TEST 3 PRACTICE Flashcards
22 yr old present to ed with cc of “they are making me look toward heaven” Admits to a past diagnosis of schizophrenia, “but God cured me of it.” Review of the medical record reveals that he was discharged from the hospital the previous week on respiradone 4 mg at bedtime. His dose was increased to 6 mg by his outpatient psychiatrist 2 days prior to today’s visit. The patient believe that angels are forcing him to look up to heaven and he is unable to look “down to the devil in hell.” His mental status demonstrates a cooperative and appropriately dressed young man, alert, and oriented three times. Speech is not spontaneous, mood is worried, with flat afect. Thoughts are logical without looseness. He denies suicidal or homicidal ideation but has delusions. His insight is poor, but his judgement and impulse control are not currently impaired. Has upward gaze and his eyes are bilateral:
Medication induced dystonia (EPS); next step is benztropine
MOST COMMON IN YOUNG MEN!
antipsychotic medication can cause extrapyramidal symptoms (i.e. acute dystonia)
caused by dopamine antagonist needs to be treated with anticholinergic medication such as benztropin, or antihistamines such as diphenhydramine
50 yo woman with schizoaffective disorder, bipolar type complains of nervous tics. Currently being treated with haloperidol 100 mg, denies significant affective symptoms but complains of chronic auditory hallucinations of whispers without commands. No suicidal or homicidal ideation, noted to be sticking tonuge in and out.
tardive dyskinesia, decrease dose, and switch to different atypical antipsychotic
25 yo admitted with new onset of psychotic symptoms consisting of command hallucinations to harm others, paranoid delusions, and agitation. He begun olanzapine, After several days he is found lying in bed with eyes open but not responsive. Noted to be seating but is resistant to being moved. Vitals demonstrate 101.4F, bp 182/98, pulse 104, rep 22 breaths/min
NMS; acute mental status changes, diaporesis, rigidity, fluctuating vital signs
43 yo with schizophrenia being followed in an outpatient community mental health clinic after being discharged from hospital. While hospitalized she was on risperidone. She has some paranoia, and ideas of reference, but denies auditory or visual hallucinations. Her mental status examination is significant for moderate psychomotor slowing, with little spontaneous speech, but coarse tremor of her hands. Her stated mood is “fine” and has blunted affect, with little expression, gait is wide based, and shuffling
Parkinsonism; bradykinesia, shuffling gait, masked faces, coarse tremor, increased risk factor is woman and older age
32 yo admitted with the provisional diagnosis of psychotic disorder, rule-out dipolar. After 10 days, he is stabilized on valproate and aripiprazole. The nurses are concerned his medications need to be increased or switched as he has been recently sleeping less and is more agitated, often pacing the hallways. Upon examination, he admits to feeling “edgy,” but he denies racing thoughts increased energy, paranoia, delusions, stating “I just can’t stop walking; I feel like I’m going crazy!”
akathisia; treat with beta blocker or benzo
You are caring for 22 y/o male on the trauma unit who becomes acutely agitated. You order haloperidol 5mg IV push. The pt is still agitated 20 minutes later so you order the dose to be repeated. Suddenly the pt’s head turns to one side (he can’t move it back) and his eyes are involuntarily looking upward
What is going on?
What are you going to do about it?
having an acute dystonic reaction: treat with: anti-cholinergic i.e. benzotropine, trihexyphenidyl, diphehydramine
During your first clinic, you are seeing a 37 y/o male with schizoaffective disorder who was stared on olanzapine at his last visit by the previous resident. He complains that he gets dizzy whenever he stands up from a chair. Although his HR was 73 in the waiting room, it is now 93 after standing and walking back to the exam room.
What is going on?
What are you going to do about it?
alpha-1 blockade (CNS effect along with impotence, failure to ejaculate, etc), switch to a different drug; if olanzapine is the only thing that works, maybe work around it;
You have been caring for a pt who was admitted to the hospital for a COPD exacerbation. She received clozapine at home and this was continued while she was in the hospital. The pt is now going home, and you want to write her a prescription for clozapine to take upon hospital discharge. You are told that you can’t!
What’s up with that? what Side effect?
You can’t write a prescription for clozapine bc you have to be a registered physician; responsible for causing agraunlar cytosis
24 yr old woman is seen in ed after superficially cutting both her wrists. Her explanation is that she was upset because her bf of 3 weeks broke up with her. When asked, she says that she had numersoud sexual partners. Which therapy would she respond to?
dialectical behaioral therapy; this is a form of cognitive therapy and has been show to be effective at treating BPD. The therapy attempt to help the patient explore their own behavior, thoughts, feelings, in the present without delving into the patient’s childhood, which tends to be regressive for these patients, resulting in increased suicidal behavior and acting
35 yr old has a history of being afrain to speak in public. He normally handles his fear by avoiding this activity or by keeping the size of the audience to a minimum. He is required to give a presentation in front of a large audience in 2 weeks and has been extremely anxious about it to the point where he cannot sleep. Although the public speaking event is new, he says he has had similar fears most of his life (>6 months). The clinician would also want to rule out substance use issue or other medical coniditions that may be related to anxiety. The patient is afraid he will somehow embarrass himself in in front of the audience.
SAD; treat with CBT: Relatxation training followed by progressive desensitization. Pharmacologic ineterventions include benzos beta blockers. Currently, the longer lasting drugs are SSRI (sertraline, fluxoxetine)
15 yr old is hospitalized for suicide attempt. Made attempt after fight with bff after a party, and had several month history of irritability, worsening performance in school, poor sleep, anhedonia, anergia, and isolation from her family and friends. Diagnosed with depression and released. Comes back happy, says suicide was only for attention, and seems all good. Parents then say she thought there were camera’s in the doctors office recording her and that she is being stalked by several of the boys at her school:
schizoaffective: diagnosed with mdd with suicide attempt, treated and now has evidence of paranoia
35 yr old has lived in a state psychiatric hospital for the past 10 years. She spends most of her day rocking, muttering solftly to herself, looking at her reflection in a small mirror. She needs helpwith dressing showering, and she often giggles and laughs for no apparent
schizophrenia: disorganized speech and behavior, flat or inappropriate affect, great functional impairment, and inability to perform basic activities such as showering or preparing meals. Grimacing along with silly and odd behaviorand mannerisms is common
20 yr old woman brought to ed, after family can’t get her to eat or drink for 2 days. Patient is awake bu completely unresponsive both vocally and nonverbally. She actively resists any attempt to be moved. Her family reports that during the previous 7 months, she has become increasingly withdrawn, socially isolated, and bizarre; often speaking to people no one else could see:
catatonic schizophrenia, characterized by marked psychomotor disturbances including prolonged immobility, posturing, extreme negativism (the patient actively resists any attempts made to change his or her position). or waxy flexibility (patient maintains the position in which she is placed), mutism, echolalia (repitition of words said by another person), echopraxia (repetition of movements made by another person) Periods of immobility and nutism can alternate with periods of extreme agitation
21 yr old brought ED by parents bc he has not slept, bathed or eaten for 3 days. The parents report that for 6 months their son has been acting strangly “not himself,” he has been locking himself in his room, talking to himself, writing on walls. 6 weeks prior to visit, their son became convinced that a fellow student was stealing his thoughts and making him unable to learn his school material. In the past 2 weeks they noticed that their son has become depressed and has stopped taking care of himself (no bathing, eating, getting dressed, etc). On exam, he appears dirty, disheveled, low energy, and suicidal:
schizoaffective disorder (only actively been not bathing, eating, been depressed, etc for 2 weeks at most if not 3 days).
woman believes her childhood friend had a daughter that went to med school and that this was all so that she could become a psychiatrist and commit her (and the girl lives in california and has no contact with the woman whatsoever)
delusional disorder (other than this one delusion, the woman can function, work, etc)
23 yr old graduate student presents with severe abdominal cramps, bloating, difficulty concentrating. BF says that she’s been extremely mean the past few days and anything he says sets her off. He does not recall any other changes in behavior:
Need SSRI (fluoxetine). Lithium has no known benefits in PMDD but would be gold standard for bipolar.
Patient does not use drugs, symptoms appear episodically and otherwise normal functioning. Behavior seems strange, but no overt signs of psychosis. Reports having pms:
bipolar. Pms or pmdd does not account for manic symptoms. Need lithium
33yr old writer is brought to ed by sister who voices concern that her sibling is acting “out of control.” The patinet laughs at sister’s accusation and rapidly retorts, “I feel great! She’s the one with something wrong.” The patient paces around the room, speaking rapidly. The ER MD attempts to redirect the interview several times, but the patient keeps talking. Her sister reports that the patient was like this several months ago, but otherwise has been normal. She remembers that both episodes seemed to occur around the time of her sister’s period. The patient responds by chanting, “yes, yes! I’ve got the PMS!” The patient has no known medical problems, substance abuse or fam history of psychiatric illlness.
bipolar: the patient presents in a manic state with elevated mood, irritability, psychomotor agitation, and rapid, pressured speech. Need lithium
35 yo man is brought to office by his wife. He had previously suffered a major depressive episode 2 years prior and ceased medications 6 months ago. More recently, the patient had been working many overtime hours for several weeks to complete a project at work, and had slept much less than normal without apparent ill effect. When the project was completed, the patient continued to sleep little, shifted his activities to socializing and drinking with his colleagues. The patient admits he has not drunk this heavily since college. For the past few days the patient has crashed back into depression:
bipolar: pattern of decreased need for sleep, yet with no decrease in eergy level. Increased goal directed activity and excessive pleasure-seeking activity (drugs, alcohol), Need lithium
27 yr old woman has been feeling lue fo the past 2 weeks. Has little energy and trouble concentrating. She states that 6 weeks ago she had been feeling very good, with lots of energy and no need for sleep. She says that this pattern has been occurring for at least the past 3 years though the episodes have never been so severe that she couldn’t work
cyclothymic disorder
a 24 yr old with chronic schizophrenia is brought to the ed after his parents found him in his bed and were unable to communicate with him. On examination, the man is confused and disoriented. He has severe muscle rigidity, a temp of 39.4C his bp is elevated,, and he has a leucocytosis.
He is suffering from ____ and should be given ______
The patient has neuroleptic malignant syndrome NMS a life-threatening complication of antipsychotic treatment.
a 54 yr old with a chronic mental illness seems to be constantly chewing, he does not wear dentures his tongue darts in and out, and grimaces, frowns, and blinks excessivley:
tardive dyskinesia; an extra pyramidal symptom assocaited with typical antipsychotics bc they work by blocking D2 dopamine receptors in the mesolimbic and mesocortical areas of the brain. However, these same medications also bind to dopamine receptors in other areas of the brain, such as the nigrostriatal pathway, thereby causing a variety of eps.
32 yr old woman is brought to the ed by police after being found standing in the middle of a busy highway, naked, commanding traffic to stop. In the emergency room. she is agitated and restless, with pressured speech, and an affect that alternates between euphoric and irritable. Her father is contacted and states that this kind of behaviour runs in the family
bipolar, manic
71 yr old woman with history of early AD is brought to hospital bc she “just isn’t acting like her normal self” On mental status exam, she is lethargic, easily distractable, and oriented only to peson. At baseline, she is oriented to person and place, but has difficulty recalling the date and time. Physical examination and diagnostic workup are suggestive of an uncomplicated urinary tract infection (UTI).
Which feature most distinguishes her delirium from AD?
decreased attention
disorientation
cognitive deficits
behavioral disturbances
decreased attention
both delirium and dementia can result in behavioral disturbances, cognitive deficits, and poor orientation. However, in all cases of delirium there is an alteration in level of attention. In early dementia, attention and concentration are typically maintained
71 yr old woman with history of early AD is brought to hospital bc she “just isn’t acting like her normal self” On mental status exam, she is lethargic, easily distractable, and oriented only to peson. At baseline, she is oriented to person and place, but has difficulty recalling the date and time. Physical examination and diagnostic workup are suggestive of an uncomplicated urinary tract infection (UTI). What is the most important component of treating this patient’s delirium?
treat her UTI with antibiotics
64 yr old with CAD and no prior psychiatric history who experienced visual hallucinations, paranoia, and fluctuation of attention and awareness on the evening of postoperative day number three following CABG. On examination later that night, the patient is oriented to person, place, and situation, but not to time. Otherwise, his mental status examination and physical examination are essentially unremarkable
delirium
next: find the CAUSE of the delirium by reviewing the medical record, performing focused history and physical examination, and obtaining clinically guided laboratory and imagine studies
A 40 year old male with Down’s syndrome has symptoms of advanced dementia consistent with Alzheimer’s disease. Why is early onset Alzheimer’s disease common in Down’s syndrome?
the amyloid precursor protein (APP) is located on chromosome 21
Patients with FTDP-17 have which of the following brain abnormalities?
Extensive deposition of intracellular hyperphosphorylated tau protein in neurons and glia
T/F: HIV encephalopathy is frequently treated with HAART therapy
How do they present on histo?
HIV associated dementia persists DESPITE HAART therapy:
Microglial nodules and
TEST: multinucleated giant cells near blood vessels
Involves white matter, diencephalon, and brainstem
OBESE requests antidepressent______ older person that has insomnia and is underweight:
buproprion bc it is an atypical with appetite suppression quality; mirtazepine bc it increases appetite and causes sedation
older patients with insomnia and continued weight loss requires an antidepressent. What do you prescribe and how does it work?
Mirtazepine: sedation (H1 receptor antagonism)
increased appetite, weight gain (H1 receptor antagonism)
_______ is used in smoking cessation and DOES NOT CAUSE SEXUAL DYSFUNCTION BC IT LACKS THE SERATONERGIC COMPONENT
buproprion
87 y.o. male, 8 yrs of education, retired ironworker
progressive memory loss for 2-3 years:
repeating questions
word finding difficulties
difficulty with IADLs (e.g., finances, cooking, driving)
visual hallucinations for 5 months; animals, people invading home paranoia, irritability
relevant med hx: atrial fib, macular degeneration, cataracts,
hearing loss, freq dizziness + falls, recent CT: generalized atrophy
meds: warfarin, furosemide, zinc, risperidone for hallucinations
Prominent motor symptoms on exam: cogwheeling, rigidity
Lewy Body DM
Woman believes that a family of young children moved into the house, and so she cooks food for the kids to feed them, no idea that the hallucination isn’t real; could be about small animals that come into the room, parkinsonism, COGWHEEL, sleep problems, bradykinesia.
lewy body dementia, adverse reaction to l/dopa (falls syncope, autonomic dysfunctino)
62 y/o man, right handed, w/ MA in Ed, retired teacher and realtor
5-6 year hx of memory problems, insidious onset, gradual progression. Word finding problems, forgetting events and conversations, getting lost in familiar areas, forgetting appointments. Retired because unable to perform his duties as realtor.
Early Stage AD:
Cardinal symptom: impaired learning of new information, reflecting earliest involvement of medial temporal region
Verbal memory tests – most sensitive
decreased delayed recall
decreased immediate but NORMAL delayed recall is NOT likely dementia
Impairment should be judged relative to estimated premorbid status
69 yr old retired engineer with history of ht and hyperlipidemia has been suffering from memory problems over the last several months. Previously, he functioned at a much higher level. Mild aphasia, memory impairment, and executive dysfunction are evident on mental status examination:
vascular dementia
75 yr old is brought by his daughter for psychiatric eval. He has become increasingly forgetful over the past year, missing engagements with his children and grandchildren. He has gotten lost several times driving in his own neighborhood. He has no psychiatric history, but he has felt lonely since the passing of his wife 14 months ago. His medical history is significant for poorly controlled hypertension. Which of the following additional features is necessary in order to accurately diagnose vascular dementia?
loss of independence in one or more independent activities of daily living. CT or MRI may show lacunar infarcts or microvascular changes in vascular dementia, wheras generalized cortical atrophy and ventricular enlargement are the changes seen in AD. Individuals with vascular Dementia usually remain alert, whereas those with delirium display a fluctuation in consciousness. While psychotic symptoms such as delusions and hallucinations can be seen, they are not necessary or specific for vascular dementia
75 yr old is brought by his daughter for psychiatric eval. He has become increasingly forgetful over the past year, missing engagements with his children and grandchildren. He has gotten lost several times driving in his own neighborhood. He has no psychiatric history, but he has felt lonely since the passing of his wife 14 months ago. His medical history is significant for poorly controlled hypertension.
how would this patient be predicted to perform on cognitive testing if he has vascular dementia as opposed to depressive illness?
better effort with poor insight (whereas depressed individuals typically make little effort)
73 yr old with vascular dementia becomes verbally aggressive at a nursing home. Geriatric psychiatrist is asked to evaluate for treatment. What is the initial step in managing the patient’s behavior?
chlorpromazine donepezil lorazepam physical restraints verbal de-escalation
verbal de-escalation. antipsychotics like chlorpromazine should be avoided because the anticholinergic and orthostatic side effects, and benzos like lorazapam may cause disinhibition in patients, worsening their behavior and possibly causing a fall
24 yr old comes to ed with chief complaint of “my stomach is rotting out from the inside.” States that 6 months of crying on a daily basis, decreased concentration, energy and interest in her usual hobbies. Lost 25 lbs during that time and connot get to sleep, and when she does wakes up early in the morning.
major depression: over 2 weeks of symptoms, anhedonia, crying, anergia, decreased concentration, 25 lb weight loss, and insomnia (early morning waking).
25 yr old with chief complaint of depressed mood for 1 month. Mother died 1 month ago, and since then has felt sad and been very tearful. Difficulty concentration, lost 3lbs, not sleeping soundly through the night:
uncomplicated bereavement (symptoms such as major depression, sadness, weepiness, insomnia, reduced appetitie, weight loss. Considered normal if less than 2 months. For this to be major depression, it would have to accompany marked functinal impairment, morbid preoccupations with unrealistic guilt or worthlessness, suicidal ideation, marked psychomotor retardaion, and psychotic symptoms in addition to the original symptoms described above).
45 yr old states “ever since my husband died suddenly of a hear attack 9 weeks ago, I can’t sleep.” Since then the patient has a very depressed mood, been crying, lost interest in activities, is fatigued, and has insomnia. Why is this major depression instead of bereavement?
the patient exhibits a marked functional impairment: guilt about things other than actions taken or not taken by the survivor at the time of loved one’s death, thoughts of death other than the survivor feeling he/she would be better off dead without the loved one, a morbid preoccupation with worthlessness, maked psychomotor retardation, marked and prolonged function impariment, and hallucinations other than the survivor believeing he can hear the voice of the loved one
39 yr old married woman presents with 1 month of a gradually worsening depressed mood, with increased sleep, low energy, and difficulty concentrating, but no appetite or weight changes. Her medical history is significant for multiple sclerosis, but she is currently not taking medication. Her mental status exam is notable for psychomotor slowing and a depressed and blunted affect. Physical exam demonstrates several different sensory and motor deficits.
major depressive disorder du to another medical condition
52 yr old executive presents with the new onset of depression, early-morning awakening, decreased energy, distractibility, anhedonia, poor appetite, and weight loss for the past 3 months. His symptoms began shortly after he suffered a MI, and although he experienced significant sequelae, he felst less motivated and fulfilled in his life and work, believing that he is now “vulnerable.” As a result, he does not push himself as he used to and his work output is beginning to decline. He feels “empty” but denies suicidal ideation
major depression disorder
14 yr old presents with 15 months of being irritable and depressed almost constantly. The boy has difficulty concentrating, and has lost 5 lbs during that time without trying. He states that he feels as if he has always been depressed, and he feels hopeless about ever feeling better. He denies suicidal ideation or hallucinations. He is sleeping well and doing well in school, though his teachers have noticed that he does not seem to be able to concentrate as well as he had previously.
dythymic disorder (for adults it is 2 years)
19 yr old woman has history of anger and irritability which occurs on monthly on an average. During this time, she reports feeling anxious and “about to explode,” which notes during this time she can’t concentrate and sleeps much more than she needs to. During the several days these symptoms last, she skips her classes because she can’t function
premenstrual dysphoric disorder
55 yr old woman presents with psychiatrist with a depressed mood, decreased energy, and weight gain with a normal appetit. She never had these symptoms before and denies past psychiatric history. Her mental status examination is significant for a depressed-appearing female but is otherwise unremarkable. Physical exam is notable for diffusely enlarged thyroid gland and coarse, brittle hair:
depressive disorder due to another medical condition (hypothyroidism); obtain thyroid studies for this patient, including determinations of thyroid stimulating hormone, triiodothyronine, and thyroxine levels
34 yo suffered from major depression in the past and has at least a 10yr period of depressed mood with insomnia, fluctuating appetite, and decreased ability to concentrate. He also notes that his self-esteem is low and is experiencing no suicidal ideation, psychotic symptoms or weight loss (continues working)
persistant depressive disorder (dysthymia)
45 yr old man with history of schizophrenia and alcohol use disorder was brought by ambulance after he was found sleeping on the floor of a homeless shelter. He appears drowsy, but arousable, and mumbles, “the voices are killing me.” He admits to taking a bottle of lorazepam because “I just couldn’t take it anymore.” Which of the following antipsychotics has been associated with decreased suicide attempts?
clozapine has been shown to reduce suicide attempts in patients suffering from schizophrenia and schizoaffective disorder
50 yr old with history of chronic treatment-resistant schizophrenia was admitted last night after reemergence of command auditory hallucinations telling him to “do bad things.” He had been recently hospitalized and stabilized on clozapine. He denies missing any doses. What addition is the most common form of substance abuse in patients with schizophrenia and likely contributed to the patient’s recent psychotic episode?
nicotine is the most frequent used substance by schizophrenics. Patients with schizophrenia are three times more likely to be addicted to nicotine compared to the general population. Smoking induces cytochrome P450 enzyme activity which results in significantly lower clozapine concentrations, and resulted in reemergence of psychotic symptoms.
26 yr old woman brought to ed by husband after she begins screaming that her children are calling to her and becomes hysterical. The husband states that 2 weeks previousl, the couples two children were killed in a car accident, and since that time the patient has been agitated, disorganized, and incoherent. He states that she wil not eat bc she believes he has been poisoning her food, and she has not slept for the past 2 days. The pateint believe that the nurses in the emergency room are going to cause her harm as well. The patient is sedated and later sent home. One week later, all her symptoms remit spontaneously. which of the following would be her most likely diagnosis?
delirium schizophreniform disorder mdd with psychotic features brief psychotic disorder PTSD
brief psychotic disorder is characterized by the sudden appearance of delusions, hallucinations, and disorganized speech or behavior, usually following a severe stressor. The episode lasts at least 1 day and less than 1 month, and is followed by full spontaneous remission. For the woman in the question, the psychotic episode was clearly precipitated by the death of the children. Schizophreniform disorder is differentiated from brief psychotic disorder by temporal factors (in schizophreniform disorder, symptoms are required to last more than 1 month) and lack of association of a stressor. PTSD has a more chronic course and is characterized by affective, dissociateive, and behavioral symptoms
a 75 yr old man is being cared for in a hospice setting. he has a widely spread prostatic carcinoma that is terminal. Which of the following psychiatric symptom is seen in 90% of terminal patients?
delusions hallucinations flighth of ideas anxiety depression
delusions are extremely common in terminally ill patients
22 yo man brought to ed after becoming exceedingly anxious in college dormroom, stating that the college administration was sending a hit squad to kill him. He also notest that he can see visions of men dressed in black who are carrying guns and stalking him. His thought process is relatively intact, without thought blocking or losse associations. His urine test is positive for; barbiturates heroin benzodiazepine amphetamines MDMA (ecstasy)
amphetamine intoxication can result in a psychosis very closely resembling acute paranoid schizophrenia, with symptoms incuding paranoid delusions and visual hallucinations. Some investigators believe that prominent visual hallucinations and a relative absence of thought disorder are more charactersitc of amphetamine psychosis, but other investigators believe the symptoms are indistinguishable. Other drugs that produce psychosis similar to schizophrenia include PCP and LSD
72 yo woman is brought to ed by daughter after she was found rummaging in the garbage cans outside. Daugher states that the patient never had behavior like this. On interview, the patient states she sees martians hiding around her home and on occasion she hears them, too. She also demonstrates a constructional apraxia, with difficulty drawing a clock and intersecting pentagons. All of these symptoms point to a medical cause for this patients behavior except one.
Which symptom is common in patients with a psychiatric cause for their behavior instead of medical?
patients age
no previous history
visual hallucinations
auditory hallucinations
constructional apraxia
auditory hallucinations are quite common in psychiatrically caused psychoses, but the rest of the items point to a medical psychosis. Other signs that point to a medical cause could be altered mental status signs such as speech, movement or gait disorders, problems with alertness, memory, concentration, or orientation, and concurrent substance abuse history or medical problem
Children with ADHD have a deficit in ________, which are cognitive abilities to formulate a goal, plan the actions to achieve the goal, and maintain the plan in memory in order to execute it.
a. high-level cognition
b. intelligence quotient
c. affective functioning
d. executive functioning
d. executive functioning
What is the likelihood that a 42-year-old mother will give birth to an infant diagnosed with Down syndrome?
a. 1 out of 70
b. 1 out of 150
c. 1 out of 1000
d. 1 out of 30
a. 1 out of 70
The estimated hereditability of autism spectrum disorder is _______.
a. 40%
b. 90%
c. 20%
d. 70%
b. 90%
Behavior patterns of autism spectrum disorder include all of the following EXCEPT
a. adherence to routines.
b. preoccupation with a particular interest.
c. self-injurious behaviors.
d. ability to start but not end a conversation.
d. ability to start but not end a conversation.
________ uses shaping and positive reinforcement to improve the social, communicative, and behavioral skills of children with autistic disorder by intensively training and rewarding specific behaviors.
a. Behavioral family training
b. Multisystemic therapy
c. Applied behavior analysis
d. Social psychoanalysis
c. Applied behavior analysis
The most commonly inherited cause of mental retardation is ________, which occurs when a DNA series makes too many copies of itself and “turns off” a gene on the X chromosome.
a. cultural-familial
b. fragile X syndrome
c. Down syndrome
d. phenylketonuria
b. fragile X syndrome
As children with ADHD mature, about __________% will continue to have the disorder during adolescence.
a. 30
b. 65
c. 50
d. 25
c. 50
For every ________ girl(s) diagnosed with autistic disorder, about ________ boys are diagnosed.
a. one; two
b. three; four
c. one; four
d. two ; five
c. one; four
Which of the following is true of the two symptom clusters of ADHD has two symptom clusters (hyperactive-impulsive and inattentive)?
a. Hyperactive symptoms are always more severe than inattentive symptoms.
b. Children commonly have symptoms from each cluster.
c. Symptoms from one cluster always predominate clearly in cases of ADHD.
d. Hyperactive symptoms persist longer over the lifespan than do inattentive symptoms
b. Children commonly have symptoms from each cluster
________ is an indication of the neurodevelopmental basis of autistic disorder during the first few years of life.
a. Accelerated head and brain growth
b. Delayed development of fine motor skills
c. Rapid weight gain
d. Delayed skeletal development
a. Accelerated head and brain growth
For every ________ girl(s) diagnosed with autistic disorder, about ________ boys are diagnosed.
a. one; two
b. three; four
c. one; four
d. two ; five
c. one; four
Hand flapping, spinning, and ritualistic pacing are repetitive behaviors that serve no observable social functions. Collectively, these are called
a. compulsions.
b. disorder of verbal expression.
c. coping mechanisms.
d. stereotyped behaviors.
d. stereotyped behaviors.
In treating ADHD, ________ teaches parents how to reward positive behaviors and decrease negative behaviors.
a. medication monitoring
b. cognitive restructuring training
c. behavioral parent training
d. communication skills curriculum
c. behavioral parent training
Which of the following is one of the factors that likely contributes to the increased prevalence of autism spectrum disorder in recent years?
a. lack of special education programs
b. the measles virus
c. changes in diagnostic criteria
d. MMR vaccines
c. changes in diagnostic criteria
a 28 yr old is brought to the psychiatrist by her mother. The patient has been progressively isolating herself from everyone, is talking to people who aren't there, is having auditory hallucinations, and the delusional belief that her mother is going to kick her out of the house so it can be turned into a theme park. Which of the following is the lifetime prevalaence for this disorder? 1% 3% 5% 10% 15%
1