CP 1/ (Incorporated 1-64 Dr M, AP1&2 Flashcards
Which of the following fine motor tasks involved in dressing does a child typically master last?
- Zipping a jacket
- Buttoning a sweater
- Tying laces on shoes
- Strapping Velcro on boots
- Snapping buttons on a coat
Tying laces on shoes (~5yo)
The parents of a seven-year-old child report that their child has “mood swings” which consist of the child suddenly becoming irritable, angry, and throwing tantrums. When asked what precipitates these episodes, they reply, “When we tell him ‘no’ or he does not get his way.” Based on this information, which diagnosis is most appropriate preliminarily?
Oppositional defiant disorder
During the acute initial refeeding phase of treatment for a patient with severe anorexia nervosa, which of the following is the most helpful focus of psychotherapeutic interventions with the patient?
- Framing the use of disordered eating behavior as a maladaptive coping mechanism
- Identifying triggers for relapse and developing plans to prevent relapse
- Exploring developmental, familial, and cultural antecedents to illness
- Challenging cognitive distortions and negative core beliefs
- Coaching, supporting, and providing behavioral reinforcement
Coaching, supporting, and providing behavioral reinforcement
A 7yo is seen for anxiety after repeatedly refusing to get on the school bus, and voicing an irrational fear that the bus will crash. Which of the following questions would be most useful for exploring an operant conditional model as an explanation for the child’s anxiety?
- “How do you feel when you’re on the bus?”
- “How often do you suppose buses get into accidents?”
- “Have you ever been in a car accident, even a small one?”
- “Have you ever seen any bad bus accidents on television?”
- “How do your parents respond when you are afraid of the bus?”
“How do your parents respond when you are afraid of the bus?”
[Operant conditioning is a learning process through which the strength of a behavior is modified by reinforcement or punishment.]
Current evidence regarding the efficacy of family therapy as treatment for eating disorders reports that it:
- is superior to individual therapy for patients of all ages.
- is efficacious for adults, but adolescents are less likely to respond.
- is superior to individual therapy for adolescents 6-12 months after treatment.
- improves remission rates for adults in anorexia nervosa but not in bulimia nervosa.
- is superior to individual therapy at the end of treatment, but effects are not sustained.
-is superior to individual therapy for adolescents 6-12 months after treatment.
The parents of a 6yo report the child has been having difficulty in multiple settings. The child has difficulty taking turns in conversations, frequently monopolizes conversations with topics that are not of interest to peers, and does not follow social norms such as saying “good morning” in response to his teacher’s greeting. In addition, the child has a hard time understanding jokes, often interpreting what is being said quite literally. The parents report that otherwise the child is interested in making friends, has a variety of interests, and is able to adapt to variations in routine. On exam, the child makes good eye contact and speaks with the psychiatrist in a very formal tone. Which of the following is the most likely diagnosis?
- Language disorder
- Speech sound disorder
- Autism spectrum disorder
- Childhood-onset fluency disorder
- Social (pragmatic) communication disorder
Social (pragmatic) communication disorder
A 16yo comes to the ED for agitation and paranoia. The patient seems to be hallucinating and says, “I’m walking on air.” Physical exam show tachycardia. The clinical picture is most characteristic of:
- cocaine withdrawal
- caffeine intoxication
- marijuana withdrawal
- prescription opioid withdrawal
- dextromethorphan intoxication
dextromethorphan intoxication (creates dissociative feelings, present in many over the count medications such as sleep aids)
Which of the following aspects of attention-deficit/hyperactivity disorder is most likely to improve as children age?
- Impulsivity
- Hyperactivity
- Inattention
- Peer relationships
- Academic difficulties
Hyperactivity
By which age should the corticospinal tracts have completed myelination in typically developing children?
3 years
Parents describe their 10yo as a “girly boy.” They state that most of their son’s friends are girls, and he prefers to “play house” and play with dolls. They report no distress or impairment in the teen’s functioning. Which of the following is the most likely diagnosis?
- Anxiety disorder
- Gender dysphoria
- Body dysmorphic disorder
- Separation anxiety disorder
- Nonconformity to gender role
Nonconformity to gender role
Following a normal full-term birth, by what age are circadian sleep rhythms similar to those of an adult generally established in the child?
6 months
Boys with which of the following variables are more likely to delay first sexual intercourse until after age 18?
- Anxiety symptoms
- Physical aggression
- Depressive symptoms
- Increased alcohol use
- Higher maternal education level
Anxiety symptoms
Which psychodynamic theorist posited that development occurs in sequential, clearly defined stages, and that each stage must be resolved for development to proceed smoothly?
Erik Erikson
- Trust vs mistrust (birth to 18 months)
- Autonomy vs shame and doubt (18 months to 3 years)
- Initiative vs guilt (3 to 6 years)
- Industry vs inferiority (6 to 12 years, school age)
- Identity vs role confusion (12 to 18 years; Dr. A-D’s 15yo twins)
- Intimacy vs isolation (19 to 40 years)
- Generativity vs stagnation (40 to 65 years)
- Ego integrity vs despair (65 to death)
*In which stage of Piaget’s theory of cognitive development do children first understand conservation of volume?
*Concrete operational
Piaget’s stages of cognitive development:
+Sensorimotor period: birth->2 years
+Preoperational period: 2->7 years (“they draw on everything”)
+Concrete operational stage: 7->12 years (“they love dinos, collecting things like cards”; they first understand conservation of volume in the concrete operational stage)
+Formal operational stage: 13->adulthood (able to think abstractly, logically, apply these processes to hypothetical situations)
Typically developing children acquire an understanding of the difference between inner life and outer reality (theory of mind) by what age?
Four years
A young girl has marked developmental regression, progressive loss of acquired motor and language skills, stereotyped repetitive hand movements, muscle hypotonia, autonomic dysfunctions, and severe cognitive impairment. Which of the following genes is most likely to be involved in the etiology of these symptoms?
- INPP5E coding for pharbin
- Elastin gene on chromosome 7
- ASXL1 coding for a chromatin-binding protein
- MECP2 coding for methyl CpG-binding protein 2
- Partial deletion of the short arm of chromosome number 5
MECP2 coding for methyl CpG-binding protein 2
Gender identity is typically established by what age?
Three years
A ten-year-old child remains sad and angry about his parents’ divorce but no longer believes that he caused the separation. This cognitive change is an example of ___.
decentration
Due to the slowed growth of neural language synapses, children older than six years of age have more difficulty that younger children with:
- learning a new language
- acquiring new vocabulary words
- decoding non-verbal social cues
- understanding rules for grammar
- inferring word meanings from context
learning a new language
The Freudian stage of latency (6-puberty) is correlated with which of Erikson’s stages?
Erikson’s: industry vs inferiority (6-12yo, school age, the child compares self worth to others)
[Freud’s theory of psychosocial development emphasizes that as humans develop, they become fixated on different and specific objects through their stages of development.
Oral: birth-1yo
Anal: 1-3yo
Phallic: 3-6yo
Latency: 6-puberty (here the drives are seen as dormant and hidden and pleasure is mostly related to secondary process thinking)
Genital: puberty on]
What is the most common fear among preschool-age children who are faced with a terminal illness?
- Losing their toys
- Disappointing caretakers
- What happens after death
- Separation from caretakers
Separation from caretakers
What is the earliest age by which 90% of girls in the United States will have reached menarche?
14 years
By what age can typically developing children answer open-ended questions such as why, when and how?
Five years
Parental loss due to an external cause (suicide, homicide or accident) during childhood most elevates the risk for depression as a young adult when the loss occurs in ___ ___.
early childhood
Which of the following is proposed to be a basic emotion, learned directly or inferred by infants during the first year of life?
- Envy
- Fear
- Shame
- Pride
- Guilt
Fear
A 12yo patient comes for therapy after summer break. The patient has lost a significant amount of weight and is now at the 20th percentile compared to age group for weight and 60th percentile for height. The patient decided to eat a healthier diet, identifies no concerns about the weight loss, and wants to lose another 5-10 pounds. Previously the patient had consistently been at the 75th percentile for weight, but felt self-conscious about appearance. The parents are concerned because the patient spends much time researching the nutritional content of food and has restricted intake to a limited range of food items. Which of the following is the best description of the patient’s current behaviors?
- Bulimia nervosa
- Anorexia nervosa
- Healthy eating approach
- Body dysmorphic disorder
- Avoidant/restrictive food intake disorder
Anorexia nervosa
In females, which of the following is typically the first marker of impending puberty?
- Menarche
- Increase in total body fat
- Acceleration of linear growth
- Increase in muscle mass and strength
- Appearance of secondary sexual characteristics
Acceleration of linear growth
An adolescent patient is hospitalized on the neurology service for sudden onset loss of vision. Medical workup is negative and the primary team is unsure of the etiology. The resident walks the patient and when they approach a bin in the hall the patient walks around it. What is the most likely diagnosis?
Conversion disorder
Difficulty with which of the following physical tasks would be most concerning if noted in an elementary school-age child?
- Writing legibly
- Playing team sports
- Jumping and hopping
- Playing a musical instrument
- Sewing and using hand tools
Jumping and hopping
The decline in a toddler’s sharing behavior between ages two and three is most closely related to the normal developmental milestone of sense of being an ___ self.
autonomous
Terrible twos, less sharing!
The parents of a 4yo are concerned that she is unable to tie her shoes. She is able to run, kick a ball, ride a tricycle and zip up her coat. What is the most likely explanation?
Normal development
[Shoe tying is usually reached around 5yo;
Always remember, what we are seeing may be consistent with normal development!]
What genetic syndrome is the most common cause of inherited intellectual disability?
Fragile X
[In contrast, what is the most common genetic cause of intellectual disability? Down Syndrome.]
Which of the following childhood environmental factors is most prevalent in patients diagnosed with dissociative identity disorder in the United States, Canada and Europe?
- Physical abuse
- Loss of a parent
- Medical procedures
- Surgical procedures
- Exposure to terrorism
Physical abuse
Gender identity is believed to be most strongly influenced by which of the following factors?
- Innate feelings
- Parental influence
- Cultural expectations
- Chromosome complement
- Mirroring of the same-sex parent
Innate feelings
Which of the following tests primarily measures flexibility in shifting cognitive sets?
- Trails B
- Boston naming
- Digits backwards
- Rey complex figure
- Pantomime use of objects
Trails B
Panic disorder typically first manifests during which stage of life?
Late adolescence
A school-aged boy does well academically but most of his energy is channeled into basketball, and he states that he hopes to become a professional basketball player. He teases girls at school, but plays mostly with boys. With which of the following of Freud’s psychosexual stages of development do these characteristics correspond?
Latency
[Freud’s Latency (6-puberty) corresponds to Erikson’s Industry vs inferiority (6 to 12 years, school age]
Freud’s theory of psychosocial development emphasizes that as humans develop they become fixated on different and specific objects through their stages of development.
Oral: birth-1yo (Receiving pleasure through nursing and sucking (stuck? histrionic)
Anal: 1-3yo (The toddler focuses on receiving pleasure in evacuating his bowels (stuck? OCD)
Phallic: 3-6yo (the gratitification is now focused on the phallis) [Eliza Grey attack at 5yo!]
Latency: 6-puberty [Here the drives are seen as dormant and hidden, and pleasure is mostly related to secondary process thinking] [Freud’s latency: 6-puberty, lines up somewhat with Erikson’s Industry vs Inferiority: 6-12yo, school age]
Genital: puberty on -> (There is genital interest, but expressed in love relationships, families, responsibilities of adulthood)
Parental criminality is a factor associated with increased ___ of developing conduct disorder.
risk
A 4yo has a slim torso, long legs and all 20 primary teeth. The child can walk and run, but does so quickly and intensely, often walking up on toes. The child is ambidextrous and can ride a small bicycle with training wheels although appears a little uncertain when doing so. Which of these physical findings should raise concern about the child’s physical development?
- Ambidexterity
- Walking on toes
- Presence of all baby teeth
- Pace and intensity of walking
- Uncertainty when riding a bicycle
Walking on toes
An electroencephalogram for a child who seems to often stare into space and then blink for a few seconds is likely to show the ___ cycles per second spike-and-wave activity characteristic of absence seizures.
three
EEG shows 3 cycles per second, 3Hz spike-and-wave activity in absence seizures
Parents bring a 15yo noting that, despite having a curfew, she stayed out all night for the fourth time in a month. Over the past year, she has persistently violated parental rules, reacts with rage when attempts are made to address this, and is often edgy and confrontational with the slightest annoyance. She is impatient and unkind to a younger sister, and threatens to hit the father when limits are set. The school reports no concerns about behavior in that setting. There is no history of substance use. In the interview, she is pleasant, easy to engage and cooperative, but admits to minimal regard for her parents’ rules, seeing them as “old school” and unnecessarily limiting. Which is the most likely diagnosis?
- Conduct disorder
- Adjustment disorder
- Oppositional defiant disorder
- Antisocial personality disorder
- Disruptive mood dysregulation disorder
Oppositional defiant disorder
To be eligible for special education services a student must require specific interventions in order to make progress in school and have a ___ disability.
documented
A 16yo girl has periodic fantasies involving degradation and masochism (the tendency to derive pleasure, especially sexual gratification, from one’s own pain or humiliation). She describes these fantasies as disturbing and accompanied by both excitement and anxiety. These fantasies most likely represent which of the following?
- A risk factor for future paraphilic sexual behavior
- Evidence of prior exposure to sexual maltreatment
- A normal precursor to homosexual orientation in adulthood
- Turning against the self as defense against unresolved Oedipal wishes
- Part of the normal process of determining personal sexual behavior patterns
Part of the normal process of determining personal sexual behavior patterns
Which of the following most seriously threatens the external validity of a research study?
- Placebo responses in the study population
- A study population that is not representative of the population to be treated
- Mortality or differential attrition during the course of treatment during the study
- Maturation due to natural change during the period between baseline and post-test
- Statistical regression or regression toward the mean
A study population that is not representative of the population to be treated
[External validity is the validity of applying the conclusions of a scientific study outside the context of that study. In other words, it is the extent to which the results of a study can be generalized to and across other situations, people, stimuli, and times.]
Pharmacological treatment in autism spectrum disorder is most likely to have a positive effect on which of the following?
- Aggressiveness
- Gaze aversion
- Prosodic modulation
- Gestural communication
- Pragmatic communication
Aggressiveness
Functional magnetic resonance imaging studies have shown the highest level of response to anticipated rewards in the nucleus accumbens (ventral striatum along with olfactory tubercle; what’s in the dorsal striatum? caudate + putamen) during which of the following developmental periods?
- Infancy
- Toddlerhood
- Mid-latency
- Adolescence
- Adulthood
Adolescence
[Adolescence is also the stage of development at which dopamine receptor density in the striatum occurs, possibly accounting for increased response to rewards for behavior during this stage.]
During which stage of development does the maximal number of axons and synapses exist?
Infancy
Piaget’s major contribution to development was a theory that explains how individuals learn about and ___ the world.
understand
[Piaget’s stages of cognitive development:
+Sensorimotor period: birth->2 years
+Preoperational period: 2->7 years (“they draw on everything”)
+Concrete operational stage: 7->12 years (“they love dinos, collecting things like cards”; they first understand conservation of volume in the concrete operational stage)
+Formal operational stage: 13->adulthood (able to think abstractly, logically, apply these processes to hypothetical situations)]
___ ___ signifies the ability to shift back and forth between general concepts and specific examples.
Abstract reasoning
[In Piaget’s stages of cognitive development, abstraction is a major part of the Formal operational stage (13->adulthood) and differentiates it from the Concrete operational stage (7->12 years)]
[Piaget’s stages of cognitive development:
+Sensorimotor period: birth->2 years
+Preoperational period: 2->7 years (“they draw on everything”)
+Concrete operational stage: 7->12 years (“they love dinos, collecting things like cards”; they first understand conservation of volume in the concrete operational stage)
+Formal operational stage: 13->adulthood (able to think abstractly, logically, apply these processes to hypothetical situations)]
A 5yo who mother was in a minor car accident thinks that he is responsible for causing the accident because he yelled “I hate you” in protest when his mother left him with a baby-sitter an hour earlier. This belief represents age-appropriate ___ thinking.
egocentric (Mr. Beard’s final words to his dad)
REM sleep is first evident at which stage of development?
In utero
A 9yo achieved urinary continence at 4yo, but started wetting the bed again at 6yo. The family has tried various management strategies including waking the child at night, but the patient is difficult to arouse and has enuresis at different times in the night. The patient’s father and paternal uncles wet the bed until they were approximately 10yo. Which of the following points to a possible psychiatric comorbidity?
- Difficulty arousing from sleep
- Positive family history of enuresis
- Resistant to behavioral management
- Enuresis during different sleep stages
- Having a previous period of continence
Having a previous period of continence
The psychiatric assessment of a child or adolescent should always include ___ interviews.
parental
Identity diffusion, as defined by Erik Erikson, describes ___ of continuity in how the self is experienced in relationships over time.
lack
Obsessive-compulsive disorder (OCD) with childhood onset has ___ psychiatric comorbidity than that of adult onset.
greater
Children of birth mother’s who die by suicide are at ___ risk of completed suicide.
higher
Children demonstrate a preference for the human voice and speech over other sounds at what age?
Birth
A 9yo has been successfully treated for attention-deficit/hyperactivity disorder for years with methylphenidate (ritalin, concerta, etc). During the past two months, the medication has not been as effective despite multiple dose adjustments. It is decided that the child needs a different medication. Which of the following would be the best choice?
- Buspirone
- Atomoxetine
- Desipramine
- Risperidone
- Mixed amphetamine salts
Mixed amphetamine salts (Adderall, etc)
Per the WHO, mental health prevention measures are universal, selective and indicated. Which of the following would be an indicated intervention?
- Playing the “Good Behavior Game” in the school classroom
- Giving emotional resilience courses for emergency personnel
- Restricting access to tobacco and alcohol to those over a certain age
- Initiating a promotional campaign to discourage unsafe dieting behavior
- Providing parenting training for parents of children with conduct problems
Providing parenting training for parents of children with conduct problems
What is the most highly heritable of all mental disorders?
Autism spectrum disorder (young woman at WFM register said her “ENTIRE family” has Autism spectrum disorder, the most highly heritable of all mental disorders)
Limitations of Piaget’s model of cognitive development include a failure to adequately include ___ factors relevant to learning.
emotional
[Piaget’s stages of cognitive development:
+Sensorimotor period: birth->2 years
+Preoperational period: 2->7 years (“they draw on everything”)
+Concrete operational stage: 7->12 years (“they love dinos, collecting things like cards”; they first understand conservation of volume in the concrete operational stage)
+Formal operational stage: 13->adulthood (able to think abstractly, logically, apply these processes to hypothetical situations)]
A 5yo watching his first July 4th parade asks as it begins, “Mommy, will there be clowns in the parade today like at the circus we went to?” This question is most likely the result of use of previous experiences to think ___.
categorically
A typically developing two-year old child is able to demonstrate the language and speech milestone to use ___-word or longer phrases.
two
A 14yo broke his nose playing hockey, it is noticeably asymmetric and it has bothered him since. He says he just wants to look normal again. Parents say self-esteem has been low since the break and they hope surgery will help. What is the most likely psychological outcome for this patient following cosmetic surgery?
- An improvement in quality of life
- Continued preoccupation with appearance
- No change in esteem despite less focus on his nose
- Chronic anxiety which will generalize to other stresses
- Relational problems with parents for encouraging the surgery
An improvement in quality of life (Brother Jon)
During which stage of development does the maximal pruning of cortical synapses occur?
Adolescence (don’t smoke up in adolescence, will mess up synaptic pruning!)
A 5yo has difficulties adjusting to the first transition from home into a school setting. Teachers are concerned about persistent social withdrawal and the consistent experience that the child does not seek or accept consoling when upset. The child was adopted three years ago after a series of problematic foster placements where care was physically and emotionally inadequate. On exam the child looks shy and initially clings to the mother. Later while playing with blocks the child becomes frustrated. The mother tries to gently intervene which leads to an overly fearful and aggressive response by the child. What is the most likely diagnosis?
Reactive attachment disorder
[Reactive attachment disorder arises from a failure to form normal attachments to primary caregivers in early childhood.]
A 10yo notes he started collecting basketball cards, an interest shared with his dad and friends. He is excited because he is the only one of his friends who has several cards. He says things at home and school are OK. His parents say he is doing well, though his grades in school could be higher. According to Erikson, what developmental task is most relevant for this child?
Industry vs inferiority
Erikson’s stages:
- Trust vs mistrust (birth to 18 months)
- Autonomy vs shame and doubt (18 months to 3 years)
- Initiative vs guilt (3 to 6 years)
- Industry vs inferiority (6 to 12 years, school age)
- Identity vs role confusion (12 to 18 years; Dr. A-D’s 15yo twins)
- Intimacy vs isolation (19 to 40 years)
- Generativity vs stagnation (40 to 65 years)
- Ego integrity vs despair (65 to death)
A 17yo comes to the ED with family after inflicting lacerations on the thigh with a plastic knife. On exam, the patient does not make eye contact, has limited facial expression, and postures periodically in a stereotypic manner. Speech is monotone, and the patient covers the ears at times during the interview reporting, “It is too loud.” The patient says the cutting was not a suicide attempt but can’t say more and reports, “My parents can provide additional information.” The parents note the patient has always been intolerant of noise and has also always been “quirky and socially awkward” but has appeared more withdrawn over the past three days since the parents shared a plan to separate. The patient has few friends and prefers solitary activities. There is no previous history of self-injurious behavior. Which of the following is the most likely diagnosis?
- Autism spectrum disorder
- Major depressive disorder
- Social communication disorder
- Schizotypal personality disorder
- Borderline intellectual functioning
Autism spectrum disorder
In 2-3yo children the capacity to tolerate frustration is primarily influenced by which of the following:
- Ability to internalize social norms
- Quality of the parent-child attachment
- Ability to use language to describe affect
- Exposure to peer group social interactions
- Resolution of ambivalent feelings towards parents
Quality of the parent-child attachment
The development of brain gray matter volume peaks during which stage of development?
Late childhood
[Makes sense because maximal pruning is in adolescence, immediately after the peak development of gray matter in late childhood!]
A 5-month-old attempts to get his father’s attention by making gurgling noises, waving his arms, and kicking his feet. The mother responds by gently tickling the baby, who laughs happily. This social interaction is best explained within which of the following developmental concepts?
- Arousal
- Imprinting
- Attachment
- Temperament
- Theory of mind
Attachment
A 6yo prefers opposite gender clothing and play scenarios. If this child were to develop symptoms of gender dysphoria, what would be the most common course of symptoms?
- Worsens during adolescence
- Remains stable into adulthood
- Continues until reassignment surgery
- Resolves spontaneously by adulthood
- Waxes and wanes throughout adulthood
Resolves spontaneously by adulthood
Beginning to ___ peer relationships and pursuing group activities is a developmental task of the school-age stage.
establish
Prior childhood adversity is a ___ factor for the development of posttraumatic stress disorder.
risk
A 14yo boy reports he has felt sexually aroused spending time with male friends. The says that consciously he is significantly more attracted to females than males, but wonders if his feelings of arousal mean he is homosexual. Which of the following statements is most accurate to communicate to the patient?
- He is most likely homosexual, but will not fully feel that way for a few years.
- These feelings are common and his sexual preference will continue to solidify.
- If he feels more attracted to females than males then he is, by definition, heterosexual.
- This statement was probably made due to erotic transference and should be carefully explored.
- He is most likely bisexual, and his feelings for people of both genders may change over the next few years.
These feelings are common and his sexual preference will continue to solidify.
Untreated depression in pregnancy is associated with poor maternal and infant outcomes, including pregnancy complications, preterm birth, and behavioral problems in the child. Current evidence shows that selective serotonin reuptake inhibitor use in pregnancy is associated with neonatal ___ syndrome.
adaptation
[Neonatal adaptation syndrome generally presents within a few hours following birth and may include a combination of respiratory distress, feeding difficulty, jitteriness, irritability, temperature instability, sleep problems, tremors, shivering, restlessness, jaundice, rigidity, and hypoglycaemia.]
The father of a 3.5yo boy who goes to preschool notes that recently the boy has come into the bathroom when the father is in the shower. He seems happy to see his dad emerge and is very interested in observing his father’s genitals. On one occasion the boy asked, “Why is it so fat?” pointing to his father’s penis. This behavior is most likely an indication of which of the following?
- Normal preschool-age sexual interest
- Inappropriate exposure to adult sexuality
- Sexual molestation by a non-family member
- Response to sex education in preschool curriculum
- An early indication of homosexual or bisexual orientation
Normal preschool-age sexual interest
Throughout the course of psychotherapy a patient with borderline personality disorder reports a history of growing up in an abusive household, wishing to escape abusive parents but also depending on them, and abruptly ending relationships due to “feeling too close to the other person and getting scared.” According to Margaret Mahler’s model this patient’s problems can be formulated as not having worked through which stage?
Rapprochement (establishment or resumption of harmonious relations)
Underlying heart defects are a ___ contraindication to treatment with psychostimulants.
relative
Which of the following substances is in several OTC cold remedies and is abused to produce a dissociative feeling?
- Ethanol
- Ephedra
- Acetaminophen
- Pseudoephedrine
- Dextromethorphan
Dextromethorphan (“Robo tripping”)
Which of the following molecular mechanisms is best supported as a possible explanation for how early life stress could lead to the development of psychiatric disorders in adulthood?
- DNA methylation
- Alternative splicing
- Deletion mutations
- Gene amplification
- Reciprocal translocations
DNA methylation
[DNA methylation decreases gene expression]
The ___ process used to provide community care to children and youth is best described as an individualized, family-driven and youth-guided team planning process.
wraparound
When a parent dies to facilitate a child’s adaptive mourning process it is essential to give the child opportunities to ___ feelings of loss.
express
Which of the following patient characteristics best differentiates bulimia nervosa from binge eating disorder?
- Normal BMI
- Duration of symptoms
- History of laxative abuse
- Degree of control over food intake
- History of non-suicidal self-injurious behavior
History of laxative abuse
A child with autism spectrum disorder is placed in a therapeutic foster home where a consistent response is made to a given action with the goal of improving the child’s functioning. This technique derives from which learning theory?
Behaviorism
The likely course for development of children after parents’ divorce is that children do ___ in one-parent homes, provided stable parental functioning and financial security.
well
When do cortisol levels peak in healthy children?
- Morning
- Afternoon
- Evening
- Night
Morning
A 17yo boy comes in with macroorchidism, long face, large everted ears, prominent jaw, a high arched palate, intellectual disability, frequent hand-flapping. He most likely has which genetic abnormality?
Trinucleotide repeat/expansion in the FMR1 gene
[Fragile X syndrome is the most common cause of INHERITED intellectual disability]
In Heinz Kohut’s theory of self-psychology, the term “self-objects” means other ___ in the environment who perform particular functions for the self.
people
What is the risk of individuals developing schizophrenia when a sibling has the disorder but the parents do not?
10%
Pathogenic copy number variants affecting DNA base pairs are associated with ___-___, which often presents with failure to thrive in infancy, hyperphagia, early obesity, hypogonadism, obsessive-compulsive disorder, short stature, small hands and small feet.
Prader-Willi
[Copy number variations have been identified in the imprinted chromosome 15 region associated with Prader-Willi syndrome and Angelman syndrome. These diseases might be caused by copy number variants due to inversions and deletions in critical genes.]
What is the lifetime prevalence in the US of conduct disorder?
~10% (males = 12.0%, females = 7.1%)
Serum ferritin levels were inversely correlated with the severity of ADHD. The children with the most severe ___ deficiency were the most inattentive, impulsive, and hyperactive. This result suggests that low stores may explain as much as 30% of ADHD severity.
iron
Psychoeducation and ___ are the first line treatment for children with retentive encopresis.
laxatives
The average age of onset of trichotillomania is ___.
adolescence
A teacher assigns each child in the class to solve as many math problems as they can on their own in a 20-minute period. The teacher makes a note of each student’s progress, divides the class into groups to further work on the problems together, and provides help to each group when members are stuck. This strategy makes use of the educational concept ___.
zone of proximal development
By age ___ years, toddlers can typically manipulate scissors.
three years
An adolescent boy was engaged in therapy lasting ten weeks. During this therapy the boy was able to relate his test-taking anxiety, chronic feeling of interpersonal inadequacy, and inaccurate sense of physical unattractiveness to an earlier relationship with his father who was often critical and harsh, and unpredictably embarrassed the boy in social settings. Therapy used most likely was ___
short-term psychodynamic
During a psychiatric evaluation, using a qualified interpreter who has proficiency in the family’s language of origin would help develop the ___ alliance between a culturally competent psychiatrist and a new immigrant patient and family.
therapeutic
A youth who has been on long-term risperidone treatment develops tardive dyskinesia which continues despite initially reducing the dose, and then sequential optimal trials of aripiprazole, olanzapine and quetiapine, each for sufficient duration and dose. The most appropriate next step is to switch to ___.
clozapine (multiple trials have shown clozapine does not worsen TD; valbenazine and deutetrabenazine are approved for TD, but not enough youth data)
The ___ ___ represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure.
odds ratio
Base rates are a statistic used to describe the percentage of a population that demonstrates some characteristic. Base rates indicate probability based on the ___ of other information.
absence
Prevalence is the proportion of persons who ___ a condition at or during a particular time period.
have
Incidence refers to the proportion or rate of persons who ___ a condition during a particular time period.
develop
Cumulative incidence is calculated as the number of ___ events or cases of disease divided by the total number of individuals in the population at risk for a specific time interval.
new (if there is a time period, they mean cumulative incidence rather than prevalence)
Positive predictive value is the probability that subjects with a positive screening test truly ___ the disease.
have
***___ is an important guide when arranging the infrastructure necessary to provide telepsychiatric consultation to a school.
***Family Educational Rights and Privacy Act (FERPA) [HIGH YIELD]
After a recent substance abuse relapse, from an MI (Miller and Rollnick) perspective after a self-deprecating statement the following might be helpful:
“This recent relapse is making you upset because you were trying hard to stay sober”
REDS, in motivational interviewing stands for:
Roll with Resistance
Express Empathy
Develop Discrepancy
Support Self-Efficacy
In transition from in person to web-based psychotherapy for an eight year old, web-based therapy efficacy will be helped by implementation with the ___ of a parent, caregiver, or teacher.
support
*___ is the non-pharmacologic treatment of choice for ADHD validated in treatment trials.
*Behavioral parent training/Parent management training
involves appropriate behaviors, positive reinforcement is part of this
___ is one of the psychiatric disorders most likely comorbid in an adolescent with diabetes.
Major depressive disorder (Anytime looking at chronic medical disorders and co-morbidity, most often find MDD as main comorbidity)
- Which traumatic event is most commonly experienced by adolescents in the United States?
- Sexual abuse
- Natural disaster
- Physical abuse
- War-related trauma
- Death of a loved one
*Death of a loved one
A ten-year-old’s report card is all A’s, but a C in math which has always been difficult. What is an assessment instrument that would be helpful to assess the child’s academic deficit?
- Wide Range Intelligence Test
- Stanford-Binet Intelligence Scales (use around 5yo, some of the others can’t use that early. It is not super-standardized like WISC)
- Leiter International Performance Scale
- Wechsler Intelligence Scale for Children (For kids over 6 and the most standardized tests)
- Woodcock-Johnson Tests of Achievement
-Woodcock-Johnson Tests of Achievement (Child has all A’s except for one in a specific learning area so this it good test to hone in on the different areas)
In youth with substance use disorders, evidence suggests the chance for recovery in a peer support group is best optimized if the patient is peer-matched along which parameter?
- Age
- Gender
- Ethnicity
- Substance of choice
- Socioeconomic status
Age (Developmental level)
The MTA study at the 6-to-8 year follow up regarding ADHD treatment from childhood to adolescence suggested periodic drug holidays ___ be given to assess continued need and benefit.
should
The classic triad of HIV-related encephalopathy in children is characterized by ___, acquired microcephaly and developmental delays.
pyramidal tract motor deficits
Illness anxiety disorder is ___ excessively that you are or may become seriously ill.
worrying
Metformin has been shown to reduce ___-___ associated with antipsychotic use.
weight-gain
***Number needed to treat is calculated as 1 / ___
***Absolute risk reduction [VERY HIGH YIELD]
In application of dialectical behavior therapy for adolescents, which of the following skills should be taught first?
- Mindfulness
- Distress tolerance
- Emotion regulation
- Self-management
- Interpersonal effectiveness
Mindfulness
____ denotes or relates to a person who sense of personal identity and gender corresponds with their birth sex.
cisgender
transgender denotes or relates to a person whose sense of personal identity and gender does not correspond with their birth ___.
sex
Which of the following changes in sleep architecture occurs as a result of sleep deprivation?
- Increased sleep latency
- Decreased sleep efficiency
- Increased sleep fragmentation
- Decreased NREM sleep duration
- Increased REM sleep duration
Increased REM sleep duration (REM sleep is really critical for our health and wellbeing.)
What is most likely psychological explanation for school-age children’s fantasies about superheroes and heroic acts?
Strategy to manage fears related to knowledge of world events
Chromosomal ___ analysis testing assesses for deletions or duplications of sections of DNA.
microarray (Chromosomal microarray analysis looks at smaller segments, assessing for deletions or duplications in sections of DNA. SNPs - single nucleotide polymorphisms are important here too in addition to deletions and duplications and can also be seen through chromosomal microarray analysis testing)
[Microarray assays are used to identify CYP enzyme DNA sequence variants that may explain patient’s intolerance of medications if we suspect they are a poor metabolizer for example]
The Treatment of Severe Childhood Aggression (TOSCA) study enrolled children ages 6-12 with both diagnosed attention-deficit/hyperactivity disorder and disruptive behavior (Conduct disorder, Oppositional defiant disorder) with significant aggression. Participants whose symptoms did not resolve in the first stage of the study received augmented treatment which of the following?
- Lithium
- Fluoxetine
- Risperidone
- Parent training
- Methylphenidate
Risperidone
Family from other country punishes 8yo causing welts 1-2x/week which is cultural norm from country they were in previously. Psychiatrist should remain ___ yet firm while discussing US societal and legal norms.
empathetic
An ___ for a child with autism spectrum disorder is appropriate in the setting of new onset of developmental regression.
electroencephalogram
___ is an ethical principle referring to the importance of providing patients with truthful information about their medical conditions to allow them to make a truly informed decision about accepting or rejecting recommended medical interventions.
Veracity (conformity to facts; accuracy, providing truthful information)
Which of the following is most helpful in working up the diagnosis of nonepileptic seizures in children?
- Structural MRI
- Routine electroencephalogram (EEG)
- Serum creatine kinase levels
- Serum prolactin levels
- Prolonged video EEG
Prolonged video EEG (Odds are low of capturing spell with random/routine EEG which is why you recommend prolonged video EEG to w/u diagnosis of nonepileptic seizures in children)
A five-year-old child is observed to serve toy food onto the parent’s miniature plastic plate, then hands the serving dish to the parent and says, “Now you feed me!” This is an example of ___
Cooperative play
For a medicine to be efficacious and having fewer side effects, we want a ___ number needed to treat and a higher number needed to harm.
lower
A child has a history of angry outbursts. The child and parents develop a plan for grocery shopping that, if the child asks for candy at the checkout stand, has a meltdown and is unable to stay calm, the child will lose video game play time for the day. Which of the following terms best describes this strategy?
- Time out
- Token economy
- Attending and ignoring
- Praise and positive reinforcement
- Antecedent-behavior-consequence
Antecedent-behavior-consequence
A previously healthy child with a history of ADHD and depression is medically admitted for vomiting, headache, increased intracranial pressure, hepatosplenomegaly, skin desquamation (peeling), and musculoskeletal/abdominal pain. Caregivers report use of cod liver oil for the child’s depression and ADHD over the last few years with steady increases in dosing due to lack of perceived effectiveness. The child has an otherwise normal diet and also is prescribed melatonin and clonidine. Toxicity due to what is the most likely etiology of the patient’s symptoms?
Vitamin A (When you see cod liver oil think Vitamin A. Increased intracranial pressure and hepatosplenomegaly, think Vitamin A)
The psychiatrist serving as an expert witness testifies in court that the adolescent defendent was psychotic at the time of the alleged crime. As evidence of this, the psychiatrist cites multiple witnesses who reported that the defendant ran out fo his antipsychotic medication and began complaining about hearing voices in the days before the crime. The prosecutor objects that the psychiatrist’s testimony is predicated on hearsay evidence, but the judge rules that the objection is invalid for which of the following reasons?
- The psychiatrist cited the witness accounts to justify an expert opinion
- The jury will decide if the psychiatrist’s argument is valid and persuasive
- The judge considers the witness accounts cited by the psychiatrist to be highly credible
- The psychiatrist cited the witness accounts to establish the fact of the patient’s symptoms (is a bit overly definitive: “to establish the fact”)
- The prosecutor is attempting to discredit the psychiatrist prior to cross examination
The psychiatrist cited the witness accounts to justify an expert opinion (how else will you say the expert opinion if you can’t say the diagnosis? Need collateral to establish diagnosis)
___ was a large ADHD study with children 6yo+ with four arms, many large studies have four arms like MTA did. There was medication (stimulant) alone, combined (stimulant + behavioral therapy), behavioral therapy alone, treatment as usual (no difference from typical treatment/not as much follow-up). What is established is that medications are really important for ADHD. The combined treatment was similar to medication by itself. The behavioral treatment alone was not up to the mark. When kids have ODD or something, combined arm might get more leverage. If child just has ADHD, medication alone is an effective treatment.
MTA
One of the findings of the MTA study was that as children grow and develop into adolescents, 50-60% will ___ have symptoms of ADHD compared to childhood, so needing to persist with treatment is not necessarily true.
not
One of the findings of the MTA study was that often over time hyperactivity decreases first, impulsivity decreases some and ___ is the most recalcitrant, hardest to treat and most lingering feature of ADHD.
inattentiveness
Long-term ADHD data hasn’t supported stimulants lowering weight/height of children. That said, a study showed those children on stimulants lose 1.5cm. Children with ADHD were interestingly taller than peers so normalized perhaps because of this. Nonetheless, it’s important to keep considering the continuous need for medication. Can ___ during summer with almost all psychiatric medication. Think through every year whether everything is needed.
reassess
*Motivational interview where we (REDS):
Roll with Resistance
Express Empathy
Develop Discrepancy
Support Self-Efficacy
was developed by which two people?
*Miller and Rollnick
A 12yo girl admitted with features of paranoia, hallucinations, and mood lability is found to be resistant to antipsychotic management. She subsequently develops facial tics, autonomic instability and obtundation. Work-up reveals an adnexal mass. Removal of the mass is most likely to help normalize the activity of a receptor for which of the following neurotransmitters?
- GABA
- Serotonin
- Dopamine
- Glutamate
- Acetylcholine
Glutamate (This is classic picture for anti-NMDA receptor encephalitis. It is thought to be resistant to antipsychotics which makes sense because anti-NMDA receptor encephalitis is glutamate based)
What stage of infancy is most associated with cooing, imitating, and other efforts to facilitate reciprocal social interactions?
- 1-2 months
- 3-7 months
- 8-18 months
- 19-36 months
3 to 7 months (a long window allows for a bell shaped development, think about this with windows in terms of test options)
A 13-year-old is brought for an initial assessment. The patient has an extensive psychiatric history with multiple diagnoses. The psychiatrist chooses to combine the unstructured interview with a more structured technique using a respondent-based interview. Which instrument would be most representative of a structured assessment using this technique?
Diagnostic Interview Schedule for Children (fully structured)
Kiddie ___ ___ ___ ___ ___ (Semi-scructured, still allow for some open ended in additional to structured questions) (This is the one we are most likely to see in a clinical trial) (the initial pages are unstructured information gathering, then there are screening sets; may be helpful to take a look at how the questions are written b/c with children can be tough to know how to ask these questions such as about mania; 3 is true sx, 1 is absence of sx, 2 is not sure; anytime you hit 3, need to do supplemental module on that particular disorder)
Schedule for Affective Disorders and Schizophrenia
Object Permanence is a concept from ___.
Piaget
Object Konstancy is a concept from ___ ___.
melanie Klein
In the ___-operational stage for Piaget (2-7yo) have egocentrism, magical thinking, animism.
pre
The majority of graduate medical education funding is derived from what source?
Medicare
The psychiatrist treating the ten-year-old child of divorcing parents receives a subpoena from the attorney for one of the parents requiring the psychiatrist to appear in court and provide a copy of the child’s psychiatric medical record. The parents are in conflict about the child’s custody. The psychiatrist thinks that a court appearance would jeopardize the treatment alliance. After obtaining legal advice, the psychiatrist’s response upon receiving such a subpoena should be to:
*seek informed consent from each parent to share information with the court. (the usual question is what’s your next best step, which would be reach out to your attorney. This question goes beyond this. You have to try and get informed consent from each parent. If the parents don’t give the consent, you still need to participate)
Which of the following neurotransmitter systems is most prevalent and widely distributed in the human brain?
Glutamatergic (85% of the synapses in the brain are glutamatergic)
When compared to an older child, adolescent, or adult, which of the following findings on mental status examination in a school-age child is most likely related to potential delays in cognitive development?
- Thought blocking during interview
- Command hallucinations to harm peers
- Insistence that others are trying to hurt him
- Difficulty differentiating fantasy from reality
- Disorientation to self, day, place and situation
Difficulty differentiating fantasy from reality (Think of someone with mild/moderate ID. May have a lot of difficulty with distinguishing reality vs fantasty. The other answer choices in this question are signs of psychosis or delirium)
A three-year-old in preschool is most likely to identify a classmate as a “friend” based upon the other child’s:
- gender
- ethnicity
- physical appearance
- similarity of play interests
- status within the larger peer group
similarity of play interests
If an adolescent on an atypical antipsychotic medication presents with akathisia but without dystonia, which of the following medications would be most appropriate?
- Lithium
- Propranolol
- Benztropine
- Trihyxyphenidyl
- Diphenhydramine
Propranolol (akathisia, think beta blockers first)
An unmedicated 17-year-old patient presents with complaints of an uncomfortable and irresistible urge to move the legs, which usually occurs when laying down at bedtime, and is immediately relieved following movement, stretching, or walking around. Which of the following is the most appropriate first step intervention?
- Low-dose clonidine
- Low-dose propranolol
- Low-dose diphenhydramine
- High-dose omega-3-fatty acids
- Iron supplementation if deficient
*Iron supplementation if deficient (Sounds like restless leg syndrome. 25% of ADHD children can have RLS. Important to ask on initial interview in clinic about both RLS and OSA in our patients, don’t just ask about hours of sleep, get a bit more detail)
A student has been referred for a school-initiated psychiatric consultation. The parents refused consent. What is the most appropriate next step for the psychiatrist to take?
- Meet with the student at least once to assess for risk of harm to self or others
- Recommend that the school obtain a court order for the evaluation to proceed
- Refer the student and parents for an assessment in the psychiatrist’s private practice (Shouldn’t do this, drum up business for your practice. Need to be careful about anti-kickback laws. You are in a consult setting with school. Can’t be a double agent, this would be unethical)
- Advise the school to initiate a special education evaluation despite parental objections
- Observe the child in school unobtrusively and make recommendations to teachers
Observe the child in school unobtrusively and make recommendations to teachers [In questions like these where you don’t have consent. Think of least invasive thing you can do, most conservative thing you can do. You are hired by the school and your responsibility is to them. School mental health people sometimes sit in class and observe and provide information such as were they disrupting, did they get up, etc. If parent doesn’t consent to you meeting them you can’t meet the child. If you don’t have consent you can’t see them, this applies to consultation questions too, but this doesn’t mean you can’t observe class.]
- **[MEMORIZE THIS] Sexual awareness and attraction in early adolescence is linked to which of the following biological factors?
- Adrenal androgens
- Gonadal development
- Pheromone emissions
- Epigenetic gene activation
- Cerebral cortical maturation
Adrenal androgens [MEMORIZE THIS, IT IS NOT THE GONADS!]
The psychiatrist evaluates a 17-year-old patient who reports sometimes feeling detached from himself and his surroundings. The patient also reports episodes during which he seems to “lose track of time.” Friends have told the patient that he has behaved in ways that he does not remember. The patient denies hallucinations. There is no apparent delusional thinking. Reality testing and orientation are intact. The patient’s diagnosis is most likely associated with which of the following?
- Trauma
- Intellectual disability
- Alcohol and drug use
- Medical comorbidity and etiology
- Prodrome to a primary psychotic disorder
*Trauma [Its really important to think through a history of trauma. A lot of what may present as potential bipolar could be PTSD, which can lead to irritability and other symptoms)
Which of the following scenarios may be considered a relative contraindication to a child being evaluated via telepsychiatry?
- Depressed and suicidal child in their home
- Hyperactive and oppositional child at their school
- Anxious and somatic child at their primary care office
- Acutely psychotic adolescent in an emergency department
- Assaultive and aggressive adolescent in a detention facility
Depressed and suicidal child in their home [Would not be good to be suicidal at home…]
___-based approaches are powerful for identifying rare high penetrance gene variants.
Pedigree
Methylation is an epigenetic mechanism that ___ transcriptional machinery from accessing DNA and thus leads to decreased gene transcription.
inhibits
Glycine is a predominantly ___ neurotransmitter
inhibitory
___ is the main excitatory neurotransmitter in the central nervous system.
Glutamate
GABA is the main inhibitory ___ in the adult vertebrate brain.
neurotransmitter
Intense fear of gaining weight is a necessary feature to ___ anorexia nervosa.
diagnose
Abstraction is a new cognitive capacity gained when children reach the stage of ___ operations.
formal (13-> adulthood)
Prader-Willi syndrome (obesity, ID, short) involves a ___ of genetic material.
microdeletion
Longitudinal follow-up reliably ___ bipolar from unipolar depression in a patient who presents with an initial episode of depression.
differentiates
Elementary school-age children typically start to engage in social activities without their parents, have a best friend, can show ___ though may sometimes impulsively say things to friends that are unkind.
empathy
Veracity is an ethical principle that means ___ or “speaking truly” from “verax.”
accuracy
___ is the most common comorbid psychiatric disorder in patients with epilepsy.
Major depressive disorder
___ neurons regulate sleep and originate in the tuberomammillary brain nuclei.
Histaminergic
A holding environment, per Winnicott’s thoughts on infant development of assertiveness and sense of competence, encourages ___ while protecting the infant from harm.
spontaneity
Norepinephrine is mostly synthesized in the ___
locus coeruleus
The ___ has the highest concentration of serotonin-producing cells in the brain.
raphe nuclei
Electrocardiogram is appropriate to detect the most common ___ complications associated with myotonic dystrophy.
cardiac
Goodness of fit describes the relevance of understanding ___ in working with parent-child relational problems.
temperament
Adolescent cortical synapse remodeling is also believed to be associated with preferential loss of ___ synapses.
excitatory
Remember that responses to ___ may at times be normative.
stress
In those with persistent pain the ___ receptor is down-regulated in the ventral striatum.
dopamine
Hypophosphatemia is one of the lab abnormalities that may be seen in ___ syndrome.
refeeding
___ increases formation of tetrahydrobiopterin (BH4) , which increases production of serotonin, norepinephrine, and dopamine which may be how it is an effective augmentation agent for depression.
L-methylfolate
The AMPA receptor is ___ by the presence of glutamate.
stimulated
When Pavlov’s dog drooled on hearing a bell, the drool is the ___ response.
conditioned
Beginning to develop concern for others and learning to share typically happens at ___ years.
four
In utero exposure to cannabis during neuronal development is associated with cognitive ___ in the infant.
deficits
In children with cancer, ___ prophylaxis of pain and stress during difficult procedures may result in Post traumatic stress disorder.
inadequate
One in four people born with the ___ deletion develop schizophrenia.
22q11.2
DiGeorge syndrome/22q11.2 deletion syndrome/ velocardiofacial syndrome is a syndrome caused by the deletion of a small segment of chromosome 22. It is characterized by developmental delay, cardiac abnormalities, palate defects, immune deficiency, and an increased risk of schizophrenia.
