Psychiatry

Question 1

An 8-year-old girl with ADHD and ODD has had trials of 2 methylphenidate formulations. Both provided only partial response at lower doses, and increasing the dose resulted in intolerable side effects. Which pharmacological adjustment is most appropriate?

1. Discontinue methylphenidate and start atomoxetine
2. Discontinue methylphenidate and start an amphetamine
3. Discontinue methylphenidate and start extended-release guanfacine
4. Continue one of the methylphenidate formulations at a lower dose, and add extended-release guanfacine

Answer 1

2. Discontinue methylphenidate and start an amphetamine

Question 2

What is a common side effect of α2-agonists (clonidine and guanfacine) that can limit their use in the treatment of ADHD?

1. Insomnia
2. Appetite suppression
3. Stomach upset
4. Bradycardia

Answer 2

4. Bradycardia

Question 3

An 15-year-old male presents with severe conduct disorder, including initiating physical fights, violence with a weapon, breaking and entering, destroying property, and truancy from school. What is the most appropriate psychosocial intervention?

1. Parent Management Training
2. Cognitive-Behavioural Therapy
3. Multisystemic Therapy
4. Collaborative Problem Solving

Answer 3

3. Multisystemic Therapy

Question 4

Which medication class is supported by the most evidence for efficacy in the treatment of aggressive behaviour that is associated with ADHD?

1. Atypical antipsychotics
2. Anticonvulsants
3. α2-Agonists
4. Stimulants

Answer 4

4. Stimulants

Question 5

Which therapeutic technique is most specific to Trauma-Focused CBT?

1. Relaxation training to help cope with trauma-related physical symptoms
2. Learning to modulate emotions related to the trauma
3. Developing a trauma narrative and processing it
4. Graduated exposure to reminders of the trauma

Answer 5

3. Developing a trauma narrative and processing it

Question 6

Which pediatric mental health condition is LEAST likely to respond better to a selective serotonin reuptake inhibitor (SSRI) than to placebo?

1. Major depressive disorder
2. Generalized anxiety disorder
3. Social anxiety disorder
4. Obsessive-compulsive disorder

Answer 6

1. Major depressive disorder

Question 7

What is the most effective psychotherapeutic approach in the treatment of pediatric obsessive-compulsive disorder (OCD)?

1. Exposure and Response Prevention
2. Thought Records and Cognitive Restructuring
3. Distraction and Avoidance Techniques
4. Parent Management Training

Answer 7

1. Exposure and Response Prevention

Question 8

A 14-year-old girl with severe OCD is being treated with CBT/ERP in combination with her first trial of an SSRI. After 6 weeks at sertraline 200 mg/day, she has shown moderate improvement but still experiences significant OCD-related impairment. What should be the next step in her pharmacological management?

1. Cross-titrate from sertraline to fluoxetine
2. Cross-titrate from sertraline to clomipramine
3. Continue current dose of sertraline
4. Augment sertraline with risperidone

Answer 8

3. Continue current dose of sertraline

Question 9

Up to what age have antidepressants been associated with an increased risk of suicide-related events?

1. 17 years
2. 24 years
3. 64 years
4. All age groups

Answer 9

2. 24 years

Question 10

Interpersonal therapy for adolescents (IPT-A) is an evidence-based treatment for adolescent depression. What are the 4 potential areas of focus in IPT-A?

1. Parent-child disputes, sibling rivalry, peer conflicts, romantic break-ups
2. Grief, role transition, role disputes, interpersonal deficits
3. Family conflict, bullying, social anxiety, poor social skills
4. Empathy, reciprocity, picking up on social cues, theory of mind

Answer 10

2. Grief, role transition, role disputes, interpersonal deficits