PMHNP Boards - Purple Book PDF Study Guide

PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 1. Asterixis: involuntary flapping movements of the hands 2. Akinesia: inability to initiate movement 3. Why are older adults more sensitive to psych meds?: They have lower muscle mass and higher body fat concentrati...

PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 1. Asterixis: involuntary flapping movements of the hands 2. Akinesia: inability to initiate movement 3. Why are older adults more sensitive to psych meds?: They have lower muscle mass and higher body fat concentration, also decreased intracellular water, decreased protein binding, and decreased metabolism 4. Etiology of ODD: Temperament Parents who model extreme ways of expressing emotions Trauma Unresolved conflict 5. Erikson's Psychosocial Stages: 1. Trust vs. Mistrust (birth-1 year) - if needs are met, infants develop basic trust 2. Autonomy vs. Shame and Doubt (2-3 years) - toddlers learn to exercise will and do things for themselves, or doubt their abilities 3. Initiative vs. Guilt (3-6 years) - preschoolers learn to initiate tasks and carry out plans, or feel guilty about efforts to be independent 4. Industry vs. Inferiority (6-11 years) - children learn the pleasure of applying themselves to tasks, or feel inferior 5. Identity vs. Identity Diffusion (12-18 years) - teens work at redefining sense of self by testing roles and integrating them to form a single identity, or become confused about who they are 6. Intimacy vs. Isolation (early adulthood: 19-mid 20s) - young adults struggle to form close relationships and gain capacity for intimate love, or feel socially isolated 7. Generativity vs. Stagnation/Self-Absorbtion (middle age: late 20s-50s) middle aged discover a sense of contributing to the world, usually through family and work, or they may feel lack of purpose 8. Integrity vs. Dispair (old age: 60s and beyond) - when reflecting on his or her life, the older adult may feel a sense of satisfaction or failure 6. Phases of a therapeutic relationship: Introduction, Working - clarify expectations, identify mutual goals; implement tx plan; monitor pt health; preventative healthcare; measure/evaluate outcomes Termination 7. Freud's Psychosexual Stages: 1. Oral Stage - (birth to 1 year) pleasure centers around mouth (sucking, biting, swallowing) 2. Anal Stage - (1-3 years) withholding elimination/ultimate release = pleasure, toilet training 3. Phallic Stage - (4-6 years) pleasure around genitals, identifies with same-sex parent, attraction toward opposite sex parent 1 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 4. Latency Stage - (6-puberty) pleasure around social-interactions with others, represses all interest in sexuality 5. Genital Stage - (puberty to death) sexual reawakening, pleasure outside of family 8. Gray matter: composed largely of nerve cell bodies and unmyelinated interneu- rons and dendrites; working area of the brain and contains the synapses, the area of neuronal connection 9. White matter: myelinated axons of neurons 10. Anticholinergic intoxication: psychosis, dry mouth, hyperpyrexia, mydriasis, restlessness, tachycardia 11. Nurse practitioner core competencies: scientific foundation leadership quality practice inquiry technology and information literacy policy health delivery system ethics independent practice 12. Confidentiality: -clients right to assume that info given to provider will not be disclosed -protected through Medical Record Confidentiality Act of 1995 -requires signed medical authorization and consent to release medical info 13. HIPAA: guarantees clients 4 fundamental rights: 1. to be educated about HIPAA rights 2. to have access to their own medical records 3. to request amendment of their health info to which they object 4. to require their permission for disclosure of their personal info 14. Health Information Technology for Economic and Clinical Health Act (HITECH): -incentive payments for sharing specific EMR data -meaningful use incentives -EHR's can improve both individual and population based health outcomes -EHR's can improve quality, safety, efficiency, effectiveness, and outcomes 15. Ethical principles: Justice: doing what is fair Beneficence: promoting well being and doing good Nonmaleficence: doing no harm Fidelity: Being true and loyal 2 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix Autonomy: doing for self Veracity: Telling the truth Respect: treating everyone with equal respect 16. Mental illness in homeless population: -50% homeless people have co-oc- curring substance and mental illness -Schizophrenia 15-45% of US homeless -greater risk risk for violence and noncompliance 17. Migrant worker: persons who leave their permanent residences to take agri- cultural jobs in different locations 18. seasonal worker: worker who travels from their permanent residences sea- sonally for agricultural employment 19. sexual identity: How people identify psychologically on a continuum between female and male and to whom they are sexually and/or affectionately attracted. 20. gender identity: a person's identity along a continuum between normative constructs of masculinity and femininity -biological factors may include pre/postnatal hormone levels and gene expression -social factors may include gender messages from family, mass media, and cultural attitudes 21. gender dysphoria: the formal diagnosis to describe a marked incongruence between one's experienced and expressed gender and the gender assigned at birth 22. sexual orientation: direction of sexual attraction -asexual -bisexual -heterosexual -homosexual -transgender -transsexual -LGBTQ 23. sexual behavior: The manner in which humans experience and express their sexuality, including attracting partners, sexual interactions and social interactions between individuals 24. forensic: the application of scientific knowledge to legal problems 25. forensic science: application of a broad range of sciences to answer ques- tions of interest to the legal system 3 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 26. forensic nursing: Practice of nursing when health and legal systems inter- sect; the forensic nurse provides direct services to individual clients; consultation services to nursing, medical, and legal agencies; and expert court testimony in areas dealing with trauma and/or investigations of questioned deaths, adequacy of services delivery, and specialized diagnoses of specific conditions as related to nursing. 27. forensic risk assessment: Protects the public from individuals with known mental disorders having dangerous, violent and criminal histories 28. risk assessment: psychiatric evaluation performed in ED after arrest and before person is confined to a correctional facility 29. transference: displacement of feelings for significant people in the client's past on the PMHNP in the present relationship 30. countertransference: the nurse's emotional reaction to the client based on her or his past experiences 31. Signs of countertransference: -intense emotional reactions (positive or neg- ative) on first contact -recurrent anxiety or uneasiness while dealing with the client -uncharacteristic carelessness in interaction and follow up -difficulty empathizing -resistance to others treating/interacting with client -preoccupation with or dreaming about the client -frequently running overtime or cutting time short -depression or other strong emotions during or after interaction with the client -feedback from others over involvement with the client 32. Psychodynamic (psychoanalytic) theory: -focus on concepts of intrapsychic conflict among structure of the mind -designed to explain neurosis and high anxiety such as phobias and hysteria -later expanded to include normal and abnormal development and personality development -assumes all behavior is purposeful and meaningful -most mental activity is unconscious- urges, feelings, adn fantasies that would be unacceptable to the person's values if consciously experienced -conscious behavior 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 behaviors 4 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 33. Principle of Psychic Determinism: Even apparently meaningless, random, or accidental behavior is actually motivated by underlying unconscious mental content 34. Id: -contains primary drives/instincts, urges, or fantasies -drives are largely unconscious, sexual, or aggressive in content, and infantile in nature -operates on the pleasure principle, seeks immediate satisfaction -present at birth and motivates early infant actions -"I want" 35. Ego: -contains the concept of external reality -rational mind, responsible for logical and abstract thinking -functions in adaptation -mediates between demands of drives and environmental realities -operates on the reality principle -begins to develop at birth as infant struggles to deal with environment -"I think, I evaluate" 36. Superego: -ego-ideal -contains sense of conscience or right vs wrong -aspirations, ideals, moral values -regulated by guilt and shame -begins to fully develop around age six as a child comes into contact with external authority figures such as other parents, teachers, coaches, etc -"I should" 37. denial: avoidance of unpleasant realities by unconsciously ignoring their exis- tence 38. Projection: Unconscious rejection of emotionally unacceptable personal at- tributes, beliefs, or actions by attributing them to other people, situations, or events 39. Regression: Return to more comfortable thoughts, behaviors, or feelings used in earlier stages of development in response to current conflict 40. Repression: Unconscious exclusion of unwanted, disturbing emotions, thoughts, or impulses from conscious awareness 41. Reaction formation: Often called overcompensation, unacceptable feelings, thoughts or behaviors are pushed from conscious awareness by displaying and acting on the opposite feeling, thought, or behavior 42. Rationalization: Justification of illogical, unreasonable ideas, feelings, or ac- tions by developing an acceptable explanation 5 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 43. Undoing: behaviors that attempt to make up for or undo an unacceptable action, feeling, or impulse 44. Intellectualization: Attempts to master current stressor or conflict by expan- sion of knowledge, explanation, or understanding 45. Suppression: conscious analog of repression, conscious denial of a disturb- ing situation, feeling, or event 46. Sublimation: Unconscious process of substitution of socially acceptable, con- structive activity for strong unacceptable impulse 47. Altruism: Meeting the needs of others in order to discharge drives, conflicts, or stressors 48. Piaget's Theory of Cognitive Development: 1. Sensorimotor (birth-2 years): object permanence, ability to understand that objects have an existence indepen- dent of the child's involvement with them 2. Preoperational (2-7 years): more extensive use of language and symbolism, magical thinking 3. Concrete operations (7-12 years): child begins to use logic, develops concepts of reversibility and conservation 4. Formal operations (12-adult): ability to think abstractly, thinking operates in a formal, logical manner 49. Reversibility: realization that one thing can turn into another and back again 50. Conservation: ability to recognize that although the shape of an object may change, it will still maintain characteristics that enable it to be recognized as that object 51. Harry Stack Sullivan's Interpersonal Theory: -behavior occurs because of interpersonal dynamics -relationships and experiences influence one's personality development, which is called the self-system (the total components of personality traits) -understanding behavior requires understanding the relationships in the person's life -when the person's need for satisfaction and security is interfered with by the self-system, mental illness occurs 52. Interpersonal theory - 2 drives of behavior: 1. drive for satisfaction: basic human drives such as sleep, sex, hunger 2. drive for security: conforming to social norms of a person's reference group 53. Sullivan's stages of interpersonal development: 1. Infancy (0-18months): oral gratification, anxiety occurs for the first time 6 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 2. Childhood (18mo-6 years): Delayed gratification 3. Juvenile (6-9 years): Forming of peer relationships 4. Preadolescence (9-12 years): Same sex relationships 5. Early adolescence (12-14 years): Opposite-sex relationships 6. Late adolescence (14-21 years): Self-identity developed 54. Maslow's Hierarchy of Needs: 1. Survival: water, air, food, sleep 2. Safety and security: protection (emotional/physical) 3. Love and belonging: Affection, intimacy and companionship 4. Self-esteem: sense of worth 5. self-actualization: achieving one's potential, being all that one can be 55. Becker's Health Belief Model: Healthy people do not always take advantage of screening or preventative programs because of: 1. perception of susceptibility 2. seriousness of illness 3. perceived benefits of treatment 4. perceived barriers to change 5. expectations of efficacy 56. Transtheoretical Model of Change: 1. Precontemplation: no intention to change 2. Contemplation: Thinking about changing, aware that there is a problem but not committed to change 3. Preparation: Made decision to change, ready for action 4. Action: Engaging in specific, overt actions to chagne 5. Maintenance: Engaging in behaviors to prevent relapse 57. Motivational Interviewing (MI): -focused, goal-directed therapy -builds on Transtheoretical model -motivation is elicited from the client -nonconfrontational, nonadversarial 58. Bandura's Self Efficacy and Social Learning Theory: -behavior is the re- sults of cognitive and environmental factors -people learn by observing others, relying on role-modeling -behavioral change and maintenance are functions of outcome expectations and efficacy expectations 59. Self-efficacy: perception of one's ability to perform a certain task at a certain level of accomplishment 7 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 60. Leininger's Theory of Cultural Care: -Regardless of culture, care is unifying focus and essence of nursing -Health and well-being can be predicted through cultural care. 61. Orem's Theory of Self-Care: Self-care = activities that maintain life, health, and well-being 62. Peplau's Interpersonal Theory: -first significant psych nursing theory -based in part on Sullivan's interpersonal theory -sees nursing as an interpersonal process in which all interventions occur within the context of the nurse-client relationship -therapeutic nurse-client relationship central to nursing -promote adaptive responses is the goal -behavior represents the person trying to adapt to internal or environmental forces 63. Watson's Caring Theory: -caring is an essential component of nursing -"carative factors" guide the core of nursing and should be implemented in health- care -carative factors are those aspects of care that potentiate therapeutic healing and relationships 64. Reflective practice: -systematically make sense of experience -process to tell a story about self and others to gain insight into practice -enhances critical thinking to problem-solve and enhance clinical reasoning and decision-making 65. Conflict: occurs when a person believes his needs, interests, or values are incompatible with others 66. Conflict resolution: directed by a neutral party who facilitates a win-win situation 67. Negotiation: discussion among two or more people with the goal of reaching an agreement 68. Mediation: voluntary and confidential process in which a third party facilitates discussion to reach an agreement 69. Arbitration: Process in which a third party reviews evidence from both sides and makes a decision to settle the case 70. Professional civility: behavior that shows respect toward another person 71. Critical thinking: -acquisition of knowledge with an attitude of deliberate in- quiry -making clinical decisions based on EBP 8 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix -develops self awareness through a meta-cognitive process to gain new insights about self and in relation to others 72. Research utilization: Process of synthesizing, disseminating and using re- search-generated knowledge to make a change in practice; a subset of the broader evidence-based practice 73. Qualitative hierarchy: -RCT, meta-analysis, or systematic review -evidence based guidelines based on systematic review -RCT without randomization -Systematic review of descriptive/qualitative studies -Expert opinion/committee reports 74. Quantitative hierarchy: -Systematic reviews of descriptive/qualitative studies -Single descriptive or qualitative study -expert opinion/committee -systematic review of RCTs -well-designed controlled trials without randomization -systematic reviews or meta-analysis -well-designed RCT 75. internal validity: independent variable (the treatment) caused a change in the dependent variable (outcome) 76. external validity: sample is representative of a population and the results can be generalized 77. descriptive statistics: -used to describe basic features of the data in the study -numerical values that summarize, organize, and describe observations -can be generated by either quantitative or qualitative studies 78. Descriptive statistics- examples: -Mean: average of scores -Standard deviation -Variance 79. Inferential statistics: -numerical values that enable one to reach conclusions that extend beyond the immediate data alone -Quantitative research designs 80. Inferential statistics - examples: -t test -Analysis of variance (ANOVA) -Pearson's r correlation -Probability -p value 81. Standard deviation: indication fo the possible deviations from the mean 9 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 82. variance: how the values are dispersed around the mean; the larger the variance, the larger the dispersion of scores 83. t test: assesses whether the means of 2 groups are statistically different from each other 84. Analysis of Variance (ANOVA): tests the differences among 3 or more groups 85. Pearson's r correlation: tests the relationship between 2 variables 86. Probability: likelihood of an event occurring, lies between 0 and 1, and impos- sible event has a probability of 0, and certain event has a probability of 1 87. P value: -level of significance, describes the probability of a particular results occurring by chance alone -if p = 0.1, there is a 1% chance probability of obtaining a result by chance alone 88. Institutional Review Boards: -risks to participants are minimized -participant selection is equitable -adverse events are reported and risks and benefits are reevaluated -informed consent obtained and documented -data and safety monitoring plans are implemented when indicated -overall, rights and welfare of human research participants are protected -authority to approve, require modifications, or disapprove of any research activi- ties 89. PDSA cycle: Plan Do Study Act 90. IOM's quality aims: Safe Effective Client-centered Timely Efficient Equitable 91. Quality improvement: -agency-specific projects that aim to improve systems, decrease cost, and improve productivity -provides standardized method to identify gaps in practice and systems to evaluate ways to improve structure, function, and resources in care delivery 92. ANA position statement: -supports collaboration efforts among state boards of nursing, professional organizations, patient safety centers, and health systems to develop Just Culture initiatives 10 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix -holds people accountable for their behaviors and investigates errors -goal of creating open and fair learning environment to design safe systems and manage choices -mindset that affects work environment to proactively look for system breakdowns and identify ways to improve systems 93. Patient centered care model: Welcoming environment Respect for clients' values and expressed needs Client empowerment or "activation" Sociocultural competence Coordination and integration of care Comfort and support Access and navigation skills Community outreach 94. Health policy development: Decisions, actions, and plans to achieve specific healthcare goals -4 components = Process, Policy reform, Policy environment, Policy makers 95. Neuron: Basic cellular unit of the nervous system, responsible for conducting impulses from one part of the body to another 96. Cell body: Soma, made up of the nucleus and cytoplasm within the cell membrane 97. Axon: transmits signals away from the neuron's cell body to connect with other neurons and cells 98. denrites: Collect incoming signals from other neurons and send the signal toward the neuron's cell body 99. Somatic nervous system: conveys information from the CNS to skeletal muscles; responsible for voluntary movement 100. Autonomic nervous system: regulates internal body functions to main- tain homeostasis; conveys info from CNS to smooth muscle, cardiac muscle, and glands; responsible for involuntary movement; divided into sympathetic and parasympathetic NS 101. sympathetic nervous system: excitatory division, prepares body for stress (fight or flight), stimulates or increases activity of organs 102. parasympathetic nervous system: Maintains or restores energy; inhibits or decreases activity of organs 11 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 103. Cerebrum: The largest part of the brain. Divided into two hemispheres (right and left halves). It is also broken into four different lobes. 104. Left hemisphere: dominant in most people, controls most right-sided func- tions 105. Right hemisphere: controls left-sided functions 106. Corpus callosum: large bundle of white matter connecting 2 hemispheres; area of sensorimotor info exchange between the 2 hemispheres 107. Frontal lobe: largest and most developed lobe -motor function -premotor area -association cortex -seat of executive functions -language (Broca's area) -personality variables 108. Motor function: responsible for controlling voluntary motor activity of specific muscles 109. Premotor area: coordinates movement of multiple muscles 110. Association cortex: Allows for multimodal sensory input to trigger memory and lead to decision-making 111. Seat of executive function: working memory, reasoning, planning, prioritiz- ing, sequencing behavior, insight, flexibility, judgment, impulse control, behavioral cueing, intelligence, abstraction 112. Temporal lobe: -language (Wernicke's area) -Auditory -Memory -Emotion -Integration of vision with sensory info -Problems in temporal lobe can lead to visual or auditory hallucinations, aphasia, and amnesia 113. Broca's area: Expressive speech 114. Wernicke's area: Receptive speech or language comprehension 115. Occipital lobe: -visual cortex -integrates vision with other sensory info -problems can lead to visual field defects, blindness, and visual hallucinations 12 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 116. Parietal lobe: -primary sensory area -taste -reading and writing -problems can lead to sensory-perceptual disturbances and agnosia 117. Cerebral cortex: -controls wide array of behaviors -controls contralateral (opposite) side -sensory info is relayed from the thalamus and then processed and integrated in the cortex -responsible for much of the behavior that makes us human (speech, cognition, judgment, perception, and motor function) 118. Limbic system: Essential system for regulation and modulation of emotions and memory Includes hypothalamus, thalamus, hippocampus, amygdala 119. Hypothalamus: key role in appetite, sensations of hunger and thirst, water balance, circadian rhythms, body temperature, libido, and hormone regulation 120. Thalamus: Sensory relay station (except smell); modulates flow of sensory info to prevent overwhelming the cortex; regulates emotions, memory, and related affective behaviors 121. Hippocampus: regulates memory and converts short-term memory into long term memory 122. Amygdala: responsible for mediating mood, fear, emotion, and aggression; also for connecting sensory smell information with emotions 123. Basal ganglia: -complex feedback system to modulate and stabilize somatic motor activity (info from CNS to skeletal muscles) -movement initiation -learning and automatic actions (walking, driving) -extrapyramidal motor system/nerve tract -involuntary motor activities (muscle tone, posture, coordination of movement and common reflexes) -psychotropic meds can affect EP motor nerve track, causing EPS -contains Caudate and Putamen -Problems can lead to bradykinesia, hyperkinesias, and dystonia 124. Brainstem: made of cells that produce NTs -includes midbrain, pons, medulla, cerebellum, and reticular formation 125. Midbrain: houses the ventral tegmental area and the substantia negra (areas of dopamine synthesis) 13 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 126. Pons: houses the locus ceruleus (area of norepinephrine synthesis) 127. Medulla: together with the pons, contains autonomic control centers that regulate internal body functions 128. Cerebellum: -responsible for maintaining equilibrium; acts as a gross move- ment control center (movement, balance, posture) -each hemisphere has ipsolateral (same side) control -problems can lead to ataxia -Romberg test to detect deficiencies 129. Reticular formation: -primitive brain -receives input from cortex; integration area for input from postsensory pathways -innervates thalamus, hypothalamus, and cortex -regulation of involuntary movement, reflex, muscle tone, vital signs, blood pres- sure, respiratory rate -critical to consciousness and ability to mentally focus, to be alert and pay attention to environmental stimuli 130. Glia: structures that form the myelin sheath around axons and provide pro- tection and support 131. neurons: nerve cells responsible for conducting impulses from one part of the body to another 132. dendrites: receive information to conduct impulse toward the cell body 133. axon: sends or conducts information away from cell body 134. synapse or synaptic cleft: -connection site and area of communication between neurons where neurotransmitters are released -converts electrical signal (action potential) from presynaptic neuron into a chem- ical signal (neuron transmitter) that is transferred to postsynaptic neuron -NTs are released at synapse as the result of action potential 135. phases of action potential: Depolarization, repolarization 136. depolarization: initial phase of the action potential (excitatory response), when sodium and calcium ions flow into the cell 137. repolarization: restoration phase (inhibitory response), when potassium leaves the cell or chloride enters the cell 138. Neurotransmitters: -chemicals synthesized from dietary substrates that communicate information from one cell to another 139. path of neurotransmitter: released from presynaptic neuron, cross the synapse, bind to a specific receptor on the postsynaptic neuron 14 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 140. Neurotransmitter categories: Monoamines Amino acids Cholinergics Neuropeptides 141. Classification requirements for neurotransmitters: 1. must be present in nerve terminal 2. stimulation of neuron must cause release of NT in sufficient quantities to cause an action to occur at postsynaptic membrane 3. effects of exogenous transmitter on postsynaptic membrane must be similar to those caused by stimulation of presynaptic neuron 4. mechanism for inactivation or metabolism of the NT must exist in the area of the synapse 5. Exogenous drugs should alter the dose-response curve of the NT in a manner similar to the naturally occurring synaptic potential 142. Monoamines: Biogenic amines Dopamine, norepinephrine, epinephrine, serotonin 143. Dopamine: known as a catecholamine, produced in the substantia nigra and ventral tegmental area; precursor is tyrosine; removed from sunaptic cleft by MAOa enzymatic action 144. Dopaminergic pathways: Mesocortical, mesolimbic, nigrostriatal, tuberoin- fundibular 145. Norepinephrine: catecholamine, produced in locus ceruleus of the pons; precursor is tyrosine; removed from the synaptic cleft and returned to storage via an active reuptake process; major neurotransmitter implicated in mood, anxiety, and concentration disorders 146. Epinephrine: Catecholamine, produced by adrenal glands; system is also referred to as adrenergic system 147. Serotonin: An indole, produced in the raphe nuclei of the brainstem; precur- sor is tryptophan; removed from the synaptic cleft and returned to storage via an active reuptake process; major NT implicated in mood and anxiety disorders 148. Amino acid NTs: glutamate, GABA, glycine, aspartate 149. Glutamate: universal excitatory NT, major NT involved in process of kindling, which is implicated in seizure disorders and possibly bipolar disorder; imbalance implicated in mood disorders and schizophrenia 150. Aspartate: excitatory, works with glutamate 15 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 151. GABA: universal inhibitory NT, site of action of benzo's, alcohol, barbiturates and CNS depressants 152. Glycine: inhibitory NT, works with GABA 153. Cholinergic NTs: Acetylcholine 154. Acetylcholine: synthesized by the basal nucleus of Meynert; precursors are acetylcoenzyme A and choline 155. Neuropeptide NTs: Non opioid (substance P, somatostatin) Opioid type (endorphins, enkephalins, dynorphins) -modulate pain, decreased neuropeptides thought to cause substance abuse 156. Acetylcholine imbalance: decrease = Alzheimer's, memory disorders increase = Parkinson's 157. Dopamine imbalance: increase = schizophrenia, psychosis decrease = substance abuse, anhedonia, Parkinsons 158. Norepinephrine imbalance: decrease = depression increase = anxiety 159. Serotonin imbalance: decrease = depression, OCD, anxiety, schizophrenia 160. GABA imbalance: decrease = anxiety 161. Glutamate imbalance: increase = BPD, psychosis from ischemic neurotoxi- city or excessive pruning decrease = memory and learning difficulty, negative symptoms of schizophrenia 162. Opioid neuropeptide imbalance: decrease = substance abuse 163. Enzymatic destruction: occurs either in the cytosol or in the synapse NT can be destroyed by MAO in teh cytosol or catechol-O-methyl transferase (COMT) intracellularly or in the synapse 164. Reuptake pumps: can remove NT from acting in the synapse; NT will be reloaded into the presynaptic neuron and will be recycled 165. Dopamine function: thinking, decision making, reward seeking behavior, fine muscle action, integrated cognition 166. Dopamine deficit: Mild: poor impulse control, poor spatiality, lack of abstract thought Severe: Parkinsons, Endocrine alterations, movement disorders 167. Dopamine excess: Mild: improved creativity, improved ability for abstract thinking, improved executive functioning, improved spatiality Severe: disorganized thinking, loose association, tics, stereotypic behaviors 16 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 168. Norepinephrine functions: alertness, focused attention, orientation, primes "fight or flight," learning, memory 169. Norepinephrine deficit: dullness, low energy, depressive affect 170. Norepinephrine excess: anxiety, hyperalertness, increased startle, para- noia, decreased appetite 171. Serotonin functions: regulation of sleep, pain perception, mood states, tem- perature, regulation of aggression, libido. precursor for melatonin 172. Serotonin deficit: irritability, hostility, depression, sleep dysregulation, loss of appetite, loss of libido 173. Serotonin excess: sedation, increased aggression, hallucinations (rare) 174. Acetylcholine functions: attention, memory, thirst, mood regulation, REM sleep, sexual behavior, muscle tone 175. Acetylcholine deficit: lack of inhibition, decreased memory, euphoria, anti- social action, speech decrease, dry mouth/blurred vision/constipation 176. Acetylcholine excess: over-inhibition, anxiety, depression, somatic com- plaints, self-consciousness ,drooling, extrapyramidal movements 177. GABA functions: reduces arousal, reduces aggression, reduces anxiety, reduces excitation 178. GABA deficit: irritability, hostility, tension, worry, anxiety, seizure activity 179. GABA excess: reduced cellular excitability, sedation, impaired memory 180. Glutamate function: memory, sustained automatic functions 181. Glutamate deficit: poor memory, low energy, distractible 182. Glutamate excess: Kindling, seizures, anxiety/panic 183. Opioid type peptides function: modulate emotions, reward center function, consolidation of memory, modulate reactions to stress 184. Opioid peptide deficit: hypersensitivity to pain/stress, decreased pleasure sensation, dysphoria 185. Opioid peptide excess: insensitivity to pain, catatonic-like movement distur- bance, auditory hallucinations, decreased memory 186. computed tomography (CT): provides a 3D view of brain structures, differ- entiates structures based on density, provides suggestive evidence of brain-based problems but no specific testing for psych disorders 17 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix -cannot differentiate between white/gray matter, cant view structures close to bone tissue, underestimates brain atrophy 187. MRI: series of 2D images to represent the brain -can separate white/gray matter, structures close to bone -expensive, contraindications (metal), claustrophobia 188. functional imaging: technique that measures function of areas of the brain and bases the resulting assessment on blood flow; may use radioactive pharma- ceuticals to cross the blood brain barrier 189. EEG and evoked potential testing: least expensive, convey info on electrical functioning of the CNS 190. Magnetoencephalography (MEG): similar to EEG, detects different electri- cal activities; often used in complement with EEG 191. single photon emission computed tomography (SPECT): provides info on the cerebral blood flow; limited availability; expensive but less than PET 192. Positron Emission Tomography (PET): Provides images of the brain when positron-emitting radionuclei interact with an electron; expensive procedure that requires extensive resources and support team 193. Combined functional and structural imaging: newest imaging, attempts to examine structure in conjunction with function Functional MRI (fMRI), 3D event related functional MRI, Fluorine magnetic spec- troscopy, Dopamine D2 receptor binding 194. Olfactory test: -test sense of smell and ensure patency of nasal passages -have the client close eyes and test each nostril separately while other is occluded, ask to identify familiar odors 195. Optic nerve test: -test vision with Snellen chart -examine inner aspect of eyes with ophthalmoscope -test peripheral vision using confrontation test 196. Oculomotor nerve test: -test extraocular movements -equality of pupils, reaction to light, ability to accommodate -corneal light reflex -test motor function of the 5 extrinsic eye muscles together with CN 4 and 6 197. Trochlear nerve test: test with CN 3 and 6 198. Trigeminal nerve test (Motor): -palpate masseter muscles with the fingertips while client clenches teeth -look for disparity in tension between two muscles (indicates paralysis/weakness) 18 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix -look for tremor of lips, involuntary chewing movements, and spasm of masticatory muscles 199. Trigeminal nerve test (sensory): -tactile perception of face, touch with cot- ton -corneal reflex with cotton wisp -superficial pain of skin and mucosa with pin pricks -sense of touch in oral mucosa 200. Abducens nerve test: same as CN 3 and 4 201. Facial nerve test (motor): -inspect face for flaccid paralysis -elevate eyebrows, wrinkle forehead, close eyes, frown, smile, puff cheeks 202. Facial nerve test (sensory): test taste of sugar, vinegar, salt 203. Acoustic nerve test: -use audiometer or whisper test -Weber and Rinne tests for hearing loss 204. Glossopharyngeal nerve test: test with cranial nerve 10 205. Vagus nerve test: -elevation of uvula, have client open mouth and say ah -gag reflex 206. Accessory spinal nerve test: -strength of sternocleiomastoid and trapezius muscles against resistance 207. Hypoglossal nerve test: -look for tremors and other involuntary movement when protruding tongue 208. Diadochokinesia: ability to perform rapid alternating movements 209. Dyssynergia: finger to nose, heel to knee test 210. Stereognosis: ability to distinguish forms by placing objects in the client's hands while his or her eyes are closed 211. Graphesthesia: ability to identify figure, letters, or words by tracing them on palm of hand 212. Dysdiadochokinesia: inability to perform rapid alternating movements; re- sult of a lesion to the posterior lobe of the cerebellum 213. astereognosis: inability to discriminate between objects based on touch alone; result of a lesion in the parietal lobe 214. Agraphesthesia: inability to recognize letters or numbers drawn on the clients hand 19 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 215. Common indicators of child abuse: -hx of unexplained multiple fractures -burns, hand or bite marks -injuries at various stages of healing -evidence of neglect -bruising on padded parts of the body 216. Diseases with increased T4: Graves disease Thyrotoxicosis due to T4 Hashimoto's thyroiditis Acute thyroiditis 217. Disease with decreased T4: Primary hypothyroidism Secondary hypothyroidism (pituitary insufficiency) Tertiary hypothyroidism (hypothalamic failure) Thyrotoxicosis due to T3 Renal failure Cushing's syndrome Cirrhosis 218. TSH: normal 2-10 mU/I stimulation of thyroid gland by TSH causes release and distribution of stored thyroid hormones -when T3/4 are high, TSH decreases -when T3/4 are low, TSH increases 219. Primary hypothyroidism: TSH levels rise because of low thyroid hormone 220. Secondary hypothyroidism: pituitary gland failure, TSH not secreted and blood levels of TSH decrease 221. Diseases with increased TSH: Primary hypothyroidism Thyroiditis 222. Diseases with decreased thyroid levels: Hyperthyroidism Secondary and tertiary hypothyroidism 223. Systemic effects of hypothyroidism: Mimics unipolar mood disorders -confusion -decreased libido -impotence -decreased appetite -memory loss -lethargy -constipation 20 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix -headaches -slow/clumsy movements -syncope -weight gain -fluid retention -muscle aches -slowed reflexes -somatic discomfort -slowed speech and thinking -sensory disturbances -cerebellar ataxia -loss of amplitude in EKG 224. Systemic effects of hyperthyroidism: Mimics symptoms of BPD -restlessness -emotional lability -short attention span -compulsive movement -fatigue -tremor -insomnia -impotence -weight loss -increase in appetite -abdominal pain -excessive sweating -flushing -elevated upper eyelid leading to decreased blinking, staring, fine tremor of eyelid -tachycardia -dysrhythmia 225. Calcium: normal 8.8-10.5 mg/dl 99% located in bone major cation for structure of bones and teeth -enzymatic cofactor for blood clotting -required for hormone secretion -required for function of cell receptors -required for plasma membrane stability and permeability -required for transmission of nerve impulses and contraction of muscles 21 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix Balance is mediated by interactions among parathyroid hormone, vitamin D, and calcitonin 226. Increased levels of Ca: Acidosis Hyperparathyroidism Cancers (bone, leukemia, myeloma) Drugs (thiazide diuretics, hormones, vitamin D, Ca) Vitamin D intoxication Addison's disease Hyperthyroidism 227. Decreased levels of Ca: Alkalosis Hypoparathyroidism Renal failure Pancreatitis Inadequate dietary intake of Ca, vitamin D Barbiturates, anticonvulsants, acetazolamide, adrenocorticosteroids 228. Systemic effects of hypocalcemia: -increased neuromuscular excitability -confusion -paresthesias around the mouth and digits -muscle spasms in hands and feet -hyperreflexia -convulsions -tetany -continuous severe muscle spasm -EKG - prolonged QT interval -intestinal cramping -hyperactive bowel sounds 229. Systemic effects of hypercalcemia: -fatigue -weakness -lethargy -anorexia -nausea -constipation -behavioral changes -impaired renal function -EKG - shortened QT interval, depressed T waves -bradycardia -heart block 22 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 230. Sodium: normal 135-148 90% of extracellular fluid cations Regulated osmolality Works with K and Ca to maintain neuromuscular irritability for conduction of nerve impulses Regulated acid-base balance Regulates renal retention and water excretion Maintains systemic BP 231. Increased levels of Na: Hypovolemia Dehydration Diabetes Insipidus Excessive salt ingestion Gastroenteritis Adrenocorticosteroids, methyldopa, hydralazine, cough medicine 232. Decreased levels of Na: Addison's disease Renal disorder GI fluid loss from vomiting, diarrhea, nasogastric suction, ileus Diuresis Lithium, vasopressin, diuretics 233. Systemic effects of hyponatremia: -lethargy -headache -confusion -apprehension -seizures -coma -hypotension -tachycardia -decreased urine output -weight gain -edema -ascites -Jugular vein distention 234. Systemic effects of hypernatremia: -convulsions -pulmonary edema -thirst -fever -dry mucous membranes -hypotension 23 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix -tachycardia -low jugular venous pressure -restlessness 235. Magnesium: normal 1.3-2.1 mEq/l Major intracellular cation Regulated by kidney 236. Increased levels of Mg: Addison's disease Adrenalectomy Renal failure Diabetic ketoacidosis Dehydration Hypothyroidism Hyperthyroidism 237. Decrease levels of Mg: Hyperaldosteronism Hypokalemia Diabetic ketoacidosis Malnutrition Alcoholism Acute pancreatitis GI loss from vomiting, diarrhea, NG suction, fistula Malabsorption syndrome Pregnancy induced hypertension 238. Systemic effects of hypomagnesemia: -depression -confusion -irritability -increased reflexes -muscle weakness -ataxia -nystagmus -tetany -convulsions 239. Systemic effects of hypermagnesemia: -nausea/vomiting -muscle weakness -hypotension -bradycardia -respiratory depression -depressed skeletal muscle contraction and nerve function 24 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 240. Chloride: normal 98-106 mEq/l major anion in extracellular fluid provides electroneutrality in relation to sodium Transport is passive, follows active transport of Na 241. Increased levels of chloride: Acidosis Hyperkalemia/hypernatremia Dehydration Renal failure Cushing's syndrome Hyperventilation Anemia 242. Decreased levels of Chloride: Alkalosis Hypokalemia/hyponatremia GI loss from vomiting/diarrhea, NG suction, fistula Diuresis Overhydration Addison's disease Burns 243. Potassium: normal 3.5-5.1 Major intracellular electrolyte Regulates intracellular fluid osmolality, provides balance for intracellular electrical neutrality Required for glycogen deposition in liver and skeletal muscle cells Regulated by the kidney aldosterone levels, insulin secretion, and changes in pH 244. Increased K levels: -acidosis -insulin deficiency -Addison's disease -acute renal failure -hypoaldosteronism -infection -dehydration 245. Decreased K levels: -alkalosis -excessive insulin -GI loss -laxative abuse -burns -trauma -surgery 25 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix -cushing's syndrome -hyperaldosteronism -thyrotoxicosis -anorexia nervosa -diet deficient in meat and vegetables 246. Systemic effects of hyperkalemia: -muscle weakness -paralysis -tingling lips and fingers -restlessness -intestinal cramping -diarrhea -EKG - narrow and taller T waves, shortened QT (mild), depressed ST seg- ment/prolonged PR interval/widened QRS complex leading to cardiac arrest (se- vere) 247. Systemic effects of hypokalemia: -impaired carbohydrate metabolism -impaired renal function -polyuria -polydipsia -skeletal muscle weakness -smooth muscle atony -cardiac dysrhythmias -paralysis and respiratory arrest 248. ALT: normal 5-35 U/l produced by liver, acts as catalyst in the transamination reaction necessary for amino acid production -found in liver cells in high concentrations and moderate amounts in body fluids, heart, kidneys, skeletal muscles 249. Pronounced elevated ALT levels: Liver disease/damange, such as hepatic cancer, hepatitis, or infectious mononucleosis 250. Moderately elevated ALT levels: -biliary obstruction -recent CVA -muscle injury from intramuscular injections, trauma, infection, and seizures -muscular dystrophy -acute pancreatitis -intestinal injury -MI -CHF 26 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix -renal failure -severe burns 251. AST: normal 5-40 U/l measures the level of the enzyme that catalyzes the reversible transfer of an amino group between amino acid, aspartate, and alphaketoglutamic acid -exists in large amounts in both liver and myocardial cells and smaller amounts in skeletal muscles, kidneys, pancreas, and brain 252. Pronounced elevated AST levels: -acute hepatocellular damage -MI -shock -acute pancreatitis -Mono 253. Moderate elevated AST levels: -biliary tract obstruction -cardiac arrhythmias -CHF -liver tumors -chronic hepatitis -muscular dystrophy -dermatomyositis 254. Slightly elevated AST levels: -pericarditis -cirrhosis, fatty liver -pulmonary infarction -DTs -CVA -hemolytic anemia 255. Gamma glutamyl transpeptidase (GGT): normal 10-38 IU/l -assists with transfer of amino acids and peptides across cell membranes 256. Elevated GGT: occurs in cirrhosis and pancreatic or renal disease -hepatobiliary tract disorders -hepatocellular carcinoma -hepatocellular degeneration such as cirrhosis -hepatitis -pancreatic or renal cell damage or neoplasm -CHF -Acute MI (after 4-10 days) -hyperlipoproteinemia -DM with HTN 27 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix -seizure disorder -significant alcohol ingestion 257. Primary prevention: aimed at decreasing incidence of mental disorders -helping people avoid stressors or cope more adaptively 258. Secondary prevention: aimed at decreasing the prevalence of mental dis- orders -early case finding -screening -prompt and effective tx 259. Tertiary prevention: aimed at decreasing the disability and severity of a mental disorder -rehabilitative services -avoidance or postponement of complications 260. Biological risk factors: history of mental illness in family, poor nutritional status, poor general health 261. Anosognosia: A patient's inability to realize that he or she is ill, which is caused by the illness itself. 262. Alogia: relative absence of speech 263. First pass metabolism: process by which the drug is metabolized by P450 enzymes in the intestines and liver prior to going to the systemic circulation 264. steady state: point at which the amount of drug eliminated between doses is approximately equal to the dose administered 265. Cytochrome P450 inhibitors: buproprion clomipramine cimetidine clarithromycin fluoroquinolones grapefruit and grapefruit juice ketoconazole nefazodone SSRIs 266. P450 inducers: carbamazepine St. John's Wort phenytoin phenobarbital tobacco 28 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 267. agonist effect: drug binds to receptors and activates a biological response 268. inverse agonist effect: drug causes the opposite effect of agonist, binds to same receptor 269. partial agonist effect: drug does not fully activate the receptors 270. antagonist effect: drug binds to the receptor but does not activate biological response 271. excitatory response: Depolarization Involves OPENING of sodium and calcium channels with these ions going INTO the cell 272. inhibitory response: Repolarization; involves the opening of chloride chan- nels with chloride going into the cell, potassium leaving, or both 273. therapeutic index: Relative measure of the toxicity or safety of a drug; ratio of the median toxic dose to the median effective dose high TI = high margin of safety low TI = low margin of safety 274. Tolerance: process of becoming less responsive to a particular drug over time 275. tachyphylaxis: acute decrease in response to a drug 276. Schedule I: Nonmedical substances High abuse potential Research only No prescription available ex: heroin, marijuana 277. Schedule II: Medicinal drugs High abuse/dependency potential Written prescription ONLY No telephone orders No refills Ex: morphine, codeine, fentanyl, methadone, Dilaudid, Oxycontin, Vicodin, am- phetamine salts, methylphenidate 278. Schedule III: Less abuse potential than II, more than IV Telephone orders allowed if written prescription given first Renew prescription every 6 months Limit 5 refills Ex: appetite suppressants, butalbital, testosterone, Suboxone 29 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 279. Schedule IV: Less abuse potential Ex: Darvon, Talwin, Benzodiazepines, Provigil, phenobarbital, Ambien, Lunesta, Restoril, Nuvigil 280. Schedule V: Lowest abuse potential Handled similar to noncontrolled drugs Ex: Buprenex, Robitussin with codeine, Phenergan with codeine, Lomotil 281. Pregnancy FDA ratings: A: Controlled studies show no risk B: No evidence of risk in humans C: Risk cannot be ruled out D: Positive evidence of risk X: Absolutely contraindicated 282. Benzodiazepines in pregnancy: Floppy baby syndrome; cleft palate 283. Tegretol in pregnancy: Neural tube defects 284. Lithium in pregnancy: Epstein anomaly (rare heart defect) 285. Depakote in pregnancy: Neural tube defects, specifically spina bifida; atrial septal defect; cleft palate; possible long term developmental deficits 286. Medications that induce depression: -Beta blockers -Steroids -Interferon -Accutane -Retrovirals -Antineoplastic -Benzodiazepines -Progesterone 287. Medications that induce mania: -Steroids -Antabuse -Isoniazid (INH) -Antidepressants in people with BPD 288. Drugs that can cause false positive for amphetamines: Stimulants Wellbutrin Prozac Trazodone Ranitidine Serzone Decongestants Pseudoephedrine 30 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 289. Drugs that can cause false positive for Alcohol: Valium 290. Drugs that can cause false positive for Benzo's: Zoloft 291. Drugs that can cause false positive for cocaine: Amoxicillin Most antibiotics NSAIDs 292. Drugs that can cause false positive for heroin or morphine: Quinolones Rifampin Codeine Poppy seeds 293. Drugs that can cause false positive for methadone or PCP: OTC cough medicine 294. Psychoanalytics therapy: Freud behavior is determined by unconscious motivations and instinctual motivations and instinctual drives -promotes change by development of greater insight and awareness of maladap- tive defenses 295. Cognitive therapy: Beck -external events do not cause anxiety or maladaptive responses -a person's expectations, perceptions, and interpretations of events cause anxiety -allows clients to view reality more clearly through examination of their central distorted cognitions -Goal is to change clients irrational beliefs, faulty conceptions, and negative cog- nitive distortions 296. Behavioral therapy: Lazarus focuses on changing maladaptive behaviors by participating in active behavioral techniques such as exposure, relaxation, problem solving, and role playing 297. DBT: Linehan -common with Borderline personality disorder -focus on emotional regulation, tolerance for distress, self-management skills, interpersonal effectiveness, and mindfulness, emphasis on treating therapy-inter- fering behaviors 298. Goals of DBT: Decrease: -suicidal behaviors -therapy-interfering behaviors -emotional reactivity -self-invalidation 31 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix -crisis-generating behaviors -passivity Increase: -realistic decision making -accurate communication of emotions 299. Existential therapy: Frankl -reflection on life and self-confrontation is encouraged -accepting freedom and making responsible choices -basic dimension of humans includes finding meaning and purpose in life -goals are to live authentically and focus on the present and personal responsibility 300. Humanistic therapy: Rogers -person-centered therapy -self-directed growth, self actualization -people are born with capacity to direct themselves toward self-actualization -each person has the potential to actualize and find meaning 301. Interpersonal therapy: Klerman, Weissman -EBT, focus on interpersonal issues that are creating distress -Time limited, active, focused on present and interpersonal distress -treat aspects of depression, effective for adults and adolescents -applied to treat interpersonal distress related to other disorders, including BPD, substance use, and eating disorders 302. EMDR: Shapiro -form of behavioral and exposure therapy -bilateral stimulation - moving eyes back and forth, alternating tapping on hand or knee, sounds in ears -used for PTSD -Goal = achieve adaptive resolution 303. Desensitization phase of EMDR: -Visualize trauma, verbalizes negative thoughts or maladaptive beliefs, remains attentive to physical sensations -Limited time while client maintains rhythmic eye movements -Instructed to block out negative thoughts, breathe deeply, verbalize what they are thinking, feeling, imagining 304. Installation phase of EMDR: Installs and increases the strength of the positive thought that they have declared as a replacement of the original negative thought 305. Body scan phase of EMDR: visualizes trauma along with the positive thought and then scans his or her body mentally to identify any tension within 32 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 306. 10 therapeutic factors that differentiate group therapy from individual therapy: 1. Instillation of hope 2. Universality 3. Altruism 4. Increased development of socialization skills 5. Imitative behaviors 6. Interpersonal learning 7. Group cohesiveness 8. Catharsis 9. Existential factors 10. Corrective refocusing 307. 1. Instillation of hope: participants develop hope for creating a different life; members are at different levels of growth, gain hope from others that change is possible 308. 2. Universality: participants discover that others have similar problems, thoughts, feelings, they are not alone 309. 3. Altruism: results from sharing oneself with another and helping another 310. 4. Increased development of socialization skills: new social skills are learned maladaptive social behaviors are corrected 311. 5. Imitative behaviors: increase skills by imitating behaviors of others 312. 6. Interpersonal learning: interacting with others increases adaptive inter- personal relationships 313. 7. Groups cohesiveness: participants develop an attraction to the group and other members as well as a sense of belonging 314. 8. Catharsis: participants experience catharsis as they openly express their feelings, which were previously suppressed 315. 9. Existential factors: groups enable participants to deal with the meaning of their own existence 316. 10. Corrective refocusing: participants reexperience family conflicts in the group, which allows them to recognize and change behaviors that may be prob- lematic 317. Pregroup phase: the leader considers the direction and framework of the group -purpose 33 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix -goals -membership criteria -membership size -pregroup interview -informed consent 318. Forming phase: members are concerned about self disclosure and being rejected Goals and expectations are identified, boundaries are established Development of trust and rapport is important 319. Storming phase: Members are resistant, may begin to use testing behaviors Issues r/t inclusion, control, and affection begin to surface Leaders tasks are to allow expression of both positive and negative feelings, assist group in understanding underlying conflict, adn examine nonproductive behaviors 320. Norming phase: Resistance to the group is overcome by members Strong attraction to the group and others emerges Open and spontaneous communication occurs, group norms are established 321. Performing phase: Group's work becomes more focused Creative problem solving and solutions begin to emerge Experiential learning Group energy directed toward completion of goals 322. Adjourning phase: Preparation made to end the group Members and leaders express feelings about each other and termination Discussion and overview of what has been learned, as well as what issues still need to be worked on, takes place 323. Family system: process by which all family members operate together 324. Family systems theory: based on the idea that one could not understand any family member without understanding how all family members operate togeth- er 325. Boundaries: barriers that protect and enhance the functional integrity of families, individuals, and subsystems 326. Clearly defined boundaries: maintain person's separateness while empha- sizing belongingness 327. Rigid or inflexible boundaries: May lead to distant relationships and disen- gagement 328. Diffuse boundaries: blurred and indistinct boundaries, lead to enmeshment 34 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 329. Circular causality: ongoing feedback loop series of actions and reactions that maintain a problem individuals and emotional problems are best understood within the context of relationships and through assessing interactions within an entire family 330. Family homeostasis: Tendency of families to resist change in order to main- tain a steady state. 331. Morphogenesis: family's tendency to adapt to change when changes are necessary 332. Morphostasis: family's tendency to remain stable in the midst of change 333. Family Systems Therapy: Bowen a person's problematic behavior may serve a function or purpose for the family or be a symptom of dysfunctional patterns -focus on chronic anxiety within families -Goals are to increase family's awareness of each member's function within the family and to increase levels of self-differentiation 334. Triangles: dyads that form triads to decrease stress; the lower the level of family adaptation the more likely a triangle will form 335. Nuclear family emotional system: level of differentiation of the parents usually equal to the level of differentiation of the entire family 336. Multigenerational transmission process: dysfunction present over several generations 337. Family projection process: parents transmitting their own level of differenti- ation onto the most susceptible child 338. Emotional cutoffs: attempting to break contact with family of origin 339. Sibling position: influences interactions and personality characteristics 340. Structural Family Therapy: Minuchin -how, when, and to whom family members relate in order to understand and change family's structure -Symptoms rooted in context of family transaction patterns; symptom is a function of the health of the whole family and maintained by structural problems -Main goal is to produce structural change in family organization to more effectively manage problems 341. Family structure: The invisible set of functional demands organizing interac- tion among family members. 35 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 342. Structural mapping (genogram): mapping relationships using symbols to represent overinvolvement, conflict, coalitions, etc 343. Experiential therapy: satir behavior is determined by personal experience and not by external reality focus is on being authentic, freedom of choice, human validation, and experiencing the moment goal is to increase self worth of each family member - goal is growth rather than reduction of symptoms 344. Strategic therapy: haley symptoms are viewed as metaphors and reflect problems in the hierarchal struc- ture treatment goal is to help family members behave in ways that will not perpetuate the problem behavior interventions are problem focused; more symptom focuses than structural therapy 345. Straightforward directives: tasks that are designed in expectation of the family member's compliance 346. Paradoxical directives: negative task that is assigned when family members are resistant to change and the member is expected to be noncompliant 347. Reframing belief systems: Problematic behaviors are relabeled to have more positive meaning 348. Solution focused therapy: deshazer, o'hanlon, berg focus is to rework solutions that have previously worked goal is effective resolution of problems through cognitive problem solving and use of personal resources and strengths 349. Miracle questions: Asking clients to imagine how things would be if they woke up tomorrow and their problem was solved. Solution-focused therapists use the miracle question to help clients identify goals and potential solutions. 350. Exception finding questions: based on the premise that bad behaviors do not happen all the time. Asking patients to recall a time when a behavior did not occur broadens a patient's perspective and allows the patient to consider other options 351. Scaling questions: A solution-focused technique that asks clients to observe changes in feelings, moods, thoughts, and behaviors. On a scale of zero to 10, clients are asked to rate some change in their experiences. 36 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 352. omega-3 fatty acids: ADHD dyslexia cognitive impairment dementia cardiovascular disease asthma lupus RA -Interacts with warfarin, increases anticoagulant effect 353. Sam-e: Depression osteoarthritis liver disease -may cause hypomania, hyperactive muscle movement, possible serotonin syn- drome 354. Tryptophan: Depression Obesity insomnia headaches fibromyalgia -Risk of serotonin syndrome with use of SSRIs, MAOIs, and St. Johns Wort 355. Vitamin E: -Enhance immune system, protecting cells against effects of free radicals -Neurological disorders, diabetes, premenstrual syndrome -Interacts with warfarin (icnreasing anticoagulant effect), antiplatelet drugs, and statins (increase additive effect and risk of rhabdo 356. Melatonin: used for insomnia, jet lag, shift work, cancer -sets timing of circadian rhythms and regulates seasonal responses -interacts with ASA, NSAIDs, beta blockers, corticosteroids, valerian, kava kava, alcohol -can inhibit ovulation in large doses 357. Fish oil: -used for BPD, HTN, lowering triglycerides, and decreasing blood clotting -Interacts with warfarin, ASA, NSAIDs, garlic, and ginkgo -may alter glucose regulation 358. Black cohosh: menopausal symptoms premenstrual syndrome dysmenorrhea 37 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 359. Belladonna: anxiety 360. Catnip: sedation 361. Chamomile: Sedation, anxiety 362. Ginkgo: delirium, dementia, sexual dysfunction caused by SSRIs 363. Ginseng: depression, fatigue 364. Valerian: sedation 365. Object loss theory MDD: Fairbairn, Winnicott, Guntrip early psychological development issues lay the foundation for depressive respons- es in later life; the child is able to form relationships but then experiences a loss, usually maternal. (maternal death, illness, or emotional lack of availability) depth of loss then produces responses including separation anxiety, grief, mourn- ing, despair predisposes child to react in similar ways to future losses 366. Aggression Turned Inward Theory MDD: freud early psychological development issues lay the foundation for depressive respons- es in later life ; the child is able to form relationships but then experiences a loss, real or imagined but unexpected, usually maternal. this loss can be death, illness, or lack of emotional availability, birth of sibling. uses defense mechanisms to deal with conflict created by desire for love of mother but co-occurring with anger for love of mother the child turns the anger inward which is more acceptable, and rationalizes that he or she was the cause of the abandonment, then develops guilt over the lost love. a similar reaction occurs as an adult in response to loss (low self-esteem, exces- sive guilt, inability to cope with anger, self-destructive impulses) 367. Cognitive Theory MDD: Beck cognitive diathesis-stress model in which developmental experiences sensitize a person to respond to stressful life events in a depressed manner 38 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 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 things are going to happen to them because of their own personal shortcomings this promotes low self esteem and beliefs that the person deserves to have bad things happen to them, promotes pessimistic perceptions about the world at large and about their future when confronted by stressful events, tend to appraise them and potential conse- quences in a negative, hopeless manner and therefore are more depressed than others 368. Learned Helplessness-Hopelessness Theory: seligman modified cognitive theory individual becomes depressed related to perceptions of a lack of control over life events and experiences these perceptions are learned over time, and this lack of control leads to poor coping and adapting the individual becomes passive and non reaction because of self-perceptions of personal characteristics of helpless, hopeless, powerless 369. Genetic predisposition MDD: Clear genetic link - might be polygenic single nucleotide molymorphism (SNP) disorder Having a depressed parent is the single strongest predictor of depression; children of depressed parents are 3x more likely to have MDD in their lifetime than the general population The earlier the age of onset for MDD and more severe the symptoms, the more likely it is that a person has a strong genetic predisposition for depression 370. Endocrine dysfunction MDD: may be endocrine etiology Neurovegetative symptoms (sleep/appetite/libido disturbance, lethargy, anhedo- nia) r/t function of hypothalamus and pituitary and their hormones high incidence of postpartum mood disturbance suggestive of endocrine distur- bance 39 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix dysphoria often triggered by changes in levels of sex steroids that occur during menstrual cycle Deregulation of the hypothalamic-pituitary-adrenal axis (HPA) 371. Hypothalamic-pituitary-adrenal (HPA) axis: controls physiological re- sponse to stress and consists of interconnected feedback pathways between hypothalamus, pituitary gland, and adrenal glands Hypothalamus releases corticotropin-releasing hormone (CRH), which stimulates the pituitary to release adrenocorticotropic hormone (ACTH), stimulates adrenals to release cortisol hyperactivity of HPA and elevated cortisol levels shown to be present in people with MDD Over time, elevated cortisol levels damage the central nervous system by altering neurotransmission and electrical signal conduction Evidence shows cortisol can cause changes in size and function of brain tissue over time MDD may be associated with proinflammatory cytokine activation HPA dysregulation is rational for dexamethasone suppression test 372. Possible NT abnormalities causing MDD: -dysregulation of D, NE, or 5HT -low levels of endogenous catecholamines in specific brain areas -5HT levels shown to be low in postmortem studies on people who commit suicide and people with MDD -Low precursor tryptophan -Low 5HT metabolite -Receptor sensitivity for NT set unusually high in specific brain areas --> stronger NT receptor cascade required to induce neuronal activity -Low density of receptor sites in specific brain areas -Hypometabolism in brain areas regulating mood, appetite, and cognition 373. Structural brain changes MDD: Hypovolemic hippocampus Hypovolemic prefrontal cortex-limbic striatal regions Common in people with brain damage 40 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 374. Chronobiological theory: This biological theory of the etiology of depression states that the desynchronization of the circadian rhythms produces a symptom constellation collectively called MDD 375. Risk factors for MDD: Genes/family hx Prior episode of MDD Female gender Postpartum period Medical comorbidity Single marital status Environmental stressors, multiple losses 376. Diagnostic criteria for MDD: 1. 5/8 SIGECAPS Sleep change Interest change Guilt Energy decreased Concentration decreased Appetite change Psychomotor decrease Suicide 2. not due to medical disorder or other psych disorder 3. lasting at least 2 weeks 377. Labs to check with MDD: Thyroid B12 Folate Sleep study Drug screen 378. Celexa (citalopram): Dose: 20-40mg SE: Sedation, sex dysfunction, agitation, yawning, GI disturbance, weight gain 379. Lexapro (escitalopram): Dose: 10-20mg SE: somnolence, headache, sex dysfunction, GI disturbance 380. Prozac (fluoxetine): Dose: 20-80mg SE: Insomnia, headache, GI disturbance, sex dysfunction Long half life No discontinuation syndrome 381. Luvox (Fluvoxamine): Dose: 100-300mg SE: Sedation, sex dysfunction, agitation, GI disturbance Dose above 150 can be divided BID 41 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 382. Paxil (paroxetine): Dose: 20-60mg SE: headache, GI disturbance, somnolence, sex dysfunction Discontinuation syndrome very common 383. Zoloft (sertraline): Dose: 50-200mg SE: Sex dysfunction, GI disturbance, somnolence, headache 384. Viibryd (vilazodone): Dose: 20-40mg SE: diarrhea, nausea, dry mouth (lower risk of sexual side effects) 385. Elavil (amitriptyline): Dose: 50-300mg Also used for chronic pain (usually neuropathic), insomnia 386. Anafranil (clomipramine): Dose: 100-250mg Approved for OCD 250mg/day max (increased seizure risk) 387. Norpramin (desipramine): Dose: 100-300mg Also used for ADHD (off-label for pediatric clients and ADHD) 388. Sinequan (doxepin): Dose: 100-300mg Also used for insomnia 389. Tofranil (imipramine): Dose: 100-300mg Also used for enuresis and separation anxiety 390. Pamelor (nortriptyline): Dose: 50-150mg Also used for enuresis and ADHD 391. Vivactil (protriptyline): Dose: 15-60mg 392. Surmontil (trimipramine): Dose: 100-300mg 393. SSRIs: Increase serotonin levels in CNS by inhibiting synaptic reuptake 394. Tricyclics: Elevate serotonin and NE levels primarily by inhibiting their presy- naptic reuptake 395. MAOIs: Elevate serotonin and NE levels primarily by inhibiting MAO, the enzyme that breaks down monoamine NTs 396. SNRIs: Inhibit dual reuptake of NE and 5HT Action very selective on NTs Elevate serotonin and NE levels by inhibiting their presynaptic reuptake 397. Norepinephrine dopamine reuptake inhibitors (NDRIs): Inhibit dual reup- take of NE and D Action selective on NTs Elevate D and NE levels by inhibiting reuptake 42 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 398. Serotonin Agonist and reuptake inhibitors (SARIs): Dual action; agonist of serotonin 5HT-2 receptors; action very selective on neurotransmitters; elevates serotonin levels by inhibiting serotonin reuptake 399. Marplan (isocarboxazid) Nardil (phenelzine) Parnate (tranylcypromine): Dose: 20-60mg Dose: 45-90mg Dose: 30-60mg Also used for panic disorder, phobic disorders, selective mutism Caution: high-tyramine diet; sympathomimetic agents Divided doses BID and QID 400. EMSAM (selegiline): Dose: 6-12 mg No dietary restrictions with 6mg dosage May need higher dose to see antidepressant effect 401. Tyramine foods: Cheese: aged cheese i.e. blue, brie, camembert, roquefort Meat: Smoked, aged, cured meats such as sausages, pastrami, and salami Fish: Smoked, aged, cured fish such as pickled herring and salted fish Beverages: any aged and fermented beverages such as red wine, aged liquors, whiskey (gin and vodka permissible), beer (bottled and pasteurized permissible) Other: Bean curd (tofu), soy products, sauerkraut, miso, yeast extract, MSG, ripe bananas, avocado 402. Anticholinergic side effects: dry mouth, blurred vision, constipation, mem- ory problems 403. Antiadrenergic: orthostatic hypotension 404. Antihistaminergic: sedation and weight gain 405. SSRI class: 1st line tx for mDD serious side effects rare much safer than TCAs in case of OD effective for panic disorder, OCD, bulimia, GAD, social phobia, PTSD, PMDD 406. TCAs: 2nd line tx for MDD -affect many NTs --> more side effects -inexpensive -avoid abrupt withdrawal - discontinuation syndrome -avoid prescribing to high suicide risk 43 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix -2 week washout period if starting MAOI -use caution if also taking SSRI - can elevate concentrations 407. MAOI class: -not first line due to dangerous food and drug interactions -monitor for hypertensive crisis -tyramine free diet -combining with serotonergic agent can cause serotonin syndrome -can be fatal in OD -often poor adherence 408. MAOI side effects: insomnia hypertensive crisis weight gain anticholinergic SE lightheadedness dizziness sexual dysfunction 409. hypertensive crisis definition: occurs when MAOIs are taken in conjunction with foods containing tyramine, a dietary precursor to NE -can also occur when taken with Meperidine, decongestants, TCAs, atypical an- tipsychotics, St. Johns Wort, L-tryptophan, Stimulants, Asthma meds 410. hypertensive crisis symptoms: sudden, explosive-like headache, usually in occipital region elevated BP Facial flushing palpitations pupillary dilation diaphoresis fever 411. Serotonin syndrome symptoms: Agitation, restlessness Rapid heart rate and increased BP headache Sweating, shivering, goose bumps Myoclonic jerking, Loss of coordination Confusion, fever, seizure, unconsciousness Insomnia Autonomic Instability Tremors Diarrhea and Cramps Ataxia 44 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 412. Treatment for hypertensive crisis: D/C MAOI Give phentolamine (binds to NE receptor sites, blocks NE) Stabilize fever Reevaluate diet and adherence 413. Venlafaxine (Effexor): Dose: 75-375mg/day XR 75-225mg/day Can raise BP Safer for OD Significant discontinuation syndrome 414. Effexor side effects: Diaphoresis Headache Dizziness GI disturbance 415. Duloxetine (Cymbalta): Dose: 30mg-120mg Can elevate BP Can elevate LFTs Significant discontinuation syndrome 416. Cymbalta side effects: Dizziness Headache GI disturbance 417. Trintellix (Vortioxetine) Dose and side effects: Dose: 5, 10, 20mg Dizziness Nausea Diarrhea 418. Levomilnacipran (Fetzima): Dose: 40-120mg daily SE: nausea/vomiting, constipation, sweating, palpitations, urinary hesitancy, HTN, hypotension, decreased appetite 419. ECT: -Grand mal seizure induced under anesthesia -Usually 6-12 treatments -Tx resistant depression 420. Neurotransmitter theory of ECT: Increases dopamine, serotonin, and nor- epinephrine 421. Neuroendocrine theory of ECT: Releases hhormones such as prolactin, thyroid-stimulating hormone, pituitary hormones, endophins, and adrenocorti- cotropic hormone 45 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 422. Anticonvulsant theory of ECT: Exerts an anticonvulsant effect, which then produces an antidepressant effect. 423. Side effects of ECT: Systemic: headaches, muscle aches, drowsiness Cognitive: memory disturbance, confusion Possible cardiovascular effects 424. Wellbutrin: Dose: 150-450mg/day Contraindicated if client has seizure or eating disorder SR offers BID dosing, XL is once daily dosing Can increase energy level Also used for ADHD and smoking cessation Caution with caffeine and in people with panic d/o 425. Side effects of Wellbutrin: Headache Nervousness Tremors Tachycardia Insomnia Decreased appetite 426. Remeron: Dose: 15-45mg/day Inverse relationship between dosage and sedation 427. Remeron side effects: Weight gain Sedation Increased cholesterol 428. Trazodone: Dose: 200-600mg/day Safer in OD Priapism possible Not well tolerated antidepressant dosage because of sedation Most commonly used as hypnotic at 50-200mg May prolong QT interval 429. Trazodone side effects: Sedation Nausea Headache Hypotension 430. TMS: Tx resistant depression Placement of small wire coil on scalp to conduct electrical current, creating a magnetic field through the tissues of the head 5 sessions per week for 6 weeks 46 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 431. TMS side effects: Minimal Headache Scalp discomfort Tingling/twitching face muscles Lightheadedness Hearing discomfort during procedure 432. Risk factors for suicide: Male age 45 or older Female age 55 or older Divorced/single/separated White Living alone Psychiatric disorder Physical illness Substance abuse Previous attempt Family history Recent loss Male gender 433. Pseudodementia: A condition with clinical symptoms of dementia but not due to organic disease and without the permanent cognitive sequelae. Seen in elderly MDD patients Acute onset of dementia symptoms 434. Functional assessment: Determines the degree to which the person's abil- ities and performance match the demands of their life 435. Skill deficit: inability to perform a functional skill despite the physical ability - as seen in dementia 436. Performance deficit: Ability to perform a functional skill but lacks the moti- vation to do so, as in depression 437. Activities of daily living (ADLs): Basic self-care skills, such as bathing, dressing, eating, toileting 438. Instrumental activities of daily living (IADLs): Complex activities needed for independent functioning, such as shopping, cooking, driving, and housekeeping 439. Executive functioning: Judgment and planning, ability to maintain a calen- dar, manage money and appointments, prioritize activities 440. Drug combinations that can cause Serotonin syndrome: SSRIs and MAOIs 47 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix Drug and herbal interactions SSRIs and St. John's wort 441. Symptoms of serotonin syndrome: Autonomic instability Altered sensorium Restlessness Agitation Myoclonus Hyperreflexia Hyperthermia Diaphoresis Tremor Chills Diarrhea and cramps Ataxia Headache Insomnia 442. Discontinuation syndrome symptoms: Flu-like symptoms (due to choliner- gic rebound) Fatigue and lethargy Myalgia Decreased concentration Nausea and vomiting Impaired memory Paresthesias, including "shock-like" sensations Irritability Anxiety Insomnia Crying without provocation Dizziness and vertigo 443. Risk factors for discontinuation syndrome: Medications with short half life Abrupt discontinuation Noncompliant, irregular use pattern High dose range Long term treatment Prior history of discontinuation syndrome 444. Persistent Depressive Disorder (Dysthymia): disorder similar to MDD but with less acute symptoms with more protracted, chronic disease course, and no psychotic symptoms 48 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix -Chronically depressed mood that occurs for most of the day, more days than not, for at least 2 years -Low self-esteem, self-criticism, and perception of incompetence in comparison with others Vegetative symptoms less common Women are 2-3 times more likely 445. Common symptoms of PDD: Low energy Poor concentration Difficulty making decisions Hopelessness Inadequacy Mild anhedonia Social withdrawal Brooding about past issues Subjective irritability or anger Decreased productivity 446. PMDD (premenstrual dysphoric disorder): Dysphoric symptoms that occur in response to changing hormones during menstrual cycle -Symptoms during luteal phase, onset 1 week before menses, usually ends 1-2 days after menses begins -Tx hormonal contraceptives, SSRIs 447. PMDD symptoms: Lability Irritability Depressed mood Anxiety Low energy Sleep disturbances 448. Lithium: Dose: 1200-2400mg/day (acute) 900-1200mg/day (maintenance) -Gold standard for treating manic episodes -Evidence of antisuicidal effects -Action largely unknown -Narrow therapeutic window 449. Serum lithium level: Drawn at trough 12 hours post-dose Therapeutic range 0.5-1.2mEq/l Level greater than 1.2mEq/l increases risk for toxic side effects 49 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix 450. Baseline labs before starting Lithium: Thyroid panel Serum creatinine BUN Pregnancy test EKG over 50 451. Lithium side effects: Endocrine: Weight gain, impaired thyroid function CNS: Fine hand tremors, fatigue, mental cloudiness, headaches, coarse hand tremors with toxicity, nystagmus Dermatological: Maculopapular rash, pruritis, acne GI: GI upset, diarrhea, vomiting, cramps, anorexia Renal: Polyuria, polydipsia, diabetes insipidus, edema, microscopic tubular changes Cardiac: T-wave inversions, dysrhythmias Hematological: Leukocytosis Toxicity: Slurred speech, confusion, severe GI effect NSAIDs and ACE inhibitors may double levels 452. Tegretol: Dose: 10-20mg/kg/day Hepatic enzyme inducer Monitor LFTs Alternative to lithium or depakote Black box warning: agranulocytosis, aplastic anemia 453. Tegretol side effects: Nausea, dizziness, sedation, headache, dry mouth, constipation, skin rash Rare: agranulocytosis, aplastic anemia, Stevens-Johnson syndrome (particularly in Asians) 454. Valproic acid/Depakote: Dose: 15-40mg/kg/daily Depakote minimizes GI effects More effective than lithium for rapid cycling and mixed BPD 455. Depakote side effects: nausea, diarrhea, abdominal cramps, sedation, tremor Rare: increased liver enzymes, Stevens-Johnson syndrome 456. Lamictal: Dose: 25-600mg/day Helps in depressive phase of BPD Titrate slowly - 25mg x 2 weeks, 50mg x 2 weeks, etc 50 / 51  PMHNP Boards - Purple book Study online at https://quizlet.com/_7stwix Use with depakote may double Lamictal level and should be factored in to dosing Use with tegretol may increase metabolism Often used in combination with lithium, 2nd generation antipsychotics, and antide- pressants 457. Lamictal side effects: Dizziness, ataxia, somnolence, diplopia, nausea, headache, hepatotoxicity Rare: life-threatening rashes, including Stevens-Johnson syndrome, leukopenia 458. Stevens-Johnson Syndrome: Rare, potentially fatal immune reaction to a foreign antigen that can occur with exposure to any anticonvulsant drug Tx = stopping medication, supportive measures (may need hospital burn unit) 459. Symptoms of Stevens-Johnson Syndrome: Facial swelling Tongue swelling Macules, papules, and "burning" confluent erythematic rash Skin sloughing Prodromal headache, malaise, arthralgia, painful mucous membranes may occur before rash 460. Lab monitoring for long term lithium use: CBC Renal function Thyroid and Parathyroid (TSH, Ca levels) 51 / 51