1- Diagnosis and Psychopathology Flashcards
Research on biogenic theories of autism:
Select one:
A. has demonstrated that biological and genetic factors are secondary to psychosocial factors in the etiology of this disorder.
B. has recently identified the specific gene that is responsible for the majority of cases.
C. has found that obstetric complications are the cause of most cases of this disorder.
D. has confirmed that biological and genetic factors are the primary cause although no single factor seems to be responsible for the majority of cases.
Correct Answer is: D
Studies investigating the biological and genetic contributions to Autistic Disorder have confirmed that these factors play a dominant role. However, no single factor has been identified as the most important one.
Additional Information: Etiology (Autism Spectrum Disorder)
Research suggests that the best single treatment for Agoraphobia is: Select one: A. implosive therapy. B. flooding. C. systematic desensitization. D. psychotropic medication.
Correct Answer is: B
Flooding involves exposing an individual to anxiety-provoking stimuli while preventing an avoidance response. In-vivo flooding is considered the most effective psychological treatment for Agoraphobia, with reports of long-term improvement for to 75% of treated patients.
Additional Information: Treatment (Agoraphobia)
Selye’s General Adaptation Syndrome involves the processes termed:
Select one:
A. alarm, resistance, exhaustion.
B. anticipation, defensiveness, exhaustion.
C. alarm, stimulation, resistance.
D. attention, accommodation, adaptation.
Correct Answer is: A
This paradigm was an early attempt to explain how we react to stress. It postulates that after we become aware of the stressful situation (alarm), we summon our resources and meet the challenge (resist). After the trauma is over, we collapse (exhaustion).
Research comparing patients with schizophrenia from non-Western developing countries to those from Western industrialized countries has found that they differ in terms of: Select one: A. symptoms B. age and gender C. gender and prognosis D. course and outcome
Correct Answer is: D
Several studies conducted by the World Health Organization have consistently found differences in the course and outcome of schizophrenia patients from developing and industrialized countries. Patients from developing countries more often exhibit an acute onset of symptoms, a shorter clinical course, and a complete remission of symptoms. No consistent differences were found between these two groups in regards to age, gender, or type of symptoms.
Additional Information: Culture (Schizophrenia)
A young woman is very anxious because, lately, she finds that she frequently misperceives things in the environment, which has caused some embarrassing moments at work and elsewhere. For example, at work, she mistook the coat rack for the company president. As a result, she is not enjoying her job or usual social activities as much as she used to. The woman's symptoms are most suggestive of Select one: A. hallucinations. B. illusions. C. agoraphobia. D. social phobia.
Correct Answer is: B
Note that the woman is misperceiving actual stimuli and that her other symptoms are directly related to this misperception. A misperception of a real stimulus is referred to as an illusion.
A headache that begins in the frontal or occipital area of the head and then proceeds to involve a bilateral dull ache is: Select one: A. a common migraine. B. a classic migraine. C. a cluster headache. D. a tension headache.
Correct Answer is: D
Migraine headaches cause unilateral throbbing pain. Cluster headaches cause intense pain behind the eye (which are the incorrect responses). So you’re left with “tension headache,” which is the correct answer.
Masters and Johnson found that their version of sex therapy, which incorporates education about sexuality, training in communication skills, and the technique known as sensate focus, is most effective for treating: Select one: A. premature ejaculation. B. impotence. C. sexual aversion. D. orgasmic disorder.
Correct Answer is: A
Masters and Johnson found that close to 100% of individuals with premature ejaculation were helped by their program which incorporated education about sexuality, improving communication, and sensate focus.
A diagnosis of childhood onset Conduct Disorder:
Select one:
A. requires an onset of two or more symptoms prior to age 13.
B. is equally common in boys and girls.
C. is associated with less overt aggression than adolescent onset Conduct Disorder.
D. is associated with a poorer prognosis than adolescent onset Conduct Disorder.
Correct Answer is: D
Age of onset of Conduct Disorder is correlated with a number of factors including symptoms (childhood onset is associated with more severe aggression) and prognosis – i.e., individuals with childhood onset are much more likely to continue to engage in antisocial behaviors in adolescence and adulthood.
Additional Information: Conduct Disorder
Which of the following best describes the results of studies investigating the role of psychosocial stressors in the course of Major Depressive Disorder, Recurrent?
Select one:
A. psychosocial stressors typically play a more significant role in triggering the first or second episodes than subsequent episodes.
B. psychosocial stressors typically play a more significant role in triggering episodes late in the course of the disorder than the first two episodes.
C. psychosocial stressors play a similar role in triggering episodes early and late in the course of the disorder.
D. psychosocial stressors do not play a role in the disorder since, by definition, Major Depressive Disorder is not triggered by external events.
Correct Answer is: A
Major Depressive Disorder, Recurrent involves two or more Major Depressive Episodes, which are characterized by five or more specific symptoms of depression present during the same two week period and representing a change from the previous level of functioning. Individuals with this disorder very commonly have more than two Major Depressive Episodes in the course of their lifetimes, and studies suggest that psychosocial stressors are more likely to trigger an episode early in the course of the disorder than they are later on.
A person repeatedly awakens from sleep in a state of fear, disorientation, and unresponsiveness to others. The person later can barely recall the episode at all. The most likely diagnosis for this person is Select one: A. Narcolepsy. B. Nightmare Disorder. C. Sleep Terror Disorder. D. Depersonalization Disorder.
Correct Answer is: C
Sleep Terror Disorder is characterized by repeated episodes of awakening in fear, often with a scream of panic. The person displays evidence of fear and autonomic arousal, and responds poorly or not all to the efforts of others to offer comfort. At the time, the person does not remember any dream in detail and cannot recall the entire episode later on.
Regarding the other choices, Nightmare Disorder involves repeated awakenings with detailed recall of frightening dreams, often with a recurrence of the same or similar themes. Unlike a person with Sleep Terror Disorder, a person with Nightmare Disorder quickly becomes alert and oriented after awakening. Narcolepsy is characterized by brief sleep and sudden sleep attacks during the period of the person’s normal waking; either or both cataplexy (sudden loss of muscle tone) and hypnagogic or hypnopompic hallucinations must be present. Depersonalization Disorder involves a lasting or recurrent feeling that the person is detached from, or is an outside observer of, one’s own mental processes or body, as if in a dream.
A psychologist working with a substance-addicted client bases his approach to treatment on Marlatt and Gordon’s relapse prevention model. The counselor is likely to incorporate all of the following into his treatment approach except
Select one:
A. identification of situations and cognitions that trigger the urge to use.
B. referral to an inpatient clinic immediately if a client uses the substance.
C. focus on minimizing the abstinence violation effect.
D. helping the client to develop “positive addictions.”
Correct Answer is: B
Marlatt and Gordon’s relapse prevention (RP) model for the treatment of substance addiction is a cognitive-behavioral approach that focuses on identifying and reducing or eliminating factors that can precipitate relapse. Treatment begins with assessment of the environmental and emotional factors that increase the risk of relapse, such as time spent with friends who still use, the client’s beliefs about the benefits of using, and any unrealistic expectations he has about treatment and abstinence. Based on this assessment, the counselor then works with the client to develop a set of applicable cognitive and behavioral interventions, including some that apply to the immediate situation (e.g., self-monitoring of behavior and cognition to reduce exposure to high risk situations) and some global lifestyle changes, such as encouraging the development of alternative, positive addictions, such as exercise or meditation. A central component of the RP model is to reduce what Marlatt and Gordon refer to as the abstinence violation effect (AVE). This occurs when a client “slips” or “lapses” by using the substance again, and attributes the slip to internal, stable and global causes (e.g., “I’m hopeless” or “I’ll always be an addict”). The AVE causes reduced feelings of self-efficacy and esteem and thereby often increases cravings to use, leading to a full-blown relapse. The RP model seeks to reduce this effect by, for example, directing the client’s attention to situational factors that could have triggered the slip and modifying unrealistic expectations about the course of addiction.
referral to an inpatient clinic immediately if a client uses the substance.
Contrary to this choice, immediate referral to an inpatient clinic following any use of the substance would reinforce the notion that a slip constitutes a full-blown relapse and that the client has failed in his efforts. Therefore, it would not likely be part of treatment based on the RP model.
Following surgery, a 73-year-old man reports visual hallucinations, displays poor alertness and spotty recognition of his family, and does not know why he is in the hospital. Most likely, the man is experiencing Select one: A. Dementia B. Delirium C. Amnestic Disorder D. a Psychotic Disorder
Correct Answer is: B
Delirium is characterized by a disturbance in cognition, impaired attention, and changes in cognition, due to a medical condition or other physiological cause such as substance intoxication. Specific symptoms may include reduced awareness of the environment, inability to sustain attention, memory deficits, disorientation, and language disturbances. Hallucinations sometimes occur. Delirium by definition develops rapidly and its symptoms fluctuate, usually over the course of the day. Often, the course is brief and temporary. Of the choices listed, the symptoms are most consistent with Delirium.
Dementia is a generally permanent disturbance in cognition and memory, and the question suggests that the deficits are temporary in nature by noting that the man just got out of surgery. Also, in dementia, alertness level is usually not impaired. Amnestic Disorder is characterized by an inability to recall previously learned information or retain newly learned information; it also usually is a permanent disturbance that becomes progressively worse over time. And psychotic disorders such as Schizophrenia involve symptoms such as delusions, hallucinations, disorganized or catatonic behavior, and flat affect. Only hallucinations are mentioned by the question and they are common in Delirium, which is more consistent with the rest of the presentation.
Of the following, which risk factor for childhood depression is the most prominent? Select one: A. substance use in parents. B. comorbid disorder such as ADHD. C. a parent with a depressive disorder. D. low socioeconomic status
Correct Answer is: C
Most experts agree that a family history of depression increases the risk of childhood depression more than any other one factor. By some estimates, for instance, maternal depression increases the risk of childhood depression by a factor of 3 to 5. The presence of depression in a parent can lead to depression in multiple ways, such as genetics, marital discord, and poor parenting skills. Other risk factors for childhood depression include substance abusing parents, a divorce, parental unemployment, frequent moves, and illness.
Which of the following conclusions about the effectiveness of treatments for Attention-Deficit/Hyperactivity Disorder (ADHD) is best supported by empirical research?
Select one:
A. stimulant medication and behavior therapy are equal in effectiveness.
B. stimulant medication alone is just as effective as the combination of it with behavior therapy.
C. the combination stimulant medication and behavior therapy is more effective than either treatment used alone.
D. behavior therapy alone is just as effective as the combination of it with stimulant medication.
Correct Answer is: C
The National Institute of Mental Health (NIMH) conducted a comprehensive study of four modalities of treatment for ADHD: 1) stimulant medication alone; (2) behavioral treatment alone; (3) a combination of medication and behavioral treatment; or (4) routine community care. The study found that the combination treatment and the medication-management treatment were superior to intensive behavioral treatment and routine community treatment.
stimulant medication alone is just as effective as the combination of it with behavior therapy.
However, contrary to this choice, the researchers did not conclude that medication alone was equal in effectiveness to the combination treatment. The latter allowed patients to be administered lower doses of medication, worked better than medication alone in improving some areas of functioning, and resulted in greater family satisfaction. Therefore, they concluded that stimulant medication combined with behavior therapy is the most effective modality.
Of the following, which treatment modality is, according to recent research, most likely to be effective in treating Borderline Personality Disorder?
Select one:
A. Interpersonal Therapy (IPT)
B. Dialectical Behavior Therapy (DBT)
C. Rational Emotive Behavior Therapy (REBT)
D. Reality Therapy
Correct Answer is: B
Dialectical Behavior Therapy (DBT) is a cognitive-behavioral therapy intended to treat Borderline Personality Disorder as well as other long-standing behavioral disorders. The term “dialectical” reflects the treatment’s focus on the synthesis of opposites, such as the acceptance of the client in the context of helping them change, as well as the therapy’s goal of replacing rigid, dichotomous thinking with flexible, dialectical thinking. Treatment includes a variety of cognitive and behavioral interventions, focused on specific goals and learning new skills, such as teaching mindfulness, skills training, cognitive modification, and exposure. Research has found DBT to be an effective mode of treatment for Borderline Personality Disorder, especially in the control of self-mutilating and self-damaging impulsive behavior.
Abrupt cessation of chronic alcohol use typically results in which of the following symptoms?
Select one:
A. depression, lethargy, and hypersomnia
B. irritability, decreased heart rate, and increased appetite
C. nausea, diarrhea, and fever
D. autonomic hyperactivity, insomnia, and nausea
Correct Answer is: D
Alcohol Withdrawal is characterized by two or more of the following symptoms, following cessation of chronic, heavy use: autonomic hyperactivity (e.g., sweating, increased pulse), hand tremor, insomnia, nausea or vomiting, transient hallucinations or illusions, psychomotor agitation, anxiety, and grand mal seizures. Symptoms typically begin within 4-12 hours after the person stops drinking, peak during the second day of abstinence, and decrease markedly by the fourth or fifth day.
Additional Information: Substance-Induced Disorders
Of the following, which is most likely to cause rapid and abrupt changes in cognitive functioning? Select one: A. Dementia of the Alzheimer's Type B. AIDS Dementia Complex C. Vascular Dementia D. Korsakoff's syndrome
Correct Answer is: C
Dementia is characterized by multiple cognitive deficits such as memory impairment, language disturbances, and impairments in executive functioning that have a specific physiological cause–i.e., a medical condition or the persisting effects of a substance. Vascular Dementia is diagnosed in individuals who have Dementia judged to be caused by a cerebrovascular disease such as a stroke. Its onset is typically abrupt and it typically has a fluctuating, stepwise course characterized by rapid changes in cognitive functioning and orientation.
By contrast, the course in Alzheimer’s Dementia tends to be slow and progressive, with abilities deteriorating over the span of several years. In AIDS Dementia Complex, the course is also typically progressive, but punctuated by abrupt accelerations. Korsakoff’s syndrome is dementia caused by a lack of thiamine in the brain, which is usually caused by chronic alcoholism and sometimes by severe malnutrition. Onset is variable–sometimes rapid and sometimes insidious.
According to current cognitive-behavioral theories, a central factor in the maintenance of anorexia nervosa symptom is
Select one:
A. intense fear of gaining weight.
B. positive reinforcement from family and friends for weight loss.
C. the need to control eating.
D. a fear of sexuality and sexual maturity.
Correct Answer is: C
Cognitive-behavioral therapy is commonly used to treat anorexia nervosa, and is empirically supported as an effective intervention. There are a few different cognitive-behavioral theories of the disorder, but they are similar. They emphasize two major factors in the maintenance of the disorder: an extreme need to control eating, and an extreme tendency to judge self-worth on the basis of body shape and weight. Treatment, after addressing the immediate need to begin eating and gaining weight, includes self-monitoring, examination and restructuring of distorted beliefs, and relapse prevention training.
Prior to puberty the incidence of Major Depressive Disorder:
Select one:
A. is about equal for boys and girls Correct
B. is greater for boys than for girls
C. is greater for girls than for boys
D. doesn’t become evident in either gender before mid-adolescence
Correct Answer is: A
The incidence of Major Depressive Disorder in adult females compared to adult males is 2:1. This gender difference becomes evident in mid-adolescence. Prior to puberty the incidence of Major Depressive Disorder is about equal for boys and girls.
Blood-Injection-Injury Type of Specific Phobia, relative to other types of Specific Phobias, is characterized by: Select one: A. dry skin B. childhood onset C. awareness the fear is irrational D. low blood pressure
Correct Answer is: D
In most of the Specific Phobias there is an increase in heart rate and blood pressure. However, in the Blood-Injection-Injury Type there is an initial brief acceleration in heart rate followed by a deceleration and a drop in blood pressure. This often results in vasovagal fainting. Due to this unique physiological response to the feared stimulus, the recommended treatment involves tensing muscles, rather than relaxing them, in the presence of the feared stimulus.
Although the Blood-Injection-Injury Type usually does begin in childhood, so do many of the other Specific Phobias. In all Specific Phobias the person recognizes that the fear is excessive or unreasonable, except in children who may not recognize this (* incorrect options).
Possible causes of a Mood Disorder caused by a known organic factor such as a medical condition or substance use include:
Select one:
A. PCP use, cataracts, and ulcer
B. viral illness, hallucinogen use, and carcinoma of the pancreas
C. barbiturate use, hypothyroidism, and broken bones
D. hyperthyroidism, cerebral palsy, and arthritis
Correct Answer is: B
The DSM identifies the following disorders as possible causes of organically-based mood symptoms: substances such as hallucinogens and PCP; endocrine disorders, such as hypo- or hyperthyroidism; carcinoma of the pancreas; viral illness; and structural disease of the brain, such as that caused by a stroke.
The most serious potential medical side effect of Bulimia Nervosa is Select one: A. dehydration. B. electrolyte imbalance. C. fatigue. D. malnutrition.
Correct Answer is: B
Electrolytes are salts that conduct electricity; they are found in the body fluid, tissue, and blood. Examples are chloride, calcium, magnesium, sodium, and potassium. Electrolyte imbalance can be caused by the frequent induced vomiting and overuse of laxatives that occur in Bulimia Nervosa. The most frequently found electrolyte disturbance in Bulimia is hypokalemia, a reduced level of potassium in the blood. Electrolyte imbalances can cause cardiac irregularities and cardiac arrest, potentially leading to death. Dehydration and fatigue are also potential side effects of Bulimia, but their potential consequences are not as serious as those of electrolyte imbalance.
Additional Information: Associated Features (Bulimia Nervosa)
Autistic children tend to do as well as or better than other children the same age on tests of Select one: A. abstract problem solving. B. facial recognition. C. response speed. D. field independent processing.
Correct Answer is: D
Field dependence-independence is a construct viewed as a dimension of cognitive style, or the way in which individuals think, perceive, remember, and use information to solve problems. Those with a field independent cognitive style tend to use internal referents to solve problems and tend to see environments in terms of their constituent parts rather than as organized wholes. By contrast, a field dependent style relies on external or environmental referents to solve problems; perception tends to be dominated by the overall organization of the environment (or field) rather than its individual parts. Autistic individuals tend to have a field-independent cognitive style, and on some tasks that assess field independence, they consistently outperform their same-age peers. For example, numerous studies have found that autistic children outperform age-matched children on the Childhood Embedded Figures Test, which requires examinees to identify a simple figure hidden in a complex background design. Good performance on this test indicates field independence because it requires separating an item from the field in which it is embedded.
Research on Eye Movement Desensitization and Reprocessing (EMDR) in the treatment of Post-Traumatic Stress Disorder has suggested that
Select one:
A. the eye movement phase of treatment is not necessary for its success.
B. the eye movement phase of treatment is crucial for its success.
C. the desensitization phase of therapy is not necessary for its success.
D. it is an ineffective treatment.
Correct Answer is: A
Eye Movement Desensitization and Reprocessing (EMDR) is an approach to psychotherapy that applies ideas from multiple therapeutic modalities, such as psychodynamic, cognitive-behavioral, and interpersonal. It focuses on past experiences that contribute to current problems and current situations that trigger their symptoms. Thus, it is typically applied to problems resulting from disturbing and unresolved life experiences and specifically to Post-Traumatic Stress Disorder (PTSD). EMDR involves eight phases of treatment. A number of these phases, after history taking and ensuring that the client is stable enough to handle emotional distress, involve imaginal exposure to the trauma that underlies the problem. In addition, during phases 4 through 6, clients imaginally attend to the trauma, or a positive cognition, at the same time as they attend to another stimulus, usually their own eye movements. It is thought that simultaneous attention to another stimulus facilitates information processing. However, meta-analyses of studies evaluating the EMDR’s effectiveness in treating PTSD have suggested that, while EMDR is an effective form of treatment, it is no more effective than other modalities that involve imaginal exposure to the trauma without eye movements. Thus, although it has been noted that studies with larger samples are needed for clarification, the general research consensus is that the eye movement phase of treatment does not contribute to the efficacy of EMDR.
A child of a military veteran with Post-Traumatic Stress Disorder is most likely to display which of the following behavioral problems? Select one: A. eating disturbances B. kleptomania C. hyperactivity D. Oppositional Defiant Disorder
Correct Answer is: C
When a parent suffers from Post-Traumatic Stress Disorder, the whole family is affected, and children are particularly vulnerable to the disruption it causes in the family system. The disorder often impairs one’s ability to parent, and it may render parents more likely to become impatient, angry, or neglectful with their children. Young children especially are not cognitively equipped to make sense of this behavior, and research has identified a number of behavioral problems they are likely to display. Depression, anxiety, self-blame, aggression, hyperactivity, and social withdrawal are common, and so are symptoms of PTSD itself, such as low frustration tolerance and outbursts of anger–some describe PTSD as a disorder that may be transmitted intergenerationally. Even though such children may experience a variety of behavioral problems, hyperactivity is the best answer because, of the choices listed, it is the one most commonly identified as occurring in children of PTSD sufferers.
One common barrier to treatment in cases of Anorexia Nervosa is
Select one:
A. the associated feature of mild paranoid delusions impairs the development of rapport and trust.
B. symptoms are often ego-systonic so patients resist presenting for treatment.
C. family denial that the patient has a problem.
D. patients’ lack of physical strength due to extreme thinness prevents them from engaging in psychotherapy.
Correct Answer is: B
Individuals with Anorexia Nervosa rarely present for treatment on their own because they have a distorted body image and wish to be extremely thin. When they do seek treatment on their own, it is usually due to distress about the physiological and psychological consequences of starvation, not because of weight loss per se. More commonly, the patient is “dragged into” therapy by concerned family members. Thus, one common barrier to treatment is the patient’s lack of motivation to change in regards to the core symptoms, starvation and weight loss. Therefore, treatment of Anorexia Nervosa may require an initial inpatient stage in order to restore the person to a more healthy weight, and special attention to the therapeutic relationship is often necessary.
Regarding this choice (“family denial that the patient has a problem”), family denial is sometimes an issue in Anorexia Nervosa, but family members are more likely to deny their own role in the problem than the fact that the patient has a problem. As noted, patients are often brought to the attention of medical professionals by family members.
Research on psychosocial treatments for smoking cessation have provided the most support for the use of which of the following types of interventions? Select one: A. group therapy. B. behavioral. C. hypnosis. D. acupuncture.
Correct Answer is: B
Treatment for nicotine is usually multimodal and psychosocial interventions are often combined with temporary nicotine replacements such as a patch or gum and/or pharmacological agents such as buproprion. Many different therapeutic approaches have been applied, and many have been found to be successful at least in some cases or some studies. However, of all psychosocial treatments for smoking cessation, behavioral approaches have the most support in the evidence-based literature. A number of reviews and meta-analyses have found that smokers undergoing behavioral treatments, as compared to control subjects, have about double the quit rate at a six-month follow-up. Examples of behavioral interventions include reinforcement for abstinence and withholding of reinforcement for non-abstinence; stimulus control, whereby stimuli or situations that cue smoking are identified and avoided; and aversive therapy, such as rapid smoking, whereby the person smokes to the point of discomfort or nausea.
Additional Information: Treatment (Substance Use Disorders)
Treatment of Gender Identity Disorder in children would be most likely to focus on
Select one:
A. acting as a role-model of gender appropriate behavior for the child.
B. helping the person “come out” as a transgendered individual.
C. peer relationships and self-esteem.
D. working with a medical professional who can prescribe medications to alter hormonal imbalances.
Correct Answer is: C
Treatment of Gender Identity Disorder in children is moderately controversial, with some arguing that any attempt to alter a child’s gender identity is sexist, and others stating that it represents a sneaky attempt to prevent the child from growing up to be homosexual. Nonetheless, a number of treatment models have been applied, even though scientific evidence of their success is limited. Typical interventions focus on social skills, self-esteem, and increasing the child’s comfort with his or her biological gender. They may include positive reinforcement for gender-appropriate behavior, setting limits on cross-gender behavior, social skills training, and parental training in self-esteem enhancement.
Of the following, which is considered the most common second-line medication for Attention Deficit/Hyperactivity Disorder (ADHD)? Select one: A. anticonvulsants B. antidepressants C. anxiolytics D. neuroleptics
Correct Answer is: B
First-line medications for ADHD are stimulant medications such as methylphenidate. However if an individual does not respond to two or more first-line medications, or is unable to tolerate the side effects of the medications, then a second-line medication may be prescribed. Antidepressant drugs (e.g., imipramine) have been found to be effective second-line medications for the treatment of ADHD. (See: American Academy of Pediatrics, Clinical practice guideline: Treatment of the school-aged child with attention deficit/hyperactivity disorder, Pediatrics, 2001, 108(4), 1033-1044.)
Additional Information: Treatment (ADHD)
Recent research on sex reassignment surgery outcomes, following surgery, indicates gender dysphoria:
Select one:
A. continues to be experienced by a majority of individuals.
B. is no longer experienced by a majority of individuals.
C. is increasingly experienced by a majority of individuals.
D. is no longer experienced by a majority of male-to-female patients, whereas female-to-male patients experienced an increase in gender dysphoria.
Correct Answer is: B
Studies of individuals who have undergone sex reassignment surgery have found the vast majority no longer expressed gender dysphoria and were psychologically, socially and sexually functioning well following surgery. Smith et al. (2005) found, post-operatively, female-to-male and homosexual transsexuals functioned better in many respects than male-to-female and non-homosexual transsexuals and non-homosexual individuals with greater psychopathology and body dissatisfaction reported the worst post-operative outcomes. (See: Smith, Y.L., Van Goozen, S.H., Kuiper, A.J., Cohen-Kettenis, P.T. (2005). Sex reassignment: Outcomes and predictors of treatment for adolescent and adult transsexuals, Psychological Medicine, 35(1), 89-99.)
A young woman with schizophrenia has difficulty initiating activities, such as paying her bills, starting assignments or reading, and once she does get started, she is unable to finish. This is an example of: Select one: A. alogia B. anhedonia C. akesthesia D. avolition
Correct Answer is: D
Avolition refers to a lack of initiative, motivation or goal-directed activities and is considered a “negative” symptom of Schizophrenia or Schizophreniform disorder when it is severe enough to prevent an individual from doing basic activities.
Alogia* refers to a lack of spontaneous speech. Anhedonia* refers to the inability to experience pleasure. Akathisia* is a movement disorder characterized by a feeling of restlessness, an inability to sit or keep still, a pressing need to be in constant motion and behaviors such as fidgeting, crossing and uncrossing the legs while sitting, rocking from foot to foot, marching in place and pacing (* incorrect options).
Research on the genetic contribution to major depression indicates the risk for depression for biological offspring is:
Select one:
A. essentially the same whether they have one or two parents with depression.
B. higher if they have one parent with depression than if they have two parents with depression.
C. higher if they have two parents with depression than if they have only one parent with depression.
D. higher if they have a mother with depression than if they have a father with depression.
Correct Answer is: A
Research findings show having a biological parent with depression increases an offspring’s risk for major depression. What may be surprising however is that the risk is similar whether one or both parents experience major depression. Studies also indicate maternal and paternal depression affect biological offspring similarly in terms of rates of major depression. (See: Lieb, R. et al., (2002). Parental major depression and the risk of depression and other mental disorders in offspring: A prospective-longitudinal community study, Archives of General Psychiatry, 59, 365-374.)
Based on the factors associated with successful smoking cessation, which of the following is most likely to relapse?
Select one:
A. a single, 28 year old man who began smoking in high school
B. a co-habitating, 33 year old woman who began smoking in graduate school
C. a divorced, 44 year old man who started during his last year of college
D. a married, 50 year old woman who started smoking during her medical residency
Correct Answer is: A
In general, the greater the level of dependence on nicotine, the harder it is to stop smoking and the amount of smoking is typically used in order to determine dependence. In this question, however, dependence is not a factor of consideration. Research indicates there are other characteristics linked to successful smoking cessation. They include: being age 35 or older, married or living with a partner, later age when started smoking and being male. Considering these factors, a young single male who started smoking at an early age is least likely to successfully quit and most likely to relapse to smoking.
Of the following, which would be the most effective treatment for Factitious Disorder?
Select one:
A. outpatient treatment using supportive therapy
B. outpatient group or family therapy
C. inpatient individual and group therapy
D. inpatient treatment using confrontational therapy
Correct Answer is: A
Treatment for Factitious Disorder typically involves symptom management rather than eliminating or “curing” the disorder, which is associated with poor therapeutic outcome. In absence of a consistently effective treatment, establishment of a strong therapeutic relationship, use of supportive therapy and consistency of care is considered the best approach for managing Factitious Disorder symptoms.
Family and group therapy can be helpful for family members coping with the client’s symptoms, but it is not the most effective treatment for Factitious Disorder.
Inpatient treatment is generally contraindicated given the client’s underlying need “to adopt the sick role” and use of confrontational techniques, with the risk of client defensiveness, denial or therapeutic relationship termination, requires caution in the treatment of Factitious Disorder. (See: Huffman, J.C. and Stern, T.A. (2003). The diagnosis and treatment of Munchausen’s syndrome, General Hospital Psychiatry, 25(5), 358-363.)
Additional Information: Treatment (Factitious Disorder)
Which of the following is most likely to be associated with ADHD in adulthood?
Select one:
A. preference for repetitive, routine work tasks
B. excessive professional perfectionism
C. frequent professional and personal relationship changes
D. avoidance of intimate relationships
Correct Answer is: C
ADHD in adulthood involves impaired social and occupational functioning associated with chief symptoms of inattention, distractability, restlessness and impulsivity. Given restlessness, an individual with ADHD is less inclined to prefer routine, repetitive tasks and, due to impulsivity and attention deficits, are less likely to be occupationally perfectionistic.
Studies have found adults with ADHD have a greater difficulty in maintaining personal and professional relationships (correct response) than controls however, while adults with ADHD often have trouble maintaining relationships, they do not avoid them. Compared to adults without ADHD, adults with ADHD tend to participate in more impulsive or risky sexual behaviors and have more sexual partners.
Laura, a 43-year-old medical billing administrator, seeks continual approval and attention from her supervisor and peers, is affectionate towards coworkers and especially flirty with the males at work social functions and, if criticized, becomes extremely hurt and angry, despite how minor of an incident. The most likely best diagnosis for Laura would be: Select one: A. schizotypal personality disorder B. borderline personality disorder C. narcissistic personality disorder D. histrionic personality disorder
Correct Answer is: D
Laura’s symptoms describe excessive attention-seeking, reactivity and emotionality which are most consistent with a diagnosis of histrionic personality disorder.
While Laura’s mood may be somewhat unstable, she does not demonstrate other characteristics of borderline personality disorder such as a pervasive pattern of unstable interpersonal relationships, marked impulsivity and instability of self-image and affects, as well as suicide threats. Individuals with narcissistic personality disorder display a pervasive pattern of grandiosity, a lack of empathy and tend to less involved with others than Laura exhibits. Like Laura though, individuals with narcissistic personality disorder are also oversensitive to criticism. A pattern of difficulties in interpersonal relationships and peculiarities in ideation, appearance, and behavior characterize schizotypal personality disorder.
Of the following, which is explicitly intended for the treatment of parasuicidal behaviors?
Select one:
A. eye movement desensitization and reprocessing
B. stress inoculation training
C. dialectical behavior therapy
D. self-control therapy
Correct Answer is: C
Parasuicide includes intentional, non-fatal, serious, self-harming behaviors such as cutting or burning. Reducing parasuicidal behaviors is a primary and explicit target of dialectical behavior therapy (DBT), which was developed to treat Borderline Personality Disorder as parasuicidal behaviors are frequently exhibited by individuals with BPD.
The purpose of stress inoculation training* is to help people acquire the necessary skills to cope more effectively with stress. While some acquired skills may help reduce parasuicidal behaviors, they are not “a primary and explicit target” of the intervention. Self-control therapy* is a behavioral intervention that is used primarily to reverse undesirable habits (e.g., overeating, smoking) and has also been found to be an effective treatment for depression. EMDR* was initially developed as a treatment for PTSD and does not primarily target parasuicidal behaviors (* incorrect options).
Parasomnias activate one or more physiological systems during the sleeping and waking cycle at an inappropriate time. Which of the following types of parasomnias involves an individual involuntarily grinding or clenching their teeth while sleeping? Select one: A. REM Sleep Behavior Disorder (RBD) B. somnambulism C. sleep bruxism D. sleep talking
Correct Answer is: C
Parasomnias are undesirable motor, verbal, or experiential phenomena that occur as primary sleep events or secondary to systemic disease and are categorized as occurring in rapid eye movement (REM) sleep, non-rapid eye movement (NREM) sleep, or as types not related to a specific sleep state. Because it involves a partial arousal, an individual exhibits symptoms of being asleep and awake at the same time. Parasomnias are most commonly caused by biological factors, stress, depression and other related factors, they tend to be more common in children than adults, and in some cases, run in families. Sleep bruxism refers to when a person involuntarily grinds or clenches their teeth while sleeping, sometimes leading to wearing down the teeth and jaw discomfort. Treatment typically involves wearing a mouth guard during sleep.
Other types of parasomnias include: somnambulism (sleepwalking), which tends to run in families; nightmares, nocturnal leg cramps, sleep talking, sleep enuresis (bedwetting), sleep paralysis, confusional arousals, sleep terrors (nigh terrors) and REM Sleep Behavior Disorder (RBD).
Which of the following parasomnias usually affects middle-aged or elderly individuals? Select one: A. night terrors B. sleep talking C. sleep walking D. REM sleep behavior disorder
Correct Answer is: D
REM sleep behavior disorder is a parasomnia that occurs later in the night than NREM disorders, usually affects middle-aged or elderly individuals, especially males, and sufferers often also have a neurological disorder. In this disorder, the temporary muscle paralysis that normally occurs during REM sleep does not occur so individuals may act out dreams through potentially violent movements or behaviors during sleep that can cause injuries to themselves or bed partners.
NREM disorders occur early in the night and include somnambulism, or sleepwalking, sleep talking, enuresis (bed-wetting), and night, or sleep, terrors* (* incorrect options). These are all more common in children.
Women diagnosed with Borderline Personality Disorder likely have similar symptoms to men diagnosed with \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. Select one: A. Antisocial Personality Disorder B. Avoidant Personality Disorder C. Narcissistic Personality Disorder D. Histrionic Personality Disorder
Correct Answer is: A
Borderline Personality Disorder has several symptoms in common with Antisocial Personality Disorder (i.e., impulsivity); however many of the behaviors are gender-related. Consequently, women are more likely to receive a diagnosis of Borderline Personality Disorder and men a diagnosis of Antisocial Personality Disorder.
Synesthesia is most readily thought of as a/an: Select one: A. physiological occurrence. B. manifestation of psychoses. C. learned occurrence. D. expression of imagination.
Correct Answer is: A
Synesthesia is a condition in which an involuntary joining of one sense is accompanied by a perception in another sense. For example, hearing is simultaneously perceived by an additional sense such as sight. Another form of synesthesia joins objects such as letters, shapes, numbers or people’s names with a sensory perception such as smell, color or flavor. Synesthesia can involve any of the senses. Colored letters and numbers is the most common form, in which a person sees a certain color in response to a certain letter of the alphabet or number. Other synesthetes hear sounds in response to smell, smell in response to touch, or feel something in response to sight. While extremely rare, some possess synesthesia involving three or more senses. It is hypothesized that synesthesia results from “crossed-wiring” in the brain, where neurons and synapses that are intended to be contained within one sensory system cross to another. Studies suggest the crossed connections may be present at birth in everyone and the connections are then later refined. It is hypothesized that adult synesthetes may retain the crossed connections.
An example of a "negative symptom" of schizophrenia is: Select one: A. poor emotional expression. B. thought disorder. C. delusions. D. hallucinations.
Correct Answer is: A
In both adults and children, the symptoms of schizophrenia can be divided into two broad categories – positive symptoms and negative symptoms.The “negative symptoms” of schizophrenia include: reduction in emotional expression or emotional and social withdrawal; lack of motivation and energy; avolition (lack of goal-directed activities); alogia (lack of spontaneous speech); poverty of thought, flat affect or ambivalence, and anhedonia, or loss of enjoyment and interest in activities, including social interaction. The positive symptoms of schizophrenia include: hallucinations (often critical or threatening voices), delusions (usually fearing people are watching, harassing, or plotting against the individual), disordered thought, disorganized speech (inability to maintain a conversation, difficulty staying on topic); agitation; and disorganized or catatonic behavior (unusual and bizarre, or difficulty planning and completing activities in an organized fashion). For a diagnosis of schizophrenia, at least two of the previous symptoms must be present for at least 6 months and must be accompanied by increased difficulty in daily living in areas such as self-care, relationships and work or school.
Individuals with narcolepsy and individuals with hypersomnia have which of the following in common? Select one: A. sleep paralysis B. cataplexy C. daytime sleep attacks D. hypnagogic hallucinations
Correct Answer is: C
Narcolepsy is a condition in which people are overcome with irresistible sleepiness and sleep attacks of brief duration that occur unpredictably. Other distinguishing features of the condition is cataplexy, a sudden loss of partial or complete muscle tone during excitement or arousal, sleep paralysis, and hypnagogic hallucinations. Hypersomnia may be either idiopathic, secondary, or periodic. Like Narcolepsy, individuals with hypersomnia experience daytime sleepiness and sleep attacks, however the attacks last longer and are more resistible than in narcolepsy and there are no auxiliary symptoms. Typically, nocturnal sleep is disrupted in narcolepsy, is prolonged in idiopathic hypersomnia and variable in secondary hypersomnia. Although the exact causes of narcolepsy and idiopathic hypersomnia are unknown, there is evidence for genetic predisposition. Causative factors in secondary hypersomnia include: neurologic, (e.g., brain tumors, head injuries, and cerebrovascular insufficiency); general medical, such as metabolic disorders, various intoxications, and conditions leading to brain hypoxia; and psychiatric, most notably depression.
A psychologist refers a client with bulimia nervosa to a physician for a medical evaluation. The physician discovers that the client has a serious medical complication associated with binging and purging, involving a low level of serum potassium. The client is at risk for kidney failure and cardiac arrest. This condition is called: Select one: A. hypoglycemia B. hypokalemia C. hyperorexia D. hypalgesia
Correct Answer is: B
Certain behaviors associated with bulimia, specifically frequent vomiting and laxative use, can lead to serious medical complications, including electrolyte disturbances. Potassium is an electrolyte that is important to the function of the nerve and muscle cells, including the heart. Hypokalemia is the name given to the condition that involves low levels of serum potassium.
Hypoglycemia* is characterized by less than normal amounts of glucose in the blood. Hyperorexia* refers to excessive appetite and hypalgesia* involves a relative insensitivity to pain (* incorrect options).
Post-traumatic amnesia (PTA) refers to the impaired orientation or amnesia following a traumatic brain injury. The duration of PTA is considered to be: Select one: A. related to outcome only for children. B. unrelated to outcome. C. a poor predictor of outcome. D. a good predictor of outcome.
Correct Answer is: D
A common symptom resulting from head injury is post traumatic amnesia (PTA), a pattern of mental disturbance characterized by memory failure for day-to-day events, disorientation, misidentification of family and friends, impaired attention and illusions. Although PTA can vary from hour to hour and day to day, its duration is most commonly used as a guide to the extensiveness of the damage. The duration of PTA appears to be a sensitive and reliable index of severity, with the longer the PTA the stronger the probability of extensive damage. While there is currently no universal agreement that PTA is a better or more sensitive predictor of outcome after traumatic brain injury than depth and duration of unconsciousness, many consider the duration of PTA the best indicator of traumatic brain injury severity and the most dependable marker of outcome prediction, even in mild cases (i.e., duration of less than one hour). PTA impaired orientation may include retrograde and/or anterograde amnesia and researchers have suggested that PTA would be more accurately called posttraumatic confusional state.
With respect to recovery, the duration of retrograde amnesia usually progressively declines while anterograde memory is frequently the last function to return especially after the recovery from loss of consciousness. Most individuals with a mild brain injury recover cognitive and behavioral functions and resolution of other symptoms within 3 to 6 months, though some continue to have symptoms for an extended period and individuals with a moderate or severe injury are likely to experience long-term symptoms and impairments in multiple areas of functioning. An increased risk for long-term impairment include: female gender, previous head trauma, and history of a neurological or psychiatric problem. (See: Ponsford, J. (2000). Factors influencing outcome following mild traumatic brain injury in adults, Journal of the International Neuropsychological Society, 6(5), 568-579.)
Orientation is most frequently measured by which of the following scales?
Select one:
A. Global Orientation and Amnesia Test
B. Gross Orientation and Awareness Test
C. Galveston Orientation and Amnesia Test
D. Gollingberg Orientation and Awareness Test
Correct Answer is: C
The Galveston Orientation and Amnesia Test (GOAT), which assesses temporal orientation primarily, was developed to serially evaluate cognition during the subacute stage of recovery from closed head injury. The scale measures orientation to person, place, and time, and memory for events preceding and following the injury.
Echolalia is not a common symptom of: Select one: A. Autism B. Schizophrenia C. Tourette's Syndrome D. ADHD
Correct Answer is: D
Echolalia is the repetition or echoing of verbal utterances made by another person. A 1983 report indicated that up to 75% of verbal persons with autism* have some form of echolalia (Prizant, 1983), but it may also be present in Tourette syndrome, developmental disability, and schizophrenia (* incorrect options). When done involuntarily, it is considered a tic. (See: Prizant, B.M. (1983). Echolalia of autistic individuals: Assessment and intervention issues. Seminars in Speech and Language, 4, 63-77. Summarized from Heffner, Gary J. Echolalia and Autism, The Autism Home Page: Echolalia Facts. July 2000. Retrieved April 2007.)
A psychologist asks a series of questions to determine whether the client has been experiencing vegetative symptoms when assessing a client who reports feeling depressed. Which of the following are vegetative symptoms?
Select one:
A. psychomotor retardation, appetite changes, social withdrawal
B. sleep difficulties, appetite changes, psychomotor retardation
C. social withdrawal, loss of concentration, reduced energy level
D. confusion, psychomotor agitation, sleep difficulties
Correct Answer is: B
Many clients may report conditions that suggest vegetative symptoms associated with a mental disorder. The classic, or “vegetative,” signs of depression include persistent problems with appetite, weight loss or gain, sleep difficulties, reduced energy level, and changes in sexual desire or function. These symptoms are mostly objective, as opposed to subjective and can serve as useful data for diagnostic screening purposes as vegetative symptoms sometimes suggest a serious mental disorder. In particular, it is useful to identify whether any of these symptoms reflects a change from the client’s previous functioning.
An individual with social or specific phobia is most likely to have which type of panic attack? Select one: A. situationally bound B. situationally predisposed C. unexpected D. uncued
Correct Answer is: A
A panic attack is a sudden, discrete period of intense apprehension, terror, or fear, often accompanied by an urge to escape or a sense of doom. It consists of four or more symptoms such as: shortness of breath, dizziness, heart palpitations or accelerated heart rate, sweating, trembling, depersonalization, sense of choking, nausea, chest pain, numbness, chill or hot flashes, a fear of dying or going crazy. The symptoms develop abruptly, usually peak within 10 minutes, and may mimic a heart attack or hyperthyroidism. Panic attacks may occur in several of the anxiety disorders. Types of panic attacks include: Unexpected (uncued) panic attacks, which are not associated with any trigger (i.e., they occur “out of the blue” ). The diagnoses panic disorder with agoraphobia and panic disorder without agoraphobia must include two or more unexpected panic attacks, and people with panic disorder also may experience the other types of panic attacks. Situationally bound (cued) panic attacks occur almost invariably on exposure to, or in anticipation of, a situational cue or trigger and are most characteristic of social and specific phobias. Situationally predisposed panic attacks are more likely to occur on exposure to a situational cue or trigger but are not invariably associated with the cue or trigger and do not necessarily occur immediately after the person has been exposed to the cue or trigger. For example, a person may have panic attacks associated with shopping mall environments; however, the person does not have an attack every time he or she goes to a shopping mall and/or does not necessarily have the attack immediately upon entering the mall (the attack may occur after he or she has been shopping for a while). These attacks are most common in panic disorder, but can also occur in social phobia or specific phobia.
Cognitive and behavioral symptoms such as impaired motor coordination, attention and memory, mental retardation, hyperactivity, impulsivity, and poor judgment are characteristic of fetal alcohol syndrome (FAS). The brain areas most likely to be effected by FAS include:
Select one:
A. brainstem, amygdala, and frontal lobes.
B. basal ganglia, hippocampus, and frontal lobes.
C. medulla, thalamus, and temporal lobes.
D. hypothalamus, thalamus, and parietal lobes.
Correct Answer is: B
Brain imaging research has found that the basal ganglia, hippocampus, and frontal lobes are most likely to be negatively impacted by repeated exposure to alcohol during prenatal development. Other commonly affected areas include the, cerebellum, corpus callosum and hypothalamus.
A psychologist meets with a patient who smiles and giggles when talking about a painful experience. The patient is most likely exhibiting: Select one: A. inappropriate affect. B. restricted affect. C. labile affect. D. mania.
Correct Answer is: A
Inappropriate affect represents a lack of congruence between an individual’s feelings and expression of those feelings.
Restricted affect* is a mild reduction in range or intensity of emotional expression and isn’t as marked as flat affect, which is an absence of emotional expression. Labile affect* is rapid and abrupt shifts in expression. Mania is an episode of very elevated, expansive mood, and an associated feature of bipolar disorder (* incorrect options).
Which of the following is considered a negative symptom? Select one: A. disorganized speech B. delusions C. anhedonia D. auditory hallucinations
Correct Answer is: C
Anhedonia is the inability to experience pleasure and a negative symptom is one in which something that should be present is missing, or is not present to a sufficient degree. The other response choices represent positive symptoms, ones in which something is present that should not be present, or is present to too great a degree.
Which of the following is not an iatrogenic stressor for elderly clients?
Select one:
A. loss of support and companionship
B. trouble reading directions on medicine labels
C. illness due to medication being over prescribed
D. drug interactions from multiple prescriptions from more than one physician
Correct Answer is: A
Loss of support and companionship is a stressor, but not an iatrogenic stressor. An iatrogenic condition is one that is produced by the treatment. Some conditions are obviously iatrogenic in nature, such as a practitioner who inadvertently uses a medical remedy to which the patient is allergic or administers an erroneous medication dose. Others forms of iatrogenesis are less obvious, like symptoms arising in response to therapists’ suggestions, e.g., recovered memory syndrome, Dissociative Identity Disorder (DID) or unproven medical/psychological treatments.
Which of the following is the term for a condition that sometimes affects people with narcolepsy, is characterized by sudden attacks of muscle weakness and loss of muscle tone, and is usually triggered by strong emotion? Select one: A. transient ischemic attack B. priapism C. cataplexy D. catatonia
Correct Answer is: C
Cataplexy (the word means “to strike down”) is a neurological condition that only occurs in people suffering from narcolepsy. It is characterized by a sudden loss of muscle tone and muscle weakness affecting both sides of the body. It is usually triggered by strong emotional experiences such as stress, anger, fear, and laughter.
Additional Information: Narcolepsy
During a board meeting, Dave's co-worker presented and took sole credit for ideas and work that Dave had done. Dave initially felt furious but forced himself to calm down and control his reaction, despite still being very upset, so as not to appear unprofessional in front of the board members. According to Selye's GAS, Dave was in the \_\_\_\_\_\_\_\_\_\_ phase. Select one: A. recovery B. resistance C. exhaustion D. alarm
Correct Answer is: B
Selye’s general adaptation syndrome (GAS) attempts to explain stress reactions and characteristic responses under conditions of stress. It postulates that after a person becomes aware of the stressful situation (alarm), they summon their resources and meet the challenge (resistance). After the trauma is over, they collapse (exhaustion).
Studies of cognitive-behavioral therapy for rheumatoid arthritis indicate:
Select one:
A. pain intensity and joint inflammation is reduced however there is little or no effect on psychological functioning
B. pain intensity and joint inflammation is reduced and, in some cases, there is a positive effect on psychological functioning
C. psychological functioning is improved however there is little or no effect on joint inflammation or pain intensity
D. psychological functioning is improved and, in some cases, there is a positive effect on joint inflammation and pain intensity
Correct Answer is: D
Research findings on the effect of multi-component cognitive-behavior therapy (CBT) for rheumatoid arthritis indicate that CBT has positive effects on psychological and social functioning. The results of CBT for the physical symptoms of rheumatoid arthritis are inconsistent and vary by study. Some studies found CBT did reduce joint inflammation, impairment and pain intensity, therefore this response (“psychological functioning is improved and, in some cases, there is a positive effect on joint inflammation and pain intensity”) is the best answer as this inconsistency is addressed by the qualifier “in some cases.” (See: O’Leary, A. (1988). A cognitive-behavioral treatment for rheumatoid arthritis, Health Psychology, 1988, 7, 527-544.)
Michael has a high-pressure legal career that involves frequent altercations with opposing counsel and ongoing stress. He commonly reacts to the stress of anger by clenching his teeth and generally tensing up. His therapist suggests biofeedback and would most likely recommend which type of biofeedback? Select one: A. EDR B. EEG C. EMG D. HRV
Correct Answer is: C Biofeedback is the process of identifying physiological variables, or responses, for the purpose of helping an individual develop greater sensory awareness and is achieved by using electronic instrumentation to monitor responses then providing the information to the individual to improve their physiological control of responding. Electromyogram (EMG) biofeedback, measures impulses in the muscles and indicates the degree of relaxation or contraction/tension. It is commonly used for conditions such as stress, tension headaches, chronic pain, muscle stiffness, incontinence, urinary urgency and frequency, and when muscles are healing. Electrodermal response (EDR) biofeedback, also referred to as galvinic skin response training (GSR), measures skin surface changes, giving feedback on the relation between emotional state and the activity of the sympathetic system via sweat gland activity, and is utilized for stress and hyperhidrosis (excessive sweating). Electroencephalogram (EEG) or neurofeedback provides information on brainwave activity and patterns. It is often used in the treatment of attention deficit hyperactivity disorder, depression, and epilepsy to improve attention, reduce impulsivity and promote recovery from head injuries and strokes. Heart rate variability (HRV), sometimes referred to as electrocardiogram (ECG), biofeedback monitors heart rate and cardiac reactivity from sensors placed on a person's fingers or wrist. It is useful for managing stress, high blood pressure, anxiety, and heartbeat irregularities. Other recognized types of biofeedback include: thermal or skin temperature (ST) biofeedback, which involves skin temperature and blood flow control; Respiratory Feedback (RFB), which involves control of breathing type and frequency; and Respiratory Sinus Arrhythmia (RSA); which involves the synchronous control of heart rate and respiration, in which there is a small rise in heart rate during inhalation and a corresponding decrease during exhalation. Depending on the reason for biofeedback, more than one type is often used. For example in this question, Michael might also use EDR to control his general stress response in addition to EMG to control the muscle tensing and teeth clenching responses. Behavioral skills training such as relaxation training, guided imagery and stress-coping techniques are also frequently used in addition to the actual biofeedback.
15 year old Susan was initially diagnosed with Bulimia-Nervosa (Purging Type). Her self-evaluation is unduly influenced by her body shape and weight. She worries about gaining weight, has been binging and purging on a daily basis for almost a year and her weight has steadily dropped to less than 85% of a minimally normal level. Her therapist reassesses Susan’s diagnosis. The salient feature to consider in the differential diagnosis of Anorexia-Nervosa (Binge-Eating/Purge Type) is her:
Select one:
A. fear of gaining weight or getting fat
B. cognitive distortions associated with body image
C. continuation of binging and purging despite weight loss
D. denial of seriousness of current body weight
Correct Answer is: C
Individuals with Bulimia-Nervosa, unlike those with Anorexia-Nervosa, Binge-Eating/Purge Type, are able to maintain body weight at or above a minimally normal weight for height and age. Anorexia-Nervosa is characterized by a refusal to maintain a minimal normal body weight, with the threshold of underweight being less than 85% of weight expected. Susan’s weight falls below this threshold and her continuation of binging and purging despite weight loss meets the refusal criteria of Anorexia.
It is also important to consider her fears of gaining weight* and denial of seriousness of her current weight, especially with respect to treatment planning. Disturbances in perception of body shape and weight (* incorrect options), and an over influence of weight and shape on self-evaluation are essential features of both disorders.
A 38 year-old woman is dependent on the prescription pain medications oxycodone and hydrocodone. She is referred to a physician's office for medication-assisted treatment of her opioid addiction. Which of the following is most likely to be administered in the induction phase of treatment? Select one: A. methadone B. buprenorphine C. naltrexone D. LAAM (l-alpha-acetyl-methadol)
Correct Answer is: B
The Drug Treatment Act of 2000 allows doctors to treat opioid dependence in their practices with FDA-approved opioid medication. In 2002, the FDA approved two medications for use in opioid addiction treatment: buprenorphine monotherapy (Subutex) and a buprenorphine/naloxone combination (Suboxone). Buprenorphine, an opioid partial agonist, activates receptors to a lesser degree than full agonists (i.e., morphine and heroin) and its effects reach a ceiling effect at moderate doses - not increasing, even with increases in dosage. At low doses, it has enough agonist effect to enable opioid-addicted individuals to discontinue misuse of opioids without experiencing withdrawal symptoms. Under certain circumstances and in high doses, it can block the effects of full opioid agonists and precipitate opioid withdrawal syndrome like an opioid antagonist. Buprenorphine carries a lower risk of abuse, addiction, and side effects than full agonists. Subutex (buprenorphine) is more often used at the beginning of treatment and withdrawal syndrome can be precipitated in individuals maintained on it.
Suboxone, containing the opioid antagonist naloxone, was designed to decrease the potential for abuse by injection and is more often used in maintenance treatment of opiate addiction. Both methadoneand LAAM (l-alpha-acetyl-methadol)* are effectively used to treat opioid addiction (* incorrect options); however they are not available in practice settings other than Opioid Treatment Programs (OTPs) (i.e., methadone clinics). (See: Kissin, W., McLeod, C., Sonnefeld, J., & Stanton, A. (in press). Experiences of a national sample of qualified addictions specialists who have and have not prescribed buprenorphine for opioid dependence. Journal of Addictive Diseases. http://buprenorphine.samhsa.gov/index.html)
Research comparing anxiety over the lifespan indicates:
Select one:
A. younger adults are more likely to benefit from cognitive-behavioral therapy, whereas older adults are more likely to benefit from pharmacotherapy.
B. younger adults are more likely to be underdiagnosed and older adults more likely to be misdiagnosed as having an anxiety disorder.
C. younger adults are less likely to have comorbid symptoms of depression than older adults.
D. younger and older adults are equally likely to perceive symptoms as result of physical health problems.
Correct Answer is: C
Anxiety is the most common psychiatric disorder in older adults, with generalized anxiety disorder being the most prevalent anxiety disorder according to recent findings. Research indicates comorbid symptoms of depression frequently occur in all adults with anxiety, however occurs more often in older adults.
younger adults are more likely to benefit from cognitive-behavioral therapy, whereas older adults are more likely to benefit from pharmacotherapy.
Older and younger adults with anxiety have been found to benefit about equally from cognitive-behavioral therapy (CBT) and pharmacotherapy.
younger adults are more likely to be underdiagnosed and older adults more likely to be misdiagnosed as having an anxiety disorder.
Underdiagnosis is more common among older adults, as well as undertreatment of anxiety disorders compared to younger adults.
younger and older adults are equally likely to perceive symptoms as result of physical health problems.
Findings show older adults are more likely than younger adults to attribute anxiety symptoms to physical health problems and therefore more likely to see a medical professional instead of a mental health professional for help.
(See: Stanley, M. A. & Beck, J.G. (2000). Anxiety disorders, Clinical Psychology Review, 20, 731-754.)
A measurement scale often used in rehabilitation settings to indicate a patient's level of response and ability to function is the Rancho Los Amigos scale, named for the rehabilitation hospital where it was created in California. Using this scale, a person recovering from a brain injury is most likely to have a low score: Select one: A. when admitted. B. at time of discharge. C. 12 months after discharge. D. several years after discharge.
Correct Answer is: A
The Rancho Los Amigos Scale provides a descriptive guideline of the various stages a brain injury patient will experience as he/she progresses through recovery and is most helpful in assessing the patient in the first weeks or months following an injury because it is based on observations of the patient’s response to external stimuli and does not require cooperation from the patient. The Rancho scale is often administered in acute rehabilitative settings following release from intensive care and evaluates eight levels of functioning. At the lowest score, or level I. No Response, a patient appears to be in a deep sleep and is unresponsive to stimuli.
As recovery progresses, functioning is then reflected by the higher levels of the scale. These levels include: level II. Generalized Response: limited reflexes and often the same, regardless of stimuli presented. III. Localized Response: responses specific but inconsistent, are related to the type of stimulus presented, may follow simple commands in an inconsistent and delayed manner. IV. Confused-Agitated: heightened state of activity, severely confused, disoriented, and unaware of present events; unable to perform self-care however if physically able, may perform motor activities such as sitting and walking as part of agitated state. V. Confused-Inappropriate, Non-Agitated: appears alert and responds to simple commands; some agitated behavior in response to external stimuli; is highly distractible, difficulty learning new information; memory impaired; verbalization often inappropriate; self-care activities with assistance. VI. Confused-Appropriate: shows goal-directed behavior, relying on cueing for direction; able to relearn old skills (i.e., activities of daily living); new learning limited by memory problems; has beginning awareness of self and others. VII. Automatic-Appropriate: goes through daily routine, is robot-like with appropriate behavior and minimal confusion; has shallow recall of activities; superficial awareness of condition but lacks insight; judgment, problem solving, and planning skills are impaired, requiring some supervision. VIII. Purposeful-Appropriate: alert and oriented; able to recall and integrate past and recent events; can learn new activities and continue in home and living skills; deficits in stress tolerance, judgment, abstract reasoning, social, emotional, and intellectual capacities may persist.
Screening for cognitive deficits associated with Alzheimer’s dementia and other conditions with the Mini Mental Status Exam (MMSE) tends to result in a disproportionate number of:
Select one:
A. false positives for African-African and other minorities.
B. true positives for individuals from lower socioeconomic backgrounds.
C. false negatives for African Americans and other minorities.
D. true negatives for individuals with lower levels of education.
Correct Answer is: A
Due to the tendency to overestimate cognitive deficits among African Americans and other minority groups, the MMSE results in a disproportionate number of false positives. Research indicates the MMSE also overestimates cognitive deficits for individuals with lower socioeconomic backgrounds and lower levels of education. When controlling for education level and socioeconomic status, research findings have been mixed on whether the racial bias persists or can be eliminated. (See: Lampley-Dallas, V. T. (2001). Neuropsychological screening tests in African Americans, Journal of the National Medical Association, 93(9), 323-328.)
Research on the cognitive affects of chemotherapy and radiation on children with cancer indicate:
Select one:
A. cognitive abilities are affected only during the course of treatment with both radiation and chemotherapy.
B. cognitive abilities are affected only during the course of treatment with radiation, whereas chemotherapy is associated with developing cognitive problems following treatment.
C. young boys are at greater risk to have cognitive problems than girls.
D. younger children are at greater risk for more problems and more severe problems than are older children
Correct Answer is: D
Between infancy and 15 years of age, cancer is the leading cause of death by disease among U.S. children. Among the 11 major types of childhood cancers, leukemias (blood cell cancers), brain and other central nervous system (CNS) tumors account for over half of new cases. Treatment for childhood cancers can include chemotherapy, radiation, surgery and stem cell transplants. Radiation and chemotherapy affect cognitive ability in children due to damage to the tiny blood vessels that carry nutrition and oxygen to the brain, resulting in calcifications; interference with the growing and thickening of the myelin; and with the growth and development of connecting nerve structures over time. Factors that increase the risk of long-term cognitive effects include: diagnosis of cancer at a very young age, cancer treatment that results in reduced energy levels, cancer treatment that affects hearing or vision, cancer treatment that results in physical disabilities, cancer therapy that includes treatment to the central nervous system, numerous or prolonged school absences, a history of learning problems before being diagnosed with cancer.
Research also indicates young girls are more vulnerable to lingering cognitive problems than boys, and children with acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma are at a higher risk of developing later cognitive problems than those who have other forms of blood cancers. In fact, as many as 40% of all pediatric ALL patients treated with chemotherapy alone will develop serious learning disabilities within two to three years following treatment and for children who receive cranial radiation, with or without chemotherapy, the percentage is 80% to 90%. The most common cognitive problems found as a result of radiation and chemotherapy are with handwriting, spelling, reading or reading comprehension, understanding math concepts, attention deficits (tend to drift off and are easily distracted), short term memory and information retrieval, planning and organizational skills, social maturity and social skills.
A serious complication of binging and purging involves a low level of serum potassium that can lead to kidney failure and cardiac arrest. This condition is called: Select one: A. hyponatremia. B. hypokalemia. C. hypoglycemia. D. hypercapnia.
Correct Answer is: B
Certain behaviors associated with bulimia, namely frequent vomiting and laxative use, can lead to serious medical complications, including electrolyte disturbances. Hypokalemia is the name given to the condition that involves low levels of serum potassium.
Hyponatremia* involves less than normal concentration of sodium in the blood; hypoglycemia* is characterized by less than normal amounts of glucose in the blood; and hypercapnia* involves greater than normal amounts of carbon dioxide in the blood (* incorrect options).
Untreated diabetes mellitus can result in which of the following symptoms?
Select one:
A. increased appetite with weight loss, confusion, mental dullness, and apathy
B. emotional lability, memory loss, depression, obesity
C. accelerated heart rate, agitation, nervousness, fatigue, insomnia
D. slowed heart rate, depression, lethargy, impaired concentration and memory
Correct Answer is: A
Insulin, which is released by the pancreas, is involved in the uptake and use of glucose and amino acids. Hypoinsulinism produces diabetes mellitus (excessive blood glucose). When untreated, diabetes mellitus results in increased appetite with weight loss, apathy, confusion, mental dullness, polyuria, polydipsia, and increased susceptibility to infection.
emotional lability, memory loss, depression, obesity
The symptoms listed in this option are associated with Cushing’s disease, which results from hypersecretion of cortisol.
accelerated heart rate, agitation, nervousness, fatigue, insomnia
The symptoms listed in this option are associated with hyperthyroidism, or Grave’s disease (other symptoms of this disorder include a speeded up metabolism, elevated body temperature, heat intolerance, and increased appetite with weight loss).
slowed heart rate, depression, lethargy, impaired concentration and memory
The symptoms listed in this option are associated with hypothyroidism (other symptoms of this disorder include a slowed metabolism, reduced appetite with weight gain, lowered body temperature, and decreased libido).
The prevalence rate for autism and autism spectrum disorders in epidemiological studies since 2000 indicate a convergence in the range of: Select one: A. 60/10,000 B. 27.5/10,000 C. 10/10,000 D. 4/10,000
Correct Answer is: A
It appears the prevalence rate for autism and autism spectrum disorders has increased worldwide over the past decade however whether there is an increased incidence of autism has yet to be determined partially due to confounding changes diagnostic classification, assessment and varied methodologies of surveys. In epidemiologic studies done in the 1960s, autism rates were typically based on “classical autism” or severe impairment of language, social interaction, and behavior. The studies estimated a prevalence rate of 4/10,000. Prevalence rates have been influenced by changes in diagnostic criteria, increased awareness of developmental problems, and improved assessment. A review of 32 epidemiologic studies done in 13 countries from 1987 to 2000 indicates a best estimate for the prevalence rate of autistic disorder being 10/10,000. Of these studies, 12 also provided data on other pervasive developmental disorders (PDDs) with the estimated prevalence rate for unspecified PDDs and PDD NOS being 15/10,000 and Asperger disorder (AD) estimated to be around 2.5/10,000. Taken together, the estimate for all autism spectrum disorders was estimated to be 27.5/10,000. The rates had wide ranges from study to study due to methodological inconsistencies and problems so the estimate is thought to be conservative. Although few in number, improved methods and diagnostic precision in the most recently reviewed studies indicate the prevalence rates for all PDDs, including autistic disorder, converge in the range of 60/10,000. These studies varied however in the reported rates of autistic disorder, PDD NOS, and AD, therefore, making it difficult to get a sense of prevalence rates for PDD subtypes. (See: Fombonne E. (1999). The epidemiology of autism: a review. Psychol. Med. 29:76-86; Fombonne E. (2003) Epidemiology of pervasive developmental disorders. Trends in Evidence-Based Neuropsychiatry 2003;5(1):29-36; and Fombonne E. (2003). The prevalence of autism. JAMA: Journal of the American Medical Association; 289(1):87-9.)
Recent research on HIV infection has examined the role of psychosocial risk factors on disease progression and prognosis. The results of studies involving infected adults has most consistently found:
Select one:
A. lower intellectual functioning and younger age are related to a more rapid progression
B. higher intellectual functioning and older age are related to a more rapid progression
C. somatic symptoms of depression and younger age are related to a more rapid progression
D. somatic symptoms of depression and older age are related to a more rapid progression
Correct Answer is: D
Findings of recent studies indicate that the factors of intellectual functioning, age and somatic symptoms of depression are significant predictors of HIV progression and prognosis. Specifically, lower IQ, older age and the presence of somatic symptoms of depression are associated with a more rapid progression from HIV infection to AIDS, HIV-related dementia, and death. (See: Farinpour, R., et al., Psychosocial risk factors of HIV morbidity and mortality: Findings from the Multicenter Aids Cohort Study (MACS), Journal of Clinical and Experimental Neuropsychology, 2003, 25(5), 654-670.)
Factitious Disorder treatment typically involves symptom management rather than curing the disorder. Which of the following is currently considered to be the most effective treatment?
Select one:
A. confrontational therapy in an inpatient setting
B. individual and group therapy in an inpatient treatment
C. supportive psychotherapy in an outpatient setting
D. group or family therapy in an outpatient setting
Correct Answer is: C
Studies indicate no specific treatment has been identified as consistently effective for Factitious Disorder; however, many agree that establishing a good therapeutic relationship and providing supportive therapy and consistency of care is the best way to manage its symptoms. (See: J. C. Huffman and T. A. Stern, The diagnosis and treatment of Munchausen’s syndrome, General Hospital Psychiatry, 2003, 25(5), 358-363.)
confrontational therapy in an inpatient setting
Inpatient treatment is often contraindicated because of the underlying need of individuals with Factitious Disorder “to adopt the sick role.”
individual and group therapy in an inpatient treatment
Confrontational techniques may elicit denial and result in the individual terminating the therapeutic relationship so they must be used with caution.
group or family therapy in an outpatient setting
Family and group therapy have not been identified as the most effective treatments, although family therapy may be useful for helping family members cope with the patient’s symptoms.
While Sleep Terror Disorder and Sleepwalking Disorder are similar in terms of sleep and EEG patterns, there are behavioral differences that distinguish them. Sleepwalking Disorder, in contrast to Sleep Terror Disorder,:
Select one:
A. is accompanied by high levels of autonomic arousal during the episode
B. is associated with prominent, organized motor activity during the episode
C. is not associated with amnesia for the episode when the individual awakens in the morning
D. is not associated with a family history of Sleepwalking and/or Sleep Terror Disorder
Correct Answer is: B
Both Sleep Terror Disorder and Sleepwalking Disorder have been linked to a family history and are associated with amnesia for the episode upon awaking in the morning. Sleepwalking Disorder is usually associated with low levels of autonomic arousal and is characterized by prominent, organized motor activity such as walking around, talking, and eating.
Both disorders do involve motor activity, although the activity associated with Sleep Terror Disorder is less organized and usually involves resisting being touched or held and sitting up.
Research utilizing functional brain imaging techniques has shown a biological basis for Attention Deficit/Hyperactivity Disorder (ADHD) and has linked it to abnormalities in the following brain structures:
Select one:
A. parietal lobe, hypothalamus, and corpus callosum
B. parietal lobe, striatum, and amygdala
C. frontal lobe, thalamus, and amygdala
D. frontal lobe, striatum, and cerebellum
Correct Answer is: D
Recent research has established a biological basis for Attention Deficit/Hyperactivity Disorder (ADHD) with abnormalities in the right frontal lobe, striatum, and cerebellum most consistently implicated in this disorder. Other areas of the brain, including certain regions of the parietal lobe, have been linked to ADHD to a lesser extent. Using the core symptoms of ADHD and functions of the major brain structures, you may have determined the frontal lobes (mediates higher-order functions), the striatum (part of the basal ganglia and composed of the caudate nucleus and the putamen) and cerebellum (involved in motor activity) are the areas linked to this disorder. (See: J. Giedd et al., Brain imaging of attention deficit/hyperactivity disorder, Annals of New York Academy of Sciences, 2001, 931, 33-49.)
Individuals with the diagnosis of Seasonal Affect Disorder are most likely to respond to light if they experience:
Select one:
A. atypical symptoms such as carbohydrate craving and hypersomnia
B. melancholic symptoms such as insomnia and weight loss
C. incomplete summer remission
D. more chronic forms of depression
Correct Answer is: A
Research on the use of light therapy for the treatment of various forms of depression has yielded the findings that for true SAD, atypical symptoms such as carbohydrate craving and hypersomnia predict a robust response, whereas melancholic symptoms such as insomnia and weight loss are generally less responsive to light (See: Terman et al., American Journal of Psychiatry, 1996, 153,:423-9). Additionally, a clear onset period with complete remission in the spring and summer months is the SAD phenotype that is most likely to respond to light. Whereas patients with more chronic forms of depression or incomplete summer remission are less likely to have a robust response, they may benefit to some extent (See: Lam et al., Journal of Affective Disorders, 2001, 63, 123-32).
A 17-year-old male has suddenly begun engaging in numerous high-risk sexual encounters, getting very little sleep, and exhibiting an inflated self-esteem. His most likely diagnosis is:
Select one:
A. ADHD
B. Bipolar I Disorder, Single Manic Episode
C. Conduct Disorder
D. none; this is normal adolescent behavior
Correct Answer is: B
Although this question provides a limited amount of information, it appears that the young man may be in the midst of a Manic Episode based on his decreased need for sleep, inflated self-esteem, and excessive involvement in pleasurable activities that are likely to result in painful consequences. Another clue is that these behaviors began suddenly, which is not characteristic of the other diagnoses listed. Although ADHD and a Manic Episode are both characterized by excessive activity, impulsive behavior, and poor judgement, ADHD must begin before age 7 and has a chronic course with no clear onset. Conduct Disorder is characterized by a persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.
Recent research indicates the most effective treatment for antisocial behavior in juvenile offenders is:
Select one:
A. behavioral-reinforcement
B. structured family intervention with parental training
C. multi-systemic therapy
D. victims family therapy
Correct Answer is: C Multisystemic Therapy (MST), targeting chronic, violent, or substance abusing juvenile offenders at high risk of out-of-home placement, is consistent with social-ecological models of behavior and findings from causal modeling studies of delinquency and drug use. The approach views individuals as being nested within a complex network of interconnected systems that encompass individual, family, and extrafamilial (peer, school, neighborhood) factors. MST is a goal-oriented, intensive family- and community-based treatment that addresses the multiple determinants and factors in each youth's social network that are contributing to his or her antisocial behavior. It is provided using a home-based model of services delivery with a typical treatment duration of approximately 4 months. Intervention strategies include strategic family therapy, structural family therapy, behavioral parent training, and cognitive behavior therapies. MST interventions typically aim to improve caregiver discipline practices, enhance family affective relations, decrease youth association with deviant peers, increase youth association with prosocial peers, improve youth school or vocational performance, engage youth in prosocial recreational outlets, and develop an indigenous support network of extended family, neighbors, and friends to help caregivers achieve and maintain such changes. MST has demonstrated long-term reductions in criminal activity, drug-related arrests, violent offenses, and incarceration. Controlled studies also showed that MST outcomes were similar for youths across the adolescent age range (i.e., 12-17 years), for males and females, and for African-American vs. white youths and families. (See: Curtis, N. M., Ronan, K. R., & Borduin, C. M. (2004). Multisystemic treatment: A meta-analysis of outcome studies. Journal of Family Psychology, 18, 411-419.)
A preoccupation with disease fears despite a medical evaluation (but does not reach delusional intensity) is most associated with:
Select one:
A. Specific ("disease") Phobia
B. Delusional Disorder, Somatic Type
C. Illness Anxiety Disorder
D. Panic DisorderCorrect Answer is: C
Among the diagnostic criteria are: preoccupation with fears of having, or the idea that one has, a serious disease based on the person’s misinterpretation of bodily symptoms; preoccupation persists despite medicatial evaluations and reassurance; belief is not of delusional intensity; etc.
The behavior therapy technique for reducing arousal to inappropriate stimuli by first masturbating to orgasm while imagining appropriate stimuli and then continuing to masturbate while fantasizing about paraphilic images after orgasm is called: Select one: A. Orgasmic Reconditioning B. Satiation Therapy C. Systematic Desensitization D. Aversive Conditioning
Correct Answer is: B
When treating individuals with paraphilias, behavior therapies are used based on the reasoning that maladaptive behavior has been learned and can therefore be unlearned.
Orgasmic Reconditioning
Orgasmic reconditioning instructs a client to begin masturbating while fantasizing about the inappropriate stimulus then switch from the paraphilic to more appropriate fantasies at the moment of masturbatory orgasm.
Systematic Desensitization
Systematic desensitization pairs slow, systematic exposure to anxiety-inducing situations with relaxation training.
Aversive Conditioning
Aversive conditioning substitutes a negative response for a positive response to inappropriate stimuli such as through pairing paraphilic urges with negative experiences, for example electric shocks or unpleasant odors.
Individuals with Tourette’s Disorder frequently suffer from a learning disorder in school. The most likely cause is:
Select one:
A. expressive language disorder
B. attentional and hyperactivity problems
C. social problems
D. environmental stressors
Correct Answer is: B
Although learning problems are associated with the disorder, children with Tourette’s Syndrome (TS) as a group have the same range of IQ as the population at large. The etiology of learning disabilities (LD), as well as the most accurate conceptualization of them as either comorbid disorders or as prevalent, variable components of the broader TS phenotype, has yet to be determined. In a recent study of more than 3100 children with Tourette’s, ADHD was the most prevalent comorbid disorder occurring in 58% of subjects. Of those with TS plus learning disabilities, 80% also had a diagnosis of ADHD. The increased rates of ADHD in those diagnosed with TS + LD and the finding that only 11 % of the TS children without ADHD had a diagnosis of LD demonstrates the potential impact of ADHD on LD as a causal factor or as a confounder for the diagnosis of LD (L. Burd, L., Freeman, R.D., Klug, M.G. and Kerbeshian, J. (2005). Tourette syndrome and learning disabilities, BioMed Central Pediatrics, 5).
Which of the following techniques will exacerbate chronic pain rather than reduce it? Select one: A. Religious coping B. Cognitive therapy C. Active coping D. Passive coping
Correct Answer is: D
Passive pain-coping strategies, a category described in Brown and Nicassio’s (1987) dichotomy of active versus passive coping strategies, are associated with worse pain and adjustment among chronic pain patients. Passive coping strategies are those that involve giving responsibility for pain management to an outside source or allowing other areas of life to be adversely affected by pain. They may also serve as psychological enforcers of pain. Examples of passive coping strategies are focusing on where the pain is and how much it hurts, restricting or cancelling social activities, or thoughts such as “ There’s nothing I can do to lessen this pain,” or “I wish my doctor would prescribe me better pain medication.”
In contrast, active coping strategies entail the patient taking responsibility for pain management including attempts to control the pain or to function in spite of it. Examples of active coping strategies include engaging in physical therapy or exercise, staying busy/active, relaxation techniques, clearing distracting thoughts and attention from the pain.
Cognitive and cognitive behavior therapy has been shown to be effective in reducing the experience of pain and improving positive behavior expression, appraisal and coping in individuals with chronic pain. (See: Morley S, Eccleston C, Williams A. (1999) Systematic review and meta-analysis of randomised controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain, 80, 1-13.)
Evidence supports a relationship between positive health outcomes and the use of religious coping to manage pain. Pargament (1990) identified three possible interactions between religion and coping: religion can influence the parts of the coping process (appraisal, coping activities, results, assistance, and motivation); contribute to the coping process by influencing perception (attribution of meaning and the feeling of control) and preventing certain events from happening (through a beneficiary life style); and it can be the resultant of the coping process through religious attributes. (See: Pargament, K.I. (1997) The psychology of religion and coping, Guilford, New York.)
The Personality Disorder that has been found to have the best prognosis is:
Select one:
A. Borderline Personality Disorder
B. Paranoid Personality Disorder
C. Dependent Personality Disorder
D. Obsessive-Compulsive Personality Disorder
Correct Answer is: A
The majority of individuals diagnosed with Borderline Personality Disorder (BPD) demonstrate significant reduction or remission of symptoms by middle age or sooner. Longitudinal studies involving those diagnosed in adolescence or early adulthood indicate that symptom resolution with impulsive symptoms are the quickest to resolve, followed by cognitive and interpersonal symptoms and finally affective symptoms are the most chronic and show the least improvement with increasing age. (See: Zanarini, M.C., Frankenburg, F.R., Hennen, J. and Silk, K.R. (2003). The longitudinal course of borderline pathology: 6 year prospective follow-up of the phenomenology of borderline personality disorder, American Journal of Psychiatry, 160, 274-283).
Briquet's syndrome is also known as a: Select one: A. Conversion Disorder B. Somatization Disorder C. Body Dysmorphic Disorder D. Hypochondriasis
Correct Answer is: B
Termed after the physican who described the condition in the 1850s, Briquet’s syndrome, or Somatization Disorder, is a chronic Somatoform Disorder with multiple physical symptoms that cannot be explained entirely by a general medical condition or the effects of a substance. The other three response choices are also Somatoform Disorders.
Cross-dressing fantasies, sexual urges or behaviors in heterosexual males is characteristic of: Select one: A. Fetishism B. Sexual Sadism C. Frotteurism D. Transvestic Fetishism
Correct Answer is: D
All of the response choices are Paraphilic conditions identified in the DSM-IV-TR. The Paraphilias are characterized by recurrent, intense sexual urges, fantasies, or behaviors that involve unusual objects, activities, or situations and cause clinically significant distress or impairment in at least one area of functioning.
Fetishism* involves the use of nonliving objects; Sexual Sadism* involves inflicting humiliation or suffering; and Frotteurism* involves touching or rubbing against a nonconsenting person for sexual excitement (* incorrect options).
Which of the following is not characteristic of Nicotine Withdrawal? Select one: A. hypersomnia B. weight gain/increased appetite C. decreased heart rate D. depressed or dysphoric mood
Correct Answer is: A
Symptoms of Nicotine Withdrawal have a rapid onset and are characterized by insomnia, decreased heart rate, increased appetite and depressed or dysphoric mood* (* incorrect options). Studies indicate that a desire to avoid negative affect, as well as the rapid withdrawal symptoms, are primary reasons nicotine dependent individuals relapse.
Individuals with Major Depressive Disorders who experience abnormalities in the sleep cycle may have any of the following sleep disturbances EXCEPT: Select one: A. early morning awakening B. sleep continuity decrease C. REM latency decrease D. slow-wave sleep increase
Correct Answer is: D
Depression is associated with decreased slow-wave or non-REM sleep as well as, early morning waking, decreased sleep continuity and earlier onset of REM sleep or decreased REM latency* (* incorrect options).
Which of the following symptoms will be most quickly eliminated by antipsychotic medication? Select one: A. delusions B. alogia C. avolition D. affective flattening
Correct Answer is: A
Studies of Schizophrenic individuals show the “positive symptoms,” such as delusions, hallucinations and thought disorder, usually respond better than the “negative symptoms” to antipsychotic treatment.
Alogia, or speechlessness, avolition, or lack of initiative or goals and affective flattening* are all negative symptoms of Schizophrenia (* incorrect options).
The presence of which of the following suggests the diagnosis is Acute Stress Disorder rather than Posttraumatic Stress Disorder?
Select one:
A. response to the traumatic stressor involved intense fear, helplessness, or horror
B. a sense of reliving or reexperiencing the traumatic stressor
C. dissociative symptoms occur during or immediately following a traumatic stressor
D. increased symptoms of anxiety, poor concentration and irritability
Correct Answer is: C
Acute Stress Disorder, is by definition, only appropriate when the duration of symptoms last at least two days and occur within one month of the extreme stressor or traumatic event. Posttraumatic Stress Disorder requires symptoms to persist for more than a month so this diagnosis cannot be made within the initial month following the traumatic stressor.
