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Question 1

Bipolar Disorder - DSM IV TR Criteria

Answer 1

a period of abnormally & persistently elevated, expansive or irritable mood lasting ≥ 1 wk or any duration if hosp. is necessary.
≥3 present during mood disturbance to a significant degree. DIGFAST

Question 2

Screening clock for dementia

Answer 2

3 points for # 12 in correct position
1 point for all 12 #s
1 point for 2 distinct hands ALWAYS ask the pt to place hands at eleven ten 
1 point for correct designated time
score of < 4 is + for impairment.

Question 3

Hamilton Depression Rating Scale

Answer 3

>23 = very severe depression
19-22 = severe depression
14-18 = moderate depression
8-13 = mild depression
0-7 = no depression

Question 4

Other common screening tools

Answer 4

BPRS = Brief Psychiatric Rating Scale - assess psychosis
PANSS = Positive & Negative Syndrome Scale - assesses schizophrenia
Mood disorder questionnaire screens for bipolar
PHQ-9 Patient Health Questionnaire; screens for depression in primary care & populations w/ co-morbid medical illness (Endorsed by APA)

Question 5

GAF & Scoring

Answer 5

Global Assessment Functioning.
0-40 or 50 = require hospitalization
71-80 minimal psychopathology
depending ≥40 can be opt.

Question 6

AIMS & Scoring

Answer 6

Abnormal Involuntary Movement Scale
1-4 oral facial movements
5-6 extremity movements
7 trunk movement
8-10 global judgement related to sx present
11-12 dental & denture status that may influence score.

Question 7

Lithium labs

Answer 7

Thyroid indices
Creatinine Clearance
Sodium
Lithium levels 0.6 - 1.2 Tx acute mania
                     0.8 - 1.0 Maintenance Tx

Question 8

Neuro-imaging

Answer 8

PET scan - primarily experimental brain mapping
MRI - Gross structure of the brain, new onset psychosis or dementia, delineate gray & white matter. Structural, metabolic & functional imaging
EEG - measures electrical activity of the brain. New onset of seizures, esp. in children, evaluate brain tumors & abscesses, subdural hematomas, CVA’s, intracranial hemorrhage
CT - Brain Mapping, specific or minute brain abnormalities are enhanced, areas of ischemia, areas in states of dementia, tumors. Used for migraines, trauma, vertigo & dizziness.

Question 9

Cranial Nerves CNI

Answer 9

Cranial Nerve I - S

olfactory - smell test

Question 10

CNII

Answer 10

Cranial Nerve II - S

Optic - Visual Acuity, confrontation method to assess visual fields

Question 11

CNIII

Answer 11

Cranial Nerve III - M
Oculomotor
eye movement, six eye positions individually

Question 12

CNIV

Answer 12

Cranial Nerve IV - M
Trochlear
eye movement, same tests as oculomotor

Question 13

CNV

Answer 13

Cranial Nerve V
Trigeminal - B
superficial & deep structures of head & face
corneal reflex, show teeth

Question 14

CNVI

Answer 14

Cranial Nerve VI - M
Abducens
Specific eye movements, same as oculomotor

Question 15

CNVII

Answer 15

Cranial Nerve VII
Facial - B
Facial movements - corneal reflex, raise eyebrows, puff cheeks

Question 16

CNVIII

Answer 16

Cranial Nerve VIII - S
Acoustic
Hearing, whisper, tuning fork w/ Rinne positive as normal, air conduction persists twice as long as bone conduction

Question 17

CNIX

Answer 17

Cranial Nerve IX - B
Glossopharyngeal,
swallow, check for deviation of uvula to unaffected side.

Question 18

CNX

Answer 18

Cranial Nerve X - B
Vagus
Swallow, elevation of uvula, check gag reflex

Question 19

CNXI

Answer 19

Cranial Nerve XI
Accessory - M
Innervates the trapezius & sternocleidomastoid, have shrug shoulders & turn head against resistance

Question 20

CNXII

Answer 20

Cranial Nerve XII
Hypoglossal - M
have patient stick tongue out, push against the side of the cheek, check for fasciculation.

Question 21

3 levels of prevention

Answer 21

Primary Prevention - to promote health prior to any illness, (healthy diet, no tobacco)
Secondary prevention - early identification & tx of existing problems, screenings, etc.
Tertiary Prevention - Rehabilitation & restoration of health.

Question 22

DM Screening

Answer 22

Impaired Glucose Tolerance - >100 126 on 2 separate occasions
DM - Random Blood Glucose >200 w/ s/s
DM - oral glucose tolerance test >200

Question 23

Cholesterol Testing

Answer 23

Total 40 men & >50 women

Triglycerides <150

Question 24

HTN Classifications

Answer 24

Normal 160 or >100

Question 25

Thyroid

Answer 25

Thyroxine (T4) is main thyroid hormone & is converted to T3 to have effect
Anterior Pituitary controls regulation of TSH or Thyroid Stimulating Hormone which convertes T4 to T3. TSH & T4 communicate & regulate each other. Most T4 is protein bound so to check Free T4 w/ TSH is important in determining Thyroid Function.
TSH 0.35-5.5
Ft4 11.7-31.2
T31.1-2.7

Question 26

Hyperthyroidism

Answer 26

Mania
surgery or medication
TSH low, elevated or normal Ft4
T3 is elevated
nervousness, anxiety, irritability, weight loss, sweating, insomnia

Question 27

Hypothyroidism

Answer 27

Depression
Thyroid Medication
TSH elevated,
Low FT4 and Low TSH indicates dz state that involves the pituitary gland.
fatigue, unexplained weight gain, depression, muscle & joint pain.

Question 28

Freud

Answer 28

Id - Locus of instinctual drives, pleasure principal, unconscious.
Ego - Rational self, maintains balance between id, reality, superego
Superego - perfection principle, internalizes values & moral sets, forms the conscious.

Question 29

Defense Mechanisms

Answer 29

Denial - the refusal to accept reality or fact, acting as if a painful event, thought or feeling did not exist.
Projection - misattribution of a person’s undesired thoughts, feelings or impulses onto another person who does not have those thoughts, feelings or impulses. Projection is often the result of a lack of insight and acknowledgement of one’s own motivations and feelings.
Rationalization - putting something into a different light or offering a different explanation for one’s perceptions or behaviors in the face of a changing reality
Sublimation - consciously unacceptable instinctual drives are expressed in personally and socially acceptable channels.

Question 30

Interpersonal Theory (Sullivan)

Answer 30

Anxiety & self-esteem, interpersonal therapy,
focus-interpersonal relationships & social supports
non-judgmental stance
Issues - withdrawal, attachment models
Techniques - highly directive interventions

Question 31

Transactional Analysis (Berne)

Answer 31

focuses on past & current decisions the client has made.

Interpersonal security, chief disruptive force in interpersonal relations., “strokes”, rackets, life scripts,

Question 32

Gestalt Therapy (Perls)

Answer 32

Must accept personal responsibility, feelings, awareness of moment, avoidance, body messages, reversals.

Question 33

Person Centered Therapy (Rogers)

Answer 33

Unconditional positive regard, greater trust in self

Question 34

Behavioral Therapy (Pavlov, Skinner)

Answer 34

operant conditioning, variables that create consequence & affect behaviors, change cognition. Techniques - Problem Identification & assessment. requires detailed information to understand the client’s presenting problems, based on initial onset, severity & frequency. COGNITIVE RESTRUCTURING, assertiveness & social skills training.

Question 35

Rational-Emotive Therapy (Ellis)

Answer 35

neurosis is irrational thinking & behaving, emotional disturbances rooted in childhood, belief system is cause of emotional problems, examine validity of beliefs,
Goal - eliminate self-defeating outlook on life.
disputing irrational beliefs

Question 36

CBT - Cognitive Behavioral Therapy (Beck)

Answer 36

cognitive distortions, cognitive reframing, reformulate thought processes, examine where thoughts have become illogical.

Question 37

Trauma Informed Care

Answer 37

CBT - EMDR