NYU PRITE - Clinical Psychiatry 2024

Development Across Lifespan

100

The Freudian stage of latency is correlated with Erikson's stage of:

A) trust vs mistrust

B) industry vs inferiority

C) initiative vs guilt

D) autonomy vs shame

E) High school-age

What is B (industry vs inferiority)?

200

A newly gained cognitive capacity when a child reaches the stage of formal operations:

A) Centration

B) Abstraction

C) Reversibility

D) Egocentrism

E) Object Permanence

What is B (abstraction)?

300

According to Winnicott, if a mother is unable to provide a "holding environment" for the infant, what defensive process is likely to arise in the infant?

A) False self

B) Grandiosity

C) Exhibitionism

D) Frozen memories

E) Idealization of self-objects

What is A (False self)?

Winnicott describes the holding environment as a developmental stage in which the child and mother are one entity, as yet undifferentiated in the infant’s consciousness. His writings on the subject emphasized empathy, imagination and love between the caregiver and infant. The core purpose of “holding” is to allow the child to be completely unconscious of his requirement for a separate individual 

The holding environment facilitates the child’s transition to autonomy. Failure on the Mother’s part to provide an adequate holding environment results in a “false self disorder”, according to Winnicott. Winnicott’s theory of “false self disorders” is strikingly similar to descriptions of the schizoid personality. The individual’s personality is characterized by a complete lack of harmony, resulting in a distant attitude, emotional coldness and idiosyncratic autism

Winnicott argues one of the primary purposes of the therapist is to provide a “holding environment” for the client, in order that the client may begin to recognize and meet previously neglected ego needs and facilitate the emergence of the true self.

Containment is similar and yet fundamentally different to holding. Bion’s theory of containing originates from the idea that the infant projects into its mother feelings that are upsetting, fearsome, painful or in some other fashion, intolerable. The mother in turn feels the emotion herself, and is able not to react to it, but instead to contain it and give the child back the feeling in an adapted and contained form to the infant, so the child can repossess it and reintegrate the emotion as its own.

400

Ainsworth introduced the strange situation experiment to evaluate which of the following?

A) Attachment between a parent and child

B) Concrete, preoperational thinking in a child

C) A child sharing mental experience with the parent

D) Infant's ability to use adult feedback for affect regulation

E) Internal representations of the multiple caregiving in an infant

Answer A. (Attachment between a parent and child)

500

A 23 year old patient began psychotherapy due to feelings of inadequacy and depression in the context of working in a coffee shop since graduating from college and deferring medical school acceptance. The patient has been having conflicts with parents over his ambivalence about becoming a physician. Which of the following is the most likely developmental task with which the patient is struggling?

A) Identity

B) Intimacy

C) Mastery

D) Productivity

E) Generativity

What is A? (Identity)

600

REM sleep is first evident at which stage of development?

A) In utero

B) Immediately post-partum

C) At one month of age

D) At three months of age

E) At one year of age

What is A (in utero)?

700

Which perinatal factor is specifically associated with development of ADHD?

A) MATERNAL TOBACCO USE PRENATALLY

B) LIVING WITH CATS 

C) MATERNAL ILLNESS ANXIETY DISORDER

D) USE OF AN EPIDURAL DURING DELIVERY

MATERNAL TOBACCO USE PRENATALLY

Psychopharm

100

47yo pt w acute mania is unresponsive to medication. 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?

a) Lithium

b) Divalproex

c) Lorazepam

d) Bupropion

Lithium

Medications that should preferably be avoided before the procedure: Morning dose of oral hypoglycemics, lithium, diuretics, anticonvulsants, theophylline, and benzodiazepines can be withheld, and requirement should be considered only on individual basis.

Medications that should not be avoided before the procedure: Morning doses of scheduled medications like antihypertensives, thyroxine, antiemetics, antireflux, antianginal, bronchodilators, and anticholinergics should not be withheld and can be taken orally 2 h before the procedure with small sips of water.

200

A state of general fatigue, hypersomnolence, and depression may be seen during a patient’s withdrawal from which of the following

a) cocaine

b) heroin

c) wine

d) fentanyl

cocaine

300

Which of the following is the most common reason for patients to discontinue selective serotonin reuptake inhibitors early?

A) GI distress

B) Sedation

C) Agitation

D) Insomnia

E) Jitteriness 

What is A? GI distress

400

What medication strategy is most effective and rapid in the treatment of severe bipolar illness, manic phase?

a)  clonidine

b) antipsychotic + wellbutrin

c) antipsychotic + lithium

d) lithium + valproate

ANTIPSYCHOTIC MEDICATION + LITHIUM OR VALPROATE

500

Which of the following medications is an alpha-2 adrenergic agonist?

A) Atomoxetine

B) Modafinil

C) Buspirone

D) Guanfacine

E) Memantine

What is D? Guanfacine

Atomoxetine --inhibits the presynaptic norepinephrine transporter (NET), preventing the reuptake of norepinephrine throughout the brain along with inhibiting the reuptake of dopamine in specific brain regions such as the prefrontal cortex, where dopamine transporter (DAT) expression is minimal. 

Modafinil -Modafinil acts as an atypical, selective, and weak dopamine reuptake inhibitor and indirectly activates the release of orexin neuropeptides and histamine from the lateral hypothalamus and tuberomammillary nucleus, all of which may contribute to heightened arousal 

Buspirone - agonist of the serotonin 5-HT1A receptor with high affinity. It is a partial agonist of both presynaptic 5-HT1A receptors, which are inhibitory autoreceptors, and postsynaptic 5-HT1A receptors. Antagonist of the dopamine D2 receptor with weak affinity. It preferentially blocks inhibitory presynaptic D2 autoreceptors, and antagonizes postsynaptic D2 receptors only at higher doses 

Memantine -antagonist at glutamatergic NMDA receptors 

600

Which of the following medications may lead to serotonin syndrome if combined with fluoxetine?

A) Linezolid

B) Pimozide

C) Thioridazine

D) Clonidine

E) Propranolol 

What is A? Linezolid

Linezolid can reversibly inhibit monoamine oxidase (MAO). Coadministration with antidepressants, such as nonselective MAO inhibitors, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) may precipitate serotonin syndrome.

700

Pt w/ h/o bipolar presents w immobility, posturing, echopraxia. what is the first line treatment?

A) clonidine

b) imipramine

c) lorazepam

d) haldol

Lorazepam

Psychotherapy

100

During a dialectical behavior therapy session, the patient tells the therapist about strong urges to cut that had occurred a few days earlier. A therapist using the behavioral analysis strategy would most likely respond by saying which of the following?

A) "Why would you want to inflict pain on yourself?"

B) "Have you thought about how cutting might cause permanent scars?"

C) "You were thinking about hurting yourself. Let us see where your mind goes with that."

D) "At what point during the day did you first notice that you were thinking about cutting?"

E) "I am glad you were able to use the techniques you learned here to modify those thoughts."

What is D (At what point during the day did you first notice that you were thinking about cutting?)

200

Psychotherapy that has been shown to be effective in bulimia nervosa: 

a) psychoanalysis

b) cognitive behavior therapy

c) exposure therapy

d) group therapy

 cognitive behavior therapy

300

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

a) resistance

b) insight

c) confrontation

d) countertransference 

Resistance

400

When compared to patients with somatic symptom disorder, patients with illness anxiety disorder are less likely to:

A) be female

B) display la belle indifference

C) have multiple physical complaints

D) develop a major depressive disorder

What is C (have multiple physical complaints)?

500

Pt in long term psychodynamic psychotherapy attacks therapists for being controlling and uncaring. This is an example of what?

a) countertransference

b) transference

c) resistance

d) insight

Transference

600

In which of the following ways are physicians who die by suicide different from the general population of suicide completers?

A) More likely to be older

B) More likely to be married

C) Less likely to abuse illicit drugs

D) More likely to have a chronic health problem

E) Less likely to be taking antidepressant medications

What is E (Less likely to be taking antidepressant medications)?

700

44 yo pt reports hx of repeated episodes of self-mutilation and sudden changes in relationships. After several months of psychotherapy, the pt speaks in unusual accent, is irritable, and has little awareness of in-session discussions. Psych MD has past records that state pt has been Dx with borderline personality disorder and has a sexual trauma history. Dx? 

a) PTSD

b) Illness anxiety disorder

c) Dissociative Identity disorder

d) Malingering 

dissociative identity disorder

Potpourri

100

During psychotherapy, the patient describes a situation where a roommate left the apartment after receiving a call. Patient recalls “I'm being left out again”. This is an example of?

a) automatic thoughts

b) Socratic questioning

c) epiphany

d) catastrophic thinking

automatic thoughts

200

A psychiatrist is asked to interview an agitated and potentially violent patient. Which of the following actions is most appropriate?

A) Use whatever tactics are necessary to elicit cooperation

B) Refuse to interview the patient until he has been sedated

C) Be aware of own body position as well as that of the patient

D) Explain to the patient the potential consequences of his becoming violent

E) Place the chairs in such a way that the psychiatrist is between the patient and the door in order to facilitate exit if necessary

What is C (Be aware of own body position as well as that of the patient)?

300

Which of the following agents is likely to decrease lithium levels?

A) Caffeine

B) Lisinopril

C) Ibuprofen

D) Quetiapine

E) Hydrochlorothiazide

What is A (Caffeine)?

Lisinopril-->Increase Li Level

Ibuprofen -->Increase Li Level

Hydrochlorothiazide -->Increase Li Level

MAOIs-->Increase Li Level

Metronidazole -->Increase Li Level

Theophylline -->Decrease Li Level

400

Which factor most likely impedes cohesion in daily group therapy on locked adult general psychiatry units?

a) patients being asked to leave the group for a daily check-in with the treatment team

b) patient turnover on the inpatient unit

c) resident turnover on the inpatient unit

d) patients with substance use disorder

Patient Turnover

500

Which of the following is the most likely mechanism for QTc interval prolongation related to antipsychotic medications?

A) Sodium influx

B) Calcium influx

C) Sodium channel blockade

D) Stimulation of ATPase pump

E) Potassium channel blockade

What is E (Potassium channel blockade)?

600

Across all cultures, what stressful life changes are correlated with the greatest increase in death and illness in the subsequent 2 years? 

a) death of a spouse

b) financial troubles

c) unemployment

d) moving to a new city

death of a spouse

700

According to Erikson, person >65 yo with sense of satisfaction that life was productive/worthwhile has successfully managed psychosocial task of developing what?

a) Industry

b) Inferiority

c) Stagnation

d) Integrity

Integrity

Forensics/Ethics

100

In forensic psychiatry, the term “standard of care” refers to the use of treatments that are 

a) used by average reasonable practitioners

b) used by experts in the field

c) recommended by health insurance companies

d) offered on the inpatient psychiatric unit

used by average reasonable practitioners

200

Absent gross negligence, dereliction of duty in a malpractice trial is typically established by which of the following?

A) Evidence of a bad outcome

B) Testimony of expert witnesses

C) Testimony of the injured patient

D) Evidence of alternative practice procedures 

What is B (Testimony of expert witnesses)? 

What Are the Four Elements of Medical Malpractice?

• Duty: The duty of care owed to patients.
• Dereliction: Or breach of this duty of care.
• Direct cause: Establishing that the breach caused injury to a patient.
• Damages: The economic and noneconomic losses suffered by the patient as a result of their injury or illness.

300

A lawsuit charges that a psychiatric facility prematurely discharged a patient who was not approved for further stay by the managed care company. The final legal responsibility generally falls to the:

A) Psychiatrist

B) Managed care company

C) Managed care reviewer

D) Psychiatric hospital

E) Hospital medical director

What is A (psychiatrist)?

400

Mental competency of an elderly patient is determined by 

a) an evaluation performed by two different psychiatrists

b) judicial hearing

c) patient's health care proxy

d) patient's legal counsel 

judicial hearing

500

Ethical standards issued by the American Medical Association prohibit physician involvement in which of the following aspects of a death penalty case unless a commutation order is in place?

A) Assessment of competence to stand trial

B) Restoration of competence to be executed

C) Rendering an opinion about criminal responsibility

D) Serving as a fact witness at the guilt-innocence trial phase

E) Treatment of condemned prisoner to reduce mental health symptoms

What is B (Restoration of competence to be executed)?

Code of Medical Ethics states unequivocally that "a physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution." The Code goes on to say that a physician should not treat a condemned prisoner for the purpose of restoring competence, unless a commutation order is in place before treatment begins, but that "if the incompetent prisoner is undergoing extreme suffering as a result of psychosis or any other illness, medical intervention intended to mitigate the level of suffering is ethically permissible."

600

Suicidal 18 yo pt who lives with his parents is evaluated in the ED. Psychiatrist warns pt that if he does not sign in voluntarily for inpt tx, the psychiatrist will involuntarily hospitalize the pt. The pt consents to inpt care. The pt in this situation has not given valid informed consent because: 

a) he was coerced into giving consent

b) patient lacks insight

c) parents should consent on behalf of the patient

d) valid informed consent is not part of the legal process

he was coerced into giving consent

700

Female patient in twice-weekly psychodynamic psychotherapy w/ male psychiatrist for the last year begins to discuss sexual fantasies about the therapist. The therapist feels flattered by the sexual interest of this patient and notes his own feelings of attraction to her. Most appropriate next step for therapist? 

a) seek consultation with a colleague

b) refer the patient to a colleague

c) wait 5 years before starting a romantic relationship

d) tell the patient you can not continue your work together

 seek consultation with a colleague