PRITE-2

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)

Psychopharm

100

In cases of severe lithium toxicity, dialysis is typically indicated. Lithium is readily dialyzable due to its:

A) high tissue binding

B) high protein binding

C) low molecular weight

D) high volume of distribution

E) low proximal tubule resorption

What is C? low molecular weight

200

In older adults, this is the physiologic change that affects drug pharmacokinetics:

A) Increased protein binding

B) Increased total body water

C) Decreased hepatic blood flow

D) Decreased gastric transit time

E) Decreased hepatic glucoronidation

What is C (decreased hepatic blood flow)?

- Aging is associated with a reduction of approximately 40% in hepatic blood flow and 30% in liver mass 

- Prodrugs requiring activation through hepatic metabolism may be less effective in older people, and medications that are metabolized for biliary or renal excretion may require lower or less frequent doses in older people. 

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

A) There is no evidence that pharmacogenomics testing improves outcomes

B) Strong evidence supports testing for both improved outcomes and cost-effectiveness

C) Research shows promise for clinical utility, but replicated evidence about outcomes is lacking

D) Because existing studies of testing were sponsored by industry, we must disregard their results

E) A large number of well-designed studies report that testing improves outcomes but is not const-effective

What is C?  Research shows promise for clinical utility, but replicated evidence about outcomes is lacking

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 

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

When reviewing a set of extremely positive student evaluations a professor notes that one of them contains the comment, "could leave more time for questions during class." At a subsequent psychotherapy session the professor tells the psychiatrist, "I am a terrible professor. I just talk the whole time." This is an example of which of the following types of cognitive errors?

A) Personalization

B) Catastrophizing

C) Arbitrary inference

D) Selective abstraction

E) Dichotomous thinking

What is D (Selective abstraction)?

300

Throughout the course of psychotherapy a patient with borderline personality disorder reports a history of growing up in an abusive household, wishing to escape abusive parents but also depending on them, and abruptly ending relationships due to "feeling too close to the other person and getting scared." According to Mahler's model this patient's problems can be formulated as not having worked through which of the following stages?

A) Symbiosis

B) Consolidation

C) Differentiation

D) Normal autism

E) Rapprochement

What is E(Rapprochement)? 

In Mahler's theory, child development takes place in phases, each with several sub phases:

Normal autistic phase – First few weeks of life. The infant is detached and self-absorbed. 

Normal symbiotic phase – Lasts until about 5 months of age. The child is now aware of his/her mother but there is not a sense of individuality. The infant and the mother are one, and there is a barrier between them and the rest of the world.

Separation–individuation phase – The arrival of this phase marks the end of the Normal symbiotic phase. Separation refers to the development of limits, the differentiation between the infant and the mother, whereas individuation refers to the development of the infant's ego, sense of identity, and cognitive abilities. The following subphases proceed in this order but overlap considerably.

Hatching – first months. The infant ceases to be ignorant of the differentiation between him/her and the mother. "Rupture of the shell". Increased alertness and interest for the outside world. Using the mother as a point of orientation.

Practicing – from 9 to about 16 months. Brought about by the infant's ability to crawl and then walk freely, the infant begins to explore actively and becomes more distant from the mother. The child experiences himself still as one with his mother.

Rapprochement – 15–24 months. In this subphase, the infant once again becomes close to the mother. The child realizes that his physical mobility demonstrates psychic separateness from his mother. The toddler may become tentative, wanting his mother to be in sight so that, through eye contact and action, he can explore his world. The risk is that the mother will misread this need and respond with impatience or unavailability. This can lead to an anxious fear of abandonment in the toddler. A basic 'mood predisposition' may be established at this point. Rapprochement is divided into a few subphases:

Beginning – Motivated by a desire to share discoveries with the mother.

Crisis – Between staying with the mother, being emotionally close and being more independent and exploring.

Solution – Individual solutions are enabled by the development of language and the superego.

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

In Heinz Kohut's theories of self-psychology, what is meant by the term "self-objects"?

A) Personal belongings of significance used to help define the self

B) Different aspects of the self that emerge in different types of situations

C) Various components of the self that appear during different stages of life

D) Other people in the environment who perform particular functions for the self

What is D (Other people in the environment who perform particular functions for the self)?

In Kohut's theory, a self object consists of the developing child plus each of those people who give the child the abilities to maintain self structure and firmness and a sense of cohesion and steadiness.

Re-mix

100

Which of the following medications should be stopped or reduced before starting a patient on ECT?

A) Haloperidol

B) Lithium

C) Phenelzine

D) Desipramine

E) Phenoxybenzamine

What is B (Lithium)?

ECT + lithium is associated with 12-fold higher odds of delirium compared to ECT alone.

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 of the following medications would be preferable for use in an anxious patient with pulmonary disease?

A) Aprazolam

B) Bupropion

C) Buspirone

D) Clonazepam

E) Propranolol

What is C? Buspirone

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)?

Forensics/Ethics

100

The majority of research suggests that opioid-dependent offenders are more likely to remain drug abstinent following release from prison if they receive which of the following interventions?

A) Methadone maintenance while in prison

B) Prison-based Narcotics Anonymous groups

C) Injectable sustained release naltrexone while in prison

D) Weekly motivational interviewing sessions while in prison

E) Transfer to a methadone program following incarceration

What is A? Methadone maintenance while in prison

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

What is the American Psychiatric Association's position on the possession of guns by individuals with a psychiatric diagnosis?

A) Guns should be banned for all individuals with any psychiatric diagnosis

B) Individuals with a psychotic disorder should be banned from owning guns

C) Individuals who present an increased risk of violence should be banned from owning guns

D) Guns should be banned for anyone who has ever been hospitalized for psychiatric reasons

E) Once an individual has lost the right to own a gun due to mental illness, that restriction should remain in place indefinitely

What is C (Individuals who present an increased risk of violence should be banned from owning guns)?

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."