NR-547 Midterm

Name the 6 of a differential diagnosis

1.) RULE OUT Malingering or Factitous disorder 2.)Ruling out substance etiology 3.) ruling out a medical etiology 4.) Determining the specific primary disorder 5.) Differentiating adjustment disorder from the residual "other specified" and "unspecified" conditions 6.) Establishing the boundary with no mental disorder

Name the normal vitamin D levels:

20-50 ng/ML

Adjustment disorder. Symptoms must begin ___ months within exposure to the stressor and last NO MORE THAN ____ months

3 6

What is the treatment for performance based anxiety, or for people with psysiological symptoms such as tachycardia/tremor?

BB-Propanolol OR a Benzo 30-60 min before a performance for people with 1 or rare performances

_____ is an acute psychosis often precipitated by stress that can last more than 1 day BUT less than 1 month. These patients will experience COMPLETE remission and return to their full functioning. Some s/s are emotional votality, strange behavior, screaming, muteness, impaired memory of recent events

BRIEF PSYCHOTIC BREAK

What is normal creat/BUN level?

BUN: 7-18 creat: 0.6-1.2

What is the main treatment for Catatonia?

Benzodiazepines!

What is another adjunct treatment or PRN medication used as a treatment for GAD?

Buspirone- This is an anxiolytic with decreased adverse effects & drug interactions. It can take about 2-4 weeks to work and it is pretty weak however effective when used as an adjunct.

What is the tx for people with REOCCURING performance anxiety?

CBT Therapy-FIRST LINE THERAPY plus a BB/benzo 30-60 min before a performance-second line

What is the first treatment for SAD?

CBT therapy

A psychotomor syndrome that presents as a decreases reactivity to ones environment. It usually occurs in tandem with other psychiatric/medical disorders. Most associated with schizophrenia/affective disorders, autism or infectious diseases. S/s: Mutism, withdrawal, refusal to eat, staring, posturing & rigidity, negativism, echolalia, echopraxia, grimacing. The presence of 3 or more of these symptoms will lead to the diagnosis in DSM5.

Catatonia

_______ are repetitive behaviors or mental acts that are done in response to obsessions or in a rigid rule-bound way that can cause severe distress. Name some

Checking, washing, counting, need to ask/confess, symmetry/precision, hoarding, multiple comparisons, taking hours to complete a task

1 OR MORE delusions for at LEAST 1 month duration that cannot be attributes to ANY other psychiatric disorder. These patients delusions are WITHOUT hallucinations. They have false belieds that involve situations: erotomanic, persecutory, jealous, somatic, grandiose, mixed/unspecified. What disorder is this?

Delusional disorder

_____ shows there is an INCREASE activation of the amygdala which is an increase in the fear response. There is a decreased activation of the pre-frontal cortex which results in lessened reasoning.

Generalized Anxiety Disorder

What are obsessions?

Intrusive and unwanted repetitive thoughts, urges or impulses that often lead to a marked increase of anxiety or distress. 1.) Contamination 2.) Pathological doubt 3.) Somatic 4.)Aggressive, sexual thoughts 5.) Need for symmetry/ordering

Patients that have _____ & _____ delusions with delusional disorder usually have a poor prognosis vs others that have other delusions.

Jealous & Persecutory

When person that has a obsession believes that that a compulsion has to be completed or their family will die. What is this called?

OCD with delusional beliefs

What childhood infection can lead someone to developing OCD?

PANDAS- it is a beta hemolytic streptococcal infection which results from an auto-immune process that leads to inflammation of the basal ganglia that disrupts cortical-striatal-thalmic axis functioning which causes OCD.

What are some s/s that patients may complain of when having a panic attack or if they are diagnosed with panic disorder?

Palpitations, feeling of choking, smothering sensation, nausea, abd stress, derealization, dizziness, paresthesia, trembling

Name the DSM for panic disorder

Panic disorder is a MARKED PERSISTENT reoccurimg panic attacks associated with worry or concern of a negative outcome. These attacks are usually UNPROVOKED & can happen in familiar places like home or school. The panic attacks can peak from 10-20 minutes but some can last for hours. 1 month of worry after 1 panic attack 1 plus panic attack plus 4 of the somatic symptoms Avoidant behavior/anticipatory anxiety for one month

Schizophrenia is marked by a "pre-phase" in which the patient develops symptoms before the 1st psychotic episode over a few days to a few months and the symptoms may persist for over a year or more before the onset of overt psychotic symptoms.

Prodromal phase Some people may experience abstract ideas, odd perceptual experiences, strange behavior, abnormal affect, unusual speech, bizarre ideas.

How would you treat OCD?

SSRI at high doses. You DO want to start low then go high. For example, Fluoxetine at 20 mg but the patient may be therapeutic at 80 mg or Sertraline at 200 mg. PLUSSSS EXPOSURE response therapy

What is the first line treatment for Panic disorder?

SSRI plus CBT therapy

Name the first line treatment for GAD.

SSRIs

________ is associated with symptoms of schizophrenia and symptoms of a mood disorder. It can be misdiagnosed as MDD

SchizoAFFECTIVE disorder

Name different types of Psychosis

Schizophrenia schizoaffective d/o schizophreniform d/o brief psychotic episode, delusional d/o Catatonia

A patient presents with brain fog, lack of focus, insomnia & mood swing, lack of mental alertness. What lab should the PMHNP order?

THYROID FUNCTION TEST TSH: 0.4-4.5 T3: 100-200 T4: 5-11

This tool contains 24 categories that score 1-7. The clinician uses this tool to rate the patients symptoms over days to grade psychosis. It rates over symptoms such as hostility, suspiciousness, hallucinations and grandiosity. It helps to rate treatment efficacy over days.

The Brief Psychiatric Rating Scale

The _____ tool focuses on measuring clinical symptoms associated with the disorder. This one is often used within research to identify the difference between positive and negative symptoms.

The Positive and Negative Syndrome Scale

Tell me about Adjustment Disorder with anxiety

This is a disorder brought on by trauma/stress. The distress the patient feels usually OUTWEIGHS the severity of the actual trauma. New jobs, marriage, divorce, new disability

What is the GAD-7 screening tool?

This is a rapid screening for the presence of clinically significant anxiety disorders such as: GAD, Panic disorders, PTSD, & social phobias. 5-9- mild 10-14- moderate over 15- severe & active treatment is warranted

Explain GAD

This is characterized when a person WORRY about ORDINARY, everyday situations. These patients have a hard time getting over the what ifs and hyperfixate. Due to this they are unable to get more of their pressing tasks done

What is obsessive-compulsive disorder (OCD)?

This is obsessive thoughts, compulsions or both that consume at least 1 hour/day or cause significant distress or impairment. The individual has these obsessions & then need to complete a compulsion that will help them neutralize the thoughts. Usually if they do not do this then they think something bad will happen

What is schizophreniform disorder?

This is schizophrenia like symptoms that last for more than one month BUT less than 6 months. They return to their baseline of functioning usually within 6 months

Tell me about schizophrenia

This is symptoms present for a significant portion of time during a 1 month period with continuous signs of the disturbance persisting for at least 6 months. So DELUSIONS, HALLUCINATIONS or DISORGANIZED SPEECH must be present plus 2 or MORE of the following: Delusions, hallucinations, disorganized speech, grossly disorganized, negative symptoms or catatonia.

Tell me about the HAM-A

This is the Hamilton Anxiety Scale, creates to assess somatic/cognitive anxiety symptoms. MAINLY TO ASSESS ANXIETY. It does not help to assess the worry aspect usually found with GAD. less than 17- mild 18-23- mod 25-30 mod-severe

Tell me about social phobias aka social anxiety disorder

This is the fear of acting in a way that might cause judgement by others or just the fear of everyday social interactions. The patient may feel embarrassed, feel judged by others or feel self conscious. Some may use drugs/alcohol to help with coping in social interactions. These individuals fear small talk, performing, or meeting new people. Instead they avoid these interactions.For DSM5 these symptoms have to be persistent for 6 months or more.

Tell me about agoraphobia

This is the fear of or anxiety regarding places from which escape might be difficult. For DSM-5 Criteria, the patient must have fear of 2+ out of the 5 place for 6 months or more. 1.) being outside of the home alone 2.) standing in line/being in crowds 3.) using public transportation 4.)being in open spaces 5.) being in enclosed spaces: shops, theaters, cinemas people with panic disorder can have agoraphobia

What is the DSM criteria for GAD?

WORRY about everyday tasks, sleep disturbance, restlessness, fatigue and immanent fear, muscle tension or difficulty concentrating has to be persistent for six months or GREATER

What tool can be used to assess severity of a patients obsessions/compulsions?

Yale Brown OC Scale. The patient is able to rate their severity of symptoms 0-7-subclinical 8-15 mild 16-23 mod 24-31 severe 32-40 EXTREME

The PMHNP wants to rule out anemia as a cause for a patients fatigue and lack of motivation. What lab should she order?

a CBC with iron studies hg-12-18 hematocrit: 38-48%

What are some s/e of SSRIS?

hyponatremia, weight loss, weight gain, anxiety in the initial stages.

The patient has a b12 level of 126 picograms/mL. what symptoms may the patient experience?

normal B12: 190-950 picograms/mL but borderline is 200-300 & will need additional testing. depression, mania, psychotic symptoms, cognitive impairment

Name some s/s of SAD

trembling, blushing, derealization, embarrassment, fead of being judged by others