Psychiatric Mental Health Nurse Practitioner Comprehensive Exam (350 Questions with Answer, Exams of Nursing

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Psychiatric Mental Health Nurse

Practitioner Comprehensive Exam (

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Stages of Change (Transtheoretical Model) - SOLUTION (Prochaska & DiClemente) ● Precontemplation—little to no awareness of the problem or intent to change ● Contemplation—thinking about making a change in the next 6 months, weigh pros and cons ● Preparation—prepare to make change within the next month, start to make small changes ● Action—enacted the change for 1 day-6 months ● Maintenance—maintained behavior/change for 6 months or longer Maslow's Hierarchy of Needs - SOLUTION ● Physiological (food, water, shelter, warmth) ● Safety (security, stability, freedom from fear) ● Belonging/love (friends, family, spouse, lover) ● Self-esteem (achievement, mastery, recognition, respect) ● Self-actualization (pursue, inner talent, creativity, fulfillment) Benner's Model - SOLUTION ● Novice—unconscious incompetence, no experience, governed by rules and regulations ● Advanced beginner—able to analyze and deliberately act ● Competency/proficiency—2-5 yrs experience, able to synthesize info/coordinate ● Expert—flexible, intuitive, efficient MMSE Scoring - SOLUTION ○ 23-30 normal ○ 19-23 borderline ○ <19 impaired MMSE components - SOLUTION ● Orientation ● Registration (repeat 3 words)

● Attention and Calculation (count backwards from 100 by 7, spell words backward) ● Recall (repeat the same 3 words from immediate recall) ● Language (name an object, repeat a phrase, read a sentence, write a sentence, copy intersecting pentagons) Levels of Prevention - SOLUTION · Primary prevention—methods to avoid occurrence of disease (most population-based health promotion efforts) · Secondary prevention—methods to diagnose and treat existent disease in early stages before it causes significant morbidity · Tertiary prevention—methods to reduce negative impact of existent disease by restoring function and reducing disease-related complications · Quaternary prevention—methods to mitigate or avoid results of unnecessary or excessive interventions in the health system frontal lobe - SOLUTION A region of the cerebral cortex that has specialized areas for movement, abstract thinking, planning, memory, and judgement -prefrontal, motor strip, EPS, basal ganglia temporal lobe - SOLUTION hearing, language (Wernicke's), memory, emotion parietal lobe - SOLUTION sensory processing and input components of the limbic system - SOLUTION interpreting significance of sensory input; hippocampus, amygdala, hypothalamus, cingulate gyrus, thalamus anterior cingulate cortex - SOLUTION integrating complex external information; empathy, emotion processing posterior cingulate cortex - SOLUTION participates in memory and visual processing; day dreaming, values, relevance to self hypothalamus & what NTs does it balance - SOLUTION homeostasis (food, water, temperature), controls pituitary release, balance of DA and 5HT posterior pituitary - SOLUTION ADH and oxytocin

thalamus - SOLUTION relay station for incoming sensory information, allowing for processing and interpretation according to other structures' input cerebellum - SOLUTION control center for controlling voluntary movement, fine tunes movement cerebellar lesion symptoms - SOLUTION ataxia, awkward, tremor with effort, difficulty with sequential movements, balance brainstem - SOLUTION responsible for automatic survival functions; midbrain, pons, medulla where is dopamine produced - SOLUTION substantia nigra where is serotonin produced - SOLUTION raphe nuclei where is norepinephrine produced - SOLUTION locus coeruleus in the pons where is acetylcholine produced - SOLUTION Nucleus basalis of Meynert cranial nerves - SOLUTION Olfactory—smell Optic—vision Oculomotor—eye movement Trochlear—eye movement Trigeminal—face sensation & chewing Abducens—eye movement Facial—facial movements and taste Vestibulocochlear—hearing Glossopharyngeal—taste, swallowing Vagus—movement, sensation, visceral organs Accessory—spinal, neck movement Hypoglossal—tongue movement preganglionic NT of SNS - SOLUTION ACh postganglionic NT of SNS - SOLUTION NE

preganglionic NT of PNS - SOLUTION ACh postganglionic NT of PNS - SOLUTION ACh origin of SNS - SOLUTION thoracolumbar origin of PNS - SOLUTION craniosacral pharmacokinetics - SOLUTION what the body does to the drug Components of pharmacokinetics - SOLUTION absorption, distribution, metabolism, excretion (half-life, steady state by 4 half-lives) pharmacodynamics - SOLUTION what the drug does to the body examples of pharmacodynamics - SOLUTION upregulation, downregulation, actions at receptors, therapeutic index/margin of safety dopamine - SOLUTION drive, motivation, pleasure, psychosis, attention, motor, energy too much dopamine - SOLUTION schizophrenia, nausea, vomiting, addictive behavior, over movement, sexual functioning not enough dopamine - SOLUTION EPS, anhedonia, negative sx, inc temp, under movement, parkinsonism serotonin - SOLUTION depression, obsession, migraines, anxiety, intestines, nausea, sexual too much serotonin - SOLUTION inc mood, inc temp, GI sx, sexual dysfunction not enough serotonin - SOLUTION depression, SI, anxiety, panic, aggression, pain, dec temp norepinephrine - SOLUTION energy, conc, attention, vigilance, energy too much norepinephrine - SOLUTION inc mood, inc HR/BP, attention

not enough norepinephrine - SOLUTION depression, vasodilation, orthostasis, dec HR acetylcholine - SOLUTION PNS at muscarinic receptors, muscle contraction and cognition at nicotinic receptors too much ACh - SOLUTION lower HR, inc GI motility, inc sweating, inc salivation, inc cognition not enough ACh - SOLUTION inc HR, dec cognition, can't see, can't pee, can't stool, can't drool monoamine oxidase - SOLUTION deactivates NE, DA, 5HT MAOIs - SOLUTION inhibit enzymatic destruction of monoamines, risking the sudden release of stored up monoamines; food interactions w/ tyramine and drug interactions w/ anything that promotes the release of stored up NA and DA can cause hypertensive crisis MDD - SOLUTION depressed mood or anhedonia PLUS 4 of the following: sleep disturbance, weight/appetite change, fatigue/dec energy, psychomotor agitation or retardation, difficulty conc, guilt/worthlessness, SI TCAs - SOLUTION inhibit reuptake of serotonin and norepinephrine, cause anticholinergic and anti adrenergic ASE SSRI common adverse effects - SOLUTION -nausea -dry mouth -insomnia -somnolence -headache -nervousness -anxiety -gastrointestinal (GI) disturbances -anorexia -sexual dysfunction -agitation -dizziness -fatigue -jittery

-emotional flattening SSRI discontinuation syndrome - SOLUTION Flu-like symptoms, fatigue, myalgia, decreased concentration, N/V, impaired memory, paresthesia, shock like sensations, irritability, anxiety, insomnia, crying without provocation, dizziness, vertigo, agitation serotonin syndrome sx & tx - SOLUTION autonomic instability, hyperthermia, confusion/altered sensorium, myoclonus, cardiovascular instability, flushing, diarrhea, cramps, seizures, restlessness, ataxia, headache, insomnia, HYPERREFLEXIA, diaphoresis -Treatment: cyproheptadine (5-HT2 receptor antagonist) Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) - SOLUTION inc available NE and 5HT -effexor, pristiq, cymbalta, fetzima bupropion (what do you know about it) - SOLUTION Norepinephrine and dopamine reuptake inhibitor contraindicated w/ seizure history and eating disorders good for low energy depression smoking cessation and off label ADHD mirtazapine MOA - SOLUTION remeron alpha 2 blocker, inc release of 5HT and NE highly sedating, potential for weight gain bipolar disorder I/ criteria for manic episode - SOLUTION abnormal, persistently elevated euphoric OR irritable mood, plus 3 of the following or 4 if only irritable mood, for at least 1 wk or requiring hospitalization: distractibly, indiscretion, grandiose, flight of ideas, activity inc, sleep disturbance, talkative

bipolar disorder II/criteria for hypomanic episode - SOLUTION duration is 4 days and does not cause significant impairment or hospitalization Depakote range & toxicity levels - SOLUTION 50-125 mcg/mL is therapeutic level <450 limited toxicity 450-850 moderate-severity toxicity

850 coma, metabolic acidosis, resp dep Depakote Toxicity - SOLUTION coma, confusion, somnolence, seizures, dizziness, hallucinations, irritability, headache, hepatotoxicity, CEREBRAL EDEMA, tachycardia, hypotension, N/V, abdominal pain, PANCREATITIS Depakote baseline labs - SOLUTION LFT, CBC, platelets, pregnancy test Depakote side effects - SOLUTION -hepatotoxicity -weight gain -sedation -n/v -hair loss -thrombocytopenia (notify MD if these occur) -abdominal pain, dark urine, yellow tinged eyes Depakote indications - SOLUTION seizures, bipolar disorder (mixed episodes/irritability or aggression), migraine prevention Lithium indication - SOLUTION manic and depressive episodes of bipolar disorder Lithium baseline labs - SOLUTION BUN/ Cr thyroid/TSH CBC ECG over 50 ********* pregnancy test GFR

lithium birth defect - SOLUTION Ebstein's anomaly (a right ventricular outflow tract obstruction defect d/t compromised tricuspid valve) lithium therapeutic level - SOLUTION 0.6-1.2 mEq/L DC if level is 1.5 or above Lithium signs of toxicity - SOLUTION N/V, fine tremor, fatigue, tachycardia, ataxia, confusion, agitation, delirium, hypertonia, hypothermia, hypotension, seizures, renal failure, coma, death lithium level of 1.5 to 2.0 - SOLUTION mental confusion, poor coordination, coarse tremors, GI distress, dizzy lithium level 2-3 - SOLUTION tinnitus, nystagmus, ataxia ataxia - SOLUTION the loss of full control of bodily movements lithium level > 3 - SOLUTION seizures, coma, death lithium and sodium - SOLUTION Lithium decreases sodium reabsorption in the kidneys which can lead to sodium deficiency. Decreased -sodium can lead to lithium retention and toxicity. Be aware of anything that can lead to dehydration or loss of sodium diarrhea, vomiting, sweating) as lithium levels may then rise to toxic levels. lithium is the gold standard for - SOLUTION manic episodes lamotrigine - SOLUTION lamictal; anticonvulsant lamictal indications - SOLUTION seizures & bipolar depression lamictal adverse effects - SOLUTION 1. Dizziness

2. Ataxia
3. Somnolence
4. Headaches.
5. Blurred vision
6. Nausea

7. **Rash common and occasionally severe, should be d/c's if develops. Can manifest to Steven Johnsons syndrome, toxic epidermal necrolysis. watch for malaise, joint pain, purple bruised blotchy patches **Concurrent Valproic acid can double the Lamictal concentration examples of SGAs - SOLUTION Zyprexa, Clozaril, Seroquel, Abilify/aripiprazole, Risperdal, Invega/paliperidone, Latuda/lurisadone, Vraylar/cariprazine, Geodon/ziprasidone, Fanapt/iloperidone, Saphris/asenapine Seroquel adverse effects - SOLUTION sedation, weight gain, anticholinergic & antihistaminic effects zyprexa adverse effects - SOLUTION metabolic syndrome, sedation abilify adverse effects - SOLUTION akathisia, less sedation latuda administration - SOLUTION must take with 350 cal meal Latuda indication - SOLUTION bipolar depression, schizophrenia Vraylar (cariprazine) - SOLUTION atypical antipsychotic, indicated for manic episodes and schizophrenia CYP3A4 inhibitors - SOLUTION increase the concentration of drugs that are metabolized by the CYP system SICKFACES.COM sodium valproate isoniazid cimetidine ketoconazole alcohol and grapefruit juice chloramphenicol erythromycin sulfonamides ciprofloxacin omeprazole metronidazole

CYP3A4 inducers - SOLUTION decrease the concentration of drugs that are metabolized by the CYP system CRAP GPs carbemazepines rifampicin alcohol phenytoin griseofulvin phenobarbitone sulphonylureas generalized anxiety disorder DSM-V criteria - SOLUTION excessive anxiety and worry more days than not for at least 6 months about a variety of things, difficult to control the worry, with 3 or more of the following: restlessness/edginess, fatigue/dec energy, difficulty conc, irritability, tension, sleep problems children GAD sx - SOLUTION somatic sx, avoiding school, poor performance, seek excessive reassurance, perfectionistic attitude antidepressants approved for GAD - SOLUTION paroxetine, venlafaxine XR (watch BP), citalopram, escitalopram, duloxetine panic attack criteria - SOLUTION 4+ of these that develop abruptly & peak within 10 min: palpitations, sweating, trembling, shortness of breath, choking feeling, chest pain, nausea, dizziness, derealization/depersonalization, fear of losing control, fear of dying, paresthesias, chills or hot flashes followed by one month of worry it will happen again, for panic disorder medications for panic disorder - SOLUTION • SSRIs are treatment of choice: paroxetine (Paxil), sertraline (Zoloft), fluoxetine (Prozac), citalopram (Celexa), fluvoxamine (Luvox)

• If patients do not respond to SSRIs, short-term treatment with a benzodiazepine may be used:

diazepam (Valium), lorazepam (Ativan), oxazepam (Serax), chlordiazepoxide (Librium), clorazepate (Tranxene)

• Or patients may switch to another type of antidepressant such as a SNRI: venlafaxine XR (Effexor)
• Or TCA's: clomipramine (Anafranil), amytriptyline (Elavil), imipramine (Tofranil) agoraphobia dsm-5 criteria - SOLUTION Anxious about two or more:
• Using public transportation
• Being in open spaces
• Being in enclosed places (e.g., shops, cinema)
• Standing in line or being in a crowd
• Being outside of the home alone The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling in the elderly; fear of incontinence). The agoraphobic situations almost always provoke fear or anxiety. The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety. The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context.
• Other criteria note functional impairment, at least 6 months, not explained by... etc treatment for OCD - SOLUTION clomipramine, fluoxetine, sertraline, fluvoxamine, paroxetine Behavioral therapy (exposure and response prevention, cognitive behavior family therapy) PANDAS - SOLUTION Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections

separation anxiety disorder dsm-5 criteria - SOLUTION A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:

1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.
4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.
5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
7. Repeated nightmares involving the theme of separation.
8. Repeated complaints of physical symptoms (e.g., headaches, stomach aches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated. B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults. social anxiety disorder dsm-5 criteria - SOLUTION Marked fear or anxiety about one or more social situations in which the person is exposed to possible scrutiny by others Ex: social interactions, being observed, performing Fears he/she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e. humiliating or embarrassing, will lead to rejection or offend others) The social situations are avoided or endured with intense fear or anxiety The fear is out of proportion The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more Impairs functioning Specify: Performance only

medications for social anxiety disorder - SOLUTION paroxetine, sertraline, buspirone, alprazolam, clonazepam, propranolol, atenolol benzodiazepines mechanism of action - SOLUTION Enhance the affinity of the GABAA receptors for GABA benzodiazepine withdrawal symptoms - SOLUTION Insomnia, restlessness, anxiety, panic, paranoia, abdominal pain, nausea, sensitivity to light and sound, headache, fatigue, muscle twitches benzodiazepine contraindications - SOLUTION - Known drug allergy

• Narrow-angle glaucoma
• Pregnancy
• TBI Benzodiazepine antidote - SOLUTION Flumazenil buspirone - SOLUTION BuSpar Anxiolytic, anti anxiety 5HT receptor partial agonist metabolized by the liver Buspirone MOA - SOLUTION Stimulates 5-HT1A receptors, partial agonist Buspirone adverse effects - SOLUTION paradoxical anxiety, dizziness, blurred vision, headache, nausea substance use d/o dsm-5 criteria - SOLUTION maladaptive pattern of substance use leading to impairment or distress w/ 2 or more of the following: using despite failure to fulfill obligations using despite interpersonal problems tolerance, WD, inc amounts, inc time unsuccessful attempts to reduce use cravings blood alcohol levels & symptoms - SOLUTION 0.05 disinhibition

0.1 noticeable motor interference 0.2 significant motor and emotional disinhibition 0.3 confusion, stupor 0.4-0.5 coma, brainstem inhibition, death labs affected by alcohol use - SOLUTION inc AST/ALT, inc bilirubin, dec MCV, dec B12, dec folate, dec thiamine Wernicke's encephalopathy triad - SOLUTION thiamine deficiency fluctuating attention, ataxia, nystagmus Korsakoff's syndrome - SOLUTION deficient thiamine and B memory damage alcohol withdrawal symptoms & timing - SOLUTION autonomic hyperactivity (sweating, flushing, tachycardia, hypertension, hyperreflexia) anxiety & tremors > 8 hrs seizures > 12-24 hrs delirium tremens > 72 hrs alcohol withdrawal treatment - SOLUTION Long-acting benzodiazepines, fluids, thiamine, folic acid CIWA scoring - SOLUTION 0-9 absent to minimal 10-19 mild to moderate Over 20 severe WD and possible DTs 15 or higher tx sched + PRNs ICU if > 35 or resp dep CIWA - SOLUTION Clinical Institute Withdrawal Assessment for Alcohol COWS - SOLUTION Clinical Opiate Withdrawal Scale COWS scoring - SOLUTION 5-12 mild

13-24 moderate 25-36 MODERATELY SEVERE 36+ SEVERE WITHDRAWAL AUDIT-C - SOLUTION Shorter version of AUDIT for acute and critical care units

• screening test for heavy drinking and/or active abuse Score: 4-13 at risk, > 14 high risk CRAFFT - SOLUTION 6-item screen for alcohol or drugs in adolescents, 14- (C=car, R=relax, A=alone, F=forget, F= family or friends, T= trouble) score 2+ indicates problem SBIRT - SOLUTION Screening, Brief Intervention, and Referral to Treatment AUDIT scoring - SOLUTION < 8 low risk 8-14 hazardous use pattern 15+ moderate/severe use d/o and dependence CAGE - SOLUTION cut down, annoyed, guilty, eye opener Acamprosate (Campral) - SOLUTION Reduces withdrawal in abstinent alcoholics Disulfiram (Antabuse) - SOLUTION Used for alcohol aversion therapy. Clients started on Disulfiram must avoid any form of alcohol or they would develop a severe reaction. Teach pt to avoid some over-the-counter cough preparations, mouthwash etc. Naltrexone (ReVia) - SOLUTION Reduces or eliminates alcohol craving medications to abstain from opioids - SOLUTION methadone, buprenorphine

schizophrenia dsm-5 criteria - SOLUTION Two or more of the following, each present for a significant amount of time during a 1-month period (one has to be from first three) --Delusions --Hallucinations -- Disorganized speech -- Disorganized behavior -- Negative symptoms (alogia, avolition, affective flattening, dec attn, dec memory, dec language, anxiety, hostility, substance abuse) positive symptoms of schizophrenia - SOLUTION delusions and hallucinations negative symptoms of schizophrenia - SOLUTION disturbance of affect, blunting (severe reduction in the intensity of affect expression), flat affect, inappropriate affect (might laugh hysterically while describing someones death), absence of appropriate behaviors schizophreniform disorder - SOLUTION Psychotic disorder involving the symptoms of schizophrenia but lasting b/w 1-6 months brief psychotic disorder - SOLUTION Psychotic disturbance involving delusions, hallucinations, or disorganized speech or behavior but lasting less than 1 month; often occurs in reaction to a stressor. delusional disorder - SOLUTION a psychotic disorder in which the primary symptom is one or more delusions, duration 1 month or longer schizoaffective disorder - SOLUTION Psychotic disorder featuring symptoms of both schizophrenia and major mood disorder. must have hallucinations or delusions for 2 wks in absence of a major mood episode specify bipolar or depressed type first generation antipsychotics and dopamine pathways - SOLUTION -block D2 in mesolimbic pathway= reduced positive sx -block D2 in mesocortical pathway= worsens negative sx

-block D2 in nigrostriatal pathway= EPS (akathisia, dystonia, parkinsonism--rigid, tremor, bradykinesia, posture), TD (writhing, facial twitching, irreversible) -block D2 in tuberofundibular pathway= hyperprolactinemia (DA is prolactin inhibiting factor) FGAs Adverse Effects - SOLUTION CV: orthostatic hypotension, syncope (conscious to unconscious very quickly), ECG changes Dermatologic: photosensitivity Hematologic: agranulocytosis (monitor CBC) metabolic: weight gain sexual dysfunction: decreased libido antihistaminic, anticholinergic, antiadrenergic effects Neuroleptic Malignant Syndrome - SOLUTION Adverse reaction to antipsychotics with severe muscle rigidity, hyperthermia, autonomic instability (hypotension, tachycardia, diaphoresis, tachypnea), confusion/altered LOC, mutism, coma, death, elevated WBC and CPK NMS treatment - SOLUTION dantrolene--D2 agonist bromocriptine--muscle relaxant treat fever, IV hydration, benzos for muscular rigidity SGA MOA - SOLUTION block D2 and 5HT2A receptors, leaving some DA in the synapse, treat positive and negative sx of schizophrenia, 5HT2A blockade inc DA in DA pathways and also dec ACh in nigrostriatal pathway which dec risk of EPS and TD SGA adverse effects - SOLUTION anticholinergic, varying degrees of sedation, orthostasis, weight gain

baseline assessment for SGA administration - SOLUTION height, weight, BMI, BP, FBG, lipids, AIMS Abnormal Involuntary Movement Scale (AIMS) - SOLUTION this tool is used to monitor involuntary movements and tardive dyskinesia in clients who take antipsychotic medication Delirium - SOLUTION fluctuating LOC, acute onset, impaired short term memory, slurred speech, hallucinations, delusions, anxiety, fear Major Neuro Cognitive Disorder - SOLUTION aka dementia; global impairment of cognitive functioning (language, abstraction, memory, planning, attention), chronic slow development 3-10 years until death short term memory lost initially and then long term memory fails slowly NO CHANGE IN LOC personality changes NCD due to Alzheimer's Disease - SOLUTION amnesia + aphasia or apraxia or agnosia or impaired executive functioning gradual decline most common type neuronal loss, B-amyloid plaques, tau proteins Stages of Alzheimer's & MMSE score - SOLUTION Mild (MMSE >2O) decreased STM, word finding, getting lost, denial Moderate (MMSE 10-20) agnosia, aphasia, disorientation, delusions, wandering Severe (MMSE < 10) apraxia, bedbound, incontinence, feeding, supervision Montreal Test of Cognitive Ability (MOCA) scoring - SOLUTION 27+ indicates no impairment

Mini-Cog - SOLUTION 3 item recall and clock drawing test no impairment if recall is correct or if they get one word right and can draw clock Cholinesterase Inhibitors MOA, indication, drugs - SOLUTION inc amount of ACh for mild to moderate ALZ, Lewy body Aricept/donepezil Exelon/rivastigmine Razadyne/galantamine NMDA Receptor Antagonist - SOLUTION inhibits glutamate release for moderate to severe ALZ, vascular dementia memantine/Namenda vascular dementia - SOLUTION 2nd most common dementia type, formerly called multi-infarct dementia, primarily caused by CV disease, most common in men with preexisting high blood pressure and CV risks. each ischemic event further deteriorates cognition, important to prevent future events w/ statins and antiHTNs Hallmark sx: carotid bruits, fundoscopic abnormalities, and enlarged cardiac chambers. Lewy body dementia - SOLUTION A form of dementia characterized by an increase in Lewy body cells in the brain. inflammation markers Symptoms include VISUAL HALLUCINATIONS, momentary loss of attention, falling, shuffling gait and fainting, tremors rapid fluctuations in cognitive status, quicker onset sensitive to EPS from antipsychotics

Frontotemporal Dementia - SOLUTION Frontal and temporal regions degenerate, resulting in badly impaired emotional stability, decision-making and language use; disinhibition, socially inappropriate behavior, poor judgement, apathy, dec motivation, poor executive function. Pick Cells Pseudodementia - SOLUTION depression in older adults can mimic dementia sx but onset is acute, there is awareness of cognitive sx, memory and attention improve with prompting, they need encouragement to participate in interview while dementia pts will try to compensate and make up answers SLUMS scoring - SOLUTION dementia assessment tool, St Luis Mental Status Score is different based on education -High School Education or Higher Norm 27- 21-26 mild cog impairment 0-20 dementia MOCA (Montreal Cognitive Assessment) scoring - SOLUTION Screens for mild cognitive decline. 26+ normal 18-25 mild cog impairment 10-17 moderate cog impairment <10 severe cog impairment CAM (confusion assessment method) for delirium - SOLUTION dx requires the presence of features 1 and 2 AND either 3 or 4 Beers Criteria - SOLUTION originally developed by a group headed by Dr. Mark H. Beers, listing of drugs that carry high risks for older adults and criteria for potentially inappropriate medication use in older adults

Erikson's Developmental Stages - SOLUTION 1. Trust vs. Mistrust-Infants;

2. Autonomy vs. Shame/Doubt-Toddlers;
3. Initiative vs. Guilt-Young Children;
4. Industry vs. Inferiority-Older Children;
5. Identity vs. Role Confusion-Adolescents;
6. Intimacy vs. Isolation-Young Adults;
7. Generativity vs. Stagnation-Adults;
8. Ego Integrity vs. Despair-Elderly. Autism Spectrum Disorder dsm-5 criteria - SOLUTION A. Qualitative impairment in social communication and interaction across multiple contexts --limited nonverbal behavior, do not make eye contact --failure to develop peer relationships, little interest in them --failure to initiate and maintain shared gaze --lack of emotional reciprocity, adapting to social contexts B. Restricted repetitive and stereotypical patterns of behavior, interests, and activities need 2+: --preoccupation w/ restricted pattern of interests, repetitive motor mannerisms, inflexible adherence to routines (difficulty w/ transition, anticipating changes, clothing preferences, insistence on sameness), altered sensory experience (hyper or hypo) --echolalia, sounds, singing C. Symptoms present in early developmental period D. Significant impairment in social, occupational, or other important areas of functioning E. Disturbances not better explained by intellectual disability ASD comorbidities - SOLUTION -Intellectual Disability -Epilepsy -ADHD -Conduct Problems Anxiety and Mood Problems ADHD DSM-5 Criteria (types, how many sx, what age, how many settings, duration) - SOLUTION -Inattention and/or hyperactivity that interferes with functioning or development -6+ symptoms

-Before age 12 -Present in 2+ settings -Clear evidence of impairment -6 months neurotransmitters involved in ADHD - SOLUTION dopamine and norepinephrine ADHD comorbidities - SOLUTION learning disabilities, anxiety, depression, ODD, CD ADHD inattention symptoms - SOLUTION --Fails to give close attention to details/makes mistakes in school work, work, or other --Difficulty sustaining attention --Often does not seem to listen when spoken to directly --Often does not follow instructions (*not due to oppositional behaviour/failure to understand) and fails to finish things --Difficulty organising tasks and activities --Often avoids/dislikes/reluctant to engage in tasks that require sustained mental effort --Often loses things --Often easily distracted --Often forgetful ADHD hyperactive/impulsive type - SOLUTION Fidgeting leaving the seat in the classroom running or climbing excessively difficulty playing or engaging in leisure activities blurting out answers difficulty waiting to take turns talking excessively interrupts or intrudes

Conner's Rating Scales - SOLUTION Conner's Rating Scales is an assessment designed to assess ADHD and related problems in children. (20 min). Vanderbilt ADHD Parent and Teacher (ADHD) - SOLUTION 55 parent, 43 teacher items for 6-12 Initial assessment rates symptoms and impairment in academic and behavioral performance TOVA - SOLUTION -measures attention, impulsivity and adaptability -4-80+ -21.6 min to admin -has a comparison to the normative sample and to sample diagnosed with ADHD -auditory and visual Amphetamines mechanism of action - SOLUTION Stimulate release of norepinephrine and dopamine & block reuptake methylphenidates mechanism of action - SOLUTION non-competitively blocks the reuptake of dopamine and noradrenaline into the terminal by blocking dopamine transporter (DAT) and noradrenaline transporter (NAT), increasing levels of dopamine and noradrenaline in the synaptic cleft. treatment for anorexia in ADHD - SOLUTION cyproheptadine guanfacine - SOLUTION Intuniv, alpha 2 agonist, non stimulant for ADHD clonidine - SOLUTION Kapvay, alpha 2 agonist, non stimulant for ADHD Wellbutrin mechanism of action - SOLUTION DA and NE atomoxetine - SOLUTION Strattera Selective Norepinephrine Reuptake Inhibitor (inc DA and NE in the prefrontal cortex), no abuse potential, approved ages 6+, non stimulant for ADHD Generalized anxiety disorder in children - SOLUTION Need only one physical symptom (somatic sx common) Worry = academic, social, athletic performance perfectionistic approach

anxiety medications for children - SOLUTION Duloxetine 7+ Sertraline 6+ Fluoxetine 7+ Fluvoxamine 8+ Clomipramine 10+ Citalopram/Escitalopram 12+ BBW for SSRIs in children/adolescents - SOLUTION SI FDA approved medications for bipolar disorder in children - SOLUTION Zyprexa 13+ Risperdal 10+ Seroquel 10+ Abilify 10+ Depakote & Lithium 7+ DMDD dsm-5 criteria - SOLUTION ages 6-18, onset by 10 severe, recurrent temper outbursts disproportionate to the developmental level, 3x/wk for 12 months irritable, angry all day everyday b/w outbursts no periods of mood elevation or mania CANNOT be comorbid with ODD, IED, or bipolar disorder ODD DSM-5 criteria - SOLUTION pattern of angry or irritable mood & argumentative, defiant, or vindictive behavior lasting 6 months w/ at least 4 of the following: loses temper, easily annoyed, resentful or angry, argues w/ authority, actively defies or refuses to comply with rules, blames others, deliberately annoys others, spiteful or vindictive --temper tantrums not as severe as DMDD, no aggression --vindictive pattern may develop into CD --comorbid w/ ADHD commonly Conduct Disorder DSM-5 Criteria - SOLUTION rights of others or societal norms are violated, LACK OF REMORSE, 12 months of at least 3 of the following, onset by age 10 for child, after for adolescent onset: Aggression to people or animals (bullying, threats, intimidation, physical fights, weapons, stealing, forced sexual activity)

Destruction of property Deceitfulness or theft Serious violations of rules (ignores curfew, runs away) conduct disorder treatment - SOLUTION -Intense Behavioral and CBT with individual AND family! -Parent Management Training -Usually Multidimensional working on the issues from many angles (parents, individual, school, behavioral, cognitively, stress management, etc.). -SGAs, stimulants, SSRIs Intermittent Explosive Disorder - SOLUTION repeated, sudden episodes of impulsive, aggressive, violent or angry outbursts in which the child acts grossly out of proportion to the situation & destroy property afterwards they are remorseful ages 6-17 PTSD DSM-5 Criteria - SOLUTION -Exposure to actual or threatened death, serious injury, or sexual violence by directly experiencing or witnessing the trauma -Recurrent intrusions (1) of reexperiencing the event via memories, nightmares, or dissociative reactions (flashbacks) -Active avoidance (1) of triggering stimuli a/w trauma -At least 2 of the following negative cognitions/mood: negative emotions (fear, horror, anger, guilt), self blame, anhedonia, inability to experience positive emotions, lost memories, feeling detached from others -At least 2 of the following symptoms of increased arousal/reactivity: hypervigilance, exaggerated startled response, irritability/angry outburst, insomina, impaired concentration, self destructive behavior 1 month duration, clinically significant impairment specify dissociative, delayed expression FDA approved medications for PTSD - SOLUTION sertraline and paroxetine, prazosin