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.
Microglia are implicated in both neural circuit ___ of the developing brain and scavenging for damaged neurons, plaques and infectious agents.
formation
[Microglia secrete innate proinflammatory cytokines TNF-a and IL-1B in patients with inflammatory conditions that affect the brain.]
Exemption from course requirements is something that may be included as part of an Individualized Education Program, but would not be included in a ___ plan.
504
The multiple sleep ___ test is used to diagnose narcolepsy.
latency
Research regarding the process of acculturation reports that formation of a ___ identity is the best adaptational outcome for immigrant youth.
bicultural
Higher level of education is considered a ___ factor for suicide attempt in transitional-aged youth with schizophrenia.
risk
A ten-year-old child is pervasively irritable and has had four severe temper outbursts weekly for the past two years. The outbursts involve hitting others, throwing toys, screaming and can occur with minimal provocation. The child’s teacher reports that the child is alienating peers and has difficulty functioning in the classroom. Which diagnosis best characterizes this presentation?
Disruptive mood dysregulation disorder
A genetic researcher wishing to study polymorphisms including short tandem repeats could use ___ to produce many copies of the portion of the genome under study.
polymerase chain reaction
___ analysis may identify a gene responsible for autistic-like traits displayed by multiple members of a family.
Linkage
Linkage analysis: Study aimed at establishing linkage between genes. Today linkage analysis serves as a way of gene-hunting and genetic testing. Linkage is the tendency for genes and other genetic markers to be inherited together because of their location ___ one another on the same chromosome.
near
Motivational enhancement therapy for alcoholism focuses on patient ___ as a key treatment target.
ambivalence
Frieda Fromm-Reichman coined the term “___ ___” to capture aberrant qualities of mothering believed at one time to be a pathway to development of schizophrenia.
schizophrenogenic mother
Parental engagement in frequent conversation and thinking aloud is key to a toddler’s ___ development.
language
The initial learning phase of a skilled motor sequence requires recruitment of the ___ and corticocerebellar systems.
corticostriatal
By age four years, most children have developed sufficient language skills to be able to engage in:
- parallel play
- puns and wordplay
- organized arguments
- moral decision-making
- story telling using words
story telling using words
Tourette syndrome is distinguished from other tic disorders by the presence of multiple motor tics and one or more ___ tics.
vocal
A seven-year-old continues to have enuresis despite monitoring fluid intake, adequate toileting and using a reward system. The pediatrician next suggests using an enuresis alarm. This treatment, also referred to as the bell-and-pad technique, is a form of ___ ___.
Classical conditioning
Which of the following represents the greatest vulnerability to development problems in children?
- Maternal non-infectious illness
- Maternal use of antidepressants
- Maternal mental illness diagnosed before child’s birth
- Early childhood infectious illness prior to age five
- Early childhood non-infectious illness prior to age five years
Maternal mental illness diagnosed before child’s birth
Anorexia nervosa has a significant treatment literature supporting the use of structural ___ therapy.
family
___ acetylation activates transcription.
Histone
For a child with ADHD and oppositional defiant disorder it may be helpful to find out what the child enjoys and create a behavior ___ program at home and at school.
rewards
From a neurodevelopmental perspective, the youngest age at which a child possesses sufficient cognitive ability such that the child is likely to meet the Appelbaum criteria for general healthcare decisision-making capacity is approximately ___ years.
twelve
The predominant site of the endocannabinoid receptor CB1 is the ___ membrane.
presynaptic
Narcolepsy is associated with a ___-1 deficiency.
hypocretin
Whole ___ sequencing provides a highly efficient method for sequencing all protein-coding regions.
exome
If a patient sleeps 3-4 hours/night for up to two weeks in a row, to identify the mood disturbance contributing to the patient’s sleep pattern it would be helpful to ask “During these periods, how well rested do you ___ during the day?”
feel
After a stranger says “hello,” a 12-month-old child turns and looks at his mother before responding. When the mother smiles and nods her head, the infant laughs and smiles in response to the stranger. This behavior is an example of social ___.
referencing
___ is contained in sleep-promoting neurons of the ventrolateral preoptic nucleus.
GABA
The ability of preschool children to regulate their ___ is strongly enhanced by the development of language.
emotions
The three major ___ mechanisms include DNA methylation (decreases transcription), histone modification (histone acetylation activates transcription) and expression regulation by micro-RNAs.
epigenetic
Which of the following genetic tests is preferred for the detection of Trisomy 21?
- G-banded karyotyping
- Single-nucleotide polymorphism
- Fluorescence in situ hybridization
- Comparative genomic hybridization
G-banded karyotyping
For X-linked dominant inheritance of genetic disorders, females are ___ as likely as males to be affected in a multigenerational pedigree.
twice
A patient with social phobia avoids almost all social gatherings. The avoidance is regulated by a reciprocal connection between the amygdala and the ___ ___ ___ ___ ___ ___.
periaqueductal gray area of the brainstem
Oral contraceptives containing estrogens ___ serum levels of lamotrigine.
decrease
Maternal ___ use prenatally is a perinatal factor specifically associated with the development of attention-deficit/hyperactivity disorder.
tobacco
Acute alcohol intoxication is likely mediated by ___ receptor antagonism and GABA receptor agonism.
NMDA
A 16-year-old is expelled from school for the third time since the beginning of the academic year, this time for bringing a knife. The previous expulsions were for fighting and stealing from the teacher. The adolescent has also been suspended several times for bullying classmates and skipping school. Over the next decade, these types of behaviors will most likely:
- increase
- decrease
- wax and wane
- remain the same
decrease
In combination with growth hormone, ___ hormones are required to initiate the adolescent growth spurt.
gonadal (estrogen, progesterone, and testosterone)
Which of the following is the most common comorbidity in a patient with an anxiety disorder?
- A mood disorder
- A personality disorder
- Another anxiety disorder
- A substance use disorder
- An impulse control disorder
Another anxiety disorder
The ___ ___ measures the magnitude of difference between two intervention groups.
effect size
Retaining ___ in the relationship distinguishes empathy from identification.
objectivity
*The number of new events in proportion to the population at risk for the event is referred to as ___ ___.
cumulative incidence
An insurance company pays a physician a single, standardized sum for a patient’s care during a one-year period. This is known as what type of payment?
Capitation
Which of the following antiepileptic drugs reduces the efficacy of oral contraceptives?
- Valproate
- Gabapentin
- Zonisamide
- Levetiracetam
- Carbamazepine
Carbamazepine
DiGeorge syndrome/22q11.2 deletion syndrome/ velocardiofacial syndrome is a syndrome caused by the ___ 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.
deletion
___ muscle tone on electromyography when seen during REM sleep is suggestive of REM sleep behavior disorder.
Excess
A 12yo’s parents say he is “sleepy” during the day, often dazed and out of it. He is often not hungry and sometimes says he has nausea. On exam he has red eyes, runny nose and red sores around the mouth. He is likely using ___.
aerosols
Parents meet with psychiatrist about their teen who has confusion about gender and identity, and the teen refused to come to the appointment. It would be worthwhile to first ask the parents (in this visit where teen is not present and its just the parents), “what ___ do you want me to use when referring to your child.”
pronoun
A mother’s capacity to understand her infant’s internal states, which is communicated by ___ is called holding.
mirroring
Slow-wave sleep enhances the secretion of ___ ___.
growth hormone
___ ___ ___ ___ = 1 / (Absolute risk reduction)
Number needed to treat
Which of the following approaches has demonstrated efficacy in the treatment of trichotillomania?
- Group therapy
- Habit reversal therapy
- Relapse prevention therapy
- Interpersonal psychotherapy
- Psychodynamic psychotherapy
Habit reversal therapy
Which of the following infant attachment styles is characterized by paying little overt attention to the parent’s presence?
- Secure
- Avoidant
- Resistant
- Ambivalent
- Disorganized
Avoidant
A 30yo with intellectual disability and autism spectrum disorder presents with depression. On exam, the patient has a long face, large everted ears, prominent jaw, macroorchidism and a ___ arched palate as well as frequent hand flapping. The patient likely has Fragile X syndrome (caused by trinucleotide expansion of the FMR1 gene, the most common INHERITED form of intellectual disability).
high
Fragile X syndrome is caused by a trinucleotide expansion of the FMR1 gene and is the most common ___ form of intellectual disability.
inherited
Down syndrome is the most common ___ cause of intellectual disability.
genetic
What is the most common genetic cause of intellectual disability?
Down syndrome
What is the most common inherited cause of intellectual disability?
Fragile X syndrome
Between 2001 and 2013 which two of the following groups experienced the greatest increase in high-risk drinking and alcohol use disorder diagnoses?
- Males
- Adolescents
- Older adults
- Majority race/ethnicity
- Higher socioeconomic groups
Adolescents and older adults
When initially speaking with a patient who feels sad about recently learning they have end stage disease, feels hopeless, no plan to hurt themself, a fair approach would be to initially ___ the patient as having a normal reaction to an overwhelming situation.
validate
In the mesocorticolimbic system dopaminergic neurons originate in the ___ ___ ___.
ventral tegmental area
What is the rate-limiting enzyme in the synthesis of norepinephrine?
Tyrosine hydroxylase (converts L-Tyrosine to L-Dihydroxyphenylalanine aka L-DOPA)
The ___ cingulate cortex is a key component of the salience network.
anterior
The Continuous Performance Test measures ___ attention.
sustained
Family-based genetic association studies have the advantage over case-control association studies in that family-based genetic association studies are less affected by ___ population differences.
systematic
___ codes as compared to genetic codes are three-dimensional structures.
Epigenetic
Emotional ___ is an essential parental factor for healthy child development.
attunement
In the first two years of life the motor cortex develops ___ of the sensory cortex.
ahead
FDA-approved use of deep brain stimulation for treatment-resistant obsessive-compulsive disorder involves stimulation of the ___ ___ ___ ___ ___ ___.
anterior limb of the internal capsule
The ___ ___ cortex is most closely associated with working memory (temporarily storing and manipulating information).
dorsolateral prefrontal
What is the term for clusters of alleles that are in linkage disequilibrium and inherited as a single unit?
Haplotypes
___ ___ refers to the non-random association of alleles at two or more loci in a general population. When alleles are in ### ###, haplotypes (clusters of alleles that are in ### ### and inherited as a single unit) do not occur at the expected frequencies.
Linkage disequilibrium
The neural tube is formed from ___.
Ectoderm
A type ___ error is when the true null hypothesis is erroneously rejected.
1
A 30yo comes to ED reporting ringing in the ears, nausea, vomiting. Respirations are deep and rapid. Pt overdoses on numerous, unidentified pills, most likely which of the following?
- Aspirin
- Trazodone
- Propranolol
- Lorazepam
- Acetaminophen
Aspirin
A patient reports feeling detached from his surroundings, which seem fantasy-like and bizarre. In the mental status examination the psychiatrist notes the patient has having:
- illusion
- deja vu
- jamais vu
- derealization
- depersonalization
derealization
The Stroop Color Word Test relies on ___ of overlearned behaviors to assess executive function.
inhibition
Restless leg syndrome has been associated with deficiency of which substance?
Iron
Pramipexole, a first-line treatment for restless leg syndrome, is a nonergot dopamine agonist with specificity for the D2 subfamily dopamine receptor and has also been shown to bind to D3 and D4 receptors. By binding to these receptors it is thought that pramipexole can stimulate dopamine activity on the nerves fo the striatum and substantia nigra.
The neurogenic hypothesis of depression postulates that antidepressant efficacy depends on ___ in the hippocampus.
neurogenesis
In cognitive psychology, the process by which a person’s reaction to stimuli decreases with repeated presentation is referred to as ___.
habituation
Which of the following is a risk factor for rapid cycling bipolar disorder?
- Female sex
- Opiate abuse
- Hyperthyroidism
- Age under 25 years
- Narcissistic personality disorder
Female sex
What is the optimal time to conduct amniocentesis for chromosomal analysis of genetic disorders?
- 8 weeks gestation
- 12 weeks gestation
- 20 weeks gestation
- 28 weeks gestation
- 34 weeks gestation
20 weeks gestation
Antagonism at which of the following neuropeptide receptors promotes analgesic effects?
- Oxytocin
- Endorphin
- Dynorphin
- Nociceptin
- Enkephalin
Nociceptin
Which of the following conditions is held to a stricter confidentiality standard by federal law?
- Suicidality
- Homicidality
- Substance use disorders
- Psychotic disorders
- Treatment with electroconvulsive therapy
Substance use disorders
If a child expresses desire to attend a funeral, have someone familiar ___ the child.
accompany
A patient who vomits, for example in context of eating disorder, may have elevated serum ___.
amylase
- A 12-year-old child is brought by an exasperated parent for evaluation due to child’s belligerent refusal to do chores or homework. The child constantly talks back, is described as irritable much of the time, and is easily annoyed by others. The child purposely annoys other children and, as a result, does not have any friends. Which of the following diagnoses best characterizes the child’s presentation?
- Conduct disorder
- Bipolar disorder, type 1
- Oppositional defiant disorder
- Attention-deficit/hyperactivity disorder
- Disruptive mood dysregulation disorder
Oppositional defiant disorder
The four processes that reflect the flow and focus of a motivational interviewing conversation are: engaging, focusing, planning and ___.
evoking
The pleasurable effects of drugs of abuse begin with increased neurotransmitter release in the ___ ___.
nucleus accumbens
A questionnaire to screen for major depressive disorder has no inquiries pertaining to depressed mood, but has a few inquiries pertaining to spending sprees. Which of the following forms of validity is most affected?
- Content
- Criterion
- Construct
- Concurrent
- Convergent
Content
For a psychological test to demonstrate content validity it must sample the area of interest adequately.
When a child is having difficulty at school, parents aren’t sure of any stressors, child is reluctant to go in the morning, it is especially important to get child, parent and ___ collateral and so for the latter a release to speak should be obtained.
teacher
Which type of therapy focuses on building self-esteem and a cohesive sense of self, as well as improving interpersonal relationships in individuals with more severe psychopathology?
- Cognitive
- Dialectical
- Behavioral
- Supportive
- Psychodynamic
Supportive
A parent of a child with a recent suicide attempt is advised to remove firearms and parent declines saying they need them for protection and will secure them. The psychiatrist files a report with child protective services. The ethical conflict that conflicts with this decision is ___.
Autonomy
If a psychiatrist is aware of physical abuse and does not report it, this opens liability to legal ___.
sanctions
A lawsuit charges that a psychiatric facility prematurely discharged a patient who was not approved for further stay by the managed care company. The final legal responsibility generally falls to the:
- psychiatrist
- managed care company
- managed care reviewer
- psychiatric hospital
- hospital medical director
psychiatrist
Lower birth weight corrected for gestational age most strongly predicts the risk for later development of which of the following?
- Schizophrenia
- Autism spectrum disorder
- Major depressive disorder
- Intellectual developmental disorder
- Attention-deficit/hyperactivity disorder
Attention-deficit/hyperactivity disorder
*An 18yo with BPAD 1 has been euthymic for the past 12 months on lithium therapy, but has had trouble focusing on readings and maintaining attention in school. His parents describe history that aligns with ADHD, inattentive subtype. Addition of methylphenidate may improve the patient’s cognitive symptoms ___ increasing his risk of subsequent mania.
*without
An 11yo is jealous of parents attention to academic success of gifted older sibling. At summer camp, the 11yo gets strongly attached to an older camper who is accomplished martial artist that shows the child some basic skills. When the child returns home he becomes a dedicated martial artist. The parents note he seems less jealous of the older sibling. Which psychodynamic defense mechanism best accounts for the child’s behavior?
- Suppression (conscious, often healthier than repression)
- Repression (unconscious)
- Sublimation
- Displacement
- Isolation of affect
Sublimation
Which of the following cations blocks the NMDA receptor at resting membrane potential?
- Sodium
- Calcium
- Potassium
- Magnesium
- Phosphorus
Magnesium
Which of the following is the most common biological causes of prenatal neurotoxicity linked to the development of intellectual disability?
- Alcohol exposure
- Lead exposure
- Maternal diabetes
- Mercury exposure
- Radiation exposure
Alcohol exposure
Which of the following is the best predictor of later functional and adaptive outcomes in autism spectrum disorder?
- Age of onset
- Verbal ability at age five years
- Hyporeactivity to sensory input
- Presence of highly restricted, fixated interests
- Frequency of stereotyped or repetitive motor movements
Verbal ability at age five years
A pt goes to therapist noting “disturbing thoughts.” They spend 2+ hours each morning to confirm the oven is off, an hour checking CO levels in the children’s rooms each night. They say if they don’t do these things, they constantly worry the family will die of CO poisoning, despite recognition that this is highly unlikely. Which of the following techniques is most commonly used in the treatment of this condition.
- Behavioral activation
- Mindfulness techniques
- Motivational interviewing
- Encouragement to elaborate
- Exposure and response prevention
Exposure and response prevention
Disorganization of behavioral and physiological circadian rhythms is caused by ablation of which of the following areas of the brain in primates?
- Red nucleus
- Caudate nucleus
- Lentiform nucleus
- Nucleus accumbens
- Suprachiasmatic nucleus
Suprachiasmatic nucleus
Which of the following magnetic resonance imaging studies would demonstrate an abnormality in mild traumatic brain injury?
- FLAIR
- T1 weighted
- T2 weighted
- Diffusion tensor imaging
- Positron emission tomography
Diffusion tensor imaging
At approximately 18 months, the typically developing child demonstrates which of the following language development milestones?
- Uses verbs in phrases
- Uses word combinations
- Produces meaningful words
- Speaks in complete sentences
- Makes repetitive vowel sounds
Uses word combinations
By what age does core gender identity typically form?
Three years old (3)
The gag reflex and palatal elevation assess function of which cranial nerve?
The vagus nerve (X)
A typically developing 3yo should be capable of which of the following motor skills?
- Skipping
- Tandem walking
- Copying a triangle
- Pedaling a tricycle
- Following a three-step command
Pedaling a tricycle
Which of the following areas of the hypothalamus have been reported to play a central role in maternal behavior of mothers towards infants?
- Arcuate
- Preoptic
- Paraventricular
- Tuberomamillary
- Suprachiasmatic
Preoptic
“Therapeutic misconception” refers to which of the following with regard to obtaining informed consent in research trials?
- Misconception that patients with dementia cannot give consent
- Assumption by the researcher that the trial’s primary purpose is to help the patient
- Lack of understanding by subjects that they can drop out of the research trial at any time
- Misunderstanding by the researcher that the research participants will benefit from participation
- Assumption by research participants that decisions about their care are being made solely with their benefit in mind
Assumption by research participants that decisions about their care are being made solely with their benefit in mind
The evidence suggests that after completing a course of treatment for insomnia disorder, long-term outcomes are better among patients who were treated with which of the following?
- Zolpidem
- Trazodone
- Biofeedback
- Diphenhydramine
- Cognitive behavioral therapy
Cognitive behavioral therapy
Which of the following is the most commonly validated risk factor for autism?
- Birth order
- Vaccination
- Advanced parental age
- Low maternal education
- Low parental socioeconomic status
Advanced parental age
Oxytocin suppresses the ___ during emotionally charged situations.
amygdala
Energy homeostasis is thought to be regulated by leptin (inhibits hunger) receptors in which of the following brain regions?
- Midbrain
- Hippocampus
- Hypothalamus
- Periaqueductal grey
- Parabrachial nucleus
Hypothalamus
Which of the following enzymes is the rate-limiting step in the synthesis of dopamine?
- Monoamine oxidase
- Tyrosine hydroxylase
- Phenylalanine hydroxylase
- Catechol-O-methyltransferase
- Dihydroxyphenylalanine decarboxylase
Tyrosine hydroxylase
In biofeedback, the relaxation state coincides with decrease in:
- PaCO2 level
- skin conductance
- finger temperature
- parasympathetic tone
- respiratory heart rate variability
skin conductance
Damage to which of the following structures may account for flapping movements of the limbs seen in carbon monoxide poisoning?
- Caudate
- Amygdala
- Cerebellum
- Globus pallidus
- Substantia nigra
Globus pallidus
Which of the following medications have the best evidence for monotherapy treatment of bipolar depression?
- Bupropion
- Citalopram
- Quetiapine
- Lurasidone
- Ziprasidone
- Lamotrigine
- Aripiprazole
- Olanzapine-Fluoxetine combination
- > Quetiapine
- > Lurasidone
- > Olanzapine-Fluoxetine combination
Which of the following DNA-based discovery techniques can empirically interrogate a genome without any a priori genetic hypothesis?
- Twin studies
- Linkage analysis
- Candidate gene approach
- Genome-wide association studies
Genome-wide association studies
A metabolite of which of the following hormones is a potent allosteric modulator of the GABA-A receptor and has been implicated in depression?
- Cortisol
- Oxytocin
- Estrogen
- Progesterone
Progesterone
Lithium was first approved by the US FDA for treatment of acute mania in 1970. The most important reason why lithium had difficulty entering the US market is that pharmaceutical companies were reluctant to produce a drug that they could not ___.
patent
An 8yo boy is reported by teachers to be sexually seductive to other children, to openly display sexual behavior and to sexualize play activities. This is most likely a manifestation of:
- precocious puberty
- previous sexual abuse
- normal sexual behavior
- borderline intellectual disability
previous sexual abuse
A recently adopted three-year-old is brought for evaluation of inhibited, emotionally withdrawn behavior. The child rarely seeks or responds to comfort when distressed, and has limited positive affect and emotional responsiveness to others. What additional history is required for the most likely diagnosis?
- Serious neglect
- Restricted interests
- Ritualized behaviors
- Developmental delay
Serious neglect
By the age of about 15 months, typically developing children begin to achieve which of the following milesetones?
- Infer others’ emotions and content
- Engage in reciprocal conversation
- Display social smile and gesture in peer interactions
- Understand that others have minds different from their own
Understand that others have minds different from their own
In ___ conditioning, praising the spouse for having picked up dirty dishes would be an example of a positive reinforcer.
operant
Which of the following statements best describes current thinking about the relationship between attention-deficity/hyperactivity disorder (ADHD) in children and adults?
- They appear to be separate disorders, although there is some overlap.
- Most adults with ADHD did not have significant symptoms as children.
- A significant number of children with ADHD will go on to become adults with ADHD.
- Adults can receive the diagnosis of ADHD even if they did not have symptoms as children.
A significant number of children with ADHD will go on to become adults with ADHD.
Needle exchange is an example of which of the following types of reduction strategies?
- Harm
- Supply
- Access
- Demand
Harm
The ___-___ ___, striatum and thalamus form a circuit that when overactive produces worry/obsessive symptoms. This is why neurosurgical approaches for the treatment of refractory obsessive-compulsive disorder target the cortico-striatal-thalamo-cortical circuitry.
dorsolateral-prefrontal cortex
Decreased dopamine in the ___ projection of the dorsolateral prefrontal cortex is postulated to be responsible for the negative and depressive symptoms of schizophrenia.
mesocortical
Hyperactivity of dopamine in the ___ pathway mediates positive psychotic symptoms.
mesolimbic
What is the most frequently studied deep brain stimulation depression target?
Subcallosal cingulate cortex (The neurosurgeons doing deep brain stimulation aim for the SCC)
___ plays a key role in fine-tuning working memory (temporarily storing and manipulating information such as when doing mental arithmetic) function in the dorsolateral prefrontal cortex.
Dopamine
In response to stress, corticotrophin-releasing hormone (CRH) is released from the ___ ___ of the hypothalamus.
Paraventricular nucleus
___ ___ posited that development occurs in sequential, clearly defined stages, and that each stage must be resolved for development to proceed smoothly.
Erik Erikson
Erik Erikson posited that development occurs in sequential, clearly defined stages, and that each stage must be resolved for development to proceed smoothly. Erikson’s stages of development:
- 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)
- ____ vs ___ ___ (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)
Identity vs role confusion (12 to 18 years; Dr. A-D’s 15yo twins)
___ effects, when dysfunctional, have been shown to most comprehensively replicate the core symptoms of schizophrenia.
Glutamate (Part of PCP’s MOA is NMDA antagonism which produces acute psychosis that mimics schizophrenia and leads to excess neurotransmitter release that can cause agitation and seizures)
Erik Erikson defined ___ ___ as lack of continuity in how the self if experienced in relationships over time.
identity diffusion
The ___ dopaminergic pathway includes the nucleus accumbens (part of ventral striatum and mediates addiction and associated behaviors).
Mesolimbic (Dopamine blocking antipsychotics decrease pleasure by blocking the mesolimbic pathway)
Following a full-term normal birth, circadian sleep rhythms (suprachiasmatic nucleus) are similar to those of an adult by ___ months.
six (6) months
___ is the stage of development when the maximal number of axons and synapses exist.
Infancy
___ accounts for the brain’s rapid increase in size from birth through the second year of life.
Synaptogenesis
In typically developing children the corticospinal tracts have completed myelination by ___ years of age
three (3) yo
The development of brain grey matter volume peaks during ___ childhood. Adolescence is the stage of development in which maximal pruning of cortical synapses occurs.
late
The development of brain grey matter volume peaks during late childhood. ___ is the stage of development in which maximal pruning of cortical synapses occurs.
Adolescence
Synaptic ___ predominantly occurs during adolescence and young adulthood.
pruning
Freud’s theory of psychosocial development emphasizes that as humans develop they become ___ 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)
fixated
*DNA ___ recruits proteins involved in gene repression or by inhibiting the binding of transcription factors to DNA.
*methylation
*DNA ___ (generally rapid and reversible) increases expression of genes through transcription activation (acetyl groups cause histone groups to wrap DNA less tightly, so it is more readily accessible/able to be transcribed).
*acetylation (Acetylation of lysine residues in histone proteins relaxes chromatin structure)
The ___ has the highest concentration of serotonin-producing cells in the brain.
Raphe nuclei
The raphe nuclei has the highest concentration of ___-producing cells in the brain.
serotonin
Norepinephrine is mostly synthesized in the ___.
locus coeruleus
___ is mostly synthesized in the locus coeruleus.
Norepinephrine
___ prevention involves methods to detect and address an existing disease prior to the appearance of symptoms.
Secondary prevention
Secondary prevention involves methods to detect and address an existing disease ___ to the appearance of ___.
prior; symptoms
___ prevention involves methods to reduce the harm of symptomatic disease such as disability or death through rehabilitation and treatment (Pt on seroquel gets diabetes mellitus, treat with metformin).
Tertiary prevention
Tertiary prevention involves methods to reduce the harm of ___ disease such as disability or death through rehabilitation and treatment (Pt on seroquel gets diabetes mellitus, treat with metformin).
symptomatic
Tertiary prevention involves methods to ___ the harm of symptomatic disease such as disability or death through rehabilitation and treatment (Pt on seroquel gets diabetes mellitus, treat with metformin).
reduce
An epigenetic cause of fragile X syndrome involves methylation of the ___ sites of the promoter region of the fragile X mental retardation 1 gene. Fragile X syndrome is the most common cause of inherited intellectual disability (Trinucleotide repeat in FMR1 gene. Long face, large everted ears, prominent jaw, macroorchidism and a high arched palate, frequent hand flapping).
CpG
An epigenetic cause of fragile X syndrome involves methylation of the CpG sites of the ___ region of the fragile X mental retardation 1 gene. Fragile X syndrome is the most common cause of inherited intellectual disability (Trinucleotide repeat in FMR1 gene. Long face, large everted ears, prominent jaw, macroorchidism and a high arched palate, frequent hand flapping).
promoter
An epigenetic cause of fragile X syndrome involves methylation of the CpG sites of the promoter region of the fragile X mental retardation 1 gene. ___ ___ ___ is the most common cause of inherited intellectual disability (Trinucleotide repeat in FMR1 gene. Long face, large everted ears, prominent jaw, macroorchidism and a high arched palate, frequent hand flapping).
Fragile X syndrome
___’s theory 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)
Piaget
Piaget’s theory of cognitive development:
+___ 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)
Sensorimotor (birth->2 years)
Piaget’s theory of cognitive development:
+Sensorimotor period: birth->2 years
+Preoperational period: 2->7 years (“they draw on everything”)
+___ 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)
Concrete (7-12yo)
Ocular jerk movements with optokinetic ___ suggests psychogenic blindness.
drum
In bipolar affective disorder, neuroimaging shows ___ functional connectivity between amygdala and the prefrontal cortex.
decreased
Pathogenic copy number variants affecting DNA base pairs are associated with ___-___ (hyperphagia, failure to thrive, early obesity, hypogonadism, OCD, short, small hands and small feet).
Prader-Willi
___ ___ are different proteins encoded by the same gene.
Splice variants
Amygdala-___-periaqueductal gray (endorphins) is the neural pathway most consistently found to mediate reactive aggression.
hypothalamus
Amygdala-hypothalamus-periaqueductal gray (endorphins) is the neural pathway most consistently found to mediate reactive ___.
aggression
Amygdala-hypothalamus-___ gray (endorphins) is the neural pathway most consistently found to mediate reactive aggression.
periaqueductal
___ properties of nicotine are most closely associated with nicotinic acetylcholine receptor alpha4beta2.
Reward
Reward properties of nicotine are most closely associated with nicotinic acetylcholine receptor ___.
alpha4beta2
Reward properties of nicotine are most closely associated with ___ acetylcholine receptor alpha4beta2. Varenicline/Chantix is a partial agonist at alpha4beta2 nicotinic acetylcholine receptors. Varenicline activates these receptors to a lesser extent than the full agonist nicotine and also prevents nicotine from binding to these receptors.
nicotinic
The hypothalamic ___ nucleus is key to integration of neural and nutrient signals with hormonal signals from the small intestine, pancreas, liver, adipose tissue and brainstem.
arcuate
Gender ___ is typically established by 3yo.
identity
*L-Tyrosine (non-essential amino acid, can get in diet and also synthesized from phenylalanine)
is converted by Tyrosine hydroxylase to
L-Dihydroxyphenylalanine (L-DOPA)
->
Dopamine
is converted by dopamine hydroxylase to
Norepinephrine
->
Epinephrine
What is the rate limiting step in the synthesis of norepinephrine?
Tyrosine hydroxylase
The Wisconsin Card Sorting Task measures the ability to generate ___ strategies in response to feedback.
alternative
The ___ is used to measure concept formation and concept flexibility.
Wisconsin Card Sorting Test
The ___ area of the frontal cortex is most consistently activated during shifting of cognitive sets in the Wisconsin Card Sorting Test.
dorsolateral
The ___ ___ is the area of the brain primarily responsible for face recognition (Its BETO!!!)
fusiform gyrus (think about the name, “fusiform”… ITS BETO!)
Which of the following symptoms is considered an irreversible effect of chronic anabolic steroid use?
- Infertility
- Hirsutism
- Impotence
- Gynecomastia
- Testicular atrophy
Hirsutism
An infant who engages in an interactive game of peek-a-boo most closely demonstrates the concept of which of the following cognitive abilities?
- Centering
- Egocentrism
- Conservation
- Object permanence
- Tertiary circular reactions
Object permanence
Which of the changes below is supported by the literature for teachers considering “learning styles” when planning curricula?
- Transition all lectures to small group problem-based formats
- Offer several different modalities and allow students to choose
- Make no changes, lecture-based curricula result in higher test scores
- Allow students to self-declare learning styles and opt out of certain requirements
- Use supplemental material designed to address the needs of all types of learners
Use supplemental material designed to address the needs of all types of learners
A high-achieving patient becomes increasingly anxious about the perception of her work. This has led her to work longer hours to produce results that she believes will be viewed positively by her team. The therapist asks the patient whether the long hours are truly needed to be successful. She responds, “I always have to work harder than everyone else to succeed.” In cognitive theory, this statement is an example of:
- a schema
- globalization
- internalization
- an automatic thought
- a compensatory strategy
a schema
Which of the following is the most significant barrier to accessing mental health services in school-based health centers?
- Lower quality of care
- Stricter referral process
- Health insurance restrictions
- Concerns about confidentiality
- Limited access to appointments
Concerns about confidentiality
Which of the following therapies is the most likely to describe a therapeutic goal as “improving ego functioning and self-esteem”?
- Family therapy
- Exposure therapy
- Supportive psychotherapy
- Dialectical behavior therapy
- Interpersonal psychotherapy
Supportive psychotherapy
A 30yo has intermittent muscle twitching. Exam show full strength with normal muscle bulk. Electromyography shows spontaneous discharges which are relatively constant and represent firing of the motor unit. These findings are typical of:
- cramps
- spasms
- myokymia
- fibrillations
- fasciculations
fasciculations (“muscle twitches”)
A pro dancer’s performance and the show won wide acclaim, but she can’t stop replaying a minor misstep she made that was not noticed by the audience or other performers. Despite being congratulated on her performance, she feels that, due to the error, she has let herself down. Which of the following cognitive errors is the patient displaying?
- Minimization
- Personalization
- Overgeneralization
- Selective abstraction
- Dichotomous thinking
Selective abstraction
A patient prominently uses the defenses of isolation of affect and intellectualization. The patient’s description of many life events appears to involve reaction formation. Which personality trait is most likely to characterize this patient?
Obsessive-compulsive [associated with disruption in cortico (dorsolateral prefrontal cortex)-striato-thalamo-cortical circuit function]
A researcher follows two groups of people to assess for the development of dementia. One group has a history of lorazepam use and the other does not. What type of study design is being used?
Prospective cohort
Disruption in cortico (dorsolateral prefrontal cortex)-striato-thalamo-cortical circuit function is most closely associated with what group of disorders?
- Mood
- Somatoform
- Schizophrenic
- Posttraumatic stress
- Obsessive-compulsive
Obsessive-compulsive
___ introduced the strange situation experiment to evaluate attachment between a parent and child.
Mary Ainsworth
A 9yo with attention-deficit/hyperactivity disorder does not respond to methylphenidate. Which of the following medications should be tried next?
- Clonidine
- Fluoxetine
- Bupropion
- Guanfacine
- Dextroamphetamine
Dextroamphetamine
Which of the following developmental stages in psychodynamic group therapy is characterized by intimacy?
- Engagement
- Subgrouping
- Termination
- Working group
- Differentiation and individuation
Working group
Which of the following is used in biofeedback as a marker of autonomic activity?
- Heart rate variability
- Systolic blood pressure
- Diastolic blood pressure
- Respiratory rate variability
- Circadian core body temperature
Heart rate variability
A 22mo places a wooden block on a toy train track and says, “choo-choo!” while moving the block back and forth along the track. This behavior is most likely an example of which of the following types of play?
- Fantasy
- Parallel
- Symbolic
- Cooperative
- Sensorimotor
Symbolic
According to psychoanalytic theory, the term ___ ___ ___ refers to mental activity exemplified by unconscious thoughts that do not maintain logical connections.
primary process thinking
Which of the following infant and toddler temperamental styles has been shown to have the greatest association with the eventual onset of anxiety symptoms in childhood?
- Inhibited
- Irritable
- Hyperactive
- Dysregulated
- Aggressive
Inhibited
Which of the following hormones is released during sleep, but likely does not have a circadian pattern?
- Melatonin
- Cortisol
- Prolactin
- Oxytocin
- Growth hormone
Growth hormone (however, GH secretion is enhanced by slow-wave sleep)
Extracorporeal treatment is typically indicated in cases of severe lithium toxicity. Lithium is readily dialyzable due to its:
- high tissue binding
- high protein binding
- low molecular weight
- high volume of distribution
- low proximal tubule resorption
low molecular weight
A grad student says in exam week the R leg is paralyzed. On PE reflexes are normal, pt is asked to lie down flat and lift the unaffected leg. When he does this, the doctor feels increased pressure under the affected leg. What is the most likely diagnosis?
Conversion disorder
When testing for Babinski reflex, downward scraping of the shin can help the examiner overcome the ___ response by a patient.
withdrawal
A 22yo began psychotherapy due to feeling inadequate and depressed in the setting of working as a barista since graduating from college and deferring medical school acceptance. The patient has been having conflicts with his mom and dad about his ambivalence to become a doctor. What is the most likely developmental task that the patient is struggling with?
Identity (Erik Erikson’s theory of development, Identity vs role confusion: age 12-18. Adolescents experience some role confusion and mixed emotions about the specific ways in which they fit into society. They may experiment with a variety of behaviors and activities before they achieve a sense of identity.)
In malpractice lawsuits, for patient’s to win, doctor-patient ___ must be established.
relationship
The ability to temporarily store and manipulate information, such as when doing mental arithmetic, is referred to as ___ ___.
working memory (dorsolateral prefrontal)
Clinical studies of adolescents and young adults have found that physicians can decrease the risk of suicidal events when prescribing antidepressant medication by ___ titrating the antidepressant.
slowly
Hearing one’s name each time the wind rustles the leaves outside the room each morning is an example of an ___.
illusion
A form of learned fear in which a person or an experimental animal learns to respond strongly not only to a harmful stimulus, but also to a subthreshold stimulus refers to:
- avoidance
- sensitization
- habituation
- irrational fear
- learned helplessness
sensitization
Which of the following is seen most frequently as a comorbid condition in children with autism spectrum disorder?
- Selective mutism
- Intellectual disability
- Early-onset schizophrenia
- Obsessive-compulsive disorder
- Attention-deficit/hyperactivity disorder
Intellectual disability
The term ___ refers to small insertions and deletions in DNA sequence.
indels (INsertions and DELetionS in DNA sequence)
Pt comes to ED with significant paranoia, is hypervigilant, pacing and responding to unseen others. Which of the following techniques would be most appropriate to build rapport with the patient?
- Make sustained eye contact
- Acknowledge the patient’s fear
- Directly confront the patient’s paranoia
- Agree that the patient’s suspiciousness is justified
- Approach the interview as if the patient is a close friend
Acknowledge the patient’s fear
18yo has been avoiding food for the past four months. Her BMI is less than normal, and she menstruates regularly. Family members say she obsesses about being “fat,” even though she continues to lose weight. On several occasions, they have overheard her vomiting in the bathroom after consuming a large meal. She meets criteria for which of the following diagnoses?
- Bulimia nervosa
- Anorexia nervosa
- Rumination disorder
- Unspecified eating disorder
- Avoidant/restrictive food intake disorder
Anorexia nervosa
The ___ is a small region of the cerebral cortex located deep within the lateral sulcus, which is a large fissure that separates the frontal and parietal lobes from the temporal lobe. Along with the medial pre-frontal cortex, the insula is involved in both fear conditioning and fear extinction.
insula
Text messaging and online media to communicate with peers is ___ for modern adolescents socializing with their peer group.
normal
40yo goes to hospital due to concussion after MVC. No abnormalities on PE other than lacerations and ecchymoses. One week later, the patient has generalized pain, dizziness, difficulty sleeping, and recurrent nightmares when able to sleep. The patient now fears driving. Which of the following is the most likely explanation for the development of these symptoms?
- Malingering
- Adjustment disorder
- Acute stress disorder
- Somatic symptom disorder
- Posttraumatic stress disorder
Acute stress disorder
D3 has been found to be effective as an adjunct to antidepressant medications for the treatment of ___.
depression
In a properly conducted randomized clinical trial, it is inappropriate to include p values in a table showing baseline characteristics of subjects by treatment group because any differences at baseline must have arisen by chance given ___.
randomization
Which psychodynamic theory emphasizes individuals’ ability to understand their own and others’ internal states as explanations for behavior?
Mentalization theory
When the central nervous system responds to an acute cortical insult microglia processes retract, and the cell body ___.
enlarges
[Microglia secrete innate proinflammatory cytokines TNF-a and IL-1B in patients with inflammatory conditions that affect the brain.]
Which of the following diagnoses is associated with high hypnotizability potential?
- Schizophrenia
- Panic disorder
- Dissociative disorder
- Substance dependence
- Attention-deficit/hyperactivity disorder
Dissociative disorder
Synaptic ___ predominantly occurs during adolescence and young adulthood.
pruning
Grey matter volume development peaks in late ___, before the synaptic pruning time in adolescence/young adulthood.
childhood
Which of the following is the best example of a second stage or “self-conscious” emotion, which is believed to develop around the end of the second year of life?
- Envy
- Fear (earlier: within first year)
- Anger
- Altruism
- Empathy
Envy
HIPAA limits disclosure of patient health information information without patient authorization except as necessary for which of the following?
- Research
- Payment
- Education
- Medical licensure
- Medical malpractice
Payment
The validity scales of the Minnesota Multiphasic Personality Inventory-II measure the test-taking ___ of the patient.
attitude
Pt has history of depression and well-controlled epilepsy and has undergone multiple unsuccessful antidepressant trials before responding to bupropion. Pt has yet to try several antidepressants including imipramine, nortriptyline, duloxetine, selegiline. The patient’s insurance company recommends switching to another antidepressant because of bupropion’s well-known tendency to reduce seizure threshold. The psychiatrist should ___ bupropion.
continue
A 20yo comes to the ED following nausea, sweating and hematemesis. They have had recent severe headaches and numbness in the extremities. CT shows generalized brain atrophy. Labs show renal tubular acidosis and a CPK of 3120 mcg/L. The presentation is consistent with chronic use of which of the following substances?
- Phencyclidine
- Amphetamines
- Steroids
- Cocaine
- Inhalants
Inhalants (chronic use->renal tubular acidosis, CPK increase, generalized brain atrophy)
Which of the following is transmitted through the spinothalamic tract?
- Pain and Temperature
- Balance
- Vibration
- Joint position
- Tactile sense
Pain and Temperature
A patient’s managed care insurance company refuses to authorize continued hospitalization for a depressed patient who remains acutely suicidal. The treating inpatient psychiatrist remains concerned about the potential for suicide and does not discharge the patient. The psychiatrist’s actions best illustrate the ethical principle in managed care of responsibility to ___.
treat
___ REM latency on a multiple sleep latency test (MSLT) confirms the diagnosis of narcolepsy. Also see this in depressed patients.
Decreased
___ of neurons accounts for the brain’s rapid increase in size from birth through the second year of life.
Synaptogenesis
Which of the following is the most common reason for patients to discontinue selective serotonin reuptake inhibitors early?
- GI distress
- Sedation
- Agitation
- Insomnia
- Jitteriness
GI distress
Parents are concerned because their 2yo girl is playing with trucks instead of dolls, likes to wear boy’s clothes, and prefers to play with boys instead of girls. The parents have tried to change these behaviors, but the child has been resistant. When interviewed by the physician, the child insists that she is a girl. Which of the following is the most likely diagnosis?
- Gender dysphoria
- Normal development
- Transvestic disorder
- Body dysmorphic disorder
- Oppositional defiant disorder
Normal development
Which of the following neurotransmitters, present in the periaqueductal grey matter, is involved in the mediation of pain?
- Aspartate
- Serotonin
- Endorphins
- Dopamine
- Histamine
Endorphins
Glycogen synthase kinase-3 ___ is a pharmacological effect of lithium.
inhibition
Which of the following stages of development occurs first in female physical development?
- Rise in growth hormone secretion
- Onset of gonadal estrogen production
- Increase in adrenal androgen production
- Surge in luteinizing and follicle-stimulating hormones
- Organization of pulsatile release of gonadotropin-releasing hormone
Increase in adrenal androgen production
Which type of genetic variation is most commonly investigated in genome-wide association studies?
- mRNA abundance
- Translation efficiency
- Insertions or deletions
- Copy number variants
- Single nucleotide polymophisms
Single nucleotide polymorphisms (SNPs) (SNPs are locations within the human genome where the type of nucleotide present (A,T,G, or C) can differ between individuals. SNPs are the most common type of genetic variation found among people.)
What Freudian psychosexual stage of development is characterized by an intensification of libidinal drives, separation from a dependence on one’s parents, and achievement of a mature sense of self?
Genital
A 30yo has episodes of irresistible sleepiness, and falls asleep while driving. She reports experiencing episodes of paralysis and hallucinations upon awakening. These symptoms are best explained by a deficiency of ___.
Orexin/Hypocretin
[Orexin, from orexis, meaning “appetite” in Greek, is involved in the stimulation of food intake. In addition, it stimulates wakefulness, regulates energy expenditure and moderates visceral function. The most common form of narcolepsy, in which the sufferer experiences brief losses of muscle tone (cataplexy) is caused by a lack of orexin in the brain due to destruction of the cells that produce it.]
A 29yo with new-onset headache characterized by unilateral, stabbing eye pain has runny nose and conjunctival injection on the same side as the headache during episodes. The episodes occur every night after falling asleep and last up to two hours. The patient most likely has ___ headache.
cluster
Pt that says they often feel they have “no self” and her thoughts are not hers, feels like a robot and as if can’t control her body. She says she knows she has feelings, but can’t feel them instead feels emotionally numb and often feels her head is full of cotton. Recently she started having “out of body” experiences. Which of the following is the most likely diagnosis?
- Illness anxiety disorder
- Dissociative identity disorder
- Posttraumatic stress disorder
- Borderline personality disorder
- Depersonalization/derealization disorder
Depersonalization/derealization disorder
The three main components of “Meaningful use” of electronic medical records (EMR) include the use of certified EMR in a meaningful manner, the use of certified EMR to submit clinical quality measures and electronic exchange of health information to improve ___ of care.
quality
Current evidence of psychiatrists using pharmacogenomics testing in clinical practice shows promise for clinical utility, but replicated evidence about outcomes is ___.
lacking
To minimize liability for the psychiatrist providing an informal “curbside” consultation for PCP, care of the patient remains under the direction of the PCP who also remains in charge of ___ medications or additional services.
ordering
Splice variants are best defined as ___ ___ encoded by the same gene.
different proteins
Which of the following antidepressant medications is safest to use in patients with seizure disorders and depression?
- Amoxapine
- Bupropion (NO!)
- Clomipramine
- Fluoxetine
- Maprotiline
Fluoxetine/prozac
According to Erikson, the predominant emotional issue in typically developing, ___-age children is personal worth and competence.
school
[Industry vs inferiority: age 6 to 12 years.
The child compares self-worth to others (such as in a classroom environment or with other siblings). A child can recognize major disparities in personal abilities relative to other children. The role of the teacher is very important, the teacher should ensure that children do not feel inferior but proud of their individual achievements.]
Which of the following would be considered a boundary violation?
- Investing in a patient’s business
- Treating the town pharmacist in a small rural town
- Accepting a patient’s holiday gift of a hand-knit scarf
- Seeing one patient at a reduced fee while charging others the full rate
- Discussing the patient’s sexual feelings toward the psychiatrist in session
Investing in a patient’s business (boundary violations involve exploitation)
Under the Health Insurance Portability and Accountability Act (HIPAA), a provider must obtain specific consent or authorization from a patient before sharing individually identifiable health information to:
- a third party payer for the purpose of payment
- an investigator for the purpose of conducting epidemiological research
- a health care provider who is taking over the ongoing care of the patient
- a non-clinical hospital administrator for the purpose of quality improvement
- another clinician unfamiliar with the patient for the purpose of medical consultation
An investigator for the purpose of conducting epidemiological research
___ is maximized to ensure that a screening test misses only a small number of individuals with an illness.
Sensitivity
If tyrosine hydroxylase is dramatically decreased due to a specific neurotoxin, which of the following types of neurons are most likely to be impaired by this neurotoxin.
- Dopaminergic
- GABAminergic
- Glutaminergic
- Histaminergic
- Serotonergic
Dopaminergic
*L-Tyrosine (non-essential amino acid, can get in diet and also synthesized from phenylalanine)
is converted by Tyrosine hydroxylase to
L-Dihydroxyphenylalanine (L-DOPA)
->
Dopamine
is converted by dopamine hydroxylase to
Norepinephrine
->
Epinephrine
What is the rate limiting step in the synthesis of norepinephrine? Tyrosine hydroxylase
Which ethical principle, as elucidated in the Belmont Report, underlies the practice of informed consent?
Respect for persons
The frequency of typical sexual behaviors (i.e. self-stimulation, exhibitionism, sexual intrusiveness) exhibited by children of both genders peaks at what age?
five years (Eliza Gray attack!; latter part of Freud’s 3-6yo Phallic phase)
In epigenetic histone protein amino acid residue modification, acetylation is generally rapid and ___.
reversible
A right-handed patient with a history of intractable seizures underwent neurosurgical treatment. In follow-up testing, the blindfolded patient was unable to name objects placed in the left hand, but had no difficulty naming the objects when they were displayed on a screen. What was the site of the surgical intervention?
- Thalamus
- Corpus callosum
- Right parietal lobe
- Left superior temporal lobe
- Bilateral medial temporal lobes
Corpus callosum
[The corpus callosum consists of a large bundle of fibers connecting the right and left hemispheres of the brain. Each hemisphere controls movement in the opposite (contralateral) side of the body and can also specialize in performing specific cognitive and perceptual functions. The corpus callosum allows information to move between hemispheres and is therefore a very important integrative structure.]
The ___ ___ ___ Test is used to measure concept formation and concept flexibility.
Wisconsin Card Sorting (Dorsolateral frontal cortex activated during shifting of cognitive sets)
The Wisconsin Card Sorting Task measures the ability to generate alternative strategies in response to feedback.
An example of a positive (health promoting) effect of the neuroinflammatory response is ___ propagation of cytokines with associated decreased physical activity in response to a peripheral infection.
microglial
[Microglia secrete innate proinflammatory cytokines TNF-a and IL-1B in patients with inflammatory conditions that affect the brain.]
What is the most prominent lobbying and support organization for families of people with severe psychiatric disorders?
National Alliance for the Mentally Ill (NAMI)
Which of the following sleep changes is often seen in depressive disorders?
- Decreased REM latency
- Increase in total sleep time
- Increase in slow-wave sleep
- Decrease in nocturnal arousal
- Decreased core body temperature
Decreased REM latency (this is seen in depressive disorders and in narcolepsy)
Genetic deletion is involved in the development of ___ syndrome/DiGeorge syndrome/22q11.2 deletion syndrome.
velocardiofacial
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.
Positron emission tomography scanning measures what?
Glucose metabolism
Glucose “PET”
What proportion of the human genome comprises the “exome”?
2%
[Exon: a segment of a DNA or RNA molecule containing information coding for a protein or peptide sequence]
Pervasive and excessive emotionality and attention-seeking behaviors are the essential features of which personality disorder?
Histrionic (stuck in Freud’s birth-1yo oral stage)
Guanfacine and clonidine are alpha-2 adrenergic ___.
agonists
___ selectively inhibits the reuptake of norepinephrine with little to no activity at other neuronal reuptake pumps or receptor sites. Of note, it also increases SI and has a black box warning for this.
Atomoxetine
The validity of an assessment instrument refers to the extent to which it measures what it ___ to measure.
intends
The recognition of affective behavior by the mirror neuron system involves connections between the anterior mesial frontal cortex and the ___.
insula
The insula is a small region of the cerebral cortex located deep within the lateral sulcus, which is a large fissure that separates the frontal and parietal lobes from the temporal lobe.
Along with the medial pre-frontal cortex, the insula is involved in both fear conditioning and fear extinction.
Obsessive-compulsive disorder is most commonly comorbid with:
- schizophrenia
- mood disorders
- anxiety disorders
- substance use disorders
- trauma and stressor-related disorders
anxiety disorders
During the stress response in humans, corticotropin-releasing hormone (CRH) is released from the ___ ___ of the hypothalamus.
Paraventricular nucleus
The ___ regulates a wide range of behavioral and physiological activities. It controls many autonomic functions such as hunger, thirst, body temperature, and sexual activity. To do this, it integrates information from many different parts of the brain and is responsive to a variety of stimuli including light (it regulates circadian rhythms), odors (eg, pheremones), stress, and arousal (hypothalamic neurons release oxytocin directly into the bloodstream). Other functions it controls include parenting behavior, perspiration, blood pressure, and heart rate.
hypothalamus
A patient’s psychotic symptoms fail to respond to risperidone 8mg/day and lab testing shows drug levels below expected. Assuming medication adherence, genotyping for CYP450 polymorphism should reveal which of the following results?
- Two copies of variant alleles
- Two copies of wild-type alleles
- Multiple copies of wild-type alleles
- One wild-type and one variant allele
Multiple copies of wild-type alleles
The physician should recommend that a child get a hearing test if the child is not able to make two-word sentences by what age?
2 years
A researcher is contemplating a cross-over study in which study subjects serve as their own controls and participate in both arms of the treatment. This design is most likely to cause what aspect of the study to be increased?
- Precision
- Relative cost
- Between-subject variation
- Number of subjects recruited
Precision (the quality, condition, or fact of being exact and accurate.)
After a child survives a natural disaster, which of the following social factors is most likely to be protective against developing post-traumatic symptoms?
- The availability of peer support
- Timely relocation to a safer location
- Access to counseling and mental health services
- Validation of the importance of the event through media coverage
The availability of peer support
___ is the emotional reaction of the analyst to the subject’s contribution.
Countertransference
Detection of single nucleotide variants in rare genetic diseases is most likely to occur with which of the following types of genetic study?
- Exome sequencing
- DNA-protein analysis
- Family-based linkage
- RNA sequencing analysis
Exome sequencing
Exon: a segment of DNA or RNA molecule containing information coding for a protein or peptide sequence
A patient who takes olanzapine develops diabetes. Treating the patient with metformin is an example of what kind of prevention?
Tertiary (Methods to reduce the harm of symptomatic disease, such as disability or death, through rehabilitation and treatment)
Secondary prevention involves methods to detect and address an existing disease ___ to the appearance of symptoms.
prior
Which of the following methods examines the consistency with which genetic variants are passed from parent to offspring within different families?
- Recombination
- Linkage analysis
- DNA sequencing
- Genome-wide association studies
Linkage analysis
Genetic linkage is the tendency of DNA sequences that are close together on a chromosome to be inherited together during the meiosis phase of sexual reproduction.
A primary rationale for implementing collaborative care is that existing mental health care programs do not have the ___ to provide effective treatment to all patients in need.
capacity
According to ___ ___, a child who perceives the mother as an integrated person who is responsible for both good and bad experiences at the same time is said to be in the depressive position.
Melanie Klein
High voltage delta activity associated with slow eye-rolling movements on polysomnogram is characteristic of the ___ stage of sleep.
N3
Intensive case management is defined as 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 care as usual, the literature has shown which of the following effects of intensive case management?
- Decreased death by suicide
- Increased patient employment
- Reduced length of hospitalization
- Reduced incidence of metabolic syndrome
Reduced length of hospitalization
