Psychopharm
Which of the following agents has the greatest propensity for inducing tardive dyskinesia (TD)?
A. Aripiprazole
B. Clozapine
C. Haloperidol
D. Olanzapine
E. Ziprasidone
C. Haloperidol
- The risk for developing TD with conventional agents is about 5% per year of exposure, with a lifetime risk possibly as high as 50% to 60%.
- Risperidone and olanzapine have been associated with substantially lower rates of TD compared with conventional agents
- CATIE study failed to detect a difference in TD rates between perphenazine and atypical agents.
What is the most likely DSM-5 diagnosis for a child presenting with persistent, chronic irritability and frequent episodes of extreme behavioral outbursts?
A. Pediatric bipolar disorder
B. Disruptive mood dysregulation disorder
C. Oppositional defiant disorder
D. Attention-deficit/hyperactivity disorder
E. Major depressive disorder
B. Disruptive mood dysregulation disorder
- Disorder with acute temperamental outbursts on a background of chronic irritability.
- In contrast, pediatric bipolar disorder is characterized by discrete episodic periods of mood disturbance with euphoria, grandiosity, racing thoughts, and lack of need for sleep in a sustained energized state.
- Dx cannot co-exist with ODD, IED or Bipolar
Which of the following disorders has the least evidence supporting the use of ECT?
A. Catatonia associated with an underlying medical condition.
B. Depression in bipolar disorder.
C. Parkinson’s disease.
D. Negative symptoms of schizophrenia.
E. Nonmelancholic symptoms of depression.
D. Negative symptoms of schizophrenia.
In exposure with response prevention, immediately following an exposure, which response is being prevented?
A. Anxiety
B. Compulsive behaviors
C. Anxious thoughts
D. Healthy coping behaviors
E. Anger
B. Compulsive behaviors
To receive a DSM-5 diagnosis of cyclothymic disorder, an adult patient must have experienced which of the following?
A. Chronic subsyndromal symptoms of mood elevation and depression for at least 1 year.
B. Chronic subsyndromal symptoms of mood elevation and depression for at least 6 months.
C. Chronic subsyndromal symptoms of mood elevation and depression for at least 2 years.
D. At least one manic episode interposed with subsyndromal symptoms of mood elevation and depression.
E. At least one depressive episode and at least one manic episode interposed with subsyndromal symptoms of mood elevation and depression.
C. Chronic subsyndromal symptoms of mood elevation and depression for at least 2 years.
A 16-year-old male suffers from irritable mood, increased energy, decreased need for sleep, and pressured speech. He was recently started on medication by his psychiatrist to control these symptoms. He comes into your office complaining of a significant worsening of his acne since starting this new medication. What drug was he started on?
A. Oxcarbazepine
B. Lorazepam
C. Risperidone
D. Lithium
E. Lamotrigine
D. Lithium
Dermatological side effects = acne, follicular, and maculopapular eruptions. Psoriasis flare ups - Neutrophilic infiltration
Oxcarbamazepine, Lamotrigine = DRESS, SJS
Which of the following conditions is the most common inherited cause of intellectual disability? DAILY DOUBLE
A. Fetal alcohol syndrome
B. Fragile X syndrome
C. Lesch-Nyhan syndrome
D. Prader-Willi syndrome
E. Down syndrome
B. Fragile X syndrome
Which is the most common acquired cause of intellectual disability? Fetal alcohol syndrome
Most common chromosomal cause: Down Syndrome
Which of the following is a true statement about relapse after symptom remission in response to ECT?
A. Most patients who experience symptom remission in response to ECT will relapse after 6 months.
B. Remission is typically maintained for at least 12 months.
C. Medication does not affect the relapse rate after symptom remission with ECT.
D. A robust body of evidence shows that maintenance ECT prevents relapse.
A. Most patients who experience symptom remission in response to ECT will relapse after 6 months.
During CBT, a patient states that "I was arguing with my daughter last night, and she went to her room and slammed the door. Everybody hates me, and I'm a terrible parent." Which cognitive distortion is she displaying?
A. Selective Abstraction
B. Arbitrary inference
C. Overgeneralization
D. Magnification
E. Dichotomous thinking
C. Overgeneralization: making sweeping conclusions based on one single event. "The relationship did not work. No relationship will ever work".
- Selective abstraction: drawing conclusions based on just one of many elements in a situation. The dancer who thinks entire performance was ruined based on one missed step.
- Arbitrary inference: "jumping to conclusions". drawing conclusions where there is little to no evidence. i.e. wanting to talk to someone after class, saw they rushed out of the room, you conclude they must dislike you/trying to avoid you.
- Magnification: "making a mountain out of a molehill". Synonymous with catastrophizing.
- Dichotomous thinking/"all or nothing": using polarized terms such as: 'perfect' or 'failure', 'always' or 'never'. Liking and disliking things with extreme intensity. For example, “I'm lovely / I'm hateful”, “this is the Best / Worst”.
Which of the following is characteristic of major depression with atypical features?
A. Insensitivity to rejection
B. Weight gain
C. Decreased appetite
D. Low mood reactivity
E. Flaccid paralysis
B. Weight gain
Increased appetite
Marked mood reactivity
Leaden paralysis
Interpersonal reaction sensitivity
More common in women, earlier age, more chronic, lower chance of inter-episodic recovery
Which of the following statements about treating chronic pain with pharmacological agents is correct?
A. NSAIDs and Lithium have no major interactions and can be used together
B. TCAs analgesic effects occur at higher doses than those used for depression
C. TCA serum levels can help establish dosage of medication
D. TCA levels can only be reliably followed for desipramine and imipramine
C.TCA serum levels can help establish dosage of medication
- NSAIDs + Lithium = reduce renal excretion -> Lithium toxicity
- TCAs have analgesic effects at lower doses than those used for depression
- TCA levels reliably followed for desipramine, imipramine, and nortriptyline
A 4 year old girl, adopted age 6 months, presents to the clinic due to concerns of interacting with unfamiliar adults in an overly trusting way and never checking back with her mom after venturing away. She most likely has:
A. Reactive Attachment Disorder
B. PTSD
C. Disinhibited Social Engagement Disorder
D. Normal Behavior
C. Disinhibited Social Engagement Disorder
Child actively approaches and interacts with unfamiliar adults in at least 2 of the following:
- Reduced or absent reticence
- Overly familial in overly familial way
- Diminished or absent checking back
- Willingness to go off with unfamiliar adult
Reactive Attachment Disorder: Consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers
- Child rarely/minimally seeks comfort when distressed AND rarely/minimally responds to it
- Persistent social and emotional disturbance in form of limited positive affect and episodes of unexplained irritability, sadness, fearfulness
Which of the following statements best describes the relationship between TMS and seizures?
A. The site of stimulation is not significant in terms of the risk of a seizure.
B. Concurrent use of medications plays no role in seizure risk.
C. TMS intensity and frequency have no impact on the risk of a seizure.
D. The estimated risk of a seizure in ordinary clinical use is approximately 10%.
E. All TMS seizures have occurred during stimulation rather than later
E. All TMS seizures have occurred during stimulation rather than later
- Increased risk for stimulation near motor cortex
- Medications that reduce seizure threshold will increase seizure risk
- high intensity and high frequency = higher risk of seizure
- Estimated risk of seizure under ordinary clinical use is approximately 1 in 30,000 treatments (0.003% of treatments) or 1 in 1,000 patients (0.1% of patients)
An explanatory statement that links a feeling to its unconscious meaning is known as:
A. Confrontation
B. Clarification
C. Interpretation
D. Empathic validation
E. Affirmation
C. Interpretation
- Confrontation: addressing something the patient does not want to accept.
- Clarification: reformulating what the patient has said to create a coherent view of what has been communicated.
- Empathic validation: demonstration of the therapist's empathic understanding of the patient's internal state.
- Affirmation: giving succinct comments in support of the patient's statements or feelings.
Which of the following anxiety disorders has the youngest median age at onset?
A. Separation anxiety disorder
B. Panic disorder
C. Agoraphobia
D. Social anxiety disorder
E. Generalized anxiety disorder
D. Social anxiety disorder = 15 YO
Separation anxiety disorder = 16 YO
Panic disorder = 23 YO
Agoraphobia = 18 YO
GAD = 30 YO
Concomitant use of which of the following medications might be responsible for an increase in plasma clozapine levels in an adherent patient?DAILY DOUBLE
A. Carbamazepine
B. Clonazepam
C. Fluvoxamine
D. Propranolol
E. Temazepam
C. Fluvoxamine
Through what mechanism does it increase Clozapine levels? Fluvoxamine inhibits CYP450 enzymes that metabolize clozapine (CYP1A2), thus increasing clozapine levels
- Carbamazepine is a CYP450 cytochrome inducer, thus would decrease clozapine levels
- Benzodiazepines, except lorazepam, oxazepam, and temazepam, are substrates at CYP3A4
- β-Blockers are substrates of CYP2D6
An 8-year-old boy with a 6-month history of excessive eye blinking and intermittent chirping, but now the mother has noticed the development of grunting sounds since starting school this term. What is the most likely DSM-5 diagnosis?
A. Tourette’s disorder
B. Provisional tic disorder
C. Temporary tic disorder
D. Persistent vocal tic disorder
E. Transient tic disorder, recurrent
B. Provisional tic disorder
A tic is a sudden, rapid, recurrent, nonrhythmic motor movement or vocalization.
- Tourette's Disorder: Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently. For greater than a year
- Persistent (Chronic) Vocal Tic Disorder: Single or multiple motor vocal tics have been present during the illness. Without motor tics. Present for greater than a year.
- Provisional Tic disorder: Single or multiple motor and/or vocal tics. Present for less than a year
In a _______ patient receiving ECT, prolonged paralysis and associated apnea induced by ______ may occur.
A.Hyperkalemic; succinylcholine
B.Hypokalemic; succinylcholine
C.Hyperkalemic; rocuronium
D.Hyponatremic; succinylcholine
E.Hypercalcemic; rocuronium
A. Hyperkalemic; succinylcholine
Hyperkalemia is a concern in patients receiving ECT, because of the risk of cardiac arrhythmia and because of the transient rise in serum potassium caused by succinylcholine and the muscle activity that may occur during the induced seizures
In individuals with hyperkalemia, prolonged paralysis and associated apnea induced by succinylcholine may be seen
In cases where correction of hyperkalemia is not possible, the use of paralytic agents other than succinylcholine should be considered. These include nondepolarizing muscle relaxants such as rocuronium
The process of triangulation is best described by which of the following?
A. In a family system, 3 family members form a coalition and isolate from others
B. In a family system, 3 family members form a coalition and intimidate others
C. In a family system, 2 family members join and draw in or scapegoat a 3rd family member to deflect tension
D. In a family system, 2 family member join to help a 3rd family member and reduce tension
E. In a family system, 2 family members join and force a 3rd family member out of the system
C. In a family system, 2 family members join and draw in or scapegoat a 3rd family member to deflect tension
Family therapy, Murray Bowen
Theorized that 2 person emotional system is unstable and forms a 3 person system when under stress
i.e. where abuse present, the non-abusive parent might go to child and express dissatisfaction with abusive parent
Which of the following has been found in neuroimaging studies of patients with Schizophrenia?
A. Decreased size of lateral and third ventricles.
B. Increased prefrontal cortex.
C. Increased superior temporal lobe.
D. Increased thalamic volume.
E. Decreased volume in the hippocampus
E. Decreased volume in the hippocampus
Slight overall decrease in brain volume and an increase in size of ventricles.
Localized findings are less reproducible, but among the most robust are decreased size of the hippocampus, superior temporal lobe, prefrontal cortex, and thalamus.
A 47-year-old man presents to the emergency department after being found wandering aimlessly in the street. Upon examination, he is disoriented, his skin is hot and dry, he has dilated pupils, and he has absent bowel sounds. An electrocardiogram reveals a supraventricular arrhythmia. The patient most likely overdosed on which of the following medications? DAILY DOUBLE
A. Amitriptyline
B. Bupropion
C. Fluoxetine
D. Sertraline
E. Venlafaxine
A. Amitriptyline
The arrythmia was caused through what mechanism? Inhibition of voltage gated Na+ channels (widening of QRS is first sign)
Anticholinergic Toxicity = "red as a beet, dry as a bone..."
Deathly 3 C's: Coma, convulsions, cardiac arrhythmia
Antipsychotics cause cardiac arrhythmias (QTc prolongation) through inhibition of potassium channels
As part of a school project, a 12-year-old girl designs a science experiment, beginning with the formulation of an initial hypothesis that she plans to test. This cognitive ability marks a transition to which of Piaget’s stages?
DAILY DOUBLE
A. Concrete operational stage
B. Formal operational stage
C. Preoperational stage
D. Sensorimotor stage
E. Pre-sensorimotor stage
B. Formal operational stage
Which stage does a child develop object permanence? Sensorimotor stage
- Sensorimotor stage (0-2 YO): understands world through senses and actions. Object permanence (objects continue to exist even though they can no longer be seen or heard).
- Preoperational stage (2-7 YO): understands world through language and mental images. Egocentrism, Pretend play.
- Concrete operational (7-11 YO): understands the world through logical thinking and categories. Conservation (understanding that something stays the same in quantity even though its appearance changes). Death is seen as permanent.
- Formal operational stage (11 YO+): understands the world through hypothetical thinking and scientific, deductive reasoning. Abstract thinking.
42 yo female asks dr. for something to help with sleep. She travels frequently and “can’t get internal clock right.” She doesn’t want ‘drugs’ and wants natural substance. Dr. describes OTC med to improve jet lag. Where in body is substance made?
DAILY DOUBLE
A. Hypothalamus
B. Pineal Gland
C. Anterior pituitary gland
D. Posterior pituitary gland
E. Mammillary bodies
B. Pineal Gland = where melatonin is produced (stimulate sleep cycle)
Where is orexin/hypocretin produced? Hypothalamus
- Hypothalamus = orexin/hypocretin (stimulate wake cycle)
- Posterior Pit = ADH + oxytocin
- Anterior Pit = GH, LH, FSH, TSH, PRL, ACTH
- Mamillary bodies = memory
When dialectical behavioral therapy is used to treat patients with borderline personality disorder, the word "dialectical" refers to therapeutic strategies focused on:
DAILY DOUBLE
A. Alleviating psychic tension between the id and its fantasies and the superego and its responsibilities
B. Going over traumatic events and analyzing their impact on the patient
C. Reframing cognitive distortions and finding underlying mechanisms to negative thoughts
D. Role playing that seeks to improve the patient's interpersonal relationships
E. Seeking for synthesis between seemingly contradictory ideas and emotions
E. Seeking for synthesis between seemingly contradictory ideas and emotions
Who is the founder of DBT? Marsha Linehan
“The process or art of reasoning through discussion of conflicting ideas.” – The Merriam-Webster Dictionary
DBT is a modified type of CBT.
Four goals: mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance
Focus is on reducing impulses to self-harm and decreasing hospitalization
Borderline PD. Also now used in eating disorder, substance use disorder, PTSD
In studies examining biological responses to trauma-related stimuli in subjects with PTSD, which of the following findings has been repeatedly confirmed?
A. Increased heart rate
B. Decreased skin conductance
C. Decreased facial electromyographic reactivity
D. Decreased startle response
E. Increased cortisol levels
A. Increased heart rate
One of the earliest and best replicated PTSD findings is heightened autonomic and facial electromyographic reactivity to external trauma-related stimuli, such as combat sounds and film clips, as well as to internal mental imagery of the traumatic event.
Subjects with PTSD have also been found to show heightened electromyographic responses and more consistently heightened autonomic responses to startling stimuli.
Elevated startle responses suggest sensitization of the nervous system. Although substantial research has supported sympathetic overreactivity in PTSD, a surprising finding has been that cortisol is not consistently elevated in PTSD, as might be expected according to a classical stress model. This appears to be due to hypersensitivity of the hypothalamic-pituitary-adrenal axis to negative feedback.