Assorted Pertinent Topics - Part 1 of 2 Flashcards
What research study examines a group studied over a prolonged time period? (6x)
COHORT
Which statistical method attempts to address the effects of participants dropping out of a study prior to completion? (6x)
LAST OBSERVATION CARRIED FORWARD
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)
ANALYSIS OF VARIANCE
A case-control study would be appropriate in answering an epidemiological question when the (x3):
INCIDENCE OF THE DISEASE IS LOW
What most seriously threatens the external validity of a research study? (3x)
A STUDY POPULATION THAT IS NOT REPRESENTATIVE OF THE POPULATION TO BE TREATED
Test measures what it is supposed to measure (x3)
VALIDITY
Which of the following is the major negative aspect of crossover designs for research studies? (3x)
RESIDUAL EFFECTS
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)?
POWER
What is used to report the deviation of a value from its group mean, expressed in standard deviation units? (2x)
Z SCORE
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)
GOODNESS OF FIT
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)
COHORT
Which of the following types of studies is best suited to determine prevalence? (2x)
CROSS SECTIONAL
A rating instrument is said to have high reliability when which of the following properties is demonstrated: (x2)
RATINGS ARE SIMILAR AMONG DIFFERENT RATERS.
The purpose of designing study to use the double blind method is to (x2):
ELIMINATE BIAS DUE TO EXAMINER EXPECTATIONS
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)
HIGH SENSITIVITY AND LOW SPECIFICITY
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)
EFFECTIVENESS
RTC where pt receives one med for 8 weeks, then break 4 weeks, then another med for 8 weeks. what kind of study?
CROSSOVER
New instrument for PTSD does not ask about traumatic event. Raises which concern about validity?
CONTENT
Difference between incidence rates
ATTRIBUTABLE RISKS
Study design that answers whether exposure to a drug increases risk of an adverse side effect
COHORT
Study type to measure if genetic test is accurate to make dx
CROSS-SECTIONAL
“Two-hit” model = predisposing environmental factors combined with genetic risk
MONOZYGOTIC TWINS ARE DISCORDANT FOR SCHIZOPHRENIA
The concept of lifetime prevalence refers to the number of persons:
MEASURED AT A POINT IN TIME, WHO HAD A D/O AT SOME POINT DURING THEIR LIVES.
Examine relationship between exposure and effect by comparing patients with effect to patients without effect, assessing for prior exposure. Type of study?
CASE-CONTROL
What is type II error?
FINDING ANTIDEPRESSANT INEFFECTIVE WHEN IT IS ACTUALLY EFFECTIVE
What research design would be the most appropriate in establishing a causal relationship between childhood vaccination and onset of autism?
COHORT
Study reports difference that turns out to be by chance, what error is this?
TYPE I ERROR
Research into the complexity of healthcare systems and distribution of resources is best carried out in which fashion?
NATURALISTIC STUDY
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
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
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
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
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
Which study best addresses the relative influences of heritability and environment?
TWIN ADOPTION STUDIES
Why don’t twin adoption studies have methodological limitations?
ADOPTEES ARE NOT A REPRESENTATIVE POPULATION SAMPLE.
What is characteristic of the placebo effect?
THE PLACEBO EFFECT IS GREATER WHEN THE PT KNOWS THE DOCTOR.
This quality of a study indicates that the Findings can be replicated:
RELIABILITY
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
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
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
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.
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
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.
A crossover design is a variation of:
DOUBLE-BLIND
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.
Type of study design most likely to eliminate the bias of knowing what treatment is given to the pt:
DOUBLE-BLIND
Type of study to determine relationship between risk factor and development of disease
COHORT STUDY
What research design best clarifies the role of environment in behavioral genetics?
ADOPTION STUDY
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
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.
The extent to which an instrument represents the construct being measured is referred to as what type of validity?
CONTENT
What relies on statistical review/interpretation of multiple study results?
META-ANALYSIS
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
Which statistic measures magnitude of difference between two intervention groups?
EFFECT SIZE
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
Which research or statistical methodologies were used to develop the DSM-IV-TR?
DATA RE-ANALYSES AND FIELD TRIALS
What terms best defines the degree of spread of scores about the mean?
STANDARD DEVIATION
This describes the statistical concept of point prevalence:
THE PROPORTION OF A POPULATION WITH A SPECIFIC DISEASE AT ONE SPECIFIC TIME.
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
The number of individuals with a d/o at a specific time
POINT PREVALENCE
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
A statistical term that refers to the proportion of pts with the condition in question that a test accurately detects:
SENSITIVITY
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
What statistical measure should be used to determine how 2 independent variables affect the frequency of the occurrence rate of an event?
REGRESSION ANALYSIS
Statistical concept of power is defined as the
PROBABILITY OF REJECTING NULL HYPOTHESIS WHEN IT SHOULD HAVE BEEN REJECTED
An effectiveness study differs from an efficacy study by including what?
REAL WORLD CONDITIONS
Assuming there is no significant difference btwn 2 random samples of population is:
NULL HYPOTHESIS
Measure of central tendency that might best be used to analyze an outcome measure with significantly skewed distribution of its values?
MEDIAN
In a skewed distribution this is a measure of central tendency and moves furthest away from the mode in the direction of skewness:
MEAN
Specificity is:
IDENTIFYING THE # OF PT WITHOUT THE CONDITION WHO HAVE A NEG TEST RESULT
A new screening test correctly classifies early mild impairment in 75% and correctly classifies normal mentation in 85%. What does 85% refer to?
SPECIFICITY
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
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
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
Investigators wish to maximize the probability of correctly rejecting the null hypothesis. This probability is referred to as:
1 MINUS BETA
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
Dementia study with 2 groups, one with history of lorazepam use, and one without, type of study design?
PROSPECTIVE COHORT
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
What measure should be maximized in a screening test to miss the fewest individuals with an illness
SENSITIVITY
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
This measures of disease frequency is most appropriate for determining the rate of new cases of a disorder in a given time period.
INCIDENCE
In psych testing, how is content validity shown?
ADEQUATE SAMPLE OF AREA OF INTEREST
What does “validity” of an assessment mean?
MEASURES WHAT IT INTENDS TO MEASURE
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
Which of the following situational and environmental factors is most clearly associated w/ increased inpatient assaults? (6x)
CHANGE OF SHIFT
Best indication for residential treatment of substance abuse? (3x)
FAILURE TO MAINTAIN ABSTINENCE AFTER TREATMENT IN INPATIENT SETTINGS
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
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
Describe the psychiatric assertive community treatment case management model: (2x)
INTERDISCIPLINARY TEAM, SERVICES IN SITU, HIGH STAFF/PATIENT RATIO, AND INTENSIVE OUTPATIENT RESEARCH
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
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
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
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
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.
Integrated setting with primary care and mental health, which would be population based technique to provide collaborative care?
TRACKING CLINIC PATIENTS IN A REGISTRY
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
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
If interviewing an agitated patient
BE AWARE OF BODY POSITION OF SELF AND PT
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
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
Major issue with maintaining severely mentally ill in community
INSUFFICIENT RESOURCES
Basic concept of community psychiatry
CONTINUITY OF CARE
Public mental health clinicians who follow patients through all phases of treatment
CASE MANAGERS
Managed care org. asks MD to d/c a pt who still requires hospitalization. MD should:
CONTINUE ADMISSION AS LONG AS MEDICALLY NECESSARY
Principal goal of wraparound services:
PREVENT HOSPITALIZATION OR RESIDENTIAL PLACEMENTS
Essential element of wraparound treatment
FORMAL MENTAL HEALTH SERVICES AND INFORMAL COMMUNITY SUPPORT
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
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
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
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
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
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
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
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
An effective consultation-liaison psychiatry program in a medical hospital will result in which of the following?
IMPROVED TREATMENT COMPLIANCE
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
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.”
An effective role of C&L psychiatrist consulting on a manipulative, entitled patient?
MODELING AN APPROACH OF APPEALING TO THE PATIENT’S ENTITLEMENT
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.
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
