Your FREE PMHNP Flashcards 2026 – 200+ Cards

VTA → nucleus accumbens; overactivity = positive psychotic symptoms (hallucinations, delusions); target of antipsychotic D2 blockade.

VTA → prefrontal cortex; underactivity = negative/cognitive symptoms of schizophrenia.

Substantia nigra → striatum; D2 blockade here causes EPS (parkinsonism, dystonia, akathisia, tardive dyskinesia).

Hypothalamus → pituitary; dopamine inhibits prolactin; D2 blockade → hyperprolactinemia (galactorrhea, amenorrhea, gynecomastia).

Fear processing and threat detection; hyperactive in anxiety and PTSD.

Memory consolidation; atrophies with chronic stress/cortisol and in depression/PTSD.

Executive function and impulse control; matures into the mid-20s (relevant to adolescent risk-taking).

Hypothalamus → pituitary → adrenal; chronic activation raises cortisol; dysregulated in depression.

Principal inhibitory neurotransmitter; target of benzodiazepines, barbiturates, alcohol, and Z-drugs.

Principal excitatory neurotransmitter; NMDA-receptor target of ketamine/esketamine and memantine.

Regulates mood, sleep, appetite, and anxiety; raised by SSRIs, SNRIs, and MAOIs.

Arousal, attention, and stress response; raised by SNRIs, TCAs, MAOIs, and atomoxetine.

Memory and cognition; blockade causes anticholinergic effects; deficient in Alzheimer disease (treated with cholinesterase inhibitors).

Absorption, Distribution, Metabolism, Excretion — the four pharmacokinetic processes.

Time for plasma concentration to fall by 50%; about 5 half-lives to reach steady state or clear a drug.

Fluoxetine, paroxetine, and bupropion raise levels of 2D6 substrates.

Tobacco smoke induces 1A2, lowering clozapine/olanzapine levels; quitting raises levels (toxicity risk).

Fluvoxamine raises clozapine, olanzapine, and caffeine levels.

Metabolizes many psychotropics; inhibited by grapefruit and ketoconazole; induced by carbamazepine.

Induces its own metabolism (and 3A4), lowering its own and other drug levels over 2–4 weeks.

Higher drug levels and toxicity at standard doses of 2D6 substrates (many antidepressants).

Subtherapeutic levels and treatment failure at standard doses.

Sustained muscle contraction (torticollis, oculogyric crisis) hours–days after an antipsychotic; treat with IM/IV benztropine or diphenhydramine.

Subjective inner restlessness/inability to sit still; treat by lowering dose, propranolol, benztropine, or a benzodiazepine.

Bradykinesia, rigidity, and tremor from D2 blockade; treat with an anticholinergic or dose reduction.

Late-onset involuntary choreoathetoid movements (lip-smacking, tongue) from chronic D2 blockade; treat with VMAT2 inhibitors (valbenazine, deutetrabenazine); often irreversible.

Abnormal Involuntary Movement Scale — screens for tardive dyskinesia.

Fever, 'lead-pipe' rigidity, autonomic instability, altered mental status, elevated CK from D2 blockade; stop the drug, give dantrolene/bromocriptine, support.

Triad of mental-status change, autonomic instability, and neuromuscular hyperactivity (clonus, hyperreflexia); rapid onset; stop serotonergic agents, give cyproheptadine, support.

NMS = rigidity + bradyreflexia, slow onset (days); serotonin syndrome = hyperreflexia/clonus, fast onset (hours).

Allele (common in some Asian populations) predicting carbamazepine/oxcarbazepine Stevens-Johnson syndrome; screen before starting.

About 80%; bipolar disorder about 60–85% — among the most heritable psychiatric disorders.

CYP2D6/2C19 genotyping can guide antidepressant selection and dosing (CPIC guidelines).

Systematic exam to identify medical causes/comorbidities of psychiatric presentations (e.g., thyroid, neurologic).

9-item depression screen/severity, 0–27; $\ge 10$ = moderate (treatment threshold); item 9 screens suicidality.

5–9 mild, 10–14 moderate, 15–19 moderately severe, 20–27 severe.

7-item generalized-anxiety screen, 0–21; $\ge 10$ = moderate anxiety (clinically significant).

5 mild, 10 moderate, 15 severe.

Parent/teacher rating used for childhood ADHD diagnosis and monitoring.

Screens for bipolar-spectrum disorder.

Columbia-Suicide Severity Rating Scale; assesses suicidal-ideation severity and behavior.

Geriatric Depression Scale; depression screen designed for older adults.

Edinburgh Postnatal Depression Scale; perinatal/postpartum depression screen.

Cognitive screens; MoCA is more sensitive for mild cognitive impairment; MMSE $\le 23$–24 suggests impairment.

PTSD Checklist for DSM-5; self-report PTSD symptom screen.

Yale-Brown Obsessive Compulsive Scale; measures OCD severity.

10-item alcohol-use screen (WHO); $\ge 8$ indicates hazardous drinking.

Drug Abuse Screening Test; screens non-alcohol drug use.

4-item alcohol screen (Cut down, Annoyed, Guilty, Eye-opener); $\ge 2$ is positive.

Adolescent substance-use screen.

Rates alcohol-withdrawal severity; $\ge 8$–10 = medicate (benzodiazepines); $\ge 15$ = high risk of seizures/DTs.

Clinical Opiate Withdrawal Scale; 5–12 mild, 13–24 moderate, 25–36 moderately severe, >36 severe.

Appearance, Behavior, Speech, Mood, Affect, Thought process, Thought content, Perception, Cognition, Insight, Judgment.

Mood = the patient's stated, sustained emotion (subjective); affect = the observed emotional expression (objective).

Form of thinking: linear, tangential, circumstantial, loose associations, flight of ideas, word salad.

What the patient thinks: delusions, obsessions, suicidal/homicidal ideation, paranoia.

Collaborative, patient-centered method to strengthen change motivation; uses OARS (Open questions, Affirmations, Reflective listening, Summaries); rolls with resistance.

Encourage elaboration; preferred over yes/no questions in clinical interviewing.

A previous suicide attempt.

Prior attempt (strongest), a plan with means/access, hopelessness, recent loss, substance use, command hallucinations.

Limiting access to lethal means (firearms, medications) is an evidence-based suicide-prevention intervention.

Collaborative written plan: warning signs, coping strategies, supports, means restriction, crisis contacts.

Ensure safety first (patient/staff/others); de-escalate before chemical or physical restraint; use the least restrictive option.

Primary = prevent onset (education, vaccination); secondary = early detection/screening; tertiary = reduce complications of established disease.

Recovery is person-driven, holistic, and hope-based; emphasizes resilience and protective factors.

Teaching patients/families about illness and treatment to improve adherence and outcomes; tailor method and topic to the learner.

0.8–1.2 mEq/L acute, 0.8–1.0 maintenance (FDA); toxicity $\ge 1.5$ mEq/L; draw a 12-hour trough.

$\ge 5$ symptoms for $\ge 2$ weeks including depressed mood OR anhedonia; mnemonic SIGECAPS.

MDD symptom mnemonic: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidality.

Depressed mood most days for $\ge 2$ years (1 year in children/adolescents).

At least one manic episode ($\ge 1$ week or hospitalization); a depressive episode is not required.

At least one hypomanic episode ($\ge 4$ days) plus at least one major depressive episode; no full mania.

Distractibility, Impulsivity/Indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep decreased, Talkativeness.

Excessive worry more days than not for $\ge 6$ months plus $\ge 3$ physical symptoms (restlessness, fatigue, concentration, irritability, muscle tension, sleep).

Recurrent unexpected panic attacks plus $\ge 1$ month of worry about attacks or behavior change.

Marked fear of social/performance situations with scrutiny, lasting $\ge 6$ months.

Obsessions and/or compulsions that are time-consuming (>1 hr/day) or cause distress/impairment.

Trauma exposure plus intrusion, avoidance, negative cognitions/mood, and arousal/reactivity for >1 month.

Trauma-related symptoms lasting 3 days–1 month (vs PTSD >1 month).

$\ge 2$ of delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative symptoms for $\ge 1$ month, with $\ge 6$ months of disturbance.

Schizophreniform = 1–6 months of symptoms; schizophrenia $\ge 6$ months.

A mood episode concurrent with schizophrenia symptoms plus $\ge 2$ weeks of psychosis WITHOUT mood symptoms.

Psychotic symptoms 1 day–1 month with full return to baseline.

Inattentive and/or hyperactive-impulsive symptoms, several before age 12, in $\ge 2$ settings.

Persistent deficits in social communication plus restricted/repetitive behaviors; early developmental onset.

Restriction → low body weight, intense fear of weight gain, body-image disturbance.

Binge eating plus compensatory behaviors $\ge 1$/week for 3 months; usually normal weight.

Instability of relationships, self-image, and affect plus impulsivity; fear of abandonment, splitting, self-harm.

Disregard for/violation of others' rights since age 15; requires age $\ge 18$ and conduct disorder before 15.

Acute, fluctuating disturbance of attention/awareness from a medical cause; reversible.

Delirium = acute, fluctuating, altered consciousness, reversible; dementia = gradual, progressive, clear consciousness.

First-line for depression/anxiety; block serotonin reuptake (sertraline, escitalopram, fluoxetine).

GI upset, sexual dysfunction, insomnia/sedation, initial anxiety, hyponatremia (SIADH), serotonin-syndrome risk.

Increased suicidal ideation/behavior in patients under 25; monitor closely early in treatment.

Venlafaxine, duloxetine, desvenlafaxine; raise serotonin and norepinephrine; can raise blood pressure.

SNRIs add norepinephrine reuptake inhibition (useful for pain/low energy); more discontinuation symptoms (venlafaxine).

Amitriptyline, nortriptyline; effective but anticholinergic and cardiotoxic (QRS widening); lethal in overdose.

Phenelzine, tranylcypromine, selegiline; require a tyramine-free diet (avoid aged cheese, cured meats, fermented foods) to prevent hypertensive crisis.

$\ge 2$ weeks between an MAOI and other serotonergic agents (5 weeks after fluoxetine) to avoid serotonin syndrome.

NDRI; no sexual dysfunction or weight gain; lowers seizure threshold (avoid in eating/seizure disorders); aids smoking cessation.

Alpha-2 antagonist; sedating and increases appetite (useful for insomnia/low weight in depression).

Serotonin modulator; used off-label for insomnia; risk of priapism.

Multimodal antidepressant with possible pro-cognitive benefit.

First-line for bipolar mania/maintenance; FDA range 0.8–1.2 acute / 0.8–1.0 maintenance mEq/L, toxicity $\ge 1.5$; monitor renal function and TSH; teratogenic (Ebstein anomaly).

Tremor, ataxia, confusion, seizures; worsened by dehydration, NSAIDs, thiazides, and ACE inhibitors (reduce lithium clearance).

For mania/seizures; monitor LFTs and platelets; boxed warnings for hepatotoxicity, pancreatitis, and teratogenicity (neural-tube defects).

Mood stabilizer/anticonvulsant; risk of agranulocytosis/aplastic anemia (monitor CBC), HLA-B*1502 SJS, autoinduction, and hyponatremia.

Bipolar-depression maintenance; titrate slowly to avoid Stevens-Johnson syndrome / TEN (boxed warning for serious rash).

Haloperidol, chlorpromazine; high D2 blockade → more EPS.

Risperidone, olanzapine, quetiapine, aripiprazole; less EPS, more metabolic side effects.

Weight/BMI, fasting glucose, lipids, and blood pressure at baseline and periodically (weight gain, diabetes, dyslipidemia).

Most effective for treatment-resistant schizophrenia; boxed warnings: agranulocytosis (ANC monitoring), seizures, myocarditis, orthostatic hypotension, GI hypomotility/ileus.

Weekly ANC initially; hold if ANC <1,000/µL (general population). The FDA REMOVED the Clozapine REMS in 2025, but label-schedule ANC monitoring is still recommended.

Increased mortality in elderly patients with dementia-related psychosis (not an FDA-approved use).

Caused by many antipsychotics (e.g., ziprasidone, IV haloperidol); risk of torsades de pointes.

D2 partial agonist; lower metabolic burden; can cause akathisia.

Methylphenidate, amphetamine salts; first-line for ADHD; controlled substances; boxed warning for abuse/dependence; monitor cardiovascular status, growth, BP/HR.

Nonstimulant (NRI) for ADHD; boxed warning for suicidal ideation in children/adolescents.

Enhance GABA; rapid anxiolytic but risk of dependence/tolerance/withdrawal; boxed warning with opioids (respiratory depression/death).

Anxiety, insomnia, tremor, seizures; potentially life-threatening; taper gradually.

5-HT1A partial agonist; non-sedating, non-dependence anxiolytic; takes 2–4 weeks (not PRN).

Opioid antagonist for alcohol and opioid use disorder; must be opioid-free ~7–10 days first (precipitates withdrawal). Oral naltrexone NO LONGER carries a boxed warning — hepatotoxicity is now a Warnings-section caution.

Reduces alcohol craving; renally cleared.

Causes an aversive reaction (flushing, nausea) with alcohol by inhibiting aldehyde dehydrogenase.

Partial opioid agonist (often with naloxone) for OUD; induct in mild–moderate withdrawal (COWS-guided) to avoid precipitated withdrawal.

Full opioid agonist for OUD; dispensed via licensed programs; QTc risk.

Opioid antagonist; reverses overdose.

TSH, CBC, CMP (electrolytes, glucose, renal/hepatic), B12/folate, urine drug screen; consider HCG in females.

Can mimic depression; check TSH.

Renal function (BUN/creatinine), TSH, pregnancy test, and ECG if cardiac risk.

Complementary agent; induces CYP3A4 and risks serotonin syndrome with serotonergic drugs.

Clozapine.

Lamotrigine (slow titration).

Identifies and restructures cognitive distortions; uses behavioral activation; first-line for depression/anxiety.

All-or-nothing thinking, catastrophizing, overgeneralization, mind reading, personalization.

Graded exposure to feared stimuli; first-line for phobias, OCD (ERP), and PTSD.

Core conditions: unconditional positive regard, empathy, and congruence (genuineness).

Time-limited; targets grief, role transitions, role disputes, and interpersonal deficits.

Based on conditioning; uses reinforcement and extinction.

Pavlov; learning by pairing stimuli (associative learning).

Skinner; behavior shaped by consequences (reinforcement/punishment).

Positive = add a stimulus to increase a behavior; negative = remove an aversive stimulus to increase a behavior.

For borderline PD/self-harm; four modules: mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness.

Acceptance and commitment therapy; builds psychological flexibility through values-based action and defusion.

Explores unconscious conflicts; works with transference and countertransference.

The patient projects feelings about past figures onto the therapist.

The therapist's emotional reactions toward the patient.

Unconscious coping: denial, projection, displacement, sublimation, regression, reaction formation.

Precontemplation → contemplation → preparation → action → maintenance ($\pm$ relapse).

Consciousness-raising in precontemplation; commitment/planning in preparation; relapse prevention in maintenance.

Unfreeze → change → refreeze.

Trust vs Mistrust (infancy, 0–18 months).

Autonomy vs Shame/Doubt (toddler, 1–3 years).

Initiative vs Guilt (preschool, 3–6 years).

Industry vs Inferiority (school-age, 6–12 years).

Identity vs Role Confusion (adolescence, 12–18 years).

Intimacy vs Isolation (young adulthood).

Generativity vs Stagnation (middle adulthood).

Integrity vs Despair (late adulthood).

Sensorimotor (0–2), preoperational (2–7), concrete operational (7–11), formal operational (11+).

Develops in Piaget's sensorimotor stage.

Preconventional, conventional, and postconventional moral reasoning.

Secure, anxious-ambivalent, avoidant, and disorganized attachment styles.

Process by which the infant develops a sense of self separate from the caregiver.

Focuses on family organization, boundaries, subsystems, and hierarchy.

Differentiation of self, triangulation, and multigenerational transmission.

Externalize the problem; re-author the patient's life story.

The collaborative bond; the strongest predictor of psychotherapy outcome.

The therapeutic alliance.

Safety; Trustworthiness/Transparency; Peer support; Collaboration/Mutuality; Empowerment/Voice/Choice; Cultural/Historical/Gender issues.

Realize, Recognize, Respond, Resist re-traumatization.

Professional limits that protect the therapeutic relationship; crossings vs violations.

Capacity, disclosure of information, understanding, and voluntariness.

Capacity = a clinical, decision-specific determination by a provider; competency = a legal determination by a court.

Communicate a choice, understand the information, appreciate the situation/consequences, and reason about the options.

Competent patients may refuse, even life-sustaining treatment (with exceptions such as emergencies or court orders).

Protects PHI; permits use/disclosure for treatment, payment, and operations without authorization.

Stricter than HIPAA; protects substance-use-disorder treatment records.

Clinician duty to protect identifiable third parties from a patient's serious threat (warn, notify police, hospitalize).

Duty to warn/protect, mandatory abuse reporting, danger to self/others, and a court order.

Child abuse, elder abuse, and dependent-adult abuse must be reported.

Varies by state; many allow minors to consent for SUD, mental-health, reproductive, or STI care.

Respect for the patient's right to self-determination.

Acting in the patient's best interest.

'Do no harm.'

Fair, equitable distribution of care and resources.

Danger to self, danger to others, or grave disability (unable to meet basic needs).

Voluntary = the patient consents and may request discharge; involuntary = legally mandated based on commitment criteria.

Use the least restrictive intervention that ensures safety.

A short-term involuntary hold (commonly ~72 hours) for evaluation when criteria are met.

A harmful breach of professional limits (e.g., a sexual or financial relationship with a patient).

Assessment, diagnosis, outcomes identification, planning, implementation, and evaluation.

Structured questions that assess the cultural context of a patient's presentation.

Housing, income, education, discrimination, and access — drivers of mental-health disparities.

Respectful, identity-validating care for LGBTQ+ patients (correct names/pronouns; nonjudgmental).

Educational accommodations; IDEA provides IEPs for eligible students with disabilities; 504 provides accommodations.

Prohibits disability discrimination and mandates reasonable workplace accommodations.

Up to 12 weeks of unpaid, job-protected leave for serious health conditions (including mental health).

A document stating treatment preferences for future psychiatric crises when capacity is lost.

Established the duty to protect identifiable victims.

A non-dangerous person capable of surviving safely in freedom cannot be confined.

Established a right to treatment for the involuntarily committed.

Established committed patients' right to refuse medication (with due process).