Treatment - Part 1 of 3 Flashcards
Which is associated w/ worsened retrograde amnesia during ECT? (5x)
BILATERAL ELECTRODE PLACEMENT
47y/o pt w acute mania is unresponsive to pharmacotx. Pt’s current med regimen includes lithium, divalproex, clonazepam, olanzapine, bupropion. ECT is begun, pt is continued on previous med regimen. After 2 ECT tx, pt becomes delirious. Cause? (x3)
LITHIUM
Which med should be held before ECT? (x3)
LITHIUM
Most important potential side effect of ECT to discuss with 78 yo patient (2x)
COGNITIVE DYSFUNCTION
Pt w/ hx of melancholic depression is severely dehydrated, emaciated, and catatonic. He began withdrawing, talking about death, stopped eating and drinking and lost 20lbs. Tx of choice? (x2)
ELECTROCONVULSIVE THERAPY (ECT)
What is associated with a markedly increased risk of complications from ECT? (x2)
COPD
Transcranial magnetic stimulation for Tx of depression targets which brain regions? (X2)
PREFRONTAL CORTEX
What medical condition has highest relative risk for adverse event with ECT?
CONGESTIVE HEART FAILURE
The ability of magnetic seizure therapy to target specific brain regions implicated in depression gives it what potential advantage, compared with traditional ECT:
FEWER COGNITIVE SIDE EFFECTS
58 y/o with MDD is getting ECT, develops dense retrograde amnesia after 3rd treatment. How can this be ameliorated?
INCREASING THE INTERVAL BETWEEN ECT TREATMENTS
Pt has not responded to adequate trials of SSRI, SNRI, TCA, MAOI, but feels improved with 8 treatments of ECT. What next?
CONTINUE MAINTENANCE ECT FOR AT LEAST 10 WEEKS
Deep brain stimulation targeting what area of the brain is most studied for treatment of depression
SUBCALLOSAL CINGULATE CORTEX
Most serious side effect of rTMS
SEIZURES
What barbiturate is used in ECT to produce a light coma?
METHOHEXITAL
Greatest risk of death w/ ECT:
RECENT MI
Indication for treating a manic w/ ECT:
DANGEROUS LEVELS OF EXHAUSTION
Prophylactic Treatment for a pt with severe delusional depression following a course of ECT includes what?
COMBINATION OF ANTIPSYCHOTICS AND ANTIDEPRESSANTS
ECT is least likely to be effective for patients who have?
CHRONIC SCHIZOPHRENIA
What condition is a relative contraindication to ECT?
CARDIAC ARRYTHMIA
A 70 y/o patient presents with severe psychotic depression. Patient stopped eating and speaks very little. Failed multiple med trials. What’s next?
ECT
Psych MD is counseling a pt about risks and benefits of ECT. What statement correctly describes the risk of cognitive impairment?
HIGH DOSE UNILATERAL ELECTRODE REPLACEMENT IS ASSOCIATED WITH LESS COGNITIVE IMPAIRMENT.
Med that is assoc w prolonged seizures/confusional state during ECT:
LITHIUM
Which medication should be discontinued prior to ECT?
BUPROPION
What eeg read Correlates to a positive response to ECT?
INCREASED ECT-INDUCED FRONTAL DELTA ACTIVITY
TMS advantages over ECT
LACK OF ANESTHESIA
Most commonly limits the use of ECT:
COGNITIVE IMPAIRMENT
Which is a limitation of the MMSE? (7x)
MAY FAIL TO DETECT VERY MILD COGNITIVE IMPAIRMENT
Question to ask when evaluating for immediate recall (3x)
CAN YOU REPEAT THESE SIX NUMBERS?
What task is useful in evaluating a pt’s ability to concentrate? (2x)
PERFORMING SERIAL 7’S
On MSE, thought process with lack of goal directedness, excessive details, and difficulty with closure describes a thought pattern of: (2x)
CIRCUMSTANTIALITY
Ability to alternate b/w general concepts and specific examples
ABSTRACT REASONING
SI, tearful, sad, does not smile, normal prosody, affect?
CONSTRICTED
In addition to orientation, attention, calculation, language and registration, what other cognitive domain does the mmse test?
RECALL
What is being assessed when patient is asked to repeat words “Apple, table, penny”?
REGISTRATION
Which area of MSE relies primarily on patient report?
MOOD
Psych MD asked pt “what would you do if you lost your prescription?” This question primarily assesses:
JUDGMENT
Psychiatrist asks “How many quarters are in $15?”, examining what ability
COGNITION
Which of the following is the most significant problem with the use of the global assessment of functioning scale?
IT CONFOUNDS SYMPTOMS AND FUNCTIONING
Which of the following represents a disorder of the content of thought?
OBSESSIONS
Communication d/o assoc w/ neurological and psych d/o
MUTISM
Asking a patient to recite a series of numbers in reverse order is a standard test of:
CONCENTRATION
The difference between an idea of reference and a delusion of reference is that the former is:
HELD WITH LESS CONVICTION
The purpose of asking a pt to start at 100 and count backwards by 7’s is to measure which of the following?
CONCENTRATION
A disorder of content of thought
PARANOIA
Asking a pt, “which one does not belong in the following group: 13 pennies, a piggy bank, and a cow?” is a test of which domain:
ABSTRACT REASONING
Asking the patient “how are an apple and an orange alike?” assesses which of the following cognitive functions?
ABSTRACT REASONING
Asking a patient to interpret the phrase “Don’t cry over spilled milk” tests what?
ABSTRACT THINKING
A pt reports, “undercover agents are all there, and they’re gonna kill me.” Pt’s comment is best described as:
A DELUSION
Asking pt what they would do in a hypothetical situation is testing what?
JUDGMENT
Why is there limited value of serial sevens as a test of concentration?
SUCCESSFUL PERFORMANCE REQUIRES ARITHMETIC SKILL
Disorder of what element of MSE is evidenced by patient repeatedly referring back to the answer to a previous question?
THOUGHT PROCESS
Elderly pt with profound apathy, how do you distinguish depression from executive dysfunction?
CLOCK DRAWING
Word that pt makes up is a ____.
NEOLOGISM
The term for abnormally slow speech seen in depression
BRADYLALIA
5 days after CABG a 47 y/o M is disoriented to time and place. He identifies his right and left but not that of the examiners. Can draw square and circle but not a clock. This is:
DYSPRAXIA
Which of the following statements specifically tests concentration?
SAY THE LETTERS OF THE ALPHABET BACKWARDS STARTING WITH “Z”
Fluent speech w preserved comprehension, inability to repeat statements is consistent with what type of aphasia?
CONDUCTION
A 62 yo pt is referred for complaints of memory problems. The patient reports feeling more forgetful and gives examples of “losing my keys, handbag, or forgetting the names of aquaintances.” The pt denies any other neurocognitive symptoms. Family members confirm the patient’s report, and feel that this has been a gradual change over the last year. Family members report that the pt is a former hx professor who continues to enjoy intellectual activities and they need to prepare if the patient is going to lose these capabilities as a result of dementia. The standard MMSE would be a relatively insensitive instrument for this patient because it:
HAS A CEILING EFFECT FOR WELL-EDUCATED PERSONS
What test would be considered most useful to specifically evaluate concept formation, reasoning, and executive functioning? (5x)
WISCONSIN CARD SORTING TEST (WCST)
What psychological tests measure test-taking attitudes at time of exam (4x)
MMPI (MINNESOTA MULTIPHASIC PERSONALITY INVENTORY) VALIDITY SCALE
Most appropriate brief screening instrument that a pt can fill by him/herself at physician’s office to screen for depression is (3x)
BECK DEPRESSION INVENTORY
Which test is an objective measure of personality in adults and is helpful in confirming diagnosis of personality disorder? (3x)
MILLON CLINICAL MULTIAXIAL INVENTORY (MCMI)
An appropriate purpose for projective testing is: (3x)
DETECTING THE PRESENCE OF SUBTLE PSYCHOTIC THOUGHT PROCESSES
Which of the following is a pt self-reported questionnaire? (x2)
BECK ANXIETY INVENTORY
Which of the following tests would be considered most useful to specifically evaluate concept formation with set shifting? (2x)
WISCONSIN CARD SORTING TEST (WCST)
MMPI does what? (2x)
IDENTIFIES MAJOR AREAS OF PSYCHOPATHOLOGIC FUNCTIONING
Wisconsin card sorting test (WCST) assesses (2x)
ABSTRACT REASONING AND FLEXIBILITY IN PROBLEM SOLVING
What psychological test determines neuropsychologic impairment? (2x)
HALSTEAD-REITAN BATTERY
A broad-based rating scale for psychiatric symptoms in children? (2x)
CHILD BEHAVIOR CHECKLIST (CBCL)
Most specific test for assessing executive functioning? (x2)
WISCONSIN CARD SORTING TEST (WCST)
4 y/o child is administered the “false beliefs task” in which two dolls act out a scene, whereby one doll switches the location of a marble from one site to another, while the other doll leaves the scene of the action. When the other doll returns to look for the marble, the child correctly points out that it will look in the original location. This response demonstrates the child is showing evidence of (x2):
THEORY OF MIND
This is considered as an unstructured psychological test (x2):
RORSCHACH INKBLOT
What does the Wisconsin card sorting task most accurately measure?
THE ABILITY TO GENERATE ALTERNATIVE STRATEGIES IN RESPONSE TO FEEDBACK
Compared to “treatment as usual”, how does the IMPACT model of integrated care (which recommends screening for depression of at least 75% of primary care patients and following through with psych eval/mgmt) differ?
DOUBLES THE EFFECTIVENESS OF DEPRESSION TREATMENT
In problem solving training, what is the next step after using specific behavioral terms and feeling expressions
THE OTHER PARTNER PARAPHRASES THE STATEMENT OF THE PROBLEM
Pt asked to draw clock, keeps tracing circle over and over again
PERSEVERATION
Test that measure flexibility in shifting cognitive sets
TRAILS B
Which test requires rapid and efficient integration of attention, visual scanning and cognitive sequencing?
TRAIL MAKING TEST
Name of test where pt is told to name the colors in which the words are printed rather than reading the words themselves
STROOP COLOR WORD TEST
What test requires rapid and efficient integration of attention, visual scanning, and cognitive sequencing?
TRAIL-MAKING TEST (TMT)
When interpreting IQ test results, what indicates need for further assessment?
VERBAL SCORE SIGNIFICANTLY HIGHER THAN NONVERBAL SCORE
IQ scores generally considered to be stable beginning at:
7 YEARS OLD
To obtain additional about unconscious drives and psychodynamic processes, which test would be most helpful?
THEMATIC APPRERCEPTION TEST (TAT)
Psych MD tests a medical pt with go/no-go test in which psych MD asks pt to tap the table once if Psych MD taps it once, but not to tap the table if psych MD taps it twice. Psych MD is screening for deficits in?
EXECUTIVE FUNCTIONING
Which of the following tests is used for assessment of expressive language?
BOSTON NAMING TEST
Test to discriminate cognitive difficulties in Alzheimer’s from those in depression:
BOSTON NAMING TEST
Test for anxiety that does not include Qs about physical sx such as tachycardia and diaphoresis would be considered lacking in what?
CONTENT VALIDITY
Psychiatrist wishes to assess a pt’s premorbid intellectual functioning. Which of the following tests would be best for this purpose?
READING SUBSET OF THE WIDE RANGE ACHIEVEMENT TEST
Awareness of own symptoms rated by:
GLOBAL ASSESSMENT SCALE
Which of the following is the best test for general assessment of a patient’s psychiatric symptom patterns?
SYMPTOM CHECKLIST-90-REVISED (scl-90)
Measures attention, concentration, and freedom from distractibility:
WECHSLER ADULT INTELLIGENCE SCALE (WAIS)
Judgment by experts that items on a test “makes sense” is an example of:
FACE VALIDITY
Bender-Gestalt diagrams assesses:
NEUROPSYCHOLOGICAL IMPAIRMENT
Which test assesses ability to attend to a task while inhibiting interfering stimuli?
STROOP COLOR WORD TEST
What would be a useful screening test to evaluate an 8 y/o child’s academic performance?
WIDE RANGE ACHIEVEMENT TEST (WRAT)
What does the clock drawing task test?
ATTENTION, VISUOSPATIAL, PLANNING, EXECUTIVE FUNCTION (NOT orientation)
Pt scores on revised Wechsler adult intelligence scale (WAIS-R) subtests for picture arrangement and block design are very low compared to scores on other subtests. Most suggestive of:
LESION IN NONDOMINANT HEMISPHERE
Test to assess intelligence in 4 y/o?
STANFORD-BINET
Stanford-Binet most similar to:
WECHSLER INTELLIGENCE SCALE FOR CHILDREN – III
Which assessment instrument best measures cognitive functioning in a 4 year old child?
WECHSLER PRESCHOOL AND PRIMARY SCALE OF INTELLIGENCE-REVISED WPPSI-R
Test more specific to identify specific learning disability in child w/ full scale IQ of 93 on WISC- III
WOODCOCK-JOHNSON PSYCHO- EDUCATIONAL BATTERY – REVISED
25 y/o M scores in MMPI are all normal except for elevated scores on the depression and psychasthenia scales. This suggests:
HAS DEPRESSION WITH ANXIETY AND OTHER NEUROTIC SYMPTOMS
Thematic apperception test is used for
INTERFERING MOTIVATIONAL ASPECTS OF BEHAVIOR
Which tests can be used for projective personality testing?
RORSCHACH, DRAW A PERSON, THEMATIC APPERCEPTION (NOT MMPI)
Which is a Projective Assessment test:
THEMATIC APPERCEPTION TEST (TAT)
The personality test in which a pt is shown pictures of situations and asked to describe what is happening in each picture is:
THEMATIC APPERCEPTION TEST (TAT)
This tool best measures the degree of self-care in children with MR:
VINELAND ADAPTIVE BEHAVIOR SCALE
8 yo child recently had Wechsler Intelligence Scale for Children (WISC-IV) and received full scale IQ of 60. Which additional tests would determine if child meets criteria for intellectual disability (mental retardation)? (2X)
VINELAND ADAPTIVE BEHAVIOR SCALES, 2ND EDITION (VABS-II)
A psychological test that demonstrates high reliability:
WECHSLER ADULT INTELLIGENCE SCALE (WAIS)
Test correlates most strongly w premorbid fcn in pt w early dementia
WECHSLER ADULT INTELLIGENCE SCALE II VOCABULARY TEST
A known limitation of the Minnesota Multiphasic Personality Inventory?
NORMS DO NOT ACCOUNT FOR OUTCOMES BASED ON RELIGION AND RACE
Computer assisted continuous performance testing is used to assess what?
ATTENTION
Most useful instrument to assess a non-verbal 3-year-old child who plays alone in the corner, stacking/unstacking blocks?
AUTISM DIAGNOSTIC OBSERVATION SCHEDULE (ADOS)
Which psychological test has been validated for adolescents, elderly and ethnic minority groups, and is recommended for the assessment of psychological functioning in patients from diverse cultures?
MINNESOTA MULTIPHASIC PERSONALITY INVENTORY (MMPI-2)
Neuropsychological test that specifically evaluates impairments in frontal lobe function in adults?
WISCONSIN CARD SORTING TASK (WCST)
On what test would perseverative error be considered a specific outcome of clinical relevance?
WISCONSIN CARD SORTING TEST (WCST)
75 y/o pt presents with symptoms of dementia. Especially poor performance on which of the following neuropsychological tests might suggest a Dx of vascular dementia rather than Alzheimer’s dementia?
WISCONSIN CARD SORTING TEST (WCST)
Patient is shown a picture of a person standing next to window and is asked to describe what happened. What test?
THEMATIC APPERCEPTION TEST (TAT)
27 y/o depressed patient treated with SSRI and tranylcypromine (and with 5- hydroxytryptophan) now presents with VH, mild confusion, myoclonic jerks, diaphoretic, flushing, restless: (6x)
SEROTONIN SYNDROME
What drug has a curvilinear therapeutic window? (6x)
NORTRIPTYLINE
