1. Increase prolactin - Stop prolactin (stop the agent that cause increase prolactin) 2. 3-year-old masturbates, play with self,says naughty things - FREUD’s PSYCHOSOCIAL STAGES OF DEVELOPMENT – PHALLIC STAGE – 3-6 years old - This is NORMAL for children this age. - PNEUMOIC – Old Age Parents Love Grandchildren - Oral (0-18 months), Anal (18 months – 3 years), Phallic (3 years to 6 years), Latent (6 to 12), Genital (12 +) - ACUTE STRESS DISORDER o A d/o resulting from exposure to a major stressor, with SX of ANX, depression, dissociation,recurring nightmares,sleep disturbances, problemsin concentrations, reliving the event, dreams, flashbacks – UP to ONE MONTH – Less than 1 month. o If LONGER than 1 month = PTSD 3. 5-year-old tells you his brother sodomized him - Tell mom don’t leave him alone with patient and call CPS implement crisis - QUESTION – Child is playing with doll in a sexual way – You SUSPECT sexual abuse - Perform FURTHER ASSESSMENT and GATHER ENOUGH INFO BEFORE Calling CPS to report suspected Sexual Abuse – You HAVE to report but you have to have something (assessment data) to report – Assess = FIRST 4. 13-year-old want to smoke - Ask him of his plan to stop smoking - 5. 14-year-old girl clenching her teeth - Cranial nerve V-Trigeminal nerve (FIVE) - 7 = Facial Paralysis – Bells Palsy Know Cranial Nerves 6. 16-year-old falls with the wrong crowd - Conduct disorder 7. 16-year-old refuse treatment - Send to psych specialist for acting out kids – Referrals – Have to see if you are going to refer the same patient to the same provider – Cannot refer the patient to another provider that is the same as you (ie psych) – you must refer to a neurologist or another specialist or PCP 8. 16-year-old shows up with mother for first therapy - Confidential (mom sits in lobby) 9. ACE inhibitors - HTN & Heart Failure - This medication can cause increased lithium levelsto toxic levels – must collaborate with PCP to determine whether to change ACE or change Lithium – Can’t use both 10. ACE inhibitors are the drug of choice for what? - Heart failure/HTN 11. Acute stress disorder (ASD) - LESS THAN 1 MONTH - Can be 2 to 4 weeks - A disorder resulting from exposure to a major stressor, with symptoms of anxiety, dissociation, recurring nightmares, sleep disturbances, problems in concentration, and moments in which people seem to “relive” the event in dreams and flashbacks for as long as 1 month following the event - Symptoms that occur immediately after the event but resolve in less than 3 days would not meet criteria for acute stress disorder (PB) - Acute stress disorder must occur within 1 month of the traumatic event and resolve within that 1-month period. If the symptoms persist for more than 1 month and meet criteria for PTSD, the diagnosis is changed from acute stress disorder to PTSD (PB) LITHIUM • First-line neuro-protective fort bipolar • Ibuprofen & Lithium o INCREASES the serum level up to double • Lab Values concerning for patient on Lithium: o Leukocytosis o Creatinine o BUN o NA+ o 4 + PORTEIN in Urine o + Pregnancy Test • NSAID, dehydration and Thiazidesincreasesrisk of lithium toxicity: o Lithium Toxicity o LITHIUM LEVEL – 0.5 – 1.2 mEq/L o MONITOR for TOXICITY: Toxicity = > 1.2 mEq/l • TOXICITY: o Slurred speech, confusion,severe GI effect – diarrhea/nausea/vomiting, metallic taste and SEVERE tremor. • PREGNANCY CATEGORY D o Lactation Category L3 o Risk of Hypothyroidism o AVOID in pregnancy, especially 1st trimester – Ebstein anomaly, cardiac defect. 12. ADPIE - Assessment - Diagnosis - Planning - Implementation - Evaluation CBT – Daily Log – Depression & Anxiety 13. Adult panic disorder - Buspar Pharmacological Management (PB PG 209) - SSRIs - BNZs, usually used forshort-term symptom control or “bridge” medication when - starting an SSRI or other antidepressant • Buspar effective as an adjunct to an antidepressant • Other non-benzodiazepine anxiolytic meds used as adjuncts 14. Aggressive patient to give - IM Geodon 15. Agoraphobia - Fear of open spaces 16. Agoraphobia treatment - BZs: Short term symptom relief - SSRIs: long term maintenance • Fluoxetine (Prozac) • Paroxetine (Paxil) • Sertraline (Zoloft) - SNRIs: long term maintenance • Venlafaxine (Effexor) - TCAs: long term maintenance - Pharmacological Management (PB page 211) - SSRIs - BNZsfor short-term use - Beta blockers(off-label use) used for discrete episodes ofsocial anxiety – contraindicated for clients with asthma 17. Alprostadil (PGE1) - Ductal-dependent Congenital Heart disease (all forms) - Prostaglandin E1 (PGE1), also known as alprostadil, is a naturally occurring prostaglandin which is used as a medication. In babies with congenital heart defects, it is used by slow