quiz
After being treated with sertraline for over a year, a 23-year-old man continues to suffer from significant symptoms of depressed mood and intermittent anxiety. He has recently been admitted to a substance dependence treatment program for alcohol use (up to 15 drinks per day for the last 2 years) and has been sober for 2 weeks. Psychotherapy within the program reveals that his depressed mood pre-dated the start of his heavy drinking. There is no current suicidal ideation and no history of attempted suicide. At this point, the patient has discontinued sertraline by choice. Is he a reasonable candidate for transcranial magnetic stimulation (TMS)?
Yes, he fulfills criteria to qualify for a trial of TMS.
Yes, he can receive the treatment. TMS involves an electromagnetic coil placed on the scalp, creating a magnetic field that penetrates the skull by a few centimeters. This depolarizes neurons in the superficial cortex; through neural pathways, this local stimulation causes functional changes in other brain regions. Its approval is based on a study of high frequency TMS over left dorsolateral prefrontal cortex (DLPFC). However, low-frequency right sided stimulation has also shown efficacy. TMS is approved for treatment resistant depression defined as having failed at least one attempt, not two pharmacological trials. TMS is done on an outpatient basis, requires no anesthesia and does not involved loss of consciousness. Recent alcohol dependence is not a contraindication for TMS. The only contraindication is for patients with ferromagnetic metal within 30 cm of where the electromagnetic coils is placed. Caution should be exercised for patients with an implantable device controlled by physiological signs.
There can be multiple reasons for a client to select a complimentary or alternative form of treatment (CAT). Which of the following statements are true regarding the selection of CATs?
The cost of CAT is generally higher.
The medical doctor has more control of the client through the use of CATs.
Conventional treatment is successful.
Preference for natural vs synthetic treatments.
Preference for natural vs synthetic treatments.
The evidence-based therapy that the PMHNP recommends for adolescents with anorexia nervosa is:
Family-based therapy
Family based therapy is the correct choice. CBT is used with adults. Because adolescents with anorexia are not able to make good decisions about food or eating, the family is mobilized to assist the patient and carry out therapeutic interventions, such as refeeding and other efforts to restore the patients' weight to a healthy level. Because caloric intake must be high to increase weight, the family must be physically present and monitor each meal, regardless of the time needed for the adolescent to finish eating.
There are some psychiatric disorders with a significant evidence of familial transmission. Because of this, a thorough family history is needed because this information can aide in the formulation of an accurate diagnosis. Which of the following psychiatric disorders has the highest familial transmission?
Bipolar I-II disorders
If a patient's father has bipolar disorder, the patient has a 25 times more likely chance of having bipolar disorder. Bipolar Disorders have the highest familial transmission out of those listed. Schizophrenia is listed second highest in terms of familial transmission. This is in your Carlat textbook.
Post-traumatic stress disorder is generally caused by suffering a trauma or multiple traumas. While newer research is showing there may be a genetic predisposition that when suffering a trauma, a patient with a family history is more likely to suffer from PTSD. Generally, it is still considered a mental illness caused by a reaction to trauma. PTSD falls under the umbrella of trauma and stress related disorders and per DSM-5-TR, exposure to a traumatic or stressful even is listed explicitly as a diagnostic criterion.
Sue, a 14-year-old client has been diagnosed with bulimia nervosa. She has been noting with purging behaviors which include all of the following except:
vomiting
use of laxatives
use of diuretics
restricting intake
restricting intake
Purging behaviors can include vomiting, excessive use of laxatives or diuretics, rarely use of syrup of ipecac, use of thyroid hormone, may reduce or omit insulin doses, etc. Restriction of calories is noted with anorexia nervosa.
There are certain specifiers for bipolar and related disorders. One of the specifiers can be with melancholic features. Which of the following would be a symptom of melancholic features?
Early morning wakening
Correct answer is early morning awakening. See DSM-5-TR. Melancholic features can include: loss of pleasure in almost all activities, lack of reactivity to usually pleasurable stimuli, profound despondency, worsened depression in the morning, early morning awakening (usually 2 hours earlier), psychomotor agitation or retardation, significant anorexia or weight loss, and excessive or inappropriate guilt.
A client comes into the office with the following symptoms: restlessness, feels keyed up, problems focusing, irritability, muscle tension, and sleep disturbance. They share that worry is a constant in their life and they tend to worry about everything. The most likely diagnosis would be:
Generalized Anxiety Disorder
The correct answer is Generalized Anxiety Disorder, see DSM-5-TR book. While depression and anxiety can share many of the same symptoms, there is no mention of a traumatic event, anhedonia, feeling hopeless or helpless, use of substances, etc.
Harold, a schizophrenic client comes into the clinic for a medication management appointment. He tells the provider that he is having a lot of problems with feeling "jittery" since he started on aripiprazole. The nurse practitioner notes he is pacing around the room, will sit still for just a moment, stand up and pace again. The correct term for this movement disorder would be...
Akathisia
Akathisia is the correct answer. Covered in the Kaplan & Sadock textbook. Akathisia is extreme motor restlessness with an inability to relax, feeling jittery, moving and pacing and changing positions frequently and include a sense of anxiety. Tardive dyskinesia and can include choreiform movement of the tongue, fingers, toes, puckering movements of the mouth, etc. and are screened via an AIMS exam. Parkinsonism includes muscle stiffness, drooling, shuffling gait, cogwheel rigidity, pill rolling movements, etc. Restless leg syndrome is a creeping sensation of the calves and an irresistible urge to move the legs particularly during sleep. Based on the vignette the client did not share there were issues with sleep or specific issues with just the legs.
Obsessions are recurrent thoughts/images/urges which cause marked distress for a client with Obsessive-Compulsive Disorder (OCD).
T/F
True
Obsessions are the recurrent thoughts/images/urges and compulsions are the repetitive behaviors. See DSM-5-TR
Rebecca is an inpatient schizophrenic client at a state hospital. She insists that all the staff and other clients call her Elizabeth, Queen of England. What type of delusions is the client suffering from?
Grandiose delusions
The client is suffering from grandiose delusions. Grandiose delusions can involve them thinking they are a famous person or they have magical powers. Often grandiose and religious delusions can have some overlap. Paranoid delusions involve a thought process of someone/something being out to kill or harm them, or can be about someone talking about them, and can involve a radio or television. Delusions of control is a belief that someone/something is trying to control them. Religious delusions may be they think they are God or an Angel or for example have power over death. Your Carlat book has excellent examples.