Psychiatric Disorders and Treatments, Exams of Nursing

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Tarasoff Principle - ANSWER 1976 - duty to warn victims of potential harm from client Deontological Theory - ANSWER Ethical theory that states an action is judged as good or bad based on the act itself regardless of the consequences Teleological Theory - ANSWER Ethical theory that states an action is judged as good or bad based on the consequence or outcome Virtue ethics - ANSWER ethical theory that states actions are chosen based on the moral virtues (eg. honesty, courage, compassion, wisdom, gratitude, self-respect) or the character of the person making the decision Erikson's developmental stage infancy age range - ANSWER birth-1 year Erikson's developmental stage infancy developmental tasks - ANSWER trust vs. mistrust Erikson's developmental stage infancy indications of developmental mastery - ANSWER Ability to form meaningful relationships, hope about the future trust in others Erikson's developmental stage infancy indication of developmental failure - ANSWER poor relationships, lack of future hope, suspicious of others Erikson's developmental stage early childhood age - ANSWER 1-3 yo Erikson's developmental stage early childhood developmental task - ANSWER autonomy vs. shame and doubt Erikson's developmental stage early childhood indications of developmental mastery - ANSWER self-control, self-esteem, willpower Erikson's developmental stage early childhood indications of developmental failure - ANSWER poor self-control, low self esteem, self-doubt, lack of independence Erikson's developmental stage late childhood age - ANSWER 3-6yo Erikson's developmental stage late childhood developmental task - ANSWER initiative vs guilt

Erikson's developmental stage late childhood indications of developmental mastery - ANSWER self-directed behavior, goal formation, sense of purpose Erikson's developmental stage late childhood indications of developmental failure - ANSWER lack of self-initiated behavior, lack of goal orientation Erikson's developmental stage school-age ages - ANSWER 6-12yo Erikson's developmental stage school-age developmental task - ANSWER industry vs. inferiority Erikson's developmental stage school-age indications of developmental mastery - ANSWER ability to work; sense of competency and achievement Erikson's developmental stage school-age indications of developmental failure - ANSWER sense of inferiority, difficulty with working, learning Erikson's developmental stage adolescence ages - ANSWER 12-20yo Erikson's developmental stage adolescence developmental task - ANSWER identity vs role confusion Erikson's developmental stage adolescence indications of developmental mastery - ANSWER personal sense of identity Erikson's developmental stage adolescence indications of developmental failure - ANSWER identity confusion, poor self-identification in group settings Erikson's developmental stage early adulthood ages - ANSWER 20-35 years Erikson's developmental stage early adulthood developmental task - ANSWER intimacy vs isolation Erikson's developmental stage early adulthood indications of developmental mastery - ANSWER committed relationships, capacity to love Erikson's developmental stage early adulthood indications of developmental failure - ANSWER emotional isolation, egocentrism Erikson's developmental stage middle adulthood ages - ANSWER 35-65 yo Erikson's developmental stage middle adulthood developmental task - ANSWER generativity vs. self-absorption or stagnation

Erikson's developmental stage middle adulthood indications of developmental mastery - ANSWER ability to give time and talents to others, ability to care for others Erikson's developmental stage middle adulthood indications of developmental failure - ANSWER self-absorption, inability to row and change as a person, inability to care for others Erikson's developmental stage late adulthood age - ANSWER >65yo Erikson's developmental stage late adulthood developmental task - ANSWER integrity vs despair Erikson's developmental stage late adulthood indications of developmental mastery - ANSWER fulfilment and comfort with life, willingness to face death, insight and balanced perspective on life's events Erikson's developmental stage late adulthood indications of developmental failure - ANSWER bitterness, sense of dissatisfaction with life, despair over impending death Psychodynamic (Psychoanalytic) Theory - ANSWER -Sigmund Freud -all bx is purposeful and meaningful -principle of psychic determinism -most mental activity is unconscious -conscious behaviors and choices are affected by unconscious mental content -childhood experiences shape adult personality -instincts, urges, or fantasies function as drives that motivate thoughts, feelings, and bx -Id, Ego, Superego -conflict is experienced consciously as anxiety Principle of psychic determinism - ANSWER Even apparently meaningless, random, or accidental behavior is actually motivated by underlying unconscious mental content Intellectual disability typical age onset - ANSWER infancy- usually evident at birth ADHD typical age onset - ANSWER early childhood (per DSM by age 12) Schizophrenia typical age onset - ANSWER 18-25 for men 25-35 for women Major Depression typical age onset - ANSWER late adolescence to young adulthood dementia typical age onset - ANSWER most common after age 85 Freud's Id - ANSWER -contains primary drives or instincts -drives are largely unconscious -operates on the pleasure principle

-"I want" pleasure principle - ANSWER the id seeks immediate satisfaction freud's ego - ANSWER -rational mind, logical and abstract thinking -"I think, I evaluate" Freud's superego - ANSWER -sense of conscience or right vs wrong -develops around age 6 -"I should or ought" Freud's psychosexual stage of development oral stage age - ANSWER 0-18 months Freud's psychosexual stage of development oral stage primary means of discharging drives and achieving gratification - ANSWER sucking, chewing, feeding, crying Freud's psychosexual stage of development oral stage psych disorder linked to failure of stage - ANSWER schizophrenia, substance abuse, paranoia Freud's psychosexual stage of development anal stage age - ANSWER 18 months- years Freud's psychosexual stage of development anal stage primary means of discharging drives and achieving gratification - ANSWER sphincter control, activities of expulsion and retention Freud's psychosexual stage of development anal stage psych disorder linked to failure of stage - ANSWER depressive disorder Freud's psychosexual stage of development phallic stage age - ANSWER 3-6 years Freud's psychosexual stage of development phallic stage primary means of discharging drives and achieving gratification - ANSWER exhibitionism, masturbation with focus on Oedipal conflict, castration anxiety, and female fear of lost maternal love Freud's psychosexual stage of development phallic stage psychiatric disorder linked to failure of stage - ANSWER sexual identity disorders Freud's psychosexual stage of development latency stage age - ANSWER 6years- puberty Freud's psychosexual stage of development latency stage primary means of discharging drives and achieving gratification - ANSWER peer relationships, learning, motor-skills development, socialization

Freud's psychosexual stage of development latency stage psych disorder linked to failure of stage - ANSWER inability to form social relationships Freud's psychosexual stage of development genital stage age - ANSWER puberty forward Freud's psychosexual stage of development genital stage primary means of discharging drives and achieving gratification - ANSWER integration and synthesis of behaviors from early stages, primary genital-based sexuality Freud's psychosexual stage of development genital stage psych disorder linked to failure of sage - ANSWER sexual perversion disorders Cognitive Theory - ANSWER -Piaget

• four stages of development Piaget developmental stage sensorimotor age - ANSWER birth-2 years Piaget developmental stage sensorimotor - ANSWER the critical achievement of this stage is object permanence Piaget developmental stage preoperational age - ANSWER 2-7 years Piaget developmental stage preoperational - ANSWER more extensive use of language and symbolism magical thinking Piaget developmental stage concrete operations age - ANSWER 7-12 years Piaget developmental stage concrete operations - ANSWER child begins to use logic develops concepts of reversibility and conservation Piaget developmental stage formal operations age - ANSWER 12 years-adult Piaget developmental stage formal operations - ANSWER ability to think abstractly thinking operates in a formal, logical manner interpersonal theory - ANSWER -Harry Stack Sullivan -self-system -when the person's need for satisfaction and security is interfered with by the self system, mental illness occurs -humans experience anxiety and bx is directed toward relieving the anxiety, which then results in interpersonal security self system - ANSWER interpersonal theory total components of personality traits

two drives for behavior in interpersonal theory - ANSWER -the drive for satisfaction -the drive for security Freud's defense mechanisms - ANSWER -denial -projection -regression -repression -reaction formation -rationalization -undoing -intellectualization -suppression -sublimation -altruism Hierarchy of needs - ANSWER -Maslow -survival -safety and security needs -love and belonging -self-esteem -self-actualizaiton Sullivan's stage of interpersonal development infancy age - ANSWER birth-18 months Sullivan's stage of interpersonal development infancy developmental task - ANSWER oral gratification, anxiety occurs for the first time Sullivan's stage of interpersonal development childhood age - ANSWER 18 months- 6 years Sullivan's stage of interpersonal development childhood developmental task - ANSWER delayed gratification Sullivan's stage of interpersonal development juvenile age - ANSWER 6-9 years Sullivan's stage of interpersonal development juvenile developmental task - ANSWER forming peer relationships Sullivan's stage of interpersonal development preadolescence age - ANSWER 9- years Sullivan's stage of interpersonal development preadolescence developmental task - ANSWER same-sex relationships

Sullivan's stage of interpersonal development early adolescence age - ANSWER 12- years Sullivan's stage of interpersonal development early adolescence developmental task - ANSWER opposite- sex relationships Sullivan's stage of interpersonal development late adolescence age - ANSWER 14- years Sullivan's stage of interpersonal development late adolescence developmental taks - ANSWER self-identity developed Health Belief Model - ANSWER Marshall Becker explains that healthy people do not always take advantage of screening or preventative programs because of certain variables: -perception of susceptibility -seriousness of illness -perceived benefits of tx -perceived barriers to change -expectations of efficacy transtheoretical model of change - ANSWER states that change such as in health bx occurs in 6 predictable stages -precontemplation -contemplation -preparation -action -maintenance motivational interviewing - ANSWER miller and rollnick -focused, goal-directive therapy -motivation is elicited from the client -nonconfrontational, nonadversarial self-efficacy and social learning theory - ANSWER -albert bandura -behavior is the result of cognitive and environmental factors theory of cultural care - ANSWER -madeline Leininger -regardless of the culture, care is the unifying focus and the essence of nursing theory of self-care - ANSWER Dorothy orem -self care therapeutic nurse-client relationship theory or interpersonal theory - ANSWER Hildegard Peplau -first significant psych nursing theory

-sees nursing as an interpersonal process in which all interventions occur within the context of the nurse-client relationship phases of the nurse-client relationship - ANSWER -orientation -working phase (identification, exploration) -termination phase (resolution) caring theory - ANSWER jean Watson caring is an essential component of nursing t test - ANSWER assesses whether the means of two groups are statistically different from each other analysis of variance (ANOVA) - ANSWER tests the difference among three or more groups pearson's r correlation - ANSWER tests the relationship between two variables probability - ANSWER likelihood of an event occurring lies between 0 and 1 an impossible event has probability of 0 a certain event has a probability of 1 P value - ANSWER aka level of significance describes the probability of a particular result occurring by change alone if P=0.1, there is a 1% probability of obtaining a result by chance alone Donabedian model - ANSWER structure, process, outcome process of quality improvement PDSA cycle - ANSWER Plan Do Study Act monoamines - ANSWER -biogenic amines -dopamine -norepinephrine -epinephrine -serotonin dopamine - ANSWER -catecholamine -produced in the substantia nigra and ventral tegmental area -precursor is tyrosine -removed from synaptic cleft by monoamine oxidase (MAO) enzyme action -D1-like and D2-like receptors

four dopaminergic pathways - ANSWER -mesocortical -mesolimbic -nigrostriatal -tuberoinfundibular norepinephrine - ANSWER -catecholamine -produced in the locus ceruleus of the pons -precursor is tyrosine -major neurotransmitter implicated in mood, anxiety, and concentration disorders -Alpha 1 and 2 receptors epinephrine - ANSWER -catecholamine -produced by the adrenal glands -referred to as the adrenergic system serotonin - ANSWER -known as an indole -produced in the raphe nuclei of the brainstem -precursor is tryptophan -major neurotransmitter implicated in mood and anxiety disorders -5HT1a, 5HT1d, 5HT2, 5HT2a, 5HT3, 5HT4 receptors amino acids - ANSWER glutamate, aspartate, gamma-aminobutyric acid (GABA), glycine glutamate - ANSWER -universal excitatory neurotransmitter -major neurotransmitter involved in process of kindling (implicated in sz dx and bipolar dx) -imbalance implicated in mood dx and schizophrenia -AMPA and MNDA receptors aspartate - ANSWER another excitatory neurotransmitter -works with glutamate GABA - ANSWER universal inhibitory neurotransmitter -site of action of benzos, alcohol, barbiturates, and other CNS depressants -GABAa and GABAb receptors glycine - ANSWER -another inhibitory neurotransmitter -works with GABA cholinergics - ANSWER acetylcholine acetylcholine - ANSWER synthesized by the basal nucleus of Meynert -precursors are acetylcoenzyme A and choline -nicotinic and muscarinic receptors

neuropeptides - ANSWER -nonopioid type (substance P, somatostatin) -opioid type (endorphins, enkephalines, dynorphins) -modulate pain -Decreased amount of neuropeptides is thought to cause substance abuse

• opioid type receptors: mu, kappa, epsilon, delta, sigma dopamine general function - ANSWER thinking decision making reward-seeking behavior fine muscle action integrated cognition dopamine symptoms of deficit - ANSWER mild: pour impulse control, poor spatiality, lack of abstractive thought -severe: Parkinson's disease, endocrine alterations, movement disorders -substance abuse, anhedonia Dopamine symptoms of excess - ANSWER -mild: improved creativity, improved ability for abstract thinking, improved executive functioning, improved spatiality -severe: disorganized thinking, loose association, tics, stereotypic bx -schizophrenia, psychosis norepinephrine general function - ANSWER alertness focused attention orientation primes fight or flight learning memory norepinephrine symptoms of deficit - ANSWER -dullness, low energy, depressive affect -depression norepinephrine symptoms of excess - ANSWER -anxiety, hyper alertness, increase startle, paranoia, decreased appetite -anxiety serotonin general function - ANSWER regulation of sleep pain perception mood states temperature regulation of aggression libido precursor for melatonin serotonin symptoms of deficit - ANSWER irritability, hostility, depression, sleep dysregulation, loss of appetite, loss of libido

OCD, anxiety disorders, schizophrenia serotonin symptoms of excess - ANSWER sedation, increased aggression, hallucinations (rare) acetylcholine general function - ANSWER attention, memory, thirst, mood regulation, REM sleep, sexual behavior, muscle tone acetylcholine symptoms of deficit - ANSWER lack of inhibition, decreased memory, euphoria, antisocial action, speech decrease, dry mouth, blurred vision, constipation alzheimers dx acetylcholine symptoms of excess - ANSWER overinhibition, anxiety, depression, somatic complaints, self-consciousness, drooling, EPS parkinsonian symptoms GABA general function - ANSWER reduces arousal, reduces aggression, reduces anxiety, reduces excitation GABA symptoms of deficit - ANSWER irritability, hostility, tension and worry, anxiety, seizure activity anxiety disorders GABA symptoms of excess - ANSWER reduced cellular excitability sedation impaired memory glutamate general function - ANSWER memory, sustained automatic functions glutamate symptoms of deficit - ANSWER poor memory, low energy, distractible learning difficulty, negative symptoms of schizophrenia glutamate symptoms of excess - ANSWER kindling, seizures, anxiety or panic bipolar affective disorder, psychosis from ischemic neurotoxicity or excessive pruning peptides opioid type general function - ANSWER modulate emotions, reward center function, consolidation of memory, modulate reactions to stress peptides opioid type symptoms of deficit - ANSWER hypersensitivity to pain and stress decreased pleasure sensation dysphoria substance abuse peptides opioid type symptoms of excess - ANSWER insensitivity to pain catatonic-like movement disturbance auditory hallucinations

decreased memory structural imaging - ANSWER provides evidence of size and shape of anatomical structure -computed tomography CT -Magnetic resonance imaging MRI computed tomography CT - ANSWER provides a three-dimensional view of the brain structures -differentiates structures based on density provides suggestive evidence of brain-based problems but not specific testing for psychiatric disorders -advantage: widely available, relatively inexpensive -disadvantage: lack of sensitivity, cannot differentiate white matter from gray mater; cannot view structures close to the bone tissue; underestimation of brain atrophy, inability to image sagittal and coronal views magnetic resonance imaging (MRI) - ANSWER provides a series of 2D images that represent the brain -advantages: can view brain structures close to the skull and can separate white matter from gray matter; readily available; resolution of brain tissue superior to CT scanning -disadvantages: expensive, many contras to use, claustrophobia Functional imaging - ANSWER measures function of areas of the brain and bases the resulting assessment on blood flow -may use radioactive pharmaceuticals to cross blood-brain barrier -mainly used for research -EEG and evoked potentials testing -magnetoencephalography MEG -single photon emission computed tomography SPECT -positron emission tomography PET EEG and evoked potentials testing - ANSWER least expensive test convey info on electrical functioning of CNS Magnetoencephalography MEG - ANSWER similar to EEG detects different electrical activities used in complementary fashion with EEG testing single photon emission computed tomography (SPECT) - ANSWER information of cerebral blood flow limited available expensive positron emission tomography PET - ANSWER images of brain when positron-emitting radionuclei interact with an electron

expensive combined structural and functional testing - ANSWER examine structure in conjunction with function mainly for research functional MRI fMRI 3D, event realted functional MRI 3fEMRI Fluorine magnetic spectroscopy Dopamine D2 receptor binding genetic testing FDA required in people of Asian descent - ANSWER presence of HLA- B*1502 allel inherited variant of HLA-B gene prior to prescribing carbamazepine d/t risk of steven Johnson syndrome and toxic epidermal necrolysis TEN normal BMI - ANSWER 20- overweight BMI - ANSWER 26- obese BMI - ANSWER 30- what to watch for if on psychtropics such as carbamazepine (Tegretol) or clozapine - ANSWER elevated temp agranulocytosis steven Johnson syndrome med risk - ANSWER carbamazepine or lamotrigine blurry vision side effect in psychotropics - ANSWER anticholinergic side effect Seroquel may cause cataracts what can both lithium and anorexia nervosa cause - ANSWER peripheral edema Free thyroxine T4 normal levels - ANSWER 0.8-2.8ng/dL interfering factors of Free T4 - ANSWER values can be increased during tx with heparin, aspirin, and propranolol values can be decreased during tx with furosemide (Lasix) or Methadone TSH values can be increased during therapy with what - ANSWER lithium systemic effects of hypothyroidism - ANSWER decreased T4 and increased TSH mimics symptoms of unipolar mood dx systemic effects of hyperthyroidism - ANSWER increased T4 and decreased TSH

may mimic symptoms of bipolar affective disorders interfering factors of calcium levels - ANSWER values can be increased by excessive ingestion of milk or during tx with lithium, thiazide diuretics, alkaline antacids, or vitamin D -values can be decreased during tx with anticonvulsants, aspirin, calcitonin, corticosteroids, heparin, laxatives, diuretics, albuterol, and oral contraceptives magnesium is a cause of neuromuscular what - ANSWER excitability interfering factors of magnesium levels - ANSWER values can be increased by drugs such as antacids, laxatives containing mg, salicylates, and lithium interfering factors of ALT levels - ANSWER values can be increased with Tylenol, allopurinol, aspirin, ampicillin, carbamazepine, cephalosporins, codeine, digitalis, indomethacin, heparin, isoniazid, methotrexate, methyldopa, oral contraceptives, phenothiazines, propranolol, tetracycline, and verapamil GGT is used to evaluate and monitor clients with what - ANSWER known or suspected alcohol abuse levels rise even after ingestion of small amounts of alcohol primary preventions - ANSWER aimed at decreasing the incidence (number of new cases) of mental disorders helping people avoid stressors or cope with them more adaptively secondary prevention - ANSWER aimed at decreasing the prevalence (number of existing cases) of mental disorders early case finding screening prompt and effective tx tertiary prevention - ANSWER aimed at decreasing the disability and severity of mental disorder rehabilitative services avoidance or postponement of complications drug steady state - ANSWER drugs usually are administered once every half-life to achieve this it takes approx. 5 half lives to achieve a steady state and 5 half lives to completely eliminate a drug enzyme inducers can - ANSWER decrease the serum level of other drugs that are substrates of that enzyme possibly causing subtherapeutic drug levels

CP450 inhibitors - ANSWER bupropion clomipramine cimetidine clarithromycin fluoroquinolones grapefruit ketoconazole nefazodone SSRIs CP450 inducers - ANSWER carbamazepine hypericum/ st johns wort phenytoin phenobarbital tobacco enzyme inhibitors can - ANSWER increase the serum level of other drugs that are substrates of that enzyme possibly causing toxic levels agonist effect - ANSWER Drug binds to receptors and activates a biological response inverse agonist effect - ANSWER Drug causes the opposite effect of agonist; binds to same receptor partial agonist effect - ANSWER drug does not fully activate the receptors antagonist effect - ANSWER Drug binds to the receptor but does not activate a biological response schedule 1 drugs - ANSWER nonmedicinal substances high abuse potential used for research only not available by prescription heroin and marijuana typical antipsychotics - ANSWER haloperidol (Haldol), haloperidol deconate (Haldol deconate) loxapine (loxitane) thioridazine (mallaril) thiothixene (navane) fluphenazine (prolixin), fluphenazine deconate (prolixin doconate) mesoridazine (serentil) trifluoperazine (stelazine) chlorpromazine (thorazine) perphenazine (trilafon)

second generation antipsychotics - ANSWER clozapine (Clozaril) ziprasidone (Geodon) risperidone (Risperdal) quetiapine (Seroquel) olanzapine (Zyprexa) aripiprazole (abilify) paliperidone (Invega) iloperidone (fanapt) asenapine (saphris) lurasidone (luatuda) mood stabilizers - ANSWER valproic acid (depakene) divalproex sodium (Depakote) lithium carbonate (eskalith, lithobid, lithonate, lithotabs) lamotrigine (lamictal) carbamazepine (tegretol) carbamazepine ER (equetro) oxcarbazepine (Trileptal; off label) Tricyclics - ANSWER clomipramine (anafranil) amoxapine (asendin) amitriptyline (Elavil) desipramine (norpramin) nortripyline (pamelor) doxepin (sinequan) trimipramine (surmontil) imipramine e(tofranil) protriptyline (vivactil) Serotonin selective reuptake inhibitors SSRIs - ANSWER citalopram (celexa) fluvoxamine (Luvox) paroxetine (paxil) paroxetine mesylate (pexeva) fluoxetine Prozac) sertraline (Zoloft) escitalopram (Lexapro) Monoamine oxidase inhibitors MAOIs - ANSWER phenelzine (nardil) tranylcyprmie sulfate (parnate) selegiline transdermal (EMSAM) SNRIs and other agents - ANSWER trazodone (Desyrel) venlafaxine (Effexor) desvenlafaxine (Pristiq) mirtazapine (Remeron)

nefazodone (serzone) bupropion (Wellbutrin, Forfivo, Aplenzin) duloxetine (Cymbalta) vilazodone (viibryd) vortioxetine (brintellix) levomilnacipran (Fetzima) Benzodiazepines BNZs - ANSWER lorazepam (Ativan) clonazepam (klonopin) chlordiazepoxide (Librium) oxazepam (serax) clorazepate (tranxene) alprazolam (xanex) anxiolytics - ANSWER buspirone (buspar) other agents to tx anxiety dx - ANSWER propranolol (Inderal) atenolol (Tenormin) stimulants - ANSWER amphetamine/destroamphetamine (Adderall) dexmethylphenidate (focalin) dextroamphetamine (Dexedrine) methylphenidate (Ritalin) lisdexamfetamine dimesylate (Vyvanse) other ADHD and ADD agents - ANSWER guanfacine (intuniv) clonidine (kapvay) atomoxetine (Strattera) antidepressants such as desipramine (norpramin), venlafaxine (Effexor), and bupropion (Wellbutrin) are also used schedule II drugs - ANSWER medicinal drugs in current use high potential for abuse and dependency written script only no telephone orders no refills on script morphine sulfate, codeine, fentanyl, methadone, hydromorphone (dilaudid), oxycodone (oxycontin, Percocet), hydrocodone (Vicodin etc), amphetamine salts, methylphenidate schedule III drugs - ANSWER medicinal drugs with less abuse than II telephone orders if followed by written script prescription must renew Q6months refills limited to 5 appetite suppressants, butalbital, testosterone, buprenorphine/naloxone schedule IV drugs - ANSWER medicinal drugs with less abuse than III

dextropropoxyphene (Darvon), pentazocine (talwin), benzos, modafinil (Provigil), phenobarbital, zolpidem (ambien), eszopiclone (Lunesta), temazepam (Restoril), armodafinil (nuvigil) schedule V drugs - ANSWER lowest abuse potential handled similar to noncontrolled drugs buprenorphine (buprenex), cheratussin (robitussin) with codeine, promethazine (Phenergan) with codeine, diphenoxylate/atropine (Lomotil) pregnancy category A - ANSWER Controlled studies show no risk pregnancy category B - ANSWER no evidence of risk to humans pregnancy category C - ANSWER risk cannot be ruled out pregnancy category D - ANSWER Positive evidence of isk Pregnancy category X - ANSWER absolutely contraindicated teratogenic risks of benzos - ANSWER floppy baby syndrome cleft palate teratogenic risks of carbamazepine (tegretol) - ANSWER neural tube defects teratogenic risks of lithium (Eskalith) - ANSWER Epstein anomaly teratogenic risks of divalproex sodium (Depakote) - ANSWER neural tube defects specifically spina bifida atrial septal defect cleft palate possible long term developmental deficits med that can induce depression - ANSWER beta blockers steroids interferon isotretinoin (Accutane) some retroviral drugs antineoplastic drugs benzos progesterone meds that can induce mania - ANSWER steroids disulfiram (Antabuse) isoniazid (INH) antidepressants in persons with BP

meds that can cause false positives for amphetamines - ANSWER stimulants Wellbutrin Prozac trazodone ranitidine nefazodone (serzone) nasal decongestants pseudoephedrine meds that can cause false positives for alcohol - ANSWER valium meds that can cause false positives for benzos - ANSWER zoloft meds that can cause false positives for cocaine - ANSWER amoxicillin most antibiotics NSAIDS meds that can cause false positives for heroin or morphine - ANSWER quinolones rifampin codeine poppy seeds meds that can cause false positives for methadone or PCP - ANSWER OTC cough meds (Nyquil) dextromethorphan psychoanalytic therapy - ANSWER Freud promotes change by development of greater insight and awareness of maladaptive defenses Cognitive therapy - ANSWER Aaron Beck goal is to change clients irrational beliefs, faulty conceptions, and negative cognitive distortions behavioral therapy - ANSWER Arnold Lazarus focus on changing maladaptive bx by participating in active bx techniques such as exposure, relaxation, problem solving, and role playing Dialectical behavior therapy - ANSWER Marsha Linehan focuses on emotional regulation, tolerance for distress, self management skills, interpersonal effectiveness, mindfulness, with an emphasis on treating therapy- interfering bx goals of DBT - ANSWER decrease suicidal bx decreased therapy interfering bx decrease emotional reactivity decrease self invalidation

decrease crisis-generating bx decrease passivity increase realistic decision making increase accurate communication of emotions and competencies existential therpay - ANSWER viktor frankl goal to live authentically and to focus on the present and on personal responsibility humanistic therpay - ANSWER carl rogers person-centered therapy self directed growth and self actualization people are born with capacity to direct themselves toward self actualization interpersonal therapy - ANSWER Gerald klerman and myrna Weissman evidence based therapy focus on interpersonal issues creating distress time limited, active, focus on the present and on interpersonal distress eye movement desensitization and reprocessing EMDR - ANSWER Francine shapiro behavioral and exposure therapy PTSD goal to achieve adaptive resolution 3 phases of EMDR - ANSWER desensitization phase installation phase body scan group phases - ANSWER pregroup phase forming phase storming phase norming phase performing phase adjourning phase family systems therapy - ANSWER Murray Brown focus on chronic anxiety within families tx goal to increase familys awareness of each members function within the family and to incrase levels of self determination structural family therapy - ANSWER Salvador minuchin main tx goal to produce structural change in the family organization to more effectively manage problems changing transactional patterns and family structure experiential therapy - ANSWER virginia satir focus on being authentic, freedom of choice, human validation, and experiencing the moment

tx goals to develop authentic, nurturing communication and increased self worth of each family member overall goal is growth rather than symptom reduction alone does not focus on particular techniques strategic therapy - ANSWER jay haley tx goal to help family embers behave in ways that will not perpetuate the problem bx interventions are problem focused solution focused therapy - ANSWER steve deshaer bill ohanlon and insoo berg focus to rework for the present situations that have worked previously tx goal is effective resolution of problems through cognitive problem solving and use of personal resources and strengths omega 3 fatty acid supplements - ANSWER used for ADHD, dyslexia, cognitive impairment, dementia, CVD, asthma, lupus, and rheumatoid arthritis interacts with warfarin Sam-e supplement - ANSWER used for depression, osteoarthritis, and liver dx may cause hypomania, hyperactive muscle movements, and possible serotonin syndrome tryptophan supplement - ANSWER used for depression, obesity, insomnia, headaches, and fibromyalgia increased risk of serotonin syndrome with use of SSRIs, MAOIs, and st johns wort vitamin E supplement - ANSWER used in enhancing immune system and protecting cells from effects of free radicals used for neurological dx, diabetes, and PMS interacts with warfarin, antiplatelet drugs, and statins increasing risk of rhabdomyolysis melatonin supplement - ANSWER used for insomnia, jet lag, shift work, and cancer interacts with aspirin, NSAIDS, beta blockers, corticosteroids, valerian, kava kava, and alcohol can inhibit ovulation in large doses fish oil supplement - ANSWER used for bipolar disorder, hypertension, lowering triglycerides, and decreasing blood clotting interacts with warfarin, aspirin, NSAIDs, garlic, and ginkgo may alter glucose regulation black cohosh herbal uses - ANSWER menopausal symptoms PMS dysmenorrhea belladonna herbal use - ANSWER anxiety

catnip herbal use - ANSWER sedation chamomile herbal use - ANSWER sedation anxiety ginkgo herbal use - ANSWER delirium, dementia, sexual dysfunction caused by SSRIs Ginseng herbal use - ANSWER depression fatigue valerian herbal use - ANSWER sedation MDD object loss theory - ANSWER -early psychological developmental issues lay the foundation for depressive responses later in life -the accomplishment of the first stage of development in which the child is able to form relationships is normal -during the second stage of development, the child experiences traumatic separation from significant objects of attachment (usually a maternal object) MDD aggression turned inward theory - ANSWER -Freud -assumes that early psychological developmental issues lay he foundation for depressive responses later in life -the accomplishment of the first stage of development in which the child is able to form relationships is normal -during the second stage of development, the child experiences the loss of the significant mothering person MDD cognitive theory - ANSWER -Beck -represents cognitive diathesis- stress model in which developmental experiences sensitize a person to response to stressful life events in a depressed manner -assumes that people with a tendency to be depressed think about the world differently than nondepressed people and that depressed people are more negative and believe that bad tings are going to happen to them because of their own personal shortcomings and inadequacies MDD learned helplessness-hoplessness theory - ANSWER Seligman -modified aspect of cognitive theory -a person becomes depressed due to perceptions of lack of control over life events and experiences -these perceptions are learned over time, especially as the person perceives others seeing him or her as inadequate MDD genetic predisposition theory - ANSWER having a depressed parent is the single strongest predictor of depression

MDD endocrine dysfunction theory - ANSWER HPA axis result of abnormal stress response related to HPA dysregulation MDD abnormalities of neurotransmitter function theory - ANSWER dysregulation of dopamine, serotonin, and norepinephrine MDD structural brain changes - ANSWER hypovolemic hippocampus hypovolemic prefrontal cortex-limbic striatal regions MDD chronobiological theory - ANSWER desynchronization of circadian rhythms produces the symptoms constellation collectively called MDD DSM MDD diagnostic criteria - ANSWER -anhedonia or depressed mood or both -depressed mood most of the day, nearly every day, as indicated by subjective reports or observations of others (irritability in kids) -marked anhedonia in all or almost all ADLs -at least 3 or more significant symptoms present during the same 2 week period that represent a change in previous functioning -weight loss/gain of more than 5% of body weight -hypersomnia or insomnia nearly every day -psychomotor agitation or retardation -fatigue or loss of energy -self-deprecating comments or thoughts -feelings of worthlessness or excessive or inappropriate guilt nearly every day -decreased concentration and memory -symptoms that begin within 2 months of significant loss and do not persist beyond 2 months is bereavement not MDD SSRIs act on - ANSWER increasing serotonin levels TCAs act on - ANSWER elevating serotonin and norepinephrine levels MAOIs act on - ANSWER elevating serotonin and norepinephrine levels SNRIs act on - ANSWER inhibiting dual reuptake of norepinephrine and serotonin citalopram (celexa) - ANSWER -SSRI -tablet -20-40mg/day -SE: sedation, sexual dysfunction, agitation, yawning, GI disturbances, wt gain -preg C -lact L2 -proglonged QTc interval in doses above 40mg (20mg in older adults) and in those susceptible to prolonged QTc escitalopram (Lexapro) - ANSWER -SSRI

-tablet -10-20mg/day -SE: somnolence, headache, sexual dysfunction, GI disturbances -prego C -Lact L2 fluoxetine (Prozac) - ANSWER -SSRI -capsule, tablet, or liquid -20-80mg/day -SE: insomnia, headache, GI disturbances, sexual dysfunction -Long half-life -Prego C -Lact L2 -discontinuation syndrome unlikely fluvoxamine (Luvox) - ANSWER -SSRI -tablet -100-300mg/day -SE: sedation, sexual dysfunction, agitation, GI disturbances -Doses above 150mg should generally be given BID -Prego C -Lact L2 Paroxetine (Paxil CR, Pexeva) - ANSWER -SSRI -tablet or liquid -20-60mg/day -SE: headache, GI disturbances, somnolence, sexual dysfunction -Prego D -Lact L2 -Discontinuation syndrome very common Sertraline (Zoloft) - ANSWER -SSRI -tablet -50-200mg/day -SE: sexual dysfunction, GI disturbances, somnolence, headache -Prego C -Lact L2 Vilazodone (Viibryd) - ANSWER -Serotonin partial agonist reuptake inhibitor SPARI -tablet -20-40mg -SE: diarrhea, nausea, dry mouth, lower risk of sexual side effects -Prego C -Lact unknown, is excreted in breast milk Amitriptyline (Elavil) - ANSWER -TCA

-tablet or IM -50-300mg/day -also used for chronic pain (particularly neuropathic pain), insomnia -Prego C -Lact L2 clomipramine (Anafranil) - ANSWER -TCA -Capsule -100-250mg/day -approved for OCD -250mg/day maximum d/t increased seizure risk -Prego C -Lact L2 Desipramine (Norpramine) - ANSWER -TCA -tablet or capsule -100-300mg/day -also used for ADHD (off label for pediatric clients and for ADHD) -Prego C -Lact L2 Doxepin (Sinequan) - ANSWER -TCA -Capsule or liquid -100-300mg/day -also used for insomnia -Prego C -Lact L5 AVOID imipramine (Tofranil) - ANSWER -TCA -Tablet, capsule, or IM -100-300mg/day -also used for enuresis and separation anxiety -Prego D -Lact L2 Nortriptyline (Pamelor) - ANSWER -TCA -capsule or liquid -50-150mg/day -also used for enuresis and ADHD -Prego D -Lact L2 Protriptyline (Vivactil) - ANSWER -TCA -tablet -15-60mg/day -Prego C