PMHNP certificate study guide Flashcards
Best Interview Technique for identifying antisocial disorder
The Stress Interview: You confront inconsistencies in the patient history.
Classical Conditioning is learning by
association
Operant conditioning is learning by
consequences
Autonomy
The right to self-govern free from external control or influnece
Beneificence
Doing good, promoting well being
Nonmaleficence
Do no harm
Veracity
Conformity to facts, truthfulness and accuracy
Justice
equitable and reasonable
Respect
regard for the feelings, wishes, rights, and traditions of others
Deontological Theory
An action is judged as good or bad based on its merits REGARDLESS of the consequence
Teleolgical Theory
The goodness or badness of an action is based on its foreseeable consequences
Virtue ethics
Actions are based on moral principles
Dependent Variable
The factor that changes as a result of the independent variable
Independent Variable
The intervention intended to cause the change
Internal Validity
The degree to which an experiment avoids confounding independent variables
The more causative the factors are controlled the higher the
internal validity
A high internal validity indicates
a stronger cause and effect relationship
External Validity
Degree to which findings from one study can be applied to real world situations
The more controls exerted to enhance internal validity the…
weaker the external validity
Reliability
Accuracy over time, items, and researchers
Descriptive Statistics
Identifies basic features of a data set
Inferential statistics
allows samples to be generalizable to the population
Leading cause of death for 1-44
unintentional injuries
Leading cause of death for 45-64
Cancer
Leading cause of death for 65 and older
heart disease
Specificity
Looks for true negatives
Sensitivity
Looks for true positives
Perceived susceptibility
One’s belief regarding the chance of getting a condition
Perceived Severity
One’s belief of how dangerous a condition and its sequelae would be if contracted
Name some of the key concepts of the Health Belief Model
Perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy
Name some key concepts of the Transtheoretical Model (TTM)
Stages of change, Decisional Balance, Self-efficacy, process of change
precontemplation, contemplation, preparation, action, and maintenance are all part of…
The stages of Change from the Transtheoretical Model
Considering pros and cons are part of what part of what health care model?
Decisional Balance from the Transtheoretical Model
Confidence, temptation, importance ruler, confidence ruler are what part of what health care model?
Self-Efficacy from the transtheoretical model
Consciousness raising, dramatic relief, self re-evaluation, environmental re-evaluation, self-liberation, helping relationships, counter conditioning, reinforcement management, stimulus control, social liberation are all part of what part of what health care model?
Process of Change from transtheoretical model
Five parts of Maslow’s hierarchy of needs from base to top
physiologic needs, safety needs, love and belonging, self-esteem, self-actualization
What part of Maslow’s hierarchy does a hospital general provide?
physiological and safety
What part of Maslow’s hierarchy can a partial hospitalization address?
Needs of belonging and eventually self-esteem
What part of Maslow’s hierarchy can vocational rehab, psychodynamic therapy and psychoanaylsis address?
helps work through self-actualization
High risk situations with immediate precipitant to relapse…there are four
Negative emotional states, interpersonal conflict, social pressure, positive emotional states
Leaving a high-risk situation, positive self-talk, calling a friend, planning another activity, contingency planning, avoidance of high-risk situations are all examples of…
effective coping in the relapse prevention theory
Using the vice as the coping strategy, lingering in a high-risk environment, minimizing potential harms are all examples of
ineffective coping in the relapse prevention theory
Belief in one’s ability to effectively cope and the expectation about the outcome
self-efficacy
Cognitive restructuring in which the lapse is distinguished from a relapse and seen as an isolated mistake, the client resumes abstinence behavior despite negative feelings of failure, OR the client decides to negate sobriety and attempts to quell negative emotional state by further lapses.
Abstinence violation effect (AVE)
Learned behaviors occur in a social context, expectations and outcomes reinforce the behavior and increase sustainability
Social Learning Theory
The patient learns a healthy behavior and likes the result, increases likelihood of continuing the behavior
Direct experience
Freebie skip
Freebie skip
The patient observes a negative consequence to a behavior, which reduces the likelihood that the behavior will be adopted. Patient has learned not to do the potentially harmful behavior.
Vicarious learning
Erik Erikson’s developmental stage 0-1
Trust vs. Mistrust
Erik Erikson’s developmental stage 1.5-3
Autonomy vs. Shame
Erik Erikson’s developmental stage 4-6
Initiative vs. Guilt
Erik Erikson’s developmental stage 7-12
Industry vs. inferiority
Erik Erikson’s developmental stage 13-20
identity vs. role confusion
Erik Erikson’s developmental stage 21-35
intimacy vs. isolation
Erik Erikson’s developmental stage 36-65
Generativity vs. stagnation
Erik Erikson’s developmental stage >66
Ego integrity vs. despair
What mental health disorders are associated with mistrust?
Dysthymia, Schizotypal personality, Addictive predisposition
What mental health disorders are associated with shame?
Obsessive compulsive personality disorder, Paranoid personality
What mental health disorders are associated with inferiority?
Dependent personality
What mental health disorders are associated with guilt?
Inhibition Fear, timidity Somatization
What mental health disorders are associated with role confusion?
Antisocial personality, Borderline personality
What mental health disorders are associated with isolation?
Schizoid personality disorder, Avoidant personality
What mental health disorders are associated with stagnation?
Narcissistic, Avoidance
What mental health states are associated with despair?
Isolation and desperation
Building blocks of knowledge. The child develops a mental representation of the world (units of information relating to aspects of the physical world).
Schemas by Jean PIaget
A process that enables the transition from one stage to another
Jean Piaget’s adaptation
Three components of Jean Piaget’s adapatation?
Equilibrium, assimilation, accommodation
A force that moves the development along, happens when a child’s schema can deal with the new information by assimilation
Jean Piaget’s equilibrium
Uses an existing schema to deal with a new object or situation (e.g., an 18-month-old child sees a bald-headed man with a bowtie, and immediately starts crying saying “no doctor, no doctor”).
Jean Piaget’s assimilation
When the child is unable to assimilate the new information into an existing schema, they form a new one (e.g., the 18-month-old child’s mother explains that even though the man is wearing a bowtie and is bald, he is not a doctor because he is not giving the child a shot. The child then learns not every bald-headed man with a bowtie is going to give him an injection).
Jean Piaget, accomodation
What are Jean Piaget’s four stages of cognitive development?
sensorimotor, preoperational, concrete operations, formal operations
What developmental stage is sensorimotor in Jean Piaget’s theory?
Sensorimotor (birth to 2 years): The child learns that an object still exists even if he cannot see it.
What developmental stage is preoperational in Jean Piaget’s theory?
Preoperational (2–7 years): The child learns a symbolic representation of either pictures or words. A child cries if, when he says cookie, he receives a picture of the cookie rather than the cookie. Egocentricity with difficulty taking the viewpoint of another.
What developmental stage is concrete operations in Jean Piaget’s theory?
Concrete operations (7–11 years): Children start to work things out in their heads, develop number conservation (four quarters is the same as $1.00, is the same as 100 pennies).
Sullivan’s Stages of Interpersonal Development Birth-18 months
Developmental task oral gratification
Sullivan’s Stages of Interpersonal Development 18 months to 6 years
Delayed gratification (toilet training)
Sullivan’s Stages of Interpersonal Development 6-9 years
Social skills/peer realtionships
Sullivan’s Stages of Interpersonal Development 9-12 years
Same-sex relationships
Sullivan’s Stages of Interpersonal Development 12-14 years
Opposite Sex relationships
Sullivan’s Stages of Interpersonal Development 14-21 years
Developed self-identity
Freud stages 0-18 months
Oral gratification
Freud Stages 18 months - 3years
Anal/ toilet training/delayed gratification
Freud Stages 3-6 years
Phallic/Sexual exhibitionism
Freud Stages 6-16 years
Latency/socialization and identity development
Defense Mechanisms: Denial
Refusal to believe a painful reality
Defense Mechanisms: Displacement
Shifting an impulse toward a more acceptable object
Defense Mechanisms: Rationalization
Self-Justifying explanation instead of reality which is perceived as threatening
Defense Mechanisms: Projection
Disguising one’s impulse by attributing it to others
Defense Mechanisms: Reaction Formation
Switching unacceptable impulses into the opposite impulse
Defense Mechanisms: Regression
Retreating to a previously mastered developmental stage
Defense Mechanism: Conversion
Psychological angst manifested as a physical symptom
Defense Mechanism: Dissociation
Out of body experience, disconnected from the physical world
Defense Mechanism: Humor
Seeking a funny aspect in a stressful situation to reduce associated anxiety
Defense Mechanism: intellectualization
Considering an emotional issue in intellectual terms
Defense Mechanism: Undoing
Behavior in an attempt to correct a past unacceptable behavior
Defense Mechanism: Sublimation
Substituting a socially acceptable constructive activity for a robust contrasting impulse
Super Ego
Morality, right versus wrong, guilt versus shame, moral obligations versus fantasies. The therapist attempts to function in the role of an external superego.
Clinical caritas guide the practice of nursing and are essential in creating a therapeutic relationship and alliance for healing.
Jean Watson
Cultural care, patients have the same basic needs regardless of culture, but culture provides context for care and meaning for suffering.
Madeline Leininger
Theory of interpersonal relationships. Emphasis on the give and take of the nurse-client relationship, asking open ended questions, reflective listening, affirming, validation, etc..
Hildegard Peplau
A psychodynamic phenomenon characterizing the perceived bond between the patient and therapist. It is the most predictive factor of a successful outcome.
Therapeutic alliance
What are the three phases of therapy?
Orientation, working/treatment, and termination
Based on the premise that unconscious motivations and instinctual drives cause the implementation of defense mechanisms. Change happens by promoting greater insight and awareness regarding defense mechanisms. Based on speculation of psychodynamic development factors that may have occurred earlier in life.
Psychoanalytic therapy
Focuses on present events and maladaptive responses/behaviors. Helps the client to view reality more objectively by examining cognitive distortions and automatic thought patterns.
CBT
Most common and effective therapy for clients with borderline and narcissistic traits. Aims to regulate emotions, increase distress tolerance, develop self-management and interpersonal skills, and promote mindfulness.
DBT
Socratic questioning to enhance reflection and self-confrontation. Based on the premise of finding purpose in one’s life and circumstances. Emphasizes accepting reality and responsible decision-making.
Existential therapy
Sometimes called patient-centered therapy. Assumes man is good. Specific aims include facilitating self-directed growth toward self-actualization and finding meaning in life and circumstances. Gratitude Journals. Encourages socialization behaviors, loving, kindness, meditation, altruism, savoring.
Humanistic Therapy
Socratic questioning to examine interpersonal issues that are creating current distress. Manualized and time limited. Focuses on the present and interpersonal distress. Specially developed for symptoms of depression, effective in adolescents and adults.
Interpersonal therapy
Distraction by bilateral stimulation of both cerebral hemispheres by moving eyes back and forth between two point, or alternating tapping between hands, or stereo sounds alternating between ears. Commonly used in PTSD to achieve adaptive resolution. Patient must be able to tolerate and narrate their trauma.
Eye movement desensitization and reprocessing.
Developed by Irvin Yalom and builds on CBT and psychoanalytic constructs and involves 10 therapeutic curative factors.
Group Therapy
Universality
Participants discover others with similar circumstances, thoughts, feelings, behaviors.
Altruism
Provides an opportunity to help participants progress in something.
Interpersonal learning
Interactions with other people provide opportunities to learn about relationship dynamics and intimacy.
Imitative behaviors
Allows participants to copy the behaviors of others. The behavior may be adaptive or maladaptive.
Group Cohesiveness
Participants develop an attractive to other group members and a sense of belonging is enhanced
Catharsis
The opportunity to openly express previously suppressed feelings, thoughts, and insights
Existential factors
Participants learn to find meaning in loss and suffering, and learn to deal with the frustrations of reality rather than reverting to a previous pattern of avoidance
Corrective Refocusing
Participants can visit issues related to the family of origin through the recapitualtion of family dynamics as they arise within the group. The group serves as a substitute family where group members are siblings and the facilitator is the parental figure.
Installation of Hope
Participants can witness changes in other group members, allowing them to actualize the possibility of social skills.
Increased development of social skills
Group provides a natural laboratory for immediate feedback regarding the effectiveness of an individual’s adaptive or maladaptive behavior
The Five phases of group dynamics
Forming, storming, norming, performing, adjourning
What is the Forming stage?
Feeling guarded and anxious and fearful. The leader should identify goals, expectations, and boundaries in this phase.
What is the Storming stage?
Participants will demonstrate resistance, sabotaging, and clique formation. Leader should allow for expression of both positive and negative feelings and help the group to examine nonproductive behaviors and underlying conflicts.
What is the Norming stage?
Group members overcome initial resistance and begin to develop cohesion. Open and spontaneous communication occurs and the group norms are solidified.
What is the performing stage?
The primary objective and work of the group become more focused, members begin to engage in creative problem-solving, interpersonal learning takes place in the group, and the group is unified toward goal achievement.
What is the Adjourning stage?
Active termination process. Leaders and members express feelings about each other in regard to termination, review achieved goals and outcomes, and identify future work remaining.
Protective mechanisms that maintain the functional integrity of the family unit, individuals, and subsystems within the family.
Boundaries
This type of boundary causes estrangement in the long-term or disengagement in the short term.
Rigid Boundaries
This type of boundary causes enmeshment and parentification of children.
Diffuse boundaries
This type of boundary allows individuals to maintain their unique identities while communicating love and belonging to all members of the system.
Clearly defined boundaries.
circular causality
a feedback loop characterized by a series of actions and reaction that pereptuate a problem.
Familial tendency to resist change in order to maintain a steady state, even if the state is one of dysfunction.
Homeostasis
The family’s tendency adn ability to change when necessary or remain the same in the midst of change.
Adaptability
This assumes an individual’s behavior serves a role or function with in the family unit perpetuating or protecting against dysfunction.
Family systems therapy
Perceiving one’s intrinsic value rather than depending on external relationships and circumstances to derive self-worth.
Self-differentation
A dyadic relationship that extends to a triad in order to reduce stress within the dyad more commonly occurs in morphostatic (less adaptable) families
Triangles
Characterized in families where parental units, levels of differentiation are reflective of familial differentiation (e.g. if parents perceive their intrinsic self-worth, those in their care will also perceive their self-worth).
Nuclear Family
Passing along dysfunctional behaviors throughout generations of the family unit.
Transmission process
Parental differentiation is transmitted to the most susceptible child. (Parent derives their self-worth from the relationship with a child, creates an enmeshed dyad).
Projection Process
The breaking of contact with the family of origin
Cutoffs
An influencing factor in familial interactions and individual personality characteristics.
Birth order
Drawing from a family systems therapy in which the therapist’s role is to gain an understanding of familial transactions in order to implement a change of organization to manage problems more effectively. Symptoms are a product of dysfunctional transaction patterns within the family. The family structure is a frame created by functional demands that articulate the transactional processes.
Structural family therapy
Problem focused therapy that focuses on changing the sequence of interactions that is causing the problem. This therapy aims to help family members behave in a manner that will not perpetuate problem behaviors and thereby reduce symptoms.
Strategic Family therapy
A therapist capitalizes on solutions that previously worked while enhancing individual and familial self-efficacy. This strength based approach uses Socratic questioning to elicit necessary information and to probe for possible solutions.
Solution focused therapy.
If a miracle were to happen tonight while you are asleep, and tomorrow morning you awoke to find that the problem no longer existed, what would be different? How would you know if the miracle took place? How would others know if the miracle took place?
Miracle Question
Inquiring about a time in life when the problem did not exist helps the family move toward solutions by noting exception to the problem pattern of behavior.
Exception finding questions
On a 1 to 10 scale with 1 being the worst and 10 being the best how woul dyou rate your feelings now…or how important is it to you to make this change now?
Scaling questions
These therapies include guided imagery, meditation, yoga, and biofeedback.
Mind-body interventions
These interventions include acupressure, acupuncture, massage, and reflexology
Manipulative physical interventions
Tryptophan as an alt therapy
Commonly used for pain, depression HA, obesity. INCREASES risk of serotonin syndrome when used with SSRI, MAOI, and St. John’s Wart
Sam-e as an alt therapy
used for depression and pain. Adverse effects include manic symptoms, movement disorders and serotonin syndrome
Omega 3 fatty acids as an alt therapy
used for ADHD, inflammatory conditions, and circulatory problems. Known to interact adversely with NSAIDS and anticoagulants. Risk compounded when used with SSRIs. Should be stopped before surgery.
These organize life preserving reflexes, promote arousal or sleep, and process sensory input and motor output (hand to stove, pain withdraw), mediated by interneurons.
Brainstem and spinal cord
This regulates eating, drinking, sexual behavior, aggression, temperature, and the endocrine system.
hypothalamus
The hypothalamus regulates
eating, drinking, sexual behavior, aggression, temperature, and the endocrine system.
The limbic system includes
amygdala, septal area, hippocampus, and the cingulate gyrus which control emotions.
This system includes the amygdala, septal area, hippocampus, and the cingulate gyrus which control emotions.
limbic system
The frontal lobe controls
reasoning, planning, parts of speech movement, emotions, problem-solving, and personality
Reasoning, planning, parts of speech movement, emotions, problem-solving, and personality are controlled by
the frontal lobe
The parietal lobe regulates
touch, pressure, temperature, pain and perception
Touch, pressure, temperature, pain and perception are controlled by the
parietal lobe
Recognition, hearing and memory are found in
the temporal lobe
The temporal lobe is involved in
recognition, hearing, and memory
The occipital lobe controls
vision
The cerebellum involves
movement, balance, and posture
movement, balance and posture are due to
cerebellum
This controls respirations, heart rate, and blood pressure
the brainstem
The brainstem controls
respirations, heart rate, and blood pressure
Dysfunctions of the cerebral cortex include
Alzheimer’s disease, frontotemporal dementia, vascular dementia
When does the frontal lobe reach full maturity and when might it began to atrophy?
mid to late 20’s and the 60’s
This lobe controls voluntary movement and ability to project future consequences due to current behaviors, governs according to social cues, distinguishes similarities and differences
Frontal lobe
This is IN the dominant hemisphere of the brain and is associated with SPEECH production (fluency)
Broca’s area
A dysfunction in Broca’s area may result in
stuttering and expressive aphasia
Incongruent affect, decreased motivation, impaired judgement and attention and confabulation may indicate a dysfunction where?
Frontal lobe
This comprises 83% of the brain, both right and left hemispheres, separated by the central sulcus.
Cerebrum
The brain is subdivided into 52 areas referred to as
Broadmann’s areas.
Regulates the feedback system to stabilize the information transmitted from the CNS to skeletal muscles
Basal Ganglia AKA corpus striatum
What are the three dopminergic pathways
mesocorticolimbic, nigrostriatal, and tuberoinfundibular
Transmits dopamine to the prefrontal cortex and midbrain
Mesocorticolimbic
ADHD is due to a disorder of which dopaminergic pathway?
Mesocorticolimbic
Addiction is due to a disorder of which dopaminergic pathway?
Mesocorticolimbic
Schizophrenia is due to a disorder of which dopaminergic pathway?
Mesocorticolimbic
Aversion-related thoughts, reward-related thoughts (incentive, pleasure, positive reinforcement), and executive function are all part of which dopaminergic pathway?
Mesocorticolimbic
Transmits dopamine from the substantia nigra, also in the midbrain, and to the putamen and caudate nucleus.
Nigrostriatal
Chorea is due to which dopaminergic pathway?
Nigrostriatal
Parkinson’s disease is due to which dopaminergic pathway?
Nigrostriatal
Motor functioning and associate learning are all part of what dopaminergic pathways?
Nigrostriatal
Transmits dopamine from the hypothalamus to the pituitary gland, and influences the secretion of prolactin-releasing hormone.
Tuberoinfundibular
Hyperprolactinemia is the primary disorder in which dopaminergic pathway?
Tuberoinfundibular
This dopaminergic pathway triggers the release of prolactin
Tuberoinfundibular
Tourette’s syndrome, Parkinson’s, Cognitive Impairment, Inattention, Choreiform movements, ruminations, bradykinesia, hyperkinesia, and dsytonia are all a dysfunction of what brain structure.
Basal ganglia
Contains the diencephalon (thalamus and hypothalamus. Contains components of the limbic system and Wernicke’s area.
Temporal lobe
This area in the brain is associated with comprehension
Wernicke’s area
Processes memory and emotional response (mood, fear, anxiety, aggression)
Amygdala
Receives sensory inputs (touch, audio, visual), serves as the gateway to the cortex, provides a functional delay of impulses to keep from overwhelming the cortex.
Thalamus
CVAs that alter the perception of inputs and lead to unresponsiveness, alterations in sleep-wake cycles and receptive aphasia are all dysfunctions of this brain structure
thalamus
Directly above the brainstem, controls homeostasis and hormones, controls the pituitary gland by secreting releasing hormones, also creates oxytocin and vasopressin.
Hypothalamus
This controls the autonomic nervous system such as emotional response, temperature, hunger, thirst, sexual behavior, sleep-wake cycle and memory
Hypothalamus.
Master gland of the body; controlled by the hypothalamus to maintain homeostasis by the release of hormones.
Pituitary gland
The anterior pituitary gland releases which hormones?
(Go Find Long Acting Tylenol Please)
Growth hormone, follicule stimulating hormone, leutinizing hormone, adrenocorticotropic hormone, thyroid simulating hormone, and prolactin
The posterior pituitary gland releases which hormones?
oxytocin and vasopressin
This part of the brain has sensory area integration, sense of touch, attentiveness, spatial awareness, conscious awareness of the opposite side of the body language
Parietal lobe
Primary visual cortex, receives stimuli via optic tracts, interprets color, form, and movement if visually perceived objects.
Occipital lobe
What: temporal
Where: parietal
Dysfunction of the cerebellum results in
loss of trunk control
Automatic programmed reflexive behaviors, all cranial nerves come from here and integrate sensory input from the head, neck and face
brainstem
Brainstem area: Dopaminergic cell bodies originate from within, associated with reward circuits cognition, motivation, and orgasms), and extends to the temporal lobe.
Ventral tegmental area
This brainstem area receives input from cortex, innervates the thalamus and hypothalamus, regulates involuntary movement, reflexes, muscle tone, and vital signs.
Medulla oblongata
This system regulates bodily functions to maintain homeostasis, conveys information from the central nervous system to the peripheral nervous system, and regulates involuntary movements; emotions.
Autonomic Nervous System
This system controls the excitatory, prepares the body for fight, flight, or freeze during stress.
Sympathetic nervous system
This system is inhibitory; allows for resting, digesting, and orgasming.
Parasympathetic system.
This system is comprised of spinal nerves and cranial nerves, responsible for voluntary movements, conducting impulses from the central nervous system to the periphery skeletal muscles.
Somatic nervous system
Cranial Nerve I
Olfactory/smell
Cranial Nerve II
Optic/Visual fields
Cranial Nerve III
Oculomotor Coordinated eye movements, eye lid droop, pupil dilation
Cranial Nerve IV
Trocheal downward medially
Cranial V
Trigeminal Opthalmic, maxillary, mandibular to allow chewing
Cranial VI
Abducens eye movement downward gaze
Cranial VII
Facial Facial expression, touch sensation
Cranial VIII
Vestibulocochlear hearing and balance
Cranial IX
Glossopharyngeal gag reflex, taste, salivation
Cranial X
Vagus vital signs, vocal tone swallowing
Cranial XI
Accessory/spinal shoulder shrug head turn
Cranial XII
Hypoglossal tongue movement
What are the effects of acetylcholine
INCREASES heart rate, secretions, sweating, salivation, memory, muscle contractions
What are the associated pathologies with acetylcholine
Increased: Parkinsonism Decreased: Dementia
What are the effects of norepinephrine?
INCREASES heart rate, alertness, well being/ DECREASES: pain sensitivity, circulation
What pathologies are associated with norepinephrine?
Increased: Anxiety Decreased: Depression
What are the effects of dopamine?
INCREASES: sense of well-being satiety DECREASES hunger and cravings
What medication categories are dopamine antagonists?
antipsychotics
What are the associated pathologies for dopamine?
INCREASED: psychosis DECREAESED: Parkinson’s disease, anhedonia, addiction
What are the effects of Serotonin (5-HT)?
INCREASES well being, satiety, reduces pain perception
What medication categories are serotonin antagonists?
Atypical antipsychotics
What are the associated pathologies of Serotonin (5-HT)?
INCREASED: serotonin syndrome DECREASED: Depression, OCD, Anxiety
What are the effects of Glutamate?
Most common excitatory neurotransmitter, heightens perception (usually taste)
What are the effects of GABA?
Inhibitory increases sleepiness, decreases anxiety, alertness, memory, muscle tension
What are the associated pathologies of GABA?
Decreased: Anxiety
What are the effects of Opioids (neuropeptides)?
INCREASES sedation; DECREASES anxiety and pain perception
What are the effects of histamines?
INCREASES: alertness, stomach acid, skin sensitivity
Altered alpha waves in an EEG are due to
coma and anoxic brain injury
Altered beta waves in an EEG are due to
barbiturates, benzodiazepines, neuroleptics
These EEG waves are considered abnormal in the awake adult
Theta waves
These EEG waves are associated with deep sleep, abnormal ones indicate localized pathology, diffuse, and generalized dysfunction consistent with delirium.
Delta waves
What scan is commonly used in psychiatry to distinguish dementia?
PET Scan
A normal developed human as how many chromosomes?
46 total, 23 pairs from each parent.
What is the risk for schizophrenia inheritability?
50%
What is the risk for bipolar inheritability?
70%
at is the risk for ADHD inheritability?
70%
A 12 item tool with a 5 point rating scale for seven body areas where tardive dyskinesia commonly manifests
Abnormal Involuntary Movement Scale (AIMS)
What is an abnormal AIMS score and what do you do?
2 body areas or three or greater in one body area. Discontinue or reduce offending medications.
A clinician administered, four item scale to assess the objective and subjective symptoms of akathisia ( a syndrome of motor restlessness, subjective experience of mental unease) in patients receiving psychotropic medications.
BARS
A two question survey administered to parents and teachers to quantify symptoms of ADHD. What score is markedly atypical?
Connors Rating Scales-Revised (CRS-R) >70
Short clinician adminstered screening tool for alcohol use disorder.
CAGE-AID
A screening test for cognitive function comparable to the mini mental status exam. Tests for orientation, memory, attention, and executive function.
Saint Louis University mental status (SLUMS)
Developed to detect early mild cognitive impairment; better suited to those with higher educational attainment. What score is normal regardless of education?
Montreal Cognitive Assessment >26
A 30 item binary questionnaire to measure depressive symptoms in older adults. The short form contains 15 questions.
Geriatric Depression Scale (GDS)
Self-report or clinician assisted measure of depressive symptoms comprised of 17-21 questions commonly used at baseline and to measure progress of treatment.
Hamilton Rating Scale for Depression (HAM-D)
A self-administered depression screening tool commonly used in primary care settings as a reliable measure of the severity of depressive symptoms.
Patient Health Questionnaire (PHQ 2/9)
A 16 item self-report survey assessing the severity of depression. Best used in someone who is diagnosed rather than to diagnose depression.
Quick Inventory of Depressive Symptomatology (QIDS)
A self-report, clinician administered 10 item scale to evaluate severity of obsessions or compulsions in previously diagnosed children with OCD. AGES 6-14.
Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS)
A self report 10 item scale for people older than 14 to measure progress of OCD in patients previously diagnosed.
Yale Brown Obsessive Compulsive Scale (YBOCS)
A nine-item administered/observed rating scale to quantify the severity of alcohol withdrawal symptoms to guide medication dosing and monitor response to treatment over time.
CIWA
A clinician administered/observed tool to quantify the severity of opioid withdrawal symptoms in order to guide medication management. Commonly used in MAT during induction of buprenorphine.
COWS
Night Terrors (sleep cycle and memory)
Non REM sleep disorder therefore the patient will not remember the nightmare
Nightmare disorder (sleep cycle and memory)
REM sleep and there fore the patient may recollect the nightmare.
Legislation and enforcement to ban or control the use of hazardous products or to mandate safe and healthy practice are what type of prevention?
Primary
Education about healthy and safe habits is what type of prevention?
Primary
Immunizations against infectious disease are what type of prevention?
Primary
This type of prevention aims to prevent disease or injury before it ever occurs.
Primary
This type of prevention aims to reduce the impact of a disease or injury that has already occurred.
Secondary
Regular exams and screening tests to detect disease in its earliest stages are what type of prevention?
Secondary
Daily low dose aspirin and/or diet and exercise programs to prevent further heart attacks or strokes are what type of prevention?
Secondary
Suitably modified work so injured or ill workers can return safely to their jobs are what type of prevention?
Secondary
This type of prevention aims to soften the impact of ongoing illness or injury that has lasting effects.
Tertiary
Cardiac or stroke rehabilitation programs, chronic disease management programs are what type of prevention?
Tertiary
Support groups that allow members to share strategies for living well are what type of prevention?
Tertiary
Vocational rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible are what type of prevention?
Tertiary
Reframing beliefs in Strategic Family Therapy
Relabeling a problematic behavior to have a more positive family
Creating family triangles to decrease stress is what type of therapy?
An intervention in family systems therapy
Mapping relationships using symbols is also known as structural mapping is an intervention used in
Structural family therapy
Giving family a task in expectation of their compliance is considered what type of intervention in what type of therapy?
Directive in Strategic family therapy
Functionalism is what type of theory?
macro theory
Family systems, social exchange, symbolic interaction are what types of theories?
micro theory
What is a mesosystem?
It is when multiple influences in a child’s life interact such as parents’ relationship with school.
What is a microsystem in therapy?
A child’s interaction with an influence (e.g. the child’s relationship with their family, child’s relationship with masa media, the impact of the school on the child)
According to Erikson’s eight stages of development, egocentricity can come as an unsuccessful resolution of the psychosocial crisis called
Intimacy versus isolation
Carol Gilligan’s concept supported Kohlberg’s with the idea
that the progression of moral development occurs in three major divisions
The scientist who noted a discernible pattern in the difference in cognitive processing between young children and older children while scoring Binet Intelligence Tests is
Jean Piaget
The process of self-reappraisal to assess the effect of a particular unhealthy behavior on others is
environmental re-evaluation
self-liberation is a process found in the behavioral change stage of
preparation
The process of concsiousness raising, dramatic belief, and re-evaluation is found in
contemplation
The process of re-evaluation is found in
contemplation
The process of counter-conditioning, stimulus control and helping relationship is found in
the action stage
excessive dependcy, envy, and jealousy are found in which of Freuds stages?
oral
Messiness, defiance, and rage are found in which of Freuds stages?
Anal
Sexual identity issues are found in which of Freuds stages?
sexual identity
Excessive inner control is found in which of Freud’s stages?
Latency stage
According to Mahler differentiation phase is?
Child recognizes separation from the caretaker at 5-10 months
According to Mahler the practicing phase is?
The child experiences increased independence and separateness of self
According to Mahler the rapprochement phase is?
The child seeks emotional refueling from the caretaker
According to Mahler the consolidation phase is?
The sense of separateness is established
In the theory of change outcome, the pathway involving the cessation of monitoring in a project that has no responsibility for outcomes, met, or unmet is?
ceiling of accountability
In the theory of change outcome the pathway involving the basic ideas behind one intermediate outcome being a prerequisite for the next is?
Rationales
In the theory of change outcome the measurable things that are visible when a person is about to or has reached an intermediate result are?
Indicators
In the theory of change outcome the strategy is also known as?
the intervention
If in a case study a patient is suicidal or has a disorder like borderline the single best type of therapy is?
DBT
If in a case study a patient is experiencing the continuation phase of depression and CBT is not an option the single best answer is?
psychotherapy
Rational-emotive therapy was developed by
Albert Ellis
The concept of behaviorism was developed by
John B. Watson
Operant conditioning theory was developed by
B. F. Skinner
Classical conditioning was developed by
Ivan Pavlov
Interpersonal therapy is about how many sessions?
12-20
Behavioral therapy is about how many sessions?
10 or fewer
Psychodynamic therapy generally takes how many sessions?
more than 20
CBT generally takes how many sessions?
5-20
Providing a secure environment for the patient to recover is called
Milieu Therapy
A natural medicine utilized to treat impaired cognition with convicing results, improving cognitive function, neuropsychiatric symptoms with age-related cognitive decline, mild impairment and mild to moderate dementia is?
Ginkgo biloba
A natural medicine used to treat anxiety and insomnia is?
Valerian
This natural medicine is thought to lower the risk of developing major depression, prenatal depression, and bipolar depression
omega-3 fatty acids
The patient has short stature, ocular hypertelorism, and low-set ears. They have a lifelong symptoms of awkward social skills, including being overtalkative, inattentive, and hyperactive The differential diagnosis includes
Noonan
Diazepam (Valium) is commonly prescribed to treat anxiety disorder and works by
binding to the benzodiazepine receptors which enhances the inhibitory effect of GABA
Cultivating a spirit of inquiry is the
zero step
Asking questions in a well-defined format is the
first step
Collecting relevant evidence is the
second step
Critically appraising to evaluate the validity, reliability, and applicability of the evidence is the
third step
Those with intermittent explosive disorder differ from those with disruptive mood disregulation because
IED is likely to lead to property destruction or physical assault while disruptive mood dysregulation is more likely to be verbally abusive or physically but not usually property.
the first action that should be taken by a psychiatric-mental health nurse practitioner when faced with an aggressive patient who starts shouting is
to alert security
When speaking with a talkative patient in a clinical interview, the psychiatric-mental health nurse practitioner should
show interest by interrogating further
When determining an herbal supplement regimen for a patient, the psychiatric-mental health nurse practitioner would investigate specific ingredients based on the fact that
current regulatory requirements are not effective in management of supplements.
a degenerative brain disorder attributed to thiamine deficiency and is often found in patients with alcohol use syndrome. Its signs include ataxia, confusion, and blurred vision resulting from nystagmus.
Wernicke encephalopathy
The patient is exhibiting mild to moderate intoxication of lithium, which presents with symptoms of vomiting, abdominal pain, dry mouth, ataxia, dizziness, slurred speech, nystagmus, lethargy or excitement, and muscle weakness. Lithium levels will be…
1.5-2.0
the patient reports persistent nausea and vomiting, blurred vision, syncope, and hyperactive deep tendon reflexes. The nurse practitioner orders a laboratory test, expecting to see a lithium value of:
2-2.5
The process in which an electrical impulse is converted into a chemical impulse at the synapse is
excitation-secretion coupling
The neurotransmitter that is responsible for the inhibition of wakefulness is
gamma-aminobutyric acid (GABA)
Self-determination is based on
patient autonomy to make sound healthcare decisions
The typical antipsychotic does not improve the condition of the patient. In such cases, the patient can be prescribed clozapine. The clozapine is chosen as the last resort in such cases because it
causes sedative side effects by blocking alpha 1 adrenergic receptors
Suddenly the patient becomes agitated, is talking to himself, and begins pacing back and forth, moving closer and closer to the nurse practitioner. The nurse practitioner, feeling unsafe, will:
step away from the patient and call for security to be present for the remainder of the assessment
the most effective way to address aggression and violent tendencies when the patient has demonstrated the ability to practice restraint
Prevention strategies that are developed with the patient’s input
What two minerals are low in patients with alcohol use disorders due to poor eating habits and malabsorption of minerals
Thiamine and niacin
Psychoeducational teaching is best received and implemented once the patient has had time for medication to begin working effectively. Typically, this is after
2 weeks
When introducing a patient with mental health illness to new surroundings with new faces and personalities, it is important to include
milieu therapy
Before providing the victim of domestic violence with any written material or information on resources, emergency plans, or documented telephone numbers for the children, the nurse practitioner will determine
what would happen if the perpetrator found the educational material in the home.
In a situation where there is conflict in the family unit, the best treatment plan for optimal recovery is to treat the family as a whole with
functional family therapy
What is a “closeness circle”
determining the people in the patient’s life that contribute to the depression and those the patient feels safe with
a widely used tool to determine the severity of alcohol use and is especially beneficial when patients self-identify there may be a problem
AUDIT
an excellent initial tool if the practitioner suspects alcohol use may be an issue, but it is brief and used to identify a patient’s alcohol use that the patient may not report.
CAGE
screening tool is specific to patients who are pregnant and drinking
T-ACE
a screening and intervention approach used to determine and treat high-risk behaviors that may lead to alcohol use disorder
SBIRT
To determine which screening tool to use for substance use disorder in an young adult female, the psychiatric-mental health nurse practitioner needs to
determine if the patient is pregnant
If the patient successfully quits smoking, the nurse practitioner anticipates that the necessary change to the patient’s olanzapine use will be
a decrease in dosage
When transitioning from an MAOI to another medication such as a stimulant you should
stop the MAOI and wait 14 days
universal excitatory neurotransmitter
glutamate
Patients who use antipsychotic medications and are poor metabolizers of CYP2D6 are at risk for
antipsychotic-induced extrapyramidal symptoms
Suffering within a cultural group is called
cultural idiom of distress.
Overactivation of the hypothalamic-pituitary-adrenal (HPA) axis resulting in glucocorticoid cortisol elevation is one consideration in the treatment of
MDD
A patient presenting with severe hyperthermia, muscle rigidity, diaphoresis, and ocular clonus reports having taken an overdose of a prescribed psychiatric medication approximately 12 hours ago. The nurse practitioner suspects an overdose of:
MAOI
Slurred speech, incoordination, unsteady gait, and impaired attention or memory, nystagmus and decreased reflexes. The nurse practitioner suspects an overdose of what medication?
Benzodiazepines
flushing, dry mucous membranes and skin, fever, and altered mental status and cardiac arrest. The NP suspects an overdose of what medication?
TCA
