AAPL Landmark - Questions on Mental Health Practice Guidelines Flashcards
In order to pass the “Frye test,” experts must be able to:
A) show that their peers have accepted the science used in testimony
B) Present scientific evidence to the court in support of their testimony
C) Demonstrate their scientific tests in Court
D) Present published papers of books that support their opinion
E. Present their own publications supporting their opinions.
A. Show that their peers have accepted the science used in testimony.
It was the “general acceptance” by the scientific community of one’s opinions that was essential to determining who was an expert.
In multiple appellate court decisions, the broadest guiding principal defining a psychiatrist’s duty to protect a third party from a dangerous patient has been formulated as follows:
A) Only when the name of a specific potential victim is identified does a psychiatrist incur a duty to protect.
B) Only when a specific potential victim is identified does a psychiatrist incur a duty to protect
C) Only when a specific threat is made in the presence of the psychiatrist is a duty incurred
D) A psychiatrist has a duty to protect any class of persons who may be foreseeably harmed by a dangerous person.
D) A psychiatrist has a duty to protect any class of persons who may be foreseeably harmed by a dangerous person.
Courts have found that psychiatrists are liable for failing to protect foreseeable victims, when the name of the victim was not known (tarasoff), when no specific victim was threatened (naidu v. Saird and Lipari v. Sears), and when no specific threat was made to the psychiatrist (Jablonski v. U.S.).
Hypnotically refreshed testimony may have usefulness:
A) In guaranteeing the truth of repressed memory
B) In accurately relaying very specific forgotten details
C) In helping a subject relax and concentrate in order to better relay information
D) In avoiding coerced testimony
C) In helping a subject relax and concentrate in order to better relay information
“Abuse of discretion” in the context of the law means:
A) A judge inappropriately applies the law
B) A judge abuses his or her discretion in evaluating evidence for admission
C) A judge decides arbitrarily and blatantly in error about evidentiary admissibility
D) All of the above
D) All of the above
It is more difficult to obtain adequate informed consent for experiments with involuntarily committed patients because:
A) A high risk-to-benefit ratio requires greater understanding
B) Involuntarily committed patients may not be as informed
C) A lack of liberty requires procedural protections regarding informed consent
D) Involuntarily committed patients may have less monitoring
E) Involuntarily confined patients live in an inherently coercive” environment, which might make it difficult for them to voluntarily consent.
E) Involuntarily confined patients live in an inherently coercive” environment, which might make it difficult for them to voluntarily consent.
Kaimowitz v. Dept. of Mental Health for the State of Michigan ruled that involuntarily confined patients were unable to give consent for experimental psychosurgery.
The Daubert majority recommended that the judge conducting a preliminary Daubert hearing inquire about:”
A) Whether the science has been tested
B) Whether the science has been peer reviewed and published
C) Whether the science has a known or potential rate of error
D) Whether the science has been generally accepted
E) All of the above
E) All of the above
When a psychiatrist believes that his or her patient/client poses an imminent threat to a third party, the duty to warn that third party:
A) Has been established at a federal level by a USSC decision
B) Has been established as a federal law by act of Congress
C) Has developed from state-specific case law that is binding only at a state level
D) Was first outlined and advocated by the APA
C) Has developed from state-specific case law that is binding only at a state level
Hypnotically refreshed testimony:
A) Is equivalent in reliability to a test for blood type
B) Has well-established validity
C) Is treated the same in virtually all jurisdictions
D) Is available only in cases involving homicide crimes
E) Has the potential to be unreliable
E) Has the potential to be unreliable
Rock v. Arkansas, State v. Hurd
Under Frye, a psychiatric expert’s testimony that contradicted a statement in the DSM would be most problematic if that expert had testified that the DSM is:
A) Instructive
B) Commonly used
C) Written by experts in the field
D) Authoritative
E) Merely a guide in formulating a diagnosis
D) Authoritative
Because Frye is the “general acceptance” test, the more generally accepted a piece of evidence, the less reliable any expert testimony that contradicts that piece of evidence would be.
You have been treating a woman in your private practice for the past 5 years. She is a 69 year old retired widow who lives with her son. During your session, you notice that she has a black eye covered with makeup and bruises on her arms. During therapy, she breaks down crying and divulges that her son has been beating her up. She begs you not to say anything to the authorities because she feels that she is financially dependent on her son and scared to live alone. What is the most appropriate way to handle this confidentiality situation?
A) Reassure her that you will maintain confidentiality and provide her with a pamphlet of community support resources for battered women
B) Validate her fears and reassure her that HIPAA laws prohibit you from sharing any unauthorized clinical information
C) invite the son to her next therapy appointment to work through conflicts that may be occurring in the home
D) Validate her fears but inform her that this is a case of elder abuse and you need to report this abuse to the authorities for her safety.
E) Inform her that as a psychiatrist, you are required to maintain her confidentiality. however, you will inform her internist, who may decide to report the abuse to the authorities.
D) Validate her fears but inform her that this is a case of elder abuse and you need to report this abuse to the authorities for her safety.
As a result of the Daubert, Joiner, and Kumho Tire decisions, Rule 702 of the Federal Rules of Evidence has been amended to include which condition for admissibility of expert testimony?
A) The expert’s knowledge is limited to information based only on academic work and not on experience
B) Testimony is based on precedent from relevant case law
C) Testimony is the product of reliable principles and methods.
D) The expert receiving training at a reputable medical school
C) Testimony is the product of reliable principles and methods.
Physician/patient privilege belongs to:
A) The patient’s defense attorney
B) The prosecuting attorney
C) The patient’s treating clinician
D) The patient
E) The patient’s next of kin
D) The patient
Privilege is the patient’s right to bar the clinician from testifying about information gathered in the course of treatment in legal settings
P=Privilege=Patient
Modern informed consent standards regarding medical decisions are primarily driven by the concept of:
A) Autonomy
B) Paternalism
C) Justice
D) Beneficence
E) Competence
A) Autonomy
A mental health expert’s concerns about the future of mental health testimony under the Daubert standard might include:
A) Likelihood of “junk” science being admitted into evidence
B) Role of the judge as gatekeeper
C) A judge’s reticence to admit a complicated but generally accepted psychological test
D) All of the above
D) All of the above
In federal courts, hypnotically refreshed testimony offered by defendants is:
A) Inadmissible absent a showing of undue hardship
B) Admissible but subject to the Federal Rules of Evidence
C) Admissible under the Frye standard
E) Inadmissible under the Daubert standard
B) Admissible but subject to the Federal Rules of Evidence
The Fed Rules of Evidence will govern the admissibility of any offered hypnotically refreshed testimony by a defendant
The Delaware Supreme Court agreed that Dr. Naidu’s decision to discharge a psychiatric patient was the proximate cause of Mr. Laird’s death because:
A) The patient was discharged the same day his psychotic behavior led to Mr. Laird’s death.
B) The patient was discharged on a month before his psychotic behavior led to Mr. Laird’s death.
C) The court found that temporal span alone was not a sole determination of proximate cause.
D) None of the above.
C) More than 5 months after Mr. Putney was discharged from the Delaware State Hospital and while he was still psychotic, he intentionally drove his car into Mr. Laird’s car, killing Mr. Laird. The trial court found Mr. Putney’s negligent discharge as the proximate cause of Mr. Laird’ death. The Delaware Supreme Court agreed, refuting the argument that too much time had elapsed to link the psychiatric discharge to the cause of death. As the court noted, “temporal span” by itself was insufficient to define proximate causation.
A man with chronic schizophrenia is evaluated in the emergency room and appears to be actively hallucinating. He says that he wants to sign himself into the hospital because the aliens tell him to do so. As a psychiatrist, you should:
A) Allow the patient to voluntarily sign himself into the hospital
B) Sign the patient into the hospital as an involuntary patient.
C) Assess for competence to sign voluntary admission forms and allow him to sign if competent
D) If not competent to sign voluntary papers, sign the patient into the hospital as an involuntary patient based only on his lack of competence.
C. In Zinermon v. Burch, the USSC decided that it was foreseeable that a person requesting treatment for mental illness may not be competent to given informed consent for voluntary hospitalization, which should be specifically assessed at the time of admission. As such, patients should not be automatically able to voluntarily sign themselves into a hospital without a competence evaluation.
As outlined in Tarasoff, the duty of a psychiatrist to protect a third party from potentially dangerous patient:
A) Is based on a psychotherapist’s responsibility for his or her patient’s actions as part of the legal treatment framework.
B) Arises from abilities psychiatrist are supposed to have to predict violence in the mentally ill.
C) Arises purely from a functional policy directive intended to minimize violent behavior in the mentally ill.
D) Is rooted in the special relationship between a psychotherapist and a patient, with an emphasis on foreseeability.
D. The court in Tarasoff and other appellate courts have rooted the duty of a psychiatrist to protect a third party from a potentially dangerous patient in the special relationship between a psychotherapist and patient. This relationship puts a psychiatrist in a unique place to potentially foresee a danger to a particular third party or class of people, and in turn creates a duty to protect them. This duty is akin to that which a medical doctor has to the public when treating a potentially contagious patient. While the courts have acknowledged this duty, they have also voiced skepticism about psychiatry’s actual ability to predict violence based on any scientific model. They duty arises in relation to specific foreseeable dangers; psychiatrist are otherwise not legally responsible for all the conduct of their patients.
Which of the following was a safeguard to ensure reliability of hypnotically refreshed testimony as established in State v. Hurd?
A) Sessions should be conducted by a licensed psychiatrist or psychologist
B) the hypnotist should be independent of the parties involved
C) Sessions should be videotaped.
D) Only the hypnotist and the subject should present during the session
E) All of the above.
E. All of the choices presented in this question are safeguards that were presented in the State v. Hurd decision to help ensure reliability of hypnotically refreshed testimony.
Which of the following best describes the rules regarding child abuse reporting described in State v. Andring?
A) Physician-patient privilege does not extend to group therapy because patients waive their confidentiality rights when they agree to participate in a group therapy format.
B) Physician-patient privilege supersedes mandated reporting of child abuse if the perpetrator is engaged in mental health treatment.
C) Mandated reporting of child abuse rarely preempts physician-patient privilege.
D) The Federal Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act Amendments of 1974 included provisions to protect a patient’s identity, diagnosis, prognosis, and treatment and preempts the state’s mandated reporting requirements.
E) Federal laws designed to protect the identity, diagnosis, prognosis, and treatment of patients engaged in alcohol or drug treatment are preempted by state-mandated reporting of child abuse requirements.
E. Federal laws designed to protect the identity, diagnosis, prognosis, and treatment of patients engaged in alcohol or drug treatment are preempted by state-mandated reporting of child abuse requirements. In State v. Andring, the MN Supreme Court ruled that physician-patient privilege does extend to group therapy and
Informed consent must be:
A) Voluntary
B) Informed
C) Competent
D) All of the Above
D) All of the above.
Which if the following is true regarding mandated reporting requirements?
A) They include requirements to provide referrals and treatment to appropriate aftercare services.
B) Physicians and psychologists are required to provide informed consent on evidence-based, trauma focused CBT.
C) They are jurisdiction dependent.
D) They represent a discretionary duty for professionals.
C) Mandated reporting requirements are jurisdiction dependent.
Informed consent is required in which of the following situations?
A) Before prescribing standing antipsychotic medications
B) Before seclusion in the hospital
C) Before administering an emergency IM for dangerousness.
D) When the patient is admitted to the hospital involuntarily.
A) before prescribing standing antipsychotic medications per Clites V. Iowa.
The Kumho Tire opinion suggests that expert testimony based on clinical experience would be:
A) Inadmissible on its face
B) More highly scrutinized than scientific or technical expert testimony.
C) Admissible only when there is proof that it is scientific.
D) Subject to the same inquiry to assure reliability and relevance as other testimony.
E) Exempt from Daubert.
D) Subject to the same inquiry to assure reliability and relevance as other testimony. Per Daubert, the judge acts as a gatekeeper to ensure standards of quality.
Various state appellate courts have found which of the following as evidence of negligence in failing to exercise reasonable care to discharge the duty to protect third persons from a potentially dangerous patient?
A) Failing to adequately review records related to the patient’s past psychiatric history prior to discharging the patient.
B) Failing to consider involuntarily hospitalizing a voluntary patient and agreeing to discharge him instead with a reasonable aftercare plan.
C) Failing to address a patient’s likelihood of relapsing on drugs of abuse and not taking prescribed medication after discharge.
D) All of the above.
D) All of the above. All of the options noted have been found as evidence of negligence and discharge a duty to protect. The standard of negligence is what a reasonable psychiatrist would pursue.
The following statement best reflects the reasoning for the ruling in State v. Andring:
A) A patient’s self-incriminating statements made during group therapy are different that those made during individual therapy and are therefore admissible to the court of law
B) The standard of confidentiality that protects physician-patient privilege during testimony in a trial is different than the standard for cooperating with law enforcement during an investigation of sexual abuse.
C) Mental health treatment records are not considered to be protected by physician-patient privilege.
D) Group therapy treatment records are protected by physician-patient confidentiality.
E) When alleged perpetrators are enrolled in sexual offender treatment, they waive their right to confidentiality.
D. Group therapy records are protected by physician-patient confidentiality.
What is the significance of the following statement from the majority’s decision in Tarasoff: “The protective privilege ends where the public peril begins”?
A) A psychiatrist’s duty to protect others from a dangerous patient is ultimately limited by public policy arguments protecting the confidential nature of the doctor-patient relationship.
B) A psychiatrist’s duty to protect the confidential nature of communications with a patient is ultimately limited by the need to protect the public from a potential and foreseeable danger.
C) A psychiatrist’s responsibility to the public is ultimately greater than his responsibility to keep on particular patient safe.
D) A psychiatrist must protect his privilege to practice his profession but must also keep the public safe from psychiatric overclaim.
B) privilege of confidential communication is not without limits and ultimately may be sacrificed when a foreseeable harm can be averted by breaking confidentiality.
In which situation would a physician not have to give information regarding the risk of refusing a procedure?
A) If the patient is a physician.
B) If the risk is commonly known.
C) if the risk is very rare.
D) if the patient is signing him-or-herself in voluntarily to a hospital.
B) If the risk is commonly known. Truman v. Thomas found that it constituted malpractice for a physician to fail to inform of the consequences of refusing a medical procedure. Exceptions to disclosure include if the patient already knows the risk, such as if it is commonly known.
