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PMHNP Exam > PMHNP Exam > Flashcards

PMHNP Exam Flashcards

1
Q

The CRAFFT

A

It consists of a series of 6 questions developed to screen adolescents for high-risk alcohol and other drug use disorders simultaneously.
* Have you ever ridden in a CAR driven by someone (including yourself) who was high or had been using alcohol or drugs?
* Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
* Do you ever use alcohol or drugs while you are by yourself ALONE?
* Do you FORGET things you did while using alcohol or drugs?
* Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use?
* Have you ever gotten into TROUBLE while you were using alcohol or drugs?
Administration: The CRAFFT is a self-administered screening but it can be read to the adolescent if necessary.
Scoring and interpretation: Score (1) point for each “YES” answer. A score of (2) or more indicates the need for further assessment.

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2
Q

CAGE-AID

A
  1. Have you ever felt you should cut down on your drinking or drug use?
  2. Have people annoyed you by criticizing your drinking or drug use?
  3. Have you ever felt bad or guilty about your drinking or drug use?
  4. Have you ever had a drink or used drugs first thing in the morning (eye opener) to steady your nerves or to get rid of a hangover?
    “0” for no and “1” for yes. A score of 1 or above accurately detects 91% of alcohol users and 92% of drug users. A score of 2 or greater is considered clinically significant.
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3
Q

Screening Brief Intervention Referral to Treatment (SBIRT):

A

Screen for substance abuse disorders

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4
Q
  • The practice delivery for brief intervention is guided by the acronym FRAMES:
A

o Feedback-tell them about the risks of their current level of alcohol use.
o Responsibility – reinforce any decision to change (or not) lies with the service user.
o Advice – based on facts about their drinking, offer simple and direct advice to the service user re: impact on them and offer your advice to change.
o Menu – provide them with a menu of options for behavior change.
o Empathetic interviewing – consider their perspective/ be non-judgmental.
o Self – efficacy – encourage the person to believe they can change.

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5
Q

Signs and Symptoms of alcohol withdrawal

A
  • Nausea and vomiting
  • Tremors
  • Paroxysmal sweats
  • Tactile disturbances
  • Auditory disturbances
  • Visual disturbances
  • Headaches
  • Anxiety
  • Agitation
  • Altered sensorium
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6
Q

Delirium

A
  • **Acute onset
  • **Altered level of consciousness
  • **Inattention
  • **Confusion
  • Changes in cognition
  • Poor prognosis: 1-year mortality rate of clients with delirium is up to 40%
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7
Q

Pharmacological Management of Delirium

A

Symptomatic treatment for agitation and psychotic symptoms
* Antipsychotic agents
* **Haloperidol (Haldol): Haloperidol is the preferred treatment for agitated delirious patients (as described by the guidelines of the American Psychiatric Association).
* Atypical antipsychotic agents
* Anxiolytic agents for insomnia

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8
Q

Nonpharmacological Management of Delirium

A
  • Monitor for safety needs.
  • Pay attention to basic needs.
  • It is helpful to have in the client’s room familiar people; familiar pictures or decorations; a clock or calendar; and regular orientation to person, place, or time.
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9
Q

Dementia

A

Dementia is a group of disorders characterized by graual development of multiple cognitive deficits:
* Impaired executive functioning
* Impaired global intellect
* Impaired problem-solving
* Impaired organizational skills
* Altered memory

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10
Q

Dementia of Alzheimer’s type (DAT)

A
  • Most common type
  • Classified as a cortical dementia.
  • ***Gradual onset and progressive decline without focal neurological deficits
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11
Q

Dementia due to HIV disease

A
  • Classified as a subcortical dementia.
  • Early signs of HIV dementia: Cognitive decline, motor abnormalities *(lack of coordination, tremors, dystonia, ataxia), and behavioral abnormalities
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12
Q

Clinical signs of late-stage HIV-related dementia

A
  • Global cognitive impairment
  • Mutism
  • Seizures
  • Hallucinations
  • Delusions
  • Apathy
  • Mania
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13
Q

Lewy body disease

A
  • Presents with **recurrent visual hallucinations. **
  • Parkinson feature (bradykinesia, tremor)
  • Adversely react to antipsychotics especially typical antipsychotics.
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14
Q

Vascular dementia (VD)

A
  • Second most common type.
  • Primarily caused by cardiovascular disease and characterized by step-type declines.
  • Most common with men with preexisting high blood pressure and cardiovascular risk factors.
  • **Hallmarks: carotid bruits, fundoscopic abnormalities, and enlarged cardiac chambers
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15
Q

Pick’s disease

A
  • Also known as frontotemporal dementia/frontal lob dementia.
  • More common in men
  • **Personality, behavioral, and language changes (slurred) in early stage.
  • Cognitive changes can occur in later stages.
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16
Q

Huntington’s disease

A

Subcortical type of dementia
* Characterized mostly by motor abnormalities
* Psychomotor slowing and difficulty with complex tasks.
* High incidence of depression and psychosis.

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17
Q

Etiology of dementia

A
  • Diffuse cerebral atrophy and enlarged ventricles in dementia of Alzheimer’s type (DAT)
  • ***Decreased acetylcholine and norepinephrine in DAT
  • Genetic loading
    o Family history of dementia in first-order relative
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18
Q

Psychosis and agitation in Dementia

A
  • ***Try nonpharmacological therapies first.
  • ***Atypical antipsychotics should be used as first-line agents in patients with psychotic symptoms of dementia.
  • **Use lowest effective dose and attempt to wean periodically.
    o **    Benzodiazepines should be avoided, if possible, in most patients with dementia, as they are particularly vulnerable to their adverse effects such as sedation, falls, and delirium.
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19
Q

Primary prevention:

A
  • Aimed at decreasing the incidence (number of new cases) of mental disorders.
  • Example: Stress management classes for graduate students, smoking prevention classes.
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20
Q

Secondary prevention:

A
  • Aimed at decreasing the prevalence (number of existing cases) of mental disorders.
  • Screening
  • Example: telephone hotlines, crisis intervention, disaster responses
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21
Q

Tertiary prevention:

A
  • Aimed at decreasing the disability and severity of a mental disorder
  • Rehabilitative services
  • Avoidance or postponement of complications
    o Example: Day treatment programs; case management for physical, housing, or vocational needs; social skills training.
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22
Q

The guiding principles of Motivational Interviewing

A

Ask Open-ended questions
* The patient does most of the talking.
* Gives the provider the opportunity to learn more about what the patient cares about (e.g., their values and goals).
* Example: I understand you have some concerns about your drinking. Can you tell me about them? Verses Are you concerned about your drinking?
Make Affirmations
* Can take the form of compliments or statements of appreciation and understanding.
* Helps build rapport, validates, and supports the patient during the process of change.
* Most effective when the patient’s strengths and efforts for change are noticed and affirmed.
Example:
* I appreciate that it took a lot of courage for you to discuss your drinking with me today.
* You appear to have a lot of resourcefulness to have coped with these difficulties for the past few years.
Use Summarizing
* Ensure mutual understanding of the discussion so far.
* Links discussions and ‘checks in’ with the patient.
* Point out discrepancies between the person’s current situation and future goals.
* Demonstrates listening and understanding of the patient’s perspective.
Example:
If it is okay with you, just let me check that I understand everything that we’ve been discussing so far. You have been worrying about how much you’ve been drinking in recent months because you recognize that you have experienced some health issues associated with your alcohol intake, and you’ve had some feedback from your partner that she isn’t happy with how much you’re drinking. But the few times you’ve tried to stop drinking have not been easy, and you are worried that you can’t stop. How am I doing?

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23
Q

The guiding principles of Motivational Interviewing

A

Express Empathy Listen rather than talk; communicate respect for and acceptance of client
Avoid Argumentation Avoid confronting denial; encourage the client to make progress toward change
Roll with Resistance Divert or direct the client toward positive change; listen more carefully
Develop Discrepancy Promote the client’s awareness of consequences of continued use; clarify how present behavior is in conflict with important goals
Support Self-Efficacy Elicit and support hope; encourage the client’s capacity to reach their goals

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24
Q

Transtheoretical model of change-Precontemplation

A

a. ***The person is not aware that there is a problem with their behavior. **
b. The person has not intention to change.

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25
Q

Action step for Precontemplation stage

A

***Provide information and feedback to raise the person’s awareness of the problem and the possibility of change. Do not give prescriptive advice.

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26
Q

Transtheoretical model of change-Contemplation Stage

A

The person is thinking about changing; is aware that there is a problem but not committed to changing.

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27
Q

Action Step for Contemplation Stage

A

***Help the person see the benefits of changing and the consequences of not changing.

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28
Q

Transtheoretical model of change-Preparation Stage

A

The person has made the decision to change; is ready for action.

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29
Q

Action Step for Preparation Stage

A

***Help the person find a change strategy that is realistic, acceptable, accessible, appropriate, and effective.

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30
Q

Transtheoretical model of change-Action Stage

A

The person is engaging in specific, overt actions to change.

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31
Q

Action Step for Action Stage

A

***Support and be an advocate for the person. Help accomplish the steps for change.

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32
Q

Transtheoretical model of change-Maintenance Stage

A

The person is engaging in behaviors to prevent relapse.

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33
Q

Action Plan for Maintenance Stage

A

***Help the person identify the possibility of relapse and identify and use strategies to prevent relapse.

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34
Q
  1. Transtheoretical model of change-Relapse
A
  • “When was your last relapse?”
  • What led to the relapse and what are your plans for getting past it and avoiding another relapse?”
  • “What keeps you from having another relapse?”
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35
Q

Action Plan for Relapse

A

Help the person holistically look at the situation.

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36
Q

Kindling

A

The tendency of some regions of the brain to react to repeated low-level bioelectrical stimulation by progressively boosting synaptic discharges, thereby lowering seizure thresholds.

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37
Q

Addiction

A

Compulsive substance use despite harmful consequence.

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38
Q

Potency

A

The amount of drug required to produce an effect of given intensity.

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39
Q

Give ______ for a high potency medication like haldol

A

Low Dose

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40
Q

Give ____ for low potency medication, like chlopromazine

A

High Dose

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41
Q

Etiology of ADHD

A

**Abnormalities of fronto-subcortical pathways (Refer PB 336)
* Frontal cortex
* Basal ganglia (motor control, motor learning, executive functions and behaviors, and emotions).
Abnormalities of reticular activating system (ability to focus, fight-flight response, regulating arousal and sleep-wake transitions). **
Structural abnormalities producing neurotransmitter abnormalities
* Dopamine dysfunction
* Norepinephrine dysfunction
* Serotoinin
Mnemonic: DNS

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42
Q

Pharmacological Management ADHD-Stimulants

A

(Adderall and methylphenidate)
* Assess cardiac history before placing patient on stimulants (amphetamines for example can cause elevated heart rate and blood pressure, and increase risk of heart attack, and stroke).
* Amphetamines are approved in children ages 3 years and older.
* Methylphenidate are approved in children ages 6 years and older.

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43
Q

Pharmacological Management of ADHD-Non-Stimulants

A
  • Alpha agonist or alpha 2 adrenergic receptor agonist: Guanfacine and Clonidine is FDA approved in ages 6-17 years with ADHD.
  • Strattera (Atomoxetine) (selective norepinephrine reuptake inhibitor) is approved for children aged 6 and older with ADHD.
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44
Q

Signs of stimulants abuse

A
  • ***Insomnia
  • ***Tremors
  • ***Increase blood pressure and heart rate
  • ***Heart palpitations
  • Agitation
  • Anxiety
  • Irritability
  • Mood swings
  • Elevated mood
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45
Q

Nonpharmacological Management of ADHD

A
  • Behavioral therapy
  • Patient and parent cognitive behavioral training program
  • Psychoeducation
  • Treatment of learning disorders
  • Family therapy and education
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46
Q

Borderline personality disorder

A
  • Impulsivity, often with self-damaging behavior
  • Recurrent suicidal behavior
  • Patter of unstable, intense interpersonal relationships
  • Frantic efforts to avoid real or imagined abandonment
  • Identity disturbances
  • Chronic feelings of emptiness
  • Inappropriate, intensified affective anger responses
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47
Q

Treatment for Borderline Personality Disorder

A

Nonpharmacologic Treatment: Dialectical Behavioral therapy (DBT)

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48
Q

Antisocial personality disorder (APD)

A
  • Reckless disregard for welfare of others
  • Lack of remorse; indifference to the feelings of others
  • Failure to conform to social norms
  • Repeated acts that are grounds for arrest
  • Deceitfulness, lying, and use of aliases for profit or pleasure
  • Impulsivity and failure of future planning
  • Consistent irresponsibility
    Note:
  • ***Both adopted and biological children of parents with APD are at increased risk for developing APD.
  • ***APD is three times more commonly diagnosed in males than in females
  • ***A higher frequency of APD is associated with low socioeconomic status and urban settings.
  • ***APD is more common among first-degree biological relatives (both male and female) of those diagnosed with APD.
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49
Q

Antisocial Personality Disorder-Treatment

A

Nonpharmacologic Treatment:
* Cognitive Behavioral Therapy (CBT)
* Behavioral Therapy

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50
Q

Schizoid Personality Disorder

A
  • Voluntary social isolation
  • Indifferent to other people: Shows an apparent lack of care in relation to how others perceive them.
  • Shows little to no interest in sexual activity with another person.
  • Derives no pleasure in social activities
  • Lacks close friends or social supports.
  • Appears cold and detached
  • Exhibits affective flattening
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51
Q

Autism spectrum disorder

A

Persistent deficits in social communication and social interaction across multiple settings associated with deficits in:
* Social reciprocity
* Nonverbal communication
* Developing, maintaining, and understanding relationships.
* Restricted repetitive behavior
* Stereotyped or repetitive motor movements
* Insistence on sameness
* Highly restricted with fixed interests
* **Children with autism often like to line up, stack, or organize objects and toys in long tidy rows.

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52
Q

Risk Factors for Autism

A
  • Male gender
  • Intellectual disability
  • Genetic loading
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53
Q

Parents may report the following symptoms in Autism

A
  • No response when called by name
  • Little or no eye contact
  • No imaginary play
  • Little interest in playing with other children
  • Intense tantrum
  • Extremely short attention span
  • Self-injurious behavior
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54
Q

Screening for Autism

A
  • Modified checklist for Autism in Toddlers (M-CHAT)
  • Autism Diagnostic Observation Schedule-Generic (ADOS-G)
  • Ages and Stages Questionnaires (ASQ)
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55
Q

Pharmacological management of Autism

A
  • Antipsychotics are effective for symptoms such as tantrums; aggressive behavior, self-injurious behavior, hyperactivity; and repetitive, stereotyped behaviors
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56
Q

Disruptive mood dysregulation disorder (DMDD)

A
  • Childhood depressive disorder that is diagnosed in children older than age 6 but younger than age 18.
  • Chronic dysregulated mood (“moody”)
  • Frequent intense temper outbursts/tantrums
  • Severe irritability
  • Anger
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57
Q

Treatment for Disruptive mood dysregulation disorder (DMDD)

A

Stimulants, antipsychotics, antidepressants
Ritalin

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58
Q

Intermittent explosive disorder (IED)

A
  • Involves repeated, sudden episodes of impulsive, aggressive, violent behavior, or angry verbal outbursts in which the patient reacts grossly out of proportion to the situation.
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59
Q

Treatment for Intermittent explosive disorder

A
  • SSRI for example Fluoxetine
  • ***Mood stabilizers: Lithium and Carbamazepine
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60
Q

Fragile X Syndrome

A

***Large head, elongated face, hyperextensible joints, abnormally large testes, short stature

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61
Q

Major Depressive Disorder

A
  • Dysregulation of one or more biogenic amine neurotransmitters: Dopamine, Norepinephrine, Serotonin (DNS)
  • **Cognition and memory symptoms of MDD in the older adult population (pseudodementia) often are confused with dementia-related symptoms. **
  • Clients with dementia usually have a premorbid history of slowly declining cognition.
  • In MDD, cognitive changes have a relatively acute onset and are significant when compared to premorbid functioning.
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62
Q

Pharmacological management of MDD

A
  • Inform client that therapeutic effect may take at least 4-6 weeks
  • Once started, continue antidepressants for a minimum of 6-12 months
  • If the client has more than two prior episodes of MDD, consider continuing antidepressants indefinitely
  • Antidepressant rebound is common when stopping antidepressants abruptly, particularly when drugs with short half-lives are involved.
  • Firstline: Selective Serotonin Reuptake Inhibitors (SSRIs)
    o Serious side effects are rare.
    o Much safer in overdose than TCAs
  • **Selective serotonin reuptake inhibitors (SSRIs) serotonin and noradrenaline reuptake inhibitors (SNRIs), Bupropion, Mirtazapine, are typically used as first-line medications because their safety and tolerability may be preferable to patients and clinicians compared to those of tricyclic antidepressants (TCAs) and monoamine oxidase (MAO) inhibitors. **
  • Second line: Tricyclic Antidepressants (TCAS) (refer PB page 156)
    o Electrocardiogram changes and cardiac dysrhythmias are possible; avoid in clients known to have susceptibility (personal or family history). Monitor EKG before treatment and annually in older adults.
    o Avoid abrupt withdrawal because of significant discontinuation syndrome.
    o Avoid prescribing to people who are at high risk for suicide.
    Note (refer PB page 163): All antidepressants indicated for children, adolescents, and young adults (up to age 24 years) carry a black box warning about an increase in suicidal thoughts; monitor closely for suicidal thoughts, behavior, agitation, and aggression in children taking antidepressants.
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63
Q

Non-Pharmacological Management of MDD

A
  • Electroconvulsive Therapy (ECT)
  • Cognitive Behavioral Therapy (CBT)
  • Transcranial Magnetic Stimulation (TMS)
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64
Q

Electroconvulsive Therapy

A
  • MDD with psychotic features
  • Treatment resistant depression
    Contraindications:
  • Cardiac disease
  • Compromised pulmonary status
  • History of brain injury or brain tumor
  • Anesthesia medical complications
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65
Q

Adverse effects of ECT

A
  • Possible cardiovascular effects
  • Systemic effects (e.g. headaches, muscle aches, drowsiness)
  • Cognitive effects (e.g. memory disturbance and confusion).
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66
Q

Clinical Management of Suicidality

A
  • Always assume client is serious when he or she vocalizeds suicidal thoughts.
  • Consider hospitalization
  • Consider mobilizing available social resources
    ***Note: There is not enough evidence that the use of “no harm to self/others/safety” contracts can reduce the risk of suicide.
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67
Q

Bipolar Disorder

A

DIG FAST
* Distractibility
* Implusivity – poor judgement, spending sprees, reckless driving
* Grandiosity – increased self esteem
* Flight of ideas – racing thoughts
* Activities – psychomotor agitation
* Sleep – decreased need
* Talkativeness – pressured speech

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68
Q

Differences Between Bipolar I and Bipolar II

A
  • Bipolar I and II are similar in that periods of elevated mood and symptoms of depression can occur in both types of the condition.
  • The main difference between the two types is the degree to which mania presents:
  • In bipolar I disorder, a person experiences a full manic episode, which causes extreme changes in mood and energy Symptoms are severe enough that they may interfere with a person’s functioning at home, school, or work.
    o During a manic episode, a person can experience symptoms for at least a week.
  • In bipolar II disorder, less severe symptoms occur during a hypomanic episode.
    o Symptoms of hypomania mirror those of mania, except they last for a shorter period, **at least four days, and are less severe. **
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69
Q

Neurotransmitter involved in mood disorder:

A

Dopamine, Norepinephrine, Serotonin, GABA, Glutamate.

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70
Q

What disorder must be ruled out when making a diagnosis of MDD?

A

***Bipolar Disorder

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71
Q

Pharmacological Management of Bipolar Disorder

A
  • ***Lithium: Neuroprotective treatment of choice for bipolar disorder (can protect nerve cells from damage).
  • Lamotrigine (Lamictal): Bipolar depression. ***
  • Olanzapine in combination with Fluoxetine (Prozac) (Symbyax) is FDA approved for the treatment of bipolar depression.
  • Lurasidone (Latuda) – Bipolar depression
  • Divalproex sodium (Depakote) is effective in management of acute manic and depressive episodes and is also useful in prevention of relapse of both manic and depressive episodes.
  • Carbamazepine can be used to treat manic episodes associated with bipolar disorder.
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72
Q

Nonpharmacological of Bipolar Disorder

A
  • Cognitive behavioral therapy (CBT)
  • Behavioral therapies
  • Interpersonal therapies
  • Supportive groups
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73
Q

Normal values of Free thyroxine T4 (FT4)

A

normal values 0.8 to 2.8 ng/dl

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74
Q

Thyroid disorders

A
  • FT4 test is done to determine thyroid status, to rule out hypo- and hyperthyroidism, and to evaluate thyroid therapy
  • Thyroid-stimulating hormone (0.5-5.0 Mu/L)
  • TSH testing is commonly performed to establish the diagnosis of primary hypothyroidism.
  • When T3 and T4 are high (hyperthyroidism), TSH secretion decreases
  • When T3 and T4 are low (hypothyroidism), TSH secretion increases.
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75
Q

Normal TSH level

A

***0.5-5.0 Mu/L

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76
Q

Symptoms of Hypothyroidism (decreased T4, increased TSH)

A
  • Sensitive to cold (cold intolerance)
  • Confusion
  • Decreased libido
  • Impotence
  • Decreased appetite
  • Memory loss
  • Lethargy
  • Constipation
  • Headaches
  • Slow or clumsy movements
  • Weight gain
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77
Q

Symptoms of hyperthyroidism (increased T4, decreased TSH)

A

May mimic symptoms of bipolar affective disorders (mania)
* **Sensitive to heat (heat intolerance)
* Irritability/agitation*
* Motor restlessness
* Emotional lability (exaggerated changes in mood e.g., uncontrollable laughing and crying)
* Short attention span
* Compulsive movement
* Fatigue
* Tremor
* Insomnia
* Impotence
* Weight loss

78
Q

Generalized anxiety disorder (GAD)

A
  • GAD is excessive worry, apprehension, or anxiety about events or activities and occurs more days than not for a period of at least six months
  • The person finds it hard to control the anxiety
79
Q

Nonpharmacological Management of GAD

A
  • Cognitive Behavioral Therapy
  • Relaxation therapies
  • Stress management
  • Supportive counseling
80
Q

Pharmacological Management of GAD

A
  • SSRIs (Escitalopram (Lexapro) and paroxetine (Paxil).
  • Buspirone (Buspar)
  • Benzodiazepines (Alprazolam (Xanax), Clonazepam (Klonopin)
81
Q

Social anxiety disorder

A
  • Social anxiety disorder is a marked and persistent fear of social or performance situations in which embarrassment may occur.
82
Q

Nonpharmacological Management of Social anxiety disorder

A
  • CBT
  • Exposure therapy
  • Relaxation therapy
83
Q

Pharmacological Management of social anxiety disorder

A
  • SSRIs (sertraline, paroxetine)
  • Benzodiazepines, short-term use
  • Betablockers:
    o Used for discrete episode relief for example, before having to attend a scheduled function.
84
Q

Oppositional defiant disorder (ODD)

A

It is 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:
* Loses temper
* Touchy or easily annoyed
* Angry or resentful
* Argues with authority
* Actively defies or refuses to comply with request for rules from authority figures
* Blames others
* Deliberately annoys others
* Spiteful or vindictive

85
Q

Nonpharmacological treatment of Oppositional defiant disorder (ODD)

A

Therapy is mainstay
* Individual therapy
* Family therapy, with emphasis on child management skills
* Evidence-based treatment: child and parent problem-solving skills training
* Adolescent Transitions Program

86
Q

Conduct Disorder

A

A repetitive and persistent pattern of behavior in which the rights of others or societal norms or rules are violated. The presence of at least three of the following criteria must be present in the past 12 months, with one in the past 6 months:
* Aggressive toward people or animals-bullies, threatens, intimidates, initiates physical fights, uses a weapon to cause physical harm to others, physically cruel to people or animals, stealing while confronting a victim, forced sexual activity on someone.
* Destruction of property-engaged in fire-setting, destroyed others’ property.
* Deceit or theft-broke into house, building, or car, lies, steals items.
* ***Lack of remorse

87
Q

Pharmacological treatment of conduct disorder

A

Treatment: Target mood and aggression
* Aggression and agitation treated with antipsychotics, mood stabilizers, selective serotonin reuptake inhibitors (SSRIs), and alpha agonists (Clonidine and Guanfacine)

88
Q

Nonpharmacological Treatment of conduct disorder

A
  • Behavioral therapy
    o Family therapy
    o Individual therapy
89
Q

Conversion disorder

A
  • Conversion disorder is a mental condition in which ** a person has blindness, mutism, paralysis, or paresthesia (glove stocking syndrome), other nervous system (neurologic) symptoms that cannot be explained by medical evaluation. **
  • Symptoms usually begin suddenly after a stressful experience.
90
Q

Nonpharmacological treatment of conversion disorder

A
  • Cognitive Behavioral Therapy (CBT)
  • Physical therapy
91
Q

Adjustment Disorders

A
  • An adjustment disorder is an emotional or behavioral reaction to a stressful event or change in a person’s life. The reaction is considered an unhealthy or excessive response to the event or change within three months of it happening.
  • 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.
  • A sudden illness or restriction to your child’s life due to chronic illness may also result in an adjustment response.
92
Q

** Adjustment disorder with depressed mood:

A

Presents with feelings of depression, tearfulness, and hopelessness.

93
Q
  • ***Adjustment disorder with anxiety:
A

Presents with symptoms of feeling restless, nervousness, lack of concentration.

94
Q
  • Adjustment disorder with mixed anxiety and depression:
A

A patient has a mix of symptoms from both of the above subtypes (depressed mood and anxiety).

95
Q
  • Adjustment disorder with disturbance of conduct:
A

A child may violate other people’s rights or violate social norms and rules. Examples include not going to school, destroying property, driving recklessly, or fighting.

96
Q
  • ***Adjustment disorder with mixed disturbance of emotions and conduct:
A

A child has a mix of symptoms from all the above subtypes.

97
Q

Post Traumatic Stress Disorder

A
  • PTSD is the reexperiencing of an extremely traumatic event accompanied by symptoms of increased arousal (hyperarousal) and avoidance of stimuli associated with the trauma.
98
Q

PTSD pharmacological treatment

A
  • SSRIs, TCAs
  • ***Prazosin for nightmares
99
Q

PTSD nonpharmacological treatment

A
  • Eye movement desensitization and reprocessing (EMDR)
  • CBT
  • Exposure therapy with Response Prevention (ERP)
  • Supportive group therapy
  • Relaxation therapies
100
Q

Obsessive compulsive disorder

A
  • OCD is the presence of anxiety-provoking obsessions and/or compulsions that function to reduce the person’s subjective anxiety level.
101
Q

Obsession component

A
  • Defined as recurrent and persistent thoughts, impulses, or images that are experienced and cause anxiety and distress.
  • Experienced as intrusive and inappropriate
102
Q

Compulsion

A
  • Defined as repetitive behaviors or mental actions that a person feels driven to perform in response to an obsession.
103
Q

Risk factors for OCD

A
  • First-degree relatives
  • ***PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection) should be considered in all children with sudden onset OCD symptoms.
104
Q

OCD pharmacological treatment

A
  • SSRIs (Sertraline and Fluoxetine): Clients often need higher dosing range for adequate symptom control).
  • TCA (Clomipramine)
105
Q

OCD nonpharmacological treatmet

A
  • CBT
  • Exposure therapy
106
Q

Tourette

A
  • Tourette Syndrome is one type of Tic Disorder.
  • Tics are involuntary, repetitive movements and vocalizations
    Tourette Syndrome (TS), also known as Tourette’s Disorder:
  • At least 2 motor tics and at least 1 vocal (phonic) tic have been present, not necessarily at the same time.
  • Tics may wax and wane in frequency but have occurred for more than 1 year.
  • Tics started to appear before the age of 18.
  • Tics are not caused by the use of a substance or other medical condition.
107
Q

Primary neurotransmitter involved in Tourette

A
  • Dopamine, Norepinephrine (Noradrenaline), Serotonin.
108
Q

Tourette pharmacological treatment

A
  • Atypical antipsychotic
  • FDA: Haloperidol, Pimozide, Aripriprazole
  • Medications such as clonidine (Catapres, Kapvay) and guanfacine (Intunive) can help control behavioral symptoms such as impulse control problems and rage attacks.
  • Antidepressants such as Fluoxetine (Prozac) might help control symptoms of sadness, anxiety, and OCD.
109
Q

Tourette nonpharmacological treatment

A
  • Behavior therapy
  • CBT
110
Q

Schizophrenia age of onset

A
  • 18-25 years old in males
  • 25-35 years old in females
111
Q

Schizophrenia etiology

A
  • Genetic defects such as:
    o Inadequate synapse function
    o Excessive pruning of synapses
    o Excitotoxic death of synapses
  • Intrauterine insults may contribute to etiological picture:
    o Prenatal exposure to toxins, including viral agents
    o Oxygen deprivation
    o Maternal malnutrition, substance use, or other illness
112
Q

Schizophrenia positive symptoms

A
  • Hallucinations
  • Delusion
  • Referential thinking
  • Disorganized behavior/speech
  • Hostility
  • Grandiosity
  • Mania
  • Suspiciousness
    Excess Dopamine = Mesolimbic
113
Q

Schizophrenia negative symptoms

A
  • Affective flattening
  • Alogia or poverty of speech
  • Avolition (lack of motivation or ability to do tasks)
  • Apathy (lack of interest)
  • Abstract-thinking problems
  • Anhedonia (inability to feel pleasure)
  • Attention deficit
    Decreased DA = Mesocortial Pathway
114
Q

Neurobiological defect associated with schizophrenia

A

Several abnormal brain structures have been identified in people with schizophrenia:
* ***Enlarged ventricles
* Smaller frontal and temporal lobes
* Reduced symmetry in temporal, frontal and occipital lobes
* Cortical atrophy
* Decreased cerebral blood flow
* Hippocampal and amygdala reduction
MRI/PET SCAN

115
Q

Suspected alterations in chemical neuronal signal transmission in schizophrenia

A
  • Excess dopamine in mesolimbic pathway
  • Excess glutamate
  • Decreased gamma-aminobutyric acid (GABA)
  • Decreased serotonin
116
Q

Preventative care in schizophrenia

A
  • Monitor routine labs to screen for complications of treatment
  • ***Fasting serum glucose and fasting lipid panels
  • ***Weight, BMI, and waist-to-hip ratio (measures abnormal obesity).
  • Liver and kidney function (based on medication)
  • Complete blood count
  • Perform annual eye exam if on typical antipsychotic agent or Seroquel
117
Q

Schizophrenia nonpharmacological treatment

A
  • Individual therapy
  • Group therapy
  • Assertive community treatment (ACT)
118
Q

Erikson’s Trust vs Mistrust

A
  • Infancy: Birth – 1-year-old
  • Ability to form meaningful relationships, hope about the future, trust in others.
  • Faith in environment
  • Unfavorable outcome: Poor relationships, suspicion, fear of the future.
119
Q

Erikson’s shame vs doubt

A
  • Early childhood: 1-3 years old.
  • Self-control, self-esteem, and willpower
  • Sense of adequacy
  • Unfavorable outcome: Feelings of shame and self-doubt, poor self-control, low self-esteem, lack of independence.
120
Q

Erikson’s Initiative Vs Guilt

A
  • Late childhood: 3-6 years old
  • ***Ability to initiate one’s own activities, to be a “self-starter”.
  • Self-directed behavior, goal formation, sense of purpose.
  • ***Initiative leads to a sense of purpose and can help develop leadership skills, failure results in guild. Essentially, kids who do not develop initiative at this stage may become fearful of trying new things. When they do direct efforts toward something, they may feel that they are doing something wrong.
  • Unfavorable outcome: Sense of guilt, lack of self-initiated behavior, lack of goal orientation.
121
Q

Erikson’s Industry vs Inferiority

A
  • School-age: 6-12 years-old.
  • Ability to learn how things work, to understand and organize.
  • Ability to work, sense of competency and achievement.
  • ***Friends and classmates play a role in how children progress through the industry versus inferiority stage. Through proficiency at play and schoolwork, children are able to develop a sense of competency and pride in their abilities.
  • ***Unfavorable outcome: A sense of inferiority at understanding and organizing.
122
Q

Erikson’s Identity vs Role Confusion

A
  • Adolescence: 12-20 years old.
  • ***Personal sense of identity: A solid sense of identity means that you know who you are, what you value, and how you see yourself in society.
  • ***Seeing oneself as a unique and integrated person (a unity in thought, emotion, and action).
  • Unfavorable outcome: Confusion over who and what really one is, poor self-identification in group setting.
123
Q

Erikson’s Intimacy Vs Isolation

A
  • Early adulthood: 20—35 years old.
  • Committed relationships and capacity to love.
  • Unfavorable outcome: Inability to form affectionate relationships, emotional isolation.
124
Q

Erikson’s generativity vs stagnation

A
  • Middle adulthood: 35-65 years old
  • Ability to give time and talents to others, ability to care for others.
  • Concern for family and society in general.
  • Unfavorable outcome: Concern only for self.
125
Q

Erikson’s Integrity vs Despair

A
  • Late adulthood: >65 years old.
  • Fulfillment and comfort with life, willingness to face death, insight, and balanced life events.
  • A sense of integrity.
  • Unfavorable outcome: Bitterness, dissatisfaction with life, despair over prospect of death.
126
Q

***Jean Piaget’s four stages of cognitive development pg 44

A

Sensorimotor
Object permanence: Object permanence describes a child’s ability to know that objects continue to exist even though they can no longer be seen or heard.
Object constancy: Object Constancy allows us to trust that our bond with those who are close to us remains whole even when they are not physically around. With Object Constancy, absence does not mean disappearance or abandonment, only temporary distance.

127
Q

Freudian Psychosexual Stages of Development table

A

Pg 49 of notes

128
Q

Bowlby’s attachment theory

A
  • It is a psychological theory that seeks to explain how individuals create reliable emotional connections, bonding relationships, and emotional regulation between humans based on psychological and physiological needs.
  • ***According to Bowlby, humans have an innate need for attachment or emotional bonding with other human beings from birth through life. Failure to foster attachment and create emotional bonds in childhood can lead to psychological disruptions, emotional imbalances, and behavioral trouble in adulthood.
  • Bowlby’s attachment theory proposes that early attachments play a vital role in shaping one’s emotional and social connections throughout life.
  • ***The theory claims that infants develop strong emotional bonds with trusted caregivers or figures in their early lives. These caregivers create real-world interactions and provide safety, comfort, stability, and warmth for the infant, which leads to emotional safety and self-regulation.
129
Q

Devaluation

A
  • It’s used when a person attributes themselves, an object, or another person as completely flawed, worthless, or as having exaggerated negative qualities
130
Q

Cognitive Therapy

A
  • Aaron Beck
  • Goal is to change clients’ irrational beliefs (negative thoughts), faulty conceptions, and negative cognitive distortions.
131
Q

Behavioral therapy

A
  • Focuses on changing maladaptive behaviors by participating in active behavioral techniques such as exposure, relaxation, skills training, problem-solving, and role-playing, modeling.
132
Q

Cognitive Behavioral Therapy (CBT)

A

Cognitive-behavioral therapy aims to change our thought patterns, our conscious and unconscious beliefs, our attitudes, and, ultimately, our behavior, to help us face difficulties and achieve our goals.
* The therapist and the client work together as a team to identify the client’s problems, devise strategies for addressing them, and create solutions.
CBT is based on several core principles, including:
1. Psychological problems are based, in part, on faulty or unhelpful ways of thinking.
2. Psychological problems are based, in part, on learned patterns of unhelpful behavior.
3. People suffering from psychological problems can learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives.
CBT treatment usually involves efforts to change thinking patterns. These strategies might include:
* Learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality.
* Gaining a better understanding of the behavior and motivation of others.
* Using problem-solving sills to cope with difficulty situations.
* Learning to develop a greater sense of confidence in one’s own abilities.
CBT treatment also usually involves efforts to change behavioral patterns. These strategies might include:
* Facing one’s fears instead of avoiding them.
* Using role playing to prepare for potentially problematic interactions with others.
* Learning to calm one’s mind and relax one’s body.

133
Q

***Trauma-Focused Cognitive Behavioral Therapy

A
  • Trauma-Focused cognitive behavioral therapy (TF-CBT) addresses the mental health needs of children, adolescents, and families suffering from the destructive effects of early trauma.
  • ***The treatment is particularly sensitive to the unique problems of youths with post-traumatic stress and mood disorders resulting from sexual abuse, as well as from physical abuse, violence, or grief.
134
Q

Dialectical Behavioral Therapy

A
  • Originated by Marsh Linchan
  • Used for borderline personality disorder.
  • During DBT, the therapist/provider should be an active listener.
    o Listen to the person in the moment, truly utilizing the skills of actively listening.
    o Reframe what the patient is saying.
135
Q

Goals of DBT

A
  • Decrease suicidal behaviors
  • Decrease therapy-interfering behaviors
  • Decrease emotional reactivity
  • Decrease self-invalidation
  • Decrease crisis-generating behaviors
  • Decrease passivity
  • Increase realistic decision-making
  • Increase accurate communication of emotions and competencies
136
Q

Humanistic therapy

A
  • Originated by Carl Rogers
  • Person-centered therapy
  • Concepts include self-directed growth and self-actualization
  • Each person has the potential to actualize and find meaning.
137
Q

Existential therapy

A
  • Emphasizes accepting freedom and making responsible choices.
  • ***Existential therapy is also well suited to those facing issues of existence, for example, those with a terminal illness, those contemplating suicide, or even those going through a transition in their life.
  • ***Understand patient’s subjective experience.
  • Reflection on life and self-confrontation is encouraged.
  • Goals are to live authentically and to focus on the present and on personal responsibility.
138
Q

Interpersonal therapy

A
  • Focus on interpersonal issues that are creating distress.
  • ***The goal is to help people to identify and modify interpersonal problems, to understand and to manage relationship problems.
139
Q

Eye Movement Desensitization and Reprocessing (EMDR)

A
  • A form of behavioral and exposure therapy.
  • Used for Post-traumatic stress disorder (PTSD)
  • Goal is to achieve adaptive resolution
140
Q

Desensitization phase of Eye Movement Desensitization and Reprocessing

A
  • The client visualizes the trauma, verbalizes the negative thoughts or maladaptive beliefs, and remains attentive to physical sensations. This process occurs for a limited time while the client maintains rhythmic eye movements. He or she is then instructed to block out negative thoughts; to breath deeply; and then to verbalize what he or she is thinking, feeling, or imaging.
141
Q

Installation phase of Eye Movement Desensitization and Reprocessing

A
  • The client installs and increases the strength of the positive thought that he or she has declared as a replacement of the original negative thought.
142
Q

Body scan phase of Eye Movement Desensitization and Reprocessing

A
  • The client visualizes the trauma along with the positive thought and then scans his or her body mentally to identify any tension within.
143
Q

Psychodynamic therapy

A
  • Focuses on unconscious processes as they are manifested in the client’s present behavior.
  • ***The goals of psychodynamic therapy are client self-awareness and understanding of the influence of the past on the present behavior.
144
Q

Family Homeostasis under family therapies

A

Tendency of families to resist change and to maintain a steady state.

145
Q

Morphogenesis under family therapies

A

a family’s tendency to adapt to change when changes are necessary

146
Q

Morphostasis under family therapies

A

A family’s tendency to remain stable in the midst of change.

147
Q

Boundaries under family therapies

A

Barriers that protect and enhance the functional integrity of families, individuals, and subsystems. System boundaries can be physical or psychological.

148
Q

Family Systems Therapy/Systemic Family Therapy

A
  • Originated by Murray Bowen
  • Focus is on chronic anxiety within families.
  • Treatment goals are to increase the family’s awareness of each member’s function within the family and to increase levels of self-differentiation (being able to possess and identify your own thoughts and feelings and distinguish them from others).
  • Triangles: Dyads that form triads to decrease stress; the lower the level of family adaption, the more likely a triangle with develop.
    o ***Triangles/Triangulation/Self-differentiation, genograms (genomes)
149
Q

Structural family therapy

A
  • ***A type of family therapy that assesses the subsystems, boundaries, hierarchies, and coalitions within a family (its structure) and focuses on direct interactions between the family members as the primary method of inducing positive change.
  • The main treatment goal is to produce a structural change in the family organization to more effectively manage problems.
  • Genograms (or structural mapping)
  • ***Clearly defined hierarchies/Boundaries
150
Q

***Enactment in Structural Family Therapy

A
  • IN an enactment, family members are asked to play out relationship patterns spontaneously during a therapy session (talk with each other rather than to the therapist). This serves the dual purpose of allowing the therapist to see firsthand how clients interact, instead of relying on their descriptions, and having clients experience different ways of interacting (map, track and modify the family structure).
151
Q

Strategic therapy

A
  • Interventions are problem focused. Strategic therapy is symptom focused.
  • Paradoxical directives: A negative task that is assigned when family members are resistant to change, and the member is expected to be noncompliant (use this technique with caution).
  • Straightforward directives: Tasks that are designed in expectation of the family member’s compliance.
  • Reframing belief systems: Problematic behaviors are relabeled to have more positive meaning (e.g., jealousy reframed to caring).
152
Q

Solution-Focused therapy

A
  • Focus is to rework for the present situation solutions that have worked previously.
  • Treatment goal is effective resolution of problems through cognitive problem-solving and use of personal resources and strengths.
    Miracle questions: “If a miracle were to happen tonight while you were asleep, and tomorrow morning you awoke to find that the problem no longer existed, what would be different?”
    Exception-finding questions:
  • Directing clients to a time in their lives when they problem did not exist, which helps them move toward solutions by assisting them in searching for any exceptions to the patter.
  • “Was there a time when the problem did not occur?”
    Scaling questions:
  • “On a scale of 1-10, with 10 being very anxious and depressed, how would you rate how you are feeling now? This is useful for highlighting small increments of change.
153
Q

***Self defense mechanisms: Projection

A

This involves individuals attributing their own unacceptable thoughts, feelings, and motives to another person. For example, a person who is angry at a colleague might accuse the colleague of being hostile towards them. Here, the individual is projecting their own hostility onto the colleague, rather than recognizing and accepting that the anger originates within themselves.

154
Q

***Self defense mechanisms: Displacement

A

Displacement is the redirection of an impulse (usually aggression) onto a powerless substitute target. The target can be a person or an object that can serve as a symbolic substitute. Ex: Somone who might be frustrated by their boss at work might go home and ick their dog.

155
Q

*** Self Defense Mechanisms: Sublimation

A

is similar to displacement but takes place when we manage to displace our unacceptable emotions into behaviors which are constructive and socially acceptable, rather than destructive activities. Sublimation is redirecting unacceptable feelings into an acceptable channel. For example, if a mother of a child killed in a drive-by shooting becomes involved in legislative change for gun laws and gun violence.

156
Q

***Self Defense Mechanisms: Intellectualization

A

Concentrating on intellectual aspects to avoid emotional aspects of a difficult situation. It attempts to master current stressor or conflict by expansion of knowledge, explanation, or understanding. Example: Imagin a person who has just been diagnosed with a serious illness. Instead of expressing fear, sadness, or anger, they immerse themselves in learning everything about the disease. They focus on the statistical survival rates, treatment plans, and the scientific aspects of the illness, rather than addressing their feelings of fear or grief about being sick.

157
Q

***Self Defense Mechanisms: Rationalization

A

An attempt to logically justify generally unacceptable behavior.

158
Q

***Self Defense Mechanisms: Repression

A

Unconscious (involuntary) exclusion of unwanted, disturbing emotions, thoughts, or impulses from conscious awareness. For example, a young child is bitten by a dog. They later develop a severe phobia of dogs but have no memory of when or how this fear originated.

159
Q

***Self Defense Mechanism: Suppression

A

Conscious (voluntary) analog of repression; conscious denial of a disturbing situation, feeling, or event. For example, a person might choose not to think about a troubling even during work hours to maintain focus on their job.

160
Q

***Self Defense Mechanism: Altruism

A

Meeting the needs of others in order to discharge drives, conflicts or stressors. For example, someone who struggled with addiction might find a sense of healing and purpose in helping others overcome similar challenges.

161
Q

***Self Defense Mechanism: Reaction Formation

A

It occurs when an individual unconsciously replaces unacceptable or threatening internal desires and thoughts with their exact opposites on the conscious level. This mechanism often manifests in behaviors that are exaggerated or overly demonstrative, and they typically oppose the person’s true feelings. For example, a person who feels hostility towards someone may exhibit overly friendly behavior towards them. This isn’t a genuine change in feelings, but rather a defense against the anxiety and internal confluct caused by the unacceptable hostile feelings.

162
Q

***Read on Irvin Yalom characteristics of group therapy

A

128 in PB

163
Q

Adverse childhood experiences

A
  • Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years).
  • ***Felitti et al (1988) seminal study of the long-term sequelae of ACE found a positive relationship between ACEs and significant heart disease, fractures, diabetes, obesity, unintended pregnancy, sexually transmitted diseases, depression, anxiety, cancer, COPD, chronic bronchitis, sleep disorder, dissociative disorders, eating disorders, and alcoholism.
164
Q

Biopsychosocial framework of care: Recovery Model is characterized by several key principles

A
  • Hope and Optimism:
    o The model instills hope in individuals by emphasizing that recovery is possible, and individuals can lead fulfilling lives despite mental health challenges.
  • Person-Centered Care:
    o The recovery approach recognizes the unique experiences, preferences, and goals of each individual. It promotes person-centered care, involving individuals in decision-making about their treatment plans and goals.
  • Empowerment:
    o Empowerment is a central theme in the Recovery Model It involves promoting individuals’ sense of control over their own lives, treatment choices, and recovery journey. Encouraging self-efficacy and autonomy is essential.
  • Holistic Perspective:
    o Instead of focusing solely on symptoms reduction, the model takes a holistic view of individuals, considering their physical, emotional, social, and spiritual well-being. It recognizes that recovery involves more than the absence of symptoms.
  • Collaboration and Partnership:
    o Recovery is viewed as a collaborative process between individuals, their families, and mental health professionals. Shared decision-making and active collaboration in treatment planning are essential components.
  • Cultural Competence:
    o The model acknowledges and respects cultural diversity. It recognizes that individuals from different cultural backgrounds may have unique perspectives on mental health and recovery, and interventions should be culturally sensitive.
  • Strengths-Based Approach:
    o The Recovery Model emphasizes identifying and building on an individual’s strengths rather than focusing solely on deficits or weaknesses . This strengths-based approach encourages the development of coping skills and resilience.
  • Lifelong Process:
    o Recovery is considered a lifelong process rather than a fixed destination. It recognizes that individuals may experience setbacks or relapses, and ongoing support is crucial for sustained recovery.
  • Peer Support:
    o The involvement of peers who have lived experience with menta health challenges is often encouraged. Peer support provides a unique form of empathy, understanding, and roe modeling.
  • Community Integration:
    o The model promotes community integration and participation as crucial aspects of recovery. This may include vocational and educational pursuits, social connections, and active engagement in community life.
  • Quality of Life:
    o Beyond clinical outcomes, the Recovery Model places importance on improving individuals’ overall quality of life. This involves addressing social determinants and enhancing well-being in various life domains.
165
Q

Biopsychosocial framework of care: Recover Model

A

** A treatment approach which does not focus on full symptoms resolution but emphasizes resilience and control over problems and life.
* The recovery model aims to help people with mental illnesses and distress to look beyond mere survival and existence.
* Recovery is not about “getting rid” of problems but seeing beyond a person’s mental health problems, recognizing, and fostering their abilities, interests, and dreams.
* It supports the view that they should get on with their lives, do things and develop relationships that give their lives meaning.
* Non-Linear: Recovery is not a step by step process, but one based on continual growth, occasional setbacks, and learning from experience. ***

166
Q

Four Dimensions of Recovery

A
  1. Health: Over coming or managing one’s diseases or symptoms and, for everyone in recovery, making informed healthy choices that support their physical and emotional well-being.
  2. Home: Having a stable and safe place to live.
  3. Purpose: Participating in meaningful daily activities such as a job, school, volunteerism, family caretaking or creative pursuits. It also means having the independent income and resources to take part in society.
  4. Community: Engaging in relationships and social networks that provide support, friendship, love, and hope.
167
Q

Assertive Community Treatment (ACT) (PB page 254)

A
  • An intensive, integrated approach to community mental health service delivery.
  • Mental health services are provided in a community setting (rather than a more restrictive residential or hospital setting) to people experiencing serious mental illness.
    o Primary Goal: To help people become independent and integrate into the community as they experience recovery. The goal of ACT is to reduce the reliance on hospitals by providing round-the-clock services to the people who need it most.
  • Treatment is centered around the patient’s personal strengths, needs, and desires for the future.
  • ACT follows a holistic approach to treatment, meaning that all areas of the patient’s life are targets for improvement.
168
Q

HIPPAA and confidentiality

A
  • HIPPAA does not allow the PMHNP to make most disclosures about psychotherapy for a patient’s condition without their authorization.
  • Two separate releases of information are required to release information on patient’s chemical and psychiatric to a third party.
    Exceptions to Confidentiality (PB page 17)
  • When appropriate persons or organizations determine that the need for information outweighs the principle of confidentiality.
  • If a client reveals an intent to harm self or others.
  • Answering court orders, subpoenas, or summonses.
  • Information given to attorneys involved in litigation.
  • Releasing records to insurance companies.
  • Meeting state requirements for mandatory reporting of diseases or conditions.
169
Q

Informed consent

A
  • Communication process between provider and client that results in client’s acceptance or rejection of proposed treatment.
  • An explanation of relevant information that enables the client to make an appropriate and informed decision.
  • The right of all competent adults or emancipated minors.
  • Emancipated minors: Persons younger than 18 years old who are married, parents, or self-sufficiently living away from the family domicile.
170
Q

Elements of Informed Consent

A
  • Decision capacity: Patients should have the capacity (or ability) to make the decision.
  • Full disclosure: The provider should disclose information on the treatment, test, or procedure in question, including the expected benefits and risks, and the likelihood (or probability) that the benefits and risks will occur.
  • Comprehension: The patient should be able to comprehend the relevant information.
  • Voluntariness: The patient should voluntarily grant consent, without coercion.
  • Documentation: Provider must document in medical record that informed consent has been obtained from client.
    Note: If patients are not able to do the above components, family members, court-appointed guardians, or others (as determined by state law) may act as “surrogate decision-makers” and make decisions for them.
171
Q

Justice

A

Doing what is fair, fairness in all aspects of care. Just leads us to ensure that the care is provided on a faire and equal basis, regardless of patients’ social status, financial status, sexual orientation, or ethnicity.

172
Q

Nonmaleficence

A

**Doing no harm.
* Example: Stopping a medication that is causing harmful side effects of discontinuing a treatment strategy that is not effective and may be harmful.
* Imminent danger. **

173
Q

Fidelity

A

**Being true and loyal.
Fidelity comes from the Latin “fides” meaning faithfulness: It 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. **

174
Q

Veracity

A

Telling the truth.
* Patients need to know the truth about their medical conditions and treatment options.

175
Q

Autonomy

A
  • ***Right to self-determination
  • Allows healthcare teams to respect and support a patient’s decision to accept or refuse life-sustaining treatments.
  • Rennie Vs Klein court case: An involuntary committed patient who has not been found incompetent, absent an emergency, has a qualified right to refuse psychotropic medication. ***
176
Q

Respect

A

Treating everyone with equal respect.

177
Q

***Key Differences between Veracity and Fidelity

A

Focus:
* Veracity focuses on truthfulness and providing accurate information to patients.
* Fidelity focuses on loyalty, trustworthiness, and keeping promises within the healthcare relationship.
Communication:
* Veracity is primarily concerned with communication and the ethical obligation to be honest and transparent.
* Fidelity extends beyond communication to encompass loyalty, trust, and matinating the integrity of the healthcare relationship.

178
Q

Research Question Population

A

This refers to the group of individuals or patients you are interested in studying. It defines the characteristics of the participants involved in the research.

179
Q

Research Question Intervention

A

This describes the specific intervention or exposure that is being studied. It could be a treatment, therapy, program, drug, or any other active intervention.

179
Q

Research Question Comparison

A

This component outlines the comparison group or alternative intervention against which the new intervention is being assessed. It helps establish a baseline for comparison.

180
Q

Research Question Outcome

A

This specifies the outcome or the result you are looking to measure or observe in the study. It clarifies what you aim to achieve or determine by conducting the research.

181
Q

Research Question Time

A

This component refers to the timeframe over which the study is conducted. It helps set the duration for which the intervention and comparison are assessed, and outcomes are measured.

182
Q

Research Level 1

A

o Evidence from a systematic review of meta-analysis of all relevant RCT’s (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results.

183
Q

Research Level 2

A

o Evidence obtained from at least one well-designed RCT (e.g., large multi-site RCT)
* PMHNP interventions follow evidence-based practice guidelines, are always client goal-directed and take into account the client’s ethnicity and culture.
* A key part of PMHNPs work is to use empirical evidence in educating their clients, client’s families, and the community about mental health, psychiatric illness, and effective management of illness.

184
Q

Rights of Patients

A
  • Confidentiality, informed consent, least restrictive environment, give consent for treatment and withdraw consent at any time.
185
Q

Health Policy

A
  • Decisions, actions, and plans by a group, community, or organization, to achieve specific healthcare goals: developed through laws and regulations.
  • An example is a Health and Human Services (HHS) policy that delineates what HHS is willing to expend to achieve the goal of one of its mandate projects.
186
Q

Four components of Health Policy

A
  • Process: Formulation, implementation, and evaluation (FIE)
  • Policy reform: Changes in programs and practices.
  • Policy environment: Arena the process takes place in (government, media, public)
  • Policy makers: Key players and stake holders
  • ***Assess/address organizational barriers and facilitators.
  • Meet/brainstorm with stake holders***
187
Q

Patient Advocacy

A
  • A nurse advocate ensures that patients’ autonomy and self-determination are respected
  • Reduce the stigma of mental illness (education)
  • Help clients receive available services.
  • Advocating is getting up, showing, and telling people the value of what you do as a PMHNP
  • Promote mental health by participating in one or more of these professional organizations.
    o American Nurses Association (ANA)
    o American Psychiatric Nurses Association (APNA)
    o International Society of Psychiatric Nurses (ISPN)
188
Q

Quality Improvement

A

Projects designed to improve systems, decrease cost, and improve productivity.
For example: **a retrospective chart review. **
Process of Quality Improvement (PDSA) (PB page 55)
Process of quality improvement can be PDSA cycle:
* Plan: Plan the change
* Do: Carry out the plan.
* Study: Examine the results
* Act: Decide what actions will improve the process.

189
Q

Reflective Practice

A
  • Linking theory to practice.
  • ***Debriefing strategies
190
Q

Culturally Competent: Mental Health Care

A
  • Cultural competency describes the ability to effectively interact with people belonging to different cultures.
  • It is the active process of taking each patient’s background into account when providing treatment, as well as respecting cultural beliefs, heritage, and traditions.
  • Culturally competent and effective staff are:
    o Patient and family centered
    o Respectful and non-judgmental.
    o Able to appropriately change their approach in response to different cultural situations.
  • Understand and consider culture, economic and education status, health literacy level, family patterns and situations, and traditions (including alternative and folk remedies), communicate in language and at a level that the client understands.
  • Cultural expected response to a stressor = meaning/context
191
Q

Existentialism

A
  • Existentialism is a philosophy that emphasizes individual existence, freedom, and choice.
  • It is the view that humans define their own meaning in life and try to make rational decisions despite existing in an irrational universe (a philosophy based on the belief that the universe is irrational and meaningless and that the search for order brings the individual into conflict with the universe).
  • It focuses on the question of human existence, and the feeling that there is no purpose or explanation at the core of existence.
  • ***It emphasizes accepting freedom, taking action, and believes that the individuals must take personal responsibility for themselves.

PMHNP Exam (1 decks)

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