Assorted Pertinent Topics - Part 1 of 2 Flashcards
1
Q
What research study examines a group studied over a prolonged time period? (6x)
A
COHORT
2
Q
Which statistical method attempts to address the effects of participants dropping out of a study prior to completion? (6x)
A
LAST OBSERVATION CARRIED FORWARD
3
Q
Groups of pts w/ MDD, dysthymic d/o, and adjustment d/o were given mood scales. In order to compare the means of scores of these three groups, most appropriate statistical methods is: (3x)
A
ANALYSIS OF VARIANCE
4
Q
A case-control study would be appropriate in answering an epidemiological question when the (x3):
A
INCIDENCE OF THE DISEASE IS LOW
5
Q
What most seriously threatens the external validity of a research study? (3x)
A
A STUDY POPULATION THAT IS NOT REPRESENTATIVE OF THE POPULATION TO BE TREATED
6
Q
Test measures what it is supposed to measure (x3)
A
VALIDITY
7
Q
Which of the following is the major negative aspect of crossover designs for research studies? (3x)
A
RESIDUAL EFFECTS
8
Q
What is the method for estimating sample size required to detect statistical effects of defined size for variables with well-known variances is referred to as which of the following types of analysis (x3)?
A
POWER
9
Q
What is used to report the deviation of a value from its group mean, expressed in standard deviation units? (2x)
A
Z SCORE
10
Q
5 y/o boy becomes restless, impulsive, and difficult to manage when not given sufficient exercise. Teacher gives him increased motor activity, and his behavior improves. This is an example of: (2x)
A
GOODNESS OF FIT
11
Q
A group of researchers studied the temperament of a group of children at age 3 months, 2 years, 5 years, and 20 years to determine relationships between initial temperamental characteristics of children who eventually had psychiatric problems. This is an example of what type of study? (2x)
A
COHORT
12
Q
Which of the following types of studies is best suited to determine prevalence? (2x)
A
CROSS SECTIONAL
13
Q
A rating instrument is said to have high reliability when which of the following properties is demonstrated: (x2)
A
RATINGS ARE SIMILAR AMONG DIFFERENT RATERS.
14
Q
The purpose of designing study to use the double blind method is to (x2):
A
ELIMINATE BIAS DUE TO EXAMINER EXPECTATIONS
15
Q
A test that detects 98% of the people who have a disease, but also provides a false positive result for many of the people without the disease, would have a: (x2)
A
HIGH SENSITIVITY AND LOW SPECIFICITY
16
Q
A researcher wants to compare a new atypical antipsychotic medication to the already existing atypical antipsychotics. The researcher wants to conduct the study in routine clinical situations rather than using highly selected subjects. Which of the following study designs would be the most appropriate? (x2)
A
EFFECTIVENESS
17
Q
RTC where pt receives one med for 8 weeks, then break 4 weeks, then another med for 8 weeks. what kind of study?
A
CROSSOVER
18
Q
New instrument for PTSD does not ask about traumatic event. Raises which concern about validity?
A
CONTENT
19
Q
Difference between incidence rates
A
ATTRIBUTABLE RISKS
20
Q
Study design that answers whether exposure to a drug increases risk of an adverse side effect
A
COHORT
21
Q
Study type to measure if genetic test is accurate to make dx
A
CROSS-SECTIONAL
22
Q
“Two-hit” model = predisposing environmental factors combined with genetic risk
A
MONOZYGOTIC TWINS ARE DISCORDANT FOR SCHIZOPHRENIA
23
Q
The concept of lifetime prevalence refers to the number of persons:
A
MEASURED AT A POINT IN TIME, WHO HAD A D/O AT SOME POINT DURING THEIR LIVES.
24
Q
Examine relationship between exposure and effect by comparing patients with effect to patients without effect, assessing for prior exposure. Type of study?
A
CASE-CONTROL
25
What is type II error?
FINDING ANTIDEPRESSANT INEFFECTIVE WHEN IT IS ACTUALLY EFFECTIVE
26
What research design would be the most appropriate in establishing a causal relationship between childhood vaccination and onset of autism?
COHORT
27
Study reports difference that turns out to be by chance, what error is this?
TYPE I ERROR
28
Research into the complexity of healthcare systems and distribution of resources is best carried out in which fashion?
NATURALISTIC STUDY
29
Researchers wish to study a group of students who were exposed to a terrorist attack in which some of their classmates were killed, and compare the students to other students who had not undergone such a trauma. For the study to be considered quasi-experimental, which of the following requirements must be met?
BASELINE DATA MUST HAVE BEEN COLLECTED BEFORE THE EVENT
30
Company X develops new medication for depression. Although the initial trials reveal only modest, statistically insignificant mood benefits, the research team decides to analyze the drug’s effects in subgroups. By subgrouping the subject pool into 20 subgroups, the researchers find statistically significant mood benefits for men/women w birthdays in the early fall. Conclusion that can be drawn from finding is that it is:
AN ARTIFACT OF MULTIPLE ANALYSES
31
In the analysis of results of the national comorbidity study (1994), a nonresponse adjustment weight was included. This inclusion was important for what reason?
NONRESPONDERS WERE FOUND TO HAVE HIGHER RATES OF ILLNESS
32
Research suggests that the frequency of alcoholism in lesbians as compared to heterosexual women was greater only in lesbians over 55 years of age. Which of the following is considered to be the best explanation for this finding?
COHORT PHENOMENON RELATED TO SOCIOCULTURAL ISSUES
33
Examining relationship between exposure to psychotropic during pregnancy and Epstein’s anomaly between women with Epstein’s anomaly and a group of women who had babies w/o this anomaly is an example of
CASE CONTROL STUDY
34
Which study best addresses the relative influences of heritability and environment?
TWIN ADOPTION STUDIES
35
Why don’t twin adoption studies have methodological limitations?
ADOPTEES ARE NOT A REPRESENTATIVE POPULATION SAMPLE.
36
What is characteristic of the placebo effect?
THE PLACEBO EFFECT IS GREATER WHEN THE PT KNOWS THE DOCTOR.
37
This quality of a study indicates that the Findings can be replicated:
RELIABILITY
38
Results are combined from a number of studies of similar design. An overall estimate of the effect of a variable is made which incorporates the information provided by all the studies. The procedure is termed?
META-ANALYSIS
39
A psychiatrist employed by an institution wants to use pt data for research later. How can she get the progress notes?
KEEP HER OWN SEPARATE RECORDS
40
Small pilot study measures changes in MMSE scores to compare the efficacy of two meds for the treatment of Alzheimer’s. Data says there’s difference between meds, but not statistically significant. What do you need to do to clarify?
ENROLL MORE SUBJECTS TO OBTAIN A LARGER SAMPLE SIZE
41
Clinical trial: 2 study meds in 8 hospitals. 20 receive drug 1 in hospitals A,B,C,D, while 20 receive drug 2 in hospitals E,F,G,H. Drug 1 is proven and indicated treatment. Which critical confounder biases the results?
DRUG ASSIGNMENT DEPENDS ON PARTICIPANT’S HOSPITAL.
42
A clinical trial will assess the impact of two atypical antipsychotic meds on glucose intolerance. Half of the participants will start on drug 1 and then be treated with drug 2, while the other half will start on Drug 2 then drug 1. What type of experimental design?
CROSSOVER DESIGN
43
Power analysis is a statistical method used to:
ESTIMATE THE SAMPLE SIZE REQUIRED TO DETECT STATISTICAL EFFECT OF A DEFINED SIZE FOR TWO OR MORE PREDICTORS.
44
A crossover design is a variation of:
DOUBLE-BLIND
45
Adoption research in one method to delineate genetic versus environmental influences on phenotype. The limitation of this approach:
ADOPTEES ARE NOT REPRESENTATIVE SAMPLE AND ADOPTIVE AND BIOLOGICAL PARENTS MAY RESEMBLE ONE ANOTHER.
46
Type of study design most likely to eliminate the bias of knowing what treatment is given to the pt:
DOUBLE-BLIND
47
Type of study to determine relationship between risk factor and development of disease
COHORT STUDY
48
What research design best clarifies the role of environment in behavioral genetics?
ADOPTION STUDY
49
Twin studies of patients with schizophrenia have consistently identified substantial proportions of monozygotic twin pairs that are discordant for the illness. The most likely explanation is:
A “TWO-HIT” MODEL OF PATHOGENESIS EXISTS IN WHICH PREDISPOSING ENVIRONMENTAL FACTORS COMBINE WITH GENETIC RISKS
50
The reliability of an assessment instrument, such as diagnostic interview, refers to the ability of an instrument to:
YIELD CONSISTENT RESULTS WHEN USED BY DIFFERENT EXAMINERS OR AT DIFFERENT TIMES.
51
The extent to which an instrument represents the construct being measured is referred to as what type of validity?
CONTENT
52
What relies on statistical review/interpretation of multiple study results?
META-ANALYSIS
53
Researcher is reviewing a questionnaire to screen for MDD, notices that the questionnaire has no Qs pertaining to depressed mood but has a few Qs pertaining to spending sprees. What form of validity is most affected?
CONTENT
54
Which statistic measures magnitude of difference between two intervention groups?
EFFECT SIZE
55
Ten pts are given daily doses of a single antidepressant until their mood becomes euthymic. Eight pts respond to 1mg, one pt responds to 5mg, and one pt responds to 10mg. what best reflects the skewed distribution of effective dose in this group of pts?
MEDIAN
56
Which research or statistical methodologies were used to develop the DSM-IV-TR?
DATA RE-ANALYSES AND FIELD TRIALS
57
What terms best defines the degree of spread of scores about the mean?
STANDARD DEVIATION
58
This describes the statistical concept of point prevalence:
THE PROPORTION OF A POPULATION WITH A SPECIFIC DISEASE AT ONE SPECIFIC TIME.
59
Person estimating usefulness of tx study will use number needed to treat statistic to represent number of pts who need to be treated to produce one additional good outcome beyond that obtainable w control for comparison condition. NNT formula?
INVERSE OF THE ABSOLUTE RISK REDUCTION
60
The number of individuals with a d/o at a specific time
POINT PREVALENCE
61
A resident performs a research study utilizing all of the outpatients with any psychiatric disorder, who were treated during the first 2 months of the resident’s outpatient experience. The resident discovers that of the 47 patients diagnosed with any psychiatric disorder, six meet the criteria for OCD. Which of the following statistic best defines this info?
THE POINT PREVALENCE OF OCD IS 6/47
62
A statistical term that refers to the proportion of pts with the condition in question that a test accurately detects:
SENSITIVITY
63
A method for making a prediction based on observable data in order to assess the valve of the one variable in relation to another is
REGRESSION ANALYSIS
64
What statistical measure should be used to determine how 2 independent variables affect the frequency of the occurrence rate of an event?
REGRESSION ANALYSIS
65
Statistical concept of power is defined as the
PROBABILITY OF REJECTING NULL HYPOTHESIS WHEN IT SHOULD HAVE BEEN REJECTED
66
An effectiveness study differs from an efficacy study by including what?
REAL WORLD CONDITIONS
67
Assuming there is no significant difference btwn 2 random samples of population is:
NULL HYPOTHESIS
68
Measure of central tendency that might best be used to analyze an outcome measure with significantly skewed distribution of its values?
MEDIAN
69
In a skewed distribution this is a measure of central tendency and moves furthest away from the mode in the direction of skewness:
MEAN
70
Specificity is:
IDENTIFYING THE # OF PT WITHOUT THE CONDITION WHO HAVE A NEG TEST RESULT
71
A new screening test correctly classifies early mild impairment in 75% and correctly classifies normal mentation in 85%. What does 85% refer to?
SPECIFICITY
72
Which is used to evaluate the relative frequencies or proportions of events in 2 populations that fall into well defined categories/2 dichotomous variables
CHI - SQUARE
73
An 80 y/o pt presents with sudden onset seizures, hallucinations and aggressive behavior. A preliminary CT scan of head does not show abnormalities. The pt’s family wants to know what is the likelihood that the pt has no changes in his brain given the CT scan. Which of the following concepts would need to be used to respond to the family’s concerns about the CT scan results?
NEGATIVE PREDICTIVE VALUE
74
Residents working on QI project to improve missed handoffs. Aware that this is a systemic problem. Next step?
DESIGN A PROTOCOL TO DETERMINE THE PREVALENCE OF MISSED HANDOFFS
75
Investigators wish to maximize the probability of correctly rejecting the null hypothesis. This probability is referred to as:
1 MINUS BETA
76
In a properly conducted randomized trial, why don’t you include P-values in the baseline characteristics table?
ANY DIFFERENCES AT BASELINE MUST HAVE ARISEN BY CHANCE GIVEN RANDOMIZATION
77
Dementia study with 2 groups, one with history of lorazepam use, and one without, type of study design?
PROSPECTIVE COHORT
78
A cross sectional study shows less depressive disorders in people who use a natural pill. They then observe people from the same population for a year and find that prevalence of depression is lower in those who regularly used the pill. They then recruit a sample from the same population and randomly assign people to pill or placebo for one year. This didn’t show any difference. Assuming no major flaws in design or analysis, what is the most likely explanation for the discrepancies in results?
SOME UNKNOWN VARIABLE CONFOUNDED THE NON-RANDOM RESULTS
79
What measure should be maximized in a screening test to miss the fewest individuals with an illness
SENSITIVITY
80
In a randomized controlled trial, one group got usual antipsychotic and benzos for rescue. experimental group got new antipsychotic and NO rescue. Group responses equal. What threatens validity in this study?
CONFOUNDING VARIABLE
81
This measures of disease frequency is most appropriate for determining the rate of new cases of a disorder in a given time period.
INCIDENCE
82
In psych testing, how is content validity shown?
ADEQUATE SAMPLE OF AREA OF INTEREST
83
What does “validity” of an assessment mean?
MEASURES WHAT IT INTENDS TO MEASURE
84
What design measure is increased in a crossover study where study subjects serve as their own controls: Precision, between subject variation, relative cost, or number of subjects recruited
PRECISION
85
Which of the following situational and environmental factors is most clearly associated w/ increased inpatient assaults? (6x)
CHANGE OF SHIFT
86
Best indication for residential treatment of substance abuse? (3x)
FAILURE TO MAINTAIN ABSTINENCE AFTER TREATMENT IN INPATIENT SETTINGS
87
29 y/o schizophrenic frequent ER visits and hospitalizations. Hallucinating, agitated, not violent or suicidal, cooperative. Ran out of meds a few days ago. Had been doing well on olanzapine for several months and was doing fairly well in structured living environment. Denies command AH. What should the next intervention here be? (3x)
CONTACT CASE MANAGER TO VERIFY ENVIRONMENTAL SUPPORT
88
Patient with MDD; psychiatrist prescribes antidepressant, psychologist provides interpersonal therapy. Who is responsible & accountable for what? (2x)
PSYCHIATRIST IS RESPONSIBLE & ACCOUNTABLE FOR ALL TREATMENT; PSYCHOLOGIST JUST FOR PSYCHOTHERAPY
89
Describe the psychiatric assertive community treatment case management model: (2x)
INTERDISCIPLINARY TEAM, SERVICES IN SITU, HIGH STAFF/PATIENT RATIO, AND INTENSIVE OUTPATIENT RESEARCH
90
29 y/o M pt with hx of CPS 8x hospitalization in 14 months, stopped his meds and is unable to take care of himself, becomes paranoid and stays on the street, eating out of garbage cans and his family is unable to support him anymore. The most appropriate intervention to decrease this pt’s risk of future hospitalizations: (2x)
ASSERTIVE COMMUNITY TREATMENT
91
As part of comprehensive pain management team for pt w hx of narcotic abuse, a consulting psychiatrist may appropriately be asked to do which of the following? (2x)
RESOLVE CONFLICTS BETWEEN THE PATIENT AND THE TREATMENT TEAM
92
Pt consults psychiatrist b/c former psychiatrist has retired & pt wishes to continue Tx w antidepressants. The pt is seeing a counselor for weekly psychotherapy and plans to continue. The psychiatrists eval confirms the Dx of MDD and psychiatrist feels that continuing the pt ‘s antidepressant is indicated. Next step? (2x)
ESTABLISH A CLEAR UNDERSTANDING OF THE DIVISION OF RESPONSIBILITIES BETWEEN PSYCHIATRIST AND COUNSELOR
93
Psychiatrist sees family of a pt who is in vegetative state. All staff, except one nurse, & all of family, except one adult child, believe it is “time to let go.” But nurse & adult child claim signs of recognizing & responding to them despite all of the evidence of cortical brain death. Most appropriate next step? (x2)
MEET SEPARATELY WITH FAMILY AND STAFF TO EXPRESS ISSUES OF POLARIZATION
94
Psych unit staff wants initiative that decreases completed suicides inpatient. Which will have the greatest effect of decreased suicides while maintaining therapeutic environment and minimizing staff burden?
REDESIGNING THE PHYSICAL SPACE TO ELIMINATE POTENTIAL ANCHOR POINTS FOR HANGING.
95
Integrated setting with primary care and mental health, which would be population based technique to provide collaborative care?
TRACKING CLINIC PATIENTS IN A REGISTRY
96
Existing mental health care programs that do not have the capacity to provide effective treatment to all patients in need would be a primary rationale for implementing what?
COLLABORATIVE CARE
97
Of the following which is most effective in reducing inpatient hospital use, increasing housing stability, controlling psychiatric sx, and improving quality of life, for the severely mentally ill.
ASSERTIVE COMMUNITY CARE
98
If interviewing an agitated patient
BE AWARE OF BODY POSITION OF SELF AND PT
99
Evidence based treatment algorithm to maximize chances of successful consultation
PLAN A FOCUSED WORKSHOP FOLLOWED BY RETURN VISITS FOR FURTHER TRAINING AND PROBLEM-SOLVING SESSIONS
100
Pt has phoned the ED complaining of hallucinations that command the pt to kill others. Psychiatrist’s first action:
OBTAIN PHONE NUMBER, ADDRESS OF PATIENT
101
Major issue with maintaining severely mentally ill in community
INSUFFICIENT RESOURCES
102
Basic concept of community psychiatry
CONTINUITY OF CARE
103
Public mental health clinicians who follow patients through all phases of treatment
CASE MANAGERS
104
Managed care org. asks MD to d/c a pt who still requires hospitalization. MD should:
CONTINUE ADMISSION AS LONG AS MEDICALLY NECESSARY
105
Principal goal of wraparound services:
PREVENT HOSPITALIZATION OR RESIDENTIAL PLACEMENTS
106
Essential element of wraparound treatment
FORMAL MENTAL HEALTH SERVICES AND INFORMAL COMMUNITY SUPPORT
107
31 y/o postpartum F distressed by fantasies of smothering baby, tearfully describes feeling overwhelmed by the burden of the child care. She denies SI/HI, but describes feeling some evil external force taking her baby away. Requests outpt psych f/u & refuses voluntary admission> her husband says everything is fine. Next step:
INVOLUNTARY ADMISSION
108
How to manage telephone conversation with labile patient who ended relationship with boyfriend and is having SI with plan, but is willing to stay with family and allows you to speak with family?
NEXT DAY OUTPATIENT FOLLOW UP WITH PSYCHIATRIST
109
50yr old pt divorced and laid off from work presents to ED with SI with plan to OD on tylenol, lacks social support and has impulsive history, disposition?
INPATIENT HOSPITALIZATION
110
What response would be based on a purely laisonal model of psychosomatic medicine give for a pt who may be depressed?
ADVISE THE TEAM ON HOW TO PROPERLY DIAGNOSE DEPRESSION
111
C&L psych sees 58 y/o widowed pt medicine wants to discharge d/t neg workup for abd pain and nausea. Pt refuses to return home to adult kids because the food they prepare are making her sick and causing her sxs. MSE unremarkable and no past psych hx. Next step?
SCHEDULE MEETING WITH THE MEDICAL TEAM, PATIENT, AND FAMILY
112
Psych MD sees 62 y/o pt who has been hospitalized after an acute MI because staff report that “the pt is driving us crazy.” The nurses complain that pt is constantly requesting info about his condition and treatment, and will refuse tests and medications if he feels the explanations are not sufficient. On interview pt admits that “I am a perfectionist” but is proud of this fact, saying that it is “the secret of my success.” Pt is aware of the staff’s frustration, but feels his requests for information are reasonable. The best advice to the Tx team?
ANSWER THE PT’S QUESTIONS AND ACTIVELY INVOLVE THE PT IN ALL PORTIONS OF HIS TREATMENT
113
Psych eval requested on management of 32 y/o pt admitted by internal medicine for tx of severe gastrointestinal viral infection—dehydration, nausea, vomiting, fever. Pt has hx schizoaffective disorder, controlled w stable doses of clozapine over the past year. Staff concerned that pt might be delusional/hallucinating, as pt has appeared somewhat confused/inattentive. On exam, pt is oriented to person, place but not time. Pt somewhat slow, appears visibly ill/tired. Pt complains of stiffness, there is some rigidity to movements. Psych recommendation?
DISCONTINUE CLOZAPINE
114
Which of the following is the principal service provided by the liaison component of consultation-liaison psychiatry?
TEACHING PSYCHOSOCIAL ASPECTS OF MEDICAL CARE TO OTHER HEALTHCARE WORKERS
115
An effective consultation-liaison psychiatry program in a medical hospital will result in which of the following?
IMPROVED TREATMENT COMPLIANCE
116
58 yo patient with breast cancer on the C&L service, recently put on palliative level and develops depression. She is hopeless but denies SI. What is the most appropriate response?
VALIDATE THE PATIENT’S FEELINGS
117
Consultant evaluates patient for capacity. Patient refusing meds, procedures, yells at nurses, orders take out into hospital, threatens lawsuits if demands not met. Patient accuses doctor of being abusive, screams at doctor, when asked for explanation of behavior “you’re just another person here to abuse me!” Best response and advice for medical team is?
"THE PATIENT IS A DIFFICULT PATIENT TO WORK WITH. LET’S TALK ABOUT WAYS TO MANAGE THE PATIENT’S BEHAVIOR.”
118
An effective role of C&L psychiatrist consulting on a manipulative, entitled patient?
MODELING AN APPROACH OF APPEALING TO THE PATIENT’S ENTITLEMENT
119
27 y/o angry, agitated pt is admitted to the ER. He is evaluated during initial interview as non- psychotic and high risk for imminent violence. He refuses medication. What would be the most appropriate intervention at this time?
USE EXTERNAL RESTRAINT WITH CALM REASSURANCE.
120
24 yo pt comes to ed with wrist cuts. pt reports having no intention to die but wanted to feel things. Admits to other self harm behaviors when stressed. Admission to psych hospital would be most supported by what in the patient's history?
RECENT ALCOHOL ABUSE
121
27 y/o uninsured pt was hospitalized in an intensive care unit after a near lethal OD which followed the ending of a long-term relationship. Pt is medically ready for discharge, but is ambivalent about follow-up psych care, noncommittal when asked about regretful feelings for surviving. Best approach?
INPATIENT HOSPITALIZATION
122
What psychiatric symptom does not require pharmacologic treatment in the ER?
SUICIDALITY
123
There are 3 primary components of “meaningful use” of electronic medical records (EMR). These include certified EMR in a meaningful manner, use of certified EMR technology to submit clinical quality measures, and which of the following?
ELECTRONIC EXCHANGE OF HEALTH INFORMATION TO IMPROVE QUALITY OF CARE
124
Q150. Intensive case management is a program with elements of the assertive community treatment model, assertive outreach model, and case management model with a caseload of up to 20 patients. When compared to usual care, research demonstrates which desirable effects of intensive case management?
REDUCED LENGTH OF HOSPITALIZATION
125
24y/o Colombian-American is concerned about how to maintain his parent’s cultural heritage after he marries a Caucasian. Which type of acculturative stress is he dealing with? (4x)
INTEGRATION
126
47 y/o F w/ increased preoccupation with questioning her lifelong affiliation with her church and has been spending time visiting other churches. Concerned she is losing her faith, feels guilty and anxious. No SI, MSE normal, states would never act against her moral beliefs. Dx? (3x)
RELIGIOUS OR SPIRITUAL PROBLEM
127
14 y/o Native American Indian girl brought to mental health center b/c she has visions of spirits. Tells psychiatrist spirits are elders who appear, give her advice. No hx substance abuse/mental disorder. Interview w parents reveals they are traditional
& feel daughter’s visions are a gift. But they are worried about schoolwork, which has deteriorated b/c she has been preoccupied with spirits. Tx should focus on: (3x)
DEALING WITH HER SCHOOL PROBLEMS
128
How is ethnicity defined? (2x)
GROUP OF INDIVIDUALS SHARING SENSE OF COMMON IDENTITY, COMMON ANCESTRY, SHARED BELIEFS, & HX
129
20 y/o western trained psychiatrist of northern European descent has been asked to treat a 40 y/o Hindu patient who emigrated to the US 2 years ago. The patient presents with complaints of weakness, fatigue, headaches, insomnia, palpitations, and decreased appetite. The patient also reports a 5 lb weight loss over the last month, dysphoric mood with intermittent anxiety, and suicidal ideation. In addition to assessing the patient’s level of suicidality, it would be appropriate for the psychiatrist to do which of the following when beginning treatment? (2x)
ASK THE PATIENT WHAT HE BELIEVES EXPLAINS THE SYMPTOMS
130
Racial/ethnic group with highest rate of suicide? (x2)
NATIVE AMERICANS
131
Social psychological study of the view of self in some western cultures has delineated differences from the definition of self in many non-western cultures. What best describes the basis for positive self-esteem in those non-western cultures? (2x)
POSITIVE CONTRIBUTIONS TO THE GROUP AND HARMONIOUS RELATIONS
132
Acculturation outcome associated with high risk for suicide, substance abuse, and alcoholism (x2):
LACKING STRONG ALLEGIANCE TO NATIVE CULTURE, AND NOT INCORPORATING HOST CULTURE
133
Puerto Rican and other Latin American pts are more likely than those from western culture to report their depression as what? (x2)
NERVOUSNESS
134
Appropriate response to immigrant patient with vague complaint
"HOW WOULD YOU DESCRIBE YOUR PROBLEM TO A FAMILY MEMBER OR FRIEND?
135
Females of which ethnicity report highest rates of intimate partner violence?
NATIVE AMERICAN
136
Research shows dissociative symptoms most commonly represent what worldwide?
NORMAL PART OF RELIGIOUS/RITUAL EVENT
137
What DSM-IV diagnosis is likely for 41 y/o man with increasing sense of conflict about changing his beliefs from work-oriented to faith-oriented. No past or present psych symptoms, stable vocational hx.
RELIGIOUS AND SPIRITUAL PROBLEM
138
48 y/o with chronic sadness and no relationships since husband died 12 years ago. Normal grieving, no DSM-IV criteria for d/o, has successful career and close friends. States has conversations with her dead husband and he talks to her. Believes in heaven. Likely classification of these experiences is:
PART OF A BELIEF SYSTEM ENDORSED BY HER RELIGION
139
According to the World Health Organization, what is the number one psychiatric cause of loss of years of healthy life as measured by disability-adjusted life years for individuals between ages of 15 and 40 years?
UNIPOLAR MAJOR DEPRESSION
140
Whenever the culture of western med has been a focus of inquiry by anthropologists, what diagnosis has been seen as a culture bound syndrome in north America?
DISSOCIATIVE IDENTITY D/O
141
Pt’s family believes depression is 2/2 santeria curse. During assessment, psych should focus on...
LEARNING FROM PT AND FAMILY WHAT THEY BELIEVE THE COURSE OF THIS ILLNESS IS EXPECTED TO BE
142
Immigrants to US experience stress & demoralization most during which period?
DURING FIRST 1-3 YEARS IN THE COUNTRY
143
22 yo M pt complains of fatigue, abd pain, weight loss and believes it is caused by nocturnal
emissions of semen. What is pt’s ethnic background?
SOUTHEAST ASIAN
144
Common ancestry + a shared sense of identity, beliefs, and history
ETHNICITY
145
An accurate statement regarding assessment for cultural ID:
INFLUENCED BY ONE’S DEGREE OF ACCULTURATION
146
30 y/o MD who has emigrated from China to the US continues to take pride in family recipes, but has recently embraced American ballroom dancing. This represents which of the following:
ACCULTURATION
147
The culturally and Linguistically Appropriate Services (CLAS) federal standards for healthcare organizations require the organizations to:
HAVE PT-RELATED MATERIALS AVAILABLE IN THE PT’S NATIVE LANGUAGES.
148
A Japanese family who recently moved from Japan brings their 6 yo child for an evaluation. They express concerns that the child appears depressed, is reluctant to go to school, and is fearful that harm will befall the parents. During the evaluation it is noted that the child sleeps in the same room as the parents. Which of the following is the most likely explanation of this sleeping arrangement?
CULTURAL NORM
149
Psychiatrist evaluates recent immigrant with complaint of “altered nerves” Clinical interpreter from pt’s cultural background explains that culturally the nervous system is believed to be altered by stressful life events. What cultural group does pt most likely belong to?
HISPANIC AMERICAN
150
What most accurately describes scientific understanding of the concept of race?
SOCIOPOLITICAL DESIGNATION ASSIGNING INDIVIDUALS TO A PARTICULAR GROUP THAT HAS MEANING DERIVED FROM PREVAILING SOCIETAL ATTITUDES
151
How is “race” different than “ethnicity”?
RACE IS BASED ON PHYSICAL CHARACTERISTICS WHEREAS ETHNICITY INCORPORATES MULTIPLE FACTORS
152
American psychiatrists over dx in African American patients w mood/psychotic sx?
SCHIZOPHRENIA
153
Which of the following is a component of the psychiatrist’s formal cultural formulation of a pt’s disorder:
THE PT’S EXPLANATION OF THE ILLNESS
154
Culture-bound syndrome in Caribbean and states bordering Gulf of Mexico – anxiety, GI distress, weakness, fear of being poisoned, attributed to witchcraft
ROOTWORK
155
Which is the most significant disadvantage of using a family member as interpreter for a patient who does not speak the psychiatrist’s language?
PT MAY CENSOR COMMENTS TO KEEP INFO FROM THE FAMILY
156
Most common complaint in southeast Asians who are dx w/ mental disorder is:
MULTIPLE SOMATIC SYMPTOMS
157
Culture bound in industrialized countries per DSM IV
BULIMIA
158
What culture-bound syndromes would be Dx for a pt with of insomnia, HAs, anorexia, fears, despair, diarrhea, & anger?
ATAQUE DE NERVIOS
159
Which demographics indicate both a common ancestry and a shared sense of identity, belief and history?
ETHNICITY (NOT RELIGION)
160
Family response to a member with ataque de nervios would most likely be to do what?
RALLY TO SUPPORT RELATIVE BY REMOVING STRESSORS
161
Treating 40 year old Hindu patient who presents with weakness, fatigue, headaches, insomnia, palpitations, decreased appetite. 5 lb weight loss over last month, dysphoric mood with intermittent anxiety, suicidal ideation. What else to assess besides suicidality?
ASK PATIENT WHAT THEY BELIEVE IS CAUSING SYMPTOMS
162
Hand washing rituals are most related to what defense mechanism? (4x)
UNDOING
163
A defense mechanism characterized by a self of object representation that is disavowed by placing it into someone else, and inducing the latter to unconsciously identify with the self/object representation: (4x)
PROJECTIVE IDENTIFICATION
164
Young man recounts how his father kicked his puppy to death, no emotion when telling the therapist this despite therapist’s upset response. Defense mech? (3x)
ISOLATION OF AFFECT
165
Semiconsciously diverting attention from a conflict in order to minimize discomfort is an example of what defense mechanism? (3x)
SUPPRESSION
166
Which defense mechanism most relevant to etiology of delusional disorders (like paranoia) according to psychodynamic theory: (2x)
PROJECTION
167
A parent who just learned that her child has been injured and taken to the hospital, arranges for a neighbor to care for her other children and then rushed to the hospital. What defense mechanism did the parent use to handle her own fear? (2x)
SUPPRESSION
168
Defense mechanism: a transient return to earlier behaviors characteristic of earlier stage of development in response to stress/conflict, despite overall maturation (2x)
REGRESSION
169
According to psychoanalytic theory, feelings of persecution are most reflective of which of the following defense mechanisms?
PROJECTION
170
Defense mechanism that involves internalizing the qualities of an object?
INTROJECTION
171
Patient with murderous impulses towards a neighbor gives the neighbor a bouquet of flowers. This is an example of:
REACTION FORMATION
172
Couple in therapy review argument at family reunion, husband told his sister-in-law that his wife was superior to her in every way, the wife expressed disapproval, husband became quiet and later fell down a flight of stairs. What defense mechanism is this?
TURNING AGAINST SELF
173
Management of patient in denial immediately after MI:
SUPPORTING THE PATIENT, UNLESS DENIAL INTERFERES WITH CARE
174
Per psychoanalytic theory, unacceptable affects and impulses are commonly gratified in socially acceptable ways through:
SUBLIMATION
175
30 y/o in therapy struggles with feelings of ambivalence about mom. Mom now has metastatic BrCA. If the patient uses anticipation as a defense mechanism, she might:
SET ASIDE A NIGHT OF THE WEEK TO HAVE DINNER WITH MOM TO DISCUSS MOM’S RXN TO DIAGNOSIS
176
Major psychological defense mechanism that determines the form and quality of OC symptom is
REACTION FORMATION
177
One group member alternates between being the “scapegoat” for the group or the “spokesman” for the group. These events are a group version of what?
PROJECTIVE IDENTIFICATION
178
When asked about a coworker after a recent conflict, a patient states “I harbor no ill feelings toward him, but he truly hates me.” The is example of which defense mechanism?
PROJECTION
179
Disassociation is what type of defense mechanism?
NEUROTIC DEFENSE
180
Pt is annoyed by family’s expression of concern for his condition, saying, “what they are saying is all in the talk.” What defense mechanism is this?
DEVALUING
181
7 y/o states he knows Dad died, but why didn’t he come to the birthday party? Defense mechanism:
DENIAL
182
In Vaillant’s model of life span development, what is classified as a mature defense mechanism:
HUMOR
183
Pt’s wife states he drinks almost every night. Pt states he never drinks to excess, never drinks outside the home, never needs an eye opener, and drinking does not affect his work performance. This is an example of which defense mechanism?
DENIAL
184
A child is jealous of the older sibling’s accomplishment and becomes less jealous when he (the patient) accomplishes something. Which defense mechanism is this?
SUBLIMATION
185
Couples therapy, husband complains that MD wife works too long hours, she says she stays late to make sure everything is “right” checking and rechecking her work. Notes that once in high school she wished her straight-A brother dead and later he died on hunting trip. Her checking behavior is an example of: (2x)
UNDOING
186
In a session, a couple seems blissfully content when happy but enraged when frustrated by the other. They alternate between over-idealizing and devaluing the other. This is an example of?
SPLITTING
187
Obsessive-compulsive symptoms are characterized by which defense mechanism?
ISOLATION AND UNDOING
188
Scientific development that made NIMH epidemiological catchments area studies possible (9x)
THE DEVELOPMENT OF OPERATIONALIZED DIAGNOSTIC CRITERIA AND STANDARDIZED INSTRUMENTS
189
According to NIMH Epidemiologic Catchment Area Program’s reports on ethnicity & prevention of mental disorders, the lifetime rates of APD are: (5x)
EQUAL AMONG ASIANS, HISPANICS, AFRICAN- AMERICANS, AND WHITES.
190
Which is listed on President’s New Freedom Commission on Mental Health (2003?) (2x)
ADDRESSING MENTAL HEALTH AS VIGOROUSLY AS PHYSICAL HEALTH
191
Core characteristic of the "system of care" movement in community mental health?
EMPOWERING FAMILIES TO PARTICIPATE IN TREATMENT PLAN DECISIONS
192
Stage that panic d/o presents?
LATE ADOLESCENCE
193
#1 preventable cause of death in USA
TOBACCO USE DISORDER
194
In a QI project which outcome indicator that is feasible to measure and relevant to mental health
CHANGE IN DEPRESSION SCORE FROM ADMISSION TO DISCHARGE ON A RATING TOOL
195
Outcome of deinstitutionalization
HIGHER RATIO of MENTALLY ILL PATIENTS IN PRISONS AS COMPARED TO HOSPITAL
196
What psychiatric illness is the leading cause of disability in persons 15-44y?
MDD
197
Pts with unipolar depression differ epidemiologically from pts with bipolar d/o in what way?
THE DISCREPANCY BETWEEN MALE FEMALE LIFETIME PREVALENCE RATES IS GREATER.
198
What is an example of secondary prevention?
SCREENING FOR DEPRESSION.
199
In the Institute of Medicine classification system developed to clarify different aspects of prevention, the category of “indicated interventions” refers to which of the following?
INTERVENTIONS THAT FOCUS ON HIGH-RISK INDIVIDUALS TO ENHANCE RESILIENCE AND PREVENT ONSET OF THE ILLNESS
200
Check fasting lipid panels before starting treatment before atypical antipsychotics. Which health quality implemented according to the aims of the Institute of Medicine?
SAFETY
201
Which of the following probabilities most accurately describes the likelihood of patients with schizophrenia committing homicide compared with the general population?
EQUAL LIKELIHOOD
202
Which of the following factors is most closely associated with child abuse and neglect?
HOUSEHOLD POVERTY
203
Which of the following is the most common method of completed suicide in female children and adolescents?
FIREARMS
204
In the US, what is the most common method of completed suicide?
SHOOTING ONESELF
205
A finding regarding epidemiology of nicotine use:
YOUNG ADULTS REPORT THE HIGHEST RATES OF SMOKING
206
Socioeconomic status is correlated to risk for mental illness, such as those who are disadvantaged by social class are more likely to develop a mental d/o. research shows that this correlation is accounted for mainly by greater:
VULNERABILITY TO THE IMPACT OF STRESSFUL LIFE.
207
Which population has highest prevalence of Schizophrenia?
MONOZYGOTIC TWIN OF SCHIZOPHRENIC PT
208
When compared to younger age groups, the prevalence estimates of MDD in persons older than 65 years are:
LOWER IN BOTH MEN AND WOMAN
209
Prevalence of psychotic disorders after age 65 is:
LOWER IN BOTH MEN & WOMEN
210
What somatoform d/o has male=female?
HYPOCHONDRIASIS
211
What distinguishes hypochondriasis from delusional d/o, somatic type?
INSIGHT
212
Leading cause of death for 15-24 y/o African American males?
HOMICIDE
213
What best characterizes the current explanation for group differences in prevalence of psychiatric illness?
FACTORS THAT PROMOTE VULNERABILITY TO STRESS
214
Past years annual prevalence much higher than annual incidence
DISEASE IS CHRONIC
215
According to the WHO, the world's greatest cause of mortality, ill health and suffering is what?
DEPRESSION AND SUICIDE
216
The rate of illicit drug usage in high school is highest among which groups in USA?
CAUCASIAN AMERICANS
217
Highest prevalence psych d/o?
ANXIETY DISORDERS
218
What is prevalence of Alzheimer’s in >85 y/o?
16-25%
219
Lifetime prevalence rate for ETOH abuse and dependence
15%
220
Lifetime prevalence of schizophrenia
1%
221
Risk factor most predictive of a pt having emergent SI:
PERVASIVE INSOMNIA
222
Assessment instrument used in epidemiology study relies solely on subjects report:
GENERAL HEALTH QUESTIONNAIRE
223
Intimate partner violence is most common in which of the following demographics ?
LOW INCOME FAMILIES
224
According to the epidemiological Catchment Area Project, what condition is associated with higher rates of mood and anxiety symptoms compared to those with low back pain?
IRRITABLE BOWEL SYNDROME
225
Disorder carrying greatest global burden of disease?
MDD
226
What is the best predictor of healthy aging in elderly individuals?
REMAINING IN CONTACT WITH FRIENDS
227
Way sexual health changes in older individuals
REFRACTORY PERIOD FOR MEN INCREASES
228
According to USPSTF ,which demographic group has highest prevalence of depression?
PREVIOUSLY MARRIED
229
Which ethnic group in the US has the lowest 12 month prevalence of alcohol use disorder
ASIAN AMERICANS AND PACIFIC ISLANDERS
230
Routinely informing pts about confidentiality limits is an example of what ethical skill? (6x)
BUILDING ETHICAL SAFEGUARDS INTO WORK
231
What ethical principle provides the most appropriate basis for psychiatric intervention in a mentally incompetent patient? (5x)
BENEFICENCE
232
In ethics, beneficence is: (5x)
APPLYING ONE’S ABILITIES SOLELY FOR THE PATIENT’S WELL-BEING. PHYSICIAN ACTS PATERNALISTIC
233
Difference between a boundary violation and boundary crossing is? (5x)
BOUNDARY VIOLATIONS ARE CHARACTERISTICALLY EXPLOITATIVE
234
“First do no harm” refers to which of the following principles: (4x)
NONMALEFICENCE
235
F pt in twice-weekly psychodynamic psychotx w male therapist for the last year begins to discuss sexual fantasies about the therapist. The therapist feels flattered by the sexual interest of this patient and notes his own feelings of attraction to her. The most appropriate next step for the therapist is to: (4x)
SEEK CONSULTATION WITH A COLLEAGUE
236
A suicidal 18 y/o pt who lives with his parents is evaluated in the ED. The psychiatrist warns the pt that if he does not sign in voluntarily for inpt tx, the psychiatrist will involuntarily hospitalize the pt. The pt consents to inpt care. The pt in this situation has not given valid informed consent because: (x3)
HE WAS COERCED INTO GIVING CONSENT
237
A famous entertainer comments publicly about having problems cutting down on ETOH use despite knowing negative effects on family members. Well-known psychiatrist, never met the entertainer, goes on a news program and says that the entertainer is most likely experiencing ETOH abuse. What explains ethics of MD? (2x)
UNETHICAL BECAUSE THE PSYCHIATRIST HAS NOT EXAMINED THE ENTERTAINER
238
What reflects opinion of APA on practice of charging a pt for a missed appointment (2x)
SUPPORTS IT IF IT IS CONTRACTED WITH THE PATIENT
239
Watson’s experiment with “Little Albert” demonstrated that an 11 y/o child, who previously shown no phobic response to a stimulus, learned to fear the stimulus after it was repeatedly paired with a loud noise. This would be unethical b/o violation of: (2x)
NONMALEFICENCE
240
Paternalism can be justified by which of the following basic ethical principles (x2):
BENEFICENCE
241
Pt’s spouse calls the patient’s psychiatrist to ask about changes in the patient’s medication. Which of the following would be an appropriate initial response for the psychiatrist to make? (2x)
INFORM THE SPOUSE THAT THE PATIENT’S CONSENT IS REQUIRED TO DISCUSS TREATMENT
242
Most appropriate time to discuss advance directives with a pt (x2)
WHEN THE PT IS COMPETENT
243
The three component of informed consent include: the presentation of information, the voluntariness of consent on the part of pt, and (x2):
MENTAL COMPETENCE
244
Patient attracted to therapist, what should therapist do?
SEEK SUPERVISION FROM COLLEAGUE
245
SI pt needs hospitalization, but insurance thinks partial. What to do?
ADMIT PT TO HOSPITAL AND APPEAL INSURANCE
246
Pt’s insurance refuses to pay for continued hosptialization for a depressed patient who is acutely suicidal. The psychiatrist remains concerned about SI and does not discharge the patient. This best illustrates the ethical principle in managed care of responsibility to ___
TREAT
247
Documents that first promoted first human subject consent in research
NUREMBERG CODE
248
Accepting flowers from a paranoid patient to make patient feel relaxed
BOUNDARY CROSSING
249
What would be a situation in which to report a colleagues behavior?
BEING AGGRESSIVE TOWARD PATIENTS ON THREE DIFFERENT OCCASIONS DURING SHIFTS IN THE ED
250
Ethics of inpatient psych for SI pt refusing tx?
BENEFICENCE
251
On-call resident evaluates new patient with bad dementia. Realizes patient was one of the resident’s former professors and mentors. Resident is the only psychiatrist on the unit. Attending is called and tells resident the hospital doesn’t have a relevant policy. What’s the optimal way to handle this?
FINISH THE EVALUATION AND PROVIDE ANY URGENT TREATMENT BUT INSIST ON A TRANSFER OF CARE AS SOON AS POSSIBLE
252
Psych MD wishes to charge pts for appointments that they do not keep. According to code of ethics of APA, such a policy is:
ETHICAL IF PT IS SPECIFICALLY NOTIFIED IN ADVANCE
253
Psych MD is approached at social gathering by a neighbor who seeks advice about recent Sx of depression and anxiety that neighbor has experienced since being fired from work. Which action would constitute establishment of doctor-pt relationship?
ADVISING NEIGHBOR TO START CBT W ONE OF SEVERAL PROVIDERS
254
Psychiatrist judges patient under managed care plan will need combined psychopharm and psychotherapy for > 1yr. Knows that health plan stops paying after 20 visits. Most ethical to tell patient:
PATIENT MAY NEED MORE TX THAN INSURANCE COVERS
255
APA addressed ethics of sexual relationships between psychiatrists & pts by stating
NOT PERMISSIBLE TO HAVE A SEXUAL RELATIONSHIP WITH A CURRENT OR FORMER PATIENT
256
Ethical standards dictate that the psychiatrist should do what in child custody evals?
INTERVIEW ALL PARTIES TO THE LITIGATION
257
An internal medicine resident who is asked by the residency program to take a leave of absence due to erratic behavior must undergo a psychiatric assessment before returning to clinical duties. Which of the following statements best describes the obligation of the examining psychiatrist?
STATE CLEARLY TO PT PRIOR TO EVALUATION THE PURPOSE OF THE EVALUATION AND THAT THE INFORMATION MAY BE TRANSMITTED TO THE RESIDENCY PROGRAM
258
According to APA, it is unethical for a psychiatrist to:
PARTICIPATE IN LEGALLY AUTHORIZED EXECUTION
259
Fact that participants did NOT receive available indicated treatment in the Tuskegee Syphilis study is an ethical violation of justice, beneficence or non-maleficence?
NON-MALEFICENCE
260
Psychiatrist warns 24 y/o pt- if pt does not sign in to a hospital voluntarily, the patient will be involuntarily committed. This approach violates the spirit of:
INFORMED CONSENT
261
A psychiatrist wishes to charge patients for appointments that they do not keep. According to the code of ethics of the APA, such policy is:
ETHICAL IF THE PT IS SPECIFICALLY NOTIFIED IN ADVANCE
262
Psychiatrist determines that fully informing a pt of tx risks would negatively impact pt’s health/welfare & documents rationale for tx the patient without informing the patient of all the risks. This psychiatrist is intending to use which of the following?
THERAPEUTIC PRIVILEGE
263
Forcing med on pt directly challenges which of the following?
AUTONOMY
264
Providing pts with an understanding of their disorders and options for treatment is honoring which of the following principles of ethics:
AUTONOMY
265
Adolescent with recent SA is about to be discharged from hospital. The parents refuse a request to remove firearms from the house, stating, “I need firearms to protect my family and I will make sure they are secured.” Which ethical principle CONFLICTS with the psychiatrist making a CPS report?
AUTONOMY
266
16 y/o says she think she may be pregnant but does not want to involve her parents. What should guide the psychiatrist’s actions?
THE PATIENT’S ABILITY TO GIVE CONSENT WILL VARY FROM STATE TO STATE TO STATE
267
Failing to obtain informed consent defies which principle of ethics?
AUTONOMY
268
It is ethical for a psychiatrist to bill pt for a missed appointment if:
IF PAYMENT FOR MISSED APPT FALLS IN CONTRACTUAL AGREEMENT.
269
Pt who is poor but talented asks if he can barter for services. You like the pt’s product. What describes the nature of this proposal to accept goods in lieu of fees
IT IS NOT RECOMMENDED AS IT MAY COMPROMISE TREATMENT BOUNDARIES
270
Psychiatrist wishes to charge pts for appointments that they do not keep. According to code of ethics of the American psychiatric association such a policy is:
ETHICAL IF THE PATIENT IS SPECIFICALLY NOTIFIED IN ADVANCE
271
Pt qualifies for ECT, but does not want his doc to tell him the risks. He is a “chronic worrier” and fears hearing the risks will make him anxious, perhaps to the point of refusing treatment, which he believes he needs. What is the best response?
DOCUMENT THE PT’S KNOWING AND VOLUNTARY WAIVER AND PROCEED WITH TREATMENT
272
Insurance company tells psychiatrist to switch generic drug. You know alternatives may be good too. What do you do?
CONTACT INSURANCE AND ASK FOR NON- FORMULARY APPROVAL
273
Psychiatrist calls pt at home; wife asks how pt is doing. What principle governs response?
CONFIDENTIALITY
274
How should a psychiatrist handle an interview about the misbehavior of a prominent government employee?
COMMENT ON HUMAN BEHAVIOR GENERALLY, BUT REFUSE TO OFFER OPINIONS ABOUT THE SPECIFIC PERSON
275
Son of 70 y/o pt calls psych MD to reports his mom has b/c depressed in last 6 months, but pt denies being sad and refuses to see psych MD. Son mentions that he will bring mother to the appointment under the pretense of having her back pain checked. Most appropriate response from psych MD would be to:
TRY TO DISSUADE THE SON FROM USING DECEPTION
276
Gag-rule clauses in some managed care plans may prohibit docs enrolled in their plans from taking which action?
ADVISING PTS ABOUT TREATMENTS NOT COVERED BY HMO
277
The psych MD who released medical records and audiotapes of the treatment of the poet Anne Sexton to the author who was writing a biography after her death could have been criticized for violating what principle?
CONFIDENTIALITY
278
Psych MD is treating a child whose parents are divorced. Under what circumstance is it ethically acceptable for the psychiatrist to have a romantic relationship with the child’s parent?
UNDER NO CIRCUMSTANCES
279
A pt suffers as a result of the pt’s psychiatrist going on vacation w/o providing coverage. The psychiatrist’s problematic behavior violates which of the following ethical principles?
FIDELITY
280
The efforts of psychiatrists to achieve “parity” legislation for mental illness can best be seen as illustrating which of the following moral principles?
JUSTICE
281
If a third party is supervising a therapy case, the resident should inform the patient..
THAT HIS CASE WILL BE DISCUSSED
282
A psychiatrist and spouse are attending a concert. During intermission, the psychiatrist sees that they will cross paths in the lobby with one of the psychiatrist’s patients. Which of the following would be the most appropriate conduct for the psychiatrist in this situation?
WALK BY WITHOUT INDICATING KNOWING THE PATIENT, UNLESS THE PATIENT INITIATES CONTACT.
283
Psychiatrist prescribes medication to a psychotherapy pt of another mental health professional, what is his liability in this treatment arrangement?
PSYCHIATRIST RETAINS FULL RESPONSIBILITY FOR PATIENT’S CARE
284
Pt with history of bipolar disorder hospitalized 2 weeks ago for mania and SI. Improved but 2 days before being allowed home visit, patient stops all meds. Doctor states if patient refuses meds, cannot go home for visit. Patient relents and accepts meds after hearing this. From ethical standpoint, response from doctor can be considered:
COERCIVE BUT ACCEPTABLE IF THE DOCTOR BELIEVED NON-ADHERENCE WOULD CAUSE SIGNIFICANT HARM
285
Most significant barrier to accessing mental health services in school-based health centers
CONCERNS ABOUT CONFIDENTIALITY
286
Which is a boundary violation? Investing in a pt’s business, treating the town pharmacist in a small town, accepting pt’s gift of hand-knit scarf, seeing a pt at a reduced fee compared to others, discussing pt’s sexual feelings in session
INVESTING IN A PATIENT’S BUSINESS
287
The Belmont Report states that the underlying principle of informed consent is
RESPECT FOR PERSONS
288
Central principle of Goldwater Rule:
IT IS UNETHICAL FOR PSYCHIATRISTS TO OFFER PROFESSIONAL OPINIONS ON PUBLIC FIGURES WITHOUT A FACE-TO-FACE EVALUATION
289
A patient has refractory depression. The psychiatrist isn’t sure what to try next and consults a supervisor. What ethical principle is illustrated by the consult?
NONMALEFICENCE
290
Conducting a session after hours in a local coffee bar is an example of__?
BOUNDARY VIOLATION
291
Piaget’s contribution to development was a theory explaining what phenomenon? (2x)
HOW INDIVIDUALS LEARN AND UNDERSTAND THE WORLD
292
Multiaxial system introduced in what edition of DSM
DSM III
293
Otto Kernberg’s model for tx of patients with narcissistic personality disorder differs from that of Kohut in that in Kernberg’s model, the goals of psychotherapy include:
INTEGRATING IDEALIZATION AND TRUST WITH RAGE AND CONTEMPT
294
According to Aaron Beck, the primary defect in depression involves which of the following?
COGNITIVE DISTORTION
295
Piaget was interested in:
HOW A CHILD ARRIVES AT ANSWERS
296
First edition of the DSM to exclude homosexuality as a diagnosis:
DSM-III-R (1987)
297
The case of “Little Hans” led Freud to develop a psychological theory of the formation of which of the following symptoms?
PHOBIA
298
In terms of the normal functioning of the personality, Anna Freud’s contributions were in the realm of:
DEFENSE MECHANISMS
299
Theorist introduced the concepts of introversion and extroversion:
CARL JUNG
300
Kohut’s theory of personality is based on?
THE INDIVIDUAL’S NEED FOR EMPATHIC INTERACTION WITH SELF-OBJECTS
