PMHNP Board Review: Key Concepts and Definitions, Exams of Advanced Education

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PMHNP BOARD 2023 REVIEW

parasympathetic nervous system does what? - maintains and restores energy; inhibits or decreases activity of organs peripheral nervous system connects to what? - PNS to CNS to receptors, muscles, and glands NIHSS Stroke Scale: What is range and meaning of score? - 15-item neurological examination used to evaluate the effect of acute cerebral infarction on the levels of consciousness, language, neglect, visual- field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss. Very Severe: >25. Severe: 15 - 24. Mild to Moderately Severe: 5 - 14. Mild: 1 - 5 What is responsible for the fight or flight response - sympathetic nervous system (part of ANS) Course of cardioembolic stroke - sudden onset of maximal neuro deficits; quick recovery after reperfusion What is a lumbar puncture used for? - diagnose infectious, auntoimmune issues, and paraneoplastic syndromes What are arterial gases taken for? - used to measure concentrations of atmospheric gases when patients are in respiratory distress What is a non-contrast head CT scan used for? - helpful in excluding the diagnosis of normal pressure hydrocephalus What is the presentation of normal pressure hydrocephalus? - abnormal (magnetic) gait, urinary incontinence, cognitive decline

What is an EEG used for? - to measure brain wave activity for people with sleep or suspected seizure disorders What is the presentation of Steven Johnson Syndrome? - it is a specific, life-threatening drug rash characterized by blisters giving way to dermis and hives on the lining of any mucous membrane What lab evidence supports dx of Eosinophilia and systemic symptoms (DRESS)? - DRESS is a drug induced rash and lab work shows elevated eosinophils and liver enzymes, renal insufficiency, and positive cardiac enzymes S/S of mixed delirium - cyclical manifestation of psychomotor retardation and agitation with disturbance in consciousness; risk factors include infection, fever S/S of hyperactive delirium - psychomotor agitation, restlessness, and hypervigilence S/S of hypoactive delirium - psychomotor retardation and apathy S/S and cause of vascular dementia - 2nd most common dementia caused by progressive cardio/cerebrovascular disease which manifests with cognitive decline and plateau phases where lost functioning is not regained S/S and cause of Huntington's dementia - Subcortical disease characterized by motor abnormalities including psychomotor slowing, choreoathetoid movements and executive dysfunction including impaired language, memory, and insight as disease progresses S/S of Pick's disease or frontotemporal dementia - personality change and cognitive decline S/S of Kulver-Bucey Syndrome - subtype of pick's disease including uninhibited cheerfulness, hypersexuality, and hyperorality

S/S of Creutzfeldt-Jakob Disease - precipitous onset of cognitive decline that rapidly progresses to death; symptoms include fatigue, cog impairment, and eventually aphasia, apraxia, emotional lability, and psychosis S/S of Alzheimer's Disease - Most common type of dementia; gradual onset and progressive decline without focal neurological deficits What is a focal neurological deficit? - a problem with nerve, spinal cord, or brain function. It affects a specific location, such as the left side of the face, right arm, or even a small area such as the tongue. Speech, vision, and hearing problems are also considered focal neurological deficits. S/S of HIV-associated dementia - neurocognitive disorder with parenchymal abnormalities that can be seen on an MRI and manifests with a progressive decline with associated symptoms including OCD, GAD, Dep, and mania What is PANDAS? - Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections, which can lead to severe OCD What are signs and symptoms of Wilson's disease - excessive accumulation of copper in liver, brain, kidney, cornea; inherited disorder of copper metabolism; check serum ceruloplasmin, the copper carrying protein What does the tuberoinfundibular pathway do? - transmits dopamine from hypothalamus to pit gland and increases prolactin releasing hormone What does the nigrostriatal pathway do? - transmits dopamine from the midbrain to the caudate nucleus which triggers movement disorders What does the mesolimbic pathway do? - transmits dopamine from the prefrontal cortex to midbrain; associated with thought disorder Where is Broca's area located and what does it do? - left frontal lobe, speech production and fluency

What are symptoms of dysfunction in Broca's area? - incongruent affect, decreased motivation, impaired judgment and attention, confabulation What is Wernicke's area? - - Area of brain involved in understanding language

• Posterior left temporal lobe What is the parietal lobe responsible for? - Contains the primary somatic sensory area, which integrates somesthetic information (pressures, pain, temperature, touch)., spatial awareness and conscious awareness of the opposite side of the body What is the occipital lobe responsible for? - vision and coordination of eye movements; interpretation of color and movement What are pharmacokinetics? - what the body does to the drug (absorption, distribution, metabolism, excretion) What are pharmacodynamics? - what the drug does to the body What does dopamine do? - primary driver of reward system; increases sense of well-being and satisfaction What does serotonin do? - Affects mood, hunger, sleep, and arousal, and reduces pain perception What does GABA do? - a major inhibitory neurotransmitter it reduces arousal, aggression, anxiety, and excitation; increases sleepiness What do cannabinoids do? - Act as neurotransmitter to inhibit release of glutamate and GABA, thus dampening both neuronal excitation and inhibition; increases hunger, reduces motivation and sex drive What does acetylcholine do? - enhances muscle contractions, sweating, salivation and it is prescribed to enhance memory; helps regulate the body's internal functions

What is the antagonist effect? - Drug binds to the receptor but does not activate a biological response What is the agonist effect? - drug binds to receptor and activates response What is the inverse agonist effect? - does not bind to receptors and has opposite effect of agonist What is the partial agonist effect? - binds to receptors but does not fully activate it; muted biological response What does norepinephrine do? - helps control alertness and arousal; associated with fight or flight; implicated in depression and mania What are extensive metabolizers? - normal metabolizers; prescribe as directed What are poor metabolizers? - requires lower dose of medication and longer titration schedule and the patient still may not achieve therapeutic effect What are slow metabolizers? - require lower doses of medication because it stays in system longer What are ultra-rapid metabolizers - need higher doses because it is processed out quickly Tachyphylaxis - rapid decrease in response to a drug; "poop out" What does an enzyme inhibitor do? - slows down catabolism and makes NT to remain in circulation longer Akathesia - inability to remain still; motor restlessness and confused with anxiety Dystonia - abnormal involuntary muscle movement/spasm from antipsychotic that blocks dopamine

Akinesia - complete or partial loss of muscle movement; flat affect, apathy Tardive dyskinesia (TD) - a late-onset, irreversible neurologic side effect of antipsychotic medications; characterized by abnormal, involuntary movements such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet Pseudoparkinsonism - A medication-induced temporary constellation of symptoms associated with Parkinson's disease, including masked face, tremor, reduced accessory movements, shuffling gait, bradykinesia and stiffening of muscles. What are tricyclics used for? - depression and chronic neuropathic pain; targets poor appetite, sleep disturbance, and depressed mood What does Hamilton rating scale measure? - anxiety; higher the score, higher likelihood of anxiety or panic disorder What are the 4 facets of readiness to learn? - emotional, physical, experiential, and knowledge readiness What is the Fairweather Lodge Model? - a vocational rehab service that allows those with SMI to run their own businesses What is sublimation? - unconscious process of substitution of socially acceptable, constructive activity for strong unacceptable impulse What is malingering amnesia - no hx of amnestic episode, antisocial personality traits; episode specific amnesia (not global), self-serving timing of onset and recovery Appearance of depressed children - psychomotor agitation, anxiousness, irritability, dysphoria, selectively mute, flat affect

What is rumination disorder? - Feeding disorder of infancy and early childhood; regurgitation after eating without swallowing the spit up food; common in infants with unstable environments and a variety of caretakers; lasts at least 1 month Signs of bulimia and anorexia - Russell's sign, hypertrophy of salivary glands, erosion of dental enamel (rectal prolapse only in bulimia) What is stilted speech? - Awkwardly formal, even archaic, speech incorporating unnecessarily complex words; common in schizophrenia What is fictitious disorder? - falsification of physical or psychological S/S associated with identified deception (intentionally cause self injury to receive medical attention) AKA Munchausen's What is malingering disorder? - fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain; or to avoid consequences What is a somatoform disorder? - A mental illness that causes bodily symptoms that cannot be tracked back to any specific cause; unrelated symptoms What is dysdiadochokinesia (DDK)? - impaired ability to perform rapid alternating movements What is agraphesthesia? - inability to recognize symbols, letters or numbers traced on the skin What is choreiform movement? - repetitive and rapid, jerky, involuntary movement that appears to be well-coordinated What is astereognosis? - The inability to identify objects through touch What is Cotard's syndrome? - person believes he or she is dead; associated with psychotic depression What is Capgras syndrome? - - fixed belief the pt has that familiar people have been replaced by identical imposters who behave exactly like original person; associated with psychosis

Acute Intermittent Porphyria (AIP) S/S and test - screened in urine; manic or psychotic symptoms; associated with abd pain, N/V muscle pain, numbness, hallucinations, and paranoia; occurs after excessive alcohol consumption; rec drug use; stress or fasting Circumstantial speech - overly inclusive speech pattern that includes unnecessary details and digressions, but eventually reaches the point Tangential speech - Listener responds by taking the topic in a different, but related direction; never returns to main point Flight of ideas - a confused state in which thoughts and speech go in all directions with no unifying concept Loosening association of speech - illogical connection between thoughts digressing in multiple directions but sentence structure remains in tact What sleep stage has night terrors and parasomnia? - 3/4; within 3 hrs of falling asleep What are intersecting pentagons - used to assess visuospatial impairment; functioning of parietal lobe, basal ganglia, and prefrontal cortex pseudocyesis - a sensation of being pregnant when a true pregnancy does not exist Fragile X Syndrome (FXS) - most commonly inherited cause of intellectual disability; when a DNA series makes too many copies of itself and turns off a gene on the X chromosome; associated with autism, schizotypal PD, ADHD, social anx disorder Thelarche - onset of breast development conduction aphasia - a speech disorder characterized by the inability to repeat words with intact spontaneous speech production and comprehension; rare

hypnagogic hallucinations - vivid sensory phenomena that occur during the onset of sleep Hypnopompic hallucinations - hallucinations that occur when awakening from sleep; seen in narcolepsy frotterism disorder - preoccupation with touching and rubbing against non consensual persons; excitement from rubbing, not coercion illusion - misinterpretation of external stimuli, such as shadow; distinguish from hallucinations- thought you saw someone or a shadow Inhibited grief - a person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations schizoid personality disorder - a personality disorder characterized by persistent avoidance of social relationships and little expression of emotion schizotypal personality disorder - Person has several traits that causes interpersonal problems, including inappropriate affect, paranoid/magical thinking, off beliefs; cognitive and perceptual distortions and eccentric behaviors Cluster B personality disorders - antisocial, borderline, histrionic, narcissistic Cluster C disorders - avoidant, dependent, obsessive-compulsive Cluster A disorders - paranoid, schizoid, schizotypal Rhett's syndrome (genetically) - disruption in social interactions during regressive phases and characterized by impaired physical growth, loss of hand movements, and poor coordination Lab values indicating alcoholism - decreased MVC and increased triglycerides

PICO - Patient/population Intervention Comparison Outcome Cochrane Database - The most comprehensive collection of systematic reviews; used for evidence based treatment What does prozac do to statins? - increases statin concentrations bc imipramine - TCA antidepressant; used for nocturnal enuresis d/t anticholinergic effects Doxepin SE and dosing - TCA, anticholinergic properties like dry mouth, orthostasis, urinary hesitancy, and retention leading to dysuria. Dosed at 25 to 300 daily with a therapeutic plasma range of 100- Late on-set SE of antidepressants - emotional disinhibition; apathy; emotional blunting d/t downstream effect of serotonin on the dopamine NT system in frontal lobe Haldol warning about absorption - do not take within 2 hrs of antacid; interferes with absorption Foods with tyramine include... - Aged cheeses and meats; smoked fish soy sauce Risperdal SE - insomnia, agitation, orthostatic hypotension, headache, anxiety existential therapy - Victor Frankl -an insight therapy that focuses on the elemental problems of existence, such as death, meaning, choice, and responsibility, emphasized making courageous life choices. It tries to promote self-knowledge and self-actualization. It emphasizes free will and believes that through choices one can become the person he or she wants to be. Concepts of free will, meaning, freedom, and isolation are identified with existential therapy.

interpersonal theory - Harry Stack Sullivan: The theory that personality development and behavior disorders are related to and determined by relationships between persons. People are goal directed towards attainment of satisfaction and security needs. Sense of self is determined by how a person feels others view them Disinhibited Social Engagement Disorder - A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults; can be a response to child abuse or neglect