PMHNP Certificate Study Disorders Flashcards
A constellation of symptoms marked by an acute onset (hours to days) causing short-term decline in cognition with a disturbance in consciousness and inattention.
Delirium
Delirium that is characterized by psychomotor retardation, apathy
hypoactive delirium
Delirium that is characterized by psychomotor agitation, restlessness, hypervigilance
Hyperactive delirium
Delirium that is characterized by cycling through psychomotor agitation and retardation, from apathy to hypervigilance
mixed delirium
A constellation of signs and symptoms characterized by the gradual onset of multiple cognitive impairments in executive function, intellect, impaired problem-solving, and alteration in memory with preservation of level of consciousness.
Dementia
Usually occurs in the sixth decade of life, indicated for use in acute extrapyramidal symptoms such as dystonia, oculogyric crisis, and diaphragm spasm and is the most prevalent type. It is characterized by a gradual onset and progressive decline, without focal neurological deficits.
Alzheimers
Characterized by abnormal clumps of protein causing neuronal malfunction, and characterized by visual hallucinations of small creatures, exacerbated by antipsychotic medications.
Lewy Body Dementia
Onset in the fifth–sixth decade of life, more common in men, marked by personality change; cognitive decline occurs later in this disease process.
Pick’s disease (frontotemporal lobe dementia)
Dementia that is characterized by Uninhibited cheery, hypersexual, hyperorality (carbohydrates especially)
Kluver-Bucy syndrome
Precipitous onset prion disease, sometimes referred to as mad cow disease. Remarkable for a rapid decline that progresses to death within 6 months. It is more common in middle-aged adults and initially presents as fatigue, flu-like symptoms, and cognitive impairment. Later, it progresses with aphasia, apraxia, emotional lability, and psychosis.
Creutzfeldt–Jakob disease
Subcortical dementia characterized by motor abnormalities including psychomotor slowing, choreoathetoid movements, and executive dysfunction complicated by impaired language, memory, and insight later in the disease process.
Huntington Disease
Rare under age 65, more sudden onset, caused by cardiovascular and cerebrovascular disease, manifests with progressive cognitive decline in a stepwise fashion, evidenced by rapid episodic deterioration with interspersed plateau phases marking new baselines. Previously lost function is not regained.
Vascular Dementia
In the treatment of dementia what are the three main medications of choice?
memantine, donepezil, Rivastigmine
Antipsychotics and dementia
While antipsychotics are not recommended and have a black box warning they can be used at the lowest effective dose with attempts at weaning periodically.
Co-occurring depression and dementia
Treat depressive symptoms targeting insomnia first, followed by loss of appetite, irritability, and depressed mood.
Least amount of most effective doses for 6 to 12 months and attempt to taper, although usually chronic and may require lifelong treatment.
Depressive symptoms may be less severe as dementia progress and as awareness of circumstances diminishes.
characterized by duration of associated loss of consciousness at the time of injury, effect on verbal and motor skills, and posttraumatic amnesia.
Traumatic brain injury
used to assess visuospatial impairment, which reflects the function of the right parietal lobe, basal ganglia, and prefrontal cortex.
intersecting pentagon
a precipitous onset cognitive decline that rapidly progress to death; symptoms include fatigue and cognitive impairment and eventually aphasia, apraxia, emotional lability, and psychosis
Creutzfeldt–Jakob disease
Disorganized behavior with accompanying (one of three of the following) delusions, hallucinations, and/or disorganized speech (marked by frequent derailment or incoherence) lasting 1 day to <1 month
Brief psychotic disorder
Disorganized behavior with accompanying (one of three of the following) delusions, hallucinations, and/or disorganized speech (marked by frequent derailment or incoherence) lasting >1 month but <6 months
Schizophreniform Disorder
Disorganized behavior with accompanying (one of three of the following) delusions, hallucinations, and/or disorganized speech (marked by frequent derailment or incoherence) lasting more than 6 months
Schizophrenia
What are the diagnostic criteria/symptoms of schizophrenia?
Either delusions, hallucinations, or disorganized speech WITH either grossly disorganized or catatonic behavior OR negative symptoms such as affect blunting, avolition, anhedonia, apathy, alexithymia)
A deeply held belief despite evidence to the contrary lasting at least 1 month without prominent hallucinations.
Delusion
What are the types of delusions?
JPEGS (Jealous, Persecutory, Erotomaniac, Grandiose, Somatic)
The patient has characteristic features of schizophrenia (hallucinations, delusions, disorganization) >2 weeks without prominent mood symptoms, AND manic or depressive features are present most of the time when not in psychosis.
Schizoaffective Disorder
Which phase of schizophrenia is characterized by odd beliefs, ideas of reference, unusual perceptual experiences, negative symptoms, and deterioration of function prior to the onset of active psychosis.
Prodrome
Which phase of schizophrenia is characterized by delusions, hallucinations, disorganized speech, grossly disorganized behavior, and negative symptoms.
Active psychosis
Which phase of schizophrenia is characterized by persistent functional impairment, abnormalities in affect, impaired cognition, and impaired communication.
Residual phase
biochemistry of the sleep-wake cycle is regulated by the
hypothalamus
Lightest stage of sleep, can last up to 15 minutes, drowsiness easily disrupted, muscle tone begins to relax, hypnic jerks (head nods, sensation of falling).
NREM Stage 1
Accounts for 40% to 60% of total sleep time, more difficult to arouse, eye movement slows, activity busts (sleep spindles) and K complexes occur on EEG. Body temp and heart rate decrease.
NREM Stage 2
Accounts for 5% to 15% of total sleep time (higher in duration during periods of rapid growth and development), deep restorative sleep, delta waves occur on the EEG, most difficult to arouse, parasomnias (sleepwalking, night terrors, somniloquy [sleep talking]) occur in this stage.
NREM stage 3
Usually occurs 90 minutes after sleep onset and can last from 10 to 15 minutes.
REM Stage 4
Two or more episodes of sleep latency less than 8 minutes and or two or more episodes of sleep with rapid eye movement periods
Narcolepsy
What test can be used to diagnosis narcolepsy?
Cerebrospinal fluid testing with hypocretin (orexin) level <109
Characterized by difficulty falling asleep, staying asleep, or waking up too early (given opportunity for sleep) with EDS.
Insomnia
Sleep disorder characterized by multiple episodes of apnea and waking during the night.
Obstructive sleep apnea
A diagnosis of exclusion characterized by persistent sleepiness despite getting at least 7 hours of sleep overnight. Symptoms include a strong sleep drive, difficulty waking up from sleep accompanied by feelings of confusion, combativeness, or irritability
Hypersomnolence Disorder
A movement disorder of the lower limbs triggered at the moment of falling asleep, creating an irresistible urge to move the legs that disrupts the initiation of sleep. Symptoms may arise also in the upper extremities
Restless leg syndrome
Pharmacological agents to assist in sleep may include:
Benzodiazpeines (last resort), sedative hypnotics (ambien and lunesta), melatonin receptor (Ramelteon), Orexin receptor antagonist (Suvorexant), antidepressants TCAs, mirtazapine, trazadone, and stimulants (armodafinil and modafinil)
What hormone is often found elevated in patients with depression and early morning awakening?
cortisol
What stage of sleep are night terrors and parasomnias likely to occur?
Stage 3-4. They do not occur during REM or stage 1 or 2.
characterized by the tetrad of hypersomnia (excessive daytime sleepiness), cataplexy (transient loss of motor tone in the presence of strong emotions, e.g., embarrassment, laughter, fear), and sleep paralysis (partial or total loss of muscle function during sleep-wake transition).
Narcolepsy
What is a good diagnostic difference between narcolepsy and hypersomnia?
Narcolepsy has sleep paralysis or cataplexy and hypersomnia does not.
What infection has been associated with severe obsessive compulsive disorder?
Streptococcus
What sleep problem might arise when a patient starts an SSRI?
Increased sleep latency (difficulty falling asleep)
Which medication is a serotonergic agent commonly used to help with sleep latency and maintenance, which can reduce wandering at night?
Trazadone
Which antidepressants category have been used to treat chronic neuropathic pain in addition to major depressive disorder, specifically targeting symptoms of poor appetite, disturbed sleep, and depressed mood.
TCA
What are four risk factors for developing postpartum depression?
poor marital relationships, stressful life events, negative attitude towards pregnancy, and lack of social support.
What are some atypical presentations of depression?
Increased appetite, increased sleep, physical sensation of heaviness, binge eating, pornography, risk taking behavior, substance use disorder
How long does a depressive episode need to last in order to be categorized as MDD?
two weeks
What are some ways children may manifest depression that is different than adults?
irritability, somatic complaints, and social withdrawal
What are some ways the elderly may present with depression that is different then adults?
somatic complaints, hypochondriacal symptoms, psychotic delusions, or ambivalence about the severity of symptoms
SSRIs carry a black box warning for all
children
Which nonpharmacological treatments can be used for depression first?
Exercise, CBT, family therapy group therapy, interpersonal psychotherapy, phototherapy
Which antidepressants can raise blood pressure?
SNRI
What should you check before starting SSRI?
Baseline labs and an EKG
What is the most common electrolyte abnormality associated with antidepressants?
hyponatremia
What are TCAs at high risk for and when should they be avoided?
high risk for overdose and avoided in patients with cardiac disease or conduction defects
MAOIs are third line in depression AFTER?
ECT
How long is the washout from all SSRI/SNRI if starting an MAOI?
14 days
What are the symptoms of a hypertensive crisis related to antidepressant use?
worst headache ever, facial flushing, palpitations, pupillary dilation, fever, diaphoresis
How do you treat hypertensive crisis?
Phentolamine 5-15 mg IV or IM and ED evaluation
What are the indications for ECT?
Patient preference, nihilistic delusions with severe neurovegetative symptoms, treatment resistance, benefits outweighs the risk of treatment/anesthesia
What are the contraindications for ECT?
Cardiovascular disease, aortic stenosis, pulmonary insufficiency, inability to tolerate anesthesia
Possible adverse effects of ECT?
Cardiovascular ischemia, headache, muscle aches, cognitive impairment
skin surface electrode/coil on the scalp to create a magnetic region throughout the head. Performed in an office setting, does not require anesthesia, requires five sessions per week for 6 weeks.
Transcranial magnetic stimulation
Indicated for treatment resistant depression, requires a pulse generator implanted in the subclavian area (anesthesia required). Adverse effects can include voice changes, muscle spasms, dyspnea, throat or neck pain, skin tingling, and dysphagia.
Vagal Nerve Stimulation
Characterized by a depressed mood most of the day for a majority of the days for at least 2 years.
Dysthymia