Georgette’s Flashcards
Benefits of Lithium treatment
Gold standard for treating manic episodes
Neuroprotective
Antisuicidal effect
Normal serum values for lithium
0.5 to 1.2 mEq per liter
Common Baseline labs before initiation with lithium
Thyroid panel (Hyperthyroid can appear as mania)
Serum creatinine (0.6 to 1.2 mg/dL)
BUN (10 to 20 mg/dL)
Urinalysis (Large amount of protein in urine (+4) May indicate kidney disease
Pregnancy test (12 to 51 years of age are considered child bearing)
ECG for clients >than 50
Clinically significant side effects of lithium
Hypothyroidism
Course hand tremors with toxicity
Maculopapular rash
Diarrhea, vomiting, cramps, anorexia
Polyuria with related polydipsia
T-wave inversion
Leukocytosis
Carbamazepine (Tegretol) Black box warning for
Agranulocytosis (low WBCs) and Aplastic anemia (deficiency of all types of blood cells)
pallor, fatigue, headache, nose bleeds, bleeding gums, skin rash, shortness of breath
Steven Johnson syndrome particularly in Asians (Screen for HLAB1502 allele before initiation)
A hypertensive crisis occurs when
MAOIs are taken in conjunction with certain medication’s
Common medication include: Meperidine (Demerol), stimulants, decongestants, asthma medication,
Symptoms of hypertensive crisis include
Sudden, explosive like headache, usually in occipital region
 Hypertension, Flushing, palpitations, diaphoresis, fever
Treatment of hypertensive crisis includes
Discontinuing the MAOI
Phentolamine (Blocks by binding to norepinephrine receptor sites)
The treatment for serotonin syndrome
Cryptoheptadine (antihistamine)
Cardinal sign of serotonin syndrome is
Cardinal sign of serotonin syndrome is myoclonic jerking, hyper reflexia, confusion, shivering, goosebumps, tachycardia and hypertension
Teratogenic risks of benzodiazepines
Floppy baby syndrome, cleft palate
Teratogenic risks of carbamazepine
Neural tube defects
Teratogenic Risk of lithium
Ebstein anomaly
Teratogenic risk of Depakote
Spina bifida
For patients taking clozapine and/or carbamazepine (tegretol), Risk for neutropenia is monitored by which lab value
ANC only
DC Clozapine at ANC less than 1000 (Neutropenia) Regardless of whether the patient is showing signs of infection or not
DC clozapine at wbc’s 2000 to 3000 (Agranulocytosis)
For patients taking clozapine, what should the patient be closely monitored for
Signs of infection (Fever, chills, sore throat, weakness)
What is normal BMI
18.5 to 24.9
A BMI less than —— requires hospitalization
<15
Physical exam findings for anorexia
Low BMI
Russells sign (Calluses on dorsum of hand secondary to Induced vomiting)
Brittle hair and nails
Lanugo on face extremities and trunk
Amenorrhea
Emaciation
Bradycardia
Hypotension
BMI for a patient with bulimia nervosa is usually
Normal
As Wellbutrin is know to have more or less sexual side effects
Less sexual side effects because it is an NDRI
Which antidepressant is appropriate for patients experiencing depression with low energy and fatigue
Wellbutrin
Which antidepressant is contraindicated in patients with a history of seizure or anorexia/bulimia
Wellbutrin. Wellbutrin decreases seizure threshold
What are some known cytochrome P450 inhibitors
Pneumonic: SICK FACES.COM
Sodium valproate
Indomethacin
CLARITHROMYCIN/ Cimetidine
Ketoconazole
Fluconazole
alcohol
Chloramphenicol
ERYTHROMYCIN
Sulfonamide
Cipro
Omeprazole
Metronidazole
Grapefruit juice
Wellbutrin 
What are some common cytochrome P450 inducers
CARBAMAZEPINE (TEGRETOL)
Tobacco
Phenobarbital
Dilantin
Oral Contraceptives
Pneumonic: BS CRAP GPS
Barbiturates , St. John’s wort, carbamazepine,  rifampin, alcohol, phenytoin, Griseofulvin,  Phenobarbital, sulfonylureas 
Which common antipsychotic is metabolized by cytochrome P450 enzyme CYP1A2
Clozapine (Clozaril)
Which medications are known to reduce renal clearance
Indocin (NSAID)
Ibuprofen
Thiazides
Ace inhibitors
Why are older adults more sensitive to psychotropic medication
Most psychotropic medications are lipophilic and highly protein bound
Older adults have more body fat and less protein which makes them more likely to develop toxicity to two accumulation of medications
Also, older adults have slower metabolism and less muscle mass
Pharmacodynamics is
What a medication does to a persons body
An agonist does what
Binds to receptors and activates a biological response
An inverse agonist does what
Has the opposite effect of an agonist. Inverse agonists do not bind to receptors
Partial agonist do what
Does not fully activate the receptor
Antagonists do what
Bind to the receptor but does not activate it biological response
A BMI greater than 30 indicates
Obesity
In which areas of the brain is dopamine produced
Substantial nigra
ventral tegmental
nucleus accumbens 
In which area of the brain is norepinephrine produced
Locus ceruleus
medullary Formation
reticular formation
In which area is serotonin produced
Raphae nuclear of the brain stem
Glutamate is considered the universal
Excitatory neurotransmitter
GABA is considered the universal
Inhibitory neurotransmitter
Acetylcholine is synthesized by which area
The basil nucleus of Maynert 
Increased levels of corticotropin releasing hormones in which areas of the brain will increase symptoms of anxiety
Increased levels of corticotropin releasing hormone in the amygdala, hippocampus, and Locus coeruleus will increase symptoms of anxiety
The follow up care of the patient with ADHD should include
Monitor clinical progress overtime

Use standardized reading scales (Vanderbilt, Connors which both include parent and teacher input)
Autism spectrum disorder is best defined as
Persistent deficits in social communication and social interaction across multiple settings
Assessment findings you would expect to see in autism spectrum disorder includes
No response when called by name
Little or no eye contact
Non-verbal communication
Often likes to lineup, stack, or organize objects and toys
Common Screen tools used for autism spectrum disorder equal
Modified checklist for autism in toddlers (M-CHAT)
Autism diagnostic observation schedule -Generic (ADOS-G)
Ages and stages questionnaire’s (ASQ)
Pharmacological management in autism spectrum disorder may include
Antipsychotics which are affective for symptoms such as tantrums, aggressive behavior, self-injurious behavior, hyperactivity, and repetitive stereotypes behaviors
The corpus callosum is
An area of sensorimotor information exchange between the two hemispheres Of the cerebrum
Each hemisphere of the cerebrum is divided into four major lobes which are
Frontal lobe
Temporel lobe
Occipital lobe
Parietal lobe
Functions of the frontal lobe include
Executive function: Working memory, reasoning, planning, prioritizing, sequencing behavior, insight, flexibility to come in judgment, impulse control
Language (Broca’s area) expressive speech
Disturbances of the frontal lobe can lead to
Personality changes, emotional and intellectual changes
Temporal lobe functions include
Language (Wernicke’s area)
speech reception, language comprehension, Memory, facial recognition, Hearing, Speech, emotion
Functions of the Frontal lobe
Thinking, planning, problem-solving, emotions, Behavioral control, Decision making
Z
Functions of the Parietal lobe
Perception, object classification, spelling, Knowledge of numbers, Visual-spatial processing
Functions of the Occipital lobe
Vision, visual processing, color identification
Functions of the Cerebellum
Gross and fine hand motor skills, hand to eye coordination skills, and balance
Functions of the brain stem
Regulates body temperature, heat rate, breathing, swallowing
The clock drawing test 
Take a minute or two to complete
Quick screen for possible dementia / Alzheimers
Difficulties with the clock drawing test indicates constructional apraxia / lesions to the right parietal lobe

The limbic system Lies within the cerebrum and is composed of the
Thalamus, hypothalamus, Hippocampus, and amygdala
The function of the limbic system is to
Regulate and modulate emotions and memory
The function of the hypothalamus is two
Regulate appetite, circadian rhythm and libido
The function of the hippocampus is to
Regulate motivation, stress, emotion
Regulate memory and convert short-term memory into long-term memory
The function of the amygdala is
Mediation of fear, anxiety, aggression, and rage
Mediation of mood, fear, emotion, and aggression
 A typical antipsychotics antagonize the
they (block) the 5HT2a serotonin receptor
mesolimbic dopamine pathway
Excess dopamine causes positive psychotic symptoms
Antagonism of D2 receptors in the mesolimbic pathway helps decrease the positive symptoms of psychosis
Mesocortical dopamine pathway
Decreased dopamine in the mesocortical pathway causes negative and depressive symptoms of schizophrenia
Nigrostriatal dopamine pathway
The nigrostriatal dopamine pathway mediates motor movements
The blockade of D2 receptors in this pathway leads to the development of extrapyramidal symptoms (EPS) because of inverse rise in acetylcholine levels (inc salivation, teary eyes, diarrhea)
Long-standing blockade of D2 receptors in the nigrostriatal pathway can lead to tardive dyskinesia
Tuberoinfundibular dopamine pathway
Blockade of D2 receptors in this pathway can lead to increased prolactin levels which causes galactorrhea (risperidone), amenorrhea, gynecomastia, sexual dysfunction.
Long term hyperprolactinemia can lead to osteoporosis
Types of EPS (extrapyramidal symptoms) include:
Dystonia (Sustained muscular skeletal contractions) Oculargyric crisis, tortacollis
Akathisia (ants in pants)
Parkinsonism (same symptoms as Parkinson’s)
Tardive dyskinesia (repetitive oral and tongue smacking)
EPS is caused by
excessive D2 blockade (antagonism) from antipsychotic therapy
Decreased dopamine = Increased acetylcholine (remember inverse relationship)
Treatment of EPS includes
Anticholinergics like benztropine (Cogentin) for dystonia and Parkinsonism
Beta blockers for akathisia
Treatment of Tardive Dyskinesia is to stop or reduce the current dose of antipsychotic or start an atypical antipsychotics. Treatment can also include valbenazine (Ingrezza). Never give benztropine for TD. It can worsen TD
Occulogyric crisis
A rare form of dystonia which can lead to permanent injury and involves prolong involuntary upward deviation of the eyes
Treatment is benztropine (Cogentin)
Neuroleptic malignant syndrome is
A type of EPS
typically caused by taking too much of a first generation antipsychotic which decreases levels of dopamine too greatly
severe muscle rigidity which can cause rhabdomyolysis, MUTISM, Fever, tachycardia, confusion
Labs: CPK (elevated from muscle contraction and muscle distraction)
myoglobinuria, elevated WBCs (Leukocytosis) elevated LFTs
Treatment is discontinue the antipsychotic. Then give dantrolene (muscle relaxer) and a D2 agonist (like bromocryptine) to increase dopamine levels
To commonly used rating scales for the severity of akathisia are
The Barnes Akathisia rating scale
Extrapyramidal Symptom rating scale 
Which antidepressant is associated with the most adverse cardiovascular side effects
citalopram (Celexa)
2011 warning about prolonged QTC intervals in doses greater than 40 mg (>20mg in older adults)
The study of a drug absorption, metabolism, distribution, and excretion is called
Pharmacokinetics
The study of what a drug does to the body is
Pharmacodynamics
Hallmark sign of fetal alcohol syndrome is
Underdeveloped features
(Small head circumference, small eye openings, small nose, Small lips, low nasal bridge, epicanthal skinfolds,
Absorption is defined as
Method and rate and which drugs leave the site of administration.
With oral medications absorption normally occurs in a small intestine and then the liver
Distribution is defined as
When the drug leaves the systemic circulation and enters the interstitium and cells
Most psychotropic medication’s are lipophilic and highly protein bound. Only the unbound portion of the drug is active
Patients with low protein levels related to malnutrition, aging can potentially experience toxicity
Which classification of medications is moved commonly associated with mania like side effects?
Steroids (Flonase, prednisone)
Which classification of medication is most commonly associated with depression like side effects
Steroids (Flonase (fluticasone), prednisone)
Isotretionoin (Accutane) Is associated with which two side effects?
Depression
Birth defects (patients who are pregnant and taking Accutane should be recommended to stop immediately)
Propranolol is known to exacerbate or cause which psychiatric diagnosis
Depression
A physical description of a patient with fragile X syndrome would include
A description of larger structures
Large, long head and ears.
Macrorchidism (Abnormally large testes)
Hyper extensible joints
Crossed eyes (Strabismus), Highly arched palette
Tricyclic antidepressants are known to cause what and should be avoided in patients with a history of what?
TCAs are known to cause EKG changes and cardiac dysrhythmias
Should be avoided in patients with history of cardiac dysrhythmias
If necessary in this population EKG should be monitored before treatment begins and annually
What causes a hypertensive crisis
MAO eyes are taken in conjunction with certain medication‘s
Meperidine (Demerol) Can result in coma or severe respiratory depression
Stimulants and other sympathomimetics (Amphetamines, cocaine)
TCAs, atypical antipsychotics
What are the symptoms of a hypertensive crisis
Sudden, explosive like headache, usually in occipital region
Hypertension, palpitations, pupillary dilation, diaphoresis, fever, Flushing
What is the treatment for a hypertensive crisis
Discontinue the MAOI
Give phentolamine (Blocks norepinephrine)
What causes serotonin syndrome
Taking too much of an Antidepressant (SSRI, MAOI, TCA, SNRI)
TRIPTANS (Migraine medication) Imitrex (sumatriptan)
At John’s Wort
What are the symptoms of serotonin syndrome
Hyperreflexia, myoclonic jerking, loss of coordination
Agitation, restlessness, palpitations, rapid heart rate, hypertension, headache, sweating, shivering, goosebumps
Confusion, fever, seizures, unconsciousness
 What is the treatment for serotonin syndrome
Discontinue the offending agent and provide support of treatment including
Judicious use of benzodiazepines
Serious overdose may require Cryptoheptadine (Anti-histamine) , and anticonvulsants 
When switching from an SSRI to an MAOI how long should a practitioner have the patient weight
14 days
When switching from Prozac to an MAOI how long should the practitioner have the patient wait
5 to 6 weeks
When switching from an MAOI back to Prozac how long should a practitioner have the patient wait
Two weeks
When switching medication’s a good rule of thumb is to always wait at least how many days regardless of drug class
14 days
When switching from Prozac is best to wait how long because of Prozac’s long half life
5-6 weeks
Serotonin discontinuation syndrome is caused by
Abrupt discontinuation
Symptoms of Serotonin discontinuation syndrome 
Flu like symptoms
Fatigue and lethargy
Myalgia
Decreased concentration

Which Antidepressant Is most likely to cause discontinuation syndrome if stopped abruptly
Zoloft (sertraline) has a short half-life so discontinuation syndrome is more likely
Delusions are defined as
Firmly maintained false beliefs despite evidence to the contrary
Paranoia is defined as
Believing that people are out to get you
Referential thinking is defined as
The belief that Cues and events in a patient’s every day life Have special meaning just for them
Components of mental status exam
Appearance
Behavior
Speech
Mood
Affect
Thought process
Thought content
Thought process as part of the MSE is defined as
Assessment of the patient’s organization of thoughts and ideas

Tangential thought process as part of the MSE is defined as
Moving from thought to thought in a way that may or may not relate to the question and never gets to the point
Circumstantial thought process as part of the MSE is defined as
Providing unnecessary detail but eventually answering the question
Thought content as a part of the mental status exam is defined as
Themes that occupy the patients thoughts and perceptual disturbances
Examples: SUICIDAL IDEATION, HOMICIDAL IDEATION, auditory or visual hallucinations
MMSE (Folstein scale) uses what to assess concentration, calculation, and attention?
Counting backwards from 100 by 7 (Serial 7’s)
MMSE (Folstein scale) uses what to assess registration (Ability to learn new material)
Slowly and clearly say the names of three unrelated objects. Ask the patient to repeat them
The MMSE (Folstein scale) defines registration as
The ability to learn new material
The MMSE (Folstein scale) uses what to assess fund of knowledge
Ask the patient who the current president is
Appraisal of the patient suicidal ideation, plan, method, intent would be documented in which part of the patients psychiatric evaluation?
Mental status exam
Which demographic group is at the highest risk of suicide 
Older, single, white, males, with depression
Treatment for alcohol withdrawal begins with a CIWA score of
8 or greater for (prn only)
15 or greater for (scheduled + prn)
Diazepam and lorazepam are commonly used.
Which three medications are approved by the FDA for the treatment of alcohol use disorder
Acomprosate (campral)
Disulfiram (Antabuse)
Naltrexone (vivitrol)

Acomprosate and naltrexone decrease Alcohol consumption
Signs and symptoms of withdrawal according to the clinical opioid withdrawal scale (COWS)
Yawning
ability/anxiety
Myalgia
Pupillary dilation
Pilo erection
Lacrimation
Rhinorrhea
COWS severity scale
0-4 none
5-12 mild
13-24 MODERATE
25-35 moderate/severe
>36 severe
It is best to give Buprenorphine or Suboxone (buprenorphine/ naloxone) when the patient is in a state of
Moderate withdrawal
Antabuse (disulfiram) should not be administered until the patient has been alcohol free for at least
12 hours
Patients should refrain from using anything containing alcohol (Vinegar, aftershave, perfume, mouthwash, cough medication) for how long after discontinuing disulfiram
2 weeks
The normal value for a mini mental status exam is
25-30 Normal
24-21 Mild dementia
20-10 Moderate dementia
9-0 Severe dementia
The normal value for the HAM-D depression rating scale is
(0-27)
0-7 normal
8-13 mild depression
14-18 moderate depression
19-22 severe depression
23-27 very severe depression
The normal value for the PHQ-7 depression rating scale is
(0-27)
0 - 4 Normal
5 - 9 Mild
10 - 14 Moderate
15 - 19 Moderated to severe
20 - 27 Severe
A normal value for the HAM-A anxiety rating scale is a less than
HAM A (0 - 56)
0 -17 Mild anxiety
18 - 24 Moderate anxiety
25 - 56 Severe anxiety
A normal score for the GAD Anziety rating scale is
GAD (0 -23)
0 - 4 Normal
5 - 9 Mild
10 - 14 Moderate
15 - 21 Severe
A normal value for the Beck Depression rating scale is
Beck (0-63)
0 - 9 Normal
10 - 18 Mild
19- 29 Moderate
30- 63 Severe
What is the acronym used to guide treatment for the brief intervention for treatment of alcohol 
FRAMES
Feedback
Responsibility
Advice
Menu
Empathetic interviewing
Self efficacy
What is the most commonly used screening tool for alcohol abuse
CAGE
Item responses on the CAGE are scored 0 or 1, with a higher score an indication of alcohol problems. A total score of 2 or greater is considered clinically significant
What does the CAGE acronym stand for
Felt the need to (cut down)
(Annoyed) by you mentioning your drinking
Felt (guilty) about your drinking
Felt the need to drink first thing in the morning to steady your nerves (Eye-opener)
Delirium is characterized by
Short term changes in cognition
Disturbances of consciousness
Inattention
Delirium has a poor prognosis and
A one-year mortality rate of 40%
The Pharmacological treatment of choice For delirium is
Haldol
Haldol is preferred for agitated patients
Avoid benzodiazepines unless alcohol withdrawal is involved
What are the two types of dementia
Cortical and sub cortical
Describe cortical dementia
Affecting the outer layer of the brain (Cortex) Which plays a critical role in memory and language
Examples include Crutchfield Jacobs, Picks, and Alzheimer’s dementias
What symptoms characterize cortical dementia
Severe memory impairments and aphasia
Describe subcortical dementia
The early symptoms of clumsiness (MOTOR), irritability, and depression are what differentiates subcortical dementia from cortical dementia
Examples include Huntington’s, Parkinson’s, vascular, Lewy body, and AIDS dementia
In the later stages both types of dementia have similar presentations
Alzheimer’s dementia
without focal neurological deficits
Vascular dementia
Diffuse cerebral atrophy and enlarged ventricles
Decreased acetylcholine and norepinephrine
Carotid bruit, funduscopic abnormalities, and enlarged cardiac chambers
HIV dementia
Early signs are motor abnormalities (coordination, tremors, dystonia), cognitive decline, and Behavioral abnormalities
Picks dementia (aka frontotemporal dementia or frontal dementia)
language changes (slurred speech)
Huntington’s dementia
A high incidence of depression and psychosis
Lewy body dementia
visual hallucinations
Commonly used standardized instruments for assessing level of impairment in dementia
Montreal cognitive assessment (MoCA)
Mini-Cog
St. Louis University mental status examination (SLUMS)
What are the preferred treatment for psychosis and agitation in dementia
Try non-pharmacological treatments first
Atypical antipsychotics are considered first line treatment
Benzodiazepines should be avoided as these patients are susceptible to their adverse effects (falls, sedation, and delirium)
The goal of primary prevention is to, then name examples
Decrease the incidence of new cases
PREVENTION
Examples include stress management classes, smoking prevention, drug abuse prevention classes
The goal of secondary prevention is to, then name examples
Decrease the prevalence of existing cases
Examples include SCREENING, hotlines, crisis intervention, disaster response
The goal of tertiary prevention, and provide examples
Decrease the disability and severity of existing cases
Examples include REHABILITATION
What is kindling
The process of neuronal membrane threshold sensitivity dysfunction
Process through which increasingly low severity stimuli can activate negative responses over time. (Seizures)
Define addiction
A cluster of cognitive, behavioral, and physiological symptoms indicating that the patient continues to use substances despite significant substance related problems
Potency is defined as
The relative dose require to achieve certain effects
ADHD requires how many attention symptoms and how many hyperactive symptoms
Six or more symptoms of an attention and six or more symptoms of hyperactivity
What are the symptoms of inattention In ADHD
Lack of attention to detail
Inability to maintain attention
Poor listening skills
No follow through
Disorganization
Avoids hard tasks
Loses things
Distracted
Forgetful
What are the Symptoms of hyperactivity in ADHD
Fidgety
Inability to stay in seat
Running and climbing
Inability to engage in quiet activities
Always on the go
Excessive talking
Blurting out information
Difficulty waiting for turn
Interrupting others
There are three types of ADHD what are they
ADHD, inattentive type (Lack of Symptom criteria for hyperactivity)
ADHD, hyperactive type (Lack of Symptom criteria for an attention)
ADHD combined type (All criteria for hyperactivity and inattention are met)
What is the etiology for ADHD
Abnormalities of frontal sub cortical pathways (Frontal cortex, basal ganglia, reticular activating system)
Basal ganglia (Motor control)
Reticular activating system (Arousal, sleep wake cycle, ability to focus)4
What are the neurotransmitter abnormalities affecting ADHD
dopamine dysfunction
Norepinephrine dysfunction
Serotonin dysfunction
Pharmacological management of ADHD
Before starting stimulants assess cardiac history
AMPHETAMINES (Adderall) can be prescribed in children ages THREE and older
Methylphenidate (Ritalin, Concerta) and Amphetamines can be prescribed in children’s ages six and older
Alpha-2 agonist (Non-stimulants- Guanfacine, clonidine, Atomoxetine (Strattera)) Can be prescribed to children ages six and greater
In order to diagnose ADHD in children what must be determined
Intellectual functioning based on psychometric testing
Psychometric testing:
Connor’s parent and teacher reading skills
Vanderbilt ADHD diagnostic parent and teacher rating skills
What are signs of stimulant abuse
Insomnia
Tremors
Hypertension and tachycardia
Palpitations
What does non-pharmacological management of ADHD include
Behavioral therapy
Patient and parent cognitive behavioral training program
Psychoeducation
Treatment of learning disorders

Family therapy and education
Describe autism spectrum disorder
Persistent deficits in social communication and social interaction across multiple settings
Characteristics of borderline personality disorder
Impulsivity, often with self damaging behavior
Recurrent suicidal behavior
Non-pharmacological treatment for borderline personality disorder
dialectical behavioral therapy
Characteristics of antisocial personality disorder
Reckless disregard for the welfare of others
Lack of remorse and indifference to the feelings of others
Rett Syndrome occurs primarily in who and what are common physical findings
Girls
Common physical findings are loss of purpose for hand skills
stereotypic hand movements
Deceleration in head growth really look like shit
Disruptive mood dysregulation disorder (DMDD) Is characterized by
Diagnosed in children older than age 6 but younger than age 18

Chronic diss regulated mood
Frequent temper outbursts and tantrums
Severe irritability and anger
Pharmacological management of major disruptive mood disorder includes
Atypical antipsychotics
Stimulants (for irritability)
Antidepressants
Mood stabilizers
What is the pneumonic for diagnosing depression
SIGE CAPS
Sleep disturbance
Interest reduced
Guilt or self blame
Energy loss or fatigue
Concentration Diminished
Appetite Diminished
Psycho motor Changes
Suicide Ideation
Pharmacological management of major depressive disorder includes educating the patient about
The therapeutic effect of Antidepressant treatment may take 4 to 6 weeks
Once antidepressants have been started continue them for minimum of 6 to 12 months
If a client has more than two prior episodes of major depressive disorder consider continuing antidepressants indefinitely
Tricyclic antidepressants should be avoided in patients with a known history or Family history of
Cardiac dysrhythmias
TCAs are known to cause EKG changes and cardiac dysrhythmias
If a patient With major depressive disorder is experiencing treatment resistance or psychotic features Watch alternative treatment should be considered
Electroconvulsive therapy
What are possible contraindications for electroconvulsive therapy
Cardiac disease
Compromise pulmonary status
History of brain injury or brain tumor
Complications with anesthesia
What are some possible adverse effects When treating patients with electroconvulsive therapy
Possible cardiovascular effects
Systemic effects (Headache, myalgia, drowsiness)
Cognitive effects (memory disturbance, confusion)
When treating children, adolescence, or young adults with antidepressants, what should you practitioner always take into consideration
All antidepressants carry a black box warning about increased suicidal thoughts. Patients should be monitored closely for suicidal thoughts/behavior
What is a symptom of major depressive disorder that is commonly confused with dementia related symptoms
Cognition and memory loss
How can the practitioner differentiate between cognitive and memory loss symptoms in patients with major depressive disorder versus patients with dementia
Clients with dementia usually have a pre-morbid history of slowly declining cognition
In major depressive disorder cognitive changes have a relatively acute onset
No harm contracts are generally considered
Ineffective at reducing the risk/rate of suicide
There is insufficient evidence to prove no harm contracts work
What characteristic of fluoxetine (Prozac) Provides the greatest degree of safety for patients who have severe depression
Les potential for injury with intentional overdose
The pneumonic for mania in bipolar disorder is
DIG FAST
distractibility
Impulsivity
Grandiosity
Flight of ideas (Racing thoughts)
Agitation (Psycho motor)
Sleep (Decreased)
Talkativeness (Pressured speech)

The neurotransmitters involved in bipolar disorder are
GABA, Glutamate, serotonin, norepinephrine, dopamine

An added benefit of using lithium to treat bipolar disorder is that lithium is considered
Neuro protective
Which combination medication is FTA approved for the treatment of bipolar disorder
Symbyax (Prozac and Zyprexa)
According to the most recent treatment guidelines for bipolar disorder type one with psychotic features the best pharmacologic treatment choice would be an
Antipsychotic To stabilize the patient faster
Aside from the obvious symptoms of Steven Johnson syndrome (Tongue swelling, papules, rash, skin sloughing, painful mucous membranes) another important symptom to remember is
Fever
Non-pharmacological management of bipolar disorder includes
CBT
Behavioral therapy’s
Interpersonal therapy’s
Supportive groups
Milieu therapy
What are normal free thyroxine (FT4) lab values
0.8-2.8 ng/dl
What are normal thyroid stimulating hormone lab values
0.5 - 5.0 mU/l
When T4 and T3 are high, TSH secretion is
Decreased
T3 and T4 are low, TSH secretion
Increases
Hypothyroidism is defined as
Increased TSH (Decreased T4 and T3)
Systemic effects of hypothyroidism include
Cold intolerance
Confusion
Decreased libido
Weight gain
Hyperthyroidism is defined as
Decreased TSH (Increased T3 and T4)
Systemic effects of hyperthyroidism include
Heat intolerance
Irritability
Agitation
Anxiety
Tachycardia
Mood swings
Weight loss
ALT (Alanine aminotransferase) Normal lab values are
5 to 35 U/l
When liver damage occurs serum ALT levels rise as much as
50 times normal
Commonly seen laboratory findings in patients with alcohol dependence and abuse
AST/ALT ratio of >2.0
Elevated:
Glutamyltransferase
Mean corpuscular volume
Prothrombin time
Uric acid
Total cholesterol
Triglycerides
Decreased:
Magnesium
Calcium
Potassium
BUN
H&H
Platelet
Albumin
Oppositional defiant disorder is characterized by what two symptoms
An enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior lasting at least 6 months with at least four of the associated symptoms
Argues with authority
Absence of physical aggression

How is oppositional defiant disorder managed
Non-pharmacologically
Individual Therapy
family therapy (emphasis on child management skills), teaching parents
about positive reinforcement and boundary settings.
Evidence based treatment : Child and parent problem-solving skills (Adolescent Transitions Program ATP)
What are the defining characteristics of conduct disorder
Lack of remorse
Aggression to people or animals
The rights of others or societal norms or rules are violated
What is the pharmacological management of conduct disorder
Target mood and aggression
Aggression and agitation are treated with antipsychotics, mood stabilizers, SSRI, and alpha agonists
Which symptoms are characteristic of conversion disorder
NEUROLOGICAL symptoms that cannot be explained by medical condition
Mutism
Blindness
Paralysis
Paresthesia (Glove stocking syndrome)
 Symptoms usually begin suddenly after a stressful event
Which symptoms are characteristic of adjustment disorder
EMOTIONAL or behavioral reaction to a stressful situation
An unhealthy reaction/response to an event that occurs within three months of it happening
Example: Stressful events or changes in the life of your child or adolescent may be a family move,
the parents’ divorce or separation, the loss of a pet, or the birth of a sibling.
What are the subtypes types of adjustment disorder
Adjustment disorder with depressed mood
Adjustment disorder with anxiety
Adjustment disorder with mixed depression and anxiety
Adjustment disorder with Disturbance of conduct
Adjustment disorder with mixed emotions and conduct (A combination of all the above disorders)
In the absence of other significant clinical symptoms, grief is usually classified as
Adjustment disorder
Post traumatic stress disorder is best described as
Re-experiencing of an extremely traumatic event accompanied by symptoms of increased arousal and avoidance of stimuli associated with the trauma
Off label pharmacological management of nightmares may include
alpha antagonist like prazosin
What is the inclusion criteria for Tourette’s syndrome
At least 2 motor tics and at least 1 vocal (phonic) tic have been present, not necessarily at the same time
Tics are not caused by the use of a substance or other medical condition.
What is the primary neurotransmitter involved in Tourette’s syndrome
dopamine
Serotonin
Norepinephrine
A common medication used in the treatment of Tourette’s syndrome is
Haldol (D1 and D2 antagonist) because of the excessive levels of dopamine
Also Aripiprazole
What is the only known antipsychotic that has been shown to reduce the risk of suicide In patients diagnosed with schizophrenia
Clozaril
Most second generation antipsychotics (Clozapine, olanzapine, Quetiapine, and risperadone) cause the undesirable side effect of
Weight gain
Ziprasidone (Geodon), aripiprazole (abilify), and lurasidone (latuda) are weight neutral.
aripiprazole (least sedating)
What is the etiology of schizophrenia
Inadequate synapse formation
Excessive pruning of synapses
Excitotoxic death of neurons
Prenatal exposure to toxins, including viral agents
What are some common in neurobiological findings in patients with schizophrenia
Enlarged ventricles
Smaller frontal and temporal lobes
Cortical atrophy
Decreased cerebral blood flow
Smaller hippocampus and amygdala
What are the characteristic neurotransmitter concentrations in schizophrenia
Excessive dopamine in mesolimbic pathway
Decreased dopamine in the nasal cortical pathway
Excessive glutamate
Decreased gaba
Decreased serotonin
What is the average ave age of onset of Symptoms of schizophrenia in men
18 to 25
Men tend to have more negative symptoms
What is the average age of onset forsymptoms of schizophrenia in women
Age is 25 to 35
Women usually experience more dysphoria than men and tend to have paranoid delusions and more hallucinations than men
Atypical antipsychotics are effective at managing symptoms of schizophrenia because of your action on which receptors
D2 and 5HT2A
And have less EPS
What are the positive symptoms of schizophrenia and what is the cause
Hallucinations
Delusions
Referential thinking
Disorganized behavior
Hostility
Grandiosity
Mania
Suspiciousness
Caused by excessive dopamine in the mesolimbic pathway
What are the negative symptoms of Schizophrenia and what is the cause?
The “A’s”
Affect (Flattened)
Alogia (Poverty of speech)
Avolition
Apathy
Abstract thinking (Inability)
Anhedonia
Attention deficit
The cause is decreased dopamine in the mesocortical pathway
What Is a non-pharmacologic method of treatment for patients with schizophrenia
ACT (Assertive community treatment)
An evidence based, multidisciplinary team approach which is available to patient with schizophrenia living in the community.
This is an alternative to restrictive residential or hospital settings
Which aspects of preventative care should be considered during follow up with patients with schizophrenia
In order to screen for complications of treatment practitioners should monitor:
serum glucose
lipid panels
Weight
BMI
Waist to hip ratio
 How many stages of human development are there according to Erikson? What are they?
eight
Infancy 0-1
Early childhood 1-3
LATE CHILDHOOD 3-6
SCHOOL-AGE 6-12
Adolescence 12-20
Early adulthood 20-35
Middle adulthood 35-65
Late adulthood >65
What is the developmental task of infancy according to Erikson
Infancy 0 to 1 year
Trust versus mistrust
What is a developmental task of early childhood according to Erikson
Early childhood 1 to 3 years
Autonomy versus shame and doubt
What is the developmental task of late childhood according to Erikson
LATE CHILDHOOD 3 to 6 years
INITIATIVE v GUILT
What is the developmental task of school age according to Erickson
SCHOOL AGE 6 to 12 years
INDUSTRY v INFERIORITY
What is the developmental task of adolescence according to Erikson
Adolescence 12 to 20 years
Identity versus role confusion
What is the developmental task in early adulthood according to Erikson
Early adulthood 20 to 35 years
Intimacy versus isolation
What is the developmental task of middle adulthood according to Erikson
Middle adulthood 35 to 65 years
Generativity versus self absorption (Stagnation)
What is the developmental task in late adulthood according to Erikson
Late adulthood greater than 65 years
Integrity versus despair
What are indications of developmental mastery in late childhood according to Erikson
Self directed behavior, Ability to be a self starter
Purpose
What is an indication of developmental mastery in school age children according to Erikson
Competency
Friends and classmates play a role in how children progress
Through proficiency at play and schoolwork, children are able to develop a sense of competency and pride in their own ability
How many stages of cognitive development are there according to Piaget. What are they called?
Sensorimotor (0-2) Object permanence
PREOPERATIONAL (2-7) Egocentric, Magical thinking (Believe their thoughts can influence their environment)
Concrete operational (7-12) Reversibility and conservation
FORMAL OPERATIONAL (>12) ability to think abstractly, thinking operates in a formal, logical manner
Define object permanence
Objects continue to exist after they are no longer seen
Define object constant y
Absence does not mean disappearance or abandonment
Describe the phallic stage of Freud’s psychosexual stages of development
Occurs ages 3-6
Exhibition, masturbation with focus on oedipal conflict, anxiety of castration males in fear of lost maternal love in females
Can lead to sexual identity disorders if failure to fulfill stage
Idealization is it coping method for dealing with
Anxiety
What are two key themes used in motivational learning
Affirm the patient’s positive treats
Reflective listening
Being non-confrontational and non-adversarial
What are the 5 predictable stages of change that occur according to the trans theoretical model of change
Precontemplation: Not aware of the problem. Practitioner should raise the patient’s awareness without giving any prescriptive advice
Contemplation: Aware of a problem but not committing to change. The practitioner should help the patient see the benefits of change and the consequences of not changing,
Preparation: The patient has made the decision to change. The practitioner should help the patient find a change strategy
Action: The patient is engaging in overt actions to change. The practitioner should support and advocate for patient
Maintenance: The patient is engaging in behaviors to prevent relapse. The practitioner should help the patient identify the possibility of relapse and identify and use strategies to avoid relapse
Who developed cognitive therapy and what is the goal
Cognitive therapy was developed by Aaron Beck
The goal is to change clients irrational beliefs, faulty conceptions, and negative cognitive distortions
What techniques does behavioral therapy employ to help change patient’s maladaptive behaviors
Modeling
Exposure
Relaxation
Problem-solving
Role-playing

What is the aim of cognitive behavioral therapy
Change the patient’s thought patterns, conscious and unconscious beliefs, Attitudes, and behavior to increase their ability to attain goals and face face difficulties
How does cognitive behavioral therapy work
The patient and Therapist work as a team to identify problems, devise strategies, and create solutions
(SKILLS TRAINING AND EXPOSURE)
Some essential cognitive behavioral therapy tools are
JOURNALING
COGNITIVE RESTRUCTURING  (Exploring the cause of Faulty thinking, and then restructuring and reframing them
Nightmare exposure
Relaxed breathing
Unraveling cognitive distortions
Exposure and response prevention
PANDAS is
(Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections)
Sudden onset of OCD symptoms associated with streptococcal infection
Existential therapy is aimed at
Understanding the patient subjective experience
Existential therapy emphasizes
Making responsible choices and excepting freedom
Understanding the patient’s subjective world/experiences
Goals of existential therapy are to
Focus on the present and on personal responsibility
Understand the patient’s subjective world/experiences
Existential therapy is suited for
Terminal illness, suicidal thoughts
Humanistic therapy is also known as known as
Person centered therapy
Humanistic therapy involves the concept of
People are born with the capacity for:
Self-directed growth
Self actualization
What is the goal of interpersonal therapy
identify and modify interpersonal problems to manage relationships
Which psychiatric disorder is EMDR most commonly used in
PTSD
Although both CBT and EMDR are used in PTSD, EMDR is preferred
What is the goal of EMDR
To achieve adaptive resolution
What are the three phases of EMDR
Desensitization phase
Installation phase
Body Scan
What does the desensitization phase of EMDR involve
Client visualizes the trauma and verbalizes the negative thoughts or maladaptive beliefs are remaining attentive to physical sensations.
This process occurs for a limited time While the client maintains rhythmic eye movements
The client is then instructed to block out negative thoughts and to verbalize their feelings
What does the installation phase of EMDRinvolve
The patient installs it increases positive thoughts that they have declared as a replacement of the original negative thought
What does the body scan phase of EMDR involve
The client Visualize the trauma along with a positive thought and then scans their body mentally to identify any tension
Irving alone was the first person to
What is the reticle perspective on group work and identified 10 therapeutic factors unique to Group Therapy
What are the unique factors of group therapy as defined by Irving Yalom
Installation of hope
Universality
Altruism
Increase development of socialization skills
Imitated behaviors
Interpersonal learning
Group cohesiveness
Catharsis
Existential factors
Corrective refocusing
What is the focus of family systems therapy
Focus is on chronic anxiety within families
Uses genomes and triangles
What are the treatment goals of family systems therapy
To increase levels of self differentiation And awareness of each members function within a family
What are triangles within family systems therapy
Dyads that form triads to decrease stress
The lower the level of family adaptation the more likely a triangle will develop
Structural family therapy examines
The boundaries and hierarchy within a family
What is the difference between strategic Family therapy and structural family therapy
Strategic Family therapy is more symptom focused than structural family therapy
What is a paradoxical directive within strategic therapy
A paradoxical directive is a negative Task that is assigned to a family member who is resistant to change (use with caution)
Solution focused therapy utilizes
Miracle questions
” If a miracle water happen tonight while you were asleep and tomorrow morning you a walk to find the problem no longer existed, what would be different?”
“ How would you know the miracle to place?”
“ How would others know?”
Which complementary/alternative therapy is used to treat pain and depression
Acupuncture
List the 11 defense mechanisms
Denial
Projection
Regression
Repression
Reaction formation
RATIONALIZATION
Undoing
INTELLECTUALIZATION
Suppression
Sublimation
Altruism
The defense mechanism of projection is best described as
Individuals attributing their own unacceptable thoughts and feelings to another person.
“ Do you hate someone but you know this is an unacceptable emotion so you ‘solve’ the problem by believing they hat you”
A defense mechanism of displacement is best described as
redirection of an impulse (usually aggression) Onto a powerless substitute target
The defense mechanism of sublimation is best described as
 Displacement of unacceptable emotions into behaviors which are constructive and socially acceptable
The defense mechanism of INTELLECTUALIZATION Is best described as
Concentrating on the intellectual aspects of a situation to avoid emotional aspects
The defense mechanism of RATIONALIZATION is best described as 
An attempt to logically justify an unacceptable behavior
Research has shown a correlation between ACE adverse childhood experiences (Traumatic events occurring between the ages of zero and 17) and
Heart disease, fractures, diabetes, unintentional pregnancy, depression, anxiety, COPD, Chronic bronchitis, sleep disorders, Dissociative disorders, Eating disorders, alcoholism
When working with avoidant patients with the history of trauma what communication techniques are effective/helpful
Communication techniques that increase arousal
Activation of the amygdala is needed so that memories stored there can be re-processed
How is the recovery model defined
There is an emphasis on resilience and control over problems Rather than full symptom resolution
Recovery as defined by the recovery model is
Not about getting rid of problems for a rather fostering ones own Abilities, interests, dreams
Recovery as defined by the recovery model is a process which is
Non-linear With occasional setbacks and learning from experience
The four dimensions of recovery according to the recovery model are
 Health
 Home
Purpose
Community
Alternative community treatment Is centered on
The patients Personal strengths, and needs, and desires for the future
It serves as an alternative to more restrictive Residential or hospital settings for patients with more severe mental illness
Tics are contraindicated for what classification of medication
Stimulants
Use guanfacine instead
The priority item after being notified by a patient at a have been raped or abused is to
Assure them that they are safe
The best setting to preform a psychiatric exam/interview on a patient is
In a private office or private area with the door open or partially open
If a child comes to your office with their parents and says that they were abused, make sure to
Interview the patients separately
Notify CPS
If a child is playing with a toy in a sexual way during your interview then you should be suspicious of
Sexual abuse
Immediately notify CPS
Therapeutic alliance is built with adolescents by reassuring them that
Information is confidential
Interview them without parents in the room
If a patient has a repeated history of self harm or suicidal ideations it’s important to notify them during your first meeting
About the limits of confidentiality
It Create an ethical dilemma to separate parents from children for the purpose of interviewing them However,
You must advocate for your patient (In this case the child) who has the right to confidentiality
When taking this exam
Inter-collaboration is encouraged and delegation is often incorrect
You have identified a gap in care when OB patients are discharged without Risk assessment for postpartum depression. You Work in conjunction with your coworkers to Create andimplement a screening process. In this scenario you have
Identified a problem and collaborated to find a solution
During this exam referring out should always be considered
As a last option. Ensure that there’s nothing else you can do for your patient before referring out. This may include lab work, counseling, testing etc.
When considering symptoms of a mental health disorder within a cultural context, ensure that you have the patient
Contextualize their symptoms with regards to their culture. Just because the patient appears to have symptoms of mental illness does not mean that they have a diagnosable mental illness. 
You can offer them a brief supportive therapy
If a patient has lost a job or house appropriate intervention would be
Brief supportive therapy
not medication
When attempting to reduce Mental health stigma within a diverse community the practitioner must use
Multicultural teaching
Ethnospecific assessment parameters
Common belief among Native Americans is the mental illness and or substance use disorder can be caused by
An imbalance between individuals in the world
The ethnic group with the highest rate of suicide and suicide attempts in the US is
Native Americans
If an employee of your office is attempting to take away a healing stick from a patient and the best action is to
Teach the employee about cultural competency and sensitivity
If a patient wants you to release information to their traditional healer you must first
Obtain clearance for informed consent from the patient
Normal TSH values are
0.5 - 5.0
If your patient taking depakote presents with signs of a heptaotoxicity (abdominal pain in the upper right portion of abdomen, reddish brown urine, jaundice, fatigue) Your next action should be to
To a liver function test checking me AST and ALT levels
Normal AST levels
5-40
Normal ALT levels
5-35
What is the therapeutic range for valproic acid
50 a 125
What are toxic levels for valproic acid
> 150
What are signs of valproic acid toxicity
Disorientation
Lethargy
Respiratory depression
Nausea/vomiting
What should be your next action if your patient presents with valproic acid toxicity
Stop valproic acid
Check valproic acid level
Check LFT and ammonia level
Kava is
An herbal supplement used for anxiety, stress, insomnia
Kava can cause
Liver damage
Kava interacts with
Xanax (can cause excessive drowsiness)
CNS depressants (Can cause excessive drowsiness)
Lamictal (lamotrigine) Has a black box warning for
Steven Johnson syndrome (FEVER, Bodyaches, rash, peeling skin, tongue swelling)
Which mood stabilizer is the least likely causes weight gain
Lamictal (lamotrigine)
Also the least likely chance of causing metabolic syndrome
Which antipsychotics cause the least weight gain?
Ziprasidone
Aripiprazole
Lurasidone
Which antipsychotic is the least sedating
Aripiprazole
How should the practitioner manage antipsychotic induced weight gain
Primary action should be nonpharmacological strategies to include exercise and nutritional counseling
If primary action unsuccessful, pharmacological interventions consist of switching to another antipsychotic with less potential for a weight gain
Ziprasidone (Geodon)
Aripiprazole (abilify)
Lurasidone (latuda)
The signs of infection caused by agranulocytosis in patients taking carbamazepine or Clozaril are
Sudden fever
Chills
Sore throat
Weakness
If a lithium level is greater than 1.4 in the practitioner must
Discontinue lithium regardless of symptoms and signs of toxicity
If a lithium level is 1.3 or 1.4 the practitioner may
Continue to Prescribe with him while monitoring the patient for signs and symptoms of toxicity
The neuroprotective treatment of choice for bipolar disorder is
Lithium
The only known Antipsychotic medication that has shown to reduce the risk of suicide in patients diagnosed with schizophrenia is
Clozaril 
ACE inhibitors (lisinopril) NSAIDs (ibuprofen, indocin), and thiazides (hydrochlorothiazide) can reduce
Renal clearance and cause lithium toxicity
Patients who are taking Lithium should be encouraged to
Increase their fluid intake to avoid dehydration
What should be the practitioners intervention if they suspect lithium toxicity
Discontinue lithium
Check Serum lithium levels
A washout time of how many half-lives is recommended between cessation of the previous drug and the introduction a new drug to avoid serotonin syndrome
5
When treating cancer patients experiencing depression medication’s with the least chance of drug drug interactions are
Citalopram (celexa) and escitalopram (lexapro) both are SSRIs
For patients with chronic neuropathic pain who are experiencing depression the best choice of antidepressant is
an SNRI
Cymbalta (Duloxetine)
Effexor (venlafaxine)
What classification of medication is used for chronic neuropathic pain
Alpha-2 Delta Ligands
Lyrics (Pre-Gabalin)
Gabapentin 
Which classification of antidepressants has the lowest incidence of sexual dysfunction side effects
NDRIs
Bupropion (Wellbutrin)
Both SSRIs and SNRIs can both cause sexual side effects
Which classification of antidepressants will help depressed patients were also experiencing fatigue
Bupropion (Wellbutrin) which is in an NDRI
Bupropion (Wellbutrin) is know to increase risk of 
Seizure
For children and adolescents taking SSRIs and SNRIs what should be assessed with each visit
Frequency and severity of self harm
Which SSRI can cause insomnia and should be taken in the morning
Prozac (Fluoxetine)
If a patient is self-medicating with alcohol it is considered
A barrier to treatment
Which mental health disorders are known to increase thoughts of self harm
Depression
Bipolar disorder
Alcohol abuse
Eating disorders
Schizophrenia
Which personality disorder is most likely to present with homicidal ideation
Antisocial personality disorder
Few experimental studies exist and investigate the placebo effect of antidepressants in
Children and adolescents
When compared to adults, children with depression have a reduced placebo rate.
This is because few parents want their children to receive placebos instead of standard of care
Which areas of the brain can cause aggression, impulsivity, and abstract thinking problems in patients with schizophrenia
Abnormality in the prefrontal cortex, amygdala, basal ganglia, hippocampus, and limbic regions of the brain
Patients with schizophrenia have low tolerance to
ALPHA 2 ADRENERGIC RECEPTOR AGONIST like (GUANFACINE AND
CLONIDINE)
The NEUROPTOTECTIVE EFFECTS of these medications are limited
ARE LIMITED
Stimulants potentially the release of which neurotransmitter
Dopamine
Prescribing stimulants to patients with schizophrenia can cause an increase in which symptoms and why?
Stimulants can cause an increase in positive symptoms because of increased levels of dopamine in the mesolimbic system
 A patient with a long-term history of medication not adherence would benefit from
A Case Manager who could arrange for a nurse to go to the patient’s home to administer their medication
What are the benefits of exercise programs for patients with schizophrenia
Exercise can improve cognition, quality of life, and long-term health
If patients with schizophrenia are the higher risk for relapse sometimes they are switched from oral to intramuscular Haldol. What is the ratio and what is the maximum dose intramuscularly per visit?
20 x’s the daily dose for the first month
15-10 x’s the daily dose for every month after the first
The patient should receive no more than 100 mg intramuscular per visit. They can return after 5 to 7 days to receive the rest of the dose if it exceeds 100mg
Define delusion
I firmly maintained belief despite information to the contrary
When performing a mental status examination of a preschool child (3-5), Information is obtained primarily through
CLINICAL OBSERVATION by listening and observing cues
The MMSE (Folstein scale) defines Recall as
Memory
Ask the patient if they can recall the three words you previously asked them to remember
Can the min mental status exam be used in pediatric patients 
No
Which atypical antipsychotic can be given intramuscularly for rapid stabilization of psychosis
Ziprasidone (Geodon)
Aripiprazole (abilify)
Paliperidone (Invega)

Dystonia is caused by and characterized by
D2 receptor blockade in the nigrostriatal dopamine pathway
Painful muscle spasms in the neck, stiff neck 
Increased Acetylcholine levels can cause
Increased salivation, watery eyes, diarrhea
Reglan can cause
EPS (Tardive dyskinesia, Parkinsonism)
Which two neurotransmitters are affected when a patient is experiencing extraparametal symptoms
Dopamine is decreased by the antipsychotics and acetylcholine is increased. There is an inverse relationship between dopamine and acetyl choline
What are normal prolactin levels in men and women
Men <20
Women <25
If a patient who is taking olanzapine (Zyprexa) Tells you that they have begun smoking what should you do
Increase the patient’s dose of olanzapine
Tobacco is an inducer And will decrease the serum levels of olanzapine
If a patient who is taking olanzapine tells you that they have quit smoking you should
Decrease their dose of olanzapine. Tobacco was acting as an inducer thereby increasing the metabolism of olanzapine. With the tobacco no longer present serum olanzapine levels will increase
Which classification of medication is associated with mania, depression, and psychosis
Steroids
If a patient who is taking antidepressants or mood stabilizers begins a medication that can cause depression or mania,what should the practitioner do
Increase the dose of either the antidepressant or a mood stabilizer to counteract the potential symptoms of depression or mania
Which to neurotransmitters are involved in addiction
Dopamine and GABA
If a patient with anorexia complains of pain after eating which diagnosis should the practitioner consider
Delayed gastric emptying
Are which medication can delay gastric emptying
Ranitidine
Omeprazole
Famotidine

Which classification of medication can decrease the absorption of psychotropic medication’s
Proton pump inhibitor antacids
Which symptom should be closely monitored in older adults (>65) who are taking SSRIs
Anxiety
If a medication causes a paradoxical effect the practitioner would want to
Avoid prescribing the medication future
Ziprasidone (geodon) can cause 
QT prolongation
The FDA now warrants that citalopram should don’t be given and doses greatest and 40mg daily (>20mg/daily in older adults) because
Doses over 40 mg can cause prolongation of the QT interval and lead to an abnormal heart rhythm (including torsade de pointes)
Apoptosis is defined as
Neuronal loss and cell death
The greatest risk for developing symptoms of bipolar disorder is
Family history (Highly inherited)
When diagnosed after the age of 45, bipolar disorder is almost always associated with
A medical condition
If a patient with borderline PD presents with irritability, anger, and self-harming behavior, The Practitioner should consider prescribing
lithium
If a patient with borderline PD presents with depressed mood, emotional lability, interpersonal
problems, rejection sensitivity, aggression, and hostility
The practitioner should consider prescribing Depakote
If a patient presents with borderline personality disorder exhibiting symptoms of self harm and suicidality then the therapy of choice is
Dialectical behavioral therapy because it has evidence of decreased suicidality in patients with borderline personality disorder
What are two techniques used in the process of diagnosing a patient with borderline personality disorder
Journaling and diary

Which medications can help control the behavioral symptoms such as impulse control problems and rage in Tourette’s syndrome
clonidine (Catapres, Kapvay) and guanfacine (Intuniv)
Acute stress disorder is
A psychiatric diagnosis that may occur in patients within 4 weeks of a
trauma
Versus posttraumatic stress disorder in which symptoms manifest >four weeks after the event
What is the eitology of ADHD inattentive type
Abnormalities in the prefrontal cortex
What part of the frontal cortex is specifically involved in executive function
Dorsolateral prefrontal cortex
If a patient’s parents were to become anxious during psychoeducation regarding ADHD the providers first action would be to
Stop and provide support to the parents
The symptoms most characteristic of obsessive compulsive disorder OCD or
Recurrent and persistent thoughts, impulses, images, compulsions (example motor tics)
Neurotransmitters affected are serotonin and norepinephrine
Distinguishing characteristic between obsessive compulsive disorder Tourette’s disorder is
The absence of Intrusive and persistent thoughts with Tourette’s disorder (tics only)
The presence of Intrusive thoughts with obsessive compulsive disorder (tics + intrusive/persistent thoughts)
What are the definitions of and differences between Factitious disorder and malingering disorder
Factitious disorder is self-induced harm to produce symptoms of illness (No secondary gain)
Malingering disorder symptoms are faked to achieve secondary gain.
What is the priority action if a child reports factitious disorder by other
Immediately report/notify CPS
What are the symptoms the most characteristic of reactive attachment disorder
Fearful, inhibited, withdrawn, apathetic, shows no emotion towards caregivers
The product of the severely dysfunctional really relationship with caregiver, neglect
Two defining characteristics of general anxiety disorder are
Excessive worry for > 6 months
To defining characteristics of panic attack are
Abrupt surge of intense fear
Impending doom
Panic disorder is best described as 
Recurrent unexpected panic attacks
The pharmacological treatment of choice for panic disorder or
the SSRIs Paroxetine (paxil), fluoxetine (Prozac), sertraline (Zoloft)
Disruptive mood dysregulation disorder is the best defined as
A depressive disorder occurring in children > age 6 but > age 18
These children are severely moody and irritable with frequent intense anger outbursts and temper tantrum’s
The ‘Broken Mirror’ theory of Autusm
Dysfunction of the mirror neuron system causes Poor social interaction and cognition
Which questionnaire would be most appropriate if the patient is irritable, depressed, with labile mood
Mood disorder questionnaire
It is important for the practitioners remember that nightmares in children can be attributed to
A family history or genetic predisposition
Which what are three things that should be ruled as possible causes of delirium in an older adult
Vitamin B 12
Folic acid
Infection
If a patient has pseudo dementia, primary diagnosis is
Depression (With memory and cognition impairment)
Compared to dementia, the onset of pseudo dementia is
Acute And associated with depressive symptoms
When interviewing a patient with Pseudo dementia a practitioner would expect the answer of
“ I don’t know”
vs the lack of an answer or confabulation with dementia
Irritability, anger, hallucinations, and delusions can all the symptoms of what in older adults
Depression
The primary characteristics that defines cortical dementia from subcortical dementia is
Subcortical dementia involves motor abnormalities (coordination, ataxia, dystonia, tremors)
Cortical dementia involves Language in memory impairments (aphasia, amnesia)
Preferred treatment for HIV dementia is
Antiretrovirals
What area of the brain is involved in speech comprehension
The temporal lobe (Wernicki’s area)
What area of the brain is involved with Speech expression
The frontal lobe (Broca’s area)
What are considered first-line agents in patients with psychotic symptoms of dementia
Atypical antipsychotics
What symptoms would the practitioner expect to see in a patient with a frontal lobe tumor
Personality changes and aggression
The substantia nigra helps to regulate
Motor movements
Signs of lead poisoning
Developmental delay, learning difficulties, Irritability, Loss of appetite, Weight loss, Sluggishness and fatigue, Abdominal pain, Vomiting, Constipation, hearing loss, Seizures, eating things such as paint chips, that aren’t food (pica).
How does multisystem family therapy work and who is it targeted for
Youth‘s age is 12 to 17 years who present with serious antisocial, problematic behavior, and with serious criminal offenses
The patient’s parents are empowered with resources and skills to help effectively manage their children
Multi system family therapy utilizes which types of services
Home based model of service delivery to reduce barriers that keep families from accessing services
The most important factor in effective hildhood grieving is
An intact family
What are the neurotransmitters involved in mood disorders
GABA, glutamate, dopamine, norepinephrine, serotonin
If a member is uncomfortable sharing with the group in the practitioner should
Encourage them to continue attending group
And individual sessions for the group member
Awareness of body sensations especially breath awareness is a key element of
Mindfulness meditation
What exercise can help provide resilience in children
Self-esteem building
If a patient is unable to construct a chronological narrative in the provider could assist by using
Closed ended questions
If a therapy session is scheduled for a husband and wife and one member cannot be present the Therapist should
Reschedule
If a 15-year-old brother sodomizes Their five year old brother, the therapist should insist that
The brother not be left alone with the younger brother
Also, the therapist should initiate crisis management
What is normal for boys to develop what between the ages of nine and 16 years
Breast buds
Usually resolve within six months
Therapist should order which lab value for a patient presenting with rheumatoid arthritis
ESR
Eosinophil sedimentation rate
An increased intercranial pressure can cause an infants cry to sound
Shrill
Why are women more likely to become intoxicated as well as Develop alcohol induced liver problems than men
Women produce less alcohol dehydrogenase than men
The grasp reflex (Palmer reflex) is normal unit what age
5-6 months
The startle reflex (Moro reflex) Is normal up until 
5-6 months
The Babinski reflex is normal up until
2 years
When the sole of the foot is stroked in an upward motion the toes fan out
Phosphodiesterase type 5
(PDE5) ie Cialis/Viagra are
Rapidly absorbed
IF a patient presents with NORMOCYTIC MACROCYTIC
ANEMIA give which supplements
FOLIC ACID
B12
IRON
The practitioner should screen all adolescent ADHD patients for
Substance abuse
Likewise all adolescence with substance abuse disorder should be screened for ADHD
The right of the habius corpus allows patients to
Leave the hospital AMA if they feel like they have been falsely hospitalized
Acute disseminated encephalomyelitis (ADEM) is characterized by a brief but widespread attack of inflammation in the brain and spinal cord that damages myelin – the protective covering of nerve fibers. ADEM often follows viral or bacterial infections, Neuro exam findings might include
Asymmetrical movement of the extremities
Ataxia
Paresthesia
Fatigue/weakness/confusion

When attempting to answer your PICOTquestion what is the highest level of evidence (level 1)
Level 1 = A systematic review of all relevant randomized controlled trials
PICOT stands for
Problem
Intervention
Comparison
Outcome
Time
The practitioner can assist a patient who is having difficulty constructing a timeline of their symptoms by
Asking specific questions that will anchor the patient’s memory or link memorable events together
Iatrogenic disease/illness is defined as
Tests, surgeries, medications that cause side effects
And example would be risperidone causing breast discharge
And effective means for convincing employees of implementing a new policy change would be to explain how the new policy will
Improve the quality of patient care
For the nurse practitioner functioning in the outpatient setting in effect means for demonstrating continuous quality improvement would be to
Develop an instrument to monitor clinical outcomes
For the nurse practitioner working with patients who have depression and anxiety and effective means to assess performance and outcomes would be to implement
standardize rating scale at regular intervals
Auto immune diseases can increase levels of what
Cytokines
What are some common signs and symptoms of alcohol withdrawal
Tremors
Paroxysmal sweal
Tactile disturbances
Auditory disturbances
Visual disturbances
Headaches
Three Pharmacological treatments of alcohol dependence may include
Acamprosate (Not metabolized in the liver) maintain sobriety By controlling drinking urges and cravings
Disulfiram (Antabuse)
Naltrexone (vivitrol) blocks the effects and feelings of alcohol. Naltrexone reduces alcohol cravings and the amount of alcohol consumed

Who determines the scope of practice within a given state
Deterrined by State legislative statues (State board of nursing). It defines the nurse practitioners role and varies broadly from state to state
Who determines the standards of practice for a nurse practitioners
The American nurses association
What are two exceptions to patient confidentiality
Patient discloses intent to harm self or others
Answering court orders, subpoenas, or summons
Informed consent is defined as
A communication process between provider in patient that results in a patient accepting or refusing the plan of care
Desmopressin his medication used for
Enuresis (nighttime bed wetting)
Decreases urine production
If a new black box warning is issued by the FDA The practitioner should do work before taking patients office medication or putting patient on to the medication
Research the risk and benefits
It is important for the Practitioner to do what two things for every medication and treatment they prescribe
Provide the patient with full disclosure
Document the disclosure and education
Reflective practice is defined as
Using debriefing strategies after an adverse event
Process of continual adaptation and learning
Name three legal concerns for tele medicine 
Confidentiality
Medical errors
Jurisdictional authority
If a pregnant patient is found to be misusing alcohol, The primary action of the nurse practitioner is two
Refer her to a residential treatment facility (Not report her for using alcohol while pregnant)
Example of Nonmaleficence: Doing no harm
Example: Stopping a medication that is causing harmful side effects or discontinuing a treatment strategy that is not effective and may be harmful.
Imminent danger.
Fidelity is defined as
Being true and loyal.
Fidelity, comes from the Latin “fides” meaning faithfulness, is concerned with promise keeping, integrity, and honesty,
It also involves meeting the patient’s reasonable expectations (role fidelity) such as being respectful, competent, and professional
Just culture is defined as
In a just culture, individuals are continually learning, designing safe systems, and managing behavioral choices.
The process of continuous quality improvement utilizes which acronym
PDSA
Plan
Do
Study
Act
Within the four components of health policy who are the policy makers
Process
Policy reform
Policy environment
Policymakers (Stakeholders and key players)
To assess barriers and facilitate evidence-based practice, PMHNPs should assess what among health-care providers
assess baseline knowledge, beliefs, and practices among health-care providers using a survey.
Defined the case management model
Nurses can optimize client self-care, reduce fragmentation of care, provide quality care across the continuum, improve clients’ quality of life, patient care and outcomes, reduce length of hospitalization, increase client, and staff satisfaction,
This model allows nurses to demonstrate there strengths as members of the multidisciplinary health care teams.
Tarasoff principle holds that providers have a
Tarasoff principle (Tarasoff v. Regents at the University of California, 1976):
Duty to warn potential victim of imminent danger of homicidal clients,
Donaldson versus Connor determined that
It is unconstitutional to commit person involuntarily who is not immediately a threat to themselves or others
Risk factors for suicide
Previous suicide attempt
Ages 45 or older if male
Ages 55 or older if female
Divorced, single, or separated
Caucasian
Normal T3 values
0.9 to 2.8 nanomoles per liter (nmol/L)
The Saint Louis University Mental Status. (SLUMS) Examination for detecting mild cognitive impairment and dementia. What is a normal score
SLUM (0-30)
27 - 30 Normal
21 - 26 Mild
0 - 20 Dementia
