectively<\/p>\n\n\n\n
No (not confidential)<\/p>\n\n\n\n
If TSH is abnormal<\/p>\n\n\n\n
confusion<\/p>\n\n\n\n
Hyperthermia
Diaphoresis
Tachycardia
Altered LOC<\/p>\n\n\n\n
MDD
BPD
Alcohol use disorder
Eating disorder
schizophrenia<\/p>\n\n\n\n
inducers<\/p>\n\n\n\n
bipolar disorder<\/p>\n\n\n\n
Adjustment disorder with depressed [or anxious, both etc.] mood<\/p>\n\n\n\n
yes<\/p>\n\n\n\n
What are 2 examples?
Cortical
ALZ and Mad cow Ds<\/p>\n\n\n\n
What are 3 examples?
Subcortical
HIV dementia, Huntington’s and Parkinson’s<\/p>\n\n\n\n
increased mental health access to those who need it most<\/p>\n\n\n\n
Intact family system<\/p>\n\n\n\n
Normalize grief and loss
(don’t tell them what to do\/how to grieve)
(responses vary)
supportive group therapy<\/p>\n\n\n\n
Screen ADHD patients for substance use
Screen SUD patients for ADHD<\/p>\n\n\n\n
patient’s trust<\/p>\n\n\n\n
obtain patient consent<\/p>\n\n\n\n
assess for involuntary treatment (don’t forcefully give medication)<\/p>\n\n\n\n
nonmaleficence<\/p>\n\n\n\n
least restrictive environment<\/p>\n\n\n\n
assess knowledge<\/p>\n\n\n\n
12-51<\/p>\n\n\n\n
Male: <20
Female: <25<\/p>\n\n\n\n
mood and sleep<\/p>\n\n\n\n
social skill deficit
inappropriate affect<\/p>\n\n\n\n
Iatrogenic S\/S, assess medical history to ID if S\/S are caused by the medication or not<\/p>\n\n\n\n
Hydroxyzine or buspirone (not benzodiazepine)<\/p>\n\n\n\n
Lying or withholding information under oath<\/p>\n\n\n\n
family member
another provider<\/p>\n\n\n\n
debriefing strategies<\/p>\n\n\n\n
Pt safety; assess the patient<\/p>\n\n\n\n
QTc prolongation<\/p>\n\n\n\n
risk for QTc prolongation (Note:max 40mg in adults <65)<\/p>\n\n\n\n
damage or loss of the dopamine-producing cells of the midbrain, leading to dopamine depletion in the basal ganglia<\/p>\n\n\n\n
caused by DA blockade in the nigrostriatal pathway causing sx resembling Parkinson’s Ds; tremor, shuffling gait, drooling, rigidity<\/p>\n\n\n\n
non-judgmental questions
“how has that trauma affected you?”
“When did this happen”<\/p>\n\n\n\n
“DIB”
Desensitization
installation
Body Scan<\/p>\n\n\n\n
to achieve adaptive resolution<\/p>\n\n\n\n
Desensitization phase<\/p>\n\n\n\n
Desensitization phase<\/p>\n\n\n\n
Installation phase; because replacing negative thought with positive thought<\/p>\n\n\n\n
Body Scan; successful resolution will result in the pt having no body tension when seeing the trauma and the positive memory side by side; if (+) tension, pt is still working through to achieve resolution<\/p>\n\n\n\n
confidentiality<\/p>\n\n\n\n
the change should be evidence based<\/p>\n\n\n\n
At baseline -pre-treatment, then at regular intervals to monitor response to Tx<\/p>\n\n\n\n
signs not ready: no coping skills, still blaming others<\/p>\n\n\n\n
Primary<\/p>\n\n\n\n
Secondary<\/p>\n\n\n\n
Tertiary<\/p>\n\n\n\n
ABC, airway breathing, circulation
Maslows hierarchy<\/p>\n\n\n\n
the umbrella answer<\/p>\n\n\n\n
metabolic syndrome<\/p>\n\n\n\n
Atypical 5HT2A specific<\/p>\n\n\n\n
UDS and r\/o sub
Consider IM Geodon or Invega<\/p>\n\n\n\n
Latuda, Abilify, Geodon<\/p>\n\n\n\n
between therapists\/pcps\/SW\/RN, the ENTIRE team<\/p>\n\n\n\n
T3, T4 low<\/p>\n\n\n\n
T3, T4 high<\/p>\n\n\n\n
T3\/T4 low, hypothyroid, cold, slow
T3\/T4 high, hyperthyroid, hot, flushed, tachy<\/p>\n\n\n\n
Spina bifida<\/p>\n\n\n\n
Hepatotoxicity: RUQ pain, reddish brown urine-
Do LFTs<\/p>\n\n\n\n
anxiety and insomnia<\/p>\n\n\n\n
Asians. They CANNOT have tegretol. Test all asians for this allele.<\/p>\n\n\n\n
Aplastic anemia
Agranulocytosis-DC at ANC less than 1000<\/p>\n\n\n\n
unusual bleeding or bruising, mouth sores, infections, fever, sore throat, fatigue<\/p>\n\n\n\n
HCG–risk of ebstein anomaly<\/p>\n\n\n\n
SJS<\/p>\n\n\n\n
BUN
CRE
urine protein<\/p>\n\n\n\n
kidney impairment; 4+ protein in urine=you cannot start on lithium<\/p>\n\n\n\n
lithium<\/p>\n\n\n\n
clozaril<\/p>\n\n\n\n
lithium<\/p>\n\n\n\n
NSAIDS
ACE’s
Thiazides\/HCTZ<\/p>\n\n\n\n
dehydration
hyponatremia
lithium s\/e inc N\/V, which will effect electrolytes, and dehydration status<\/p>\n\n\n\n
course tremors<\/p>\n\n\n\n
hypothyroidism
maculopapular rash
leukocytosis
twave inversion<\/p>\n\n\n\n
muscle rigidity<\/p>\n\n\n\n
Inc CPK, WBC, LFT
Rhabdomyolosis
myoglobinuria
Can lead to mutism<\/p>\n\n\n\n
DC the offending agent
bromocriptin-D2 agonis
dantrolene: muscle relaxant
Make sure if ? is asking for agonist or relaxant<\/p>\n\n\n\n
HYPERREFLEXIA
myoclonic jerks<\/p>\n\n\n\n
ciproheptadine<\/p>\n\n\n\n
follow proper transition protocols
SSRI to MAOI=14 days
Prozac to MAOI=5-6 weeks
Triptans (Imitrex sumatriptan) can also cause SS due to serotonin increase with the use
give any NDRI welbutrin<\/p>\n\n\n\n
safest for OD first line treatment for depression<\/p>\n\n\n\n
citalopram and escitalopramless drug to drug interactions<\/p>\n\n\n\n
NDRI wellbutrin<\/p>\n\n\n\n
wellbutrin due to lower risk of sexual s\/e<\/p>\n\n\n\n
wellbutrin due to decreasing the seizure threshold<\/p>\n\n\n\n
SNRI or TCA for treatment of BOTH<\/p>\n\n\n\n
alpha 2 delta ligands
Gabapentin
Lyrica<\/p>\n\n\n\n
SSRI
least chance of drug drug interactions
Celexa and lexapro are good choices<\/p>\n\n\n\n
increase SH kids, and young adult<\/p>\n\n\n\n
long time for effect
side effects esp n\/v\/d
NO ABRUPT stopping d\/t Serotonin discontinuation syndrome<\/p>\n\n\n\n
alcohol use<\/p>\n\n\n\n
fever, shivering, muscle aches and nausea diarrhea, agitation, cog impairment\u2026 (think flu like sx’s)
disequilibrium<\/p>\n\n\n\n
MAOI and tyramine
MAOI and TCA
MAOI and Atypical AP
MAOI and decongestant
MAOI and stimulants
MAOI and asthma meds<\/p>\n\n\n\n
HA
Diaphoresis
fever
facial flushing
pupillary dilation
palpitation<\/p>\n\n\n\n
DC Agent
Give Phenolamine<\/p>\n\n\n\n
male 18-25
female 25-35<\/p>\n\n\n\n
always be assessing for SI<\/p>\n\n\n\n
inadequate synapse formation
excessive pruning of synapses
intrauterine insult (drugs\/toxin\/viral agent\/malnutrition\/substance use, mental illness, o2 deprivation)<\/p>\n\n\n\n
ventrical enlargement<\/p>\n\n\n\n
excess DA in mesolimbic pathway<\/p>\n\n\n\n
will potentiate DA release (worsening schizophrenias positive symtpoms) bc stimulants tap into the reward and addiction pathway inc dopamine<\/p>\n\n\n\n
Assertive community treatment
Post hospital DC
not in the hospital<\/p>\n\n\n\n
do not try to disprove
If HARMFUL delusions, notify authority
Also notify potential victim<\/p>\n\n\n\n
interpret a proverb<\/p>\n\n\n\n
to assess organization of patients thoughts
tangential: no rip to a ?
circumstantial: gets around to anss after going in circles with unnecessary details<\/p>\n\n\n\n
SI HI
plan
Hallucinations
delusions<\/p>\n\n\n\n
tool used to assess cognitive status in adults<\/p>\n\n\n\n
spell a word backward or serial 7’s<\/p>\n\n\n\n
remember 3 words<\/p>\n\n\n\n
Person place time<\/p>\n\n\n\n
Who is the president? Governor?<\/p>\n\n\n\n
takes 1-2 minutes
easy to administer
tests right hemisphere health,cannot do it they have a prob in R side.<\/p>\n\n\n\n
haldol
fluphenazine
Chlorpromazine
thioridazine<\/p>\n\n\n\n
rispeidone
olanzapine
seroquel
abilify
ziprasidone
lurasidone
clozipine<\/p>\n\n\n\n
positive sx of schizophrenia<\/p>\n\n\n\n
negative sx of schizophrenia
anhedonia
mask face
slow speech
isolative<\/p>\n\n\n\n
excess DA in this pathway but it doesn’t cause any sx,
but when DA is decreased in this pathway due to AP (dopamine blockade) increases acetylcholine=EPS sx<\/p>\n\n\n\n
excess DA is normal here
but when it is decreased with AP leads to increased prolactin and hyperprolactinemia<\/p>\n\n\n\n
breast DC
amenorrhea
osteoporosis
breast enlargement<\/p>\n\n\n\n
risperidone<\/p>\n\n\n\n
female prolactin—normals
male less than 20ng\/ml
female less than 25ng\/ml<\/p>\n\n\n\n
DA blockade in the NS pathway<\/p>\n\n\n\n
acute sustained contraction of muscles, usually of the head and neck
spasms
painful<\/p>\n\n\n\n
cogentin\/benztropine IM, but may need Oral follow up for several days<\/p>\n\n\n\n
ANXIETY
restless
cannot sit still
pacing rocking<\/p>\n\n\n\n
propranolol\/or beta blocker
client with asthma on bronchodilators due to increased risk of bronchospasm when given beta blockers<\/p>\n\n\n\n
difficulty iniating motion<\/p>\n\n\n\n
cogentin\/benztropin<\/p>\n\n\n\n
DIFFICULTY INITIATING MOVEMENT;
PSEUDO PARKINSONIAN SX’S:
muscle rigidity
shuffling gait
mask like facial expression
affect may be flat or blunted
pill rolling tremors (motor slowing)<\/p>\n\n\n\n
chewing\/lip smacking
facial dyskinesia
Treatment: dec dose of offending agent or switch to a different AP or can switch to clozaril.
can have onset between a few weeks and 2 years post starting of medication<\/p>\n\n\n\n
TD<\/p>\n\n\n\n
benztropine\/cogentin<\/p>\n\n\n\n
cause low serum levels<\/p>\n\n\n\n
cause high serum levles<\/p>\n\n\n\n
TD<\/p>\n\n\n\n
smoking is a strong inducer.
therefore smoking increases drug metablolism and you may need to dose higher. If they stop smoking serum levels will increase.
Always assess for smoking\/cessation of.<\/p>\n\n\n\n
tegratol<\/p>\n\n\n\n
disulfram
steroids
isoniazide
antidepressants<\/p>\n\n\n\n
steroids
beta blockers
interferon
accutane-can cause birth defects too<\/p>\n\n\n\n
increase the dose to adjust for the medication (steroids) influencing mania<\/p>\n\n\n\n
increase dose of zoloft to adjust for the increase in depression for the interferon<\/p>\n\n\n\n
DA
GABA<\/p>\n\n\n\n
major inhibitory neurotransmitter<\/p>\n\n\n\n
irritability
insomnia
tremors
delayed gastric emptying-feeling fullness\/bloated<\/p>\n\n\n\n
Signs of delayed gastric emptying<\/p>\n\n\n\n
PROTON PUMP INHIBITORS
famotidine
omeprazole
ranitidine<\/p>\n\n\n\n
Decrease absorption of psychotropic medication<\/p>\n\n\n\n
May increase anxiety
paradoxical effect<\/p>\n\n\n\n
May increase agitation
paradoxical effect<\/p>\n\n\n\n
neuronal loss or cell death<\/p>\n\n\n\n
DIGFAST<\/p>\n\n\n\n
Distractible
Impulsive choices
Grandiosity
Flight of ideas
Active
Sleep not needed
Talkative<\/p>\n\n\n\n
impulsivity is often with associated with recurrent SI and self harming behavior<\/p>\n\n\n\n
DBT
to decrease recurrent SI
Marsha Linehan<\/p>\n\n\n\n
can be result of a stressful experience<\/p>\n\n\n\n
parasthesia
paralysis
blindness
Mutism<\/p>\n\n\n\n
an emotional disturbance caused by ongoing stressors within the range of common experiences (dx of a new disease) (recent move) (loss of loved one)<\/p>\n\n\n\n
Condition in which a person acts as if he or she has a physical or mental illness when he or she is not really sick.
Ie drinking contaminated urine<\/p>\n\n\n\n
common in kids from foster care
kid goes back to real parent and may appear withdrawn, no emotions toward caregiver,
FOSTER is key word
Doesn’t seek comfort when distressed<\/p>\n\n\n\n
NO AGGRESSION in ODD
defiant to authority
deliberately annoy others<\/p>\n\n\n\n\n
with emphasis on child management skills<\/li>\n<\/ul>\n\n\n\n
no remorse
violent
raping\/beating
theft
arson
INTENSE<\/p>\n\n\n\n
When 18; think of Antisocial personality disorder<\/p>\n\n\n\n
Medication and therapy
to target symptoms of mood and aggression<\/p>\n\n\n\n
An anxiety disorder in which fear and related symptoms are experienced soon after a traumatic event and last LESS THAN 1 MONTH<\/p>\n\n\n\n
Increased arousal
Reexperiencing the event
avoidance
nightmares<\/p>\n\n\n\n
prazosin\/minipress<\/p>\n\n\n\n
EMDR
SSRI
CBT<\/p>\n\n\n\n
see purple book<\/p>\n\n\n\n
panic attack: acute\/seldom<\/p>\n\n\n\n
propanolol<\/p>\n\n\n\n
2 motor tic
1 vocal tic
for ONE year (even if ? says 6 months) its still most likely the correct answer<\/p>\n\n\n\n
DA-da dysfunction is major NT in tourette
NE
S<\/p>\n\n\n\n
stimulant<\/p>\n\n\n\n
non stimulant<\/p>\n\n\n\n
TRUE<\/p>\n\n\n\n
FDA approved
haldol
abilify
pimozide
guanfacine
clonidine
esp if kid is having impulse control problems<\/p>\n\n\n\n
yes
normal.
normally by teen years they disappear. no treatment unless meeting dsm criteria for tourettes. tourettes needs trmt. 2 motor 1 vocal<\/p>\n\n\n\n
frontal cortex<\/p>\n\n\n\n
S
NE<\/p>\n\n\n\n
causes OCD
from strep infection
treat with SSRI prozac in kids, in adults use sertraline.
adults can also get TCA like clomipramine<\/p>\n\n\n\n
in kids, mood d\/o 6-17yo
kid has bipolar disorder but is not 18 yet<\/p>\n\n\n\n
irritible for no reason
tantrums for no reason
Mad\/Sad for no reason<\/p>\n\n\n\n
reacts grossly out of proportion to the situation<\/p>\n\n\n\n
aggressive
HAVE REMORSE, feel bad about it all later<\/p>\n\n\n\n
mood questionnaire<\/p>\n\n\n\n
assess the family tree\/hx for this<\/p>\n\n\n\n
AT LEAST SIX MONTHS
If less it is ASD<\/p>\n\n\n\n
Gaba
glutamate
SE<\/p>\n\n\n\n
poor cognition
broken mirror theory of autism-<\/p>\n\n\n\n
a teacher and a parent evaluation<\/p>\n\n\n\n
Yes, so don’t give a vmat 2 and a stimulant together. wipes one another out<\/p>\n\n\n\n
carbamazepine
rifampin
alcohol
phenytoin
griseofulvin
phenobarbital
sulfonylureas<\/p>\n\n\n\n
Valproate
ketoconazole
isoniazid
sulfonomides
choramphenical
amiodarone
erythromycin
quinidine
grapefruit juice<\/p>\n\n\n\n
CRAP GPS induces my rage
Carbamazepine
Rifampin
Alcohol
Phenytoin
Griseofulvin
Phenobarbital
Sulfonylureas<\/p>\n\n\n\n
1A2
2E1
2C9
2D6
3A4
1A2. AcetAminophen- 1 big word with 2A
2E1 – 21 years to drink ETOH
2C9- Warfarin factors 2, C, 9
2D6- 2D echo-cardiac drug metabolism
3A4- most common, metabolizes up to 60% of ALL medications, so if its not one of the above it is likely 3A4.<\/p>\n\n\n\n
NE
SE<\/p>\n\n\n\n
SSRI: prozac<\/p>\n\n\n\n
ssri: sertralin
or TCA (clomipramine)<\/p>\n\n\n\n
WATCHERS x 6 months
Worry
Anxiety
Tension
Concentration
Hyperarousal
Energy Loss
Restlessness
Sleep issues<\/p>\n\n\n\n
precontemplation: Not acknowledged an issue. ” I don’t have a drug problem”<\/p>\n\n\n\n
impaired communication
impaired social interaction
poor eye contact
sensory issues
poor cognition<\/p>\n\n\n\n
mirror neuron is dysfunctional<\/p>\n\n\n\n
male
intellectual disability
genetic loading-inc risk with family member with autism<\/p>\n\n\n\n
M-Chat: modified checklist for autism<\/p>\n\n\n\n
can be genetic
so ASSESS family for same problem<\/p>\n\n\n\n
Gaba and Glutamate<\/p>\n\n\n\n
Vit B12 and folic acid<\/p>\n\n\n\n
subcortical dementia<\/p>\n\n\n\n
memory and language<\/p>\n\n\n\n
motor, behavioral<\/p>\n\n\n\n
cognitive screening
present with:
agitation
irritability<\/p>\n\n\n\n
pseudo dementia<\/p>\n\n\n\n
prefrontal cortex<\/p>\n\n\n\n
lewy body<\/p>\n\n\n\n
frontal lobe
picks disease
personality changes
behavioral
language (slurred)<\/p>\n\n\n\n
developmental delay
learning difficulties
irritability
loss of appetite
weight loss
sluggishness
fatigue
abd pain
vomiting
constipation
hearing loss
seizures
pica<\/p>\n\n\n\n
Pulse
sweating
restlessness
pupil size
bone aches
running nose
tearing
GI upset
yawning
tremors
anxiety\/irritability
goosebumps<\/p>\n\n\n\n
cognitive functions
decision making
emotions
impulse control<\/p>\n\n\n\n
medullary reticular formation<\/p>\n\n\n\n
raphe nuclei of the brainstem\/sleep<\/p>\n\n\n\n
the ventral tegmental area VTA
and nucleus accumbens<\/p>\n\n\n\n
Meynert<\/p>\n\n\n\n
SE and NE<\/p>\n\n\n\n
smoking
caffeine
lack of exercise
diet low in cal and vit D<\/p>\n\n\n\n
ST to LT memory
emotions
stress
learning<\/p>\n\n\n\n
fear
anger
anxiety
aggression
stress<\/p>\n\n\n\n
balance<\/p>\n\n\n\n
cognitive functions
decision making
empathy
impulse control
emotions
decision making<\/p>\n\n\n\n
social skills
tumor here can cause behavioral problems<\/p>\n\n\n\n
give the infant to the parents to hold and
grieve their loss<\/p>\n\n\n\n
calcium and vitamin d
weight bearing exercises
not using tobacco<\/p>\n\n\n\n
trying to replace automatic negative beliefs\/irrational thoughts with positive \/ functional thoughts<\/p>\n\n\n\n
Person centered
self actualization
self directed growth<\/p>\n\n\n\n
problem solving techniques
role playing
skills training
relaxation<\/p>\n\n\n\n
interpersonal distress with lots of people and in several settings.
also used in marital conflict for a 12-16 weeks.
Think relationship distress with this<\/p>\n\n\n\n
triangles
triangulation
self differentiation
genograms<\/p>\n\n\n\n
hierarchies keyword
structural mapping
genograms<\/p>\n\n\n\n
problem focused\/symptom focused
paradoxical strategies
or a straight forward directive
Reframe patients belief system<\/p>\n\n\n\n
miracle question
miracle solution
exception based finding questions
scaling questions<\/p>\n\n\n\n
focused on the strengths of client<\/p>\n\n\n\n
promote the relationship between client\/provider. if they won’t talk, you can f\/u with closed ended questions if the child remains avoidant\u2026 stays avoidant, then go to parents as a last resort<\/p>\n\n\n\n
reschedule both of them. they must both be present.<\/p>\n\n\n\n
how is that loss affecting you\u2026how do you feel about it?
Not affected? maybe you don’t need to focus on it too much<\/p>\n\n\n\n
give plenty of meds until they can see a new provider\u2026maybe three month supply<\/p>\n\n\n\n
tell parents to separate the siblings
cps<\/p>\n\n\n\n
ESR level, which indicates inflammation<\/p>\n\n\n\n
Population
Intervention
Comparison
Outcome
Time<\/p>\n\n\n\n
systematic reviews of random control trials (RCTs) -highest internal validity due to randomizations<\/p>\n\n\n\n
at least 1 RCT<\/p>\n\n\n\n
by reading current up to date journals<\/p>\n\n\n\n
intracranial pressure; inconsolable<\/p>\n\n\n\n
when patient is admitted<\/p>\n\n\n\n
3 to six year old
phallic stage<\/p>\n\n\n\n
six months<\/p>\n\n\n\n
testosterone. so check this if c\/o dec libido.<\/p>\n\n\n\n
age<\/p>\n\n\n\n
testosterone<\/p>\n\n\n\n
etoh enzyme
women have less than men so get intoxicated faster compared to men<\/p>\n\n\n\n
supportive group therapy<\/p>\n\n\n\n
grasp\/palmar
moro\/startle
babinski
grasp\/palmar 5-6 months
moro\/startle 5-6 months
babinski 9-12 months<\/p>\n\n\n\n
sexual dysfunction
viagra
short absorption, rapidly absorbed<\/p>\n\n\n\n
AN BMI is very low, high chance of hospital admission
VS changes like bradycardia. if parents won’t admit call cps. bmi to admit are 12, 13, 14.<\/p>\n\n\n\n
use early screening and early intervention<\/p>\n\n\n\n
depression and pain<\/p>\n\n\n\n
harm to self or others<\/p>\n\n\n\n
legal, not medical concept, that protects patients from unlawful hospitalization<\/p>\n\n\n\n
HI. even more than ASPD.<\/p>\n\n\n\n
nervous system is affected<\/p>\n\n\n\n
A. switch med
b. dec depakote
c. ask them to exercise<\/p>\n\n\n\n
ask a specific question that will provide an anchor to a timeline, like a wedding, bday, new job, etc.<\/p>\n\n\n\n
assesses their knowledge of meds<\/p>\n\n\n\n
assess medication hx<\/p>\n\n\n\n
an iatrogenic illness is an illness that is caused by a medication or physician.<\/p>\n\n\n\n
policy making
advocacy<\/p>\n\n\n\n
cytokine levels<\/p>\n\n\n\n
for nighttime bed wetting
reduces urine production esp at noc<\/p>\n\n\n\n
have low tolerability due to lowers BP<\/p>\n\n\n\n
violates trust<\/p>\n\n\n\n
nonpharm
setting alarms
bladder training<\/p>\n\n\n\n
discharge. If still blaming others they are not ready. Need to take responsibility for their actions.<\/p>\n\n\n\n
intervention based on why they are not compliant<\/p>\n\n\n\n
validate their concerns to promote communication<\/p>\n\n\n\n
document why.
and document support for off label use.
MSL or trials<\/p>\n\n\n\n
excessive weight
obesity
diabetes
smoking
HTN
narrowed airways<\/p>\n\n\n\n
vit B12 deficiency<\/p>\n\n\n\n
Good! low score is severe cognitive deficit<\/p>\n\n\n\n
SI<\/p>\n\n\n\n
25-30 is normal
21-24 mild
10-20 moderate
0-9 severe<\/p>\n\n\n\n
27-30 Normal
21-26 Mild
0-20 dementia<\/p>\n\n\n\n
0-7 Normal
8-13 mild
14-18 moderate
19-22 severe
23 plus very severe<\/p>\n\n\n\n
0-4 normal
5-9 mild
10-14 moderate
15-19 moderate to severe
20-27 severe<\/p>\n\n\n\n
0-9 normal
10-18 mild
19-29 moderate
30-63 severe<\/p>\n\n\n\n
under 17 mild
18-24 moderate
25 plus severe<\/p>\n\n\n\n
0-4 normal
5-9 mild
10-14 moderate
15-21 severe<\/p>\n\n\n\n
0-4 none
5-12 mild
13-24 moderate
25-35 mod to severe
35 plus severe<\/p>\n\n\n\n
0-9 none
10-15 mild
16-20 moderate
21 plus severe<\/p>\n\n\n\n
mod: treatment at 13 and above for scheduled. consider buprenorphine or Suboxone. methadone consider safety concerns and under supervision
pulse
sweating
restlessness
pupil size-dilated
bone aches
runny nose
tearing
gi upset
yawning
tremors
anxi\/irritable
goosebumps<\/p>\n\n\n\n
scheduled medication starts at score of 15
Nausea
vomiting
tremor
sweats
anxiety
agitation
tactile disturbances
auditory disturbances
HA
orientation<\/p>\n\n\n\n
disulfram no etoh for two weeks after stopping\/none 12 hours before starting<\/p>\n\n\n\n
exaggeration of good qualities of the person or object lost, followed by acceptance for the loss. widow exaggeraes how amzing her not so amazing husban is<\/p>\n\n\n\n
tramadol
dextromethorphan
alprazolam
clonazepam
carvedilol
diphenhydramine<\/p>\n\n\n\n
always to work late and tells boss “I’m not the only one”<\/p>\n\n\n\n
new diagnosis so you go home and do tons of research<\/p>\n\n\n\n
varies state to state
defines role and action
varies broadly<\/p>\n\n\n\n
determined by american nurses association
judges care given
reasonably prudent is standard<\/p>\n\n\n\n
the assurance that messages and information are available only to those who are authorized to view them<\/p>\n\n\n\n
when info outweighs risk (think murder trial)<\/p>\n\n\n\n
if client can repeat the benefits and risks o the med\/<\/p>\n\n\n\n
right to self determination
EXCEPT
rennie vs klein: right to refuse medication if NOT-found incompetent<\/p>\n\n\n\n
least restrictive first<\/p>\n\n\n\n
safety
continual learning
designing safe systems
managing behavioral choices<\/p>\n\n\n\n
treatment approach doesn’t really focus on the dx\/illness
looking beyond the dx and search out abilities dreams goals
self direction
finding meaning in life despite the dx
person centered
individualized
NON LINEAR not step by step but based on growth setbacks and learning experiences<\/p>\n\n\n\n
improving systems
decrease cost
improve productivity<\/p>\n\n\n\n
quality improvement initiative<\/p>\n\n\n\n
not a project
an effective strategy<\/p>\n\n\n\n
linking theory to practice
providing feedback<\/p>\n\n\n\n
school age 6-12
becoming industrious and getting confidence about what they can do\u2026 fx is feeling bad and inferior<\/p>\n\n\n\n
age 20-35
in a loving relationship
starting a family
fx is feeling alone and isolated<\/p>\n\n\n\n
magical thinkeers
preoperational
“if i think about a new dress I will get one”<\/p>\n\n\n\n
formal operations
logical and abstract
algebra etc<\/p>\n\n\n\n
screening and community education<\/p>\n\n\n\n
crisis intervention
hotlines
disaster response<\/p>\n\n\n\n
rehab
active treatment<\/p>\n","protected":false},"excerpt":{"rendered":"