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NRNP 6660 MIDTERM EXAM STUDY
GUIDE
Agreement as to process - Correct answer 1. introduction
- consent to proceed
- nature of interaction
- amount of time for the interview
- assess if treatment is voluntary or involuntary Define privacy and confidentiality - Correct answer 1. Assure privacy, explain meaning of confidentiality and who information will be shared with
- explain duty to warn
- fee family members with the patient present, ensure consent is given (provider should listen not present information.
- If recordings or one way mirrors are used patient must be informed and give consent. Define respect and consideration - Correct answer Treatment patients with respect and be considerate to circumstance to alleve or not further aggravate anxiety Define Rapport - Correct answer Harmonious responsiveness of the provider to the patient. Empathic interventions increase rapport to understand patient feelings while maintaining objectivity mostly nonverbal (putting pen down or leaning towards patient) What is a crucial element of empathy - Correct answer Objectivity as it differentiates empathy from identification. Identification causes lose of objectivity and blurs boundaries. What are the ingredients for good patient provider relationship - Correct answer 1. Desire for help
- Providers respect and consideration
- non-judgmental attitude
- demonstration by provider they understand what patient is stating or emoting
- patient thinks provider cares
- genuiness of provider. What questions about self should the provider answer - Correct answer 1. Provider qualifications, if sarcastic address issue that provoked it.
- No personal information directly unless it is patient centered, NO physician centered information. Define unconscious transference in a patient - Correct answer The process of a patient unconsciously and inappropriately displacing onto individual in patients current life those patteren of behavior and emotional reactions that originated with significant figures usually from childhood. What is unconscious counter-transference - Correct answer The provider unconsciously displaces onto the patient patterns of behavior or emotions as if they were a significant figure from earlier in the providers life. What are resistances - Correct answer The processes conscious or unconscious that interfere with the therapeutic objectives of treatment What is repression, and how do interpretations help? - Correct answer Repression causes unawareness, interpretations are interventions that undo the processes of repression and allow the unconscious thought and feelings that come to awareness. What does a patient centered interview? - Correct answer Focus of interview is on understanding the patient and enabling the patient to tell his or her story, the individuality of the patients experience is the main theme What information according to Adolf Meyer is collected in the interview - Correct answer 1. early life experiences
- family
- education
- occupation
- religious beliefs
- hobbies/talents
- relationships
- losses. What type of questions are asked in a patient centered approach. - Correct answer Focuses on strengths and weaknesses.
What is completed in the waiting room - Correct answer demographic and insurance forms information given on practice contact for after hours HIPAA mandated information. list of medications requested name and address of primary care identification of major medical problems and allergies. major reason for the visit. rating scales PHQ-9, or QIDS-SR How should the interview room be set up. - Correct answer 1. choice of hardback or soft chair
- interviewer and patient chairs should be equal in height.
- patient and psychiatrist should be seated 5-6 feet apart.
- provider should not be behind a desk.
- provider should be dressed professionally and be well groomed.
- distractions should be kept to a minimum How do you initiate the interview. - Correct answer 1. greet patient in waiting room
- introduce self
- extend hand and see if patient shakes it if not may be important.
- indicate way to waiting room 5 in interview room offer to hang coat up
- indicate where patient can sit.
- ask what the patient prefers to be called.
- indicate how much time is alloted for the interview
- explain process, confidentiality 10 begin inquiry with open ended questions
- if referred elicit the patients understanding of why they are being referred. What are open ended question used for in the initial interview. - Correct answer allows the patient to telol his or her story which is the primary goal of the data collection to elicit the patients story of their health and illness. Does open ended questions provide structure - Correct answer NO, they identify an area but provide minimal structure as to how to respond.
does close ended questions provide structure - Correct answer YES, provides much structure and narrows the field from which a response may be chosen. the ultimate closed ended question leads to a yes or no answer. and can be used to understand some of the specifics of the patients history. What are the parts of the psychiatric interview - Correct answer 1. identifying data
- source and reliability
- chief complaint
- present illness
- past psychiatric history
- substance use abuse
- past medical history
- family history
- developmental and social history
- review of systems
- mental status examination
- physical examination
- formulation
- DSM-5 diagnosis
- treatment plan. What are the 2 overarching elements of the psychiatric interview - Correct answer patient history and mental status examination. Identifying Data includes - Correct answer 1. patients name
- pts. age
- pts. sex
- pts marital status/SO
- race
- ethnicity
- occupation Source and reliability includes - Correct answer Important to clarify where the information has come from especially if others have provided information or records reviewed and the interviewers assessment of how reliable the data is.
appetite psychomotor agitation/slowing suicidality What questions do you ask in the psychiatric interview for anxiety - Correct answer 1. Generalized anxiety symptoms (where when who how long, how frequent)
- panic disorders symptoms: HOw long until peak somatic symptoms including racing heart sweating shortness of breath trouble swallowing sense of doom fear of recurrence agoraphobia
- obsessive-compulsive symptoms: checking cleaning organizing rituals, hang-ups, obsessive thinking, counting, rational vs. irrational beliefs
- posttraumatic stress disorder: Nightmares, flashbacks, startle repsonse, avoidance,
- social anxiety symptoms
- simple phobias, heigts, planes spiders etc. What questions do you ask in the psychiatric interview ofr psychosis - Correct answer Hallucinations: auditory visual olfactory tactile paranoia delusions: TV, radio, thought broadcasting, mind control refernetial thinking patients perceptions: spiritual or cultural context of symptoms relaity testing. What other questions should be ask in the psychiatric interview - Correct answer ADHD symptoms Eating disorder ymptoms: binging purging excessive exercising. what is included in the psychiatric history - Correct answer all psychiatric illnesses over lifetime including symptoms and treatment any comorbid conditions description of past s/s inclding when they occured how long they lassted and frequency and severity What is included in past treatment of episodes. - Correct answer outpatient treatment psychotherapy day treatment partial hospitalization inpatient treatment
voluntary or involuntary admissions what precipitated the need for the highter level of care support groups vocational training medication electroconvulsive therapy light therapy alternative treatments what questions should be ask about prior medications - Correct answer how long what doses- to establish adequacy of the trialis why stopped response side effects was there compliance What is included in the lethality history - Correct answer past suicidal ideation, intent, plan attempts- nature perceived lethality , save potential, suicide notes, giving away things or death preparations. what is included in violence and homicidality hisotry - Correct answer 1. domestic violence violent actions or intent legal complications, outcome of the victiom what is included in the hisotory of nonsuicidal self injurious behavior. - Correct answer cutting burning banging head biting oneself feelings include relief of distress that acoompany or follow behavior degree gone to to hide evidence of these behbaviors. What information is gathered in the substance abuse section - Correct answer what substances (prescribed or not) route of use, frequency and amount (pts minimize) tolerance understanding of volume
both past and present. past surgery How is the PMH important. - Correct answer understanding patients reaction to illnesses, coping skills employed. important consideration when determining potential causes of mental illness as well as comorbid or confounding factors and may dictate potential treatment options or limitations. what affects can medical illnessess have on psychiatric disorders - Correct answer medical illnesses can precipitate a psychiatric disorder mimic a psychiatric disorder (hyperthyroid) be precipitated by a psychiatric diorder or treatment (metabolic syndrom) and influence the choice of treatment (hepatic disease) What neurological issues should be revied in the PMH - Correct answer seizures, head injury pain disorders Where does prenatal, birth, or developmental issues go in the Psych assess. - Correct answer PMH Were should the assess of menstual cycle, reproductive history, or preganancy plans be placed. - Correct answer PMH Where are current medications charted - Correct answer PMH Where are allergies charted - Correct answer PMH Why is the family history important - Correct answer many psychiatric illnesses, and responses to medication can be familial. fomation of psychoscial background What is charted in the family history - Correct answer psychiatric dianoses, medicxations hospitalizations, substance use disorders lethality of suicide attempts medical illnesses family traditions beliefs
expectations role in family What does the developmental and socual hisotry cover. - Correct answer reviews the stages of the patients life why is the dev/social hx important - Correct answer tool in determining the context of psychiatric symptoms and illnesses and may identify some of the major factors in the evolution of disorder. how should the deve/social hx be obtained - Correct answer chronologically what information is covered in the deve./social hx - Correct answer prenatal/birth hx developmental milestones childhood history including home environment members of the family social environmnet including the number and quality of friendships detailed school history how far education went special education circumstances learning disorders bheaivoral problems at school academic performance extracurricular activities physical or sexualo abuse work hixoty including jobs, performance, reasons for changing jobs, current work status relationships with supervisors or coworkers income financial issues insurance including pharmacy military history including rank achieved, combat exposure disciplinary actions discharge status marriage/relationships sexual preference current family structure interpersonal relationships legal history hobbies, interests, pets leisure activities cultural and religious influences practices.
What are important s/s covered in the ROS - Correct answer neurological and systemic symptoms such as fatigue or weakness illnesses that may be contributing to present complaints or influence the choice of therapuetic agents(endocrine, hepatic renal disorders) ROS is organzied by the major systems of the body. What is the MSE - Correct answer the psychiatric equivalent of the physical examination. explores all the areas of mental functioning and denotes evidence of s/s of mental illness. information is gathered throughout interview. What are the parts of the MSE - Correct answer Appearance behavior motor activity Speech mood affect thought content thought process perceptual disturbances cognition abstract reasoning insight judgement physical exam how is appearnce important, what is charted. - Correct answer Is a general description of how the patient looks and acts during the interview includes: ⁍ clothing ⁍body jewelry ⁍distinguishing features ⁍disfigurations ⁍scars ⁍tattoos ⁍grooming/hygiene
why is patient behavior important what is charted. - Correct answer description of pts behavior includes a general statement about if the pt is exhibiting actue distress, and approach to interview. ⁍cooperative ⁍agitated ⁍disinhibited ⁍disinterested ⁍context is important in the consdieration of behavior. How is motor activity descibed. - Correct answer normal slowed (bradykinesia) agitatied (hyperkinesia) gait freedom of movement unusual or sustained postres pacing hand wringing tics jitteriness tremor restlessness lip/tongue smaking protursions tardive dyskinesia akathisia parkinsonian features How is speech described - Correct answer elements considered are fluency amount rate tone volume stuttering word finding difficulties paraphasic errors amount of speech refers to: normal increased decreased
What is compulsions - Correct answer repetitive, ritualized behaviors that patients feel complelled to perform to avoid an increase in anxiety or dreaded outcome. what are delusions - Correct answer false fixed ideas that are not shared by others and can be divided into bizarre and nonbizarre examples are grandiose, erotomanic, jealous, somatic, and persecutory suicidality and homicidality fall under the category of thought content. What is thought process - Correct answer describes how the thoughts are formulated organized and expressed normal thought process described as linear, organized, and goal directed. What is flight of ideas - Correct answer patient rapidly moves from one thought to another at a pace that is difficult for the listner to keep up with but ideas are logically connected what is circumstantial thought process - Correct answer pt overincludes details and material that is not directly relevant to the subject or an answer to the question but does eventually return to address the subject/question. What is a tangential thought process - Correct answer similar to circumstantial thought process but pt never returns to the original point or question. thoughts are seen as irrelevant and related in aminor and insignifiacant manner define loose thought or associations - Correct answer thought process that is diffcult or impossible to see the connections between the sequential content. Define preservation in thought process - Correct answer the tendency to focus on a specific idea or content without the ability to move on to other topics. Systematic errors are - Correct answer Caused by flaws in the hospital system What substance has been implicated in mood disorders with a seasonalo patter. - Correct answer Melatonin
If a patient receiving clozapine shows a WBC of 2,000per cc the clinician should - Correct answer Stop the administration of clozapine at once Somatizing patients can be difficult to treat because - Correct answer They may be reluctant to engage in self relection and psychological exploration Common pretreatment lithium tests include - Correct answer Serum electrolytes serum BUN ECG Pregnancy test The medical record is ac cessible to who - Correct answer the patient In a psychiatric interview of a violent patient what may be required - Correct answer patient may have to be medicated before taking history increased serum calcium has been associated with what mood disorder - Correct answer depression serum bicarbonate, and serum amylase may be elevated in patients with what disorder - Correct answer bulimia nervosa Serum bicarbonate may be decreased in patients with what dx - Correct answer panic disorder What polysomnography anbormalities are present in schizophrenia - Correct answer increased sleep latency Thyroid function test changes in hypothyroidism include3 - Correct answer serum protien bound iodine is decreased serum free thyroxine is decreased serum T3 uptake is decreased serum T3 concentration is decreased What is a patient's account of a medical history. - Correct answer Psychiatric history or anamnesis
-saphris - Correct answer atypical antipsychotic medication used to treat schizophrenia and acute mania associated with bipolar disorder. It was chemically derived via altering the chemical structure of the tetracyclic (atypical) antidepressant, acute treatment of adults with schizophrenia and acute treatment of manic or mixed episodes associated with bipolar I disorder with or without psychotic features in adults.Based on its exceptionally high, unequaled (among antipsychotics) affinity for the 5-HT2A, 5-HT2C, 5-HT6, and 5-HT receptors, and very high affinity for the α2 and H1 receptors, asenapine, given normal tolerability, should theoretically demonstrate among the highest improvements in the negative symptomology of schizophrenia adverse effects. Very common (>10% incidence) adverse effects include: Somnolence Common (1-10% incidence) Weight gain Increased appetite Extrapyramidal side effects (EPS; such as dystonia, akathisia, dyskinesia, muscle rigidity, parkinsonism) Sedation Dizziness Dysgeusia Oral hypoaesthesia Increased alanine aminotransferase Fatigue behaves as a partial agonist at the 5-HT1A receptors. Carbamezapine -tegratol - Correct answer used primarily in the treatment of epilepsy and neuropathic pain.[2] It is not effective for absence seizures or myoclonic seizures. It is used in schizophrenia along with other medications and as a second-line agent in bipolar disorder. Carbamazepine appears to work as well as phenytoin and valproate Common side effects include nausea and drowsiness.Serious side effects may include skin rashes, decreased bone marrow function, suicidal thoughts, or confusion It should not be used in those with a history of bone marrow problems. plasma half-life is about 30 hours when it is given as single dose, but it is a strong inducer of hepatic enzymes and the plasma half-life shortens to about 15 hours when it is given repeatedly. a sodium channel blocker. It binds preferentially to voltage-gated sodium channels in their inactive conformation, which prevents repetitive and
sustained firing of an action potential. Carbamazepine has effects on serotonin systems but the relevance to its antiseizure effects is uncertain. There is evidence that it is a serotonin releasing agent and possibly even a serotonin reuptake inhibitor iloperidone -fanapt - Correct answer treatment of schizophrenia Iloperidone is a monoamine directed towards acting upon and antagonizing specific neurotransmitters, particularly multiple dopamine and serotonin receptor subtypes. high affinity to serotonin 5HT2A , dopamine D2 and D3 and noradrenaline α1 receptors , moderate affinity for dopamine D4, serotonin 5HT6 5HT7, and low affinity for the serotonin 5HT1A dopamine D1 and histamine H1 receptors hypotension, dizziness, and somnolence were very common side effects ranging from mild to moderate in severity. A second study showed that co administration of food decreased the severity of these effects. This study also indicated that repeat administration of iloperidone could decrease the effects of hypotension lamotrigine -lamictal - Correct answer anticonvulsant medication used to treat epilepsy and bipolar disorder. For epilepsy, this includes focal seizures, tonic-clonic seizures, and seizures in Lennox-Gastaut syndrome. In bipolar disorder, it is used to treat acute episodes of depression, rapid cycling in bipolar type II, and prevent recurrence in bipolar type I. Common side effects include sleepiness, headache, vomiting, trouble with coordination, and rash.Serious side effects include lack of red blood cells, increased risk of suicide, Stevens-Johnson syndrome, and allergic reactions the sodium channel blocking class of antiepileptic drugs. This may suppress the release of glutamate and aspartate, two of the dominant excitatory neurotransmitters in the CNSIt antagonises the following receptors with the following IC50 values 5-HT3, IC50=18μM σ receptors, IC50=145μM a half-life of 29 hours and volume of distribution of 1.36 L/kg.Lamotrigine is rapidly and completely absorbed after oral administration. Its absolute bioavailability is 98% and its plasma Cmax occurs from 1.4 to 4.8 hours Lithium - Correct answer lithium salts, are primarily used as a psychiatric medication This includes the treatment of major depressive disorder that does not improve following the use of other antidepressants, and bipolar
