277. QUESTION 1 4 A 21-year-old male college student was brought to Student Health Services by his girlfriend who was concerned about changes in her boyfriends behaviors. The girlfriend says that recently he began hearing voices and believes everyone is out to get him. The student says he is unable to finish school because the voices told him he was not smart enough. The girlfriend relates episodes of unexpected rage and crying. Past medical history noncontributory but family history positive for a first cousin who had mental problems. Denies current drug abuse but states he smoked marijuana every day during his junior and senior years of high school. He admits to drinking heavily on weekends at various fraternity houses. Physical exam reveals thin, anxious disheveled male who, during conversations, stops talking, cocks his head and appears to be listening to something. There is poor eye contact and conversation is rambling. Based on the observed behaviors and information from girlfriend, the APRN believes the student has schizophrenia. Question 1 of 4: Describe the positive symptoms of schizophrenia and relate those symptoms to the case study patient. Question 2 of 4: Explain the genetics of schizophrenia. Question 3 of 4: The APRN reviews recent literature and reads that neurotransmitters are involved in the development of schizophrenia. What roles do neurotransmitters play in the development of schizophrenia? Question 4 of 4 The APRN reviews recent literature and reads that structural problems in the brain may be involved in the development of schizophrenia. Explain what structural abnormalities are seen in people with schizophrenia. QUESTION 1 6 A 34-year-old female was brought to the Urgent Care Center by her husband who is very concerned about the changes he has seen in his wife for the past 3 months. He states that his wife has had been depressed and irritable, has complaints of extreme fatigue, has lost 10 pounds and has had insomnia. He has come home from work to find his wife sitting in front of the TV and not moving for hours. In the past few days, she suddenly has become very hyperactive, has been talking incessantly, has been easily distracted and seems to flit from one thing to another.. She hasnt slept in 3 days. The wife went on an excessive shopping spree for new clothes that resulted in their credit card being denied for exceeding the line of credit. The wife is unable to sit in the exam room and is currently pacing the hallway muttering to herself and is reluctant to talk with or be examined the ARNP. Physical observation shows agitated movements, rapid fire speech, and hyperactivity. Based on the history and observable symptoms, the APRN suspects that the patient has bipolar type 2 disorder. The APRN refers the patient and husband to the Psychiatric Mental Health Nurse Practitioner for evaluation and treatment. Question 1 of 6: Discuss the role genetics plays in the development of bipolar 2 disorders. Question 2 of 6: Explain how the hypothalamic-pituitary-adrenal (HPA) system may be associated with bipolar type 2 disease. Question 3 of 6: Discuss the role inflammatory cytokines play in the development and exacerbation of bipolar type 2 symptoms Question 4 of 6: Discuss the role of the amygdala in bipolar disorder. Question 5 of 6: How does neurochemical dysregulation contribute to bipolar disorders? Question 6 of 6: What is the current status of the use of nutraceuticals in management of depression? QUESTION 1 2 A 27-year-old female presents to the Emergency Room, with a chief complaint of palpitations, rapid heart rate, sweating, tremors, and inability to catch her breath. The symptoms started about 10 hour ago and have gotten worse. She states she has some chest pain that remains constant no matter what. She also has numbness and tingling around her mouth and lips. She says she knows something terrible is going to happen. She denies having any similar episode in the past. Past medical history noncontributory. Social history significant for recent stressor of applying for medical school and taking the Medical College Admission Test (MCAT). She had not received the results prior to the episode but is sure that the failed the test. Says she doesnt know if anyone else in her family has had similar episodes. Physical exam reveals a thin, anxious appearing female who is profusely sweating despite cool ambient air temperature. BP 176/88, Pulse 136, and respirations 26. Electrocardiogram negative for evidence of myocardial infarction and all lab data within normal limits except for mild respiratory alkalosis. The patients symptoms are subsiding and the patient states she is feeling better. The APRN suspects the patient has just experienced a panic attack. Question 1 of 2: What are panicogens and how do they contribute to the development of panic attack symptoms? Question 2 of 2: How does the GABA-benzodiazepine (BZ) receptor systems contribute to panic attacks/disorders? QUESTION 1 2 A 21-year-old female college junior makes an appointment to see the APRN in the Student Health Clinic. The student tells the APRN that it has gotten harder and harder for her to attend classes, especially her history class where the class is preparing for the semesters end presentations. She says she is terrified to speak to the class and is considering dropping the class so she will not have to present. She has a significant impairment in social activities and has resigned from her sorority. She is unable to go to the library to study as she feels everyone is looking at her and mocking her. She admits to having some of these symptoms in high school, but the guidance counselor was able to work with her to decrease some of her symptoms. Past medical history noncontributory except for the milder symptoms exhibited in high school. Family history noncontributory. Social history positive for anxiety related to social situations that has had a negative impact on both her scholarly and social endeavors. The APRN diagnoses the student with social anxiety disorder (SAD). Question 1 of 2: Describe the areas of the brain that are associated with social anxiety disorder. Question 2 of 2: How is oxytocin associated with SAD? QUESTION 1 2 A 36-year-old female comes to see the APRN in clinic with a chief complaint of Im so and I feel all keyed up all the time. She states she feels restless, keyed up, and on edge most of the time. She fatigues easily and has difficulty concentrating and says her mind goes blank. She admits to being irritable and snapping at her coworkers which she worries will affect her job. She says the symptoms have been present for about 8 or 9 months. and Increased muscle tension. She has had difficulty falling asleep or stay sleeping. Further questioning revealed that prior to her symptoms, her parents got divorced which has been a great stressor for her. Past medical history noncontributory. Social history positive for a case of nerves when she was in high school that seemed to resolve after she graduated from college. No drug or alcohol history. The APRN believes the patient has generalized anxiety disorder (GAD). Question 1 of 2: Discuss the role of neurotransmitters in the expression of GAD. Question 2 of 2: Explain the structural brain changes that occur in people with GAD. QUESTION 1 2 A 27-year-old man comes to the Veterans Administration Hospital at the insistence of his fiancée who accompanies him to the appointment. She tells the APRN that her fiancée has not been the same since he returned from his second tour in Iraq. He was an infantryman with a local Marine Reserve unit and served 2 tours and was honorably discharged. Since his return, he has had difficulty sleeping, and says he sleeps with one eye open and fears sleep. Deep sleep brings vivid nightmares. He grudgingly admits to having experienced several traumatic events during his second tour of duty. He is unwilling to discuss them and will not reveal specific details. He is short tempered and irritable and is afraid to be around people as he doesnt want to snap at people and alienate them. He startles easily at loud noises, especially the sounds of cars backfiring. He admits to thinking there are threats everywhere and spends an excessive amount of time searching for them but never finding any. He has intrusive memories almost every day and says he really isnt interested in doing much of anything. He is very worried that these symptoms are irreparably hurting his relationship with his fiancée who he loves very much. The APRN diagnoses him with post-traumatic stress disorder (PTSD). Question 1 of 2: Describe the changes seen in the brain structure in patients with PTSD. Question 2 of 2: Briefly discuss the role glucocorticoids may have on the development of PTSD. QUESTION 1 2 A 17-year-old male high school junior comes to the clinic to establish care. He recently moved from a relatively urban area to a very rural area and has just started his junior year in a new school. The mother states that she has noticed that her son has been frequently washing his hands and avoids contact with any dirty or soiled object. He uses paper towels or napkins over the knob on a door when opening it. According to the mother, this behavior has just appeared since moving. The patient, upon close questioning, admits that he is grossed out by some of the boys in the boys room since they use the toilet and do not wash their hand afterwards. He is worried about all the germs the boys are carrying around. Past medical history is noncontributory. Social history -lives with parents and 2 siblings in a house in a new town. Is an honors student. Based on these behaviors, The APRN thinks the patient has obsessive-compulsive disorder (OCD). Question 1 of 2: What is primary pathophysiology of OCD? Question 2 of 2: Describe the role the dorsal anterior cingulate cortex (dACC) has in reinforcement of obsessive behaviors.