Missed Questions Flashcards
- A psychologist does not have a prior written release of information from his patient. If the psychologist were to receive a telephone call from a third party, which of the following statements is inaccurate?
- The psychologist may listen to what the caller has to say.
- The psychologist may not acknowledge that the patient is in therapy unless extenuating circumstances apply.
- The psychologist may breach confidentiality if extenuating circumstances apply.
- The psychologist may not engage in such a telephone conversation unless extenuating circumstances apply.
When a psychologist receives a phone call from a third party, and there is no prior written release, the psychologist may listen to what the caller has to say (Response 1) but generally may not share any confidential information, even the fact that the patient is in psychotherapy (Response 2). There are extenuating circumstances in which the psychologist may breach confidentiality (Response 3), such as if the caller is giving credible information to suggest that the patient is a danger to self or others.
- According to changes in California Law in 2011, which of the following statements best summarizes the Health and Safety Code (124260) regarding minors in outpatient mental health treatment without parental consent?
- The minor must be able to “participate intelligently” in treatment.
- The minor must be able to “participate intelligently” in treatment, and be a danger of hurting self or others or be an alleged victim of child abuse or incest.
- The minor must be 12 years of age or older and be able to “participate intelligently” in treatment.
- The child must be 12 years of age or older, be able to “participate intelligently” in treatment, and be a danger of hurting self or others or be an alleged victim of child abuse or incest.
Effective January 1, 2011 the Health and Safety Code (124260) allows for minors to be seen in outpatient mental health treatment without parental consent provided that the minor is 12 years of age or older and is able to “participate intelligently” in treatment. There is no longer the requirement that the minor must either present a danger to self or others, of have been the victim or abuse or incest.
- You have been called to consult on a patient who manifests seizures despite the lack of expected findings on the EEG. In the course of the evaluation, you determine that these seizures are deliberately produced. Which of the following diagnoses should you immediately withdraw as a possibility?
- Malingering.
- Factitious disorder.
- Conversion disorder.
- No mental disorder.
Keep in mind that the question is asking you to identify which diagnosis is not a possibility given the patient’s symptom presentation. A conversion disorder is diagnosed when there are pseudo-neurological symptoms, such as seizures, which cannot be explained fully by medical findings, and the symptoms are not intentionally produced. It is hypothesized that symptoms in conversion disorder are an attempt to resolve an unconscious conflict. Therefore, as soon as it is determined that the symptoms are intentionally produced, a conversion disorder must be eliminated from consideration. Factitious disorder (Response 2) is diagnosed when there is deliberate production or faking of symptoms and there are no external incentives present (e.g., no financial gain, no avoidance of military duty); rather the patient is motivated to produce the symptoms to assume the sick role. Malingering (Response 1) is found in the category of other conditions that may be a focus of clinical attention. Any of the conditions or problems of this category may be coded and may be a focus of treatment, however, they are not considered mental disorders. Malingering is coded when there is intentional production or gross exaggeration of symptoms, motivated by external incentives (e.g., financial gain). Thus it is possible that if the patient is malingering, he or she may not have any additional mental disorder (Response 4).
- As a psychologist, in terms of recommending psychotropic medications for your patients, you:
- may not recommend psychotropic medications as that is beyond a psychologist’s scope of practice.
- may recommend specific psychotropic medications for specific disorders, as long as the medications have been approved for the patient’s disorder (e.g., Ritalin for ADHD).
- may recommend a general class of psychotropic medications for a disorder (e.g., antipsychotic medications for schizophrenia).
- may recommend medications as an adjunct to psychotherapy.
A psychologist may certainly suggest to a patient the possibility that medications may be of benefit in treatment (ruling out Response 1). The psychologist could then refer the patient to a psychiatrist for a medication evaluation. It would be beyond the psychologist’s scope of practice to recommend a specific medication (e.g., Ritalin), or even a specific category of medications (e.g., an antipsychotic) (ruling out Responses 2 & 3). The decision as to what medication might be most helpful for a patient should be left to the psychiatrist to discuss.
- Which of the following presentations would not meet criteria for autism spectrum disorder?
- A child exhibits deficits in social communication and interaction, has neither language impairment nor intellectual impairment, and evidences restricted, repetitive patterns of behavior.
- A child exhibits deficits in social communication and interaction, has both language impairment and intellectual impairment, and evidences restricted, repetitive patterns of behavior.
- A child exhibits deficits in social communication and interaction, has intellectual impairment but no language impairment, and evidences restricted, repetitive patterns of behavior.
- A child exhibits deficits in social communication and interaction, has both language impairment and intellectual impairment, and does not evidence restricted, repetitive patterns of behavior.
In the DSM-5, autism spectrum disorder is a new disorder that encompasses autistic disorder, Asperger’s disorder, and child disintegrative disorder. The two essential features are: 1) persistent deficits in social communication and interaction; and 2) restricted, repetitive patterns of behavior. The disorder is specified as with or without accompanying intellectual impairment, and with or without accompanying language impairment. Neither language impairment nor intellectual impairment is required for the diagnosis. Thus, the presentation that would not meet criteria for autism spectrum disorder is one in which either deficits in social communication and interaction are absent, or there is no evidence of restricted, repetitive patterns of behavior (Response 4).
- According to APA’s 2010 amendments to the Ethics Code, when ethics and law conflict, psychologists should:
- make known their commitment to the Ethics Code, and take steps to resolve the conflict consistent with the Ethics Code; this standard should not be used to justify violating human rights.
- comply with the law, after making known their commitment to the Ethics Code.
- take steps to resolve the conflict; if the conflict is not resolved, they should uphold the higher ethical standard.
- make known their commitment to the Ethics Code, and take steps to resolve the conflict; if the conflict is not resolved, they may then comply with the law.
In 2010, APA made a few amendments to the ethics code, subsequent to the backlash of learning of the involvement of psychologists in the enhanced interrogation torture program of the Bush administration. The 2010 amendment states that when ethics and law conflict, psychologists make known their commitment to the Ethics Code and take steps to resolve the conflict consistent with the Ethics Code (ruling out Response 2). The code then states that under no circumstances may this standard be used to justify or defend violating human rights. In the 2010 amendment the phrase “if the conflict cannot be resolved, psychologists may then comply with the law,” was deleted (ruling out Response 4). Psychologists are only required to uphold the higher ethical standard (Response 3) when there is no conflict, for example if the ethics code requires records to be maintained for a longer period of time than the law requires.
- Which of the following factors best differentiates between paranoid personality disorder and delusional disorder, persecutory type?
- Impairment in overall functioning.
- Time frame.
- Impairment in interpersonal functioning.
- The presence of delusions.
Although there are other distinguishing criteria between paranoid personality disorder and delusional disorder, persecutory type, a key difference is the presence of delusions. Delusions are fixed, false beliefs that are unchangeable. Individuals with paranoid personality disorder have a pervasive distrust and suspiciousness of others and tend to interpret actions of others as deliberately demeaning, threatening, and malevolent; however, there are no delusions present. The hallmark of delusional disorder is one or more delusions of at least 1 month’s duration. The overall duration of the disorder, impairment in overall functioning, as well as impairment in interpersonal functioning, do not distinguish the two disorders.
- When will an interim suspension order most likely be issued?
- When a license revocation has been stayed.
- When the licensee has violated the Business and Professions Code and continuing to practice would endanger the public. (correct answer, your response)
- After a negotiated settlement between the Board of Psychology, the licensee, and the licensee’s legal representation.
- When a licensee is incarcerated following conviction for a felony.
An interim suspension order requires that the licensee immediately suspend practice. This occurs when the licensee has been both in violation of the Business and Professions Code or convicted of a crime related to licensed activity, and the licensee continuing to practice would represent a danger to the public (Response 2). An interim suspension order occurs before there is opportunity for negotiated settlement (Response 3). When a license revocation is stayed (Response 1), typically the licensee is placed on probation. When a licensee has been incarcerated following the convicted of a felony (Response 4) the psychology license is automatically suspended. This, however, is different from an interim suspension order.
- A dependent adult is defined as:
- a person between the ages of 18 and 64 who has an intellectual or developmental disability.
- a person between the ages of 18 and 64 who has an intellectual or developmental disability, or a chronic mental illness.
- a person between the ages of 18 and 64 who is gravely disabled.
- a person between the ages of 18 and 64 who has physical or mental limitations that restrict the ability to carry out normal activities or protect his or her rights.
According to California law a dependent adult is defined as “a person between the ages of 18 and 64 who has physical or mental limitations that restrict the ability to carry out normal activities or protect his or her rights.” The other responses include people who may qualify as dependent adults (those with intellectual or developmental disabilities, chronic mental illness, or grave disability). There are, however, many adults with chronic mental illness (Response 2) and some with intellectual or developmental disabilities (Response 1) who are not considered dependent adults. The definition of dependent adult is much broader than someone who is gravely disabled (Response 3).
- During a forensic evaluation, you assess a patient who appears to feel no distress at having no close friends and having lost contact with his family. Prior to being fired for petty theft, he had worked for several years successfully at computer programming. Based on this information alone, this man’s most likely diagnosis would be:
- paranoid personality disorder.
- antisocial personality disorder.
- schizotypal personality disorder.
- schizoid personality disorder.
This individual appears to be detached from social relationships and exhibits little expression of emotion; these symptoms are the hallmarks of schizoid personality disorder. Although schizotypal personality disorder (Response 3) is also characterized by a pattern of deficits in social and interpersonal functioning marked by discomfort with and reduced capacity for close relationships, in schizotypal personality disorder there are additionally peculiarities in cognition, perception, ideation, appearance and behavior. In this scenario there is no evidence of the mistrust and suspiciousness that is the hallmark of paranoid personality disorder (Response 1). Petty theft is far from sufficient to establish the pervasive pattern of disregard for and violation of others’ rights that is necessary for the diagnosis of antisocial personality disorder (Response 2).
- What are the requirements for parental consent, when a minor is seeking services to prevent or treat a pregnancy?
- Parental consent is required for any services related to pregnancy.
- Parental consent is not required for services involving contraception and abortion.
- Parental consent is not required for any services related to pregnancy.
- Parental consent is not required for any services related to pregnancy if the minor is over 12, and the victim of sexual abuse.
According to the California Family Code (Section 6925), parental consent is not required for the provision of services related to pregnancy and its prevention. This is not limited to minors over 12 who are victims of sexual abuse (ruling out Response 4). Not all services are included, however. The law specifically excludes sterilization (ruling out Response 3), and allows for services involving contraception and abortion. The Health and Safety Code (Section 123450) is written such that a minor may request an abortion without parental consent by petitioning the juvenile court; according to case law, however, minors can receive abortions without parental consent, without actually needing to petition the juvenile court.
- A psychologist is treating a family and becomes aware of an instance of child abuse. She chooses not to report the child abuse, as she knows it will disrupt the therapeutic alliance and the family will terminate treatment. Her failure to report child abuse will result in:
- no liability, as she is acting the best interest of her clients.
- civil liability and up to $5,000 in fines.
- criminal liability and up to $5,000 in fines.
- suspension or revocation of her license.
According to the California Penal Code, a person who fails to report an instance of child abuse, which he or she knows to exist or should reasonably know to exist, is guilty of a misdemeanor, punishable by a jail term not to exceed six months, or a fine of not more than one thousand dollars ($1,000), or both. A mandated reporter who willfully fails to report abuse or neglect, or impedes or inhibits a report of abuse or neglect, when that abuse or neglect results in death or great bodily injury, shall be punished by not more than one year in a county jail, or a fine of not more than five thousand dollars ($5,000), or both. As a rule of thumb, criminal liability (Response 3, correct answer) includes punishment that may involve jail or prison, while civil liability (Response 2) only involves monetary damages. While the BOP may ultimately choose to either suspend or revoke the psychologist’s license, they may also take lesser actions against the psychologist (ruling out Response 4).
- A 65-year-old woman presents to treatment six months after her husband dies. She complains that she is frequently forgetting things and is generally confused. To receive a diagnosis of mild neurocognitive disorder (NCD), at a minimum this patient must evidence:
- memory problems and one or more additional cognitive deficits (e.g., complex attention, executive function, language, perceptual-motor, or social cognition) that interfere with independent functioning.
- memory problems and one or more additional cognitive deficits (e.g., complex attention, executive function, language, perceptual-motor, or social cognition) that do not interfere with independent functioning.
- memory problems or one or more cognitive deficits (e.g., complex attention, executive function, language, perceptual-motor, or social cognition) that interfere with independent functioning.
- memory problems or one or more cognitive deficits (e.g., complex attention, executive function, language, perceptual-motor, or social cognition) that do not interfere with independent functioning.
According to the DSM-5, major neurocognitive disorder (NCD) is diagnosed when there is significant cognitive decline from a prior level of functioning in one or more domains (e.g., complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition). At a minimum, cognitive decline in only one domain is required for the diagnosis. Additionally, the cognitive deficits must interfere with independent functioning in everyday activities. In contrast, mild neurocognitive disorder (NCD) is diagnosed when there is modest cognitive decline from a prior level of functioning in one or more domains (e.g., complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition). Similar to NCD, at a minimum, cognitive decline in only one domain is required for the diagnosis. In minor NCD, however, the cognitive deficits do not interfere with independent functioning in everyday activities (Response 4, correct answer).
- A physician refers you a patient who has angina. The patient reports to you that his symptoms are intermittent but generally worsen when he visits his family-of-origin, as he gets stressed and anxious when spending time with his parents and siblings. One possible diagnosis for this man is:
- somatic symptom disorder. (your response)
- illness anxiety disorder.
- psychological factors affecting other medical conditions. (correct answer)
- conversion disorder.
A difficult question! The man has a diagnosed somatic symptom (angina or chest pain) that worsens when he is stressed or anxious. His presentation meets criteria for psychological factors affecting other medical conditions (Response 3), which requires that a medical symptom or condition is present, and that psychological or behavioral factors affect the medical condition (e.g., exacerbate the symptoms or interfere with treatment). Somatic symptom disorder (Response 1) is diagnosed when one or more somatic symptoms are present and there are excessive thoughts, feelings, or behaviors related to the symptoms (e.g., the patient with angina worries excessively about having a heart attack, takes his blood pressure several times a day, or restricts his activities). Illness anxiety disorder (Response 2) involves the preoccupation with having or acquiring a serious illness, and somatic symptoms are either not present, or mildly present. Conversion disorder (Response 4) is diagnosed when there are one or more symptoms affecting voluntary motor or sensory functioning, and there is clinical incompatibility between the symptoms and recognized neurological or medical conditions.
- Which of the following best summarizes the diagnostic criteria for schizophrenia?
- Bizarre delusions or two or more psychotic symptoms with a decline in social or occupational functioning.
- At least one positive symptom as well as at least one negative symptom with a decline in social or occupational functioning.
- Two or more psychotic symptoms with a decline in social or occupational functioning.
- Two or more psychotic symptoms, at least one of which must be delusions, hallucinations, or disorganized speech, with a decline in social or occupational functioning.
In the DSM-5, Criterion A of schizophrenia requires two or more psychotic symptoms: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, or negative symptoms. Additionally at least one of the symptoms must be delusions, hallucinations, or disorganized speech (Response 4, correct answer). The DSM-5 eliminated the allowance that bizarre delusions or two or more voices conversing suffice for a diagnosis of schizophrenia; thus the requirement is now the presence of at least two symptoms (ruling out Response 1). There is no requirement that there be at least one positive symptom and at least one negative symptom (ruling out Response 2).
