NR 606 MID TERM EXAM TEST BANK 2024, Exams of Nursing

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NR 606 MID TERM EXAM TEST BANK

2024 WITH ACTUAL CORRECT

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an evidence-based treatment that can help clients manage life with a mood disorder by promoting regularity in daily routines interpersonal and social rhythm therapy Early intervention for youth at genetic risk for developing BPT IRPT with Data-Informed Referral (IPSRT+DIR) before symptoms manifest shows promise in helping youth establish more regular sleep-wake cycles which may help decrease mood fluctuations the preferred drug for adolescents with bipolar disorder with mixed features Divalproex The hallmark clinical feature of DMDD chronic, persistent irritability and anger. DSM5 criteria of DMDD outbursts of temper >3 times per week, chronically irritable or anger that is observable to others, symptoms present >12 months, symptoms present in at least 2 out of 3 settings (home, school, peers), ages 6-18, onset before age 10 when can DMDD not be diagnosed if bipolar, intermittent explosive disorder, or oppositional defiant disorder are present screening tool for DMDD

KSADS-PL

therapies for DMDD CBT= first line computer-based interpretation bias training (IBT) to help children and adolescents more accurately interpret others' emotions medications for DMDD stimulant medications- decrease irritability Antidepressants- irritability and other mood problems Atypical antipsychotics- control severe outbursts of temper/ aggression which medication requires up to 30% increased dosage for clients who smoke concurrently olanzapine factors associated with an increased likelihood of developing ASD having a sibling with ASD, having older parents, having certain genetic conditions such as Fragile X syndrome or Down syndrome, or having a very low birth weight DSM-5 criteria for ASD includes ersistent deficits in communication and social interaction across multiple contexts and restrictive, repetitive patterns of behavior, interests, or activities. Symptoms must appear early in development and can cause clinically significant impairment in functioning. Early signs of ASD include avoiding eye contact showing little interest in peers or caretakers limited language abilities frustration with minor changes in routine repetitive behaviors The American Academy of Pediatrics recommends that all children be screened for ASD at which well- child visits? 18 month and 24 month general developmental screening tool. Parent-completed questionnaire; series of 19 age-specific questionnaires screening communication, gross motor, fine motor, problem-solving, and personal adaptive skills; results in a pass/fail score for domains. ages and stages questionnaires Standardized tool for screening of communication and symbolic abilities up to the 24-month level; the Infant Toddler Checklist is a 1-page, parent-completed screening tool communication and symbolic behavior scales

This is a general developmental screening tool. Parent-interview form; screens for developmental and behavioral problems needing further evaluation; single response form used for all ages; may be useful as a surveillance tool. parents evaluation of developmental status Parent-completed questionnaire designed to identify children at risk for autism in the general population. modified checklist for autism in toddlers This is an interactive screening tool designed for children when developmental concerns are suspected. It consists of 12 activities assessing play, communication, and imitation skills and takes 20 minutes to administer. screening tool for autism in toddlers and young children Enhances new skill development through rewards-based motivational systems applied behavior analysis therapy Provides educational resources, coping strategies, and communication skills for parents of children with ASD parent training Improves social skills including conversation, being a good sport, and managing teasing from other children social skills training may be used for clients with ASD who have hyperactivity, impulsive behaviors, and sleep problems. guanfacine and clonidine may be used for clients with ASD who have aggressive behaviors, tantrums, sleep disorders, or motor tics. second gen antipsychotics may be used for clients with ASD who have repetitive behaviors and aggression. Tricyclic antidepressants (clompiramine) may be used for clients with ASD who have hyperactivity, short attention spans, and impulsive behaviors. stimulants rare neurodevelopmental disorder that is typically caused by a mutation in the methyl CpG binding protein and is characterized by normal growth and development early in life followed by impaired growth and development later in life Rett syndrome

what usually happens when boys develop Rett syndrome? severe problems when they are born and die shortly after birth one of the most disabling aspects of Rett syndrome, interfering with all body movements, including eye gaze and speech Apraxia TS often occurs comorbidly with other psychiatric conditions such as ADHD, OCD, learning difficulties, depression four diagnostic criteria are required for TS including: he presence of multiple motor tics and one or more vocal tics, which may not occur concurrently tics may wax and wane in frequency but have persisted for more than 1 year since the first tic onset tic onset is before 18 years of age tics are not caused by the use of a substance or other medical conditions scaling for Tics 0= none 10= minimal 20=mild 30=moderate 40=marked 50=severe caused by contraction of the diaphragm or oropharynx muscles and include frequent throat clearing, sniffs, chirps, barks, or grunting simple vocal tics are of short duration and can include eye blinks, facial grimaces, shoulder shrugs, or extension of the extremities. simple motor tics include a combination of simple tics that last for a longer duration. complex motor tics characterized by abrupt, sharp bark or grunt vocalization of socially unacceptable words, including obscenities, or ethnic, racial, or religious slurs. This type of tic is less common. Complex vocal ttics: coprolalia a less common complex motor tic that involves making obscene gestures Complex motor tics: Copropraxia complex vocal tic characterized by repeating the last heard word or phrase

Complex vocal tics: Echolalia first-line intervention for TS psychoeducation medications for TS pimozide and aripiprazole Childhood-onset schizophrenia (COS) is diagnosed in clients younger than... 13 he most common symptom in children with COS auditory hallucinations Children in the pre-operational stage think _____ and use what to represent objects? symbolically, use words or pictures in which stage of piaget's model does thinking become more logical and organized about events and children can reason inductively concrete operational (age 7-11) which stage is defined by the ability to reason abstractly and consider hypothetical problems as well as moral, ethical, social, and political issues? formal operations (12+) Can a parent access information if the provider has concerns about parental abuse or neglect? the provider can decide whether or not to treat the parent as a personal representative If the parent is not the child's personal representative under HIPPA, do they have access to the health records? depending on state laws- if the state has a law against it then no, if the state does permit the provider to share health information then the provider is able to A challenge to prescribing psychoactive medications in the perinatal period is the paucity of evidence regarding the true risks for the pregnant client and developing fetus If a pregnant client is stable on their current medication regimen what should the PMHNP keep in mind keep them on current med rather than switching When should the PMHNP refer the patient to a perinatal psychiatrist when the patient is on a high-risk medication for pregnancy most common adverse effect associated with SSRIs and SNRIs

neonatal withdrawal syndrome symptoms of neonatal withdrawal syndrome Symptoms include tremors, high-pitched crying, and disturbed sleep increase the risk of atrial septal defects. paroextine symptoms of newborn toxicity r/t benzodiazepine use during pregnancy Symptoms include sedation, floppy muscle tone, and potential breathing issues at birth bipolar medications that are considered teratogenic and should be avoided during pregnancy. valproic acid and carbamazepine Atypical antipsychotics that increase risk of gestational diabetes and large for gestational age infants olanzapine and quetiapine has also been found to increase the risk of musculoskeletal malformations in infants olanzapine the most used antipsychotics during pregnancy risperidone and quetiapine medications that are safe for breast feeding SSRIs, benzos, valproic acid, quetiapine medications that are safe for bottle feeding lithium, lamotrigine, clozapine smoking- related pregnancy complications ectopic pregnancy, placental abruption, placenta previa, fetal mortality, and stillbirth, as well as preterm birth and low birth weight infants Smoking-related effects on neonates include sudden infant death syndrome and birth malformations such as oral clefts and neural tube defects smoking effects on infants, children, and adolescents include asthma, cognitive impairment, lower respiratory illness, attention deficit hyperactivity disorder (ADHD), and central nervous system tumors Health problems associated with alcohol use disorder include increased risk for miscarriage, stillbirth, congenital anomalies, low birth weight, small for gestational age, and preterm delivery

risk of using cannabis during the perinatal period including preterm labor, low birth weight and small for gestational age deliveries, and adverse effects on fetal and adolescent brain growth, executive functioning skills, behavioral problems, and academic achievement Cocaine use during pregnancy is linked with poor pregnancy-related outcomes including premature rupture of membranes, placental abruption, preterm birth, low birth weight, and small for gestational age deliveries, as well as long-term effects in children and adolescents including lower short- term memory, child and adolescent delinquent behavior, earlier age of sexual activity, and substance use complications of opioid use during the perinatal period eclampsia, heart attack or heart failure, and sepsis. Infants experience significant adverse effects, including neonatal abstinence syndrome, third trimester bleeding and mortality, postnatal growth deficiency, microcephaly, neurobehavioral problems, and sudden infant death syndrome includes policies, regulations, or laws that intentionally or unintentionally lead to discrimination structural stigma an example of structural stigma MAT encompasses the attitudes, beliefs, and behaviors of groups or individuals which form a stereotype that creates an emotional reaction or prejudice and results in discrimination. public stigma refers to the shame individuals internalize about negative stereotypes, may prevent themselves from seeking help self-stigma only validated behavioral health screening instrument designed specifically for pregnant women. It screens for alcohol, tobacco, marijuana, and illicit drug use. In addition, validated screening questions for depression and domestic violence can be included. The 4Ps Plus validated for use with adults to generate a risk level for each substance class. It can be self-administered or conducted via clinician interview and combines screening and brief assessment of past 90-day problematic use into one tool Tobacco, Alcohol, Prescription medication, and other Substance Use (TAPS) Tool assess substance use disorder risks among adolescents 12-17 years old. NIDAMED's Screening Tools for Adolescent Substance Use

when is inpatient treatment recommended for alcohol use disorder in pregnant women? for clients at risk for moderate, severe, or complicated alcohol withdrawal as indicated by a score of more than 10 on the CIWA meds for tobacco use disorder that are safe in pregnancy nicotine replacement therapy (NRT), bupropion, or a combination why use IR over ER in pregnancy an help minimize infant exposure during pregnancy and breastfeeding. OUD meds that are safe during pregnancy methadone and buprenorphine OUD meds that are safe during breastfeeding methadone, buprenorphine, and naltrexone neurological condition characterized by persistent, uncontrollable worrying that causes emotional distress + symptoms on most days, for a period of at least six months. GAD mood disorder characterized by depressive symptoms that last longer than two weeks + 5 or more of the following: irritable mood, diminished interest in activities, significant weight or appetite changes, fatigue, feelings of worthlessness, sleep disturbances, and the diminished ability to concentrate MDD Untreated MMHDs can have long-term negative impact on mother including Have poor nutrition Use substances such as alcohol, tobacco, or drugs Experience physical, emotional, or sexual abuse Be less responsive to baby's cues Have fewer positive interactions with baby Experience breastfeeding challenges Question their competence as mothers Untreated MMHDs can have long-term negative impact on the child including Low birth weight or small head size Pre-term birth Longer stay in the NICU Excessive crying Impaired parent-child interactions Social-emotional, cognitive, language, motor, and adaptive behavior development Adverse Childhood Experience

Risk Factors for MMHDs Smoking Lack of social support Poor relationship quality Pregnancy complications Personal or family history of depression History of physical or sexual abuse Unintended pregnancy Life stress Chronic physical conditions Prior pregnancy with fetal/infant loss History of mental illness pathophysiology of the baby blues The abrupt change in hormones that occurs when the placenta is delivered may contribute to the development of symptoms and may be exacerbated by fatigue, pain, overstimulation, lack of support, or insecurity baby blues symptoms Poor concentration Moody Feeling sad Fatigue Easily angered Insomnia Anxiety Crying without reason Poor concentration baby blues causes Drastic hormonal changes Fatigue after giving birth and breastfeeding Sudden changes in routine caring for baby Lack of support from partner or family Transition to being a mother the most common maternal mood disorder depression when can the specifier "with peripartum onset" be applied can be applied to depressive disorders if the onset of mood symptoms occurs during pregnancy or in the four weeks following childbirth. criteria for perinatal psychosis as a "brief psychotic disorder with peripartum onset"

when symptoms present suddenly during pregnancy or within the first 4 weeks after birth and last at least one day but no more than one month. who has the highest risk of a postpartum psychotic episode preexisting bipolar disorder Current recommendations from the American College of Obstetricians and Gynecologists (ACOG) include screening how often? at least once during the perinatal period using a validated instrument, increasing the frequency of visits when symptoms are identified, and referring clients for appropriate pharmacotherapy and psychotherapy treatments The American Academy of Pediatrics (AAP) recommends incorporating the Edinburgh Postnatal Depression Scale (EPDS) how often into infants' 1, 2, 4, and 6-month well check visits using a cutoff score of 10 as an indicator that maternal depression may be present what must be ruled out before starting SSRIs for perinatal depression bipolar II Medications for perinatal bipolar disorder lithium, lamotrigine First line therapy for perinatal PTSD first line= psychotherapy SSRIs may be used for comorbid depression screening tool used for bipolar disorder MDQ Screening tool used for depression PHQ- tool used to monitor symptoms of bipolar disorder after diagnosis young mania rating scale tool used to assess clients who present with symptoms of psychosis brief psychiatric rating scale how can maternal depression and anxiety can impact fetal development in utero increase the risk for preterm birth and low birth weight, and lead to an insecure attachment between the mother and infant as well as suboptimal breastfeeding practices Diagnostic criteria for GAD in children and teens

only one physical or cognitive symptom is required for diagnosis whereas three symptoms are required for adult diagnosis Screen for Child Anxiety Related Disorders (SCARED) tool Child Version enables providers to screen for several types of anxiety disorders, including generalized anxiety, panic disorder, separation anxiety, and social anxiety. A total score of ___ or more points on the SCARED scale indicates a potential anxiety disorder 25 To meet diagnostic criteria for OCD, the obsessions and compulsions must be time-consuming (>1 hour per day) and disrupt normal routines, functioning, or relationships. PANDAS pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections lab test to detect PANDAS Cunningham panel First-line treatment for mild to moderate OCD CBT which includes exposure and response prevention If symptoms persist after two or more trials of an SSRI or clomipramine and failure to respond to CBT, treatment may be augmented with an atypical antispcyhotic Body dysmorphic disorder (BDD) type of obsessive-compulsive disorder in which an individual becomes preoccupied with one or more perceived flaws in physical appearance that are not visible or appear slight to others screening tools for use with clients who may have BDD Body Dysmorphic Disorder Questionnaire (BDDQ) The BDD Yale-Brown Obsessive Compulsive Scale for Adolescents (BDD-YBOCS-A) scoring for BDD-YBOCS-A Scores range from 0-to 48. Scores above 20 indicate the presence of BDD. The higher the score, the more severe the disorder screening tool that provides different scoring thresholds to screen for mild, moderate, or moderately severe depression GLAD-PC SSRI acute phase of treatment goals

Aim is to achieve a significant reduction or disappearance of symptoms for 8-12 weeks. SSRI continuation phase of treatment goals Aim is to consolidate treatment gains and prevent relapse for 6 to 12 months SSRI maintenance phase of treatment goals Aim is to prevent relapse by continuing treatment for those with recurrent, severe, or chronic depression. _______ is a possible late-onset side effect in clients who take antidepressant medication emotional disinhibition presentation differences of children vs adults with BiPD Children typically experience more rapidly cycling moods and mixed episodes characterized by symptoms of both mania and depression together validated tool used for dx BiPD Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children interview tool Atypical antipsychotic medications labs CBC (every 3 months for 1 year and then annually)

HbA1C (every 3 months for 1 year and then annually) 50% of children age 8-15 experiencing a MH condition do not receive treatment 13-20% of children (1 of 5) experience a MH condition in a given year 13% of children 8-15 years old experience a MH condition 17% of HS students seriously consider suicide 14 years olds age at which 1/2 of all lifetime cases of mental illness begin 1 in 5 women will suffer from a maternal MH d/o like postpartum depression Less than 15% of women with a maternal MH d/o

receive treatment 1 in 7 women with a maternal MH d/o experience depression during pregnancy Up to 50% of women who live in poverty will suffer from a maternal MH d/o More than 600,000 US women will suffer from a maternal MH d/o every year Anxiety and depression have risen in teen girls by 37%, which will increase the number of women suffering with postpartum depression weathering cumulative effects of stress Depression rates in Black moms are more than doubled d/t weathering Nearly 50% of pregnancies are unplanned 6-12 months time during which PMHNP should work with woman to adjust MH medication in anticipation of planned pregnancy SSRIs and SNRIs during pregnancy rare adverse effect of persistent pulmonary hypertension in the neonate

common adverse effect of postnatal abstinence syndrome 9impacts up to 30% of babies born to mothers who take antidepressant medication. Symptoms include tremors, high-pitched crying, and disturbed sleep. Incidence of symptoms typically peaks between 2-4 days after birth. There is no evidence that discontinuing or tapering dosages in the last trimester reduces the risk to the infant. Paroxetine may increase the risk of atrial septal defects.) mood stabilizers during pregnancy Discontinuation of medications for pregnancy is associated with a relapse rate of 80-100% Benzodiazepines during pregnancy may be taken with caution for anxiety during pregnancy; however, a risk of newborn toxicity must be considered and monitored if used. Symptoms include sedation, floppy muscle tone, and potential breathing issues at birth

Lithium during pregnancy exposure during the first trimester has a small but statistically significant risk of cardiac malformations. The development of the heart begins as early as the third week of gestation with the 4-chamber fetal heart formed by gestational week 7 2nd generation antipsychotics during pregnancy neonatal withdrawal syndrome can occur in newborns. The infant may need a few days of additional monitoring after delivery, but the client should remain on her optimized dose. Lamotrigine during pregnancy is considered safe during pregnancy but may not be effective for manic episodes. Lithium exposure during the first trimester has a small but statistically significant risk of cardiac malformations, which increases with higher doses of the medication valproic acid and carbamazepine are considered teratogenic and should be avoided during pregnancy. Safe for Breastfeeding -SSRIs

-benzodiazepines

-valproic acid (infant serum drug levels must be monitored)

-quetiapine

-olanzapine -risperidone Safe for Bottle Feeding -lithium (serum levels must be monitored and the infant should be observed for signs of toxicity including cyanosis and hypotonia)

-lamotrigine (maternal levels of lamotrigine increase after delivery which increases exposure to infant through breast milk)

-clozapine (due to the increased risk of adverse effects, including neutropenia, breastfeeding may not be recommended for clients who must take clozapine. If the client chooses to breastfeed, monitoring of white blood counts is required) FASD fetal alcohol spectrum disorders

Up to 1 in 20 US school children may have FASDs.

Physical issues (low birth weight and growth; problems with heart, kidneys, and other organs; damage to parts of the brain)

Behavioral and intellectual disabilities (learning disabilities and low IQ; hyperactivity; difficulty with attention; poor ability to communicate in social situations; poor reasoning and judgment skills) which can lead to: -Lifelong issues with -school and social skills -living independently -mental health -substance use -keeping a job -trouble with the law alcohol-related pregnancy complications miscarriage, stillbirth, congenital anomalies(heart, kidneys, brain, other organs), low birth weight, small for gestational age, and preterm delivery, FASDs, neurodevelopmental and central nervous system deficits, speech and language challenges, cognitive and behavioral deficits, impaired executive functioning, and psychosocial difficulties in adulthood

Drinking while pregnant costs the US $5.5 billion Cannabis-related pregnancy complications preterm labor, low birth weight and small for gestational age deliveries, and adverse effects on fetal and adolescent brain growth, executive functioning skills, behavioral problems, and academic achievement

Disruption of brain development before birth Smaller size at birth; higher risk of still birth

Higher chance of being born too early, especially when a woman uses both marijuana and cigarettes during pregnancy

Harm from second-hand marijuana smoke: Behavioral problems in childhood and trouble paying attention in school Smoking-related pregnancy complications ectopic pregnancy, placental abruption, placenta previa, fetal mortality, and stillbirth, as well as preterm birth and low birth weight infants (Avşar et al., 2021). Smoking-related effects on neonates include sudden infant death syndrome and birth malformations such as oral clefts and neural tube defects, whereas effects on infants, children, and adolescents include asthma, cognitive impairment, lower respiratory illness, attention deficit hyperactivity disorder (ADHD), and central nervous system tumors Structural stigma (aka. institutional stigma)

includes policies, regulations, or laws that intentionally or unintentionally lead to discrimination. Structural stigma can limit access to resources and other opportunities, thereby impacting the well- being of the stigmatized group. A program policy that prohibits individuals from using specific forms of prescribed medication for addiction (MAT) treatment is an example of structural stigma. Public stigma encompasses the attitudes, beliefs, and behaviors of groups or individuals which form a stereotype that creates an emotional reaction or prejudice and results in discrimination. A stereotypic belief that individuals choose to use alcohol or other drugs and blame them for their substance use disorder is an example of public stigma. Healthcare providers who have a conscious or unconscious bias against clients who use substances in the perinatal period may not provide appropriate care and treatment Self-stigma refers to the shame individuals internalize about negative stereotypes. For individuals affected by SUDs, self-stigma may lead to feelings of being flawed or unworthy of love or connection. It may also prevent them from seeking help intervention stigma "Individuals working in [medication-assisted treatment] MAT experience discrimination and prejudice from other healthcare professionals, especially abstinent treatment professionals who disagree with the use of medications to treat opioid use disorders. This discrimination and prejudice stem at times from stigma toward addiction diagnoses, and at other times toward unique features of MAT itself. cocaine-related pregnancy complications premature rupture of membranes, placental abruption, preterm birth, low birth weight, and small for gestational age deliveries, as well as long-term effects in children and adolescents including lower short- term memory, child and adolescent delinquent behavior, earlier age of sexual activity, and substance use opioid-related pregnancy complications Pregnant people with OUD are at a greater risk of eclampsia, heart attack or heart failure, and sepsis. Infants experience significant adverse effects, including neonatal abstinence syndrome (NAS) caused by maternal opioid use. NAS affects between 45% to 94% of infants exposed to opioids in utero and has accounted for $3 billion in hospital costs over the last decade (Prince & Ayers, 2022). Other opioid- related health outcomes include an increased risk of toxemia, low birth weight, respiratory complications, third trimester bleeding and mortality, postnatal growth deficiency, microcephaly, neurobehavioral problems, and sudden infant death syndrome (SIDS). Generalized anxiety disorder (anxiety) a neurological condition characterized by persistent, uncontrollable worrying that causes emotional distress. Patients with diagnosed anxiety show symptoms on most days, for a period of at least six months.

In addition to worrying, common symptoms of anxiety include restlessness, irritability, muscle tension, fatigue, and sleep disturbances. Patients with anxiety disorders often show increased activity in the amygdala and prefrontal cortex. Positron emission tomography (PET) scans have also shown reduced serotonin binding in patients with anxiety. Risk factors for developing anxiety include genetic predisposition (family history of anxiety), being female, recent life stressors, chronic physical illness, and lack of support during childhood psychosis Symptoms: Hallucinations: perceptual experiences in the absence of external stimuli Delusions: fixed false, irrational beliefs. Thought Disorder: impairment in the process of thinking and difficulty organizing thoughts in a logical pattern. Disorganized Behavior: disordered or impaired behavior or communication Depression Depression is a mood disorder characterized by depressive symptoms that last longer than two weeks. Depressive symptoms include depressed or irritable mood, diminished interest in activities, significant weight or appetite changes, fatigue, feelings of worthlessness, sleep disturbances, and the diminished ability to concentrate. Though the exact cause is unknown, depression can be influenced by genetic and environmental factors. Stressful life events, such as giving birth or experiencing emotional trauma, can also impact the development of depression. Recent research has tied depression to decreased activity of the prefrontal cortex. The prefrontal cortex controls attention, memory, mood, and personality. Depression is also linked to neurotransmitter imbalances. Neurotransmitters are chemicals that control the actions of neurons (nerve cells). An imbalance of specific neurotransmitters can influence the activity of the brain, leading to changes in brain function. MDD

Depression Medications

SSRIs:

• Action: inhibits reuptake of serotonin
• Common ADEs: N, agitation, headache, sexual dysfxn

SNRIs:

• Action: inhibits reuptake of serotonin and NE
• Common ADEs: N, sweating, insomnia, tremors, sexual dysfxn

TCAs (eg amitriptyline, clomipramine, desipramine, doxepin):

• Action: inhibits reuptake of serotonin; blocks receptors (NE, histamine ACh
• Common ADEs: dry mouth, C, blurred vision, urinary retention, sedation, wt gain, hypotension, tachycardia, sexual dysfxn

Monoamine Oxidase Inhibitors (MAOIs): Action: increases norepinephrine and serotonin by inhibiting the enzyme that inactivates it Examples: isocarboxazid, phenelzine, tranylcypromine Common Side Effects: sedation, dizziness, sexual dysfunction, and hypertensive crisis Lithium labs serum lithium level (5 days after any dosage change and regularly at 6-month intervals)

renal function (every 6 months)

thyroid function (every 6 months) Valproic acid (Depakote) labs serum valproate level

LFTs (every 3 months for 1 year and then annually)

CBC (every 3 months for 1 year and then annually) Carbamazepine labs serum carbamazepine level

renal function (every 3 months for 1 year and then annually)

LFTs (every 3 months for 1 year and then annually)

CBC (every 3 months for 1 year and then annually) lithium Action: alters cation transport in the nerve and muscle

Indication: euphoric mania, rapid cycling, maintenance therapy

Adverse Effects: gastrointestinal (GI) effects, tremor, polyuria

Monitor plasma levels. Reduce dose in clients with renal failure. Use caution with concurrent diuretics. Use to protect against suicide. lamotrigine (Lamictal) Action: affects sodium channel ion transport and enhances the activity of y-aminobutyric acid (GABA)

Indication: maintenance therapy, monotherapy for bipolar disorder

Adverse Effect: benign rash, GI effects, dizziness, headache

This drug is equal in efficacy to lithium. Educate clients and assess for rash at each visit. Ten percent of rashes are benign. There is a risk for rare Stevens-Johnson Syndrome rash and multi-organ failure. Take at bedtime due to sedation side effect. valproic acid (Depakene) Action: affects ion transport and enhances the activity of y-aminobutyric acid (GABA)

Indication: acute mania, mixed mood, comorbid substance use, multiple prior episodes

Adverse Effect: GI effects, weight gain

This drug is equal to lithium. Monitor plasma levels. If using with lamotrigine decrease valporate levels by 50%. Second generation antipsychotics: aripiprazole (Abilify) cariprazine (Vraylar) lurasidone (Latuda) quetiapine (Seroquel) asenapine (Saphris) risperidone (Risperdol) olanzapine (Zyprexa) ziprazadone (Geodon)

Action: DA, NE, and 5-HT receptor antagonists

Indication: acute bipolar depression, acute manic or mixed episodes, bipolar maintenance/adjunct

Adverse Effect: weight gain, sedation, GI effects

Indications vary with each medication. Check for monotherapy vs. adjunct indication. Monitor for extrapyramidal effects. extended release (XR) form may improve adherence. Monthly injection may improve adherence. Select second generation antipsychotics first to decrease risk of side effects and long-term adverse effects. carbemazepine (Tegretol) Action: glutamate voltage gated sodium and calcium channel blocker (Glu-CB

Indication: acute mania, mixed mood

Adverse Effect: GI effects, sedation, hyponatremia, neutropenia, rash (Stevens-Johnson Syndrome)

Monitor plasma levels. Consider genotyping clients with Asian ancestry; the HLA-B 2501 allele increases risk of Steven-Johnson Syndrome. Sensorimotor 0-2 years of age Cognitive abilities are based on reflexes; children master object permanence and causality. Preoperational 2-7 years of age Child can use mental representations, symbolic thought, and language; thinking is egocentric. Concrete Operational 7-11 years of age Child uses logical operations when thinking and solving problems; thinking is concrete. Formal Operational 12 years and older Adolescent can use abstract reasoning in addition to logical operations; Child can understand theories, hypothesize, and comprehend abstract ideas such as love and justice. MAT Medications for Substance Use Disorders

SBIRT (Screening, Brief Intervention, and Referral to Treatment) Screening Quickly assesses the severity of substance use and identifies the appropriate level of treatment.

Brief intervention Focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.

Referral Guidance to treatment provides those identified as needing more extensive treatment with access to specialty care. Barriers to Treatment Many parents report a lack of sufficient information or access to services (Hansen et al., 2021).

Parents and adolescents may be reluctant to seek help due to stigmas or negative perceptions towards mental health services (Aguirre Velasco et al., 2020).

Although some children and adolescents receive treatment, many drop out before receiving effective treatment, often due to poverty, language barriers, living in communities with scarce resources, and stressors such as problems in the family, violence in the community, unstable housing, unemployment, and food insecurity.

Cost, scheduling conflicts, long waitlists for services, and high staff turnover also create impediments for families seeking care. Privacy and HIPAA

depression and anxiety during pregnancy Selective serotonin reuptake inhibitors (SSRIs) are first-line treatments for depression and anxiety during pregnancy. Selective norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and bupropion are also considered safe treatment options. The most common adverse effect associated with SSRIs and SNRIs is neonatal withdrawal syndrome, which impacts up to 30% of babies born to mothers who take antidepressant medication. Symptoms include tremors, high-pitched crying, and disturbed sleep. Incidence of symptoms typically peaks between 2-4 days after birth (Corrêa et al., 2021). There is no evidence that discontinuing or tapering dosages in the last trimester reduces the risk to the infant. Paroxetine may increase the risk of atrial septal defects.

Benzodiazepines may be taken with caution for anxiety during pregnancy; however, a risk of newborn toxicity must be considered and monitored if used. Symptoms include sedation, floppy muscle tone, and potential breathing issues at birth bipolar d/o during pregnancy Lamotrigine is considered safe during pregnancy but may not be effective for manic episodes. Lithium exposure during the first trimester has a small but statistically significant risk of cardiac malformations, which increases with higher doses of the medication (Nonacs, 2021b). The risks and benefits of lithium treatment must be carefully considered with the client when prescribing this medication. Consider the gestational age of the embryo and fetus when discussing risks and benefits. Knowing fetal development and risks, in this case cardia formation and the client's current gestational age is important information when counseling. If the valproic acid and carbamazepine are considered teratogenic and should be avoided during pregnancy. psychosis during pregnancy Women who take atypical antipsychotic medications, particularly olanzapine and quetiapine, during pregnancy are at increased risk of gestational diabetes and large for gestational age infants in (Wang et al., 2021). Discontinuing treatment may not decrease the risk of developing gestational diabetes. Olanzapine has also been found to increase the risk of musculoskeletal malformations in infants (Ellfolk et al., 2021). Risperidone and quetiapine are the most used antipsychotics during pregnancy. Neither medication appears to cause malformations. Antipsychotic medications may cause neonatal withdrawal symptoms; close monitoring of the newborn may be indicated for several days after delivery. State Policies on substance use during pregnancy may involve: authorizing civil commitment criminalizing the behavior as child abuse or neglect requiring providers to notify child protective services when an infant is affected by illegal substance abuse requiring providers to report or test for prenatal drug exposure, which is permissible evidence in child- welfare proceedings In 2023 , the Guttmacher Institute reported: 24 states and the District of Columbia consider prenatal substance use to be child abuse 3 states and the District of Columbia consider it grounds for civil commitment 25 states and the District of Columbia mandate provider reporting of suspected prenatal drug use 8 states require providers to test for prenatal drug exposure if drug use is suspected 19 states have created or funded drug treatment programs specifically for pregnant people 10 states prohibit publicly funded drug treatment programs from discriminating against pregnant people Punitive Policies Of pregnant women who were anonymously tested for drug use, the prevalence of use was found to be similar between Black and White women, but Black women were 10 times more likely to be reported to law enforcement.

Indigenous women suffer from higher SUD rates compared to other racial and ethnic groups and are disproportionately affected by criminalization laws at the federal, state, and tribal levels.

Consistent use of medication for OUD treatment during pregnancy is significantly lower for women of color. 4P’s Plus the only validated behavioral health screening instrument designed specifically for pregnant women. It screens for alcohol, tobacco, marijuana, and illicit drug use. In addition, validated screening questions for depression and domestic violence can be included. AUD tx No use of alcohol during pregnancy is considered safe. The PMHNP should advise pregnant clients who use alcohol to abstain or minimize use during pregnancy and breastfeeding. Behavioral therapy and harm reduction counseling may assist clients to discontinue or decrease alcohol use. Although acamprosate and naltrexone are commonly used in medication-assisted treatment (MAT) in nonpregnant adults, little information is available from well-controlled studies on safe use during pregnancy. Inpatient treatment is recommended for clients at risk for moderate, severe, or complicated alcohol withdrawal as indicated by a score of more than 10 on the Clinical Institute Withdrawal Assessment of Alcohol ScaleLinks to an external site., Tobacco Use d/o tx The PMHNP should advise clients to discontinue tobacco use during pregnancy and may perform or refer clients for psychotherapy and support. After reviewing the risks and benefits with the client, nicotine replacement therapy (NRT), bupropion, or a combination of these interventions may be initiated (Ramsey et al., 2021). Higher doses of NRT may be required in pregnant clients due to the metabolic changes of pregnancy. Use of immediate-release preparations of NRT such as gum or an inhaler rather than a slow-release preparation can help minimize infant exposure during pregnancy and breastfeeding. Evidence to support the efficacy of NRT and bupropion during pregnancy is mixed, and bupropion exposure in the fetal period is associated with slightly elevated rates of congenital heart defects through the overall number remains low. Insufficient evidence exists for the use of varenicline during pregnancy. Although animal data suggests that nicotine exposure during breastfeeding could interfere with lung development or present a risk of sudden infant death syndrome (SIDS), risks are not well-established. Bupropion may offer a better option OUD tx Clients should be advised to avoid the abrupt discontinuation of opioid use as opioid withdrawal during pregnancy can risk harm to both the mother and infant. Methadone and buprenorphine are the most prescribed MAT for OUD in pregnancy. Dosing may be increased during the second and third trimesters due to increased blood volume and metabolism. Naltrexone is not usually recommended for use during pregnancy due to concerns about detoxification and an uncertain safety profile in pregnancy (Savard et al., 2022). Clients who initiate treatment during pregnancy or who become pregnant while using MAT should continue treatment through pregnancy, labor, delivery, and the postpartum period. The use of methadone, buprenorphine, and naltrexone are considered safe during breastfeeding

Baby Blues For the first few days following childbirth, between 50-80% of new mothers will experience a period of adjustment may cause temporary mood swings, tearfulness, and irritability. Additional symptoms include anxiety, decreased appetite, difficulty sleeping, worrying, and physical or emotional exhaustion. Typically, symptoms resolve within a few days to a few weeks and do not significantly impair maternal function. Good self-care, emotional support, and reassurance from friends and family can help manage symptoms. Symptoms Poor concentration Moody Feeling sad Fatigue Easily angered Insomnia Anxiety Crying without reason Poor concentration Causes Drastic hormonal changes Fatigue after giving birth and breastfeeding Sudden changes in routine caring for baby Lack of support from partner or family Transition to being a mother Self-care during the Baby Blues Ask for help Rest often Sleep when possible Stay active Eat well

Self care Get social support Body dysmorphic disorder (BDD) a type of obsessive-compulsive disorder in which an individual becomes preoccupied with one or more perceived flaws in physical appearance that are not visible or appear slight to others (APA, 2022). BDD typically begins in adolescence and can be particularly debilitating, causing clinically significant distress or impairment in functioning. Individuals with BDD engage in repetitive behaviors such as checking mirrors, excessive grooming, picking, or seeking reassurance. Hospitalization may be indicated for clients with severe BDD.

CBT has been found to be an effective treatment for adolescents with BDD, both in reducing symptoms and improving mood and quality of life (Jassi & Krebs, 2021). CBT may be used alone or in combination with medication, typically an SSRI. BDD Yale-Brown Obsessive Compulsive Scale for Adolescents (BDD-YBOCS-A) is used to help clinicians determine the severity of the Body dysmorphic disorder (BDD). Scores range from 0-to 48 Autism Spectrum Disorder (ASD) Therapy Applied behavior analysis (ABA) therapy.: Enhances new skill development through rewards-based motivational systems Speech and language therapy.: Improves understanding and use of speech and language Occupational therapy.: Improves life skills and uses sensory integration to improve responses to sensory input Physical therapy: Improves gross motor skills Parent training.: Provides educational resources, coping strategies, and communication skills for parents of children with ASD Dietary therapy.: Helps develop positive, healthy food habits in children and youth who may have aversions to certain foods or textures Social skills training: Improves social skills including conversation, being a good sport, and managing teasing from other children Autism Spectrum Disorder (ASD) medications guanfacine Alpha-agonist medications, such as guanfacine or clonidine, may be used for clients with ASD who have hyperactivity, impulsive behaviors, and sleep problems. aripiprazole Second-generation antipsychotic medications may be used for clients with ASD who have aggressive behaviors, tantrums, sleep disorders, or motor tics.