Mental Health Assessment Questionnaires and Substance Abuse Screening, Exams of Nursing

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Autosomal Dominant - ANSWER Genetic inheritance, is more rare (i.e. Huntington's Disease is present in more than one generation. Autosomal Recessive - ANSWER Expressed in one generation, inherited from Unaffected parent is more common. CAGE Questionnaire - ANSWER For substance abuse, Cut, Annoyed, Guilty, Eye opene r Suicidal Risk Assessment - ANSWER SLAP: Social support, Lethality, Access to means, Plan and previous attempts, & family history Suicidal Risk Assessment # ISPATHWARM - ANSWER ISPATHWARM: Ideation, Substance abuse, Purpose for living, Anxiety/agitation, Trapped feeling,

Hopelessness, Withdrawing from friends, Anger with rage, Reckless in behaviors, Mood changes Depression Assessment SIGECAPS - ANSWER SIGECAPS: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor retardation, Sociality Mania Assessment DIGFAST - ANSWER DIGFAST: Distractibility, Indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep deficit, Talkativeness Mental Status Exam Components (All Borderline Subjects Are Tough Troubled Characters) - ANSWER Appearance, Behavior, Speech, Affect, Thought Process, Thought Content, Cognitive Examination Hamilton Depression Rating (HDRS) for very severe depression - ANSWER more than 2 3 Hamilton Depression Rating (HDRS) for severe depression - ANSWER 19-

Hamilton Depression Rating (HDRS) for moderate depression - ANSWER 14- Hamilton Depression Rating (HDRS) for mild depression - ANSWER 8-13 Hamilton Depression Rating (HDRS) for no depression - ANSWER 0- Hamilton Anxiety Rating for moderate to severe anxiety - ANSWER 25- Hamilton Anxiety Rating for mild to moderate anxiety - ANSWER 18- Hamilton Anxiety Rating mild anxiety - ANSWER < General screening labs - ANSWER CBC, CChem, Thyroid, Hepatic, b12, foliate, drug levels Lithium labs - ANSWER evaluate thyroid function, check keratinize clearance regularly Depakote labs - ANSWER check hepatic function Olfactory Nerve (On) - ANSWER CN I: Sensory: (test by smell- coffee, tea, non-astringent smells) Optic Nerve

(Old) - ANSWER CN II: Sensory- visual acuity test (confrontation method to assess visual fields) Coulometer (Olympus) - ANSWER CN III: Motor- eye movement (follows penlight through six fields of gaze, test OD, OS individually) Trochlear Nerve (Towering) - ANSWER CN IV: Motor- eye movement (superior oblique-same test as coulometer) Trigeminal Nerve (Tops) - ANSWER CN V: Both- superficial and deep structures of head and face, mystification/corneal reflex (test by show teeth) Abduces Nerve (A) - ANSWER CN VI: Motor- specific eye movements (test same as coulometer) Facial Nerve (Fin) - ANSWER CN VII: Both- taste of anterior 2/3 of tongue, sensation in ear canal, facial movement (use salt/sugar for taste, evaluate corneal reflex, raise eyebrows, keep eyes closed, and resist attempt to open, puff cheeks) Acoustic Nerve

(And) - ANSWER CN VIII: Sensory- Hearing/tickling watch and whisper (tuning fork with Rinse- positive as normal, when air conduction persists twice as long as bone conduction) Glossopharyngeal Nerve (German) - ANSWER CN IX: Both- Swallow, taste of posterior 1/3 of tongue, pain, touch, and temp of mucosa and pharynx (check for deviation of uvula to unaffected side) Valgus Nerve (Viewed) - ANSWER CN X: Both- Elevation of the uvula (swallow, have patient say amah and check uvula elevation, gag reflex, and ability to swallow water) Accessory Nerve (A) - ANSWER CN XI: Motor- Innervates trapezius and sternocleidomastoid (shrug shoulders against resistance, turn head against hand on cheek) Hypoglossal (Hop) - ANSWER CN XII: Motor- motor of the tongue (pushes tongue against the inside of cheek, stick out tongue and check for fasciculation) Lithium therapeutic levels (acute mania) - ANSWER 0.6-1. me/L Lithium therapeutic levels (maintenance) - ANSWER 0.8-1. me/L

Lithium adverse effect level - ANSWER > 2 me/L >2.5 me/L = seizure, death Valproic acid therapeutic levels - ANSWER 50-120 up/ml Sensitivity - ANSWER true positives (the degree to which those who have a disease screen positive) Specificity - ANSWER true negatives (the degree to which those who not have a disease test negative) Incidence - ANSWER frequency with which a disease appears in a population given the rate in which new cases occur during a specific time period Prevalence - ANSWER proportion of a population that is affected by a disease at a particular time Major cause of death for adolescents - ANSWER motor vehicle accident, suicide,

accidents, homicide, malignancy, cv or congenital disease Major cause of death for young adults - ANSWER Motor vehicle accidents, homicide, suicide, injuries, heart disease, AIDS Major cause of death for middle age adult - ANSWER Heart disease, accidents, lung cancer, CVA, breast and colorectal cancer, COPD Major cause of death for elderly adults - ANSWER Heart disease, CVA, COPD, pneumonia and influenza Primary prevention - ANSWER measures to promote health prior to onset of problems (teaching) Secondary prevention - ANSWER focuses on early identification and treatment of existing problems (screening) Tertiary prevention - ANSWER rehabilitation and restoration of health

Diagnosis of diabetes - ANSWER fasting BG > 126 on 2 separate occasions random BG of >200 with s/s of diabetes oral glucose tolerance test > Total cholesterol recommendations - ANSWER < LDL recommendation - ANSWER <100, <70 goal HDL recommendation - ANSWER >40 men >50 women Triglycerides recommendation - ANSWER < Mitral stenosis - ANSWER loud first heart sound (s1) murmur, low pitched, mid diastolic, apical crescendo rumble Mitral regurgitation - ANSWER third heart sound (S3) with systolic murmur at 5th intercostal space midclavicular line (apex), may radiate to base or left axilla, musical, blowing, or high pitched Aortic stenosis - ANSWER systolic, "blowing", rough harsh murmur at second right ICS usually radiating to the neck

Aortic regurgitation - ANSWER diastolic, "blowing" murmur at second left ICS S1 - ANSWER mitral/tricuspid (AV) valves closure S2 - ANSWER aortic/pulmonic (semilunar) valves closure systole - ANSWER period between S1 and S2 diastole - ANSWER period between S2 and S S3 - ANSWER "Kentucky", increased fluid states (CHF, pregnancy) S4 - ANSWER "Tennessee", stiff ventricular wall (MI, left ventricular hypertrophy, chronic hypertension ) HIV window period - ANSWER immune system responding to viral presence in serum but virus hidden in lymphatic system Ego defense mechanisms - ANSWER compensation, denial, displacement, Identification, intellectualization, introjection, isolation, projection, rationalization, regression, sublimation, suppression, undoing Transactional Analysis - ANSWER Eric Berne: description of what people do and say

themselves and to each other Interpersonal Theory - ANSWER Harry Sack Sullivan, Peplum Interpersonal Theory: the bad me - ANSWER Develops in response to negative feedback, feelings of anxiety, discomfort, displeasure, and distress Interpersonal theory: the good me - ANSWER Develops in response to positive feedback, feelings, of pleasure, contentment, and gratification Interpersonal Theory: The not me - ANSWER Develops in response to intense anxiety, feelings of horror, dread, awe, loathing Gestalt Therapy - ANSWER Fredrick Perl’s: the whole is more important than the sum of it's parts (increased awareness of self and responsibility) Person-Centered Therapy - ANSWER Carl Rogers: Unconditional Positive Regard, genuineness, warmth accurate empathy, respect, permissiveness (development of self-direction) Behavioral Therapy - ANSWER Pavlov (,

Skinner, Bandura, Wolfe Understanding human behavior, scientific method Applied Behavioral Analysis - ANSWER direct extension of BF Skinner's radical behaviorism, Operant conditioning- all behavior result of consequences Neobehavioristic Meditational Stimulus Response - ANSWER S- R Model. Classical conditioning, based on research of Pavlov , Guthrie. Model of mediating and intervening variables that create consequence and affect behaviors. Social Cognitive Theory - ANSWER Pavlov's classic dog study, external stimulus events, external reinforcement, cognitive meditational processes Rational Emotive Therapy - ANSWER Albert Ellis. Neurosis is irrational thinking and behaving, emotional disturbances are rooted in childhood but continue through re- indoctrination in the now Cognitive Behavioral Therapy - ANSWER Aaron Beck. How one thinks largely determines how one feels and behaves. Cognitive

distortions created by certain pathologies like depression/anxiety crate systematic bias. Collaborative Empiricism - ANSWER Agreeing that something is the truth (therapist and client create collaboration to identify dysfunctional interpretations and try to modify them) Trauma Informed Care - ANSWER Goals are safety, awareness through mindfulness, managing physiological arousal. Narratives are constructed sometimes. Most commonly used: CBT and EMDR, and adjunctive body/energy work, group therapy. Avnet Report - ANSWER 1969: demonstrated efficacy of treatment with short-term therapy, paid for by commercial insurance (setting the foundation for 3rd party payment) Role of Psychiatric Nurse - ANSWER Peplum identified the 6 nursing sub-roles: mother- surrogate, technician, manager, socializing agent, health teacher, and counselor/ psychotherapist Physical Conditions to Group Therapy - ANSWER no barriers

between participants, 5- 10 participants, either open-ended or close-ended depending on the focus of group Yalow Principles - ANSWER Universality, Hope, Altruism (helping others), imparting information (education) , Corrective recapitulation of the primary family experience, Development of socializing techniques, Imitative behavior, cohesiveness, existential factors (direction in life, responsibility), catharsis, interpersonal learning, self-understanding Autocratic Leadership - ANSWER "This is how it is" type. Leader focused, members encouraged to adopt leader's ideas, member participation limited, low individual creativity, low cohesiveness, low productivity Democratic Leadership - ANSWER Most effective type. Member focused, group problem solving, unlimited member participation, encouraged creativity, high cohesiveness, high productivity

Laissez-Faire Leadership - ANSWER Undetermined focus, no defined strategy, inconsistent member participation, creativity not addressed, low cohesiveness, low productivity Family Systems Theory - ANSWER Bowen. Usually there is an identified patient (the symptom barer within the family). Goal: coach families to develop more solid self to stand against anxiety, triangles, and goal are differentiation. Focus on relationships and not individuals, use "I think" rather than "I feel". Therapy can occur without family. Present. Triangles - ANSWER Family Systems Theory: building blocks of any emotional system. A person focuses on a different object, idea or person to manage anxiety between Him/her and another person in the family. De- triangulating allows increased Differentiation of self and decreased emotional reactivity. Emotional Reactivity - ANSWER Family Systems: To react without separating thoughts and feelings as individuals learn about the emotional processes in family- they can Establish themselves as an individual with own beliefs within family.

Cutoffs - ANSWER Family Systems: Immature separation of people from each other Fusion - ANSWER Family Systems: Ways that people borrow and lend a self to another Strategic Family Therapy - ANSWER Jay Haley: families inadvertently develop strategies to solve problems and the strategies become the problems. Therapist designs strategies for eliminating problematic behaviors, paradoxical interventions aimed at changing behaviors. Structural Family Therapy - ANSWER Minchin: Structure, subsystems, boundaries. Families with diffuse boundaries (enmeshed) have more chaos, families with rigid Boundaries (disengaged) have less emotional support. Goal: develop clearly defined generational boundaries, unified view on family issues, Open communication. Keep hierarchy. Lazarus - ANSWER Theory of stress and coping. internal stress exceeds a persons Resources and endangers wellbeing.

Stress Diathesis Model: Watson - ANSWER Caring is central theme. Caring only effective when interpersonal (holistic), clients need holistic care enhancing humanism, health and quality of living. Erikson: Trust vs. Mistrust - ANSWER infancy (birth to 18 mo.), develop trust in primary Caretaker and generalize to others. When fails child has difficulty receiving and giving. Erikson: Autonomy vs. Shame and Doubt - ANSWER Early Childhood (18 mo.- 3 years), Gain some self- control and will power. When fails child lacks self- confidence and rage Against one’s self. Erikson: Initiative vs. Guilt - ANSWER Later childhood (3 to 6 years), to identify and Direct activities. When fails child has feelings of inadequacy and guilt. Erikson: Industry vs. Inferiority - ANSWER School Age (6-12), self- confidence and peer Recognition. When fails child has low self-esteem and poor interpersonal relations.

Erikson: Identity vs. Role confusion - ANSWER Adolescence (12-20 years), development of secure self-identity. When fails person lacks direction and confidence in self. Erikson: Intimacy vs Isolation - ANSWER Early Adulthood (20- 39 years), development of close relationship with the other people. When fails the person has low self-esteem, feelings of emotional isolation, loneliness, and depression. Erikson: Generativity vs Stagnation - ANSWER Adulthood (40-59 years), focusing on career and family, getting involved in the community. When fails person feels unproductive and alone in the world. Erikson: Integrity vs Despair - ANSWER Elderly adults (60 and over), looking back in life with satisfaction and few regrets. When fails the person have feelings of regrets, bitterness, and despair. Cognitive Theory - ANSWER Piaget: human intelligence is an

extension of biological adaptation . Sensorimotor - ANSWER 0-2 years (reflecxive movements, understanding action and result, differentiate self from other objects, hold mental image) Preoperational - ANSWER 2-7 years (symbolic play, only present no clear understanding of time, non-contested respect for authority, can't distinguish fantasy from reality) Concrete operational - ANSWER 7-11 years (understanding of spatial relations, think about past and present, begins to value others) Formal operational - ANSWER 11-15 years (future thinking, abstract thinking, complex problem solving) Theory of Object Relations - ANSWER Margaret Mahler: normal autism (0-2 mo), symbiosis (3-5 mo), separation of individuation- separation of caretaker from self. Imprinting - ANSWER Lorenz: critical period after birth in

which imprinting takes place, ethological studies (animal studies) Modern Cognitie Conditioning - ANSWER Bandura: learn by observing others, model observed behaviors, strengthened through reinforcement Pavlov - ANSWER Neural stimulus repeated, paired with unconditioned stimulus, results in learnin g John B. Watson - ANSWER conditioning, personality is outcome of conditioning experiences unique to child Operant conditioning - ANSWER Skinner- voluntary response depends on consequence Ecological Systems Model - ANSWER Urie Bronfenbrenner: ecological transitions or changes in an individual's role or setting affect development. DNA strands linked by what 4 nucleotide bases? -

ANSWER adenine paired with thymine, guanine paired with cytosine Genotype - ANSWER Genetic code (trisomy 21) Phenotype - ANSWER human expression (down syndrome) Asian decent: FDA requirement to check prior to prescribing carbamazepine? - ANSWER HLA-B*1502 allele (due to Stevens- Johnson syndrome) IQ: mild retardation - ANSWER 50-55 to 70 IQ: moderate retardation - ANSWER 35-40 to 50- IQ: severe retardation - ANSWER 20-25 to 35- IQ profound retardation - ANSWER <20- Most common type of ADHD - ANSWER combined type Most common childhood disorder - ANSWER ADHD ADHD primary symptoms - ANSWER inattention, distractibility, impulsivity, hyperactivity ADHD comorbidities - ANSWER learning disabilities, anxiety, depression, ODD, CD Labs that can indicate med cause for hyperactivity - ANSWER hematocrit, lead levels,

thyroid function Cluster A personality DO - ANSWER Paranoid, Schizoid, Schizotypal (Odd) Cluster B personality DO - ANSWER Borderline, Narcissistic, Antisocial, Histrionic (Angry) Cluster C personality DO - ANSWER Avoidant, Dependent, Obsessive-Compulsive (Anxious) Paranoid Personality DO - ANSWER More common in schizophrenic families. SUSPECT: Spousal infidelity suspected, Unforgiving, Suspicious of others, Perceive attacks, Everyone viewed as either friend or enemy, Confiding in others is feared, Threats perceived in benign events. Schizoid Personality DO - ANSWER More males (lacking nurturing in childhood). DISTANT: Detached, Indifferent to criticism or praise, Sexual experiences of little interest, Takes performed solitarily, Absence of close friends, Neither desires or enjoys closeness, Takes pleasure in few activities. Schizotypal Personality DO - ANSWER increased association in families with schizophrenia. ME PECULIAR: Magical thinking, Experiences unusual perceptions, Paranoid ideation, Eccentric behavior or appearance, Constricted or inappropriate affect,

Unusual or odd thinking and speech, Lacks close friends, Ideas of reference, Anxiety in social settings, Rule our psychotic and pervasive development DO. Antisocial Personality DO - ANSWER 75% of people convicted of crimes have this, familial pattern. CORRUPT: Conformity to the law is lacking, Obligations ignored, Reckless disregard for safety of self or others, Remorse lacking, Underhanded, Planning insufficient, Temper. Borderline Personality DO - ANSWER Frequent hx of childhood abuse/sexual abuse. I DESPAIR: Identity disturbance, Disordered unstable affect with marked mood reactivity, Emptiness feelings, Suicidal behaviors, gestures, that are recurrent, Paranoid ideation under duress, Abandonment sense, Impulsivity, Rage that is inappropriate, Relationship instability with extremes of idealization and devaluation. Histrionic Personality DO - ANSWER PRAISE ME: Provocative, relationships overvalued, Attention seeking and uncomfortable when not, Influenced easily, Style of speech exaggerated without details, Emotions shallow and rapid shifting, Made-up in ways to draw attention, Emotions exaggerated. Narcissistic Personality DO - ANSWER often intelligent. SPEEECIAL: Special (believes in own uniqueness), Preoccupied with fantasies, Envious,

Entitlement, Excessive admiration required, Conceited, Interpersonal exploitation, Arrogant, Lacks empathy. Avoidant Personality DO - ANSWER CRINGES: Certainty of being liked prerequisite for involvement, rejection sensitive and preoccupied, intimate relationships avoided, New relationships avoided, Gets around occupational work that involves interpersonal contact, Embarrassment potential prevents new activities, Self-view is one of inferiority, ineptness. Dependent Personality DO - ANSWER more common in women. RELIANCE: Reassurance required for decisions, expressing any disagreement is difficult, life responsibilities assumed by others, Initiating projects difficult, alone, nurturance needs excessive, companionship needed urgently at all times, exaggerated fears of being left to care for others. Obsessive Compulsive Personality DO - ANSWER LAW FIRMS: Loses the point of activities, ability to finish anything compromised by perfection, worthless objects overvalued and cherished, friendships excluded as work focus of life, inflexible and over conscientious, reluctant to delegate, miserly, stubborn. maturational Crisis - ANSWER transitional crisis, throughout the lifecycle, when old

methods of coping no longer work Situational crisis - ANSWER from events (loss of others, change of employment, status of significant other, physical illness, suicide) Adventitious Crisis - ANSWER disasters (fires, earthquakes, riots, crimes of violence) Becks Cognitive Triad - ANSWER Individual holds negative view of self, individual evaluates ongoing events in negative way, individual misinterprets available data and assumes future holds no hope Highest risk group for suicide success - ANSWER older white men (widowed) Highest risk group for unpredictable suicide attempt - ANSWER teenage boys Thanatology - ANSWER the study of death, dying, grief 5 stages of grief - ANSWER Kubler/Ross: Denial, Anger, Bargaining, Depression, Acceptanc e 4 stages of grief for children - ANSWER Bolwby: numbness, disequilibrium,

disorganization and despair, reorganization Comorbid with ADHD - ANSWER anxiety (25%), depression (25%), ODD (50%) Xenophobia - ANSWER fear of foreigners Value Orientation - ANSWER Present, past, future orientation (how the patient verbalizes pride in accomplishments and variety of aspects of self) Activity Orientation - ANSWER Measurable achievements (education, career, parenting), spontaneous being (satisfied with being self with or without accomplishments), emphasizing self-development in all aspects as integrated whole Human Nature Orientation - ANSWER View of humans as evil, requiring constant discipline or self-control, or as neutral (neither good or bad), view of humans as subject to environment with little control over destiny (in harmony with environment, master over nature) Relational Orientation - ANSWER Individualistic (more frequent interpersonal relationships with outsiders than with family), lineal (value group goals over individual, tendency toward