Treatment - Part 2 of 3

Question 1

A leading hypothesis as to why atypical antipsychotic medications are less likely than typical neuroleptic agents to cause EPS is based one which of the following properties of atypical antipsychotics?

Answer 1

RAPID DISSOCIATION FROM D2 RECEPTORS

Question 2

35 y/o pt is started on a trial of clozapine for treatment-refractory schizoaffective disorder. During the initial medication titration, pt complains of sedation and orthostatic hypotension as well as flu-like symptoms, but seems symptomatically improved. However after a dose increase from 150 to 200mg, pt develops a fever to 102 degrees, tachycardia to 130bpm, and an acute metal status change. CXR, urine studies, and blood culture are unremarkable. A CBC reveals a WBC of 11.4, with an elevated eosinophil percent of 7%. Which known toxic risk of clozapine is the most likely Dx?

Answer 2

MYOCARDITIS

Question 3

A 30yo w. 5yo hx of Schizophrenia, prior failed Haldol and Risperidone trial, despite adherent to meds continues to have severe psychotic symptoms. Med recommendation at this time is..

Answer 3

CLOZAPINE

Question 4

30 yo on Clozapine for treatment resistant schizophrenia presenting with dyspnea, orthostatic hypotension and HR 130bpm. Elevated Eosinophil , EKG with non-specific T wave changes. Further most likely test to guide treatment

Answer 4

TROPONIN LEVEL

Question 5

What lab finding is most typically associated with NMS?

Answer 5

INCREASED CREATINE KINASE LEVELS

Question 6

Appropriate management of neuroleptic malignant syndrome:

Answer 6

HYDRATION AND COOLING

Question 7

Antipsychotics are associated with what?

Answer 7

DYSTONIA, POIKILOTHERMY, LIPID SOLUBILITY, AND LOWER SEIZURE THRESHOLD

Question 8

Which of the following effects is the basis for dantrolene’s efficacy in the treatment of neuroleptic malignant syndrome (aka nms)?

Answer 8

SKELETAL MUSCLE RELAXANT

Question 9

32 y/o pt with hx of schizoaffective d/o stable on clozapine is admitted to internal medicine service for a severe GI viral infection. Pt is confused, slow, appears visibly ill and tired. Pt c/o stiffness and there is some rigidity to the movements. What should be recommended?

Answer 9

DISCONTINUE CLOZAPINE

Question 10

Which antipsychotic has least effect on prolactin?

Answer 10

CLOZAPINE

Question 11

A slow titration of Clozapine is required to decrease the risk of:

Answer 11

SEIZURES

Question 12

Which neuroleptic has the weakest affinity for the dopamine D2-like receptor?

Answer 12

CLOZAPINE

Question 13

Clozapine clearance decreased by

Answer 13

CIMETIDINE

Question 14

Which med is contra-indicated with clozapine?

Answer 14

CARBAMAZEPINE

Question 15

Schizophrenic on haldol 5mg presents to ED “unable to see.” Appears distressed, writhing and moaning. States “I’m unable to stop looking up.” What is the best treatment?

Answer 15

ADMINISTER BENZTROPINE 1MG IV NOW

Question 16

What manifestations is the most common side effect of conventional antipsychotic meds?

Answer 16

AKATHISIA

Question 17

What antipsychotic medication would be the best choice to avoid motor symptoms in Parkinson’s disease?

Answer 17

CLOZAPINE

Question 18

What antipsychotic medication is helpful in treating Tourette’s?

Answer 18

HALOPERIDOL

Question 19

Pt develops feelings of restlessness, an inability to relax, jitteriness, pacing, and rapid alternation of sitting and standing shortly after being started on a low dose of haloperidol. Addition of what medications would be most effective in managing these symptoms?

Answer 19

ATENOLOL

Question 20

The therapeutic effect of 2nd generation antipsychotics on negative symptoms of schizophrenia is thought to be related to the induction of expression in what area of the brain?

Answer 20

PREFRONTAL CORTEX

Question 21

Psych MD orders quetiapine 50 mg for an 82 y/o nursing home pt w/ dementia who has become severely agitated. Soon after, the psychiatrist receives a call from a family member who is concerned about the “black box” warnings associated with antipsychotics in the elderly. Which of the following is the most accurate information the psychiatrist could give the family member regarding the potential safety risks of this medication? (x2)

Answer 21

ATYPICAL ANTIPSYCHOTICS INCREASE MORTALITY; THIS MUST BE BALANCED AGAINST ANY POTENTIAL BENEFIT

Question 22

Blockade of dopamine receptors in tuberoinfundibular tracts results in breast enlargement, galactorrhea, impotence, and amenorrhea. Mechanism is increase of:

Answer 22

PROLACTIN

Question 23

Correlation of plasma drug concentration with the clinical effectiveness is best established for which antipsychotics?

Answer 23

CLOZAPINE AND HALOPERIDOL

Question 24

Acutely psychotic pt started on risperdal 2 mg qhs. Increased to 3 mg BID over next few days. Pt becomes increasingly agitated, restless, unable to stop pacing. Most appropriate intervention?

Answer 24

ADD PROPRANOLOL 10 MG TID

Question 25

Psychotic pt given haldol, acute laryngospasm. In addition to intubation, give:

Answer 25

COGENTIN

Question 26

Schizophrenic OD’d on antipsychotics, has EPS and urinary retention. Tx?

Answer 26

AMANTADINE

Question 27

Pts over 65 y/o are less likely to tolerate higher doses of antipsychotics due to:

Answer 27

DECREASED HEPATIC METABOLISM

Question 28

25 y/o pt is brought to the ED with a sudden onset of severe spasms of the neck and eyes deviated up and to the right. The pt has had a viral illness with nausea and vomiting and was given prochlorperazine yesterday. Which of the following meds would be most appropriate to prescribe for this patient?

Answer 28

DIPHENHYDRAMINE

Question 29

A neonate has transient hyperreflexia, irritability, and tremors followed by a period of depressed interactive behavior and poor response to environmental stimuli. What did the childs mother use?

Answer 29

OLANZAPINE

Question 30

In the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, which medication was the most effective due to its low rate of discontinuation, high reduction in psychopathology, and longest time to discontinuation of treatment

Answer 30

OLANZAPINE

Question 31

Patient started on clozapine for treatment-resistant schizophrenia has initial ANC of 2200/mm3. How frequently should you get a CBC with diff?

Answer 31

WEEKLY

Question 32

greatest risk factor for developing akathisia? Male sex, younger age, rapid dose escalation, lower potency agents, positive symptoms

Answer 32

RAPID DOSE ESCALATION

Question 33

Quetiapine is known to develop diabetes, if starting metformin, this is an example of what kind of prevention? (primary, secondary, tertiary or quaternary?)

Answer 33

TERTIARY

Question 34

What psychotropic can cause a decrease in benzo plasma levels? (6x)

Answer 34

CARBAMAZEPINE

Question 35

Which benzo accumulates with repeated administration, should be avoided in chronic renal failure, and most likely to accumulate with repeated dosing? (3x)

Answer 35

DIAZEPAM

Question 36

Which of the following medications would be preferable for use in an anxious patient with pulmonary disease? (3x)

Answer 36

BUSPIRONE

Question 37

If prescription benzo is necessary for a patient w/ severe hepatic dysfunction which of the following is most appropriate choice to avoid elevated serum levels. (2x)

Answer 37

LORAZEPAM

Question 38

Which benzo is reliably absorbed given IM? (2x)

Answer 38

LORAZEPAM

Question 39

Which of the following reverses the effects of benzodiazepines? (2X)

Answer 39

FLUMAZENIL

Question 40

47 yo with well controlled epilepsy well controlled on monotherapy develops nausea, ataxia, and diplopia when treated with erythromycin. Which antiepileptic?

Answer 40

CARBAMAZEPINE

Question 41

Decreases congenital malformations in women taking anti-epileptic medications

Answer 41

FOLIC ACID

Question 42

The use of flumazenil for treating benzo OD is limited by …

Answer 42

THE RISK OF INDUCING WITHDRAWAL SEIZURES IN BENZO- DEPENDENT PTS

Question 43

75 y/o pt with cirrhosis should be given which of the following meds:

Answer 43

TEMAZEPAM

Question 44

False positive urine toxicology screen for Benzodiazepines?

Answer 44

SERTRALINE

Question 45

Buspirone is thought to exert anxiolytic effects primarily due to its actions at which receptor?

Answer 45

5HT-1A

Question 46

Benzo half-life < 6 hrs

Answer 46

TRIAZOLAM

Question 47

Pharmacokinetic property most related to relative abuse potential of benzos

Answer 47

TIME TO ONSET OF ACTION

Question 48

Benzodiazepam absorbed PO or IM

Answer 48

LORAZEPAM

Question 49

Benzo w/o active metabolites

Answer 49

LORAZEPAM

Question 50

Longest half-life amongst alprazolam, flurazepam, lorazepam, temazepam and triazolam

Answer 50

FLURAZEPAM (DALMANE) USED FOR INSOMNIA

Question 51

Most common side effect of benzos

Answer 51

DROWSINESS

Question 52

Which of the following benzos has an active metabolite?

Answer 52

CHLORDIAZEPOXIDE

Question 53

Which of the following sleep changes is produced by all benzos?

Answer 53

DECREASE IN REM

Question 54

Breakthrough panic anxiety in a patient treated with short-acting benzodiazepines can be managed by switching the pt to what medication?

Answer 54

CLONAZEPAM

Question 55

75 y/o pt has developed tolerance to clonazepam over many years, now taking 5mg clonazepam at night but still with poor sleep. Pt denies any mood or anxiety symptoms, no drug problems. Next step:

Answer 55

SLOWLY WITHDRAW THE PT’S CLONAZEPAM AND REEVALUATE

Question 56

Pts on chronic benzos develop:

Answer 56

AMNESIA

Question 57

Benzo that would be the safest to prescribe for a 70y/o pt:

Answer 57

LORAZEPAM

Question 58

35 yo patient presents with frequent panic attacks, which begin with feelings of dread, sweating, shaking, fear of doom and death lasting 20 min. Which medication provides immediate relief:

Answer 58

LORAZEPAM

Question 59

How likely is escalation of benzodiazepine dose when prescribed for long term use?

Answer 59

MOST PATIENTS WILL MAINTAIN A STABLE DOSE OVER TIME

Question 60

FDArequiresthatgenericsnotbesignificantlydifferentfromtheparentcompoundsinwhat way? (6x)

Answer 60

BIOEQUIVALENCE

Question 61

After OD, pt has fever, confusion, tachycardia, dry mouth, urinary retention, dilated and unresponsive pupils. Which medication would treat this? (Anticholinergic toxicity) (4x)

Answer 61

PHYSOSTIGMINE

Question 62

Pt presents to ED c/o ringing in ears, abdominal pain, and is found to have mild metabolic acidosis. Overdose of what substance? (4x)

Answer 62

ASPIRIN

Question 63

Hepatitis C treatment with interferon can cause what psychiatric symptom? (3x)

Answer 63

DEPRESSION

Question 64

Which of the following agents used to treat patients with Alzheimers disease has a mechanism of action related to an antiglutaminergic mechanism? (x2)

Answer 64

MEMANTINE

Question 65

In addition to life support, which class of meds to consider for the treatment of neuroleptic malignant syndrome? (2x)

Answer 65

DOPAMINE AGONISTS (bromocriptine)

Question 66

What medication may cause mood d/o in pts being treated for melanoma? Also worsens fatigue and cognitive inefficiency: (2x)

Answer 66

INTERFERON

Question 67

What med is effective in tx of motor/vocal tics associated w Tourette syndrome refractory to tx with antipsychotics and alpha adrenergic agonists? (x2)

Answer 67

TETRABENAZINE

Question 68

Pt confused, disoriented, dry mouth, dilated unresponsive pupils. Likely ingested: (2x)

Answer 68

BENZTROPINE

Question 69

Flumazenil is used to treat: (2x)

Answer 69

BENZO INTOXICATION

Question 70

This is a relative contraindication for interferon treatment in pt’s with Hepatitis C: (2x)

Answer 70

DEPRESSION WITH SUICIDAL IDEATION

Question 71

The effects of caffeine on which of the following results in increased dopaminergic activity? (x2)

Answer 71

ADENOSINE RECEPTOR

Question 72

A pt with cancer, pain, depressed mood, poor appetite, fatigue, impaired concentration, prognosis is less than three weeks. What should you treat with?

Answer 72

METHYLPHENIDATE

Question 73

Contraindication for treatment for psychostimulants

Answer 73

UNDERLYING HEART DEFECT

Question 74

54 yo female takes prozac 60 mg for MDD, having worsening migraines then fever, diarrhea, and “muscles are tightening up”. Which medicine is causing these sx?

Answer 74

SUMATRIPTAN

Question 75

84 yo pt goes to ED with fever, dry mouth, visual hallucinations. Is found tachycardia, restless, toxicity of what medication most likely caused symptoms?

Answer 75

BENZTROPINE

Question 76

Prolonged ingestion of high doses pyridoxine causes:

Answer 76

SUBACUTE SENSORY NEUROPATHY

Question 77

Physostigmine is useful in treating toxic syndrome from overdose with:

Answer 77

SCOPOLAMINE

Question 78

Pt in ED for treatment of OD – was found 4 hrs ago after ingesting 10 cold med packs of 650mg Tylenol, antihistamine, and alpha 1 agonist decongestant. Pt is pale and vomiting. How do you decide whether to use N-acetylcysteine as an antidote?

Answer 78

PT’S SERUM N-ACETYL-P-AMINOPHENOL (APAP) LEVEL OVER TIME

Question 79

Tx of pts w/ substance abuse who have acute pain

Answer 79

PATIENT-CONTROLLED ANALGESIA

Question 80

Which of the following agents has been shown to moderate weight gain in some pts treated w/ valproate and atypical antipsychotic?

Answer 80

METFORMIN

Question 81

Pt took 20 tabs 500mg acetaminophen tabs 6 hours ago. Pt is 52kg, pulse 96, BP 135/65. Pt alert and in NAD. Serum acetaminophen level is 60 Ug/ml. Liver fxn test are minimally elevated. Most appropriate action?

Answer 81

N-ACETYL-CYSTEINE

Question 82

A post-op pt’s was receiving 75mg IM meperidine. After switching to meperidine 100mg po pt reports inadequate pain relief. She has no past psych and abuse issues. This is due to:

Answer 82

THE LOWER POTENCY OF PO MEPERIDINE COMPARED TO IM

Question 83

Acetylcysteine is Tx of choice for OD of:

Answer 83

ACETAMINOPHEN

Question 84

OD on sleeping pill. Hot skin, blurry vision, urinary retention, dry mucous membranes, tachycardia, decreased bowel sounds. What is the pill?

Answer 84

DIPHENHYDRAMINE

Question 85

Risk of hepatotoxicity will peak in how many hours after acetaminophen overdose?

Answer 85

72 TO 96 HOURS

Question 86

MC complication of corticosteroid therapy?

Answer 86

MOOD DISORDER

Question 87

Molecular targets for improving cognition in schizophrenia have shown promise via which of the following mechanisms?

Answer 87

D1 RECEPTOR AGONISM

Question 88

Which med is helpful in Tourette Syndrome who can’t tolerate clonidine?

Answer 88

GUANFACINE

Question 89

Guanfacine’s primary effect is through what mechanism of action?

Answer 89

PRESYNAPTIC ALPHA2 ADRENERGIC RECEPTOR ACTIVATION

Question 90

Key element in emergency treatment of pt w serotonin syndrome, beyond stopping offending agent is:

Answer 90

SUPPORTING VITAL FUNCTIONS

Question 91

Restlessness, myoclonus, hyperreflexia, diaphoresis, shivering, tremor, and confusion are compatible with which diagnosis?

Answer 91

SEROTONIN SYNDROME

Question 92

Research on the use of psychostimulants to treat pts w/ secondary depressive symptoms in medical setting suggest:

Answer 92

WHEN TREATED WITH THESE AGENTS, PT MAY ENGAGE IN REHABILITATION SOONER.

Question 93

A psychiatry consult is placed regarding a patient with SI. History of Bipolar disorder and admitted for VRE bacteremia. BP of 171/95, temp of 100.9. Has tremors, hyperreflexia, myoclonic jerks, not oriented at all, has visual hallucinations. Meds include linezolid, lithium, sertraline, Risperdal. What is diagnosis?

Answer 93

SEROTONIN SYNDROME

Question 94

What drug has been known to cause hypertensive crisis?

Answer 94

PHENELZINE

Question 95

African Americans tend to have higher activity of which of the following cytochrome p450 enzymes?

Answer 95

3A4

Question 96

Sudden death in children taking which medication?

Answer 96

TRICYCLICS

Question 97

47 yo pt presents with fever, confusion, and tremor and found to be tachy and diaphoretic. Clonus easily elicited on exam. Pt suspected to have serotonin syndrome, is taking Celexa and Lithium. What additional medication may have contributed to syndrome?

Answer 97

ST. JOHN’S WORT

Question 98

Autonomic instability, nonfocal neurological signs, and elevated temp associated with which elevated lab value?

Answer 98

CREATININE PHOSPHOKINASE (CPK)

Question 99

Drug-drug interactions in pts taking HIV meds are particularly problematic with which medication:

Answer 99

METHADONE

Question 100

In addition to benzos, which class of meds is assoc with falls in pts older than 60?

Answer 100

ANTIDEPRESSANTS

Question 101

The potency of medication refers to which of the following properties of a medication?

Answer 101

RELATIVE DOSE REQUIRED TO ACHIEVE A CERTAIN EFFECT

Question 102

60 yo pt with chronic schizophrenia takes cogentin for neuroleptic induced parkinson now has increased urine retention and confusion. What medication would be the best alternative for treating this patient’s condition?

Answer 102

AMANTADINE

Question 103

Most of the body’s serotonin is located where?

Answer 103

GI TRACT

Question 104

Common side effect of acetylcholinesterase inhibitors

Answer 104

DIARRHEA

Question 105

Diphenhydramine’s ability to treat acute dystonia is due to action on which receptor?

Answer 105

MUSCARINIC-1

Question 106

28 y/o with BMDII wants to use phototherapy for depressive Sx treatment in winter. What should you advise?

Answer 106

CAN BE USED BUT REQUIRES VIGILANCE AND CAREFUL TITRATION OF DOSE

Question 107

Which med is used to treat hep C viral infection and is associated with depression, anxiety, and cognitive impairment?

Answer 107

INTERFERON-ALPHA

Question 108

In pts who surreptitiously use excess sulfonylurea, which of the following substances can be administered to r/o possible insulinoma?

Answer 108

TOLBUTAMIDE

Question 109

Which of the following medications inhibits the enzyme ETOH acetaldehyde dehydrogenase?

Answer 109

DISULFIRAM

Question 110

Buprenorphine’s advantages over clonidine, in the management of patients with opioid withdrawal, include better control of which of the following symptoms?

Answer 110

CRAVINGS

Question 111

Therapeutic index is a relative measure of which of the following characteristics of a medication?

Answer 111

RELATIVE MEASURE OF DOSING TOXICITY TO SAFETY

Question 112

Pharmacokinetic factor that declines w/ aging?

Answer 112

GLOMERULAR FILTRATION RATE

Question 113

Patients >65 y/o are more sensitive to psych meds. What physiologic change occurs with aging?

Answer 113

DECREASED PHASE 1 OXIDATION

Question 114

Agitated pt gets rapid tranquilization in ED. Using oral concentrate instead of IM or IV has what advantage?

Answer 114

DECREASED FEELINGS OF HELPLESSNESS

Question 115

What herbal (phytomedicinal) is used as a hypnotic?

Answer 115

VALERIAN

Question 116

The FDA requires that pharmaceutical companies demonstrate that a generic drug is not significantly different from the parent compound in which way?

Answer 116

BIOEQUIVALENCE

Question 117

What is the underlying mechanism of action of sildenafil in erectile dysfunction?

Answer 117

ENHANCEMENT OF NITRIC OXIDE

Question 118

What substance is associated with a risk of bleeding when taken with anti-platelet drugs or warfarin?

Answer 118

GINGKO BILOBA

Question 119

Clonidine mechanism of action:

Answer 119

ALPHA-2 AGONIST

Question 120

42 y/o pt has primary insomnia. Pt complains of difficulty falling asleep, but then sleeps through the night. Which of the following would be the best medication to prescribe for this pt after addressing sleep issues:

Answer 120

ZALEPLON

Question 121

Combined use of Lithium and SSRI is known to increase the risk of which of the following conditions?

Answer 121

SEIZURES

Question 122

28 y/o pt wants to stop smoking with the help of a nicotine replacement product. Pt plans to have orthodontia within the next 2 months; has psoriasis; and has multiple environmental allergies that often cause nasal stuffiness, sore throats, and itchy, watery eyes. Nicotine replacement best?

Answer 122

NICOTINE LOZENGES

Question 123

Prepubertal children differ from adolescents and adults with regards to dosing of liver metabolized medication requiring?

Answer 123

HIGHER WEIGHT ADJUSTED DOSES OF MEDICATION

Question 124

Effective for OCD

Answer 124

PAROXETINE, PHENELZINE, FLUVOXAMINE, CLOMIPRAMINE (NOT BUPROPION)

Question 125

This is an effective pharmacologic treatment for symptoms of OCD?

Answer 125

CLOMIPRAMINE

Question 126

What pharmacokinetic property remains most stable with age

Answer 126

ABSORPTION

Question 127

Irreversible effect of chronic anabolic steroid use

Answer 127

HIRSUTISM

Question 128

What does current evidence show regarding psychiatrists using pharmacogenomics testing in clinical practice?

Answer 128

RESEARCH SHOWS PROMISE FOR CLINICAL UTILITY, BUT REPLICATED EVIDENCE ABOUT OUTCOMES IS LACKING

Question 129

Bipolar II patient w/ CDK, HTN, DMII, obesity has uncontrolled depressive episodes. Currently euthymic on mood stabilizer with significant SE. What med should be trialed: Lithium, Quetiapine, Olanzapine, Lamotrigine, Divalproex?

Answer 129

LAMOTRIGINE

Question 130

Medication caused syncopal episode with hyperthermia, headache, flushing, and tachycardia with hypotension requiring IV fluids in a patient who has a history of schizophrenia, GAD, and EtOH Use Disorder

Answer 130

DISULFIRAM

Question 131

9 year old with ADHD not responding to methylphenidate, next medication?

Answer 131

DEXTROAMPHETAMINE

Question 132

Methadone patient gets pregnant. Best recommendation?

Answer 132

CONTINUE METHADONE MAINTENANCE

Question 133

Marker of autonomic activity and biofeedback:

Answer 133

HEART RATE VARIABILITY

Question 134

What medication can lead to serotonin syndrome if combined with fluoxetine

Answer 134

LINEZOLID

Question 135

First line treatment for restless leg syndrome: Carbamazepine, Clonazepam, Pramipexole, Gabapentin, Imipramine.

Answer 135

PRAMIPREXOLE

Question 136

Which of the following ADHD meds has a black box warning for suicidal ideation in children and adolescents (Modafinil, Atomoxetine, Methylphenidate, Lisdexamfetamine, Dextroamphetamine)

Answer 136

ATOMOXETINE

Question 137

Which is an alpha-2 adrenergic agonist: atomoxetine, buspirone, modafinil, guanfacine, memantine

Answer 137

GUANFACINE

Question 138

Reason for IV atropine administration to patient prior to triggering the electrical stimulus during ECT

Answer 138

PREVENT BRADYCARDIA AND ASYSTOLE

Question 139

Clinically significant increase in lamotrigine concentration may occur if co-administered with: (8x)

Answer 139

VALPROIC ACID

Question 140

Teratogenic effect of both VPA and carbamazepine: (3x)

Answer 140

NEURAL TUBE DEFECTS

Question 141

Carbamazepine should be D/C’ed if the absolute neutrophil count is below: (2x)

Answer 141

3,000

Question 142

Pt w/ treatment-resistant mania and h/o rapid cycling is being treated w/ carbamazepine and thyroxine. After adding clozapine the pt is clinically stabilized. The pt’s most recent WBC is below 3,000. Intervention? (2x)

Answer 142

D/C CARBAMAZEPINE

Question 143

Which of the following anticonvulsants may be associated with kidney stones? (2x)

Answer 143

TOPIRAMATE

Question 144

Pt with treatment resistant, rapid cycling bipolar disorder who recently started lamotrigine develops a rash on the face. Pt admits to a mild sore throat and thinks he may have a fever. Which of the following is the best recommendation for the psychiatrist to make to the pt? (2x)

Answer 144

DISCONTINUE LAMOTRIGINE AND COME TO THE APPROPRIATE ER

Question 145

Which med decreases the efficacy of oral contraceptive? (2x)

Answer 145

OXCARBAZEPINE

Question 146

Drug prophylactic for treatment of migraines: (2x)

Answer 146

VALPROATE AND TOPIRAMATE

Question 147

Interaction between valproic acid and lamotrigine that causes severe derm reactions?

Answer 147

VALPROIC ACID INHIBITS GLUCONURONIDATION

Question 148

Associated with neural tube defect in first trimester of pregnancy:

Answer 148

VALPROATE

Question 149

Which of the following meds is associated with benign maculopapular rash in approximately 10-15% of pt’s within the first 3 weeks of treatment?

Answer 149

CARBAMAZEPINE

Question 150

After psychiatrist adds new med, pt turns bright red w/ sunburn like rash, similar to SJS. Which med caused this?

Answer 150

LAMOTRIGINE

Question 151

Inducer and substrate of CYP3a4 (ie may require dose increase after several weeks to maintain steady state)

Answer 151

CARBAMAZEPINE

Question 152

Lancinating face pain, triggered by minor sensory stimuli, best treated initially with:

Answer 152

CARBAMAZEPINE

Question 153

Which drug used in the treatment of patients with epilepsy is assoc w hyponatremia?

Answer 153

CARBAMAZEPINE

Question 154

Coarsening of facial features and hirsuitism are SE of what med?

Answer 154

VALPROATE

Question 155

Acute onset of hematuria and lumbago? Side effect of which anticonvulsant?

Answer 155

TOPIRAMATE

Question 156

Pt taking carbamazepine for BMD presents with weakness and pallor. The psychiatrist notes the presence of a non-blanching rash on the patient’s arms. The most immediate lab test to order is:

Answer 156

CBC

Question 157

Lamotrigine is effective treatment for what mood disorder?

Answer 157

BIPOLAR DEPRESSION

Question 158

Fetal exposure to valproate during pregnancy increases risk of:

Answer 158

NEURAL TUBE DEFECTS

Question 159

8 y/o Dx w/ Bipolar d/o is about to start valproic acid. What needs to be monitored frequently?

Answer 159

LIVER FUNCTION

Question 160

Which antibiotic may significantly raise carbamazepine levels and precipitate heart block?

Answer 160

ERYTHROMYCIN

Question 161

What justifies using Valproate more commonly that lithium for BMD in pts > age 65?

Answer 161

CHANGES IN RENAL CLEARANCE MAKES LITHIUM DOSING PROBLEMATIC

Question 162

Side effect more frequent in carbamazepine than lithium:

Answer 162

DIZZINESS

Question 163

Hair loss + weight gain are SE of which anticonvulsant:

Answer 163

DIVALPROEX SODIUM

Question 164

Which of the following baseline labs should be obtained for pt being treated with valproate?

Answer 164

LIVER FUNCTION TESTS

Question 165

What CBC value is most important to follow when on Depakote?

Answer 165

PLATELETS

Question 166

What is the most common reason pts discontinue valproate?

Answer 166

WEIGHT GAIN

Question 167

Adequate as a monotherapy for juvenile myoclonic epilepsy:

Answer 167

VALPROATE

Question 168

Adequate for monotherapy generalized tonic clonic szs:

Answer 168

VALPROATE

Question 169

Of these meds (topiramate, lamotrigine, valproic acid, levetiracetam, Oxcarbazepine), which is most likely to be free of any significant interaction with other antiepileptic medications?

Answer 169

LEVETIRACETAM

Question 170

Valproate’s epigenetic modifying properties due to effect on ___?

Answer 170

HISTONE DE-ACETYLASE

Question 171

Treatment of choice for lithium intoxication who manifests impaired consciousness, neuromuscular irritability, and seizures is (10x)

Answer 171

HEMODIALYSIS

Question 172

Which med is thought to have a protective effect independent of its mood- stabilizing effect against suicide risk in pts w mood disorder? (4x)

Answer 172

LITHIUM

Question 173

Psoriasis exacerbated by: (3x)

Answer 173

LITHIUM

Question 174

32 y/o F pt w/ BMD has been treated with lithium. Pt reveals to her psychiatrist that she is now pregnant. Attempts to dc lithium in the past have led to relapses of the pt’s disorder, with severe associated morbidity. A trial of an antipsychotic in the past resulted in NMS, and pt has since refused to use them. Which of the following would be the best option for treatment during the pregnancy? (3x)

Answer 174

CONTINUE LITHIUM

Question 175

A pt who was previously stable on Lithium presents with symptoms of toxicity after their PMD starts them on a HTN medicine. Which of the following is the is the most likely mechanism of interaction between the lithium and the HTN medication (X3)?

Answer 175

REDUCED RENAL CLEARANCE

Question 176

What lab test should be conducted prior to initiation of lithium tx (x3)?

Answer 176

TSH

Question 177

A 32 yo F comes to the ED with CC of 2 weeks of diarrhea. On exam she is anxious and tremulous and is not oriented to date or time of the day. She states she is taking “some drug” for Bipolar disorder and adds that she started doubling her dose a month ago because she “wasn’t getting better fast enough.” She denies use of drugs/ETOH. Which medication would most likely cause the symptoms described? (x2)

Answer 177

LITHIUM

Question 178

62 y/o F w bipolar d/o develops altered mental status, dysarthria, ataxia in hosp after meds are added in hospital to her lithium. What medication could cause this? (2x)

Answer 178

INDOMETHACIN COMPETES WITH LITHIUM FOR EXCRETION AND CAUSES LITHIUM TOXICITY SYMPTOMS

Question 179

Lithium exposure in first trimester of pregnancy increases risk of congenital abnormalities in which organ? (2x)

Answer 179

HEART

Question 180

Lithium can be removed via hemodialysis because? (2x)

Answer 180

HAS NO METABOLITES

Question 181

Stable, steady state Lithium levels are generally obtained within: (2x)

Answer 181

4-5 DAYS

Question 182

Which of the following factors is a predictor of a poor response to lithium? (2x)

Answer 182

RAPID CYCLING

Question 183

What factor is thought to predict a poor response to lithium treatment for pts with bipolar disorder? (2x)

Answer 183

MIXED MANIC/DEPRESSED EPISODE

Question 184

Giving charcoal is an ineffective treatment for pt who OD’d on (x2):

Answer 184

LITHIUM

Question 185

Which of the following medications was first used as a treatment for gout and later promoted by john cade for treatment of unstable mood? (X2)

Answer 185

LITHIUM

Question 186

What can decrease Li levels

Answer 186

CAFFEINE

Question 187

Li induced polyuria tx with least effect on Li level?

Answer 187

AMILORIDE

Question 188

Bipolar pt on lithium and Zoloft for 3 yrs. Level 0.8. More depressed and fatigued, low energy level. Increasing Zoloft ineffective. Next step:

Answer 188

OBTAIN TSH LEVEL

Question 189

This cardiovascular disturbance is most common for Lithium:

Answer 189

BENIGN T WAVE CHANGES.

Question 190

Medication most likely to cause cognitive side effects, even seizures, if taken at same time as ECT?

Answer 190

LITHIUM

Question 191

A psychotropic with same pharmacokinetic properties in Asian Americans and White Americans

Answer 191

LITHIUM

Question 192

Lithium serum levels should be monitored by evaluating:

Answer 192

TROUGH LEVELS 12 HOURS AFTER LAST DOSE

Question 193

Which med can decreased serum concentration of lithium

Answer 193

AMINOPHYLLINE

Question 194

BMD Tx with Li x 2 years develops rapid cycling. What lab test should be done?

Answer 194

THYROID FUNCTION TESTS

Question 195

SE of toxic serum lithium levels

Answer 195

ST DEPRESSION, QTC PROLONGATION, ATAXIA, TREMOR, DYSARTHRIA, NEPHROTOXIC SX, STATUS EPILEPTICUS

Question 196

24 y/o F in 2nd trimester now manic w/ no psychotic fx’s. Hx of 1 episode of mania, diagnosed bipolar I. D/C lithium when she decided to have kids. Willing to begin Tx.

Answer 196

RESTART LITHIUM

Question 197

The most common cause of severe polyuria with lithium is:

Answer 197

NEPHROGENIC DIABETES INSIPIDUS

Question 198

While taking lithium patients should:

Answer 198

MAINTAIN SODIUM INTAKE

Question 199

A CNS structure that is likely to suffer permanent damage following lithium toxicity:

Answer 199

CEREBELLUM

Question 200

Interferes w/ clearance of lithium

Answer 200

IBUPROFEN

Question 201

Cardiac effects of lithium resemble what on EKG

Answer 201

HYPOKALEMIA (LOW T WAVES)

Question 202

Predictor of positive response to lithium prophylaxis:

Answer 202

HISTORY OF GOOD INTER-EPISODE FUNCTION

Question 203

In patients on lithium, what type of thyroid dysfunction can occur?

Answer 203

HIGH PREVALENCE OF THE PRODUCTION OF THYROID AUTOANTIBODIES

Question 204

Intake of this increases lithium levels

Answer 204

FLUOXETINE

Question 205

Which of the following laboratory tests is essential prior to prescribing lithium?

Answer 205

BUN AND CREATININE

Question 206

55 y/o pt with guilt, anhedonia, insomnia, and sad mood has been treated for 10 wks with fluoxetine 60mg qam. His mood and appetite have improved, though he still has difficulties with concentration, hopelessness, and tearfulness. He denies a h/o manic or psychotic symptoms. The medication most likely to augment the antidepressant effect of his current regimen would be:

Answer 206

LITHIUM

Question 207

Pt on lithium and paxil. Lithium is ineffective despite a therapeutic level. What do you do?

Answer 207

DISCONTINUE PAXIL

Question 208

Which nervous system structure is likely to suffer permanent damage from lithium OD?

Answer 208

CEREBELLUM

Question 209

Lithium can raise what serum electrolyte?

Answer 209

CALCIUM

Question 210

Tx of acute mania w/ lithium. What is the best adjunctive agent?

Answer 210

ECT

Question 211

Characteristic that makes lithium readily dialyzable:

Answer 211

LOW MOLECULAR WEIGHT

Question 212

When used at a therapeutic dose during pregnancy, the dose of which medicine should be reduced in the postpartum period to minimize ASE’s? Lithium, Lamotrigine, Carbamazepine, Topiramate, Valproate

Answer 212

LITHIUM

Question 213

What is a pharmacological effect of lithium?

Answer 213

GLYCOGEN SYNTHASE KINASE-3 INHIBITION

Question 214

Most likely to be enhanced by the strategies of putting the pt at ease, finding the pt’s pain and expressing compassion, evaluation pt’s insight, and showing expertise: (5x)

Answer 214

RAPPORT

Question 215

The factor most consistently associated with therapy outcome in psychotherapy research: (3x)

Answer 215

STRENGTH OF THERAPEUTIC ALLIANCE

Question 216

A set of feelings that a patient reenacts in the therapeutic relationship are called: (x2)

Answer 216

TRANSFERENCE

Question 217

Business executive hospitalized for bleeding ulcer repeatedly argues with a well-liked head nurse and threatens to leave AMA. Best action for C&L psychiatrist is: (2x)

Answer 217

LISTEN TO PT’S COMPLAINTS ACKNOWLEDGE HIS DISCOMFORT WITH THE PASSIVE POSITION THAT HE IS UNACCUSTOMED TO

Question 218

Common theme in psychotherapy in the elderly: (2x)

Answer 218

LOSS

Question 219

As opposed to long-term psychotherapy, time-limited therapy more likely to: (2x)

Answer 219

SELECT CENTRAL ISSUE AS FOCUS

Question 220

For the treatment of pts with compulsive sexual behavior, the best results have been seen with which of the following approaches? (2x)

Answer 220

TWELVE STEP GROUPS

Question 221

Two most powerful predictors of outcome in any form of psychotherapy are: (2x)

Answer 221

EMPATHY AND THERAPEUTIC ALLIANCE

Question 222

The best response to a pt who reports a fixed false belief that his neighbor is poisoning his dog and sitting all day at the window monitoring is: (2x)

Answer 222

EMPATHIZE WITH THE PT, BUT AVOID DIRECT CONFRONTATION ABOUT THE DELUSION

Question 223

Psychotherapy where pts realistically evaluate their interactions w others & therapist offers direct advice/helps pts make decisions/ignores transference issues. (2x)

Answer 223

INTERPERSONAL PSYCHOTHERAPY (IPT)

Question 224

Most likely represents an acceptable boundary crossing by a therapist as opposed to a boundary violation: (2x)

Answer 224

RECEIVING COOKIES AS AN EXPRESSION OF GRATITUDE BY A PT NEAR TERMINATION.

Question 225

Therapeutic empathy is best described as the therapist’s ability to: (2x)

Answer 225

GRASP PT’S INNER EXPERIENCE FROM PT’S PERSPECTIVE

Question 226

Motivational interviewing often used as part of the treatment of which conditions? (2x)

Answer 226

SUBSTANCE ABUSE

Question 227

Therapeutic technique where therapist instructs the patient to hold onto a symptom: (2x)

Answer 227

PARADOXICAL INTERVENTION

Question 228

Without evident distress, pt calmly reports to the psychiatrist, “Since I was last here, my significant other dumped me.” The doctor responds by pointing out the discrepancy between the pt’s affect and the content described. This response is an example of: (2x)

Answer 228

CONFRONTATION

Question 229

Psych resident dislikes alcoholic pts and avoids working with them. In discussing the problem, says that pts are hopeless and unmotivated and she can’t empathize with them. Example of? (2x)

Answer 229

COUNTERTRANSFERENCE

Question 230

Catharsis is: (2x)

Answer 230

VERBAL EXPRESSION OF SURPRESSED TRAUMATIC EXPERIENCES AND FEELINGS

Question 231

barrier to widespread use of telepsychiatry

Answer 231

PHYSICIAN DISSATISFACTION

Question 232

Example of behavioral analysis strategy

Answer 232

“AT WHAT POINT DURING THE DAY DID YOU FIRST NOTICE YOU WERE THINKING ABOUT CUTTING

Question 233

Pt BIB police to ED with disorganized behavior. Pt askes “are you a real psychiatrist?” Best response?

Answer 233

I’M A RESIDENT WHICH MEANS I AM A PHYSICIAN WHO IS RECEIVING SPECIALTY TRAINING IN PSYCHIATRY.

Question 234

Recent meta- analyses have suggested what with regard to the use of psychotherapy to treat depression?

Answer 234

OTHER PSYCHOTHERAPIES HAVE EFFICACY COMPARABLE TO CBT

Question 235

Psychiatrist’s mind wanders during sessions, what should the psychiatrist do?

Answer 235

EXAMINE INNER THOUGHTS AND FEELINGS

Question 236

What theory is the basis of mentalization-based therapy?

Answer 236

BOWLBY’S ATTACHMENT THEORY

Question 237

During initial psych interview, pt tearfully discusses painful ending of romantic relationship. What should Dr. say to establish therapeutic alliance?

Answer 237

IT SOUNDS LIKE THIS HAS BEEN VERY DIFFICULT FOR YOU.
HOW ARE YOU COPING?

Question 238

Psychiatrist behavior of raising eyebrows, leaning towards pt, saying “Uh-huh”

Answer 238

FACILITATION

Question 239

Redirecting discussion by talking about irrelevant stuff

Answer 239

RESISTANCE

Question 240

During a clinical interview, the physician recapitulates what the pt has said so far and says to pt “I just want to make sure that I’ve got everything right up to this point”. This is an example of:

Answer 240

SUMMATION

Question 241

When psychiatrist asks about mania, pt responds, “that sounds exactly like my cousin,” and proceeds to tell long story about cousin but doesn’t answer the psychiatrist’s request. This is an example of:

Answer 241

TANGENTIALITY

Question 242

In initial psych interview, pt frustrated that his last psychiatrist had brief visits & “just gave me another pill every time.” Interviewing psychiatrist responds “so you would like your psychiatrist to listen & understand you before adjusting your meds.”

Answer 242

CLARIFICATION

Question 243

Pt who had difficult childhood calls therapist mother’s name and quickly corrects error. What is this an example of?

Answer 243

PARAPRAXIS

Question 244

Pt w/ BMD who has been making progress in long-term psychodynamic psychotherapy enters session obviously distraught. After listening to scattered seemingly unimportant details of recent daily life, therapist asks if pt is avoiding something too uncomfortable to talk about. Pt responds w intense anger/distress. “I just heard you are getting a divorce, I am sick about it. Here I am counting on you to help me sort out my chaotic life and messed-up relationships, and you can’t even keep your own marriage together! What are you, some kind of hypocrite? I think I should leave and find someone who knows what they’re doing!” Best response for the therapist to make?

Answer 244

“I AM GOING TO NEED A MOMENT TO THINK ABOUT WHAT YOU’VE SAID AND ARE FEELING BEFORE I CAN RESPOND.”

Question 245

8yr old evaluated for asthma, found to have ADHD symptoms, put on stimulant, behavioral problems continue, sent to psychiatrist and psychologist, this is an example of what level of collaborative care?

Answer 245

SHARED (INTEGRATED) CARE

Question 246

17 y/o receiving counseling for school truancy. Student understand truancy is not a desirable behavior and is discusses ways to improve school attendance. What stage of change is student in?

Answer 246

PREPARATION

Question 247

College student in therapy, the Dean calls therapist requesting info about the student’s therapy due to recent reports from a dorm supervisor. Therapist should:

Answer 247

REFUSE THE DEAN’S REQUEST FOR INFORMATION

Question 248

An important counter-transference issue in an interethnic psychotherapeutic relationship is:

Answer 248

DENIAL OF DIFFERENCES

Question 249

An important counter-transference issue in an interethnic psychotherapeutic relationship is:

Answer 249

DENIAL OF DIFFERENCES

Question 250

Abstinence compliance increases with random UDS. This is ex of:

Answer 250

PARTIAL REINFORCEMENT

Question 251

A new pt asks therapist, “are you Christian?” What is best response?

Answer 251

“ARE YOU CONCERNED THAT IF WE ARE NOT OF THE SAME RELIGION, I WON’T BE ABLE TO TREAT YOU PROPERLY?’

Question 252

Exchange during initial interview after pt’s former therapist closed his practice: pt expresses concern about new therapist being too young/inexperienced, states she doubts new therapist can provide any new insights. Best response to further goal of getting to know pt, establish whether therapy w new therapist would be appropriate

Answer 252

“IT CAN BE VERY HARD TO START OVER WITH A NEW THERAPIST. HOW HAVE YOU BEEN FEELING ABOUT HAVING TO END YOUR TREATMENT WITH DR. BROWN?”

Question 253

A patient repeatedly becomes distressed after what seems, even to the pt, to be minor disappointments. The patient also seems to suffer from extreme narcissistic vulnerability. A therapist utilizing self-psychology would be most likely to interpret this due to which of the following factors?

Answer 253

A LACK OF DEVELOPMENTALLY APPROPRIATE EMPATHY FROM CAREGIVERS

Question 254

Treating a much older pt who asks about therapist’s age. Best response:

Answer 254

“MAYBE YOU’RE CONCERNED ABOUT WHETHER I AM EXPERIENCED ENOUGH TO TREAT YOU?”

Question 255

Pt seeing new psychotherapist weekly x3 wks hesitantly complained about being able to overhear much of what pt in the preceding session was saying. Pt assured therapist that he had tried not to listen and had left the waiting room to wait outside until the other pt had left. Which is best response?

Answer 255

APOLOGIZE FOR THE LACK OF PRIVACY AND INDICATE THAT FURTHER MEASURES, SUCH AS MUSIC SYSTEM IN THE WAITING ROOM, WILL BE UTILIZED

Question 256

MD sees psychiatrist w increasing sense of dislike for a blaming, externalizing pt who pits family members against the MD. What should psychiatrist discuss w MD?

Answer 256

COUNTERTRANSFERENCE

Question 257

A pt with h/o lifelong depression & failed relationships complains (very angry) (after several weeks of therapy) that she is expected to trust the Dr. without even knowing anything about him (credentials or personally) what should the Dr say?

Answer 257

EMPATHIZE WITH THE PT’S FEARS OF TRUST AND FEELING OF BEING AT A DISADVANTAGE

Question 258

Psychotherapy technique for children with Tourette’s syndrome.

Answer 258

HABIT REVERSAL

Question 259

62 y/o with lung cancer, weight loss, fatigue, and persistent cough. Pat refuses to accept Dx of cancer and states will “get over this infection.” Pt refuses all further testing and asks for antibiotics to “recover in peace.” C&L psychiatrist’s role is:

Answer 259

EVALUATE PT’S COPING STYLE AND HELP THE MEDICAL TEAM SEE THE PT’S RESPONSES IN THE CONTEXT OF HER UNIQUE PERSONALITY AND LIFE CIRCUMSTANCES

Question 260

Young female starting cognitive therapy with a female resident asks for a hug. Resident should first:

Answer 260

EXPLAIN WHY PHYSICAL CONTACT IS AVOIDED

Question 261

C&L psychiatrist uses all therapeutic approaches except:

Answer 261

EXPLORATORY PSYCHODYNAMIC

Question 262

Psychiatrist is treating an older pt who is a successful executive. Pt feels grateful for the help w/ his depression and offers some tips on investing to the psychiatrist. What is the most appropriate action at this point from the psychiatrist?

Answer 262

EXPLORE PT’S MEANINGS AND FEELINGS ABOUT THE OFFER

Question 263

Female psych resident says pt saw resident in town over weekend. Followed her around. Thought she could later shop at same stores and eat at same restaurants as her greatly admired therapist. Nothing wrong in pt’s bx or material suggesting she is dangerous. Pt apologizes convincingly, says will not do again. Hopes therapist will not fire her. What is next best step?

Answer 263

INTERPRET PT’S LONGING TO IDENTIFY W THE PSYCHIATRIST

Question 264

What if pt asks whether you’re still in training during intake interview?

Answer 264

INFORM THE LEVEL OF TRAINING

Question 265

Midway through psychotherapy session, a psychiatrist’s mind wanders despite repeated refocus. Best immediate action:

Answer 265

EXAMINE OWN INNER FEELINGS ABOUT THE PATIENT

Question 266

Pt sees therapist and makes threats and becomes agitated. Therapist feels uneasy, the next step is to:

Answer 266

INTERRUPT INTERVIEW TO GET HELP

Question 267

Young pt in therapy returns to school, announces to therapist that he can pass classes, will graduate. Best response:

Answer 267

OFFERING CONGRATULATIONS

Question 268

Beginning therapist feels great empathy for depressed pt fails to maintain sufficient distance to observe self-destructive patterns. To avoid this pay attention to:

Answer 268

OVERIDENTIFICATION WITH PATIENT

Question 269

Social skills training for those with persistent mental illness is an essential part of:

Answer 269

PSYCHIATRIC REHABILITATION

Question 270

Therapist is working w family of schizophrenic. Strategies include informing about illness, social support, management guidelines. Therapist encourages calm problem solving approach/facilitates stress and stigma reduction when possible. Which model is therapist using?

Answer 270

PSYCHOEDUCATIONAL

Question 271

Biofeedback usually helps pts with which medical syndrome?

Answer 271

RAYNAUD’S SYNDROME

Question 272

What interventions are consistent w the theoretical assumptions of crisis Tx?

Answer 272

REASSURANCE, BRIEF HOSPITALIZATION, PSYCHODYNAMIC INSIGHT, TREATMENT WITH PSYCHOTROPIC MEDICATIONS (NOT FOCUSING ON PAST RELATIONSHIPS)

Question 273

During last session of successful psychodynamic psychotherapy, pt warmly expresses gratitude for everything, saying that the help the therapist has given has made a big difference. Appropriate response?

Answer 273

RESPOND BY SAYING YOU TOO HAVE ENJOYED THE WORK

Question 274

What is an example of a boundary violation?

Answer 274

INVESTING IN A PT’S BUSINESS

Question 275

After attending several sessions of individual psychotherapy for anxiety and depression, 24 y/o M revealed his homosexuality to his heterosexual male psychiatrist. Therapist realizes he is uncomfortable when pt expresses longings for a male. Therapist also tends to overemphasize any material that might represent pt’s heterosexual wishes. The next best step for the psychiatrist would be to:

Answer 275

SEEK CONSULTATION TO DISCUSS COUNTERTRANSFERENCE ISSUES

Question 276

Pt w/ mild MR in program designed to develop new behaviors by modeling/reinforcement, then practice them.

Answer 276

SOCIAL SKILLS TRAINING

Question 277

Therapist preoccupied w/ patient. Acknowledges this but unable to shake feeling

Answer 277

TALK TO SUPERVISOR

Question 278

15 y/o male bib parents, does not want to speak with psych

Answer 278

THANK HIM FOR COMING IN AND ASK HIM IF HE’D LIKE TO BE SEEN ALONE OR WITH HIS PARENTS

Question 279

What was most important factor in determining tx outcomes in National Institute of Mental Health Treatment of Depression Collaborative Research Program (1996)?

Answer 279

THERAPEUTIC ALLIANCE

Question 280

While assessing for DV, examiner says to pt/spouse, “The tension that builds up between you must be incredibly stressful. It’s not unusual that people who are stressed out can have trouble controlling themselves or can do things they didn’t intend, like screaming at or even hitting their partner. Has anything like that happened to you?” Which technique is this?

Answer 280

NORMALIZATION

Question 281

Pt repeatedly redirecting discussion by talking about irrelevant topics is example of:

Answer 281

RESISTANCE

Question 282

Core principle of motivational interviewing that is used to treat addictive behaviors:

Answer 282

DEVELOP DISCREPANCY

Question 283

Individual psychotherapy for alcoholics most effective when it focuses on:

Answer 283

INTERACTIONS WITH PEOPLE

Question 284

Programmed practice, or exposure therapy, is an indicated treatment for what disorder?

Answer 284

AGORAPHOBIA

Question 285

Pt with multiple social fears is terrified of public speaking. As the next step in treatment, the therapist arranges for the pt to give 15 minutes talk to clinical staff. This is an example of:

Answer 285

FLOODING

Question 286

Exposure and flooding together with response prevention are techniques of behavioral therapy aimed at which of the following?

Answer 286

HASTENING THE EXTINCTION OF A CONDITIONED FEAR OR ANXIETY RESPONSE

Question 287

Elements common to both CBT and eye movement desensitization and reprocessing in the treatment of patients with PTSD include:

Answer 287

CONTROLLED EXPOSURE TO TRAUMA RELATED TRIGGERS

Question 288

Pt w fear of heights. Pt instructed to visualize crossing a bridge. What is the therapeutic technique?

Answer 288

IMAGINAL EXPOSURE

Question 289

Meta-analysis suggests which of the following for psychotherapy to treat depression?

Answer 289

OTHER PSYCHOTHERAPIES HAVE EFFICACY COMPARABLE TO CBT

Question 290

During an initial office evaluation, the pt tells the psychiatrist, “my spouse told me I had to be evaluated.” Which of the following would be the most empathic response?

Answer 290

“HOW DO YOU FEEL ABOUT THAT?”

Question 291

The concept of the identified patient in therapy refers to:

Answer 291

ONE FAMILY MEMBER WHO HAS BEEN LABELED THE PROBLEM BY THE FAMILY

Question 292

Psychosocial therapy that has shown efficacy in some studies in improver cancer survival rates:

Answer 292

GROUP THERAPY WITH OTHER CANCER PATIENTS

Question 293

Comprehensively researched therapy for mood d/o’s

Answer 293

INTERPERSONAL PSYCHOTHERAPY

Question 294

Therapeutic focus on the on pt’s current social functioning is most characteristic of:

Answer 294

INTERPERSONAL PSYCHOTHERAPY

Question 295

26 y/o pt with depressed mood and dissatisfaction with life, feeling isolated and having few friends who is not under undue stress and historically copes well with personal problems would benefit from what type of psychotherapy?

Answer 295

INTERPERSONAL THERAPY

Question 296

Which psychotherapy would therapist be inclined to gratify pts’ dependency needs?

Answer 296

SUPPORTIVE

Question 297

Pt enters psychotherapy because of problems in his relationship with his wife. During the sessions, pt talks about his family of origin, his boss, and his problems at work, but never discusses details about his wife. This is an example of which of the following?

Answer 297

RESISTANCE

Question 298

Principle of confrontation:

Answer 298

“I THINK YOU’D RATHER TALK ABOUT YOUR JOB THAN FACE THE SADNESS YOU FELT IN OUR LAST SESSION”

Question 299

Example of empathic comment

Answer 299

“YOU MUST FEEL TERRIBLE RIGHT NOW.”

Question 300

Recovering addict in relapse prevention therapy, and has many risk factors. Rather than developing a coping strategy for each risk factor, do what?

Answer 300

FOCUS ON SKILL TRAINING, COGNITIVE REFRAMING, AND LIFESTYLE INTERVENTIONS