PMHNP Certification Exam Questions and Answers, Exams of Nursing

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LMR GEORGETTE’S PMHNP CERTIFICATION

EXAM WITH 200 UPDATED QUESTIONS AND

ANSWERS2022-2024(100% CORRECT ANSWERS)

What are assessed in the Thought Content of the MSE - ANSWER>>SI/HI, Plan, Hallucinations

• PNEUMOIC - Old Age Parents Love Grandchildren - ANSWER>>• Oral (0-18 months), Anal (18 months - 3 years), Phallic (3 years to 6 years), Latent (6 to 12), Genital (12 +)
• FREUD's PSYCHOSOCIAL STAGES OF DEVELOPMENT - PHALLIC STAGE - 3 - 6 years old - ANSWER>>• 3-year-old masturbates, play with self, says naughty things
• This is NORMAL for children this age. What do you do when a patient has an increased prolactin level? - ANSWER>>• Stop prolactin (stop the agent that cause increase prolactin)
• ACUTE STRESS DISORDER - ANSWER>>• A d/o resulting from exposure to a major stressor, with SX of ANX, depression, dissociation, recurring nightmares, sleep disturbances, problems in concentrations, reliving the event, dreams, flashbacks - UP to ONE MONTH - Less than 1 month.
• If LONGER than 1 month = PTSD
• Symptoms that occur immediately after the event but resolve in less than 3 days would not meet criteria for acute stress disorder What would you do if a 5-year-old tells you his brother sodomized him? - ANSWER>>• Tell mom don't leave him alone with patient and call CPS implement crisis If a child is playing with doll in a sexual way, what do you do first? - ANSWER>>• You

SUSPECT sexual abuse - Perform FURTHER ASSESSMENT and GATHER ENOUGH INFO BEFORE Calling CPS to report suspected Sexual Abuse - You HAVE to report but you have to have something (assessment data) to report - Assess = FIRST If a 13-year-old tells you he want to smoke, what would be an appropriate response? - ANSWER>>• Ask him of his plan to stop smoking If a 14-year-old girl clenching her teeth, what cranial nerve would you suspect? - ANSWER>>• Cranial nerve V-Trigeminal nerve (FIVE) What cranial nerve is responsible for Bells Palsy? - ANSWER>>7 = Facial Paralysis What cranial nerves do you assess for corneal sensation - ANSWER>>Nerves 5 & 7 What cranial nerves do you assess for papillary reaction to light and accommodation? - ANSWER>>Nerves 3,4,& 6 What cranial nerves do you assess for 6 cardinal fields of gaze & extra-ocular movements? - ANSWER>>Nerves 3, 4, & 6 What cranial nerves do you assess for corneal light reflex? - ANSWER>>3, 4, & 6 Cranial Nerve 1 - ANSWER>>Olfactory (smell) Cranial Nerve 2 - ANSWER>>Optic - vision Cranial Nerve 3 - ANSWER>>Oculomotor (eye movement): The occulomotor nerve is responsible for motor enervation of upper eyelid muscle, extraocular muscle and pupillary muscle.

Cranial Nerve 4 - ANSWER>>Trochlear (eye movement): The trochlear nerve controls an extraocular muscle. Cranial Nerve 5 - ANSWER>>Trigeminal: The trigeminal nerve is responsible for sensory enervation of the face and motor enervation to muscles of mastication (chewing). Cranial Nerve 6 - ANSWER>>Abducens (motor): The abducent nerve enervates a muscle, which moves the eyeball. Cranial Nerve 7 - ANSWER>>Facial nerve: The facial nerve enervates the muscles of the face (facial expression). Cranial Nerve 8 - ANSWER>>Vestibulocochlear (hearing and balance): The vestibulocochlear nerve is responsible for the sense of hearing and balance (body position sense). Cranial Nerve 9 - ANSWER>>Glossopharyngeal: The glossopharyngeal nerve enervates muscles involved in swallowing and taste. Lesions of the ninth nerve result in difficulty swallowing and disturbance of taste. Cranial Nerve 10 - ANSWER>>vagus nerve: The vagus nerve enervates the gut (gastrointestinal tract), heart and larynx. Cranial Nerve 11 - ANSWER>>accessory: The accessory nerve enervates the sternocleidomastoid muscles and the trapezius muscles. Cranial Nerve 12 - ANSWER>>Hypoglossal (tongue movement): The hypoglossal nerve enervates the muscles of the tongue. What is the best action for a 16 y/o with conduct disorder that refuses tx? -

ANSWER>>• Send to psych specialist for acting out kids - Referrals - Have to see if you are going to refer the same patient to the same provider - Cannot refer the patient to another provider that is the same as you (ie psych) - you must refer to a neurologist or another specialist or PCP What is a priority consideration for a 16-year-old that shows up with mother for first therapy? - ANSWER>>• Confidentiality (ex. mom sits in lobby) What is important to know about ACE inhibitors (Meds for Heart failure/HTN) - ANSWER>>• This medication can cause increased lithium levels to toxic levels - must collaborate with PCP to determine whether to change ACE or change Lithium - Can't use both What medication INCREASES Lithium serum level up to double - ANSWER>>Ibuprofen Why is Lithium used? - ANSWER>>• First-line neuro-protective for bipolar

• Lab Values concerning for patient on Lithium: - ANSWER>>• Leukocytosis
• Creatinine
• BUN
• NA+
• 4 + PORTEIN in Urine
• • Pregnancy Test
• Lithium (Eskalith/Lithobid) Toxicity - ANSWER>>• Normal Range of LITHIUM LEVEL - 0.5 - 1.2 mEq/L
• MONITOR for TOXICITY: Toxicity = > 1.2 mEq/l
• Slurred speech, confusion, severe GI effect - diarrhea/nausea/vomiting, metallic taste and SEVERE tremor.

Common side effects of Lithium (Eskalith/Lithobid) - ANSWER>>Nausea, fine-hand tremors (start monitoring for toxicity), increased urination and thirst What pregnancy category is Lithium (Eskalith/Lithobid) - ANSWER>>CATEGORY D: AVOID in pregnancy, especially 1st trimester - Ebstein anomaly, cardiac defect What increases risk of lithium (Eskalith/Lithobid) toxicity? - ANSWER>>NSAID, dehydration and Thiazides What co-morbid risk in increased with Lithium (Eskalith/Lithobid)? - ANSWER>>• Risk of Hypothyroidism What do symptoms of hypothyroidism (decreased T4 & increased TSH) mimic? - ANSWER>>Unipolar mood disorders:

• confusion
• decreased libido
• impotence
• decreased apetite
• memory loss
• lethargy
• constipation
• headaches
• slow or clumsy movements
• syncope
• weight gain
• fluid retention
• muscle aches and stiffness
• slowed reflexes
• somatic discomfort including aching and joint stiffness

• slowed speech and thinking
• sensory disturbances including hearing
• cerebellar ataxia (may present with symptoms of an inability to coordinate balance, gait, extremity and eye movements)
• loss of amplitude in ECG What do symptoms of hyperthyroidism (decreased TSH & increased T4) mimic? - ANSWER>>Bipolar affective disorders
• motor restlessness
• emotional lability
• short attention span
• compulsive movements
• fatigue
• tremor
• insomnia
• impotence
• weight loss
• increased appetite
• abdominal pain
• excessive sweating
• flushing
• elevated upper eyelid leading to decreased blinking, starring, and fine tremor
• tachycardia
• dysrhythmias What does ADPIE stand for? - ANSWER>>• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation

Recommend CBT for - ANSWER>>Depression & Anxiety (keep a daily log) pg 209 and every PB pages for each dx - ANSWER>>all thing for each disorder What medication is best for an aggressive patient? - ANSWER>>IM Geodon Medications to improve anxiety... - ANSWER>>act directly or indirectly on GABA system

• SSRIs
• Benzodiazepines
• Tricyclics (TCA)
• Buspirone
• Tiagabine (Gabitril)
• gabapentin
• propranolol in children:
• alpha agonists : clonidine (catapres) & guanfacine (tenex) advantages of Benzodiazepines with short have lives - ANSWER>>- less daytime sedation
• less drug accumulation
• quick onset
• useful for tx of insomnia disadvantages of Benzodiazepines with short have lives - ANSWER>>increase risk of addiction non-pharmacological Management for anxiety - ANSWER>>- behavioral therapy
• CBT
• interpersonal therapies

• community self help groups
• alternate therapies as adjunct tx SSRI's - ANSWER>>- first line tx for anxiety
• act on serotonin and indirectly on GABA
• takes 3-4 weeks to reach symptom control
• black box warning for kids is SI Agoraphobia treatment - ANSWER>>• BZs: Short term symptom relief
• SSRIs: long term maintenance
• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)
• SNRIs: long term maintenance
• Venlafaxine (Effexor) TCAs: long term maintenance
• Beta blockers (off-label use) used for discrete episodes of social anxiety - contraindicated for clients with asthma Alprostadil (PGE1) - ANSWER>>• Ductal-dependent Congenital Heart disease (all forms)
• Prostaglandin E1 (PGE1), also known as alprostadil, is a naturally occurring prostaglandin which is used as a medication. In babies with congenital heart defects, it is used by slow injection into a vein to open the ductus arteriosus until surgery can be carried out. By injection into the penis or placement in the urethra, it is used to treat erectile dysfunction.
• 0.05-0.1 mg/kg/min IV/IO infusion initially, then 0.01-0.05 mg/kg/min IV/IO Amygdala - ANSWER>>• A limbic system structure involved in memory and emotion, anxiety, particularly fear and aggression

Anorexia nervosa - ANSWER>>• Anorexia (SAFETY = KEY)

• BMI less than 18.
• BMI < 16 = AUTOMATIC ADMISSION
• An eating disorder in which an irrational fear of weight gain leads people to starve themselves
• Anorexia admission criteria for hospitalization
• Weight loss over 30 % over 6 months, severe hypothermia (temp lower than 36 C or 96.8 F), heart rate less than 40 beats per minute, systolic blood pressure less than 70 mm hg, and hypokalemia (less than 3 mEq/L).
• Set up family therapy (especially adolescent pts since they have no control over food choices)
• ANOVA (analysis of variance) - ANSWER>>• 3 or more
• An inferential statistical test for comparing the means of three or more groups PROZAC Causes What? - ANSWER>>• Increase Anxiety in Elderly
• Apoptosis - ANSWER>>• Cell death in aging/elderly
• Appreciative inquiry - ANSWER>>• An organizational change philosophy and process building organizations around what works, rather than focusing on and trying to fix what doesn't work
• An organizational change strategy that directs the group's attention away from its own problems and focuses participants on the group's potential and positive elements
• Discovery (best of what is)

• Dream (wishes or dreams of organization)
• Design (decide what you want to change)
• Destiny (make it happen, implanting change)
• Identify the problem
• Analyze the problem
• Generate solutions
• Implement best solution
• Assertive Community Treatment (ACT) - ANSWER>>• Community-based programs that provide many of the services that are necessary for successful community living; include case management, problem solving, social skills training, support teaching on a 24/7 basis
• Assertive questions - ANSWER>>• Use "I want", "I need", or "I feel" to convey basic assertions and get your point across firmly. For example "I feel strongly that we need to bring in a third party to medicate this disagreement" another example "Dave, your request has caught me off guard. I'll get back to you within the half hour". Transtheoretical Model of Change - ANSWER>>• States that change such as in health behaviors occurs in six predictable stages
• Precontemplation: The person has no intention to change.
• Contemplation: The person is thinking about changing; is aware that there is a problem but not committed to changing.
• Preparation: The person has made the decision to change; is ready for action.
• Action: The person is engaging in specific, overt actions to change.
• Maintenance: The person is engaging in behaviors to prevent relapse.

erectile dysfunction medications - ANSWER>>• Avanafil (Stendra) 15 minutes prior to sex

• Tadalafil (Cialis) 45 minutes prior to sex
• Vardenafil (Levitra) 45 minutes prior to sex
• Sildenafil (Viagra) 1 hour prior to sex - brand-name version of the generic drug. It is a phosphodiesterase type 5 (PDE5) inhibitor.
• Beck depression inventory - ANSWER>>• A questionnaire useful for determining the level of depression
• 0 - 13 minimal depression
• 14 - 19 mild depression
• 19 - 29 Moderate depression
• 30 - 63 severe depression Intimate therapy for child with a score 10 Big Freaking Problems - ANSWER>>• Bupropion Fluoxetine Paxil
• Those are strong inhibitors of 2D
• Borderline personality disorder treatment - ANSWER>>• Dialectical behavior therapy If a boy patient states that he wishes to be a girl and tells you not to tell his parent, what do you do? - ANSWER>>Don't tell If you see a bruise on the padded part of patient's arm, what do you do? - ANSWER>>• Say I see you have bruises on your arm
• Ask what happened
• Can an advanced directive ever be revoked? - ANSWER>>• Yes, at any time

Can asthma medications cause depression? - ANSWER>>• Yes

• Examples: INTERFERON
• Can you take Buspar during pregnancy? - ANSWER>>• Category B: OK if really needed
• Can you take Klonopin during pregnancy? - ANSWER>>• Category C: Avoid if possible; does excrete into breast-milk and infant could get withdrawal symptoms
• Floppy baby
• Carb and Barb (Carbamazepine and Phenobarbital) - ANSWER>>• Strong inducers of 3A
• Decrease INR
• Change agent - ANSWER>>• The person formally in charge of guiding a change effort
  • Administrator - Usually the person on top in the facility is responsible for being the change agent.
• Charge of DEA - ANSWER>>• State and federal A child in foster home 5 years poor eye contact, isolated self, eat without difficulty.. what is dx - ANSWER>>autism A child in foster home since birth, eats without interest, shows little emotion.. what is dx?
• ANSWER>>REACTIVE ATTACHMENT DISORDER = Look for NO Emotion
• Child reports Sexual abuse - ANSWER>>• Interview the young child and infants with parent

TRICYCLIC ANTIDEPRESSANTS (TCAs) - ANSWER>>Not commonly used due to side effects and overdose toxicity risk; however, TCAs should be considered for appropriate patients who do not respond to other antidepressants. There are nine TCAs approved by the FDA for depression (amitriptyline, amoxapine, desipramine, doxepin, imipramine, maprotiline, nortriptyline, protriptyline, trimipramine), and one approved for OCD - clomipramine (Anafranil). Tertiary TCAs (more sedating): Amitriptyline tablets (G): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg. Imipramine tablets and capsules (G): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 125 mg, 150 mg. Secondary TCAs (less sedating): Desipramine tablets (Norpramin, [G]): 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg. Nortriptyline capsules (Pamelor, [G]): 10 mg, 25 mg, 50 mg, 75 mg, and 10 mg/5 mL oral solution. Side Effects: Most common: Sedation, dry mouth, constipation, weight gain, sexual side effects, urinary hesitation, blurred vision. Serious but rare: Seizure; cardiac effects including orthostasis, arrhythmias, QT prolongation, AV block. Clozaril (Clozapine) - ANSWER>>• DC Clozapine at

• ANC < 1000
• WBC 2000- 3000 ANC & WBC WEEKLY for 6 months:
• When a patient is on Clozapine monitor for signs for agranulocytosis such as:
• Sores in the mouth, throat,

• Chronic infections of the gums, throat, or skin,
• Fever
• Chills
• Co-morbidities of bipolar - ANSWER>>• Anxiety, alcohol and substance abuse
• Inducer; Pushes the substrate out of the exit pathways, < the serum level of other drugs, < therapeutic effect. - ANSWER>>I'll Come See Pumpkin Pie Tomorrow or Monday And Chow
• Carbamazepine/Oxcarba (1A2, 2C19 and 3A4)
• St. John's Wart (3A4)
• Phenytoin
• Phenobarbital
• Tobacco (1A2)
• OCP (1A4) (watch with use of Topamax/Tegretol)
• Methadone (1A2)
• Antiretroviral
• Cyclosporine Or Bull Shit CRAPGPS
• Barbiturates
• St. Johns Wart
• Carbamazepine
• Rifampin
• Alcohol (chronic use)
• Phenytoin
• Griseofulvin
• Phenobarbital

• Sulfonylureas
• Inhibitors : Blocks the enzymatic pathways, limiting substrate excretion, Increase the serum level of other drugs, Increase toxic risk - ANSWER>>Sickfaces.com
• Sodium Valproate
• Isoniazid
• Cimetidine
• Ketoconazole
• Fluconazole
• Alcohol
• Chloramphenicol
• Erythromycin
• Sulfonamides
• Ciprofloxacin
• Omeprazole
• Metronidazole Plus Grapefruit juice
• DBT (Dialectical behavior therapy) - ANSWER>>• Relaxation muscle prior to DBT • Borderline Patients - NO meds - DBT therapy what therapy uses a diary log - ANSWER>>• CBT what medication is used for ENURESIS - ANSWER>>• DDAVP (Desmopressin) Works in the SAME manner of ANTIDIEURTIC HORMONE
• Makes less urine - Used for ENURESIS what medications increase INR? - ANSWER>>Depakote and Disulfiram

What medication causes Spina bifida? - ANSWER>>Depakote, so check HCG level

• DIGFAST for Mania - ANSWER>>• Distractibility
• Indiscretion
• Grandiosity
• Flight of ideas
• Activity increase
• Sleep deficit
• Talking increase
• Disseminated Encephalomyelitis - ANSWER>>• Assess for asymmetry of extremities
• Along with this pattern, the patient usually get neurological symptoms which may include
• Confusion, drowsiness, and even coma
• Unsteadiness and falling
• Visual blurring or double vision (occasionally)
• Trouble swallowing
• Weakness of the arms or legs
• Fever
• Headache Disulfiram - ANSWER>>Disulfiram (sold under the trade name Antabuse) is a drug used to support the treatment of alcohol use disorder by producing an acute sensitivity to ethanol (drinking alcohol). Disulfiram works by inhibiting the enzyme acetaldehyde dehydrogenase, causing many of the effects of a hangover to be felt immediately following alcohol consumption.
• Increase Coumadin

• Does impaired judgement mean one is incompetent? - ANSWER>>No
• Does the de facto rule of proxy apply in same sex marriages? - ANSWER>>• No Drug affects with Flonase - ANSWER>>(just know that Flonase has interaction with Zantac & Tegretol)
• Zantac (histamine 2 blocker) antagonist
• Per ANCC study material - Flonase (ALL Steroids) can induce MANIA and DEPRESSION - If you have a patient with bipolar disorder who is stable on a mood stabilizer and becomes manic after prescription of a steroid, the mood stabilizer will need to be increased. If you have a patient with MDD who is stable on an antidepressant and becomes depressed after starting a steroid, you may need to increase the antidepressant - just remember though, make sure you understand what the question is asking - safety first
• Early onset of HIV dementia - ANSWER>>• Apathy : lack of interest
• Abnormal of MRI_ slow
• Cognitive functions: memory, reasoning, judgment, concentration, and problem solving
• Other common symptoms are changes in personality and behavior, speech problems, and motor (movement) problems such as clumsiness and poor balance
• Show brain atrophy (shrinkage) therapies & dx - ANSWER>>• EMDR - PTSD - Shapiro
• DBT - Borderline Personality D/O - Linehan
• Interpersonal therapy - Interpersonal conflict - Klerman and Weismann
• CBT - if nothing fits CBT works for most.
• Encopresis Treatment - ANSWER>>Behavior management:

• Toilet refusal behavior,
• scheduled toileting time,
• incentives
• prevention of constipation EPS - ANSWER>>• Clients who experience any form of EPS are at increased risk of TD
• Acute dystonia: is the first symptom that an individual will develop, and it can occur within hours of taking the medication. It usually presents as involuntary contractions of the face and neck muscles and can be painful.
• akathisia: Once the patient has been taking an antipsychotic for a few days, they can start to experience another side effect of consistently feeling restlessness or jittery
• Parkinsonism: typically occur withing a few weeks after starting an antipsychotic. Parkinsonism can include muscle motor deficits such as rigidity, postural shuffle, tremors, a shuffling gait, and difficulty initiating movements
• tardive dyskinesia: Long term continuation of antipsychotics for three months or more, which can sometimes be irreversible if it is not attended to quickly enough. Symptoms of tardive dyskinesia can include involuntary rhythmic movements such as grimacing, lip smacking, chewing, tongue flicking, as well as excessive eye blinking what mood stabilizer is least cause metabolic syndrome - ANSWER>>lamictal depakote can cause - ANSWER>>hepatoxicity (liver) = RUQ pain & reddish brown urine valproic acid - ANSWER>>range is 50 - 125, toxicity is greater than 150 depakote toxicity - ANSWER>>confusion, lethargy, and respiratory depression

• do you liver function test
• check ammonia levels - increase ammonia causes confusion patients taking Kava for anxiety or insomnia need? - ANSWER>>A liver function test, can cause hepatoxicity there is a drug to drug interaction with kava and Benzodiazepines TCA can cause - ANSWER>>hepatoxicity What can Steven Johnson syndrome - ANSWER>>lamictal and carbamazepine (tegretal) Tegretal increases risk for SJS in Asians S/S: fever and rash Tegretal (Carbamazepine) and clozaril - ANSWER>>can cause agranulocytosis d/c for ANC for less than 1,000 and monitor for s/s of infection Clozaril (Clozapine) can.. - ANSWER>>decrease SI in PTs with schizophrenia what is gold standard medication for bipolar - ANSWER>>Lithium - it can decrease SI for bipolar PT's check what levels with lithium - ANSWER>>TSH, HCG, bun, creatinine, UA what medication can increase lithium toxicity - ANSWER>>NSAIDS, thiazides, and ACE inhibitors (lisinopril)

they reduce renal clearance why should you not take lithium in pregnancy? - ANSWER>>causes ebstein anomaly (especially in the first trimester) lithium can cause - ANSWER>>leukocytosis, hypothyroidism, maculopapular rash, twave inversion, tremors (fine hand Tremors), GI upset,

• course hand tremors = can indicate toxicity Signs of lithium toxicity - ANSWER>>muscle weakness, confusion, incoordination, palpitations, severe GI upset, drowsiness, find hand tremors priority action - d/c lithium and check serum levels NMS (neuroleptic malignant syndrome) - ANSWER>>Can be caused by antipsychotics
• extra muscle rigidity that can lead to mutism
• increase CPK levels
• myoglobinuria (muscle contractions and muscle destruction which is what is responsible for increase CPK levels
• increase WBC & LFT *If the patient goes to the gym a lot with a reddish/cherry color that would indicate myoglobinuria Tx:
• stop med
• give bromocriptine (dopamine agonsit)
• give dantrolene (muscle relaxant)

Serotonin Syndrome - ANSWER>>Caused by antidepressants - SSRIs, TCA, SNRIs, MAOIs

• Triptans - migraine medications, also are risk for SS
• hyperflexia (myoclonic jerks) TX:
• stop med
• give cyproheptadine *NDRIs (Wellbutrin) do not increase serotonin levels How long should you wait to switch medications that are serotonin meds - ANSWER>>2 weeks (ex. SSRIs to MAOI) wait 5-6 weeks for fluoxetine to MAOI *prozac has a long half life Why are SSRIs first line? - ANSWER>>They are safer and less potential for causing injury with potential overdose depression + cancer, give what meds - ANSWER>>Give a SSRI like citalopram or escitalopram because they have less potential for drug to drug interactions depressed + neuropathic pain - ANSWER>>SNRI - duloxetine (Cymbalta) TCAs

Gabapentin Schizophrenia - ANSWER>>Age on onset: 18 - 25 in males 25 - 35 in females

• the dx has the highest rate of dx's that increases risk for self harm - even more than depression or bipolar
• can aggression, impulsivity, abstract thinking problems,
• changes or abnormalities in the prefrontal cortex, amygdala, basal ganglia, hippocampus, and limbic regions of the brain can cause aggression & impulsivity
• MRI/PET will show a decrease in size of the lobes of the brain, and an INCREASE is the ventricles d/t increased cerebral blood flow
• Do not give stimulants - increased dopamine
• positive symptoms of schizo is due to too much dopamine
• Tx:
• assertive community treatment
• Long term non-compliance of meds then should refer to ACT team (ACT is a form or rehabilitation post hospitalization in the home)
• social skills rehabilitation (is a tertiary level of prevention)
• refer to exercise program (aerobic exercises can help improve cognition and quality of life and long term health what is the dx that increases HI the most - ANSWER>>antisocial personality disorder

How do you calculate dose of monthly IM haldol - ANSWER>>You multiply their daily dose by 20 ex. if a PT is taking 5mg BID, you would multiply 10X20= 200 but you can only give 100mg, so give 100mg and tell them to come back in two weeks for their other 100mg What is a delusion? - ANSWER>>Is the false belief firmly maintained despite the evidence to the contrary (ex. their family member is part of a cult) Mini Mental Status Exam - ANSWER>>Thought process - you want to assess your PT's thoughts if they are normal or abnormal - organization of thoughts Tangential thinking- Thought process - ANSWER>>the patient never gets to the point. they move from thought to thought with never getting to the point Circumstantial thinking - thought process - ANSWER>>a PT goes in circle and provide unnecessary details before getting to the point What is another name for the MMSE - ANSWER>>Folstein Scale What areas of the brain does the clock function test target? - ANSWER>>If cannot draw the clock it can indicate a problem with the right hemisphere/right parietal lobe Hyperactivity of dopamine in the mesolimbic pathway mediates what type of psychotic symptoms - ANSWER>>positive symptoms = mesolimbic pathway decreased dopamine in the mesocortical projection to the dorsolateral prefrontal cortex is postulated to be responsible for what types of schizophrenia symtoms? - ANSWER>>negative and depressive symptoms = mesocortical pathway

What are the positive symptoms of schizophrenia? - ANSWER>>delusions, hallucinations, disorganized speech, disorganized or catatonic behavior What are the negative symptoms of schizophrenia? - ANSWER>>flat affect, social withdrawal, lack of motivation, lack of speech or thought, anhedonia Nigrostraital Pathway - ANSWER>>- mediates motor movements

• when dopamine is blocked in this pathway it can lead to increased acetylcholine levels
• blocked dopamine can lead to EPS
• long standing D2 blockade in this pathway can lead to tar dive dyskinesia what is the relationship between dopamine and acetylcholine - ANSWER>>If you decrease dopamine in the nigrostaital pathway it will lead to increased acetylcholine levels low dopamine and high acetylcholine = EPS Tuberoinfundibular pathway - ANSWER>>if you decrease dopamine in this pathway it will increase prolactin levels When prolactin levels are high it can cause hyperprolactinemia what are symptoms of hyperprolactinemia? - ANSWER>>amenorrhea, galactorrhea (breast discharge), sexual dysfunction, and gynecomastia long-term can cause osteoporosis what medication is known to increase prolactin level - ANSWER>>risperidone male = less an 20 is normal women = less than 25 is normal

if levels are high, switch to another antipsychotic acute dystonia - ANSWER>>muscle spasms of face, tongue, neck, or back

• subjectively painful
• facial grimacing TX = cogentin (benzotropine) IM route Akathisia - ANSWER>>restlessness, pacing, difficulty standing, feet constantly in motion (rocking) TX:
• beta blocker - propranolol (first line) - avoid giving beta blockers to PT's taking bronchodilators like albuterol (since beta blockers can cause bronchospasm)
• anticholinergics (cogentin) 2nd line
• benzodiazepines (3rd line) Akinesia - ANSWER>>Absence of movement, difficulty initiating motion, subjectively feeling lack of motivation to move
• often mistaken for laziness or lack of interest TX: cogentin peusdo-parkinsonian symptoms - ANSWER>>Presence of symptoms of Parkinson's disease produced by D2 blockade