AAPL Landmark - Questions on Mental Health Practice Guidelines

Question 1

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.

Answer 1

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.

Question 2

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.

Answer 2

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.).

Question 3

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

Answer 3

C) In helping a subject relax and concentrate in order to better relay information

Question 4

“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

Answer 4

D) All of the above

Question 5

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.

Answer 5

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.

Question 6

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

Answer 6

E) All of the above

Question 7

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

Answer 7

C) Has developed from state-specific case law that is binding only at a state level

Question 8

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

Answer 8

E) Has the potential to be unreliable

Rock v. Arkansas, State v. Hurd

Question 9

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

Answer 9

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.

Question 10

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.

Answer 10

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.

Question 11

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

Answer 11

C) Testimony is the product of reliable principles and methods.

Question 12

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

Answer 12

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

Question 13

Modern informed consent standards regarding medical decisions are primarily driven by the concept of:

A) Autonomy
B) Paternalism
C) Justice
D) Beneficence
E) Competence

Answer 13

A) Autonomy

Question 14

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

Answer 14

D) All of the above

Question 15

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

Answer 15

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

Question 16

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.

Answer 16

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.

Question 17

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.
C0 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.

Answer 17

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.

Question 18

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.

Answer 18

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.

Question 19

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.

Answer 19

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.