ANCC PMHNP review questions graded A ANCC PMHNP review questions graded A, Exams of Nursing

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Denial is a defense mechanism that keeps some aspect of reality from one's conscious awareness. Isolation of affect is detaching feelings from a particular experience. Intellectualization is abstract thinking. Pre - group : leader considers direction & framework.

1. Forming : Orientation. Goals & expectations are identified & boundaries established. 2. Storming : Transition. Members test & act out to define themselves & the group norms. Members should feel free to disagree with each other. 3. Norming : Cohesiveness. Members develop standards (cohesiveness). Therapeutic alliance forms 4. Working ; Performing. Individual growth & team productivity, & effectiveness occur. Members experiment with new ideas or behaviors & egalitarianism develops. 5. Adjourning ; Termination. The closure of the group. Primary task; discuss & review outcomes & achievements, explore feelings of what worked (and what didn't), and any feelings of loss. Introducing new concerns or initiatives is not appropriate. The PMHNP has the authority, accountability, and responsibility to change nursing practice, make decisions in care, and take action consistent with the obligation to promote health and provide optimal care. Correct answer: It allows patients to attend exclusively to their own needs The benefits of group therapy include the following: It increases insight into oneself It increases social skills It is cost-effective It promotes a sense of community Individual counseling provides a set time for patients to attend exclusively to their own needs. A PMH-NP can utilize several Socratic-type questions to elicit information and find solutions in solution-focused therapy. Exception-finding questions seek solutions by deep-diving into the past when the problem did not exist and discovering what the family did and did not do.

The Miracle question asks how the family's life would be different if the problem miraculously disappeared overnight. Scaling questions help people realize incremental changes over time. Interrogation questions are not used in solution-focused therapy. Social preventative factors can include a low-stress occupation, higher socioeconomic status, or higher level of education. Biological factors may include no family history of mental illness or good general health. Psychological factors can include healthy self-esteem or an internal locus of control. There is no category for preventative environmental factors, as these would most likely fall within the other categories. There are three phases of therapy: orientation, working, and termination. The orientation phase aims to establish trust and identify goals with the client. The PMH-BC establishes boundaries, sets expectations for treatment, and outlines a timeline for completing goals. Computer literacy is the level of expertise and familiarity someone has with computers. It generally refers to the ability to use an application rather than to write code. Individuals who are very computer literate are called power users. Computer competency is the ability to demonstrate proficiency in software applications, such as Microsoft Word, Excel, and PowerPoint, and knowledge of computer terminology, hardware selection, and simple maintenance functions. Information literacy involves recognizing when information is needed and locating and using it efficiently. Information competency is often used as a synonym for information literacy. Hypernatremia : seizures thirst Dry mucous membranes Tachycardia Restlessness Hyponatremia : (water follows salt) When sodium in fluids outside cells drops below normal, water moves into the cells to balance the levels. This causes the cells to swell with too much water. Brain cells are susceptible to swelling, and this causes many of the symptoms of low sodium. ADH can cause the body to retain h20 instead of excreting it in the urine.

seizures confusion apprehension lethargy -Most disease processes are multifactorial, meaning environmental and genetic factors cause them. Single-gene disorders are rare. -Veterans should be assessed for problems with memory, sleep, light sensitivity, balance, and other symptoms that may signal a brain injury. A lack of appetite, resistance to examination, and increased alcohol use may indicate depression or another coping issue but not brain trauma without other symptoms. -Systems thinking is the understanding of structures that undergird complex systems and using this understanding to effect significant and enduring change. Systems thinking is essential for nurse practitioners who wish to enact effective quality improvement initiatives. Instead of isolating small parts of a system (providers, patients, illnesses), systems thinking looks at the whole, considering more significant numbers and patterns of interaction to understand. -The morbidity rate describes a given disease present. The mortality rate describes the death rate Elderly patients who are prescribed psychotropic medication have a higher risk of falls. Most of the fall risk is associated with the side effects of sedation, dizziness, and postural hypotension. The Health Insurance Portability and Accountability Act (HIPAA) guarantees patients four fundamental rights: To be educated about HIPAA privacy protection To have access to their medical records To request an amendment of their health information to which they object To require their permission for disclosure of their personal information In this question's scenario, the provider would allow the patient to request an amendment because it is her right under the Health Insurance Portability and Accountability Act (HIPAA). In 1965, Dr. Loretta Ford (a public health nurse) and Dr. Henry Silver (a pediatrician) established the first nurse practitioner program at the University of Colorado.

Which class of medication prevents the excessive release of glutamate? Correct Answer: Serotonin antagonist/reuptake inhibitors Serotonin antagonist/reuptake inhibitors block 5HT2A receptors. This action inhibits glutamate release in the prefrontal cortex of the brain. SARIs work by inhibiting serotonin: They are antagonists to inhibit the 5HT2a receptor, increasing the amount of active serotonin throughout the central nervous system (CNS). Lamotrigine is a glutamate release inhibitor FDA-approved for partial and tonic-clonic seizures and BPD. Lamotrigine acts by blockade of voltage-sensitive sodium channels, which modulate the release of glutamate and aspartate and slightly affect calcium channels. Around 25% of those diagnosed with a mood disorder experience manic or hypomanic episodes. Almost all patients who experience a manic or hypomanic episode also experience periods of depression. The severity and duration of the highs and lows differentiate the types of bipolar disorder: Bipolar I disorder: These patients experience at least one manic episode and may or may not share a major depressive episode. Bipolar II disorder: These patients experience at least one hypomanic episode and one major depressive episode. Cyclothymic disorder: These patients experience mood swings but are not severe enough to be called major depressive or manic episodes. Schizoaffective disorder is a psychotic disorder characterized by patients experiencing symptoms of schizophrenia and depression or mania. -Successful resolution of the psychosocial stage Intimacy vs. Isolation results in developing loving sexual relationships: At three years of age, landmarks of normal behavioral development include the following: Rides tricycle Jumps from the bottom of steps Alternates feet going upstairs Builds tower of 9 or 10 cubes Copies a circle and a drawn cross Puts on shoes

Unbuttons buttons Feeds self well Understands taking turns with others The vestibular system includes the inner ear and brain parts that help control balance and eye movement. This system, when dysregulated, can mimic symptoms of panic and anxiety. Outcomes management uses aggregate variance data to change a system of health care practice. Variance is any event that alters patient progress toward expected outcomes. Sources of variance include practitioner behavior (competency), the severity of illness, and practice patterns that either expedite care or inhibit care delivery. -Psychiatric evaluations are considered risk assessments, not forensic risk assessments. Regardless of their legal history, any patient could be a candidate for a psychiatric and risk assessment in the emergency room setting. -Forensic risk assessments are specifically for those with a violent, dangerous, and criminal record. They often occur in a judicial arena such as jail, prison, or court. -Delirium presents with a constellation of acute-onset symptoms, including rapid cognitive decline with disturbances of attention and consciousness. -There are different kinds of dementia, and Alzheimer's disease is the most common. -Vascular dementia is the second most common type in persons over 65 years of age, involving a progressive cognitive decline in a step-like fashion -Patient confidentiality is protected by the Health Insurance Portability and Accountability Act (HIPAA). However, patient confidentiality can be broken in the following circumstances: The patient demonstrates the increased potential for self-harm or harm to others There is suspected abuse of children, older adults, or people with disabilities The nurse practitioner determines that the patient needs to be hospitalized The patient requests that their information be shared with a third party It is inappropriate for the nurse practitioner to vent or complain about a patient to anyone. -In 1965, Dr. Loretta Ford (a public health nurse) and Dr. Henry Silver (a pediatrician) established the first nurse practitioner program at the University of Colorado. -Medicare Part B provides coverage for ambulatory practitioner services and physical, occupational, and speech therapy. It also covers medical equipment, diagnostic tests, and some preventative care. Covered preventive services include the following:

-Pap smears -Mammography -Screening for colorectal cancer -Screening for prostate cancer -Screening for cardiovascular disease -Screening for diabetes -Glaucoma screening -Influenza vaccinations -Pneumonia vaccinations -The Connor's Rating Scale or CRS-R is a 2-question assessment tool completed by parents and teachers to assess symptoms of ADHD. -The Young Mania Rating Scale or YMRS is a self-reporting or clinician observation tool to assess young patients' severity of manic symptoms. -The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) is a self- reporting/clinician observation tool to assess the severity of OCD symptoms in those ages 6-14. The Yale-Brown Obsessive-Compulsive Scale is a self-reporting tool for patients over 14 years. Suppose the patient develops psychiatric symptoms that have slowly worsened over time. The cause is more likely to be a mental disorder than a medical condition. If their symptoms develop acutely over minutes or hours, the reason is likely to be medical. The most important question for an emergency psychiatric nurse practitioner is whether the presenting problem is medical, psychiatric, or both. Medical causes of a mental disorder include the following: -Acute onset (within hours or minutes) -First episode -Geriatric age -Current medical illness -Significant substance abuse -Nonauditory disturbances of perception -Neurological symptoms such as loss of consciousness, seizures, or head injury -Mental status changes such as disorientation or diminished alertness -Constructional apraxia (difficulties drawing a clock)

-Serotonin and norepinephrine are removed from the synaptic cleft and returned to storage via an active reuptake process. -Dopamine is removed from the synaptic cleft by monoamine oxidase. -Clarifying involves summarizing what the patient said and seeking clarification for accuracy. It is an expanded psychiatric interview technique. -Silence and reflection are facilitating techniques. "Why" questions are considered an obstructive intervention. -Antidepressants are known to potentiate both manic and depressive episodes in patients with bipolar disorder without a mood stabilizer or antipsychotic. Ziprasidone, olanzapine, quetiapine, and risperidone are all atypical antipsychotics. Ziprasidone is the least likely to cause weight gain and has been shown to lower triglyceride levels. Ziprasidone is the antipsychotic of choice for patients at an increased risk of developing metabolic syndrome. Irvin Yalom was the first to put a theoretical perspective on group work. He identified ten curative factors that differentiate group work from individual therapy: -Instillation of hope -Universality -Altruism -Increased socialization skills -Imitative behaviors -Interpersonal learning -Group cohesiveness -Catharsis -Existential factors -Corrective refocusing -Sigmund Freud founded psychoanalysis. Carl Rogers originally developed humanistic therapy. Viktor Frankl developed existential therapy. -existential therapy encourages reflection on life and self-confrontation. This therapy emphasizes accepting freedom and making responsible choices. Existential therapy purports that the fundamental dimension of humans includes finding meaning and purpose in life. The goals of this therapy are to live authentically and focus on personal responsibility.

The primary goal of interpersonal therapy is to solve interpersonal or relationship distress. A goal of dialectical behavioral therapy is to increase accurate communication of emotions. The main goal of psychoanalytic therapy is to understand how past development impacts one's behavior. Hepatic cytochrome P450 enzyme interactions can induce or inhibit the metabolism of certain drugs, thus changing their desired concentration levels. Enzyme inducers decrease the serum level of other drugs that are substrates of that enzyme, possibly resulting in subtherapeutic drug levels. Inducers include carbamazepine, hypericum (St. John's wort), phenytoin, phenobarbital, and tobacco. Enzyme inhibitors can increase the serum level of other drugs that are substrates of that enzyme, possibly resulting in toxic levels. Inhibitors include bupropion, clomipramine, duloxetine, fluoroquinolones, nefazodone, and SSRI. Mental status findings for PTSD are often similar to the presentation of anxiety. Still, there may be brief psychotic features during flashbacks of the trauma. Fluoxetine (Prozac) is the only selective serotonin reuptake inhibitor and the only drug FDA- approved for treating depression in adolescents. Vilazodone (Viibryd) is not an SSRI but rather a SPARI (serotonin partial agonist reuptake inhibitor) and a serotonin multimodal (S-MM). It is not FDA-approved for adolescents. Vortioxetine (Trintellix) is not an SSRI but a serotonin multimodal (S-MM) and is not FDA- approved for adolescents. Buproprion (Wellbutrin) is not an SSRI but an NDRI (norepinephrine dopamine reuptake inhibitor). It is not FDA-approved for adolescents. Splenomegaly (enlarged spleen) is a gastrointestinal finding suggestive of alcohol dependency, not an endocrine finding. Other gastrointestinal results include hepatomegaly (enlarged liver) and intestinal tenderness. Testicular atrophy, gynecomastia (enlargement or swelling of breast tissue in males), and sexual dysfunction are all endocrine findings suggestive of alcohol dependency. Environmental toxins impact physical and mental health. Mercury poisoning should be suspected and ruled out based on the patient's history of working in a landfill.

Mercury poisoning presents neuropsychiatric symptoms (including psychosis) and medical symptoms (ataxia, peripheral neuropathy, and dysarthria). Lead poisoning can lead to severe lead encephalopathy with dizziness, ataxia, headaches, and possible delirium but does not have the associated dysarthria or neuropathies the patient reports. Manganese can manifest as "manganese madness" with excited laughter, nightmares, and emotional lability symptoms. Early signs of lead poisoning are skin pigmentation and G.I. disturbances. Preventative factors are factors that protect a person from developing a psychiatric condition. They fall into three categories: biological, psychological, and social. -Biological preventative factors: No h/o family mental illness Healthy nutritional status Good general health -Psychological preventative factors: Good self-esteem & concept Internal locus of control Healthy ego defenses -Social preventative factors: Low-stress occupation Higher socioeconomic & education The antidepressant class of medications called selective serotonin reuptake inhibitors (SSRIs) provide a therapeutic effect by inhibiting serotonin reuptake pumps, thus increasing serotonin availability in the synaptic cleft. Examples of SSRIs: Paroxetine Sertraline Fluoxetine Escitalopram Fluvoxamine Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI)

Phenelzine is a monoamine oxidase inhibitor (MAOI) Diazepam is a benzodiazepine. The mini-mental status exam (MMSE) is a brief instrument to assess the patient's overall cognitive functioning. Asking the patient to spell the word "world" backward assesses their attention. Asking the patient to say this "no ifs, ands, or buts" assesses their ability to repeat what they hear. Asking the patient to remember the three objects, apple, table, and penny assesses their short- term memory. Asking the patient to tell the year, season, month, date, and day assesses their orientation. -Kluver-Bucy syndrome is a rare behavioral disorder caused by head trauma or encephalitis damage to both sides of the anterior temporal lobe. It is characterized by hypersexuality, putting things in the mouth, distractibility, visual agnosia (cannot recognize), and possibly seizures. -Antimanic agents such as lithium have a slower onset of action. Suppose the mania is acute and the patient is in distress. In that case, it is standard practice to add a DRA or SDA to reduce the psychotic symptoms of acute mania. -Patients with narcissistic personality disorder act self-important. They are preoccupied with envy, fantasies of success, and ruminations about the uniqueness of their problems. --They reject criticism and need constant admiration from others. -Patients with dependent personality disorder fear abandonment, feel helpless when alone, and are miserable when relationships end. They desperately desire the approval of others, and they often volunteer for unpleasant tasks to gain the favor of others. -Patients with obsessive-compulsive personality disorder are perfectionistic and rigid: often workaholics who are indecisive, excessively scrupulous, and preoccupied with detail. -Patients with paranoid personality disorder are suspicious, have few friends, and read hidden meanings into innocent remarks. Drug Facts Fluoxetine (active metabolite: norfluoxetine): prototype SSRI, longest-acting drug Fluvoxamine: shortest acting SSRI Escitalopram: most specific SSRI and "cleanest." Paroxetine: most teratogenic SSRI

The most potent blocker of 5-HT reuptake: Paroxetine The least potent blocker of 5-HT reuptake: Bupropion The most potent blocker of N.A. reuptake: Desipramine The least potent blocker of N.A. reuptake: Mirtazapine Most selective inhibitor of 5-HT reuptake: Escitalopram Most selective inhibitor of DA reuptake: Bupropion Most selective inhibitor of N.A. reuptake: Oxaprotiline Maximum antimuscarinic activity: Amitriptyline Maximum antihistaminic activity: Nefazodone Maximum a1 blocking activity: Doxepin Minimum antimuscarinic, a1 blocking, and antihistaminic activity: Venlafaxine Doxepin contains high antimuscarinic, antihistaminic, and a-blocking (maximum) activities. Fluoxetine is the longest-acting, and nefazodone is the shortest-acting antidepressant. Sertraline, citalopram, and escitalopram have the least interactions with other drugs and are sleep-wake neutral. Fluoxetine and Paroxetine are the most activating drugs and should be taken in the morning. Fluvoxamine is always sedating and should be taken in the evening. The onset of effect neurovegetative symptoms- 1-3 weeks emotional/cognitive: symptoms- 2-6 weeks How long to treat: 6-12 months: if 1st or 2nd episode Two years: if third episode, elderly, psychotic features, refractory depression, > 2 episodes in 5 years Taper TCAs slowly (over weeks-months) because they can cause withdrawal reactions Tapering of any kind of antidepressant may be required based on the: half-life of the medication and the patient's sensitivity It is essential to be particularly vigilant over the first two weeks of therapy as neurovegetative symptoms may start to resolve while emotional and cognitive symptoms may not (patients may be particularly at risk for suicidal behavior during this time)

SSRI + TCA = Increased TCA concentration (due to CYP2D6 inhibition; most prominent with fluoxetine) TCAs are the only antidepressants in which effectiveness depends upon serum level. Nortriptyline is the only TCA with a "therapeutic window," i.e., at a higher than therapeutic level

• it not only increases the risk of toxicity and is ineffective. Personality disorder characteristics Cluster A: Weird, Odd, unusual, eccentric, and asocial Cluster B Wild, Dramatic with affective instability Cluster C Worried, Anxious Irvin Yalom was the first to put a theoretical perspective on group work. He identified ten curative factors that differentiate group therapy from individual therapy: Instillation of hope Universality Altruism socialization skills Imitative behaviors Interpersonal learning Group cohesiveness Catharsis Existential factors

10. Corrective refocusing Irvin Yalom also believed that all groups go through specific phases: Pre-group Forming Storming Norming Performing Adjourning Munchausen syndrome, a factitious disorder, is characterized by repeated and deliberate falsification of physical or psychological symptoms. It is not a culture-bound syndrome.

Amok is a term in Malaysia that refers to a dissociative episode characterized by depression followed by violent, aggressive, or homicidal behavior. Possession syndrome describes South Asian presentations of an involuntary trance characterized by possessing a secondary personality. Shenjing shuairuo is a term used most often in China to classify a collection of neurological symptoms believed to result from a rapidly modernizing society. -Dementia is a progressive decline of cognition. Although dementia patients can exhibit hallucinations, this is typically a disease of aging. -Wernicke-Korsakoff syndrome is a brain disorder caused by drinking too much alcohol and a lack of thiamine. -Heavy alcohol use causes inflammation of the stomach lining and digestive tract, which reduces the body's ability to absorb vitamins. -Substance-induced psychosis can mimic symptoms of schizophrenia. -Thyrotoxicosis encephalopathy is also a brain disorder related to nutrient deficiency of thiamine, which mimics schizophrenia. Mirtazapine does not induce or inhibit any cytochrome p450 enzymes. Citalopram is a weak inhibitor of cytochrome p450 2D6. Fluoxetine inhibits 2D6 and 3A4. Fluvoxamine is an inhibitor of 1A2, 3A4, and 2C9/2C19. The frontal lobe is the most prominent, most developed lobe. Its functions: Controlling the voluntary motor activity of specific muscles Coordinating movement of multiple muscles Allowing for multimodal sensory input to trigger memories Executive functioning, which includes reasoning, impulse control, planning, prioritizing, intelligence, and abstraction Expressive speech Personality development The Young Mania Rating Scale or YMRS is a self-reporting/clinician observation tool to assess young patients' severity of manic symptoms. The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) is a self-reporting/clinician tool for those ages 6-14. The Yale-Brown Obsessive-Compulsive Scale is a self-reporting tool for patients over 14

There are more than 35,000 suicides in the United States each year. This is in contrast to 20, deaths due to homicide each year. The ratio of suicide attempts to completed suicides is 25:1. Over the past few decades, the rate of suicide has increased in adolescents and decreased in the elderly. In the United States, suicide is the 10th leading cause of death. The most common suicide site globally is the Golden Gate Bridge in San Francisco, California. Suicide rates are lowest in New Jersey and highest in Montana. Anticholinergic side effects include dry mouth, sedation, blurred vision, fever, urinary retention, agitation, confusion, and seizures. Orthostatic hypotension is an antiadrenergic side effect. Weight gain is an antihistaminergic side effect. Individuals prescribed Clozapine (Clozaril) must be enrolled in a clozapine risk evaluation and management strategy program (REMS) while receiving this therapy. Monitoring involves frequent bloodwork because of the significant risk of neutropenia and monitoring for serum lipid and glucose changes. The patient is monitored for myocarditis and seizures. Seroquel, risperidone, and olanzapine require serum lipid, glucose, and BMI monitoring. Risperidone requires monitoring of prolactin levels. Parkinson's disease results from a disruption of the nigrostriatal dopaminergic pathway. When dopamine transmission is disrupted in the mesocorticolimbic pathway, disorders such as ADHD, addiction, and schizophrenia can result. A disruption in the tuberoinfundibular pathway results in hyperprolactinemia. Disruptions in the caudate nucleus dopaminergic pathway can create low motivation. Specifiers used to describe mood disorders include the following: With atypical features: These patients eat a lot and gain weight, sleep excessively, and feel sluggish or paralyzed. They are also sensitive to rejection. With melancholic features: These patients feel worse in the morning than in the afternoon, and they experience decreased appetite, weight loss, and agitation. They also tend to feel excessively guilty and have trouble making decisions. With anxious distress: These patients have high tension, restlessness, worry, and fear. With catatonic features: These patients exhibit either motor hyperactivity or inactivity.

With mixed features: These patients are experiencing a mixture of both manic and depressive symptoms. With peripartum onset: These patients develop a mood episode during pregnancy or within a month of having their baby. With psychotic features: These patients develop delusions or hallucinations and mood symptoms. With rapid cycling: These patients have experienced at least four mood episodes in the past year. With seasonal pattern: These patients regularly become ill at a specific time of the year. A stroke in the temporal lobe of the cerebral cortex could impact Wernicke's area, which functions as receptive speech and language comprehension. Problems in the temporal lobe can impact emotions and lead to auditory and visual hallucinations. Damage to Broca's area would more likely result in expressive aphasia. (Frontal lobe) Their speech will still contain important content, but they may omit articles, prepositions, and other words that only have grammatical significance. Patients will also lose the ability to repeat, as the Broca area, Wernicke's area, and arcuate fasciculus are required to repeat words or phrases. These patients do not entirely lose their ability to comprehend, but they exhibit an increased effort of speech. This is because language comprehension is primarily a function of Wernicke's area. Therefore, they are typically aware of their deficits, and Broca aphasia patients are likely to become frustrated and often develop depression. It is also essential to differentiate dysphasia from dysarthria. Those with dysarthria have problems speaking because of an inability to move mouth and tongue musculature, while expressive aphasia is more issues with word-finding. Damage to Wernicke's area results in receptive aphasia. (Temporal lobe) However, the content is often challenging to understand because of paraphrastic errors. Language output is fluent with a regular rate and intonation, but patients with Wernicke aphasia are unaware of their deficits. Diazepam is the longest-acting benzodiazepine with a half-life of 20 -100 hours. Clonazepam; 18-50 hours half-life Lorazepam; 10-20 hours half-life. Cluster A disorders: -Paranoid personality disorder -Schizoid personality disorder -Schizotypal personality disorder Cluster B disorders:

-Antisocial personality disorder -Borderline personality disorder -Histrionic personality disorder -Narcissistic personality disorder Cluster C disorders: -Avoidant personality disorder -Dependent personality disorder -Obsessive-compulsive personality disorder -Biopsychosocial factors in the family of origin are thought to contribute to developing personality disorders. -Patients with suicidal thoughts usually exhibit severe hopelessness and believe that through suicide, they will experience secondary gain. -Selective abstraction refers to when individuals take things out of context. -Circular reasoning is a logical fallacy where a person begins with what they want to end with when making a statement. -Personalization is unrelated to suicidal thinking. It refers to a patient's tendency to attribute events to him or herself without any apparent reason. -Oppositional defiant disorder is characterized by multiple examples of negativistic behavior persistent for at least six months, usually beginning when a child is three or four years old. Problems with the frontal lobe can lead to personality, emotional, and intellectual changes. -temporal lobe can lead to aphasia and amnesia. -occipital lobe can lead to visual field defects. -parietal lobe can lead to sensory-perceptual disturbances and agnosia. Calcium values can be decreased during treatment with anticonvulsants, aspirin, corticosteroids, heparin, and oral contraceptives. Because medications alone do not treat a person's environmental or interpersonal stressors and their responses to stressors, an integrated approach is the most beneficial in treating mental illness. The most common reasons patients seek individual psychotherapy are as follows: Loss Interpersonal conflict

Symptomatic presentations such as panic, anxiety, phobias, and negativity Unfulfilled expectations and life transitions Characterological issues such as narcissism or aggressiveness In 2001, the Institute of Medicine published Crossing the Quality Chasm: A New Health System for the 21st Century. This report identified six goals for quality improvement in health care: Safe: Avoiding injuries to patients from the care intended to help them Effective: Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions Timely: Reducing waits and sometimes harmful delays for both those who receive and those who provide care Efficient: Avoiding the waste of equipment, supplies, ideas, and energy Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status Common herbals with psychoactive effects used to treat insomnia: Valerian Catnip Chamomile, which also helps with anxiety Other herbals with psychoactive effects: Ginkgo helps with delirium, dementia, and sexual dysfunction Black cohosh is used to treat menopausal symptoms, premenstrual syndrome, and dysmenorrhea Belladonna is used in treating anxiety Ginseng helps with depression and fatigue Melatonin can inhibit ovulation at higher doses Abstinence violation effect (AVE) AVE is the cognitive restructuring technique that distinguishes a lapse from a relapse by distinguishing it as an isolated event. Sigmund Freud created psychoanalytic therapy. Behavior is determined by unconscious motivations and instinctual drives

Along with Melanie Klein, Anna Freud is most well known for her contributions to psychoanalytic child psychology and object relations. Aaron Beck developed cognitive therapy, and his daughter, Judith Beck, continued his work. The goal is to change clients' irrational beliefs and negative cognitive distortions. External events do not cause anxiety. A person's reaction To the stressor causes anxiety. Behavioral therapy focuses on changing maladaptive behaviors through exposure, relaxation, problem- solving, and role-playing. Dialectical behavioral therapy; by Marsha Linehan. borderline personality disorder Existential therapy: live authentically and focus on personal responsibility Carl Rogers originally developed humanistic therapy, also known as person-centered therapy. Interpersonal therapy: clearman and Weissman= evidence-based therapy. time-limited active focused on the present Eye movement desensitization and reprocessing; Used exclusively in post-traumatic stress disorder Group therapy benefits- cost-effective increases social skills In family systems theory, one cannot understand any family member without understanding how all family members operate together clearly defined boundaries-maintain persons individual NES while emphasizing a sense of belonging rigid or inflexible boundaries-may lead to distant relationships diffuse boundaries lead to enmeshment family systems therapy-Murray Bowen chronic anxiety within families increase awareness of each family member's function Structural family therapy-Salvador Minuchin-how family members relate to the family structure use of a genogram, Experiential therapy-Virginia Satir- behavior is determined by personal experience and not external reality

focus on being authentic. The goal is to develop nurturing communication. no focus on a particular technique Biofeedback has the most evidence of effectiveness and teaches people to control autonomic functions such as breathing, heart rate, and perception. Olfactory nerve (CN I) The olfactory nerve transmits the sense of smell to the brain. Optic nerve (CN II) The optic nerve = vision. Oculomotor nerve (CN III) The oculomotor nerve moves the eyeball and upper eyelid. Trochlear nerve (CN IV) The trochlear nerve moves the eye downward and inward. Trigeminal nerve (CN V) The trigeminal nerve largest cranial nerve motor and sensory functions. Chewing and clenching the teeth and sensation of muscles in the ear's tympanic membrane. Abducens nerve (CN VI) The abducens nerve controls eye movements to look outward. The facial nerve (CN VII) The facial nerve produces facial expressions and has both motor and sensory functions. Vestibulocochlear nerve (CN VIII) The vestibulocochlear nerve is involved with a person's hearing and balance. The glossopharyngeal nerve (CN IX) The glossopharyngeal nerve possesses both motor and sensory functions. It is taste Vagus nerve (CN X) The vagus nerve provides motor, sensory, and parasympathetic functions. It plays a role in taste sensation, provides movement to the throat and soft palate, and regulates heart rhythm. The accessory nerve (CN XI)

The accessory nerve provides motor function to the neck. It controls muscles that allow a person to rotate, extend, and flex the neck and shoulders. The hypoglossal nerve (CN XII) The hypoglossal nerve supplies the tongue muscles. Valproic acid can elevate ammonia levels, provoking symptoms ranging from fatigue to coma. When valproic acid levels are therapeutic and thought to be helpful for prescribed symptoms, the addition of l-carnitine can help lower ammonia levels. The nucleus accumbens is one of the principal nuclei involved in the neural circuitry underlying reward and motivation and is one of the main targets of the mesocorticolimbic reward pathway. A large body of evidence from several species, including humans, has implicated this pathway in reward processing, addiction, and goal-directed behavior. A Russian group reported the successful use of bilateral cryocingulotomies to treat intractable heroin addiction in 348 patients. Follow-up was reported in 187 of these patients, 62% of whom were found to be completely free of opioid use after two years, while another 13% showed partial improvement. Aripiprazole can cause restless agitation such as akathisia-like activation. It is not typically known to cause extrapyramidal symptoms (EPS). The restlessness is stressful and is frequently the reason for discontinuing aripiprazole. Exposure therapy helps to desensitize the individual from the trauma experience. It is a form of cognitive- behavioral therapy that helps victims of trauma process the event, whether an assault or another type of traumatic experience, to decrease the fear the individual experiences when triggered. Dialectical behavior therapy (DBT) is most commonly used to treat personality disorders. Electroconvulsive therapy (ECT) is a pharmacological treatment procedure often performed on those suffering from treatment-resistant depression and bipolar disorder. Psychodynamic therapeutic synthesizing (PTS) is not an actual nonpharmacological treatment method. Patients with narcissistic and borderline personality disorders are often prescribed dialectical behavioral therapy (DBT). The goal is to help the patient learn self-regulation with emotions and increase stress

tolerance. Medication by itself does not allow someone to develop insight into the problem. DBT also stresses self-management, mindfulness, and interpersonal skills. Coping skills are considered an immediate determinant. Coping skills can be strong or weak, and their presence or absence can determine relapse. Accessibility to substance, rationalization, and minimizing consequences are antecedents of lapse and relapse. Freud's stages of psychosexual development: (Old Age Parents Love Grandchildren) Oral: birth to 12-18 months Anal: 12-18 months to 3 years Phallic: 3 to 5-6 years Latency: 5-6 years to adolescence Genital: adolescence to adulthood Successful resolution of the anal stage of psychosexual development provides the basis for developing personal autonomy and capacity for self-confidence. Failure to resolve the anal stage results in pathological traits of excessive orderliness, stubbornness, willfulness, frugality, and parsimony. Anal characteristics and defenses are typically seen in obsessive-compulsive disorders. Bipolar disorder accounts for 25 percent of all completed suicides. The lifetime risk of suicide in those diagnosed with bipolar disorder is 15 times greater than that of the general population. These individuals are more likely to complete suicide if they have a history of suicide attempts and have spent most of the past year in a depressed episode. Neurotransmitters fall into four categories: Monoamines Amino acids Cholinergic Neuropeptides (divided into nonopioid type and opioid type) Dopamine, norepinephrine, and serotonin are examples of monoamine neurotransmitters.

Glutamate, GABA, aspartate, and acetylcholine are examples of amino acids. The mental status exam does not require direct questioning, as the PMH-NP observes the patient's demeanor and presentation of symptoms. The information obtained may differ significantly from what the patient reports The initial mental status exam is an essential picture of a patient's current baseline status. It can be used to monitor changes from baseline as treatment progresses. The Centers for Medicare and Medicaid Services (CMS) administer the two major public insurance programs, Medicaid and Medicare. Both federal and state tax dollars fund Medicaid. In 2011, Medicaid provided health care for 60 million eligible persons, 85% of whom were children. Those eligible for Medicaid include the following: Low-income children Low-income pregnant women Elderly and disabled individuals who qualify for the Supplemental Security Income Program Federal tax dollars fund Medicare. In 2011, it provided health care for 47 million eligible people. Those eligible for Medicare include the following: Those aged 65 and older have worked 40 quarters and paid Medicare taxes Specific younger individuals with disabilities Individuals with end-stage renal disease Individuals in need of a kidney transplant Individuals receiving Social Security Disability and who have amyotrophic lateral sclerosis Humanistic therapy focuses on self-growth and self-actualization, finding meaning in life and its circumstances. Existential therapy also targets finding meaning and purpose in life but is based on accepting reality and making responsible decisions. Interpersonal therapy is time-limited and focused on the present stressor.

Dialectical behavioral therapy stresses emotional regulation, increasing stress tolerance, developing interpersonal skills, and mindfulness. Primary, secondary, and tertiary prevention are public health preventative factors. Mental status exam findings of autism are as follows: -Little or no eye contact -Flat or blunted affect -Lack of emotional reciprocity -Stereotyped or repetitive motor mannerisms -Expressive and receptive language impairment A durable power of attorney can cover physical, mental, and terminal illnesses. Living wills are prepared while the client is mentally competent so that the client's health care wishes can be fulfilled in times of incapacitation. A durable power of attorney can assist chronically mentally ill patients during times of relapse and when their mental judgment is impaired. A durable power of attorney is a legal document indicating clients' health care wishes for times when they are unable to make decisions for themselves Erik Erikson's stages of psychosocial development:

• Trust vs. Mistrust: birth to 12-18 months (Hope)
• Autonomy vs. Shame/doubt: 1 to 3 years (Will)
• Initiative vs. Guilt: 3 to 6 (Purpose)
• Industry vs. Inferiority: 5-12yrs (Competence)
• Identity vs. Role Confusion: 12 to 18 years (Fidelity)
• Intimacy vs. Isolation: 18 to 40 years (Love)
• Generativity vs. Stagnation: 40 to 65 (Care)

• Ego Integrity vs. Despair: 65+ (Wisdom) Females with bipolar disorder are more likely to experience rapid cycling and mixed states and are more likely to experience depressive episodes. They also have higher rates of comorbid alcohol use disorders and eating disorders. Patients suffering from impaired memory or Alzheimer's disease present with a decrease in acetylcholine. Parkinsonian symptoms an increase in acetylcholine. Schizophrenia- increase in dopamine. Psychosis due to an increase in glutamate. Autism spectrum disorder (ASD) affects about 1% of the population in the United States. Other essential facts regarding ASD:
• ASD is more common in children with a family history of pervasive developmental disorders
• The concordant rate for an identical twin with autism is 60%
• The incidence is 2 to 5 cases per 10,000 in the U.S.
• The male-to-female ratio is 4:1
• The onset of symptoms is before age 3
• About 10% of people with autism also have a genetic or chromosomal condition such as Down syndrome or fragile X syndrome EMDR is the gold standard in treating PTSD and involves having the patient recall distressing events/images while generating one type of bilateral sensory input such as hand tapping or side-to-side eye movements. DBT is used in treating borderline personality disorder, not PTSD. Oculomotor disturbances, cerebellar ataxia, and mental confusion suggest a diagnosis of Wernicke's encephalopathy.

Hyperactive traits of ADHD: Fidgets Leaves seat Runs or climbs Is unable to engage in quiet activities Is always on the go Talks excessively Blurts out information Has a difficult time waiting their turn Interrupts others InInattentive traits of ADHD: Fails to give attention to details Has difficulty sustaining attention Does not listen when spoken to Does not follow through on instructions Is disorganized Avoids or dislikes tasks that require sustained mental effort Loses things Is distracted Is forgetful Hypernatremia can cause dehydration, diabetes insipidus, and gastroenteritis. Anxiety rating scales: Zung's Anxiety Scale, the Hamilton Rating Scale for Anxiety (HAM-A), and the Yale- Brown Obsessive-Compulsive Scale (Y-BOCS) Hypokalemia

• Alkalosis
• Excessive insulin
• Burns
• Trauma
• Surgery
• Cushing's syndrome
• Hyperaldosteronism
• Thyrotoxicosis
• Anorexia nervosa
• Diet deficient in meat and vegetables Hyperkalemia
• Acidosis