Missed dx and psych exam questions Flashcards
Research suggests that the best single treatment for Agoraphobia is: Select one: A. implosive therapy. B. flooding. C. systematic desensitization. D. psychotropic medication.
Correct Answer is: B
Flooding involves exposing an individual to anxiety-provoking stimuli while preventing an avoidance response. In-vivo flooding is considered the most effective psychological treatment for Agoraphobia, with reports of long-term improvement for to 75% of treated patients.
A young woman is very anxious because, lately, she finds that she frequently misperceives things in the environment, which has caused some embarrassing moments at work and elsewhere. For example, at work, she mistook the coat rack for the company president. As a result, she is not enjoying her job or usual social activities as much as she used to. The woman's symptoms are most suggestive of: A. hallucinations. B. illusions. C. agoraphobia. D. social phobia.
Correct Answer is: B
Note that the woman is misperceiving actual stimuli and that her other symptoms are directly related to this misperception. A misperception of a real stimulus is referred to as an illusion.
Masters and Johnson found that their version of sex therapy, which incorporates education about sexuality, training in communication skills, and the technique known as sensate focus, is most effective for treating: Select one: A. premature ejaculation. B. impotence. C. sexual aversion. D. orgasmic disorder
Masters and Johnson found that close to 100% of individuals with premature ejaculation were helped by their program which incorporated education about sexuality, improving communication, and sensate focus.
A diagnosis of childhood onset Conduct Disorder:
Select one:
A. requires an onset of two or more symptoms prior to age 13.
B. is equally common in boys and girls.
C. is associated with less overt aggression than adolescent onset Conduct Disorder.
D. is associated with a poorer prognosis than adolescent onset Conduct Disorder.
Correct Answer is: D
Age of onset of Conduct Disorder is correlated with a number of factors including symptoms (childhood onset is associated with more severe aggression) and prognosis – i.e., individuals with childhood onset are much more likely to continue to engage in antisocial behaviors in adolescence and adulthood.
A person repeatedly awakens from sleep in a state of fear, disorientation, and unresponsiveness to others. The person later can barely recall the episode at all. The most likely diagnosis for this person is Select one: A. Narcolepsy. B. Nightmare Disorder. C. Sleep Terror Disorder. D. Depersonalization Disorder.
Correct Answer is: C
Sleep Terror Disorder is characterized by repeated episodes of awakening in fear, often with a scream of panic. The person displays evidence of fear and autonomic arousal, and responds poorly or not all to the efforts of others to offer comfort. At the time, the person does not remember any dream in detail and cannot recall the entire episode later on.
Regarding the other choices, Nightmare Disorder involves repeated awakenings with detailed recall of frightening dreams, often with a recurrence of the same or similar themes. Unlike a person with Sleep Terror Disorder, a person with Nightmare Disorder quickly becomes alert and oriented after awakening. Narcolepsy is characterized by brief sleep and sudden sleep attacks during the period of the person’s normal waking; either or both cataplexy (sudden loss of muscle tone) and hypnagogic or hypnopompic hallucinations must be present. Depersonalization Disorder involves a lasting or recurrent feeling that the person is detached from, or is an outside observer of, one’s own mental processes or body, as if in a dream.
Of the following, which risk factor for childhood depression is the most prominent? Select one: A. substance use in parents. B. comorbid disorder such as ADHD. C. a parent with a depressive disorder. D. low socioeconomic status
Correct Answer is: C
Most experts agree that a family history of depression increases the risk of childhood depression more than any other one factor. By some estimates, for instance, maternal depression increases the risk of childhood depression by a factor of 3 to 5. The presence of depression in a parent can lead to depression in multiple ways, such as genetics, marital discord, and poor parenting skills. Other risk factors for childhood depression include substance abusing parents, a divorce, parental unemployment, frequent moves, and illness.
Possible causes of a Mood Disorder caused by a known organic factor such as a medical condition or substance use include:
Select one:
A. PCP use, cataracts, and ulcer
B. viral illness, hallucinogen use, and carcinoma of the pancreas
C. barbiturate use, hypothyroidism, and broken bones
D. hyperthyroidism, cerebral palsy, and arthritis
Correct Answer is: B
The DSM identifies the following disorders as possible causes of organically-based mood symptoms: substances such as hallucinogens and PCP; endocrine disorders, such as hypo- or hyperthyroidism; carcinoma of the pancreas; viral illness; and structural disease of the brain, such as that caused by a stroke.
Autistic children tend to do as well as or better than other children the same age on tests of Select one: A. abstract problem solving. B. facial recognition. C. response speed. D. field independent processing.
Correct Answer is: D
Field dependence-independence is a construct viewed as a dimension of cognitive style, or the way in which individuals think, perceive, remember, and use information to solve problems. Those with a field independent cognitive style tend to use internal referents to solve problems and tend to see environments in terms of their constituent parts rather than as organized wholes. By contrast, a field dependent style relies on external or environmental referents to solve problems; perception tends to be dominated by the overall organization of the environment (or field) rather than its individual parts. Autistic individuals tend to have a field-independent cognitive style, and on some tasks that assess field independence, they consistently outperform their same-age peers. For example, numerous studies have found that autistic children outperform age-matched children on the Childhood Embedded Figures Test, which requires examinees to identify a simple figure hidden in a complex background design. Good performance on this test indicates field independence because it requires separating an item from the field in which it is embedded.
A child of a military veteran with Post-Traumatic Stress Disorder is most likely to display which of the following behavioral problems? Select one: A. eating disturbances B. kleptomania C. hyperactivity D. Oppositional Defiant Disorder
Correct Answer is: C
When a parent suffers from Post-Traumatic Stress Disorder, the whole family is affected, and children are particularly vulnerable to the disruption it causes in the family system. The disorder often impairs one’s ability to parent, and it may render parents more likely to become impatient, angry, or neglectful with their children. Young children especially are not cognitively equipped to make sense of this behavior, and research has identified a number of behavioral problems they are likely to display. Depression, anxiety, self-blame, aggression, hyperactivity, and social withdrawal are common, and so are symptoms of PTSD itself, such as low frustration tolerance and outbursts of anger–some describe PTSD as a disorder that may be transmitted intergenerationally. Even though such children may experience a variety of behavioral problems, hyperactivity is the best answer because, of the choices listed, it is the one most commonly identified as occurring in children of PTSD sufferers.
Research on the genetic contribution to major depression indicates the risk for depression for biological offspring is:
Select one:
A. essentially the same whether they have one or two parents with depression.
B. higher if they have one parent with depression than if they have two parents with depression.
C. higher if they have two parents with depression than if they have only one parent with depression.
D. higher if they have a mother with depression than if they have a father with depression.
Correct Answer is: A
Research findings show having a biological parent with depression increases an offspring’s risk for major depression. What may be surprising however is that the risk is similar whether one or both parents experience major depression. Studies also indicate maternal and paternal depression affect biological offspring similarly in terms of rates of major depression.
Parasomnias activate one or more physiological systems during the sleeping and waking cycle at an inappropriate time. Which of the following types of parasomnias involves an individual involuntarily grinding or clenching their teeth while sleeping? Select one: A. REM Sleep Behavior Disorder (RBD) B. somnambulism C. sleep bruxism D. sleep talking
Correct Answer is: C
Parasomnias are undesirable motor, verbal, or experiential phenomena that occur as primary sleep events or secondary to systemic disease and are categorized as occurring in rapid eye movement (REM) sleep, non-rapid eye movement (NREM) sleep, or as types not related to a specific sleep state. Because it involves a partial arousal, an individual exhibits symptoms of being asleep and awake at the same time. Parasomnias are most commonly caused by biological factors, stress, depression and other related factors, they tend to be more common in children than adults, and in some cases, run in families. Sleep bruxism refers to when a person involuntarily grinds or clenches their teeth while sleeping, sometimes leading to wearing down the teeth and jaw discomfort. Treatment typically involves wearing a mouth guard during sleep.
Other types of parasomnias include: somnambulism (sleepwalking), which tends to run in families; nightmares, nocturnal leg cramps, sleep talking, sleep enuresis (bedwetting), sleep paralysis, confusional arousals, sleep terrors (nigh terrors) and REM Sleep Behavior Disorder (RBD).
Synesthesia is most readily thought of as a/an: Select one: A. physiological occurrence. B. manifestation of psychoses. C. learned occurrence. D. expression of imagination
Correct Answer is: A
Synesthesia is a condition in which an involuntary joining of one sense is accompanied by a perception in another sense. For example, hearing is simultaneously perceived by an additional sense such as sight. Another form of synesthesia joins objects such as letters, shapes, numbers or people’s names with a sensory perception such as smell, color or flavor. Synesthesia can involve any of the senses. Colored letters and numbers is the most common form, in which a person sees a certain color in response to a certain letter of the alphabet or number. Other synesthetes hear sounds in response to smell, smell in response to touch, or feel something in response to sight. While extremely rare, some possess synesthesia involving three or more senses. It is hypothesized that synesthesia results from “crossed-wiring” in the brain, where neurons and synapses that are intended to be contained within one sensory system cross to another. Studies suggest the crossed connections may be present at birth in everyone and the connections are then later refined. It is hypothesized that adult synesthetes may retain the crossed connections.
Orientation is most frequently measured by which of the following scales?
Select one:
A. Global Orientation and Amnesia Test
B. Gross Orientation and Awareness Test
C. Galveston Orientation and Amnesia Test
D. Gollingberg Orientation and Awareness Test
Correct Answer is: C
The Galveston Orientation and Amnesia Test (GOAT), which assesses temporal orientation primarily, was developed to serially evaluate cognition during the subacute stage of recovery from closed head injury. The scale measures orientation to person, place, and time, and memory for events preceding and following the injury.
A psychologist asks a series of questions to determine whether the client has been experiencing vegetative symptoms when assessing a client who reports feeling depressed. Which of the following are vegetative symptoms?
Select one:
A. psychomotor retardation, appetite changes, social withdrawal
B. sleep difficulties, appetite changes, psychomotor retardation
C. social withdrawal, loss of concentration, reduced energy level
D. confusion, psychomotor agitation, sleep difficulties
Correct Answer is: B
Many clients may report conditions that suggest vegetative symptoms associated with a mental disorder. The classic, or “vegetative,” signs of depression include persistent problems with appetite, weight loss or gain, sleep difficulties, reduced energy level, and changes in sexual desire or function. These symptoms are mostly objective, as opposed to subjective and can serve as useful data for diagnostic screening purposes as vegetative symptoms sometimes suggest a serious mental disorder. In particular, it is useful to identify whether any of these symptoms reflects a change from the client’s previous functioning.
Michael has a high-pressure legal career that involves frequent altercations with opposing counsel and ongoing stress. He commonly reacts to the stress of anger by clenching his teeth and generally tensing up. His therapist suggests biofeedback and would most likely recommend which type of biofeedback? Select one: A. EDR B. EEG C. EMG D. HRV
Feedback
Correct Answer is: C
Biofeedback is the process of identifying physiological variables, or responses, for the purpose of helping an individual develop greater sensory awareness and is achieved by using electronic instrumentation to monitor responses then providing the information to the individual to improve their physiological control of responding. Electromyogram (EMG) biofeedback, measures impulses in the muscles and indicates the degree of relaxation or contraction/tension. It is commonly used for conditions such as stress, tension headaches, chronic pain, muscle stiffness, incontinence, urinary urgency and frequency, and when muscles are healing.
Electrodermal response (EDR) biofeedback, also referred to as galvinic skin response training (GSR), measures skin surface changes, giving feedback on the relation between emotional state and the activity of the sympathetic system via sweat gland activity, and is utilized for stress and hyperhidrosis (excessive sweating).
Electroencephalogram (EEG) or neurofeedback provides information on brainwave activity and patterns. It is often used in the treatment of attention deficit hyperactivity disorder, depression, and epilepsy to improve attention, reduce impulsivity and promote recovery from head injuries and strokes.
Heart rate variability (HRV), sometimes referred to as electrocardiogram (ECG), biofeedback monitors heart rate and cardiac reactivity from sensors placed on a person’s fingers or wrist. It is useful for managing stress, high blood pressure, anxiety, and heartbeat irregularities.
Other recognized types of biofeedback include: thermal or skin temperature (ST) biofeedback, which involves skin temperature and blood flow control; Respiratory Feedback (RFB), which involves control of breathing type and frequency; and Respiratory Sinus Arrhythmia (RSA); which involves the synchronous control of heart rate and respiration, in which there is a small rise in heart rate during inhalation and a corresponding decrease during exhalation. Depending on the reason for biofeedback, more than one type is often used. For example in this question, Michael might also use EDR to control his general stress response in addition to EMG to control the muscle tensing and teeth clenching responses. Behavioral skills training such as relaxation training, guided imagery and stress-coping techniques are also frequently used in addition to the actual biofeedback.
15 year old Susan was initially diagnosed with Bulimia-Nervosa (Purging Type). Her self-evaluation is unduly influenced by her body shape and weight. She worries about gaining weight, has been binging and purging on a daily basis for almost a year and her weight has steadily dropped to less than 85% of a minimally normal level. Her therapist reassesses Susan’s diagnosis. The salient feature to consider in the differential diagnosis of Anorexia-Nervosa (Binge-Eating/Purge Type) is her:
Select one:
A. fear of gaining weight or getting fat
B. cognitive distortions associated with body image
C. continuation of binging and purging despite weight loss
D. denial of seriousness of current body weight
Correct Answer is: C
Individuals with Bulimia-Nervosa, unlike those with Anorexia-Nervosa, Binge-Eating/Purge Type, are able to maintain body weight at or above a minimally normal weight for height and age. Anorexia-Nervosa is characterized by a refusal to maintain a minimal normal body weight, with the threshold of underweight being less than 85% of weight expected. Susan’s weight falls below this threshold and her continuation of binging and purging despite weight loss meets the refusal criteria of Anorexia.
It is also important to consider her fears of gaining weight* and denial of seriousness of her current weight, especially with respect to treatment planning. Disturbances in perception of body shape and weight (* incorrect options), and an over influence of weight and shape on self-evaluation are essential features of both disorders.
A 38 year-old woman is dependent on the prescription pain medications oxycodone and hydrocodone. She is referred to a physician's office for medication-assisted treatment of her opioid addiction. Which of the following is most likely to be administered in the induction phase of treatment? Select one: A. methadone B. buprenorphine C. naltrexone D. LAAM (l-alpha-acetyl-methadol)
Correct Answer is: B
The Drug Treatment Act of 2000 allows doctors to treat opioid dependence in their practices with FDA-approved opioid medication. In 2002, the FDA approved two medications for use in opioid addiction treatment: buprenorphine monotherapy (Subutex) and a buprenorphine/naloxone combination (Suboxone). Buprenorphine, an opioid partial agonist, activates receptors to a lesser degree than full agonists (i.e., morphine and heroin) and its effects reach a ceiling effect at moderate doses - not increasing, even with increases in dosage. At low doses, it has enough agonist effect to enable opioid-addicted individuals to discontinue misuse of opioids without experiencing withdrawal symptoms. Under certain circumstances and in high doses, it can block the effects of full opioid agonists and precipitate opioid withdrawal syndrome like an opioid antagonist. Buprenorphine carries a lower risk of abuse, addiction, and side effects than full agonists. Subutex (buprenorphine) is more often used at the beginning of treatment and withdrawal syndrome can be precipitated in individuals maintained on it.
Suboxone, containing the opioid antagonist naloxone, was designed to decrease the potential for abuse by injection and is more often used in maintenance treatment of opiate addiction. Both methadoneand LAAM (l-alpha-acetyl-methadol)* are effectively used to treat opioid addiction (* incorrect options); however they are not available in practice settings other than Opioid Treatment Programs (OTPs) (i.e., methadone clinics).
Research comparing anxiety over the lifespan indicates:
Select one:
A. younger adults are more likely to benefit from cognitive-behavioral therapy, whereas older adults are more likely to benefit from pharmacotherapy.
B. younger adults are more likely to be underdiagnosed and older adults more likely to be misdiagnosed as having an anxiety disorder.
C. younger adults are less likely to have comorbid symptoms of depression than older adults.
D. younger and older adults are equally likely to perceive symptoms as result of physical health problems.
Correct Answer is: C
Anxiety is the most common psychiatric disorder in older adults, with generalized anxiety disorder being the most prevalent anxiety disorder according to recent findings. Research indicates comorbid symptoms of depression frequently occur in all adults with anxiety, however occurs more often in older adults.
younger adults are more likely to benefit from cognitive-behavioral therapy, whereas older adults are more likely to benefit from pharmacotherapy.
Older and younger adults with anxiety have been found to benefit about equally from cognitive-behavioral therapy (CBT) and pharmacotherapy.
younger adults are more likely to be underdiagnosed and older adults more likely to be misdiagnosed as having an anxiety disorder.
Underdiagnosis is more common among older adults, as well as undertreatment of anxiety disorders compared to younger adults.
younger and older adults are equally likely to perceive symptoms as result of physical health problems.
Findings show older adults are more likely than younger adults to attribute anxiety symptoms to physical health problems and therefore more likely to see a medical professional instead of a mental health professional for help.
A measurement scale often used in rehabilitation settings to indicate a patient's level of response and ability to function is the Rancho Los Amigos scale, named for the rehabilitation hospital where it was created in California. Using this scale, a person recovering from a brain injury is most likely to have a low score: Select one: A. when admitted. B. at time of discharge. C. 12 months after discharge. D. several years after discharge.
Correct Answer is: A
The Rancho Los Amigos Scale provides a descriptive guideline of the various stages a brain injury patient will experience as he/she progresses through recovery and is most helpful in assessing the patient in the first weeks or months following an injury because it is based on observations of the patient’s response to external stimuli and does not require cooperation from the patient. The Rancho scale is often administered in acute rehabilitative settings following release from intensive care and evaluates eight levels of functioning. At the lowest score, or level I. No Response, a patient appears to be in a deep sleep and is unresponsive to stimuli.
As recovery progresses, functioning is then reflected by the higher levels of the scale. These levels include: level II. Generalized Response: limited reflexes and often the same, regardless of stimuli presented. III. Localized Response: responses specific but inconsistent, are related to the type of stimulus presented, may follow simple commands in an inconsistent and delayed manner. IV. Confused-Agitated: heightened state of activity, severely confused, disoriented, and unaware of present events; unable to perform self-care however if physically able, may perform motor activities such as sitting and walking as part of agitated state. V. Confused-Inappropriate, Non-Agitated: appears alert and responds to simple commands; some agitated behavior in response to external stimuli; is highly distractible, difficulty learning new information; memory impaired; verbalization often inappropriate; self-care activities with assistance. VI. Confused-Appropriate: shows goal-directed behavior, relying on cueing for direction; able to relearn old skills (i.e., activities of daily living); new learning limited by memory problems; has beginning awareness of self and others. VII. Automatic-Appropriate: goes through daily routine, is robot-like with appropriate behavior and minimal confusion; has shallow recall of activities; superficial awareness of condition but lacks insight; judgment, problem solving, and planning skills are impaired, requiring some supervision. VIII. Purposeful-Appropriate: alert and oriented; able to recall and integrate past and recent events; can learn new activities and continue in home and living skills; deficits in stress tolerance, judgment, abstract reasoning, social, emotional, and intellectual capacities may persist.
