PMHNP Certification Exam Review: Questions and Answers, Exams of Nursing

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What drugs should be avoided with Kava Kava?

• Alprazolam CNS depressants (e.g., phenobarbital, zolpidem) Cultural Formulation Interview perform what 3 functions? - Clarify meaning of illness Empower the patient Validate symptoms within cultural context What does a cultural formulation interview do? - cultural assessment What is the normal range for TSH? - 0.5 - 5.0 mu/L What are lab values in Hyperthyroidism - Decreased TSH Increased T4 and T What are labs in Hypothyroidism? - Increased TSH Decreased T4 and T What are 5 primary symptoms of Hyperthyroidism? - Heat intolerance Agitation, Anxiety, Irritability Tachycardia Mood swings Weight loss What are 4 primary symptoms of Hypothyroidism? - Cold intolerance Lethargy Weight gain Decreased libido Hypothyroidism mimics symptoms of what psychiatric disorder? - Depression Hyperthyroidism mimics symptoms of what psychiatric disorder? - Mania Valproic acid produces what teratogenic effect? - Spina bifida (neural tube defect) What is the primary organ where valproic acid is toxic? - Liver (hepatoxicity)

What are 4 signs of hepatoxicity? - Abdominal pain in the URQ Reddish-brown urine Yellowing of the skin and sclera Fatigue Abdominal pain in the URQ, Reddish-brown urine, Yellowing of the skin and sclera, and Fatigue are signs of - Hepatoxicity What is the therapeutic range for valproic acid? - 50-125 mcg/ml What is a toxic level of valproic acid? - >150 mcg/ml What are 4 signs of valproic acid toxicity? - Disorientation Lethargy Respiratory depression Nausea/vomiting Disorientation, Lethargy, Respiratory depression, and Nausea/vomiting are symptoms of toxicity with what drug? - Valproic acid With suspected toxicity with valproic acid, what labs should be drawn? - DC drug Check drug level Obtain LFTs Obtain ammonia level What is the major side effect with Kava Kava? - Liver damage What herbal supplement is sued for anxiety, stress, and insomnia? - Kava Kava What are 5 symptoms of Stephen's Johnson Syndrome? - Fever Body aches Severe red rash Peeling skin Facial and tongue swelling Severe red rash, Fever, Body aches, Peeling skin, and Facial and tongue swelling are symptoms of - Stephen's Johnson Syndrome Which mood stabilizer causes the least weight gain? - Lamotrigine (Lamictal)

Which 3 SGAs cause the least weight gain? - Lurasidone (Latuda) Aripiprazole (Abilify) Ziprasidone (Geodon) Which SGA is the least sedating? - Aripiprazole (Abilify) What are 3 hallmark symptoms of delirium? - Acute disturbance of LOC impaired cognition inattention Acute disturbance of LOC, cognition, and inattention are hallmark symptoms of - Delirium How are agitation and psychotic symptoms treated in delirium? - Low dose Haldol What 4 drugs can cause mania? - Steroids Disulfiram (Antabuse) Isoniazid (INH) Antidepressants (in BPD) Steroids, Disulfiram (Antabuse), and Isoniazid (INH) can induce - Mania What 6 drugs can induce depression? - Steroids Beta blockers Interferon, Isotretinoin (Accutane) Retroviral drugs, Antineoplastic drugs Benzodiazepines Progesterone Steroids can induce what 3 psychiatric states? - Mania Depression Psychosis What medication to treat acne cause cause birth defects? - Isotretinoin (Accutane) What is the therapeutic range for lithium? - 0.6-1.2 mEq/L What medication has a neuroprotective effect for bipolar disorder? - Lithium What is the gold standard for treating manic episodes - Lithium

What mood stabilizer has anti-suicidal effects? - Lithium What 5 labs should be drawn with lithium? - Thyroid panel (TSH) Serum creatinine BUN Urinalysis HCG What is a normal SCr range? - 0.6-1.2 mg/dL What is the normal range for BUN? - 10-20 mg/dL When should you suspect kidney disease with a urinalysis? - 4+ protein 4+ protein in the kidney suggests - Kidney disease What are 7 side effects of lithium? - Hypothyroidism Fine hand tremors Maculopapular rash GI upset (N/V/D, cramps, anorexia) Polyuria, polydipsia, diabetes insipidus T-wave inversions Leucocytosis What are 7 signs of lithium toxicity? - Severe nausea, vomiting, diarrhea Confusion Drowsiness Muscle weakness Heart palpitations Coarse hand tremor Unsteadiness while standing or walking Which 3 drugs can increase lithium levels by decreasing renal clearance? - NSAIDs (ibuprofen, indomethacin) Thiazides ACEI What is a toxic level of lithium? - 1.5 mEq/L or higher At what level do you monitor lithium closely (but not discontinue)? - 1.3 mEq/L or higher

With suspected lithium toxicity, what do you do first? - Lithium level (not VS) What is the appropriate action if lithium level is 1.5 mEq/L? - DC lithium Check lithium level What 2 conditions can increase lithium levels? - Dehydration Hyponatremia What birth defect can lithium cause? - Ebstein anomaly (congenital heart defect) What 3 neurotransmitters are associated with ADHD? - DNS What 3 parts of the brain are affected with ADHD? - Frontal cortex Basal ganglia Reticular Activating System The Frontal cortex, Basal ganglia, Reticular Activating System are associated with which psychiatric disorder? - ADHD Inattentive Type ADHD demonstrates abnormalities in which part of the brain? - Prefrontal cortex What should be done before placing a patient on stimulants for ADHD (priority)? - Cardiac history Excessive worry, apprehension, or anxiety about events or activities that occurs more days than not for a period of at least 6 months is - GAD If a patient is receiving Haldol 5 mg PO bid, how much Haldol Decanoate should they receive? - 20 x 10 mg = 200 mg (q month) What is the formula for converting oral Haldol to depot form? - 20 x daily dose What does thought process assess? - thoughts and ideas The way a patient organizes his thoughts and ideas is called - Thought process A normal thought process is described as - Logical Linear Coherent

Goal-oriented Moving from thought to thought and never getting to the point is called - Tangentiality ("goes on tangent") Providing unnecessary detail but eventually getting to the point is called - Circumstantiality ("goes in circles") Themes that occupy a patient's thoughts and perceptual disturbances is called - Thought content Thought content includes 3 items - Suicidal ideation Homicidal ideation Hallucinations/Delusions Asking a patient to count backward from 100 by seven (serial 7s) measures 3 processes - Concentration Attention Calculation Asking the year, season, date, month, and location measures - Orientation Asking a patient to repeat "bed, bad, ball" measures - Registration (ability to learn new material) Asking a patient to repeat objects 5 minutes later measures - Recall (memory) Asking the patient who is the president of the US or governor of state is measuring - Fund of Knowledge What is a simple test that can be administered in a minute or two to measure possible dementia? - Clock Drawing Test Impairments in the clock drawing test (CDT) can be associated with damage to - Right parietal lobe (right hemisphere) Hyperactivity of dopamine in the mesolimbic pathway modulates - positive psychotic symptoms Decreased dopamine in the mesocortical pathway (dorsolateral prefrontal cortex) leads to what 2 symptoms? - Negative symptoms

Depressive symptoms The nigrostriatal pathway modulates - motor movements Dopamine has what type of relationship with acetycholine - Inverse Dopamine blockage in the nigrostriatal pathway leads to what 4 side effects? - Acute dystonia Parkinsonism syndromes Akathisia Tardive dyskinesia Blocking the tuberoinfundibular pathway leads to - Increased prolactin What are 5 symptoms of hyperprolactinemia? - Amenorrhea Galactorrhea Sexual dysfunction Gynecomastia Osteoporosis (Long-term) What antipsychotic has the greatest effect on prolactin? - Risperidone What is the black box warning for carbamazepine? - Agranulocytosis What are 8 symptoms of aplastic anemia? - Pallor Fatigue Headache Fever Nosebleeds Bleeding gums Skin rash SOB Pallor, Fatigue, Headache, Fever, Nosebleeds, Bleeding gums, Skin rash, and SOB are symptoms of - Aplastic anemia What ethnic group is most susceptible to SJS with carbamazepine? - Asians Having the HLA-B1502 allele increases the risk for - SJS Which ethic group is at most likely to have the HLA-B1502 allele? - Asians

Asians are most likely to have what allele? - HLA-B* In which ethnic group must you screen for the HLA-B*1502 allele before initiating therapy? - Asian Which 2 drugs have the highest likelihood of causing agranulocytosis? - Clozaril Carbamazepine A sudden fever, chills, a sore throat, and weakness are symptoms of - Agranulocytosis What are 4 symptoms of agranulocytosis - A sudden fever Chills Sore throat Weakness At what ANC should clozapine be stopped (even if asymptomatic)? - < What is neutropenia? - <2000 PMNs What is agranulocytosis? - <500 ANC What does DIGFAST stand for? - Distractibility Indiscretion Grandiosity FOI Activity increased Sleep decreased Talkativeness What are 5 neurological symptoms in Conversion Disorder? - Blindness Mutism Paralysis Paresthesia (glove stocking syndrome) Seizures When do symptoms typically begin with Conversion Disorder? - After a stressful experience (suddenly)

What are 5 stressful events in a child's life that can cause adjustment disorder? - Family move Parent divorce/separation Loss of pet Birth of sibling Sudden or chronic illness A child with an Adjustment Disorder with disturbances of conduct may have what symptoms? - Not going to school, destroying property, driving recklessly, or fighting What is the required duration of behavior for a DSM-5 diagnosis of Oppositional Defiant Disorder (ODD)? - 6 months How many symptoms must a child with Oppositional Defiant Disorder (ODD) display to meet DSM-5 criteria? - 4 An enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior is characteristic of - Oppositional Defiant Disorder (ODD) What is the mainstay treatment of Oppositional Defiant Disorder (ODD)? - Therapy What is the primary therapy used to treat Oppositional Defiant Disorder (ODD)? - Child and parent problem-solving skills training A repetitive and persistent pattern of behavior in which the rights of others or societal norms or rules are violated is what disorder? - Conduct Disorder What are 3 characteristics of Conduct Disorder? - Destruction of property Deceit or theft Lack of remorse What 2 factors differentiate Conduct Disorder from ODD? - Severity Aggression What are 4 pharmacologic treatments for Conduct Disorder? - Antipsychotics Mood stabilizers SSRIs Alpha agonists What is the mainstay treatment for Conduct Disorder? - Therapy

What type of therapy is used in the treatment of Conduct Disorder? - Behavioral therapy What is Multisystemic family therapy? - Home-based model for youth with serious antisocial and criminal offenses by empowering parents with resources and skills and reducing barriers to resources needed for effective management of youth What is the goal of multisystemic family therapy (MFT)? - Reduce barriers to resources for youth with problematic behavior What type of therapy target's youth who present with serious antisocial behavior? - Multisystemic family therapy What is the moderate range for MMSE - 10- What is the moderate range for SLUM? - 10- What is the moderate range for HAM-D? - 14- What is the moderate range for PHQ-9 - 10- What is the moderate range for BDI? - 19- What is the moderate range for HAM-A? - 18- What is the moderate range for GAD-7 - 10- What is the moderate range for COWS? - 13- If a patient's COWS score is between 5 - 12, what do you do? - Administer clonidine If a patient's COWS score is between 13 - 24, what do you do? - Administer buprenorphine (Suboxone) When do you administer clonidine on the COWS? - mild symptoms (>7) When do you administer buprenorphine (Suboxone) on the COWS? - moderate symptoms (13-24) What is a moderate range on the CIWA? - 16-

When do you administer prn benzodiazepine on the CIWA? - Mild symptoms (8 or greater) When do you administer scheduled benzodiazepine on the CIWA? - moderate symptoms (15 or higher) If a patient has severe depression (over 18 on HAM-D) (over 14 on PHQ-9) (over 29 on BDI), how do you treat it? - Medication and/or therapy Assess for suicidal ideation If a patient has moderate depression (14 - 18 on HAM-D) (10 - 14 on PHQ-9) (19 - 29 on BDI), how do you treat it? - Medication and/or therapy If a patient has mild depression (<14 on HAM-D) (<10 on PHQ-9) (<19 on BDI), how do you treat it? - Therapy or nothing If a patient has mild anxiety (<18 on HAM-A) (<10 on GAD-7), how do you treat? - Therapy or nothing If a patient has severe anxiety (>24 on HAM-A) (>14 on GAD-7) how do you treat? - Medication and/or therapy If a patient has moderate anxiety (18-24 on HAM-A) (10 - 14 on GAD-7) how do you treat it? - Medication and/or therapy What are 4 areas in the brain that can cause aggression, impulsivity, and difficulty with abstract thinking? - Prefrontal cortex Amygdala Basal ganglia Hippocampus Abnormalities in the Prefrontal cortex, Amygdala, Basal ganglia, and Hippocampus can cause what 3 symptoms? - Aggression Impulsivity Difficulty with abstract thinking What are 6 symptoms of NMS? - Extreme muscular rigidity Mutism Elevated CPK (creatine phosphokinase) Myoglobinuria Leukocytosis

Elevated LFTs Extreme muscular rigidity, Mutism, Elevated CPK (creatine phosphokinase), Myoglobinuria, Leukocytosis, and Elevated LFTs are symptoms of - NMS What are 2 symptoms of Serotonin Syndrome? - Hyperreflexia Myoclonic jerks Hyperreflexia and myoclonic jerks are symptoms of - Serotonin Syndrome How do you treat NMS? - DC antipsychotic Bromocriptine or Dantrolene What does Dantrolene treat in NMS? - Muscle rigidity How do you treat Serotonin Syndrome? - DC Antidepressant Cyproheptadine What combination medications increases the risk of Serotonin Syndrome - multiple antidepressants (SSRI/SNRI/TCA/MOAI) When switching from an MAOI to SSRI/SNRI, how long should you wait? - 2 weeks When switching from Prozac to an MAOI, how long should you wait? - 5-6 weeks When switching from Prozac to any antidepressant (TCA, SNRA, or MAOI), how long should you wait? - 5-6 weeks When switching from an SSRI/SNRI to a MAOI, how long should you wait? - 2 weeks What is the function of compulsions in OCD? - Reduce subjective anxiety level What is PANDAS? - Pediatric Autoimmune Neuropsychiatric Disorder associated with streptococcal infections in children If a child has both intrusive thoughts and tics, his most likely diagnosis is - OCD If a child has multiple tics both no ruminating thoughts, his diagnosis is most likely - Tourette's

What 2 neurotransmitters are associated with OCD? - Serotonin Norepinephrine A childhood depressive disorder that is diagnosed in children older than 6 but younger than 18 is most likely - DMDD A child with chronic dysregulated mood ("mood"), frequent intense temper outbursts, severe irritability, and anger is most likely to have what diagnosis? - DMDD The age criteria for a DSM-5 diagnosis of Disruptive Mood Dysregulation Disorder (DMDD) is - >6 and <18 (7-17 yrs.) A child who is chronically "moody" is most likely to have what diagnosis? - DMDD What are 2 symptoms associated with lead poisoning? - Developmental delay (learning difficulties) Pica (paint chips) also gastrointestinal Which 2 demographic characteristics are associated with lead poisoning? - rural areas 1970's A child with developmental delay who eats things (such as paint chips) may have - Lead poisoning What 4 assessments should be done in a patient receiving an antipsychotic that causes weight gain? - BMI Hip-to-waist ratio Glucose Lipid panel Where is norepinephrine produced? - Locus coeruleus Medullary reticular formation The neurotransmitter produced in the locus coeruleus and medullary reticular formation is - Norepinephrine What neurotransmitter is produced in the raphe nuclei in the brainstem? - Serotonin Serotonin is produced in - raphe nuclei in the brainstem

What neurotransmitter is produced in the substantia nigra, the ventral tegmental area (VTA), and the nucleus accumbens? - Dopamine What 3 areas of the brain is dopamine produced? - Substantia nigra Ventral tegmental area (VTA) Nucleus Accumbens Where is acetylcholine synthesized? - Basal nucleus of Meynert The Basal nucleus of Meynert is the area where what neurotransmitter is produced? - Acetycholine What is the function of the amygdala? - Emotions (aggression, fear, anxiety) Emotions (aggression, fear, and anxiety) originate from what area of the brain? - Amygdala What are 4 functions of the hippocampus? - Emotions Stress Learning Memory Emotions, stress, learning, and memory are functions of what structure of the brain? - Hippocampus What disorder is associated with persistent deficits in social communication and social interactions across multiple settings? - Autism Spectrum Disorder What 3 neurotransmitters are associated with Autism Spectrum Disorder? - Glutamate GABA Serotonin A child who does not respond when called by name may have - Autism A child that has little or no eye contact may have - Autism A child who likes to line up, stack, or organize objects and toys in on tidy rows may have - Autism

What theory claims that dysfunction of a particular neuron system may be a cause of poor social interaction and cognition in autism? - Broken Mirror Theory What is the DSM-5 criteria for number of tics in Tourette's Disorder? - Motor: 2 or more and Vocal: 1 or more (not necessarily at same time) What are the DSM-5 criteria for the duration of symptoms in Tourette's Disorder? -

1 year What is the age criteria for a DSM-5 diagnosis of Tourette's Disorder? - <18 yrs What is the pharmacological treatment of Tourette's Disorder? - Antipsychotic (haloperidol, pimozide, aripiprazole*) What are the 3 primary neurotransmitters involved in Tourette's Disorder? - DNS What are 11 risk factors for suicide? - Previous suicide attempt 45 and older (55 for women) Divorced, single, or separated White (Caucasian) Living alone Psychiatric disorder Physical illness Substance abuse Family history of suicide Recent loss Male gender What age is a risk factor for suicide? - 45 and older What gender is a risk factor for suicide? - Male What race is a risk factor for suicide? - White (Caucasian) What 4 demographic characteristics are risk factors for suicide? - 45 and older Single White Male

What are 5 physical characteristics of Anorexia Nervosa? - Low BMI Amenorrhea Emaciation (abnormally thin) Bradycardia Hypotension Low BMI, Amenorrhea, Emaciation (abnormally thin), Bradycardia, and Hypotension are characteristics of what psychiatric disorder? - Anorexia Nervosa What is the BMI in a patient with Bulimia Nervosa - Normal range For a DSM-5 diagnosis of Acute Stress Disorder, what is the onset of symptoms? - Within 4 weeks of traumatic event Intense anxiety and fear, helplessness, reexperiencing the event and avoidance behaviors within 4 weeks of a traumatic event is DSM-5 criteria for what disorder? - Acute Stress Disorder What are the 3 hallmark symptoms of PTSD? - Intrusive re-experiencing Increased arousal (hyperarousal) Avoidance of stimuli associated with trauma What are 3 pharmacological treatments for PTSD - SSRIs TCAs Prazosin for nightmares What 2 nonpharmacologic treatments for PTSD? - EMDR CBT What are the 12 components/symptoms of the COWS? - Pulse Sweating Restlessness Pupil size Bone aches Running nose or tearing GI upset Yawning Tremors Anxiety/irritability Gooseflesh skin Dilated pupils

Pulse, Sweating, Restlessness, Pupil size, Bone aches, Running nose or tearing, GI upset, Yawning, Tremors, Anxiety/irritability, Gooseflesh skin, and Dilated pupils are components of what scale? - COWS What are the 9 components/symptoms of the CIWA Scale? - Nausea/vomiting Tremor Sweats Anxiety Agitation Tactile disturbances Auditory disturbances Headaches Orientation Nausea/vomiting, Tremor, Sweats, Anxiety, Agitation, Tactile disturbances, Auditory disturbances, Headaches, and Orientation are components of which Scale - CIWA What are 3 treatments for Alcohol Use Disorder? - Acamprosate (Campral) Disulfiram (Antabuse) Naltrexone (Vivitrol, ReVia) Which agent for the treatment of Alcohol Use Disorder is not metabolized by the liver? - Acamprosate (Campral) Installation of hope, universality, group cohesiveness, and altruism are therapeutic factors of what group therapy? - Yalom What are 4 therapeutic factors in Yalom's Group Therapy? - Instillation of hope Universality Group cohesiveness Altruism What is an approach to organizational change which focuses on strengths rather than weaknesses? - Appreciative Inquiry What is appreciative inquiry? - An approach to organizational change which focuses on strengths rather than weaknesses What are the 3 goals of Quality Improvement? - Projects designed to improve systems, decrease cost, and improve productivity

Projects designed to improve systems, decrease cost, and improve productivity are called - Quality Improvement The process/strategy of Quality Improvement is called - PDSA Cycle Plan Do Study Act The PDSA Cycle is - The process/strategy of Quality Improvement The 4 components of Health Policy are - Process Policy reform Policy environment Policy makers Process, Policy reform, Policy environment, and Policy makers are the 4 components of - Health Policy What is 3-part "process" component of Health Policy? - Formulation, Implementation, and Evaluation (FIE) Formulation, Implementation, and Evaluation (FIE) are - The "process" component of Health Policy What is the "policy reform" component of Health Policy? - Changes in programs and practices Changes in programs and practices in Health Policy is called - Policy Reform What is the "policy environment" component of Health Policy? - The arena the process takes place in (government, media, public) The arena the process takes place in (government, media, public) is what component of Health Policy? - Policy environment What is the "policy makers" component of Health Policy? - Key players and stake holders

What component of Health Policy are Key players and stake holders? - Policy Makers What is the first action when developing Health Policy? - Assess/address organizational barriers and facilitators A treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life is called - Recovery Model What is the Recovery Model? - A treatment approach that does not focus on full symptom resolution but emphasizes resilience and control over problems and life is called What is a nonlinear treatment approach? - Not a step-by-step process, but one based on continual growth and occasional setbacks What are 3 characteristics of the Recovery Model? - Learning from experience (e.g. relapse) Nonlinear Self-directed, Individualized and Person-Centered The treatment approach that emphasizes "learning from experience," nonlinear, and self-directed/individualized/person-centered? - Recovery Model What is the SBIRT - Screens for Substance Use Disorders Screening Brief Intervention Referral Treatment What instrument screens for Substance Use Disorders - SBIRT Screening Brief Intervention Referral Treatment What is the Tarasoff Principle - Duty to warn victim of imminent danger of homicidal patients

What is the Duty to warn victim of imminent danger of homicidal patients? - Tarasoff Principle An involuntarily committed patient who has not been found incompetent, absent an emergency, has a qualified right to refuse psychotropic medications (court case) - Rennie vs. Klein Court Case What is the Rennie vs Klein Court Base? - Pts have the right to refuse treatment and use an appeal process It is unconstitutional to commit a person involuntarily (for the longest time) who is not (imminently) dangerous to self or others. Which court case? - Donalson vs. O'Connor Court Case What is the Donaldson vs. O'Connor court case? - You cannot confine (commit a person involuntarily) who is not dangerous to self or others What are 4 key components of Strategic Therapy? - Problem Focused, Symptoms focused Paradoxical directive/intervention (reverse psychology) Straight forward directive Reframe belief system The paradoxical directive, a technique to be used with caution, is used in which therapy? - Strategic Which 3 techniques are used in Solution-Focused Therapy? - Miracle Questions Exception-finding questions Scaling Questions Miracle Questions, Exception-finding questions, and Scaling Questions are used in which therapy? - Solution-Focused Which therapy uses triangles/triangulation, an self-differentiation? - Family Systems Therapy What are 3 characteristics of Family Systems Therapy? - Triangles/Triangulation Self-differentiation Genograms What are 3 characteristics of Structural Family Therapy? - Hierarchies

Boundaries Genograms Hierarchies, Boundaries, and Genograms are characteristics of what therapy? - Structural Family Therapy Genograms are used in which 2 family therapies? - Family system therapy Structural therapy What type of therapy should be performed when a patient presents with a cultural syndrome? - Brief supportive therapy What type of therapy should be used in a patient who has just lost their job? - Brief supportive therapy What is the most important concept in working with patients from different cultues? - Respect What should you teach a patient interested in meditation? - muscle relaxation How to Mexican American's view mental illness? - An imbalance between an individuals' relationship with the world Which ethnic group views mental illness as an imbalance between an individuals' relationship with world? - Native American Which ethnic group has the highest incidence of suicidal attempt and completion? - Native American Cultural syndrome is - A culturally expected response to a stressor A culturally expected response to a stressor is called - Cultural Syndrome How should multicultural teaching be conducted? - Ethnospecific If a patient is regularly taking Kava, what lab should you get? - LFTs What is the key symptom in suspecting Stephen's Johnson Syndrome? - Fever Which antipsychotic has the least weight gain? - Ziprasidone (Geodon)

Which SGA is the least sedating? - Aripiprazole (Abilify) Which 3 antipsychotic causes weight gain? - Quetiapine (Seroquel) Olanzapine (Zyprexa) Clozapine (Clozaril) What is the first action to take with a patient who is gaining weight from an SGA? - nonpharmacologic nutritional counseling (diet) exercise CBT When should clozapine be discontinued? - ANC < 1,000 (even if asymptomatic) One of your patients receiving psychiatric medication develops an infection. What do you consider? - Agranulocytosis What antipsychotic is antisuicidal in schizophrenia? - Clozapine When a young woman is suspected of a toxic dose of lithium, what lab should you obtain initially? - HCG If a patient has signs/symptoms of lithium toxicity but you have no labs available, what do you do? - DC lithium What is one of the most important teaching points you should make in a patient taking lithium? - Stay hydrated A patient with what medical condition is at risk for lithium toxicity? - Cardiac failure (hyponatremia) What is the key indicator for NMS? - Extreme muscle rigidity - Increased CPK Extreme muscle rigidity and increased CPK is the key indicator of - NMS What is the key indicator of Serotonin Syndrome? - Muscle jerks (myoclonic) Muscle jerks (myoclonic) are the key indicator of - Serotonin Syndrome If a depressed patient is taking a triptan for migraines, what should you prescribe for depression? - Bupropion

What is first line treatment for MDD? - SSRIs What are the 2 antidepressants of choice in a depressed patient with cancer? - Citalopram (Celexa) Escitalopram (Lexapro) What is the antidepressant of choice in a depressed patient with sexual dysfunction? - Bupropion What is the antidepressant of choice in a depressed patient with decreased energy? - Bupropion What are 3 treatments for depressed patients with neuropathic pain? - SNRI (safety) TCA Gabapentin Which SSRI is most likely to cause insomnia? - Fluoxetine (Prozac) What question is important to ask in the social history with a depressed patient? - Alcohol intake (self-medicating) What BBW do all antidepressants have? - Suicidal ideation (<24 yrs.) Suicidal ideation for children, adolescents, and young adults <24 years is a BBW with what medications? - Antidepresssants What question should ask all adolescent patients at each visit? - Self harm (frequency and severity) Which 2 groups is it especially important to ask about SI at each visit? - Adolescence Schizophrenics Why do children have a decreased placebo response with antidepressants? - Few evidence-based studies What is the onset of schizophrenia in males? - 18-25 What is the onset of schizophrenia in females? - 25-35 What question should ask schizophrenic patients at each visit? - SI

What is the most likely diagnosis in a patient with homicidal ideation? - Antisocial Personality Disorder What would yo expect to see on an MRI/Pet scan in a patient with schizophrenia? - All structures decreased except ventricles Which class of agents should be avoided in patients with schizophrenia? - Stimulants (increased DA) Which 3 structures in the brain are associated with aggressive and impulsive behavior? - Prefrontal cortex Amygdala Hippocampus What is Assertive Community Treatment (ACT)? - Form of rehabilitation post hospitalization for SMI Case management approach Patients with SMI who are discharged from the hospital should be referred to - Assertive Community Treatment (ACT) Can patients receive Assertive Community Treatment (ACT) while in the hospital? - No Which services can be provided in the home for SMI patients? - Assertive Community Treatment (ACT) What is the best treatment program for SMI patients with poor medication adherence? - Assertive Community Treatment (ACT) Social skills training in a schizophrenic patient is what type of prevention? - Tertiary What are 3 benefits of aerobic exercise in schizophrenic patients? - Increased cognition Quality of Life Long-term health How do you convert oral Haldol to IM (depot form)? - 20 x daily dose

When converting oral Haldol to depo form, what the maximum dose should administer? - >100 mg (administer weekly if necessary) What is a delusion? - A firm belief despite contrary evidence A firm belief despite contrary evidence is - delusion How often is Haldol Decanoate typically adminitered? - monthly How do you conduct a MSE in a preschooler (3-5 yo) - Clinical observation (listen/observe) What is thought content? - SI/HI, plan What are the 5 components of the MMSE (Folstein's) - Concentration/attention/calculation Orientation Registration/ability to learn new material Recall/memory Fund of Knowledge What pharmacologic characteristic makes SGA's unique? - 5-HT2A antagonism What is responsible for the decreased incidence of EPS with SGAs? - 5HT2- antagonism What antipsychotic should you give to a patient with their first psychotic episode? - SGA (IM) Which 4 SGAs are available in IM form? - Ziprasidone (Geodon) Olanzapine (Zyprexa) Aripiprazole (Abilify) Paliperidone (Invega) What agent other than antipsychotics increase prolactin? - Metoclopramide (Reglan) What is a normal prolactin level in men? - <20 What is a normal prolactin level in women? - <25