1 / 18100%
Oppositional defiant disorder (ODD): Loses temper, touchy. Therapy is main stay
Conduct disorder: Aggressive, inflecting pain on orders, animal cruelty. Not
remorseful, mod & therapy Intense pharmacological management---goal is to target
mood and aggression. Use SSRI, Alpha agonist (guanfacine or clonidine). Use
behavioral Therapy, family and individual therapy.
Factitious Disorder: Use of external agents that mimic disease symptoms for NO
REASON
Malingering: faking disease and symptoms for GAIN
Conversion Disorder: Mental disorder in which a person has blindness, mutism,
paralysis, paresthesia, or other nervous system (neurologic) symptoms that cannot be
explained by medical evaluation. May have gone through trauma, lost a love one.
Grief & Loss pg. 169: Unlike in MDD in grief and loss, self-esteem is usually preserved.
Offer pt. Psychotherapy Adjustment Disorder pg. 170: symptoms of depression but less
than six months.
Usually patient moving from one place to another PTSD PG 222: Clusters of symptoms,
patient re-experience trauma, Increased arousal, hyper arousal,& Avoidance of stimuli.
Schizophrenia Pg.235
Males 18-25
Females 25-35
-Inadequate synapse formation, excessive pruning of synapses, Intrauterine insults
Positive symptoms: Hostility, grandiosity mania, suspiciousness
Negative symptoms: Affective flattening, alogia or poverty of speech, avolition, apathy,
abstract thinking
Everything small in schizophrenic patient except the ventricles. They have enlarged
ventricles.
Decreased GABA, &Serotonin, increased dopamine, and Glutamate.
Question:
Which of the following structural changes is common in individuals with schizophrenia?
A. Decreased Glutamate and Decreased GABA
B. Increased Electrical activity in the frontal lobes
C. Increased s7e of the cerebral ventricles
SSRI first line for depression and safer in overdose. It takes 4-6 weeks to be effective.
Educate patient to continue medication for 6 to 12 months. (Recommended).
Zoloft has the shortest hall-life (Do not abruptly stop) sexual dysfunction Prozac is long
half life
TCA is second line monitor EKG, cardiac, not for patient who high risk for suicide due
to lethality. It 'Is very lethal.
All antidepressants carry a Black box warming (High risk for patient feeling suicidal)
Non-pharmacological measure
ECT-Pg.159-Treatment resistant depression, MDD with psychiatric features. ECT is
contraindicated for cardiovascular disease, brain tumor, and pulmonary condition.
Anesthesia medical complication. Memory problem and HA are common after
procedure
CBT
Wellbutrin in having sexual issues, fatigue, low energy, remember not on seizure
pleating disorder.
Adjustment Disorder pg. 170: symptoms of depression but less than 5ix months,
usually patient moving from one place to another
PTSD PG 222: Clusters of symptoms: patient re-experience trauma, increased
arousal/hyperactive arousal, & Avoidance of stimuli
Med: SSRI, TCAs, Prazosin for nightmare
Benzo's are not recommended for PTSD
CBT,EMDR. Exposure therapy with response prevention, supportive group therapy.
Relaxation therapy.
Acute Stress Disorder: Loss than 1 month
PTSD; More than a month
OCO----Pg.218: First-degree relative, PANDAS (Streptococcal infection in a pediatric
can cause OCD)
For OCO.Pt can take SSRI. TCAs, (Clompraminn), Second-generation anti-psychotics
such as Fespendone). CBT, exposure therapy.
Bipolar Disorder
Decrease need for sleep, not tired after days without sleeping
GABA, Dopamine, serotonin, norepinephrine
Oppositional defiant disorder (ODD). Loses temper, touchy, Therapy is main stay
Conduct disorder: Aggressive, inflecting pain on orders, animal cruelty, not
remorseful, med & therapy intense pharmacological management goal is to large mood
and aggression. Use SSRL Alpha agonist (guanfbono clonlidino).
Use behavioral Therapy, family and individual therapy.
Factitious Disorder: Use of external agents that mimic disease symptoms for NO
REASON
Malingering: faking disease and symptoms for GAIN
Conversion Disorder: Mental disorder in which a person has blindness, mutism,
paralyses, paresthesia, or other nervous system (neurologic) symptoms that cannot be
explained by medical evaltootion. May have gone through trauma, lost a love one
Grief & Loss pg. 169: Unlike in MDD in grown and loss, self-esteem a usually.
Tourette syndrome: type of tics that are involuntary repetitive movement and
Vocalizations. At least 2 motor lics & at least must present for more than one year.
Should appear before the age18. caused using a substance or other medical condition.
Stimulant can cause TICS, SO IF have Tics and ADHD, and you cannot place them on
Stimulant
Tourette: dopamine, serotonin, norepinephrine
Med management: Atypical antipsychotics, SSRI (Prozac) Non-pharmacological
behavioral therapy. CBT, Deep brain stimulation. For PTSD (non-combative, do not give
Anticonvulsants)
Binge drinking
Females cannot drink more than 4 beers at once, Males cannot drink more than 5 beers
at once
Variance: Anything that can affect the Pi's progress toward their expected outcome
Schizophrenia Pg.235
Males 18-25
Females 25-35
-Inadequate synapse formation, excessive pruning of synapses, Intrauterine Insults
Positive symptoms: Hostility. Grandiosity, mania, suspiciousness
Negative symptoms: Affective flattening, logia or poverty speech, evolution, apathy.
Abstract thinking
Everything is small in schizophrenic patient except the ventricles, they have enlarged
ventricles
Decreased GABA, & Sarolons, ipruasod dopanune, urkd Glutamate.
Depression
Concentration problem, memory problem, appetite chances, psychomotor changes,
suicidal thoughts, energy, Fatigue, guilt, sell-blame.
Depression can cause memory problem, Dopamine. Serotonin and norepinephrine.
SSRI first line tor depression and suffer in overdose it takes 4-6 weeks to be effective.
Educate patient to continue medication for 6 t0 12 months. (Recommended)
Zoloft has the shortest half-Ete (Do not abruptly stop) sexual dysfunction
Prozac is long hall life
Oppositional defiant disorder (ODD): Loses temper, touchy. Therapy is main stay
Conduct disorder: Aggressive, inflicting pain, animal cruelty, not remorseful, med &
therapy_______________________
Intense pharmacological management---goal is to target mood and aggression. Use
SSRI, Alpha agonist (guanfacine, clonidine)
Use behavioral Therapy, family and Individual therapy.
Factitious Disorder: Use of external agents that mimic disease symptoms for NO
REASON
Malingering: faking disease and symptoms for GAIN
Conversion Disorder: Mental disorder in which a person has blindness, mutism.
Paralyses, paresthesia, or other nervous system (neurologic) symptoms that cannot be
explained by medical evaluation. Have gone through trauma, lost a love one.
Grief & Loss pg. 169: Unlike in MOD in grief and loss, esteem is usually preserved,
Offer pL psychotherapy
Adjustment Disorder pg.170: symptoms of depression but less than six months
usually patient moving from one place to another
Question:
Which of the following structural changes is common in individuals with schizophrenia?
A. Decreased Glutamate and Decreased GABA
B. Increased Electrical activity in the frontal lobes
C. Increased size of the cerebral ventricles
D. Increased total brain volume
C is the correct answer everything else is small except the Ventricles
Clozapine: For chronic schizophrenic not responded to other medication, this not first
line due to potential risk of decreased ANC levels. Given if suicidal thoughts. Monitor
risk neutropenia Absolute Neutropbd Count ONLY not in conjunction with the WBC
count.
During first six months: weekly, second months (every 2 weeks, then monthly ANC
remains normal
A patient with a diagnosis of schizophrenia has a history of suicidal ideation and suicide
attempts. The PMHNP should consider which antipsychotic medication that is the only
antipsychotic to reduce the risk of suicide in schizophrenia?
A Latuda (urasidone)
B. Ablify (anpriprazole)
C. Corari(Clozapine)
D. Anvega (loperidone)
Prozac is long half-life
TCA is second line monitor EKG, cardiac, not for patient who high risk for suicide due to
lethality. It is very lethal. Al antidepressants carry a Black box warning (High risk for
patient feeling suicidal)
Non-pharmacological measure
ECT-Pg.159--Treatment resistant depression, MDD with psychotic features. ECT is
contraindicalod for cardiovascular disease, brain tumor, pulmonary condition,
anesthesia medical complication. Meruoty problem and HA are common after procedure
CBT
Wellbutrin if having sexual issues, fatigue, low energy, remember not on seizure treating
disorder
Question
Which characteristic of fisoxetine (Prozac) provide the greatest degree of safety for
patents who have severe depression
A. Greater efficacy of TCA
B. Less potential for drug interaction
C. Less potential for injury with potential overdose
D. Less potential for suicidal (thinking)
Tourette syndrome: A type of ticn that are involuntary movement and vocalizations. Al
least 2 motor lics & at least 1 vocal must be present for more than one year. Should
appear before the age of 18.Tics are not caused using a substance or other medical
condition.
Stimulant can cause TICS, SO IF Pt have Tics and ADHD you con not place them on
Tourette: dopamino, serotonin, and norepinephrine
Med management: Atypical antipsychotics, SSRI (Prozac)
Non-pharmacological behavioral therapy, CBT, brain stimulation. For PTSO (non-
combative, do not give Anticonvulsants).
Depression
Concentration problem, memory problem, appetite changes, psychomotor changes,
suicidal thoughts, energy, fatigue, guilt, seolf-blame, interest reduced, sleep
disturbance.
Depression can cause memory problem. Dopaoune, serotonin and norepinephrine
SSRI first line for depression and safer in overdose It takes 4-6 weeks to be effective,
Educate patient to continue medication for 6 to 12 months, (recommended)
Zoloft has the shortest half-le (Do not abruptly stop) sexual dysfunction.
Medication
Bromocriptine (Peroled) D2 agonist blocker-Normal medication for NMS Dentrolona for
muscle relaxant
Serotonin syndrome pg.157-158
Hyperreloxia,myodionsc jerks, agitation, restlessness, rapid HR, elevated BP.HA.
Treatment: Cyproheptadine
Causes of SS
Patonl on SSRIs & Mongamine oxkdase inhibstors (MAOls); Placing patient on more
than one SSRI, drug & herbal interactions, St John's worth Switching from one SSRI to
MAOI wait for 14 days except when switching from Prozac (wait 5-6 weeks) due to
Prozac has longer shelf life, Also ,non-compliant patient, we use Prozac due to longer
half-life. It will stay in the body the longest
Serotonin discontinuation Syndrome pg. 165
Question:
The risk of bleeding on SSRI, NSAIDs, or aspirin is an example of which of the
following?
a. Pharmacodynamics
b. Pharmacokinetics
c. Absorption
d. Distribution
Not diagnosed in children, kids with conduct disorder move on to become antisocial
personality disorder in adult.
Antisocial PO: reckless behavior, disregard for the welfare of others, lack of remorse,
indifference to the feelings of others.
RETT Syndrome pg.344
Primary in girls, develop normally until about 5-7 month of ago, then suddenly they loss
purposeful hand skills, stereotypical hand movement, seizures, regular respirations
deceleration of head growth.
DMDD (disruptive mood dysregulation disorder) pg. 355 high yield
Childhood disorder diagnosed in children older than ago 6 but younger than age 18
Chronic dysregulated mood (moody) severe irritability, anger, temper outburst. Moody
for no reason. Sad, depressed, moody (bipolar symptom in children)
Intermittent explosive disorder- not on pb
Repeated Impulsive, aggressive, violent behavior, angry, reacting grossly out of
proportion. Situation causes this child to react to something.
ADHD: Frontal cortex (Dorsolateral prefrontal cortex) and basal ganglia: Dopamine,
Norepinephrine, serotonin,
Dorsolateral prefrontal cortex: Executive function, cognitive planning, working,
memory, problem solving, maintaining attention
Stimulant (Adderall--3 years and older) (methylphenidate 6 years and older)
With stimulant assess cardiovascular disease, do electrocardiogram
Non stimulant (Guanlacine, conidine FDA approved 6-17 with ADHD----Alpha agonist
Or alpha 2 adronergic receptors blockers Il medication is not FDA approved, the risk
and benefit should be documented.
Signs of stimulant abuse. Agitation, anxiety, irritability, mood swings, elevated, Mood,
insomnia
Non-pharmacological management of ADHD
Behavioral therapy, Patient and parent behavioral training program, psychoeducation,
treatment of learning disorders, family therapy and education
Conner's parent and teacher rating scales, Vanderblt ADHD diagnostic parent rating
and teacher scales
Parent and teacher makes diagnoses of ADHO
Borderline personality Disorder pg.320
Impulsivity, often with sell-damaging, behavior, recurrent suicidal behavior. BPD-
Dialectal Behavioral Therapy.
Psychosis and agitation in dementia
Try non-pharm therapy first, next use lowest effective dose and wean periodically
Benzos should be avoided if possible; it can cause o paradoxical effect.
Level of prevention--pg.103
Primary-preventing now cases key word, stress management, smoking prevention,
holding prenatal classes.
Secondary: screening, decreasing number of existing cases, crises intervention,
telephone hotline, Disaster response.
Tertiary, social skills training. Disability and severity of cases, rehabilitative services
Diagnosis & treatment
Tolerance: Decreased effects of the same dose of medication overtime
Addiction: compulsive substance use despite harmful consequence
Potency. The amount of drug required lo produce an effect of given intensity, ADHD pg.
335
Dementia
Gradual development multiple of cognitive deficits, impaired executive function (frontal
lobe) impaired global function, and organizational skills.
Cortical dementia (Alzheimer's) Memory and language (amnesia and aphasia)
Subcortical dementia: HIV related (dementia) involves depression, apathy,
abnormalities, concentration, attention, lack of coordination, (ataxia); behavior
Abnormalities
Most common is dementia of Alzheimer s type
Lewis body: recurrent visual hallucinations
Vascular dementia: cardiovascular disease
Picks disease AKA frontotemporal dementia
Personality & behavioral changes in early stage, while cognitive changes, mutism
S0ZU106.nalucinations, delusions, apathy, mania are late stage
Delirium
Acute onset, sudden abrupt, altered level of consciousness, inattention, changes in
cognition poor concentration, poor prognosis. 1 year mortality 40%, Caused by
Substance or infector (could occur in hours or days)
Symptoms: agitation and psychotic symptom give antipsychotic (use low, dose Haldol,
non-pharmacological management
Satiety pay attention to basic needs, familiar pictures, calendar,
Yawning, Insomnia, Irritability, muscle aches, lacrimation, sweating, nausea, vomiting,
diarrhea, rhinorrhea, sweating, restlessness, runny nose.
Glutamate: Universal excitatory neurotransmitter, imbalance implicated in seizure
disorders, bipolar disorder and schizophrenia aminobutyric acid (GABA): Universal
Inhibitory neurotransmitter, site of action of benzodiazepines, alcohol, barbiturates, and
other CNS depressants such as addiction.
Acetylcholine: Synthesized by the basal nucleus of Meynert
Dopamine: Produced in the substantia nigra and the ventral togmental area.
Four dopaminergic pathways
Mesolimbic: Causes positive symptoms, hallucination, delusion
Mesocortical: Causes negative symptoms, flat low energy, lack of interest
Nigrostriatal: Causes (EPS) extra pyramidal side effects such as rigidity, movement.
Reciprocal relationship with acetylcholine (Ach) in an attempt to decrease dopamine, we
increase ACH & the increase in ACH levels leading to EPS.
Tuber infundibular; increased prolactin levels causes, Breast discharge,
agalactorrhea, gynecomastia, sexual problems, bone demineralization Rep
Extrapyramidal Side Effects (EPS)
Akathisia: Motor restlessness; inability to remain; rocking, pacing, or constant motion:
Often mistaken for increasing anxiety (Barnes Akathisia Rating Scale)(8ARS) &
Simpson-Angus Rating Scale (SRS) medication: Beta blocker (No albuterol (asthma
patient can cause bronchospasm, give Cogentin,& Benzodiazepine
Akinesia: Absence of movement, difficulty initiating motion, subjective feeling of lack of
motivation to move. Often mistaken for laziness or lack of interest (Cogentin)
Question:
A patient with a known diagnosis of Bipolar 1 disorder presents to your clinic
complaining of manic Symptoms and insomnia, the patient has been stabilized for the
past 6 months on her medication. To determine if the medication change or increase is
warranted it is important to gather more information. You suspect a possible medication
induced manic episode when the patient endorses what?
a. She was recently placed on a beta-blocker for anxiety
b. She was recently prescribed a benzodiazepine by her primary care
c. She recently had an acute lark up her rheumatoid attains aim received medication tor
one week tor atablzaton
C is the correct answer steroid can cause a manic episode
What will the PMHNP expect to see in the physical exam for a patient with Anorexia?
Nervosa?
A. Rectal prolapse
B. Hypertrophy of the salivary glands
C. Russell sign
D. Low body mass index
D is the correct answer
Norepinephrine dopamine reuptake inhibitor (NDRI)- PP Pg.160
First line treatment for MDD is SSRI, but sometimes you have to switch to (NDRI)
Wellbutrin used for patients with low energy and patients with sexual problems. Switch
from SSRI Io NDRI
Remember itis contraindicated if patient has seizures, eating disorder, bulimic patients.
Wellbutrin can decrease seizure.
Neurotransmitters
Norepinephrine: Produced in the locus coerulous; major neurotransmitter implicated in
Serotonin: Produced in the rephe nuclei of the brainstem. Major neurotransmitter
Glutamate; Universal excitatory neurotransmitter, imbalance implicated in seizure
disorders, bipolar disorder, and schizophrenia
Y-aminobutyric acid (GABA): Universal inhibitory neurotransmitter, site of action of
benzod azepines,alcohol,barbiturates, and other CNS depressants such as addiction
Acetyicholine: Synthesized by the basal undoes of Meynen
Dopamine: Produced in the substantia nigra and the ventral tegmental area.
Four dopaminergic pathways
Mesolimbic: Causes positive symptoms, hallucination, delusion
Mesocortical: Causes negative Symptoms, flat low energy, lack of interest
Nigrostriatal: Causes (EPS) extra pyramidal side effects such as agility movement.
Reciprocal selabonship with acetylcholine (Ach) in an attempt to decrease dopamine.
vO
Moase ACH &Ine increase in ACH levels leading to EPS.
ubetontundibular Increased prolactin levels causes Breast discharge.
Questions
What part of the brain is responsible for regulating mood, range, fear, emotion, and
aggression?
A. Hippocampus
B. Temporal lobe
C. Occipital lobe
D. Amygdala
Correct answer is D Amygdala
Question:
Which serotonin receptor antagonism makes an antipsychotic Atypical?
a. 5HT2A
b. 5HT4A
C. 5HT1A
d. 5HT3A
Question:
A 59-year-old African American female presents to the hospital for evaluation, the
PMHNP completes the mini mental status examination and clock drawing the patient is
unable to correctly draw the face of the clock, which area of the brain is likely to have
compromised function
A Cerebellum
b. Cerebrum
c Wemicke's area
d. Corpus callosum
Correct answer is B Cerebrum (Right hemisphere)
Cerebrum is divided into left & right hemisphere. Right responsible for recognition of
facial expression, music and visual images Clock drawing test: screen for signs of