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The Ninja’s Guide to PRITE

The Best PRITE Review…..EVER

Foreword

The purpose of this review is to provide you with HIGH-YIELD PRITE topics. The Ninja’s Guide to PRITE focuses on the most important areas to cram into your brain in the month preceding PRITE. It is suggested that going over old PRITE exams is the best preparation for PRITE. This guide provides a comprehensive summary of old PRITEs in an attempt to help with a more efficient review. Other items in this guide include a psychopharmacology review, a psychotherapy review, and a miscellaneous topics high-yield review. The various Ninja reviews combine information from the Massachusetts General Hospital Psychiatry Review, Synopsis of Psychiatry and Synopsis of Psychopharmacology by Kaplan and Sadok, the APA Psychiatry Textbook and other excellent sources. Remember that these materials are copyrighted, so please do not sell this free learning tool. With these tools, it is my hope that you will completely rock the PRITE. Best of Ninja Luck,

Melissa Pereau, MD
Psychiatry Chief Resident Loma Linda Department of Psychiatry

Table of Contents
A Ninja’s Guide to PRITE Questions...………………………………………….4-60 A Ninja’s Guide to Psychopharmacology……………………………………...61-66 A Ninja’s Guide to Psychotherapy……………………………………………...67-76 A Ninja’s Guide to Freud and Other Important Stuff………………………….77-90

A Ninja’s Guide to PRITE Questions

Special Thanks to All Who Contributed
PGY-4 Andy Hayton Melissa Pereau Bryan Wick Lucia Cheng Tao Yan PGY-3 Serina Srikureja Katy Roman PGY-2 Christoff Le Roux Timothy Lee Aimee Ellison Daman Brar Ming Xi PGY-1 Carolina Osorio Nick Mahaffey Taujay Williams Michael Quines

bulimia. and diplopia Subthalamic nucleus Right Parietal Lobe Right parietal Prolactin Normal Pressure Hydrocephalus Medulloblastoma 20 y/o with 1 yr of bitemporal headaches. polyuria. For 2 months emotional outburst aggressive and transient confusion neuro exam normal. This is suggestive of what diagnosis? 5 y/o with 4 month history of morning HA. getting lost. Further w/u should initially focus on what factor? Which term describes state of immobility that is constantly maintained? Ability of catatonic pt to hold same position CVA Cataplexy Catalepsy Cerebellopontine angle .This guide contains all PRITE questions from 2001-2006. unsteadiness with falls and headaches. What will MRI of brain show? Hypothalamic tumor Previously pleasant mom becomes profane and irresponsible over 6 Frontal lobe months: Unilateral hearing loss with vertigo. Thus. Patient is on no meds. vomiting. All questions that were disputed or have more than one accepted answer have been deleted. It is divided into sections based on relevance and further categorized by frequency of questions. tactile and auditory content. Where is lesion Which hormone secreted in functional pituitary adenoma: CT & MRI show ventriculomegaly are out of proportion to sulcal atrophy. falls. mild facial weakness and ipsilateral limb ataxia is most commonly associated with tumors in what locations: Catatonia 52 y/o with h/o unipolar depression is brought to ED with a first Metabolic disorders episode of catatonia. episodic mood swings and occasional hallucinations with visual. and recent problems with gait. Additional stars*** indicate the total of times the question has appeared in PRITE. Supramarginal gyrus or insula inability to repeat. CT head reveals tumor where: Bitemporal Hemianopsia Temporal lobe Temporal lobe Memory loss occurs for a discrete period of time Anterograde Alcohol Syndrome characterized by fluent speech. Location of lesion in the brain? Acute onset of hemiballismus of LUE & LLE. a question in bold with **** means the question has been featured in 4 PRITE exams from 2001-2006. All bold questions have been featured in at least two PRITES from 2001-2006. MRI is most likely to show lesion located where? Left sided hemi-neglect is associated with lesion located where? 60M right-handed. w/o associated signs. polydipsia. only writes on right half of paper. UDS is neg. preserved comprehension. Neurology Amnesia Amnesia preceded by epigastric sensation and fear are associated with electrical abnormality where? Memory loss pattern in dissociative amnesia Amnesia characterized by loss of memory of events that occur after onset of etiologic condition or agent What psychoactive drug produces amnesia? Brain Lesions Visual problem in pituitary tumor compressing optic chiasm 32 y/o pt 1-month history of worsening headaches.

deviation of gaze to R. and is falling to the left. diplopia Brain Stem Infarction Transient symptom associated with carotid stenosis: *** Monocular blindness 62 y/o M w DM is not making sense. R hemiplegia with arm and face weaker than leg. When asked which arm is her L. Work up revels elevated anticardiolipin titers and no other risk factors for stroke. L pupil enlarged and unreactive. left sided face numbness. unable to understand or repeat verbal commands. dysfluent. nystagmus. CT will show what? Pt with acute onset vertigo. ER TPA exam notes weakness of R extremities and severe dysfluent aphasia. Pathology type and area: Abulia refers to impairment in ability to: Sudden-onset left hemiparesis with deviation of eyes to the right Thromboembolic stroke L MCA (middle cerebral artery) Spontaneously move and speak Right putaminal hemorrhage Sudden onset vertigo/nausea. vomiting. CT and MRI brain no abnormalities but ventricles smaller than usual. nausea. Alert but appeared frustrated. Normal intonation but no one in the family can understand it. and L homonymous hemianopsia. Face drooping on R and dragging R leg. **** 58 y/o M h/o HTN. This is caused by: Post. Papilledema present. she replies “yours. cig smoking and sudden inability to speak. hoarseness/dysphagia.Chronic Afib develops aphasia and R hemiparesis at noon. Most appropriate treatment: Young adult gained 70 lbs in last year c/o daily severe headaches Prevent blindness sometimes assoc with graying out of vision. Exam: ptosis R eyelid. Dx? Lateral medullary stroke Rapid onset of right facial weakness. saying “thar szing is Wernicke’s aphasia phrumper zu stalking”. telegraphic speech. unaware of L UE/LE. what will suggest R lateral medullary infarct? R MCA infarct w/ edema and uncal herniation R facial loss of touch + temp sensation 46 y/o M w/ double vision + pain R eye. 12 hrs later. Flaccid L arm. right sided face Right medullary infarction numbness. hoarseness. left limb weakness. but denies Parietal lobe CVA anything wrong and when asked to raise L arm raises R. hiccups. pt is unconscious.” Dx? CT scan with occipital and intraventricular hyperintensities Which med has secondary prevention against embolic stroke in patients with Afib? As opposed to strokes caused by arterial embolism or thrombosis. decreased pinprick and temp sensation on left 65 y/o diabetic presents to ED c/o acute L sided weakness. inability to elevate or adduct R eye + R pupillary dilation. those caused by cerebral vein or venous sinus thrombosis are Atrophy of right temporal lobe on cross section associated with occlusion of: Parenchymal hemorrhage Oral warfarin More often associated with seizures at onset Middle cerebral artery . L hemiplegia and hemisensory deficit. but CT at 1:30 PM has no acute lesion. ataxia of the limbs. He verbally responds to questions with similar utterances but fails to successfully execute any instruction. Appropriate intervention at this point is? Abnormal elevated metabolic findings associated with increased risk of Plasma homocysteine stroke in patients under 50 73 y/o found on floor. diminished gag reflex on right. Communicating artery aneurysm Aphasia w/ effortful fragmented. staggering gait. In ER examined within 40 mins of onset: Aphasic. CT head showed no hemorrhage. Goal of treatment in this case: Patient with hypertension develops vertigo. is seen in a lesion where? Post frontal lobe 39 year old with h/o of multiple miscarriages develops an acute left Plasmapheresis sided hemiparesis. Unintelligable sounds for speech.

b/l Babinski. Exam shows small reactive pupils. R beating nystagmus on lateral gaze. No corpus callosum lesions. and mild R hemiparesis that lasted 2 hrs. unable to stand. Dx? Cerebellar hemorrhage Motor speech paradigm activation task on fMRI – hyperactivity in right Calcarine fissure temporal lobe. vertigo. The initial test should be? CT Head Post stroke depression in an 80 y/o pt who is R handed is associated Correlate with left hemispheric involvement with cognitive impairments that Fluent speech with preserved comprehension but inability to repeat statements is consistent with what type of aphasia? Normal Romberg w eyes open but loses balance with eyes closed. nystagmus. eyes deviate to L. Dx? 66 y/o M in ED w/ sudden occipital HA. Where is abnormality? Conduction Cerebellar vermis 65 y/o with h/o HTN. In ED is stuporous. CT would show intraparenchymal hemorrhage in: Higher frequency & greater severity of depression associated w/ cortical & subcortical strokes Left homonymous hemianopsia Left basal ganglia Left anterior frontal Pt with hypertension develops painless vision loss on the left eye. PE Ischemic optic neuropathy revels blindness in the left eye and afferent papillary defect on the left. This is: Dyspraxia Pt in ED with sudden HA and collapsing. He identifies his right and left but not that of the examiners. poor balance and dysarthria. Damage is where? Inability to recognize objects by touch: Astereognosis In managing acute ischemic stroke. gaze deviated to the R. decreased R corneal reflex. dizziness. w/ occasional ocular bobbing. MRI shows several T2 hyperintensities in the white matter periventricularly. administer this within 48 hrs of Aspirin onset of stroke for beneficial effect in reducing risk of recurrent stroke. 2 days ago had Intravenous thrombolytic agents milder/similar symptoms that resolved in 30 minutes.Loss of ability to execute previously learned motor activities (which is not the result of demonstrable weakness. Exam shows rigid neck. truncal ataxia. some lethargy. mild lethargy. b/l hyperreflexia. yesterday had similar episode x45 minutes. R facial weakness. N/V. ataxia or sensory loss) is associated with lesions of? Left parietal cortex 58 y/o s/p CABG – anomia for fingers and body parts. Tx? Lower facial weakness w/ relative sparing of forehead can be stroke in Internal capsule Prosopagnosia is: Inability to recognize faces 57 y/o diabetic w/ HTN c/o several episodes of visual loss “curtain falling” over his L eye. errors involving Left medial temporal stroke right and left. Fluent speech and excellent comprehension Visual disturbances associated with occlusion of the right posterior cerebral artery? 65 y/o with HTN collapsed. transient speech and language disturbance. What hemorrhage? 5 days after CABG a 47 yr M is disoriented in time and place. No enhancement with gadolinium. disability and death: . Suggests presence of what? Extracranial L internal carotid stenosis Head injury with LOC followed by lucid interval for a few hours then Epidural rapidly progressing coma. finger to nose testing is ataxic. inability to write thoughts/take notes/make calculations.5 hrs ago. N/V. CT shows no stroke or hemorrhage. no papilledema. no focal CN or motor signs. worse with Cerebellar infarct head movement. R hemiparesis + hemisensory deficit. Meniere’s with sudden vertigo. Can draw square and circle but not a clock. slurred speech. Current sx started 1. Dx? 63 y/o with new onset aphasia and R hemiparesis.

electrolyte imbalance. CT neg. insomnia. fluctuations Diffuse lewy body disease in cognitive function. no tinnitus. EEG diffuse slowing. Dx? Two days after bowel surgery. 53 y/o is delirious. polydipsia Cancer patient on chemo is disoriented and agitated. inattentive. diplopia. Hep C was dx and treated 2 months ago. severe that pt collapses and is immobilized when symptoms start. No aphasia or visual field deficit. confusion states. No residual s/s. Why? A consult is requested for an inpatient on a medical ward who is agitated and hallucinating. tingling of lips. picking at clothes. Pt appears to be flushed and hot with dry skin. thirst. but then continues to draw squares when asked to draw other shapes. or UTI. hallucinosis and other symptoms of psychosis. mydriasis. Correctly draws a square when asked. or maximize staff continuity assigned to pt? Delirium in HIV patients treated with what parental agent? Mild confusion. Maximize staff continuity assigned to pt Low dose of a high-potency antipsychotic Hyponatremia Haldol Drug-drug interaction Discontinue anticholinergic drugs Delirium Clouding of consciousness 65 y/o M 6 months confusion episodes. R arm and hand lightly Anterior cerebral artery (left) affected. diphenhydramine for sleep and a renewed prescription for doxepin. Poor eye contact. Wife says he is normal between episodes. cog impairment. Afebrile VSS. mild diff with serial subtractions. MSE would reveal: 75 y/o F is 8 days s/p total hip replacement and has delirium. Her diazepam and doxepin were discontinued just prior to surgery. a rapid pulse and diminished bowel sounds. Over weeks found with loss bladder control. Held for observation. CSF. colorful. abulia and lack of spontaneity. Exam: Normal language. ataxia. atypical depression. mod diff with trails test. She is getting meperidine for pain. Poor attention. severe headaches. Dx? Vertebrobasilar insufficiency Component of type A behavior most reliable risk factor for CAD Hostility 70 y/o F sudden onset paralysis R foot and leg. Diagnosis: Dementing illness with limb and axial rigidity tremor. nodding off Suggests delirium rather than dementia Dementia Perseveration Acute hydrocephalus Medication toxicity. Hallucinated images are fully formed. Myoclonic jerks occur spontaneously. Since then pt is more irritable. muttering. UTI. routine labs and UDS normal. Treat with: A 70 y/o +HIV heroin abuser is treated with Lopinavir and Ritonavir and fluoxetine for MDD. vivid and pt has little insight into their nature. dysarthria. Brain MRI unremarkable. ALOC or association with any particular activity. disorientation. lethargy. memory. visual Lewy body dementia hallucinations of children playing in his room. “not himself” x 10 days. atypical depression.70 y/o w/ attacks of “whirling sensations” w/n/v. Her confusion is likely due to: medication toxicity. diazepam WDRL. dysarthria. What is your first recommendation? 52 y/o w/ depression and HTN. and diarrhea. Dx? . Which vascular area: Complications of a cerebellar hemorrhage? Delirium Multifocal myoclonus in a comatose patient indicates: Metabolic Encephalopathy 50M male w/ progressive dementia. hearing impairment. electrolyte imbalance. EEG w/ sharp Subacute Spongiform Encephalopathy waves 79 y/o with decreasing mental state over 3 weeks has an exaggerated Spongiform Encephalopathy startle response with violent myoclonus that is elicited by turning on the room lights. Best recommendation for pt with delirium? Minimize contact with family members or limit sleep meds to diphenhydramine. speaking loudly. No AH. diazepam withdrawal. Occurs several times daily for 1 minute. mild symmetric rigidity and bradykinesia. or touching the patient. Neg neuro exam.

Family wants to keep at home. tonic contracture of left side. perseveration. Dx? Detection of 2 Apolien e4 alleles is useful in dx dementia b/c Neurofibrillary tangles in Alzheimer’s are composed of: 80 y/o Alzheimer’s with increasingly combative behavior. hyperventilates. no LOC during Sz In young pt w/ epilepsy. Assoc with dysfunction in what area of the brain? Alzheimer’s disease risk – Apolipoprotein E phenotype Binswanger disease has pseudobulbar state. female. loss of executive function. delusions. attention deficits.e. tactile & olfactory hallucinations. agitation and dementia is: What cognitive enhancers is an NMDA receptor antagonist? Neuronal damage from excitotoxicity secondary to glutamate sensitivity. suspicious. abnormal proprioception. galantamine and rivastigmine Seizures 19 yr old woman has bouts of motor agitation. What interventions would be most helpful in this situation? Which meds have best results for treating agitation in dementia? Clock drawing test is quickly administered and sensitive screen for which d/o? Amyloid precursor protein in Most common cause of dementia: Individuals over 40yo with Down’s syndrome frequently develops: What baseline labs should be taken before starting tacrine? Known risk factors for dementia: Neuronal enzyme that is the target of drugs to treat Alzheimer’s i. standing 100/55. Treat with: Pick’s disease Nortriptyline Memantine Memantine 75 y/o with mild intermittent forgetfulness. During the interview. Lewy Body disease confusion. affect lability. Convulsive episode with leftward eye deviation. BP laying down 135/90. patient abruptly stops paying attention and begins rapidly pacing around the room. tx depression w/ Lack of prolactin elevation after szs suggests what kind of szs: Seizure focus right frontal region Psychogenic Seizure Prozac Non-epileptic . family hx. What should be the next step? Which procedure confirms the diagnosis of non-epileptic seizures? Video telemetry or EEG between episodes? Antiepileptic for juvenile myoclonic epilepsy Wait 15 mins. Down Syndrome Acetyl cholinesterase Video telemetry (CL: Should be more accurately called EEG Video telemetry) Valproic Acid Complex partial seizures are differentiated from simple partial seizures Simple seizures have no loss of consciousness by: but have altered responsiveness to outside stimuli.70 y/o woman has dementia. Lab studies reveal macrocytic anemia most likely caused by a deficiency of 74F PI. eyes deviate to right w/ hemiparesis of left side 28 female w/ HA. Frequent falls and dizziness when getting out of bed. Daughter would like to keep the pt at home if possible. BL limb and axial rigidity without tremor. seemingly meaningless writing. hallucinations. then obtain prolactin level ɛ4ɛ4 Dementia Assessing for caregiver burnout Anti-psychotics Alzheimer’s Alzheimer’s Disease Alzheimer’s disease Alzheimer’s ALT and AST (baseline and f/u) Age. and Vitamin B12 dysesthesia. indifference. asynchronous tonic-clonic sz. poor ADL’s Safest heterocyclic antidepressant for a 78 y/o with depression. gait disorder. AND: An 80yo pt with Alzheimer’s is brought in for increasingly combative behavior. Give what med? Increases probability of dx of Alzheimers Hyperphosphorylated tau proteins Haldol Dementia characterized by personality change. often followed by intense. Frontal lobe impulsivity. also mood lability. Postictally.

hyperesthesia of face Huntington’s Disease . 29 y/o awakened by headaches in middle of night. Located around L eye and assoc with lacrimation. activity What is EEG likely to show? EEG that reveals posterior alpha and anterior beta activity is most likely to have been obtained from whom? A relaxed adult with eyes closed Absence Endocrine 73 y/o man w/ onset of fatigue. followed by immediate and full resumption of consciousness without awareness of what has happened. triptans should NOT be given to: Patients with CAD Flashing lights traveling slowly from left to right in left visual field persist 30 minutes followed by difficulty with expression and concentration that subsides after 30 minutes. perceptual disturbances.32 y/o with partial complex seizures refractory to treatment. Doll’s eyes elicits full horizontal eye movements. swelling of face. and carpopedal spasm. tearing of the left eye and rhinorrhea. Lasts 2-10 seconds. His spontaneous limb movements are symmetrical. DX? Headaches Hypoparathyroidism 35 y/o M awakens frequently middle of night with severe Cluster headaches headaches. Sharp stabbing sensation in left nostril. Unilateral. followed by headache and nausea. PE shows alopecia and absent DTR. Cluster headaches periorbital. PE and MRI are normal. a 73-year-old man is comatose. lasts 1 hr. Cause? What is the diagnostic value of transient paresis or aphasia after a seizure? Complex partial epilepsy aura has what symptom? Localizes the focus of seizure Lip smacking Head & eyes deviate to right and right arm extends immediately before Left cerebral hemisphere a generalized tonic-clonic seizure Gustatory special sensory seizures (auras) localize where? Insular cortex First sz with focal onset and second generalization in a 58 y/o patient Glioblastoma multiforme is most likely the consequence of what? 10 y/o child freq episodes brief lapses of consciousness without premonitory sxs. weight gain. Associated with automatism such as lip smacking. Papilledema. The EEG shows? 8 y/o observed to have brief episodes (seconds) of interruption of Burst od 3 cycles per second spike & wave consciousness. ptosis and miosis. ptosis. Best test: 26 y/o male is awakened by early morning headaches that last 60-90 minutes. Headaches are so severe that pt is afraid to go to sleep. No association w stress. Which organic caused needs to be ruled out? Thyroid Physical finding associated with Hypothyroidism: Slow relaxation of deep tendon reflexes A 32 y/o s/p thyroidectomy presents c/o frequent panic attack. which sometimes occurs nightly and lasts approx 1-2 hrs. MRI nml. Dx? Young pt new onset headaches w/ periods of visual obscuration. constipation. Likely dx is: In treating migraines. picture of Mesial temporal sclerosis MRI shown. (picture) Drug-addicted healthcare professional experiences seizure that is not Meperidine a withdrawal phenomenon. Burst suppression pattern His eyes are open but he does not fix and follow with his eyes. The reflexes are mildly hyperactive. excruciating. + lacrimation and rhinorrhea. cold intolerance. rhinorrhea. severe muscle cramps. depressed mood. unilateral Cluster headaches lacrimation. These ictal episodes most likely caused by what kind szs: EEG 3 days s/p cardiac arrest and CPR. Asymmetry of pupils. progressive cognitive inefficiency. severe retro-orbital pain. Dx? Migraine w/ aura Lumbar puncture Cluster headaches Man awakens 4am with severe HA.

R leg weakness and shaking. no sensory deficit. no weakness. PM exam showed generalized brain atrophy. remote memory Often deficient on close examination even when is: it seems well preserved “My father was very involved in my life. R toe is downgoing. nucleated cells 10. Better after sitting down. +oligoclonal bands. After obstruction was relieved pt remained unconscious. Ankle jerk on Left is diminished. 26 year old with sudden onset back pain. reflexes symmetric. (Path picture of brain atrophy). Straight leg raising on the right is limited by sharp pain at 45 degrees. How to Dx? MRI of lumbar spine 50 y/o male with acute neck pain radiating down L arm. Visual hallucinations. Review of hx reveals several episodes of transient neurological deficits that resolved spontaneously after a few days. no sensory deficit. What test should be ordered? .1 F and was tx for UTI. Spasms in the right Order MRI scan of the lumbar spine paraspinal muscles in the lumbar region. gait problems. & truncal rigidity is seen in what condition? Motor dysfunction in Parkinson’s associated with: Characteristics of Parkinson’s tremor Spine New-onset back pain after shoveling – left paraspinal muscle spasm. Also progressive dementia and full time care. brisk DTR and musculocutaneous reflexes throughout. Current exam shows normal CN & sensory. Most appropriate treatment? Haloperidol Huntington’s disease Huntington’s disease High potency antipsychotics Unconscious filling in of memory gaps Thiamine A conscious memory that covers for another memory that is too painful Screen memory to hold in the consciousness is: Example of declarative memory Retention and recall of facts In patients with pronounced defects in recent memory.Treatment of Huntington’s chorea 98 y/o M in ER. festination. Management: Conservative (bed rest) with NSAIDS Reduce dose of levodopa Subthalamic nucleus Parkinson’s disease Parkinson’s disease Parkinson’s disease Increased activity in subthalamic nucleus and pars interna of globus pallidus Being Inhibited with Volitional Movement Declarative memory (facts) 23 y/o CF in office for f/u appt after an ER visit 2 days earlier for sudden diplopia. and equivocal plantar reflex on L. minimal R leg weakness. akinetic condition w diff swallowing and speaking. No muscle weakness. short term memory loss and believes wife is possessed by demons. Pt had fever 103. Recommendations? Implantation of deep brain stimulation electrodes is an effective tx for Parkinson’s. Her spinal fluid is most likely to show what? Protein 50mg. had cardiac arrest and died. negative straight leg raise. Pt had a progressive neuro condition presented in his early 30’s w involuntary irregular movements of all extremities and face but after 15 yr course evolved into rigid. Optimal location for electrodes? Gait disturbance w/ involuntary acceleration Lewy bodies visualized Gait consisting of : postural instability. difficulty w/ speech which resolved after a few hours. unconscious after choking on chicken. MRI of C spine to r/o cord compression urinary incontinence. Next step? 77 y/o gets numbness and aching in buttocks and thighs down to legs when walking > 100 ft. I remember going to football Medial temporal lobe games in the snow with him” is an example of memory associated with what part of the brain? What is the role of the hippocampus and parahippocampal gyrus? Parkinson’s Disorder Parkinson’s tx w/ levodopa. Diagnosis: Cross section of the brain picture with generalized atrophy: Treatment for Huntington’s disease: Memory Confabulation is: 45 y/o with nystagmus and ataxia.

HA. Pseudotumor cerebri Chronic acne treated with isotretinoin. Dorsal part of hand unaffected. and coma. Severe spasms and rigidity of limbs intermittently and later more Antiglutamic and anidecarboxylase (antipersistent/continuous: GAD) antibodies Progressive weakness over several days – absent reflexes worse Acute inflammatory polyneuropathy in lower extremities – slow conduction velocity. w/ Lumbar spinal stenosis weakness and numbness. weakness of opponens R thumb and adduction of 4th and 5th digits. decreased pinprick in sacral and perianal area. Decreased sensation R 4th and 5th digits extending into palm of hand and ending at crease of wrist. Reflexes intact. weak finger abduction/adduction especially 5th digit: Presence of mood disorder Metoclopramide Female Ulnar nerve entrapment at the elbow Injury R upper extremity in 29 y/o M. decreased R ankle jerk. pain persists with standing. particularly thumb. middle finger bilaterally. MRI lumbar spine continues to have back pain radiating to R leg. Arms aches in morning from shoulders to hands. Relieved by sitting. forefinger. Dx? Loss of pain and temp sensation on one side with motor paralysis and Hemisection propioception on the other. Lumbar puncture elevated opening pressure with no cells. CT low-density lesion in L temporal lobe. Culprit: Which gender has a higher risk for tardive dyskinesia (TD)? General Neurology Persistent numbness n the L hand. 62 mg/dl glucose. a pregnant 38 y/o F has numbness in both hands. tends to rotate neck to left – touching the chin Treat with botulinum toxin prevents deviation – prominent right SCM spasm. BL papilledema and no other abnormalities. Cause: Right neck pain. shooting down legs. confusion. discomfort with low frequency sounds. Tx? Severe occipital HA. tearing of the left eye. and left facial weakness on exam. stupor. EEG with lateralized high-voltage sharp waves arising in the L temporal region. Next step in management: 68 y/o pain in buttocks while walking. decreased sensation in 4th/5th digits (palmar/dorsal). Tenderness in lumbar paravertebral area.Patient treated conservatively with analgesics and muscle relaxants. Spinal syndrome is: Contralateral loss of pain and temp sensation Brown-Sequard syndrome includes: beginning below lesion Fall from a ladder with persistent back pain and inability to void. with slow wave complexes repeating at 2-3 second intervals. CT is normal. difficulty holding pencil in R Ulnar nerve hand. Diagnosis: Mechanism of action of botulinum toxin at neuromuscular junction: Benign intracranial HTN etiology: Median neuropathy at the wrist Inhibition of acetylcholine from presynaptic terminals Hypervitaminosis A Fever. weak flexion of right foot. Internuclear ophthalmoplegia is an ocular motility disorder often Multiple Sclerosis seen in patients with: During 2nd trimester. Dx?*** . conduction block Patient with pain behind the left ear progressing to numbness of Idiopathic Bells palsy the left side of the face. seizures. and 22mg/dl protein. Dx? Tardive Dyskinesia The single most consistently documented and significant risk factor in Advanced age the epidemiology of tardive dyskinesia is? Risk factor for TD TD in 63 y/o w/ end stage renal failure. evolving over Herpes Simplex Encephalitis several days. increased by coughing/sneezing. Cauda equina compression Bilateral leg weakness.

Increased Romberg sway. Vascular evaluation of lower extremities Vasovagal syncopal attack 81 y/o. Dx? Peripheral neuropathy 14 year old after a demanding physical test becomes extremely weak Periodic paralysis and unable to stand. followed several days later by progressive weakness. Also creeping and crawling sensations in legs. 3 days fever. Later has problems with horizontal&vertical gaze. Slowness/rigidity improved slightly with levodopa. Difficulty in Progressive Supranuclear Palsy voluntary vertical upward/downward gaze. malaise and severe pain L ribcage. Test most likely to yield Dx? Closed TBI. EKG: minimally prolonged PR. Pt has difficulty walking with broad-based. A tuning fork used during the Weber test reveals a failure to lateralize. initially no LOC. stiff-legged gait. Pain relieved by stopping for a couple of minutes. ankle jerk clonus. Ankle jerks are absent. unequal. She has trouble discriminating words “fat” “cat” “mat”. small pupils nonreactive. Cervical spondylosis Stiff legged gait. QT interval.8. then resuming. caused by Ulnar nerve lesion Severely sensitive. Increased LE tone/spastic catch. and the woman's perception of air conduction is better than that of bone conduction. slow movement. involuntary saccades Unilateral foot drop with steppage gait indicates: Progressive Supranuclear Palsy Peroneal nerve compression Mucosal lesion that heals and then pt has pain in trigeminal nerve area Post-herpetic Neuralgia 49 y/o w/ DM2 presents with severe burning of soles of feet and insomnia b/c the touch of the sheet against the feet is painful. Labs: K=2. +3/5 weakness of LE. hyperactive knee jerks. Most likely dx is: Ropinirole Restless Legs syndrome Tremor decreasing with volitional movements and appears primarily in Resting tremor an attitude of repose: Gait abnormality. Father and grandfather had similar episodes. PE shows sensory level at T10 to pinprick. Oculocephalic reflexes normal. lasts few seconds. asymmetric UE rigidity. No sensory or motor deficits. Urge to move legs can be suppressed voluntarily for short while but is ultimately irresistible. Knee and ankle jerks are hyperactive. decreased sensation in 4th. *** Upper motor neuron lesions have: Weakness and spasticity Pt c/o pain when walking that radiates from lower back and is severe in the calves. 5th digit. Patient recovers in 5 minutes. slightly weaker on R. Causal agent: 58M truck driver w/ weakness/numbness of left hand Ulnar neuropathy Weakness of opponens of thumb and adduction of 4th. b/l babinski. QRS. PE is positive for depressed DTR’s. 5th digits extending into palm and ending at crease of wrist. Dx? Transverse myelitis Severe jabbing pain. 50% reduction in vibratory sense at ankle and impaired proprioception at toes. but knee jerks present. R>L. Dx? Best pharmacologic tx for Restless Legs Syndrome? Pergolide . adducts legs while walking. Poor vertical eye movement. then 20 minutes later LOC. do not dilate. lancinating pain on the cheek Trigeminal neuralgia What condition is a forerunner of MS? Transverse Myelitis 23 y/o develops tingling paresthesias in the lower extremities. triggered by light touch on Tic douloureux face Irregular. h/o similar episodes after strenuous exercises. but do constrict to accommodation Most common symptom in narcoleptics Syphilis Sleep attacks 49 y/o with gradual hearing loss. Exam shows decreased sensation to pin and touch up to ankle.Stiffness of legs while walking and spasms of LE while sleeping. Red rash with Varicella Zoster Virus clear vesicles overlaid in T5 dermatome. Dx? Sensorineural hearing loss (b/l) Which drug for the tx of parkinsonism has been associated with sudden sleep attacks? 65 y/o M trouble falling asleep 2/2 unpleasant aching and drawing sensations in calves and thighs.

thumb. Dx? Pt with double vision when looking to the left shows her eyes on Internuclear ophthalmoplegia primary gaze. extensor pollicis longus) and in wrist/finger flexors. On right gaze and vertical gaze the eyes move normally. No paresis or reflex abnormalities in extremities. pupils constrict well with light on R eye. Dx? Which med reduces accumulation of plaques and disability in pt’s with Interferon beta-1a relapsing remitting MS: 3 month progressive limb weakness L>R. index. Major depression. feet dorsal flexors. CT with normal atrophy. Dx? Young adult w/ headache behind left ear. Spinal fluid of patient w/ acute inflammatory polyneuropathy shows: Inclusion Body Myositis High protein. Optic neuritis Diminished acuity in L eye. PTSD. Sensory systems in the ring finger split the ringer finger longitudinally. MRI shows: Treatment of Trigeminal Neuralgia: Electrophysiologic signs of denervation: Gabapentin Fibrillation and positive sharp waves . CSF Herpes Simplex Encephalitis shows lymphocytic pleocytosis and many RBC’s. Normal CN. ptosis. tinnitus then vertigo 22 year old with pain in the right hand that radiates into the forearm and bicep muscle. and irritability (MRI shows hyperintensity in frontal lobe and what looks like a finger protrusion) Horner’s syndrome is characterized by? DM patient with creeping paresthesias and burning pain in L anterolateral thigh. when looks left has isolated L eye nystagmus. DTRs normal.Resting. MRI shows T2 hyperintensity in the Left temporal lobe. intellectual deterioration. Dx? 75 y/o WWII veteran w gradual onset forgetfulness. weakness in neck extensor muscles. incomplete closure of left eye w/ blinking. Alzheimer's disease. Dx? Female with vertigo and diplopia. with gadolinium enhancement in this area in T1 weighted image. poor effort maintenance. On left gaze the right eye fails to adduct and there is nystagmus in the left eye. (NOT dissociative amnesia) Patient s/p surgery develops weakness and wasting of small muscles Lower brachial plexus paralysis of the hand and sensory loss of the ulnar border of the hand and inner forearm. fast/slurred speech. Dx? Hippocampal atrophy has been identified in all of the following disorders: Miosis. DTRs normal. cognitive impairment. but only constrict weakly with light on L eye. Dx? Recurrent deafness. reduced perceptual motor Multiple Sclerosis speed. non-intentional tremor Parkinson’s disease 25 y/o female with L eye pain which increases with moving the eye. middle ring finger. No sensory deficit or other cranial nerve deficit. Dx? Neurosyphilis Brief episodes of sudden loss of muscle tone. increased gamma globulin. problems swallowing. with intense emotion are characteristic of: narcolepsy Term for sudden. and cannot adduct R eye. protein 110. lower face on left. Pupils round and reactive. normal cell count 49 year old develops seizure disorder that is difficult to control. Dx? Multiple Sclerosis 41 y/o chronic fatigue. Paraesthesias in the palm of the hand. Elevated CK. no weakness. Gadolinium enhancement of left facial nerve Impaired taste sensation. LP=35 WBCs (most lymph). Speech nasal and neck flexors weak. Motor tone/coordination/gait normal. in distal and proximal muscles (quadriceps. L ptosis and difficulty keeping L eye adducted. & anhidrosis of forehead Meralgia paresethetica Meniere’s disease Median nerve entrapment at the wrist. irrepressible shock-like contraction of a muscle triggered by an event in CNS? Neoplasms of the thymus are associated with: Myoclonus Myasthenia Gravis 20 y/o occasional double vision when looking to R and normal acuity in Myasthenia Gravis each eye alone. 2 days later twisting of face. EEG shows periodic discharges. gait impaired. Paralysis of forehead.

wine improves. Exam normal but no reaction when light shone on L eye. Spinal fluid shows no cells and elevated protein. and painful tingling in both feet and incoordination. Urinary incontinence. and learning 25 y/o male with 7 months of depression. medial brainstem fine motor tasks. Underlying illness affects neuronal bodies where? 45 year old with gradual progressive weakness over the past 3-4 months. EMG has increased amplitude with repetitive nerve stimulation. leukocytes 5. During admission he develops severe akinetic mutism and seizures and dies. This is consistent w: Seen in electrophysiologic testing in myasthenia gravis Demyelinating lesion of L optic nerve Decremental response to repetitive stimulation Involuntary set of flowing jerky movements in multiple joints describe: chorea 34 y/o with persistent numbness in thumb/forefinger/middle Carpal tunnel syndrome finger/palm in the fourth month of pregnancy. degeneration. Arm muscles twitch and cramp easily. Is familial. EEG mild diffuse slowing. protein 110. spongiform neuronal insomnia. attempts to look at person/object Blepharospasm results in tonic eyelid closure. CT/MRI normal. absent DTRs. weak neck muscles. Dx? Gradually progressive weakness of legs and dysarthria over months – Amyotrophic lateral sclerosis fasciculations of tongue – prominent left upper extremity weakness – muscle spasticity – brisk reflexes – normal sensation Fasciculations. Dx? 25 y/o pt with pain in L periorbital region. Dx? Adult LP with opening pressure 190. unreactive pupils. Weakness and numbness below middle of thorax. diffuse amyloid plaques. forgetfulness. particularly in the LUE. Orbital pain with L eye paralysis of adduction and elevation of the eye Diabetic 3rd nerve palsy but normal pupil function. ptosis. dysarthria. Can watch television without difficulty. coordination. clumsiness and weakness with holding objects. protein level 37. Dx? Bacterial meningitis Inability to carry out motor activites on verbal command despite intact apraxia comprehension & motor function indicates? 55 y/o hx of weakness and clumsiness x several months. Essential criterion for the declaration of brain death prior to organ donation requires? A positive apnea test . cranial nerve exams wnl. increased when using hands/writing/volitional activities. plantar reflexes are extensor. nml glucose Weakness in limbs 2 weeks after a viral gastroenteritis. Weakness in Acute inflammatory polyneuropathy UE/LE. hoarse voice. glucose 27. fibrillation and sharp waves. Diabetic 6th nerve palsy Exam=paralysis of abduction of R eye. Labs normal. Difficulty w/ Anterior horn of spinal cord. Dx? Drug for trigeminal neuralgia (most effective in treatment) carbamazepine 53 y/o with insidious onset of blurred vision. Stress worsens. and severe astrogliosis Involuntary choreic movements of BL UE. extensor plantar reflexes. Increased LE DTR’s. Most common cause of aseptic meningitis: What does the cerebellum do in the human adult brain? Essential tremor Enteric virus Diverse roles in movement. Reflexes Amyotrophic lateral sclerosis are generally brisk. weight loss. weakening. Sensory. Pain radiates to forearm. is apathetic and monosyllabic. behavior. Amyotrophic lateral sclerosis Atrophy of the intrinsic muscles of the right arm and forearm.Shaking hands. diplopia x1 day. Electrophysiology shows widespread fasciculations. LP 23 mononuclear cells. Botulism 6th nerve palsy. followed by blurring then loss of vision in left eye. Brain autopsy shows: 55 y/o with DM and HTN develops R periorbital pain and diplopia.000. fibrillations. Dx? 5 y/o cannot maintain eyes open. positive sharp waves on EMG + progressive weakness over several weeks Amyotrophic lateral sclerosis Young pt recovering from flew-like illness w/ progressive weakness Acute transverse myelitis and numbness of legs and feet. and cortex atrophy. Extraocular movements normal.

numb. No new stressors. PCP. insomnia. multimeric ion Increase probability of opening in presence of a channels do what? ligand. poor appetite. PE normal. lasts several minutes. All labs and scans normal. impaired Acute stress d/o memory for accident What symptom is more likely to occur in acute stress d/o than in PTSD? Reduction in awareness of surroundings . nicotine. dysarthria. One week earlier pt witnessed her child being fatally injured in a motor vehicle accident. What diagnosis is likely? Adult in MVA. What area of the body has the most serotonin? Neurotransmitter assoc w/ reward & reinforcement in nicotine dependence Radiology Neuroimaging that measures neuronal glucose metabolism CT scan is better then MRI for what? What does functional MRI measure? PET scan Differentiating hemorrhaging from edema. Anxious. and progressive nystagmus. Disappears spontaneously or when called by his wife. and difficulty performing daily routines. not uncomfortable. Dx? Paralysis when awakening. Detects blood flow GI tract Dopamine Sleep 5 y/o with screaming/crying for no reason about 1 hour after Sleep-terror episode falling asleep. trembling. 1) Antibody panel with presence of ? 2) What type of tumor is likely present? Neurotransmitters Where are the major clusters of cell bodies containing serotonin in brain? DA release in which structure represents a common final event associated with the reinforcing effects of opiates. Can see/hear but cannot move during episodes. Boy has no memory of the event. detached. morning headaches. sweating. stops with falling asleep Age-related sleep pattern change Predominantly non-REM sleep problem What aspect of sleep is increased in older adults? Sinusoidal waves at 9-11 Hz on EEG is: 67 y/o with MDD doing well on SSRI but continues to have insomnia and sleepiness during day. decreased stage 4 sleep. mother cannot gain his attention for 5 minutes. Snores loudly. and night sweats. daytime sleepiness or h/o falls. nonpathological Greater wakefulness intermixed with sleep Enuresis Duration of awakenings Deep sleep Breathing-related sleep disorder REM sleep behavior disorder associated with which pathology: Involuntary jerking of legs while falling asleep. Sits up in bed with eyes open. MRI and CSF normal. amphetamines. MDD has what sleep abnormality? Sleep paralysis Shortened REM latency. and alcohol? What neurotransmitters has been associated with anxiety? Raphe nucleus in brain stem Nucleus Accumbens Norepinephrine Positive allosteric modulators of neurotransmitter-gated. no head trauma. Dx? Axis I Disorders Acute Stress Disorder 32 y/o with no psychiatric history brought to ER with 2 days of memory Acute stress d/o loss.41 y/o without family h/o corticocerebellar degeneration presents with 1) anti-Yo 2) Ovarian Carcinoma 3-month h/o ataxia of gait/limbs. Neuro exam normal. cocaine. No hallucinations. increased awakenings in the second half of the night Parkinson’s disease Normal phenomenon. nightmares.

As adult still has symptoms. mild tremor Prevalence of separation anxiety d/o and GAD in children follows what GAD increases/Sep anxiety decreases with age pattern with regard to age? 18 y/o restless. bupropion. euthymic. oppositional defiant disorder.Acute stress d/o differentiated from PTSD by ADHD Duration of sx’s A 7 y/o child BIB parents report he’s been hyperactive since age Teacher report 4. Dx? Anxiety Disorders Differential Dx of anxiety in the ER typically includes Treatment for severe performance anxiety Pulmonary Embolism Propranolol 36 y/o with several episodes of palpitations. Tx: Methylphenidate Which psychiatric disorders is co morbid with ADHD? Disruptive behavior disorders ADHD comorbid disorder These empirical non-stimulant meds have empirical support to treat ADHD: What procedure is necessary to diagnose childhood ADHD? Antidepressant for ADHD Depression clonidine. No change in sleep. imipramine. low BP. insomnia. 32 y/o w/ ADHD mixed type as child. irritability. appetite. fidgety. 3-month hx of anxiety. He sleeps well and his appetite is good. used to be good student up until 2-3 yrs ago. no substance use GAD Core feature of GAD 35 y/o truck driver dx’ed w/ GAD. feels mind going blank. History indicates he was treated with stimulants since second grade. His energy level is low. will not play quietly outdoors. sweating. Does not want med that causes sleepiness Bipolar Disorder What predicts bipolarity in adolescent with depression? Which med is treatment of choice for bipolar with rapid cycling? Excessive worrying Buspar Psychotic symptoms Valproate . interrupts. Work suffering due to anxiety. What did the findings of the study reveal w/ respect to ADHD symptom changes? Current thinking about relationship between ADHD in children and adults: Significant number of children will go on to become adults with ADHD Abnormal LFTs would be most commonly associated w/ what medication used to treat ADHD in children/adol? Pemoline 8 y/o boy with ADHD. fatigue > 1 yr. poor concentration. Initial tx regimen: Paroxetine and CBT Weight loss. has trouble sitting still to do homework. What else do you need to make the dx of ADHD? Child w ADHD ineffective tx with methylphenidate. Next step in management: Dextroamphetamine The multimodal tx study of children w/ ADHD examined the Medication management superior to comparative responses over 14 months of children to medication community care treatment and intense psychosocial interventions. SOB. and chronic motor Monitor the tics only tic disorder has worsening of his tics on a good dose of a stimulant that seems to control his ADHD. thin. Hyperthyroidism elevated HR. atomoxetine Clinical interview of parents and child Buproprion Studies show effective intervention for children with ADHD is to involve Behavioral management their parents in what part of tx? What med used for ADHD has been associated with liver damage? Atomoxetine (Strattera) Failing grades. mild depression. poor organization. talks constantly. trembling. & insomnia. spending sprees. How do you manage this further in trying to improve the tics? Which med would you prescribe for 20 y/o college student being Methylphenidate worried over his grades? He complains that he has not been able to focus on studying and that his mind wanders frequently during classes. spontaneous trips ADHD ditching class. no anhedonia.

poor appetite. Treatment of choice? 40 y/o w/ 6 kids: insomnia. inattention. spells backwards. type I Marked fluctuations of mood from sadness to euphoria five times over Bipolar disorder w/ rapid cycling course of one year. Which diagnosis likely: Hx of MDD. low self esteem and poor concentration possibly has dysthymia.Bipolar pt w/ 2 hospitalizations for mania taking lithium Needs lifetime lithium tx First-degree relatives of patient with BMD II have a higher incidence of MDD what disorder? What drug is good for acute mania? Lithium 32 y/o with diarrhea x2 weeks. Which feature would support the dx? Unipolar Major Depression Sxs > 1 year 10 y/o child with 2-month h/o irritability. neg med w/u Normal M except is paranoid about wife cheating on him Patient believes he is the Son of God. What med caused these sx? BMD II with rapid cycling have higher prevalence of what endocrinologic dysfunction? What symptoms are seen in a manic episode but not in MDE? Suggest underlying bipolar in 27 y/o female who presents w/ first major depressive episode Tx of acute mania w/ lithium. distractible. no eye contact and has psychomotor agitation. both mood and cognition are improved. Paranoid delusion that husband is trying to kill her. SSRI and withdrawal. and not oriented to Lithium date/time of day. No family h/o psychiatric d/o. 1200 mg daily Bipolar w/ rapid cycling Bipolar disorder. What is the best adjunctive agent? Bipolar w/ 4+ manic episodes / yr for 3 years. but slowly. messes up serial sevens. Dx? DSM-IV defines h/o major depression plus h/o mixed manic and depressive episode as: Hypothyroidism Flight of ideas Family hx of bipolar ECT Carbamazepine. insomnia. impulsive spending Bipolar d/o. What medication should treat? . dizziness/nausea. sleep disturbance. Taking “some drug” for BMD and patient doubled her dose a month ago when she felt she wasn’t getting better fast enough. restless. mixed Delusional Disorders Term for unreasonable and sustained belief that patient acknowledges Overvalued idea may not be true when challenged Length of time criteria for delusional d/o Body dysmorphic d/o vs. Despite all classes of meds marked fluctuations from sadness to euphoria 5x during the year. After 4 wks of trazadone. Dx? Which depressive symptom is a melancholic feature specifier in Lack of pleasure DSM-IV? Depression increases risk of mortality from what dz? Hepatitis C treatment with interferon can cause what psychiatric symptom? Ischemic heart disease Depression One month Intensity with which pt insists on perceived body deficits Delusional d/o. is anxious. Delusional d/o somatic type: Complaints of skin infection with insects. somatic type Delusional d/o Delusion An important distinction between depressive symptoms in patients with Usually maintain intact self esteem cancer as compared to those patients with depression but no cancer is that the patients with cancer? WHO study 1990. On examination. poor appetite. This sx is called: Depression 60 y/o w/ depressive syndrome has memory problems. Incorrect Pseudodementia on date. guilt. Child attempted to run in front of a car. what is 2nd worldwide leading source of years of healthy life lost to premature death/disability (#1 is ischemic heart disease): 17 y/o with depressed mood. thinks husband is poisoning her. irritable.

Distant with psychiatrist. has stressors and depression. and cognitive inefficiency are worsened by what medication? Not useful in routine clinical practice Mood-congruent delusion Mood-congruent delusion MDD MDD Lower Dose of Antipsychotic Meds. guilt. Several month hx of depressive sx’s. 60 y/o with depression & paranoia treated with 50mg Zoloft and 6mg risperidone. looks fatigued. feels ineffective at work. Which prophylactic treatment should be recommended: Suicidal thoughts. 8-12 year-olds w/ depression most often show what? Somatic complaints 27 y/o M seen in ED c/o insomnia. experience the Expectation of continued failure world as self-defeating. She says “When the real darkness descends on me specially in the middle of the night I don’t want to call anyone. lacks energy." What is more indicative of MDD rather than uncomplicated bereavement Having thoughts of suicide Treatment of Adolescent Depression Study showed what modality to Fluoxetine and CBT be best treatment of depression? Cognitive triad of depression: negative self-perception. Mood and paranoia have greatly improved. Tx? Electroconvulsive therapy (ECT) Distorted negative thoughts Depression Cyclothymic disorder Continue imipramine 200 mg x 5yrs Consider tx w/ antidepressant . decreased SIMD concentration for 2 weeks and is now acutely suicidal. “I can't accept he is gone…. Depressed to happy in the morning. I should have been able to save him”. Leaden paralysis Irritability Interferon Interferon 77 yr F whose husband died 6 wks ago complains about the length of time it took for the dress. tx? Pancreatic cancer patient just diagnosed. depression. constant worrying. after successful treatment w/ imipramine 200 mg qd. dehydration. No insomnia or poor appetite. anorexia. hopelessness. On PE masked faces and cogwheel rigidity present.Compared to older adolescents with depression. She sounds irritable. What is the next step? What is a characteristic of atypical depression? Major depressive episode in children presents as: What medications may cause mood d/o in pts being treated for melanoma? Fatigue. feels depressed. “The only family at home is my gun” An effective antidepressant for depression w/ atypical features is Sertraline Reproductive years Relaxation Training Place on suicide precautions phenelzine Child must have depressed or irritable mood for what length of time in One year order to meet criteria for dysthymic do? Dexamethasone suppression test for diagnosing mood disorders: 50 y/o individual with depression believe he is responsible for the destruction of the world. Pt has h/o ETOH use daily for the past 3 months. No episodes meeting criteria for mania. AH of voice telling him he is bad. AND? What augmentation strategies for treatment-refractory depression has Electroconvulsive therapy (ECT) shown the highest efficacy and replicability? Tx for worsening depression. hypersomnia. This is an example: Depressed pt believes responsible for destruction of world 61 y/o with left frontal lobe damage secondary to cerebrovascular accident may be predisposed to which psychiatric syndrome? 9 y/o with increased irritability and aggression for 3 mo. severely weight loss. Hx suggests most likely dx? Pt w/ unipolar depression has had 3 recurrence of depression each separated by 1 yr. according to Beck's model is a manifestation of: Which disease is most likely to present as pain disorder 34 yr woman presents “unable to reach her potential” with mood switches frequently (day to day and sometimes within one day) from mildly to moderately. What is the most likely Dx? First-line tx for 9y/o w/ depression Women at highest risk of MDD during: M w/ HTN and MI. Used to be easygoing. no support system. catatonia Depression. tells nurses he wishes he was dead. Grades dropping. On follow up pt c/o slow thinking & excessive salvation.

The recent confusion is NOT caused by Melancholia is characterized Pt whose spouse had left 5 days before reports sleep problems. weight loss. loss of energy. Was dx w/ MDD several months ago and taking doxepin 25 mg tid and diazepam 5 mg tid were d/c before surgery. Possible laxative abuse. Currently on meperidine. mechanical movements. Dx? Combination of antipsychotics and antidepressants Cognitive distortion Cerebral involvement Bupropion Atypical depressive disorder anhedonia Adjustment d/o with depressed mood 35 y/o pt presents with severe depression with episodes of anxiety for Addison’s disease 9 months that have become so bad he can no longer leave the house. has severe weight loss. skin Phenolphthalein pigmentation. loss of appetite. steatorrhea. diarrhea. what diagnoses has been seen as a culture bound syndrome in north America? Patient with memory lapses. and cold tolerance. purging subtype? Bulimia and depression. “Do you find things in your possession that you cannot explain?” Trying to elicit: Detachment of emotional component from perception 20 y/o in MVA. Stat lab Potassium test: Abdominal pain. and crying especially at night. diphenhydramine. hypokalemia. Dx? How many symptom-free weeks must be between two episodes of depression for them to be considered separate and therefore recurrent according to DSM-IV? 8 symptom free weeks Dissociative Disorders Focused attention and altered consciousness usually seen in pts with Trance dissociative disorders is called Whenever the culture of western med has been a focus of inquiry by anthropologists. Contraindicated: What test findings are associated with anorexia and bulimia? Bulimia nervosa presents in which personality d/o? Which enzymes can be increased in serum of pt’s with bulimia: MDD Hypochloremic alkalosis with hypokalemia Emphasize how treatment will allow the patient to focus energy on other matters. no injuries – speaks softly. Measure: Complication of anorexia nervosa least likely to resolve after restoring Osteoperosis weight is? Bulimia comorbid with What electrolyte abnormality is most seen in bulimics? In overcoming the resistance to treatment often encountered with patients who have anorexia nervosa. Also little frogs in her room.Prophylactic Treatment for a pt with severe delusional depression following a course of ECT includes what? Beck says primary defect in depression Presence/severity of depressive sx in MS is correlated with: 29 y/o M h/o recurrent depression & 1. what is it most useful for the psychiatrist to emphasize? What metabolic abnormality is commonly found in pts with anorexia nervosa. feels calm. Medication? 8 days after hip surgery a 75 W has episodes of disorientation. dim vision. hyperpigmentation of exposed skin. hypokalemia. poor concentration. sadness. feels detached Pts that “cut” as a form of self-mutilation typically _. anhedonia. amenorrhea. In mid morning she is ok. and elevated serum amylase Borderline Amylase . despair.5 PPD smoking. sleeplessness. Decreased serum potassium Bupropion Bradycardia. talks like an adult at times then like a scared child at other times. SI. Dx? Psychiatrist asks. Eating Disorders The primary focus of behavior therapy in the treatment of anorexia nervosa is to Restore weight Dissociative identity do Dissociative identity disorder Dissociation Derealization Depersonalization Claim to feel no pain Dehydrated bulimic w/ BP 100/60 and orthostasis HR 60. Functioning fine until spouse left.

interferes with work. Is this likely factitious d/o or malingering? Impulse Control Disorders What is a very common impulse control d/o NOS? Comorbid condition w/ pathological gambling Pathological gambling in what grouping OCD Hx of OCD. Pt's lies are grandiose and extreme. He provides the MD with a list of immunosuppressive meds and requests that a transesophageal echo be done. mortality rates for anorexia nervosa are: Factitious Disorder What factor differentiates malingering from factitious disorder? Psychiatrist is evaluating frequent liar. describes: 25 y/o with OCD diagnosed 2 years ago is likely to benefit from what medicine (in addition to psychotherapy)? Clomipramine 35M w/ severe OCD. failed multiple meds.2 Having external incentive Pseudologia fantastica 25 y/o prisoner claiming to be depressed is hospitalized after he Factitious disorder swallowed some razor blades. Dx? What condition shows motivation to assume the sick role? Factitious disorder 24 y/o M seen in ED with chest pain claims to have a rare connective Factitious d/o (malingerers usually avoid invasive tissue d/o and said he required a recent heart transplant due to aorta tests) dissection. Compulsions while recognizing the irrationality and absurdity of the behaviors. or image that causes marked distress is Obsession Obsessive-compulsive symptoms are characterized by which defense Isolation and undoing mechanism? What infectious agent can exacerbate or cause initial manifestation of Group A beta-hemolytic streptococcus OCD in children? M obsesses about killing his g/f. What section on PET will have increased activity? Pediatric Autoimmune Disorder Associated with Streptococcus OCD (PANDAS) is associated with what disorder? Children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) often manifest: Panic Disorder Choreiform movements and OCD symptoms . what next? Cingulotomy Patient presents to PMD thinking he has contracted infectious disease. Pt appears to believe the stories. impulse. Medication Patient with contamination fears and hand washing rituals is treated with response prevention combined with: Principal behavioral technique for OCD Exposure therapy Exposure & response prevention Repetitive behaviors that the pt feels impelled to perform ritualistically. This is called 85 percent 0. No drug or past psych/med hx. Zoloft only partially effective. He has no sternotomy scar and outside records indicate his story is false. Razor blades were carefully wrapped with surgical tape before swallowing. picks his face w/ a Fluvoxamine pin. thought. Instead of killing. CBT and ECT. Caudate Constant worrying. repetitively counts to 100 to distract from worry. Next: Try another SSRI Pathologic gambling Major depression Impulse Control d/o A genetic susceptibility for OCD is suggested by evidence that there is Tic disorders a familial link with Anterior capsulotomy and/or cingulotomy are indicated and demonstrated effective for pts with what severe incapacitating disorder? Which condition is least likely to respond to hypnosis? OCD OCD Persistently intrusive inappropriate idea. Confesses he wanted some time out of prison.Anorexia dx requires wt below what percentage of normal wt At 30 years after presentation for treatment.

pharmacological tx of pts with panic d/o should generally continue for what length of time? Phobias Diagnosis for child w/ behavioral inhibition Social Phobia Panic d/o Anticipatory anxiety (in panic d/o) A few minutes 8-12 mos 10 y/o is seen in outpt clinic w/ hx of extreme fear of using the bathroom at school. palpitations. pressured speech. social phobia. Grades have fallen significantly in period after abuse began and peer relations have suffered as well. dissociation. flat affect. anxious. afraid to go to work. Parents concerned re: anhedonia. mumbles to self. ataxia. repetitive play. insomnia. avoiding people Social phobia Principle aim of treatment of child with school phobia is: Return child to school Most effective approach in behavioral treatment of phobias: PTSD What symptom commonly develops relatively late in children with PTSD? Sense of foreshortened future 12 y/o disclosed to counselor hx of sexual abuse by relative. He states to be afraid that other children will laugh if they hear or smell him in the bathroom. poor sleep. and stupor. Dx? Dysprosody is an abnormality of What is a negative sx of schizophrenia? 20 y/o avoids everyone but parents. grandiose. vomiting. No psychotic sx’s. intrusive thoughts Sx for F 2 months after traumatic experience Schizophrenia Schneiderian first-rank symptom of schizophrenia: What factor is a good prognostic indicator in schizophrenia? Successful psychosocial interventions in schizophrenics: 16 y/o boy treated as outpatient for Schizophrenia after recent inpatient first break. shaking. Goal of outpatient eval: Late-onset schizophrenia is more common in men or women? Hearing voices arguing about oneself Female gender Assertive community treatment Address patient’s feelings of depression and screen for SI women PTSD PTSD Increased arousal and intrusive thoughts In-vivo exposure 44 y/o pt with schizophrenia is admitted to an inpatient psychiatric unit. sleep problems. flushing. nightmares. Dx? Social phobia Avoids interpersonal situations due to anxiety and panic attacks Social phobia 28 y/o M episodic anxiety. diarrhea. Hears indistinct voices PTSD saying name 30 y/o impulse to cut. Water intoxication After several days pt has muscle tremor. crying frequently. restlessness. withdrawn. irritability. polyuria. chest tightness. Report PTSD made to authorities. Always quiet. Denies depression or substance use. sits at home doing nothing. Delusions. Stopped going to school. During eval. some bizarre movements. Dx? 10 y/o fearful. Mostly at work or w/ group of friends. No psychosis. 38 y/o lost leg in accident 1 mo ago. Insomnia. Characterizes schizophrenics that smoke 29 y/o 1 wk euphoria. inability to concentrate due to thinking about event. Embarrassed. Feels everyone watching him.What is the principle goal of the cognitive-behavioral therapy of panic Using restructured interpretation of disturbing d/o? sensations Hyperthyroidism should be ruled out as part of the DDx of what psychiatric d/o’s Which clinical feature distinguishes panic disorder from pheochromocytoma? Panic attack reaches peak in Once it becomes effective. pt reports anxiety. Need what else for dx schizoaffective d/o Subtype of schizophrenia less severe and starts older Speech Social inattentiveness Schizophreniform Require more neuroleptic med Psychotic sx’s x 2 wks in absence of mood sx’s Paranoid . Flashbacks of childhood abuse. AH. twitching.

lack of precipitating factors Duration Crossover to clozapine Chronic course. dry skin. somatization d/o? Somatization d/o Low intelligence Look again for organic etiology Fear of having a disease Alogia Acute onset 24 y/o w/ sudden onset stumbling and pain in legs. elevated Anticholinergic intoxication temperature. negative psych eval Main clinical factor of hypochondriasis vs. negative neuro Conversion workup – saw a counselor previously for protracted grief after father’s death – increased conflict with husband Tourette’s Disorder What symptoms are most commonly associated with Tourette’s syndrome? Pathologic findings in brain of Tourette’s? What antipsychotic medication is helpful in treating Tourette’s? which med is helpful in Tourette Syndrome who can't tolerate clonidine? One of the earliest sx of Tourette’s: Comorbid condition w/ Tourette’s in kids: Obsessions and compulsions No abnormality Haloperidol Guanfacine Eye-blinking and head jerking ADHD Personality Disorders Which disorder has greatest co-incidence of alcohol abuse and dependence? Which personality d/o should be considered in diff dx of cyclothymic d/o? Antisocial personality disorder Histrionic . dilated pupils.Most closely correlates w/ social fx in schizophrenics: Communication d/o assoc w/ neurological and psych d/o 28F mute. Not on meds. catatonic. delusions Cessation of smoking Carbamazepine Capgra’s syndrome Schizophrenic with VH. Cause? Identical-appearing imposter has replaced Dad Negative symptoms Mutism Lorazepam Initial onset during adolescence Inappropriate saccades (saccadic intrusions) Hallucinations of two or more voices conversing Echolalia Early age onset. negative medical workup. What tx? What condition in patients with schizophrenic or schizophreniform psychosis is associated with poor prognosis? Most common eye tracking movement abnormality in pts with schizophrenia? No additional criterion A symptoms are required for the diagnosis of schizophrenia if the patient has which symptom? What is the term for senseless repetition in schizophrenics? What is associated with poor prognosis in schizophrenics? Schizophreniform disorder differs from schizophrenia primarily in Schizophrenic with poor response to 3 trials of antipsychotic meds. agitation. Cause? Schizophrenic stabilized on haldol 10. Return of psychotic sx’s after starting med for another condition. multiple organ systems What is commonly associated with conversion d/o? Somatic sx/complaint. rigid. marked thirst. unfavorable prognosis. hallucinations. next step? What are the characteristics of childhood-onset schizophrenia? Schizophrenic on haldol 10 develops acute EPS. Dx? Poverty of speech and content are Good prognostic feature in schizophrenia Somatoform Disorders Preoccupation and fear of having contracted serious disease Hypochondriasis based on misinterpretation of bodily sxs despite medical eval and reassurance 25 y/o referred by plastic surgeon. negative symptoms. claims that part of her face is Body dysmorphic disorder swollen Multiplicity of complaints. restlessness.

AH w/ command to harm self. Had fight w/ g/f now psychotic. little interest in sex. Borderline tumultuous relationships. cutting. Annoyed. before was very good student except for not been able to finish assigned projects at college. Dx? Histrionic Educate staff about splitting Desire for social relationships Dependent personality disorder Dependent personality disorder Brief Inpatient Hospitalization Borderline Borderline Borderline 29 y/o w/ rapid mood swings minutes to hours. such counting loudly or repeating words silently. oculomotor disturbances. postnatal growth retardation. Avoidant personally unappealing. Schizoid PD What DSM IV Axis II Dx? Common symptoms of paranoid personality disorder Preoccupation w/ unjustified doubts of loyalty/trustworthiness of friends/associates 20 yr man with poor performance in college. Classmates have described bizarre behavior. appendicular ataxia in LE only and normal eye movement.Which intervention is helpful in dealing with a borderline pt on a medical ward? Setting firm limits with the pt on the structure of the medical care What is useful information to confirm diagnosis of antisocial personality School counseling records d/o (APD) in 20 y/o patient? Saccadic smooth pursuit eye movements are more frequent in which personality disorder? Schizotypal 40 y/o M. Constant SI. Cut down. He does not want to follow others rules but his owns. +impulsivity. You should: Avoidant PD differs from Schizoid PD by: DDx of histrionic personality disorder includes what other personality d/o? Which personality d/o should be in the dif dx of agarophobia 23M w/ Borderline. Brief paranoia and AH after a break-up. he believes nobody understands him and are against him. Guilty. intrauterine growth retardation and learning difficulties. First step in acute management is… What is the function of Al-anon Evidence that alcoholism is hereditary Thiamine Helps relatives cope with alcoholics drinking Adopted Siblings Fetal Alcoholism is associated with facial dysmorphisms. ataxia. What level of care Which personality d/o has chronic feelings of emptiness? Personality d/o w/ transient psychotic symptoms 22 y/o M w/ self-mutilation. stress-related paranoia. occasional cocaine. cutting Pts w/ this personality d/o most likely to have 1st degree relatives with depression Borderline Pts with which personality d/o sees themselves socially inept. depression. Most likely dx? Obsessive Compulsive personality disorder Patient with body dysmorphic d/o may have what personality d/o? Narcissistic Which personality disorder is characterized by a style of speech that is Histrionic excessively impressionistic and lacking in detail? What personality disorder results in displays of rapidly shifting and shallow expression of emotions in patients? 22 y/o borderline splitting inpatient staff. ***** Can alcohol fumes at work (brewery) cause a pt on disulfiram headaches? . poor self-image. and dysarthria. no close friends. or inferior to others? What personality disorders should be the main consideration in differential Dx of schizotypal personality disorder? Avoidant Alcohol 50 y/o w/ ETOH dependence admitted to ER for confusion. Eye opener cerebellar degeneration (alcoholic) Yes Fetal alcohol syndrome associated with:*** CAGE *** Unsteady gait. emotional detachment. Walks with lurching broad-based gait.

receives IV dextrose 5%. oculomotor paralysis. SGGT. What remission specifiers would apply to the dx of ETOH dependence? Individuals who consume ETOH at night usually develop: Decreased sleep latency In comparison to men. nausea. vs. Experiences confusion. Dx? Comorbid disorder in men with PTSD Fragmentation of stage 4 sleep Faster progression of disorder ETOH-induced psychotic d/o ETOH abuse/dependence What is a side effect of both naltrexone and disulfiram? Elevated LFTs A 25 y/o pt has been dx'd with ETOH dependence. Alcoholism. Depression. extreme agitation. Alcoholic. and hypotension occurs in what ethnic group? Alcohol abuse in men is commonly associated with what comorbid mental disorder? Characteristic of alcohol-induced blackouts Priority of treatment: Marital problems. Why? mucosa Avoid which drug in patient intoxicated with alcohol or a sedative drug? Lorazepam Characteristic of Cloninger’s type 1 alcoholism Late onset Individual psychotherapy for alcoholics is most effective when focusing Interactions with people on? What is the most serious complication for a pt who ingests ETOH while Hypotension on disulfiram. What drug will likely decrease these? Lab elevated in alcoholics Wernicke’s encephalopathy Wernicke’s encephalopathy Triglycerides. global confusion Nausea and vomiting Naltrexone MCV Equal dose of alcohol corrected for body weight lead to higher BAL in Lower levels of alcohol dehydrogenase in gastric woman than me. maligning AH and clear sensorium. SGOT Solitary drinking Sleep fragmentation Patient can stop taking it and resume drinking Pathological intoxication Ophthalmoplegia.Sixth cranial nerve palsy is associated with which alcohol-related syndrome? In ER following MVA. What is dx? Wernicke’s dz triad Drinking ETOH while taking disulfiram is most likely to produce what symptoms? Alcohol on disulfiram reports alcohol cravings. AH on and off alcohol. and dysarthria Tests for detecting excessive drinking Pattern of drinking in women alcoholics (as opposed to males): Which complication of heavy EtOH use likely to persist beyond first week of withdrawal? What is the principle problem with disulfiram in the treatment of alcoholics? Verbally and physically aggressive after a small amount of ETOH.. Pts over 65 who experience chronic insomnia are most likely to have what comorbid psych conditions Primary characteristic of Wernicke encephalopathy Alcoholic hallucinosis differs from DTs in that alcoholic hallucinosis is characterized by what? Eval of which lab test is most specific for chronic heavy alcohol consumption Asians Antisocial personality Anterograde amnesia for time while heavily intoxicated but awake Alcoholism detox and abstinence Alcohol abuse Acute onset A clear sensorium %CDT Percent Carbohydrate deficient transferring . tachycardia. ataxia. physiologic rxn to ETOH including rash. Pt has neither had Early full remission ETOH to drink nor met any of the criteria for alcohol dependence in the past 6 mos. woman who abuse EtOH are more likely to also Axis I diagnosis have… An idiosyncratic. During withdrawal give benzo plus Haldol What is decreased with heavy ETOH intake Glucose Alcohol intoxication causes what sleep abnormalities Characteristic of female as opposed to male alcoholics 60 y/o alcoholic with 4 day h/o unstructured. MCV.

What are signs? After OD pt has fever. muscular rigidity. dilated and unresponsive pupils. Recurrent unsuccessful efforts to control use abuse? 15 y/o is found unresponsive by parents after pt returns from a party.Substances Motivational interviewing is often used as part of the treatment of Substance abuse which conditions? After Cannabis ingestion (in chronic use) cannabis can be detected in urine how long? What is NOT likely to be an effective intervention for a physician with a substance abuse problem? Which drug causes euphoria. “seeing sounds” and “patterns of colors” associated w/ actual auditory stimuli Synesthesia For polysubstance dependence need criteria for: Substances as a group. HTN. social withdrawal. excessive perspiration. tachycardia. nystagmus? Acute caffeine withdrawal symptoms include: What does the pentobarbital challenge test do? Person who smokes a pack of cig/day stops smoking and has need for cig after every meal. This is an example of: Pupillary constriction Physostigmine Physostigmine physicians PCP Patient-controlled analgesia Partial reinforcement . a feeling like “flying above the dance floor”. friend confirms pt used heroin. dilated unresponsive pupils. confusion. dry mouth. Which medication would treat this? What medication treats anticholinergic toxicity? Naltrexone prevents relapse of opioid dependency most effectively in which group? Ataxia. pupils dilated in college student after attending a party. urinary retention. This is… Tachycardia. Likely ingested: Motivational interviewing of patients with addictive disorders addresses what? Maximum duration of PCP in the urine: Maximum time cocaine metabolites detectable in urine? What is perceptual abnormality in which hallucinogenic drugs cause moving objects to appear as a series of discrete and discontinuous images? Most often abused hallucinogens associated with What technique may be dangerous in managing patient with PCP intoxication? Benztropine Ambivalence about becoming drug free 8 days 4 Days Trailing Tolerance to euphoric effects Talking the patient down While intoxicated. normal or small pupils suggests intoxication with what? Tx of pts w/ substance abuse who have acute pain Abstinence compliance increases with random UDS. Drug? One Month Observing the physician until the physician becomes motivated to seek treatment Ketamine Headache Estimates the starting dose of pentobarbital used for barbiturate detoxification Environmental trigger Cocaine What drug is used to treat autonomic sxs associated with heroin Clonidine withdrawal? 22 y/o female confused. but not for any particular substance How should Buprenorphine and the buprenorphine/nalaxone combo Sublingually be administered? Prolonged ingestion of high doses pyridoxine causes: Subacute sensory neuropathy Most common cause of organic paranoid symptom Stimulant abuse Physostigmine is useful in treating toxic syndrome from overdose with: scopolamine Which dx criteria helps to establish dx of substance dependence vs. dry mouth. disoriented. nystagmus.

never hospitalized Recovering addict in relapse prevention therapy. dry mucous membranes. No other health problems. and HA. hypersomnic. and has many risk Focus on skill training. requesting double portions Cocaine . decreased bowel sounds. sees halos. Intoxicated with: 2 days s/p hospitalization dysphoric. lifestyle interventions do what? Opioid NOT detected in standard UDS What substance is only detected in urine for 7-12 hours after ingestion? Fentanyl ETOH Use of levomethadyl acetate hydrochloride (LAAM) for management of Elimination of need to take home doses pt w/ opioid dependence allows for In nicotine dependence. fatigued. Recently moved to older house in an industrial city. Liver fxn test are minimally elevated. dizziness. crackles on lung exam. The mother is concerned about hearing problems. BP 135/65. tachycardia. sense of fragmentation and detachment during intoxication Common cause of acute cerebellar ataxia in adults Abrupt withdrawal of nicotine is followed by what symptom? Methylenedioxymethamphetamine (MDMA) LFT’s Lead serum levels Ketamine Intoxication with antiepileptics Insomnia What substance can cause dementia w/ long-term use Inhalants 16 year-old adolescent with burns to the face 2/2 playing with a spray Inhalant abuse paint can that ignited. confusion. Pt alert and in NAD.What terms best describes buprenorphine's action at the mu opioid receptor? UDS performed on pt who eats poppy seed bagels may yield false positives for? Area of brain associated w/ reward effects of cocaine At what receptors does phencyclidine's major action occur? What is the most commonly abused substance among patients with schizophrenia? Partial agonist Opiates Nucleus accumbens n-methyl-d-aspartate acid (NMDA) Nicotine Check for residual physical dependence of opiates by administering: naloxone Pt took 20 500mg acetaminophen tabs 6 hours ago. flashes of color. decreased appetite. What is the pill? Dopamine Diphenhydramine 35 y/o hypoventilates. Hot skin. Pt is 52kg. Dx? What symptoms of nicotine withdrawal may persist in a patient for up Increased appetite to 6mos? In treatment of recovering addict. blurry vision. neurotransmitter most associated w/ reward and reinforcement is OD on sleeping pill. irritability. cognitive reframing. pulse N-acetyl-cysteine 96. Codeine and mild arrhythmia on EKG. recent ETOH and Hallucinogen persisting perception d/o LSD. pinpoint pupils. Serum acetaminophen level is 60 uG/ml. Rather than developing a coping strategy for each risk factor. unemployed. Grades dropped from A’s to F’s. rehearsal strategies help with what? Identifying internal high-risk relapse factors Symptom of cocaine withdrawal Hypersomnolence Speedball Heroin and cocaine Miosis (pupillary constriction) due to OD on: Methadone prescription in heroin dependence is called what kind of strategy? Needle exchange is an example of what types of reduction strategies Heroin Harm reduction Harm reduction Apathetic and nervous. Which lab test helpful for dx? Dissociative compound. vivid dreams. and factors. ataxia. urinary retention. blue lips. Most appropriate action? Causes long-term inhibition of new serotonin synthesis and decrease in serotonin terminal density Lab to get prior to starting naltrexone 9 y/o child with apathy.

” What is diagnosis? What substance is a common cause of flashbacks? Acute anxiety. abdominal pain. dilated pupils. ataxia. worse diuresis and insomnia – attributes everything stress at work Has intoxication syndrome but not a substance of abuse What med is not used in tx of opioid maintenance and relapse prevention? What is the mu opioid partial agonist approved by the FDA for the treatment of patients with opioid dependence? Phenobarbital tolerance test is helpful in detox from what? Flumazenil is used to treat: Pt presents to ED c/o ringing in ears. buprenorphine and clonidine are used) Buprenorphine Benzodiazepines Benzo intoxication Aspirin Amphetamines 20 y/o with acute onset belligerence. Management: What is a characteristic of hallucinogens? Addictive craving is minimal Acetylcysteine is Tx of choice for OD of: Acetaminophen The risk of hepatotoxicity will peak in how many hours after acetaminophen overdose? 72 to 96 Somatic Treatments Anticonvulsants A clinically significant increase in the concentration of lamotrigine may occur if it is co-administered with: Valproic Acid A pt w/ treatment-resistant mania and h/o rapid cycling is being D/C carbamazepine treated w/ carbamazepine and thyroxine.22 y/o with sudden onset anxiety. The pt’s most recent WBC is below 3. palpitations. flushed. restless. pupils not dilated. SOB. and chills. hypervigilance. anger. fears college police will know participated in weekend “hash-bash festival. best treated Carbamazepine initially with: Which drug used in the treatment of patients with epilepsy is associated with hyponatremia? General Antidepressants Antidepressant less likely to cause sexual dysfunction Buproprion Carbamazepine . Administer ammonium chloride depersonalization. and sweaty palms x2 days. irritable. HTN.000. After adding Clozapine the pt is clinically stabilized. dizziness. Overdose of what substance? Tachycardia. Horizontal nystagmus. and slurred speech. triggered by minor sensory stimuli. and cloudy sensorium following ingestion of a street drug. and is found to have mild metabolic acidosis. nauseous. Intervention? Carbamazepine should be DC'd if the absolute neutrophil count is below Coarsening of facial features and hirsuitism are SE of what med? Drug prophylactic for treatment of migranes Adequate for monotherapy generalized tonic clonic szs: Antiepileptic drug that can cause renal stones Prophylaxis of adult migraines Teratogenic effect of both VPA and carbamazepine: 8 y/o dx’d w/ Bipolar d/o is about to start valproic acid. methadone. distortion of body image. Cannabis induced anxiety disorder lightheadedness. What needs to be monitored frequently? Which antibiotic may significantly raise carbamazepine levels and precipitate heart block? Side effect more frequent in carbamazepine than lithium VPA Valproic Acid Valproate Topirimate Topiramate Neural tube defects Liver function 3000 Erythromycin Dizziness Hair loss + weight gain are SE of which anticonvulsant Divalproex sodium Lancinating face pain. Paranoid. UDS shows? Cannabis Caffeine intoxication Caffeine Bupropion (naltrexone.

myoclonus 20 y/o lethargic. can’t remember other meds. (NOT bupropion) Muscarinic Mirtazapine What antidepressant has plasma level that correlates with therapeutic Imipramine response? 45 y/o with first episode MDD. receiving antidepressant MDD patient with good response to venlafaxine presents with dysphoria. mild confusion. lethargy. Cause of sx? Which med for pt w/ severe social phobia who failed fluoxetine and venlafaxine Effective for OCD Receptor blocked by antidepressants -> blurred vision Which antidepressant has strongest histamine-R affinity? Serotonin syndrome Serotonin discontinuation syndrome Phenelzine Paroxetine. but depression worsens over months. clomipramine. confused. myoclonus. beyond stopping offending agent is: Bethanechol 25 tid Urinary retention Venlafaxine Venlafaxine Trazodone Trazodone Supporting vital functions Mirtazepine (vs other antidepressants) has low incidence of what side Sexual SE effect? Orthostatic hypotension is least likely to occur as a S/E with what antidepressants? Sertraline. Best intervention? Antidepressant preferable for >65 yo Antidepressant blood levels What antidepressant increases REM sleep? What antidepressant has an FDA pregnancy use B rating? Educate patient on the differences between antidepressants like Paxil and benzodiazepines. (Nortriptyline. diaphoretic. hyperrreflexia. shivering. imipramine. sweating. Temp 101.) Sertraline Which antidepressant has active metabolites that extend its effective half-life? 50 y/o fireman became clinically depressed after sustaining a Sertraline myocardial infarction. mood is improved. What is an appropriate medication to prescribe? 27 y/o depressed patient treated with SSRI and tranylcypromine and now presents with VH. as he is worried about becoming dependent on it (a friend was addicted to Valium). flushing.5.38 y/o taking imipramine 300mg qday for recurrent MDD. Antidepressant with low risk of weight gain 37 yo in 125 daily of imipramine. on Paxil and insight-oriented therapy. Appropriate action? Which is a muscarinic SE of antidepressants? What antidepressant is known to have caused hypertension? Phenylethylamine antidepressant that targets serotonin and norepinephrine reuptake inhibition What pharmacological treatment should be used for long-term insomnia in patients with dementia over 65 years of age? Antidepressant w/ shortest elimination half-life Key element in emergency treatment of pt w serotonin syndrome. Takes Paxil only occasionally. tremors. Urinary retention. restless. After 3 weeks. tremor. but has difficulty passing urine and mild erectile dysfunction. diaphoresis. tremor. Desipramine Desipramine Bupropion Bupropion What meds could be helpful in the treatment of depression in persons Bupropion over the age of 65 because it does not produce orthostatic hypotension Which antidepressant is well suited for Rx of depression in older pts with cardiovascular disease. flushing. fluvoxamine. poor balance after running out of medication. and myoclonic jerks: Restlessness. amitriptyline and trazodone may cause orthostatic hypotension. nausea. restless – recently started on Serotonin syndrome Prozac. Tx? Antidepressant causes Parkinson’s sx Bupropion Bupropion Bethanecol Amoxapine . and confusion are compatible with: Serotonin Syndrome Serotonin syndrome Confusion. like Valium. phenelzine. agitation.

nausea. dizziness.MAOI 45 y/o woman on phenelzine for MDD. or QT on ECG Psychiatrist plans to add nortriptyline as adjunct to fluoxetine. blurred vision. Which OTC medication would most likely cause this? What drug is contraindicated for a pt receiving MAOI? Meperidine 2 wk waiting period recommended when switching from phenelzine to Tranylcypromine is an amphetamine derivative tranylcypromine because: Which med is irreversible MAO-B inhibitor? What drug has been known to cause hypertensive crisis? Selegiline Phenelzine Phenelzine 2 week washout of which med is needed before starting fluoxetine Which MAOI is least likely to cause drug-food interaction in therapeutic Moclobemide antidepressant doses Pt taking phenelzine is treated in ED for chest pain. mood symptoms. constipation. QRS. parasthesias. 2C19. goes into coma. and headache Serotonergic antidepressants are appropriate treatment for depression Inhibit platelet functioning in 54 yr old patient with recent coronary artery bypass graft surgery because they: Which is a common side effect leading to discontinuation of SSRI’s GI distress early in treatment? Which of the following SSRIs has longest half-life? Fluoxetine Which of the SSRI antidepressants has the longest mean half-life? SSRI w/ no or mild inhibition of major P450 isoenzymes of 1A2. pt Meperidine (Demerol) develops hyperreflexia. anxiety Malaise. He should proceed how? Useful blood levels can be obtained for which TCA? Arrhythmia Bethanechol Tricyclics Tricyclics Start nortryptyline at lower than norm dose Desipramine Which of the following TCAs should be avoided in pts w/ Parkinson’s? Amoxapine Dry mouth. urinary retention. While treated. S/E of what psychotropic? Do NOT use in pt w/ narrow-angle glaucoma Orthostatic hypotension associated with TCAs is caused by blockade of what receptor? SSRI Fluoxetine should NOT be prescribed with what? Which of the following SSRIs has mild anticholinergic activity? The SSRI most likely to cause discontinuation syndrome: Most typical SE of fluoxetine Discontinuation syndrome associated with SSRI consists of: Amitriptyline Amitriptyline Alpha1-adrenergic Phenelzine Paroxetine Paroxetine Nervousness. HTN. 2D6. takes OTC medication for Pseudoephedrine cold sx and develops hypertensive crisis. Which med is most likely cause? At 10 mg selegiline does not require dietary restriction b/c MAO-B is not involved with intestinal tyramine reaction Most frequent side effect of MAOI’s Hypotension MAOIs affect catecholamines by directly retarding: Deactivation Minimum recommended washout period for fluoxetine prior to starting 5 weeks MAOI TCA What drug has a curvilinear therapeutic window? Nortriptyline Optimal strategy in maintenance treatment with tricyclics for pt w/ recurrent MDD Full-dose antidepressant therapy Monitor tricyclic (TCA) overdose by: EKG Most frequent cause of death following TCA overdose What drug is useful in the Rx of uninary retention secondary to TCA therapy *** Sudden death in children taking which medication? Increased PR. 2C9. restlessness. 3A4 Increases paxil concentration Citalopram Citalopram Cimetidine .

and amenorrhea. now with fever. Treatment? Which antipsychotic has least effect on prolactin? Clozapine Which neuroleptic has the weakest affinity for the dopamine D2-like receptor? Clozapine clearance decreased by Which med is contra-indicated with clozapine? What is the treatment of acute dystonia? What manifestations is the most common side effect of conventional antipsychotic meds? Periodically assess neuroleptic side effects using Benzodiazepines What psychotropic can cause a decrease in benzodiazepine plasma levels? Benzo half-life < 6 hrs Pharmacokinetic property most related to relative abuse potential of benzos 75 y/o pt with cirrhosis should be given which of the following meds: Clozapine Cimetidine Carbamazepine Benztropine Akathisia AIMS Carbamazepine Triazolam Time to onset of action Temazepam Which benzodiazepine is metabolized through glucuronidation (phase Lorazepam II metabolism) in the liver? Which benzo is reliably absorbed given IM? Lorazepam . stiffness. confusion. tachycardia. nonfocal neurological signs. What should be recommended? 23 yo hospitalized for psychotic break complains of thickened speech. inhibited by fluoxetine. Pt c/o stiffness and there is some rigidity to the movements. atenolol) Ziprasidone WBC 2000-3000. Diphenhydramine Eye deviation.What is a sleep disturbance likely to occur after initiating a trial of an SSRI? Cytochrome P450 (CYP450) subenzyme. slow. and elevated temp associated with which elevated lab value? Which med reduces the acute sx of neuroleptic induced akathisia? Which atypical antipsychotic causes least weight gain? What hematological finding necessitates immediate dc of clozaril? Retinal pigmentation from long-term tx with: Bruxism 2D6 α1-Blockade Olanzapine Creatine phosphokinase (CPK) Beta blockers (propranolol. grimacing. granulocytes 1000-1500 Thioridazine Mechanism by which risperidone cause very little EPS despite binding w/ high affinity to a dopaminergic D2 receptor Serotoninergic 5HT2 antagonism What is a major side effect of clozapine? Seizures Most common side effect with clozapine tx is Antipsychotic associated with development of cataracts Sedation Quetiapine Blockade of dopamine receptors in tuberoinfundibular tracts results in breast enlargement. increases TCA levels Antipsychotics Antipsychotic drug adrenergic effect causing orthostatic hypotension Which med has increased risk of hyperglycemia and DM? Autonomic instability. Mechanism is increase of: Prolactin How do antipsychotic meds elevate prolactin (PRL)? PRL is under tonic inhibitory control by DA Recent schizophrenic med adjustment. impotence. Pt is confused. appears visibly ill and tired. diaphoresis. galactorrhea. Dx? IV Haldol related torsades de pointes is associated with what? Galactorrhea in female pt on risperdal secondary to: What lab finding is most typically associated with NMS? Appropriate management of neuroleptic malignant syndrome Antipsychotics are associated with what? Neuroleptic malignant syndrome Low magnesium levels Inhibition of tuberoinfundibular dopaminergic pathway Increased Creatine Kinase Levels Hydration and cooling Dystonia. posturing. poikilothermy. and lower seizure threshold. Was given haldol and clonazepam. lipid solubility. 32 y/o pt with hx of schizoaffective d/o stable on clozapine is admitted Discontinue clozapine to internal medicine service for a severe GI viral infection.

Was on lithium. slow. ataxia. Has previous episodes of mania and is dx'd with bipolar I. and seizures is ***** Which is the most common reason for adolescent stop lithium Lithium can cause a decrease in which blood level? What lab test should be conducted prior to initiation of lithium treatment? Li serum levels should be monitored by evaluating: BMD tx with Li x2 years develops rapid cycling. tremor. diagnosed bipolar I. DC’d lithium when she decided to have kids. Next step: Obtain TSH level The most cause of severe polyuria with lithium is: While taking lithium patients should: A psychotropic with same pharmacokinetic properties in Asian Americans and White Americans Administration of activated charcoal is ineffective in overdose of: Psoriasis exacerbated by: Nephrogenic diabetes insipidus Maintain sodium intake Lithium Lithium Lithium Obstetrician requests urgent psych office consult for 24 y/o pt in 2nd Lithium trimester of first pregnancy who is acting bizarre. low energy level. temazepam and triazolam Most common side effect of benzos Which benzo accumulates with repeated administration? What benzo should be avoided in chronic renal failure? Benzo most likely to accumulate w/ repeated dosing Patients on chronic benzos develop: Lithium 62 y/o F with bipolar d/o develops altered mental status. what type of thyroid dysfunction can occur? Intake of this increases lithium levels Pt who has been treated with lithium for bipolar shows a good response in stabilization of mood. and unable to concentrate. but dc’d when planning pregnancy.8. Level 0. SE of toxic serum lithium levels 24 y/o in 2nd trimester is now manic without psychotic fx’s. flurazepam. dysarthria. status epilepticus. Best recommendation: Interferes w/ clearance of lithium Ibuprofen Cardiac effects of lithium resemble what on EKG Predictor of positive response to lithium prophylaxis In patients on lithium. Restart lithium Which of the following factors is a predictor of a poor response to Rapid cycling lithium? Lithium induced tremor is usually reduced by which of the following Propranolol meds? Bipolar pt on lithium and Zoloft for 3 yrs. dysarthria and ataxia in hosp after meds are added in hospital to her lithium. Lithium side effect? Stable. lorazepam. What lab test should be done? Lorazepam Flurazepam (Dalmane) used for insomnia Drowsiness Diazepam Diazepam Diazepam Amnesia Indomethacin competes with Li for excretion and causes Li toxicity symptoms Heart Hemodialysis Worsening acne Uric acid TSH Trough levels 12 hours after last dose Thyroid fxn tests S-T depression. neuromuscular irritability. Willing to begin tx. Hx of one episode of mania. steady state Li levels are generally obtained within: Methadone Hypokalemia (low T waves) History of good inter-episode function High prevalence of the production of thyroid autoantibodies Fluoxetine Absolutely 4-5 days . but reports feeling dull. nephrotoxic symptoms. Increasing Zoloft ineffective. Pt is manic w/o psychosis. More depressed and fatigued. What medication could cause this? Lithium exposure in first trimester of pregnancy increases risk of congenital abnormalities in which organ? Treatment of choice for lithium intoxication who manifests impaired consciousness.Benzo w/o active metabolites Longest half-life amongst alprazolam. QTc prolongation.

What way would you recommend? Which of the following produces best outcome in terms of drug consumption and criminal behavior for heroin-dependents? 28 yr old on methadone maintenance therapy develops worsening anxiety and flu-like symptoms since switched from valproate to carbamazepine for seizure control 2 weeks ago. What has been demonstrated? In pts who surreptitiously use excess sulfonylurea. given the same dose and condition. give: Difference in the rate and extent to which a brand name vs a generic drug becomes available to the site of action.Factor most predictive of effective methadone tx 22 y/o heroin dependent female discovers she is pregnant and wants to detox. Both med are found to have a significant therapeutic effect individually. has EPS and urinary retention. What should be the next step in management? 20 y/o pt w/cancer pain is on a methadone maintenance program. Recommendation? Due to its rate of oral absorption. What physiologic change occurs with aging? Agitated pt gets rapid tranquilization in ED. acute laryngospasm. is measured as: Schizophrenic OD'd on antipsychotics. Glomerular filtration rate Decreased phase 1 oxidation Decreased feelings of helplessness Cogentin Bioequivalence Amantadine Alpha-2 agonist Psychological Testing Most appropriate brief screening instrument that a pt can fill by him/herself at physicians office to screen for depression is: Test to discriminate cognitive difficulties in Alzheimer’s from those in depression A test for anxiety that does not include questions about physical symptoms such as tachycardia and diaphoresis would be considered lacking in what? An appropriate purpose for projective testing is to: Beck depression inventory Boston Naming Test Content validity Detect the presence of subtle psychotic thought processes Judgment by experts that items on a test “make sense” is an example Face validity of: Awareness of own symptoms rated by: What psychological test determines neuropsychologic impairment? Which test is most helpful in confirming diagnosis of personality do? Bender-Gestalt diagrams assess Global Assessment Scale Halstead-Reitan Battery Millon clinical multiaxial inventory Neuropsychological impairment . and the combo treatment is more efficacious than the summed effects of each med given alone. which of the following substances can be administered to r/o possible insulinoma? Psychiatrist is called to eval a pt on a medical floor who has developed acute dysarthria w/ protruding tongue and torticollis. Which med is suspect? Concurrent use of phenelzine and meperidine can cause hypermetabolic reaction secondary to what? Pharmacokinetic factor that declines w/ aging? Patients >65 are more sensitive to psych meds. Staff feels request for additional narcotics represent drug-seeking behavior. In addition to intubation. what most enhances the euphoria produced by benzodiazepines with methodone? What average dose range of methadone yields the best results in decreasing illicit use? General Psychopharmacology Two antidepressants are tested alone and as a combo treatment against a waitlist control group in pts with treatment resistant MDD. Using oral concentrate instead of IM or IV has what advantage? Psychotic pt given haldol. Tx? Clonidine mechanism of action: Total daily dose Methadone maintenance until delivery then detoxification Maintaining on methadone Increase the methadone dose Give pt more opioid med to achieve adequate pain control b/c of pt’s tolerance Diazepam 60-100mg Two treatments main effects and an interaction effect Tolbutamide Metoclopramide Indirect pharmacodynamic effects at a common bioactive site.

selfdisturbances Parental functioning . (NOT MMPI) Thematic Apperception Test (TAT) Thematic apperception test (TAT) Wechsler Adult Intelligence Scale (WAIS) Which test correlates most strongly with pre-morbid functioning in a pt Wechsler adult intelligence scale II vocabulary with early dementia? test Wisconsin card sorting test (WCST) assesses What tests is useful for evaluation of executive functioning? MMSE What mini mental status question tests immediate recall? What task is useful in evaluating a pt's ability to concentrate? Biological consequences of psychological stress affect which mechanism? Disharmony between feeling tone and speech content Psychiatrist asks “How many quarters are in $15?” examining what ability Abstract reasoning and flexibility in problem solving Wisconsin card sort test Repeating 6 numbers Performing serial 7s Neuro-immuno-endocrine function Inappropriate Cognition Psychologic Theory Psychic determinism is: Most important protective factor in determining preschool age child’s response to disaster is? Risk factor influencing psychological outcome of child following Prior conflictual relationship between child death of parent: and deceased parent Behaviors result from unconscious mix of drives. executive function (NOT orientation) Lesion in nondominant hemisphere Standford-Binet Wechsler Intelligence Scale for Children – III Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) Woodcock-johnson psycho-educational battery revised Identifies major areas of psychopathologic functioning MMPI (Minnesota Multiphasic Personality Inventory) Validity Scale 25 y/o M scores in MMPI are all normal except for elevated scores on Has depression w/ anxiety and other neurotic the depression and psychasthenia scales. Draw-a-Person.Which test assesses ability to attend to a task while inhibiting interfering stimuli? What would be a useful screening test to evaluate an 8 y/o child's academic performance? What does the clock drawing task test? Pt scores on revised Wechsler adult intelligence scale (WAIS-R) subtests for picture arrangement and block design are very low compared to scores on other subtests. visuospatial. This suggests: symptoms Objective psychological test MMPI Measures test-taking attitudes Thematic apperception test is used for What psych tests would be considered the most unstructured? What tests can be used for projective personality testing? Which is a Projective Assessment test: The personality test in which a patient is shown pictures of situations and asked to describe what is happening in each picture is: A psychological test that demonstrates high reliability: MMPI Inferring motivational aspects of behavior Rorschach inkblot Rorschach. defenses. Most suggestive of: Test to assess intelligence in 4 y/o? Stanford-Binet most similar to Which assessment instrument best measures cognitive functioning in a 4 yr old child? Test more specific to identify specific learning disability in child w/ full scale IQ of 93 on WISC-III MMPI does what? What psychological tests measure test-taking attitudes at the time of examination Stroop Color Word Test Wide range achievement test (WRAT) Attention. object relationships. Thematic Apperception. planning.

This phenomenon is Acts as a container for the patient’s projected anxieties about being defective Altruism Animism conformity Resilient individuals who do well in developmental course through life despite being at high risk for negative outcomes are thought to be Having the ability to find. According to Minuchin's theory of family interactions. The content of one is poured in shorter wider glass and the other to a longer narrow glass. "why did you hurt me?" Which thought process does this behavior exemplify? Experimental subjects were ask to make a judgment but gave wrong answer in spite of knowing the right one because they didn’t want to disagree with responses of other participants. Wife similar convictions. what term describes behaviors at the level of the individual that maximize fitness at the level of the gene? 3 y/o girl hurt herself w/ tricycle. anima refers to: 29 y/o complains about mistreatment from boyfriend. regularity. and affirmation is central to which psychoanalytic theory? Self psychology 66 y/o sent threatening letters to the president. 4 y/o insists it is ruined. Jung. and twinship needs? Man’s underdeveloped femininity Masochism Mirroring Objective psychological research Self Object The fundamental developmental need of all persons for mirroring. adaptability and persistence are examples of: Kohut’s theory of personality is based on? Cartesian dualism from the theories of René Descartes refers to Studies in which monkeys are raised in varying degrees of isolation have been important in contributing to what theories of human development? Which of following statements identifies what both traditional healing and modern psychotherapeutic practices may have in common: Temperamental variables The individual’s need for empathic interaction with self objects. passive Activity level. Patient displays: Child dances for mother and basks in gleam of mother’s eyes. often referring to disease as “our disease”. idealizing. use and internalize protected in adulthood most importantly by: social supports Piaget interested in: How child arrives at answers According to C. When asked which has more liquid he says it’s the same. Conservation is the ability to do what? Understand that objects or quantities remain the same despite a change in physical appearance Family Therapy What best illustrates a double bind in a family? Betty's parents encourage college. this is: . thinks CIA is following Shared psychotic disorder him.Psychological function of a medication According to sociobiologic theory. Piaget’s concept of this is: Per Piaget. Then she hit the tricycle and asks. validation. According to self-psychology. approach-withdrawal to new situations. mother never leaves his side and responds to questions for him. While in the hospital. Therapist finds it hard to make her self-reflective about her role in this. dependent on husband. Proud of generous nature but complains how little she gets back. but complain that expenses will be a hardship for the family 11yo boy has frequent episodes of ulcerative colitis requiring frequent Enmeshed hospitalization. 10 y/o puts it in freezer and Conservation (also reversibility) tells him it will be ok. The potential of human nature for both good and evil The significance of attachment The therapist helps the patient experience an emerging sense of learning and mastery over the problem Conservation What is achieved in Piaget’s stage of concrete operations? 8 yr boy sees 2 bottles w same amount of liquid.G. experiencing: Early behaviorist theory promoted what What term describes the role that others perform for the individual in regard to mirroring. According to Piaget he is exhibiting: Conservation 4 y/o child upset when ice cream melts. gets frustrated and fatigued.

Feel useful to society through behaviors that 60 y/o group is to? protect future generations Eriksonian stage >65 yo task Integrity According to Erikson. What defense mechanism is this? A parent who just learned that her child has been injured and taken to Suppression the hospital. wishes. arranges for a neighbor to care for her other children and then rushed to the hospital. and guiding in the next generation is: Erikson theorized that a successful developmental task in the 40. husband told his Turning against self sister-in-law that his wife was superior to her in every way.Eriksonian Stages Erikson’s psychosocial stage in which a person invest energy Generativity vs Stagnation into establishing. taking pride in results is which stage? Industry vs inferiority Erickson stage issue. preconscious. What defense mechanism did the parent use to handle her own fear? Management of patient in denial immediately after MI: Supporting the patient. or feelings that are attached to a single dream image? Freud’s psychological theory of development Melanie Klein differed from Freud in her emphasis on what factor? Freud says depression is anger turned inward against self due to Freud says that boys resolve oedipal complex by: What developmental period does the child realize he/she is the child of his/her parents and the child’s parents have a relationship with one another? Freud believed pt had fantasies of incest with opposite-sex parents coupled with feelings of jealousy toward the same-sex parent during which stage: Which ego defense is seen when an adolescent belittles parents in order to defend against regressive pull toward childhood? This model divides the mind into conscious. and unconscious? Tendency for groups to arrive at more extreme decisions than for individual group members alone Anal retentive Biological processes and bodily sensations come to have a psychological meaning Condensation Drive theory Early object relations Identification with the lost object Identifying w/ fathers Latent Phallic Autonomy vs. caring for. shame and doubt Autonomy vs shame and doubt Autonomy vs shame and doubt Reversal of Affect Topographical Group polarization Defense Mechanisms Hand washing rituals are most related to what defense Undoing mechanism? Semiconsciously diverting attention from a conflict in order to Suppression minimize discomfort is an example of what defense mechanism? Couple in therapy review argument at family reunion. the pleasure an adult might take in controlling others and in making order out of chaos relates to which psychosexual stage of development? According to contemporary psychoanalytic theory. husband became quiet and later fell down a flight of stairs. 75-y/o Finding meaning in what one has done Achieving sense of self-control and free will. unless denial interferes with care . struggling between cooperation and willfulness (Erikson) Compulsions & obsessions are related to development disturbance during which of Erikson’s psychosocial stages? Eriksonian phase correspond w/ Freud’s anal phase Psychoanalysis and Freud According to classical psychoanalytic theory. from birth to 18 months. children experience an emerging “self” as a result of what event? What is the combination of several unconscious impulses. the wife expressed disapproval. a child who strives to be competent by learning new skills.

Per psychoanalytic theory, unacceptable affects and impulses are commonly gratified in socially acceptable ways through: 30 y/o in therapy struggles with feelings of ambivalence about mom. Mom now has metastatic BrCA. If the patient uses anticipation as a defense mechanism, she might: Defense mechanism: behaviors characteristic of earlier stage of development in response to stress/conflict

Sublimation Set aside a night of the week to have dinner with mom to discuss mom’s rxn to diagnosis Regression

Major psychological defense mechanism that determines the form and quality of OC symptom is Reaction formation Defense mechanism: one party acting out what other party feels Projective identification One group member alternates between being the “scapegoat” for the group or the “spokesman” for the group. These events are a group version of what? Which defense mechanism most relevant to etiology of delusional disorders according to psychodynamic theory: Which defense mechanism is thought to be involved with the expression of paranoia Projection Identification

Projection Projection

When asked about a coworker after a recent conflict, a patient states “I Projection harbor no ill feelings toward him, but he truly hates me.” The is example of which defense mechanism? Disassociation is what type of defense mechanism? Young man recounts how his father kicked his puppy to death, no emotion when telling the therapist this despite therapist’s upset response. What defense mechanism is this? Neurotic defense Isolation of affect

Patient is annoyed by family’s expression of concern for his condition, Devaluing saying, “what they are saying is all in the talk.” What defense mechanism is this? 7 y/o states he knows Dad died, but why didn’t he come to the birthday Denial party? Defense mechanism: Pt’s wife states he drinks almost every night. Pt states he never drinks Denial to excess, never drinks outside the home, never needs an eye opener, and drinking does not affect his work performance. This is an example of which type of defense mechanism?

Therapy
32 y/o F with mixed anxiety and depression has been working Apologize and acknowledge that the silence well in supportive-expressive psychotherapy once weekly for the had felt hurtful to the patient past 3 months. Focus has been on issues related to the childhood neglect and abuse she experienced and how these impact her current relationships. In one of her regular sessions, she is silent and tearful. With encouragement from her therapist, she reports that her 18-month-old daughter has been hospitalized with meningitis and she is very upset and worried. The therapist listens silently. The patient leaves the session early, stating that she has nothing really to talk about and misses the next session. When she comes the following time, she is angry and accuses the therapist of being uncaring and insensitive for not even expressing concern about her child or empathizing with her distress. The therapist’s immediate response should be? Business executive hospitalized for bleeding ulcer repeatedly Listen to patient’s complaints and argues with a well-liked head nurse and threatens to leave AMA. acknowledge his discomfort with the passive Best action for C&L psychiatrist is: position that he is unaccustomed to Common theme in psychotherapy in the elderly: Loss As opposed to long-term psychotherapy, time-limited therapy more likely to: Select central issue as focus In treating an older patient with depression who is a successful The latter executive, he offers you some tips on investing. What do you do? Do you accept the offer as a way to validate the patient’s success OR explore the patient’s meanings and feelings about the offer OR accept the information but do not act on it?

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

“Are you concerned that if we are not the same religion, I won't be able to treat you properly?” Exchange during initial interview after patient’s former therapist closed “It can be very hard to start over with a new his practice: patient expresses concern about new therapist being too therapist. How have you been feeling about young and inexperienced, states she doubts new therapist can provide having to end your treatment with Dr. Brown?” any new insights. Best response to further goal of getting to know patient and establish whether therapy w/ new therapist would be appropriate Treating a much older patient who asks about therapist’s age. Best “Maybe you’re concerned about whether I am response: experienced enough to treat you?” Intensive, short-term dynamic psychotherapy is contraindicated for what condition? Acute exacerbation of chronic schizophrenia

Pt seeing new psychotherapist weekly x3 wks hesitantly complained Apologize for the lack of privacy and indicate about being able to overhear much of what the patient in the preceding that further measures, such as a music system session was saying. Pt assured therapist that he had tried not to listen in the waiting room, will be utilized and had left the waiting room to wait outside until the other pt had left. Which is best response? Psych resident dislikes alcoholic pts and avoids working with them. In Countertransference discussing the problem, says that pts are hopeless and unmotivated and she can't empathize with them. Example of? MD sees psychiatrist with increasing sense of dislike for a blaming, Countertransference externalizing patient who pits family members against the MD. What should the psychiatrist discuss with the MD? Pt is seen by psychiatrist because has been depressed for 1 yr since he was fired in spite of having another job. The psychiatrist tells the pt: men often feel that they are not allowed any failures but I can tell that u have moved on from this successfully and have no reasons to dwell in it. The pt then withdraws. The most likely cause of pt response is that he felt Cut off by the premature offering of reassurance The beginning phase of therapy with a child who was an incest victim Dealing with prior betrayal and establishing trust should first focus on what? with the therapist 5 y/o enacts fight between two dolls. What should therapist do? Describe doll’s affect without attributing anger to the child After several months of weekly individual psychotherapy, woman with MDD and panic d/o describes repressed memories of being sexually abused by stepfather. Therapist responds neutrally, explores pt's experience of them. Pt reports increasing conviction despite sister insisting it was impossible and she plans on getting lawyer if parents do not admit and apologize. Which is best approach? 50 y/o man hospitalized for depression and melancholia. First few therapy session should focus on: Document carefully the unfolding process and obtain supervision

Educate patient on nature of illness and treatment

A pt with h/o lifelong depression & failed relationships complains (very Empathize with the Pt’s fears of trust and feeling angry) (after several weeks of therapy) that she is expected to trust the of being at a disadvantage. Dr. without even knowing anything about him (credentials or personally) what should the Dr say? Two most powerful predictors of outcome in any form of psychotherapy are Empathy and therapeutic alliance 62 y/o with lung cancer, weight loss, fatigue, and persistent cough. Evaluate patient’s coping style and help the Patient refuses to accept dx of cancer and states will “get over this medical team see the patient’s responses in the infection.” Patient refuses all further testing and asks for antibiotics to context of her unique personality and life “recover in peace.” C&L psychiatrist’s role is: circumstances Young female starting cognitive therapy with a female resident asks for a hug. Resident should first Explain why physical contact is avoided C&L psychiatrist uses all therapeutic approaches except: Exploratory psychodynamic Pt who recurrently goes to ED because of severe chest pain. Has been worked up for everything and all test are normal. He states that something needs to be done to “fix” his pain. Psych consult is placed. MSE and neuro is normal. Past hx reveals his father died of lung CA. Next intervention as psychiatrist is: Explore pt's feelings about father's death. 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 Explore the pt meanings and feelings about the point from the psychiatrist? offer

Father is dying. Pt is not a drinker, but went from bar to bar drinking Identification with or incorporation of patient’s dad’s favorite drink. Bars are similar to those dad used to go to. Best father interpretation of this behavior: What do you do if a patient asks whether you’re still in training during Inform of level of training an intake interview? Patient sees therapist and makes threats and becomes agitated. Therapist feels uneasy, the next step is to: Use of meds with therapy optimal when: What has been shown to be an evidence-based treatment for individuals with conduct d/o? Young pt in therapy returns to school, announces to therapist that he can pass classes, will graduate. Best response: Beginning therapist feels great empathy for depressed pt. fails to maintain sufficient distance to observe self-destructive patterns. To avoid this pay attention to: Interrupt interview to get help Meanings and effects of meds integrated into pt’s understanding Multisystemic therapy Offering congratulations Overidentification w/ patient

40 y/o eats and sleeps too much, craves sweets, poor concentration, Phototherapy irritable, constant conflicts with husband. States “I always feel better in spring.” What is the treatment? Child has high-activity motor level. Teacher should Social skills training for those with persistent mental illness is an essential part of: Which psychotherapy uses transference interpretations and clarification to develop insight and resolve conflict? Therapist is working with the family of a schizophrenic. Strategies include informing about illness, social support, management guidelines. Therapist encourages a calm, problem solving approach and facilitates stress and stigma reduction when possible. Which model is therapist using? Biofeedback usually helps pts with which syndrome? Provide brief errands to do when child particularly restless Psychiatric Rehabilitation Psychodynamic psychotherapy Psychoeducational

Raynauds syndrome Reassurance, brief hospitalization, psychodynamic insight, treatment with psychotropic medications (not focusing on past relationships) Receiving cookies as an expression of gratitude by a patient near termination

What interventions are consistent w/ the theoretical assumptions of crisis tx? What most likely represents an acceptable boundary crossing by a therapist as opposed to a boundary violation?

During last session of successful psychodynamic psychotherapy, pt Respond by saying that you too have enjoyed warmly expresses gratitude for everything, saying that the help the the work therapist has given has made a big difference. Appropriate response? A 12 y/o F refuses to attend school b/c she fears her mother may die in an accident. Initial management should include: After attending several sessions of individual psychotherapy for anxiety and depression, a 24 y/o M revealed his homosexuality to his heterosexual male psychiatrist. The therapist realizes he is uncomfortable when the pt expresses longings for a male. The therapist also tends to overemphasize any material that might represent the pt’s heterosexual wishes. The next best step for the psychiatrist would be to: Pt w/ mild MR in tx program designed to develop new behaviors by modeling and reinforcement, then practice them Therapist preoccupied w/ patient. Acknowledges this but unable to shake feeling 15 y/o male bib parents, does not want to speak with psych One of chief factors in predicting outcome of therapy is: Returning the girl to her current classroom Seek consultation to discuss countertransference issues

Social skills training

Talk to supervisor Thank him for coming in and ask him if he’d like to be seen alone or w/ his parents Therapeutic alliance

Couples therapy, husband complains that MD wife works too long Undoing hours, she says she stays late to make sure everything is “right” checking and rechecking her work. Notes that once in high school she wished her straight-A brother dead and later he died on hunting trip. Her checking behavior is an example of:

25 y/o AA M 1st year law student seeks therapy for “academic paralysis” brooding about racial and socioeconomic differences between himself and roommates. Comfortable w/ AA psychiatrist, open about racial slights. Most important goal: Psychodynamic Therapy “Deficit model” of psychological illness in psychodynamic psychotherapy define psychopathology as: 43 y/o m very successful executive goes to psychiatrist because wife has threatened to leave if he doesn’t change. He does not understand wife's complaints that he is driven, perfectionist, demanding, controlling and unavailable. He believes he is just a good man. In recommending optimal initial treatment plan, key considerations for choice of therapy should include: 25 y/o F never on a date after 6 mo of psychodynamic psychotherapy. Began to struggle w/ positive feelings about M therapist that she finds hard to accept. At the same time she starts to date. Therapist believes it is transference. Therapist said nothing, he believed an interpretation might interfere w/ positive learning experience. This is example of: Determines if pt has ego strength for therapy Goals of brief psychodynamic psychotherapy compared to long-term psychodynamic psychotherapy differ how Primary intervention in highly expressive psychotherapy:

Use shared ethnic background to offer insight as how patient’s alienation may be rooted in something more than current situation

Weakened or absent psychic structures

The difficulty of demonstrating to the pt that his ego syntonic traits are maladaptative.

A practical/supportive approach Assessment of quality of relationships Discussion of transference in the latter Interpretation

pt is often tardy. Supervisor warns not to be late. Pt has anxiety about Overdetermination losing job. When father dies he leaves town w/o telling supervisor. Again given warning. Next day a train causes him to be late. In therapy, the overlapping of multiple potential causes for tardiness is an example of what? 38 y/o patient in dynamic psychotherapy for depression says she is Suggest that conjoint therapy with the patient lesbian and is dissatisfied with her otherwise good relationship with her and her partner might be a productive way to partner of 7 yrs b/c she wants a child and her partner does not. She explore this complicated issue thinks about leaving the relationship but this makes her feel sadness and a sense of loss. What is best intervention? What best describes current psychoanalytic thinking about the source The therapists total emotional reaction to the of countertransference phenomena in the therapist patient 32 y/o F, divorced 3 times, sees a male psychiatrist, saying she needs Try to get advice but then be angry at the therapy because she is paralyzed about choosing a career. The therapist for giving it patient has started and stopped college twice, held several waitress and clerk jobs. She hoped the therapist could tell her what job to pursue. In the initial interview she asks the therapist to send bills directly to her father, who manages her money because she has difficulty managing bills and credit cards. She explained she has to live at home to save money, but hates this because she frequently fights bitterly with her father who always wants to control her. A transference issue that the therapist should expect to be a central theme in the therapy is that the patient will: “Deficit model” of psychological illness in psychodynamic Weakened or absent psychic structures psychotherapy define psychopathology as: In psychodynamic therapy, interpretation of transference and resistance until insight fully integrated is called: Cognitive Behavioral Therapy Primary focus of a cognitive therapy approach to suicidal behavior: Programmed practice, or exposure therapy, is an indicated treatment for what disorder? Addressing all or nothing beliefs and helping pt learn problem solving Agoraphobia Working through

Pt with depression being treated with CBT tells psychiatrist about Catastrophizing waking up and being worried about work. Pt has big project that is due in two weeks and is half done, but pt is sure work will not be finished on time. Example of which cognitive error? Patient has severe stress and conflict at work, therapist identifies the CBT problem of maladaptive responses based on rigid thought schemas and decides to target automatic negative thoughts through reality checking and guided association. What type of therapy is this? Flooding, graded exposure, and participant modeling: Confrontation of anxiety-provoking experiences

a couple seems blissfully content when happy but enraged when frustrated by the other.” What behavioral therapy has relaxation training. “selective abstraction” is what? Cognitive error: when asked about his day. to identify and correct: In cognitive therapy. amongst other things. This is an example of? Dialectical Behavioral Therapy Dialectical behavior therapy is utilized for Which type of therapy has individual sessions to analyze selfdestructive cognitions/feelings/actions. hierarchy construction. and group sessions with skills training to improve relationships and decrease impulsivity? Purpose of DBT to diminish what? Family Therapy Structural model of family therapy characterizes family as Borderline personality do Dialectical Behavioral Therapy Parasuicidal Thoughts Complex system comprised of alliances and rivalries What type of group therapy is based on the unit functioning to maintain Family group therapy its own homeostasis of interacting? According to strategic and structural family therapies – underlying Observable and reported family behavior basis for analysis of symptoms in children. and visual imagery of stimulus? All of the following are strategies for change in cognitive therapy: Eliciting and testing automatic thoughts Exposure therapy Flooding Interpretation of interactional process Overgeneralization Patient’s focus on a detail taken out of context and conceptualizes a experience based on this element Selective abstraction Systematic desensitization Using reattribution. questioning the evidence.An important technique or goal of cognitive therapy is? Which psychotherapeutic technique is most clearly indicated for treatment of simple phobia? Take agoraphobic to crowded place and stay there until anxiety dissipates The LEAST utilized approach used in cognitive therapy in pt w/ substance dependence A CBT therapist works with a therapist. They alternate between overidealizing and devaluing the other. and families sequences What is an important technique of structural family therapy? The concept of the identified patient in therapy refers to: Contraindication to family therapy Observing the relative influence of each family member on the outcome of an activity One family member who has been labeled the problem by the family Strong religious or culture beliefs against outside intervention In family therapy. is more hostile to father. (NOT employing interpretation) Marital Therapy When conducting marital therapy with a couple who begin to talk Focus on the couple’s responsibility to about divorce. what should the psychiatrist’s stance be? decide the future of their relationship Which tx is contraindicated in initial treatment of pt experiencing domestic violence? The basis for a self-psychological strategy in marital therapy is best indicated by what? Couples therapy: what is the goal of acceptance work? Conjoint marital therapy Demonstrating the conflicts arising from each spouse’s need to have his or her self-object needs met by the other Each partner taught to understand the other’s position and release the struggle to change him or her Splitting In a session. fantasizing consequences. parents. and has become less so as a consequence of above therapy changes. pt replies “I was late for work b/c I misplaced my keys” then “I didn’t speak up in the staff mtg. developing alternatives. a previously distant couple begins to communicate Triangulation more frequently and intimately. This behavior is called: Group Therapy Major task of a group therapy during initial engagement phase is: Determining limits of emotional safety . After this happened the daughter who used to be close to mom.

which is an example of: Catharsis is: Principle of confrontation: Paradoxical intervention Resistance Verbal expression of suppressed traumatic experiences and feelings “I think you’d rather talk about your job than face . What illustrates supportive therapy: Reassurance Supportive therapy differs from psychoanalytic therapy in that the Reinforces ego defenses therapist who is conducting supportive therapy does what? Therapy Terms Therapeutic technique where therapist instructs the patient to hold onto a symptom: A highly motivated patient in psychodynamic psychotherapy finds that he has nothing to say. Describes fear of imminent death. the confirmation of reality by comparing Consensual validation one's own conceptualizations with those of other group members and thereby correcting interpersonal distortions is known as what? Initial tasks in starting supportive group therapy are deciding logistics and selecting patients.A psychiatrist who uses network therapy to treat patients with addictive A team leader disorders is functioning as: What factor is thought to be most important for promotion of healing in Cohesion a group psychotherapy setting In terms of group dynamics. feeling Interpersonal therapy 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? During the initial phase of interpersonal psychotherapy (ITP). Seen for psychotherapy. Next step: Stage of group development where members testing norms. given SSRI. competing w/ each other. Psychiatrist tells him cardiologist is excellent. he is receiving best care. seeking autonomy What is a major therapeutic goal of self-help groups? Exclude a patient from a weekly outpatient group treatment group Differentiation stage of group development is best characterized by what dynamic: What is the therapeutic factor of treating bulimics in group therapy to openly disclose personal attitudes toward body image and give detailed experiences with binging/purging? Hypnosis Ability to get so caught up in an experience that one loses awareness Hypnotizability of surroundings What statements regarding hypnosis is correct Psychiatric disorders with high hypnotizability include Most important guideline re: hypnosis Interpersonal Therapy Comprehensively researched therapy for mood d/o’s Therapeutic focus on the on pt's current social functioning is most characteristic of: Psychotherapy where patients realistically evaluate their interactions with others and the therapist offers direct advice/helps patients make decisions while ignoring transference issues is: Interpersonal psychotherapy Interpersonal psychotherapy Interpersonal psychotherapy (IPT) Hypnotizability is a measurable trait Hypnotizability: Dissociative disorders Record on videotape Create and maintain therapeutic environment keeping in mind culture of the group Differentiation Overcoming maladaptive behaviors Pt has tendency to assume deviant role Testing and competition Universality A 26 y/o pt with depressed mood and dissatisfaction with life. the therapist IPT middle phase: Current relationships focuses on the patient's: Supportive Therapy Which best defines goals of supportive psychotherapy? Improvement of reality testing and reestablishment of the usual level of functioning After mild MI 70 y/o seen by psychiatrist for depression. what IPT initial phase: Role transition problem is the therapist most likely to identify for therapeutic focus with the patient? In the middle phase of interpersonal psychotherapy (IPT).

” Absorption Acting out Alexithymia Empathic validation Facilitation Free association Grasp the patient's inner experience from the pt's perspective Paradoxical intent Rapport Resistance A set of feelings that a patient reenacts in the therapeutic relationship Transference are called: Geriatrics What characteristic is associated with better adaptation in individuals >65? What characterizes executive abilities in healthy individuals >65? Uncritical acceptance of ideas Show no significant change Which is NOT common in patients >65: depression. leaning towards pt. Therapist comment: It must hurt when you are treated that way. R hemiparesis. cog d/o. MRI T2 scan showed. What should therapist say? Most frequent route for HIV transmission in teenage girls What is a poor prognostic sign for HIV? Median duration of asymptomatic stages of HIV infection in the US is 10 years Heterosexual contact Dementia . Gay couple seeks therapy. finding the pt's pain and expressing compassion. and normal CSF. AIDS and progressive hemiparesis and R homonymous visual field Progressive multifocal leucoencephalopathy deficit assoc w patchy white matter lesions on MRI with normal routine CSF. HIV negative feels betrayed and believes HIV positive partner was unfaithful.the sadness you felt in our last session” Example of empathic comment Common experience of becoming so caught up in a movie that one ignores the environment is example of what component of hypnotic process? Patient in group therapy calls another patient at home to object to something said in session A person’s inability or difficulty to describe or be aware of emotions or mood is called In psychotherapy a pt states that he still feels devalued by criticism of father. such as abstinence AIDS patient with memory problems. phobias. and visual spatial coordination. BL Progressive multifocal leukoencephalitis visual field deficits. This is example of: Psychiatrist behavior of raising eyebrows. One has HIV. Psychotic d/o ETOH d/o. fluency. one is negative. evaluating insight. and showing expertise? Redirecting discussion by talking about irrelevant stuff “You must feel terrible right now. dx? AIDS Dementia Complex When is a psychiatrist permitted to notify a 3rd party identified to be at When patient with AIDS unwilling or unable to risk for contracting HIV from a patient take autonomy-preserving precautions. psychotic d/o What causes of decreased vision in older adults is characterized by an Macular degeneration inability to focus on an object as a result of retinal damage Medicare pays for hospice care when a physician declares that a patient has a maximum life expectancy of how long? 6 months HIV/AIDS End stage AIDS with worsening fine motor movement. L limb ataxia. saying “Uh-huh” Replaced use of hypnosis by Freud Therapeutic empathy is best described as the therapist's ability to: Therapy technique of prescribing a pre-existing sx behavior in relationship therapy What is most likely to be enhanced by strategies of putting the pt at ease.

progressive weakness of extremities over weeks. shows good response to toys/stimuli. slow speech development. Uses no system. doesn’t respond well to limits. Pediatrician is unconcerned. Stomachaches and headaches on school days. Dx? Which ages of children are interested in secrets. Called what (in attachment theory): Security of attachment Transitional object Object constancy An 18 month old shows a marked awareness of vulnerability to Object constancy separation and seems to be constantly concerned about the mother’s actual location is exhibiting Mahler’s stage of? Development 7 y/o with temper tantrums. refuses to go to school. poor social Reactive attachment d/o interactions. spends hours operations trying to find all options randomly and incompletely. third visit continues normal activities while warily eyeing other child. Psychiatrist should tell family: 5 y/o adopted at age 4 now hugging strangers. What temperamental trait is this? Occupied w/ rules. Recognition of unattainable goals Reassurance and provide reading materials Reactive attachment d/o 3 y/o with diminished appetite. understands others have separate feelings and School-age motivations Which event precipitates midlife crisis? 7 month old not crawling.AIDS pt. parents are detached from him. Child is alert. easily frustrated. refuses to play at Slow to warm up first visit. and participating in organized games? Sex play from 8-13 yo indicative of: Separation anxiety d/o Elementary school Typical children Young child tries to determine how many seating arrangements there Typical approach for this stage of concrete are for a family of 5 around a table. fears parents will die. Nightmares about being kidnapped. After 2 weeks in hospital is improving and friendly with staff members. responsive. but EMG shows no denervation Chronic inflammatory demyelinating polyradiculoneuropathy In considering safe sex practices for avoiding HIV infection. oral sex is Can rarely transmit virus best characterized by: ECT Greatest risk of death w/ ECT What barbiturate is used in ECT to produce a light coma? Indication for treating a manic w/ ECT ECT has increased complications in patients with what medical condition? ECT is least likely to be effective for patients who have? What condition is a relative contraindication to ECT? Recent MI Methohexital Dangerous levels of exhaustion COPD Chronic schizophrenia Cardiac arrythmia Childhood and Development Attachment The “strange situation” in child development is used to assess the infant’s ____ in attachment theory: 2 y/o does not want to let go of wool blanket and resists going anywhere without it. sits normally. Distal sensory deficit for pinprick and vibration. Attachment type is: Toddler soothed at night by inner memory of secure relationship with mother. Slow nerve conduction. age appropriate vocabulary. second visit stays with mom. This approach suggests: Onset of puberty in boys begins with Testicular enlargment 2 y/o clings to mother when introduced to new child. collecting. Dx? 20-month child repeatedly returns to her mom when playing w/ other 2-y/o children Rapprochement .

Which med is child taking? 6 yo at school cries for mom. is angry and rude. Child has never been completely dry. decreased appetite. child has shown irritability. Parents note that since med was started. carries it w/ him everywhere and becomes upset if anyone tries to take it away. Has no trouble at school and completes schoolwork. smooth muscle dz Adolescence Accommodation . development is innate Psychiatrist is evaluating a 5 y/o child in kindergarten. and insomnia. Wax and wane. Child's hearing and vision are normal. the difficult child shows what characteristics? To define learning disability. The child also seems to have some trouble understanding questions.Ask a child “What makes a train go?” He replies “The smoke makes it Pre-operational thinking go. Dx? Learning triangular relationships Oppositional Defiant Disorder Oedipal stage The development of full postural control in children by 4 yrs old correlates neuroanatomically with the developmental maturity of what? Myelination of cerebellar fibers Supported by ethologic perspective of moral development Moral principles inherited as a species. Family Hx of tic d/o. He refused to stay w/ a baby-sitter until it was retrieved. attitudes. increase with stress. Expecting the dead relative to wake up Early adolescence (11-13 y/o) A preschooler presents to psychiatrist after being placed on Dextroamphetamine psychotropic med by a PCP. other kids start crying Myelination is completed in what developmental stages? The first sign of puberty in a female is most commonly? 9 yo is evaluated for bedwetting several times a week. and responses at a preoperational stage of cognitive development include: Adolescent with a congenital physical deformity is most vulnerable to emotional disturbance during what period of development? Gonadal hormones feeling relief on setting a fire Explain to family may be transient Explain this is normal and child will eventually give it up on his own. Explanation? Stage of development associated w/ setting up clubs. skin picking. The psychiatrist should: A child’s understanding of death. Child interacts well with other children. Teacher reports that the child has a limited vocabulary and immature grammar in comparison to the other children. Which tx modality is likely to be most effective? Normal loss of 25-40% of neurons in fetal brain in the 2nd half of gestation is called: What is the mechanism for regulating cell production and elimination of inappropriate axonal connections in the developing brain? Differential dx in a 6 y/o with daily fecal soiling includes: The stage of life in which consolidation of a personally acceptable sexual identity generally occurs is called? Process by which children modify their existing schemas to adapt to new experiences is: Contagion Childhood Breast buds Bell and pad Apoptosis Apoptosis Anal stenosis. hypothyroidism. Hirschsprung’s dz. look for discrepancy between: Language Intense expressions of mood Intellectual potential and performance Integration of clinical and experimental observations in early childhood Infants are born with sophisticated perceptual development supports what statement about infant/parent abilities that facilitate attachment interactions? In combo with growth hormone (GH).” This is: Child argues with mom. first step: A 2 y/o M has been preoccupied with a small blanket for several months. making rules Latency Ability of preschool children to regulate emotions is most strongly enhanced by the development of: According to Thomas and Chess’ categories of temperament. what is required to initiate the adolescent growth spurt? Sign of pyromania 6 yo w/ 4 wk intense eye-blinking and lip pursing. Child does well Mixed receptive & expressive language d/o with puzzles and other performance activities. social withdrawal.

and excludes other age appropriate interests. language. What is the Dx? Lithium. Normal hearing. behavior decreases in Incompatible with a positively reinforced frequency if: behavior Repeated presentation of a conditioned stimulus without being paired Partial reinforcement with its unconditioned stimulus will result in what? Biofeedback training to treat tension headache is an example of what type of learning? Reinforcing behavior with reward every third time a behavior is done is called: Learned helplessness model for Systematic desensitization is derived from Operant conditioning Fixed Ratio Depression Classical conditioning theory . and feeding.” Asperger’s syndrome Mental retardation Language development Abnormality in what domains is the most important in establishing the Interpersonal relations dx of autistic do? 3 yo not speaking intelligibly. difficulty maintaining relationships d/t odd interpersonal style. talks on and on about them. Dx What d/o occurs most frequently in pts with autistic d/o? The long-term outcome in autism is most closely correlated with? Language development Asperger’s syndrome “It’s naptime now. DX? 7M w/ poor social skills. haldol. propanolol (not Medications for tx of aggression in an individual w/ MR clonazepam) 10 yo IQ 69. Parents worried about Express some concern to parents autism. impairment in social skill. Mild Mental Retardation Compared with other children his age he has sig. to improve after being punished for failing or failing no matter how hard the child tries? According to operant conditioning. has difficulty w/ transitioning from one activity to another. What explanation would he best understand? Mental Retardation Person w/ MR who achieves 1st grade education fits which diagnostic classification? Moderate Mental Retardation 6 y/o child in 1st grade is doing very poorly. findings that would confirm dx of MR? Deficits in self-care and social skills PDD/Asperger’s/Autism What is most important when trying to differentiate between autism and Asperger’s? An 8 y/o boy has marked social delay. dressing. and oblivious to personal space. Risk that a subsequent child will be autistic in a family with one autistic child is: 5% Conditioning and Learning Conditioning Learning from consequences of one’s actions Behavioral frequency altered by application of positive and negative consequences Operant conditioning Operant conditioning Example of learned helplessness is a child who stops all attempts Failing no matter how hard the child tries. thioridazine. but she is tired and it is naptime. WISC-R IQ score is 60. preoccupied with small electronic devices. has poor eye contact.Cognitive developmental tasks of adolescence include acquiring the capacity for: The age at which children typically first use sentences of 2 or more words is: Gender identity becomes consolidated between what ages? A more complex understanding of causality and multilevel realities 24 months 2-3 years Earliest age infant likes to look more at strongly patterned shapes like faces? 1 wk What age can infant first recognize mother’s face as distinct from other 1 month faces? 3 yr old boy wants to play with his mom. cognitive and language wnl.

Psychiatrist tells parents not to give candy during a tantrum under any circumstances. What is the mechanism of the behavior? If a response inhibitory to anxiety occurs in the presence of anxietyevoking stimuli. the presentation of an aversive stimulus that is Punishment contingent upon the occurrence of a particular response is known as: Child who fears bike riding becomes less fearful after watching other children having fun while bike riding. Imitating one's valued mentor while performing psychotherapy is an Social learning example of what type of learning? Form of learned fear in which a person or an animal learns to respond Sensitization more strongly to an otherwise innocuous stimulus is: A mother gives an 8 y/o a "time out" for five min in the bedroom Punishment because of his misbehavior. Commonly becomes nauseated and vomits in waiting room prior to the treatment. When she takes the exam without any medication. she finds that she has much greater difficulty than usual remembering the material. dies of a myocardial infarction. This is called: Imprinting 30 y/o morbidly obese pt refuses to change eating and exercise habits. An overall estimate of the effect of a variable is made which incorporates the information provided by all the studies. Reliability Meta-analysis .” One month later his father. This reaction is example of Classical conditioning 22 y/o experiences a earthquake (7. This is called: Reciprocal inhibition Learning Worsening temper tantrums in 3 y/o. The now obvious disparity between pt’s current behavior and knowledge of the circumstances surrounding his father's death is an example of which learning theory process? Research and Statistics Research Design Which research studies examine a group studied over a prolonged time period? *** Study reports difference that turns out to be by chance Which study best addresses the relative influences of heritability and environment? What is characteristic of the placebo effect? Findings can be replicated Results are combined from a number of studies of similar design. then develops a strong aversion to meat loaf. it weakens the connection between the stimuli and the anxiety. Which learning principal? Modeling During a certain time in development an animal is sensitive to a stimulus that provokes a behavior pattern at that time but not later. This is an example of what behavioral technique? In learning theory. Pt avoids classes in the same building that the seminar was in. also obese. The tantrums would occur at home and would escalate until given candy.Patient ate meat loaf then had a severe GI virus. Outcome? A medical student takes amphetamines to stay awake while studying State-dependent learning for an exam. The procedure is termed? Cohort Type I error Twin adoption studies The placebo effect is greater when the pt knows the doctor. Cognitive dissonance “I’ll worry about my health when I am 65. First occurred in grocery store Tantrums will increase then decrease and child was quieted with candy. Cocaine craving triggered by sight of crack house is an example of what type of learning? Classical conditioning Classical conditioning Pt undergoing chemotherapy. In the months Aversive conditioning that follow he develops fearful reaction to sudden or loud noises.0) during a seminar.

and 20 years to determine relationships between initial characteristics of the infant and a subgroup of children who eventually had psychiatric problems. This is an example of: The deviation of x from its mean.square Analysis of variance .D. 5. but also high false positive High sensitivity. low specificity rate Which is used to evaluate the relative frequencies or proportions of events in 2 populations that fall into well defined categories Groups of pt with MDD. What do you need to do to clarify? The purpose of designing study to use the double blind method is to: Eliminate bias due to examiner expectations Clinical trial: 2 study meds in 8 hospitals. Which critical confounder biases the results? A clinical trail will assess the impact of two atypical antipsychotic meds Crossover design on glucose intolerance. which expressed in standard deviation units. and adjustment d/o were given mood scales. Data says size there’s difference between meds.B. 20 receive drug 1 in hospitals Drug assignment depends on participant’s A. children described as “high reactive” at age 4 months were characterized by: Small pilot study measures changes in MMSE scores to compare the Enroll more subjects to obtain a larger sample efficacy of two meds for the treatment of Alzheimer’s.G. proven and indicated treatment.F. What type of experimental design? Psychiatrist is developing a new questionnaire about traumatic stress.H.C. In order to compare the means of the scores of these groups. Compare the score of hurricane survivors to Which of following actions would be most appropriate to test the those with no prior trauma measure’s construct validity? Type of study to determine relationship between risk factor and development of disease Cohort Study Chess and Thomas studied temperamental characteristics of a group Cohort of children at ages 3 months. but not statistically significant. while 20 receive drug 2 in hospitals E. while the other half will start on Drug 2 then drug 1. Teacher gives him increased motor activity. How can she get the progress notes? A case-control study can appropriately answer an epidemiological question when the: Keep her own separate records Incidence of disease is low Compared to those described as “low reactive” in Kagan’s longitudinal Higher rates of social anxiety at age 13 study of childhood inhibition. impulsive. Standard deviation Sensitivity A method for making a prediction based on observable data in order to Regression analysis assess the valve of the one variable in relation to another is Statistical concept of power is defined as the Probability of rejecting null hypothesis when it should have been rejected The assumption that there is no significant difference between two random samples of population is called: Null hypothesis What is a measure of central tendency that might best be used to Median analyze an outcome measure with significantly skewed distribution of its values? Identifying the # of pt without the condition who Specificity is have a neg test result Test detects 98% of people w/ disease.A psychiatrist employed by an institution wants to use pt data for research later. Drug 1 is hospital. Half of the participants will start on drug 1 and then be treated with drug 2. Type of study? Statistics 5 yr old boy becomes restless. is called? The validity of an assessment instrument refers to: What terms best defines the degree of spread of scores about the mean? A statistical term that refers to the proportion of pts with the condition in question that a test accurately detects: Z-score The extent to which it measures what it intends to measure. 2. and his behavior improves. what statistical methods would be most appropriate? Chi . and difficult to manage Goodness of fit when not given sufficient exercise. dysthymia.

stereotyped behaviors. short stature. Dx? 40 y/o man developed gradually progressive dementia and abnormal involuntary movements. large anteverted ears. Hurler’s. macroorchidism. abundant café au lait spots. and stroke-like episodes (MELAS) HLA-DR2 Fragile X syndrome Fragile X Fragile X Fragile X Early-onset Parkinson’s disease Adrenogenital syndrome.Genetics Apoptosis of cortical neurons differs from necrosis in that it: Involves expression of specific genes 13y/o with developmental delay. Phenylketonuria . hyperextensible joints. foraging for food and having many temper tantrums. enlarged aortic root. hyperactive behavior. long ears. Tay-Sachs. lactic acidosis. myopathy. Hurler’s syndrome. TayDown syndrome Sachs disease and phenylketonuria all cause mental retardation. DX? Skin tumors. high arched palate Most common inherited mental retardation: What d/o is due to triple repeat gene defect? Mutations in the gene that codes for the parkinson protein are most commonly associated with which parkinsonism? The most likely recombination frequency between two loci from pedigree data Superoxide dismutase (SOD) Prader-Willi syndrome NF-1 (neurofibromatosis-1 gene) Mitochondrial encephalopathy. Which one does NOT have autosomal-recessive inheritance pattern? What neurological syndromes is the result of trisomy 21? Process of gene expression Strongest genetic contribution Genetic linkage studies investigates what in medico-psychiatric research: What is part of routine workup of child with mental retardation but without dysmorphic features or neurological findings? Pattern of inheritance in Wilson’s disease Pattern of inheritance in Huntington’s disease Karyotyping is a method of genetic analysis characterized by which technique Polymerase chain reaction (PCR) used in genetic linkage studies involves: What conditions associated with MR have an autosomal recessive inheritance pattern? Down syndrome DNA transcribed to mRNA and produces proteins Cyclothymic disorder Co-segregation of genes during meiosis Chromosomal analysis Autosomal recessive Autosomal dominant Analyzing chromosomal structures Amplification of microsatellite markers Adrenogenital syndrome. Older brother and father have similar illness. Best Dx test Excess CAG triplets in DNA analysis Genetic anticipation Earlier onset or worsening with each generation (with each transmission of unstable DNA) What are genetic polymorphisms? Variant DNA sequences prevalent in >1% of a population A logarithmic odds (LOD) score for a gene represents what? Familial amyotrophic lateral sclerosis gene mutation A 4 y/o child that was hypotonic as an infant is now demonstrating developmental delays. Down syndrome. Lisch nodules on iris is diagnostic of mutation on which gene: Which is the most common mitochondrial disorder (of 4 listed)? Which is seen in 90 – 100% of pt w/ narcolepsy (genetics) Developmental disability syndromes associated with a triple repeat genetic abnormality: MR. connective tissue d/o. impaired Fragile X social interactions. narrow face.

“rubbery” consistency. uses a four-point position through full extension of all four extremities. falls. ill health and suffering is what? The rate of illicit drug usage in high school is highest among which groups in USA? Highest prevalence psych d/o? What is prevalence of Alzheimer’s in >85 y/o? Lifetime prevalence rate for ETOH abuse and dependence Lifetime prevalence of schizophrenia Disease is chronic Depression and suicide Caucasian Americans Anxiety disorders 16-25% 15% 1% Culture How is ethnicity defined? Groups of individuals sharing a sense of common identity. Developing operationalized diagnostic criteria and standardized instruments Unipolar major depression The discrepancy between male female lifetime prevalence rates is greater. enlargement of calves with firm. Point prevalence Monozygotic twin of schizophrenic pt Lower in both men and woman Lower in both men & women Hypochondriasis Homicide What best characterizes the current explanation for group differences Factors that promote vulnerability to stress in prevalence of psychiatric illness? Past years annual prevalence much higher than annual incidence According to the WHO. and whites. No h/o mental d/o or substance abuse. Parents feel visions are gift but are worried about the child’s preoccupations interfering with schoolwork. and shared beliefs and history 14 y/o Native American girl with visions of elder spirits who appear and Work on problems in school give her advice. the world's greatest cause of mortality. a common ancestry. Has family h/o similar sx in males. 1) EMG reveals? 2) Genetic mutation in what protein? Epidemiology Scientific development that made NIMH epidemiological catchments area studies possible *** According to NIMH Epidemiologic Catchment Area Program’s reports on ethnicity and prevention of mental disorders. When rising from the ground. attributed to witchcraft Rootwork . Wide based stance and walks waddling. short-lasting motor unit potentials with weakness. the prevalence estimates of MDD in persons older than 65 years are: Prevalence of psychotic disorders after age 65 is: What somatoform d/o has male=female? Leading cause of death for 15-24 y/o African American males? The development of operationalized diagnostic criteria and standardized instruments Equal among Asians. increased recruitment 2) Dystrophin decreased DTRs and normal sensation. the lifetime rates of APD are: *** What scientific developments made the NIMH epidemiological catchment area studies possible: *** Leading cause of neuropsychiatric disability worldwide Pts with unipolar depression differ epidemiologically from pts with bipolar d/o in what way? What is an example of secondary prevention? The number of individuals with a d/o at a specific time Which population has highest prevalence of Schizophrenia? When compared to younger age groups.4 y/o does not run/climb. GI distress. Treatment goal: Gender is best understood as referring to: Ways in which cultures differentiate roles based on sex Which of following most accurately describes scientific understanding Sociopolitical designation assigning individuals of the concept of race? to a particular group that has meaning derived from prevailing societal attitudes American psychiatrists tend to overdiagnose what in African American Schizophrenia patients with mood and psychotic sx? Culture-bound syndrome in Caribbean and states bordering Gulf of Mexico – anxiety. Screening for depression. fear of being poisoned. Hispanics. has iliopsoas/quadriceps/gluteal 1) Small. weakness. AfricanAmericans.

abuse. MSE normal. Needs supportive therapy. Concerned she is losing her faith. fears. Nonmaleficence Pt who is poor but talented asks if he can barter for services. stable vocational hx. States has conversations with her dead husband and he talks to her. What best describes the nature of this proposal to treatment boundaries accept goods in lieu of fees . diarrhea. 1) What type of d/o is this? 2) What is best treatment? 1) Culture-bound syndrome. Likely classification of these experiences is: Ethics What ethical principle provides the most appropriate basis for psychiatric intervention in a mentally incompetent patient? *** In ethics.A family response to a member with ataque de nervios would most likely be to do what? Which is the most significant disadvantage of using a family member as interpreter for a patient who does not speak the psychiatrist’s language? Most common complaint in southeast Asians who are dx w/ mental disorder is: 50 y/o Cambodian woman with 2 kids suffered catastrophic trauma from the Pol Pot regime in Cambodia (rape. 47 y/o with increased preoccupation with questioning her lifelong Religious or spiritual problem affiliation with her church and has been spending time visiting other churches. antidepressant. feels guilty and anxious. no DSM-IV criteria for d/o. Has no past or present psych symptoms. No SI. Beneficence. Normal grieving. Ataque de nervios HAs. despair. Believes in heaven. anorexia. AND? Across all cultures. Dx? 48 y/o with chronic sadness and no relationships since husband died Part of a belief system endorsed by her religion 12 years ago. concerned he might die once his penis retracts into his abdomen. has successful career and close friends. Autonomy. Most ethical to tell patient: According to APA. it is unethical for a psychiatrist to: The fact that participants did NOT receive available indicated treatment in the Tuskegee Syphilis study is an ethical violation of justice. 2) Supportive therapy Spirituality What DSM-IV diagnosis is likely for 41 y/o man with increasing Religious and spiritual problem sense of conflict about changing his beliefs from work-oriented to faith-oriented. Pt may censor comments to keep info from the family Multiple somatic symptoms Group therapy of people of the patient’s own background who share the same experience Death of a spouse Culture bound in industrialized countries per DSM IV Bulimia What culture-bound syndromes would be Dx for a pt with of insomnia. states would never act against her moral beliefs. escaped refugee camp with 2 kids). Has PTSD/MDD sx that are increased when her now grown daughter dates man patient doesn’t like. watched family starve. knows that health plan stops paying after 20 visits. what stressful life changes is correlated with greatest increase in death and illness in the subsequent 2 years? Rally to support the relative by removing stressors in her life. beneficence is: *** Psychiatrist judges patient under managed care plan will need combined psychopharm and psychotherapy for > 1yr. & anger? 29 y/o recent immigrant from China believes his penis is shrinking. Physician acts Paternalistic Patient may need more tx than insurance covers Participate in legally authorized execution Non-maleficence Justice. You like It is not recommended as it may compromise the pt's product. beneficence or non-malfeasance? What are the core psychiatric principles? Beneficence Applying one’s abilities solely for the patient’s well-being.

he would have to do what? A physician who is testifying as an expert in court is different from a Professional opinions regular or “fact” witness in that the expert is allowed to testify about what? Several states established that the verdict guilty but mentally ill to be When compared to guilty. which he believes he needs.Psychiatrist wishes to charge pts for appointments that they do not keep. The defendant is unable to do what? At the beginning of a radio talk show a psychiatrist states he is not Duty entering into a doctor-patient relationship with any of the callers. the defendant delusionally believed that the father was being tortured by demons and killing him was the moral thing to do. perhaps to the point of refusing treatment. She is Testify about all her psychiatric problems suing her employer for sexual harassment and is using her anxiety (cocaine abuse) disorder as proof of the damage she has suffered as a consequence of the harassment. social. What principle Confidentiality governs response? How should a psychiatrist handle an interview about the misbehavior of a prominent government employee? Gag-rule clauses in some managed care plans may prohibit docs enrolled in their plans from taking which action? Comment on human behavior generally. You know alternatives may be good too. According to code of ethics of the American psychiatric association such a policy is: Pt qualifies for ECT. He is a “chronic worrier” and fears hearing the risks will make him anxious. guilty but mentally ill is an option when a defendant pleads not guilty by reason of insanity intended to ensure access to treatment but is because: essentially similar In evaluating the sanity of a criminal defendant. or occupational needs Exam is not confidential Make a will Mental competency of elderly pt determined by? *** Judicial hearing Psychiatrist is treating a 34 yo for anxiety and cocaine abuse. The psychiatrist has to inform her that if he is subpoenaed to court. Standard of care refers to treatments that are Used by Average Reasonable Practitioners Lawsuits against psychiatrist most frequently arise from issues Suicide Attempts concerning: . but does not want his doc to tell him the risks. wife asks how pt is doing. but refuse to offer opinions about the specific person Advising pts about treatments not covered by HMO Legal and Forensics What is the primary role of the psychiatric expert witness? *** Criterion for a covered disability under Americans with Disabilities Act: What determines disability? Pt getting psych exam to determine suitability for a job must be informed: Testamentary capacity refers to a person’s ability to? *** Render an opinion based on scientific knowledge Substantially limits one or more major life activities Impairment affects ability to meet personal. or state of mind at time of offense? State of mind at time of offense The rule that finds people not guilty by reason of insanity due to M’Naghten rule mental illness that impaired their knowledge of the nature quality and consequences of their actions or they were incapable of realizing that these acts were wrong is called what? The criminal defendant tells the psychiatrist doing a forensic eval “I Appreciate the wrongfulness of his conduct know that killing my father was illegal. What do you do? Ethical if the patient is specifically notified in advance Document the pt's knowing and voluntary waiver and proceed with treatment Contact insurance and ask for nonformulary approval Psychiatrist calls pt at home. Hereby he does not have ___ towards a patient in case of a malpractice suit. What is the best response? Insurance company tells psychiatrist to switch from working drug to generic.” However. the forensic psychiatrist should focus on current state of mind.

The psychiatrists eval confirms the dx of MDD and psychiatrist feels that continuing the pt ‘s antidepressant is indicated. and intensive outpatient research Pt consults a psychiatrist because a former psychiatrist has Establish a clear understanding of the retired and the pt wishes to continue tx with antidepressants. Consents but cannot explain reason for surgery. psychiatrist prescribes antidepressant. the Dean calls therapist requesting info about the student’s therapy due to recent reports from a dorm supervisor. Your answer is: The most relevant issue for a geriatric or forensic psychiatrist in cases were the finances of an elderly are in dispute between partner and children is: When should a schizophrenic admitted to a medical hospital for evaluation of chest pain have a formal assessment of decision-making capacity? The most appropriate time for a physician to discuss an advance directive with a pt is Usually must be maintained Refuse the Dean’s request for information Will assess pt's competency to make one’s own medical decision Whether the elderly has a mental disorder and whether is adequately treated When there is reason to believe that the patient lacks the ability to understand. or reason logically with the info relevant to healthcare decisions When the pt is competent 78 yo w/ deteriorating personal hygiene. Next step? 29 yo schizophrenic frequent ER visits and hospitalizations. Hallucinating. Best Contact case manager to verify intervention: environmental support . cooperative.The four basic elements that must be proven in order to sustain a Harm to the patient claim of malpractice against a physician include a duty of care owed to the patient. Who is responsible all treatment. The division of responsibilities between pt is seeing a counselor for weekly psychotherapy and plans to psychiatrist and counselor continue. Legally. Therapist should: Medical resident consults psychiatry because a 38 y/o F pt refused dialysis secondary to “antisocial personality” and the resident wants you to convince her to stay for treatment. significant weight loss. psychologist just for & accountable for what? psychotherapy Describe the psychiatric assertive community treatment case management model: Interdisciplinary team. high staff/patient ratio. appreciate. psychiatrist should: What characterizes the majority of defendants with psychiatric disorders who are found unfit to stand trial? An attorney requests psychiatric consultation when his defendant wants the worst possible outcome from the trial because he feels he deserves the worst punishment possible. had been stable and doing well. What direction should you take for this case? US Supreme Court Decision Washington v Harper 1990. not violent or suicidal. services in situ. Potentially with power to make treatment decisions resectable masses in lung and brain requiring further consent for surgical and oncological treatment. the right to refuse treatment is limited for prison inmates because: Informed consent requires: presentation of information. and what? Patient’s confidentiality after death College student in therapy. Ran out of meds a few days ago. causation. defendant states “I think murder is wrong but killing a spy M’Naughten Rule from Mars who is trying to steal the secret of life is right.” This poses a problem for what type of evaluation of criminal responsibility? Case Management Patient with MDD. agitated. Psychiatrist is responsible & accountable for psychologist provides interpersonal therapy. negligence. voluntary consent from patient. Signs urgently request probate court appoint guardian voluntary admission form but later forgets doing this. and: They can regain fitness in less than 90 days Probably meets criteria for finding of incompetence to proceed Prison security concerns outweigh individual autonomy interests Mental competence Murder trial.

Which is most consistent with pt’s behaviors? 18 yo in ED. Xray of child's arm show hairline fx and healing callous. Psychiatrist’s responsibility to pt Final legal responsibility falls on 29 y/o severely depressed with SI. Pt frightened. family insisted she not tell anyone. Mother says he fell down stairs. What should the next intervention here be? What are “least restrictive alternatives” for patients with serious mental illnesses? Pt has psychotherapist. remorseful. anger and agitation after moving in with adult child. Stopped taking meds days ago because prescription ran out and caseworker was unavailable to get new one.In ED evaluating a 29 yo F with frequent ED visits and psych admits for chronic schizophrenia. Agreed to voluntary admit. Had been doing well on olanzapine for several months and was doing fairly well in structured living environment. Raped 2 mo earlier. No hx of stealing. jeans not her size. What justifies involuntary hospitalization in this patient? 20 y/o pt is brought to ER by friend who is concerned about pt’s Violence to others potential for assaultiveness. Which feature is most indicative of this risk? Psych d/o in violent people Substance related d/o Duty as outlined by Tarasoff Best predictor of future violent behavior is: What does NOT predict violence? What is the relationship of violence to mental d/o? Homicide and homicidal behaviors are most often related to what factors? Drug least effective as adjunctive tx of chronic violent behavior 70 y/o presents with fearfulness. Denies command AH. Threatens to kill his wife and daughter to “take them with me”. agitated but not violent or suicidal and cooperative w interview. failing grades. Major issue with maintaining severely mentally ill in community Basic concept of community psychiatry Initial step when child is referred for evaluation: Public mental health clinicians who follow patients through all phases of treatment Contact case manager and ensure she has environmental support Treatment should occur in a setting that interferes minimally with the patient’s civil rights To follow up by seeing pt at appropriate scheduled intervals and by communicating regularly w/ psychologist about pt’s clinical status and tx plan Psychiatrist Notify the wife Meet separately with family and staff to express issues of polarization Making sure family is not present Insufficient resources Continuity of Care Consent for eval from guardian Case managers Violence and Abuse 23 y/o admitted in inpatient unit w dx acute psychotic d/o after If the patient continues to threaten his mother threatening to beat up his mother (with whom he lives). decreases risk in others Emotions not associated with mental illness Diazepam Psychological abuse Provide support and allow to vent Pregnancy Domestic violence Admit child for care and protection despite mother’s objections A cry for help . just raped. Understand stealing as: Protect the Potential Victim of a Dangerous Patient Past violent behavior Non violent criminal activity mental d/o heightens risk in some. Actively hallucinations. Pt referred to psychiatrist who prescribes medication. What action should psychiatrist take first? 16 y/o caught for shoplifting jeans. insomnia. On first visit pt is resigned and timid during exam. Immediate intervention: Characteristic of women with increased risk of battery Females have comparable rates to males for: 20yo pt brings 2yo child to ER with multiple bruises. Legal responsibility: How do you resolve a mixed decision for among staff and family of a dying patient (continue tx vs let die): Goals of initial dialogue w/ doc requesting consult except. Says she slipped on ice and hit head. Mother has healing black eye and cut lip. but 2 days later demands to sign out AMA. avoiding friends.

Suicide No harm contract between patients and clinicians are? Rate of completed suicide highest for adult males when? Most common method for completed suicides in adolescents In documenting suicide risk-assessment. Continues to see friends. Assure patient of no pathology spells. Dx and Tx? Normal bereavement in prepubertal children Wish to unite w/ dead loved one A 5 y/o has been enuretic after mother died in an MVA 4 days ago and keeps saying. No SI. “Why me?” According to Elizabeth Kubler-Ross. What would suggest a pathological Cont. Diagnosis: 1-month post death of loved one. no SI. “We would have been married 30 yrs this month. poor sleep. feelings of guilt or thoughts of suicide? A 30 y/o patient recently dx w/ Hodgkin’s dz constantly states. key risk management strategy is to discuss what factors in the record? Pt with which medical condition most likely to commit suicide? The leading cause of death among gun buyers in the first year after the weapon was purchased is: What psychiatric symptom does not require pharmacologic treatment in the ER? Along w/ depression most common comorbid disorder in physician suicide is Preventing adolescent suicide: Consistent predictor of future suicidal behavior What factors is most highly correlated with completed suicide in adolescent males? Which d/o is most common among pts who complete suicide Which commonly precipitates suicide in the elderly? Most powerful statistical risk factor for completed and attempted suicide Most common method of committing suicide for women in the US is: 15 y/o pt depressed + suicidal has an alcoholic father. Physical exam normal. decreased appetite." The father wonders if the children should attend the funeral.” His daughter confirmed his level of functioning only took a dip a week ago. no prior depressive episodes. feelings of worthlessness grief rxn? Risk factor that can adversely influence psychological outcome of a child following death of a parent? Conflictual relationship w/ deceased parent . "Mommy will come home soon. What is your recommendation? Which symptom would indicate MDD rather than just bereavement? Poor appetite and sleep. SI Shock and denial Regression in bowel and bladder control Normal grief 58 yo have week’s h/o intense feelings of sorrow and bitterness only 6 Delayed grief mos after wife’s death. FamHx of depression. hearing the voice of the loved one. Spouse died 6 wks ago. Prior d/c from hospital the next step should be: 1993 – highest rate of suicide in 75-84 y/o age group: Pt with which dx are most likely to engage in parasuicidal behaviors? Unhelpful in making decisions Older than 65 Firearms Why the psychiatrist rejected alternative ways of responding Symptomatic HIV infection suicide Suicidality Substance dependence Remove firearms Prior attempts Previous suicide attempt mood Loss Having a psych illness Firearms Ensure that any lethal means are unavailable at home Caucasian-American males Borderline d/o Most common time for pt w/ schizophrenia to attempt suicide is during Recovery phase of the illness When is there the highest risk of suicide in MDD patients recently dc’d 0-3 months after dc from hospital? Prevalence rate of suicide in general adolescent population? 10% Bereavement 62 y/o requests antidepressant. Crying Bereavement. Moderate diff sleeping and poor appetite only assoc sxs. the patient’s reaction is consistent with what phases? What is a symptom of normal bereavement in a <5 y/o child after the death of a parent? 60 y/o lost spouse 2 wks ago – sadness comes and goes The child and sibling should both be allowed to attend if they want to go.

whenever husband tries to kiss her she becomes disgusted. endorses anhedonia. Best way to handle material is: 8 y/o boy is sexually seductive to other children. Which is the best treatment for his problem? Patient dissatisfied with marriage. refusing coitus. 4) recurrent major depression Sexuality 25yo male pt has noted sexual arousal and even attained erections while rubbing up against unsuspecting women on subway. Tx? 65 yo M with impotence has diabetes and AF. Tx? Risk of complicated bereavement 1) ambivalent relationship to deceased. Avoids sex by neglecting personal hygiene. cleans house. Dx? Masturbation in adults as viewed by contemporary psychiatry is best described as: Homosexual couple w/ sexual dysfunction. no sex in year despite husband’s efforts. Diagnosis? Psychiatrist conducting and independent medical exam for individual’s employer to determine fitness to return to work after med suspension due to supervisory complaints of erratic behavior and lapses in judgment. openly display sexual behavior. States she feels Antidepressant medication and psychotherapy her mother hovering over her and sees mother at night. Patient has normal job function. Consider: Reluctance to discuss sex issues or take sex hx Sildenafil inhibits which enzyme? Pt uses oral sex as sole source of sexual gratification. Friends are concerned. A psychiatrist recommends sildenafil after an internist said pt is safe from cardiac standpoint to have sexual activity. otherwise MSE is normal. uncomfortable. Do you tell pt his impotence is due to diabetes or erectile dysfunction parallels diabetic complications or that sildenafil works for the majority of patients with diabetes? 65 y/o patient w MDD c/o anorgasmia after starting treatment with fluoxetine. She reports seeing her brother in her room since the accident. but not being “out” in workplace. This is most likely a manifestation of? Pt tells Dr “ I feel like a woman trapped in man’s body” most likely dx Thorough med eval and treatment of any medical cause or d/o should be performed before entering therapy Squeeze technique Sildenafil works for the majority of patients with diabetes Sildenafil Sexual aversion disorder Psychopathological only if it is compulsive Possibility of link between problems of substance abuse and acceptance of sexual orientation Physician’s own anxiety Phosphodiesterase 5 Partialism Omit the material unless it is directly related to the reported work problems Normal sexual behavior Gender identity disorder .” When should the child be told about his mother’s death? 45 y/o still grieving for mother 3 years after her death. anxious. 3) preexisting low self-esteem & insecurity. and to sexualize play activities. does not remember the accident but never lost consciousness. What explains pt seeing brother in her room? 10 y/o M s/p MVA sustained burn and crush injuries to R foot 4 days ASAP ago.A 6 y/o girl hospitalized for surgery to repair a fracture sustained in a Bereavement MVA in which her mother was injured an brother died. 2) simultaneous grieving for multiple deaths. She is receiving vicodin and benadryl. keeps asking for his mother who was killed in the accident and having nightmares crying out “Daddy help Mommy. the individual reveals being homosexual. Despite having been informed that the results of the exam are not confidential and will result in a report to the employer. This is: Treatment of premature ejaculation: Cross-dressing for the purpose of sexual excitement is called: Frotteurism Fluoxetine Transvestic fetishism What treatment should be offered first to otherwise healthy 34 y/o man Training in behavioral techniques to delay for premature ejaculation? ejaculation What statement describes principles of treatment of pt with sexual dysfunction? 25 yo M w/ premature ejaculation refuses meds.

paired with right hypothesis What dopamine agonist has been used to treat pts with erectile dysfunction? Diabetes Cyproheptadine Couple psychotherapy (instead of somatic therapy) Cognitive development – sexual behavior determined by self-image and gender identity Apomorphine Miscellaneous Two weeks after beginning a strict diet. Friends said this happened similarly from time to time. aggressive.Chronic disease causing progressive erectile failure 35 y/o woman who repots being happily married responds well to fluoxetine for depression. a 24 yo patient has Acute Intermittent Porphyria abdominal and limb pain. pale and tachycardic on exam. Erikson Who established that learning produces changes at the neuronal level. Preoccupied w/ job. Most helpful tx? New-onset ED despite satisfactory sex life w/ wife. in hospital is irritable. seems not to listen to parents or teachers. in Eric Kandel turn facilitated by alterations in gene expression: The approach to diagnosis that has been taken in current editions of the DSM is considered to grow from and be closest to that of whom? Emil Kraepelin Who first differentiated between dementia praecox and manic-depressive Emil Kraepelin illness? Anna Freud’s contribution to child development based on conceptualizing: Developmental lines in six areas of adaptive functioning DSM II called Dysthymic disorder what? Depressive neurosis Caregiver’s attempts to underscore child’s feeling state (Stern) Attunement . On follow-up. He is anxious. what is the place of expert opinion in Ranks as evidence comparable to case studies evidence-based medicine? What is a neologism? Tx apathy d/o without accompanying depression What medication has been known to precipitate a tic disorder? Patient makes up a word Methylphenidate Methylphenidate 10 y/o girl w/ hep B is evaluated for persistent difficulty w/ schoolwork since 1st grade. Unable to orient and seems to be responding to hallucinations. Diagnosis? According to APA guidelines. If needed treatment what will you give? methylphenidate Stockholm syndrome is defined as: Development in hostages of positive emotional feelings toward captors Which sxs common in pt after anabolic steroid discontinuation? Depression 20 y/o football player injured. Anabolic steroids grandiose. arguing more. Nml PHx Explains psychosexual in infants and children. Cause? History of Psychiatry Who characterized mental illness based upon the interaction of the four humors? Who noted that major mental illnesses have different courses and outcomes? Who developed Moral Treatment? Developed interpersonal theory of psychiatry Hippocrates Emil Kraepelin Phillipe Pinel Melanie Klein Who coined the term "contact comfort" and demonstrated that newborn Harry Harlow Rhesus monkeys separated from their mothers chose contact comfort over food and water? Which individual coined the term “schizophrenia” and introduced the terms Eugene Bleuler “ambivalence” and “autism”? Which individual articulated a theory of psychosocial developmental phases according to a predetermined sequence? Erik H. complains of anorgasmia. Often looses homework.

Hiccups/n/v. Tourette's (haldol vs tx w Clonidine) .A Ninja's Guide to Psychopharmacology Antipsychotics Typical Antipsychotics Indications: Schizophrenia (treats + sx. Agitation.sx worse). Hemiballismus. may make . MDD with psychotic fx. Acute mania.

more prevalent in high potency): 1)PD (women 2x more. Avoid in elderly. tongue. 2)Dystonia(spasms of jaw. sore throat. constipation. anorgasmia) 6)Sexual-erectile dysf. h/o TD or antichol delirium Atypical Antipsychotics Indications: Schizophrenia. restless). cooling. or children. clonidine. 4)TD (6 mos later. 3)Agranulocytosis (sx=fever. so not as much depletion of DA compared with typicals. less SE and EPS. 2nd and 3rd trimester is safer. Avoid in ETOH wd (inc sz) -Low Potency: SE are anticholinergic.blurred vision. Anticholinergic sx. . Women more prevalent. priapism (Thioridazine #1) 7)weight gain 8)Chlorpromazine=skin discoloration/photosens 9)Thioridazine=retinal pigment+vision loss SE (neurologic. Inc w stress. Inc PRL. dantrolene or bromocriptine.benadryl. SE (non-neuro. mental status change. medically unstable. AIDS dementia. Men more prevalent. inc QTc). MR. muscle rigidity. eyes) more in men. but also block 5HT (normally INHIBITS DA). 6)Epilepsy(low potency) 7)Sedation (low potency) Fun facts: -Avoid in 1st trimester. Comes in Depot. sedation. impotence. 5)NMS (inc temp. 3)Akathesia (pacing. Better for tx of psychosis due to tumor/organic/substance use. benzos. epilepsy.amantadine). or rapid dissolving tabs. Treats neg sx much better than typicals SE(general): Sedation. Huntington's. inc CPK). tx=antichol or Benadryl. QTc prolong. tx=propranolol. more prevalent in low potency): l)prolong QTc and arrythmia. possible EPS/TD/NMS -Risperdal: good in kids. autonomic sx. Parkinson' s(PD) features=nigrostriatal. 4) Peripheral antichol—dry mouth (tx=sugarless gum). etc). 2)ortho hypo due to alpha blockade (tx== pressors). -Cigarettes decrease amt serum antipsychotics -Don't use Epi for ortho hypotension or hypotension in OD-has paradoxical reaction and dec BP -These meds are contraindicated in cardiac problem pts. Tx=dc med. Specific SE include Weight gain (#3 after Clozaril and Olanzepine). inc PRL=tuberoinfundibular) -High potency: SE are mainly neurologic. abn muscular jerking/limb/trunk/perioral abn movement. Tourette's. cardiac (arrhythmia. 5)Inc PRL (gynecomastia. urinary retention(tx=bethanechol). tx=antichol. acute angle glaucoma/prostatic hypertrophy. including PD and EPS. especially Chlorpromazine (congenital defects).Mechanism of action: block D2 receptors (dec psychosis=mesocortical. inc time to ejaculation. Aggression Mechanism of action: Blocks D2 like typicals. po.

NO EPS. OCD. weight gain. Cognitive impairment after prolonged use. 2)Pancreatitis Monitor CBC. SE: GI (n/v/d). Mood Stabilizers (first line are Li. inc sz. can be very sedating. -Clozapine: Not first line. hair loss. depression sx in BMD. NSAIDS VPA Indications:BMD. IM. Cyclothymia. After 1st trimester is mood stabilizer of choice among other 1st line meds. elderly due to thyroid/renal/cognitive problems associated with Li. No weight gain. PD. SE include: weight gain/sedation (#1). Do not use VPA in pregnancy (NT defects) vs Li can be used after 1st trimester. inc LFTs. Carbamazepine) Lithium Indications: Acute mania. BMD. Comes in po. sedation. tremor (tx=propranolol). decreases suicidality in BMP 6-7x more than placebo/other mood stabilizers. PTSD Compared w Li: VPA preferred in children. is used for TD with other meds or severe psychosis refractory to other meds. SE: Polyuria. more QTc prolongation than other atypicals -Ziprasidone: Good for Schizophrenia with prominent depression. Sialorrhea with inc risk of aspiration. causing diuresis. Li is better for treating depression/SI associated with BMP. impulse control disorders. Tx=HCTZ (counterintuitive) -Dec Na diet/dehydration/diuretics/ACEl can cause Li toxicity.acute mania. Weight gain. metabolic syndrome. migraines. -Li is inc by ACE-I. Agranulocytosis. tremor. VPA usually has less serious adverse effects. SE include weight gain (#2 after Clozaril). inc risk sz in DM. Explosive anger. and dialysis -1st trimester is inc risk Ebstein's cardiac abn. PTSD. NO EPS. rapid tab. agitation .-Olanzepine: indicated for OCD. gastric lavage. VPA. Hypothyroid (women and rapid cycling pts have 2x inc risk) tx=synthroid vs dc lithium Fun Facts: -Li antagonizes ADH. PCO. partial/gen epilepsy. Acute mania and BMD. BMD. HCTZ. EKG changes. trigeminal neuralgia. Alopecia. LFTs and BHcg Carbamazepine Indications: Acute mania. Nephro DI. SE include ortho hypotension. Impulse control. -Quetiapine: Good for PTSD and anxiety sx. inc LFTS. SIADH Rare/fatal SE: l)hepatotoxicity (especially if on Phenobarbital). LOW EPS. Tx=Kayexalate (not charcoal).

diplopia. social phobia. Has NO weight gain (compared w other 1st line). OCD. can cause HTN crisis/stroke/death. weight gain. nystagmus Lamotrigine: good for depression in BMD. nightmares/vivid dreams. SIADH. eneuresis MAOIs Indications: Atypical depression. diplopia. SE include dec language and cognitive function. Tx:phentolamine. somatic disorders. sexual dysfunction. panic d/o GAD Names: Phenelzine. . Selegiline (PD.SE: Anemia/Agranulocytosis. do not use in kids (2% SJ). tremor/PD. -Serum levels can be monitored with Nortryptyline. nifedipine SSRIs Indications:MDD. Serotonin syndrome. Steven's Johnson. Hepatitis. renal calculi. panic. Imipramine. Topiramate: good for mood stabilization in obese pts. In pregnancy causes craniofacial and NT defects Monitor CBC. ortho hypo. SE(general): GI/n/v. premature ejaculation -Less SE than TCAs. sedation. DC FOR ALL RASH. induce mania. anxiety. explosive outbursts. postpartum depression. not MDD).Steven's Johnson syndrome. LFTs and Renal function q 3 mos Other Mood Stabilizers (2nd line) Indications: BMP. BMD. Desipramine -Clomipramine: OCD -Nortryptiline: “curvilinear window”. PTSD. can be used relatively safely in the elderly -Imipramine: Panic w agoraphobia. Epilepsy. social phobia. GAD. panic w agorophobia. OCD SE(general): Antichol inc cardiac conduction time/arrythmia. Tranylcypromine -When mixed w tyramine or stimulants. Chronic pain SE(general): dizziness. psychosis in epileptics. GI. SE:Rash. headache. Gabapentin: good for chronic pain/tri neuralgia/polyneuropathy. pigmented retina. confusion. Antidepressants TCAs Indications: MDD. causes weight loss. chronic pain syndromes.

autonomic instability. at higher doses inc NE and DA SE: Discontinuation syndrome. Venlafaxine Indications: MDD. insomnia. smoking cessation Mechanism of action: dec reuptake of DA and NE SE: Activating sx (including inc energy. GAD Mechanism of action: dec 5HT reuptake at lower doses. Monitor for AH or VH (related to DA). Has very short half life so is good in hepatic/renal impaired pts. feeling "jittery. restlessness. tremor. inc anxiety. Mirtazepine Indications:MDD. delirium/death." -Paroxetine: Indicated for Panic/social phobia/anxiety. -Sertraline: Indicated for panic/anxiety along w Paroxetine. including inc energy. Buproprion Indications: MDD. can inc LFTS/Cholesterol Trazodone Indications: Insomnia (is poor antidepressant and multiple side effects at doses higher than 300 mg) Mechanism of action: 5HT2 receptor agonist and SSRI SE: Priapism. DO NOT USE IN BULEMICS or sz d/o patients. Longest half life. Mechanism of action: 5HT2 agonist and some inc NE. Has activating sx. Tx=dantrolene. inc risk of seizures. restlessness. weight loss. Melancholic MDD especially. especially with prominent insomnia or in patients with cancer/AIDs needing weight gain. sedative. ortho hypo. -No inc cardiac or sz risk. No weight gain or sexual side effects. SE include inc anticholinergic sx. strong antihistamine and blocks alpha 2 SE: Sedation (good for insomnia). is a good adjunctive treatment in pts with sexual side effects on SSRIS. HTN.Serotonin syndrome:diarrhea. feeling "jittery"). cooling. Has dec interaction with other drugs and is somewhat sedating -Citalopram: Lower side effect profile than some SSRIs. weight loss. weight gain (good for cancer patients). tremor. agitation. Self tapers. inc sexual dysfunction. -Less likely to precipitate mania than TCAs. restlessness. rare agranulocytosis (monitor CBC). S enantiomer Lexapro is similar drug. No QTc prolongation or Antichol SE . insomnia. myoclonus. remove offending agent -Fluoxetine: Indicated for Bulemia or Anorexia.

Cholinesterase Inhibitors Indications: Alzheimer' s. add Buproprion or switch to Buproprion. viagra -Insomnia-Trazodone . improves erectile dysfunction SE: Ortho hypo. SE: sedation.acute mania/agitation. 3rd trimester use leads to addiction in newborn. Librium Short acting: Lorazepam (rapid onset). Flurazepam. inc PRL. n/v/diarrhea/bradyarrythmia. anticonvulsant. TBI (Donepezil) Mechanism of action: decreases inactivation of Ach to improve memory Se: GI (Ach side effects). 2nd line tx for akathesia. but only with caution and choice of medications with long half life/long onset action. They may be used chronically. NMS. Long acting: Diazepam(rapid onset). ataxia. very addictive -Chlordiazepoxide (Librium): good in ETOH wd treatment -Flumazenil: reverses benzos. AH/VH. chorea. -Alprazolam: use in anxiety with depressed features. dizziness. arrythmia. respiratory depression in COPD or Sleep apnea. Lewy Body.Benzodiazepines Indications: Panic/anxiety. Oxazepam. Temazepam Ultra Short acting: Alprazolam (rapid onset) and Triazolam -Clonazepam: long half life. EPS< tremors. Dependence to benzos (especially with rapid onset benzos). Use with caution: if OD on multiple meds (including TCAs). Bromocriptine associated with pleural effusions and other lung SE Treatment of Medication Side Effects -TD=dc drug. -Donepezil has less peripheral Ach effects than others -Tacrine=liver failure Parkinson's Meds Indications: PD. insomnia (short term). These medications are generally indicated for short term (1-2 week) tx of panic/anxiety/etc. contraindicated in pregnancy. reversing the benzo (anti-sz med) may precipitate sz caused by other meds included in the OD. Clonazepam. some indication for Vit E -Akathesia=propranolol -Dystonia=benztropine or benadryl -NMS-Dantrolene or Bromocriptine -Sexual dysfunction=dec/dc SSRI. with goal of using other medication or adjunctive therapy. good for tx panic/anxiety with lower potential for abuse compared with rapid acting shorter half life meds.

you may learn common terms that go together in PRITE (CBT: automatic negative thoughts. ted hose. Pemoline -Tourette’s can be treated with Haldol/Risperdal or clonidine -Haldol for treatment of Tics (unless caused by ADHD meds. Best are olanzepine and risperdal -Risperdal good for aggression/agitation or impulsive behavioral problems in addition to ADHD -Imipramine for eneuresis -Clomipramine for OCD -Fluoxetine for Bulemia and Anorexia (Do NOT use Buproprion) A Ninja’s Guide to Psychotherapy Disclaimer: This therapy guide is not designed to be a comprehensive review of psychotherapy. but it may help fill in any gaps in your therapy education to date. Urinary retention=Bethanechol -Ortho hypo with alpha blockade=inc fluid intake. norepinephrine for hypotension (NO epi. monitor for respiratory depression/airway -ETOH: benzos to prevent sz. pilocarpine mouth wash. Dexedrine. phentolamine for Hyperthermia. anti-arrythmia meds. Blurred vision=pilocarpine eye drops. First. then dc med) -Psychosis treat with atypicals. benzos for sz. Adderall. banana bag for volume/nutrient depletion Tips for Peds/Adolescent Psych Meds -ADHD meds include Ritalin.-Anticholinergic SE: GI upset=take w food. NO DEMEROL-lethal -Thyroid hormones: emesis/lavage/charcoal/cholestyramine. telemetry. Melanie Klein: object relations) to pick up points. Not all of this is high-yield. Dry mouth=sugarless gum. dec caffeine. monitor EKG. an overview of the spectrum of techniques used in therapy: . consider change HTN meds Treatment of OD -Benzos: emesis/lavage/charcoal. Psychodynamic: transference. BRAT diet for diarrhea. pressors. consider flumazenil -Buproprion: lavage/charcoal. If nothing else. This material is a summary from Kaplan and Sadok texts and the Mass General Psychiatry Review. prophylactic benzos for seizures -Clozaril: charcoal and sorbitol -Antipsychotics: lavage/charcoal. 0. monitor EKG -SSRI: lavage/charcoal. can cause paradoxical hypotension). propranolol -TCAs: lavage/charcoal. benzos for sz prophylaxis -Opiates: Naltrexone. clozapine generally not indicated. The purpose of this guide is to introduce you to terms associated with various therapies to help with PRITE multiple-choice questions.9%Nacl if Na depletion toxicity -MAOI: emesis/lavage/charcoal. monitor EKG -Li: emesis/lavage. Dialysis (no charcoal). inc sodium (if approved by PMD).

Psychoanalytical Psychotherapy • Overview: Based on Freudian tradition of uncovering unconscious aspects of a patient’s mental life. Unconsciously “hey this therapist reminds me of my overbearing mother. sometimes a couch is used. • Patient: must be very motivated. Resistance: unconscious and conscious forces within a patient that resist treatment. Transference: the patient’s unconscious redirection of feelings from the past toward therapist. this patient reminds me of my jerk ex-husband. advice. Close attention is paid to: 1.” “I see” The spectrum goes from Most Psychoanalytic (“couch therapy”) to Most Supportive. while more supportive forms of therapy use more praise and encouragement in therapy. Unconsciously “hey.” More Supportive: Encourage to elaborate: request more information Empathic validation: “That must be really hard for you” Advice/Praise: therapist gives concrete advice or direct praise to the patient Affirmation: “uh-huh. “So do you mean to say….” 2. repressed feelings.” 3.Interpretation⇒Confrontation⇒Clarification⇒Encourage to elaborate⇒Empathic validation⇒Advice/Praise⇒Affirmation More Psychoanalytic: Interpretation: bringing the unconscious thoughts to the surface (conscious). Ex: patient repeatedly comes to sessions late due to unconsciously resisting treatment . Confrontation: openly addressing suppression through confronting the patient Clarification: reformulation. Psychoanalytic therapy tends to have more neutral interactions between the therapist and patient (praise. • Occur 5-6x per week x1 hour for 3-5 years. and validation are not generally psychoanalytic techniques). family issues from early in a patient’s life. • Therapist: may not be visible to the patient. good frustration tolerance. Focuses on unconscious conflicts. and difficulty with current relationships. and the therapist remains neutral. with Interpretation being more psychoanalytic and Affirmation being primarily supportive. and have minimal pathology • Goals/Techniques: resolve internal conflict and symptom relief through examination of transference as a means of unlocking unconscious. I. Countertransference: the therapist’s unconscious association of feelings from the past directed at the patient.

May use medications (as opposed to Psychodynamic psychotherapy. “ego splitting. and increase insight into interpersonal events. say the first thing that comes to your mind. III.”) and Donald Winnicott (transitional object. Expressive Psychotherapy (“Insight-Oriented Therapy”) • Overview: same goals and techniques used in Psychodynamic therapy with a few differences. Sifneos. Objects relations psychotherapy: Melanie Klein (Object relations are related to drives. a specific treatment focus (one specific thing to be worked on/resolved). and ongoing significant emotional suffering • Goals/Techniques: focuses on a current interpersonal transference in an attempt to reorganize personality. Self-psychology: Heinz Kohut (“mirroring. and high levels of therapist activity. resolve conscious conflict. Brief Psychotherapy • Overview: Main focus is on brevity (limited # of sessions understood at the beginning). or risk of self-harm) • Limited to 12-20 hour-long sessions. Uses “here and now” interpretation. Classical Psychotherapy: Freud 2.”) Please don’t ask what these things are. a specific problem to work on. functional. I have no idea.” a bunch of stuff on narcissism) II. and other measures to develop modern short-term therapy. 4.• 4. Malan. Free Association: undirected expression of conscious thoughts and feelings as an attempt to “tap into” the unconscious. has intact reality testing. But these terms/people sometimes show up on PRITE so it’s good to know.” infant-mother relationships. “depressive/paranoid/schizoid positions. after which therapy is terminated . “good enough mother. • Essential Features of Brief Therapy: Patients selected with specific inclusion criteria (moderate emotional distress. modified neutrality • Patient: can tolerate frustration. Other people involved in conceptualizing this form of therapy were Mann. decreasing frequency. substance abuse. Four Subtypes of psychoanalytic therapy (High Yield PRITE associations): 1. good impulse control. may be related to unconscious stuff. desire for relief. patient selection (rigid criteria). Ego psychology: Anna Freud 3. which generally doesn’t use meds). Improve object relations. • Occur 3x/week for 30-50 minutes • Therapist: face-to-face interaction. ability to commit to treatment) and exclusion criteria (no psychosis. • Famous People: Franz Alexander first started to alter traditional psychodynamic therapy by shortening sessions. Basically. confront/clarification.

etc) 3. reestablishes defense mechanisms. Unresolved grief: facilitate grieving process 2. Social role disputes: make plan of action to solve interpersonal role disputes (conflict with coworker. spouse. May be combined with medication management. feels worse during this phase. Interpersonal Therapy • Overview: developed by Klerman. children move out of home) and earn self-esteem in mastering a new role. selects focus. • Occurs 1x/week for 30-50 minutes. the patient must have a specific area to work on (loss. Patient: see above exclusion and inclusion criteria. Mainly. 4. Clarification is important. non-neutral. • Patient: most commonly treats MDD • Goal/Techniques: Improve interpersonal skills by examining 4 problem areas: 1. and established working alliance. clarify feelings. conflict) and understand that # of sessions is limited. IV. being out of step with expected developmental stage. can last months • Therapist: face-to-face with patient. Sessions begin with summary of last session. V. and resolution of what initially brought the patient to therapy. with an active focus on helping the patient deal with a life crisis. provides advice. Homework is given. utilized by Harry Stack Sullivan. Three phases of therapy: 1) Initial phase (evaluation thru session 3) evaluates the patient. and restating focus. sympathy. and support while reinforcing the patient’s strengths. Supportive Psychotherapy • Overview: Usually brief. issues of separation and aloneness.” Primarily used to treat depression. 3) Termination phase (sessions 8-16) patient accepts treatment ending. interpersonal conflicts. Transference must be quickly identified and worked through. Interpersonal deficits: learn to establish healthy relationships and decrease social isolation Interpersonal therapy works to improve interpersonal communication. 2) Middle phase (session 4-9) where patient starts to worry there won’t be enough time in treatment. Social role transitions: mourn and accept the loss of an old role (demotion in job.• • • Therapist: must keep treatment focused and moving forward as there are pre-established limited # of sessions. and symptom reduction. explores specific past trauma. • Occurs for 12-16 weeks with monthly maintenance thereafter. Brief therapy works on transference issues. it is a brief therapy that addresses relationships in the “here and now. discuss termination of therapy relationship. . and provide reassurance. Goals/Techniques: four common foci are losses. Especially effective for acute grief reactions.

and confrontation. similar to methadone maintenance. Treats phobias. Dialectical Behavioral Therapy: treats BPD/personality disorders using combination of supportive/cognitive/behavioral techniques. reintegration of coping skills. learn new skills. 5. 3. may have ego deficits. Flooding: Similar to systematic desensitization in that a stimuli is presented and the goal is to desensitize oneself to fear/anxiety. where abstinence from illicit drugs leads to positive reinforcement with methadone. no hierarchy. and has in-vivo exposure (actually presented with real fear rather than imagining it). focus on conscious external events (no analysis of transference). Ex: patient has fear of heights. Addresses ambivalence. advice.• • Patient: may be undergoing a life crisis. VI. Biofeedback . Positive reinforcement: using a “token economy” to reward patients for desired behavior. seeks to not reinforce maladaptive behaviors. 2. increases motivation. poor impulse control. Uses conditioning and modeling. Works on decreasing response to anxiety-provoking stimuli. Think about less feared and use relaxation techniques (mental imagery. Good use in Schizophrenics. Uses reality testing. and restructure the patient’s environment. Works to improve interpersonal skills. and strengthen defenses. Goals/Techniques: form a therapeutic alliance. relaxing muscles and decreasing autonomic responses) to desensitize self to fear/anxiety. no relaxation techniques. poor reality testing. empathy. Ex: patient fear of heights. go to top of highest building and sit there until fear subsides. Now go up on the hierarchy (increased anxiety-provoking) and repeat the above to desensitize gradually up the hierarchy. and decrease selfdestructive behaviors. low level of frustration tolerance. Make a hierarchy of least feared to most feared. VII. Can also be used in addicts. However. Uses homework. Developed by John Watson. and cognitive restructuring. These patients are generally less functional that patient participating in the other above types of therapy. EMDR: saccadic eye movements used to treat PTSD 4. advice. • Types of Behavioral Therapy: 1. Behavioral Therapy • Overview: focuses on reducing overt behaviors that are symptoms of mental illness. Systematic Desensitization (Wolpe): counterconditioning to decrease maladaptive anxiety. impaired object relations.

eating disorders with exercise. and many others. The patients uses relaxation techniques to selfmodify autonomic functions to produce resolution of multiple symptoms. Therapist states this cognitive distortion is “overgeneralization” in that NOBODY will ever love the patient and then the patient works to disprove the distortion (test validity). 3) patient expects failure and hardship. test logic of automatic thoughts. EDO. activity scheduling (behavioral modification of anhedonia and PMR). Behavioral techniques: various homework with activities to improve self-reliance and find new healthy ways to cope with stressors(replacing substances. Basically. TMJ. This is an automatic negative thought that is the result of a maladaptive cognitive distortion/error. skin temperature. and behaviors that cause mental disorders. HTN. CBT combines cognitive therapy (identifying and challenging underlying cognitive errors) with behavioral therapy (removing unwanted behaviors) • Occurs over the course of 15-20 weeks • Therapist: the goal is to teach the patient to become their own therapist through a series of assignments. OCD. Ex: patient believes nobody will ever love her(automatic negative thought) because her boyfriend broke up with her. their faulty logic. Cognitive techniques: elicit automatic thoughts. asthma. Social Anxiety Disorder. 2) patient sees the world as a negative place. • Techniques: 3 main components 1. . Methods: uses EMG. 3.• • • Overview: Designed by Miller to assume voluntary control of the autonomic nervous system and other biologic systems using operant conditioning. and other measurements to monitor physiologic states. and close interaction between therapist and patient • Patient: CBT is proven to help with patients with MDD. • Techniques for Specific Disorders: 1. BMD. • Goals: identify and alter “cognitive distortions” that maintain symptoms. arrhythmias. Cognitive Behavioral Therapy • Overview: focuses on the interplay of maladaptive thoughts. Didactics: teach the patient about their mental disorder. Phobias. the cognitive triad. identify cognitive distortion. homework. and Substance Abuse. Conditions treated: include Reynaud’s. epilepsy. and cognitive distortions 2. fecal incontinence. BP. VIII. etc). suicidality. MDD: provides education (informational intervention). Panic Disorder. migraines. art. tension HA. CBT strives to identify negative “automatic thoughts” that are generated by “cognitive distortions. feelings.” Example: patient believes he is too fat to have friends. The cognitive triad is 1) negative self perception. GAD. Psychotic Disorders. test validity of cognitive distortion. maladaptive thoughts and feelings lead to unhealthy behaviors.

participant modeling (therapist exemplifies a behavior [touching a snake] and encourages patient to copy the behavior). Social Anxiety Disorder. cognitive interventions to help break intrusive thoughts/ritualistic behaviors. functional analysis (examine function before vs. relaxation techniques. Ex: “All these people think I’m an idiot. OCD: education. exposure intervention (desensitization exercises). cognitive restructuring (monitoring and “catching” thoughts that precipitate anxiety. imaginal exposure (narrate trauma. GAD: education. cognitive interventions to challenge “all or nothing” thoughts (“I had one drink. imaginal exposure to worries. Phobias: exposure interventions. cognitive restructuring body image and challenging negative thoughts about body. I blew it. selfmonitoring. cognitive interventions to challenge perpetual fear of danger. monitoring mood to early detect destabilization. 2.cognitive restructuring (challenge negative views of self). I might as well continue. relaxation techniques. improving regularity of circadian system through healthy behaviors (exercise. 3. cognitive restructuring (decrease negativity and catastrophizing). diets.”). selfmonitoring and reporting EDO behaviors. problem-solving (find new ways to cope with stressors rather than binge/purge).) and other dysfunctional thinking. social skills training. 8. 9. after substance abuse). and some interoceptive exposures (as used in panic d/o). etc). education. Anorexia Nervosa: positive and negative reinforcement procedures initially to protect health and decrease hospitalization/decompensation. motivational interviewing. 6. BMD: stress management. Panic Disorder: education to stop the “fear-of-fear” cycle and stop catastrophic misinterpretations (“I am having a heart attack”). problem-solving skills to improve compliance with care. 5. extinguish extreme emotional response. Substance abuse. 10. problem-solving (identify new means . interoceptive exposure (exposure to physiologic symptoms of anxiety through running in place or hyperventilating. desensitization invivo. stimulus-control (decreasing triggers [ex: don’t eat in mall with all skinny friends]). exposure and response prevention (desensitization and flooding). cognitive interventions (examine cognitive distortions and negativity). similar to desensitization). Also use the above techniques for Bulemia. 11. and problem solving (assertiveness training). desensitization. 4. relaxation training. Bulimia Nervosa: education (including health education). PTSD: education. 7. learn to feel safe).

Contagion: expression of an emotion in one member elicits the expression of emotion in another member 6. Psychotic Disorders: education. encourage and stimulate character change (helps identify malignant character deficits in a patient through group reflection. and relive them to increase insight 2. and to promote healthy change). social skills training. psychotic. • Goals: Re-establish pre-morbid levels of functioning in people with acute distress. • Therapist: plans and organizes group after identifying specific goals of the group. 13. IX. • Patients: patients selected for a group based on needs/diagnosis/goals of group. helps to establish cohesion 4. 8. absence of censure and difference of opinion is tolerated. and contingency management (contracts.of coping with stressors). Groups need to be somewhat homogeneous in ego development for psychodynamic groups. Abreaction: unearth repressed emotions. Inspiration: imparting a sense of optimism to group members 10. 12. and skillfully guided interpersonal interaction in a collection of patients brought together by a leader for a shared therapeutic goal. positive reinforcement). Altruism: one member helps another. Imitation: emulation or modeling of one’s behavior after another person 9. or mental illness support groups). • Therapeutic Factors in Group Therapy (PRITE questions in past) 1. Corrective Familial Experience: group re-creates family of origin for one member to help them work through original conflict 7. 3. Personality disorders (need longer treatment CBT than Axis I d/o): emotional regulation (identify. reduction of therapy-interfering behaviors (resistance). manic. Acceptance: feeling of being accepted by the group. Reality Testing: person’s ability to evaluate the world outside of themselves and perceive reality accurately . Active SI. 5. closely observed. stress management. cognitive interventions to promote medication compliance. tolerate and modify emotions). Group Therapy • Overview: group therapy offers the opportunity for purposefully created. Cohesion: group is working together for a common goal. Empathy: group member can put himself in the psychological framework of another member and understand the thinking. feeling. challenge cognitive distortions. support targeted populations (medical illness like cancer. and emotionally sadomasochistic individuals are contraindicated. stress management and problem-solving (new coping skills rather than unhealthy mechanisms). and behavior. provide relief for target symptoms (ex: eating disorders).

CBT: weekly up to 6 months. Empathy and Reality Testing. and sibling order. Ventilation: expression of suppressed feelings. work on present/past life situations. social learning. helps adapt to environment. and integrate the family into society. One technique used is “reframing” (ex: “This child is impossible. Goals are to increase family member differentiation. and communication. 2. Psychodynamic: 1-3x/week for years. Understand how the parents operate from models from their own parents/families. or events to group members to ameliorate a sense of shame or guilt (aka self disclosure) Types of Group Therapy: 1. family emotional system. establish healthy role relationships. Conditioning. shared universal dilemmas. Reinforcement. meets family members’ individual needs. Uses genograms. ideas. Experimental/Humanistic: core concepts are attachment theory and “psychotherapy of the absurd” (seriously). phobias or compulsions treated. . works on cognitive distortions to relieve specific psychiatric symptoms. Universalization and Reality Testing 2. Catharsis. heterogeneous groups. including a family life chronology in the first 2 sessions. Cohesion. acceptance. Goals are to resolve problems by improving communication and problem-solving skills while balancing change vs. education on treatment. 3. Supportive: weekly over months. Inpatient: daily groups with rapid turnover of patients. X. Bring to light hidden patterns and understand the purpose of these patterns. 4.” problem solving.” Can be changed to “This child is trying to distract you from an unhappy marriage). Bowen Family Systems: core concepts are differentiation of self. Universalization: the idea that an individual is not alone with their problems 12. • Techniques: collect a thorough history. focus on interpret unconscious conflict to challenge defenses and reduce shame. This is the #1 empirically supported family/couples therapy.• 11. • Occurs weekly for 1-2 hours • Family may present with a single family member identified as the “problem” but the dynamic is likely much more complex than that • Goals: alter interactions and improve functionality of the family as a unit of individuals. and manage anxiety. emphasis on the “here and now. cope with destructive forces inside and outside the family. • Types of Family Therapy: 1. Examine Transference. Family Therapy • Overview: seeks to resolve family conflict. Goals are creativity. triangulation. decrease triangulation. Reality testing. Behavioral/CBT: core concepts are functional analysis. for neurotic disorders. 3.

and homework based problem solving. and challenge resistance. identify transference within the family dynamic.” Psychoeducational: core concepts are expressed emotion. Goals are improving flexibility/adaptability. and change occurs through conscious insight into unconscious processes. Milan System: core concepts are neutrality.4. circular interaction between family and therapists. disentangle interlocking pathologies. increasing self-esteem and fostering cohesion through wacky activities like family sculpture. family hierarchy. Goals are creation of newer. This is the #1 family based therapy for families with a member with schizophrenia or another major psychiatric disorder. coalition/alliance. Goals include increasing insight/empathy. scapegoating. and rehabilitation.” changing maladaptive patterns. engagement with the family. and engagement/enmeshment.” XI. and “circular questions” designed to improve empathy (“What do you think concerns your wife most about your illness”). Psychodynamic: core concepts are projective identification (projecting your undesirable characteristics onto another person). “paradoxical directives. address double binds. This is super famous family therapy and sometimes gets tested. education workshops. “longterm brief therapy” (long session with a month between sessions). more useful life stories. Techniques include therapist team behind a one-way mirror. 6. 8. Believe individual cannot change until the system that sustains them changes. finding a balance between connectedness and differentiation. family life cycle transitions. 7. Structural: core concepts are boundaries. understanding the family system in the context of a narrative story. Narrative: core concepts are narrative stories of the family system designed to make others understand the dynamic. Strategic: core concepts are power/control.” “counterparadoxical interventions” (intentionally engage in unwanted behaviors to increase insight). relapse prevention. Goals are problem-solving with identification of “exception to the rules”. role changes. adapting to change. splitting. “hypothesizing. Goals include improving social skills and communications. May have 2 therapists. Goals are unmasking the “family game. externalize problems rather than blaming single members for problems. problem-solving. not the therapist. 9. solutions reside with the family. disrupting sequences of behavior that perpetuate problems. families get stuck in patterns of interaction. 5. Couples Therapy . Creation of a “holding environment. enhance communication through therapeutic letters.

The Interview: components should include evaluation of each partner’s motivation to participate in treatment. Life cycle implies that transition from one life cycle to another has the highest risk for divorce and conflict (mid life crisis. psychosis. abreaction (recovering suppressed feelings to remove symptoms). A couple’s relationship has a life cycle context. within the context of changes in the individual and changes in the family. Basic Principles: monitor for projective identification and re-enactment of childhood attachment issues with spouse. Treatment Interventions: interpretation of unconscious processes. and identify the biggest sources of conflict. promote accountability and responsibility. Communication skills are essential. parapraxes (“Freudian slips”). countertransference. role playing (role reversal to increase empathy). identifying each member’s view of what the problem is. A Ninja’s Guide to Freud and Other Important Stuff Sigmund Freud Associated with the terms resistance.• • • • • • Overview: focuses on the pattern of interactions between two people while taking into account the individual history of each member. aging. problem-solving. or when divorces is actively being sought out. promote well-being as a unit. etc). Goals: alleviate distress. and paradoxical interventions (reverse psychology stuff where a therapist tells member NOT to change. assessing for infidelity. providing a safe environment in the first session. leading to change). Interpretation of Dreams . catharsis. communication skills training (including learning active listening skills and learning to fight constructively with specific rules). Contraindicated in cases of domestic violence. repression (hiding distressing material in the unconscious) and many more. transference.

in dream they are concerned about their brother’s desire to rob a bank). • Displacement: intensity toward an object is redirected to a more neutral/acceptable object (example: dreamer unconsciously wants to kill their mother. • Two layers in dreams: manifest layer is what is remembered/recalled of dream.or something like that). latent layer is the unconscious wish that is not recalled. • Preconscious: this is the area where thoughts are held before being pushed into the conscious mind. The following terms are sometimes seen on PRITE. the aim . requesting a definition. in the dream they want to kill an unknown female stranger [more acceptable object]). and psychotherapy helps to attach words to unconscious thoughts and bring them to the conscious mind. The instinct has 4 basic characteristics: the source (part of body from which instinct arises). • Symbolic representation: innocent symbol represents a complex set of feelings (example: dreamer sees a puppy. Unacceptable unconscious wishes held here may be pushed into consciousness by psychic energy. • Secondary revision: rational portions of dreams that resemble waking life (dreams acting out work/home scenarios.Based on the premise that dreams are unconscious wishes (potentially childhood wishes) that are not accessible in waking life. • Unconscious: the area of the primary process (see above definition) that is incoherent and represents wish fulfillment. being on call. Freud used this theory to identify the workings of the conscious and unconscious mind. • Condensation: several unconscious impulses are attached to one manifest dream image (example. Instinct refers to a pattern of genetically derived behavior that is independent of learning. • Conscious: ideas/thoughts are in the conscious mind due to “psychic energy” (attention cathexis). the impetus (intensity of instinct). which actually represents their feelings of vulnerability and fear of being castrated/neutered…. • Primary process: the above incoherent esoteric characteristics of the manifest layer (nonsensical dream aspects that are recalled). a man with a face made of bread playing a trumpet may be the dreamer’s fear of men consuming creative instincts… or something like that). • Projection: dreamer’s unacceptable wishes are put onto another person in the dream (example: dreamer wants to rob a bank. Memories are separate from words. Freud began to consider instinct theory. which pushes these thoughts into the conscious forefront. etc) The Topographical Model of the Mind Based on principle that the mind is divided into layers. Instinct and Drive Theory After developing the topographical model of the mind.

The Reality principle is generally learned. outside body). • Libido Instinct: sexual/pleasure drives • Ego Instinct: non-sexual instincts/drives • Aggression: dual instinct theory refers to the balance between libido and aggression. Occurs unconsciously • Ego: spans all three areas of the mind (conscious. defense mechanisms (unconscious). Develops a sense of reality (distinguish inside body vs. The Structural Theory of the Mind Freud moved from the topographical model of the mind to the structural theory of the mind. the libido is withdrawn from the mother (object) and reinvested in the person’s ego. Specific types of instinct are libido. which focused on the ego. which sometimes leads to conflict. perception. contact with reality. there is a later trauma. Reality Principles The Pleasure principle is that humans avoid pain and seek pleasure. • Judgment: anticipates the consequences of actions. mediates between the id and the external world and delays drives is socially unacceptable. • Primary narcissism: after birth the neonate is completely narcissistic. Proscribes what a person should not do. • Superego: establishes and maintains the moral conscience. and unconscious). with all libido invested in meeting their own needs. • Id: unorganized instinctual drives that are part of the primary process (see above). when a person falls in love with an idealized version of themselves projected onto someone else. and aggression. and the object/target of the instinct. The ego helps to modify the id. There can be a loss of reality testing and grandiosity. . The Reality principle is that which delays/postpones the pleasure principle when it is not appropriate. id. Narcissism Basic principle is that the person’s libido is invested in the ego rather than in other persons. Functions of the Ego • Controls instinctual drives. • Secondary narcissism: if after object attachment occurs with the mother.(generally an action toward decreasing tension). preconscious. based on values internalized from parents. • Freud regarded homosexuality as a narcissistic form of object choice. It’s a regression. and superego. The addition of the mother figure leads to withdrawal of the libido from self and redirected onto the external object (mom). and delay/modification of drives (to make them socially acceptable). • Relation to reality: mediates between internal world and external world. This is object attachment. ego. where aggression aims to destroy Pleasure vs. It is responsible for logic/abstraction (conscious).

Repels others and avoid intimacy. • Hypochondriasis: overemphasizing illness. pushing them into the unconscious. 1. Immature • Acting out: giving in to an impulse to relieve tension (burning down a house) • Blocking: inhibiting or blocking thoughts. Look how benevolent I am. Object relations: developing satisfying relationships stems from early interactions with parents and other early significant figures. “The whole world is an angry place!” “This job is so uncaring!”) . which puts one’s feelings onto others (“They want to harm me.”) 2. Neurotic • Controlling: obsessive management of external environment to decrease anxiety and resolve conflict • Displacement: shift emotion from one object to another (bad day at work. • Somatization: transform conscious or unconscious conflict into body sensations/symptoms to avoid dealing with it. he probably really needs a car.• reality testing (distinguish between fantasy and reality). hallucinations) • Projection: endowing your feelings onto someone else (“Why is mom so angry today?” when really YOU are angry). and basically are grouped from the most primitive (like projection) to most mature (like sublimation). Narcissistic (Most Primitive) • Denial: abolishes external reality (“I don’t have cancer”). is a regression to avoid guilt and responsibility • Introjection: internalizing an object’s quality. Defense Mechanisms These are very common on PRITE. (Kid with stomach pain on test days).”) • Passive aggressive behavior: indirect aggression that is not overt (like procrastination that makes someone else suffer). 3. and adaptation to reality (adapt to change). • Regression: return to a less developed phase (“I want my teddy bear”) • Schizoid fantasy: autistic retreat to avoid conflict. Can include paranoid delusions and delusional disorders. Blocking thoughts can lead to increased tension. (“Poor thief. go home and yell at your spouse) • Externalization: generalized projection where the entire world/external environment is attributed with personal elements (feeling angry. • Distortion: reshapes reality to suit internal needs (delusions. An example is identification with an aggressor (internalization) leading to belief that the aggression is under one’s control.

like an earthquake safety kit in the garage) • Asceticism: gratification through limitation and renunciation • Humor: using humor to tolerate terrible experience. As a result.. • Suppression: consciously postponing discomfort (one child in car accident.”) • Sublimation: impulse gratification by converting socially unacceptable impulses to acceptable actions (gardening. painting). • Rationalization. you go give your neighbor a present even thought you hate them). his dad kicked a puppy to death.) 4. No affect in telling story). (“disassociative fugue” is when a person goes places/does things but retains no memory and appears confused afterwards. Have fun with that one…. Suppression: choosing not to think about the rape that happened at age 5). Mature Defenses • Altruism: providing a gratifying service to others for the vicarious experience (volunteering to raise money for cancer makes you feel all warm and fuzzy inside). I’ll save loads of money on shoes. This is different from suppression. Repression is similar to thought blocking. which consciously avoids the thought (Repression: forgetting (unconscious) a rape at the age of 5. except no tension is observed with repression. • Repression: put an undesirable thought/feeling into the unconscious to avoid dealing with it. and is a numbing of sensorium in response to trauma) • Reaction formation: unacceptable impulse/emotion is converted to an acceptable impulse (you hate your neighbor because they are noisy at all hours of the night. using rational explanations to justify an unacceptable behavior or belief (“I’m allowed to take stacks of napkins home from McDonald’s because they’ll just throw them away anyway”) • Disassociation: modify one’s character/identity to avoid emotional distress. Feelings/impulses are acknowledged and modified. Disassociation is often used by patients with borderline personality disorder.Inhibition: renounce ego functions to decrease anxiety Intellectualization: use intellect to avoid an emotional/affective experience (get cancer. • Anticipation: anticipate future discomfort (coming up with a realistic back-up plan for problems in the future. but this hatred feels unacceptable/elicits guilt. spend all your time on internet learning about it to avoid emotionally experiencing having cancer) • Isolation: separate an idea from an affect (“isolation of affect” PRITE question has a patient who blankly tells therapist that. rather than first rushing to ER. suppresses fear and calls the • • . as a child. now that I’ve lost both my legs. This defense mechanism actually focuses on the experience (“Well. • Sexualization: making a neutral object sexual to decrease anxiety related to a prohibited impulse (No clue.

regression.  Goal: develop trust and dependence and gratify libido without conflict with aggression. Related to autonomy/independence with a good balance of control vs. individualization. then goes to ER). jealousy  Resolution of this stage: learn to give and receive without excessive dependency/envy and build trust/self-reliance. and the person will continue to struggle with unresolved issues from previous stages. confronting pathology specific to each stage. envy.  Resolution: autonomy. hunger. maintaining a balance between overcontrol/undercontrol. these are Freudian Developmental stages that often are tested on PRITE. reaction formation. Anal (1-3 years old): concepts of control (over anal sphincter).  Common defense mechanisms: undoing. and isolation.  Common defense mechanisms: projection and denial in early oral.other kids at home to make sure they are safe and cared for.  Goal: separation. initiative without guilt. devouring. While some theory seems a bit weird (penis envy. increasing aggressive drives. castration fears). and satiation. displacement and “turn against self” in later oral. and defiance. Obsessive-compulsive neurosis pathology develops in this stage. • Oral (0-18 months): concepts of thirst. These stages correlate with Eriksonian Stages (discussed next). Aggression (oral sadism.  Pathology: overcontrol leads to being overly neat/orderly.  Pathology in this stage: narcissism. Loss of control leads to messiness. The goal is to progress through these stages linearly. • . Therapy seeks to find these unresolved issues and bring resolution towards better mental health. and the shift from a passive/dependent phase (oral) to an active phase. Libido (oral eroticism) vs. pessimism. Failing to resolve pathology leads to incomplete passage through each stage. the overall principle of working through unresolved early-life issues is reasonable. dependence on objects/people for self-esteem. Psychosexual Developmental Stages Basically. and destroying). and willful. self-determining behaviors without shame and doubt. stubborn. undercontrol in the anal stage (age 1-3 years) will forever struggle with autonomy issues and balance of control (making them “anal retentive” and overcontrolling). ambivalence. biting. shame/self-doubt due to lack of control. leading to resolution of conflict/pathology and moving onto the next stage in life. Example: A person who does not resolve the issues of overcontrol vs.

hormonal development.  Common defense mechanisms: sublimation. Regressive enuresis can occur here.  Resolution: pride and self-competence. Develop Ego and begin to master skills. develop adult roles. feminine shame due to lack of strong urine stream (seriously…). • • Genital (11/13-Adulthood): physical maturity. and learning to take initiative. regulation of drive impulses. Undercontrol leads to not focusing on learning in this stage. sexual identity. overcome oedipal issues for organization of character.  Resolution: integrating psychosexual development. castration anxiety in males. There is the potential for regression in this transition from anal stage (balance of control. and accept cultural values.  Pathology: competitiveness/ambition. and excitement. sets the stage for gender identity. Start to play and learn while fighting overcontrol and obsessions. penis envy in females. Goals: gender identity. repression • Latency (5/6-11/13 years old): development of the superego in the phallic stage leads to instinct control. previous unsuccessful resolution leads to pathology in adulthood. initiation without guilt. • Phallic (3-5 years old): sexual interest. Overcontrol leads to closure/stunting of personality development. with problems with overcontrol/undercontrol. becoming autonomous. Pathology: neurosis.  Pathology: Issues of control (like in anal stage).  Goals: separate from dependence on parents. . stimulation. There is a struggle against regression and this stage may reopen all conflicts in previous stages. the libido gets sublimated (directed into socially acceptable behaviors). generate superego based on identification with parent of the same sex. retention. develop mature object relations.  Goals: finish the work started in the phallic stage by further integrating oedipal identification and consolidating sex roles. Unconscious oedipal issues (boy’s competition with father for the mother’s love) and castration anxiety. increasing drives.    Urethral Transition Stage (between anal and phallic stages): release vs. Common defense mechanisms: Intellectualization vs. abnormal development of human character Resolution: ability to maintain curiosity without embarrassment. mastering tasks/objects. leading to the need to reresolve them. autonomy) moving onto phallic stage. In latency.  Pathology: reopening/reworking previous development and potential for regression.

self-doubt. correlates with Anal): Developing a sense of justice and maintaining a balance between good will/cooperativeness and willfulness.”  Defense mechanisms: projection and introjection  Virtue: hope  Pathology: schizophrenia (aggravated crisis due to failing to develop hope). Regulate the will. Compete with same sex parent. “Taking and holding onto things. “If everything goes back to childhood. depression (feeling empty. clearly defined stages." •  Trust vs. impulsivity. Initiative vs. correlates with phallic): exploration. leading to doubt>autonomy and a harsh conscience). and psychosomatic illnesses.”  Virtue: will  Pathology: persecutory paranoia (stuck between trust/autonomous will and mistrust/doubt). inhibition. Oedipal impulse is overcome and the child can then compete in the outside world and learn to lead an active adult life. from infancy and childhood through old age and senescence. OCPD (conflict with hold on/let go. This can cause conversion disorder. aggressive. role inhibition. Self-certain vs. conquest. curiosity. competitive. addictions issues Autonomy vs. Will to be oneself vs. self-conscious. correlates with Oral): starting to take in the world and learn trust based on quality maternal relationship. then everything is somebody else’s fault and taking responsibility for oneself is undermined. The superego is developed to regulate initiative. and that each stage must be satisfactorily resolved for development to proceed smoothly. Failure leads to guilt. no good). A virtue is associated with each stage.  “Being on the make. Role anticipation vs.  “Holding on and letting go. and rivalry. jealousy. paranoia.”  Virtue: purpose  Pathology: overcompensation for the conflict between initiative and guilt. Epigenetic principle: development occurs in sequential. Resolution: reintegration and resolution of previously unresolved conflicts leads to maturation of personality and capacity for selfrealization. • • . Shame and Doubt (18mo-3 years. Guilt (3-5 years old. Erik Erikson Adapted some of Freud’s theories of development to formulate a theory of development that covers the entire span of the life cycle. Mistrust (0-18 months. preoccupation with genitals.

divorce. and a “detached yet active concern with life. compare self with others and care how others perceive them. sense of futility. Task identification vs.• • • • • Industry vs. sustaining loyalties to others despite contradiction of value systems (accepting people for who they are). correlates with genital): puberty.  Virtue: care  Pathology: alcoholism. Role Confusion (13-21 years old. holding onto integrity. Falling in love serves to clarify one’s sense of identity projecting your identity onto another person. the child will not integrate well into society. Isolation (21-40 years old): looks at the virtue of love within a balanced identity. Despair (60 years old until death): accepting responsibility for one’s own life. Identity vs. Stagnation (40-60 years old): establishing and guiding the next generation. Importance of feeling needed.”  Virtue. and this stage serves to broaden social scope to include groups. Intolerance of individual differences is the way the youth attempts to ward off a sense of their own identity loss. to make compromise and to self-sacrifice. including schizoid personality disorder. Integrity vs. not just specifically your own offspring. the reaction may be to become detached and self-absorbed.  Virtue: love  Pathology: isolation and detached states. pride. Inferiority (5-13 years old. wisdom  Pathology: failing to attain integrity leads to becoming deeply disgusted with the external world and contemptuous of persons and institutions. escapisms (alcohol and other sexual infidelity). cliques. Failure of generativity leads to stagnation. This all leads to creative inhibition and conformity.  Pathology: role confusion ensues when the person cannot formulate a sense of identity. organizations and society.  Virtue: fidelity. Intimacy vs. poor development of the superego and guilt. genderrelated identity disorders. Intimacy is tied to fidelity. imbalance between overcontrol/undercontrol. Ego loss occurs when becoming closer to others. correlates with latency): learning new skills. premature invalidism. and borderline psychotic episodes. work ethic. If there is no development of trust/balance of control/creation of superego.  Virtue: competence  Pathology: failure to complete previous stages leads to mistrust/pessimism. withering of leadership roles/destruction of companies. and mid-life crisis. This results in delinquency. Learn to find role in society. Generativity vs. Disgusts masks the fear of death and a sense of . In addition. they will not learn new skills and become competent. and diligence. Identify with teachers. Person has already learned to form intimate relationships. Failure leads to identity diffusion and role confusion.

Shame and Doubt (holding on vs. if you don’t resolve the bad stuff in each stage. independence and the development of will • Pathology: develops when shame and doubt dominate autonomy 1.despair that “time is now too short for the attempt to start another life and try out alternate routes to integrity. Overcontrol leads to obsessions/compulsions. individualization Erikson: Autonomy vs. 3. Feeling starved and empty also leads to thrill seeking behaviors 18 months to 3 years Freud: anal stage (control of sphincters). Plainly stated. messiness. but it is very useful for providing good care for your patients.” “Healthy children will not fear life if their elders have integrity enough not to fear death. Social mistrust leads to oral dependency and substance abuse due to the feelings of emptiness and hunger. HOPE. This section is not high-yield for PRITE. hopelessness and mental pathology. Associated conditions: 1. you will go on to the next stage with unresolved baggage and continue through life with that baggage. willfulness and anal retention 5. schizoid personality disorder. 4. balance between over control/under control. delusional disorders. and sadomasochism .” Erik Erikson Pathologic Development In both Freud and Erikson’s developmental theories one concept is central: failure to resolve conflict and mature through each stage leads to significant residual pathology. trust/give/receive. Projection (defense mechanism associated with this stage) leads to social mistrust. paranoia. Shame>autonomy leads to feeling dirty. hopelessness. delinquent behavior and paranoia about control 3. dysthymia 2. Birth to 18 months Freud: oral stage (feeding. Rigorous toilet training leads to excessive cleanliness and compulsions 4. needs. object relations). narcissism. understanding the roots of pathology. Mistrust (taking and holding onto things). Doubt>autonomy leads to obsessive personality 2. letting go). Undercontrol causes ambivalence. Separation in infancy leads to depression. and paranoid schizophrenia. nutrition. Erikson: Trust vs. and making a kickass bio-psycho-social-spiritual formulation for oral boards. A person who does not resolve oral/trust/mistrust stages will have a lifelong struggle with dependence. projection • Pathology: Impaired trust leads to mistrust. trust.

Loss of identity through overidentification with others and formulation of cliques 2. ego identity). Erikson: Identity vs. and disruptive behavior 20s to 40s Freud’s last sage was the genital stage. gender identity. integration into society • Pathology: development of inferiority due to problems completing goals 1. feeling inadequate. fidelity to oneself. begin to establish identity). there may be prolonged dependence 3. Inferiority (learn skills. Fear of not fulfilling one’s purpose leads to psychosomatic disease 5 to 13 years Freud: latency stage (superego developed in phallic stage now controls/regulates desires and wishes). • Pathology: identity confusion 1. roles. identification with parents leading to the development of superego to regulate drives. phobias. 1. Mistrust (in earlier stage) PLUS shame and doubt leads to persecutory delusions 7. Guilt leads to anxiety disorders. guilt secondary to drives vs. emphasis is on reworking unresolved issues from the previous stages. Refusal to be controlled causes impulsivity 3 to 5 years Freud: phallic stage (issues of oedipal conflict. reworking conflict). gender identity disorder. sexual identity. conscience.6. • Pathology: guilt related to impulses and desires leads to symptom formation. Role confusion leads to conduct disorder. compensatory drive for money/power/prestige later in adulthood at the expense of intimacy (later stages suffer due to incompletion of this stage) 13 years to 20s (Adolescence) Freud: genital stage (maturation. competition with parent). initiative. which focused on continuing to work through previous conflict throughout adulthood. and sexual inhibition/impotence 3. The remaining discussion on development of psychopathology will focus on Erikson. purpose. Guilt (expedition. learning. If unable to leave the home. . Punishment for impulses leads to conversion disorder due to oedipal wishes. sexual inhibition (due to fear of punishment) 2. competence. Work inhibition. mastery of skills Erikson: Industry vs. Erikson: Initiative vs. child learns values and recognizes the external world. separation/independence. Role Confusion (puberty. penis envy/castration anxiety).

projective tests “detect the presence of subtle psychotic thought processes. knowledge and skills. Lacking generativity and acceptance often leads to suicide Neuropsychologic Testing This is a highly tested area on PRITE. An example is the MMPI. • Pathology: the inability to take risks. and inability to accept life 1. Despair (accept the life cycle and the proximity of death). capacity to love and isolation leads to schizoid personality disorder 40s to 60s Erikson: Generativity vs. sacrifice/compromise. and losing hope for the future. Stagnation (guiding the next generation). Per PRITE. love. caring. 60s to End of Life Erikson: Integrity vs. 2. The intelligence quotient (IQ) is the ratio of mental age/chronological age. Reliability refers to the ability to reproduce the test results. Validity shows if a test can accurately test what it is supposed to. Contemplation of past failures. An example is the Rorschach test. no generativity. newly achieved personal intimacy with social groups. Declining physical health leads to anxiety. psychosomatic illness. Stagnation leads to “escapism” into alcohol/substances. hypochondria and depression. leading to depression and disappointment 3. • Pathology: develops when a person cannot generate of skills and share knowledge with the next generation 1. • Projective: ambiguous stimuli that the patient responds to and the response is then interpreted. infidelity and mid-life crisis 2. healthy detachment and wisdom • Pathology: the knowledge that time has run out.Erikson: Intimacy vs. Society suffers. the patient suffers. Types of Tests • Objective: typically pencil-and-paper tests with specific questions that can yield numeric scores to be analyzed.” Intelligence Tests The IQ test was introduced in 1905 by Alfred Binet. which is multiplied by 100. Isolation (maintaining identity while establishing intimacy). Examples are questions asking you to choose the “projective test” or will give you the name of the test and ask you its function. current problems. An IQ of . tribal leaders.

• Word-Association Technique: created by Jung. the patient draws a person (shows a representation of the expression of the self).” Projective Tests • Rorschach Test: set of 10 inkblots are a stimulus for associations. 50-70 is mild MR. Includes Hamilton Rating Scale for Depression. Interpretation of responses requires an experienced clinician. the WAIS has high reliability and the WAIS-II vocabulary test most strongly correlates with pre-morbid functioning in a patient with early dementia. It’s super cool). Per PRITE. half are black and white. patient is presented with a word and must give the first word that comes to mind. per PRITE. Per PRITE. The average IQ is 100. Cognitive Testing . is “a test in which a patient is shown pictures of situations and asked to describe what is going on in each picture” (an example is a woman seated on a couch looking up at an older man). Personality Assessment Objective Tests • MMPI: uses 10 scales in a configurational approach (see a nice little graph based on responses in 10 categories) to “identify major areas of psychopathologic functioning” (per PRITE) and measures test-taking attitudes during the examination (can detect malingering. The latest revision is the WAIS-III. The Beck Depression Inventory. It uses verbal IQ (previously leaned factual info) and performance IQ (visuospatial/visuomotor skills). • Wechsler Adult Intelligence Scales (WAIS) is the most widely used intelligence test.” • Structured Clinical Diagnostic Assessments: these are tests that give a numerical score to show severity of a particular illness.” “My greatest fear is”). • Draw-a-Person Test: first used to test intelligence in children. they are shown in a particular order. is the “most appropriate brief screening instrument that a patient can fill out alone at a physician’s office to screen for depression. and below 20 is profound MR. answering questions falsely.100 would imply that your mental age (thinking ability) matches your chronological age (how old you are). It is the most widely used projective test. and the SCID. etc. • Thematic Apperception Test (TAT): per PRITE. An IQ of 90-100 is normal. it is the test “the most helpful in confirming a personality disorder. • Million Clinical Multiaxial Inventory: test with brief administration time and correlates well with DSM-III. • Sentence Completion Test (SCT): has sentence stems that the patient completes (“Sometimes I wish. Yale-Brown Obsessive-Compulsive Scale (YBOCS). It also serves to “infer motivational aspects of behavior” per PRITE. and reaction times are recorded. This is similar to free association and brings unconscious to conscious.

there is the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSIR. Achievement • Woodcock-Johnson Psychoeducational Battery-Revised (W-J): scores reading and mathematics. PRITE: determines neuropsychologic impairment. and then a memory testing portion where the original design is removed and the patient must copy the design from visual memory. is composed of 10 separate test that function to differentiate brain damaged patients from those who are neurologically intact. which is closest to the original Stanford Binet. In a PRITE question. and attention span • Boston Naming Test: examines verbal confrontation and naming. Child and Adolescent Psychological Assessment Intelligence • Wechsler Intelligence Scale for Children-III (WISC-III): WAIS-III can be modified for children ages 5-15 in the WISC-III. this test helps to more specifically identify learning disability with children that have otherwise normal IQ. Receptive and Expressive Language • Token Test: examines patient’s ability to comprehend verbal instructions. grammatical complexity.” Test Batteries • Halstead-Reitan Battery of Neuropsychological Tests: determines neuropsychologic impairment per PRITE. with the goal of learning the groups through trial and error. Has two phases. first with the patient allowed to copy the design with the original design in front of them. suit) that the patient is not aware of. • Trail Making Test: patient connects letters and numbers together in sequential order to test concentration and executive functioning Visuomotor Coordination • Bender Gestalt Test: tests visuomotor coordination by copying designs on paper. Helps screen for organic dysfunction. Schizophrenics function similar to chronic brain damaged patients. and other measures of academic achievement. For preschoolers.Executive Functioning • Wisconsin Card Sorting Test (WCST): assesses “abstract reasoning and flexibility in problem solving” per PRITE. on PRITE). written language. per PRITE. . per PRITE “discriminates cognitive difficulties in Alzheimer’s disease from those in depression. Cards are sorted into groups (color.

• • • • • • • • • • Cohort Studies: follow a well-defined population over a long period of time (longitudinal). ANOVA: analysis of variance that compares 2 or more groups Chi Squared: evaluates the relative frequency/proportion of events in a well defined population Z score: deviation of the score from the group mean. 15y.• Wide Range Achievement Test-3 (WRAT-3): screen for deficits in reading. Can be modified to test those with visual and hearing impairments. Random assignment. often will see at various intervals (2y. socialization. Type 2 error: keeping a false null hypothesis. The units of a Zscore are standard deviations (ex: 2 standard deviations above the mean) T test: compares 2 sets of observations Type 1 error: rejecting the null hypothesis (states there is NO difference between the things being observed) falsely. and motor domains. 20y. Please also refer to the Ninja’s Guide to PRITE Questions for all statistics questions used since 2001. living skills. etc). • . This can decrease study bias. and that there IS a difference between two things when there isn’t. Per PRITE. 3y. this is a useful test to screen academic performance. communication skills. Statistics Here are some basic statistics that will be helpful for PRITE questions. when there IS a difference between 2 groups. This is stating that the null hypothesis is false. Retrospective Studies: looks at past data/events Cross Sectional Studies: looks for information about prevalence of a certain disease in a population Clinical Trials: some patients are treated and compared with a control population who are not receiving treatment. spelling and math. Adaptive Behavior • Vineland Adaptive Behavioral Scales: evaluates adaptive behavior. Cross-over: a study where the placebo group eventually gets treatment and the group previously treated gets placebo.