MH 709 FINAL Exam Study Guide Questions And Answers Verified 100% Correct

MH 709 FINAL Exam Study Guide Questions And Answers Verified 100% Correct 1. Describe the dysregulated HPA axis seen in chronic stress. - ANSWER Stressinduced hypercortisolism leads to "burn out" of system with subsequent chronic hypocortisolism. However, cortico-releasing factor continues to be released, which stimulates further release of norepinephrine and leads to anatomical changes and neurotransmitter abnormalities. 1. Which two medication classes are first-line treatments for PTSD symptoms? - ANSWER SSRI's and SNRI's. 1. Which antidepressant medications have FDA approval for treatment of PTSD? - ANSWER Sertraline, paroxetine, and venlafaxine. 1. Which alpha blockers may be used to treat PTSD symptoms? - ANSWER Clonidine and prazosin. 1. Describe the titration schedule of Prazosin. - ANSWER 1mg for two nights, then increase by 2mg every 4 days up to 20mg until achieved effect. 1. Which two side effects require monitoring when prescribing Prazosin? - ANSWER Orthostatic hypotension and reflex tachycardia. 1. What is the patient's primary fear in Panic Disorder? - ANSWER A future panic attack. 1. How long does a typical panic attack last? - ANSWER Peaks at 10 minutes. 1. Name four of the diagnostic criterion required for a diagnosis of Panic Disorder. - ANSWER Palpitations, rapid heart rate, pounding heart, sweating, trembling, shaking, sensation of shortness of breath, smothering feeling, choking sensation, chest pain, nausea, GI upset, dizziness, lightheadedness, faintness, unsteady, derealization, depersonalization, fear of losing control, fear of "going crazy," fear of dying, paresthesias, chills, heat sensations. 1. How long must symptoms be present for a diagnosis of Agoraphobia to be made? - ANSWER At least six months. 1. What is the primary fear associated with Social Anxiety Disorder? - ANSWER Fear of being judged or critiqued, either negatively or positively. 1. What are key determinants when differentiating between anxiety disorders? - ANSWER Breadth of avoidance behaviour and motivation behind avoidance behaviour. 1. What is the treatment focus in Specific Phobias? - ANSWER Exposure-based systematic desensitization. 1. What are the key symptoms associated with Generalized Anxiety Disorder? - ANSWER Restlessness, feeling keyed up, feeling on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep difficulties. 1. What are the primary fears associated with Generalized Anxiety Disorder? - ANSWER Day to day routine life events. 1. What are some of the most common obsessions seen in Obsessive Compulsive Disorder? - ANSWER Contamination fears, excessive doubting, need for order/symmetry, aggressive (towards self or others) or sexual thoughts or images, religion, numbers or colors. 1. How much time per day must be spent in unwanted obsessive thinking for a diagnosis of Obsessive Compulsive Disorder? - ANSWER At least one hour. 1. What is a mental compulsion? - ANSWER Internal cognitive rituals that are repeated over and over in order to neutralize and anxiety provoking obsessive thought. 1. What are the key factors in differentiating between typical intrusive thoughts and those to qualify for a diagnosis of Obsessive Compulsive Disorder? - ANSWER How frequent are the symptoms? Do they cause the person distress? Do they interfere with normal activities? 1. Aside from Cognitive Behavioral Therapy (CBT), what is one primary non- pharmacological treatment for Obsessive Compulsive Disorder and how does it work? - ANSWER Exposure Response Prevention (ERP). Repeated exposure to anxiety provoking stimuli without engaging in compulsive rituals gradually desensitizes person to the anxiety over time. 1. What does "appraisal" mean in Obsessive Compulsive Disorder? - ANSWER The meaning that the individual gives to the intrusive thought. 1. What are four common appraisals to challenge in Obsessive Compulsive Disorder? - ANSWER Over-importance of thoughts, over-estimation of danger, inflated sense of responsibility, and need for certainty and control. 1. Which tricyclic antidepressant is FDA-approved to treat Obsessive Compulsive Disorder, and what is it's starting dose and most common side effects? - ANSWER Clomipramine: 25mg/day; anticholinergic side effects, weight gain, sedation, nervousness, dizziness, headache. 1. Fluvoxamine, and SSRI, is considered a first-line treatment for Obsessive Compulsive Disorder. What does the dosing titration and patient education include for this medication? - ANSWER Immediate release: 50mg/day, increase by 50mg/day within one week. If further response required may increase by 50mg/week up to 300mg/day. Controlled release: 100mg/day, increase by 50mg/week up to maximum dose of 300mg/day. Patient education includes that may take weeks for therapeutic benefits, sedation is common- take majority of dose at HS if splitting dose, GI upset, sexual side effects, sweating, headache and dizziness may occur. 1. What are key differences between Major Depressive Disorder and Grief? - ANSWER MDD has a more persistent depressed mood that universally impacts thoughts about the future and the ability to feel or anticipate pleasure. Grief has more focus on the loss and comes in waves, with intermittent relief and the ability to feel some joy, or humor. Thought content in grief is usually more focused on the loss. 1. What is the duration of symptoms required to meet criteria for Major Depressive Disorder? - ANSWER The symptoms of MDD - consistent, depressed mood, and/or loss of pleasure interest plus 5 (or more of the following sx) anhedonia, psychomotor slowing or agitation, hypersomnia or hyposomnia, loss of energy, decreased ability to concentrate, thoughts of death or dying, feelings or worthlessness or guilt, significant weight loss or gain must be present for 2 weeks. 1. The PMHNP has just prescribed an antidepressant medication to a patient who is depressed. The patient says, "How long do I have to take this?" I don't want to have to take medication forever?" What are the general recommendations for discontinuing pharmacologic treatment for depression? - ANSWER The PMHNP should explore what it means to the patient to be taking medication. Generally, if depressive symptoms resolve and the patient remains symptom free for six months, a tapered discontinuation can be discussed with the patient. 1. What are the signs and symptoms of serotonin syndrome? - ANSWER Autonomic instability (elevated temperature, increased BP and pulse Mental Status changes- confusion, agitation, hallucinations GI symptoms- Nausea, vomiting, diarrhea Neuromuscular- Tremors, loss of coordination