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ANCC Certification PMHNP, Exams of Nursing

University of Colorado - Colorado Springs (UCCS)Nursing

ANCC Certification PMHNP , ANCC Certification PMHNP

Typology: Exams

2024/2025

Available from 07/03/2025

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ANCC Certification PMHNP
Mood Disorders
- Most common psych illnesses
Primary characteristic is persistent disturbance in mood
- Major Depressive Disorder
Often occurs without precipitating event
- MDD
Object loss theory
- Fairbairn, Winnicott & guntrip
Aggression turned inward theory of MDD
- Freud
Cognitive Theory
- Beck
Learned Helplessness-Hopelessness Theory
- Seligman
Genetic predisposition
- Strong genetic load for depression for child of depressed parent -having 3 fold
increase in lifetime risk of MDD & 40% chance of depressive episode before age 18.
Endocrine dysfunction Theory
- Probably related to etiology of MDD
Sleep disturbances, appetite disturbances, libido disturbances, lethargy, anhedonia are
neurovegitative symptoms that are related to functions of the
- Hypothalamus and pituitary gland secretions
Endocrine dysfunction and pregnancy
- A high incidence of postpartum mood disturbances is suggested with this
Hypothalamic-pituitary-adrenal axis (HPA)
- A theory of MDD, may be a result of an abnormal stress response related to
dysregulation of this system
HPA axis
- Controls the physiological response to stress and is composed of interconnective
feedback pathways between the hypothalamus, pituitary gland, and adrenal gland.
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ANCC Certification PMHNP

Mood Disorders

  • Most common psych illnesses Primary characteristic is persistent disturbance in mood
  • Major Depressive Disorder Often occurs without precipitating event
  • MDD Object loss theory
  • Fairbairn, Winnicott & guntrip Aggression turned inward theory of MDD
  • Freud Cognitive Theory
  • Beck Learned Helplessness-Hopelessness Theory
  • Seligman Genetic predisposition
  • Strong genetic load for depression for child of depressed parent - having 3 fold increase in lifetime risk of MDD & 40% chance of depressive episode before age 18. Endocrine dysfunction Theory
  • Probably related to etiology of MDD Sleep disturbances, appetite disturbances, libido disturbances, lethargy, anhedonia are neurovegitative symptoms that are related to functions of the
  • Hypothalamus and pituitary gland secretions Endocrine dysfunction and pregnancy
  • A high incidence of postpartum mood disturbances is suggested with this Hypothalamic-pituitary-adrenal axis (HPA)
  • A theory of MDD, may be a result of an abnormal stress response related to dysregulation of this system HPA axis
  • Controls the physiological response to stress and is composed of interconnective feedback pathways between the hypothalamus, pituitary gland, and adrenal gland.

Hypothalamus releases

  • corticotropin-releasing hormone (CRH) Adrenocorticotropin hormone (ACTH)
  • Released by pituitary in response to CRH by hypothalamus Cortisol
  • Released by adrenal glands in response to ACTH by pituitary gland Hyperactivity of the HPA axis
  • Demonstrated to be present in individuals with MDD. May also have elevated cortisol levels Elevated cortisol levels
  • Over time damages the CNS by altering neurotransmission and electrical signal conduction. Cortisol over time can cause changes in size and function of brain tissue Dexamethasone suppression test (DST)
  • Not commonly used in clinical practice for screening of depression as it is too non specific. Hypovolemic hippocampus and hypovolemic prefrontal cortex-limbic striatal regions
  • Abnormalities demonstrated by neuroimaging in individuals with chronic and severe depression Brain damage, including that from stroke and trauma
  • Depression is a acommon comorbidity in individuals who have experienced these events What is the Chronobiological theory of MDD
  • Desynchronization of the circadian rhythms produces the symptom constellation collectively called MDD Circadian rhythms control these biological processes that are frequent problems with depressed individuals
  • Sleep-rest cycle disturbances * Increased cortisol secretions * REM abnormalities Increased emotional reactivity Frequent waking More intensified dreaming Diurnal variations to circadian-related behaviors Decreased arousal and energy levels Decreased activity patterns * Incidence of MDD
  • 5% of U.S. population ages 18 and older each year. About 9.9 million Americans

Appearance, speech, affect, mood, thought process, thought content (including suicidal thoughts/behaviors); cognition, orientation, memory, concentration, abstraction, judgment

  • Mental Status Exam Endocrine Disorders implicated in MDD
  • Hypothyroidism, DM, hyperaldosteronism, and Cushing's/Addison's Disease Infectious and inflammatory states implicated in MDD
  • Mono, AIDS, viral and bacterial pneumonia; systemic lupus erythematosus, temporal arteritis, tuberculosis Nutritional disorders implicated in MDD
  • Pernicious anemia and pellagra Psychiatric disorders commonly associated with MDD
  • Anxiety disorders, eating disorders, Bipolar disorder, substance abuse/dependence disorders One should continue use of antidepressants for a minimum of
  • 8 - 12 months If patient has prior episodes of depression, than consider using antidepressants
  • For longer than 8-12 months Medication and counseling
  • Research demonstrates that the most effective intervention is a combination of these two treatment modalities Action primarily to increase serotonin levels in CNS by inhibiting their reuptake:
  • Selective Serotonin Reuptake Inhibitors (SSRIs) Elevate serotonin and norepinephrine levels primarily by inhibiting their reuptake
  • Tricyclic Antidepressants (TCAs) Elevate serotonin and norepinephrine levels primarily by inhibiting MAO, the enzyme that destroys neurotransmitters
  • Monoamine Oxidase Inhibitors (MAOIs) Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
  • Inhibit dual reuptake; action very selective on neurotransmitters; elevate serotonin and norepinephrine levels by inhibiting their reuptake. Norepinephrine Dopamine Reuptake Inhibitors (NDRIs)
  • Inhibit dual reuptake; action very selective on neurotransmitters; elevate dopamine and norepinephrine levels by inhibiting their reuptake.

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 SSRIs side effects
  • Most common side effects of this class: gi upset, sexual dysfunction, nervousness, headache and dry mouth Name the six SSRIs
  • Celexa, Lexapro, Prozac, Luvox, Paxil (Pexeva), Zoloft. Which is safer in overdose, Paxil or Nortriptyline?
  • Paxil. SSRIs are safer in overdose than TCAs. SSRI's are also effective for treatment of panic disorder, OCD, bulimia, GAD social phobia and
  • PTSD and premenstrual dysphoric disorder Which SSRI has long half-life?
  • Prozac Two SSRIs have potential for teratogenic effects, name them.
  • Paxil and Zoloft This SSRI has a black box warning for liver toxicity.
  • Luvox GI upset, sexual dysfunction, nervousness, headache and dry mouth are common side effects associated with...
  • SSRIs Second line drugs for treatment of MDD:
  • Tricyclic Antidepressants (TCAs) The side effect profile for TCAs
  • Dirty side-effect profile Dirty side effect profile contributes to
  • Poor patient compliance Anticholinergic dirty side effects associated with TCA's:
  • Dry mouth, blurred vision, constipation, memory problems. Caused due to muscarinic receptor blockade. Antiadrenergic dirty side effects associated with TCAs:

A TCA with multiple uses that include chronic pain, insomnia, sciatica, fibromyalgia, trigeminal neuralgia and diabetic neuropathy.

  • Elavil. Never first-or second-line agents for MDD
  • MAOIs Occurs with MAOIs are taken with foods containing tyramine
  • Hypertensive crisis Tyramine
  • A dietary precursor to norepinephrine When monoamine oxidase is inhibited
  • Tyramine exerts a strong vasopressor effect What is released when tyramine exerts vasopressor effects?
  • Catecholamines, epinephrine, and norepinephrine which will increase blood pressure and heart rate Certain medications can cause hypertensive crisis and possible death when administered with an MAOIs. Name them:
  • Meperidine, SSRIs, decongestants, TCAs, atypical antipsychotics; St. John's wort, L- trytophan, Ritalin, asthma medications. Symptoms of hypertensive crisis:
  • Sudden, explosive-like headache, usually in occipital region; increased BP, facial flushing, palpitations; pupillary dilation; diaphoresis and fever. What medication is given to treat hypertensive crisis?
  • Phentolamine Phentolamine
  • Binds with norepinephrine receptor sites, blocks norepinephrine. MAOI's are ______ in overdose.
  • Not safe. Dirty side-effect profile and stringent dietary restrictions promote __________________.
  • Poor patient compliance In addition to hypertensive crisis, clinically significant side effects of MAOIs include:
  • Insomnia, weight gain, anticholinergic side effects, light-headedness and dizziness, and sexual dysfunction.

MAOI, generic selegiline

  • Ensam MAOI, generic isocarboxazid
  • Marplan MAOI, generic phenelzine
  • Nardil MAOI, generic tranylcypromine
  • Parnate No dietary restrictions with 6 mg dosage
  • Ensam transdermal patch (Restrictions needed for 12 mg patch) MAOI also used for panic disorder, phobic disorders, and selective mutism
  • Marplan, Nardil and Parnate. Oral MAOIs should be given in _______doses.
  • Divided doses, bid and qid. Two SNRIs:
  • Effexor and Cymbalta NDRI:
  • Wellbutrin Wellbutrin and Wellbutrin XL dosing:
  • 150 - 450 mg daily. Headache, nervousness, tremors, tachycardia, insomnia, decreased appetite are side effects from:
  • Wellbutrin, an NDRI antidepressant Wellbutrin, bupropion, is also used for ADHD and ___________.
  • Smoking cessation. Wellbutrin SR requires _______ __________.
  • BID dosing. Wellbutrin can increase:
  • Energy level Wellbutrin in contraindicated in patients with eating disorders and ___________.
  • Seizures.

Therapies used with the depressed individual

  • CBT and Brief (Solution focused) Therapy, Group therapy, Family therapy Identify 12 risk factors for suicide

  • 45 & male; >55 & female; divorced, single, separated; white; living alone, psychiatric disorder; physical illness; substance abuse; previous attempt; FH of suicide; recent loss, male gender. Symptoms of depression that may be more pronounced in children:

  • Irritability, somatic complaints and social withdrawal. Core symptoms of depression that are less common in children before onset of puberty:
  • Psychosis, motor retardation, hypersomnia and increased appetite. In children, MDD has a
  • strong separation anxiety component Population that responds better to SSR's than to TCA's:
  • Children Children taking antidepressants should be monitored closely for
  • Suicide Individuals admitted to long term care facilities are ____% more likely to die within the first year than the normal control population
  • 65 It is important to complete a _______ __________ for elderly individuals with depression.
  • Functional Assessment One reasons to complete a functional assessment on an elderly patient is to
  • Identify whether problems are related to dementia or depression. Drug combinations that may cause serotonin syndrome:
  • SSRIs & MAOIs; Durg and herbal interactions; SSRIs & St. John's wort Autonomic instability, restlessness, agitation, myoclonis, hyperreflexia, hyperthermia, diaphoresis; altered sensorium, tremor, cills, diarrhea and cramps, ataxia, headache and insomnia:
  • Symptoms of serotonin syndrome Flu-like symptoms, fatigue and lethargy, myalgia, decreased concentration, nausea/vomiting, impaired memory, shock-like sensations; irritability, anxiety, insomnia, crying without provocation, dizziness and vertigo:
  • Symptoms of discontinuation syndrome Why should TCAs be discontinued slowly?
  • Clients can get cholinergic rebound syndrome: nausea, gi upset, diaphoresis, myalgias, especially of neck muscles. Patients who have had two or more episodes of MDD usually require
  • Lifelong medication. Time criteria for MDD
  • Symptoms present over a two week period Symptom criteria for MDD
  • Either depressed mood OR loss of interest or pleasure AND four other symptoms: Weight loss/gain, insomnia/hypersomnia, psychomotor agitation/retardation, fatigue/loss of energy, feelings of worthlessness/guilt, poor concentration/thinking, recurrent thoughts of death.