NR 547 Week 4 Midterm Study Guide (Week 1 - 4)

existing symptoms a) New patients or new onset symptoms require full workup b) Pre-existing conditions and diagnosis should be taken into account when formulating your differentials c) Pre-existing conditions may exclude some differentials 2. Social determinants of health and the psychiatric mental health nurse practitioners (PMHNPs) role in addressing SDOH at the individual and population levels. SDOH have a significant impact on health, quality of life, and life expectancy in relation to mental health. Social and environmental factors can influence genetic determinants of health and illness and affect the risk for mental illness and substance use disorders. Discrimination, racism, social exclusion, Adverse early life experiences, Poor education, Unemployment, underemployment, job insecurity, Poverty, Neighborhood deprivation, Food insecurity, Poor housing quality and housing instability 3. Review basics of laboratory analysis including: 1. CBC- Hgb 12-18 grams/100 mL /hct: 38%-48%/ Plt: 150,000-300,000/mL /WBC 5k-10k 2. CMP-NA 135-145/ K 3.5-5/ CL95-105/BICARB 22-28/ CREAT 0.6-1.2 BUN 7-18 3. Thyroid function tests TSH: 0.4-4.5 mIU/L T3: 100-200 ng/dL T4: 5-11 ug/dL 4. Vitamin B12 levels- psychiatric symptoms associated with B12 deficiency include depression, mania, psychotic symptoms, and cognitive impairment B12 190-950 ok if 2-300 borderline and additional testing possibly needed 5. Vitamin D levels- 20-50 ng/mL. A level less than 12 ng/mL indicates a de昀椀ciency. 4. Know terms 1. Alogia- short answers, using few words to communicate. 2. Avolition- lack of initiative, withdrawal from work/school 3. Anosognosia- functional inability to recognize illness. fear of dentists, injections Animal type: fear of specific animal or insect. Situational type: fear of a k) Role of social determinants in the development of anxiety 2. Non-pharmacological treatments of anxiety, including counseling methods st 3. Pharmacological management including antidepressants and beta-blockers-SSRIs 1 line treatement for GAD/SAD/PD- escitalopram (Lexapro), paroxetine (paxil) duloxetine (Cymbalta) 4. Medications (including antidepressants) to avoid with acute anxiety. 5. Screening Tools for various anxiety disorders a) GAD-7 0-21 score, with 0-3 points for each of seven questions. 5-9 mild 10-14 moderate >15 severe b) Ham-A- 0-56 score, with 0-4 points for each 14 questions. Scores ≤17 mild anxiety/18-24 indicate mild to moderate/ 25-30 moderate to severe/ >30 severe anxiety c) YBOC- 0-40 score with higher scores indicating greater severity of OCD symptoms. 10 questions 0- 4 each. Total score of under 7 subclinical/ 8-15 mild OCD/ 16-23 moderate OCD/ 24-31 severe/ 32- 40 extreme OCD. 3. Basic treatment options including counseling strategies. a) Treatments often reflect concomitant depression treatment st b) SSRIs 1 line treatement for GAD/SAD/PD- escitalopram (Lexapro), paroxetine (paxil) duloxetine (Cymbalta) c) Review basic counseling strategies SSRIs are the first-line option • Start low and go slow. • Routine increase to higher doses not recommended, but a subgroup might benefit. 3. Initial or prodromal phase of schizophrenia – symptoms Prodromal symptoms usually develop before the first psychotic episode over a few days to a few months and may persist for a year or more before the onset of overt psychotic symptoms Symptoms are typically negative and may be overlooked due to their similarity to other conditions, such