SA2021 Flashcards
Which risk factor for substance use disorder is cited by the CDC for people with autism spectrum disorder?
Bullying
A system is set up where pediatrician can call child psychiatrist essentially at time of service to discuss patients with mental health needs. The child psychiatrist’s role in these “access programs” or informal consultation programs is generally to provide:
Education to the primary care provider about diagnostic and treatment options.
In a longitudinal analysis of depression/anxiety treatment for young people, when measuring treatment as usual, what was noted in regards to symptom change when compared to baseline?
A large reduction in symptoms initially
Cross cultural studies of infant temperament show that Western children differ from non-Western children in that Western children:
Demonstrate higher activity levels
As of 2020, research suggests that autism and seizures have a:
shared underlying pathology
Which class of medication is the first line treatment for catatonia in youth?
Benzodiazepines
In the presence of a family history of psychiatric disorders, harsh parenting leads to a 13-fold increase of which personality pathology?
Borderline
A pediatric oncologist calls a child psychiatrist because the mother of a 10yo girl who has just died has begun to bathe her. What should the child psychiatrist recommend the oncologist do?
Allow the mother to continue uninterrupted
Which characteristic of individuals with autism spectrum disorder makes it difficult for them to identify and report forms of sexual victimization?
Communication impairments
Sixteen years of consistent stimulant treatment of children with attention-deficit/hyperactivity disorder (ADHD) in the Multimodal Treatment Study of ADHD (MTA) study was associated with a reduction in adult height along with an ___ in body mass index.
increase
The onset of unipolar depression occurs on average how many years earlier in people with history of childhood maltreatment compared to people without this history?
4 years earlier
In comparing children and adolescent refugee and asylum seekers displaced less than 2 years to those displaced more than 2 years, those displaced more than 2 years had higher prevalence of which disorder?
- Anxiety
- Attention deficit/hyperactivity disorder
- Depression
- Posttraumatic stress disorder
Attention-deficit/hyperactivity disorder
According to a retrospective chart review, in adolescent patients with history of concussion presenting with chronic posttraumatic headaches, up to 70% met criteria for what?
Medication-overuse (non-steroidal anti-inflammatory drugs, acetaminophen).
At what age do individuals generally possess the capacity to appreciate the long-term consequences of their choices?
21
Which medication is the first line treatment of attention-deficit/hyperactivity disorder in children with intellectual disability/intellectual development disorder?
Methylphenidate
A child’s obsessive-compulsive disorder and depression worsen during the pandemic, along with intrusive thought that family members will die from COVID. To help the child accept feelings of helplessness and work on developing control of the situation and creating meaning, it is suggested to FaceTime grandparents daily and to read a story together. This approach best fits under which orientation?
Acceptance and commitment therapy
In order to best assess and treat consequences of the pandemic in youth, which developmentally informed perspective is recommended?
Trauma
It is generally acceptable to continue an effective, tolerated dose of a pharmacologic treatment for anxiety disorders for how many months after remission?
12 months
What is the most effective method for obtaining information about a pediatric patient’s gender identity and expression as well as underlying psychiatric difficulties related to gender?
Direct patient interview
In the Collaborative Lithium Trial cohort discontinuation study, which of the following clinical outcomes in the lithium treatment group was most common?
- Completed suicide
- Completed 28 weeks of the discontinuation trial
- Discontinued due to emergence of mood symptoms
- Reported 1 or more adverse events
Reported 1 or more adverse events
A 9yo boy presents to the ED due to chronic irritable and angry moods with regular temper outbursts that the parents no longer feel able to safely manage at home. Parents report that he has outbursts of anger every other day that resolve within 6-12 hours. During the most recent outburst, he threw rocks at their house and broke all the first-floor windows after parents insisted he play outside for an hour prior to using their Nintendo Switch. This description is most consistent with which psychiatric disorder?
Disruptive mood dysregulation disorder
According to research on the age of first suicide attempt among people with lifetime mood disorders, which of the following lifetime comorbid disorders was significantly higher among childhood (aged 5-12) attempters compared to adult attempters?
- Alcohol use disorder
- Attention-deficit/hyperactivity disorder
- Eating disorder
- Obsessive-compulsive disorder
- Posttraumatic stress disorder
Posttraumatic stress disorder
Which of the following treatment options reduced repeat hospitalization at one-year follow-up in youth with treatment-resistance schizophrenia according to the Hospital Clinic of Barcelona study?
- ECT alone
- ECT+clonazepam
- ECT+clozapine
- ECT+risperidone
ECT+clozapine reduced repeat hospitalization at one-year follow-up in youth with treatment-resistance schizophrenia according to the Hospital Clinic of Barcelona study
Which term describes the condition in which the epileptic activity itself contributes to severe cognitive and behavioral impairments beyond what one might expect from the underlying pathology?
Epileptic encephalopathy
When compared to males with autism, females with autism are ___ likely to display restricted interests.
less
Suppression of ___ production by exposure to luminous devices has the most impact on circadian rhythm problems which lead to insomnia in the tween and teen population (more so than cognitive overstimulation related to screens, delays in time going to bed, expecting a text while in the sack).
melatonin
A parent of a depressed child in hospital refuses to allow consultation by child psychiatry consult team in hospital. The consulting psychiatrist should provide advice and support to the treating physician’s team ___ directly assessing the adolescent.
without
Which of the following educational accommodations has been shown to be effective on randomized controlled trials in children <=14 years of age?
- Breaking assignments into smaller units
- Completing tests in a smaller group
- Extended testing time
- Read aloud accommodations
Read aloud accommodations
Which families are most likely to respond to the Incredible Years Parenting Intervention?
Families with both child and parenting difficulties
Which of the following medications is currently Food and Drug Administration-approved for treatment of at least one of these conditions (social anxiety, generalized anxiety, separation anxiety, and panic disorder) in pediatric patients 6-18 years old?
- Duloxetine
- Escitalopram
- Fluoxetine
- Sertraline
- Venlafaxine
Duloxetine
Which medication has the most evidence for decreasing repetitive behaviors in children and adolescents with comorbid obsessive-compulsive disorder and autism spectrum disorder?
- Aripiprazole
- Citalopram
- Fluvoxamine
- Fluoxetine
- Risperidone
Fluoxetine
From what source(s) are high school girls most likely to obtain and use nonmedical prescription drugs?
- Bought from a friend
- From a prior prescription
- Given free by a friend
- Multiple sources
From a prior prescription
The US Preventive Services Task Force concluded that current evidence suggests that screening for depression should begin at what age?
12 years
Video gaming has been shown to be associated with release of which neurotransmitter in the amygdala?
Dopamine
A large number of studies support the interaction between early-life stress and which neurotransmitter transporter promoter and gene polymorphism on disease vulnerability and illness course in depression and bipolar disorder?
Serotonin
Which of the following student characteristics represents the greatest risk that the student will be a future “school shooter”? The student:
- Has autism spectrum disorder and has been aggressive
- Has been making threats against peers on social media
- Has been severely bullied and is depressed
- Is white and male
Has been making threats against peers on social media
Among youth with substance use disorders, mental health service use is significantly higher in schools which:
- Are in rural settings
- Are public
- Have higher student-teacher ratios
- Use more prevention activities
Use more prevention activities
If consulting child psychiatrist learns parents of a child with serious medical illness are considering stopping the medical treatment recommended by the pediatric team and starting an alternative treatment, what would consulting child psychiatrist’s most appropriate initial response be?
Help the parents to feel comfortable discussing their interest in an alternative treatment with the pediatric team themselves
Longitudinal studies examining prospective manic episodes found what approximate percent of youth with severe mood dysregulation developed manic, mixed, or hypomanic episodes?
1%
A recent study comparing family-based treatment (FBT) for adolescents with bulimia nervosa with cognitive-behavioral therapy adapted for adolescents with bulimia nervosa showed a predictor for improved response from family-based treatment (FBT) as compared to CBT-A is what?
Lower rates of family conflict
Which of the following problems is associated with gender identity-based discrimination in youth?
- Antisocial behaviors
- Borderline personality disorder
- High-risk sexual behaviors
- Obsessive compulsive disorder
- Posttraumatic stress disorder
High-risk sexual behaviors
One significant neurobiological finding of youth exposed to the effects of lighter maternal alcohol use during pregnancy compared to those without any exposure is:
Greater total cerebral volume including greater regional cortical volume and surface area throughout the temporal, occipital, and parietal lobes.
What percentage of children and adolescents in the United States have experienced at least one type of sexual assault in their lifetime?
10%
A physician should order an antinuclear antibody test when concerned about which condition associated with psychosis?
Systemic lupus erythematosus
Autistic traits in children with obsessive-compulsive disorder can affect the course of the illness in which of the following ways?
- Compulsions are more severe
- Functional impairment is increased
- Illness severity is worse as age increases
- Response to family therapy is decreased
Functional impairment is increased
What is the most common adverse effect of antipsychotic medications in children and adolescents?
- Extrapyramidal side effects
- Hyperprolactinemia
- Increased cholesterol
- Sedation
- Weight gain
Sedation
Which laboratory measure or neurobiological marker best differentiates epileptic seizures from psychogenic nonepileptic seizures?
- Decreased creatine kinase level post ictal
- Increased creatine kinase level post ictal
- Increased prolactin level 10 to 20 minutes after an ictal event.
- Increased white blood cell level after single partial epileptic seizure
Increased prolactin level 10 to 20 minutes after an ictal event.
Which intervention accounts for increased rates of of seclusions/restraints/holds when using verbal de-escalation in comparison to a behavioral modification program?
Repeated negative reinforcement
Which Eriksonian developmental stage best describes the use of media for home and school to help with play and learning?
Industry versus interiority
Which of the following statements best characterizes the proposed mechanism for how glucose levels were affected during the 12-weeks of treatment with either quetiapine extended-release or aripiprazole?
- Antipsychotics do not affect glucose metabolism
- Insufficient time for changes in glucose metabolism
- Insulin levels were increased
- Weight gain increased utilization of blood glucose
Insulin levels were increased
Which of the following aspects of irritability and its associated outbursts in youth is most difficult to measure with presently available diagnostic instruments?
- Duration of outbursts
- Frequency of outbursts
- Intensity of outbursts
- Prevailing mood between outbursts
- Quality of outbursts
Prevailing mood between outbursts
Making sure a physician obtains not only parental consent but also pediatric patient assent for a treatment such as deep-brain stimulation for malignant Tourette’s disorder exemplifies which principle of medical ethics?
Autonomy
At what age does the conception of finality, which is required to fully understand death, usually begin?
7 years
What type of testing is recommended if a chromosomal syndrome is suspected?
- Chromosomal microarray
- Fragile X testing
- Karyotype analysis
- Mitochondrial DNA testing
- Whole exome sequencing
Karyotype analysis
Compared to Parent-Child Interactive Treatment, use of Chicago Parent Program for treatment of behavioral problems in preschoolers is as effective and ___.
more cost effective
Which model of developmental competencies focuses on the unique experiences of racial-ethnic minority and immigrant youth and their normative development?
Integrative
Which of the following conditions precede the development of catatonia in young adults with autism?
- Delusions
- Hallucinations
- Life stressors
- Seizures
Life stressors
In the shared decision model to forgo life-sustaining treatment in a child, what factor should most influence both physicians’ and parents’ perspectives on decision-making?
Likelihood of improvement
___ leads to numbness, which enables tolerance, integration, flexibility, and acceptance in individuals with high functioning autism spectrum disorder?
Alcohol
An ethical principle that supports making a report for medical neglect when parental refusal to consent for gender-affirming care despite significant dysphoria or worse in the transgender patient includes:
Mill’s Harm Principle
Pervasive difficulty better predicts a diagnosis in early childhood disruptive mood dysregulation disorder, which is a key reason for need for ___ screenings to diagnose this condition.
multiple
Which test should be ordered for all children with intellectual disability of unknown etiology?
Microarray
A 10yo boy presents with acute onset isolated psychotic symptoms in the absence of manic, depressive, or anxious symptoms. Antipsychotic is prescribed and pt discharged home. Pt returns a week later and is diagnosed with encephalitis. Which of the following diseases if most likely responsible for the psychotic symptoms progressing to encephalitis?
- Human immunodeficiency virus
- Lyme disease
- Mycoplasma pneumonia
- Rabies
Mycoplasma pneumonia
Based on comparisons of commonly used interventions for pediatric insomnia, which treatment is recommended as the first line treatment in children?
Behavioral interventions
A 13yo with ADHD who is prescribed trazodone PRN and atomoxetine comes to the ED with altered mental status. UDS is done and is falsely positive for which substance?
Amphetamines
Which of the following medications is considered a first-line FDA-approved medication to treat schizophrenia in adolescents?
- Asenapine
- Olanzapine
- Paliperidone
- Ziprasidone
Paliperidone
The most common child and adolescent psychiatrist cited barrier to adhering to the guidelines on screening and monitoring of patients on atypical antipsychotics is:
Parental forgetfulness in obtaining tests
Which therapy has the strongest empirical support for anxiety disorders in children and adolescents?
Cognitive-behavioral therapy
A child with anxiety presents with activation secondary to fluoxetine. According to a recent meta-analysis looking at tolerability of treatments for pediatric anxiety, which of the following medications is the best next choice in order to avoid disinhibition and impulsiveness?
- Duloxetine
- Escitalopram
- Paroxetine
- Sertraline
Duloxetine
Which of the following depression rating scales is widely used for both screening and outcome measurement, is available in the public domain, and is compatible with many electronic health records?
- Beck’s Depression Inventory
- Children’s Depression Inventory
- Patient Health Questionnaire 9 (PHQ-9)
- Quick Inventory of Depressive Symptoms
- Reynolds Adolescent Depression Scale
Patient Health Questinnaire 9 (PHQ-9)
What percentage of patients with adolescent first episode depression experience only one episode of depression throughout their life span?
50
Which anxiety symptom measure has specific subscales for panic, generalized anxiety, separation anxiety, social phobia and school avoidance?
Screen for Child Anxiety Related Disorders (SCARED)
Which factor is supported by the evidence to be most related to the development of self-esteem in children?
Parental warmth
Which of the following proficiencies during kindergarten is the strongest predictor of reading ability in 2nd grade?
- Expressive language
- Mathematics
- Phonemic awareness
- Receptive vocabulary
Receptive vocabulary
For youth with persistent aggression following stimulant optimization and behavioral therapy, treatment with which of the following substances yielded the greatest reduction in aggression?
- Dextroamphetamine-amphetamine
- Divalproex
- Placebo
- Risperidone
Risperidone
Measurement-based care is the administration of rating scales at which level to guide clinical decisions, track symptom improvement, and monitor response to treatment?
Individual patient
An argument against the use of nootropics (cognitive enhancers) solely for cognitive enhancement is selective enhancement may diminish ____ and sensitivity to pain.
creativity
Which of the following populations seems to be at greatest risk for increased blood pressure with regular caffeine consumptions?
- Prepubertal boys
- Prepubertal girls
- Postpubertal boys
- Postpubertal girls
Postpubertal boys
According to the National Survey on Drug Use and Health, approximately what proportion of adolescents who reported past-year nonmedical use of prescription drugs specifically reported nonmedical use of prescription opioid medications?
1/2
In patients with eating disorders receiving parenteral or oral feeding, management and replacement of which element can prevent refeeding syndrome?
Phosphate
Among parents with serious mental illnesses who have Child Protective Services (CPS) involvement, what demographic characteristic results in higher likelihood of CPS-directed change in living arrangements for the child/children involved?
- Nonwhite race/ethnicity
- Parental status as the father
- Primary psychiatric diagnosis of a psychotic disorder
- Unemployment
Parental status as the father
In articles reporting results of randomized controlled trials, which of the following funding source was most associated with reports of “spin”?
- Industry
- Non-governmental organization
- Private
- Public
Public
Which of the following features of irritability when found on repeated assessments is most predictive of an early childhood disruptive mood dysregulation disorder in preschoolers?
- Persistent anger
- Physical aggression
- Quick recovery
- Rapid escalation
Rapid escalation
Awareness of the guidelines, working within an academic practice, and what other factor predicted overall greater adherence to monitoring guidelines for patients on atypical antipsychotics?
- Fewer years in practice
- Perceived importance of guidelines
- Receiving reminders to monitor
- Use of an electronic medical record
Fewer years in practice
Which reading skills deficit is the primary obstacle to reading comprehension for a child with dyslexia?
Decoding
African Americans are how much more likely than non-hispanic whites to receive a diagnosis of conduct disorder instead of attention-deficit/hyperactivity disorder?
2.5 times
Among transitional age youth, research suggests that the rate of completed suicides in the non-student population is double that of full-time students for which of the following reasons?
- Increased access to mental health services on college campuses?
- Increased access to primary care services on college campuses
- Reduced access to firearms on college campuses
- Reduced social isolation on college campuses
Reduced access to firearms on college campuses
Use of central nervous system stimulants in treatment-naive youths is associated with which changes in height and weight?
Reduced weight and height velocity
When conducting a forensic evaluation on a child or adolescent based on evidence-based practice principles, the psychiatrist should undertake which task first?
Meet with the consulting attorney and determine the specific questions that need to be addressed through the forensic evaluation.
Stimulant medication is associated with a reduced risk of having an ___ ___ in patient with ADHD.
unintentional injury
Based on recent research, sudden worsening of which of the following symptoms in a patient with autism spectrum disorder should alert the psychiatrist to evaluate closely for catatonia?
- Anxiety
- Depression
- Self-injurious behavior
- Suicidal thoughts
Self-injurious behavior
Higher alcohol consumption has the greatest effect on reversing the expected maturation in which of the following behaviors?
- Delayed discounting
- Novelty seeking
- Sensation seeking
- Trait impulsivity
Trait impulsivity
Avoidant/restrictive food intake disorders can be distinguished from anorexia nervosa and is more likely to be equal amongst both sexes due to lack of:
Weight or shape concerns
Which mechanism associated with suicide clusters occurs when individuals perceive suicidal behavior to be more common in the community than such behavior truly is?
Descriptive norms
School ___ identification resources have been associated with greater mental health service use in youth.
early
The Virginia ___ Threat Assessment Guidelines is a widely used threat assessment tool for schools (and helpful for psychiatrists) that provides freely available, comprehensive forms for documenting and conducting a threat assessment.
Student
Approximately what percentage of women and adolescent sex trafficking survivors have contact with healthcare providers while in captivity?
30%
Youth enrolled in clinical research studies involving treatment with atypical antipsychotics in addition to multiple other psychotropic medications are often subject to surveillance bias. ___ bias means that these youth might receive more metabolic monitoring leading to increased detection of metabolic side effects.
Surveillance
Which generation of Latino and Asian American immigrant adolescents has the LOWEST risk of suicide?
First
A large Kaiser Permanente Health System study of validated diagnoses of first-episode psychoses revealed that those patients were most likely to have which of the following experiences in the three-year period prior to diagnosis?
- A psychiatric diagnosis other than psychosis
- Psychiatric hospitalization
- Utilization of some health care services
- Utilization of some specialty outpatient mental health services
-Utilization of some health care services
