PRITE

What response would be based on a purely laisonal model of psychosomatic medicine give for a pt who may be depressed?

ADVISE THE TEAM ON HOW TO PROPERLY DIAGNOSE DEPRESSION

What ethical principle provides the most appropriate basis for psychiatric intervention in a mentally incompetent patient? (5x)

BENEFICENCE

This cardiovascular disturbance is most common for Lithium

BENIGN T WAVE CHANGES.

Phenobarbital tolerance test is helpful in detox from what?

BENZODIAZEPINES

38 y/o taking imipramine 300mg qday for recurrent MDD. After 3 weeks, mood is improved, but has difficulty passing urine and mild erectile dysfunction. Appropriate action?

BETHANECHOL 25MG TID

A 79yr old man seeks therapy following stress due to uncontrolled online shopping, patient begins to understand how each purchase improved mood and improved loneliness, this best explains what learning theory?

OPERANT CONDITIONING

In biofeedback, the autonomic nervous system can come under voluntary control through which of following mechanisms?

OPERANT CONDITIONING

Learning from consequences of one's actions (2x)

OPERANT CONDITIONING

The most common complication of temporal arteritis is caused by occlusion of the: (2x)

OPHTHALMIC ARTERY

Wernicke's disease triad:

OPHTHALMOPLEGIA, ATAXIA, GLOBAL CONFUSION

Increased risk-taking behavior. Where is lesion?

ORBITOFRONTAL CORTEX

68 y/o pt is depressed following a hip surgery. Pt is withdrawn, looks blank, shows dysarthria, weakness, PMR, hyperreflexia, and has trouble swallowing. MRI of the head will show?

PERIVENTRICULAR WHITE MATTER DEMYELINATION

Unilateral foot drop with steppage gait indicates:

PERONEAL NERVE COMPRESSION

What symptom best differentiate chronic traumatic grief from uncomplicated bereavement?

PERSISTENT AVOIDANCE OF DEATH REMINDERS

According to Erikson, the predominant emotional issue in normal, school-aged children is: (2x)

PERSONAL WORTH AND COMPETENCE

Risk factor most predictive of a pt having emergent SI:

PERVASIVE INSOMNIA

What neuroimaging modality measures neuronal glucose metabolism

PET SCAN

In what FREUDIAN developmental period does a child see he/she is a child of his/her parents & that parents have a relationship to each other not solely related to their roles as parents?

PHALLIC

38 single F, having difficulty with the prospect of not having children. Tearful, contemplating adoption. What is the most likely diagnosis?

PHASE OF LIFE PROBLEM

30 y/o pt has been treated for unreasonable fear of eating in public places, feeling of embarrassment in public places, and anger over the possibility of being scrutinized. Pt has not responded to high doses of paroxetine, citalopram, buspirone, and alprazolam, each of them administered for 4-6 wks. Which meds would be appropriate for next?

PHENELZINE

Treatment for patients with MAOI related hypertensive crisis in the ER may involve the administration of which of the following meds?

PHENTOLAMINE

An overweight sedentary pt wants to exercise to prevent cognitive loss

PHYSICAL ACTIVITY AIDS COGNITIVE FUNCTION IN LATER LIFE

Naltrexone prevents relapse of opioid dependency most effectively in which group?

PHYSICIANS

After OD, pt has fever, confusion, tachycardia, dry mouth, urinary retention, dilated and unresponsive pupils. Which medication would treat this? (Anticholinergic toxicity)

PHYSOSTIGMINE

Abnormal elevated metabolic findings associated with increased risk of stroke in patients under 50

PLASMA HOMOCYSTEINE

39 y/o pt with hx of multiple miscarriages develops an acute left sided hemiparesis. Work up reveals elevated anticardiolipin titers and no other risk factors for stroke. Appropriate intervention at this point is?

PLASMAPHERESIS

Two 4-yr olds playing, one makes loud noise, the other does not want to play any more. Why?

PLAY PRODUCED EXCESSIVE ANXIETY FOR CHILD

According to Kohlberg, moral judgment made by older school-age children are based largely on which of the following?

PLEASING THOSE IN AUTHORITY

Small insertions, deletions, or duplications w/in DNA molecule are called

POINT MUTATIONS

Which is a characteristic of polysomnography for pts with REM sleep behavior d/o?

POLYSOMNOGRAPHY NOTABLE FOR REM SLEEP W/O ATONIA

Which drug for the tx of Parkinson's disease is associated with new onset of pathological gambling, increased libido, and hypersexuality: (3x)

PRAMIPEXOLE

Pt with flashbacks, nightmares, and insomnia as a result of sexual trauma is improving slightly with Zoloft but still having nightmares, next step in mgmt.?

PRAZOSIN

Ask a child, "What makes a train go?" He replies, "The smoke makes it go." This is what kind of thinking?

PRE-OPERATIONAL THINKING

Child engaged with imaginative play with therapist, states doll house on fire, therapist pretends to call 911, child says it's not actually a fire it's just pretend, what transition in Piaget's model of cognitive development is this child demonstrating?

PRE-OPERATIONAL TO CONCRETE OPERATIONAL STAGE

68yo with dull R-sided non-throbbing HA's worse at night and with prolonged chewing. Best initial tx?

PREDNISONE

Unlike adults with bipolar disorder, prepubertal children with bipolar disorder are believed to have:

PREDOMINANTLY CHRONIC MIXED MANIC STATES

More likely to be the focus of Interpersonal Psychotherapy

ROLE TRANSITIONS

Culture-bound syndrome in Caribbean and states bordering Gulf of Mexico - anxiety, GI distress, weakness, fear of being poisoned, attributed to witchcraft

ROOTWORK

Which drug for the tx of Parkinsonism has been associated with sudden sleep attacks? (2x)

ROPINIROLE

PTSD. what predicts best long-term outcome?

Rapid onset of symptoms

Cognitive error: when asked about his day, pt replies, "I was late for work b/c I misplaced my keys" then, "I didn't speak up in the staff mtg."

SELECTIVE ABSTRACTION

Most common form of sequence variation in the genome?

SINGLE NUCLEOTIDE POLYMORPHISMS

Which of the following effects is the basis for dantrolene's efficacy in the treatment of neuroleptic malignant syndrome (aka nms)?

SKELETAL MUSCLE RELAXANT

Complication of heavy EtOH likely to persist beyond first week of withdrawal?

SLEEP FRAGMENTATION

A pt presents with a hx of irresistible episodic sleepiness that is accompanied by a vivid, dreamlike state at the onset of an episode. Which of the following additional sleep symptoms are likely to be present?

SLEEP PARALYSIS

Melatonin agonists are useful in treating which type of sleep disorder?

SLEEP PHASE DELAY

Physical finding associated with hypothyroidism:

SLOW RELAXATION OF DEEP TENDON REFLEXES

2 y/o clings to mother when introduced to a new child, refusing to join in play during 1st visit. On 2nd visit, child plays behind mother, and on 3rd visit, she seems to continue her usual activities while warily eyeing the new child. What temperamental traits or constellations best describes this child's behavior? (2x)

SLOW-TO-WARM-UP

57 y/o office worker w numbness in 4th/5th digit of right hand, which wakes patient in middle of night. Nerve conduction study finding most likely to explain syndrome?

SLOWED CONDUCTION VELOCITY ACROSS THE ELBOW IN THE ULNAR NERVE

75yo M getting into several car accidents. Good physical health, no disease, no meds. Most likely cause of motor vehicle accidents?

SLOWER VISUAL PROCESSING

75 y/o pt has developed tolerance to clonazepam over many years, now taking 5mg clonazepam at night but still with poor sleep. Pt denies any mood or anxiety symptoms, no drug problems. Next step

SLOWLY WITHDRAW THE PT'S CLONAZEPAM AND REEVALUATE

Using cash only due to substantial discomfort while writing checks or signing credit card receipts in the presence of others (because of messy handwriting)?

SOCIAL ANXIETY DISORDER

Imitating one's valued mentor while performing psychotherapy is an example of what type of learning?

SOCIAL LEARNING

At a minimum, state physician health programs provide which services to impaired physician?

STRUCTURED MONITORING PROGRAM

Couple has sought couples' therapy due to chronic episodic fighting. Solution focused therapist might make which intervention?

BETWEEN NOW & NEXT TIME, I WANT EACH OF YOU TO THINK ABOUT WHAT THE TWO OF YOU ARE DOING DIFFERENTLY IN TIMES OF NOT ARGUING

FDA requires that generics not be significantly different from the parent compounds in what way?

BIOEQUIVALENCE

The FDA requires that pharmaceutical companies demonstrate that a generic drug is not significantly different from the parent compound in which way?

BIOEQUIVALENCE

The first-line treatment for retentive encopresis:

BIOFEEDBACK

Male and female prevalence rates are comparable for which of the following disorders?

BIPOLAR DISORDER

Which group children are at greatest risk for death resulting from child abuse?

BIRTH TO 3 Y/O OLD

5 y/o cannot maintain eyes open, attempts to look at person/object results in tonic eyelid closure. Can watch television w/o difficulty. Extraocular movements NML. Dx?

BLEPHAROSPASM

What causes the cardiac toxicity of imipramine in overdose?

BLOCKADE OF VOLTAGE-GATED SODIUM CHANNELS

When practicing Davanloo's short-term dynamic psychotx, one must consistently...

CLARIFY AND RELENTLESSLY CONFRONT THE PT'S DEFENSES

One controversy about pediatric bipolar disorder is whether severe irritability and emotional dysregulation are predictive of

CLASSIC BIPOLAR DISORDER IN ADULTHOOD

Learned helplessness is based on principles of:

CLASSICAL CONDITIONING

Pt with cocaine addiction experiences cravings for cocaine whenever passing by a "crack house". This reaction exemplifies

CLASSICAL CONDITIONING

Systematic desensitization is derived from this theory

CLASSICAL CONDITIONING THEORY

What standard of proof applies to civil involuntary psych commitment?

CLEAR AND CONVINCING EVIDENCE

When testifying in court on behalf of pt, Doctor can comment on which of the following topics?

CLINICAL PRESENTATION

Elderly pt with profound apathy, how do you distinguish depression from executive dysfunction?

CLOCK DRAWING

Which medication is most effective in the treatment of cataplexy?

CLOMIPRAMINE (TCAs 2/2 TO INC NE)

Breakthrough panic anxiety in a patient treated with short-acting benzodiazepines can be managed by switching the pt to what medication?

CLONAZEPAM

Most effective treatment for REM sleep behavior disorders.

CLONAZEPAM

These empirical non-stimulant meds have empirical support to treat ADHD:

CLONIDINE, BUPROPION, IMIPRAMINE, ATOMOXETINE

Which antipsychotic has least effect on prolactin?

CLOZAPINE

Which antipsychotic is associated w/decreased psychotic symptoms, decreased substance use, and increased abstinence in schizophrenics and addicts?

CLOZAPINE

Which antipsychotic med is associated with decreased psychotic sxs, decreased substance use, and increased abstinence in pts with schizophrenia and addictive d/o?

CLOZAPINE

The presence of which of the following would suggest that a patient has somatization disorder rather than a general medical condition?

COMPLAINTS INVOLVING MULTIPLE ORGAN SYSTEMS

Structural model of family therapy characterizes family as

COMPLEX SYSTEM COMPRISED OF ALLIANCES AND RIVALRIES

The purpose of asking a pt to start at 100 and count backwards by 7's is to measure which of the following?

CONCENTRATION

Which practice is common to all couple and family therapies and contributes to a therapeutic outcome?

CONCEPTUALIZING DIFFICULTIES IN RELATIONAL TERMS

What is the combination of several unconscious impulses, wishes, or feelings that are attached to a single dream image?

CONDENSATION

Which comorbid diagnosis of childhood ADHD worsens the prognosis into adolescence and adulthood to the greatest degree?

CONDUCT DISORDER

Fluent speech w preserved comprehension, inability to repeat statements is consistent with what type of aphasia?

CONDUCTION

Electrodiagnostic test finding most indicative of a demyelinating neuropathic process?

CONDUCTION BLOCK

Pt c/o hearing loss on right side. When tuning fork held at vertex of skull, pt hears sound better on the right. When fork is held in front of the pt's ears, pt reports hearing it better on the left. Dx?

CONDUCTIVE HEARING LOSS ON THE RIGHT

Risk factor that can adversely influence psych outcome of child after death of parent

CONFLICTUAL RELATIONSHIP W/ DECEASED PARENT

Experimental subjects were asked to make a judgment but gave a wrong answer in spite of knowing the right one because they didn't want to disagree with responses of other participants. This phenomenon is:

CONFORMITY

What medical condition has highest relative risk for adverse event with ECT?

CONGESTIVE HEART FAILURE

According to theories of infant socialization, successful attachment most likely promotes survival through which of the following?

CREATING A BOND SO THAT THE ADULT WILL PROTECT THE INFANT FROM DANGER

Psych MD in the ER evaluates a 27 y/o pt with no past psychiatric history who presents with SI following an altercation with her boyfriend. The psych MD makes a diagnosis of adjustment disorder with mixed emotional features. What is initially most appropriate for the psych MD to recommend for this pt?

CRISIS INTERVENTION

What factor is necessary to consider when deciding if a patient's grief is defined as normal or abnormal?

CROSS-CULTURAL GRIEF PRACTICES

52 y/o pt with EtOH dependence present with several days of severe headache, nausea, and low grade fever. Physical exam reveals mild disorientation, nuchal rigidity, and mild spasticity in the lower extremities. A head CT is unrevealing. LP: 55/mm3 leukocytes (mostly lymphocytes), 45 mg/dl glucose, protein: 43 mg/dl, and presence of occasional gram positive spherical cells. The most likely causative organism is?

CRYPTOCOCCUS NEOFORMANS

10 y/o IQ 69. Findings that would confirm Dx of MR?

DEFICITS IN SELF-CARE AND SOCIAL SKILLS

58 y/o have week's h/o intense feelings of sorrow and bitterness only 6 mos after wife's death. "We would have been married 30 yrs this month." His daughter confirmed his level of functioning only took a dip a week ago. Moderate diff sleeping and poor appetite only assoc Sxs. No SI. Physical exam normal. Dx:

DELAYED GRIEF

Alcoholic p/w 2 days confusion, AH/VH, disorientation, distractibility, with fever, tachycardia, and tremor. EEG shows low-voltage fast waves superimposed on slow waves. He is on long term olanzapine treatment for schizoaffective d/o. Dx?

DELIRIUM DUE TO ETOH WITHDRAWAL

21 y/o pt is hospitalized w/ 4 wk hx of progressive paranoia, irritability, confusion and sleep disturbance. Psych MD elicits pt hx of viral illness preceding the onset of psychiatric Sx and mental status changes. No family psych hx. Benadryl markedly made Sx worse. Dx:

DELIRIUM SECONDARY TO VIRAL ENCEPHALITIS

Normal male, except that he is paranoid about wife cheating on him:

DELUSIONAL D/O

This is a relative contraindication for interferon treatment in pt's with Hepatitis C

DEPRESSION WITH SUICIDAL IDEATION

Longitudinal studies has showed that obesity in later childhood, adol and adulthood can be predicted most commonly by presence of which psychiatric d/o in childhood and adol? (2x)

DEPRESSIVE

The presence of adverse life events has been associated with precipitation of which of the following aspects of bipolar disorder?

DEPRESSIVE EPISODE

Phase of child development *Melanie Klein* where they are able to integrate good & bad elements of caregiver into one unified 'object'

DEPRESSIVE POSITION

Immigrants to US experience stress & demoralization most during which period?

DURING FIRST 1-3YR IN COUNTRY

A patient requests an alternative tx for depression. His psychiatrist does not practice this tx himself but refers the pt to one who does. In 6mo the pt has complications from the tx and sues the 1st psychiatrist for malpractice. Which element of malpractice is missing in this case?

DUTY

After a pt assaults a roommate on a psych inpt unit the tx team decides to have pt arrested and transferred to jail. Decision is based on ...?

DUTY TO OTHER HOSPITALIZED PTS

What psychodynamic theory emphasizes need to receive empathy from parents or important figures in order to develop a sense of self-worth?

EGO-PSYCHOLOGY

Monitor TCA overdose using which test

EKG

Cardiac effects of lithium resemble what on

EKG HYPOKALEMIA (LOW T WAVES)

Which of the following surgical procedures can be used in the treatment of epilepsy refractory to meds? (2x)

ELECTRICAL STIMULATION OF THE VAGUS NERVE

Medical specialty with highest rate of substance use d/o:

EMERGENCY MEDICINE

16 y/o says she think she may be pregnant but does not want to involve her parents. What should guide the psychiatrist's actions?

THE PATIENT'S ABILITY TO GIVE CONSENT WILL VARY FROM STATE TO STATE TO STATE

Retinal pigmentation from long-term Tx with

THIORIDAZINE

What sx leads to focused attention, altered consciousness usually seen in pts w dissociative d/o (2x)

TRANCE

A set of feelings that a patient reenacts in the therapeutic relationship are called:

TRANSFERENCE

Pt reenacts therapeutic relationship

TRANSFERENCE

A 61 yo with memory problems that started about 2hrs prior to ED presentation, unable to remember recent events, anxious and frustrated. Dx?

TRANSIENT GLOBAL AMNESIA

What condition is a forerunner of MS-not INO (2x)

TRANSVERSE MYELITIS

When interpreting IQ tests, what indicates a need for further assessment?

VERBAL SCORE SIGNIFICANTLY HIGHER THAN NONVERBAL SCORE

Chiropractic adjustments are a known precipitant for which of the following acute conditions? (2x)

VERTEBRAL ARTERY DISSECTION

Most specific test for assessing executive functioning?

WISCONSIN CARD SORTING TEST (WCST)

On what test would perseverative error be considered a specific outcome of clinical relevance?

WISCONSIN CARD SORTING TEST (WCST)

What test would be considered most useful to specifically evaluate concept formation, reasoning, and executive functioning?

WISCONSIN CARD SORTING TEST (WCST)

Normal bereavement in prepubertal children

WISH TO UNITE W/ DEAD LOVED ONE

Test more specific to identify specific learning disability in child w/ full scale IQ of 93 on WISC-III

WOODCOCK-JOHNSON PSYCHO- EDUCATIONAL BATTERY - REVISED

Pt w/ schizophrenia has recently been discharged from the hospital after a first psychotic episode. Family oriented therapy goals should include?

EDUCATING THE FAMILY ABOUT THE PATIENT'S ILLNESS AND PROVIDING SUPPORT FOR IMMEDIATE PROBLEMS

What test is most helpful to distinguish dementia vs delirium

EEG

The best response to a pt who reports a fixed false belief that his neighbor is poisoning his dog and sitting all day at the window monitoring is

EMPATHIZE WITH THE PT, BUT AVOID DIRECT CONFRONTATION ABOUT THE DELUSION

Two most powerful predictors of outcome in any form of psychotherapy are

EMPATHY AND THERAPEUTIC ALLIANCE

In overcoming the resistance to treatment often encountered with patients who have anorexia nervosa, what is most useful for the psychiatrist to emphasize?

EMPHASIZE HOW TREATMENT WILL ALLOW THE PATIENT TO FOCUS ENERGY ON OTHER MATTERS

Pt presents with personality changes, cognitive difficulties, affective lability, and olfactory and gustatory hallucinations. The most likely medical cause of this presentation is: (2x)

HERPES SIMPLEX VIRUS (HSV) INFECTION

Gelastic seizures are at which brain foci?

HYPOTHALAMUS. (Gelastic seizures are characterized by fits of uncontrollable laughing or crying. They are most often associated with hypothalamic hamartomas, benign collections of neurons and glia.)

BMD II with rapid cycling have higher prevalence of what endocrinologic dysfunction?

HYPOTHYROIDISM

According to Erikson, a child who strives to be competent by learning new skills and taking pride in the results is in which stage? (Also correlated with the Freudian stage of latency) (3x)

INDUSTRY VS INFERIORITY

A preschooler presents to psychiatrist after being placed on psychotropic med by a PCP. Parents note that since med was started, child has shown irritability, skin picking, decreased appetite, social withdrawal, insomnia. Which med is child taking?

DEXTROAMPHETAMINE

Child w ADHD ineffective Tx with methylphenidate. Next step in management: (4x)

DEXTROAMPHETAMINE

Orbital pain with L eye paralysis of adduction and elevation of the eye but normal pupil function. Dx?

DIABETIC 3RD NERVE PALSY

Which is an advantage for CT head vs MRI?

DIAGNOSING ACUTE EPIDURAL HEMORRHAGE

Due to its rate of oral absorption, which benzo most enhances the euphoria produced by benzodiazepines when used with methadone?

DIAZEPAM

Which benzo accumulates with repeated administration, should be avoided in chronic renal failure, and most likely to accumulate with repeated dosing?

DIAZEPAM

Stage of group development where members testing norms, competing w/ each other, seeking autonomy

DIFFERENTIATION

Business executive hospitalized for bleeding ulcer repeatedly argues with a well-liked head nurse and threatens to leave AMA. Best action for psychiatrist is: (2x)

LISTEN TO PT'S COMPLAINTS ACKNOWLEDGE HIS DISCOMFORT WITH THE PASSIVE POSITION THAT HE IS UNACCUSTOMED TO

28yo homosexual M reports being victim of domestic violence and has not reported. What is the best response for the psychiatrist to make?

LISTEN TO PT'S CONCERNS AND EXPLORE THEM

In addition to antipsychotics what is the most effective augmentation tx in depression

LITHIUM

Somatic sx/complaint, negative medical workup, negative psych eval. Next step?

LOOK AGAIN FOR ORGANIC ETIOLOGY

A nurse w/ 24 hr hx of anxiety and insomnia has a generalized tonic-clonic seizure. Dx?

LORAZEPAM WITHDRAWAL

Which commonly precipitates suicide in the elderly?

LOSS FIREARMS

Which finding would you expect if someone is diagnosed with ulnar neuropathy at the elbow?

LOSS OF SENSATION IN THE FOURTH AND FIFTH DIGIT AND WEAKNESS OF INTRINSIC HAND MUSCLES

Findings supporting ulnar neuropathy at elbow?

LOSS OF SENSATION OF 4/5TH DIGIT AND WEAKNESS OF INTRINSIC HAND MUSCLES

What is a limitation of an epidemiologic cohort study?

LOSS TO FOLLOW-UP

Intimate partner violence is most common in which of the following demographics?

LOW INCOME FAMILIES

Pt taking phenelzine is treated in ED for chest pain. While treated, pt develops hyperreflexia, HTN, goes into coma. Which med is most likely cause?

MEPERIDINE (DEMEROL)

DM pt with creeping paresthesias and burning pain in L anterolateral thigh. DTRs normal, no weakness. Dx?

MERALGIA PARESTHETICA

Multifocal myoclonus in a comatose patient indicates: (2x)

METABOLIC ENCEPHALOPATHY

When compared to younger adults, anxiety disorders in adults over age 65 have less of what comorbid condition:

LESS COMORBIDITY WITH ALCOHOL ABUSE

What is the advantage of buprenorphine compared to methadone taper in detoxification from opiate dependence?

LESS RISK OF RESPIRATORY SUPPRESSION

Pt is taking MMPI-2 intentionally endorses items that reflect social desirability. Which scales to catch this pattern of item endorsement?

LIE SCALE

What is the 5HT3 receptor classification?

LIGAND GATED

35 year old woman reports history of recurrent depression always beginning in fall/early winter and remit by spring. She is trying to become pregnant, what's best tx?

LIGHT THERAPY

40 y/o eats and sleeps too much, craves sweets, poor concentration, irritable, constant conflicts with husband. States "I always feel better in spring." What is the treatment?

LIGHT THERAPY

Final phase of Mahler's separation — ability to maintain positive emotional attachment in face of frustration

OBJECT CONSTANCY

paranoid personality d/o: developmental failure to achieve

OBJECT CONSTANCY

Which condition is least likely to respond to hypnosis?

OCD

Finish "epidemic" with clozapine in 1975

agranulocytosis

What event assoc. w/ highest rates of PTSD

experiencing sexual violence

52 y.o. With delirium - eeg

generalized theta and delta activity (slowing)

Piaget's major contribution to development theory explain...

how individuals learn about and understand the world

barrier to widespread use of telepsychiatry

physician dissatisfaction

what can decrease Li levels

caffeine

10 y/o child with 2-month h/o irritability, inattention, sleep disturbance, and withdrawal. Child attempted to run in front of a car. No family h/o psychiatric d/o. On examination, no eye contact and has psychomotor agitation. What med?

SSRI

Which genetic abnormality presents with marcroorchidism, intellectual disability, and frequent hand flapping in teenager?

Trinuclotide repeat in FMR1 gene

What characteristic is associated with better adaptation in individuals >65?

UNCRITICAL ACCEPTANCE OF IDEAS

8 yr old with mild intellectual disability likely to have difficult with?

UNDERSTANDING SOCIAL CUES OF PEERS

Research on the use of psychostimulants to treat pts w/ secondary depressive symptoms in medical setting suggest

WHEN TREATED WITH THESE AGENTS, PT MAY ENGAGE IN REHABILITATION SOONER

The most relevant issue for a geriatric or forensic psychiatrist in cases where the finances of an elderly are in dispute between partner and children is:

WHETHER THE ELDERLY HAS A MENTAL DISORDER AND WHETHER IT IS ADEQUATELY TREATED

Which cancer treatment may be followed by a subcortical dementia due to a leukoencephalopathy with onset after 6 months post-treatment?

WHOLE BRAIN RADIATION

In documenting suicide risk-assessment, key risk management strategy is to discuss what factor?

WHY THE PSYCHIATRIST REJECTED ALTERNATIVE WAYS OF RESPONDING

When documenting suicide risk assessment, key strategy is to discuss ...

WHY THE PSYCHIATRIST REJECTED ALTERNATIVE WAYS OF RESPONDING

What would be a useful screening test to evaluate an 8 y/o child's academic performance?

WIDE RANGE ACHIEVEMENT TEST (WRAT)

Medical resident consults psychiatry because a 38 y/o F pt refused dialysis secondary to "antisocial personality" and the resident wants you to convince her to stay for treatment. Your answer is:

WILL ASSESS PT'S COMPETENCY TO MAKE ONE'S OWN MEDICAL DECISION

Which developmental syndrome results from deletion that spans a number of genes

WILLIAMS

75 y/o pt presents with symptoms of dementia. Especially poor performance on which neuropsychological tests might suggest a Dx of vascular dementia rather than Alzheimer's dementia?

WISCONSIN CARD SORTING TEST (WCST)

Patient with moderately severe dementia enrolled in a study. Proxy consent obtained from patient's spouse. Patient wishes to withdraw from study due to nausea, but spouse wants to continue. What do you do?

WITHDRAW THE PATIENT FROM THE STUDY BECAUSE NOT DOING SO BREACHES HIS AUTONOMY.

In normal aging, last cognitive abilities to decline

WORD KNOWLEDGE

Which is important when working w/ family members who are caregivers to pts w/dementia?

WORK W/ FAMILY SHOULD ENHANCE EFFECTIVENESS OF CARE TO PT

Dorsal-lateral-pre-frontal cortex plays important role in what activity?

WORKING MEMORY

An important technique in supportive therapy is...

WORKING PRIMARILY IN THE PRESENT

In psychodynamic tx, interpretation of transference & resistance until insight fully integrated is called

WORKING THROUGH

Menninger's triangle of insight provides a framework for identifying links between the patient's current interpersonal relationships, early-life interactions with family members or other important caregivers, and the transferential relationship with the therapist. What is this process?

WORKING THROUGH

In pt with MDD and social phobia the IPT targets social isolation by

WORKING WITH THE PT TO HELP INCREASE SOCIAL CONTACTS, STRENGTHEN THE CURRENT RELATIONSHIPS.

What is the legal process that asks the court to immediately evaluate if a pt has been hospitalized w/o due process of law? (2x)

WRIT OF HABEAS CORPUS

A resident is discharging a patient and notes a significant omission in the resident's last, handwritten progress note. Which of the following is the best course of action?

WRITE AN ADDENDUM TO THE PROGRESS NOTE WITH THE CURRENT DATE

Pt with HTN develops painless vision loss in the left eye. Exam: blindness in L eye and afferent pupillary defect on the left. MRI: several T2 hyperintensities in the white matter periventricularly. No corpus callosum lesions. No enhancement with gadolinium. Dx?

ISCHEMIC OPTIC NEUROPATHY

Obsessive-compulsive symptoms are characterized by which defense mechanism?

ISOLATION AND UNDOING

The mood disturbance of PMDD is characterized by ...

IT CAN BE AS SEVERE AS IN MDD

Schizophrenia with onset in childhood is different from adult-onset because...

IT IS MORE LIKELY TO HAVE A GRADUAL ONSET

[2 antibodies] Severe spasms and rigidity of limbs intermittently and later more persistent/continuous, ANTIGLUTAMIC AND ANTIDECARBOXYLASE ANTIBODIES [Identical] 100. 20 y/o occasional double vision when looking to R and normal acuity in each eye alone. L ptosis and difficulty keeping L eye adducted. Pupils round and reactive. Speech nasal and neck flexors weak. No paresis or reflex abnormalities in extremities. Dx?

MYASTHENIA GRAVIS

The development of full postural control in children by 4 yrs old correlates neuroanatomically with the developmental maturity of what?

MYELINATION OF CEREBELLAR FIBERS

Term for sudden, irrepressible shock-like contraction of a muscle triggered by an event in CNS?

MYOCLONUS

Abundant hyperpigmentation spots present at birth with cutaneous and subcutaneous tumors appearing during early and late childhood and hamartomas of the iris are diagnostic of a mutation in which gene?

NF-1 (NEUROFIBROMATOSIS-I GENE)

Most commonly abused substance among patients with schizophrenia? (2x)

NICOTINE

28 y/o pt wants to stop smoking with the help of a nicotine replacement product. Pt plans to have orthodontia within the next 2 months has psoriasis and has multiple environmental allergies that often cause nasal stuffiness, sore throats, and itchy, watery eyes. Nicotine replacement best?

NICOTINE LOZENGES

Patient with long history of treatment resistant depression on phenelzine complaining of sweating, palpitations, and headache. BP = 210/118. Recently took OTC medicine to treat URI. What is the most appropriate intervention?

NIFEDIPINE

Pt taking tranylcypromine for atypical depression called Psych MD, reports HA, vomiting, chills, palpitations over one day. Pt asks if he continue med during illness. In addition to directing pt to stop med, emergent Tx would 1st include what med?

NIFEDIPINE

Which of the following is more common in patients experiencing a first episode psychotic depression at old age compared to younger age?

NIHILISTIC DELUSIONS

According to both strategic and structural family therapies, which of the following is the underlying basis for analysis of symptoms and dysfunction in children, parents, and families?

OBSERVABLE AND REPORTED FAMILY BEHAVIOR SEQUENCES

According to strategic and structural family therapies - underlying basis for analysis of symptoms in children, parents, and families

OBSERVABLE AND REPORTED FAMILY BEHAVIOR SEQUENCES

What is NOT likely to be an effective intervention for a physician with a substance abuse problem? (2x)

OBSERVING THE PATIENT UNTIL HE/SHE BECOMES MOTIVATED TO SEEK TREATMENT

What is an important technique of structural family therapy?

OBSERVING THE RELATIVE INFLUENCE OF EACH FAMILY MEMBER ON THE OUTCOME OF AN ACTIVITY

What symptoms are most commonly associated with Tourette's syndrome?

OBSESSIONS AND COMPULSIONS

20 y/o M with poor performance in college, before was very good student except for not being able to finish assigned projects at college. Classmates have described bizarre behavior, such as counting loudly or repeating words silently. He does not want to follow others' rules but his own, he believes nobody understands him and are against him.

OBSESSIVE COMPULSIVE PERSONALITY DISORDER

Pt prominently uses the defenses of isolation of affect & intellectualization. Description of life events appears to involve reaction formation. What personality trait is most likely to characterize this pt? (2x)

OBSESSIVE-COMPULSIVE

Bipolar pt on lithium and Zoloft for 3 yrs. Level 0.8. More depressed and fatigued, low energy level. Increasing Zoloft ineffective. Next step

OBTAIN TSH LEVEL

Most clearly predictive of alcohol abstinence for alcoholics who attend AA meeting:

OBTAINING A SPONSOR

Memory loss pattern in dissociative amnesia

OCCURS FOR A DISCRETE PERIOD OF TIME

Learning triangular relationships is what developmental stage-freud (NOT CLASSIC FREUDIAN STAGE)

OEDIPAL STAGE

In some Japanese and Korean cultures, rather than an intense fear of embarrassing oneself socially, social phobia symptoms may instead manifest with intense fear of what?

OFFENDING OTHERS

In pts with pronounced defects in recent memory, remote memory is:

OFTEN DEFICIENT ON CLOSE EXAMINATION EVEN WHEN IT SEEMS WELL PRESERVED

Heavy smoking will likely affect the dosing of which of the following medications?

OLANZAPINE

The concept of the identified patient in therapy refers to

ONE FAMILY MEMBER WHO HAS BEEN LABELED THE PROBLEM BY THE FAMILY

What factor is associated with a better long-term prognosis in pts w schizophrenia?

ONSET AFTER 35 YEARS OF AGE

What the mechanism of biofeedback?

OPERANT CONDITIONING

Most ethical action when psychiatrist receives subpoena for records pertaining to patient arrested for selling marijuana

OPPOSE SUBPOENA DUE TO LACK OF PT CONSENT

Child argues with mom, is angry and rude. Has no trouble at school and completes schoolwork. Dx? (2x)

OPPOSITIONAL DEFIANT DISORDER

25 y/o F with L eye pain which increases with moving the eye. Diminished acuity in L eye, pupils constrict well with light on R eye, but only constrict weakly with light on L eye. Dx?

OPTIC NEURITIS

The most common possible cause of a posterior cerebral artery infarct in 36 y/o F with hx of migraine (2x)

ORAL CONTRACEPTIVES

Which med has *secondary prevention* against embolic stroke in pts with A-fib?

ORAL WARFARIN

5 y/o presents w/ sudden onset of slurred speech and gait difficulty. Exam shows truncal ataxia and nystagmus, mild dysarthria and extensor plantar responses. Recent h/o measles. MRI, UA, blood work unremarkable. Dx?

ACUTE CEREBELLITIS

Intensive, short-term dynamic psychotherapy is contraindicated for what condition?

ACUTE EXACERBATION OF CHRONIC SCHIZOPHRENIA

Pt recovering from surgery of an intracranial hemorrhage 2/2 arterial aneurysm, develops a sudden onset of headache, vomiting and progressive decline of consciousness. Pupils are miotic, and abducens muscles are weak bilaterally. Etiology:

ACUTE HYDROCEPHALUS

Progressive weakness over several days - absent reflexes worse in lower extremities - slow conduction velocity, conduction block A 54-year-old patient had a viral upper respiratory infection 2 weeks ago and now presents with a 3-day episode of progressive, symmetric weakness in the legs, and tingling in the toes and fingers. On exam, Achilles and patellar deep tendon reflexes are diminished. Nerve conduction studies demonstrate decreased conduction velocity and decreased amplitude of action potentials. The most likely Dx: (4x)

ACUTE INFLAMMATORY DEMYELINATING POLYNEUROPATHY

Weakness in limbs 2 weeks after a viral gastroenteritis. Weakness in UE/LE, absent DTRs. Spinal fluid shows no cells and elevated protein. EMG shows slow conduction velocity, prolonged distal motor latency, and conduction block. (2x)

ACUTE INFLAMMATORY POLYNEUROPATHY

Primary characteristic of Wernicke encephalopathy

ACUTE ONSET

Psych MD was consulted for anxiety and depression. Pt reports severe pain and indicates that doctors refuse to prescribe enough medication to control pain. A factor important for psychiatrist to consider:

ACUTE PAIN IS OFTEN UNDERTREATED, AND POOR PAIN MANAGEMENT CAN CONTRIBUTE TO ANXIETY AND DEPRESSION.

Pt c/o progressive weakness of several days. Exam + for generalized weakness and absent reflexes. Nerve conduction studies show slowing of velocities. Dx? (2x)

ACUTE POLYNEUROPATHY

28 y/o with acute urinary incontinence and unsteady gait. Also reports 1 week h/o numbness progressing from both feet up to abdomen. Light touch, temperature, and pinprick are reduced below the midthoracic region. Vibration and position sensation in both feet are absent. Muscle bulk and tone are normal. Strength in BLE are reduced, R>L. Brisk DTRs in BLE with + Babinski's. What's the Dx?

ACUTE TRANSVERSE MYELITIS

A young pt w/ a few days of progressive weakness and numbness of both legs and feet after recovering from a flu-like illness. Exam: weakness and loss of sensation to all sensory modalities below the middle of the thorax. DTR: brisker on the lower extremities, plantar reflexes are extensor. Pt has had several episodes of urinary incontinence. Other neuro exam and vital: normal. LP: 23 mononuclear cells, protein level: 37mg/dl, and normal glucose. Dx:

ACUTE TRANSVERSE MYELITIS

Young pt recovering from flu-like illness w/ progressive weakness and numbness of legs and feet. Weakness and numbness below middle of thorax. Increased LE DTR's, extensor plantar reflexes. Urinary incontinence. LP 23 mononuclear cells, protein level 37, nml glucose

ACUTE TRANSVERSE MYELITIS

35 y/o pt p/w severe depression with episodes of anxiety for 9 months that have become so bad he can no longer leave the house. He has severe weight loss, hyperpigmentation of exposed skin, and cold tolerance. Dx?

ADDISON'S DISEASE

16 y/o boy treated as outpatient for Schizophrenia after recent inpatient first break. Parents concerned regarding anhedonia, withdrawn. No psychosis. What is the goal of outpatient eval? (2x)

ADDRESS PT'S FEELINGS OF DEPRESSION AND SCREEN FOR SI

Primary focus of a cognitive therapy approach to suicidal behavior

ADDRESSING ALL OR NOTHING BELIEFS AND HELPING PT LEARN PROBLEM SOLVING

Which is listed on President's New Freedom Commission on Mental Health (2003?) (2x)

ADDRESSING MENTAL HEALTH AS VIGOROUSLY AS PHYSICAL HEALTH

Caffeine results in dopaminergic activity, where?

ADENOSINE RECEPTOR

The effects of caffeine on which of the following results in increased dopaminergic activity?

ADENOSINE RECEPTOR

11 y/o with reading disability. Most likely comorbid dx:

ADHD

Failing grades, poor organization, spending sprees, spontaneous trips ditching class, fidgety, euthymic. No change in sleep, appetite, no anhedonia. Dx?

ADHD

20 y/o pt w/ acute onset belligerence, distortion of body image, depersonalization, and cloudy sensorium following ingestion of a street drug. Horizontal nystagmus, ataxia, and slurred speech, pupils not dilated. Management:

ADMINISTER AMMONIUM CHLORIDE

Schizophrenic on haldol 5mg presents to ED "unable to see." Appears distressed, writhing and moaning. States "I'm unable to stop looking up." What is the best treatment?

ADMINISTER BENZTROPINE 1MG IV NOW

In long-term opioid therapy for management of chronic pain, the sign most indicative of addiction is?

ADMINISTRATION BY NON-PRESCRIBED ROUTES

Child w IQ of 68 will likely have adjustment issues and struggles w which developmental stage?

ADOLESCENCE

The capacity to set reasonable goals for one's self and to accept one's imperfections and others limitations is typically first realized during which developmental stage?

ADOLESCENCE

Tic severity begins to decrease during which age period?

ADOLESCENCE

Adoption research in one method to delineate genetic versus environmental influences on phenotype. The limitation of this approach:

ADOPTEES ARE NOT REPRESENTATIVE SAMPLE AND ADOPTIVE AND BIOLOGICAL PARENTS MAY RESEMBLE ONE ANOTHER.

What research design best clarifies the role of environment in behavioral genetics?

ADOPTION STUDY

Symptoms of fatigue, depression, darkening of skin and mucosa, what test do you get?

ADRENOCORTICOTROPIC HORMONE (ACTH) STIMULATION TEST

What 4 conditions associated w mental retardation have an autosomal recessive inheritance pattern?

ADRENOGENITAL SYNDROME HURLER'S TAY-SACHS PHENYLKETONURIA

Which tools can be used when a person wishes to assign a surrogate to make healthcare decisions during future periods of mental incapacity?

ADVANCE DIRECTIVE

The single most consistently documented and significant risk factor in the epidemiology of tardive dyskinesia is?

ADVANCED AGE

On the expressive-support spectrum of therapeutic interventions, which is considered the most supportive therapy intervention

ADVISING

Gag-rule clauses in some managed care plans may prohibit docs enrolled in their plans from taking which action?

ADVISING PTS ABOUT TREATMENTS NOT COVERED BY HMO

A 5 year old child whose mother was in a minor car accident believes he is responsible for causing the accident because he yelled "I hate you" in protest when his mother left him with a baby sitter an hour earlier. This belief represents which of the following?

AGE APPROPRIATE EGOCENTRIC THINKING

Pharmacological treatment in autism spectrum disorder is most likely to have a positive effect on? (4x)

AGGRESSIVENESS

36 y/o pt c/o dysphoria, insomnia, fatigue, poor concentration. Pt is started on sertraline 50mg, increased to 100mg in 2 weeks. 2 months after dose increase, pt reports mood greatly improved. However, pt notes new onset of sx of delayed ejaculation, frequently to point of anorgasmia. He believes this began almost immediately after dose increase. First step in management of problem would be?

DECREASE THE SERTRALINE DOSAGE TO 50MG/DAY

Agitated pt gets rapid tranquilization in ED. Using oral concentrate instead of IM or IV has what advantage?

DECREASED FEELINGS OF HELPLESSNESS

Pts over 65 y/o are less likely to tolerate higher doses of antipsychotics due to

DECREASED HEPATIC METABOLISM

Increased risk of EPS indicates

DECREASED LEVEL OF DA RECEPTORS

Patients >65 y/o are more sensitive to psych meds due to what physiologic change occurs with aging?

DECREASED PHASE 1 OXIDATION

Early stage HIV type I associated dementia as compared to early onset dementia has which of the following deficits?

DECREASED PROCESSING SPEED

A characteristic of non-REM sleep?

DECREASED RECALL OF DREAM ACTIVITY

Alcohol use is associated with what changes in sleep?

DECREASED REM SLEEP

Individuals who consume ETOH at night usually develop:

DECREASED SLEEP LATENCY

Sinusoidal waves at 9-11 Hz on EEG is:

DEEP SLEEP

Supportive psychotherapy classically involves supporting and accepting the patient's

DEFENSE MECHANISMS

44 yo M found wandering aimlessly, brought into ED, BP is 200/132, HR 112 and regular. Pt is belligerent, picking his skin, feels like insects crawling on his skin. Oriented only to name, tremulous, is diaphoretic, dilated pupils, palmar erythema, and spider angiomata on chest. What explains his symptoms?

DELIRIUM TREMENS

Changes w/ sleep associated with aging: [2, EEG]

DELTA WAVE AMPLITUDE DECREASES AND PROPORTIONALLY LESS TIME IS SPENT IN STAGE 3 AND 4

80 yo male tells PCP he thinks his wife of 55 years is having an affair his wife and two middle aged children disagree. Pt acknowledges no clear evidence of his belief. Pt is healthy, no psych history, no hallucinations, cognitive testing is normal for age. Dx?

DELUSIONAL DISORDER

What is a poor prognostic sign for HIV?

DEMENTIA

In cases of recovered memory, the role of the therapist is to

DEMONSTRATE EMPATHY FOR THE PATIENT WITHOUT ENDORSEMENT OF THE MEMORY

24 yo homeless with SI requests hospitalization. This is 3rd visit in span of 2 weeks. Pt is organized, coherent. When asked what would be different with this hospitalization, pt attacks the doctor. Best next step of action?

CALL LAW ENFORCEMENT

28 y/o with BMDII wants to use phototherapy for depressive Sx treatment in winter. What should you advise?

CAN BE USED BUT REQUIRES VIGILANCE AND CAREFUL TITRATION OF DOSE

Adult's patterns of interacting with others predicted by what according to object relations and attachment theory

CAPACITY TO PERCEIVE AND THINK ABOUT THE INTENTIONS OF OTHERS

Patient reports that an identical-appearing impostor has replaced his father. What is the name of this delusion (2x)?

CAPGRAS SYNDROME

Which of the following is most likely to reduce pain in postherpetic neuralgia

CAPSAICIN METHYLPREDNISONE ????????????????

Which anticonvulsant is contraindicated with clozapine?

CARBAMAZEPINE

Association between *HLA B1502 allele* and Steven- Johnson syndrome in Asian, who are treated with which agent?

CARBEMAZEPINE

Most appropriate initial tx for idiopathic Parkinson dz in an 81 y/o pt

CARBIDOPA/LEVODOPA

Which is the most sensitive and specific lab test for identifying heavy drinking and monitoring Tx?

CARBOHYDRATE DEFICIENT TRANSFERASE (CDT)

What condition is a relative contraindication to ECT?

CARDIAC ARRHYTHMIA

45 y/o pt has recurrent episodes of LOC. A detailed description by family: pt reporting a feeling of faintness accompanied by pallor, followed by collapse and LOC, and several seconds later by a few bilateral jerks of the arms and legs. Prior to recovery, the pt's face and chest are flushed. No precipitating factors are identified. Which of the following is the most likely explanation:

CARDIAC SYNCOPE

What is a core component for collaborative care interventions for psychiatric disorders in primary care settings?

CARE COORDINATION AND CARE MANAGEMENT FOR PATIENTS BY A NON-PHYSICIAN PROVIDER

Typical phase of life problem in middle adulthood?

CARING FOR BOTH ONE'S CHILDREN AND PARENTS

Theorist introduced the concepts of introversion and extraversion:

CARL JUNG

45 y/o M, with recurrent episodes of LOC while wearing a shirt with a tight collar, has feeling of faintness accompanied by pallor, followed by collapse and LOC, and several seconds later by a few bilateral jerks of the arms and legs. Entire episode lasted less than one minute. Most likely explanation?

CAROTID SINUS SYNCOPE

a 45 yo man has loss of consciousness by wearing a shirt with tight collar, feels faint, collapses, and has a few bilateral jerks of limbs

CAROTID SINUS SYNCOPE

Which term describes state of immobility that is constantly maintained? (Ability of a catatonic pt to hold the same position) (2x)

CATALEPSY

19 y/o pt expresses the belief that she failed a recent midterm exam despite studying a great deal for the test. The patient is convinced that this means she will lose scholarship money and will need to drop out of college. The patient is an excellent student who is prone to excessive worrying. Her belief that she is going to have to drop out of college because she did poorly on the midterm exam is an example of which of the following types of distortion?

CATASTROPHIC THINKING

Pt with depression being treated with CBT tells psychiatrist about waking up and being worried about work. Pt has big project that is due in two weeks and is half done, but pt is sure work will not be finished on time. Example of which cognitive error?

CATASTROPHIZING

Based on epidemiological studies from 1994-2004, which groups has highest suicide completion rate?

CAUCASIAN AMERICAN MEN IN THEIR 60s

The rate of illicit drug usage in high school is highest among which groups in USA?

CAUCASIAN AMERICANS

Attribution processes are defined primarily as individual:

CAUSAL EXPLANATIONS OF EVENTS AND PERSONAL EXPERIENCES

During treatment of alcohol dependence, the psychiatrist works with a patient on planning for emergencies and drink refusal skills. This is using what therapeutic mentality?

CBT

Identifying new routes home from work for alcoholic patient is example of which type of therapy?

CBT

Psychotherapy that has been shown to be effective in bulimia nervosa:

CBT

What is first line tx for PTSD in children and adolescents?

CBT

Unsteady gait, appendicular ataxia in LE only and normal eye movement. Walks with lurching broad based gait. (8x)

CEREBELLAR DEGENERATION (ALCOHOLIC)

66 y/o M in ED w/ sudden occipital HA, dizziness, vertigo, N/V, unable to stand, mild lethargy, slurred speech. Exam: small reactive pupils, gaze deviated to the R, nystagmus, w/ occasional ocular bobbing, R facial weakness, decreased R corneal reflex, truncal ataxia, b/l hyperreflexia, b/l Babinski. Dx?

CEREBELLAR HEMORRHAGE

65 y/o w/ hx of HTN, Meniere's with sudden vertigo, N/V, worse with head movement, R beating nystagmus on lateral gaze, finger to nose testing is ataxic, poor balance and dysarthria. Dx?

CEREBELLAR INFARCT

Tremor with a frequency of around 3 Hz, irregular amplitude, most evident towards the end of reaching movements: (2x)

CEREBELLAR TUMOR

52 y/o M presents with a chief complaint of gait difficulties. On exam: mild dysarthria, very mild finger to nose ataxia and minimal heel to shin ataxia. Romberg test: negative, but very unsteady while walking and walks with a broad-based, lurching gait. The plantar reflexes are flexor. Imaging studies are most likely to demonstrate?

CEREBELLAR VERMIS ATROPHY

Unilateral hearing loss, vertigo, unsteadiness, falls, headaches, mild facial weakness and ipsilateral limb ataxia is most commonly associated with tumors in what locations?

CEREBELLOPONTINE ANGLE

A CNS structure that is likely to suffer permanent damage following lithium toxicity

CEREBELLUM

Abnormal emotional expressions such as pathological laughter or crying caused by lesions affecting cortical subcortical circuits linking:

CEREBELLUM FRONTAL CORTEX and PONS

43 y/o pt w/ memory loss x 8 months associated with abd pain, wt loss, joint distention/pain, fever, lymphadenopathy, hyperpigmentation of skin, decrease hemoglobin, and fat in stool. Which test result is likely to be found in this patient?

CEREBROSPINAL FLUID WITH PAS+ CELLS INFECTED WITH TROPHERYMA

A 63 y/o pt with insidious onset of neck pain, progressive limb weakness, falls, and urinary incontinence. On exam, pt has decreased neck ROM, mild distal and proximal limb weakness, brisk DTRs with ankle clonus, and upgoing plantar reflexes. Increase muscle tone in legs. Rest of exam is normal. What is most likely dx?

CERVICAL MYELOPATHY

Pt displays spastic gait in which legs are stiff, feet scrape against floor, and legs circumduct which each step. Reflexes are increased and plantar responses are extensor bilaterally. Dx?

CERVICAL SPONDYLOSIS

Stiffness of legs while walking and spasms of LE while sleeping. Stiff legged gait, adducts legs while walking. Increased LE tone/spastic catch, hyperactive knee jerks, ankle jerk clonus. Increased Romberg sway. (5x)

CERVICAL SPONDYLOSIS

Long term emotional well being of a child following divorce depends most upon which post-divorce factor?

CESSATION OF CONFLICT BETWEEN PARENTS

Which of the following situational and environmental factors is most clearly associated w/ increased inpatient assaults? (6x)

CHANGE OF SHIFT

Which is used to evaluate the relative frequencies or proportions of events in 2 populations that fall into well defined categories

CHI - SQUARE

What situation requires the psychiatrist to step out of usual tx relationship to protect the pt or others from harm?

CHILD ABUSE

A broad-based rating scale for psychiatric symptoms in children?

CHILD BEHAVIOR CHECKLIST (CBCL)

According to Freud, which of the following is considered to be the most salient feature of normal psychosexual development in children between 1-3 years of age?

CHILD-PARENT STRUGGLES ABOUT THE NEED TO DELAY GRATIFICATION OF DESIRES

5 y/o is evaluated for ADHD. Parents complain that the child has multiple symptoms of hyperactivity, impulsivity, inattention, and distractibility. Parents also bring teacher feedback reports that confirm these symptoms and state child is failing academically and having social problems. In psych MD office child is quiet, calm and cooperative, and very engaged. The difference in clinical presentation from parent and school reports is most likely because:

CHILDREN WITH ADHD CAN PRESENT WITH BRIEF PERIODS OF HEIGHTENED FOCUS AND CALM, ESPECIALLY IN A STRUCTURED SETTING.

Involuntary set of flowing jerky movements in multiple joints describe:

CHOREA

Children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) often manifest:

CHOREIFORM MOVEMENTS and OCD SYMPTOMS

What is part of routine workup of child with mental retardation but without dysmorphic features or neurological findings?

CHROMOSOMAL ANALYSIS

Childhood-onset schizophrenia typically have a course described as:

CHRONIC AND UNREMITTING

What are the (4) characteristics of childhood-onset schizophrenia?

CHRONIC COURSE UNFAVORABLE PROGNOSIS HALLUCINATIONS DELUSIONS

AIDS pt, progressive weakness of extremities over weeks. Distal sensory deficit for pinprick and vibration. Slow nerve conduction, but EMG shows no denervation

CHRONIC INFLAMMATORY DEMYELINATING POLYRADICULONEUROPATHY

ECT is least likely to be effective for patients who have?

CHRONIC SCHIZOPHRENIA

Clozapine clearance decreased by which drug

CIMETIDINE

35 yo M w/ severe OCD, failed multiple meds, CBT and ECT, what next?

CINGULOTOMY

Chronotherapy is appropriate for:

CIRCADIAN RHYTHM SLEEP DISORDER

What chemo agent is most commonly assoc with distal sensory polyneuropathy? (2x)

CISPLATIN

In initial psych interview, pt frustrated that his last psychiatrist had brief visits & "just gave me another pill every time." Interviewing psychiatrist responds "so you would like your psychiatrist to listen & understand you before adjusting your meds."

CLARIFICATION

10-month old infant becomes distressed when parents leave child w/ babysitter without affection. Which subsequent behavior pattern is likely?

CLINGY AND AVOIDANT TOWARD PARENTS

Correlation of plasma drug concentration with the clinical effectiveness is best established for which antipsychotics?(2)

CLOZAPINE AND HALOPERIDOL

The basis for *self-psychological strategy* in marital therapy is best indicated by what?

DEMONSTRATING CONFLICTS ARISING FROM EACH SPOUSE'S NEED TO HAVE HIS/HER NEEDS MET BY OTHER

25 y/o pt with pain in L periorbital region, followed by blurring then loss of vision in left eye. Exam normal but no reaction when light shone on L eye. This is consistent with:

DEMYELINATING LESION OF LEFT OPTIC NERVE

Neural plasticity largely mediated through the capacity to rapidly change in number and morphology of?

DENDRITIC SPINES

7 y/o states he knows Dad died, but why didn't he come to the birthday party? Defense mechanism:

DENIAL

An important counter-transference issue in an interethnic psychotherapeutic relationship is

DENIAL OF DIFFERENCES

Pt becomes panicky and distressed every time psychiatrist goes on vacation, this pattern is most likely a characteristic of:

DEPENDENT PERSONALITY

Which personality d/o should be in the ddx of agoraphobia:

DEPENDENT PERSONALITY DISORDER

20 y/o in MVA, no injuries - speaks softly, feels calm, dim vision, mechanical movements, feels detached:

DEPERSONALIZATION

A feeling of being outside oneself or detached

DEPERSONALIZATION

Exam of a pt w charcot-marie-tooth type 1 shows diminished LE DTRs and deformities of b/l feet. These deformities are typical of which molecular abnormality?

DUPLICATION OF THE PERIPHERAL MYELIN PROTEIN GENE

What aspect of sleep is increased in older adults? (2x)

DURATION OF AWAKENINGS

5 days after CABG a 47 year old male is disoriented to time and place. He identifies his right and left but not that of the examiners. Can draw square and circle but not a clock. This is:

DYSPRAXIA

Antipsychotics are associated with what?

DYSTONIA, POIKILOTHERMY, LIPID SOLUBILITY, AND LOWER SEIZURE THRESHOLD

Pt is engaged in interpersonal psychotherapy for depression. In the first several sessions, the patient and therapist identify unresolved grief after the death of the patient's mother as the problem area, and relate these feelings to the patient's current depression. Which of the following will be the focus of the middle phase of treatment?

FINDING NEW ACTIVITIES AND RELATIONSHIPS TO OFFSET THE PATIENT'S LOSS

Which of the following is the most common method of completed suicide in female children and adolescents?

FIREARMS

How to prove patient not criminally responsible for attacking neighbor's house in middle of night with shotgun after hearing imaginary gunfire.

FLASHBACK PREVENTED PATIENT FROM UNDERSTANDING WRONGFULNESS OF HIS ACT

Medication useful in management of orthostatic hypotension in Parkinson's (3x)

FLUDROCORTISONE

A pt suffers as a result of the pt's psychiatrist going on vacation w/o providing coverage. The psychiatrist's problematic behavior violates which of the following ethical principles?

FIDELITY

What is the Mental Health Parity and Addiction Equity Act?

FINANCIAL REQUIREMENTS FOR MENTAL HEALTH CAN BE NO MORE RESTRICTIVE THAN MEDICAL/SURGICAL CARE

Risk factors for child abuse

FINANCIAL STRESS, PRESENCE OF A STEPPARENT

What determines whether a criminal can use the insanity defense?

FINDING BY THE JURY

Which of the following is predictive of better adaptation in bereavement?

FINDING MEANING IN LOSS

According to Erickson, what psychological issue is salient for a 75 y.o?

FINDING MEANING IN WHAT ONE HAS DONE

Without evident distress, pt calmly reports to the psychiatrist, "Since I was last here, my significant other dumped me." The doctor responds by pointing out the discrepancy between the pt's affect and the content described. This response is an example of

CONFRONTATION

Which of the following subjective effects is the basis of the appeal of MDMA?

CONNECTEDNESS TO OTHERS

In terms of group dynamics, the confirmation of reality by comparing one's own conceptualizations with those of other group members and thereby correcting interpersonal distortions is known as what?

CONSENSUAL VALIDATION

8 y/o boy sees 2 bottles w same amount of liquid. The content of one is poured in shorter wider glass and the other to a longer narrow glass. When asked which has more liquid he says it's the same. According to Piaget he is exhibiting: (2x)

CONSERVATION

Compared to preschool-age children, a school-age child with normal language development will demonstrate what ability?

CONSTRUCTING SENTENCES WITH MULTIPLE CLAUSES

In pts w/ recurrent depression, successful Tx with antidepressants should be followed by which Tx strategies?

CONT ANTIDEPRESSANT AT SAME DOSE

29 y/o schizophrenic frequent ER visits and hospitalizations. Hallucinating, agitated, not violent or suicidal, cooperative. Ran out of meds a few days ago. Had been doing well on olanzapine for several months and was doing fairly well in structured living environment. Denies command AH. What should the next intervention here be? (3x)

CONTACT CASE MANAGER TO VERIFY ENVIRONMENTAL SUPPORT

Insurance company tells psychiatrist to switch generic drug. You know alternatives may be good too. What do you do?

CONTACT INSURANCE AND ASK FOR NONFORMULARY APPROVAL

6 y/o at school cries for mom, other kids start crying. What is this called?

CONTAGION

During a group therapy session female pt describes past experiences of sexual abuse by her father. Pt states that at times she feels depressed and hopeless, and has intense thoughts of killing herself. Another pt in the groups states, "I feel the same way, and I've felt like this for a long time." Second pt's admission is reflective of which of the following therapeutic factors in group therapy?

CONTAGION

A smoker states "I need to quit, but I'm not ready yet." What is the pts stage of change?

CONTEMPLATION

Researcher is reviewing a questionnaire to screen for MDD, notices that the questionnaire has no Qs pertaining to depressed mood but has a few Qs pertaining to spending sprees. What form of validity is most affected?

CONTENT

The extent to which an instrument represents the construct being measured is referred to as what type of validity?

CONTENT

Test for anxiety that does not include Qs about physical sx such as tachycardia and diaphoresis would be considered lacking in what?

CONTENT VALIDITY

Pt in methadone tx earns number of take-home doses based on compliance with attendance and participation in groups. What kind of intervention is this? (2x)

CONTINGENCY MANAGEMENT

Pt receives $20 for negative drug test, but locked out of reward after a positive test until 3 negative tests, this is an example of which behavioral technique?

CONTINGENCY MANAGEMENT

58 y/o pt is started on citalopram 20mg for MDD. After 3 wks pt reports some improvement in vegetative sxs but remains dysphoric. What is the next step?

CONTINUE CITALOPRAM AT THE PRESENT DOSE WITH NO ADDITIONAL MED

Previous dual antipsychotic failure. Tolerating Clozapine 200mg for a month. What should be next step in medication management?

CONTINUE CLOZAPINE BY ITSELF

32 y/o F pt w/ BMD has been treated with lithium. Pt reveals to her psychiatrist that she is now pregnant. Attempts to dc lithium in the past have led to relapses of the pt's disorder, with severe associated morbidity. A trial of an antipsychotic in the past resulted in NMS, and pt has since refused to use them. Which of the following would be the best option for treatment during the pregnancy?

CONTINUE LITHIUM

Pt has not responded to adequate trials of SSRI, SNRI, TCA, MAOI, but feels improved with 8 treatments of ECT. What next?

CONTINUE MAINTENANCE ECT FOR AT LEAST 10 WEEKS

Patient in sustained opioid remission is now 10wk pregnant, how to manage?

CONTINUE METHADONE CURRENT DOSE

Next step after patient reports inefficacy of Prozac 20mg after 3 weeks?

CONTINUE PROZAC 20MG DAILY, REASSESS IN 2 WEEKS

Pt w/ hx of MDD has been taking Fluoxetine 40 mg PO QDay for one year since achieving remission of third depressive episode. Pt wants to stop medication because of sexual side effects responsive to Sildenafil 100 mg PRN. What should psychiatrist recommend to pt?

CONTINUE THE FLUOXETINE AS LONG AS IT IS EFFECTIVE

1-month post death of loved one. What would suggest a pathological grief rxn?

CONTINUED FEELINGS OF WORTHLESSNESS

In pts with recurrent depression, successful treatment with antidepressants should be followed by which treatment strategy?

CONTINUING ANTIDEPRESSANTS AT THE SAME DOSAGE

Tracking pt satisfaction for agencies

CONTINUOUS QUALITY IMPROVEMENT

Elements common to both CBT and eye movement desensitization and reprocessing in the treatment of patients with PTSD include

CONTROLLED EXPOSURE TO TRAUMA RELATED TRIGGERS

Both mens ERA and acts reuse are required for which of the following?

CONVICTION OF A CRIME

What respiratory condition is associated with a markedly increased risk of complications from ECT?

COPD

Inability to name obj held in left hand, but not in right hand, indicates lesion in?

CORPUS CALLOSUM

Poststroke depression in 80 yo pt (R handed) is assoc w cognitive impairments that?

CORRELATE WITH LEFT HEMISPHERIC INVOLVEMENT

Which of the hormones has a circadian release pattern?

CORTISOL

Pts complain of not only having lost possessions, status, and strength, but also heart, blood, and intestines. What syndrome?

COTARD

MD sees psychiatrist w increasing sense of dislike for a blaming, externalizing pt who pits family members against the MD. What should psychiatrist discuss w MD?

COUNTERTRANSFERENCE

Woman is unable to achieve orgasm with her partner. Treatment = directed masturbation + ?

COUPLES THERAPY

Etiology of meningitis assoc with fever, HA, CSF pleocytosis with lymphocyte predominance, slightly elevated CSF protein, and normal CSF glucose

COXSACKIE VIRUS

60y/o on 6mg risperidone, 50mg sertraline. Slowed thinking, drooling, cog-wheeling, masked facies. Mood/paranoia improved on meds. What to do?

DECREASE DOSE OF THE ANTIPSYCHOTIC

One year after achieving methamphetamine abstinence, these craving will most likely:

DECREASE IN INTENSITY

Which of the following sleep changes is produced by all benzos?

DECREASE IN REM

Psych MD is asked to evaluate a 37 y/o F who complains of chronic vulvar pain. 12-month lack of any sexual intercourse with husband. Pt expresses ambivalence about the lack of intimacy and somewhat annoyed at husband for not understanding how painful sex has become. The gynecologist reports that a full physical and laboratory workup is remarkable except for pain in the vestibule which can be elicited with touch. Intervention?

INITIATE NORTRIPTYLINE AND SLOWLY TITRATE

Abrupt withdrawal of nicotine is followed by what symptom?

INSOMNIA

EEG biofeedback more effective than progressive muscle relaxation in treating what sleep disorder?

INSOMNIA

This major symptom of delirium may require pharmacological treatment:

INSOMNIA

Gustatory special sensory seizures (auras) localize where? [be specific! not a lobe]

INSULAR CORTEX

Otto Kernberg's model for tx of patients with narcissistic personality disorder differs from that of Kohut in that in Kernberg's model, the goals of psychotherapy include:

INTEGRATING IDEALIZATION AND TRUST WITH RAGE AND CONTEMPT

24y/o Colombian-American is concerned about how to maintain his parent's cultural heritage after he marries a Caucasian. Which type of acculturative stress is he dealing with? (4x)

INTEGRATION

To define learning disability, look for discrepancy between:

INTELLECTUAL POTENTIAL AND PERFORMANCE

A difficult child, according to Thomas and chess's categories of temperament, expect what characteristics?

INTENSE EXPRESSION OF MOOD

According to Thomas & Chess' categories of temperament, the difficult child shows what characteristics?

INTENSE EXPRESSIONS OF MOOD

Individual psychotherapy for alcoholics most effective when focusing on

INTERACTIONS WITH PEOPLE

What medication may cause mood d/o in pts being treated for melanoma? Also worsens fatigue and cognitive inefficiency:

INTERFERON

Which medication reduces accumulation of plaques and disability in pt's with relapsing remitting MS?

INTERFERON BETA-1 A

Which of the following best describes the characteristics of the normal adult alpha rhythm seen on an EEG recording?

INTERMITTENT AND POSTERIOR DOMINANT

Lower facial weakness w/ relative sparing of forehead, stroke in?

INTERNAL CAPSULE

In 8-11 y/o kids, which moral skill is the 1st one to fully develop?

INTERNALIZATION OF PARENTAL VALUES

In 8-11 y/o kids, which moral skill is the first one to fully develop?

INTERNALIZATION OF PARENTAL VALUES

Therapeutic focus on the on pt's current social functioning is most characteristic of

INTERPERSONAL PSYCHOTHERAPY

Psychotherapy where pts realistically evaluate their interactions w others & therapist offers direct advice/helps pts make decisions/ignores transference issues

INTERPERSONAL PSYCHOTHERAPY (IPT)

Which characteristic is particularly likely to be found in patients with MDD with atypical features? (2x)

INTERPERSONAL REJECTION SENSITIVITY

Abnormality in what domains is the most important in establishing the Dx of autistic do?

INTERPERSONAL RELATIONS EXPRESS SOME CONCERN TO PARENTS

10 y/o pt reports he collects baseball cards. Child is excited b/c he is only one in his peer group who owns several cards. According to Erickson, what developmental task are most relevant for this child? (2x)

INDUSTRY VS. INFERIORITY

Integration of clinical and experimental observations in early childhood development supports what statement about infant/parent interactions?

INFANTS ARE BORN WITH SOPHISTICATED PERCEPTUAL ABILITIES THAT FACILITATE ATTACHMENT

What statement about infant/parent interactions is supported by integration of clinical/experimental observations in early child development?

INFANTS ARE BORN WITH SOPHISTICATED PERCEPTUAL ABILITIES THAT FACILITATE ATTACHMENT

An accurate statement regarding assessment for cultural ID:

INFLUENCED BY ONE'S DEGREE OF ACCULTURATION

Neurocognitive functions most likely to show decline in people over 65 years of age?

INFORMATION PROCESSING SPEED

Which of the following functions is most likely to normalize in an 80 y/o pt successfully treated for depression?

INFORMATION PROCESSING SPEED

15 year-old pt is brought to ER by friends due to aggression and impaired judgment while intoxicated. On exam the pt has a mild tremor, nystagmus, slurred speech, unsteady gait and hypoactive deep tendon reflexes. The pt complains of dizziness and appears uncoordinated. Which of the following substances did the pt use?

INHALANTS

Which of the following infant and toddler temperamental styles has been shown to have the greatest association with the eventual onset of anxiety symptoms in childhood?

INHIBITED

What characteristic present in a 2 y/o is most likely to persist into adult life?

INHIBITION

Mechanism of action of botulinum toxin at neuromuscular junction: (3x)

INHIBITION OF ACETYLCHOLINE FROM PRESYNAPTIC TERMINALS

What is associated with poor prognosis in patients with schizophrenia or schizophreniform psychosis?

INITIAL ONSET DURING ADOLESCENCE

26 y/o pt with depressed mood and dissatisfaction with life, feeling isolated and having few friends who is not under undue stress and historically copes well with personal problems would benefit from what type of psychotherapy?

INTERPERSONAL THERAPY

75 y/o pt has begun to experience insomnia and fatigue after the death of her husband. She describes feeling "down in the dumps". She was previously active with many friends and social outlets. Psych MD decides that treatment should focus on pt's grief as the primary problem in order to aid mourning and facilitate pt's reintroduction into outside activities and relationships. What mode of psychotherapy would best address these goals of treatment?

INTERPERSONAL THERAPY

A treatment modality explicitly emphasizes giving pts a formal psych Dx and assigning them sick role.

INTERPERSONAL THERAPY

Intentionally assigning the sick role to a pt which serves to give the pt the permission and responsibility in order to recover is a tenet of which form of psychotherapy?

INTERPERSONAL THERAPY

Young female in psychodynamic psychotx admitted to seeing the resident downtown last weekend, followed him around, thinking she could later shop at the same stores and eat at same places as her greatly admired therapist. Pt not dangerous, convincingly apologized, stated that she would never repeat this behavior and hoped therapist would not "fire" her. Next step therapist should take?

INTERPRET PATIENT'S LONGING TO IDENTIFY WITH THE THERAPIST.

Female psych resident says pt saw resident in town over weekend. Followed her around. Thought she could later shop at same stores and eat at same restaurants as her greatly admired therapist. Nothing wrong in pt's bx or material suggesting she is dangerous. Pt apologizes convincingly, says will not do again. Hopes therapist will not fire her. What is next best step?

INTERPRET PT'S LONGING TO IDENTIFY W THE PSYCHIATRIST

Primary intervention in highly expressive psychotherapy

INTERPRETATION

Psychiatrist tells pt "You told me your feelings are hurt when spouse doesn't pay attention to you. I think you may also be saying I hurt your feelings during last session when I didn't let you finish before ending session." What interview technique is this?

INTERPRETATION

The LEAST utilized approach used in cognitive therapy in pt w/ substance dependence

INTERPRETATION OF INTERACTIONAL PROCESS

In the Institute of Medicine classification system developed to clarify different aspects of prevention, the category of "indicated interventions" refers to which of the following?

INTERVENTIONS THAT FOCUS ON HIGH-RISK INDIVIDUALS TO ENHANCE RESILIENCE AND PREVENT ONSET OF THE ILLNESS

Ethical standards dictate that the psychiatrist should do what in child custody evals?

INTERVIEW ALL PARTIES TO THE LITIGATION

Common cause of acute cerebellar ataxia in adults:

INTOXICATION WITH ANTIEPILEPTICS

In the US, which of the following is the most common precipitant of PTSD in children and adolescents?

INTRAFAMILIAL VIOLENCE

63 y/o with new onset aphasia and R hemiparesis, 2 days ago had milder/similar symptoms that resolved in 30 minutes, yesterday had similar episode x 45 minutes. Current Sx started 1.5 hrs ago. CT shows no stroke or hemorrhage. Tx?

INTRAVENOUS THROMBOLYTIC AGENTS

Defense mechanism that involves internalizing the qualities of an object?

INTROJECTION

The great majority of disease-associated genetic variants identified by genome-wide association studies occur in:

INTRONIC OR INTERGENIC REGIONS

Person estimating usefulness of tx study will use number needed to treat statistic to represent number of pts who need to be treated to produce one additional good outcome beyond that obtainable w control for comparison condition. NNT formula?

INVERSE OF THE ABSOLUTE RISK REDUCTION

31 y/o postpartum F distressed by fantasies of smothering baby, tearfully describes feeling overwhelmed by the burden of the child care. She denies SI/HI, but describes feeling some evil external force taking her baby away. Requests outpt psych f/u & refuses voluntary admission & her husband says everything is fine. Next step:

INVOLUNTARY ADMISSION

Substantially increase rate of sustained abstinence a/w Disulfiram use?

INVOLVE PATIENT'S PARTNER IN MEDICATION ADMINISTRATION

67 year old female with left facial droop. ED give TPA. What finding would indicate not stroke?

INVOLVEMENT OF UPPER AND LOWER FACE

During the initial phase of interpersonal psychotherapy (ITP), what problem is the therapist most likely to identify for therapeutic focus with the patient?

IPT INITIAL PHASE: ROLE TRANSITION

In the middle phase of interpersonal psychotherapy (IPT), the therapist focuses on the patient's

IPT MIDDLE PHASE: CURRENT RELATIONSHIPS

Instead of depressed mood, children w MDD may primarily show: (2x)

IRRITABILITY

Atomoxetine's principal mechanism of action exerts a therapeutic action because it: (2x)

IS A SELECTIVE NOREPINEPHRINE REUPTAKE INHIBITOR.

What is an accurate statement about the brain's default mode network?

IS INVOLVED IN REPROCESSING PREVIOUSLY EXPERIENCED STIMULI

Which characterizes the defendant's competency to stand trial in criminal proceedings?

IS PRESUMED UNLESS THE ISSUE IS RAISED

The best description of the data on suicide risk from meta-analysis of clinical studies of depressed children and adol treated with SSRI

MORE YOUTH APPEAR TO FAVORABLY RESPOND TO MEDS THAN REPORT SPONTANEOUSLY REPORT SUICIDALITY (THINK ABOUT THE BLACK BOX WARNING)

Which of the following psychotherapeutic techniques is based on the core principles of expressing empathy, developing discrepancy, avoiding arguments, rolling with resistance and self-efficacy?

MOTIVATIONAL ENHANCEMENT THERAPY

Pt with OCD resistant to entering treatment is a candidate for:

MOTIVATIONAL INTERVIEWING TRY ANOTHER SSRI

50 y/o man w a cut onset of neck pain radiating down left arm, progressing gait difficulty, urinary incontinence. Which test should be administered immediately?

MRI OF HEAD TO EXCLUDE DX OF ACUTE HYDROCEPHALUS

50 y/o pt is in the ED for acute onset of neck pain radiating down the left arm, progressive gait difficulty, and urinary incontinence. This test should be administered immediately.

MRI SCAN OF THE CERVICAL SPINE TO EXCLUDE A DIAGNOSIS OF SPINAL CORD COMPRESSION.

Typical feature of epileptic activity in alcoholic pt with seizure 12h after EtOH cessation (not specific EEG finding, rather nature of epileptic episodes)

MULTIPLE EPISODES

What is the most useful tool for diagnosis of narcolepsy?

MULTIPLE SLEEP LATENCY TEST

Most common complaint in southeast Asians who are dx w/ mental disorder is:

MULTIPLE SOMATIC SYMPTOMS

What has been shown to be an evidence-based treatment for individuals with conduct d/o?

MULTISYSTEMIC THERAPY

Which is an example of wrap-around, in-home, community based treatment for youth with behavioral disturbance?

MULTISYSTEMIC THERAPY

Diphenhydramine's ability to treat acute dystonia is due to action on which receptor?

MUSCARINIC-1

26 y/o pt w/ sudden onset back pain. Spasms in R paraspinal muscles in the lumbar region. Straight leg raising on the R is limited by sharp pain at 45 degrees. Ankle jerk on L is diminished. No muscle weakness, no sensory deficit. Next step? (3x)

ORDER MRI SCAN OF THE LUMBAR SPINE

Proponents of which of the following theories agree that social norms, expectations, meaning and perceptions are keys to understanding individual behavior in institutions and institutional effectiveness?

ORGANIZATIONAL CULTURE

Complication of anorexia nervosa LEAST likely to resolve after restoring weight is? (2x)

OSTEOPOROSIS

Hyperprolactinemia with antipsychotic meds increases risk of

OSTEOPOROSIS

Recent meta-analyses have suggested what with regard to the use of psychotherapy to treat depression?

OTHER PSYCHOTHERAPIES HAVE EFFICACY COMPARABLE TO CBT

What is a major therapeutic goal of self-help groups?

OVERCOMING MALADAPTIVE BEHAVIORS

A physician who is testifying as an expert in court is different from a regular or "fact" witness in that the expert is allowed to testify about which of the following?

PROFESSIONAL OPINIONS

AIDS and progressive hemiparesis and R homonymous visual field deficit assoc w patchy white matter lesions on MRI with normal routine CSF (3x)

PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY

Dx for 68yo c/o falls. PE shows upright rigid posture, stiff gait, extended knees, and pivoting while turning

PROGRESSIVE SUPRANUCLEAR PALSY Hummingbird sign - midbrain atrophy

A parent who just learned that her child has been injured and taken to the hospital, arranges for a neighbor to care for her other children and then rushed to the hospital. What defense mechanism did the parent use to handle her own fear? (2x)

SUPPRESSION

As part of comprehensive pain management team for pt w hx of narcotic abuse, a consulting psychiatrist may appropriately be asked to do which of the following? (2x)

RESOLVE CONFLICTS BETWEEN THE PATIENT AND THE TREATMENT TEAM

24 y/o F in 2nd trimester now manic w/ no psychotic sx's. Hx of 1 episode of mania, diagnosed bipolar I. D/C lithium when she decided to have kids. Willing to begin Tx

RESTART LITHIUM

The primary focus of behavior therapy in the treatment of anorexia nervosa is to:

RESTORE WEIGHT

55 y/o psychiatrically hospitalized pt with chronic schizophrenia stabilized on Clozapine. Two weeks after d/c pt p/w impending signs of psychotic relapse. Assuming pt adherence to meds and negative serum/ urine tox screens, what is most likely explanation for relapse?

RESUMPTION OF HEAVY SMOKING

Case management efficacy in substance use treatment is best established for which outcome?

RETENTION IN TREATMENT

Unconsciousness can be induced by a small area of damage where?

RETICULAR FORMATION

Exposure to light effects which brain structure?

SUPRACHIASMATIC NUCLEUS

12 y/o F not attending school for fear her mom may die in accident. Management?

RETURNING THE GIRL TO HER CURRENT CLASSROOM

Which ego defense is seen when an adolescent belittles parents in order to defend against regressive pull toward childhood?

REVERSAL OF AFFECT

13 y/o male tells psych MD "I'm tired of being the shortest boy in my class." Pt reports many of the girls are taller than he is. Both of the parents are tall. What is the most appropriate initial approach for the psychiatrist to take?

REVIEW WITH THE PT THE TYPICAL COURSE OF PUBERTY IN MALES

Pt with acute onset vertigo, what will suggest R lateral medullary infarct?

RIGHT FACIAL LOSS OF TOUCH AND TEMPERATURE SENSATION

Syndrome characterized by fluent speech, preserved comprehension, inability to repeat, w/o associated signs. Location of lesion in the brain?

SUPRAMARGINAL GYRUS OR INSULA

Right shoulder weakness on initial abduction and external rotation of the arm at the shoulder joint, after carrying sandbags. Affected nerve:

SUPRASCAPULAR

Child holds toy telephone to face and speaks to daddy. This behavior is called?

SYMBOLIC REPRESENTATION

Which is the best test for general assessment of a patient's psychiatric symptom patterns?

SYMPTOM CHECKLIST-90-REVISED (scl-90)

35 y/o F pt presents to the physician complaining of decreased interest in sexual activity and difficulty becoming aroused by her spouse over the last 3 months. Upon further questioning, the patient also reports anhedonia, difficulty sleeping, fatigue, and decreased appetite over the same time period. pt's decreased interest in sex is most likely assoc with?

SYMPTOM OF A MAJOR DEPRESSIVE EPISODE

Sudden onset vertigo/nausea, hoarseness/dysphagia, right sided face numbness, diminished gag reflex on right, decreased pinprick and temperature sensation on left?

RIGHT MEDULLARY INFARCTION

62 y/o pt evaluated for frequent falls w/o loss of consciousness. Pt w rigidity, hallucinations. Three episodes of hallucinations resolved w/o sequelae. What drug could be responsible?

RISPERIDONE

Which tests can be used for projective personality testing?

RORSCHACH, DRAW A PERSON, THEMATIC APPERCEPTION (NOT MMPI)

Borderline patient pulling away from a relationship due to growing up in abusive household is stuck in which stage

Rapprochement

Psych unit staff wants initiative that decreases completed suicides inpatient. Which will have the greatest effect of decreased suicides while maintaining therapeutic environment and minimizing staff burden?

Redesigning the physical space to eliminate potential anchor points for hanging.

What does acetylation of lysine residues in histone proteins do to chromatin structure?

Relaxes chromatin structure

15 y/o pt fell to the ground after being hit in the head while playing soccer. Pt did not lose consciousness, but was confused for following 20min.The next day, pt reported a headache and irritable, neuro exam normal. Best recommendation to family about pt?

SHOULD BE EXAMINED IN 2 WKS BEFORE RESUMING PLAY

What did the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) demonstrate about effectiveness of 2nd gen. antipsychotics for tx of schizophrenia?

SECOND GEN. ANTIPSYCHOTICS WERE NO MORE EFFECTIVE THAN FIRST GENERATIONS

Most common side effect with clozapine tx is

SEDATION

An increase in beta frequency during an awake EEG is caused by what type of medication?

SEDATIVES

F pt in twice-weekly psychodynamic psychotx w male therapist for the last year begins to discuss sexual fantasies about the therapist. The therapist feels flattered by the sexual interest of this patient and notes his own feelings of attraction to her. The most appropriate next step for the therapist is to: (3x)

SEEK CONSULTATION WITH A COLLEAGUE

Following a brief separation from the parents, a securely attached toddler is most likely to do which of the following

SEEK CONTACT EAGERLY

Convulsive episode with leftward eye deviation, tonic contracture of left side. Postictally, eyes deviate to right w/ hemiparesis of left side. Where is the seizure focus?

SEIZURE FOCUS RIGHT FRONTAL REGION

A slow titration of Clozapine is required to decrease the risk of

SEIZURES

Combined use of Lithium and SSRI is known to increase the risk of which of the following conditions?

SEIZURES

Recruitment of subjects from anxiety clinic may introduce what kind of bias?

SELECTION

Pt with depression recounts to the psychiatrist events of the last week and describes many unpleasant experiences, concerns about the sadness of some friends, and a reluctance to read the newspaper because "all the news is bad." In cognitive psychology, which of the following formulations best accounts for this patient's presentation?

SELECTIVE ATTENTION BIAS

What term describes the role that others perform for the individual in regard to mirroring, idealizing, and twinship needs?

SELF-OBJECT

The fundamental developmental need of all persons for *mirroring, validation, and affirmation* is central to which psychoanalytic theory?

SELF-PSYCHOLOGY

In school-age kids, there is research to suggest that a high level of what attribute is associated with competent social functioning?

SELF-REGULATION

7 yo with vocab of 5000 words. Delay in which language domain?

SEMANTICS

9 yo f bib-parents for outpt evaluation due to behavior difficulties at home. Daughter "explodes" when she doesn't get her way. Bossy with friend. On interview, child is calm, cooperative and interactive, denies SI/HI and states "sometimes I just get mad." What is the most appropriate level of care?

SEND THE PT HOME WITH PARENTS

What symptom commonly develops relatively late in children with PTSD?

SENSE OF FORESHORTENED FUTURE

A statistical term that refers to the proportion of pts with the condition in question that a test accurately detects:

SENSITIVITY

A form of learned fear in which a person or an experimental animal learns to respond strongly not only to a harmful stimulus, but also to a sub-threshold stimulus, refers to

SENSITIZATION

27 yo pt presents of "panic attacks." started 2 yrs ago. Intense panic attacks associated with anxiety about being away from home. Relies heavily on mother who is now sick.

SEPARATION ANXIETY DISORDER

Childhood disorder with greatest genetic association for adult onset panic attacks?

SEPARATION ANXIETY DISORDER

Presence of what disorder puts a child at greatest risk for developing panic disorder as an adult?

SEPARATION ANXIETY DISORDER

Most common fear expressed by adults leaving home to go to hospice?

SEPARATION FROM LOVED ONES

Mechanism by which risperidone cause very little EPS despite binding w/ high affinity to a dopaminergic D2 receptor

SEROTONERGIC 5HT2 ANTAGONISM

The temperamental trait of harm avoidance is associated with polymorphisms on which candidate genes?

SEROTONIN TRANSPORTER

A 34-yo pt with epilepsy has controlled seizures but develops depression. Which is the most appropriate depression med?

SERTRALINE

Adol attends a "pharm party", takes 2 methadone tabs, later found to have decreased respirations and is rushed to the ED. Which med could cause an interaction to produce this response?

SERTRALINE

30 y/o in therapy struggles with feelings of ambivalence about mom. Mom now has metastatic BrCA. If the patient uses anticipation as a defense mechanism, she might:

SET ASIDE A NIGHT OF THE WEEK TO HAVE DINNER WITH MOM TO DISCUSS MOM'S RXN TO DIAGNOSIS

Which intervention is helpful in dealing with a borderline pt on a medical ward?

SETTING LIMITS WITH THE PT ON THE STRUCTURE OF THE MEDICAL CARE

Important determinant factor to whether an individual who was exposed to trauma will develop PTSD?

SEVERITY AND PROXIMITY OF TRAUMA

Mirtazepine (vs other antidepressants) has low incidence of what side effect?

SEXUAL SIDE EFFECTS

As conceptualized by self-psychology, which of the following is the most problematic reaction a patient can have when attempting to fulfill a self-object need?

SHAME

Operant procedure in which desirable pattern is learned by reinforcement of approximation

SHAPING

The operant procedure in which a desirable behavior pattern is learned by the successive reinforcement of approximations to that behavior is called:

SHAPING

8yr old evaluated for asthma, found to have ADHD symptoms, put on stimulant, behavioral problems continue, sent to psychiatrist and psychologist, this is an example of what level of collaborative care?

SHARED (INTEGRATED) CARE

66 y/o sent threatening letters to the president, thinks CIA is following him. Wife similar convictions, dependent on husband, passive

SHARED PSYCHOTIC DISORDER

30 y/o pt recently Dx w/ Hodgkin's dz constantly states, "Why me?" According to Elizabeth Kubler-Ross, the patient's reaction is consistent with what phases?

SHOCK AND DENIAL

MDD has what sleep abnormalities? (multiple abnormalities)

SHORTENED REM LATENCY, DECREASED STAGE 4 SLEEP, INCREASED AWAKENINGS IN THE SECOND HALF OF THE NIGHT

Flavor preference determined by

cognitive association

Social psychology, occurrence of a contradiction between two attitudes or between an attitude and a behavior is referred to as:

cognitive dissonance

Study design that answers whether exposure to a drug increases risk of an adverse side effect

cohort

Essential tremor improves with

reaching for objects

Most serious threat to external validity in research study?

study population not representative to gen. pop

Child enjoys opposite gender stuff. If patient gets symptoms of gender dysphoria what's the course

resolves spontaneously by adulthood

"could leave more time for questions during class" = "I'm a terrible professor I just talk the whole time"

selective abstraction

What are the 6 primary emotions

fear anger disgust sadness surprise happiness

Longer duration of psychosis is associated w/ [demographic factor]

first generation immigrant

What substance of abuse can cause dementia w/ long-term use?

INHALANTS

What MOTOR symptom is a characteristic of atypical depression?

LEADEN PARALYSIS

mech for Qtc prolongation with neuroleptics

K channel blocked

"It's very nice to read you"

PARAPHASIA

Most important guideline re: hypnosis

RECORD ON VIDEOTAPE

First edition of the DSM to exclude homosexuality as a diagnosis:

DSM-III-R (1987)

Defining feature of mood in atypical depression

REACTIVE

Test to assess intelligence in 4 y/o?

STANFORD-BINET

HPA axis cortisol production is less active in?

Sleep onset

Most appropriate time to discuss advance directives with a pt

WHEN THE PT IS COMPETENT

What is a unique feature of DBT therapy?

TELEPHONE CONSULTATION

Benzo with a half-life <6 hrs [not midazolam]

TRIAZOLAM

Children in which age group at highest risk of abuse

UNDER 3

What herbal (phytomedicinal) is used as a hypnotic?

VALERIAN

Bipolar has decreased connectivity here (2)

amygdala and PFC

A 3y/o boy and his twin sister walk naked into a room. Boy asks why sister doesn't have penis. What is the best response?

"BECAUSE GIRLS DON'T HAVE PENISES"

Pt in psychodynamic psychotherapy repeatedly asks the therapist personal questions. The therapist consistently explores the reasons for the patient's asking, and sometimes these explorations are fruitful. Regardless, the pt persists in pressing for "real answers". The therapist response at this point is what?

"I KNOW THIS CAN SEEM VERY FRUSTRATING, BUT THE FOCUS OF THE THERAPY SHOULD BE ON YOU". [Identical] , HOW IT IS ORGANIZED IN TERMS OF BOUNDARIES AND CONSISTENT DEFINING RULES.

3 y/o boy wants to play with his mom, but she is tired and it is naptime. What explanation would he best understand?

"IT'S NAPTIME NOW."

College student tells psychiatrist "I had an exam today and I'm sure I failed it. Now I will never graduate from college". Which response is consistent with CBT?

"LET'S MAKE LISTS OF THE EVIDENCE FOR AND AGAINST YOU FAILING OUT OF COLLEGE"

Treating a much older pt who asks about therapist's age. Best response

"MAYBE YOU'RE CONCERNED ABOUT WHETHER I AM EXPERIENCED ENOUGH TO TREAT YOU?"

Consultant evaluates patient for capacity. Patient refusing meds, procedures, yells at nurses, orders take out into hospital, threatens lawsuits if demands not met. Patient accuses doctor of being abusive, screams at doctor, when asked for explanation of behavior "you're just another person here to abuse me!" Best response and advice for medical team is?

"THE PATIENT IS A DIFFICULT PATIENT TO WORK WITH. LET'S TALK ABOUT WAYS TO MANAGE THE PATIENT'S BEHAVIOR?"

F psychiatrist has been treating a 32 y/o married F pt w weekly individual psychotherapy for depressive sx, ambivalence about marriage. Therapy progressing well. Pt just learned she is pregnant, explores conflicted feelings about terminating pregnancy and her fears that unplanned pregnancy would trap her in marriage. Uncharacteristically, psychiatrist speaks strongly to pt about reasons not to make such a choice. Pt responds by saying "you are not going to make me feel guilty about this!" What statement would be most appropriate for therapist to make in response?

"YOU FELT I WAS IMPOSING A MORAL JUDGMENT ONTO YOU, AND, APPROPRIATELY, YOU OBJECTED."

Which research or statistical methodologies were used to develop the DSM-IV-TR? (2)

DATA RE-ANALYSES AND FIELD TRIALS

MAOIs affect catecholamines by directly by retarding

DEACTIVATION

According to *Holmes & Rahe*, what life event is assoc w highest stress/disruption?

DEATH OF A SPOUSE

Which time period is there highest risk of suicide in MDD patients recently discharged from the hospital?

0-3 MONTHS AFTER DISCHARGE

Post op day 4 a pt has new onset hallucinations, what is the most likely cause

DT (delirium tremens)

In CBT, ask patient to keep log for each hour and rate sense of mastery and pleasure experienced. What is this?

ACTIVITY MONITORING

Psychological function of a medication

ACTS AS A CONTAINER FOR THE PATIENT'S PROJECTED ANXIETIES ABOUT BEING DEFECTIVE

Lifetime prevalence of schizophrenia

1%

List four risks of complicated bereavement:

1) AMBIVALENT RELATIONSHIP TO DECEASED 2) SIMULTANEOUS GRIEVING FOR MULTIPLE DEATHS 3) PRE-EXISTING LOW SELF-ESTEEM &amp; INSECURITY 4) RECURRENT MAJOR DEPRESSION

50 y/o M hospitalized for depression and melancholia. First few therapy session should focus on

EDUCATE PATIENT ON NATURE OF ILLNESS AND TREATMENT

41 y/o pt w/o family h/o corticocerebellar degeneration presents with 3-month h/o ataxia of gait/limbs, dysarthria, and progressive nystagmus. MRI and CSF normal. 1) Antibody panel with presence of? 2) What type of tumor is likely present?

1) ANTI-YO 2) OVARIAN CARCINOMA

Investigators wish to maximize the probability of correctly rejecting the null hypothesis. This probability is referred to as:

1 MINUS BETA

After D/C clozapine due to WBC less than 2000 or absolute neutrophil less than 1000, how long must a patient continue to have a weekly CBC, once WBC returns to more than 3500?

1 MONTH

What age can infant recognize mothers face as distinct from other faces?

1 MONTH

Federal eligibility requirements for maintenance treatment with methadone specify that an individual must have been dependent on opioids for at least what length of time?

1 YEAR

29 y/o recent immigrant from China believes his penis is shrinking concerned he might die once his penis retracts into his abdomen. 1) What type of d/o is this? 2) What is best treatment?

1) CULTURE-BOUND SYNDROME 2) SUPPORTIVE THERAPY

Prophylactic Treatment for a pt with severe delusional depression following a course of ECT includes what?

COMBINATION OF ANTIPSYCHOTICS AND ANTIDEPRESSANTS

4 y/o does not run/climb, falls, has iliopsoas/quadriceps/ gluteal weakness, enlargement of calves with firm, "rubbery" consistency, decreased DTRs and normal sensation. Wide based stance and walks waddling. When rising from the ground, uses a four-point position through full extension of all four extremities. Has family h/o similar sx in males. 1) EMG reveals? 2) Genetic mutation in what protein?

1) SMALL, SHORT-LASTING MOTOR UNIT POTENTIALS WITH INCREASED RECRUITMENT 2) DYSTROPHIN (DUCHENNE)

Cognitive triad of depression:

1. negative self-perception 2. experience the world as self-defeating 3. expectation of continued failure

Prevalence rate of suicidal ideation in general adolescent population?

10%

What is the risk of developing schizophrenia when sibling has it but parents don't?

10%

Neuropsychological test most useful in the early diagnosis of Alzheimer disease:

10-ITEM WORD LIST LEARNING TASK.

Psychotherapy for addiction utilizes a disease-model approach and emphasizes acceptance of the disease and surrender to help beyond oneself: (2x)

12-STEP FACILITATION

DSM 5 prior age of presentation ADHD symptoms

12YO

Lifetime prevalence rate for ETOH abuse and dependence

15%

What is prevalence of Alzheimer's in >85 y/o?

16-25%

What do genome-wide association studies typically assay?

COMMON GENETIC VARIANTS

Which of the following is a positive prognostic predictor of overall outcome for children with autism?

COMMUNICATIVE SPEECH BY AGE 5

Primary psychological task of school aged children?

COMPETENCE

Children should play together with social interaction and role playing by what age?

4 Y/O

The primary psychological task of school-age children is achieving:

COMPETENCE

The immediate phase of amphetamine withdrawal is characterized by dysphoria and anhedonia as well as euphoric recall of drug use and cravings for the drug. The anhedonia and dysphoria are usually much improved in which of the following time frames?

2-4 MONTHS

At 30 years after presentation for treatment, mortality rates for anorexia nervosa are:

20%

Patient with hx of depression. Which risk factor suggests need for maintenance psychotherapy? (2X)

3 OR MORE EPISODES OF DEPRESSION IN A LIFETIME

Typical duration for alcohol detox using benzodiazepine withdrawal?

3 TO 5 DAYS

Core gender identity is typically established by what age?

3 YEARS

What age does a child first speak in complete sentences?

3 YEARS OLD

Carbamazepine should be D/C'ed if the absolute neutrophil count is below

3,000

African americans tend to have *higher activity* of which of the following cytochrome p450 enzymes?

3A4

Maximum time cocaine metabolites detectable in urine? (2x)

4 DAYS

Student presents for psych eval with continued anxiety, hyperalertness, flashbacks, and social avoidance after barely escaping an attacker 1 month ago. These symptoms are expected to last no longer than ___?

4 WEEKS

A child recently becomes adept at running and jumping and knowing the day and year is most likely to be at what age?

6 YEARS OLD

An individual with a full scale IQ of 65 could be expected to plateau at what level of academic functioning?

6TH GRADE

Ninety-five percent of right-handed people develop left hemispheric dominance for language. What percentage of left handed people develop left hemispheric dominance for language?

75%

How many symptom-free weeks must be between two episodes of depression for them to be considered separate and therefore recurrent according to DSM-IV?

8 SYMPTOM-FREE WEEKS

The formation of small peer groups who share values, speech patterns, and manners is first seen around what age?

8 YEARS

Once it becomes effective, pharmacological tx of pts with panic d/o should generally continue for what length of time?

8-12 MONTHS

Twin studies of patients with schizophrenia have consistently identified substantial proportions of monozygotic twin pairs that are discordant for the illness. The most likely explanation is:

A "TWO-HIT" MODEL OF PATHOGENESIS EXISTS IN WHICH PREDISPOSING ENVIRONMENTAL FACTORS COMBINE WITH GENETIC RISKS

16 y/o caught for shoplifting jeans. No hx of stealing, jeans not her size. Pt frightened, remorseful, insomnia, failing grades, avoiding friends. Raped 2 months earlier, family insisted she not tell anyone. Understand stealing as:

A CRY FOR HELP

AACAP Diagnosis of Bipolar I in children requires?

A DISTINCT PERIOD OF ABNORMAL MOOD AND EPISODIC SYMPTOMS

According to the AACAP Practice Parameters, diagnosis of bipolar disorder, type I in children requires which of the following?

A DISTINCT PERIOD OF ABNORMAL MOOD AND EPISODIC SYMPTOMS

In order to be judged competent to stand trial, a defendant must be able to consult with the lawyer w/ a reasonable degree of rational understand and possess what?

A FACTUAL AND RATIONAL UNDERSTANDING OF PROCEEDINGS AGAINST HIM/HER

Which of the following describes core narcissistic character pathology according to Kernberg's model?

A FUSION OF THE IDEAL SELF, THE IDEAL OBJECT, AND THE REAL SELF RESULTING IN THE DEVALUATION OF OTHERS

Pt repeatedly becomes distressed after what seems, even to the pt, to be minor disappointments. Pt also seems to suffer from extreme narcissistic vulnerability. A therapist utilizing self-psychology would be most likely to interpret this as due to?

A LACK OF DEVELOPMENTALLY APPROPRIATE EMPATHIC CAREGIVERS

A patient repeatedly becomes distressed after what seems, even to the pt, to be minor disappointments. The patient also seems to suffer from extreme narcissistic vulnerability. A therapist utilizing self psychology would be most likely to interpret this due to which of the following factors?

A LACK OF DEVELOPMENTALLY APPROPRIATE EMPATHY FROM CAREGIVERS

Which of the following is commonly regarded as the main advantage of school-based mental health?

A POPULATION THAT NORMALLY DOESN'T GET CARE HAS ACCESS TO CARE

Essential criterion for declaration of brain death prior to organ donation requires?

A POSITIVE APNEA TEST

25 y/o F never on a date after 6 mo of psychodynamic psychotherapy. Began to struggle w/ positive feelings about M therapist that she finds hard to accept. At the same time she starts to date. Therapist believes it is transference. Therapist said nothing, he believed an interpretation might interfere w/ positive learning experience. This is example of

A PRACTICAL/SUPPORTIVE APPROACH

EEG that reveals *posterior alpha and anterior beta* activity is most likely to have been obtained from whom (age of individual and state of individual)? (4x)

A RELAXED ADULT WITH EYES CLOSED

Psychiatrist who uses network therapy to treat patients with addictive disorders is functioning as

A TEAM LEADER

An urge to move, followed by sudden jerk or involuntary movement, followed by a sense of relief

A TIC

32 y/o pt is considering a course of hypnosis to help quit smoking, but voices concerns. Pt expresses worry about potential harm of hypnosis if not done properly. What would be the best initial response for the psych MD to make to pt regarding this concern?

A TRANCE PROCEDURE IS BENIGN AND REVERSIBLE BY CALM REASSURANCE

Adolescent who was previously getting along with parents is now becoming more resistant to parental control and insistent about making his own decisions about daily life. Feeling irritated with parents and guilty after minor arguments. Feelings of guilt are likely explained by?

A WISH TO SEVER THE PARENT-CHILD RELATIONSHIP

What would best help a child facilitate the mourning process when a loved one dies?

A change to express feelings or loss

Pt attempted suicide during a crisis which was worsened by pt's feelings about being unable to reach vacationing psychiatrist who did not provide coverage. What is the psychiatrist's vulnerability?

ABANDONMENT

According to the theory of self-psychology, a major cause of mental illness is:

ABSENCE OF AGE-SPECIFIC MIRRORING RESPONSES

Common experience of becoming so caught up in a movie that one ignores the environment is example of what component of hypnotic process?

ABSORPTION

During a hypnosis session a pt reports reduced awareness of sounds and other distractions in therapist's office. Pt report is reflective of which of the following components of hypnotic concentration

ABSORPTION

Wisconsin card sorting test (WCST) assesses

ABSTRACT REASONING AND FLEXIBILITY IN PROBLEM SOLVING

Process by which children modify existing schemas to adapt to new experiences is:

ACCOMMODATION

30 y/o MD who has emigrated from China to the US continues to take pride in family recipes, but has recently embraced American ballroom dancing. This represents which of the following:

ACCULTURATION

21 yo student presents with "stress and anxiety." First in family to attend college. Family wants patient to take over family farm. Patient is struggling to tell family.

ACCULTURATION DIFFICULTY

Best describes the intervention goal associated with contemplation stage of substance abuse treatment using motivational enhancement therapy: (2x)

ACKNOWLEDGE AMBIVALENCE AND EVOKE REASONS TO CHANGE

Interview w/ a pt w/ schizophrenia evokes feelings of confusion and frustration in the interviewer when the pt becomes silent. What response by the therapist would be the best approach to establishing rapport?

ACKNOWLEDGING THE INTERVIEWER'S FRUSTRATION AND INQUIRING IF THE PT FEELS SIMILARLY

Pt in group therapy calls another patient at home to object to something said in session

ACTING OUT

42 y/o surgeon experienced intense stomach cramps and palpitations when unable to immediately find the right instrument when performing an appendectomy. The surgeon was extremely alarmed by this and began to worry about the symptoms recurring. The surgeon then traded all ED calls so as to avoid these situations, began to avoid other crowded and noisy environments, and avoided a variety of social and professional settings. Likely diagnosis:

AGORAPHOBIA WITHOUT PANIC

End stage AIDS with worsening fine motor movement, fluency, and visual spatial coordination, Dx? (2x)

AIDS DEMENTIA COMPLEX

What manifestations is the most common side effect of conventional antipsychotic meds?

AKATHISIA

After gastric bypass surgery, continued abuse of what substance can be more life threatening than before surgery?

ALCOHOL

Chronic peripheral neuropathy of insidious onset, symmetric, more prominent distally in limbs, legs more than arms affected, slowly progressive, with greater sensory than motor involvement, with involvement of peripheral sympathetic nerves, and variable loss of DTR, is most likely caused by agent:

ALCOHOL

Drug of abuse that does not depend on specific neuronal membrane binding sites:

ALCOHOL

Most common substance of abuse in adolescents:

ALCOHOL

Pts over 65 y/o who experience chronic insomnia are most likely to have what comorbid psych conditions

ALCOHOL ABUSE

55 y/o pt w/ hx of ETOH dependence reports hearing voices for the past 6 weeks. Pt reports that the last episode of ETOH intoxication was 1 month prior, with moderate drinking since that time. There is no prior hx of psychosis. On exam, pt is alert and oriented. On laboratory evaluation, pt has a GGT of 54, an MCV of 110, and an AST/ALT ratio of 2.1. The most likely cause of this pt's hallucinations is:

ALCOHOL INDUCED PSYCHOTIC DISORDER

Which diagnosis is associated with the highest risk of person to person violence?

ALCOHOL USE DISORDER

Priority of treatment: Marital problems, Depression, vs. Alcoholism.

ALCOHOLISM DETOX AND ABSTINENCE

A person's inability or difficulty to describe or be aware of emotions or mood is called: (4x)

ALEXITHYMIA

60 y/o successful businessman has started psychodynamic psychotherapy with a young male therapist in one early session, the pt begins by saying, "before we get started, I want to let you know about a potentially lucrative investment opportunity." This statement is best represents

AN ATTEMPT BY PT, PROBABLY UNCONSCIOUSLY, TO SEDUCE AND TEST THERAPIST.

Informed consent is NOT required in which of the following forensic evaluations?

COMPETENCY TO STAND TRIAL

19 y/o pt reported hearing a voice that talked about what pt was thinking. The pt's speech has a normal rate and rhythm, but says things such as, "It is white, very white. I know. Things are that way. They are. I am." (Poverty of speech and content) This speech is an example of: (2x)

ALOGIA

Poverty of speech and poverty of content are aspects of which of the following conditions?

ALOGIA

First line treatment of vocal tics in Tourette syndrome: (2x)

ALPHA 2 ADRENERGIC AGONIST

Mirtazapine mediates increased release of NE and serotonin through what mechanism?

ALPHA-2 ADRENERGIC BLOCKADE

Biological consequences of psychological stress are documented to affect...

ALTERATION OF NEURO-IMMUNO-ENDOCRINE FUNCTION

Term "endophenotype" refers to what phenomena in behavioral genetics?

ALTERNATE EXPRESSED FORMS RELATED TO A DISEASE

According to sociobiologic theory, what term describes behaviors at the level of the individual that maximize fitness at the level of the gene?

ALTRUISM

In contrast to the nonamnestic type of mild cognitive impairment, the amnestic type is more likely to progress to what neurocog d/o?

ALZHEIMER'S DISEASE

Clock drawing test is quickly administered and sensitive screen for which d/o?

ALZHEIMER'S DZ

60 yo pt with chronic schizophrenia takes cogent in for neuroleptic induced parkinson now has increased urine retention and confusion. What medication would be the best alternative for treating this patient's condition?

AMANTADINE

Motivational interviewing of patients with addictive disorders addresses what? (2x)

AMBIVALENCE ABOUT BECOMING DRUG FREE

Li induced polyuria tx with least effect on Li level?

AMILORIDE

Nortriptyline is the active metabolite of which of the following TCAs?

AMITRIPTYLINE

Side effect pts on chronic benzos develop

AMNESIA

Lesions in mammillary bodies will produce what symptom?

AMNESIA, CONFABULATION, LACK OF INSIGHT

65yo pt lives alone, increasingly forgetful over the past year, lifelong difficulty recalling names of acquaintances, now has difficulty with phone calls and remembering appts. lives independently, drives, prepares meals, MSE with delayed recall of 4 words, otherwise normal. Pt upset by difficulty and is not depressed. symptoms most consistent with...?

AMNESTIC MILD COGNITIVE IMPAIRMENT

Vocabulary growth and pre-literacy language skills in preschoolers appear to be most associated with:

AMOUNT OF TALK DIRECTED TO THE CHILD

Which TCA should be avoided in pts w/ Parkinson's?

AMOXAPINE

Polymerase chain reaction (PCR) used in genetic linkage studies involves:

AMPLIFICATION OF MICROSATELLITE MARKERS

83 yo pt with mild HTN comes in with new onset headache and left hemiparesis. MRI shows right parietal lobe hemorrhage, small occipital hemorrhage and evidence of previous hemorrhage in right temporal and left parietal regions. What is likely etiology for these findings?

AMYLOID ANGIOPATHY

Protein mutation associated with Alzheimer disease in people younger than 60 yo

AMYLOID PRECURSOR

Atrophy of the intrinsic muscles of the right arm and forearm. Reflexes are generally brisk, plantar reflexes are extensor. Electrophysiology shows widespread fasciculations, fibrillation and sharp waves, normal sensation, muscle spasticity. Positive sharp waves on EMG. (5x)

AMYOTROPHIC LATERAL SCLEROSIS

Company X develops new medication for depression. Although the initial trials reveal only modes, statistically insignificant mood benefits, the research team decides to analyze the drug's effects in subgroups. By subgrouping the subject pool into 20 subgroups, the researchers find statistically significant mood benefits for men/women w birthdays in the early fall. Conclusion that can be drawn from finding is that it is:

AN ARTIFACT OF MULTIPLE ANALYSES

Mental status changes after CABG, fluent speech and excellent comprehension, inability to name fingers and body parts, right and left orientation errors inability to write down thoughts and calculation, but with good reading comprehension.

AN EMBOLIC STROKE AFFECTING LEFT ANGULAR GYRUS

Why does an Individualized Education Programs (IEP) offer more options than a 504 plan?

AN IEP ALLOWS MODIFICATION TO THE ACADEMIC REQUIREMENTS FOR THE STUDENT

15 yo pt comes to plastic surgeon w/ parents requesting rhinoplasty. The pt explains "I broke my nose playing hockey 2 years ago and it has bothered me ever since" On exam, her nose is noticeably asymmetrical. Patient shows no obvious psychological distress other than concern for her appearance. Parents report child has had poor self esteem since the injury and they are hoping the operation will help her self confidence. Which of the following is the most likely psychological outcome after cosmetic surgery?

AN IMPROVEMENT IN QUALITY OF LIFE

33 y/o pt in long term psychodynamic psychotherapy for several months is chronically late for sessions. Therapist suggests that this may be resistance. The pt says "oh, don't take it personally, I am this way with everyone". This response can be best understood as

AN UNINTENDED CONFIRMATION OF THE PROBABLE CORE SIGNIFICANCE OF THIS BEHAVIOR.

A muscular male patient presents to an outpatient psychiatric clinic complaining of discomfort in public places and excessive irritability. Though warm outside, the patient is dressed in heavy, baggy clothes, making him appear bigger than he is. The patient's belief that he is shrinking greatly distresses him. Which of the following is the most likely diagnosis for the patient? (2x)

ANABOLIC-ANDROGENIC STEROID ABUSE

Classical psychoanalytic theory says pleasure an adult might take in controlling others/making order of chaos relates to which psychosexual stage of development?

ANAL RETENTIVE

Differential Dx in a 6 y/o with daily fecal soiling includes:

ANAL STENOSIS, HYPOTHYROIDISM, HIRSCHSPRUNG'S DZ, SMOOTH MUSCLE DZ

Karyotyping is a method of genetic analysis characterized by which technique? (2x)

ANALYZING CHROMOSOMAL STRUCTURES

A child with mod-sev mental retardation wakes frequently at night, claps at inappropriate times, and has bouts of paroxysmal laughter. Dx?

ANGELMAN'S SYNDROME

3 y/o girl hurts herself w/ a tricycle. Then she hit the tricycle and asks, "Why did you hurt me?" Which thought process does this behavior exemplify?

ANIMISM

When toddler attributes a symbolic meaning to stuffed animal (e.g. teddy bear), imbuing it with the quality of being alive, this is referred to as:

ANIMISM

Psych MD sees 62 y/o pt who has been hospitalized after an acute MI because staff report that "the pt is driving us crazy." The nurses complain that pt is constantly requesting info about his condition and treatment, and will refuse tests and medications if he feels the explanations are not sufficient. On interview pt admits that "I am a perfectionist" but is proud of this fact, saying that it is "the secret of my success." Pt is aware of the staff's frustration, but feels his requests for information are reasonable. The best advice to the Tx team?

ANSWER THE PT'S QUESTIONS AND ACTIVELY INVOLVE THE PT IN ALL PORTIONS OF HIS TREATMENT

Molecular mechanism of ketamine?

ANTAGONIST AT NMDA RECEPTORS

Akinetic mutism can result from bilateral infarctions of which structure?

ANTERIOR CINGULATE GYRUS

?????? Effortful, nonfluent speech with decreased speech output. where is the lesion?

ANTERIOR FRONTAL GYRUS

55 y/o pt w/ hx of weakness and clumsiness x several months. Difficulty w/ fine motor tasks. Arm muscles twitch and cramp easily, weakening, atrophy. Sensory, coordination, cranial nerve exams wnl. Underlying illness affects neuronal bodies where (3)?

ANTERIOR HORN OF SPINAL CORD, MEDIAL BRAINSTEM AND CORTEX

55 y/o M presents w/ hx of weakness and clumsiness. Symptoms began several months earlier with difficulty buttoning his clothes, getting the car keys in the ignition, and performing other fine motor tasks. He noticed that the muscles in his arm and forearm twitched under the surface, and cramped easily. Over the past few months his arms have continued to weaken and lose muscle mass. On exam, he has diffuse wasting and weakness of BUE, fasciculations, slight spasticity on arms and legs, and hyperreflexia with extensor plantar responses. Sensory, coordination, and CN exams are normal. The underlying pathological process affects neuronal bodies in which of the following structures? (3)

ANTERIOR HORN OF THE SPINAL CORD, MEDIAL BRAINSTEM, AND PREROLANDIC CORTEX

28 y/o cocaine user complains of LBP, numbness in both legs and feet, thighs, buttocks, abdomen, and says R leg is weak and clumsy, L leg is tired. Has urinary incontinence and difficulty walking. Decreased light touch, pinprick, and temperature. Normal vibration and proprioception. DTR is hard to elicit. Muscle tone is normal. Decreased strength in B/L LE but worse on right. Diagnosis?

ANTERIOR SPINAL ARTERY INFARCTION

The uncinated fasciculus connects which of the following brain areas?

ANTERIOR TEMPORAL AND VENTRAL PRE-FRONTAL REGIONS

Amnesia characterized by loss of memory of events, occurs after onset of etiologic condition or agent

ANTEROGRADE

Pt w/ hx of CPS presented to ED with high temp, tachycardia, dilated and poorly reactive pupils, VH, agitation, constipation, and dry skin. Dx:

ANTICHOLINERGIC DELIRIUM

Schizophrenic with VH, restlessness, marked thirst, agitation, elevated temperature, dilated pupils, dry skin. Dx?

ANTICHOLINERGIC INTOXICATION

Another psychiatrist refers a pt saying this pt is "special" and needs really good treatment. You need to be careful with the pt and: (2x)

ANTICIPATE THE POTENTIAL FOR SPLITTING BETWEEN THE REFERRING MD AND YOURSELF

Which clinical feature distinguishes panic disorder from pheochromocytoma?

ANTICIPATORY ANXIETY (in panic d/o)

A 72 yo patient had an embolic infarct in the middle cerebral artery territory. ECG shows no structural abnormalities. Doppler studies of the neck arteries reveal less than 50% occlusion on both carotid arteries. An EKG reveals AFib. Which of the following strategies has the best likelihood of reducing recurrent strokes in this patient? (2x)

ANTICOAGULATION WITH WARFARIN

45 y/o still grieving for mother 3 years after her death. States she feels her mother hovering over her and sees mother at night. Friends are concerned. Patient has normal job function, cleans house, endorses anhedonia. Tx?

ANTIDEPRESSANT MEDICATION AND PSYCHOTHERAPY

In addition to benzos, which class of meds is assoc with falls in pts older than 60?

ANTIDEPRESSANTS

In the learned helplessness model, the behavioral deficits in animals exposed to uncontrollable stress is reversed by? (4x)

ANTIDEPRESSANTS

Restless Legs syndrome can be 2/2 to what class of medications

ANTIDEPRESSANTS

72 y/o pt had a lacunar infarct in the middle cerebral artery territory. Echo is normal. Doppler studies of neck arteries reveal less than 50% occlusion on both carotid arteries. EKG is normal. The best strategies to reduce recurrent stroke?

ANTIPLATELET THERAPY WITH ASPIRIN AND DIPYRIDAMOLE

Which meds have best results for treating agitation in dementia?

ANTIPSYCHOTICS

Contraindication to an interpersonal psychodynamic group comprised of people with heterogeneous dx's & levels of functioning.

ANTISOCIAL PDO

Alcohol abuse in men commonly assoc w what comorbid mental D/O

ANTISOCIAL PERSONALITY

Which disorder has greatest co-incidence of alcohol abuse and dependence? (3x)

ANTISOCIAL PERSONALITY DISORDER

In preschool-age children isolated hallucinations are common with:

ANXIETY

In the US, pts meeting the diagnostic criteria for neurasthenic often meet criteria for somatoform disorder, depression disorder, and which of the following categories of disorders?

ANXIETY

The infant temperament studies of Kagan and colleagues found strong correlation between early behavioral inhibition and subsequent development of disorders in the area of:

ANXIETY

Increased rate of comorbidity of what psychiatric disorders with with ADHD?

ANXIETY OR OPPOSITIONAL DEFIANT

Contraindication to the use of clonidine to managing opiate withdrawal [NOT hypotension]

AORTIC INSUFFICIENCY

Which of the following tests is recommended by the American Academy of Neurology to establish the diagnosis of brain death?

APNEA TEST

Normal loss of 25-40% of neurons in fetal brain in the 2nd half of gestation is called:

APOPTOSIS

What is the mechanism for regulating cell production and elimination of inappropriate axonal connections in the developing brain?

APOPTOSIS

Most commonly reported SE of stimulants in kids (2)

APPETITE SUPPRESSION AND SLEEP DISTURBANCES

The criminal defendant tells the psychiatrist doing a forensic eval "I know that killing my father was illegal." However, the defendant delusionally believed that the father was being tortured by demons and killing him was the moral thing to do. The defendant is unable to do what?

APPRECIATE THE WRONGFULNESS OF HIS CONDUCT

A 70 y/o pt is evaluated for difficulty dressing. Wears underwear backwards, unable to get his arms in armholes. Neuro exam is normal. What is this called (2x)?

APRAXIA

Conduction aphasia often occurs as a result of damage to which structure?

ARCUATE FASCICULUS

Infants are more likely to develop insecure attachment if they have primary caretakers who:

ARE UNRESPONSIVE TO THEIR INFANT'S NEEDS

6 year old with autism spectrum is referred to psychiatrist for irritability, aggression, and hitting self. Child has not responded to Risperdal. Which has the most evidence for managing irritability and aggression?

ARIPIPRAZOLE

78 y/o pt with Alzheimer's dementia living with spouse and daughter, starting to accuse the spouse of infidelity. On evaluation, he asserts that the spouse is unfaithful. He is alert and acts congenitally with the spouse, he is on donepezil. Labs and medical workup is unrevealing of any disorder outside of dementia. Next?

ARRANGE FOR REGULAR EVALUATIONS OF THE PT AND REASSURE THE FAMILY.

Metachromatic leukodystrophy associated w/ mutation in gene for which enzyme? (2x)

ARYL SULFATASE

10 y/o M s/p MVA sustained burn and crush injuries to R foot 4 days ago, does not remember the accident but never lost consciousness, keeps asking for his mother who was killed in the accident and having nightmares crying out "Daddy help Mommy." When should the child be told about his mother's death?

ASAP

Initial psychiatric intervention for 50yo married man with erectile dysfunction during sex but normal masturbatory ability, otherwise good marriage, and normal evaluation by PCP. Next step?

ASK PT TO BRING WIFE TO DISCUSS BEHAVIORAL EXERCISES

How do you test ideomotor apraxia if the patient has intact language comprehension?

ASK THEM TO PRETEND TO LIGHT A MATCH

A researcher develops a new questionnaire on the subject of traumatic stress. Which of the following actions would be most appropriate to test the measure's content validity?

ASK TRAUMA EXPERTS TO EVALUATE ITS RELEVANCE AND COMPLETENESS

A med that is most likely to slow the progression of vascular dementia:

ASPIRIN

In managing acute ischemic stroke, administer this within 48 hrs of onset of stroke for beneficial effect in reducing risk of recurrent stroke, disability and death?

ASPIRIN

29 y/o M pt with hx of CPS 8x hospitalization in 14 months, stopped his meds and is unable to take care of himself, becomes paranoid and stays on the street, eating out of garbage cans and his family is unable to support him anymore. The most appropriate intervention to decrease this pt's risk of future hospitalizations: (2x)

ASSERTIVE COMMUNITY TREATMENT

Which Tx modalities provides care for seriously mental ill pts in community via a multidisciplinary Tx team

ASSERTIVE COMMUNITY TREATMENT

80 y/o pt with Alzheimer dementia who lives with a daughter is brought in for evaluation of increasingly combative behavior. The daughter would like to keep the pt at home if possible. What intervention would be most helpful in this situation?

ASSESSING FOR CAREGIVER BURNOUT

80 y/o pt with Alzheimer's dementia who lives with the daughter is brought in for evaluation of increasingly combative behavior. The daughter would like to keep the pt at home, if possible. Which of the following interventions would be most helpful in this situation?

ASSESSING FOR CAREGIVER BURNOUT

80 y/o pt with Alzheimer's is brought in for increasingly combative behavior. Daughter would like to keep the pt at home if possible. What interventions would be most helpful in this situation?

ASSESSING FOR CAREGIVER BURNOUT

Determines if pt has ego strength for therapy

ASSESSMENT OF QUALITY OF RELATIONSHIPS

As opposed to strokes caused by arterial embolism or thrombosis, those caused by cerebral vein or venous sinus thrombosis are?

ASSOCIATED WITH SEIZURES AT ONSET

Bilineal inheritance typically reflects which of the following evolutionary population genetic features?

ASSORTATIVE MATING

42 M becomes depressed after discovering his wife is having an affair. Pt describes anger at his wife, avoids talking to her. Admits to feeling that the wife's actions are his fault, that he is a failure as a husband. The pt notes that he has begun to dwell on his past failed relationships, as well as the divorce of his parents. Pt begins CBT for depression. Most appropriate target for this type of therapy in this pt?

ASSUMPTIONS OF PERSONAL FAILURE RESULTING FROM THIS CRISIS

42 y/o pt b/c depressed after discovering his wife is having an affair. Pt describes anger at his wife and avoids talking to her. He admits to feeling his wife's actions are his fault and that he is a failure as a husband. Pt notes he has begun to dwell on past failed relationships and the divorce of his parents. He begins CBT. The most appropriate target for this type of therapy would be the pt's

ASSUMPTIONS OF PERSONAL FAILURE RESULTING FROM THIS CRISIS

Typical of Idiopathic Parkinson's disease, rather than another Parkinsonian syndrome: (x2)

ASYMMETRICAL ONSET AND PROGRESSION OF MOTOR SYMPTOMS.

What statement reflects current thinking about neurological procedures for intractable OCD?

AT PRESENT, THERE IS LITTLE EVIDENCE TO SUGGEST THAT ANY ONE PROCEDURE IS SUPERIOR TO ANOTHER

A child w/ selective mutism is most likely to have difficulties in which area?

AT SCHOOL

What culture-bound syndromes would be Dx for a pt with of insomnia, HAs, anorexia, fears, despair, diarrhea, &amp; anger?

ATAQUE DE NERVIOS

75 y/o pt with AD started on quetiapine 12.5 mg bid for agitation. According to the Omnibus Budget Reconciliation Act, what is required of the MD for good stewardship of the use antipsychotics: (2x)

ATTEMPT TO DECREASE OR STOP THE MED DOSE AT LEAST EVERY 3 MONTHS

Researcher developing test for working memory in schizophrenics. In addition to measuring immediate memory, what else should test measure?

ATTENTION

Someone taking the Continuous Performance Test (CPT) is asked to press a key whenever any letter except "X" is displayed on the screen. The letter "F" is displayed and the patient fails to press a key. Most likely a problem with,

ATTENTION

Most useful instrument to assess a non-verbal 3-year old child who plays alone in the corner, stacking/unstacking blocks?

AUTISM DIAGNOSTIC OBSERVATION SCHEDULE (ADOS)

A child with intellectual disability is free of seizures but develops epilepsy in adolescence. Pattern of onset is often seen with?

AUTISM SPECTRUM DISORDER

During psychotherapy, patient describes situation where roommate left the apartment after receiving a call. Patient recalls "im being left out again".

AUTOMATIC THOUGHTS

Adolescent with recent SA is about to be discharged from hospital. The parents refuse a request to remove firearms from the house, stating, "I need firearms to protect my family and I will make sure they are secured." Which ethical principle CONFLICTS with the psychiatrist making a CPS report?

AUTONOMY

Providing pts with an understanding of their disorders and options for treatment is honoring which of the following principles of ethics:

AUTONOMY

Eriksonian phase correspond w/ Freud's anal phase

AUTONOMY VS. SHAME AND DOUBT

Pattern of inheritance in Wilson's disease

AUTOSOMAL RECESSIVE

22 y/o experiences a earthquake (7.0) during a seminar. In the months that follow he develops fearful reaction to sudden or loud noises. Pt avoids classes in the same building that the seminar was in. What is the mechanism of the behavior? (2x)

AVERSIVE CONDITIONING

During an evaluation for competency to stand trial, a defendant tells the court-appointed forensic psychiatrist about being involved in an unsolved crime. The psychiatrist should do what?

AVOID A DETAILED DESCRIPTION OF THE DEFENDANT'S PAST OFFENSE HISTORY

What personality disorders should be the main consideration in differential dx of schizotypal personality disorder?

AVOIDANT

What is considered to be the dey component underlying the syx of selective mutism?

AVOIDANT BEHAVIOR

Which statistic measures magnitude of difference between two intervention groups?

EFFECT SIZE

2.5 y/o observes mother take an apple from the refrigerator, mother briefly turns back to the child and beings eating, when mother turns toward child he animatedly grabs for the apple and say, "my apple, not Mommy's." This behavior is best described as which developmental achievements?

AWARENESS OF BEING A SEPARATE SELF

A dislocation of shoulder joint resulting in weakness of abduction of arm, wasting of deltoid muscle and slight impairment of sensation on the lateral aspect of shoulder, involves which nerves:

AXILLARY

The blood brain barrier is made up of what kind of cells?

Endothelial

First marker of impending puberty in females?

Acceleration of linear growth

Main advantage of parallel group, randomized controlled designs compared to crossover designs

FEWER RESIDUAL EFFECTS

Patient sees psychiatrist, diagnosis depression. Treated. Patient improves. Sees social worker for weekly therapy, decompensates without reporting to psychiatrist, then commits suicide. Who is responsible?

BOTH PROVIDERS MAY BE RESPONSIBLE BECAUSE BOTH HAVE A DUTY TO KNOW THE CONDITION OF THE PATIENT

Difference between a boundary violation and boundary crossing is? (4x)

BOUNDARY VIOLATIONS ARE CHARACTERISTICALLY EXPLOITATIVE

In anatomical volumetric studies, Increased trait aggression has been associated with reduced volume of what?

Amygdala

Learn helplessness model: what can reverse behavioral deficits in animals?

Anti-depressants

What theory is the basis of mentalization-based therapy?

BOWLBY'S ATTACHMENT THEORY

The term for abnormally slow speech seen in depression

BRADYLALIA

Who contributed DEFENSE MECHANISMS

Anna Freud

Which interview technique is illustrated by validating a patient's inappropriate ED visit (eg. superficial wrist laceration) but also transitioning to their emotional needs?

CONFRONTATION

What is the similarity between copy number variation and single nucleotide polymorphisms?

Are commonly found in healthy individuals

65 y/o has first generalized tonic-clonic Sz seen by spouse and they have been confused and lethargic since. Episode began w/ repetitive shaking of right arm. Blood tests unremarkable and no hx of other recent symptoms, trauma, or metabolic disorders. What study will likely reveal cause?

BRAIN MRI

Rapid onset of right facial weakness, left limb weakness, diplopia: (2x)

BRAIN STEM INFARCTION

Which lesion causes bilateral coarse nystagmus worsening with visual fixation and present with horizontal and vertical gaze?

BRAINSTEM

Adult LP with opening pressure 190, protein 110, glucose 27, leukocytes 5,000. Dx?

BACTERIAL MENINGITIS

Pt with vascular dementia typically has neuropathological changes assoc with this part of the brain [not a lobe]

BASAL GANGLIA

3 ½ y/o girl has increasingly become interested in dressing up in her mother's clothes and shoes, with increased remarks about being a girl. It would be most consistent with a social learning theory explanation of psychosexual development to say that her behavior is based on what? (x2)

BASED ON MATERNAL MODELING AND BEHAVIOR

Researchers wish to study a group of students who were exposed to a terrorist attack in which some of their classmates were killed, and compare the students to other students who had not undergone such a trauma. For the study to be considered quasi-experimental, which of the following requirements must be met?

BASELINE DATA MUST HAVE BEEN COLLECTED BEFORE THE EVENT

25 y/o w/ VH - similar to the wavy distortions produced by heat rising from asphalt - affecting the whole of both visual fields, + vertigo, dysarthria, tingling in both hands and feet and around both sides of mouth followed by occipital headache. Most likely dx:

BASILAR MIGRAINE

Pts who are committed to psychiatric treatment institutions in most states are presumed to:

BE COMPETENT TO MAKE THEIR OWN DECISIONS

A doc meets with a pt and family to discuss treatment of pt's mild Alzheimer's disease. There are no other neurological or psychiatric symptoms or findings. The most appropriate course of action would be to:

BEGIN CHOLINESTERASE INHIBITOR TREATMENT

67 y/o with MDD doing well on SSRI but continues to have insomnia and sleepiness during day. Snores loudly, morning headaches, and night sweats. Dx?

BREATHING-RELATED SLEEP DISORDER

45 y/o pt who is in good physical health reports increased fatigue, decreased appetite, and an inability to take pleasure in usual activities. Pt is begun on fluoxetine 20mg/day, and pt's mood improves over the course of 2 weeks. However, pt now notes a new onset of anxiety symptoms, including restlessness in the arms and legs. Pt is observed to fidget and seems unable to sit still for the exam. Neurological exam: unremarkable. Which courses of Tx would be most appropriate?

BEGIN PROPRANOLOL 10MG TID

42yr old female with depression, Spanish speaking, usually seen by psychiatrist with interpreter, but this time bilingual husband will serve as interpreter, psychiatrist sees unexplained injuries and suspects abuse by husband, at next appointment pt comes with close bilingual friend and requests friend to join session, pt says husband is parking car and will be in shortly, what would be the best approach to clarify to clarify suspicions of abuse?

BEGIN SESSION WIT PT, INTERPRETER, AND PTS FRIEND WHILE HAVING THE HUSBAND REMAIN OUTSIDE

Pt w/ MDD has been unresponsive to prior trials with a TCA and SSRIs. Pt has 1st degree right bundle branch block and poorly controlled HTN. Pt w/ no SI. Next step?

BEGIN TX WITH PHENELZINE

With respect to *Rotter's social learning theory*, which of the following statements best describes having an internal locus of control?

BEHAVIOR IS SHAPED BY AN INDIVIDUAL'S EXPECTATION THAT IT WILL REALIZE A VALUED GOAL

A high functioning pt with schizophrenia resists in moving forward with life once her symptoms are under control. Largely sedentary, eats all meals at fast food. Needs to do stuff. What action should the psychiatrist choose?

BEHAVIORAL ACTIVATION

Studies show effective intervention for children with ADHD is to involve their parents in what part of Tx? (4x)

BEHAVIORAL MANAGEMENT

A 5 year-old bilingual child has progressive refusal to speak in public, being very talkative at home and refusing to speak throughout the day in his kindergarten class. He is diagnosed with selective mutism. What is the appropriate intervention?

BEHAVIORAL TREATMENT TO INCREASE THE CHILD'S TOLERANCE FOR SPEAKING IN PUBLIC

A child with autism is placed in a therapeutic foster home where a consistent response is made to a given action with the goal of improving the child's functioning. This technique derives from which of the following learning theories?

BEHAVIORISM

Psychic determinism is (2x)

BEHAVIORS RESULT FROM UNCONSCIOUS MIX OF DRIVES, DEFENSES, OBJECT RELATIONSHIPS, SELF-DISTURBANCES

Generalized anxiety disorder is characterized by excessive worrying along with what combination of symptoms?

BEING EASILY FATIGUED AND FEELING KEYED UP

According to Winnicott, which is an essential component of parenting infants?

BEING SENSITIVE TO THE CHILD'S INSTINCT FOR EXPLORATION AND GROWTH

Pt who suffers from a serious mental d/o is a defendant in a criminal matter. Even if pt understands the nature and objectives of court proceedings, pt may be found not competent to stand trial under:

BEING UNABLE TO ASSIST ATTORNEY IN THE DEFENCES

Acute onset of left facial weakness involving the forehead &amp; perioral musculature. Onset of facial weakness was preceded by pain in left ear and mastoid, and by sensation of discomfort in the left ear w/ loud noises or low pitch sounds. Dx?

BELL'S PALSY

Paternalism can be justified by which of the following basic ethical principles (x2):

BENEFICENCE

Pt confused, disoriented, dry mouth, dilated unresponsive pupils. Likely ingested

BENZTROPINE

62 y/o requests antidepressant. Spouse died 6 wks ago. Crying spells, decreased appetite, poor sleep. Continues to see friends, no SI. Fam Hx of depression, no prior depressive episodes (3x)

BEREAVEMENT--ASSURE PATIENT OF NO PATHOLOGY

Education campaigns to reduce mental illness stigma discovered unexpected findings of:

BIOLOGICAL EXPLANATION FOR MENTAL ILLNESS ARE NOT ASSOCIATED WITH MORE TOLERANT ATTITUDES TOWARDS THE ILLNESS

According to contemporary psychoanalytic theory, from birth to 18 months, children experience an emerging "self" as a result of what event?

BIOLOGICAL PROCESSES AND BODILY SENSATIONS COME TO HAVE A PSYCHOLOGICAL MEANING

Hx of MDD, irritable, restless, distractible, insomnia, poor appetite, guilt, impulsive spending

BIPOLAR D/O, MIXED

What diagnosis, considered in the absence of other comorbidities, is estimated to put one at highest lifetime risk for suicide?

BIPOLAR DISORDER

Children demonstrate a preference for the human voice and speech over other sounds at what age? (2x)

BIRTH

What is the mech of action of varenicline in the treatment of tobacco use disorders?

BLOCKS REINFORCING EFFECT OF NICOTINE

32 y/o pt reveals a long-standing preoccupation with the shape of her mouth and teeth, though she says that her friends and spouse have assured her that her feelings are inappropriate. Pt reports that she often spends an hour cleaning her teeth, so that the abnormality will be less noticeable. At times she avoids social contact, fearing that people will silently criticize the appearance of her mouth. She has no other obsessions or cleaning rituals. Best dx?

BODY DYSMORPHIC DISORDER

Bulimia nervosa presents in which personality d/o?

BORDERLINE

Pts w/ this personality d/o most likely to have 1st degree relatives with depression

BORDERLINE PD

Which personality d/o is most commonly found in pts w/ severe factitious d/o?

BORDERLINE PERSONALITY

What is a negative predictor response to treatment with AD in pts with MDD?

BORDERLINE PERSONALITY DISORDER

Test to discriminate cognitive difficulties in Alzheimer's from those in depression

BOSTON NAMING TEST

Healthy 37 y/o F business exec learns that her brother is killed in a MVA and is decapitated. Three days after the funeral, she spots a man driving a car just like her brothers and is now convinced he is not dead. She believes she is the victim of a conspiracy in which others are manipulating her into losing her mind on order to take over her business. She calls the police and begs that action be taken. A month after treatment, her symptoms are gone and within 3 months she has returned to normal function. The diagnosis is:

BRIEF PSYCHOTIC DISORDER

This treatment goal is most specific to psychoanalytic psychotherapy: x2

BRINGING UNCONSCIOUS CONFLICT INTO AWARENESS.

What is a sleep disturbance likely to occur after initiating a trial of an SSRI?

BRUXISM

Routinely informing pts about confidentiality limits is example of what ethical skill? (6x)

BUILDING ETHICAL SAFEGUARDS INTO WORK

23 y/o pt w/ excessive preoccupation with body shape. Pt is in no apparent distress, but admits to binge eating episodes followed by purging twice weekly for past 6 months, Body weight: normal. Dx: (x2)

BULIMIA NERVOSA

Pt with significant medical hx admitted to inpatient psych unit. Labs show: low K and Cl, elevated HCO3 and amylase, and normal lipase. Dx: (2x)

BULIMIA NERVOSA, PURGING TYPE

What antidepressant increases REM sleep?

BUPROPION

What meds could be helpful in the treatment of depression in persons over the age of 65 because it does not produce orthostatic hypotension

BUPROPION

Smoking cessation strategy with highest success rate

BUPROPION PLUS GROUP THERAPY

3 days s/p cardiac arrest and CPR, 73 y/o man is comatose. His eyes are open but he does not fix and follow with his eyes. Doll's eyes elicits full horizontal eye movements. His spontaneous limb movements are symmetrical. Reflexes: mildly hyperactive. The EEG shows? (2x)

BURST SUPPRESSION PATTERN

In a pt with hippocampus damage, what allows them to still learn new skills like playing tennis?

Basal ganglia

Developmental task of school-age stage

Begin to establish peer relationships and pursue group activities

Ethics of inpatient psych for SI pt refusing tx?

Beneficence

Acute anxiety, restless, flushed, irritable, nauseous, w/o insomnia -attributes to stress at work. What substance is this person intoxicated with?

CAFFEINE INTOXICATION

35yo gets blurry vision, drooping eyelids, and difficulty swallowing. Weakness of bulbar muscles. What caused this?

Botulinum

What ANTIDEPRESSANT can you add to lithium for tx resistant bipolar depression and is least likely to induce rapid cycling/mixed state?

Bupropion

Lithium can raise what serum electrolyte?

CALCIUM

One month after a MVA, a 21y/o co persistent pain in the left shoulder and arm, with sharp pain radiating into the left thumb. Exam shows weakness of the biceps. The biceps reflex on the left is absent. The most likely diagnosis is? (2x)

C-6 RADICULOPATHY

The goal of the initial phase of interpersonal psychotherapy

COLLECTING INFORMATION ABOUT PT'S SIGNIFICANT RELATIONSHIPS

Triptan drugs should not be given in abortive treatment of migraine in pts with:

CAD

Due to the increased risk of stroke and sudden death, the U.S. FDA has determined that what substance is unsafe when used in combination with ephedra?

CAFFEINE

35 y/o ED physician is referred for psychiatric evaluation by ED medical director who has noted recent changes in the physician including rambling speech, psychomotor agitation, a flushed and excited appearance, and restless demeanor. On eval, physician complains of having to work excessive and different shifts due to several members of the group being out on vacation or sick. Physician also complains of palpitations. The physician admits to using alcohol to initiate sleep and more caffeine to stay alert. Dx?

CAFFEINE INTOXICATION

Genetic linkage studies investigates what in medicopsychiatric research:

CO-SEGREGATION OF GENES DURING MEIOSIS

During the acute initial refeeding phase of treatment for a patient with severe anorexia nervosa, which of the following is the most helpful focus of psychotherapeutic interventions?

COACHING, SUPPORT, AND POSITIVE BEHAVIORAL REINFORCEMENT

Progressive LE stiffness & hyperreflexia (ankle clonus) with extensor plantar responses and decreased light touch & vibration/proprioception in b/l stocking pattern?

COBALAMIN DEFICIENCY

Not pregnant premenopausal pt in ED has galactorrhea, elevated prolactin level, pt denies seizures or antipsychotic meds. What condition could explain this?

COCAINE WITHDRAWAL

Most common psychotherapy for sex offender treatment?

COGNITIVE BEHAVIOR THERAPY

30 y/o morbidly obese pt refuses to change eating and exercise habits, "I'll worry about my health when I am 65." One month later his father, also obese, dies of a myocardial infarction. The now obvious disparity between pt's current behavior and knowledge of the circumstances surrounding his father's death is an example of which learning theory process?

COGNITIVE DISSONANCE

According to Aaron Beck, the primary defect in depression involves which of the following?

COGNITIVE DISTORTION

What most commonly limits the use of ECT

COGNITIVE IMPAIRMENT

TBI trained to use an electric tablet to assist with everyday life. Which type of intervention?

COGNITIVE REHABILITATION

98yo schizophrenic w memory loss and slowed thinking, stable on clozapine, with poor response to haldol, zyprexa, geodon and abilify. What could improve the pt's symptoms

COGNITIVE REMEDIATION THERAPY

In a group who has met for 6 therapy sessions, one pt has spoken at significant length for past 4 sessions about irrelevant issues & group members have rallied against him. What therapeutic mechanism in group psychotherapy is being undermined?

COHESIVENESS

What research design would be the most appropriate in establishing a causal relationship between childhood vaccination and onset of autism?

COHORT

Research suggests that the frequency of alcoholism in lesbians as compared to heterosexual women was greater only in lesbians over 55 years of age. Which of the following is considered to be the best explanation for this finding?

COHORT PHENOMENON RELATED TO SOCIOCULTURAL ISSUES

Type of study to determine relationship between risk factor and development of disease

COHORT STUDY

Which aspect of psychiatrist' role is based on recovery-oriented principles in a community MH center providing recovery-oriented care?

COLLABORATING IN PARTNERSHIP WITH CONSUMERS TO SUPPORT THEIR GOALS

Psychotherapy research shows which of the following practices in a therapeutic relationship is most supportive for improving outcomes?

COLLECTING FEEDBACK FROM THE PT ABOUT THE TREATMENT

Initial tasks in starting supportive group therapy are deciding logistics and selecting patients. Next step

CREATE AND MAINTAIN THERAPEUTIC ENVIRONMENT KEEPING IN MIND CULTURE OF THE GROUP

After an injection with haldol, a patient appears tremulous, dystonic, confused, and has a fever of 38.8 degrees C. Which of the following would be an essential part of the diagnostic workup for this patient?

CSF EVALUATION

Reducing the intensity of an addict's reaction to environmental reminders of drug use is a goal of what intervention?

CUE EXPOSURE TREATMENT

How does global MH differ from other areas of global medicine?

CULTURAL BELIEFS HAVE A GREATER INFLUENCE ON DX UNDERSTANDINGS

A Japanese family who recently moved from Japan brings their 6 yo child for an evaluation. They express concerns that the child appears depressed, is reluctant to go to school, and is fearful that harm will befall the parents. During the evaluation it is noted that the child sleeps in the same room as the parents. Which of the following is the most likely explanation of this sleeping arrangement?

CULTURAL NORM

When evaluating for competence to proceed in a criminal matter, the psychiatric evaluator should focus on which aspect of the defendant? (2x)

CURRENT MENTAL FUNCTIONING

Guy drinks 12-15 cups of coffee a day, has insomnia and headaches relieved by drinking coffee. Irritable and poor concentration if he doesn't drink coffee. How to treat?

CUT CAFFEINE BY 25% WEEKLY

pt is seen by psychiatrist because has been depressed for 1 yr since he was fired in spite of having another job. The psychiatrist tells the pt: men often feel that they are not allowed any failures but I can tell that you have moved on from this successfully and have no reasons to dwell in it. The pt then withdraws. The most likely cause of pt response is that he felt

CUT OFF BY THE PREMATURE OFFERING OF REASSURANCE

Which psych disorder has the strongest genetic contribution

CYCLOTHYMIC DISORDER

Mechanism explained the effect of grapefruit juice in drug bioavailability

CYTOCHROME METABOLISM

Histology consistent with Jakob-Creutzfeldt disease

CYTOSOLIC VACUOLATION OF NEURONS AND GLIA WITH PRION INCLUSIONS

Methoodological advantge of a genome wide association study in comparing individuals with schizophrenia to demographically matched controls.

Can detect common gene variants that have small effect on disease risk.

Pts w/ PTSD have higer frequency of a specific genotype, this refers to what gene identification approach

Candidate-gene approach

47 yo with well controlled epilepsy well controlled on monotherapy develops nausea, ataxia, and diplopia when treated with erythromycin. Which anti-epileptic?

Carbamazepine

Across all cultures, what stressful life changes is correlated with greatest increase in death and illness in the subsequent 2 years?

DEATH OF A SPOUSE

What was reported in the findings in the STAR*D study?

FEWER THAN 1/3 OF SUBJECTS REMITTED WHEN TREATED WITH FIRST SSRI

A 10 yo child remains sad and angry about his parent's divorce but no longer believes that he caused the separation. This cognitive change is example of what mechanism?

DECENTRATION

CNS response to fear mediated by what structure [BE SPECIFIC]

Central nucleus of the amygdala

Risk factor for developing bulimia?

Childhood sexual abuse

What is the likely course for a child's development after their parents divorce?

Children do well in one parent homes provided stable parental functioning and financial security

Role of the hippocampus and parahippocampal gyrus? (4x)

DECLARATIVE MEMORY (FACTS)

Most ethical response and reason when patient sends therapist a Facebook friend request

DECLINE DISRUPTS BOUNDARIES OF THERAPEUTIC FRAME

28 yo F with weird behaviors for 1-2 mins, putting clean silverware in dishwasher, chewing movements, normal MRI. Dx?

Complex partial seizures

New instrument for PTSD does not ask about traumatic event. Raises which concern about validity?

Content validity

Neurosurgical approach that treats refractor OCD targets what "circuitry"

Cortico-striatal-thalamo-cortico-circuitry

Most appropriate rationale for using humor in CBT

HELPING TO CREATE A NEW PERSPECTIVE ON OTHERWISE DISTORTED COGNITIONS

Which of the following agents has been shown to augment the effects of CBT on anxiety disorders? [not a commonly prescribed med]

D-CYCLOSERINE

A condition with increased frequency in pts with HIV on long term HAART:

HEPATOTOXICITY

Molecular targets for improving cognition in schizophrenia have shown promise via which of the following mechanisms?

D1 RECEPTOR AGONISM

Indication for treating a manic with ECT

DANGEROUS LEVELS OF EXHAUSTION

Pt w/ treatment-resistant mania and h/o rapid cycling is being treated w/ carbamazepine and thyroxine. After adding clozapine the pt is clinically stabilized. The pt's most recent WBC is below 3,000. Intervention?

D/C CARBAMAZEPINE

???? A 75 yo with baseline dementia admitted for new onset confusion, disoriented to time and place, work up negative, started on Haldol. After 3 days pt is much improved and minimally somnolence but still disoriented, what is the next pharmacological treatment approach

D/C HALDOL

6 y/o presents with a 3 yrs hx of disruptive behaviors at home and school. Parents report he has difficulty paying attention and completing tasks. Recently pt has b/c more oppositional and angry with adults and peers. He often states, "I am no good." What comorbid condition is most likely explanation for the child recent behaviors?

DEPRESSION

ADHD comorbid psychiatric disorder

DEPRESSION

Blunted response to TRH stimulation test correlates with ...

DEPRESSION

Clinical syndrome that is most commonly comorbid with Parkinson's disease:

DEPRESSION

Learned helplessness is a model for (2x):

DEPRESSION

Which disease is most likely to present as pain disorder

DEPRESSION

Which of the following is the most common psychiatric presentation following a stroke?

DEPRESSION

Which Sx is most common in pts with SLE?

DEPRESSION AND/OR COGNITIVE DYSFUNCTION

A profound breakdown in both the logical connection between ideas and the overall sense of goal-directedness of speech is called:

DERAILMENT

Detachment of emotional component from perception

DEREALIZATION

Psychiatrist and patient move from the day room to an interview room where they have met on several occasion. The patient states, "the room looks weird and different today it doesn't feel right." This statement is an example of:

DEREALIZATION

Starting around age 3 years, children spontaneously use language in which of the following ways?

DESCRIBE PAST EVENTS

5 y/o enacts fight between two dolls. What should therapist do?

DESCRIBE THE DOLL'S AFFECT WITHOUT ATTRIBUTING ANGER TO THE CHILD

80yr old pt with MDD has tried SSRIs and SNRIs with no improvement, wants to start TCA, no cardiac hx and EKG is normal, which medication is most appropriate due to the side effect profile?

DESIPRAMINE

A psychiatrist wished to start an inpatient on a TCA but the pt is reluctant due to hearing these drugs may cause dry mouth, constipation, blurred vision and urinary retention. What TCA would have the least side effects?

DESIPRAMINE

Antidepressant preferred for >65 year old for which blood levels are clinically useful

DESIPRAMINE

Which medications is most likely to precipitate a manic switch in a patient with bipolar I disorder

DESIPRAMINE

An appropriate purpose for projective testing is to

DETECTING THE PRESENCE OF SUBLE PSYCHOTIC THOUGHT PROCESSES

What does functional MRI measure?

DETECTS BLOOD FLOW

Pt confides to the psych MD that the pt's spouse has been physically abusing the pt. In all cases, the psych MD should do what before the pt leaves office?

DETERMINE WHETHER THE PATIENT IS IN PRESENT DANGER

Major task of a group therapy during initial engagement phase is

DETERMINING LIMITS OF EMOTIONAL SAFETY

Pt is annoyed by family's expression of concern for his condition, saying, "what they are saying is all in the talk." What defense mechanism is this?

DEVALUING

Core principle of motivational interviewing that is used to treat addictive behaviors

DEVELOP DISCREPANCY

Core principle of motivational interviewing when used to treat addictive disorder:

DEVELOP DISCREPANCY

Substance found in several over-the-counter symptom cold remedies and is abused to produce a dissociative feeling: (2x)

DEXTROMETHORPHAN

Which type of therapy has individual sessions to analyze self-destructive cognitions/feelings/actions, and group sessions with skills training to improve relationships and decrease impulsivity?

DIALECTICAL BEHAVIORAL THERAPY

Which side effect occurs less frequently in pts treated with mirtazapine vs SSRIs?

DIARRHEA

??????? 25 y/o M w 7 months depression, forgetfulness, weight loss, insomnia, painful tingling in both feet +incoordination. Involuntary choreic movements of B/L UE, apathetic, monosyllabic. Labs normal. EEG: mild diffuse slowing. CT/MRI nml. During admission develops severe akinetic mutism, seizures, dies. Brain autopsy shows?

DIFFUSE AMYLOID PLAQUES, SPONGIFORM NEURONAL DEGENERATION, AND SEVERE ASTROGLIOSIS

MRI finding for woman with memory decline, urinary incontinence, and trouble walking

DILATION OF VENTRICLES

25 y/o pt hospitalized for an acute psychotic break, begins to complain of thickened speech. Physical exam reveals eyes deviated to the upper right, grimacing, and posturing of the arms. The only meds taken were haldol and clonazepam. The most helpful treatment at this point would be

DIPHENHYDRAMINE

As result of a MVA a pt feeling panic before have to drive and has begun to avoid it. Example of mechanism of fear development [______ conditioning]

DIRECT CONDITIONING

Police brings criminal to ER requesting for notification after discharge. HIPAA true statement?

DISCLOSURE CAN BE MADE WITHOUT THE PATIENT'S CONSENT

Pt arrested for possession of cocaine, spends 2 days in jail, after missing apps with subs abuse counselor. Intervention is referred to as...?

DRUG COURT

Pt arrested for possession of cocaine, spends 2 days in jail, after missing appts with subs abuse counselor. Intervention is referred to as...?

DRUG COURT

Psych eval requested on management of 32 y/o pt admitted by internal medicine for tx of severe gastrointestinal viral infection—dehydration, nausea, vomiting, fever. Pt has hx schizoaffective disorder, controlled w stable doses of clozapine over the past year. Staff concerned that pt might be delusional/hallucinating, as pt has appeared somewhat confused/ inattentive. On exam, pt is oriented to person, place but not time. Pt somewhat slow, appears visibly ill/tired. Pt complains of stiffness, there is some rigidity to movements. Psych recommendation?

DISCONTINUE CLOZAPINE

Pt receiving weekly brief psychodynamic psychotx. 2 months into tx pt acknowledges being aware of maladaptive behaviors, reports now being able to remove himself from situations that frustrate him. The pt's account is reflective of which of the following elements of brief psychodynamic psychotherapy?

DISCREPANCY

Goals of brief psychodynamic psychotherapy compared to long-term psychodynamic psychotherapy differ how

DISCUSSION OF TRANSFERENCE IN THE LATTER

A 35 yo F has discoid lupus which has long been controlled with a stable dose of oral prednisone. She abruptly develops increased fatigue, inflamed joints, and diffuse myalgias. Pt also exhibits depressed mood and cognitive impairment. She has no prior psychiatric history and no focal neurological signs. Etiology of symptoms?

DISEASE INDUCED CEREBRITIS

Adopted children who have a biological parent with alcohol dependence are at increased risk of developing alcohol dependence when compared to their adoptive siblings. This is evidence for which of the following models of substance abuse?

DISEASE MODEL

Criteria A for schizophrenia includes delusions, hallucinations and...

DISORGANIZED SPEECH

Which concerns is the most common reason for referral of children and adol (6-16 y/o) to mental health professionals? (2x)

DISRUPTIVE BEHAVIOR

Which psychiatric disorder is comorbid with ADHD?

DISRUPTIVE BEHAVIOR DISORDERS

A patient presents to the ED after witnessing a tragic MVA in which they witnessed a death. What symptom present immediately following the event increases the individual's risk of developing PTSD?

DISSOCIATION

The most common acute effect of recreational ketamine use:

DISSOCIATION

Pt brought to ed by family because of concern for pts ability to recognize them since TBI one month ago. Pt had LOC after trauma. Tenderness and swelling over L temporal area. Neuro exam normal. Pt knows own name, but unable to identify family members or events related to family. What is diagnosis?

DISSOCIATIVE AMNESIA

Which of the following diagnoses is associated with high hypnotizability potential? (2x)

DISSOCIATIVE DISORDER

Which of the following diagnoses involves a sense of loss of identity, often following a traumatic experience and associated with inability to recall one's past?

DISSOCIATIVE FUGUE

Whenever the culture of western med has been a focus of inquiry by anthropologists, what diagnosis has been seen as a culture bound syndrome in north America?

DISSOCIATIVE IDENTITY D/O

Depression, according to Beck's model is a manifestation of: (2x)

DISTORTED NEGATIVE THOUGHTS (COGNITIVE DISTORTIONS)

Effect of lesions in one cerebellar hemisphere

DISTURBANCE OF SKILLED MOVEMENTS IN THE EXTREMITIES IPSILATERAL TO THE LESION

Pt on methadone screen positive for alcohol, achieve abstinence of alcohol by co-administering what with methadone?

DISULFIRAM

Side effect more frequent in carbamazepine than lithium

DIZZINESS

Molecular mechanism explaining how early life development contributes to psychiatric disorders

DNA methylation

Several months of weekly individual psychotx—woman w MDD, panic d/o describes repressed memories of sexual abuse by stepfather. Therapist neutral, explores pt's experience. Pt reports increasing conviction despite sister insisting it was impossible. Plans tp get lawyer if parents do not admit &amp; apologize. Which is best approach?

DOCUMENT CAREFULLY THE UNFOLDING PROCESS AND OBTAIN SUPERVISION

Pt qualifies for ECT, but does not want his doc to tell him the risks. He is a "chronic worrier" and fears hearing the risks will make him anxious, perhaps to the point of refusing treatment, which he believes he needs. What is the best response?

DOCUMENT THE PT'S KNOWING AND VOLUNTARY WAIVER AND PROCEED WITH TREATMENT

Females have comparable rates to males for what type of abuse

DOMESTIC VIOLENCE

Drug abuse activates neuro circuits. Generates signals in the ventral tegmental area and to where?

DOPAMINE INTO THE NUCLEUS ACCUMBENS

A crossover design is a variation of:

DOUBLE-BLIND

Which tricyclic antidepressant has the most potent antihistaminic effect?

DOXEPIN

The cognitive error of arbitrary inference is based on

DRAWING A CONCLUSION DESPITE THE ABSENCE OF EVIDENCE OR DESPITE EVIDENCE TO THE CONTRARY

Freud's psychological theory of development (2x)

DRIVE THEORY

mutliaxial system introduced in

DSM III

Most common psych complication from TBI

Depression

First step to determine criminal defendant is not guilty by reason of insanity

Determine the legal insanity standard to be used

55 year old brought to ED disheveled and behaving strange, stares blankly and is mute. Doesn't know who they are and all studies are negative. Has vague memory of "walking away from something horrible". Dx?

Dissociative amnesia

Compared to "treatment as usual", how does the IMPACT model of integrated care (which recommends screening for depression of at least 75% of primary care patients and following through with psych eval/mgmt) differ?

Doubles the effectiveness of depression treatment

23 yo borderline with >20 SAs seen for DBT. Therapist asks patient to not self harm for 1 yr. Pt replies " oh sure, that wont be a problem, believe me" best response?

Draw patient's attention to the fact that this commitment will be extremely hard to abide by.

These 2 symptoms make a diagnosis of NMS more likely than other neurological and general medical conditions

FEVER AND SEVERE MUSCLE RIGIDITY

What is an example of a paramnesia?

DÉJÀ VU

When combined with functional neuroimaging, what biomarker is most likely to identify those geriatric pts with mild cognitive impairment most at risk for developing Alzheimer's disease? (6x)

E-4 APOLIPOPROTEIN E ALLELE

Couples therapy: what is the goal of acceptance work?

EACH PARTNER TAUGHT TO UNDERSTAND OTHER'S POSITION & RELEASE STRUGGLE TO CHANGE HIM OR HER

What is associated with poor prognosis in schizophrenics?

EARLY AGE OF ONSET, NEGATIVE SYMPTOMS, LACK OF PRECIPITATING FACTORS

For adult, death of loved one by violent means affects grieving process in what way?

EARLY BEREAVEMENT IS SIMILAR, HOWEVER, DYSPHORIA PERSISTS FOR PROLONGED PERIOD

Melanie Klein differed from Freud in her emphasis on what factor?

EARLY OBJECT RELATIONS

Mutations in the gene that codes for the parkinson protein are most commonly associated with which parkinsonism disease?

EARLY-ONSET PARKINSON'S DISEASE

Characteristic of infants who are hypersensitive and less tolerable to environmental stimuli

EASILY STARTLED AND MORE FREQUENT CRYING

A researcher wants to compare a new atypical antipsychotic medication to the already existing atypical antipsychotics. The researcher wants to conduct the study in routine clinical situations rather than using highly selected subjects. Which of the following study designs would be the most appropriate?

EFFECTIVENESS

Secure attachment in an infant is associated with which of the following outcomes?

EMOTIONAL AND SOCIAL COMPETENCE

Which is a target of DBT in older adults that is not otherwise included in the standard DBT protocol?

EMOTIONAL CONSTRICTION

Homicide and homicidal behaviors are most often related to which of the following factors?

EMOTIONS NOT ASSOCIATED WITH MENTAL ILLNESS.

"I understand why that felt ***" is an example of which type of psychodynamic psychotherapy intervention?

EMPATHIC VALIDATION

In psychotherapy a pt states that he still feels devalued by criticism of father. Therapist comment: It must hurt when you are treated that way. This is example of

EMPATHIC VALIDATION

Therapy intervention most frequently assoc w Kohut's self-psychology:

EMPATHIC VALIDATION

16 y.o. comes home one hour past curfew several times over last few months. What response by parents is most likely to lead to positive long-term outcomes?

EMPATHIZE W/TEEN'S WISH TO STAY OUT LATE, BUT TAKE AWAY PRIVILEGES

14 y/o brought to ED after telling mom that she had been raped by stepdad. On psych eval, pt reports feeling "okay" and denies acute distress. Pt is calm during interview and appears generally unaffected by recent trauma. On further questioning, pt appears confused and believes she is at a friend's house. Which is the preferable intervention?

EMPLOY GROUNDING STRATEGIES TO ORIENT PT

2010 Patient Protection and Affordable Care Act established "health homes" to improve quality of care for medicaid patients with chronic conditions. What is strategy of these health homes?

EMPLOYING A WHOLE-PERSON APPROACH WITH CONNECTIONS TO COMMUNITY CARE AND SOCIAL AND FAMILY SERVICES

According to Winnicott's theory of the development of an infant's assertiveness and sense of competence what best describes the critical function of the holding environment?

ENCOURAGES SPONTANEITY WHILE PROTECTING THE CHILD FROM HARM

Teenager at ED with restlessness, nervousness, facial flushing, muscle twitching and tachycardia. Rambling flow of thought and speech + agitation. Most likely to have ingested:

ENERGY DRINKS

Therapist validates family's strengths/resources in dealing w pt's schizophrenia at bi-weekly family meeting. What stage of family psychoeducational model is this?

ENGAGEMENT

Mental health courts have increased what?

ENGAGEMENT IN COMMUNITY TREATMENT

Which of the following is usually the first step in treating adolescents with substance abuse disorders?

ENGAGING THE PT AND FAMILY IN STEPS TO DIMINISH DRUG-SEEKING BEHAVIOR

What is the underlying mechanism of action of sildenafil in erectile dysfunction?

ENHANCEMENT OF NITRIC OXIDE

11 y/o boy has frequent episodes of ulcerative colitis requiring frequent hospitalization. While in the hospital, mother never leaves his side and responds to questions for him, often referring to disease as "our disease." According to *Minuchin's theory of family interactions*, this is: (3x)

ENMESHED

84 y/o pt w hx of chronic alcoholism & amnesia will need, in addition to abstinence, the following intervention to prevent a progression to alcohol-related dementia:

ENSURING A GOOD NUTRITIOUS DIET

Mother of 2 school aged kids dies unexpectedly. What with improve psychological outcome for the children?

ENSURING AVAILABILITY OF PSYCHOSOCIAL SUPPORTS

Earliest evidence of cell loss in pts with Alzheimer's Dz typically occurs in which of the following areas of the brain?

ENTORHINAL CORTEX

Person who smokes a pack of cig/day stops smoking and has need for cig after every meal. This is... (3x)

ENVIRONMENTAL TRIGGER

What characterizes the memory loss in patients with dissociative amnesia? (2x)

EPISODIC

According to NIMH Epidemiologic Catchment Area Program's reports on ethnicity & prevention of mental disorders, the lifetime rates of APD are affected how by ethnicity:

EQUAL AMONG ASIANS, HISPANICS, AFRICAN AMERICANS,AND WHITES.

Which of the following probabilities most accurately describes the likelihood of patients with schizophrenia committing homicide compared with the general population?

EQUAL LIKELIHOOD

Which antibiotic may significantly raise carbamazepine levels and precipitate heart block?

ERYTHROMYCIN

Most prevalent movement d/o in those over 70 y/o?

ESSENTIAL TREMOR

Power analysis is a statistical method used to:

ESTIMATE THE SAMPLE SIZE REQUIRED TO DETECT STATISTICAL EFFECT OF A DEFINED SIZE FOR TWO OR MORE PREDICTORS.

What does the pentobarbital challenge test do? (2x)

ESTIMATES THE STARTING DOSE OF PENTOBARBITAL USED FOR BARBITURATE DETOXIFICATION

Common ancestry + a shared sense of identity, beliefs, and history

ETHNICITY

Which demographics indicate both a common ancestry and a shared sense of identity, belief and history?

ETHNICITY (NOT RELIGION)

60 y/o alcoholic with 4 day h/o unstructured, maligning AH and clear sensorium. Dx?

ETOH-INDUCED PSYCHOTIC D/O

The ability of magnetic seizure therapy to target specific brain regions implicated in depression gives it what potential advantage, compared with traditional ECT

FEWER COGNITIVE SIDE EFFECTS

62 y/o with lung cancer, weight loss, fatigue, and persistent cough. Pat refuses to accept Dx of cancer and states will "get over this infection." Pt refuses all further testing and asks for antibiotics to "recover in peace." The psychiatrist's role is

EVALUATE PT'S COPING STYLE AND HELP THE MEDICAL TEAM SEE THE PT'S RESPONSES IN THE CONTEXT OF HER UNIQUE PERSONALITY AND LIFE CIRCUMSTANCES

In split treatment, the role of the prescribing psychiatrist is?

EVALUATE THE PTS NEEDS FOR MEDICATIONS WHILE MAINTAINING REGULAR CONTACT WITH THE THERAPIST

EEG monitoring to distinguish psychogenic from true blindness

EVOKED POTENTIALS

Midway through psychotherapy session, a psychiatrist's mind wanders despite repeated refocus. Best immediate action

EXAMINE OWN INNER FEELINGS ABOUT THE PATIENT

Symptoms that may dominate picture of mood disorders w catatonia?

EXCESSIVE PURPOSELESS MOTOR ACTIVITY NOT INFLUENCED BY EXTERNAL STIMULI

A child's understanding of death, attitudes, and responses at a preoperational stage of cognitive development include:

EXPECTING THE DEAD RELATIVE TO WAKE UP

2 y/o M has been preoccupied with a small blanket for several months, carries it w/ him everywhere and becomes upset if anyone tries to take it away. He refused to stay w/ a babysitter until it was retrieved. The psychiatrist should:

EXPLAIN THIS IS NORMAL AND CHILD WILL EVENTUALLY GIVE IT UP ON HIS OWN.

6 y/o w/ 4 wk intense eye-blinking and lip pursing. Wax and wane, increase with stress. Family Hx of tic d/o. First step:

EXPLAIN TO FAMILY MAY BE TRANSIENT

Young female starting cognitive therapy with a female resident asks for a hug. Resident should first

EXPLAIN WHY PHYSICAL CONTACT IS AVOIDED

Pt recurrently goes to ED because of severe chest pain. Has been w/u for everything and all test are normal. He states that something needs to be done to "fix" his pain. Psych consult is placed. MSE and neuro is normal. Past hx reveals his father died of lung CA. Next intervention as psychiatrist is:

EXPLORE PT'S FEELINGS ABOUT FATHER'S DEATH

Psychiatrist is treating an older pt who is a successful executive. Pt feels grateful for the help w/ his depression and offers some tips on investing to the psychiatrist. What is the most appropriate action at this point from the psychiatrist?

EXPLORE PT'S MEANINGS AND FEELINGS ABOUT THE OFFER

9 yo f bib-parents for outpt evaluation due to behavior difficulties at home. Port daughter "explodes" when she doesn't get her way. Bossy with friend. On interview, child is calm, cooperative and interactive, denies SI/HI and states "sometimes I just get mad." At a follow up interview the physician learns the outbursts are related to parental disputes. What is the next treatment step?

EXPLORE REASONS FOR PARENTAL DIFFERENCES

The parents of a toddler are concerned about a rent increase in the frequency, intensity and duration of the child's temper tantrums. The parents report that the toddler gets on the floor, kicks and screams when they set limits. The child's health and developmental history is unremarkable. FMHx significant for mood disorders and ADHD and ODD. Which of the following would be most appropriate as next step?

EXPLORE THE PARENTS' CONCERNS ABOUT SEEMINGLY NORMAL BEHAVIOR

36 y/o pt is beginning psychodynamic psychotherapy for tx of long- standing problems of inability to establish satisfying ongoing relationships. Pt expresses much skepticism that "talking about my past" will help. The most appropriate response of therapist is

EXPLORE THE PROCESS DURING THE SESSION THAT MIGHT BE INTERFERING WITH THE ESTABLISHMENT OF THE THERAPEUTIC ALLIANCE

Couples dissatisfied with each other and progressing toward divorce has what?

EXPRESSION OF CONTEMPT AND STONEWALLING DURING INTERACTIONS

This symptom is essential to support a diagnosis of dissociative identity disorder (2x)

EXTENSIVE INABILITY TO RECALL PERSONAL INFORMATION

57 y/o diabetic pt =w/ HTN c/o several episodes of visual loss, "curtain falling" over his L eye, transient speech and language disturbance, and mild R hemiparesis that lasted 2 hrs. Suggests presence of what?

EXTRACRANIAL LEFT INTERNAL CAROTID STENOSIS

One of the earliest sx of Tourette's [2]

EYE-BLINKING AND HEAD JERKING

Pts in a locked in state following basilar artery occlusion typically retain what movement?

EYELIDS AND VERTICAL GAZE

W pts over 65 w MDD, Bupropion has what advantage over SSRIs?

FEWER DRUG INTERACTIONS

Recently retired woman with recent life transitions has regrets about job and daughter. Wants meaningful last few decades. What develop stage?

Ego integrity vs despair

Core characteristic of the "system of care" movement in community mental health?

Empowering families to participate in treatment plan decisions

Mental Health Pariety and Addiction Equity Act of 2008 made which guidelines for subtance use treatment

Equalized visit limits for behavioral health and medical conditions in a similar category of coverage

Which opiate has comparative safety during Tx w/ MAOI?

FENTANYL

Speedball is a combination of which two drugs

HEROIN AND COCAINE

Judgment by experts that items on a test "makes sense" is an example

FACE VALIDITY

Fetal Alcohol Syndrome is associated with: (5x)

FACIAL DYSMORPHISMS, POSTNATAL GROWTH RETARDATION, INTRAUTERINE GROWTH RETARDATION AND LEARNING DIFFICULTIES.

Psychiatrist behavior of raising eyebrows, leaning towards pt, saying "Uh-huh"

FACILITATION

"When you mentioned your sibling's problem, your voice cracked and, for a moment, I thought I heard anger in your voice." Which 2 interviewing techniques does psychiatrist use here?

FACILITATION, REFLECTION

A psychiatrist whose pt is involved in a work-related lawsuit receives a subpoena to produce the pts records of psychiatric treatment and to testify about the treatment in a court of law. Upon speaking with the attorney who issued the subpoena and who represents the opposing party, the psychiatrist is told "you will not be asked to render an independent opinion related to legal questions." Which best describes the psychiatrist's role.

FACT WITNESS

What best characterizes the current explanation for group differences in prevalence of psychiatric illness?

FACTORS THAT PROMOTE VULNERABILITY TO STRESS

What is the most common type of dissociative amnesia?

FAILURE TO RECALL EVENTS DURING PARTICULAR PERIOD OF TIME

Which of the following approaches is likely to obtain the most accurate information on the factors influencing a family's level of functioning

FAMILY COPING STRATEGIES IN RESPONSE TO PAST STRESSORS

What type of group therapy is based on the unit functioning to maintain its own homeostasis of interacting?

FAMILY GROUP THERAPY

Associated with improved outcome in late-life depression?

FAMILY HISTORY OF DEPRESSION

family psychoeducation programs for psychotic disorders reduce symptom severity and relapse risk by reversing what?

FAMILY MEMBERS EXPRESS CRITICISM, HOSTILITY AND BLAME TOWARDS THE PATIENT

Which psychosocial therapies for pts w/ schizophrenia has been shown to reduce relapse rates? (3x)

FAMILY PSYCHOEDUCATIONAL THERAPY

Characteristic of female as opposed to male alcoholics:

FASTER PROGRESSION OF DISORDER

What entity mandates public schools provide educational services for children with disabilities?

FEDERAL GOVERNMENT

When asked to describe why a same-age, same-sex peer is a "best friend," an 11-year-old child is most likely to cite which of the following as most important?

FEELING CARED ABOUT BY THE OTHER CHILD

From cognitive-behavioral perspective, which is most responsible for major depression?

FEELINGS OF DEVALUATION

Weakness of extension at knee involves a lesion in which nerve?

FEMORAL

25yo pt with no previous psych history has a new preoccupation with imagined defects in appearance, which is a cause of excessive concern. The pt has a normal medical workup and, other than the distress over appearance, the pt does not have other psych sx. Which of the following meds is most appropriate?

FLUOXETINE

Intake of this SSRI increases lithium levels

FLUOXETINE

What med has some evidence of effectiveness in both psychotic/nonpsychotic subtypes of body dysmorphic disorder?

FLUOXETINE

Which med has greatest potential to cause galactorrhea in pt on risperidone?

FLUOXETINE

Longest half-life amongst alprazolam, flurazepam, lorazepam, temazepam and triazolam

FLURAZEPAM (DALMANE) USED FOR INSOMNIA

Dermatologist asks for psych consult on 38 y/o pt. 5 years ago pt began having concerns of perceived skin irregularity she calls "bumps." Several dermatologists have been unable to convince pt it is not a dermatological issue. Aside from this no evidence of other mood or thought d/o. Firstline treatment for pt?

FLUVOXAMINE

Man obsesses about killing his g/f. Instead of killing, picks his face w/ a pin. Medication:

FLUVOXAMINE (SSRI FOR OCD)

46 y/o F pt presents w increasing dysphoria, progressively increased frequency with which she washes her hands to the point of excoriation, effective Tx

FLUVOXAMINE 200-300MG DAILY

Recovering addict in relapse prevention therapy, and has many risk factors. Rather than developing a coping strategy for each risk factor, do what?

FOCUS ON SKILL TRAINING, COGNITIVE REFRAMING, AND LIFESTYLE INTERVENTIONS

When conducting marital therapy with a couple who begin to talk about divorce, what should the psychiatrist's stance be?

FOCUS ON THE COUPLE'S RESPONSIBILITY TO DECIDE THE FUTURE OF THEIR RELATIONSHIP

Most common inherited cause of mental retardation:

FRAGILE X

Developmental disability assoc w triple repeat genetic abnormality (4x)

FRAGILE X SYNDROME

Alcohol intoxication causes what sleep abnormalities?

FRAGMENTATION OF STAGE 4 SLEEP

Replaced use of hypnosis by Freud:

FREE ASSOCIATION

Autosomal recessive trinucleotide repeat expansion is the molecular etiology of which genetic disease?

FRIEDRICH ATAXIA

65 y/o pt brought in by family for gradual onset and very slow progression of mental confusion with respect to place and time, anomia, slowness of comprehension, neglect of personal hygiene and grooming, apathy, and alterations of personality and behavior, impairment of gait and upright stance, and prominent grasp and suck reflexes. The clock drawing test is a quickly administered and sensitive screen for:

FRONTOTEMPORAL DEMENTIA OR ALZHEIMER DEMENTIA

What statement best describes the current conceptualization of family that informs family system theories and treatment approaches?

FUNCTIONING FAMILIES TEND TO HAVE CERTAIN SHARED CHARACTERISTIC ATTRIBUTES RATHER THAN COMMON STRUCTURES

Medication reduces analgesic effect when administered w/ hydrocodone

Fluoxetine

Most common inherited intellectual disability?

Fragile-X

Orexin is made in what part of the brain?

Hypothalamus

DA and what else regulates reward circuitry

GABA

18 y/o restless, feels mind going blank, poor concentration, irritability, insomnia, fatigue for 1 yr, used to be good student up until 2-3 yrs ago, no substance use. Diagnosis? (2x)

GAD

Young adult w/ headache behind left ear. 2 days later twisting of face. Impaired taste sensation. Paralysis of forehead, lower face on left, incomplete closure of left eye w/ blinking. No sensory deficit or other cranial nerve deficit.

GADOLINIUM ENHANCEMENT OF LEFT FACIAL NERVE

A compound that increases muscle mass by increasing episodic secretion of GH (2x)

GAMMA HYDROXYLBUTYRATE

17 y/o pt is brought to the ER by friends who report that he ingested a drug 2 hours earlier. Pt's behavior after the drug ingestion as relaxed and tranquil but talkative. Soon after, the pt c/o drowsiness, dizziness, and nausea. On exam, pt has an impaired but labile level of consciousness. The drug screen is negative for benzodiazepines, barbiturates, and opioids. Psych MD alerts ED to the possibility of imminent respiratory difficulty. What drug most likely caused this condition? (2x)

GAMMA-HYDROXYBUTYRATE (GHB)

A young girl says "I am going to stay a girl no matter what, even if I wear blue or have short hair". What capacity does this demonstrate?

GENDER CONSTANCY

Increase in pts with sex reassignment surgery from male to female

GENERAL HEALTH PROBLEMS

Pt working overtime develops frightening nocturnal episodes characterized by semi- wakefulness and inability to move, accompanied by the sense that an intruder is present. The pt denies daytime sleep attacks or sudden loss of motor control. Best initial tx?

GETTING SUFFICIENT SLEEP

A 25 year old bodybuilder comes to ED with euphoria, peripheral vision loss and hallucinations. Pt states these occurred after ingesting a liquid nutritional supplement an hour ago. UDS and BAL are negative. What did he ingest?

GHB

Which is a common side effect leading to discontinuation of SSRI's early in treatment?

GI DISTRESS

The most common reason that people discontinue the use of SSRI

GI SIDE EFFECTS

What supplement is associated with a risk of bleeding when taken with anti-platelet drugs or warfarin?

GINGKO BILOBA

A 10-yo child is afraid of dogs and has exposure therapy to the point where he can tolerate a small dog. A week later, he encounters a large dog. What is his response?

GIVEN THE NONCLINICAL SETTING, THE REACTION IS IMPOSSIBLE TO PREDICT

1st seizure with focal onset and secondary generalization in a 58 y/o pt is likely the consequence of what? (2x)

GLIOBLASTOMA MULTIFORME

Pt w/ episodes of severe, intermittent, lancinating pain involving the posterior tongue and pharynx, w/ radiation to deep ear structures. Triggered by swallowing of cold liquids and talking. Workup: normal. Dx? (2x)

GLOSSOPHARYNGEAL NEURALGIA

Blood level of what is decreased with heavy ETOH intake

GLUCOSE

Stimulant-induced craving for drugs of abuse is most frequently mediated by which neurochemical?

GLUTAMATE

How self help groups differ from traditional psychotherapy

GOALS AND OBJECTIVES DON'T REPRESENT PT DYNAMICS

Which characteristics of self-help groups distinguishes them from traditional psychotherapy groups?

GOALS/OBJECTIVES DON'T ADDRESS INTRAGROUP DYNAMICS

In combo w growth hormone (GH), what is required to initiate adolescent growth spurt?

GONADAL HORMONES

5 y/o boy becomes restless, impulsive, and difficult to manage when not given sufficient exercise. Teacher gives him increased motor activity, and his behavior improves. This is an example of: (2x)

GOODNESS OF FIT

Pt easily overwhelmed by thought of starting work. Therapist suggests breaking jobs into small pieces. What technique is this?

GRADED TASK ASSIGNMENTS

Cognitive strategy of typically developing school-age children in response to their environment?

GRADUALLY INTEGRATING THESE NEW EXPERIENCES INTO PRE-EXISTING MENTAL CONSTRUCTS

Age-related sleep pattern change (2x)

GREATER WAKEFULNESS INTERMIXED WITH SLEEP

Tendency for groups to arrive at more extreme decisions than for individual group members alone

GROUP POLARIZATION

Pt with schizoid personality disorder has elaborate fantasy relationships but has no real friends. Most helpful therapy to assist pt in forming satisfying interpersonal relationships?

GROUP THERAPY

Psychosocial therapy that has shown efficacy in some studies in improver cancer survival rates

GROUP THERAPY WITH OTHER CANCER PATIENTS

analyzing gentic markers in a diseased population and comparing it to the norm

Genome wide association studies

Psychotherapy technique for children with Tourette's syndrome

HABIT REVERSAL

A child with temper tantrums at home begins to have better control over her outbursts following which intervention by parents?

HAD NEGATIVE REINFORCEMENT OF THE TANTRUMS REMOVED

2 y/o child w/ hx of upper respiratory infections, most likely:

HAEMOPHILUS INFLUENZAE

80 y/o Alzheimer's with increasingly combative behavior. Family wants to keep at home. Give what medication?

HALDOL

No additional criterion A symptoms are required for the dx of schizophrenia if the pt has which of the following symptoms:

HALLUCINATIONS OF 2 OR MORE PEOPLE CONVERSING

What antipsychotic medication is helpful in treating Tourette's?

HALOPERIDOL

What psychological test determines neuropsychologic impairment? (besides Bender)

HALSTEAD-REITAN BATTERY

Methadone prescription in heroin dependence is called what kind of strategy?

HARM REDUCTION

Which of the following is characteristic of both interpersonal psychotherapy, CBT?

HAS A HERE AND NOW FOCUS

25 y/o M scores in MMPI are all normal except form elevated scores on the depression and psychasthenia scales. This suggests

HAS DEPRESSION WITH ANXIETY AND OTHER NEUROTIC SYMPTOMS

Lithium can be removed via hemodialysis because?

HAS NO METABOLITES

Women differ from men in drinking behavior and in development and effects of alcohol use d/o, compared w/ men, women:

HAVE A FASTER PROGRESSION FROM FIRST DRINK TO ALCOHOL DEP

The culturally and Linguistically Appropriate Services (CLAS) federal standards for healthcare organizations require the organizations to:

HAVE PT-RELATED MATERIALS AVAILABLE IN THE PT'S NATIVE LANGUAGES.

A father wants to know if he should allow his 5 y/o child to attend the funeral of her mother. The child expresses a desire to go. To help the child through the funeral, it will be important to do which of the following?

HAVE SOMEONE FAMILIAR ACCOMPANY THE CHILD

Hallucinations in patients with conversion disorder are characterized by?

HAVING A CHILDISH, FANTASTIC QUALITY

Resilient individuals who do well in developmental course through life despite being at high risk for negative outcomes are thought to be protected in adulthood most by:

HAVING THE ABILITY TO FIND, USE AND INTERNALIZE SOCIAL SUPPORTS

Condition most likely to account for the presence of cognitive impairment in a pt with untreated Hep C (HCV) infection and normal ammonia level who is HIV sero- negative.

HCV INFECTION OF BRAIN

Which of the following is the leading cause of child maltreatment fatalities?

HEAD INJURIES

What is Schneiderian first-rank symptom of schizophrenia: (3x)

HEARING VOICES AND ARGUING ABOUT ONESELF

The difference between an idea of reference and a delusion of reference is that the former is

HELD WITH LESS CONVICTION

Developing a plan for managing a future lapse or relapse of addictive illness is most likely to:

HELP LIMIT THE EXTENT AND LENGTH OF DRUG USE

A 16-yo high school student is placed on academic probation. What is priority in structural family therapy?

HELPING THE PARENTS DEFINE EXPECTATIONS

Psych MD is counseling a pt about risks and benefits of ECT. What statement correctly describes the risk of cognitive impairment?

HIGH DOSE UNILATERAL ELECTRODE REPLACEMENT IS ASSOCIATED WITH LESS COGNITIVE IMPAIRMENT.

In patients on lithium, what type of thyroid dysfunction can occur?

HIGH PREVALENCE OF THE PRODUCTION OF THYROID AUTOANTIBODIES

Compared to those described as "low reactive" in Kagan's longitudinal study of childhood inhibition, children described as "high reactive" at age 4 months were characterized by:

HIGHER RATES OF SOCIAL ANXIETY AT AGE 13

Prepubertal children differ from adolescents and adults with regards to dosing of liver metabolized medication requiring?

HIGHER WEIGHT ADJUSTED DOSES OF MEDICATION

Working memory requires prefrontal cortex, dorsal thalamus and what other area of the brain to function?

HIPPOCAMPUS

Predictor of positive response to lithium prophylaxis

HISTORY OF GOOD INTER-EPISODE FUNCTION

Based upon longitudinal studies, which risk factors correlated w/ suicide more than one year after initial assessment?

HISTORY OF PRIOR ATTEMPTS AND HOPELESSNESS

What personality disorder results in displays of rapidly shifting and shallow expression of emotions in patients? (3x)

HISTRIONIC

A 40-year-old pt is hospitalized for eval of fever, weight loss and ataxia. Psychiatric consultation is requested as the patient seems depressed, and a family member reports that the pt has been exhibiting progressive memory loss over the last several months. Which of the following lab tests may help explain the patient's presentation?

HIV

HIV+ pt w/ memory loss, inattention, lack of motivation, &amp; poor coordination. Normal LP. CT scan shows atrophy. MRI shows diffuse &amp; confluent white matter changes in T2, w/o any mass effect or gadolinium enhancement. Dx?

HIV- ASSOCIATED DEMENTIA

34 y/o pt w/ hx of memory impairment dies of unknown cause for autopsy. Pathological exam: diffuse and multifocal rarefaction of cerebral white matter accompanied by scanty perivascular infiltrates of lymphocytes and clusters of a few foamy macrophages, microglial nodules, and multinucleated giant cells. Most likely Dx:

HIV-ASSOCIATED DEMENTIA

Leading cause of death for 15-24 y/o African American males?

HOMICIDE

In the cognitive therapy model, what cognitive factor is most associated with suicide risk?

HOPELESSNESS

Component of type A behavior most reliable risk factor for CAD

HOSTILITY

Which of the following factors is most closely associated with child abuse and neglect?

HOUSEHOLD POVERTY

Piaget interested in:

HOW A CHILD ARRIVES AT ANSWERS

Piaget's contribution to development was a theory explaining what phenomenon? (2x)

HOW INDIVIDUALS LEARN AND UNDERSTAND THE WORLD

In the context of the psychodynamic psychotherapy, the term "frame" refers to which of the following aspects of therapy?

HOW IT IS ORGANIZED IN TERMS OF BOUNDARIES AND CONSISTENT DEFINING RULES

Pt w/EtOH detox, tx is normally outpt, which RF would lead to inpatient admission?

HX OF PRIOR WITHDRAWAL SEIZURE

What distinguishes ADHD in children vs adults?

HYPERACTIVITY

What herb would represent a concern if administered concomitantly with a SSRI?

HYPERICUM PERFORATUM (St. John's Wort) - SJW is an MAOI inhibitor and may cause serotonin syndrome

Neurofibrillary tangles in Alzheimer's are composed of:

HYPERPHOSPHORYLATED TAU PROTEINS

32 y/o pt w cocaine dependence prescribed desipramine by another MD for withdrawal-assoc depression. Psychiatrist should warn pt of what adverse effects from med interaction with cocaine?

HYPERTENSION

What has demonstrated efficacy for Irritable bowel syndrome? (NOT A MED)

HYPNOSIS

Absorption, dissociation, and suggestibility converge during

HYPNOTIC CONCENTRATION

Ability to get so caught up in an experience that one loses awareness of surroundings

HYPNOTIZABILITY

Narcolepsy is a deficiency of what?

HYPOCRETIN

Electrolyte imbalance common in chronic heavy EtOH use?

HYPOMAGNESEMIA AND HYPOPHOSPHATEMIA

Most serious complication for a pt who ingests EtOH while on disulfiram

HYPOTENSION

Pts with blood phobia have 2 stage response when exposed to stimulus. First is increased anxiety and elevated BP. 2nd response?

HYPOTENSION

9 y/o F has 3 month h/o seemingly unprovoked bouts of laughter. Worse when not sleeping well. Pt does not feel happy during these episodes. Started menstruating 6 months ago, and at Tanner stage 4. Dx? (2x)

HYPOTHALAMIC HAMARTOMA

20 y/o with 1-year h/o bitemporal headaches, polydipsia, polyuria, and bulimia plus 2-month h/o emotional outbursts, aggression, and transient confusion. Neuro exam normal. What will MRI of brain show?

HYPOTHALAMIC TUMOR

9 yo with prior urinary continence at 4 years starts wetting bed at 6, he is difficult to arouse and has enuresis at different times, male relatives wet bed until 10 year old, clue to psychiatric comorbidity

Having previous period of continence

Pt w/ BMD who has been making progress in long-term psychodynamic psychotherapy enters session obviously distraught. After listening to scattered seemingly unimportant details of recent daily life, therapist asks if pt is avoiding something too uncomfortable to talk about. Pt responds w intense anger/distress. "I just heard you are getting a divorce, I am sick about it. Here I am counting on you to help me sort out my chaotic life and messed-up relationships, and you can't even keep your own marriage together!" Best response for the therapist to make?

I AM GOING TO NEED A MOMENT TO THINK ABOUT WHAT YOU'VE SAID AND ARE FEELING BEFORE I CAN RESPOND.

College student with good grades needs repeated reassurance. What core belief might the student have?

I cannot be trusted to make a good decision

Father is dying. Pt is not a drinker, but went from bar to bar drinking dad's favorite drink. Bars are similar to those dad used to go to. Best interpretation of this behavior:

IDENTIFICATION WITH OR INCORPORATION OF PATIENT'S FATHER

Freud says depression is anger turned inward against self due to:

IDENTIFICATION WITH THE LOST OBJECT

MMPI does what?

IDENTIFIES MAJOR AREAS OF PSYCHOPATHOLOGIC FUNCTIONING

During family meeting for 75yo pt admitted for MI, how to address family unwilling to participate in discussion?

IDENTIFY THE INABILITY OR UNWILLINGNESS TO DISCUSS AS ONE OF THE FAMILY'S PROBLEMS

In treatment of recovering addict, rehearsal strategies help with what?

IDENTIFYING INTERNAL HIGH-RISK RELAPSE FACTORS

Freud says that boys resolve oedipal complex by:

IDENTIFYING WITH FATHERS

A 23 yo pt began psychotherapy due to feelings of inadequacy and depression in the context of working in a coffee shop since graduating from college and deferring medical school acceptance. The pt has been having conflicts with parents over his ambivalence in becoming a physician. Which of the following is the most likely developmental task with which the pt is struggling?

IDENTITY

30 y/o develops pain behind left ear. The following day pt complains of numbness on the L side of the face, tearing from L eye, and discomfort with low frequency sounds. Exam shows L facial weakness, but no sensory deficit. Likely diagnosis: (2x)

IDIOPATHIC BELL'S PALSY

36 y/o pt w pain behind L ear progressing to numbness of L side of face, tearing of L eye, discomfort w low frequency sounds, left facial weakness on exam. Dx? (9x)

IDIOPATHIC BELL'S PALSY

23 y/o admitted in inpatient unit w/ Dx acute psychotic d/o after threatening to beat up his mother (with whom he lives). Agreed to voluntary admit, but 2 days later demands to sign out AMA. What justifies involuntary hospitalization in this pt?

IF THE PATIENT CONTINUES TO THREATEN HIS MOTHER

Pt concerned about having brain tumor. No symptoms. Requests repeated tests of CT, PET. No other psychiatric symptoms. Diagnosis?

ILLNESS ANXIETY DISORDER

The parent of a 43 y/o pt died 5 years ago from pancreatic cancer. 4 years ago patient began feeling full after eating large fatty meals, fearing it was pancreatic cancer. Constantly weighs himself so that he is not losing weight. Now avoids going to doctor to avoid being diagnosed with cancer. No other psychiatric symptoms. What is diagnosis?

ILLNESS ANXIETY DISORDER

Misinterpretation of genuine sensory input is characteristic of which of the following perceptual abnormalities?

ILLUSION

Phenomena is most typical of hallucinogen use?

ILLUSIONS

Pt w fear of heights. Pt instructed to visualize crossing a bridge. What is the therapeutic technique?

IMAGINAL EXPOSURE

Pt w/ panic disorder failed 2 SSRI trials. Which med should be used next?

IMIPRAMINE

What antidepressant has plasma level that correlates with therapeutic response?

IMIPRAMINE

What is the limit to confidentiality in an incarcerated adult patient in a correctional setting that doesn't exist elsewhere?

IMMINENT PLANS TO ESCAPE OR CREATE DISORDER

MC Speech/Language abnormality in autism spectrum disorder

IMPAIRED PROSODY

Goal of CBT for chronic pain tx is

IMPROVE FUNCTIONING DESPITE PAIN

Goal of group CBT for chronic pain treatment?

IMPROVE FUNCTIONING DESPITE PRESENCE OF PAIN

Which best defines goals of supportive psychotherapy?

IMPROVEMENT OF REALITY TESTING AND REESTABLISHMENT OF THE USUAL LEVEL OF FUNCTIONING

What represents major goal of psychotherapy as conceptualized by self-psychology?

IMPROVING THE ABILITY TO USE THE APPROPRIATE AFFIRMING RESPONSES FROM OTHERS

An association has been reported in adol with BPD between serotonin dysregulation, suicidal behavior, aggression and ... (2x)

IMPULSIVITY

Disharmony between feeling tone and speech content

INAPPROPRIATE

Most common eye tracking movement abnormality in pts with schizophrenia?

INAPPROPRIATE SACCADES

A case-control study would be appropriate in answering an epidemiological question when the:

INCIDENCE OF THE DISEASE IS LOW

3 month progressive limb weakness L>R, problems swallowing. Normal CN, weakness in neck extensor muscles, in distal and proximal muscles (quadriceps, feet dorsal flexors, extensor pollicis longus) and in wrist/finger flexors. DTRs normal. Motor tone/coordination/gait normal. Elevated CK.

INCLUSION BODY MYOSITIS

According to operant conditioning, behavior decreases in frequency if

INCOMPATIBLE WITH A POSITIVELY REINFORCED BEHAVIOR

In malpractice suits against psychiatrists, the most common allegation? (2x)

INCORRECT TREATMENT

Which of the following is the most common reason for malpractice claims?

INCORRECT TREATMENT

The rapid learning demonstrated by children during the school-age years is paralleled neurodevelopmentally by which of the following brain processes?

INCREASE IN WHITE MATTER

Motor dysfunction in Parkinson's associated with: [what's going on in the brain?? x 2]

INCREASED ACTIVITY IN SUBTHALAMIC NUCLEUS AND PARS INTERNA OF GLOBUS PALLIDUS

What symptoms of nicotine withdrawal may persist in a patient for up to 6 mos?

INCREASED APPETITE

Most available evidence points to what effects of deployment on US military families?

INCREASED CHILD ANXIETY SYMPTOMS DURING AND AFTER DEPLOYMENT

10 month old child distressed when parents leave him with the babysitter. The parents say good bye and leave quickly without display of affection. What is most likely to observed later in life?

INCREASED CLINGING AND AVOIDANT BEHAVIOR

Correlates of a positive response to ECT include what EEG findings?

INCREASED ECT-INDUCED FRONTAL DELTA ACTIVITY

Which of the following is characteristic of sleep in individuals over the age of 65, as compared to that of young adults?

INCREASED FRAGMENTATION

Physiologic changes during REM sleep

INCREASED HEART RATE, INCREASED EYE MOVEMENTS, DECREASED MUSCLE TONE

Concurrent use of phenelzine and meperidine can cause hypermetabolic reaction secondary to what?

INDIRECT PHARMACODYNAMIC EFFECTS AT A COMMON BIOACTIVE SITE

SE with ketamine?

Increase BP

APA positions on gun possession in psych patients

Individuals who present an increased risk of violence should be banned from owning guns

Which med has FDA approval for tx of mania in children 12 years of age or older?

LITHIUM

Pt s/p surgery develops weakness and wasting of small muscles of the hand and sensory loss of the ulnar border of the hand and inner forearm. Dx?

LOWER BRACHIAL PLEXUS PARALYSIS

Animal licking/ grooming affects offspring stress. Mechanism?

Is due to DNA methylation affecting glucocorticoid recptor expression

Most common psych d/o that occurs in pts s/p organ transplant

MAJOR DEPRESSION

Mental competency of an elderly patient is determined by: (7x)

JUDICIAL HEARING

The efforts of psychiatrists to achieve "parity" legislation for mental illness can best be seen as illustrating which of the following moral principles?

JUSTICE

The EEG finding of 4-6 hz irregular polyspike activity in a patient with generalized seizures is characteristic of which of the following forms of epilepsy? (2x)

JUVENILE MYOCLONIC

16 y/o pt brought to psychiatrist's attn after having single grand mal sz. Pt's parents have noted on occasion pt has sudden jerks of entire body, resulting in dropping objects. EEG: rare 4-6 HZ irregular polyspike/wave bursts. Diagnosis? (9x)

JUVENILE MYOCLONIC EPILEPSY

EEG findings in Stage II (N2) sleep

K-COMPLEXES AND SLEEP SPINDLES

A psychiatrist employed by an institution wants to use pt data for research later. How can she get the progress notes?

KEEP HER OWN SEPARATE RECORDS

Dissociative compound, sense of fragmentation and detachment during intoxication

KETAMINE

Which drug causes euphoria, a feeling like "flying above the dance floor," social withdrawal, nystagmus? (2x)

KETAMINE

?????? Pt recently emigrated from East Africa presents to establish care at a health center. Pt denies use of alcohol, tobacco, or common street drugs, however notes that, prior to immigrating, he routinely chewed leaves of a local plant to improve concentration and help him stay awake while working long hours. Which plant did pt most likely use?

KHAT

17 yo with increased sleep duration to 18 hours, lethargy and cognitive slowing. Sleep EEG is normal.

KLINE-LEVIN SYNDROME

A 32 yo F comes to the ED with CC of 2 weeks of diarrhea. On exam she is anxious and tremulous and is not oriented to date or time of the day. She states she is taking "some drug" for Bipolar disorder and adds that she started doubling her dose a month ago because she "wasn't getting better fast enough." She denies use of drugs/ETOH. Which medication would most likely cause the symptoms described?

LITHIUM

68 y/o pt w/ hypertension develops rapidly progressing right arm and leg weakness, with deviation of the eyes to the left. Within 30 minutes of the onset of this deficit, pt became increasingly sleepy. Two hours after the onset, the patient became unresponsive. On exam: dense right hemiplegia, eyes deviated to the left, pupils: equal and reactive, a right facial weakness to grimace elicited by noxious stimuli. Cough and gag reflexes: present. Which CT finding is most likely? (2x)

LEFT PUTAMINAL HEMORRHAGE

Pt scores on revised Wechsler adult intelligence scale (WAIS-R) subtests for *picture arrangement and block design are very low* compared to scores on other subtests. Most suggestive of

LESION IN NONDOMINANT HEMISPHERE

What is the best reason for preferring the use of SSRI antidepressants over TCAs in tx of pts w/depression who are >65yo?

LESS LIKELY TO CAUSE ORTHOSTATIC HYPOTENSION

Interpersonal social rhythm therapy in bipolar focuses on what?

LIFESTYLE REGULARITY

45 y/o reports lower back pain along w/ pain and numbness in R leg and foot w/ difficulty walking x 4 wks. Exam: limited due to back pain, foot drop on right side. Nerve conduction studies: normal motor and sensory in leg. EMG: decreased recruitment and spontaneous activity in right tibialis anterior and tibialis posterior muscles. Otherwise normal. Dx:

L-5 RADICULOPATHY

Distinguishing absence seizures from partial complex seizures:

LACK OF POSTICTAL MANIFESTATIONS

According to Joint Commission, what is primary risk factor for completed suicides in medically hospitalized pts?

LACK OF PROPER ASSESSMENT FOR SUICIDE RISK

Acculturation outcomes associated with pt's high risk for suicide, substance abuse, and alcoholism:

LACKING STRONG ALLEGIANCE TO NATIVE CULTURE AND NOT INCORPORATING HOST CULTURE

Ability of preschool children to regulate emotions is most strongly enhanced by the development of:

LANGUAGE

The long-term outcome in autism is most closely correlated with?

LANGUAGE DEVELOPMENT

Statistical methods to address participants dropping out of a study prior to completion

LAST OBSERVATION CARRIED FORWARD

Which statistical method attempts to address the effects of participants dropping out of a study prior to completion? (5x)

LAST OBSERVATION CARRIED FORWARD

???? Characteristic of Cloninger's type 1 alcoholism:

LATE ONSET

Pure sensory deficit extending to midline and involving face, arm, trunk, and leg caused by lacunar infarct where?

LATERAL THALAMUS

Free RBCs protoporphyrin test in the screening for intoxifiication with

LEAD

When compared to the other subtypes of ADHD, children with the inattentive subtype have higher rates of *anxiety and somatic complaints* and

LEARNING DISORDERS

Which of the following is the best use of hypnosis in a patient with chronic PTSD with severe dissociative symptoms due to childhood abuse?

LEARNING TO GAIN VOLITIONAL CONTROL OVER DISSOCIATION

Higher frequency & greater severity of depression associated w/ cortical & subcortical strokes

LEFT ANTERIOR FRONTAL

65 y/o w/ HTN collapsed. In ED is stuporous, R hemiparesis + hemisensory deficit, eyes deviate to L. CT would show intraparenchymal hemorrhage in?

LEFT BASAL GANGLIA

58 y/o s/p CABG - anomia for fingers and body parts, errors involving right and left, inability to write thoughts/take notes/make calculations. Fluent speech and excellent comprehension

LEFT MEDIAL TEMPORAL STROKE

Loss of ability to execute previously learned motor activities (which is not the result of demonstrable weakness, ataxia or sensory loss) is associated with lesions of?

LEFT PARIETAL CORTEX

Aggressive behavior in preschoolers w otherwise normal development usually due to:

LIMITED VERBAL ABILITIES

Complex partial epilepsy aura has what symptom?

LIP SMACKING

60 y/o w/ depression & paranoia treated with 50mg Zoloft and 6mg risperidone. On follow up pt c/o slow thinking & excessive salivation. On PE masked faces and cogwheel rigidity present. Mood and paranoia have greatly improved. What is the next step?

LOWER DOSE OF ANTIPSYCHOTIC MEDS

Prevalence of psychotic disorders after age 65 is:

LOWER IN BOTH MEN & WOMEN

When compared to younger age groups, the prevalence estimates of MDD in persons older than 65 years are:

LOWER IN BOTH MEN AND WOMAN

Equal dose of alcohol corrected for body weight lead to higher BAL in woman than me. Why?

LOWER LEVELS OF ALCOHOL DEHYDROGENASE IN GASTRIC MUCOSA

Identity diffusion describes

Lack of continuity in how the self is experienced in relationships over time

Statistical method that address participants dropping out of study before completion

Last observation carried forward

School aged boy, plays BBall and w/ boys, not w/ girls. What Freud's psychosexual stage?

Latency

Which part of cortical-striatal-pallidal-thalamic cortical circuit evaluates painful stimuli

Lateral ortbitofrontal

Hormone released from adipose tissues, enters the brain and provides negative feedback / reduces food intake?

Leptin

Which of following parental tasks becomes important during toddlerhood?

Limit setting

58 yo depression and psychomotor retardation on SSRI. Tx augmented by?

Liothyronine

Among inpatients, available data indicates that catatonia most frequently occurs as a feature of what illness?

MAJOR DEPRESSIVE DISORDER

Hoarding disorder is accompanied by what disorder?

MAJOR DEPRESSIVE DISORDER

The National Practitioner Databank contains reports about which of the following types of physician problems?

MALPRACTICE SETTLEMENTS WHERE NO WRONG WAS ADMITTED

According to C.G. Jung, anima refers to:

MAN'S UNDERDEVELOPED FEMININITY

Puerto Rican and other Latin American pts are more likely than those from western culture to report their depression as what?

NERVOUSNESS

Murder trial, defendant states "I think murder is wrong but killing a spy from Mars who is trying to steal the secret of life is right." This poses a problem for what type of evaluation of criminal responsibility?

M'NAUGHTEN RULE

What causes of decreased vision in older adults is characterized by an inability to focus on an object as a result of retinal damage

MACULAR DEGENERATION

While taking lithium patients should do what to their sodium intake

MAINTAIN SODIUM INTAKE

In Operant Conditioning, a partial or intermittent reinforcement schedule results in

MAINTAINING A BEHAVIOR THAT IS RESISTANT TO EXTINCTION.

Best protection against malpractice lawsuit:

MAINTAINING GOOD DOCTOR-PT RELATIONSHIP

Which of the following produces best outcome in terms of drug consumption and criminal behavior for heroin dependents?

MAINTAINING OF METHADONE

Winnicott's notion of capacity to be alone in presence of another person pertains to:

MAINTENANCE OF ONE'S IDENTITY AMONGST OTHERS

Comorbid condition w/ pathological gambling

MAJOR DEPRESSION

According to Freud, what is a dream that is remembered on wakening?

MANIFEST DREAM

At 10 mg selegiline does not require dietary restriction because

MAO-B IS NOT INVOLVED WITH INTESTINAL TYRAMINE REACTION

Normal autism, symbiosis, differentiation, and practicing are among the developmental subphases of separation and individuation proposed by what theorist?

MARGARET MAHLER

29 y/o complains about mistreatment from boyfriend. Proud of generous nature but complains how little she gets back. Therapist finds it hard to make her self-reflective about her role in this, gets frustrated and fatigued. Patient displays

MASOCHISM

Capacity to inhibit behavioral responses improves over course of adolescence most likely because of:

MATURATION OF PREFRONTAL CORTEX

Studies show that short-term psychodynamic psychodynamic (STPP) psychotherapy is superior to supportive therapy in the treatment of complicated grief for certain pts. Which of the following pt characteristics predicts a better response to STPP than supportive therapy?

MATURE OBJECT RELATIONS

10yo w ADHD and aggressive outburst is started on a moderate dose of a stimulant. ADHD symptoms have improved, but aggression has not. In addition to behavioral intervention, what is the next best step to manage both the ADHD and aggression?

MAXIMIZE DOSAGE OF LONG ACTING STIMULANT

What is a limitation of the MMSE?

MAY FAIL TO DETECT VERY MILD COGNITIVE IMPAIRMENT

61 y/o with left frontal lobe damage secondary to cerebrovascular accident may be predisposed to which psychiatric syndrome?

MDD

9 y/o w/ increased irritability and aggression for 3 months. Used to be easygoing. Grades dropping. No insomnia or poor appetite. AH of voice telling him he is bad. Most likely Dx:

MDD

Bulimia is comorbid with:

MDD

Children with tic d/o are less likely than adolescents/adults with tic d/o to experience co-occurrence of what?

MDD

Dx for 9yo boy w/ irritability and aggression, failing grades, and hearing a voice saying he is bad.

MDD

First-degree relatives of patient with BMD II have a higher incidence of what disorder?

MDD

25 y/o pt reports experiencing intense periods of profound tiredness over the past 2-3 weeks. During these periods she has increased need for sleep and spend much of day in bed. Pt also reports increased appetite. These episodes often occur in setting of interpersonal discord. Dx?

MDD WITH ATYPICAL FEATURES

79y/o asks for eval for STD. Upset and guilty about an affair. Spouse says affair happened many years ago. Pt is sad but not confused. Dx? (2x)

MDD WITH PSYCHOSIS

In a skewed distribution this is a measure of central tendency and moves furthest away from the mode in the direction of skewness:

MEAN

Use of meds with psychodynamic psychotherapy optimal when

MEANINGS AND EFFECTS OF MEDS INTEGRATED INTO PT'S UNDERSTANDING

"My father was very involved in my life. I remember going to football games in the snow with him" is an example of memory associated with what part of the brain?

MEDIAL TEMPORAL LOBE

Gay couple seeks therapy. One has HIV, one is negative. HIV negative feels betrayed and believes HIV positive partner was unfaithful. What should therapist say?

MEDIAN DURATION OF ASYMPTOMATIC STAGES OF HIV INFECTION IN THE US IS 10 YEARS

22 y/o with pain in the right hand that radiates into the forearm and bicep muscle. Paresthesias in the palm of the hand, thumb, index, middle ring finger. Sensory systems in the ring finger split the ringer finger longitudinally. Dx? (6x)

MEDIAN NERVE ENTRAPMENT AT THE WRIST

What is required by all psychiatrists by the ABPN certification?

MEDICAL KNOWLEDGE

How do you resolve a mixed decision for among staff and family of a dying patient (continue Tx vs let die):

MEET SEPARATELY WITH FAMILY AND STAFF TO EXPRESS ISSUES OF POLARIZATION

8 y/o with persistent delayed sleep onset despite good sleep hygiene, given no indication of broader psychopathology, which med has best evidence to treat this problem and restore normal circadian rhythm? (2x)

MELATONIN

Alzheimer disease, tx with donepezil, dementia still worsening with agitation, lability and appetite disruption. What should be added?

MEMANTINE

Recurrent deafness, tinnitus then vertigo:

MENIERE'S DISEASE

Informed consent requires: presentation of information, voluntary consent from patient, and:

MENTAL COMPETENCE

What is the relationship of violence to mental d/o?

MENTAL D/O HEIGHTENS RISK IN SOME, DECREASES RISK IN OTHERS

Most typical SE of fluoxetine

NERVOUSNESS, RESTLESSNESS, AND ANXIETY

Pt in individual psychotx describes hatred for a "mean, unfair" boss. This time pt adds, "but actually, I have heard my boss talking to others in the office, and he seems pretty much ok - even his voice sounds so different from the way I hear him in my head!" According to Fonagy, pt is demonstrating which mental activity? (2x)

MENTALIZATION

Primary process thinking is characterized as ...

MENTATION FOCUSED ON DRIVES AND WISH FULFILLMENT

???? Healthcare professional has seizure as a result of drug addiction, seizure is not from withdrawal. What substance are they using?

MEPERIDINE

Drug-addicted healthcare professional experiences seizure that is not a withdrawal phenomenon. What drug caused this?

MEPERIDINE

What barbiturate is used in ECT to produce a light coma?

METHOHEXITAL

Use of what substance causes long-term inhibition of new serotonin synthesis and decrease in serotonin terminal density:

METHYLENEDIOXYMETHAMPHETAMINE (MDMA)

Pt with a long history of substance abuse is admitted to the hospital for shortness of breath. The pt is found to have multiple granulomas in both lungs a biopsy reveals the presence of talc within the granulomas. Pt most likely abusing what substance?

METHYLPHENIDATE

Which med would you prescribe for 20 y/o college student being worried over his grades? He complains that he has not been able to focus on studying and that his mind wanders frequently during classes. His energy level is low. He sleeps well and his appetite is good. History indicates he was treated with stimulants since second grade (2x).

METHYLPHENIDATE

54yr old pt dies from rapidly progressing dementia associated with myoclonus, what is most likely finding at autopsy?

MICROVACUOLATION OF GLIA AND NEURONAL DENDRITES

Ptosis R eye, dilated R pupil, double vision, L-sided hemiparesis, no cognitive impairment. Where is lesion? (x2)

MIDBRAIN

87 y.o. college grad, hx cardiovascular dx and dyslipidemia, BIB daughter who lives w/him, concerned about confusion and forgetfulness. MMSE is 21/30

MILD COGNITIVE IMPAIRMENT

6 y/o child in 1st grade is doing very poorly. WISC-R IQ score is 60. Compared with other children his age, he has significant impairment in social skill, dressing, language, and feeding. What is the Dx?

MILD MENTAL RETARDATION

Which test is an objective measure of personality in adults and is helpful in confirming diagnosis of personality disorder?

MILLON CLINICAL MULTIAXIAL INVENTORY (MCMI)

Which test to confirm personality disorder?

MILLON CLINICAL MULTIAXIAL INVENTORY (MCMI-III)

According to DBT theory, which skill should be taught to pts first & regularly practiced in order to facilitate learning of other skills?

MINDFULNESS

2 months after severe brain injury, pt opens the eyes for prolonged periods but remains inattentive, does not speak, and shows no signs of awareness of the environment or inner need. Pt is capable of some rudimentary behaviors such as following a simple command, gesturing, or producing single words or brief phrases, always in an inconsistent way from one exam to another. Which of the following is the most accurate description of the pt's condition?

MINIMALLY CONSCIOUS STATE

Which of the following psychological tests has been validated for adolescents, elderly and ethnic minority groups, and is recommended for the assessment of psychological functioning in patients from diverse cultures?

MINNESOTA MULTIPHASIC PERSONALITY INVENTORY (MMPI-2)

A female child performs a dance for her mother and basks in the gleam of her mother's eyes. According to self-psychology, the child is having an experience of (2x):

MIRRORING

How does Winnicott's "good enough parent" communicate attunement to infant?

MIRRORING

Which antidepressant has strongest histamine-R affinity?

MIRTAZAPINE

Psychiatrist on inpatient unit treats depressed pt showing SI upon admission. On 5th day pt is no longer suicidal, but psychiatrist think pt is still considerably depressed and should stay. Insurance only authorizes 5 days, so psychiatrist has to document pt is still suicidal. This is unethical because the psychiatrist is:

MISREPRESENTING THE RATIONALE FOR CONTINUED HOSPITALIZATION

According to the CDC, what change occurred in the 1980s about the location of end-of-life care in the elderly?

MORE PATIENTS ARE DYING AT HOME

Having a pt's friend or spouse monitor disulfiram administration and report to the treating psych MD is an example of:

NETWORK THERAPY

15 y/o has hx of seizures beginning at the age of 9 years, followed by prolonged motor or sensory deficits lasting days to weeks. The pattern of the seizures and the focal deficits has changed over time. The pt also has hemicranial headaches. No family hx of similar symptoms. Most likely diagnosis?

MITOCHONDRIAL ENCEPHALOMYOPATHY, LACTIC ACIDOSIS AND STROKE. (Pattern of inheritance is maternal as it is mitochondrial. Lactic acidosis can present with symptoms of vomiting, abdominal pain, fatigue, muscle weakness, and difficulty breathing.)

Child w ADHD not respond to methylphenidate IR. What med to try next (3x)

MIXED AMPHETAMINE SALTS

What factor is thought to predict a poor response to lithium treatment for pts with bipolar disorder?

MIXED MANIC/DEPRESSED EPISODE

Psychiatrist is evaluating a 5 y/o child in kindergarten. Child does well with puzzles and other performance activities. Teacher reports that the child has a limited vocabulary and immature grammar in comparison to the other children. Child interacts well with other children. The child also seems to have some trouble understanding questions. Child's hearing and vision are normal. Explanation?

MIXED RECEPTIVE & EXPRESSIVE LANGUAGE DISORDER

Test that measures test-taking attitudes

MMPI

What psychological tests measure test-taking attitudes at time of exam

MMPI (MINNESOTA MULTIPHASIC PERSONALITY INVENTORY) VALIDITY SCALE

The most important tool for evaluation of early and moderate dementia:

MMSE

Best describes the role of the observing ego:

MOBILIZES DEFENSE MECHANISMS IN RESPONSE TO SIGNAL ANXIETY

Pt with daytime sleepiness, no snoring, and decreased REM latency. Which med is recommended?

MODAFINIL

Child who fears bike riding becomes less fearful after watching other children having fun while bike riding. Which learning principal?

MODELING

An effective role of C&amp;L psychiatrist consulting on a manipulative, entitled patient?

MODELING AN APPROACH OF APPEALING TO THE PATIENT'S ENTITLEMENT

Person w/ MR who achieves 1st grade education fits which diagnostic classification?

MODERATE MENTAL RETARDATION

Neurodevelopmental risk factors for aggression in male children, has linkage of genes for what?

MONOAMINE OXIDASE A

70 Y/O pt with confusion, lethargy, fever. Dx of encephalitis is made after CSF analysis. What clinical feature suggests West Nile virus?

MONOPARESIS

What disorder is most likely to be comorbid in pts w trichotillomania?

MOOD DISORDER

Depressed pt with increased appetite, wt gain, hypersomnic and heavy feeling in limbs most likely mood description?

MOOD REACTIVITY

50 y/o pt w/ depression believes that he is responsible for the destruction of the world. This is an example of: (2x)

MOOD-CONGRUENT DELUSION

Cognitive developmental tasks of adolescence include acquiring the capacity for:

MORE COMPLEX UNDERSTANDING OF CAUSALITY & MULTILEVEL REALITIES

65 years w bipolar disorder differ from younger pts w same dx—how?

MORE MIXED EPISODES

65 yo pt with progressive weakness, worse when squatting and standing from a chair. C/o decreased strength in right hand. On exam, prominent weakness of the quadriceps bilaterally and on opposition of the thumb in the right hand. Atrophy of foreman muscles with normal DTRs. No other weakness noted on exam. Sensory exam normal. ROS negative. Labs show normal CK and neg for anti-transfer RNA synthase antibodies (Jo1). What is the most likely dx? (2x)

MYOTONIC DYSTROPHY

Biological consequences of psychological stress affect which mechanism?

NEURO-IMMUNO-ENDOCRINE FUNCTION

Hearing impairment is a feature of which chromosomal d/o

NEUROFIBROMATOSIS-2

Term for burning dysesthesia with shock-like paroxysms:

NEUROPATHIC

80% of pts in substance abuse program are in treatment, what type of quality measure does it represent?

PROCESS

75 y/o M, Korean war veteran, with gradual development of forgetfulness and cognitive deterioration, presents with very fast /slurred speech and impaired gait. A head CT shows some generalized atrophy, unusual for his age. The LP show 35 WBC, lymphocytosis and the protein level is 110mg/Dl and elevated gamma globulin. Dx?

NEUROSYPHILIS

Disassociation is what type of defense mechanism?

NEUROTIC DEFENSE

Risk factor for PTSD

Prior childhood adversity

Which are the dimensions of the Five Factor Model of Personality?

NEUROTICISM, EXTRAVERSION, OPENNESS, AGREEABLENESS, CONSCIENTIOUSNESS

How to manage telephone conversation with labile patient who ended relationship with boyfriend and is having SI with plan, but is willing to stay with family and allows you to speak with family?

NEXT-DAY OUTPATIENT F/U WITH PSYCHIATRIST

Skin tumors, abundant café au lait spots, Lisch nodules on iris is diagnostic of mutation on which gene:

NF-1 (NEUROFIBROMATOSIS-1 GENE)

A pt with cancer, pain, depressed mood, poor appetite, fatigue, impaired concentration, prognosis is less than three weeks. What should you treat with?

Methylphenidate

Which cell types secretes innate proinfammatory cytokines TNF - alpha and Il -1 B in pts with inflammatory conditions that affect the brain?

Microglia

Most closely correlates w/ social fxn in schizophrenics:

NEGATIVE SYMPTOMS

Most common factor in cases of termination of parental right: (2x)

NEGLECT BY THE PARENT

Puerto Rican and other Latin American pts are more likely than those from other western cultures to report depression as:

NERVOUSNESS

Management of patient in denial immediately after MI:

SUPPORTING THE PATIENT, UNLESS DENIAL INTERFERES WITH CARE

Pt took 20 tabs 500mg acetaminophen tabs 6 hours ago. Pt is 52kg, pulse 96, BP 135/65. Pt alert and in NAD. Serum acetaminophen level is 60 Ug/ml. Liver fxn test are minimally elevated. Most appropriate action?

N-ACETYL-CYSTEINE

16yr old hears music and his name at night, during which of the following stages of sleep if hypnagogic hallucinations?

N1

Dementia rather than depression in regards to memory has...

NAMING DEFICITS (RATHER THAN IMPAIRED NONVERBAL INTELLIGENCE)

Pt with body dysmorphic d/o may have what personality d/o?

NARCISSISTIC

Which medication to treat MS is an integrin antagonist that primarily acts by blocking lymphocytes and monocytes adhesion to the endothelial cells:

NATALIZUMAB

A physician is disciplined by a hospital at which he practices for issues related to car provided to a pt. if the disciplinary action lasts more than 30 days, the hospital must report the physician to which of following:

NATIONAL PRACTITIONER DATA BANK

Research into the complexity of healthcare systems and distribution of resources is best carried out in which fashion?

NATURALISTIC STUDY

Drinking ETOH while taking disulfiram most likely to produce what sx

NAUSEA AND VOMITING

An 80 y/o pt presents with sudden onset seizures, hallucinations and aggressive behavior. A preliminary CT scan of head does not show abnormalities. The pt's family wants to know what is the likelihood that the pt has no changes in his brain given the CT scan. Which of the following concepts would need to be used to respond to the family's concerns about the CT scan results?

NEGATIVE PREDICTIVE VALUE

40 y/o pt experiences recurrent panic attacks usually in public places. The pt leaves the area whenever a panic attack begins and then the panic Sx stop. This demonstrates which of the following types of learning patterns?

NEGATIVE REINFORCEMENT

A child practices violin to prevent parents nagging, what does this describe?

NEGATIVE REINFORCEMENT

Child displays appropriate behavior in order to avoid time outs. Which feature of operant conditioning is this?

NEGATIVE REINFORCEMENT

Cognitive-behavioral explanation of trichotillomania suggests hair pulling reduces an uncomfortable tension that the child is experiencing. Which feature of operant conditioning is this an example of?

NEGATIVE REINFORCEMENT

The evolution of addiction from an impulsive to a compulsive act is characterized by the increasing importance of which of the following factors?

NEGATIVE REINFORCEMENT

What learning pattern is demonstrated by a patient (w/ panic disorder a/w public places) leaving an area when panic attack begins, and experiencing cessation of sx?

NEGATIVE REINFORCEMENT

40 y/o dentist is referred for evaluation by staff members who are concerned about his erratic behavior, staying excessively late at the office and problems with dexterity in treating pts. He complains of numbness and weakness of limbs, loss of dexterity, and loss of balance. Which drugs is the dentist most likely abusing? (2x)

NITROUS OXIDE

Excss activation of which recpetor contributes to cell death in Alzheimer dx?

NMDA

28 y.o. hospitalized with paranoid delusions, AH, and agitation, tx w/Haldol 5, pt becomes rigid & mute, in days gets choreiform mvmt, has seizures, gets resp problems leading to ICU admit. Exam shows ovarian mass. CSF will show antibodies to?

NMDA RECEPTORS

Pathologic findings in brain of Tourette's?

NO ABNORMALITY

Male sexuality in the seventh decade is characterized by which of the following?

NO CHANGE IN SEX DRIVE

Which controlling for health status, which of the following best describes the relationship between retirement and subsequent mortality risk?

NO INCREASE IN MORTALITY RISK

Most common explanation given by individuals >65 years for difficulty maintaining sleep?

NOCTURIA

What does NOT predict violence?

NON-VIOLENT CRIMINAL ACTIVITY

Watson's experiment with "Little Albert" demonstrated that an 11 y/o child, who previously shown no phobic response to a stimulus, learned to fear the stimulus after it was repeatedly paired with a loud noise. This would be unethical b/o violation of: (2x)

NONMALEFICENCE

In the analysis of results of the national comorbidity study (1994), a nonresponse adjustment weight was included. This inclusion was important for what reason?

NONRESPONDERS WERE FOUND TO HAVE HIGHER RATES OF ILLNESS

5 y/o child several month after that he lost his mother in a MVA reports that his mother is watching him from sky every day is and example of:

NORMAL GRIEF

Research shows dissociative symptoms most commonly represent what worldwide?

NORMAL PART OF RELIGIOUS/RITUAL EVENT

Involuntary jerking of legs while falling asleep, not uncomfortable, stops with falling asleep

NORMAL PHENOMENON, NONPATHOLOGICAL

Pt presents with a slowly progressive gait disorder, followed by impairment of mental function, and sphincteric incontinence. No papilledema or headaches are reported. Likely diagnosis? (3x)

NORMAL PRESSURE HYDROCEPHALUS

While assessing for DV, examiner says to pt/spouse, "The tension that builds up between you must be incredibly stressful. It's not unusual that people who are stressed out can have trouble controlling themselves or can do things they didn't intend, like screaming at or even hitting their partner. Has anything like that happened to you?" Which technique is this?

NORMALIZATION

Which stage of group development has been met when members are less afraid of revealing individual differences so they can participate in experiential learning?

NORMING

A known limitation of the Minnesota Multiphasic Personality Inventory?

NORMS DO NOT ACCOUNT FOR OUTCOMES BASED ON RELIGION AND RACE

Safest heterocyclic antidepressant for 78 y/o w/ depression, agitation &amp; dementia is:

NORTRIPTYLINE

Dexamethasone suppression test for diagnosing mood disorders:

NOT USEFUL IN ROUTINE CLINICAL PRACTICE

29 y/o severely depressed with SI. Threatens to kill his wife and daughter to "take them with me." Legal responsibility:

NOTIFY THE WIFE

The most important feature of post-natal brain development is an increase in what?

NUMBER OF DENDRITIC AND AXONAL PROCESSES

In the individual component of DBT, a therapist spend time in

NURTURING THE PT AND REQUIRING PT TO HELP HERSELF

Females of which ethnicity report highest rates of intimate partner violence?

Native american

In cognitive theory, which maladaptive schemas are most prominent in depressive disorders?

Negative evaluations of self

Personality trait that is independent risk factor for somatic symptoms?

Neuroticism

Neuronal cell density in schizophrenia characterized by

No change

Toddler soothed at night by inner memory of secure relationship with mother. Called what (in attachment theory)

OBJECT CONSTANCY

Infant who engages in an interactive game of peek-aboo most closely demonstrates the concept of which of the following cognitive abilities?

OBJECT PERMANENCE

Early behaviorist theory promoted what

OBJECTIVE PSYCHOLOGICAL RESEARCH

Role of glycine at NMDA receptor?

OBLIGATE COAGONIST

18 month old shows a marked awareness of vulnerability to separation and seems to be constantly concerned about the mother's actual location is exhibiting Mahler's stage of?

OBJECT CONSTANCY

Pt is often tardy. Supervisor warns not to be late. Pt has anxiety about losing job. When father dies he leaves town w/o telling supervisor. Again given warning. Next day a train causes him to be late. In therapy, the overlapping of multiple potential causes for tardiness is an example of what?

OVERDETERMINATION

26yo pt thinks his brow bridge is too prominent and looks like a neanderthal. Physician finds brow bridge prominent but WNL. Pt wants plastic surgery consult. What best describes the pt's belief?

OVERVALUED IDEA

Pt is continuously suspicious that the spouse is committing adultery, but acknowledges the possibility of being wrong since there is no evidence to support the pt's belief: (x2)

OVERVALUED IDEA

Term for unreasonable and sustained belief. Patient acknowledges the belief may not be true when challenged

OVERVALUED IDEA

Which med decreases the efficacy of oral contraceptive?

OXCARBAZEPINE

Which anticonvulsant has the weakest evidence supporting use in manic episodes with bipolar disorder?

OXCARBAZEPINE (TRILEPTAL)

35 y/o w daily headaches over last several weeks lasting an hour. Sharp, severe, boring pain into right eye. Night time element of this headache?

Occurs during REM

Psychogenic blindness-differentiation from real blindness?

Ocular jerk movements with optokinetic drum

Depersonalization is classified as disturbance of which of the following?

PERCEPTION

25 yo CF started on desipramine 50mg Qday. SE of constipation, dry mouth, visual difficulties, tremor and agitated feeling. Not on any other medications. Blood level is 400ng/ml. Most likely cause?

POOR METABOLISM OF CYTOCHROME P450 SUBSTRATES

Head injury with personality changes, impulsivity and euphoria. Site of injury? [BE SPECIFIC]

Orbitofrontal cortex

14 y/o pt after a demanding physical test becomes extremely weak and unable to stand. PE is positive for depressed DTR's. Labs: K=2.8. Hx of similar episodes after strenuous exercises. EKG: minimally prolonged PR, QRS, QT interval. Father and grandfather had similar episodes. Dx? (3x)

PERIODIC PARALYSIS

Abdominal pain, diarrhea, hypokalemia, weight loss, steatorrhea, skin pigmentation. Possible laxative abuse. Measure:

PHENOLPHTHALEIN - indicator in acid/base titrations

In *Heinz Kohut's* theories of self-psychology, what is meant by the term "self-objects"?

Other people in the environment who perform particular functions for the self

What did Emmanuel Kant contribute to the field of psychiatry?

PHILOSOPHICAL FOUNDATIONS FOR CLINICAL ETHICS

The case of "Little Hans" led Freud to develop a psychological theory of the formation of which of the following symptoms?

PHOBIA

The most common deficit underlying reading disorder in English-speaking children is deficit in:

PHONOLOGICAL FUNCTIONING

45 y/o pt w/weakness of hips and thighs, and lesser extent the shoulder and neck. Also extremely difficult to rise from a squatting or kneeling position, No muscle pain. No tender. DTR: normal. Dx:

POLYMYOSITIS

Greatest prevalence of Rx drug abuse occurs in what substance class?

PAIN RELIEVERS

What condition has been shown to increase the risk of suicide to the greatest degree in persons with depression?

PAIN SYNDROMES

2nd gen antipsychotic, FDA risk of QTc prolongation

PALIPERIDONE

The most common psychiatric sx associated with pheochromocytoma?

PANIC ATTACKS

Hyperthyroidism should be ruled out as part of the DDx of what psychiatric d/o

PANIC D/O

Childhood physical and sexual abuse increases the risk for which anxiety do?

PANIC DISORDER

Respiratory illness is most clearly a risk factor for developing which anxiety disorder? (2x)

PANIC DISORDER

Therapy technique of prescribing a pre-existing sx behavior in relationship therapy

PARADOXICAL INTENT

Therapeutic technique where therapist instructs the patient to hold onto a symptom

PARADOXICAL INTERVENTION

Hypnosis would be contraindicated in the treatment of patients with

PARANOIA

40 y/o hand surgeon has come into conflict with the hospital admin. Though the hospital went out of its way to recruit this surgeon, he has felt consistently betrayed and has accused the administration of trying to exploit him by expecting that he should take more calls, though this has never been stated. Dx? (2x)

PARANOID PERSONALITY DISORDER

A 10 yo child presents with explosive outbursts at home when asked to complete tasks or when told no. These behaviors are not present while playing with siblings. Which of the following treatments has the largest body of evidence supporting its use to treat this condition?

PARENT MANAGEMENT TRAINING

Which of the following is the most effective evidence-based treatment of oppositional defiant disorder (ODD)?

PARENT MANAGEMENT TRAINING

Which of the following principles is most commonly endorsed in parent management training programs for treatment of oppositional defiant disorder?

PARENTAL ATTENTION FOR PROSOCIAL BEHAVIOR

Most important protective factor determining preschool child's reaction to disaster

PARENTAL FUNCTIONING

80 yo male evaluated for gait imbalance and falls. Wife explains that he kicks and screams while sleeping, he reports dreams of being chased. Pt likely has/will develop?

PARKINSON'S DISEASE

Gait consisting of: postural instability, festination, & truncal rigidity. Lewy bodies visualized. Also with involuntary acceleration is seen in what condition? (3x)

PARKINSON'S DISEASE

REM sleep behavior disorder associated with which dementia:

PARKINSON'S DISEASE

Medications effective for OCD [not clomipramine or luvox]

PAROXETINE, PHENELZINE

48 y/o with chronic sadness and no relationships since husband died 12 years ago. Normal grieving, no DSMIV criteria for d/o, has successful career and close friends. States has conversations with her dead husband and he talks to her. Believes in heaven. Likely classification of these experiences is:

PART OF A BELIEF SYSTEM ENDORSED BY HER RELIGION

Pt with Autism has disruptive behaviors and actively engaged in therapy with no progress, what is the next TX?

PARTIAL HOSPITALIZATION

Abstinence compliance increases with random UDS. This is ex of

PARTIAL REINFORCEMENT

Person with covert obstructionism, procrastination, stubbornness, and inefficiency may be classified as suffering from which personality d/o outside of current DSM classification?

PASSIVE-AGGRESSIVE

Best defense for against medical malpractice?

PATIENT DID NOT SUFFER A BAD OUTCOME

Negative therapeutic reaction in psychodynamic psychotherapy refers to what

PATIENT GETS WOES IN RESPONSE TO THERAPIST INTERPRETATIONS THAT ARE ACCURATE AND APPROPRIATE

In cognitive therapy, "selective abstraction" is what?

PATIENT'S FOCUS ON A DETAIL TAKEN OUT OF CONTEXT AND CONCEPTUALIZES A EXPERIENCE BASED ON THIS ELEMENT

45 y/o with R hemiparesis, CT shows L internal capsule ischemic changes extending to adjacent basal ganglia + old lacunar injury of R caudate head. LP - 65 wbcs (mostly lymphocytes), 78 protein, 63 glucose, + regain antibodies. Tx?

PCN

Ataxia, nystagmus, muscular rigidity, normal or small pupils suggests intoxication with what?

PCP

How do geneticists test for genetic markers that cosegregate with disease phenotype?

PEDIGREE ANALYSIS

What is strongest predictor in patients signing up for leadership roles in organizations that are run by consumers of mental health?

PERCEIVED SENSE OF COMMUNITY

22 yo female is hospitalized with paranoia, hallucinations, abdominal pain worse with periods, physical exam shows reduced strength in upper and lower extremities and reduced tendon reflexes. Which of the following lab values is likely to be elevated and explain her symptoms?

PORPHOBILINOGEN

Social psychological study of the view of self in some western cultures has delineated differences from the definition of self in many non-western cultures. What best describes the basis for positive self-esteem in those non-western cultures? (2x)

POSITIVE CONTRIBUTIONS TO THE GROUP AND HARMONIOUS RELATIONS

46 y/o M w/ double vision + pain R eye. Exam: ptosis R eyelid, inability to elevate or adduct R eye + R pupillary dilation. This is caused by?

POST. COMMUNICATING ARTERY ANEURYSM

Right-side palsy with equal involvement of the face, arm and leg combined with third nerve palsy is most likely due to occlusion of a branch of which artery?

POSTERIOR CEREBRAL

50 y/o pt recently began having VH of children playing. VH are fully formed, colorful and vivid, but with no sound. Pt is not scared or disturbed, but rather amused. On exam, normal language, memory, cranial nerves, no weakness or involuntary movement, no sensory deficits. DTR: symmetric. CSF/UDS nml.

POSTERIOR CEREBRAL ARTERY ISCHEMIA

65 yo with VH of children playing colorful without sound, DTR nl, CSF analysis nl

POSTERIOR CEREBRAL ARTERY ISCHEMIA

Aphasia w/ effortful fragmented, non-fluent, telegraphic speech, is seen in a lesion where?

POSTERIOR FRONTAL LOBE

Cartesian dualism from the theories of René Descartes refers to

POTENTIAL OF HUMAN NATURE FOR BOTH GOOD AND EVIL

Method for estimating sample size required to detect statistical effects of defined size for variables w well-known variances is referred to as which type of analysis (2x)?

POWER

Which of the following characteristics is common to all brief dynamic psychotherapies?

PRACTICAL WORKING THROUGH OF CONFLICT BY TRANSFERENCE INTERPRETATION

First-line treatment for restless leg syndrome (3x)

PRAMIPEXOLE

At what age due kids first exhibit ability to recognize their thoughts and feelings are their own, and that others may think and feel differently?

PRE-SCHOOL AGE

Pt able to recall his address after being prompted to do so. According to Sigmund Freud, this information is stored at what level of the topographic model?

PRECONSCIOUS

Pt w/ hx of EtOH dependence BIB wife, who states that pt's long term use of ETOH has resulted in marital separation and persistent unemployment. Pt refuses to stop drinking. Psych MD asks pt about his perspective regarding his use of ETOH, pt responds, "It may be a problem." Psych MD suggests Tx and pt says,"I will think about it." According to the stages of change model, which stage?

PRECONTEMPLATION

The cortical synaptic remodeling characteristic of normal adolescence is also believed to be associated with what neurobiological change?

PREFERENTIAL LOSS OF EXCITATORY SYNAPSES

The therapeutic effect of 2nd generation antipsychotics on negative symptoms of schizophrenia is thought to be related to the induction of expression in what area of the brain?

PREFRONTAL CORTEX

Where does the neuron morphology in the brain change the most?

PREFRONTAL CORTEX

Clinical circumstance that best warrants consideration of psychotherapy as the sole treatment for mild to moderate depression:

PREGNANCY, LACTATION, OR WISH TO BECOME PREGNANT

Animistic thinking is characteristic of which of Piaget's stages of cognitive development?

PREOPERATIONAL THOUGHT

17 y/o receiving counseling for school truancy. Student understand truancy is not a desirable behavior and is discusses ways to improve school attendance. What stage of change is student in?

PREPARATION

To prove medical malpractice, the plaintiff must establish duty, dereliction, damages and direct causation by what part of proof

PREPONDERANCE OF EVIDENCE

Pt w/ severe depression is interviewed for enrollment in an experimental trial. Pt has failed multiple medications and several courses of ECT. The pt is competent but clearly distressed at the time of consent for treatment. Next step?

PRESENT INFORMATION SEVERAL TIMES USING DIFFERENT METHODS AND FEEDBACK TESTING

First pass effect refers to which of the following aspects of a med's metabolism?

PRESYSTEMIC ELIMINATION

Young adult gained 70 lbs in last year c/o daily severe headaches sometimes associated with graying out of vision. Papilledema present. CT and MRI brain no abnormalities but ventricles smaller than usual. Goal of treatment in this case:

PREVENT BLINDNESS

Addition of methyl groups to nucleotides in promoter region of a gene has what effect on transcription?

PREVENTS TRANSCRIPTION FACTORS FROM BINDING TO DNA

Patient with significant family hx of vascular dementia, wants PCP to follow up with BP, DM, lipids. This is an example of...

PRIMARY PREVENTION

65y/o w/ h/o asthma presents for treatment of essential tremor. Which for first-line? (4x)

PRIMIDONE

Risk factor influencing psychological outcome of child following death of parent

PRIOR CONFLICTUAL RELATIONSHIP BETWEEN CHILD AND DECEASED PARENT

US Supreme Court Decision *Washington v Harper 1990*, the right to refuse treatment is limited for prison inmates because:

PRISON SECURITY CONCERNS OUTWEIGH INDIVIDUAL AUTONOMY INTERESTS

An attorney requests psychiatric consultation when his defendant wants the worst possible outcome from the trial because he feels he deserves the worst punishment possible. What direction should you take for this case?

PROBABLY MEETS CRITERIA FOR FINDING OF INCOMPETENCE TO PROCEED

Gait abnormality, slow movement, asymmetric UE rigidity. Difficulty in voluntary vertical upward/downward gaze. Slowness/rigidity improved slightly with levodopa. Later has problems with horizontal &amp; vertical gaze. Oculocephalic reflexes normal. Involuntary saccades. (2x)

PROGRESSIVE SUPRANUCLEAR PALSY Hummingbird sign - midbrain atrophy

According to psychoanalytic theory, feelings of persecution are most reflective of which of the following defense mechanisms?

PROJECTION

When asked about a coworker after a recent conflict, a patient states "I harbor no ill feelings toward him, but he truly hates me." The is example of which defense mechanism?

PROJECTION

Which defense mechanism most relevant to etiology of delusional disorders (like paranoia) according to psychodynamic theory: (2x)

PROJECTION

A defense mechanism characterized by a self of object representation that is disavowed by placing it into someone else, and inducing the latter to unconsciously identify with the self/object representation: (4x)

PROJECTIVE IDENTIFICATION

One group member alternates between being the "scapegoat" for the group or the "spokesman" for the group. These events are a group version of what?

PROJECTIVE IDENTIFICATION

22 y/o pt suffers a traumatic brain injury, and is admitted to an inpatient rehabilitation facility. There, pt has frequent episodes of sudden anger and aggression directed toward staff. On psychiatric evaluation, pt is aware of these episodes, saying, "I can't help it, I just see red." Pt denies symptoms of depression or anxiety, and there is no evidence of acute confusion on examination. The rehabilitation staff report that all behavioral strategies have failed, and that pt's outbursts are intimidating the staff. Which of the following medications has the best evidence for efficacy?

PROPRANOLOL

Lithium-induced tremor is usually reduced by which med?

PROPRANOLOL

Prognosis of acute inflammatory demyelinating polyneuropathy is poorest if the disease process involves which of the following?

PROXIMAL AXON

45 year old female pt on phenelzine for MDD, takes OTC medication for cold sx and develops hypertensive crisis. Which OTC medication would most likely cause this?

PSEUDOEPHEDRINE

Psychiatrist is evaluating frequent liar. Pt's lies are grandiose and extreme. Pt appears to believe the stories. This is called:

PSEUDOLOGIA FANTASTICA

Social skills training for those with persistent mental illness is an essential part of

PSYCHIATRIC REHABILITATION

A lawsuit charges that a psychiatric facility prematurely discharged a patient who was not approved for further stay by the managed care company. The final legal responsibility generally falls to the:

PSYCHIATRIST

Psychiatrist agrees to prescribe medication to a pt who receives ongoing psychotherapy from another mental health professional. What is the psychiatrist's liability in this treatment arrangement?

PSYCHIATRIST RETAINS FULL RESPONSIBILITY FOR THE PATIENT'S CARE

Psychiatrist prescribes medication to a psychotherapy pt of another mental health professional, what is his liability in this treatment arrangement?

PSYCHIATRIST RETAINS FULL RESPONSIBILITY FOR THE PTS CARE

Which psychotherapy uses transference interpretations and clarification to develop insight and resolve conflict?

PSYCHODYNAMIC PSYCHOTHERAPY

Therapist is working w family of schizophrenic. Strategies include informing about illness, social support, management guidelines. Therapist encourages calm problem solving approach/facilitates stress and stigma reduction when possible. Which model is therapist using?

PSYCHOEDUCATIONAL

70 y/o presents with fearfulness, anger and agitation after moving in with adult child. On first visit pt is resigned and timid during exam. Which is most consistent with pt's behaviors?

PSYCHOLOGICAL ABUSE

What characteristic of MDD is indicative of greater severity?

PSYCHOMOTOR DISTURBANCE

Which of the following is the initial treatment of choice for mild anxiety disorders in children? (2x)

PSYCHOTHERAPY ALONE

Which of the following is NOT common in patients >65: depression, cognitive d/o, phobias, ETOH d/o, psychotic d/o

PSYCHOTIC D/O

Pts w late-life depression compared w early onset depression more likely to report:

PSYCHOTIC SXS

What predicts bipolarity in adolescent with depression? (2x)

PSYCHOTIC SYMPTOMS

What is the principle problem with disulfiram in the treatment of alcoholics?

PT CAN STOP TAKING IT AND RESUME DRINKING

Which is the most significant disadvantage of using a family member as interpreter for a patient who does not speak the psychiatrist's language?

PT MAY CENSOR COMMENTS TO KEEP INFO FROM THE FAMILY

85 y/o pt w/ hx of HTN and COPD reports feeling depressed. The pt has an episode of depression 20 yrs ago, which was successfully treated with nortriptyline. The pt's HTN is currently well managed. The physician prescribes nortriptyline 25mg qday. After 1 wk, the pt calls and reports feeling no better. What would be an appropriate reason to obtain a nortriptyline level?

PT'S ADVANCED AGE

Pt in ED for treatment of OD - was found 4 hrs ago after ingesting 10 cold med packs of 650mg Tylenol, antihistamine, and alpha 1 agonist decongestant. Pt is pale and vomiting. How do you decide whether to use N-acetylcysteine as an antidote?

PT'S SERUM N-ACETYL-P-AMINOPHENOL (APAP) LEVEL OVER TIME

12 y/o disclosed to counselor hx of sexual abuse by relative. Report made to authorities. During eval, pt reports anxiety/inability to concentrate due to thinking about event/ irritability/sleep problems/crying frequently. Grades fell significantly after abuse began & relationships suffered. Dx?

PTSD

Pts with dissociative identity disorder are also most likely to meet diagnostic criteria for which of the following disorders?

PTSD

A mother gives an 8 y/o a "time out" for five min in the bedroom because of his misbehavior. This is an example of what behavioral technique?

PUNISHMENT

In learning theory, the presentation of an aversive stimulus that is contingent upon the occurrence of a particular response is known as:

PUNISHMENT

What increase risk of conduct d/o?

Parental criminality

Pt seen psychiatrist once, then psychiatrist only calls to follow-up, but doesn't take on pt care.

Patient abandonment

Gene mapping strategy to detect rare genetic variants of large effect

Pedigree linkage analysis

Evidence based treatment algorithm to maximize chances of successful consultation

Plan a focused workshop followed by return visits for further training and problem-solving sessions

Role of therapist in motivational interviewing

Points out discrepancy between behavioral and personal goals to motivate change

29 yr old w/ arm and leg weakness and abd pain, needing opiates, then becomes delirious and agitated, what test for dx?

Porphobilinogen

What syndrome has pathogenic copy number variants affecting DNA base pairs?

Prader-willi

Which is a mandate of the affordable care act designed to increase mental health service access?

Prohibition on preexisting condition denials due to hx of mental disorder

Binswanger disease

Pseudobulbar state, gait disorder, and dementia

After mild MI 70 y/o seen by psychiatrist for depression. Seen for psychotherapy, given SSRI. Describes fear of imminent death. Psychiatrist tells him cardiologist is excellent, he is receiving best care. What illustrates supportive therapy

REASSURANCE

7 month-old is not crawling. Pediatrician is unconcerned. Child is alert, responsive, sits normally, shows good response to toys/stimuli. Psychiatrist should tell family:

REASSURANCE AND PROVIDE READING MATERIALS

24 yo pt comes to ed with wrist cuts. pt reports having no intention to die but wanted to feel things. Admits to other self harm behaviors when stressed. Admission to psych hospital would be most supported by what in the patients history?

RECENT ALCOHOL ABUSE

In pts with self- injurious bx and SI, the decision to admit to the inpatient unit would be strongly supported by hx of

RECENT ALCOHOL ABUSE

Greatest risk of death with ECT

RECENT MI

If a response inhibitory to anxiety occurs in the presence of anxiety-evoking stimuli, it weakens the connection between the stimuli and the anxiety. This is called

RECIPROCAL INHIBITION

Which event precipitates midlife crisis?

RECOGNITION OF UNATTAINABLE GOALS

IPT of adults w/ depression begins w/assessment of pt's adjustment to stressful life events, role transitions and disputes, and

QUALITY OF SOCIAL CONNECTIONS

Interpersonal psychotherapy of adults with depression begins with assessment of patient adjustment to stressful life events, role transitions, disputes and

QUALITY OF SOCIAL CONNECTIONS

Antipsychotic associated with development of cataracts

QUETIAPINE

Most evidence to support protective effect in bereavement after spouse loss.

Quality of social support of the bereaved

As children progress through school age development, they begin to recognize what?

RECOGNIZE ETHNIC AND RACIAL STEREOTYPES

Psychological task of midlife is to

RECOGNIZE THE LIMITATIONS OF PERSONAL TIME AND ACCEPT THE INEVITABILITY OF DEATH

Psychiatrist recommends AA to pt who abuses alcohol, but pt reluctant. Next step?

RECOMMEND PATIENT SPEAK TO A CURRENT AA MEMBER

59 y/o ER physician with alcohol problem and depressed mood, less tolerant to day and night shift. In addition to abstinence from ETOH, what is next step?

RECOMMEND RELIEF FROM THE NIGHT SHIFT

Most common time for patient with schizophrenia to attempt suicide is during

RECOVERY PHASE OF THE ILLNESS

Theory of kindling of depressive episodes is supported by what phenomena in some?

RECURRENT WITHOUT A STRESSOR

Characteristic MRI scan finding in Alzheimer disease:

REDUCED HIPPOCAMPAL VOLUMES.

What symptom is more likely to occur in acute stress d/o than in PTSD?

REDUCTION IN AWARENESS OF SURROUNDINGS

Which type of therapy is best for those with poor reality testing, primitive/immature defense, inadequate affect regulation, & poor impulse control?

SUPPORTIVE

most common psychotherapy for crisis management?

SUPPORTIVE THERAPY

Male pt brought to ED by police after he threatening to kill his wife and admits that has thoughts of harming his spouse ever since learning of her infidelity, saying "I want her to hurt like I do now." The pt doesn't display delusions and mood problems. He admits to drinking occasionally, but in the last week and prior to violence. Next step

REFER PT BACK TO LAW ENFORCEMENT

A method for making a prediction based on observable data in order to assess the value of the one variable in relation to another is

REGRESSION ANALYSIS

A study that looks at 4 risk factors for depression uses which statistical method

REGRESSION ANALYSIS

What statistical measure should be used to determine how 2 independent variables affect the frequency of the occurrence rate of an event?

REGRESSION ANALYSIS

What is a symptom of normal bereavement in a 5 y/o child after the death of a parent?

REGRESSION IN BOWEL AND BLADDER CONTROL

Psych MD is asked to recommend treatment interventions for a 16 y/o pt with a presumptive diagnosis of conversion disorder. Which tx is most likely to be both accepted by the pt and result in functional improvement:

REHABILITATIVE TREATMENT

Which of the following strategies exemplifies use of reciprocal inhibition by a patient to attenuate anxiety?

REHEARSING MENTAL IMAGES OF PLEASURABLE EXPERIENCES WHILE ATTENDING THE PARTY

Supportive therapy differs from psychoanalytic therapy in that the therapist who is conducting supportive therapy does what?

REINFORCES EGO DEFENSES

During the initial interview of a couple presenting for therapy it is helpful to point out that the focus of therapy is primarily on the

RELATIONSHIP PROBLEM

The potency of medication refers to which of the following properties of a medication?

RELATIVE DOSE REQUIRED TO ACHIEVE A CERTAIN EFFECT

Study for dx of chronic pain syndrome. Which of the following statistical measures would be used to describe probability that an individual with chronic pain will make an error compared to an individual who is pain free?

RELATIVE RISK

65yo p/w pillow-punching (x several months) in his sleep with sudden awakening from dreams involving pursuit by assailants. Dx?

REM BEHAVIOR D/O

Which of the following is an example of semantic memory in a child?

REMEMBERING THAT THE TOWN PARADE OCCURS EVERY JULY 4TH

What is primary role of psychiatric expert witness (4x)

RENDER OPINION BASED ON SCIENTIFIC KNOWLEDGE

Frequently a medical sx in pts with anorexia:

REPRODUCTIVE HORMONE DYSFUNCTION

Women at highest risk of MDD during:

REPRODUCTIVE YEARS

A highly motivated patient in psychodynamic psychotherapy finds that he has nothing to say, which is an example of:

RESISTANCE

Pt enters psychotherapy because of problems in his relationship with his wife. During the sessions, pt talks about his family of origin, his boss, and his problems at work, but never discusses details about his wife. This is an example of which of the following?

RESISTANCE

Pt repeatedly redirecting discussion by talking about irrelevant topics is example of

RESISTANCE

Redirecting discussion by talking about irrelevant stuff

RESISTANCE

Device to treatment of Peripheral neuralgia

Transcutaneous electrical nerve stimulation (TENS)

What is most likely to be enhanced by strategies of putting the pt at ease, finding the pt's pain and expressing compassion, evaluating insight, and showing expertise?

RAPPORT

18 m/o is vulnerable to separation and constantly concerned about mother's actual location. This is representative of Mahler's stage of

RAPPROCHEMENT

3 y/o with diminished appetite, slow speech development, poor social interactions parents are detached from him. After 2 weeks in hospital is improving and friendly with staff members. Dx?

REACTIVE ATTACHMENT D/O

The most common learning disability found in school-age children

READING DISORDER

What is most common learning/communication disorder in kids receiving special ed?

READING DISORDER

Psychiatrist wishes to assess a pt's premorbid intellectual functioning. Which of the following tests would be best for this purpose?

READING SUBSET OF THE WIDE RANGE ACHIEVEMENT TEST

7 y/o referred for psych eval due to learning probs. Most helpful info would be family's approach to and hx

READING WITH THE CHILD

4 months ago the wife of a pt died and pt blames himself for her death. Next step:

REASSURANCE

65 y/o diabetic pt presents to ED c/o acute L sided weakness, deviation of gaze to R, L hemiplegia and hemisensory deficit, and L homonymous hemianopsia. 12 hrs later, pt is unconscious, L pupil enlarged and unreactive. CT will show what?

R MCA INFARCT W/ EDEMA AND UNCAL HERNIATION

How is "race" different than "ethnicity"?

RACE IS BASED ON PHYSICAL CHARACTERISTICS WHEREAS ETHNICITY INCORPORATES MULTIPLE FACTORS

Family response to a member with ataque de nervios would most likely be to do what?

RALLY TO SUPPORT RELATIVE BY REMOVING STRESSORS

Which factors in bipolar disorder is a predictor of a poor response to lithium?

RAPID CYCLING

A leading hypothesis as to why atypical antipsychotic medications are less likely than typical neuroleptic agents to cause EPS is based on which of the following properties of atypical antipsychotics?

RAPID DISSOCIATION FROM D2 RECEPTORS

Most likely to be enhanced by the strategies of putting the pt at ease, finding the pt's pain and expressing compassion, evaluation pt's insight, and showing expertise

RAPPORT

Situations where patients can be forced antipsychotics: include emergencies, treating symptoms threatening others or self's safety and..?

Restoring a criminal defendant to stand trial

Which EMG findings in pt complaining of involuntary myoclonic movements supports dx of conversion disorder?

Rising pre-movement potentials

Physostigmine is useful in treating toxic syndrome from overdose with

SCOPOLAMINE

A conscious memory that covers for another memory that is too painful to hold in the consciousness is:

SCREEN MEMORY

Pt was hit from behind while driving &amp; awoke w/ pain radiating into his left ankle. Weakness of plantar flexion and decreased ankle jerk. Straight leg raising reveals pain beyond 45 degrees on left. Dx?

S-1 RADICULOPATHY

*Winnicott* defined his concept of holding environment as the (2x):

SAFE CONTEXT PROVIDED BY CONSISTENT AND RELIABLE PARENTING

When used as a tx following a traumatic event, hypnosis has been found to

SAFELY DECREASE PAIN AND STRESS IN THOSE WHO ARE HYPNOTIZABLE

Check fasting lipid panels before starting treatment before atypical antipsychotics. Which health quality implemented according to the aims of the Institute of Medicine?

SAFETY

Therapeutic index is a relative measure of which of the following characteristics of a medication?

SAFETY

25 y/o has HA and vomiting. Pain is dull and in occipital region, worse when lying down. +severe papilledema b/l. LP shows opening pressure of 80 w/ normal CSF chemistry, and 120 RBC's in last tube. D-dimer, FDP in blood are elevated. CT normal. (3x)

SAGITTAL SINUS THROMBOSIS

Severe occipital HA, BL papilledema and vomiting. Just started birth control pills. Lumbar puncture elevated opening pressure with no cells, 62 mg/dl glucose, and 31mg/dl protein, RBC 400. CT is normal.

SAGITTAL SINUS THROMBOSIS

Causes of psych disorders in individuals w mental retardation vs general population:

SAME TYPES OF PSYCHOPATHOLOGY

What is the most dominant observable social pattern in 3rd and 4th grade students from different classrooms?

SAME-SEX GROUPINGS REGARDLESS OF ACTIVITY

L psych sees 58 y/o widowed pt medicine wants to discharge d/t neg workup for abd pain and nausea. Pt refuses to return home to adult kids because the food they prepare are making her sick and causing her sxs. MSE unremarkable and no past psych hx. Next step?

SCHEDULE MEETING WITH THE MEDICAL TEAM, PATIENT, AND FAMILY

75 y/o male brought in by family for psych eval, family reports no past psych history, has gotten suspicious, withdrawn, hostile. Talks to self, talks about being controlled by aliens, believes aliens are putting thoughts in his head. 28/30 on MOCA, MRI shows age-related changes. Diagnosis?

SCHIZOPHRENIA

Robust evidence from epidemiological studies that the offspring of older fathers have increased risk of?

SCHIZOPHRENIA

16-year-old adolescent is being evaluated for possible schizophrenia. A family history of which of the following personality d/o is most strongly associated with this dx?

SCHIZOTYPAL

Guardian of a pt with MR with medication-refractory epilepsy insists that the pt should have epilepsy surgery. Neurosurgeon believes the seizure focus can be resected, but there's a >50% chance of RUE paralysis which outweighs potential benefit from freedom from seizures. Guardian insists on surgery. Which describes physician responsibility in this case?

SHOULD PERFORM THE SURGERY ONLY UNDER COURT ORDER

What characterizes executive abilities in healthy individuals >65?

SHOW NO SIGNIFICANT CHANGE

A preschooler misses his long-term nanny who has recently moved away. To help this child, the parents should

SHOW THE CHILD PICTURES OF THE NANNY

55 y/o M with changes in his voice, orthostatic hypotension and one immobile vocal cord on inspection suffers from:

SHY-DRAGER SYNDROME

In an 80 y.o., what is likely to increase risk of impairment after bereavement (2x)?

SIGNIFICANT DEPRESSIVE SYMPTOMS SHORTLY AFTER THE LOSS

When compared with adult-onset schizophrenia, children with schizophrenia have SIMILAR deficits in

SIMILAR DEFICITS IN ATTENTION, LEARNING AND ABSTRACTION

How are complex partial seizures differentiated from simple partial seizures:

SIMPLE SEIZURES HAVE NO LOSS OF CONSCIOUSNESS BUT HAVE ALTERED RESPONSIVENESS TO OUTSIDE STIMULI

In the structural model of family therapy, the family is viewed as a

SINGLE, INTERRELATED SYSTEM WITH AN EMPHASIS ON BOUNDARIES BETWEEN THE GENERATIONS.

Most common symptom in narcoleptics:

SLEEP ATTACKS

Follow-up studies on the Drug Abuse Resistance Education (DARE) program for elementary students have reported what finding?

SMALL TO NON-MEASURABLE DECREASES IN SUBSTANCE USE BY PARTICIPANTS

60 y/o pt w/ progressive proximal arm and leg weakness, elevated creatine kinase level. MD suspects a myopathy and orders EMG. Which findings on EMG:

SMALL, SHORT DURING MOTOR UNIT ON NEEDLE EXAM

14 y/o pt with a long-standing h/o of perfectionism has recently developed a fear of talking in class after forgetting her lines in a school play. Pt says, "I don't like talking to other kids" and practices reading aloud over and over so "I remember what I am saying." Dx?

SOCIAL PHOBIA

After a stranger says "hello," a 12-month-old child turns and looks at his mother before responding. When the mother smiles and nods her head, the infant laughs and smiles in response to the stranger:

SOCIAL REFERENCING

Focus for outpatient psychotherapeutic groups for schizophrenia?

SOCIAL SKILLS DEVELOPMENT

Pt w/ mild MR in program designed to develop new behaviors by modeling/ reinforcement, then practice them

SOCIAL SKILLS TRAINING

Maturation of basal ganglia/cortical motor circuits is most closely assoc w development of:

SOCIAL SMILE

What most accurately describes scientific understanding of the concept of race?

SOCIOPOLITICAL DESIGNATION ASSIGNING INDIVIDUALS TO A PARTICULAR GROUP THAT HAS MEANING DERIVED FROM PREVAILING SOCIETAL ATTITUDES

Most commonly used cognitive therapy technique to uncover & modify automatic negative thoughts

SOCRATIC QUESTIONING

Pt with renal failure develops flaccid paralysis, difficulty speaking, dysphagia, and impaired eye movement, what is the electrolyte deficiency

SODIUM

Pattern of drinking in women alcoholics (as opposed to males):

SOLITARY DRINKING

Compared to older adolescents with depression, 8-12 year-olds w/ depression most often show what?

SOMATIC COMPLAINTS

When compared to adol, 8-12 y/o children with depression most often show which symptom? (2x)

SOMATIC COMPLAINTS

A patient has periodic pelvic pain for past two years. Had laparoscopy, diagnosed with endometriosis, started oral contraceptives and analgesics with some relief, still has symptoms. The patient reports worry that she will quit job due to pain. Calls doctor every few days to ask whether new tx should be considered or she may have cancer. Dx?

SOMATIC SYMPTOMS DISORDER

22 yo M pt complains of fatigue, abdominal pain, weight loss and believes caused by nocturnal emissions of semen. What is pt's ethnic background?

SOUTHEAST ASIAN

6 y/o child generally healthy throws a fit every time family goes hiking. Exposure to snake on one hike led child to become loud, agitated. Now child has intense distress when hiking, pleads to stay with parents at all times. Dx?

SPECIFIC PHOBIA

Pt presents with chapped and reddened hands. Upon questioning, pt admits to washing the hands many times a day because "I work in a hospital cafeteria and am intensely afraid of contracting a flesh-eating bacterial infection." The most likely Dx:

SPECIFIC PHOBIA

The parents of an 18 y/o adol who is overweight notice that their child is avoiding high caloric foods, such as meat and pasta. When the parents inquire about this, the teen says, "I am afraid of eating." He had an episode of panic which occurred while eating and was accompanied by choking feelings. A fear of choking while eating and a wish to avoid foods that might cause choking developed. The teen denies other episodes of panic. Dx? (2x)

SPECIFIC PHOBIA

Dx for IV drug user w/ severe back pain, BLE weakness, LE/buttock/sacral sensory loss, bladder incontinence, fever, TTP over second/third vertebrae.

SPINAL EPIDURAL ABSCESS

A 28 yo pt presents with a 1 year history of agoraphobia. The pt is able to drive to the local drugstore, but only with considerable pre-travel apprehension. The pt will venture alone no further then within ~5 miles of home. Personal history of panic attacks or depression is denied, although family history is positive for depression and alcoholism. The pt has had no previous treatment. The best initial pharmacological x2 treatment, and one that offers the best long-term prognosis for this patient is?

SSRI AND BZD

SE of toxic serum lithium levels

ST DEPRESSION QTC PROLONGATION ATAXIA TREMOR DYSARTHRIA NEPHROTOXIC SX STATUS EPILEPTICUS

Somnambulism during childhood is associated with which of the following stages of sleep measured by an EEG?

STAGE IV

50yo referred to psych following negative medical workup of abd pain. Pt appears depressed and in constant pain. What is the preferred psych MEd intervention?

START LOW DOSE IMIPRAMINE

A medical student takes amphetamines to stay awake while studying for an exam. When she takes the exam without any medication, she finds that she has much greater difficulty than usual remembering the material. What is this an example of?

STATE-DEPENDENT LEARNING

A 4 yo has developed what language skills?

STORY-TELLING USING WORDS

What type of family therapy uses paradoxical directives, such as prescribing the symptom or behavioral sequence?

STRATEGIC

What is the most common manifestation of acute neurosyphillis?

STROKE

Contraindication to family therapy

STRONG RELIGIOUS OR CULTURE BELIEFS AGAINST OUTSIDE INTERVENTION

What neuropsych test relies on inhibition of the over learned behaviors to assess executive functioning?

STROOP COLOR WORD TEST

In what type of family therapy are the concepts of family hierarchies, boundaries, coalitions, and alliances seen as core concepts?

STRUCTURAL

71 y.o. evaluated by geri-psych, pt just retired from long career as a judge, has a busy life full of travel, music, and reading. Pt takes only vitamins, has no medical problems. Pt is cognitively intact, older sibling has Alzheimer's, a friend told pt to take Omega-3 to prevent dementia

STUDIES DONE SO FAR DO NOT SHOW A BENEFIT IN PREVENTING COGNITIVE DECLINE, BUT THERE MAY BE OTHER BENEFITS

Most serious threat to external validity of research study?

STUDY POPULATION NOT REPRESENTATIVE

Prolonged ingestion of high doses pyridoxine causes

SUBACUTE SENSORY NEUROPATHY

79 y/o pt w/ decreasing mental state over 3 weeks has an exaggerated startle response with violent myoclonus that is elicited by turning on the room lights, speaking loudly, or touching the patient. Myoclonic jerks occur spontaneously, ataxia, EEG: sharp waves. Dx: (5x)

SUBACUTE SPONGIFORM ENCEPHALOPATHY

Vascular lesion most characteristic of sudden severe headache, vomiting, collapse, relative preservation of consciousness, few or no lateralizing neurological signs, and neck stiffness?

SUBARACHNOID HEMORRHAGE

Implantation of DBS electrodes has been shown to lead to remission in about half of patients with treatment-refractory depression. To obtain this effect, the electrode is placed in the:

SUBGENUAL CINGULATE CORTEX

Which of the following aspects of sleep is increased in older adults?

SUBJECTIVE QUALITY

A child is jealous of the older sibling's accomplishment and becomes less jealous when he (the patient) accomplishes something. Which defense mechanism is this?

SUBLIMATION

Pain by neurogenic inflammation mediated by?

SUBSTANCE P

Patients with anorexia nervosa binging and purging type are more likely than restrictive type to have comorbid:

SUBSTANCE USE

The diagnosis most associated with violent acts?

SUBSTANCE USE DISORDERS

Criterion for a covered disability under Americans with Disabilities Act:

SUBSTANTIALLY LIMITS ONE OR MORE MAJOR LIFE ACTIVITIES

Acute onset of hemiballismus of LUE & LLE. MRI is most likely to show lesion located where?

SUBTHALAMIC NUCLEUS

38 y/o pt in dynamic psychotherapy for depression says she is lesbian and is dissatisfied with her otherwise good relationship with her partner of 7 yrs b/c she wants a child and her partner does not. She thinks about leaving the relationship but this makes her feel sadness and a sense of loss. What is best intervention?

SUGGEST THAT CONJOINT THERAPY WITH THE PATIENT AND HER PARTNER MIGHT BE A PRODUCTIVE WAY TO EXPLORE THIS COMPLICATED ISSUE

A patient with somatic delusional disorder refusing to see a psychiatrist but sees a dermatologist regularly. What should the psychiatrist recommend the dermatologist do?

SUGGEST THAT THE DERMATOLOGIST ASK ABOUT DRUG USE

The leading cause of death among gun buyers in the first year after the weapon was purchased is

SUICIDE

Federal courts require psychiatric care in correctional institutions to have:

SUICIDE PREVENTION PROGRAM

During a clinical interview, the physician recapitulates what the pt has said so far and says to pt "I just want to make sure that I've got everything right up to this point". This is an example of:

SUMMATION

Acute onset of dense sensorimotor deficit in the contralateral face and arm, with milder involvement of the lower extremity, associated with gaze deviation toward the opposite side of the deficit, likely indicates occlusion of? [BE SPECIFIC]

SUPERIOR DIVISION OF THE MCA

24 y/o pt w tetraplegia after MVA showing no signs of grief or acknowledgement of poor prognosis, no significant depressive/anxious Sx. What psych intervention preferred? What psychotherapeutic school of thought emphasizes how a pt has managed feelings of envy/rage *w particular emphasis on defense mechanisms*?

SUPPORT BUT DO NOT CONFRONT THE PT ABOUT THE MEDICAL REALITIES, EGO PSYCHOLOGY

7yo M w aggression was referred by school for eval after IQ of 68 discovered. Pt was temperamentally inhibited and avoidant as an infant, difficulty interacting w peers and preoccupation with trains at age 2. No stereotypes or tic. Which aspect of this presentation is most indicative of autism spectrum disorder?

SYMPTOMS PRESENT BEFORE AGE 3

Abnormality of which neurodevelopmental process has been linked to fragile x and schizophrenia?

SYNAPTIC PRUNING

Irregular, unequal, small pupils nonreactive, do not dilate, but do constrict to accommodation:

SYPHILIS

Pt with chronic muscle wasting in both UE, loss of light touch, pain, and temperature sensation in shoulders, upper arms, and back, and painful paresthesias over the same distribution, diagnosis?,

SYRINGOMYELIA

Behavioral therapy w relaxation training/hierarchy construction/visual imagery?

SYSTEMATIC DESENSITIZATION

The behavioral therapy technique in which a pt is exposed to progressively greater fear inducing situations is referred to as

SYSTEMATIC DESENSITIZATION

What educational activity is characterized by covering new knowledge and/or current best practices, offering the correct answer and supporting literature references, and providing information about comparative performance to peers?

Self assessment continuing medical education

A surgeon unable to describe anatomical parts involved in one of his common surgeries is experiencing what type of memory impairment?

Semantic

Couple in therapy review argument at family reunion, husband told his sister-in-law that his wife was superior to her in every way, the wife expressed disapproval, husband became quiet and later fell down a flight of stairs. What defense mechanism is this?

TURNING AGAINST SELF

Neuroimaging technology most useful in studying connectivity pathways:

Single photon emission CT scan

So a patient has irresistible episodic sleepiness, and vivid dreamlike state at the onset of episode, what else is likely to be present?

Sleep paralysis

Pts with unipolar depression differ epidemiologically from pts with bipolar d/o in what way?

THE DISCREPANCY BETWEEN MALE FEMALE LIFETIME PREVALENCE RATES IS GREATER.

*Kohut's* theory of personality is based on?

THE INDIVIDUAL'S NEED FOR EMPATHIC INTERACTION WITH SELF-OBJECTS

*Kohut's* theory of personality is based on:

THE INDIVIDUAL'S NEED FOR EMPATHIC INTERACTIONS WITH SELF-OBJECTS

In cancer patients, what should you use to treat sub-threshold depression sx?

Start an SSRI

Which of the following premises is central to the sociobiologic theory of inclusive fitness?

THE KEY UNIT OF SELECTION IS ACTUALLY GENES RATHER THAN INDIVIDUALS

27 y/o M seen in ED c/o insomnia, hopelessness, anorexia, decreased concentration for 2 weeks and is now acutely suicidal. Pt has hx of ETOH use daily for the past 3 months. The most likely Dx?

Substance-induced mood disorder

CNS region containing dopaminergic neurons projecting to caudate and putamen

Substantia nigra

A post-op pt's was receiving 75mg IM meperidine. After switching to meperidine 100mg po pt reports inadequate pain relief. She has no past psych and abuse issues. This is due to

THE LOWER POTENCY OF PO MEPERIDINE COMPARED TO IM

A central premise of object relations theory:

THE MIND IS INHABITED BY MENTAL REPRESENTATIONS OF SELF AND OTHERS

Central premise of object relations theory?

THE MIND IS INHABITED BY MENTAL REPRESENTATIONS OF THE SELF & OTHERS

A logarithmic odds (LOD) score for a gene represents what?

THE MOST LIKELY RECOMBINATION FREQUENCY BETWEEN TWO LOCI FROM PEDIGREE DATA

Which of the following is the best predictor of whether or not a patient who sustained a significant trauma will develop early PTSD morbidity?

THE NATURE AND SEVERITY OF THE TRAUMA

In contrast to attachment, "bonding" is associated with

THE NATURE OF A PARENT'S RELATIONSHIP TO AN INFANT

What is characteristic of the placebo effect?

THE PLACEBO EFFECT IS GREATER WHEN THE PT KNOWS THE DOCTOR.

Psychiatrist blogs as "Dr. Empathy." Why unprofessional?

THE PSYCHIATRIST SHOULD MAKE HIS OR HER IDENTITY AND CREDENTIALS CLEAR

Worsening temper tantrums in 3 y/o. First occurred in grocery store and child was quieted with candy. The tantrums would occur at home and would escalate until given candy. Psychiatrist tells parents not to give candy during a tantrum under any circumstances. Outcome?

TANTRUMS WILL INCREASE THEN DECREASE

45 y/o pt w lung cancer and depression. Physical and emotional symptoms are stable, pt worries that "family always seems on edge with me." Family meeting shows children fear losing father, frustrated that lives seem "on hold". Daughter feels she can't invite friends over out of fear of "stressing her father." Father feels guilty about this but does prefer quiet environment. Best *strategic systemic approach* to problem?

TASK FAMILY WITH COMING UP W PRACTICAL SCHEDULE

FTD *with mutation in chromosome 17* is associated with abnormal intraneuronal deposition of which protein?

TAU

An 82-yo pt has falls, ophthalmoplegia, parkinsonism and progressive dementia. Autopsy shows:

TAU POSITIVE NEUROFIBRILLARY TANGLES

Brain of football player who died by suicide has findings typical of chronic traumatic encephalopathy, what is most typical pathology for this behavior?

TAUPATHY

22 y/o brought to ED by roommate who found him unconscious with a suicide note. Temp 100.9, BP 100/60, P 124, RR 8, warm and dry skin, dilated pupils and reactive to light, bowel sounds decreased, EKG with sinus tachy and QTC of 589, no obvious trauma. On which did pt OD?

TCA

Which of the following is the principal service provided by the liaison component of consultation-liaison psychiatry?

TEACHING PSYCOSOCIAL ASPECTS OF MEDICAL CARE TO OTHER HEALTHCARE WORKERS

DBT is unique among commonly employed psychotherapy in encouraging judicious use by pts by what?

TELEPHONE CONSULTATION

Patient is Alzheimer's dementia in clinic. Patient's daughter is frustrated with having to care for her mother more and is considering removing her from her church group because of it. What is the most initial response by the psychiatrist?

TELL HER TO CONTINUE GOING TO HER CHURCH GROUP

Psychiatrist provides psychotherapy to 22 y/o pt who lives w/ parents and dx w/ anxiety and depression. Pt reports the father threw 13 y/o sibling across the room.Sib was not injured. Multiple similar episodes. What is appropriate response for the psychiatrist?

TELL PT THAT THE PSYCHIATRIST MUST REPORT THE ABUSE TO CHILD PROTECTIVE SERVICES

Adult male presents to clinic with broken hand due to first time domestic violence toward his same-age spouse. Best response by psychiatrist?

TELL THE PATIENT THAT VIOLENCE IS HIS RESPONSIBILITY AND HE NEEDS TO STOP IT

Activity level, regularity, approach-withdrawal to new situations, adaptability, persistence are examples of:

TEMPERAMENTAL VARIABLES

Amnesia preceded by epigastric sensation/fear is associated with electrical abnormalities where?

TEMPORAL LOBE

Exclude a patient from a weekly outpatient group treatment group if

TENDENCY TO ASSUME DEVIANT ROLE

Onset of puberty in boys begins with:

TESTICULAR ENLARGEMENT

Differentiation stage of group development is best characterized by what dynamic

TESTING AND COMPETITION

Chronic rx opioid use affects which hormone?

TESTOSTERONE

What med is effective in tx of motor/vocal tics associated w Tourette syndrome refractory to tx with antipsychotics and alpha adrenergic agonists?

TETRABENAZINE

Child custody determinations in most jurisdictions are made using what principle? (4x)

THE BEST INTEREST OF THE CHILD

5 y/o has been enuretic after mother died in an MVA 4 days ago and keeps saying, "Mommy will come home soon." The father wonders if the children should attend the funeral. What is your recommendation?

THE CHILD AND SIBLING SHOULD BOTH BE ALLOWED TO ATTEND IF THEY WANT TO GO.

Scientific development that made NIMH epidemiological catchments area studies possible (9x)

THE DEVELOPMENT OF OPERATIONALIZED DIAGNOSTIC CRITERIA AND STANDARDIZED INSTRUMENTS

Agitated manic pt eval in ED, resisted voluntary psych hospitalization. Psychiatrist said, "You can come in voluntarily & choose when you will be discharged, or I'll involuntarily hospitalize you so you have no say in how long you stay in the hospital". Pt had no SI/HI. Why does psychiatrist's decision not meet standard of care?

THE PSYCHIATRIST'S USE OF COERCION INVALIDATED INFORMED CONSENT

Huntington's disease etiology is classified as a polymorphism due to what property?

THE REGION HAS MANY ALLELES DIFFERING IN THE NUMBER OF CAG REPEATS

In evaluating a patient's competence to consent to a medical treatment, the degree of strictness with which the examining psychiatrist considers the question is most affected by which of the following factors?

THE RISK-BENEFIT RATIO OF THE TREATMENT

The motivational enhancement therapy model for addiction treatment emphasizes which of the following factors?

THE ROLE OF AMBIVALENCE IN CHANGE

Studies in which monkeys are raised in varying degrees of isolation have been important in contributing to what theories of human development?

THE SIGNIFICANCE OF ATTACHMENT

Which of following statements identifies what both traditional healing and modern psychotherapeutic practices may have in common:

THE THERAPIST HELPS THE PATIENT EXPERIENCE AN EMERGING SENSE OF LEARNING AND MASTERY OVER THE PROBLEM

What was most important factor in determining tx outcomes in National Institute of Mental Health Treatment of Depression Collaborative Research Program (1996)?

THERAPEUTIC ALLIANCE

Psychiatrist determines that fully informing a pt of tx risks would negatively impact pt's health/welfare & documents rationale for tx the patient without informing the patient of all the risks. This psychiatrist is intending to use which of the following?

THERAPEUTIC PRIVILEGE

This statement best characterizes current information on the recommended initial treatment of psychotherapy or pharmacotherapy for a pt with panic disorder:

THERE ARE INSUFFICIENT DATA TO CHOOSE ONE TREATMENT OVER ANOTHER, OR COMBINATION OVER MONOTHERAPY

Pt is evaluated for unilateral lower extremity weakness with no apparent physiologic explanation.

THERE IS A RISK THAT RELEVANT NEUROLOGIC ILLNESS WILL BE IDENTIFIED IN THE FUTURE.

Best characterizes the role of spirituality in abstinence in alcoholics who attend AA?

THERE IS LIMITED EVIDENCE SUPPORTING THE ROLE OF SPIRITUALITY IN ABSTINENCE

Central characteristic of factitious disorder

THERE IS MOTIVATION TO ASSUME THE SICK ROLE

What is an effective treatment for mild to moderately severe idiopathic Raynaud's disease?

THERMAL BIOFEEDBACK

What is the most clinically significant critique of the use of randomized controlled studies

THEY ARE BETTER SUITED TO PROVIDE INFORMATION ABOUT EFFICACY RATHER THAN EFFECTIVENESS

What characterizes the majority of defendants with psychiatric disorders who are found unfit to stand trial?

THEY CAN REGAIN FITNESS IN LESS THAN 90 DAYS

45 y/o with nystagmus and ataxia, short term memory loss and believes wife is possessed by demons. Most appropriate treatment?

THIAMINE

Pt with bipolar disorder who has been on lithium for 2 years develops rapid cycling. What lab procedure should be performed?

THYROID FUNCTION TEST

A genetic susceptibility for OCD is suggested by evidence that there is a familial link with what disorder? (4x)

TIC DISORDERS

Pharmacokinetic property most related to relative abuse potential of benzos

TIME TO ONSET OF ACTION

Individuals carrying *inactive alleles of the CYP2A gene* have increased conitine levels per unit of drug ingested and are relatively protected from addiction to:

TOBACCO

Most often abused hallucinogens associated with:

TOLERANCE TO EUPHORIC EFFECTS

23 y/o pt is admitted to the hosp with rhabdomyolysis and renal failure. On examination, pt is noted to have ataxia and peripheral neuropathy. Following treatment of the pt's acute medical problems, it becomes apparent that the pt has dementia. MRI: cerebellar atrophy and diffuse white matter changes. Which long standing substance of abuse:

TOLUENE

Pt presents highly anxious with seizures, HA, emotional lability, irritability, dizziness, and confusion. MRI reveals multiple subcortical demyelinating lesions. The most likely sx is exposure to which of the following substances?

TOLUENE

Most effective med most effective for migraine prophylaxis

TOPIRAMATE

This model divides the mind into conscious, preconscious, and unconscious (2x)?

TOPOGRAPHICAL

Factor most predictive of effective methadone tx

TOTAL DAILY DOSE

Following divorce, which behaviors in non-residential father contributes most positively to child's future mental health?

TRADITIONAL PARENTING SUCH AS HELPING WITH HOMEWORK OR CELEBRATING HOLIDAYS TOGETHER

What test requires rapid and efficient integration of attention, visual scanning, and cognitive sequencing?

TRAIL-MAKING TEST TMT

What is perceptual abnormality in which hallucinogenic drugs cause moving objects to appear as a series of discrete and discontinuous images?

TRAILING

During therapy, therapist coughs while patient is speaking. Pt angrily states, "if you disagree with me just tell me, but don't be a passive aggressive jerk!" Therapist interprets that pt is consistently treating the therapist like aggressor. Which best describes this therapy modality?

TRANSFERENCE FOCUSED PSYCHOTHERAPY

14 y/o girl presents with delayed onset of puberty, short stature, and a history of cardiac abnormalities and hypertension. She has poor social skills. Psychological assessment reveals a normal verbal IQ and a below-normal performance IQ. Dx?

TURNER SYNDROME

On the way to airport for vacation, 58 yo F begins to behave in very strange way. Husband notices when he talks to her she answers appropriately w fluent speech but seems to have no ability to retain any new information. She repeatedly asks where they are going, even after he has told her many times. The episode lasts for about 6 hours. The following day she is back to normal but has no recollection of the prior day events. This episode is most consist with a diagnosis of:

TRANSIENT GLOBAL AMNESIA

2 y/o does not want to let go of wool blanket and resists going anywhere without it. Attachment type is

TRANSITIONAL OBJECT

23 y/o develops tingling paresthesias in the lower extremities, followed several days later by progressive weakness, R&gt;L. PE shows sensory level at T10 to pinprick, +3/5 weakness of LE, slightly weaker on R. Knee and ankle jerks are hyperactive, b/l congenit. Pt has difficulty walking with broad-based, stiff-legged gait. Dx?

TRANSVERSE MYELITIS

19 y/o pt presents for evaluation of depression. Pt reports a generally very low mood, although it brightens up briefly when something good happens. Pt reports feeling best in the morning. Pt has been sleeping and eating more than usual, and complains of feelings of heaviness in the extremities. Pt reports always being very sensitive to perceived rejection by others. Trials with two selective serotonin reuptake inhibitors (SSRIs) have failed. Which of the following treatments may be particularly effective for this pt?

TRANYLCYPROMINE

Constitutional and common law dictate that mental health care provided to prisoners be at or above the level of services that should be available to them if they were in the community. The "necessaries" doctrine is justified by what principle?

TREATMENT MUST BE PROVIDED TO THOSE WHO ARE PREVENTED FROM SEEKING THEIR OWN MEDICAL CARE

Constitutional and common law dictate that prisoners must receive care at or above the level of care they would receive if they were in the community. This "necessaries" doctrine is justified by which of the following principles?

TREATMENT MUST BE PROVIDED TO THOSE WHO ARE PREVENTED FROM SEEKING THEIR OWN MEDICAL CARE

10 yo boy primary nocturnal enuresis, is dry during day, no urgency, frequency, dysuria. Father had same at age 12. No other issues, wants to stop bed wetting to go to camp. What is the next step?

TRIAL OF DDAVP

12 yo arguing w his single parent mother. Mother threatens consequences and child runs to grandmother who then scolds mother for being too harsh. Family dynamic is reflective of?

TRIANGULATION

Dysfunctional process in systemic therapy illustrated by mother telling 15yo son to confront his father about his excessive drinking.

TRIANGULATION

In family therapy, a previously distant couple begins to communicate more frequently and intimately. After this happened the daughter who used to be close to mom, and has become less so as a consequence of above therapy changes, is more hostile to father. This behavior is called

TRIANGULATION

Lab tests to order for detecting excessive drinking

TRIGLYCERIDES, MCV, SGGT, SGOT.

How to diagnose Huntington Dz?

TRINUCLEOTIDE EXPANSION ANALYSIS

30 yo on Clozapine for treatment resistant schizophrenia presenting with dyspnea, orthostatic hypotension and HR 130bpm. Elevated Eosinophil count, EKG with non-specific T wave changes. What test should be obtained to guide treatment

TROPONIN LEVEL

Lithium serum levels should be monitored by evaluating

TROUGH LEVELS 12 HOURS AFTER LAST DOSE

Key characteristic of preschoolers who are securely attached

TRUST AND RECIPROCITY

32 y/o F, divorced 3 times, sees a male psychiatrist, saying she needs therapy because she is paralyzed about choosing a career. Pt has started and stopped college twice, held several waitress and clerk jobs. She hoped the therapist could tell her what job to pursue. In the initial interview she asks the therapist to send bills directly to her father, who manages her money because she has difficulty managing bills and credit cards. She explained she has to live at home to save money, but hates this because she frequently fights bitterly w her father who always wants to control her. Transference issue that therapist should expect to be central theme in therapy is

TRY TO GET ADVICE BUT THEN BE ANGRY AT THE THERAPIST FOR GIVING IT

15 y/o pt w/ hx of atypical seizures that include psychomotor attacks and generalized motor episodes. Pt does poorly in school. Exam reveals skin lesion, no other abnormalities. A mutation of which gene?

TSC-1 (TUBEROUS SCLEROSIS GENE 1)

55yo p/w depression, fatigue, weight gain, &amp; somnolence x1mo. Hx MI 3mo ago (VTach), on amiodarone, HCTZ, &amp; metformin. Management?

TSH and T4 LEVEL (SIDE EFFECT OF AMIODARONE)

According to psychoanalytic theory, the term primary process thinking refers to mental activity exemplified by?

UNCONSCIOUS THOUGHTS THAT DO NOT MAINTAIN LOGICAL CONNECTIONS

A 3 yo child has been expressing angry feelings about the arrival of a new sibling. The child has a secure attachment to parents as well as grandparents who visit frequently. During one such visit, during which the grandparents spend time holding the new baby, the child begins to bang the head rhythmically against a table. According to psychoanalytic theory, this behavior is understood as which of the following?

TURNING AGAINST THE SELF AS A DEFENSE AGAINST INTOLERABLE ANGER.

For the treatment of pts with compulsive sexual behavior, the best results have been seen with which of the following approaches?

TWELVE STEP GROUPS

Which study best addresses the relative influences of heritability and environment?

TWIN ADOPTION STUDIES

Two antidepressants are tested alone and as a combo treatment against a waitlist control group in pts with treatment resistant MDD. Both meds are found to have a significant therapeutic effect individually, and the combo treatment is more efficacious than the summed effects of each med given alone. What has been demonstrated?

TWO TREATMENTS MAIN EFFECTS AND AN INTERACTION EFFECT

Study reports difference that turns out to be by chance

TYPE I ERROR

A young child tries to determine how many seating arrangements there are for a family of 5 around a table. The child uses no system and spends hours trying to find all options randomly and incompletely. This approach suggests:

TYPICAL APPROACH FOR THIS STAGE OF CONCRETE OPERATIONS

Sex play from 8-13 y/o indicative of:

TYPICAL CHILDREN

Kluver-Bucy syndrome: placisity, hyperorality, hypersexuality and hyperphagia, can be induced in animals with bilateral resection of which structure?

Temporal lobes

The dorsolateral-prefrontal cortex, striatum and ____ are part of a loop circuit that produces worry and obsessive symptoms:

Thalamus

Most likely reason that adults are superior to adolescents in abstract thinking?

The brain undergoes: SYNAPTIC PRUNING

The three component of informed consent include:

The presentation of information The voluntariness of consent on the part of pt Mental competence

In problem solving training, what is the next step after using specific behavioral terms and feeling expressions

The other partner paraphrases the statement of the problem

Which test requires rapid and efficient integration of attention, visual scanning and cognitive sequencing? [NOT WSC]

Trail making test

Every patient diagnosed with Grave's disease needs imaging for what?

Thymoma

Integrated setting with primary care and mental health, which would be *population based* technique to provide collaborative care?

Tracking clinic patients in a registry

Persistent numbness in the L hand, decreased sensation in 4th/5th digits (palmar/dorsal), weak finger abduction/adduction especially 5th digit: (4x)

ULNAR NERVE ENTRAPMENT AT THE ELBOW

Couples therapy, husband complains that MD wife works too long hours, she says she stays late to make sure everything is "right" checking and rechecking her work. Notes that once in high school she wished her straight-A brother dead and later he died on hunting trip. Her checking behavior is an example of: (2x)

UNDOING

Hand washing rituals are most related to what defense mechanism? (4x)

UNDOING

According to the World Health Organization, what is the number one psychiatric cause of loss of years of healthy life as measured by disability-adjusted life years for individuals between ages of 15 and 40 years?

UNIPOLAR MAJOR DEPRESSION

According to Kohlberg, the highest level of moral reasoning is based on consideration of

UNIVERSAL ETHICAL PRINCIPLES

A media campaign is launched to reduce risk of suicide, example of what public health policy

UNIVERSAL INTERVENTION

What is the therapeutic factor of treating bulimics in group therapy to openly disclose personal attitudes toward body image and give detailed experiences with binging/purging?

UNIVERSALITY

Infants are more likely to have insecure attachment with poor child care if primary caretakers are also

UNRESPONSIVE TO THEIR INFANT'S NEEDS

78 y/o w/ deteriorating personal hygiene, significant weight loss. Signs voluntary admission form but later forgets doing this. Potentially resectable masses in lung and brain requiring further consent for surgical and oncological treatment. Consents but cannot explain reason for surgery. Legally, psychiatrist should:

URGENTLY REQUEST PROBATE COURT APPOINT GUARDIAN WITH POWER TO MAKE TREATMENT DECISIONS

Most effective initial treatment for pts with PCP intoxication:

URINE ACIDIFICATION

62 y/o pt with hx chest pain has and depression, one month ago started on paroxetine, presents with new onset of lethargy and headache, low Na and BUN, normal K , and Cr of 0.4. Next test

URINE OSMOLALITY

Adult burn pt is refusing to self-feed, family starts feeding pt by hand, there is no medical reason for this, and it's impeding pt recovery. How do you address this?

USE A REWARD SYSTEM TO GET PT TO START FEEDING

27 y/o angry, agitated pt is admitted to the ER. He is evaluated during initial interview as non-psychotic and high risk for imminent violence. He refuses medication. What would be the most appropriate intervention at this time?

USE EXTERNAL RESTRAINT WITH CALM REASSURANCE.

What improves outcomes in treating depression in primary care setting?

USE OF CARE MANAGERS

Pretend play in preschool children depends upon increasing ability in which skills?

USE OF ONE OBJECT TO REPRESENT ANOTHER

Pretend play in preschool-age depends upon children's increasing ability in which skills

USE OF ONE OBJECT TO REPRESENT ANOTHER

25 y/o single African-American man, who is a first year law student at an ivy league school, seeks psychotherapy for what he calls "academic paralysis." He is falling behind as he spends more time brooding about the racial and socioeconomic differences between himself and his classmates. He feels comfortable with his African American psychiatrist and speaks openly about her racial slights that he experiences every day. The most important goal of dynamic psychotherapy with this pt is to

USE THE SHARED ETHNIC BACKGROUND TO OFFER INSIGHT TO EXPLAIN HOW THE PT'S ALIENATION MAY BE ROOTED IN SOMETHING MORE THAN HIS CURRENT SITUATION

Ability of an infant to utilize symbolic representation at age 18 months allows for:

USING LANGUAGE PROFICIENTLY

All of the following are strategies for change in cognitive therapy

USING REATTRIBUTION, DEVELOPING ALTERNATIVES, QUESTIONING THE EVIDENCE, FANTASIZING CONSEQUENCES. (NOT EMPLOYING INTERPRETATION)

What is the principle goal of the cognitive-behavioral therapy of panic d/o?

USING RESTRUCTURED INTERPRETATION OF DISTURBING SENSATIONS

Which of the following is a principal goal of CBT for panic d/o?

USING RESTRUCTURED INTERPRETATION OF DISTURBING SENSATIONS

Important distinction between depressive symptoms in pts with cancer as compared to those patients with depression but no cancer is that the patients w cancer?

USUALLY MAINTAIN INTACT SELF-ESTEEM

According to classical psychoanalytic theory, what factor primarily accounts for the polarization of same sex peer groups?

UTILIZATION OF DEFENSE MECHANISMS TO AVOID SEXUAL IMPULSES

DBT primarily focuses on

UTILIZING CONTINGENCIES AND SKILLS TO REPLACE THE DYSFUNCTIONAL BEHAVIOR

Stanford-Binet most similar to which test for children

WECHSLER INTELLIGENCE SCALE FOR CHILDREN - III

Which assessment instrument best measures cognitive functioning in a 4 year old child?

WECHSLER PRESCHOOL AND PRIMARY SCALE OF INTELLIGENCE-REVISED WPPSI-R

What is the most common reason pts discontinue valproate?

WEIGHT GAIN

According to structural family therapy, what is the indicator of normal family functioning?

WELL DEFINED BOUNDARY BETWEEN PARENTS AND CHILDREN THAT PERSEVERES AUTHORITY AND FACILITATES OPEN COMMUNICATION

Will there be clowns in the parade like the circus? This is an example of

Use of previous experiences to think categorically

Sixth cranial nerve palsy is associated with which alcohol related syndrome?

WERNICKE'S ENCEPHALOPATHY

Which should raise Psych MD's index of suspicion for malingering in cases of litigation in which financial compensation is at issue?

VAGUELY DEFINED SYMPTOMS

Test measures what it is supposed to measure (x2)

VALIDITY

Adequate as a monotherapy for juvenile myoclonic epilepsy

VALPROATE

Adequate for monotherapy generalized tonic clonic szs

VALPROATE

16 y/o pt w/ new onset tonic clonic seizures. Pt reports having jerky movements which cause him to drop objects. EEG shows polyspike pattern. Which antiepileptic medication is indicated?

VALPROIC ACID

An operant conditioning reinforcement schedule that is used in casino slot machines and may play a role in the development of pathological gambling

VARIABLE-RATIO

What are genetic polymorphisms?

VARIANT DNA SEQUENCES PREVALENT IN >1% OF A POPULATION

54 y/o pt has several days of low grade fever, malaise and severe pain in the right side of the ribcage. Examination reveals an erythematous rash with clusters of tense vesicles, with clear content, on a belt distribution from the front of the chest to the back under the nipple, limited to the right side. Likely causal viral agent? (4x)

VARICELLA ZOSTER VIRUS

Pt c/o pain when walking that radiates from lower back and is severe in the calves. Pain relieved by stopping for a couple of minutes, then resuming. No sensory or motor deficits. Test most likely to yield Dx?

VASCULAR EVALUATION OF LOWER EXTREMITIES

Which antidepressant med is most likely to cause HTN?

VENLAFAXINE

The usual target for Deep Brain Stimulation in Essential Tremor:

VENTRAL INTERMEDIATE THALAMUS

17y/o is evaluated for binge eating associated with a 60 lb weight gain over the past four months. CT shows a craniopharyngioma that likely disrupts what structure? [be SPECIFIC]

VENTROMEDIAL HYPOTHALAMUS

Catharsis is: (2x)

VERBAL EXPRESSION OF SUPPRESSED TRAUMATIC EXPERIENCES AND FEELINGS

70 y/o pt w/ attacks of "whirling sensations" w/n/v, diplopia, dysarthria, tingling of lips. Occurs several times daily for 1 minute, severe that pt collapses and is immobilized when symptoms start. No residual s/s, no tinnitus, hearing impairment, ALOC or association with any particular activity. Dx?

VERTEBROBASILAR INSUFFICIENCY

Pt with PTSD who will have the most favorable prognosis in CBT involving exposure therapy

VICTIM OF A RANDOM VIOLENT ASSAULT

This tool best measures the degree of self-care in children with MR

VINELAND ADAPTIVE BEHAVIOR SCALE

8 yo child recently had Wechsler Intelligence Scale for Children (WISC-IV) and received full scale IQ of 60. Which additional tests would determine if child meets criteria for intellectual disability (mental retardation)?

VINELAND ADAPTIVE BEHAVIOR SCALES, 2ND EDITION (VABS-II)

Polyneuropathy can be caused by either deficiency or extreme excess of which of the following B vitamins?

VITAMIN B6

Which is a first rank symptom according to Kurt Schneider?

VOICES ARGUING

The psychiatrist explains to a RIESED inpatient that the pt has schizophrenia and offers antipsychotics. The psychiatrist explains risks and benefits and states that he will advocate for the patient if he takes medication.The patient does not want the medication. What feature of informed consent is missing

VOLUNTARINESS

Research coordinator requests spouse of patient to participate in study as healthy control. Which feature of informed consent is potentially being violated?

VOLUNTARISM

Socioeconomic status is correlated to risk for mental illness, such as those who are disadvantaged by social class are more likely to develop a mental d/o. research shows that this correlation is accounted for mainly by greater:

VULNERABILITY TO THE IMPACT OF STRESSFUL LIFE.

Which med would allow for larger daily reduction in benzo taper from supratherapeutic range?

Valproate

In Narcolepsy, weakness in the arms and legs with laughter would respond to which antidepressant?

Venlafaxine

Several states established that the verdict guilty but mentally ill to be an option when a defendant pleads not guilty by reason of insanity because:

WHEN COMPARED TO GUILTY, GUILTY BUT MENTALLY ILL IS INTENDED TO ENSURE ACCESS TO TREATMENT BUT IS ESSENTIALLY SIMILAR

When is a psychiatrist permitted to notify a 3rd party identified to be at risk for contracting HIV from a patient

WHEN PATIENT W AIDS UNWILLING/UNABLE TO TAKE AUTONOMY-PRESERVING PRECAUTIONS LIKE ABSTINENCE

In relapse prevention therapy, teaching a recovering pt w/ an addiction that relapse is a process rather than an event conveys what?

WARNING SIGNS PRECEDE SUBSTANCE USE

44 y/o pt with schizophrenia is admitted to an inpatient psychiatric unit. After several days pt has muscle tremor, ataxia, twitching, diarrhea, restlessness, vomiting, polyuria, and stupor. Dx?

WATER INTOXICATION

*"Deficit model"* of psychological illness in psychodynamic psychotherapy define psychopathology as

WEAKENED OR ABSENT PSYCHIC STRUCTURES

What is extinction in behavioral psychology?

WEAKENING OF THE CONDITIONED RESPONSE DUE TO WITHDRAWAL OF THE STIMULUS

Inhibitors of enzyme catechol-O-methyl transferase are used in Parkinson disease to address which disease associated problem?

WEARING OFF OF LEVODOPA EFFECT

Which psychological intelligence test demonstrates high reliability

WECHSLER ADULT INTELLIGENCE SCALE (WAIS)

Which test correlates most strongly w premorbid fcn in pt w early dementia

WECHSLER ADULT INTELLIGENCE SCALE II VOCABULARY TEST

Which test correlates most strongly with pre-morbid functioning in pt w/ early dementia:

WECHSLER ADULT INTELLIGENCE SCALE IV VOCABULARY TEST (WAIS-IV)

Exam findings suggests L5 radiculopathy in pt with back pain and foot drop?

Weakness of ankle inversion

13 y/o M w trouble keeping up w P.E. class. On exam: symmetric weakness in legs/ arms, worse in proximal muscles, most prominent in quadriceps/hamstrings. Both calves enlarged, painful w exercise. Serum creatine kinase level is 13,000. Muscle bx reveals abnormalities in dystrophin protein staining. Pattern of inheritance is?

X-LINKED

How do we test reliability of an assessment instrument?

YIELD CONSISTENT RESULTS WHEN USED BY DIFFERENT EXAMINERS OR AT DIFFERENT TIMES

A finding regarding epidemiology of nicotine use:

YOUNG ADULTS REPORT THE HIGHEST RATES OF SMOKING

Pt with addiction and social anxiety talks about painful anxiety experience at AA. Statement consistent with 12 step therapy?

You did the most important thing, you went to the meeting. It will get easier

What is used to report the deviation of a value from its group mean, expressed in standard deviation units? (2x)

Z SCORE

42 y/o pt has primary insomnia. Pt complains of difficulty falling asleep, but then sleeps through the night. Which of the following would be the best medication to prescribe for this pt after addressing sleep issues

ZALEPLON

Which atypical antipsychotic causes least weight gain?

ZIPRASIDONE

According to *Vygotsky*, objects and interactional experiences should be within the infant's ...

ZONE OF PROXIMAL DEVELOPMENT

2-3 y.o. Capacity to tolerate frustration influenced by verbal abilities and

ability to internalize social norms

effects of SSRI in pregnancy

associated with neonatal adaptation syndrome

Devlopmental concept of mother responding to baby seeking attention

attachment

Accepting flowers from a paranoid patient to make patient feel relaxed

boundary crossing

Risk factors for somatic symptoms disorder

chronic physical illness

Seizures get controlled, then has paranoid delusions, what type of seizure

complex partial

What does the hypothalamus secrete when you are stressed?

corticotropin releasing hormone CRH

Area of brain to remember a number to make a phone call [be super specific]

dorsolateral PFC

Suicide risk for adopted child whose bio mother died by suicide

elevated relative to other adoptees

In operant conditioning, a behavior will decrease if...

incompatible w/ a behavior positively reinforced

physician suicide is different than the rest of the pop

less likely to be taking antidepressant

genetic technique to analyze chromosomes for a disorder (not karyotype)

linkage analysis

Process of calcium mediated long-lasting increase in AMPA receptor signal transmission

long-term potentiation

opioid dependent offenders remain drug free with this intervention

methadone maintenance while in prison

Tx of pts w/ substance abuse who have acute pain

patient controlled analgesia

Decreases in men during andropause

penile rigidity

Newly married college graduate now needing more parental support with decisions

phase of life problem

Finding from studies of neuroimmune mechanisms of depression

pro-inflammatory cytokines are often elevated

Clinical exome sequencing heps detect which genetic abnormalities

single nucleotide substitutions

Test that differentiates alzheimers from frontal-temporal dementia

single photon emission CT scan

breakage and removal of seg of chromosome and moved to another

translocation