PMHNP Certification Exam
Dialectical behavior therapy
Marsha Linehan focuses on emotional regulation, tolerance for distress, self management skills, interpersonal effectiveness, mindfulness, with an emphasis on treating therapy-interfering bx
Health Belief Model
Marshall Becker explains that healthy people do not always take advantage of screening or preventative programs because of certain variables: -perception of susceptibility -seriousness of illness -perceived benefits of tx -perceived barriers to change -expectations of efficacy
most outspoken opponents of APRNs
Martha rogers
what medication are MAOIs strictly contraindicated with
Meperidine due to risk of hypertensive crisis and death
family systems therapy
Murray Brown focus on chronic anxiety within families tx goal to increase familys awareness of each members function within the family and to incrase levels of self determination
poor sleep is a sign of possible
OCD
meds that can cause false positives for methadone or PCP
OTC cough meds (Nyquil) dextromethorphan
Primary Prevention care practices are an essential aspect of the PMHNP role. Which is the best example of a primary prevention care strategy for community behavioral health?
Parenting skills classes for pregnant adolescents (Information reduces incidence of disease)
what direct acting dopamine receptor agonist is recommended to be used in the treatment of NMS to help lower the dopamine receptor blockade?
Parlodel
identifying pts with pseudodementia
"Don't know" answers
what does the ego say?
"I evaluate"
the pmhnp is planning to work with a client using an individual therapy model of care. during the first session, the client makes the following statement: "this is the third time my son has run away. I have grounded him, taken away his bike, even tried cutting off his allowance and confining him to his room. what should I do now?" the most therapeutic response for the PMHNP to make is..
"maybe that depends on what you are trying to accomplish"
Panic disorder pharm
- SSRIs -Benzos for short term symptom control or bridge med when starting antidepressant -buspar effective adjunct to antidepressant -other non-benzo anxiolytic meds as adjuncts
wake promoting agents for sleep dx
--Armodafinil (Nuvigil) -indicated for daytime sleepiness associated with OSA
clonidine (Catapres) for EPSE
-0.1mg PO TID -alpha 2 agonist -treats akathisia only
Benztropine (Cogentin) for EPSE
-0.5-2mg PO, TID -Anticholinergic -treats akinesia, akathisia, dystonia, pseudo-parkinson's -NO TD
PTSD diagnostic criteria
-1 month or longer -exposure to traumatic event -traumatic event persistently reexperienced in one or more ways -3 or more avoidance symptoms -2 or more increased arousal symptoms -causing significant distress or impairment in Activities of daily functioning -occur within 3 months of trauma -duration is highly variable (remit within 3 months in 50% cases, common waxing and waning)
Lithium carbonate (Eskalith, Lithobid)
-1,200-2,400mg/day (acute) -900-1200mg/day (maintenance) -SE: common- nausea, fine hand tremors, increased urination and thirst -SE: toxicity- slurred speech, confusion, severe GI effect -establish standard treatment for BP -Prego D -Lact L3 -risk of hypothyroidism -avoid in prego, especially 1st trimester -monitoring of kidney function is essential -concurrent use of NSAIDs and angiotensin-converting enzyme inhibitors (ACEIs) may double lithium level
Cariprazine (Vraylar)
-1.5-6mg QD -SE: EPSE, akathisia, GI upset, restlessness, somnolence --monitor serum lipids/glucose -assess family/personal hx CVD dx -SGA
schizophreniform prognosis
-1/3 recover completely within 6 months -2/3 develop schizophrenia or schizoaffective dx
average duration of ECT treatments
-10 weeks -gradually shift from weekly to monthly treatments over 1-3 months then maintain monthly administration for 6 months
Propranolol (Inderal)
-10-20mg/day PRN -SE: bradycardia, hypotension -performance anxiety -off label use -usually adjunctive with other agent
carbamazepine (Tegretol)
-10-20mg/kg/day -6-12mcg/mL -SE: common- Nausea, dizziness, sedation, headache, dry mouth, constipation, skin rash -SE: rare- agranulocytosis/aplastic anemia, steven johnsons syndrome, particularly in Asians (screen for HLA-B 1502 allele before initiating) -hepatic enzyme inducer -monitor LFTs -alternative to lithium or valproic acid -Prego D -Lact L2
Amantadine (Symmetrel) for EPSE
-100-200mg PO BID -dopamine agonist -treats akinesia and pseudo-parkinson's only
Iloperidone (Fanapt)
-12-24mg/day in divided doses -SE: orthostatic hypotension, sedation, dizziness -titrate slowly d/t alpha 1 agonist properties -may be helpful for PTSD hyperarousal S/S d/t alpha 1 blocking -monitor BMI, AG, WT, serum lipids/glucose -assess family/personal hx CVD dx -SGA
valproic acid (Depakene), divalproex sodium (Depakote)
-15-40mg/kg/day -SE: common- nausea, diarrhea, abdominal cramps, sedation, tremor -SE: rare- increased liver enzymes, steven Johnson's syndrome (unlike carbamazepine, divalproex does not carry screening directive for HLA-B 1502 antigen at this time) -Depakote minimizes GI effects -more effective than lithium for raid cycling and mixed Bipolar -Loading dose 20mg/kg -prego D -lact L2
combined pharmacotherapeutics and behavioral interventions COMBINE trial
-16 week RCT -1383 alcohol dependent patients -2003 -naltrexone effectively delayed time to relapse compared to placebo -acamprosate faired poorly compared to various combos of naltrexone and combined behavioral intervention (CBI) -found that any combining therapies including CBI, naltrexone, or both; performed better than any combo not including these interventions
Clonazepam (Klonopin) for EPSE
-1mg PO BID -Benzo -treats akathisia and dystonia only
Lorazepam (Ativan) for EPSE
-1mg PO TID -Benzo -treats akathisia and dystonia only
schizophreniform dx hx assess for the following
-2 + of the following frequently present during a 1 month period (delusions, hallucinations, disorganized speech, grossly disorganized bx, presence of negative symptoms) -duration of symptoms for at lest 1 month but not longer than 6 months
Schizophrenia diagnostic criteria
-2+ symptoms frequently present during 1 month period and at least 1 must be delusions, hallucinations, or disorganized speech -significant occupational/social impairment -duration at least 6 months
Brexpiprazole (Rexulti)
-2-4mg/Qday -SE: akathisia, weight gain --monitor serum lipids/glucose -assess family/personal hx CVD dx -SGA
trihexyphenidyl (Artane) for EPSE
-2-5mg PO TID -anticholinergic -treats akinesia, akathisia, dystonia, pseudo-parkinson's -NOT TD
Procyclidine (Kemadrin) for EPSE
-2.5-5mg PO BID-QID -anticholinergic -treats akinesia, akathisia, dystonia, pseudo-parkinson's -NOT TD
Propranolol (Inderal) for EPSE
-20-40mg PO TID -beta blocker -treats akathisia only
Buspirone (Buspar)
-20-60mg/day -SE: dizziness, insomnia, tremors, akathisia, stomach upset, dry mouth -helpful adjunct for anxiety -not PRN
Patient Protection and Affordable Care Act (PPACA)
-2010 -"healthcare reform" -expanded coverage to many previously uninsured Americans -provided specific benefits for those with mental illnesses with inclusion of substance use disorder in an "essential benefits package" -creation of incentives to coordinate primary care and mental health/addiction services -inclusion of mental illness s a chronic illness in creation of "health homes" -prohibits denial of coverage for preexisting conditions -provisions for community health campaigns -increased community based care
lamotrigine (Lamictal)
-25-600mg/day -blood monitoring not necessary -SE: common- dizziness, ataxia, somnolence, diplopia, nausea, headache, hepatotoxicity -SE: Rare- life threatening rashes including steven Johnsons syndrome (unlike carbamazepine, divalproex does not carry screening directive for HLA-B 1502 antigen at this time), leukopenia -indication for maintenance only -helps in depressive phase of Bipolar -titrate slowly -often used in combo with lithium, SGAs, and antidepressants
diphenhydramine (Benadryl) for EPSE
-25mg PO QID -antihistamine -treats akinesia, dystonia, pseudo-parkinson's -NOT TD, akathisia
Gabapentin (Neurontin)
-300-3600mg/day -SE: ataxia, decreased coordination, sedation, disequilibrium -used for anxiety, neuropathic pain, fibromyalgia, and as an anti-craving medication -off label use
Tiagabine (Gabitril)
-4-56mg/day -SE: dizziness, somnolence, stomach upset, tremors, dry mouth -helpful adjunct for anxiety , off label use
Lurasidone (Latuda)
-40/160mg/day -SE: akathisia, sedation, nausea -take with food to increase absorption -use with caution at lower doses in clients with renal and hepatic impairment -monitor BMI, AG, WT, serum lipids/glucose -assess family/personal hx CVD dx -SGA
Vortioxetine (Brintellix)
-5HT3 and 5HT7 antagonist -5HT 1A agonist -tablet 5, 10, 20mg -20mg QD -SE: nausea, diarrhea, dizziness -Prego C -Lact inadequate info
methylphenidate hydrochloride (Ritalin LA/ Ritalin SR/ Metadate CD/ Metadate ER/ Methylin ER)
-ADHD -Schedule II -10-60mg/day
amphetamine, dextroamphetamine (Adderall)
-ADHD -Schedule II -5-40mg/day
Atomoxetine Hydrochloride (Strattera)
-ADHD -not controlled substance -10-100mg/day
Methylphenidate transdermal patch (Daytrana)
-ADHD -schedule II -10-30mg/day (9hours)
methylphenidate hydrochloride (Concerta)
-ADHD -schedule II -18-72mg/day
Dexmethylphenidate (Focalin/Focalin XR)
-ADHD -schedule II -2.5-20mg/day
lisdexamfetamine dimesylate (Vyvanse)
-ADHD -schedule II -30-70mg/day
methylphenidate hydrochloride (Ritalin)
-ADHD -schedule II -5-40mg/day
amphetamine, dextroamphetamine (Adderall XR)
-ADHD -schedule II -5-60mg/day
methylphenidate hydrochloride (Methylin)
-ADHD -schedule II -5-60mg/day
dextroamphetamine (dexedrine)
-ADHD -scheudle II 2.5-20mg/day
guanfacine (Intuniv)
-ADHD FDA approved 6-17yo -alpha agonist -not controlled substance -1-4mg/day
bupropion (Wellbutrin SR/XL)
-ADHD off label -norepinephrine dopamine reuptake inhibitor -100-450mg/day
clonidine (Catapres)
-ADHD-off label -alpha agonist -not controlled substance -0.1-0.4mg/day
abnormal movement rating scales
-AIMS -Dyskinesia identification system condensed user scale (DISCUS) -simpson-Angus rating scale (SAS)
other substance abuse disorder screening tools
-AUDIT- alcohol use disorders identification test -S-MAST- short Michigan alcoholism screening test (or geriatric version) -CRAFFT- children and adolescent under 21 years of age -COWS- the clinical opiate withdrawal scale
dementia physical exam findings
-Amaurosis fugax (unilateral transient vision loss, described as curtain over eye) -unilateral focal-motor weakness -asymmetrical reflexes
Mahler's Separation/Individuation Theory
-Autistic - Birth to 3 months (total detachment and self absorption, infant spends most time sleeping -Symbiotic - up to 5 months, recognizes mother, but lacks sense of individuality. disruption= narcissistic personality disorder Separation: 3 phases --hatching: increased interest in outside world --Practicing - 9 to 16 months, develops physical ability to separate from mother --Rapproachement - 15 to 24 months, explores outside world but requires mothers presence and emotional support. disruption = borderline personality disorder
MDD cognitive theory
-Beck -represents cognitive diathesis- stress model in which developmental experiences sensitize a person to response to stressful life events in a depressed manner -assumes that people with a tendency to be depressed think about the world differently than nondepressed people and that depressed people are more negative and believe that bad tings are going to happen to them because of their own personal shortcomings and inadequacies
Thiothixene (Navane)
-Capsule, liquid, injection -5-60mg/day -SE: high- EPSE -SE: low- anticholinergic, sedation, hypotension -FGA
Bipolar II
-Clinical hx characterized by occurrences of one or more major depressive episodes accompanied by at least 1 manic or hypomanic episode -recurrent shifts in polarity can occur more frequently-rapid cycling
ADHD standard rating scales
-Conners parent and teacher rating scales -vanderbilt ADHD diagnostic pedant and teacher rating scales
eating disorder pharm management
-Fluoxetine FDA for bulimia nervosa -SSRIs and TCAs effective in reducing frequency of binging and purging
MDD aggression turned inward theory
-Freud -assumes that early psychological developmental issues lay he foundation for depressive responses later in life -the accomplishment of the first stage of development in which the child is able to form relationships is normal -during the second stage of development, the child experiences the loss of the significant mothering person
Bipolar biological theories
-GABA deregulation -increased noradrenergic activity -voltage-gated ion channel abnormalities -abnormalities lead to abnormal balances of intracellular and extracellular levels of neurotransmitters, which then cause subsequent disruption of electric signal transmission in brain regions -kinding
mirror psychotherapy
-Gonzalaz-Jaimes and Turbull-Plaza -psychocorporal, cognitive, neurolinguistic components -holistic focus -effective with adjustment disorder
interpersonal theory
-Harry Stack Sullivan -self-system -when the person's need for satisfaction and security is interfered with by the self system, mental illness occurs -humans experience anxiety and bx is directed toward relieving the anxiety, which then results in interpersonal security
Medicare part A
-Hospital insurance program -funded by a 2.9% tax on earnings paid by employers and workers -covers inpatient hospital services, home health, skilled nursing facilities, and hospice care
eszopiclone (Lunesta)
-Intermediate acting agent
Isocarboxazid (Marplan)
-MAOI -Tablet -20-60mg/day -also used for panic disorder, phobic disorders, selective mutism -CAUTION: high-tyramine diet; sympathomimetic agents -divided dosing BID and QID -Prego C -Lact inadequate info
Phenelzine (Nardil)
-MAOI -Tablet -45-90mg/day -also used for panic disorder, phobic disorders, selective mutism -CAUTION: high-tyramine diet; sympathomimetic agents -divided dosing BID and QID -Prego C -Lact inadequate info
Selegiline (EMSAM)
-MAOI -Transdermal patch -6-12mg -no dietary restrictions with 6mg dosage -may need higher dose to see antidepressant effect -Prego C -Lact L4 AVOID
Tranylcypromine (Parnate)
-MAOI -tablet -30-60mg/day -also used for panic disorder, phobic disorders, selective mutism -CAUTION: high-tyramine diet; sympathomimetic agents -divided dosing BID and QID -Prego C -Lact inadequate info
Hierarchy of needs
-Maslow -survival -safety and security needs -love and belonging -self-esteem -self-actualizaiton
dementia pharm management for cognitive symptoms
-N-methyl D-aspartate glutamate receptor agonists -Cholinesterase inhibitors
Memantine (Namenda)
-N-methyl D-aspartate glutamate receptor antagonist -10-20mg BID -moderate to severe alzheimers dementia -may slow degenerative process -promotes synaptic plasticity -may be used in combo with cholinesterase inhibitors -memantine/donepezil (Namzric) combo medication
Bupropion SR/XL (Wellbutrin SR, XL)
-NDRI -SR 150-400mg/day -XL 150-450mg/day -caution with caffeine and in people with panic dx
Bupropion (Wellbutrin)
-NDRI -Tablet -150-450mg/day -SE: headache, nervousness, tremors, tachycardia, insomnia, decreased appetite -contra if client has sz dx, eating dx -SR offers BID dosing -XL offers QD dosing -can increase energy level -also used for ADHD and smoking cessation -Prego C -Lact L3
Cognitive Theory
-Piaget - four stages of development
Aripiprazole Lauroxil (Aristada)
-Qmonth IM injection -441mg, 662mg, 882mg -SE akathisia -monitor serum lipids/glucose -assess family/personal hx CVD dx -SGA
Trazodone (Desyrel)
-SARI -Tablet -200-600mg/day -NE: sedation, nausea, headache, hypotension -safer in OD than TCAs -priapism possible -not well tolerated at antidepressant dosage d/t sedation -most commonly used as hypnotic at 50-200mg/HS -May prolong QTc interval -Prego B -Lact L2
Nefazodone (Serzone)
-SARI -tablet -300-600mg/day -SE: headache, drowsiness, GI disturbances -must monitor LFTs -can cause liver failure -safer in OD than TCAs -QHS or BID dosing -potent P450 3A4 inhibitor -Prego C -Lact L4 AVOID
mesocortical pathway
-SDAs increase dopamine in this pathway, causing decreased negative syptoms
Quetiapine (Seroquel/XR)
-SGA -tablet -50-800mg/day -SE: common- sedation, hypotension (orthostatic hypotension), weight gain -SE: rare- cataract formation -transient and asymptomatic elevated LFTs -monitor for cataracts -divided BID/TID -no prolactin elevation -monitor wt, BMI, AG, serum lipids/glucose -assess family/personal hx CVD dx
Clozapine (Clozaril)
-SGA -tablet or ODT -25-900mg/day -SE: common- tachycardia, drowsiness, dizziness, hypersalivation (sialorrhea), weight gain, hyperlipidemia -SE: rare- agranulocytosis, myocarditis, neuroleptic malignant syndrome -only drug for tx-resistant schizophrenia -Clozapine REMS program -risk for neutropenia is monitored by the ANC -during 1st 6 months- weekly blood draw -during 2nd 6 months- biweekly blood draw -monthly blood draw thereafter -ANC levels less than 500- suspend drug -can be challenged if benefits outweigh risk -monitor myocarditis -dose-related sz risk -significant weight gain and diabetes risk -rare hyperprolactinemia -monitor wt. BMI, waist circumference -monitor serum lipids and glucose -assess family/personal hx CVD dx
olanzapine (Zyprexa, Zyprexa Zydis, Zyprexa Relprevv)
-SGA -tablet, IM (acute); 5-20mg/day -IM (long); 150-405mg Q2-4 weeks -SE: acute- sedation, wt gain, hyperlipidemia, elevated glucose/LFTs/mild prolactin -SE: long acting- requires monitoring 3 hours post injection d/trisk of postinjection delirium sedation syndrome -significant wt gain -monitor BMI, AG, WT, serum lipids/glucose -assess family/personal hx CVD dx
Risperidone (Risperdal, Risperdal Consta)
-SGA -tablet, liquid, ODT; 2-8mg/day -Injectable; 25-50mg IM Q2 weeks -SE: hypotension, galactorrhea, nausea, insomnia -doses >6mg associated with higher incidence of EPS -less wt gain than Clozaril or Zyprexa -greatest prolactin elevation -monitor BMI, AG, WT, serum lipids/glucose -assess family/personal hx CVD dx
Duloxetine (Cymbalta)
-SNRI -Capsule -30-120mg/day -SE: dizziness, headache, GI disturbances -once daily dosing -can elevate BP -can elevate LFTs -has significant discontinuation syndrome if stopped abruptly -Prego C -Lact L3
Venlafaxine (Effexor, Effexor XR)
-SNRI -Capsule (XR), or tablet -75-375mg/day -XR 75-225mg/day -SE: diaphoresis, headache, dizziness, GI disturbances -can raise BP -QD for XR capsules -BID-TID dosing for tablets -full SNRI effect at doses at or above 150mg -safer in OD than TCAs -has significant discontinuation syndrome of stopped abruptly -Prego C -Lact L3
Levomilnacipran (Fetzima)
-SNRI -tablet 20, 40, 80, 120mg -40-120mg QD -SE: N/V, constipation, sweating, palpitations, urinary hesitancy, hypertension, hypotension, decreased appetite -Prego C -Lact inadequate info
fluoxetine (Prozac)
-SSRI -capsule, tablet, or liquid -20-80mg/day -SE: insomnia, headache, GI disturbances, sexual dysfunction -Long half-life -Prego C -Lact L2 -discontinuation syndrome unlikely
escitalopram (Lexapro)
-SSRI -tablet -10-20mg/day -SE: somnolence, headache, sexual dysfunction, GI disturbances -prego C -Lact L2
fluvoxamine (Luvox)
-SSRI -tablet -100-300mg/day -SE: sedation, sexual dysfunction, agitation, GI disturbances -Doses above 150mg should generally be given BID -Prego C -Lact L2
citalopram (celexa)
-SSRI -tablet -20-40mg/day -SE: sedation, sexual dysfunction, agitation, yawning, GI disturbances, wt gain -preg C -lact L2 -proglonged QTc interval in doses above 40mg (20mg in older adults) and in those susceptible to prolonged QTc
Sertraline (Zoloft)
-SSRI -tablet -50-200mg/day -SE: sexual dysfunction, GI disturbances, somnolence, headache -Prego C -Lact L2
Paroxetine (Paxil CR, Pexeva)
-SSRI -tablet or liquid -20-60mg/day -SE: headache, GI disturbances, somnolence, sexual dysfunction -Prego D -Lact L2 -Discontinuation syndrome very common
PTSD pharm
-SSRIs -TCAs -Benzos not recommended -antipsychotics useful during flashbacks -alpha agonists (prazosin) for nightmares off label
agoraphobia pharm
-SSRIs -benzos for short term use -beta blockers off label for discrete episodes of social anxiety
OCD pharm
-SSRIs (often need higher dosing ranges for adequate symptom control) -TCA (clomipramine) -SGAs (risperidone off label but have supportive data adjunctive with SSRI)
Vilazodone (Viibryd)
-Serotonin partial agonist reuptake inhibitor SPARI -tablet -20-40mg -SE: diarrhea, nausea, dry mouth, lower risk of sexual side effects -Prego C -Lact unknown, is excreted in breast milk
Psychodynamic (Psychoanalytic) Theory
-Sigmund Freud -all bx is purposeful and meaningful -principle of psychic determinism -most mental activity is unconscious -conscious behaviors and choices are affected by unconscious mental content -childhood experiences shape adult personality -instincts, urges, or fantasies function as drives that motivate thoughts, feelings, and bx -Id, Ego, Superego -conflict is experienced consciously as anxiety
9 dimensions of temperament
-Stella chess and Alexander Thomas -approach or withdrawal -adaptability -attention span and persistence (not quality of sleep)
clomipramine (Anafranil)
-TCA -Capsule -100-250mg/day -approved for OCD -250mg/day maximum d/t increased seizure risk -Prego C -Lact L2
Trimipramine (Surmontil)
-TCA -Capsule -100-300mg/day -Prego C -Lact inadequate data
Doxepin (Sinequan)
-TCA -Capsule or liquid -100-300mg/day -also used for insomnia -Prego C -Lact L5 AVOID
imipramine (Tofranil)
-TCA -Tablet, capsule, or IM -100-300mg/day -also used for enuresis and separation anxiety -Prego D -Lact L2
Nortriptyline (Pamelor)
-TCA -capsule or liquid -50-150mg/day -also used for enuresis and ADHD -Prego D -Lact L2
Protriptyline (Vivactil)
-TCA -tablet -15-60mg/day -Prego C -Lact inadequate data
Amitriptyline (Elavil)
-TCA -tablet or IM -50-300mg/day -also used for chronic pain (particularly neuropathic pain), insomnia -Prego C -Lact L2
Desipramine (Norpramine)
-TCA -tablet or capsule -100-300mg/day -also used for ADHD (off label for pediatric clients and for ADHD) -Prego C -Lact L2
paliperidone (Invega, Invega Sustenna [monthly], Invega Trinza [3 month])
-Tablet; 3-12mg/Day -Monthly injection; 39-234mg -3 month injection; 273mg, 410mg, 546mg, or 819mg -SE: orthostatic hypotension, hyperprolactinemia, GI upset, dizziness, headache -ER risperidone -SGA
baseline labs prior to lithium initiatin
-Thyroid -Serum creatinine -BUN -Prego -ECG for pts over 50yo
standardized rating scales for anxiety disorders
-Zungs self rating anxiety scale -Hamilton rating scale for anxiety -yale-brown obsessive compulsive scale
what is a confounder
-a factor that distorts the true relationship of the study variable of interest by virtue of also being related to the outcome of interest -often unequally distributed among the groups being compared -not associated with increased validity in a clinical research trial
polytherapy in acute withdrawal
-a newer approach that matches drugs required for safe and effective withdrawal with neurotransmitter deficits created by substance use -SSRIs -opioid antagonists nalmefene hydrochloride (Revex), naltrexone (revia), or naltrexone for ER injectable suspension [vivitrol] -N-methyl-D-aspartate (NMDA) agonists
ADHD
-a persistent pattern of inattention or hyperactivity, impulsivity, or both that interferes with functioning and development -inattention, 6+ of the following (fails to give attention to details, difficulty sustaining attention, does not listen when spoken to, does not follow through on instructions, disorganized, avoids or dislikes tasks requiring sustained mental effort, loses things, distracted, forgetful) -hyperactive and impulsive 6+ of the following (fidgets, leaves seat, runs or climbs, unable to engage in quiet activities, on the go, talks excessively, blurts out information, difficulty waiting turn, interrupts others) -several symptoms present before 12yo
conduct disorder
-a repetitive and persistent pattern of behavior in which the rights of others or societal norms or rules are violated - the presence of at least 3 of the following criteria must be present in the past 12 months , with 1 in the past 6 months (aggression toward people or animals, destruction of property, deceit or theft, serious violation of rules) -child onset before age 10 or adolescent onset after age 10
factor analysis
-a statistical technique that is leveraged to explain the variance of a large number of variables by utilizing a smaller number of unobserved factors - example is a general intelligence factor
ADHD polygenic neurobiological deficits
-abnormalities of pronto-subcortical pathways in frontal cortex and basal ganglia -abnormalities of reticular activating system -dopamine dysfunciton -norepinephrine dysfunction
alcohol abuse dx screening
-administered by asking 4 questions -each positive answer = 1 point -negative answers = 0 points -the more points the greater the likelihood of alcohol abuse dx -clients scoring 2+ are at mild-mod risk for alcohol dependency and the score is considered clinically significant -clients scoring 3 or 4 are considered high risk for alcohol dependency
Creutzfeldt-Jakob disease
-adult pt -myoclonic jerks -rapid progress towards dementia -akinetic mutism with specific EEG findings -cerebral atrophy on head CT is suggestive of late disease
Pick's disease
-aka frontotemporal dementia -neuronal loss, gloss, Pick's bodies present -more common in men -personality and bx changes in early stage -cognitive changes in later stages -Kluver-Bucy syndrome: hyper sexuality, hypoerorality, and placidity
The federal emergency medical treatment and Labor Act (EMTALA)
-aka patient anti-dumping law -requires most hospitals to provide an examination and needed stabilizing treatment, without consideration of insurance coverage or ability to pay, when a patient presents to the emergency room for attention to an emergency medical condition
self-efficacy and social learning theory
-albert bandura -behavior is the result of cognitive and environmental factors
disulfiram (antabuse) for treating caving and maintaining sobriety
-aldehyde dehydrogenase inhibitor averson therapy
Medicare Part C
-allows beneficiaries to enroll in a private plan as an alternative to the traditional fee-for-service plan -can include health maintenance organizations, preferred provider organizations, or private fee-for-service plans
anxiety meds in children
-alpha agonists often used -clonidine (catapres) 0.003-0.01mg/kg/day off label -guanfacine (tenex) 0.015-0.05mg/kg/day off label
Mirtazapine (Remeron)
-alpha2/5HT2 antagonist -tablet -15-45/day -sedation, weight gain, increased cholesterol -inverse relationship between dosage and sedation -Prego C -Lactation L3
NMS symptoms known to occur first
-altered sensorium -hyperthermia -hyperreflexia
ODD
-an enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior lasting at least 6 months with at least 4 of the associated symptoms (loses temper, touchy or easily annoyed, angry or resentful, argues with authority, actively defies or refuses to comply with request or rules from authority figures, blames others, deliberately annoys others, spiteful or vindictive)
DSM MDD diagnostic criteria
-anhedonia or depressed mood or both -depressed mood most of the day, nearly every day, as indicated by subjective reports or observations of others (irritability in kids) -marked anhedonia in all or almost all ADLs -at least 3 or more significant symptoms present during the same 2 week period that represent a change in previous functioning -weight loss/gain of more than 5% of body weight -hypersomnia or insomnia nearly every day -psychomotor agitation or retardation -fatigue or loss of energy -self-deprecating comments or thoughts -feelings of worthlessness or excessive or inappropriate guilt nearly every day -decreased concentration and memory -symptoms that begin within 2 months of significant loss and do not persist beyond 2 months is bereavement not MDD
glycine
-another inhibitory neurotransmitter -works with GABA
TCA side effects
-anticholinergic -antiadrenergic -antihistaminergic -EKG changes and cardiac dyshrythmias possible -unsafe in many co-occurring disorder such as cardiac disease -significant discontinuation syndrome
clinical management of craving
-anticraving meds such as naltrexone (revia), acamprosate (campral), ondansetron (zofran), or buprenorphine (buprenex)
norepinephrine symptoms of excess
-anxiety, hyper alertness, increase startle, paranoia, decreased appetite -anxiety
cluster C personalities
-anxious -avoidant personality disorder -dependent personality disorder -obsessive-compulsive personality disorder
schizophrenia presence of neurological nonlocalizing soft signs
-astereogonosis -twitches, tics, rapid eye blinking -dysdiadochokinesia - impaired fine motor movement -left-right confusion -mirroring
negative rewards in substance abuse disorder
-aversive, such as increased anxiety and dysphoria -mediated by GABA pathways
sleep hygiene
-avoid computer and other electronic devices for 1 hour before bedtime -never lie in bed for more than 15 minutes if not able to sleep -avoid late-in--the-day exercise intensive
avoidant personality disorder
-avoidance of activities involving significant interpersonal contact -fear of criticism, disapproval, or rejection -unwillingness to be involved with people unless sure of being liked -restraint in intimate relationships for fear of being shamed -preoccupation with being criticized or rejected in social settings -view of self as socially inept, personally unappealing, or inferior -unusual reluctance to take personal risks or engage in new activities
conduct disorder nonpharm management
-behavior therapy is mainstay -individual therpay -family therapy
Tardive Dyskinesia tx
-best tx strategy is prevention through careful monitoring -if present, tx by reducing current dose or change client to atypical agent
clonidine role in opioid withdrawal
-binds alpha 2 autoreceptors -decreases locus coeruleus cell firing -reduces noradrenergic release
binge eating disorder
-binging occurs at least 2 days weekly for 6 months
monoamines
-biogenic amines -dopamine -norepinephrine -epinephrine -serotonin
carbamazepine in BP
-black box warning agranulocytosis and aplastic anemia
valproic acid/divalproex sodium in BP
-black box warning for hepatotoxicity and pancreatitis
Lamotrigine in BP
-black box warning for serious rash
alcohol dependence and abuse produce characteristic lab findings
-blood alcohol level >100mg/dL outpatient; >150mg/dL anytime with symptoms; >300mg/dL any time -aspartate transaminase (AST)/ alanine transaminase (ALT) ration >2.0 -elevated glutamyltransferase, mean corpuscular volume, prothrombin time, uric acid, total cholesterol, and triglycerides -decreased magnesium, calcium, potassium, BUN, hemoglobin, hematocrit, platelet count, and albumin
bulimia nervosa
-both binge eating and inappropriate compensatory behaviors occur at least twice weekly for 3 months
anorexia nervosa physical exam findings
-bradycardia -hypotension -ECG changes (inversion of t-waves, ST segment depression, prolonged QT interval) -peripheral edema -hypertrophy of salivary glands -russells sign
modafinil (provigil)
-can effectively treat hypersolomnence and fatigue in depression (off label) -can rarely cause Steven Johnson's syndrome -can cause rashes -FDA for excessive sleepiness associated with narcolepsy, OSA, and shift work sleep disorder
Loxapine (Loxitane)
-capsule, liquid -20-250mg/day -SE: high- EPSE -SE: moderate- sedation, hypotension -SE: low- anticholinergic -FGA
epinephrine
-catecholamine -produced by the adrenal glands -referred to as the adrenergic system
norepinephrine
-catecholamine -produced in the locus ceruleus of the pons -precursor is tyrosine -major neurotransmitter implicated in mood, anxiety, and concentration disorders -Alpha 1 and 2 receptors
dopamine
-catecholamine -produced in the substantia nigra and ventral tegmental area -precursor is tyrosine -removed from synaptic cleft by monoamine oxidase (MAO) enzyme action -D1-like and D2-like receptors
Lewy body disease
-caused by Lewy inclusion bodies in the cortex -presents with recurrent visual hallucinations -parkinson features (bradykinesia, cogwheel rigidity, tremor) -adversely react to antipsychotics
diagnostic criteria for substance withdrawal
-cessation or reduction in substance use that has been heavy or prolonged -2+ of the following symptoms within several hours or days of reduction or cessation of the substance (hand tremor, insomnia, autonomic hyperactivity [sweating, increased HR, increased BP], N/V, hallucinations or illusions, psychomotor agitation, anxiety, seizures)
abstraction in children
-children ages 12 and younger are not expected to have abstractive thought abilities -young children have concrete thinking
Rivastigmine tartrate (Exelon) in dementia
-cholinesterase inhibitor -1.5-6mg BID -increase gradually to avoid nausea -indicated for mild-mod alzheimers disease and Parkinson's disease dementia -transdermal: 4.5, 9.5, 13.3mg/24 hour patch -retitrate if lapse in tx occurs
Donepezil (Aricept) in dementia
-cholinesterase inhibitor -5-10mg/day -approved for mild, mod, and severe Alzheimers dx -SE: common- N/V, diarrhea, appetite and weight loss, abnormal dreams, insomnia, dizziness
sjorgren's syndrome
-chronic autoimmune disorder -decreased function of salivary and lacrimal glands -dry eyes, dry mouth, enlargement of parotid gland -test for a positive anti-nuclear antibody test (ANA test) 70% -can also test ESR, CBC, rheumatoid factor, and anti-alpha fodrin antibody -diagnosis by salivary gland biopsy
cyclothymic disorder
-chronic, fluctuating mood dx with symptoms similar but less severe than BP -numerous periods of hypomanic and dysthymic symptoms -often regarded by others as temperamental, moody, unpredictable, inconsistent, and unreliable -no psychotic episodes
Persistent Depressive Disorder (Dysthymia)
-chronically depressed mood that occurs for most of the day, more days than not, for at least 2 years -prominent presence of low self esteem, self criticism, and a perception of general incompetence compared to others -less common symptoms: alteration in appetite and sleep-rest patterns
dementia due to HIV disease
-classified as subcortical dementia -parenchymal abnormalities visualized on MRI scan -HIV associated neurocognitive dx or HIV encephalopathy less severe forms -HIV can cause many psych symptoms -manifests by progressive cog decline, motor abnormalities, and bx abnormalities -co-occurs with OCD, PTSD, GAD, depression, and mania -poor prognosis- death w/in 6 months -psych symptoms usually occur in late-stage infection
schizophreniform dx
-closely resembles schizophrenia -2 differences -Total duration of illness at least 1 month but less than 6 months including prodrome, active illness period, and residual symptom phase -does not require impaired social or occupational functioning for diagnosis, although may be present
hepatic encephalopathy
-confusion, alerted LOC, and coma as result of liver failure -severity grades with West Haven criteria -focal neurological signs are less common in males
Freud's Id
-contains primary drives or instincts -drives are largely unconscious -operates on the pleasure principle -"I want"
TBI diagnostic and lab findings
-conventional structural neuroimaging studies are typically normal in mild TBI
Serotonin syndrome tx
-d/c offending agents -supportive tx of symptoms mild symptoms such as restlessness may d/c with removal of agent, close monitoring and judicious use of benzos -severe symptoms constitute a medical emergency necessitating hospitalization and tx such as cyproheptadine, anticonvulsants, and autonomic support
neurobiological factors of eating disorders
-decreased hypothalamic norepinephrine activation -dysfunction of lateral hypothalamus -decreased serotonin
neurotransmitter dysfunction in personality disorders
-decreased levels of serotonin -elevated levels of norepinephrine -dysregulaiton of dopamine receptors
HIPPA provides federal legislation protects employed Americans by
-decreasing the chance of losing existing health insurance coverage -facilitating change from one health plan to another -facilitating purchase of individual or family insurance coverage if coverage is lost from an employers plan or no other health insurance coverage is available
anxiety neurobiological theory
-deficits in limbic system, midline brainstem area, sections of cortex -predispose to abnormal stress response, with hyperactivity of autonomic nervous system -problems with HPA axis -low levels of GABA
Freud's defense mechanisms
-denial -projection -regression -repression -reaction formation -rationalization -undoing -intellectualization -suppression -sublimation -altruism
2 schizoaffective dx subtypes
-depressive -bipolar
dementia lifespan considerations in children
-diagnosis not applicable until ages 4-6yo when cognition can be fully assessed -dementia in children usually presents as deterioration in functioning
dependent personality disorder
-difficulty making everyday decisions without excessive advise -needing others to assume responsibility for most areas of life -difficulty expressing disagreement -difficulty initiating projects by himself or herself -going to excessive lengths to obtain nurturing and support from others -urgent seeking of another relationship if a close relationship ends -unrealistic preoccupation with fears of being left alone
panic disorder diagnostic criteria
-discrete episode in which client experiences 4 or more symptoms having a sudden onset and peaking within 10 minutes of onset -after 1st attack, persistent concern over having another attack, worry over the consequences of initial attack, or a significant bx change related to attack -with high somatic sensations, clients are often sensitive to new somatic experiences or perceptions -often intolerant of or concerned with common side effects of medication tx
aversion treatment pharm
-disulfiram (Antabuse) -do not administer until person has been alcohol free for at least 12 hours -can elevate liver function tests, so monitor -may potentially induce mania in people with BP disorder
Benzos for sleep disorder
-do not use in OSA -flurazepam (Dalmane) -temazepam (restoril) -triazolam (halcyon)
nonbenzo hypnotics in sleep disorder
-do not use with OSA -zaleplon (sonata) -zolpidem (Ambien, Ambien CR) -Eszopiclone (Lunesta) -Rozerem -Suvorexant (Belsomra)
nigrostraiatal pathway
-dopamine has a reciprocal relationship with acetylcholine -when serotonin is blocked by the SDA, dopamine increases, therefore ACh decreased, which causes decrased EPSE (caused by increased ACh)
Tuberonfundibular pathway
-dopamine inhibits prolactin -the blockade of dopamine by SDAs cause prolactin to increase, causing galactorrhea and gynecomastia -hyperprolactinemia is associated with antipsychotics may cause sexual problems, galactorrhea, amenorrhea, gynecomastia, and bone demineralization in postmenopausal women not on estrogen
cluster B personalities
-dramatic, affective instability -antisocial personality disorder -borderline personality disorder -histrionic personality disorder -narcissistic personality disorder
norepinephrine symptoms of deficit
-dullness, low energy, depressive affect -depression
insomnia etiology
-dysfunction in sleep-wake circuits of the brainstem
MDD object loss theory
-early psychological developmental issues lay the foundation for depressive responses later in life -the accomplishment of the first stage of development in which the child is able to form relationships is normal -during the second stage of development, the child experiences traumatic separation from significant objects of attachment (usually a maternal object)
psychodynamic theory of personality disorders
-early separations problems -object relations theory -during development, child must accomplish 2 tasks: separation and individuation -failure results in disorders
assess for abnormal labs for NMS
-elevated CPK (creatinine phosphokinase) -elevated WBCs -elevated LFTs
what are postulated physiological disturbances that may explain some symptoms of panic
-elevated catecholamines in the CNS -abnormality of the locus coeruleus -carbon dioxide hypersensitivity -impairment of lactate metabolism
Schizophrenia structural neurobiology
-enlarged ventricles -smaller frontal and temporal lobes -reduced symmetry in temporal, frontal, and occipital lobes -cortical atrophy -decreased cerebral blood flow -hippocampal and amygdala, thalamus reduction -widened cortical sulci -diffuse decrease in volume of white and gray matter
The IOM Report: The Future of Nursing: Leading Change, Advancing Health was released in 2010. The ANA listed the following as goals of nurse advocacy consistent with this report.
-ensure that NPs are equal partners with physicians and other health care professionals in redesigning healthcare -collect and use data to inform workforce planning decisions and policy making decisions that affect creation of an affective healthcare workforce -reduce regulatory barriers, to enable RNs to practice to the full extent of their training and education -support higher education for nurses, including proposed requirements for RNs to attain a baccalaureate degree within 10 years of licensure
fetal alcohol syndrome characteristics
-epicanthal skin folds -low nasal bridge -short nose -indistinct philtrum -small head circumference -small eye openings -wide set eyes -thin upper lip
antipsychotic sexual side effect
-erectile dysfunction and impaired vaginal lubrication secondary to anticholinergic as well as alpha 2 receptor effects -impaired arousal and orgasm through dopamine blocking
TCA/MAOI sexual side effects
-erectile dysfunction and impaired vaginal lubrication secondary to anticholinergic effects
delusional dx subtypes
-erotomanic (leads to obsessive bx such as surveillance or stalking) -grandiose -jealous (usually seen in men) -persecutory -somatic -mixed
authorization bils
-establish laws or programs -can recommend dollar amounts in some cases -do not allocate funds or guarantee funding for programs
schizophrenia neurochemical alterations
-excess dopamine in mesolimbic pathway -decreased dopamine in mesocortical pathway -excess glutamate -decreased gama-aminobytyric acid (GABA) -decreased serotonin
GAD
-excessive worry, apprehension, anxiety about events or activities occurring more days than not for at least 6 months -symptoms worsen as life events stress the person
antisocial personality disorder
-failure to conform to social norms -repeated acts that are grounds for arrest -deceitfulness, lying, and use of aliases for profit or pleasure -impulsivity and failure of future planning -reckless disregard for the welfare of others -consistent irresponsibility -lack of remorse, indifference to the feelings of others
Creutzfeldt-Jakob disease
-fatal and rapidly progressive dx -occurs mainly in middle age or older -initially manifests with fatigue, flulike symptoms, and cog impairment -later manifests with aphasia, apraxia, emotional lability, depression, mania, psychosis, marked personality changes and dementia -death within 6 months
insomnia risk factors
-female gender -advancing age
for panic disorder, consider general medical disorder if
-first episode panic attack symptoms occur after 45yo -panic symptoms are atypical such as: vertigo, loss of consciousness, incontinence, headache, slurred speech, amnesic pattern after attacks
TBI nonpharm management
-follow up for 1 year after anyone with TBI makes suicide attempt -treat vestibular dysfunction with PT to reduce dizziness -treat traumatic vision syndrome with OT, scanning and accommodation difficulties lead to headaches, irritability, and fatigue -treat memory impairment with OT to teach memory improvement skills
borderline personality disorde
-frantic efforts to avoid real or imagined abandonment -pattern of unstable, intense interpersonal relationships -identity disturbances -impulsivity, often with self-damaging behavior -recurrent suicidal behavior -chronic feelings of emptiness -inappropriate, intensified affective anger responses -transient psychotic symptoms of paranoia and dissociation
anxiety psychodynamic theory
-freud -anxiety initially occurs in response to stimulation of birth and need of infant to adapt to changed environment -subsequent anxiety is from intrapsychic conflict -process of unconscious repression of sexual drive is at the core -conflict exists between instinctual needs of the id and the superego
lithium in BP
-gold standard for manic episodes -antisucidial effects -action unknown -rapid cycling rarely responds to monotherapy
narcissistic personality disorder
-grandiose sense of self-importance -preoccupation with fantasies of power, success, brilliance, and beauty -belief of self-importance and being special and unique -excessive admiration required -unreasonable expectations or sense of entitlement -interpersonally exploitative -empathy lacking -envy of others and belief that others envy them -arrogant and haughty behaviors
hight potentcy FGAs
-greater risk of EPSE -less risk of sedation and anticholinergic symptoms
low potency FGAs
-greater risk of sedation and anticholinergic side effects -less risk of EPSE
obstructive sleep apnea
-headache upon awakening is common -abnormally small nasopharynx, tonsillar tissue in children, obesity
anxiety interpersonal theory
-henry stack Sullivan -humans are goal directed toward attainment of satisfaction and security needs that are normally met in interpersonal interactions -anxiety is when needs are unmet -interpersonal conflict
schizophrenia brain abnormalities noted in functional studies
-hypofrontality -decreased cerebral blood flow and metabolism -diffuse hypometabolic action in cortical-subcortical circuitry
bulimia nervosa lab changes
-hypotension -bradycardia -hypokalemia -hyponatremia -hypochloremia -hypomagnesemia -metabolic acidosis or alkalosis -elevated serum amylase
schizotypal personality disorder
-ideas of reference -odd beliefs -magical thinking -unusual perceptual experiences -paranoid ideation -inappropriate or constricted affect -bx overtly odd, eccentric, or peculiar -few or no close friends -excessive social anxiety
what is true regarding standards of practice for nurse practitioners
-identification of expected outcomes is a standard of care for PMHNPs -the standard of practice for PMHNPs includes identification of consumer resources to assist consumers in appropriate use of mental health services
ASD prevalence
-imbalances of glutamate, serotonin, and GABA are thought to be implicated in causation -brain imaging studies of children revealed microscopic and macroscopic abnormalities of the amygdala, hippocampus, and cerabellum -decreased numbers of Purkinje cells in the cerebellum are thought to play a role in the development
atypical antipsychotic MOA
-in addition to dopamine blockade found in 1st gens, 2nd gen capitalize on the interplay between dopamine and serotonin -serotonin binds to 5HT2a heteroreceptors on dopamine neurons, thus further shutting off release of dopamine -dopamine release in the nigrostriatal, tuberoinfundibular, and mesocortical pathways is enhanced
ADHD subtypes
-inattentive type -hyperactive type -combined type
SGA black box warning
-increase in mortality in older adults with dementia-related psychosis
patient centered medical homes
-initiated by the centers of medicare and medicaid services in response to a mandate for provision of targeted, accessible, continuous, and family-centered care to medicare beneficiaries with chronic diseases that require regular monitoring and care
temazepam (Resotril) for sleep dx
-intermediate action agent
serotonin
-known as an indole -produced in the raphe nuclei of the brainstem -precursor is tryptophan -major neurotransmitter implicated in mood and anxiety disorders -5HT1a, 5HT1d, 5HT2, 5HT2a, 5HT3, 5HT4 receptors
children and adolescent sleep patterns
-large amounts of slow-wave sleep
ataques de nervios
-latino cultural syndrome -provoked by disruptions in family bonds -trembling, crying, screaming -in presence of others -relief after
negative schizophrenia symptoms
-less responsive to antipsychotics -better response to atypicals -caused by decrease dopamine in mesocortical pathway
flurazepam (Dalmane) for sleep disorders
-long lasting -may cause excessive drowsiness -avoid in older adults
EPSE risk factors
-long term neuroleptic tx -older age -female presence of mood or cognitive dx
differences in alcohol metabolism between men and women
-lower levels of alcohol dehydrogenase are present in the gastric mucosae of women compared to men -there is a lower total adjusted body water content in women's bodies compared to men
theory of cultural care
-madeline Leininger -regardless of the culture, care is the unifying focus and the essence of nursing
specific criteria needed to identify substance use as abuse
-maladaptive pattern of use occurring for at least a 12 month period of sustained use -must be accompanied by repeated failure to fulfill major role obligations -must be accompanied by use in situation that presents as physically hazardous, such as drinking and driving -abuse continues despite multiple problems related to substance use patterns, such as legal, interpersonal, or social problems
TBI prevention in military personnel
-mandatory post-deployment screening for all vets returning from combat
cholinesterase inhibitors in dementia
-may be initiated for mild to mod Alzheimers dx -can lead to modest clinical improvement in some clients, with studies showing 2-3 point improvement in MSE testing -tx only symptoms, slow loss of function, and may improve agitated bx -do not prevent pathological progression of dx -not effective in severe, end-stage dx -should stop if SE, usually NV, develop -commonly used (Donepezil [Ariciept] and Rivastigmine tartrate [Exelon])
delusional disorder prevalence and demographics
-mean onset 40yo -men more likely to have paranoid delusions -women more likely to have delusions of erotomania
Rozerem
-melatonin receptor agonist
four dopaminergic pathways
-mesocortical -mesolimbic -nigrostriatal -tuberoinfundibular
antiretrovirals and protease inhibitors can interact with psych meds
-metabolized by P450 system or are CYP3A4 inhibitors
TBI cognitive disorders pharm recommendations
-methylphenidate (increase attention, processing speech, general cognitive function, learning, and memory) -dextroamphetamine (increase attention, processing speed) -bromocriptine (off label, possibly helpful in increasing executive function) -amantadine (off label, possibly helpful in increasing general cognitive function, attention, concentration)
benzo intoxication symptoms
-mild: agitation, confusion, drowsiness, blurred vision, dizziness -severe: resp depression, unresponsiveness, coma
Dopamine symptoms of excess
-mild: improved creativity, improved ability for abstract thinking, improved executive functioning, improved spatiality -severe: disorganized thinking, loose association, tics, stereotypic bx -schizophrenia, psychosis
ADHD physical exam findings
-minor physical anomalies at higher rates in people with ADHD than in the general population (hypertelorism, highly arched palate, low-set ears)
lithium-induced hypothyroidism
-more common in women -occurs in 5-35% pts treated with lithium -not a contra to lithium treatment -associated with higher rates of depression and rapid cycling
schizophrenia older adult considerations
-more women than men with rare late onset -although prodromal isolation, more often married -prognosis usually better, more responsive to meds d/t dominance of positive symptom cluster
mild TBI lifespan consideration
-most achieve full recovery within 3 months -if residual symptoms continue, 80-85% will learn within 6 months
delirium children considerations
-most common in febrile states -especially common with anticholinergic meds
dementia of Alzheimer's type (DAT)
-most common type -gradual onset and progressive decline without focal neurological deficits -hallmark amyloid deposits and neurofibrillary tangles
insomnia in children
-most commonly related to stress -often have been poor sleepers since birth -pharm tx not recommended for most children
CAGE screening test
-most commonly used screening tool for alcohol abuse -C- have you ever felt the need to Cut down on drinking -A- have people Annoyed you by mentioning your drinking -G- have you ever felt bad or Guilty about your drinking -E- have you ever had a drink the first think in the morning to steady your nerves or get rid of a hangover- Eye-opener
dementia memory impairment- immediate and intermediate
-most prominent feature of dx -usually earliest symptom -produces multiple deficits in daily functioning (unable to learn new info, forgets past info, loses valuables, forgets daily activities such as eating and dressing, becomes easily lost, has other cog deficits such as impaired executive functioning)
what are symptoms of macrocytic anemia due to b12 deficiency
-multi-segmented neutrophils -tingling and numbness in the feet -glossitis
benzo pharm tx of acute withdrawal
-mutliple daily doses of Benzos used according to a fixed schedule and gradually tapered down over several days (lorazepam [ativan], chlordiazepoxide [Librium], diazepam [valium], oxazepam [serax])
10 common alcohol withdrawal symptoms
-n/v -tremors -proxysmal sweats -anxiety -agitaiton -tactile disturbances -auditory disturbances -visual disturbances -headaches -altered sensorium
schizoid personality disorder
-neither desires no enjoys relationships -choses solitary activities -shows little to no interest in sexual activity with another person -derives no pleasure in social activities -lacks close friends or social supports -is indifferent of opinions of others -appears cold and detached -exhibits affective flattening
TBI pharm management
-no specific meds -tx-related symptoms -increased sensitivity to meds -low seizure threshold -start low and go slow
neuropeptides
-nonopioid type (substance P, somatostatin) -opioid type (endorphins, enkephalines, dynorphins) -modulate pain -Decreased amount of neuropeptides is thought to cause substance abuse - opioid type receptors: mu, kappa, epsilon, delta, sigma
rett syndorme hx assessment
-normal psychomotor development through the 1st 5 months after birth
anorexia nervosa lab changes
-normochromic, normocytic anemia -leukopenia -neutropenia -anemia -thrombocytopenia -hypokalemia -hypomagnesemia -hypoglycemia -decreased LH and FSH
dementia instruments for assessing level of impairment
-not in public domain (mini-mental state examination MMSE) -in public domain (Montreal cognitive assessment [MoCA], mini-cog, St Louis University Mental Status Examination [SLUMS])
intellectual disability physical exam findings
-oblique eye folds -small, flattened skull -large tongue -broad hands with stumpy fingers -single transverse palm crease -high check bones -brushfield spots on iris -cryptorchidism -abnormal finger and toe prints -congenital cardiac defects -early dementia -hypothyroidism
rapid cycling
-occurrence of 4 or more mood episodes during the previous 12 months -mood episodes are either major depressive or manic -other than occurring more frequently, mood episodes are same as nonrapid-cycling episodes -20% of people -most are women -identification is important -antidepressants may accelerate cycling -poorer prognosis
insomnia
-occurs at least 3 nights per week -present for at least 1 month (episodic insomnia disorder) and may persist for greater than 3 months (persistent insomnia disorder)
hyper somnolence disorder
-occurs at least 3 times per week and lasts for several months
Cluster A personalities
-odd, unusual, eccentric, asocial -paranoid personality disorder -schizoid personality disorder -schizotypal personality disorder
schizophrenia demographics men
-onset 18-25 yo -tend to have more negative side effects -tend to have poorer prognosis, more hospitalizations, and less responsiveness to meds
schizophrenia demographics in women
-onset 25-35 years -usually less premorbid dysfunction than men -usually experience more dysphoria than men -tend to have paranoid delusions and more hallucinations than men
conduct disorder demographics
-onset is earlier for boys 10-12 years than girls 16 years
intellectual disability
-onset must occur before 18yo -based on adaptive functioning NOT IQ scores
ASD incidence and demographics
-onset on symptoms before age 3 -about 10% of people with ASD also have a genetic or chromosomal conduction such as downs or fragile X
Suvorexant (Belsomra)
-orexin antagonist -suppresses wakefulness -must consider long half-life
phases of the nurse-client relationship
-orientation -working phase (identification, exploration) -termination phase (resolution)
Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study
-patients 18-65 -diagnosed with schizophrenia -assigned to olanzapine, perphenazine, quetiapine, risperidone, or (later) ziprasidone -primary outcome measure was all-cause treatment discontinuation -baseline data revealed that the rate of metabolic disturbance was higher than expected in recruited participants
williams syndrome
-patients often have elfin faces and starburst irises -common comorbidities are anxiety and depression -patients typically have supravalvular aortic stenosis, renal artery stenosis, and HTN -a genetic deletion occurs at chromosome 7
Bipolar diagnostic criteria
-period of abnormally or persistent elevated, expansive, or irritable mood lasting for at least 1 week -mood episode has rapid development and escalation of symptoms over a few days -often precipitated by significant environmental stressor -mood disturbance may result in brief psychotic symptoms -manic episodes last days to several months -briefer duration and ending more abruptly tan major depressive episodes -60% of people, a major depressive episode immediately precedes or follows a manic episode -persistent symptoms of mania -recurrent shifts on polarity -expansive or elevated mood symptoms
ASD
-persistent deficits in social communication and social interaction across multiple settings associated with deficits -restrictive repetitive behavior
Acute intermittent porphyria
-phenothiazines are safe to treat psychosis -onset is between 20 and 50 years -classic triad: episodic/acute/colicky abdominal pain, motor polyneuropathy, psychosis
dissociative disorders causes
-physical: seizures, migraines, psychedelic drugs, alcohol -psych: severe anxiety and traumatic stress
schizophrenia clinical outcome mesure standardized rating scales
-positive and negative syndrome scale (PANNS) -brief psychiatric rating scale (BPRS) -scale for assessment of positive symptoms (SAPS) -scale for assessment of negative symptoms (SANS)
older adult schizophrenia risk factors
-postmenopausal states -presence of human leukocyte antigen -positive family hx
Benzos
-potentiate effect of GABA -use is associated with Alzheimers -longer half lives are more useful for continuous, moderate to severe anxiety or as bridge meds while waiting for efficacy of SSRI (klonopin, valium) -shorter half lives require more frequent dosing and have more severe withdrawal and rebound anxiety (xanex, Ativan)
the Maudsley method
-powerful integration of all schools into a single, manualized, empirically supported method. -treats anorexia nervosa
older adult schizophrenia symptoms
-predominance of positive symptoms -high levels of persecutory delusions and hallucinations -lower levels of disorganized bx -preservation of social and occupational interest -fewer negative symptoms
obsessvie-compuslive personality disorder
-preoccupation with details, rules, order, and organization -perfectionism that interferes with task completion -excessive devotion to work and productivity -overly conscientious, scrupulous, and inflexible on issues of morality -inability to discard worn-out or worthless objects -reluctance to delegate tasks or work with others -adoption of a miserly spending style toward self and others -rigidity and stubbornness
Medicare part D
-prescription drug benefits delivered through private plans with medicare
delusional dx
-presence of 1+ nonbizarre delusions lasting for at least 1 month -psychosocial functioning and daily bx not at all impaired except as they surround content of delusion -seldom any other symptoms; in rare cases may have hallucinations or mood disturbances
agoraphobia diagnostic criteria
-presence of anxiety related to fear of developing panic-like symptoms -never met criteria for panic disorder -avoidant bx as a result of anxiety
delusional dx hs assess for the following
-presence of delusion (well organized and potentially believable) -any usual bx is explainable if content of delusion understood
OCD diagnostic crtieria
-presence of either obsessions or compulsions -person recognizing that the obsession or compulsion is excessive or unreasonable -causing marked distress, time consuming, or interferes with normal daily activity
N-methyl D-aspartate glutamate receptor agonists in dementia tx
-prevent overexcitation of glutamate receptors and stabilize the neurodegenerative process -Memantine (Namenda)
rett syndrome indicence and demographics
-primarily in girls -usually associated with intellectual disability
kindling
-process of neuronal membrane threshold sensitivity dysfunction -long-lasting, epileptogenic changes induced by daily subthreshold brain stimulation -brain becomes overly sensitive to electrical stimuli -neuronal misfiring occurs -process becomes automatic; neuronal firing occurs even without stimuli
appropriation bills
-provide spending authority for a single fiscal year (October 1-september 30) -usually originate in house of reps
the consolidated omnibus budget reconciliation act COBRA
-provides for the continuation of preexisting group health insurance (from the employer) for persons who lose coverage, whether between jobs, if they quite a job, or are fired. -coverage continuation is extended for a fixed period of time
freud's ego
-rational mind, logical and abstract thinking -"I think, I evaluate"
The lead principle of plans for transformation of mental health care in paradigms such as SAMSA, NAMI, the IOM, and the President's New Freedom Commission is...
-recovery -emphasizes the reawakening of hope, engagement in life, and empowerment over illness
structural abnormalities of personality disorders
-reduced gray-matter volume in prefrontal cortex -limbic system deregulation
confidence interval
-reflect a range of values within which one can be confident that the true value is situated -wider confidence intervals are usually based on smaller sample sizes and fewer number outcome events and indicate less precision in estimate of effect
positive schizophrenia symptoms
-respond well to antipsychotics -excess or distortions of normal brain functioning -caused by increased dopamine in mesolimbic pathway
bulimia nervosa physical exam findings
-russells sign -hypertrophy of salivary glands -rectal prolapse
ASD screening
-screened for developmental delays at well-child visit -modified checklist for autism in toddlers M-CHAT -autism diagnostic observation schedule-generic ADOS-G -ages and stages questionnaires ASQ
Vascular dementia (VD)
-second most common type -formally called multi-infarct dementia -primarily caused by CVD and characterized by step-type declines -most common in men with preexisting high blood pressure and cardiovascular risk factors -Hallmarks carotid bruits, fundoscoptic abnormalities, and enlarged cardiac chambers
contras to calcium channel blocker use
-second or third degree heart block -bradycardia -congestive heart failure
ADHD prevention
-secondary prevention is important in young clients
NMS tx
-seek immediate medical care -d/c antipsychotic meds -administration of Dantrolene (Dantrium) or bromocriptine (Parlodel) for antipsychotic induced dopamine receptor blockade -Acetaminophen (antipyretic) and cooling blanket for hyperthermia -IV hydration -Benzo for muscular rigidity (catatonic symptoms)
Rett syndrome associated features
-seizures -stereotypic hand movements
Freud's superego
-sense of conscience or right vs wrong -develops around age 6 -"I should or ought"
Triazolam (Halcion) for sleep dx
-short acting agent -little to no excess sedation -common SE: impaired memory, efficacy decreases over time, should not be used long term
Zolpidem (Ambien, Ambien CR)
-short half life drugs -may affect person the next morning -must allow for 8 hours before planned awakening -give on empty stomach
NREM stages 3 and 4
-slow-wave sleep period -deepest level of sleep -20-25% of total sleep cycle
NREM stage 2
-specific EEG waveforms -50% total sleep cycle
sleep stages are organized and sequential during sleep period
-stages 3 and 4 tend to occur in first 1/3 to 1/2 of sleep period -REM occurs cyclically throughout the night, alternating with NREM on average every 80-100 minutes -REM increases in duration toward morning
carbamazepine autoinduction
-stimulates the transcriptional up regulation of genes involved in its own metabolism -autoinduction of CYP34A and 2B6 -usually complete 3-5 weeks after the initiation of a fixed dose when taken consistently
Huntington's Disease
-subcortical type of dementia -characterized by motor abnormalities (choreoathetoid movements) -psychomotor slowing and difficulty with complex tasks -memory, language, and insight usually intact until late stages -high incidence of depression and psychosis
Asenapine (Saphris)
-sublingual; 5-10mg BID -SE: akathisia, somnolence -monitor BMI, AG, WT, serum lipids/glucose -assess family/personal hx CVD dx -SGA
antiseizure meds in acute withdrawal
-such as carbamazepine (tegretol) and valproic acid (depakene) -sometimes used to decrease seizure potential
Medicare Part B
-supplemental medical insurance program -funded by general revenues and beneficiary premiums -helps to pay output, home health, and preventative services
ADHD into adulthood
-symptoms of inattention usually remain with a decrease in impulsive and hyperactive symptoms
schizoaffective dx hx assess for the following
-symptoms of schizophrenia (2 + of the following frequently present during a 1 month period: delusions, hallucinations, disorganized speech, grossly disorganized bx, presence of negative symptoms but usually less severe than in those with schizophrenia) -symptoms of 1+ mood dx (MDD, manic episode, mixed-mood episode) -presence of delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms
Aripiprazole (Abilify)
-tablet 5-30mg/day -injection (Acute); 5.25-15mg IM -injection (monthly); 200-400mg -SE: headache, agitation, anxiety, insomnia, somnolence, akathisia, GI problems -partial agonist of D2 receptors -monitor BMI, AG, WT, serum lipids/glucose -assess family/personal hx CVD dx -SGA
Clorpromaizne (Thorazine)
-tablet, SR, liquid -50-2000mg/day -SE: high- sedation, hypotension -SE: moderate- EPSE, anticholinergic -allergic dermatitis -photosensitivity -ECG changes- QTc monitoring -FGA
Trifluoperazine (Stelazine)
-tablet, injection -5-80mg/day -SE- High- EPSE -SE- low- anticholinergic, sedation, hypotension -FGA
Molindone (Moban)
-tablet, liquid -50-225mg/day -SE: high- EPSE -SE: low- anticholinergic, hypotension -SE: very low- sedation -little or no weight gain -FGA
Thioridazine (Mellaril)
-tablet, liquid -50-800mg/day -SE: high- anticholinergic, sedation, hypotension, prolonged QT interval -SE: low- EPS -ECG changes, QTc monitoring -irreversible retinal pigmentation at doses >800mg/day -decreased libido -retrograde ejaculation -FGA
Mesoridazine (Serentil)
-tablet, liquid, injection -100-400mg/day -SE: high anticholinergic, sedation, hypotension -SE: low EPSE -ECG changes- QTc monitoring -FGA
Haloperidol (Haldol)
-tablet, liquid, injection -2-40mg/day -50-300mg IM Qmonth (deconate) -SE: very high- EPSE -SE: high- anticholinergic, sedation -SE: low-hypotension -In older adults, monitor for oculogyric crisis and pneumonia -FGA
Fluphenazine (Permitil, Prolixin)
-tablet, liquid, injection -2-40mg/day, 12.5-75mg/IM Q2 weeks (deconate) -SE: very high- EPSE -SE: low- anticholinergic, sedation, hypotension -FGA
Perphenazine (Trilafon)
-tablet, liquid, injection -8/64mg/day -SE: high- EPSE -SE: low- anticholinergic, sedation, hypotension --FGA
ziprasidone (Geodon)
-tablets; 40-200mg/day -Injectable 10-20mg acute tx -SE: common- hypotension, sedation, dizziness -SE: rare- prolongation of QTc interval, skin reaction, drug reaction with eosinophilia and systematic symptoms (DRESS) -Requires QTc monitoring -avoid coadministration with other drugs known to prolong QTc -take with food increases absorption twofold -use with caution when administering with clients at risk for hypokalemia, hypomagnesemia, after MI, or with DHF -monitor BMI, AG, WT, serum lipids/glucose -assess family/personal hx CVD dx -SGA
Rett syndrome
-the development of specific deficits following a period of normal functioning after birth
two drives for behavior in interpersonal theory
-the drive for satisfaction -the drive for security
a patient with medicare qualifies for hospice care if
-the pt has medicare part a -has a terminal diagnosis -2 physicians certify that the pt has less than 6 months to live if the illness runs its typical course
nonpharm treatment for ODD
-therapy is mainstay -evidence based treatment -child and parent problem-solving skills training -incredible years (group intervention) -parent-child interactional therapy (individual or family intervention) -adolescent transitions program (ATP; individual or family and group intervention)
lamictal dosing considerations
-titrate slowly: 25mg PO QD for 2 weeks, then 50mg PO QD for 2 weeks etc -concomitant use with divalproex may double lamotrigine level and should be factored into dosing -concomitant use with carbamazepine may increase metabolism and should be factored into dosing
Mini Mental Status Exam MMSE scoring
-total score 30 -25-30 questionable significant -20-25 mild impairment -10-20 moderate impairment -10 or lower severe impairment
NREM stage 1
-transitional stage from wakefulness to sleep -5% of normal sleep cycle
general health maintenance for alcohol dependance
-treat vitamin deficiencies such as thiamine, folic acid, and B-complex vitamins
Malan's therapy model
-triangle of conflict and triangle of persons theories -defense work -forming a portrait to resolve dynamic pathologic defenses
dementia related depression tx
-tx for 6-12 months then attempts to taper -depression may reoccur and need to be tx as a chronic condition -may have less depression as dementia progresses and they become less aware
Zalplon (Sonata) for sleep dx
-ultra short half life makes this particularly useful for initial or middle-phase insomnia
histrionic personality disorder
-uncomfortable in situations in which they are not center of attention -interactions with others characterized by inappropriate seductive or sexualized or provocative behavior, rapid shifting, and shallow emotional responses -consistent use of physical appearance to draw attention to self -speech excessively impressionistic and lacking in detail -suggestible and easily influenced -relationships considered more intimate than they are
glutamate
-universal excitatory neurotransmitter -major neurotransmitter involved in process of kindling (implicated in sz dx and bipolar dx) -imbalance implicated in mood dx and schizophrenia -AMPA and MNDA receptors
personality disorder lifespan considerations
-unusual for someone to be given a personality disorder diagnosis before ages 16-18 -an exception is antisocial personality disorder, which is often observable by onset of puberty, however, diagnosis of antisocial personality disorder is not made until age 18
antidepressants for sleep dx
-used for sedation properties -amitriptyline (Elavil), doxepin (Sinequan, Silenor); generally avoid in older adults -mirtazapine (Remeron) -Trazodone
adrenergic meds in acute withdrawal
-used to decrease blood pressure and pulse rate associated with withdrawal
clinical institute withdrawal assessment for alcohol (CIWAA)
-used to determine likelihood for withdrawal and delirium tremens (DTs), which usually occur within 24-72 hours after cessation of alcohol -10 symptoms -each symptom graded on 0-7 point scale with exception of orientation and sensorium which are graded on a 0-4 point scale -the higher the total score (max 67), the more likely the person will experience severe withdrawal and DTs -0-9 absence or very mild withdrawal -10-15 mild withdrawal -16-20 moderate withdrawal -21-67 severe withdrawal and possible DTs
typical antipsychotics MOA
-useful for treating positive symptoms by blocking dopamine in mesolimbic pathway -can make negative symptoms worse by blocking dopamine in mesocortical pathway -therapeutic effect related primarily to D2 receptor blockade
schizophrenia presence of neurological localizing hard signs
-weakness -decreased reflexes
fluconzaole (diflucan) and warfarin interaction
-will cause elevated INR -fluconzaole is a potent CYP29 inhibitor -CYP29 Metabolizes warfarin
Freud's psychosexual stage of development oral stage age
0-18 months
sensorimotor age
0-2
Hamilton Depression Rating Scale Scoring
0-7 no depression 8-13 mild depression 14-18 moderate 19-22 severe 23+ very severe
CIWAA scale interpretation
0-9 absent or very mild 10-15 mild withdrawal 16-20 moderate withdrawal 21-67 severe withdrawal
Beck depression scale scoring
0-9 not depressed 10-18 mild-mod 19-29 mod-severe 30-63 severe
lithium therapeutic plasma level
0.8-1.2mEq/L for Eskalith 0.6-1.2mEq/L for Lithobid
Free thyroxine T4 normal levels
0.8-2.8ng/dL
pancreatitis occurrence with used with valproic acid
1 in 6000 patients
how long must symptoms be present in children and teens to be diagnosed with cyclothymic disorder
1 year
prevalence of antisocial personality disorder in females
1%
dissociative identity disorder prevalence
1% general population 3% psych inpatients
Recommended clozapine cut off points for discontinuation for granulocyte counts are
1,000-1,500
response to tx with lithium or anticonvulsant med is in
1-2 weeks
Erikson's developmental stage early childhood age
1-3 yo
what % of patients with neurologic problems have conversion symptoms
1-3%
PHQ9 scoring
1-4 minimal depression 5-9 mild 10-14 moderate 15-19 moderately severe 20-27 severe
illness anxiety disorder prevalence percentage
1-5%
persons with a first degree relative with MDD have what more likely hood of developing MDD than the general public
1.5-3x more likely
what percentage of children with divorced parents have psychological trauma
1/3
corprolalia is present in what % of tourettes
10%
prevalence of borderline personality disorder in psych outpt
10%
according to the APA practice guidelines on bipolar disorder, what is the completed suicide rates in patients with BP I
10-15%
what % of teens with recurrent MDD will develop bipolar I
10-15%
prevalence of paranoid personality disorder among psych inpatients
10-30%
SLUMS (st louis university mental status)
11 items orientation, short term memory, calculations, naming of animals, clock drawing, recognition of geometric figures 0-30 score 27-30 normal 21-26 mild 0-20 dementia no cost detects earlier cognitive deficit than MMSE more limited study of validity and reliability than MMSE
Piaget developmental stage formal operations age
12 years-adult
Sullivan's stage of interpersonal development early adolescence age
12-14 years
Erikson's developmental stage adolescence ages
12-20yo
Sullivan's stage of interpersonal development late adolescence age
14-21 years
what % of the population meets criteria for 1+ personality disorders
15%
due to agranulocytosis risk, a pts baseline ANC level must be greater than what to treat with clozapine
1500
to diagnose tourettes disorder, symptoms must be present before what age?
18
Sullivan's stage of interpersonal development childhood age
18 months- 6 years
Freud's psychosexual stage of development anal stage age
18 months-3 years
Schizophrenia typical age onset
18-25 for men 25-35 for women
what is the mean age of onset for first manic, hypomanic, or major depressive episode in BPI?
18yo
Tarasoff Principle
1976 - duty to warn victims of potential harm from client
1mg of xanex equals how many mg of Ativan
2
Recommended clozapine cut off points for discontinuation for WBC blood counts are
2,000-3,000
what is the 12 month prevalence of panic disorder among adults and teens in the US
2-3%
Piaget developmental stage preoperational age
2-7 years
rate of malformations among fetuses exposed to SSRIs
2.6%
what percentage of bereaved people meet criteria for MDD
20%
normal BMI
20-25
Erikson's developmental stage early adulthood ages
20-35 years
lifetime prevalence of anxiety disorders in the US
25-35%
what percentage of time do nurse managers spend dealing with conflict
25-40%
overweight BMI
26-29
according to the DSM 5, how many non-overlapping symptoms must be present to include the "mixed features" specifier in the diagnosis of an episode of MDD, mania, or hypomania?>
3
long term inpatient care usually requires a minimum of
3 months
schizotypal personality disorder occurs in what percent of the population
3%
when unipolar patients are treated with an antidepressant, the rate of experiencing a switch to mania is estimated to be what
3-4%/year
Freud's psychosexual stage of development phallic stage age
3-6 years
Erikson's developmental stage late childhood age
3-6yo
obese BMI
30-35
Erikson's developmental stage middle adulthood ages
35-65 yo
Latuda calorie recommendation
360
by what age is the process of absorption and transportation of drugs comparable between children and adults
4 months
the teratogenic effects of valproate occur at what point in gestation
4-5 weeks
what percentage of the population has obsessive compulsive personality disorder
5-10%
AST normal range
5-40 u/L
Valproci acid/ divalproex sodium therapeutic plasma level
50-125mcg/mL
what differentiates SGAs meds form FGAs
5H2a receptor antagonist properties (FGA meds block d2 receptors; SGAs block D2 receptors and have 5H2a antagonist properties)
what substance is often found in lower concentrations in the CSF of violent, impulsive criminals
5HIAA
What is the MOA of sumatriptan?
5HT1D and 5HT1B Agonist
what serotonin receptor antagonism makes an antipsychotic "atypical"?
5HT2A
carbamazepine therapeutic plasma level
6-12 mcg/mL
Erikson's developmental stage school-age ages
6-12yo
Sullivan's stage of interpersonal development juvenile age
6-9 years
what percent of people with specific learning disorder with impairment are male
60-80%
what is the maximum dose of divalproex
60mg/kg/day
Standard deviations from the mean
68-95-99.7 for 1 2 and 3
Freud's psychosexual stage of development latency stage age
6years-puberty
Piaget developmental stage concrete operations age
7-12 years
ALT normal range
7-56 u/L
Sullivan's stage of interpersonal development preadolescence age
9-12 years
according to the CDC, what % of school aged kids are diagnosed with ADHD
9-12%
normal serum creatinine
<1.5mg/dL
Erikson's developmental stage late adulthood age
>65yo
pneumacococal vaccine for older adults
>65yo or with chronic lung conditions, chronic CVD, DMII, chronic renal disease, chronic liver disease, chronic alcohol use disorder, and immunocompromising conditions= PPSV23 <65yo = PPSV13
MOA of memantine
AKA Namenda NMDA receptor antagonist
you are treating a client with schizophrenia who takes clozapine. what lab values will indicate the client needs to d/c treatment?
ANC count of less than 1,000 uL
Cognitive therapy
Aaron Beck goal is to change clients irrational beliefs, faulty conceptions, and negative cognitive distortions
Erikson's developmental stage infancy indications of developmental mastery
Ability to form meaningful relationships, hope about the future trust in others
one of the health care changes that has occurred as a result of the affordable care act (ACA) is that doctors/hospitals/clinic groups or health systems are coming together and assuming the responsibility for quality care to large groups of individuals insured by Medicare. The health care clinics/systems doctors or hospitals that join together are called what?
Accountable Care Organization (ACO)
Isotretinoin
Accutane never to be used by someone pregnant or who may become pregnant can be stopped abruptly
what test is recommended by the WHO for ADHD screening in the general adult population
Adult ADHD self report screener
behavioral therapy
Arnold Lazarus focus on changing maladaptive bx by participating in active bx techniques such as exposure, relaxation, problem solving, and role playing
5 As for health behavior change
Assess Advise Agree Assist Arrange
what increases likelihood that psych symptoms be determined by HIV infection
CD4 count <600
which CYP enzyme is implicated as a tobacco inducer when an individual is treated with clozapine
CYP 1A2
Cytochrome P450 System
CYP1A2, 2C9, 2C19, 2D6, 3A4, and 3A5 enzymes are responsible for metabolizing over 90% of drugs processed in the liver
AST>ALT MEANING
Chronic liver disease or recent MI
available resources that synthesize currently available research information
Cochrane review clinical practice guideline
delirium screening instrument
Confusion assessment method (CAM) instrument
pregnancy category A
Controlled studies show no risk
difference for criteria for delusional disorder in DSM 5
Criterion A for delusional disorder no longer requires delusions to be non-bizarre
DIGFAST bipolar
D distractability I indiscretion G grandiosity or inflated self esteem F flight of ideas or racing thoughts A activities increase S sleep deficit T talkativeness
Delirium cause mneumonic
D-rugs E-lectrolyte abnormality L-ow oxygen saturation I-nfection R-educed sensory input I-ntracranial U-rinary or renal retention M-yocardial
EPSE cause
D2 receptor antagonism -when dopamine receptors are blocked, ACh increases, which causes EPSE -a reciprocal relationship exists between Each and dopamine
The purpose of the American Nurses Association's Psychiatric-Mental Health Nursing: Scope and Standards of Practice is...
Define the Role and actions for the NP
theory of self-care
Dorothy orem -self care
agonist effect
Drug binds to receptors and activates a biological response
antagonist effect
Drug binds to the receptor but does not activate a biological response
inverse agonist effect
Drug causes the opposite effect of agonist; binds to same receptor
REM sleep
EEG activation, muscle atonia, rapid eye movements, muscle twitches, breathing irregularities
teratogenic risks of lithium (Eskalith)
Epstein anomaly
Deontological Theory
Ethical theory that states an action is judged as good or bad based on the act itself regardless of the consequences
Teleological Theory
Ethical theory that states an action is judged as good or bad based on the consequence or outcome
who coined the term schizophrenia
Eugen Bleuler
Principle of psychic determinism
Even apparently meaningless, random, or accidental behavior is actually motivated by underlying unconscious mental content
what is used to treat OD of Benzos
Flumazenil short half life needs careful monitoring to prevent recurrence of overdose symptoms
eye movement desensitization and reprocessing EMDR
Francine shapiro behavioral and exposure therapy PTSD goal to achieve adaptive resolution
psychoanalytic therapy
Freud promotes change by development of greater insight and awareness of maladaptive defenses
most common side effect of galantamine
GI disturbance (diarrhea/nausea)
GI SE of lithium
GI upset diarrhea vomiting cramps anorexia
interpersonal therapy
Gerald klerman and myrna Weissman evidence based therapy focus on interpersonal issues creating distress time limited, active, focus on the present and on interpersonal distress
MDD endocrine dysfunction theory
HPA axis result of abnormal stress response related to HPA dysregulation
in order to obtain reimbursement from medicare, the NP must learn how to use the...
Healthcare common procedure coding system HCPCS
therapeutic nurse-client relationship theory or interpersonal theory
Hildegard Peplau -first significant psych nursing theory -sees nursing as an interpersonal process in which all interventions occur within the context of the nurse-client relationship
what schedule drug are stimulants
II
what type of psychotherapy is the most studied and used for cluster C personality disorders
Individual psychotherapy
Jason misses several appointments. the PMHNP notes she feels resentful toward Jason and is struggling with how to respond when he finally comes in for his appointment. which statement demonstrates a therapeutic response?
Jason, help me understand what is going on so we can figure out how to proceed
who coined the term schizoaffective disorder
Kasanin
who started the first nurse practitioner program
Loretta ford
females with PTSD commonly have what comorbid diagnosis
MDD
process of quality improvement PDSA cycle
Plan Do Study Act
pregnancy category D
Positive evidence of isk
dimension reduction
Process of reducing the number of variables studied to focus on a smaller number
The Stark Law
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.
Mr. Smithers, an involuntary hospitalized patient experiencing psychotic symptoms, refuses to take any of his ordered medication because he believes "Jesus Christ told me I am the prophet and must fast for a year". Your actions should be based on your knowledge of what?
Psychiatric clients can refuse treatment
AIMs screening schedule for clients on FGAs
Q6months
REM and NREM
Rapid eye movement REM alternates with 4 distinct non rapid eye movement NREM stages
SIGECAPS
S sleep disorder I interest deficit G guild E energy deficit C concentration deficit A appetite disorder P psychomotor retardation S suicidality
mesolimbic pathway
SDAs block dopamine in this pathway, causing decreased positive symptoms
APA recommends admission when there is a presence of
SI and a co-morbid medical condition possibly contributing to the suicidal risk level
SSRIs can cause what side effect in the elderly
SIADH
common inhibitors
SICK/FACES.COM/G -sodium valoproate (valproic acid) -Isoniazid (INH) -Cimetidine -Ketoconazole -Fluconazole -Alcohol (binge amounts) -Cloramphenicol -Erythromycin -Sulfonamides -Ciprofloxacin -Omeprazole -Metronidazole -Grapefruit juice
citalopram (celexa) for treating caving and maintaining sobriety
SSRI Decreases desire
first line tx for first episode major depression with mild to mod symptoms
SSRIs
social anxiety disorder pharm
SSRIs Benzos for short term beta blockers for discrete episode relief
specific phobia pharm
SSRIs TCAs short term Benzos
First line agents for chronic anxiety disorders
SSRIs acts on serotonin system and indirectly on GABA system
personality disorder pharm management for affective instability
SSRIs anticonvulsant mood stabilizers
personality disorder pharm management for impulsivity
SSRIs anticonvulsant mood stabilizers
GAD pharm
SSRIs Buspar Benzos PRN
structural family therapy
Salvador minuchin main tx goal to produce structural change in the family organization to more effectively manage problems changing transactional patterns and family structure
MDD learned helplessness-hoplessness theory
Seligman -modified aspect of cognitive theory -a person becomes depressed due to perceptions of lack of control over life events and experiences -these perceptions are learned over time, especially as the person perceives others seeing him or her as inadequate
neurotransmitters involved in suppressing the HPA axis
Serotonin GABA
FDA treatment for PTSD
Sertraline Paroxetine (Venlafaxine-2nd line)
cardia SE of lithium
T-wave inversions dysrhythmias
second line drugs for treating MDD
TCAs
for dealing with symptoms of post-menopause such as nocturnal hot flashes, anxiety, depressed mood, low energy, little motivation, diminished sex drive, and work related stress; what complimentary therapies are evidence-based
Tai chi dietary soy flaxseed
ms. Thomas has been diagnosed with MDD an dis placed on fluoxetine 20mg for her depression. for the PMHNP to effectively monitor her use of the medication, which action should be part of ongoing care.
The use of a standardized rating scale of depression
what medication combo can extend the decreased craving for food
Wellbutrin and naltrexone
Bipolar rating scales
Young mania rating scale a daily mood chart
the role of neurotransmitters in the CNS is to function as
a communication medium
classical conditioning
a conditioned stimulus elicits a conditioned response due to its proximity to an unconditioned stimulus
according to the DSM5, which is true
a culturally expected response to a stressor is not a mental disorder
partialism
a fetishistic attraction to a specific part of the body
up coding
a fraudulent practice in which provider service is billed at higher procedure costs than were actually performed resulting in a higher payment by medicare or other third party payers
Current Procedural Terminology (CPT)
a list of identifying codes owned by the American Medical Association used to describe procedures
the PMHNP is tasked with continually improving the quality of care on an inpatient unit. the NP implements...
a plan-do-study-act process
with the publication of the 2003 report, Achieving the Promise: Transforming Mental Health Care in America, mental health professionals were first sensitized to the need for what
a recovery-oriented mental health system
continuous reinforcement
a reward is given every time the target responses occurs
Mrs. French has been in individual therapy for 3 months. She has shown much growth and improvement in her functioning and insight and is to discontinue services within the next few weeks. In the next session, after you discuss service termination, she suddenly begins to demonstrate the original symptoms that had brought her to treatment initially. She is now hesitant to discharge, wants to continue services and is displaying an increase in regressive defense mechanisms. The best explanation of Mrs. French's behaviors is
a sign of normal resistance to termination seen in the termination phase of therapy
Erikson's developmental stage middle adulthood indications of developmental mastery
ability to give time and talents to others, ability to care for others
Piaget developmental stage formal operations
ability to think abstractly thinking operates in a formal, logical manner
Erikson's developmental stage school-age indications of developmental mastery
ability to work; sense of competency and achievement
akinesia
absence of movement difficulty initiating motion subjective feeling of lack of motivation to move often mistaken for laziness or lack of interest
Pregnancy category X
absolutely contraindicated
cholinergics
acetylcholine
when working with an avoidant patient with a history of trauma, what type of communication techniques are helpful
activation is needed to allow memories stored in the amygdala to be processed
substance use disorder is synonymous with what
addiction
what neurotransmitter is involved in the promotion of sleep
adenosine
separation anxiety disorder occurs at what age
after age 4
Serotonin agonist and reuptake inhibitors SARIs act on
agonist of serotonin 5HT2 receptors and elevate serotonin levels
adverse reaction with mirtazipine use
agranulocytosis
tertiary prevention
aimed at decreasing the disability and severity of mental disorder rehabilitative services avoidance or postponement of complications
primary preventions
aimed at decreasing the incidence (number of new cases) of mental disorders helping people avoid stressors or cope with them more adaptively
secondary prevention
aimed at decreasing the prevalence (number of existing cases) of mental disorders early case finding screening prompt and effective tx
Clerambault syndrome
aka erotomania
P value
aka level of significance describes the probability of a particular result occurring by change alone if P=0.1, there is a 1% probability of obtaining a result by chance alone
tumors of the upper brain stem can cause what
akinetic mutism
what is propranolol contraindicated with
albuterol due to risk of CNS stimulation
the most frequently studied gene implicated in the development of substance use disorders encodes what substance
alcohol and aldehyde dehydrogenase
norepinephrine general function
alertness focused attention orientation primes fight or flight learning memory
AACAP practice parameter for forensic evaluations
all states require a response to a subpoena request
balanced budget act of 1997
allows direct reimbursement to nurse practitioners by medicare
what receptor does mirtazapine have effect
alpha-2 adrenergic antagonist
brief psychotic dx prognosis
always returns to premorbid level of functioning
meds that can cause false positives for cocaine
amoxicillin most antibiotics NSAIDS
stimulants
amphetamine/destroamphetamine (Adderall) dexmethylphenidate (focalin) dextroamphetamine (Dexedrine) methylphenidate (Ritalin) lisdexamfetamine dimesylate (Vyvanse)
the PMHNP evaluates at 3yo male and makes the diagnosis of ADHD. following the FDA labeling of approved medication for children, what medication can be started at a child age 3?
amphetamines (methylphenidate and guanfacine are approved for 6+yo) (fluoxetine and bupropion are 8+)
most individuals with intellectual disability profound have which condition
an identified neurological condition accounting for the intellectual disability
schizoaffective dx
an uninterrupted period of illness in which the person experiences psychotic symptoms similar to those seen in schizophrenia as well as mood symptoms similar to MDD or BP
2 sample t test
analyze continuous data from two separate samples with normal distributions
aspartate
another excitatory neurotransmitter -works with glutamate
blurry vision side effect in psychotropics
anticholinergic side effect Seroquel may cause cataracts
what lab test is frequently positive with systemic lupus erythematosus
antinuclear antibody
belladonna herbal use
anxiety
what is the demographics of transient tics
as many as 15% of boys ages 8-12 may have transient tics
Mrs. Shea has come to the mental health center seeking treatment for depression. She has a history of a suicide attempt by overdose one month ago. she was started on imipramine (TCA) after that event but stopped taking the med one week later because it "did no good." The PMHNP meets with Mrs. Shea to plan care with her. What is the most appropriate initial action?
asking mrs. shea how to help her
Mr. Jonas 65yo, has been stable on Celexa 20mg QDAY. he comes in for an appointment complaining that over the last 2-3 weeks he has had nausea, fatigue, feeling weak, with a headache and decreased appetite. what action is most appropriate?
assess for hyponatremia (Can occur on SSRIs and is common in elderly patients. he is reporting symptoms of moderate hyponatremia)
t test
assesses whether the means of two groups are statistically different from each other
definition of remission during acute phase of major depression
at least 3 weeks of absence of both sad mood and reduced interest and no more than 3 remaining symptoms of a major depressive episode
PTSD delayed onset
at least 6 months between traumatic event and onset of symptoms
Attachment relationships between an infant and mother are considered critical by neurobehavioral researchers because
attachment to significant relationships facilitates self-regulation of emotions
acetylcholine general function
attention, memory, thirst, mood regulation, REM sleep, sexual behavior, muscle tone
what is revealed by studies of hallucinations in schizophrenia
auditory hallucinations are due to an over activation of the temporal-parietal cortex
in forming a therapeutic relationship with clients, the PMHNP must consider developing many characteristics that are known to be helpful in relationship-building. which is an essential part of building a therapeutic relationship?
authenticity
a client with bipolar I disorder presents to your PMHNP office for a follow up visit. during the visit the client informed you that 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 medication 2 months ago and is here to thank you for your care and tell you that he no longer needs follow up appointments. understanding the ethical conflict, you use which of the following ethical principles in working with this client?
autonomy
Erikson's developmental stage early childhood developmental task
autonomy vs. shame and doubt
dementia genetic loading
autosomal dominant trait
what best describes homeostasis in a family system
balance or stability that the family returns to despite its dysfunction
Sean is a 47 yo gulf war vet who was in combat during operation desert storm. Sean has been treated by the PMHNP for MDD and associated anxiety symptoms. during the most recent visit, the PMHNP learns that sean sustained a TBI during his service, which was recently diagnosed at the TBI clinic at the VA. what is the rational for the PMHNP to taper him off clonazepam?
benzos cause memory problems and confusion in clients with a hx of TBI
med that can induce depression
beta blockers steroids interferon isotretinoin (Accutane) some retroviral drugs antineoplastic drugs benzos progesterone
Erikson's developmental stage infancy age range
birth-1 year
Sullivan's stage of interpersonal development infancy age
birth-18 months
Piaget developmental stage sensorimotor age
birth-2 years
Erikson's developmental stage late adulthood indications of developmental failure
bitterness, sense of dissatisfaction with life, despair over impending death
MOA of amphetamine and methylphenidate
both increase intrasynaptic levels in norepinephrine and dopamine
cluster analysis
breaks a large group into smaller groups so that each individual cluster is more homologous by some measure
CP450 inhibitors
bupropion clomipramine cimetidine clarithromycin fluoroquinolones grapefruit ketoconazole nefazodone SSRIs
anxiolytics
buspirone (buspar)
though process and content age of understanding
by age 4, children have some understanding of what is real or made up
von Recklinghausen disease physical characteristics
cafe au lait spots neurofibromas
CYP1A2 substrates
caffeine clozapine duloxetine imipramine olanzapine ramelteon amitriptyline
Tim is a board-certified PMHNP working in a busy community mental health center (CMHC). he is currently seeing a client diagnosed with BPI disorder who has comorbid hypertension and diabetes. during the visit, Tim takes the client's BP and her reading is 160/94mmHg. the client denies any headaches, nausea, chest pain, or shortness of breath. the client states I can't afford all these medications so I haven't seen my doctor in 7 months and I am out of all my blood pressure and sugar medications, can you give me some? what is times most appropriate action?
call the client's PCP, explain the situation, and coordinate the client getting an appointment and medication refills
a pmhnp who is working on the consult liaison service is referred to a patient in the medical intensive care unit by the attending hospitalist. the consult note read evaluate the patient for competency to make independent medical decisions and consent for a surgical procedure. based on the scope of practice of a PMHNP, which response would be most appropriate.
call the hospitalist and provide education that competency is a legal concept and explain that you can assess the patient for the capacity to make medical decisions
what substance or technique was first used to induce convulsions to treat psychiatric illness
camphor
caffeine and nicotine with antipsychotics
can diminish effect dose may need to be higher
concurrent administration of what medication is likely to decrease levels of valproic acid
carbamazepine
CP450 inducers
carbamazepine hypericum/ st johns wort phenytoin phenobarbital tobacco
meds that are safe while breastfeeding
carbamazepine valproic acid phenytoin phenobarbital primidone (klonopin=resp depression, lithium=ekg changes and toxicity, lamtictal=fatal rash)
steven Johnson syndrome med risk
carbamazepine or lamotrigine
humanistic therpay
carl rogers person-centered therapy self directed growth and self actualization people are born with capacity to direct themselves toward self actualization
how to treat antipsychotic induced parkinsonisms
cessation of the drug
shared psychotic disorder (Folie A Deux)
characterized by development of a delusion in a client who has a close relationship with another person who already has a psychotic disorder with a prominent delusion
CYP1A2 inducers
charcoal broiled beef tobacco marijuana omeprazole cruciferous vegetables modafinil
Piaget developmental stage concrete operations
child begins to use logic develops concepts of reversibility and conservation
Bowlby attachment theory
children who come from parents with high expressed emotion and unresolved losses tend to develop disorganized attachment characterized by not feeling safe with their caregiver and an inability to feel soothing comfort
Serotonin selective reuptake inhibitors SSRIs
citalopram (celexa) fluvoxamine (Luvox) paroxetine (paxil) paroxetine mesylate (pexeva) fluoxetine Prozac) sertraline (Zoloft) escitalopram (Lexapro)
Bipolar I
clinical history characterized by occurrence of 1 or more manic or mixed episodes
Tricyclics
clomipramine (anafranil) amoxapine (asendin) amitriptyline (Elavil) desipramine (norpramin) nortripyline (pamelor) doxepin (sinequan) trimipramine (surmontil) imipramine e(tofranil) protriptyline (vivactil)
a WBC count of 4,000 on clozapine would prompt the PMHNP to do what
closely monitor CBC with diff twice a week while continuing clozapine in absence of any other signs or symptoms.
second generation antipsychotics
clozapine (Clozaril) ziprasidone (Geodon) risperidone (Risperdal) quetiapine (Seroquel) olanzapine (Zyprexa) aripiprazole (abilify) paliperidone (Invega) iloperidone (fanapt) asenapine (saphris) lurasidone (luatuda)
ambiphilia
combination of both androphilia and gynephilia
ego-syntonic personality
comfortable
Erikson's developmental stage early adulthood indications of developmental mastery
committed relationships, capacity to love
MOA of amphetamines
competitive blockage of dopamine reuptake in the synaptic cleft dopamine and norepinephrine release from presynaptic nerve terminals
what sex hormone-related condition results in increased rates of homosexuality
congenital renal hyperplasia
Combo of MAOI and serotonergic agent
contra d/t serotonin syndrome risk
clomipramine toxicity symtpoms
convulsions and coma
central points to the international society of psychiatric mental health nurses vision of mental health care in the 21st century
creation of a consumer-based system -reduction of fragmentation of services -creation of a mental health workforce to carry out the transformation of mental healthcare delivery -emphasis to providing services to underserved populations (Children, teens, older adults)
nominal or categorial data example
cultural background variables
what is the most widely used tool for assessing the healthcare safety culture within an organziation
culture of patient safety assessment developed by AHRQ
high reliability organizations
culture of safety foster a learning environment and evidence-based care promote positive working environments for nurses are committed to improving safety and quality care
hypertensive crisis tx
d/c MAOI give phentolamine (binds with norepinephrine receptor sites, blocks norepinephrine) -stabilize fever
the PMHNP sees a 12yo pt who takes Vyvanse 50mg QD for ADHD. the NP observes a tic, which the patents report began after the pt began taking the stimulant, and it has been increasing in severity. both the parents and the school report that the med is helpful. the NP...
d/cs the stimulant and prescribes Intuniv and monitors the pt
important risk factor in postpartum psychosis when monitoring response to treatment
data suggest that an episode of postpartum psychosis is essentially an episode of a mood disorder, and is usually an indicator of bipolar disorder
spironolactone, estrogen, and steroid sexual side effects
decrease sexual desire secondary to decreased testosterone
goals of DBT
decrease suicidal bx decreased therapy interfering bx decrease emotional reactivity decrease self invalidation decrease crisis-generating bx decrease passivity increase realistic decision making increase accurate communication of emotions and competencies
enzyme inducers can
decrease the serum level of other drugs that are substrates of that enzyme possibly causing subtherapeutic drug levels
systemic effects of hypothyroidism
decreased T4 and increased TSH mimics symptoms of unipolar mood dx
neurotransmitters and symptoms with schizophrenia
decreased acetylcholine = cognitive decline increased norepinephrine in reward circuits = anhedonia increased serotonin = increase severity of both positive and negative symptoms increased dopamine = increase severity of positive symptoms
when treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which reason?
decreased protein binding
Sullivan's stage of interpersonal development childhood developmental task
delayed gratification
primary clozapine overdose symptoms
delirium lethargy tachycardia hypotension respiratory failure
ginkgo herbal use
delirium, dementia, sexual dysfunction caused by SSRIs
compassion fatigue symptoms
denial about problems excessive blaming holding in emotions isolating from others an unusual amount of complaints complaining about administration functions substance abuse used to mask feelings compulsive spending overeating gambling sexual addiction poor self care and hygiene
positive predictive value (PPV)
dependent on the prevalence of a disease in a population.
early-morning wakefulness is a possible sign of
depression
oral contraceptives, reserpine, alcohol, hydralazine, amantadine, Benzos, guanethidine, and clonidine can all cause what
depression
Ginseng herbal use
depression fatigue
Freud's psychosexual stage of development anal stage psych disorder linked to failure of stage
depressive disorder
3 phases of EMDR
desensitization phase installation phase body scan
MDD chronobiological theory
desynchronization of circadian rhythms produces the symptoms constellation collectively called MDD
characteristic of preoperational stage
development of imagination and symbolic thinking, including language
inductive reasoning
devleoping generalizations from specific observations
what amphetamine isomer is most rapidly eliminated from the body
dextro-isomer in acidified urine
social anxiety disorder
diagnosed only if symptoms persist longer than 6 months do NOT feel better or experience decreased anxiety when accompanied by a trusted companion
what benzo is most rapidly absorbed when taken orally
diazepam
brief psychotic disorder
disorder with sudden onset of psychotic symptoms lasting gat least 1 day but less than a month
delusional dx risk factors
disorders of the limbic system and basal ganglia
which known teratogenic effects can be causes by the common psychotropic medications divalproex and lithium?
divalproex-spina bifida lithium- Epstein anomoly
what neurotransmitter is thought to play a major role in social phobia
dopamine
what neurotransmitter promotes wakefullness
dopamine
what TCA has the highest concentration in breast mild
doxepin
carbamazepine/ valproic acid/divalproex sodium lab monitoring
drawn 1 week after start 12 hour trough serum drug level CBC LFTs
partial agonist effect
drug does not fully activate the receptors
what is true about pharmacologic treatment of anxiety in older adults
drugs that are highly oxidized are more unpredictable than drugs that are mostly conjugated (liver enzyme functioning among other things diminishes as we age)
drug steady state
drugs usually are administered once every half-life to achieve this it takes approx. 5 half lives to achieve a steady state and 5 half lives to completely eliminate a drug
anticholinergic side effects
dry mouth blurred vision constipation memory problems from muscarinic receptor blockade
sexual side effects with typical antipsychotics
due to effects on the alpha-2 receptors
what does medicare part B cover
durable medical equipment medically necessary services and supplies and preventative services
what four elements need to be present for a malpractice lawsuit to be filed?
duty of care, breach of standard of care, injury, and injury must be related to breach of standard of care
mixed state
dysphoric hypomania
MDD abnormalities of neurotransmitter function theory
dysregulation of dopamine, serotonin, and norepinephrine
what finding would be indicative of cortical dementia
early aphasia early difficulties in calculations normal speed of cognitive processing until late in the disease euthymic mood articulate speech until late in the disease normal motor speech and control absence of adventitious movements such as tremors/tics/dystonias
a client is displaying low self-esteem, poor self-control, self-doubt, and a high level of dependancy. these behaviors indicate developmental failure of which stage of development?
early childhood
ADHD typical age onset
early childhood (per DSM by age 12)
what finding would be indicative of a subcortical dementia
early gate disturbance (impaired coordination) slow cognitive processing depressed mood dysarthria bowed or extended posture slowed motor and speech control chorea tremor tics dystonia
TCAs in anxiety
effective but affect multiple receptors and have problematic side effect profiles
what lab values confirm an NMS diagnosis
elevated creatine phosphokinase (CPK) due to skeletal muscle breakdown elevated WBCs (leukocytosis)
what to watch for if on psychtropics such as carbamazepine (Tegretol) or clozapine
elevated temp agranulocytosis
MAOIs act on
elevating serotonin and norepinephrine levels
TCAs act on
elevating serotonin and norepinephrine levels
Erikson's developmental stage early adulthood indications of developmental failure
emotional isolation, egocentrism
Fay Abdella nursing theory
emphasizes the delivery of nursing care for the whole person to meet the physical, social, emotional, intellectual, and spiritual needs of the client and family
family life cycle
empty nesting finding new meaning or redefining meaning for life normal tasks include renegotiation of marital system as a dyad, development of adult-adult relationships between grown children and their parents, realignment of relationships to include in-laws and grandchildren, and dealing with disabilities and death of parents or grandparents
enzyme inhibition vs induction
enzyme inhibition is a faster process than enzyme induction
health care economics is concerned with making decisions so the benefits outweigh the cost of resource utilization. what are two concepts that healthcare economics is concerned with in regard to fair distribution of resources and allocation?
equity and efficiency
Virtue ethics
ethical theory that states actions are chosen based on the moral virtues (eg. honesty, courage, compassion, wisdom, gratitude, self-respect) or the character of the person making the decision
Wisconsin card sorting test
evaluates executive function
Assertive Community tx (ACT)
evidence based case management program for schizophrenia
Illness management recovery (IMR)
evidence based recovery program for schizophrenia
combined structural and functional testing
examine structure in conjunction with function mainly for research functional MRI fMRI 3D, event realted functional MRI 3fEMRI Fluorine magnetic spectroscopy Dopamine D2 receptor binding
what are overlapping symptoms of both ADHD and pediatric bipolar
excessive talking increased activity distractibility
magnesium is a cause of neuromuscular what
excitability
Freud's psychosexual stage of development phallic stage primary means of discharging drives and achieving gratification
exhibitionism, masturbation with focus on Oedipal conflict, castration anxiety, and female fear of lost maternal love
Therapy approach to increase awareness of choices and responsibility for consequences of choices
existentialism theoretical framework
Mrs. Kemp is voluntarily admitted to the hospital. After 24 hours she states she wishes to leave because "this place can't help me." The best action that reflects the legal right of this client is
explain that the client cannot leave until you can complete further assessment. (almost every state allows for a brief period of detainment to assess a client for dangerousness to self or others before allowing a client to leave a hospital setting, even if the admission was voluntary)
restless leg lab findings to check
ferritin level
the most preventable cause of intellectual disability is what
fetal alcohol syndrome
CNS SE of lithium
fine hand tremors fatigue mental cloudiness headaches coarse hand tremors with toxicity nystagmus
what is a prominent risk factor for antisocial personality disorder
first degree relative with this
teratogenic risks of benzos
floppy baby syndrome cleft palate
SSRI discontinuation syndrome
flu-like symptoms agitation nausea
what medication can reduce the need for perfectionism and the development of unnecessary rituals?
fluoxetine
what drugs can be used to treat aggression
fluoxetine clonidine buspirone (antipsychotics, SSRIs, lithium, anticonvulsants, beta. blockers) (NOT bupropion)
what SSRI would cause the most issues with a pt on Clozaril
fluvoxamine it inhibits 1A2 which clozaril is a substrate of
CYP1A2 Inhibitors
fluvoxamine cimetidine ciprofloxacin grapefruit juice ketoconazole
prospective cohort study
follows similar individuals overtime with respect to certain variables to determine how those variables will impact the rate of a certain outcome
when is the use of transdermal selegiline not beneficial
for pts with pheochromocytoma due to excess norepinephrine leading to hypertensive crisis
Sullivan's stage of interpersonal development juvenile developmental task
forming peer relationships
a client who is experiencing difficulties with working memory, planning and prioritizing, insight into his problems, and impulse control presents for assessment. in planning his care, the PMHNP should apply his or her knowledge that these symptoms represent problems with the...
frontal lobe
Erikson's developmental stage late adulthood indications of developmental mastery
fulfilment and comfort with life, willingness to face death, insight and balanced perspective on life's events
Erikson's developmental stage middle adulthood developmental task
generativity vs. self-absorption or stagnation
The NP Roundtable, and advocacy organization composed of APN organizations, was successful in what
getting language included into the Congressional Reconciliation Act that allowed the Secretary of Health and Human Services to include NPs as leaders in medical home demonstration projects
how to avoid the emergence of Wernickes encephalopathy
give thiamine IM or IV 100mg prior to any fluids or food with caloric value
carbon monoxide poisoning causes lesions in what area of the brain
globus pallidus and deep cerebral white matter
Trimethoprim/Sulfamethoxazole (Bactrim) contras
glucose-6-phosphotase deficiency folate deficiency anemia
the primary excitatory neurotransmitter is
glutamate
amino acids
glutamate, aspartate, gamma-aminobutyric acid (GABA), glycine
GAD non pharm
good candidates for therapy as single tx modality
OCD associated in children with what
group A beta-hemolytic streptococcal infections (scarlet fever, strep)
which of the following client statements best describes imitative behavior as a therapeutic factor in group therapy?
group members begin to model aspects of other members of the group and group leaders
for pts with histrionic personality disorder, which therapy is useful for addressing provocative and attention seeking behavior?
group therapy
other ADHD and ADD agents
guanfacine (intuniv) clonidine (kapvay) atomoxetine (Strattera) antidepressants such as desipramine (norpramin), venlafaxine (Effexor), and bupropion (Wellbutrin) are also used
which type of hallucination is rare in persons with psychotic illnesses and is often associated with an organic etiology
gustatory
typical antipsychotics
haloperidol (Haldol), haloperidol deconate (Haldol deconate) loxapine (loxitane) thioridazine (mallaril) thiothixene (navane) fluphenazine (prolixin), fluphenazine deconate (prolixin doconate) mesoridazine (serentil) trifluoperazine (stelazine) chlorpromazine (thorazine) perphenazine (trilafon)
a pt who has borderline personality disorder experiences intense anxiety when the PMHNP goes on vacation. the most appropriate explanation for this reaction is that the pt...
has not developed object constancy
chinese ethnicity and drug metabolism
have a lower average level of CYP2D6 and may require lower doses of antipsychotics and antidepressants metabolized through that enzyme
MDD genetic predisposition theory
having a depressed parent is the single strongest predictor of depression
Madeline Leininger's theory
health as a state of wellbeing that is culturally defined and valued by a designated culture
what is the primary function of free association in psychoanalysis
helps with working through transference neurosis
experiential family therapy
here-and-now focus encourages change through growth experiences
what is the immunization vaccine recommend for those 50+
herpes zoster
teen suicide protective factors
high grade point average connectedness with family connectedness with school
Lawrence Kohlberg's Stage Theory of Moral Development criticism
his schema is Western, predominantly male, and hierarchical
acamprosate (campral) for treating caving and maintaining sobriety
homotaurine decreases craving
as a pmhnp working in an output addiction clinic, you often refer your clients to community AA and NA meetings. using yalom's therapeutic factors, you are aware that peer-led groups can inspire and encourage other group participants. which therapeutic factor is instilled in AA and NA group members.
hope
PMDD treatment
hormonal contraceptives SSRIs both
nurse practitioner process
hx assessment labs diagnosis first line tx
dopamine hypothesis
hyperdopaminergic state in striatal D2 system prompts positive symptoms
arcus senilis when seen before 40yo is associated with what disorder
hyperlipidemia
peptides opioid type symptoms of deficit
hypersensitivity to pain and stress decreased pleasure sensation dysphoria substance abuse
MAOIS and tyramine
hypertensive crisis
when conducting a neurological exam on a client, the pmhnp asks the client to hold out her arms and stick out her tongue while assessing for tremors. which cranial nerve is being assessed?
hypoglossal
a client presents with complaints 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?
hypothalamus
what disease causes risk of carpal tunnel syndrome
hypothyroidism
MDD structural brain changes
hypovolemic hippocampus hypovolemic prefrontal cortex-limbic striatal regions
a 20 year old asian man who was recently diagnosed with schizophrenia comes to your office for a follow up appointment. during the assessment, he talks about his experience in the group home, thinking that the television is sending him messages through news anchors during the 10pm evening news. what symptom is the client describing
ideas of reference
the concept of target symptom identification is best explained as
identification of specific, precise, and individualized symptoms reasonably expected to improve with medication
which of the following is a function of the psychiatric interview
identify the mental health needs of the client
strategies to manage flashbacks
identifying the phenomenon as a flashback or dissociative period of grounding techniques (noticing things in the present)
Erikson's developmental stage adolescence indications of developmental failure
identity confusion, poor self-identification in group settings
the goal fo the psychiatric assessment process performed by the PMHNP is to
identity the mental health needs of the client
Erikson's developmental stage adolescence developmental task
identity vs role confusion
Greif and bereavement pharmacological management
if needed short term use of anti-anxiety agents such as Benzos if needed short term use of sleep-induction agents such as Benzos, nonbenzo hypnotic such as Zolpidem, TCA or other sedating antidepressants, antihistamines
positron emission tomography PET
images of brain when positron-emitting radionuclei interact with an electron expensive
Mr. Johnson is a 54-year-old client you have been seeing for several weeks in therapy. while discussing his current concerns of martial stress, he lies the floor and assumes the fetal position. this is most likely an example of
immature regressive defense mechanism
antihypertensive sexual side effects
impaired vaginal lubrication due to antiadrenergic effects
Mr. Johnson is a client newly admitted to an inpatient psychiatric hospital. the PMHNP on call as the facility plans to perform the initial intake assessment and diagnostic process. Mr. Johnson asks to please talk in his room because, he says, "people make me nervous". his room is a the end of the hallway and is the farthest away from the nursing station. the PMHNP's action should be based on awareness that the best location to do the assessment is...
in a quiet place, but public enough to get assistance with client care should it be required during the assessment
The MMSE is a brief, standardized screening tool for use...
in adults to quantify cognitive status
which statement best reflects the different between nurse-client relationship and a social relationship?
in the nurse-client relationship, the primary focus on on the client and the client's needs
Freud's psychosexual stage of development latency stage psych disorder linked to failure of stage
inability to form social relationships
areas assessed by ADHD rating scales completed by parents and teachers
inattention impulsivity hyperactivity mood memory problems self-esteem sleep pattern temperament
for the ER form of divalproex, what is the correct dose adjustment compared to the regular formulation
increase ER dose by 15%
therapeutic goals of behavioral couples therapy
increase reinforcing behaviors decrease punishing behaviors replace arguing with problem solving (does not emphasize cognition)
enzyme inhibitors can
increase the serum level of other drugs that are substrates of that enzyme possibly causing toxic levels
lab findings for pt with alcohol use disorder indicate
increased LFTs increased MCV elevated triglyceride levels
systemic effects of hyperthyroidism
increased T4 and decreased TSH may mimic symptoms of bipolar affective disorders
oxcarbazepine (trileptal) metabolic side effects
increased blood sugar but normal A1c, increased peeing
signs and symptoms of cannabis intoxication are
increased sensitivity to external stimuli
SSRIs act on
increasing serotonin levels
Erikson's developmental stage school-age developmental task
industry vs. inferiority
Intellectual disability typical age onset
infancy- usually evident at birth
how does necrosis differ from apoptosis
inflammatory response
single photon emission computed tomography (SPECT)
information of cerebral blood flow limited available expensive
SNRIs act on
inhibiting dual reuptake of norepinephrine and serotonin
SSRI sexual side effects
inhibition of arousal and orgasm by increased serotonergic activity
Bipolar follow up
initially seen weekly
Erikson's developmental stage late childhood developmental task
initiative vs guilt
peptides opioid type symptoms of excess
insensitivity to pain catatonic-like movement disturbance auditory hallucinations decreased memory
clinically significant side effects of MAOIs include
insomnia hypertensive crisis weight gain anticholinergic side effects lightheadedness and dizziness sexual dysfunction
lithium is associated with what metabolic complication
insulin-like effect lowers blood glucose and increases appetite and weight gain
Freud's psychosexual stage of development genital stage primary means of discharging drives and achieving gratification
integration and synthesis of behaviors from early stages, primary genital-based sexuality
Erikson's developmental stage late adulthood developmental task
integrity vs despair
self system
interpersonal theory total components of personality traits
what therapy is most useful in depressed HIV positive patients
interpersonal therapy
Erikson's developmental stage early adulthood developmental task
intimacy vs isolation
serotonin symptoms of deficit
irritability, hostility, depression, sleep dysregulation, loss of appetite, loss of libido OCD, anxiety disorders, schizophrenia
GABA symptoms of deficit
irritability, hostility, tension and worry, anxiety, seizure activity anxiety disorders
why is group therapy beneficial?
it is always time limited (it increases social skills, is cost-effective, and enables participants to acquire the curative factors)
the Iowa model of EBP is characterized by what
it is important to determine if an identified issue is a priority for an organization
strategic therapy
jay haley tx goal to help family embers behave in ways that will not perpetuate the problem bx interventions are problem focused
caring theory
jean Watson caring is an essential component of nursing
relational theory
jean baker miller focuses on the real relationship between patient and therapist to understand and relieve conflict and social inhibition and to achieve social intimacy
Mary is a PMHNP who is working in a hospitalist role. Mary has encountered over five incidences in which attending physicians and medical residents have been demeaning to nursing staff and not answering calls in the middle of the night or telling the nursing staff to write orders and the MD would sign off in the a.m. Mary is concerned about errors and wants to improve quality, reduce error to promote safety. what concepts is Mary employing?
just culture
what herbal supplement is effective for pts with adjustment disorder with anxiety, according to an RCT
kava kava
period of symptoms required for dysthymia in kids vs adults
kids 1 year adults 2 years
glutamate symptoms of excess
kindling, seizures, anxiety or panic bipolar affective disorder, psychosis from ischemic neurotoxicity or excessive pruning
GGT is used to evaluate and monitor clients with what
known or suspected alcohol abuse levels rise even after ingestion of small amounts of alcohol
acetylcholine symptoms of deficit
lack of inhibition, decreased memory, euphoria, antisocial action, speech decrease, dry mouth, blurred vision, constipation alzheimers dx
Erikson's developmental stage late childhood indications of developmental failure
lack of self-initiated behavior, lack of goal orientation
Fragile X physical characteristics
large, long head and ears short stature hyperextendable joints postpubertal macroorchidism
Major Depression typical age onset
late adolescence to young adulthood
what ethnicity of veterans experience the highest levels of PTSD
latino
transactional leadership model
leader only intervenes when something goes wrong
EEG and evoked potentials testing
least expensive test convey info on electrical functioning of CNS
PTSD acute
less than 3 months
combo of TCAs and MAOIs
lethal serotonin syndrome, hypertensive crisis, or both adhere to two week washout period (5 weeks for fluoxetine) before switching between the two classes of medications
hem SE of lithium
leukocytosis
what hematological change is associated with lithium
leukocytosis
hypertensive crisis
life threatening and cannot be reversed unless more MAO is produced by the body sudden, explosive like headache, usually in occipital region elevated BP facial flushing palpitations pupillary dilation diaphoresis fever
probability
likelihood of an event occurring lies between 0 and 1 an impossible event has probability of 0 a certain event has a probability of 1
TSH values can be increased during therapy with what
lithium
what pharm treatment is clinically supported for treating kleptomania
lithium
in completing the pmhnp assessment for the mrs. shea, the most appropriate lab test for the PMHNP to order at this time is
liver function tests
risk factors for teen suicide
living alone substance abuse affective disorder (not low IQ)
what are of the brain has the largest concentration of norepinephrine
locus coeruleus and medullary reticular formation
PTSD chronic
longer than 3 months
Benzodiazepines BNZs
lorazepam (Ativan) clonazepam (klonopin) chlordiazepoxide (Librium) oxazepam (serax) clorazepate (tranxene) alprazolam (xanex)
schedule V drugs
lowest abuse potential handled similar to noncontrolled drugs buprenorphine (buprenex), cheratussin (robitussin) with codeine, promethazine (Phenergan) with codeine, diphenoxylate/atropine (Lomotil)
derm SE of lithium
maculopapular rash pruritus acne
ebsteins anomaly
malformation of tricuspid valve
sudden, dramatic decrease in sleep is a sign of possible
mania or schizophrenia
in bipolar I, men are more prone than women to have...
manic episodes
intervention that has evidence based findings to reduce co-morbid substance use in pts with schizophrenia
manualized group intervention with motivational enhancement
what does the term "goodness of fit" mean by Chess and Thomas
match or mismatch between a persons temperament and features of their environment
MMSE score interpretation
max 30 no cognitive impairment 24-30 (average 27) delirium/dementia (18-23 = mild, 0-7 severe)
conduct disorder lifespan consideratiosn
may be diagnosed in clients ages 18+ if criteria for antisocial personality disorder are not met
ECT when treating major depression in pts with parkinsons
may cause delirium
cross-sectional study design
measures both the risk factor and the outcome simultaneously. used to reveal associations and to identify possible risk factors "snapshot" data is obtained does not determine causation through a single study best method to determine prevalence
Functional imaging
measures function of areas of the brain and bases the resulting assessment on blood flow -may use radioactive pharmaceuticals to cross blood-brain barrier -mainly used for research -EEG and evoked potentials testing -magnetoencephalography MEG -single photon emission computed tomography SPECT -positron emission tomography PET
prospective payment system (PPS)
medicare-approved program that pays a set amount for patient care based on the Diagnosis Related Group (DRG)
schedule II drugs
medicinal drugs in current use high potential for abuse and dependency written script only no telephone orders no refills on script morphine sulfate, codeine, fentanyl, methadone, hydromorphone (dilaudid), oxycodone (oxycontin, Percocet), hydrocodone (Vicodin etc), amphetamine salts, methylphenidate
schedule III drugs
medicinal drugs with less abuse than II telephone orders if followed by written script prescription must renew Q6months refills limited to 5 appetite suppressants, butalbital, testosterone, buprenorphine/naloxone
schedule IV drugs
medicinal drugs with less abuse than III dextropropoxyphene (Darvon), pentazocine (talwin), benzos, modafinil (Provigil), phenobarbital, zolpidem (ambien), eszopiclone (Lunesta), temazepam (Restoril), armodafinil (nuvigil)
what part of the brain controls the respiratory function for the body
medulla
an initial psych eval of a pt reveals a normal mental status and appropriate bx, despite parents report of disobedience, poor grades, and laziness. to further assess the pt's functioning, the PMHNP...
meets with the parent and pt together to explore the discrepant report
glutamate general function
memory, sustained automatic functions
delirium older adult considerations
men more prone than older women for unknown reasons
black cohosh herbal uses
menopausal symptoms PMS dysmenorrhea
Hypertensive crisis and death occurring when MAOIs taken in conjunction with certain meds
meperidine decongestants TCAs atypical antipsychotics st johns wort l-tryptophan stimulants and other sympathomimetics asthma meds
how does trazodone cause activation of the CNS
metabolite activity as well as inhibition of serotonin reuptake in presynaptic receptors
GAD 7 scoring
mild 5-9 mod 10-14 severe 15-21
Hamilton anxiety rating scale scorign
mild <17 mild-mod 18-24 mod-severe 25-30
dopamine symptoms of deficit
mild: pour impulse control, poor spatiality, lack of abstractive thought -severe: Parkinson's disease, endocrine alterations, movement disorders -substance abuse, anhedonia
motivational interviewing
miller and rollnick -focused, goal-directive therapy -motivation is elicited from the client -nonconfrontational, nonadversarial
a 74 year old married women was referred to you by her pcp for a psych eval. she had a normal medical and neurological exam in the last 2 months. the client presents with her husband of 45 years who states "my wife is just not the same anymore, she is irritable and asks the same question several times, even though I've answered it many times. the client responds, oh Henry, you do the same thing, its just a normal part of getting older, and the kids think everything is fine. during the assessment you complete the MMSE and the client scores 18. as the pmhnp treating the client, you know the results of her MMSE indicate which level of cognitive impairment.
moderate cognitive impairment
peptides opioid type general function
modulate emotions, reward center function, consolidation of memory, modulate reactions to stress
Piaget developmental stage preoperational
more extensive use of language and symbolism magical thinking
adolescent manic episodes present differently than in adults
more psychotic features often associated with antisocial bx often associated with substance abuse prodromal period of significant bx problems (School truancy, failing grades)
dementia typical age onset
most common after age 85
delirium course
most symptoms resolve within 3-6 months
NMS can be differentiated from serotonin syndrome by
mutism leukocytosis dysphagia lab evidence of muscle injury (elevated CPK, myoglobinuria, rabdomyolysis)
buprenorphine and naloxone (Suboxone) for treating caving and maintaining sobriety
narcotic analgesic opioid agonist/antagonist
methadone (dolophine) for treating caving and maintaining sobriety
narcotic analgesic suppresses withdrawal
what drug can cause fatal liver failure in rare cases
nefazodone CYP3A4 inhibitor
what schizophrenia symptoms are most debilitating
negative symptoms
you have been working within 54 yo man who has been treated for schizophrenia since age 19. he has limited social interactions, likes to be alone, and has never dated nor had a desire to date. his symptoms are best explained by what?
negative symptoms
teratogenic risks of carbamazepine (tegretol)
neural tube defects
teratogenic risks of divalproex sodium (Depakote)
neural tube defects specifically spina bifida atrial septal defect cleft palate possible long term developmental deficits
does ambien need to be tapered to discontinue?
no
pregnancy category B
no evidence of risk to humans
methylphenidate metabolism
no significant CYP2D6 metabolism majority of metabolism occurs at first pass effect outside of the liver
the PMHNP working at a student mental health clinic has now been working with a freshman student for several weeks. the PMHNP leans that the student considers himself shy. he tells the NP that he has always felt uncomfortable in social situations or when he has to do oral presentations in class. he had few friends up until senior year of high school when he discovered he could enjoy himself if he had a couple of drinks before going out. he has continued this pattern in college and now occasionally drinks 2 to 3 beers on weekends as well. according to the DSM 5, does this student have a mental disorder?
no, at this point, the student does not meet criteria for a mental disorder
personality disorder pharm management for anxiety
non-benzo anxiolytics SSRIs Benzos used with extreme caution
schedule 1 drugs
nonmedicinal substances high abuse potential used for research only not available by prescription heroin and marijuana
findings during adolescent growth spurt
nonspecific pain in legs markedly elevated alkaline phosphatase level
MAOIs
not first or second line d/t dangerous food/drug interactions
Prader-Willi Syndrome physical characteristics
obesity small stature small hands and feet hypotonia hypogonadism
mr d is a 35 year old, married, high tech industry executive who is referred to the PMHNP for insomnia. mr d reports that he falls asleep quickly bu that difficulty staying asleep. he wakes up several times during the night, and believes he tosses and turns even when he is sleeping. he wakes up feeling exhausted and drinks a pot of coffee to stay awake and concentrate during his long work day. he drinks 1 glass of wine most evenings. he denies any illicit substance use. he denies any symptoms of a mood or anxiety disorder, but is feeling increasingly frustrated and concerned about his sleep. which of the following is the most likely contributing factor to mr. Ds ongoing middle insomnia.
obstructive sleep apnea
Type II research error
occur when investigators falsey reject a null hypothesis and conclude that no relationship exists between variables when, in fact, a relationship does exist. this occurs when there is insufficient power to detect the differences between variables, and is linked to adequacy of the sample size. if a sample size is too small, the study will have insufficient power to detect differences between groups, if differences exist. -consider power to avoid this error
reinforcement in substance abuse disorder
occurs int he ventral segmental area and the nucleus accumbens of the brain collectively caused the reward center -Dopamine release is enhanced further by the release of natural morphine-like neurotransmitters called neuropeptides (enkephalins, beta-endorphins)
brief psychotic disorder incidence and demographics
occurs more in younger clients (20-30yo)
which intervention by the PMHNP for a person experiencing statue de nervosa demonstrates culturally informed care?
offering brief supportive psychotherapy
selegiline in treatment of Parkinson's
offers early neuroprotective effect but lacks long term benefit
IM (revia; vivitrol) for treating caving and maintaining sobriety
opioid antagonist increases abstinence
nalmefene (Revex) for treating caving and maintaining sobriety
opioid antagonist increases abstinence
naloxone (narcan) for treating caving and maintaining sobriety
opioid antagonist, antidote blocks effects of opioids
buprenorphine (buprenex) for treating caving and maintaining sobriety
opioid partial agonist opioid antagonist agonist and antagonist, decreases cravings
Sullivan's stage of interpersonal development early adolescence developmental task
opposite- sex relationships
Sullivan's stage of interpersonal development infancy developmental task
oral gratification, anxiety occurs for the first time
a client comes into the clinic with a longstanding history of depression and chronic renal failure. he is on an antidepressant and a diuretic and complains of increased depression, mild confusion, irritability, and overall apathy from being too tired to do anything. the best initial PMHNP action at this time is
order a comprehensive metabolic panel
antiadrenergic side effects
orthostatic hypothension from alpha 1 receptor blockade
acetylcholine symptoms of excess
overinhibition, anxiety, depression, somatic complaints, self-consciousness, drooling, EPS parkinsonian symptoms
in considering whether to order an MRI of the head for a client, what would be a contra for this diagnostic test?
pacemaker
panic and anxiety episodes during sleep is a sign of possible
panic disorder
in pts preseting with dementia, what is the concern regarding brain tumors
paraneoplastic limbic encephalitis should be suspected
what part of the brain is responsible for sensory integration
parietal lobe
in what neuropsych condition are levels of coenzyme q10 lower than normal
parkinsons
FDA approved meds for GAD
paroxetine citalopram escitalopram duloxetine venlafaxine buspirone
melatonin for sleep disorders
particularly useful to correct sleep onset issues and may be helpful for the person with ADHD
substance use disorder
pattern of related use that leads to clinically significant impairment or distress with 3+ of the following symptoms within a 12 month period (tolerance, withdrawal, persistent craving or unsuccessful attempts to cut down, using larger amounts than intended, large amount of time spent obtaining substance, using substance, or recovering from substance, activities decreased or given up because of use, using despite consequences)
Freud's psychosexual stage of development latency stage primary means of discharging drives and achieving gratification
peer relationships, learning, motor-skills development, socialization
what can both lithium and anorexia nervosa cause
peripheral edema
Erikson's developmental stage adolescence indications of developmental mastery
personal sense of identity
dysthymic disorder is associated with what
personality disorders
The risk of bleeding on SSRIs, NSAIDS, or aspirin is an example of what principle
pharmacodynamics interaction is due to the risk of platelet aggregation
the study of what the body does to the drug is called
pharmacokinetics
what medication is most affective for treating social phobia/ social anxiety disorder
phenelzine (MAOI)
Monoamine oxidase inhibitors MAOIs
phenelzine (nardil) tranylcyprmie sulfate (parnate) selegiline transdermal (EMSAM)
in dbt, dialectics refers to
philosophy and approach to communicating with patients
specific phobias
phobic diagnosis should occur only when accompanied by significant functional impairment
the process of allocating scare resources is a definition of
politics
what is true regarding psychosis-induced polydipsia
polydipsia and water intoxication are associated with heavy cigarette use
sleep can be measured by
polysomnography
renal SE of lithium
polyuria with related polydipsia diabetes insipidus edema microscopic tubular changes
glutamate symptoms of deficit
poor memory, low energy, distractible learning difficulty, negative symptoms of schizophrenia
Erikson's developmental stage infancy indication of developmental failure
poor relationships, lack of future hope, suspicious of others
Erikson's developmental stage early childhood indications of developmental failure
poor self-control, low self esteem, self-doubt, lack of independence
highest level of evidence for treating PSTD-related nightmares in adults
prazosin and image rehearsal therapy
what area of the brain has been implicated to modulate pain and can help explain how TMS can decrease pain?
prefrontal cortex
what reflects current understanding of neurodevelopment and best explains risk taking behaviors in adolescent males?
prefrontal cortex is not fully mature until mid-20s or early 30s
group phases
pregroup phase forming phase storming phase norming phase performing phase adjourning phase
genetic testing FDA required in people of Asian descent
presence of HLA-B*1502 allel inherited variant of HLA-B gene prior to prescribing carbamazepine d/t risk of steven Johnson syndrome and toxic epidermal necrolysis TEN
you are asked by a church organization to work with members within your health systems to develop a flu vaccination program. according to public health principles, this is an example of what level of prevention.
primary
a community has an unusually high incidence of depression and drug use among the teenage population. the public health nurses decide to address the problem, in part, by modifying the environment and strengthening the capacities of families to prevent the development of new cases of depression and drug use. what is this an example of?
primary prevention
what is true of measures to evaluate quality improvement in healthcare
process measures can be based on scientific evidence
other agents to tx anxiety dx
propranolol (Inderal) atenolol (Tenormin)
Sarah presents for her initial intake appointment with complaints of depression. She is being treated for HTN and asthma by her PCP. Knowing that certain medications may cause or exacerbate depression, you obtain a complete medication history. Which of the following medications is known to exacerbate or cause depression?
propranolol d
The trend in legal rulings on cases involving mental illness over the past 25 years has been too..
protect the persons's freedoms or rights when they are committed to a mental hospital
food related sleep hygiene
proteins keep you awake carbs make you sleepy
semiformal community support systems
provide physical and emotional assistance provide goods and services
magnetic resonance imaging (MRI)
provides a series of 2D images that represent the brain -advantages: can view brain structures close to the skull and can separate white matter from gray matter; readily available; resolution of brain tissue superior to CT scanning -disadvantages: expensive, many contras to use, claustrophobia
computed tomography CT
provides a three-dimensional view of the brain structures -differentiates structures based on density provides suggestive evidence of brain-based problems but not specific testing for psychiatric disorders -advantage: widely available, relatively inexpensive -disadvantage: lack of sensitivity, cannot differentiate white matter from gray mater; cannot view structures close to the bone tissue; underestimation of brain atrophy, inability to image sagittal and coronal views
structural imaging
provides evidence of size and shape of anatomical structure -computed tomography CT -Magnetic resonance imaging MRI
The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)
provides federal legislation that requires any annual or lifetime limits on medical and surgical benefits be the same for mental health and substance use disorder benefits.
older Americans act (OAA)
provides improved access to transportation to older Americans and native Americans
Mr. Thompson has been forgetful lately, for example, forgetting where he has placed his keys or what time appointments are scheduled, and he has stated that he thinks these are just random behaviors that have no particular meaning. Which Freudian-based psychodynamic principle assumes that all behavior and actions are purposeful?
psychic determinism principle
first line tx for children and teens with anxiety dx
psychotherapy
Freud's psychosexual stage of development genital stage age
puberty forward
ingestion of methyl alcohol would cause hemorrhage in what part of the brain
putamen
the chief nursing officer of a large behavior health system approached the PMHNP to discuss the new healthcare effectiveness data and information set (HEDIS) behavioral health measures and specifications. the pmhnp is asked to do a retrospective chart review of all hospital discharge clients who received a follow up visit within 7 days of discharge and within 30 days of discharge. the PMHNP has been asked to engage in what?
quality improvement initiative
meds that can cause false positives for heroin or morphine
quinolones rifampin codeine poppy seeds
DBT affirms dialectical thinking, which involves examining and discussing opposing ideas to find the truth. this philosophy is a supportive principle of DBT training. the central dialectical pattern emphasized in DBT involves the tension between
radical acceptance and change (DBT emphasizes acceptance of current reality of what is and the ability to engage in personal change)
serotonins is produced in what location
raphe nuclei
the PMHNP uses CBT approach to help a pt address self-defeating bx. after identifying the stressor that causes the inappropriate bx, the initial strategy is to explore
rational and irrational beliefs about the stressor
what defense mechanisms are commonly used by persons with obsessive compulsive personality disorder
rationalization isolation intellectualization
which is the best rationale for using CBT
recognize and change his or her automatic thoughts
which communication technique is the PMHNP using in the following situation? Client: "Sorry I was late. I didn't realize what time it was". PMHNP: " this is the third time now that you have been late for our sessions. I am wondering how committed you are to our working on your problems"
recognizing
GABA symptoms of excess
reduced cellular excitability sedation impaired memory
GABA general function
reduces arousal, reduces aggression, reduces anxiety, reduces excitation
formal community support systems
regulated by laws or statutes provided by social workers financial support by social security medical support by medicare
serotonin general function
regulation of sleep pain perception mood states temperature regulation of aggression libido precursor for melatonin
negative punishment
removal of a desirable stimulus to decrease a specific behavior
amiloride is used to treat what side effects of lithium
renal side effects
the core values that underlie apn nursing and culturally competent care are
respect partnership advocacy
positive rewards in substance abuse disorder
results in the social rewards commonly associated with drug use such as disinhibition, euphoric mood, and anxiety reduction -mediated by dopamine pathways
norepinephrine dopamine reuptake inhibitors NDRIs act on
reuptake of norepinephrine and dopamine
MOA of donepezil (Aricept)
reversible acetylcholinesterase inhibition
pregnancy category C
risk cannot be ruled out
what is the importance of preventing delirium
risk of 1 year mortality rate
what is the best reason for considering the SSRI among the first-line drug choices for treating major depression
safe use in suicidal overdose clients
as a pmhnp working in a crisis evaluation center, you are aware that the initial focus of crisis assessment is on what
safety of the client and others
Sullivan's stage of interpersonal development preadolescence developmental task
same-sex relationships
what is correct regarding the study of samples from a larger population compared to study surveys of the population
samples may allow estimations of error in resulting statistics
3yo milestones
says up to 1000 words uses 3-4 word sentences balances on 1 foot plays make believe
what schedule class are Benzos
schedule 4
Freud's psychosexual stage of development oral stage psych disorder linked to failure of stage
schizophrenia, substance abuse, paranoia
temporal lobe abnormalities and differences in the corpus callosum and thalamic nuclei have been identified on MRI studies of pts with which condition
schizotypal personality disorder
eating disorder prevention
secondary prevention important in young clients
conduct disorder prevention
secondary prevention is important in younger clients
catnip herbal use
sedation
valerian herbal use
sedation
chamomile herbal use
sedation anxiety
gabapentin overdose symptoms
sedation ataxia diplopia
antihistaminergic side effects
sedation and weight gain from histamine receptor blockade
serotonin symptoms of excess
sedation, increased aggression, hallucinations (rare)
what meds should be taken on an empty stomach?
sedatives/hyponotics
Erikson's developmental stage middle adulthood indications of developmental failure
self-absorption, inability to row and change as a person, inability to care for others
Erikson's developmental stage early childhood indications of developmental mastery
self-control, self-esteem, willpower
Erikson's developmental stage late childhood indications of developmental mastery
self-directed behavior, goal formation, sense of purpose
Sullivan's stage of interpersonal development late adolescence developmental taks
self-identity developed
Erikson's developmental stage school-age indications of developmental failure
sense of inferiority, difficulty with working, learning
Tramadol and SSRI reaction
serotonin syndrome
following EBP, which laboratory screening tests and assessments should be completed prior to placing a person on an SGA?
serum glucose or hemoglobin A1c, lipid profile, wt, BMI, blood pressure, waist circumference, and family hx of CVD
what are components of interprofessional education at the Rosalind Franklin University of Medicine and Science
service component didactic clinical experience
androphilia
sexual attraction to men or masculinity
gynephilia
sexual attraction to women or femininity
Freud's psychosexual stage of development phallic stage psychiatric disorder linked to failure of stage
sexual identity disorders
Freud's psychosexual stage of development genital stage psych disorder linked to failure of sage
sexual perversion disorders
a client returns for a follow-up appointment 3 weeks after starting on fluoxetine 20mg. during this appointment you notice that her speech is a little rapid, in marked contrast to the psychomotor retardation and paucity of spontaneous speech she displayed on her first visit. instead of looking at the floor, she now makes normal eye contact. her affect has gone from constricted to expansive. she continues to have difficulty sleeping, but her energy has improved and she states she feels so much better! what should you conclude about the shift in the clients presentation?
she is becoming hypomanic
Samantha is a 26 yo partnered woman who works full time as a teacher. she is in a long-term relationship with Mary and they are getting along well, and doing well financially. they have 2 children, ages 2 and 6. Samatha is seeing the pMHNP to address her concerns that she is feeling down and sad for no reason and states, I know my life is going well but I just dont feel happy. I have always worried a lot and have been sad most of my life. as a PMHNP trained in transactional analysis (TA), you understand that personality is multifaceted and wonder if which of the following is affecting her ability to experience happiness.
she likely had a traumatic event in her childhood and her thoughts and feelings related to the event are locked together in her brain and cannot be accessed. (according to TA, when a person is traumatized the thoughts and feelings get tied tighter and the process of therapy is to unlock the two)
what change in a dose response curve is observed when a patient becomes tolerant of a medication
shift to the right
instrumental activities of daily living (IADLs)
shopping using the telephone using transportation activities that facilitate or enhance the performance of ADLs
brain structure abnormalities for dissociative identity disorder
significantly smaller hippocampus and amygdala
Magnetoencephalography MEG
similar to EEG detects different electrical activities used in complementary fashion with EEG testing
z test
similar to t test but requires either a very large sample or a known population variance
DBT draws on cognitive theory and behavioral theory, along with other theories. elements of behavioral therapy in DBT include what?
skills training and exposure (DBT focuses on cogntiive and behavioral techniques, mindfulness including medication, and emotional regulation)
informal community support
social network-family, friends who provide actual assistance in some way
In an attempt to bring the client toward the goal he or she is working on, you ask the client, "if a miracle were to happen tonight, while you slept, and you woke in the morning and the problem no longer existed, how would you know, and what would be different?" This technique is used in which type of therapy?
solution focused therapy
d-amphetamine vs L-amphetamine
some patients have different responses to each
Freud's psychosexual stage of development anal stage primary means of discharging drives and achieving gratification
sphincter control, activities of expulsion and retention
transtheoretical model of change
states that change such as in health bx occurs in 6 predictable stages -precontemplation -contemplation -preparation -action -maintenance
meds that can induce mania
steroids disulfiram (Antabuse) isoniazid (INH) antidepressants in persons with BP
solution focused therapy
steve deshaer bill ohanlon and insoo berg focus to rework for the present situations that have worked previously tx goal is effective resolution of problems through cognitive problem solving and use of personal resources and strengths
meds that can cause false positives for amphetamines
stimulants Wellbutrin Prozac trazodone ranitidine nefazodone (serzone) nasal decongestants pseudoephedrine
steven johnsons syndrome tx
stop offending agent supportive measures often in hospital burn unit
you are working with a family: mother, father, and 2 biological children. sam, the father, is very rigid and controlling, which seems to be out of fear that something might happen to his family. he worries daily and it affects his family relationships. you give sam a paradoxical directive and instruct him to intensely worry about everything he can think of for 1 hour a day. using a paradoxical directive is part of which therapy?
strategic
when working with a dysfunctional family, you find that the father worries excessively and is resistant to change. you give him a paradoxical directive to worry extremely well for 1 hour per day, knowing that he will likely be noncompliant, and thus change will occur. with this technique, you are unison which time of therapy?
strategic therapy
Donabedian model
structure, process, outcome
dopamine is produced in what location
substantia nigra
Freud's psychosexual stage of development oral stage primary means of discharging drives and achieving gratification
sucking, chewing, feeding, crying
an example of a mature, healthy defense mechanisms is...
suppression (the client channels conflicting energies into growth-promoting activities)
acetylcholine
synthesized by the basal nucleus of Meynert -precursors are acetylcoenzyme A and choline -nicotinic and muscarinic receptors
a 23 year old women is brought into the ER after attempting suicide by cutting her wrists. which nursing action by the PMHNP would be of highest priority initially.
take her vital signs
a client says to the pmhnp "some days life is just not worth it. all my wife and I ever do is fight and scream. things at home would be calmer and simpler if I just wasn't there anymore". the most therapeutic response for the PMHNP to make is
tell me what you mean by "it would be simpler if you just weren't there anymore"?
delirium symptom pattern
tends to fluctuate during the day
test recall in children
test recall after 5 minutes in school age children show be able to remember 3 objects
analysis of variance (ANOVA)
tests the difference among three or more groups
pearson's r correlation
tests the relationship between two variables
you are the pmhnp treating Tim, a 10 yo child for ADHD and social anxiety disorder. his mother presents with Tim for his scheduled individual therapy session. at the end of the session his mother says I need to take Tim to see his pediatrician and at the last visit I was told he needed some HPV shot. I don't know, he's a boy, why would he need that? what do you think? what is the pmhnps best response to her question?
the CDC recommends the hpv vaccine for all boys and girls at age 10. hpv can cause cancer in both men and women, and the vaccine is effective in protecting against the virus. can you tell me your concerns about Tim getting this vaccine?
tina is a 54 year old single white women who has been a PMHNP for over 20 years. she is considering making application to a DNP program but states of a DNP is required to practice ill get grandfathered in, no need for me to go back to school. following the 2008 license, accreditation, certification, and education (LACE) consensus model for APRN regulation, what is correct?
the DNP is an academic terminal degree and there will not be an opportunity for Tina to be grandfathered into a DNP
sunset legislation
the act must be reviewed by a certain date or be automatically rescinded
meaningful use
the concept instituted by medicare and medicaid to improve quality, safety, and efficiency, in healthcare through the use of certified electronic health record technology
Piaget developmental stage sensorimotor
the critical achievement of this stage is object permanence
who runs the Clozapine rems program
the drug company
pleasure principle
the id seeks immediate satisfaction
test specificity
the likelihood of a negative result when the patient does not have the disease of interest
Test sensitivity
the likelihood of a positive result when the pt does have the disease of interest
the numerator in an item by item measurement of a quality improvement measure is
the number of patients for whom the item was performed
a 74 year old woman presents for an evaluation. the pmhnp has her complete a MMSE and a clock drawing. the pt is unable to correctly draw the face of the clock. what area of the brain is most likely to have compromised functioning?
the right hemisphere (involved with facial expression recognition, music and visual images causing disturbances in drawing)
what is not insured by the Universal Bill of Rights for Mental Health patients
the right to refuse a particular mode of treatment is insured except in an emergent situation where the pt is deemed an imminent danger to self or others
dementia screening for the general population is not recommended for the following reason
the service has unknown balance of benefit and harm: current treatments have limited effectiveness in modifying instrumental ADLs
factor analysis
the statistical technique that seeks to explain the variance of multiples by utilizing a smaller number of unobserved factors
what meds are contraed in ECT
theophylline (cause prolonged seizures) hypoglycemic beta blockers (can cause asystole) lidocaine (can reduce seizure induction) lithium (caused prolonged seizures and confusion)
what is significant about the metabolism of cyclophosphamide, carbamazepine, theophylline, ifosfamide, and aminoglutethiamide?
they auto induce their own metabolisms
what is true regarding the treatment of older adults who are depressed
they constitute a disproportionate number of suicides
per HIPPA, an NP who is in an independent, single practitioner practice is considered a "covered entity" because
they have the ability to transmit protected health information
what is true regarding nurse-managed health centers (NMHC) in the ACA provision
they were funded in the first year
dopamine general function
thinking decision making reward-seeking behavior fine muscle action integrated cognition
what is the primary responsibility of team members on a healthcare quality improvement team
to contribute information and experience
your client sam is being treated for panic disorder with agoraphobia. he currently is being prescribed paroxetine (Paxil CR, 37.5 mg QD) and clonazepam (Klonopin, 0.5mg QD, PRN). he has been on clonazepam for 2 years and admits to needing 4 pills to achieve the same effect that 1 pill initially produced. this is possibly an example of which process?
tolerance
SNRIs and other agents
trazodone (Desyrel) venlafaxine (Effexor) desvenlafaxine (Pristiq) mirtazapine (Remeron) nefazodone (serzone) bupropion (Wellbutrin, Forfivo, Aplenzin) duloxetine (Cymbalta) vilazodone (viibryd) vortioxetine (brintellix) levomilnacipran (Fetzima)
Erikson's developmental stage infancy developmental tasks
trust vs. mistrust
in assessing a client, you ask him the meaning of the proverb "people who live in glass houses shouldn't throw stones". he replies "because it will break the windows". the correct interpretation of this finding is
unable to interpret the finding without knowing the client's age (this is a normal thought process in children younger than 12yo)
ego-dystonic personality
uncomfortable
GABA
universal inhibitory neurotransmitter -site of action of benzos, alcohol, barbiturates, and other CNS depressants -GABAa and GABAb receptors
combo of TCA and SSRI
use caution SSRI can elevate TCA concentrations because of pharmacodynamic or pharmacokinetic interactions monitor TCA levels
omega 3 fatty acid supplements
used for ADHD, dyslexia, cognitive impairment, dementia, CVD, asthma, lupus, and rheumatoid arthritis interacts with warfarin
fish oil supplement
used for bipolar disorder, hypertension, lowering triglycerides, and decreasing blood clotting interacts with warfarin, aspirin, NSAIDs, garlic, and ginkgo may alter glucose regulation
tryptophan supplement
used for depression, obesity, insomnia, headaches, and fibromyalgia increased risk of serotonin syndrome with use of SSRIs, MAOIs, and st johns wort
Sam-e supplement
used for depression, osteoarthritis, and liver dx may cause hypomania, hyperactive muscle movements, and possible serotonin syndrome
melatonin supplement
used for insomnia, jet lag, shift work, and cancer interacts with aspirin, NSAIDS, beta blockers, corticosteroids, valerian, kava kava, and alcohol can inhibit ovulation in large doses
vitamin E supplement
used in enhancing immune system and protecting cells from effects of free radicals used for neurological dx, diabetes, and PMS interacts with warfarin, antiplatelet drugs, and statins increasing risk of rhabdomyolysis
chi-square test
used to compare samples with non measurable nominal/catagorical variables example is color
student t test
used to compare the means of 2 independent sample populations
paired t test
used to compare the means of 2 related (paired) sample populations
ANOVA
used to compare the means of multiple groups to determine if all are equal, thereby generalizing the 2 sample t test to several groups
cohort studies
used to determine incidence, risk factors, and prognosis
discriminant analysis
used to determine the independent variables (x) that appear to affect a quantity of interest (y)
defense mechanisms are best viewed as a function of the ego ....
used to resolve a conflict
case-control studies
used to study rare diseases and outcomes
meds that can cause false positives for alcohol
valium
valproic acid and lamotrigine interaction
valproate doubles the elimination half life of lamotrigine
mood stabilizers
valproic acid (depakene) divalproex sodium (Depakote) lithium carbonate (eskalith, lithobid, lithonate, lithotabs) lamotrigine (lamictal) carbamazepine (tegretol) carbamazepine ER (equetro) oxcarbazepine (Trileptal; off label)
interfering factors of magnesium levels
values can be increased by drugs such as antacids, laxatives containing mg, salicylates, and lithium
interfering factors of calcium levels
values can be increased by excessive ingestion of milk or during tx with lithium, thiazide diuretics, alkaline antacids, or vitamin D -values can be decreased during tx with anticonvulsants, aspirin, calcitonin, corticosteroids, heparin, laxatives, diuretics, albuterol, and oral contraceptives
interfering factors of Free T4
values can be increased during tx with heparin, aspirin, and propranolol values can be decreased during tx with furosemide (Lasix) or Methadone
interfering factors of ALT levels
values can be increased with Tylenol, allopurinol, aspirin, ampicillin, carbamazepine, cephalosporins, codeine, digitalis, indomethacin, heparin, isoniazid, methotrexate, methyldopa, oral contraceptives, phenothiazines, propranolol, tetracycline, and verapamil
sleep circuits
ventrolateral preoptic nucleus in hypothalamus inhibits brainstem arousal in nuclei, which leads to inhibition of wake center producing restful sleep
existential therpay
viktor frankl goal to live authentically and to focus on the present and on personal responsibility
experiential therapy
virginia satir focus on being authentic, freedom of choice, human validation, and experiencing the moment tx goals to develop authentic, nurturing communication and increased self worth of each family member overall goal is growth rather than symptom reduction alone does not focus on particular techniques
endocrine SE of lithium
weight gain impaired thyroid functioning
TCA serum blood levels
well identified levels guide dosing particularly nortriptyline predicts toxicity
operant conditioning
when a reinforcement or punishment is used to modulate the frequency of a behavior
contracted service system
when the np is paid directly by the patient's payer who agrees to pay the NP for providing care for a specific population
what is true regarding the conversion to ICD-10-CM
will increase by tenfold the amount of data that describes clinical conditions
joint commission provider r/s face-to-face guidelines
within 1 hour of initiation and every 8 hours if they remain in r/s
grief and bereavement develops when
within 3 months of stressor
fact witness
witness who has knowledge about the details of a case
can nurses request an opportunity to testify in a legislative arena committee?
yes
a new client reveals to the PMHNP that her boyfriend screams at her and has repeatedly slapped and pushed her in front of her 3 year old son. she goes on to say that the boyfriend has thrown things at her and on one occasion threw a glass of water at her and hit her son in the back. should the pmhnp report this to CPS?
yes, the pmhnp has a duty to report
what drug is effective in improving sexual dysfunction in men, but when given with an antidepressant to counter its adverse sexual effects, its actually anxiolytic
yohimbine
for informed disclosure, the following must be included
you may refuse treatment education treatment alternatives
meds that can cause false positives for benzos
zoloft
