AG 2 Exam 4 Psych CH 18

4. Which of the following is considered first-line treatment for panic disorders? a. Benzodiazepines b. Selective serotonin reuptake inhibitors (SSRIs) c. Tricyclic antidepressants d. Cognitive behavioral therapy

d. Cognitive behavioral therapy

7. A no-suicide contract can prevent a suicide attempt.

False

8. Depression is the most chronic disabling and economically catastrophic medical disorder of the severe mental illnesses.

False Bipolar???

2. Depressive episodes associated with bipolar disorder are treated the same as major depressive disorder.

False Episodes of depression pose particular challenges. There are fewer approved treatments for bipolar depression. Overall, antidepressant medications do not control depression as effectively in bipolar as in unipolar depression and may trigger mania. (Page 1062). (lithium, carbamazepine, and valproic acid) should be optimized (in the case of lithium, serum level of 0.8 mEq/L or above) before starting antidepressant therapy. If depression persists 2 to 4 weeks after optimization of the mood stabilizer, it is recommended that either bupropion (antidepressant), lamotrigine (anticonvulsant, mood stabilizer), or an SSRI (antidepressant) should be added. These agents are not mood stabilizers. They are effective against depression but can precipitate mania and should not be given to a bipolar patient without a transitional mood stabilizer. Venlafaxine may also be useful in some cases of severe depression that have not responded to other therapy. Any patient developing symptoms of hypomania while taking an antidepressant should stop taking it; in addition, he or she should be slowly tapered after a period of sustained remission. Severely depressed or delusional patients may benefit from an antipsychotic.

1. The use of benzodiazepines in the patient with generalized anxiety disorder and comorbid depression can exacerbate depressive symptoms.

True

10. When combined with certain other medications, serotonin-specific antidepressants can have significant liver P450-interaction effects.

True

3. Women in abusive relationships have a greater chance of being killed by their batterers when they leave the relationship than women who stay.

True

4. Adults must show childhood onset of symptoms to receive a diagnosis of ADHD.

True

5. Parkinson's disease and dementing illnesses may commonly manifest depressive symptoms.

True

6. The best predictor of suicide risk is a history of suicide attempts.

True

9. Clozapine (Clozaril) requires laboratory monitoring at specified frequencies with results reported to a national registry.

True

16. Which of the following is a laboratory finding commonly found in patients with anorexia nervosa? a. Hypercholesterolemia b. Hypermagnesmia c. Leukocytosis d. Decreased TRH

a. Hypercholesterolemia Individuals with AN may complain of Hypothermia Constipation Lethargy or excess nervous energy. Hypotension Dry skin, and dull hair Hypertrophy of the salivary glands if the person with AN purges. Chronic dehydration can result in Impaired renal function, Cardiovascular problems, Osteoporosis. Positive laboratory findings in AN include Leukopenia Anemia Elevated BUN Elevated LFTs Hypomagnesemia Hypophosphatemia Elevated TSH Hypercholesterolemia and sinus Bradycardia 1105

5. Which of the following symptoms is not part of the diagnostic criteria for post-traumatic stress disorder (PTSD)? a. Hypersomnolence b. Blunted feelings c. Loss of interest in significant activities d. Intrusive recurrent recollections of the event

a. Hypersomnolence

12. The clinician is educating a patient about the effects of marijuana. The patient stated she has been smoking for years and believes the use does not interfere with her life. What is a significant long-term sequelae of marijuana use that the clinician should educate this patient about? a. Memory impairment b. Sexual dysfunction c. Dry mouth d. There are no long-term consequences of marijuana use.

a. Memory impairment

7. The clinician has chosen to prescribe an SSRI instead of a tricyclic antidepressant (TCA) for a patient fitting the diagnostic criteria for depression. Which of the following is not true concerning SSRIs in comparison to tricyclic antidepressants? a. SSRIs are more effective than TCAs. b. SSRIs take less time to work than TCAs. c. SSRIs have a more favorable side-effect profile than TCAs. d. SSRIs are not lethal in overdose.

a. SSRIs are more effective than TCAs. Alcohol makes SSRI's lethal

9. It is important to educate patients with depression and their family members about reporting signs of increasing depression and suicidal thoughts. This is especially true during which time period? a. Before the initiation of treatment b. 1 to 2 weeks after the initiation of treatment c. When switching to a different medication d. 1 to 2 weeks after tapering off medications

b. 1 to 2 weeks after the initiation of treatment

21. Which is the most prevalent psychiatric condition in the United States? a. Depression b. Anxiety c. Substance-related addictions d. Gambling

b. Anxiety It most commonly presents in the 20- to 45-yearold age-group and affects women more frequently than it does men. 1028

24. Assessing for adherence with prescribed medications and developing a plan for what to do if they are stopped is a major treatment issue for which of the following diagnostic groups? a. ADHD b. Bipolar c. Depression d. Anxiety

b. Bipolar

17. Which of the following is the only drug for bulimia approved by the U.S. Food and Drug Administration? a. Sertraline b. Fluoxetine c. Citoprolam d. Imipramine

b. Fluoxetine Antidepressant medications (especially SSRIs) have become mainstays of treatment of eating disorders. Fluoxetine (Prozac) 10 to 80 mg daily is the only FDA-approved drug for bulimia. It is sometimes necessary to use higher than normal doses for effective treatment of bulimia. 1106

1. The effectiveness of benzodiazepines in treating anxiety disorders suggests that which of the following neurotransmitters plays a role in anxiety? a. Acetylcholine b. Gamma-aminobutyric acid (GABA) c. Dopamine d. Serotonin

b. Gamma-aminobutyric acid (GABA)

6. Which of the following neuroendocrine abnormalities is implicated in depression? a. Decrease in adrenal size b. Increased cortisol and corticotrophin-releasing hormone c. An exaggerated response of thyrotropin (TRH) to infusion of thyroid-releasing hormone d. Increased inhibitory response of glucocorticoids to dexamethasone

b. Increased cortisol and corticotrophin-releasing hormone

2. The criteria for diagnosing generalized anxiety disorder in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision) state that excessive worry or apprehension must be present more days than not for at least: a. 1 month b. 3 months c. 6 months d. 12 months

c. 6 months

13. Cocaine acts as a stimulant by blocking the reuptake of which neurotransmitter? a. GABA b. Acetylcholine c. Dopamine d. Serotonin

c. Dopamine

22. What is recorded as clinical category two of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision)? a. Clinical disorder or focus of clinical attention b. Personality or environmental problems c. Environmental and psychosocial stressors d. Global assessment of functioning

c. Environmental and psychosocial stressors

15. Rapid eye movement (REM) sleep occurs how frequently during non-REM sleep? a. Every 30 minutes b. Every 60 minutes c. Every 90 minutes d. Every 180 minutes

c. Every 90 minutes

18. Which of the following would be important to monitor in a child receiving methylphenidate for treatment of attention deficit-hyperactivity disorder (ADHD)? a. Liver function b. Vision c. Growth parameters d. Renal function

c. Growth parameters

23. Which of the following may be used to evaluate a person's suicide risk? a. CAGE b. SANE c. SAD PERSONAS d. DIGFAST

c. SAD PERSONAS • S = Sex • A = Age • D = Depression • P = Previous attempt • E = Ethanol abuse • R = Rational thinking loss • S = Social support loss • O = Organized plan • N = No spouse • A = Availability (Page 1067).

10. A patient is experiencing extrapyramidal side effects from his antipsychotic medications. The clinician would most likely take which of the following approaches to treating these side effects? a. Give the patient a "drug holiday" until the symptoms resolve and then restart the medication. b. Switch the patient to a different antipsychotic. c. Treat the patient with anticholinergics. d. Treat the patient with anticonvulsants.

c. Treat the patient with anticholinergics. diphenhydramine (Benadryl) trihexyphenidyl (Artane) benztropine mesylate (Cogentin) biperiden (Akineton) antipsychotics. clomipramine (Anafranil) chlorpromazine (Thorazine)

14. What blood alcohol level corresponds with the signs of stupor and confusion? a. 0.05 b. 0.1 c. 0.2 d. 0.3

d. 0.3 0.05 causes disruptions in thinking, judgment, and inhibition. 0.1 produces obvious intoxication. 0.2 results in depression of motor functioning and emotional/behavioral dyscontrol. 0.3 produces stupor and confusion. 0.4 and higher produce coma. Page 1088

8. After discontinuing fluoxetine, how long must a person wait before starting a monoamine oxidase inhibitor? a. 2 weeks b. 3 weeks c. 4 weeks d. 5 weeks

d. 5 weeks Flouxetine only. All other SSRIs 2 weeks (Prozac, Sarafem, Prozac Weekly)

20. Women are at the highest risk for developing postpartum depression for up to how long after childbirth? a. 2 weeks b. 1 month c. 3 months d. 6 months

d. 6 months

3. A patient presents to the clinician after experiencing four episodes in the last month of sweating, palpitations, chest pain, nausea, and shaking. Each episode lasted about 10 minutes. The patient is now becoming very fearful of future events and has been reluctant to leave the house. The clinician suspects panic disorder but wants to rule out any possible medical causes. Which of the following medical conditions can mimic the symptoms of a panic attack? a. Pheochromocytoma b. Hyperthyroidism c. Cardiac arrhythmias d. All of the above

d. All of the above Pheochromocytoma - adrenal gland tumor

11. According to Kübler-Ross, the stages of grief occur in which order? a. Anger, denial, depression, bargaining, acceptance b. Anger, denial, bargaining, acceptance, depression c. Denial, anger, depression, bargaining, acceptance d. Denial, anger, bargaining, depression, acceptance

d. Denial, anger, bargaining, depression, acceptance

25. Bipolar disorder requires differential diagnosis from all of the following except? a. Substance abuse and medication effects b. Medical and neurological disorders c. Cluster B personality disorders and depression d. Obsessive-compulsive disorder

d. Obsessive-compulsive disorder

19. It is important for the clinician to discuss the long-term effects of sexual assault with survivors. Which of the following is the most common long-term effect of sexual assault? a. Depression b. Obsessive-compulsive disorder c. Substance abuse d. PTSD

d. PTSD