PMHNP Boards Study Guide: Medicare, Medicaid, and Health Insurance Plans, Exams of Nursing

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Medicare Part A Coverage - --Hospital insurance that covers inpatient and most skilled care. Mandatory copays for hospital days 21-150, getting higher with each period of time. Medicare Part A Eligibility - -->65 in social security automatic enrollment Medicare Part A Cost - --No cost if automatically qualified. 30-39 work quarters: ~$250/mo <30 work quarters: ~$450/mo Medicare Part B Coverage - --Supplemental medical insurance. Outpatient services, care, physical/speech therapy, some home health care, medical equipment Medicare Part B Eligibility - --Voluntary if > Medicare Part B Cost - --Deducted from monthly social security check. Enroll 3 months before 65th birthday or 4 months after, otherwise increased costs to enroll Medicare Part C - --Medicare Advantage. Get all their medical services through that plan. Medicare Part D coverage - --Prescription drug coverage Medicare Part D Cost - --Varies depending on how extensive drug benefit is. Different plans have different benefits. Medigap Plans - --Fill gaps in coverage that occur with Medicare

Medicare Advantage Plan - --Will likely eliminate need for medigap insurance? Medicaid Eligibility - --Automatic coverage not guaranteed except for poor pregnant women and children. States can refuse to cover adults/head of households who lose Temporary Assistance to Needy Families d/t refusal to work. Generally covers poor people. Medicaid funding - --Federal + state. States determine how much they want to pay in, different states have different qualities of Medicaid HMO - --Four components: Enrolled population, prepayment of premiums, coverage of comprehensive medical svcs, centralization of medical and hospital svcs Closed-panel HMO - --Specific providers identified by plan to provide the medical services to members. Staff can be salaried by HMO or an agency/group contracted by the HMO. Open-panel HMO - --Network HMO, Individual Practice Association, Point of Service Plans Network HMO - --HMO contracts with more than one group of practices Individual Practice Association - --Insurance coverage. Contract with an association of physicians to provide services to members Point of Service (POS) and Preferred Provider Organizations (PPOs) - --Insurance coverage. Patients allowed to self-refer to specialist but pay higher premium to do so. POS requires PCP is gatekeeper but pt can see a provider outside of HMO for more $$. PPOs contract to a selected group of participating providers and give discount for using a selected group of providers. Financial risk held by insurer in PPO, held by providers in POS

Managed indemnity - --Traditional model insurance coverage.. Pre-certification, catastrophic case management, minimal contract arrangement with providers. Provider groups and health plans can use quality control, utilization review, bundling of services, incentives for health behaviors. MUST seek National Committee on Quality Assurance (NCQA) accreditation Licensure - --Member of profession is granted ability to practice Accreditation - --Formal review and approval by a recognized agency of educational degree or certification programs in nursing or nursing-related programs. Certification - --Tests knowledge, skills, abilities for entry into practice. Formal recognition of the knowledge, skills, and experience demonstrated by the achievement of standards identified by the profession Education - --Formal preparation of APRNs in graduate degree-granting or postgraduate certificate programs Factors facilitating NP growth - --Demand for svcs, acceptance of role, emphasis on integrated healthcare svcs, emergence of PMHNP and decreasing stigmatization Factors constraining NP growth - --Growth competition, reimbursement struggles, overlapping scopes with other NPs, concerns about reimbursement fraud/abuse, scope of practice requiring physician supervision/collab Exceptions to confidentiality - --Information given to attorneys involved in litigation, records to insurance companies, answering court orders, mandatory state reporting, harm to self or others or child/elder abuse, determined need for info outweighs principle of confidentiality

Deontological Theory - --Action is judged as good or bad based on the act itself regardless of the consequences Teleological Theory - --An action is judged as good or bad based on the consequence or outcome Virtue Ethics - --Actions are chosen based on moral virtues (honesty, courage, compassion, etc) or the character of the person making the decision Elements of negligence that must be established to prove malpractice - --Duty, breach of duty, proximate cause, damages Duty (negligence) - --NP had a duty to exercise reasonable care when undertaking and providing treatment to the client Breach of duty (negligence) - --The NP violated the applicable standard of care in treating the client's condition Proximate cause (negligence) - --There is a causal relationship between the breach in the standard of care and the client's injuries Damages (negligence) - --Client experiences permanent and substantial damages as a result of the breach in the standard of care Competency: Legal or medical? - --Legal (NOT medical) Competency - --Determination that a client can make reasonable judgments and decisions regarding treatment and other health concerns

Durable power of attorney - --Designates an agent to act on behalf of person should he/she become unable to make healthcare decisions. Consider psychiatric DPOA for chronically ill folks! LEGALLY BINDING ALL STATES Living will - --Document prepared while client is mentally competent to designate preferences for care if client becomes incompetent or terminally ill. NOT legally binding in all states! Ego - --Concept of external reality. Rational mind. "I think, I evaluate." Develops at birth as infant struggles to deal with environment. Responsible for use of defense mechanisms. What's (id/ego/superego) responsible for use of defense mechanisms? - --Ego Superego - --Ego-ideal. Contains conscience/right vs wrong. "I should/shouldn't". Develops around age 6 when coming into contact with authority figures like teachers. Regulated by guilt or shame. Which (id/ego/superego) is regulated by shame? - --Superego Id - --Primary drives or instincts. Present at birth, motivates early infantile actions. Unconscious, sexual, aggressive, infantile urges. Oral stage age - --0-18 months (Freud stage) Oral stage - --Feeding, weaning, crying. Oral stage failure - --Schizophrenia, SUD, paranoia (Freud stage) Anal stage age - --18 mos-3 yrs (Freud stage)

Anal stage - --Demands for control/expulsion/retention, bladder/bowel elimination Anal stage failure - --Depression (Freud stage) Phallic stage age - --3-6 years (Freud stage) Phallic stage - --Genital focus. ID with same sex parent. Exhibitionism, masturbation with focus on Oedpial conflict, castration anxiety, female fear of lost maternal love. Phallic stage failure - --Sexual identity disorder (Freud stage) Latency stage age - --6 years - puberty (Freud stage) Latency stage - --Dormant sexual feelings. Peer relationships, learning, motor-skills devt, socialization. Genital stage age - --Puberty onward (Freud stage) Latency stage failure - --Inability to form social relationships (Freud stage) Genital stage - --Maturation of sexuality. Integration and synthesis of behaviors from early stages. Genital stage failure - --Sexual perversion disorders (Freud stage) Suppression - --Conscious defense mechanism to keep something from awareness Sensorimotor age - --Birth - 2 years (Piaget)

Sensorimotor stage - --Critical achievement = object permanence. Objects have an existence independent of child's involvement with them. Preoperational age - --2-7 years (Piaget) Preoperational stage - --More extensive use of language and symbolism, egocentrism, rigidity of thought, MAGICAL THINKING Concrete operations age - --7-12 years (Piaget) Concrete operations stage - --Conservation, reversibility, empathy, morality, using logic (Piaget) Reversibility - --Concrete operations stage. Realization that one thing can turn into another and back again (water and ice) Conservation - --Concrete operations stage. Ability to recognize that although the shape of an object may change, it will maintain characteristics that enable it ot be recognized as that object (clay) Formal operations age - --12 years - adult Formal operations stage - --Abstractions, thinking operates in a formal, logical manner Interpersonal theory - --Stacks. Behavior occurs because of interpersonal dynamics. Relationships and experiences influence one's personality development --> self-system Interpersonal theory drive for behavior - --Drive for satisfaction (sleep/sex/hunger), drive for security (conforming to social norms of a person's reference group)

Theory of Cultural Care - --Regardless of culture, care is unifying focus and essence of nursing. Health and well-being can be predicted through cultural care. Therapeutic Nurse-Client Relationship Theory/Interpersonal Theory - --Peplau. Nursing is interpersonal process in which interventions occur within context of nurse-client relship. Phases of nurse-client relationship - --Orientation phase, working phase (identification and exploitation), termination phase (resolution) Health belief model - --Healthy people do not always take advantage of preventive programs bcuz of perception of susceptibility, seriousness of illness, perceived benefits of tx, perceived barriers to chg, expectations of efficacy Transtheoretical model of change - --Change in health behaviors occurs in six predictable stages: Precontemplation, contemplation, preparation, action, maintenance Precontemplation - --Person has no intent to change Contemplation - --Person is thinking about changing, is aware that there is a problem, but not committed to changing it Preparation - --Person has made the decision to change, is ready for action Action - --Person is engaging in specific, overt actions to change Maintenance - --Person is engaging in behaviors to prevent relapse

Motivational Interviewing - --Builds on transtheoretical model of change. Motivation elicited from client. Nonconfrontational, nonadversarial Descriptive statistics - --Mean, standard deviation, variance Variance - --How values are dispersed around mean. Larger variance - larger dispersion of scores Inferential statistics - --Numerical values that enable one to reach conclusions that extend beyond immediate data, generated by quantitative research designs (t-test, ANOVA, pearson's r, probability, P value) T test - --Analyze whether TWO means are statistically DIFFERENT from one another ANOVA - --Tests differences among THREE OR MORE groups Pearson's r correlation - --Tests RELATIONSHIP between two variables Probability - --Likelihood of an event occurring between 0-1. 1 = absolutely yes gonna happen, 0 = no way. P value - --Level of significance. Describes probability of particular result occurring by chance alone. P = 0.01, 1% chance of obtaining result by chance alone Central nervous system - --Spinal cord and brain Peripheral nervous system - --Cranial nerves outside brain stem, peripheral nerves, somatic and autonomic NS (sympathetic and parasympathetic NS)

Somatic nervous system - --Conveys info from CNS to skeletal muscles, responsible for voluntary movement Autonomic nervous system - --Regulates internal body functions to maintain homeostasis. Autonomic = automatic. Smooth muscle, involuntary movement, sympathetic and parasympathetic nervous systems Sympathetic nervous system - --Excitatory division, fight/flight, stimulates or increases activity of organs Parasympathetic nervous system - --Maintains or stores energy, rest/digest Frontal lobe - --Largest and most developed. Motor fxn, premotor, association ctx, executive fxns, language, personality Association cortex - --Multimodal sensory input to trigger memory and make decisions Broca's area - --Expressive speech, in frontal lobe Temporal lobe - --Language (Wernicke's area), primary auditory area, memory, emotion, integration of vision with sensory information. Temporal lobe problems - --Leads to AVH, aphasia, amnesia Wernick's area - --Receptive speech or language comprehension, temporal lobe Occipital lobe - --Visual stuff. Integrates vision with other sensory information Parietal lobe - --Primary sensory area, taste, reading and writing

Parietal lobe problems - --Lead to sensory-perceptual disturbances, agnosia Cerebral cortex - --Controls opposite side of body. Sensory information relayed from thalamus, then processed and integrated in the cortex. Responsible for speech, cognition, judgment, perception, motor function. Limbic system - --Essential for regulation and modulation of emotions and memory. Hypothalamus, thalamus, hippocampus, amygdala. Hypothalamus - --Responsible for appetite, sensations of hunger and thirst, water balance, circadian rhythms, body temp, libido, hormone regulation Thalamus - --Sensory relay station EXCEPT for smell. Modulate flow of sensory information to prevent overwhelming the cortex. Regulates emotions, memory, and related affective behaviors. Hippocampus - --Regulates memory and converts short-term to long-term memory Amygdala - --Responsible for mediating mood, fear, emotion, aggression. Also responsible for connecting sensory smell information with emotions. Basal ganglia - --Complex feedback system to modulate and stabilize somatic motor activity. Movement initiation, complex motor function. Learning, automatic functions like walking/driving. Basal ganglia side effects - --Extrapyramidal functions here. Involuntary movement side effects can occur with psychotropics. Caudate - --Basal ganglia

Putamen - --Basal ganglia Midbrain - --Ventral tegmental area and substantia nigra Pons - --Houses locus ceruleus (NE synthesis) Medulla - --Along with pons, contains automatic control center that regulates internal body functions Cerebellum - --Equilibrium Reticular formation system - --Primitive brain. Receives input from cortex, integration area for input from postsensory pathways. Innervates thalamus, hypothalamus, cortex. Regulates involuntary movement like reflexes, muscle tone, vitals. Monoamines - --DA, NE, epinephrine, serotonin DA pathways - --Mesocortical, mesolimbic, nigrostriatal, tunberoinfundibular Catecholamines - --DA, NE, epinephrine Indoleamine - --5HT DA precursor - --Tyrosine NE precursor - --Tyrosine

DA production site - --Substantia nigra and ventral tegmental area 5HT precursor - --Tryptophan 5HT production site - --Raphe nuclei in the brainstem DA breakdown - --MAO enzymes NE breakdown - --Removed from synaptic cleft and returned to storage via active reuptake process 5HT breakdown - --Removed from synaptic cleft and returend to storage via an active reuptake process Glutamate - --Excitatory NT Amino acids - --Glutamate, aspartate, GABA, glycine Glutamate disorder - --Excess implicated in seizure and bipolar disorders. Imbalance in mood disorders, schizophrenia Aspartate - --Excitatory NT, nothing super important GABA - --Universal inhibitory NT. BZ, ETOH, barbiturates, CNS depressants work on GABA Glycine - --Inhibitory NT that works with GABA Acetylcholine synthesis site - --Basal nucleus of Meynert

Acetylcholine precursor - --Acetylcoenzyme A and choline DA function - --Thinking, decision making, reward-seeking behavior, fine muscle action, integrated cognition NE function - --Alertness, focused attention, orientation, priming of "fight or flight," learning, memory 5HT function - --Sleep regulation, pain perception, mood states, temperature, regulation of aggression, libido, precursor for melatonin ACh imbalance - --Increase: Parkinsonian symptoms. Decrease: Alzheimer's dz, impaired memory DA imbalance - --Increase: Schizophrenia, psychosis Decrease: Substance abuse, anhedonia, Parkinson's dz NE imbalance - --Increase: Anxiety Decrease: Depression 5HT imbalance - --Decrease: Depression, OCD, anxiety, schizophrenia GABA imbalance - --Decrease: Anxiety Glutamate imbalance - --Increase: BPAD, psychosis from ischemic neurotoxicity or excessive pruning Decrease: Memory and learning difficulty, negative symptoms of schizophrenia

Opioid neuropeptides imbalance - --Decrease: Substance abuse DA and ACh relationship - --Reciprocal. DA decreases (antagonized by rx), ACh increases --> EPS Dystonia tx - --Benztropine or diphenhydramine ABCDE moles - --Asymmetry, Border irregularity, Color variation, Diameter >6 mms, Elevation Normal T4 - --0.8 - 2.8 ng/dl Free thyroxine measures what - --T3, T Normal TSH - --2-10 mU/l High T4/T3 - --Low TSH Low T4/T3 - --High TSH Primary hypothyroidism - --TSH levels rise because of low thyroid hormone Low TSH, low T3/T4 - --Pituitary gland failure Origin of thyroid hormones - --Pituitary glands

Normal Na - --135- High Na causes and effects - --Low volume (dehy, DI, tummy troubles) or excessive salt consumption --> convlusions, pulmonary edema, thirst, fever, dry mucous membranes, hypotension, tachycardia, low jugular venous pressure, restlessness Low Na causes and effects - --Addison's dz, renal disorder, GI fluid loss (vom, diarrhea, NG suction), diuresis, lithium, diuretics --> lethargy, headache, confusion, apprehension, seizures, coma, hypotension, tachycardia, weight gain, edema, ascites Normal Mg - --1.5-2.5 mEq/l High Mg causes and effects - --Addison's dz, renal failure, DKA, dehydration, thyroid malfxn --> n/v, weakness, hypoTN, bradycardia, resp dep, depressed MSK contraction and nerve fxn Low Mg causes and effects - --Hyperaldosteronism, DKA, malnutrition, ETOHism, GI loss from vom/diarrhea/NG sxn, malabsorption --> Depression, confusion, irritability, muscle eakness, increased reflexes, tetany, convulsions Normal K - --3.5-5. High K causes and effects - --Acidosis, acute renal failure, infxn, dehydration --> Muscle weakness, paralysis, restlessness, diarrhea, EKG changes Low K causes and effects - --Alkalosis, GI loss, trauma, laxative abuse, surgery, Cushing's --> Impaired renal fxn, ployuria, polydipsia, muscle weakness, smooth muscle atony, cardiac dysrhythmias, paralysis and respiratory arrest Normal ALT - --5-

ALT >300 - --Liver disease or damage Normal AST - --5- ALT 100-300 - --Acute pancreatitis, CHF, renal failure, other injury causes AST >200 - --Acute pancreatitis, acute liver damage Primary prevention - --Keep the disease from happening in the first place. Help avoid stressors and cope with them adaptively Secondary prevention - --Aimed at decreasing severity of existing diseases. Early case finding, prompt an effective treatment. Telephone hotlines, crisis intervention, disaster responses. Tertiary prevention - --Aimed at decreasing the disability and severity of a mental disorder. Rehab, avoidance or postponement of complications. What psych drugs have been implicated in hyponatremia? - --SSRIs CYP450 Inhibitors - --Bupropion, clomipramine, cimetidine, clarithromycin, fluoroquinolones, grapefruit, grapefruit juice, ketoconazole, nefazodone, SSRIs CYP450 Inducers - --Carbamazepine, hypericum (St Johns Wort), phenytoin, phenobarbital, tobacco Tachyphylaxis - --An acute decrease in therapeutic response to a medication

Meds that induce depression - --Beta blockers, steroids, interferon, isotretinoin, some retrovirals, atineoplastic drugs, benzos, progesterone Meds that induce mania - --Steroids, disulfiram, isoniazid, antidepressants in folks with BPAD Fluoxetine pathway - --CYP540 2D Women's monitoring guidelines - --Everyone: Monthly skin/oral exams. Annual BP, urine, blood, physical, STI screen. Paps start at first sexual activity or age 21, then every 2-3 years if normal/not high risk. 13-64: At least one HIV screen 18-39: Paps start. 40-49: Monthly skin/oral exams. ECG q4y. 50+: Mammography every 2 years, Bone density screening after 65. Every 5 years thru age 75 colonography, or colonoscopy every 10 years Men's monitoring guidelines - --Monthly: Testicles, skin, oral Yearly: BP, blood, urine, physical. For MSM STI check until age 64. 13-64: At lest one HIV screen. 40-49: ECG every 4 years 50+:Every 5 years thru 75 flexible sigmoidoscopy or CT colonography OR colonoscopy every 10 years Morphogenesis - --Family's tendency to adapt to change when changes are necessary Morphostasis - --Family's tendency to remain stable in the midst of change Family systems theorist - --Bowen

Family systems focus - --Chronic anxiety in families. Raise awareness of each members' function, increase self-differentiation Multitransmission process - --Family dysfunction present over several generations Structural family theorist - --Munichin Structural family theory - --Symptoms are rooted in context of family transaction patterns. Main goal is to produce structural change in family organization to more effectively manage problems, change transactional patterns and structure. Strategic therapy theorist - --Haley Strategic therapy - --Symptoms viewed as metaphors reflecting problems in hierarchical structures. Goal to help folks behave in ways that won't perpetuate problem behr. Straightforward directives, paradoxical directives, reframing belief systems Straightforward directives - --Strategic. Tasks designed in expectation of family member's compliance Paradoxical directives - --Strategic. Negative task assigned when family members are resistant to change and member is expected to be noncompliant ("Worry very well for one hour a day") Solution-Focused therapy origintaor - --deShazer, O'Hanlon, Berg Solution-Focused Therapy - --Goal is effective resolution of probles throgh cognitive problem-solving and use of personal resources and strengths. Miracle questions, exception-finding questions, scaling questions

Miracle questions - --Solution focused therapy. "If a miracle were to happen and tomorrow your problem no longer existed, what would be different? How would you know the miracle took place? How would others know?" False positive for benzos - --Sertraline False positive for cocaine - --Amoxicillin, NSAIDs False positive for methadone or PCP - --Codeine Nurse Practitioner Core Competencies - --Mgmt pt health status Maint of NP-pt rel'ship Teaching and coaching Professional role Negotiating health care delivery systems Monitoring quality of care Providing culturally sensitive care NP Professional role core competencies - --Serving as pt advocating Implementing IT Using interdisciplinary collab Working within/across org to improve health care Practicing ethically Showing leadership Participating in policymaking

O'Connor vs Donaldson - --1976. Presence of mental illness alone isn't grounds for involuntary hospitalization. Harmlessly mentally ill pts can't be confined against their will if they can survive outside. Rennie vs Klein - --1979. Pts have the right to refuse tx and use an appeal process Rogers vs Oken - --1981. Pts have absolute right to refuse tx, but a guardian may authorize their tx Duham vs United States - --Origin of insanity defense. Individual isn't criminally responsible if the unlawful act was the product of mental illness. Thioridazine special AE - --Retinal pigmentation Class of medication that aids in pyramidal cell fxning in PFC by preventing excessive release of glutamate

• --5HT antagonist/reuptake inhibitors. These block 5HT2A, thus inhibiting glutamate release in PFC. Actus reus - --Voluntary conduct (Context: Whether or not someone was crazy in committing crime) Mens rea - --Evil intent/resolve to do harm (committing crimes) % US citizens private insurance - --64% (2014) % US citizens Medicare - --14.5% (2014) % US citizens Medicaid - --15.9% (2014) % US citizens uninsured - --16.3% (2014)

Non-24-hour sleep-wake type - --Falling asleep and usually waking progressively later than desired. Circadian rhythm disorder. Delayed sleep phase type - --Falling asleep and waking later than desired. Circadian rhythm disorder. Advanced sleep phase type - --Falling asleep and waking earlier than desired. Circadian rhythm disorder. Irregular sleep-wake type - --Falling asleep and waking at random times. Circadian rhythm disorder. Shift work type - --Sleepiness associated with changes in work schedule Circadian rhythm disorder. Desensitization - --Pt visualizes trauma, verbalizes negative/maladaptive beliefs, remains attentive to physical sensations. Tries to block out negative thoughts, breathes deeply, verbalizes what he/she is imagining. Installation - --Pt installs and strengthens positive thought he/she has declared as a replacement of the original negative thought Body scan - --Pt visualizes trauma along with positive thought, then scans his/her body mentally to identify any tension within Formal operational adolescent cognitive-spatial concepts - --Hypothetical-deductive reasoning (quick to think of excuses), imaginary audience, personal fable, propositional thinking (think of many possibilities) First NP program establishers - --Loretta Ford and Henry Silver First NP program - --1965, pediatrics

Omega-3 fatty acid use - --ADHD, dyslexia, cognitive impairment, dementia, CVD, asthma, lupus, rheumatoid arthritis Omega-3 fatty acid interxns - --Warfarin (increases anticoagulant effect) Sam-e use - --Depression, osteoarthritis, liver dz Tryptophan use - --Depression, obesity, insomnia, HA, fibromyalgia 3 question CBT technique - --1: Evidence for negative belief 2: How they interpret the situation 3: If it is true, what are the implications? Meds that can cause altered mood states as SEs - --Steroids, estrogen compounds, antiHTNsives, anti- Parkinson's, antineoplastic agents,antibacterial and antifungal agents, analgesics, isotretinoin, benzodiazepines Tyramine-rich foods - --Aged cheese (blue, brie, camembert, roquefort), smoked/aged/cured meats and fish (sausages, pastrami, salami in particular), red wine, aged liquors, whiskey (gin and whisky are ok tho), beer (bottled and pasteurized are ok), tofu, soy products, saurkraut, miso, yeast extract, MSG, ripe bananas, avocado Drugs to avoid when on MAOIs (r/t HTNsive crisis) - --Meperidine, decongestants, TCAs, atypical antipsychotics, St Johns wort, l-tryptophan, stimulants, asthma meds 5HT syndrome symptoms - --Autonomic instability, altered sensorium, restlessness, agitation, myoclonus, hyperreflexia, hyperthermia, diaphoresis, tremor, chills, diarrhea and cramps, ataxia, HA, insomnia

Bipolar disorder biology - --GABA deregulation, kindling, increased noradrenergic activity, (glutamate increase?) Ataques de nervios - --Latino cultural syndrome. Trembling, crying, screaming, usually experienced in presence of others and the person often feels relief afterwards. Usually brought on by disruptions in family bonds. Khyal - --Cambodian and "other Asians" cultural syndrome. Manifests as neck soreness, tinnitus. Anxiety levels - --I: Mild. Normal, motivates you to do stuff. II: Moderate. Normal in response to significant stressors. III: Severe. Pathological. Not good. IV: Panic. Pathological. AHHHH. Interpersonal Theory - --Sullivan. Humans are goal-directed toward attainment of satisfaction and security needs, which are usually met in interpersonal interactions. Anxiety arises when person's needs are unmet. First experienced in infant's interactions with his/her mother. Anxiety lab findings - --Sometimes compensated respiratory alkalosis (decreased CO2, decreased bicarb, normal pH) Scales for anxiety disorders - --Zung's Self Rating Anxiety Scale, Hamilton Rating Scale for Anxiety (HAM- A), Yale-Brown Obsessive Compulsive Scale (Y-BOCS) HAM-A scoring - --<17 Mild anxiety 18-25 Moderate anxiety 25-30 Severe anxiety

HAM-D scoring - --0-7 Normal 8-13 Mild depression 14-18 Moderate depression 19-22 Severe depression

23 VERY severe depression Schizophrenia structural findings - --Enlarged lateral ventricles, widened cortical sulci, diffuse decreased volume of white/gray matter, decreased volume of temporal lobe, decresaed volume in hippocampus, amygdala, thalamus Mesolimbic pathway - --Positive symptoms. Mesocortical pathway - --Negative symptoms. Nigrostriatal pathway - --DA has reciprocal rel'ship with ACh. 5HT blocked by atypical antipsychotics, DA increases and ACh decreases, leading to EPS. Tuberoinfundibular pathway - --DA inhibits PRL, so DA blockade with atypical --> elevated PRL Extrapyramidal side effects - --Akathisia, akinesia, dystonia, pseudo-Parkinson's, tardive dyskinesia NMS symptoms - --Altered sensorium, hyperthermia, hyperreflexia, autonomic instability (HypoTN, extreme muscular rigidity, tachycardia, diaphoresis, tachypnea, coma and maybe death) NMS lab findings - --Elevated CPK, elevated WBCs, elevated LFTs