History/Law Flashcards
Piaget’s contribution to development was a theory explaining what phenomenon? (2x)
HOW INDIVIDUALS LEARN AND UNDERSTAND THE WORLD
Multiaxial system introduced in what edition of DSM
DSM III
Otto Kernberg’s model for tx of patients with narcissistic personality disorder differs from that of Kohut in that in Kernberg’s model, the goals of psychotherapy include:
INTEGRATING IDEALIZATION AND TRUST WITH RAGE AND CONTEMPT
According to Aaron Beck, the primary defect in depression involves which of the following?
COGNITIVE DISTORTION
Piaget was interested in:
HOW A CHILD ARRIVES AT ANSWERS
First edition of the DSM to exclude homosexuality as a diagnosis:
DSM-III-R (1987)
The case of “Little Hans” led Freud to develop a psychological theory of the formation of which of the following symptoms?
PHOBIA
In terms of the normal functioning of the personality, Anna Freud’s contributions were in the realm of:
DEFENSE MECHANISMS
Theorist introduced the concepts of introversion and extroversion:
CARL JUNG
Kohut’s theory of personality is based on?
THE INDIVIDUAL’S NEED FOR EMPATHIC INTERACTION WITH SELF-OBJECTS
Cognitive therapy was developed by:
AARON BECK
Cartesian dualism from the theories of Rene Descartes refers to
POTENTIAL OF HUMAN NATURE FOR BOTH GOOD AND EVIL
Normal autism, symbiosis, differentiation, and practicing are among the developmental subphases of separation and individuation proposed by what theorist?
MARGARET MAHLER
Melanie Klein differed from Freud in her emphasis on what factor?
EARLY OBJECT RELATIONS
According to Holmes & Rahe, what life event is assoc w highest stress/disruption?
DEATH OF A SPOUSE
Mental competency of an elderly patient is determined by: (7x)
JUDICIAL HEARING
Testamentary capacity refers to person’s ability to (4x)
MAKE A WILL
What is primary role of psychiatric expert witness (4x)
RENDER OPINION BASED ON SCIENTIFIC KNOWLEDGE
Child custody determinations in most jurisdictions are made using what principle? (4x)
THE BEST INTEREST OF THE CHILD
Sufficient to establish that a person is incompetent to stand trial (3x)
FAILURE TO UNDERSTAND THE CHARGES ONE IS FACING
Constitutional and common law dictate that mental health care provided to prisoners be at or above the level of services that should be available to them if they were in the community. The “necessaries” doctrine is justified by what principle? (x2)
TREATMENT MUST BE PROVIDED TO THOSE WHO ARE PREVENTED FROM SEEKING THEIR OWN MEDICAL CARE.
What is the first step when determining whether or not a criminal defendant is not guilty by reason of insanity? (2x)
DETERMINE THE LEGAL INSANITY STANDARD TO BE USED.
When evaluating for competence to proceed in a criminal matter, the psychiatric evaluator should focus on which aspect of the defendant? (2x)
CURRENT MENTAL FUNCTIONING
What is most important to evaluate “competence”? (2x)
WHAT DO YOU THINK WILL HAPPEN IF YOU DON’T UNDERTAKE THIS TREATMENT?
Medication can be administered without a patient’s consent under which of the following circumstances? (2x)
AN EMERGENCY SITUATION EXISTS AND CAN BE DOCUMENTED
In malpractice suits against psychiatrists, the most common allegation? (2x)
INCORRECT TREATMENT
What is the legal process that asks the court to immediately evaluate if a pt has been hospitalized w/o due process of law? (2x)
WRIT OF HABEAS CORPUS
What documentation will legally protect a psychiatrist, if pt dies by suicide? (2x)
DETERMINE THE LEGAL INSANITY STANDARD TO BE USED
Most common factor in cases of termination of parental right: (2x)
NEGLECT BY THE PARENT
75 y/o pt with AD started on quetiapine 12.5 mg bid for agitation> according Omnibus Budget Reconciliation Act, the MD must: (2x)
ATTEMPT TO DECREASE OR STOP THE MED DOSE AT LEAST EVERY 3 MONTHS.
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 (x2):
PSYCHIATRIST
What is an unethical fee arrangement for a forensic psychiatrist (x2)?
PERCENTAGE OF PLAINTIFFS AWARD
Mental Health Parity and Addiction Equity Act of 2008 made which guidelines for substance use treatment
EQUALIZED VISIT LIMITS FOR BEHAVIORAL HEALTH AND MEDICAL CONDITIONS IN A SIMILAR CATEGORY OF COVERAGE
Which is a mandate of the affordable care act designed to increase mental health service access?
PROHIBITION ON PRE-EXISTING CONDITION DENIALS DUE TO HX OF MENTAL DISORDER
Capacity eval component for referral to mental health court
UNDERSTAND THAT THE CHOICE OF THE OPTION INVOLVES WAIVING CERTAIN CONSTITUTIONAL RIGHTS
HIPAA allows PCP and psychiatrist to discuss?
CAN DISCUSS THE CASES THAT PCP IS INVOLVED WITH
Pt seen psychiatrist once, then psychiatrist only calls to follow-up, but doesn’t take on pt care.
PATIENT ABANDONMENT
Situations where patients can be forced antipsychotics: include emergencies, treating symptoms threatening others or self’s safety and..?
RESTORING A CRIMINAL DEFENDANT TO STAND TRIAL
Licensing requirements in telepsychiatry
ONLY IN THE STATE WHERE PATIENT IS LOCATED
APA positions on gun possession in psych patients
INDIVIDUALS WHO PRESENT AN INCREASED RISK OF VIOLENCE SHOULD BE BANNED FROM OWNING GUNS
Psychiatrist wants to talk to a another physician patient provides verbal consent but not written what does HIPAA say
MAY DISCUSS THE CASE TO ADVANCE TREATMENT DECISION
Most ethical action when psychiatrist receives subpoena for records pertaining to patient arrested for selling marijuana
OPPOSE SUBPOENA DUE TO LACK OF PT CONSENT
Dementia pt with durable power of attorney, decisions need to be made by?
ASSIGNED DECISION MAKER
Psychiatrist to eval pt with bipolar DO who is exhibiting threatening behavior while inpt on CCU for cardiac ischemia. Pt was incarcerated for assaulting and officer, disturbing the peace and firearms violations. Pt verbally threatens to track down his ex-girlfriend and “teach her a lesson she’ll never forget.” Psychiatrist has legal responsibility to
INFORM POLICE THAT PT IS IN POTENTIAL DANGER
After a pt assaults a roommate on a psych inpt unit the tx team decides to have pt arrested and transferred to jail. Decision is based on?
DUTY TO OTHER HOSPITALIZED PTS
Individual w/ schizophrenia arrested after breaking into grocery store would be found incompetent to stand trial if s/he:
BELIEVES ALL LAWYERS ARE DEMONS AND REFUSES TO SPEAK TO THEM
Pt arrested for possession of cocaine, spends 2 days in jail, after missing apps with subs abuse counselor. Intervention is referred to as?
DRUG COURT
Rogers v. commissioner (1983) is a legal case that addressed the right to refuse antipsychotic meds in non-emergency situations. Based on this ruling, pts previously adjudicated as incompetent may not refuse meds in which situation?
THERE IS A COURT-APPROVED SUBSTITUTED JUDGMENT TX PLAN
In order to be judged competent to stand trial, a defendant must be able to consult with the lawyer w/ a reasonable degree of rational understand and possess what?
A FACTUAL AND RATIONAL UNDERSTANDING OF PROCEEDINGS AGAINST HIM/HER
Patient threatens criminal behavior toward property of another. Legal obligation of psychiatrist?
NONE
What situation requires the psychiatrist to step out of usual tx relationship to protect the pt or others from harm?
CHILD ABUSE
Constitutional and common law dictate prisoners must receive care at the level or above care they would receive if they were in the community. This “necessaries” doctrine is justified by which of the following principles?
TREATMENT MUST BE PROVIDED TO THOSE WHO ARE PREVENTED FROM SEEKING THEIR OWN MEDICAL CARE
Pt attempted suicide during a crisis which was worsened by pt’s feelings about being unable to reach vacationing psychiatrist who did not provide coverage. What is the psychiatrist’s vulnerability?
ABANDONMENT
When documenting suicide risk assessment, key strategy is to discuss
WHY THE PSYCHIATRIST REJECTED ALTERNATIVE WAYS OF RESPONDING
Which of the following is the most common reason for malpractice claims?
INCORRECT TREATMENT
Psychiatrist provides psychotherapy to 22 y/o pt who lives w/ parents and dx w/ anxiety and depression. Pt reports the father threw 13 y/o sibling across the room. Sib was not injured. Multiple similar episodes. What is appropriate response for the psychiatrist?
TELL PT THAT THE PSYCHIATRIST MUST REPORT THE ABUSE TO CHILD PROTECTIVE SERVICES.
Appropriate substance abuse treatment in the clinical setting has been addressed in landmark legal cases. What is the consensus?
IT IS AMONG THE RIGHTS GRANTED AS IT IS CONSIDERED A PSYCHIATRIC DISORDER
Which tools can be used when a person wishes to assign a surrogate to make healthcare decisions during future periods of mental incapacity?
ADVANCE DIRECTIVE
Pt has psychotherapist. Pt referred to psychiatrist who prescribes medication. Psychiatrist’s responsibility to pt
TO FOLLOW UP BY SEEING PT AT APPROPRIATE SCHEDULED INTERVALS AND BY COMMUNICATING REGULARLY W/ PSYCHOLOGIST ABOUT PT’S CLINICAL STATUS AND TX PLAN
80 y/o pt was admitted to a nursing home, an employee of the facility notified the pt about the state’s laws on advance directives. During that session, the patient most likely received information about which of the following issues:
THE LIVING WILL
29 y/o severely depressed with SI. Threatens to kill his wife and daughter to “take them with me.” Legal responsibility:
NOTIFY THE WIFE
Pt who suffers from a serious mental d/o is a defendant in a criminal matter. Even if pt understands the nature and objectives of court proceedings, pt may be found not competent to stand trial under:
BEING UNABLE TO ASSIST ATTORNEY IN THE DEFENCES
The most accurately describes the primary function of a mental health court:
DIRECTS MENTALLY ILL DEFENDANTS TO TX RATHER THAN PUNISHMENT
Which characterizes the defendant’s competency to stand trial in criminal proceedings?
IS PRESUMED UNLESS THE ISSUE IS RAISED
Initial step when child is referred for evaluation:
CONSENT FOR EVAL FROM GUARDIAN
Pt is admitted to ICU. Pt can communicate but is deemed incompetent. Which of the following advance directives should be used to inform the hospital staff of pt wishes?
LIVING WILL
24 yo homeless with SI requests hospitalization. This is 3rd visit in span of 2 weeks. Pt is organized, coherent. When asked what would be different with this hospitalization, attacks the doctor. Best next step of action?
CALL LAW ENFORCEMENT
Which should raise Psych MD’s index of suspicion for malingering in cases of litigation in which financial compensation is at issue?
VAGUELY DEFINED SYMPTOMS
Criterion for a covered disability under Americans with Disabilities Act:
SUBSTANTIALLY LIMITS ONE OR MORE MAJOR LIFE ACTIVITIES
What determines disability?
IMPAIRMENT AFFECTS ABILITY TO MEET PERSONAL, SOCIAL, OR OCCUPATIONAL NEEDS
Pt getting psych exam to determine suitability for a job must be informed:
EXAM IS NOT CONFIDENTIAL
In determining the disclosure of psychiatric treatment information in court, which of the following individuals is considered to hold privilege:
PATIENT
Psychiatrist agrees to prescribe medication to a pt who receives ongoing psychotherapy from another mental health professional. What is the psychiatrist’s liability in this treatment arrangement?
PSYCHIATRIST RETAINS FULL RESPONSIBILITY FOR THE PATIENT’S CARE
Pt has intractable OCD, with profound morbidity, and considers brain surgery. The surgeon must disclose this in order to obtain a valid informed consent:
THE INFORMATION MOST PATIENTS WOULD WANT TO KNOW.
A psych consultation is requested for a patient whom the medical team believes is manufacturing symptoms of an illness. Which of the following factors would be most consistent with a diagnosis of malingering?
FINANCIAL INCENTIVE FOR ILLNESS
Which of the following patients would automatically be considered as lacking the capacity to give informed consent for medical procedures?
A PATIENT WITH ALZHEIMER’S DEMENTIA WHO HAS A STATE DESIGNATED GUARDIAN
Patient refusing IV antibiotics, what is a reason he would not have capacity to do this?
DOES NOT UNDERSTAND CONSEQUENCES OF REFUSING TREATMENT
Most important finding for a psychiatrist to consider in disability determination:
DEGREE OF FUNCTIONAL IMPAIRMENT
A resident is discharging a patient and notes a significant omission in the resident’s last, handwritten progress note. Which of the following is the best course of action?
WRITE AN ADDENDUM TO THE PROGRESS NOTE WITH THE CURRENT DATE
In forensic psychiatry, the term “standard of care” refers to the use of treatments that are:
USED BY AVERAGE REASONABLE PRACTITIONERS
In evaluating a patient’s competence to consent to a medical treatment, the degree of strictness with which the examining psychiatrist considers the question is most affected by which of the following factors?
THE RISK-BENEFIT RATIO OF THE TREATMENT
Informed consent is NOT required in which of the following forensic evaluations?
COMPETENCY TO STAND TRIAL
What documentation will legally protect a psychiatrist, if pt dies by suicide?
AN SUICIDE RISK ASSESSMENT AND PROTECTIVE FACTORS.
Several states established that the verdict guilty but mentally ill to be an option when a defendant pleads not guilty by reason of insanity because:
WHEN COMPARED TO GUILTY, GUILTY BUT MENTALLY ILL IS INTENDED TO ENSURE ACCESS TO TREATMENT BUT IS ESSENTIALLY SIMILAR
The rule that finds people not guilty by reason of insanity due to mental illness that impaired their knowledge of the nature quality and consequences of their actions or they were incapable of realizing that these acts were wrong is called what?
M’NAGHTEN RULE
The criminal defendant tells the psychiatrist doing a forensic eval “I know that killing my father was illegal.” However, the defendant delusionally believed that the father was being tortured by demons and killing him was the moral thing to do. The defendant is unable to do what?
APPRECIATE THE WRONGFULNESS OF HIS CONDUCT
At the beginning of a radio talk show a psychiatrist states he is not entering into a doctor- patient relationship with any of the callers. Hereby he does not have (blank) towards a patient in case of a malpractice suit.
DUTY
A patient requests an alternative tx for depression. His psychiatrist does not practice this tx himself but refers the pt to one who does. In 6mo the pt has complications from the tx and sues the 1st psychiatrist for malpractice. Which element of malpractice is missing in this case?
DUTY
Best protection against malpractice lawsuit:
MAINTAINING GOOD DOCTOR-PT RELATIONSHIP
Pt who recently delivered a baby BIB to ER, Pt is agitated, labile, and demanding to leave because she said her baby is being poisoned. This condition is considered a psych emergency because of its associated w/?
INFANTICIDE
Standard of care refers to treatments that are
USED BY AVERAGE REASONABLE PRACTITIONERS
Lawsuits against psychiatrist most frequently arise from issues concerning:
SUICIDE ATTEMPTS
The four basic elements that must be proven in order to sustain a claim of malpractice against a physician include a duty of care owed to the patient, negligence, causation, and what?
HARM TO THE PATIENT
Best defense against medical malpractice?
PATIENT DID NOT SUFFER A BAD OUTCOME
Patient’s confidentiality after death
USUALLY MUST BE MAINTAINED
Medical resident consults psychiatry because a 38 y/o F pt refused dialysis secondary to “antisocial personality” and the resident wants you to convince her to stay for treatment. Your answer is:
WILL ASSESS PT’S COMPETENCY TO MAKE ONE’S OWN MEDICAL DECISION
The most relevant issue for a geriatric or forensic psychiatrist in cases were the finances of an elderly are in dispute between partner and children is:
WHETHER THE ELDERLY HAS A MENTAL DISORDER AND WHETHER IS ADEQUATELY TREATED
When should a schizophrenic admitted to a medical hospital for evaluation of chest pain have a formal assessment of decision-making capacity?
WHEN THERE IS REASON TO BELIEVE THAT THE PATIENT LACKS THE ABILITY TO UNDERSTAND, APPRECIATE, OR REASON LOGICALLY WITH THE INFO RELEVANT TO HEALTHCARE DECISIONS
The most appropriate time to discuss advance directive is:
AT THE TIME OF ADMISSION TO THE HOSPITAL
If pt is incompetent to make decision and has durable power of attorney, treatment recommendations will have to approved by the:
ASSIGNED DECISION MAKER
Pt’s dementia progressed to the point that the pt’s driving is affected. In addition to talking to pt, the MD should:
CONSULT STATE LAW ABOUT OBLIGATIONS FOR REPORTING THE PT’S CONDITION.
78 y/o w/ deteriorating personal hygiene, significant weight loss. Signs voluntary admission form but later forgets doing this. Potentially resectable masses in lung and brain requiring further consent for surgical and oncological treatment. Consents but cannot explain reason for surgery. Legally, psychiatrist should:
URGENTLY REQUEST PROBATE COURT APPOINT GUARDIAN WITH POWER TO MAKE TREATMENT DECISIONS
Guardian of a pt with MR with medication-refractory epilepsy insists that the pt should have epilepsy surgery. Neurosurgeon believes the seizure focus can be resected, but there’s a >50% chance of RUE paralysis which outweighs potential benefit from freedom from seizures. Guardian insists on surgery. Which describes physician responsibility in this case?
SHOULD PERFORM THE SURGERY ONLY UNDER COURT ORDER
What characterizes the majority of defendants with psychiatric disorders who are found unfit to stand trial?
THEY CAN REGAIN FITNESS IN LESS THAN 90 DAYS
An attorney requests psychiatric consultation when his defendant wants the worst possible outcome from the trial because he feels he deserves the worst punishment possible. What direction should you take for this case?
PROBABLY MEETS CRITERIA FOR FINDING OF INCOMPETENCE TO PROCEED
What distinguishes forensic from general psych evaluation?
MAINTENANCE OF CONFIDENTIALITY
16 y/o caught for shoplifting jeans. No hx of stealing, jeans not her size. Pt frightened, remorseful, insomnia, failing grades, avoiding friends. Raped 2 months earlier, family insisted she not tell anyone. Understand stealing as:
A CRY FOR HELP
US Supreme Court Decision Washington v Harper 1990, the right to refuse treatment is limited for prison inmates because:
PRISON SECURITY CONCERNS OUTWEIGH INDIVIDUAL AUTONOMY INTERESTS
Pt w/ severe GI disease requests a surgical procedure with questionable efficacy and a relatively high risk of negative effects. Level of competency a psychiatrist would require to find pt competent to make treatment decision?
RATIONAL CONSIDERATION OF ALTERNATIVES
Pts who are committed to psychiatric treatment institutions in most states are presumed to:
BE COMPETENT TO MAKE THEIR OWN DECISIONS
Both mens rea and actus reus are required for which of the following?
CONVICTION OF A CRIME
During an evaluation for competency to stand trial, a defendant tells the court- appointed forensic psychiatrist about being involved in an unsolved crime. The psychiatrist should do what?
AVOID A DETAILED DESCRIPTION OF THE DEFENDANT’S PAST OFFENSE HISTORY
Pt consumed a large amount of alcohol and discharged a firearm, wounding a neighbor. Pt remember nothing of the incident. What is true about the pt’s criminal responsibility per the insanity defense?
VOLUNTARY INTOXICATION DOES NOT EXCUSE THE CRIMINAL BEHAVIOR
What risk management strategy for dealing with a pt with SI is most likely to be rejected as invalid in a subsequent malpractice lawsuit?
A “NO-HARM” OR SUICIDE PREVENTION CONTRACT BETWEEN THE PT AND THE THERAPIST.
Pt w/ severe depression is interviewed for enrollment in an experimental trial. Pt has failed multiple medications and several courses of ECT. The pt is competent but clearly distressed at the time of consent for treatment. Next step?
PRESENT INFORMATION SEVERAL TIMES USING DIFFERENT METHODS AND FEEDBACK TESTING
Murder trial, defendant states “I think murder is wrong but killing a spy from Mars who is trying to steal the secret of life is right.” This poses a problem for what type of evaluation of criminal responsibility?
M’NAUGHTEN RULE
The National Practitioner Data Bank contains reports about which of the following types of physician problems?
MALPRACTICE SETTLEMENTS WHERE NO WRONG WAS ADMITTED
A demented patient who is driving problematically. What do you do?
CONSULT STATE LAW ABOUT REPORTING
To prove medical malpractice, the plaintiff must establish duty, dereliction, damages and direct causation by what part of proof
PREPONDERANCE OF EVIDENCE
Which statement demonstrates that a patient is incompetent to stand trial?
I AM A WIZARD AND THEREFORE HAVE DIPLOMATIC IMMUNITY
Mother of 8 yo wants ADHD eval, kids’ parents are divorced, mom reports she has primary custody, will not sign ROI for child’s dad, what is the next step?
REQUEST MOM PROVIDE COPY OF DIVORCE DECREE TO CONFIRM CUSTODY STATUS
In evaluating the sanity of a criminal defendant, the forensic psychiatrist should focus on current state of mind, or state of mind at time of offense?
STATE OF MIND AT TIME OF OFFENSE
A psychiatrist working in a primary care clinic is contacted by the PCP for informal “curbside” consultation and provides recs without evaluating the pt. What is recommended to minimize liability?
CARE OF THE PATIENT REMAINS UNDER THE DIRECTION OF THE PCP WHO ALSO REMAINS IN CHARGE OF ORDERING MEDICATIONS OR ADDITIONAL SERVICES
Primary purpose of mental health courts
DIVERT OFFENDERS WITH MENTAL ILLNESS AWAY FROM INCARCERATION
To whom is specific consent needed to share individually identifiable health information under HIPAA
AN INVESTIGATOR FOR THE PURPOSE OF CONDUCTING EPIDEMIOLOGICAL RESEARCH
HIPPA limits disclosure of patient health information without patient’s consent except for ?
PAYMENT
Radio listener sues psychiatrist after he sustains a fall and concussion after using a friend’s alprazolam following a broadcast where psychiatrist mentions alprazolam is often prescribed for insomnia:
PSYCHIATRIST WILL WIN BECAUSE A DOCTOR- PATIENT RELATIONSHIP WAS NOT ESTABLISHED
A 21 year old hospitalized for a first episode of psychosis. Parents want to be involved in care but pt does not want the team to speak to his parents due to his delusions. According to HIPAA, how much information can be shared?
PROVIDE INFORMATION GIVEN THE LACK OF CAPACITY AND LIKELY BENEFIT
Physician involvement prohibited in which aspect of the death penalty without a commutation order:
RESTORATION OF COMPETENCE TO BE EXECUTED
What is the most prominent lobbying and support organization for families of people with severe psychiatric disorders?
NATIONAL ALLIANCE FOR THE MENTALLY ILL
A neighbor asked a psychiatrist that lives next to him about increasing his prozac to 20mg because of increased depression. This establishes what between the neighbor and psychiatrist?
PATIENT-PHYSICIAN RELATIONSHIP
What is the main concept of the Mental Health Parity and Addiction Equity Act of 2008?
MENTAL HEALTH INSURANCE BENEFITS CANNOT BE LESS FAVORABLE THAN MEDICAL OR SURGICAL INSURANCE BENEFITS
Most common triggering factor for malpractice claims in psychiatric care
SUICIDE
A patient w/ hx of psychosis is arrested for shoplifting and must be evaluated for “competency to stand trial.” What is relevant: ability to waive Miranda rights, intent at time of crime, understanding of illegality of behavior, working effectively with counsel, or decision making if actively psychotic
CAN THE PERSON WORK EFFECTIVELY WITH COUNSEL?
Best reported outcome of mental health courts
QUICKER ACCESS TO COMMUNITY TREATMENT
What is associated with better transition of care at end of life?
PRESENCE OF IDENTIFIED CARE PERSON
This must be established in medical malpractice for plaintiff to prevail?
BREACH OF DUTY CAUSING HARM
Absent gross negligence, dereliction of duty in a malpractice trial is typically established by which of the following?
TESTIMONY OF EXPERT WITNESS
