Neurological and Psychological Conditions: Symptoms, Diagnosis, and Treatment, Exams of Advanced Education

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NURS 661 MARYVILLE UNIVERSITY

EXAM 1 WITH 100% CORRECT

ANSWERS 2023-

Define and identify symptoms of dystonia - Correct Answer-Involuntary muscle contractions that cause repetitive twisting movements. The condition can affect one part of the body- focal dystonia; two or more adjacent parts- segmental; or all parts- general dystonia. Cervical dystonia- cause head to twist and turn to one side. Eyelids- rapid blinking or involuntary spasms Jaw/tongue- slurred speech, drooling, difficulty chewing hand/forearm- repetitive activity (writers or musicians dystonia) Define and identify symptoms of aprosodia - Correct Answer-" Neurological condition characterized by the inability of a person to properly convey or interpret emotional prasody (ranges of rhythm, pitch, stress, intonation). Differentiate between short term and long-term memory - Correct Answer-" Short term- 30 seconds to several days " Long term- weeks, months, years " Vascular dementia and alzheimer's affect short term memory first. WHAT IS AN ILLUSION - Correct Answer-are distortions of real images or sensations. Illusions can occur in schizophrenia patients during active phases but can also occur during the prodromal phases and during periods of remissions. WHAT IS A HALLUCINATION - Correct Answer-any of the five senses may be affected. The most common are auditory with voices that are often threatening, obscene, accusatory, or insulting. Two or more voices may converse among themselves or a voice may comment on the patient's life or behavior. Visual hallucinations are common but tactile olfactory and gustatory hallucinations are unusual (their presence should prompt clinician to consider underlying medical or neurological disorder). WHAT IS A DELUSION? - Correct Answer-may assume persecutory, grandiose, religious, or somatic forms. Fixed beliefs that do not change. Identify standards for determining competency - Correct Answer-Decisional Capacity; ability to communicate a choice/ability to understand information necessary for the specific decision at hand/ ability to appreciate the implications and significance of the provided information or the choice of being made/ ability to reason by weighting the comparing options as well as consequences of the potential decision.

Know basic principles of why an MRI would be an appropriate study for a dementia diagnosis (kaplan 715) - Correct Answer-differentiate between dementia of Alzheimer's Type and vascular dementia more straightforward. Area of research is the single photon emission computed tomography (SPECT) to detect patterns of brain metabolism in dementia types. The use of these images may soon help in clinical differential diagnosis of dementing illness. What are the core symptoms needed to meet the criteria for DSM 5 premenstrual dysphoric disorder - Correct Answer-" One or more of the following must be present" " Marked affective lability (mood swings, suddenly sad or tearful, increased sensitivity to rejection) " Marked irritability or anger or increased interpersonal conflicts " Marked depressed mood, feelings of hopelessness, or self deprecating thoughts, " Marked anxiety, tension, and or feelings of being keyed up or on edge " ONE OR MORE OF THE FOLLOWING MUST ADDITIONALLY BE PRESENT TO REACH A TOTAL OF 5 SYMPTOMS when combined with above criteria. " Decreased interest in usual activities " Subjective difficulty in concentration " Lethargy, easily fatigability, marked lack of energy " Marked change in appetite, overeating or specific food cravings " Hypersomnia or insomnia " Sense of being overwhelmed or out of control " Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sense of bloating or weight gain. WHAT ARE THE AGES OF Early Adolescence - Correct Answer-(Approximately 12- years of age) Movement Toward Independence - early adolescence - Correct Answer-" Struggle with sense of identity; " Moodiness; " Improved abilities to use speech to express oneself; " More likely to express feelings by action than by words; " Close friendships gain importance; " Less attention shown to parents, with occasional rudeness; " Realization that parents are not perfect; identification of their faults; " Search for new people to love in addition to parents; " Tendency to return to childish behavior; " Peer group influences interests and clothing styles. Future interests and Cognitive Development - early adolescence - Correct Answer-" Increasing career interests; " Mostly interested in present and near future; " Greater ability to work Sexuality - early adolescence - Correct Answer-" Girls ahead of boys;

" More consistent evidence of conscience; " Greater capacity for setting goals; " Interest in moral reasoning Physical Changes - middle adolescence - Correct Answer-" Continued height and weight gains; " Growth of pubic and underarm hair; " Body sweats more; " Hair and skin become more oily; " Breast development and menstruation in girls; " Growth of testicles and penis, " Nocturnal emissions (wet dreams), " Deepening of voice, " Growth of hair on face in boys Late Adolescence - Correct Answer-(approximately 17-19 years) Movement Toward Independence - late adolescence - Correct Answer-" Firmer identity; " Ability to delay gratification; " Ability to think ideas through; Ability to express ideas in words; " More developed sense of humor; " Stable interests; " Greater emotional stability; " Ability to make independent decisions; " Ability to compromise; " Pride in one's work; " Self-reliance; " Greater concern for others Future Interests and Cognitive Development - late adolescence - Correct Answer-" More defined work habits; " Higher level of concern for the future; " Thoughts about one's role in life Sexuality - late adolescence - Correct Answer-" Concerned with serious relationships; " Clear sexual identity; " Capacities for tender and sensual love Ethics and Self-Direction - late adolescence - Correct Answer-" Capable of useful insight; " Stress on personal dignity and self-esteem; " Ability to set goals and follow through; " Acceptance of social institutions and cultural traditions; " Self-regulation of self esteem Physical Changes - late adolescence - Correct Answer-" Most girls fully developed;

" Boys continue to gain height, weight, muscle mass, body hair What is the minimum duration of symptom presentation to make a diagnosis of generalized anxiety disorder - Correct Answer-" GAD is defined as excessive anxiety and worry about several events or activities for most days during at least a 6-month period With twin studies for panic disorder, know the estimated percentage of heritability expected. - Correct Answer-" Monozygotic twins are more likely to be concordant for panic disorder than are dizygotic twins. (no data exist indicating an association between a specific chromosomal location or mode of transmission and this disorder) " Various studies have found that first degree relatives of patients with panic disorder have a 4-8 fold higher risk for panic disorder than first degree relatives of other psychiatric patients. mania - Correct Answer-severe episode of elevated/euphoric or irritable mood and increased energy that usually lasts at least a week and severely interferes with the sufferers ability to function Hypomania - Correct Answer-less severe version of mania, in that it is characterized by somewhat elevated or irritable mood that may more mildly interfere with a person's functioning. Know which types of patients could benefit from bright light therapy - Correct Answer- Seasonal Affective Disorder. Women represent 75% of patients with SAD with the mean age of 40 years. Patients rarely present older than 55 years with SAD. sleep disorder, shift workers, OCD with seasonal variation and jet lag Why is interviewing a catatonic patient challenging? - Correct Answer-impairs a person's ability to care for himself or herself and therefore requires hospitalization. (Kaplan 345). What is catatonia? - Correct Answer-a clinical syndrome characterized by striking behavioral abnormalities that may include motoric immobility or excitement, profound negativism, or echolalia, or echopraxia (mimicry of movement). Know which antidepressant is most effective for patients who also have neuropathic pain - Correct Answer-Duloxetine- SNRI Know which antidepressant has also been used for smoking cessation - Correct Answer-Buproprion- possibly that it is occupying DATSs in the striatum and nucleus accumbens in a manner sufficient to mitigate craving but not sufficient to cause abuse. Know the potential symptom presentation when prescribing sertaline and linezolid - Correct Answer-Linezolid is a weak monoamine oxidase inhibitor and has been reported to interact with selective serotonin reuptake inhibitors.

seen in older adults. Also, some evidence suggests that the prevalence of generalized anxiety disorder is particularly high in primary care setting What are the major mental symptoms of panic disorder? - Correct Answer-extreme fear and a sense of impending death and doom.Patients usually cannot name the source of their fear; they may feel confused and have trouble concentrating. physical symptoms of panic disorder? - Correct Answer-tachycardia, palpitations, dyspnea, and sweating. How long do the symptoms of panic disorder usually last? - Correct Answer-The attack generally lasts 20 to 30 minutes and rarely more than an hour. Which anxiety disorder has the youngest median age of onset? - Correct Answer-social anxiety DSM 5 criteria for Bipolar I - Correct Answer-(Table 8.1-6) requires the presence of a distinct period of abnormal mood lasting at least 1 week and includes separate bipolar I disorder diagnoses for a single manic episode and a recurrent episode based on the symptoms of the most recent episode as described below. At least 1 manic episode. Know which brain stimulation treatments is approved for the treatment of depression - Correct Answer-ECT, repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS) Which is included in DSM 5 among anxiety disorders? OCD, acute stress disorder, ptsd, panic with agoraphobia, or separation anxiety disorder - Correct Answer-Separation anxiety disorder Requirement for bipolar II - Correct Answer-One manic episode and one major depressive episode Cyclothymic disorder - Correct Answer-Chronic sub syndrome symptoms of mood elevation and depression for at least 2 years How do depressive episodes differ with bipolar II from bipolar I? - Correct Answer-They are longer Which would suggest presence of major depressive episode in addition to a normal expected response to a significant loss? A) intense sadness b) ruminates about loss c)poor appetite d) feelings of worthlessness e) poor appetite - Correct Answer-Feelings of worthlessness

What would alert a physician to presence of depression in a patient with a serious medical condition? A) weight loss b) anhedonia c) fatigue d) hypersomnoa e)insomnia - Correct Answer-Anhedonia Core symptom to meet DSM 5 diagnosis of PMDD - Correct Answer-Marked affective liability dystonia and medication compliance - Correct Answer-It can be painful and frightening and often results in noncompliance with future drug treatment regimens. What causes an increase in the risk fo dystonia? - Correct Answer-use of IM high potency antipsychotics/neuroleptics, males < 30 years What might be a cause of dystonia? - Correct Answer-May be caused by dopaminergic hyperactivity in the basal ganglia that occurs when CNS levels of the antipsychotic drug begin to fall between doses. How can dystonia be prevented - Correct Answer-yes, with prophylaxis and anticholinergics treatment of dystonia - Correct Answer-IM or IV Benadryl, IV diazepam (Valium), amobarbital (Amytal), caffeine sodium benzoate What does prosody in language refer to? - Correct Answer-ranges of rhythm, pitch, stress, intonation, etc. What might the neurological deficit of prosody be the result of? - Correct Answer- damage of some form to the non-dominant hemisphere areas of language production. how do patients with extreme aprosodia present? - Correct Answer-monotone fashion and are barely able or unable to distinguish changes in stress or intonation. Short term memory - Correct Answer-Reproduction, recognition, or recall of perceived material within minutes after the initial presentation long term memory - Correct Answer-Reproduction, recognition, or recall of experiences or information that was experienced in the distant past. Also called remote memory. Delusions - - Correct Answer-False belief, based on incorrect inference about external reality, that is firmly held despite objective and obvious contradictory proof or evidence and despite the fact that other members of the culture do not share the belief Hallucinations - Correct Answer-False sensory perception occurring in the absence of any relevant external stimulation of the sensory modality involved. Illusions - Correct Answer-Perceptual misinterpretation of a real external stimulus.

What are symptoms of dysthymia? - Correct Answer-There are associated feelings of inadequacy, guilt, irritability, and anger; withdrawal from society; loss of interest; and inactivity and lack of productivity. Dysthymia onset - Correct Answer-ost cases are of early onset, beginning in childhood or adolescence and certainly occurring by the time patients reach their 20s late onset dysthymia - Correct Answer-much less prevalent and not well characterized clinically, has been identified among middle-aged and geriatric populations, largely through epidemiological studies in the community. the core concepts of dysthymia refers to a subaffective or subclinical depressive disorder with: - Correct Answer-(1) low-grade chronicity for at least 2 years; (2) insidious onset, with origin often in childhood or adolescence; and (3) a persistent or intermittent course. The family history of patients with dysthymia is typically replete with both depressive and bipolar disorders. Premenstrual dysphoric disorder (PMDD) is: - Correct Answer-a somatopsychic illness triggered by changing levels of sex steroids that accompany an ovulatory menstrual cycle. It occurs about 1 week before the onset of menses symptoms of premenstrual dysphoric disorder (PMDD) - Correct Answer-irritability, emotional lability, headache, anxiety, and depression. Somatic symptoms of premenstrual dysphoric disorder (PMDD) - Correct Answer- edema, weight gain, breast pain, syncope, and paresthesias. Premenstrual dysphoric disorder between menstrual cyles - Correct Answer-symptoms somewhat relieve between menstrual cycles Relative minimum duration of symptoms needed to make a diagnosis of GAD - Correct Answer- monozygotic and dizygotic twins and panic disorder - Correct Answer-The twin studies conducted to date have generally reported that monozygotic twins are more likely to be concordant for panic disorder than are dizygotic twins. panic disorder in a medically ill patient: onset of symptoms - Correct Answer-The attack often begins with a 10-minute period of rapidly increasing symptoms. panic disorder in a medically ill patient: symptoms - Correct Answer-The major mental symptoms are extreme fear and a sense of impending death and doom. Patients usually cannot name the source of their fear; they may feel confused and have trouble concentrating. The physical signs often include tachycardia, palpitations, dyspnea, and sweating.

For a patient who presents to the ED with fear of dying from a heart or respiratory illness, what would be a diagnosis to consider other than hypochondriasis? - Correct Answer-Panic disorder What are children with social anxiety fearful of? - Correct Answer-fear of scrutiny or humiliation are given the diagnosis of social anxiety disorder. T Symptoms of children with social anxiety? - Correct Answer-crying, tantrums, avoidance, freezing, or even becoming "mute" in stressful situations. Under what circumstances will a child likely trigger symptoms of social anxiety? - Correct Answer-feeling exposed to possible scrutiny by others can provoke fear or anxiety, and the child will often try to avoid these feared social situations. Who must the child experience symptoms of SAD in front of in order to get diagnosed with SAD? - Correct Answer-peers performance only type of social anxiety disorder - Correct Answer-targets a specific type of performing: for example, public speaking onset of social anxiety disorder - Correct Answer-can occur as early as preschool age, but median age is 7-8 years old how many manic episodes must be noted for the diagnosis of Bipolar I - Correct Answer-At least 1 manic episode for at least 1 week or less if hospitalization is needed- symptoms must be present for most of that time during the week What therapy is used to decrease the irritability and diminished functioning of shift work? - Correct Answer-Bright light therapy What is used to treat sleep disorders in the geriatric population? - Correct Answer-Bright light therapy during the day What imbalance can be caused by panic disorder and what is one way it can be treated? - Correct Answer-respiratory alkalosis and paper bag breathing Manic episode criteria: length of symptoms - Correct Answer-symptoms that last longer than 1 week, but less than 1 week if hospitalization is required Hypomanic episode: length of symptoms - Correct Answer-greater than 4 days, but less than one week. hypomanic episode - Correct Answer-there are no psychotic features.