1- Diagnosis and Psychopathology Flashcards

Question

``` A child of a military veteran with Post-Traumatic Stress Disorder is most likely to display which of the following behavioral problems? Select one: A. eating disturbances B. kleptomania C. hyperactivity D. Oppositional Defiant Disorder ```

Answer 1

Correct Answer is: C When a parent suffers from Post-Traumatic Stress Disorder, the whole family is affected, and children are particularly vulnerable to the disruption it causes in the family system. The disorder often impairs one's ability to parent, and it may render parents more likely to become impatient, angry, or neglectful with their children. Young children especially are not cognitively equipped to make sense of this behavior, and research has identified a number of behavioral problems they are likely to display. Depression, anxiety, self-blame, aggression, hyperactivity, and social withdrawal are common, and so are symptoms of PTSD itself, such as low frustration tolerance and outbursts of anger--some describe PTSD as a disorder that may be transmitted intergenerationally. Even though such children may experience a variety of behavioral problems, hyperactivity is the best answer because, of the choices listed, it is the one most commonly identified as occurring in children of PTSD sufferers.

Answer 2

Correct Answer is: B Individuals with Anorexia Nervosa rarely present for treatment on their own because they have a distorted body image and wish to be extremely thin. When they do seek treatment on their own, it is usually due to distress about the physiological and psychological consequences of starvation, not because of weight loss per se. More commonly, the patient is "dragged into" therapy by concerned family members. Thus, one common barrier to treatment is the patient's lack of motivation to change in regards to the core symptoms, starvation and weight loss. Therefore, treatment of Anorexia Nervosa may require an initial inpatient stage in order to restore the person to a more healthy weight, and special attention to the therapeutic relationship is often necessary. Regarding this choice ("family denial that the patient has a problem"), family denial is sometimes an issue in Anorexia Nervosa, but family members are more likely to deny their own role in the problem than the fact that the patient has a problem. As noted, patients are often brought to the attention of medical professionals by family members.

Answer 3

Correct Answer is: B Treatment for nicotine is usually multimodal and psychosocial interventions are often combined with temporary nicotine replacements such as a patch or gum and/or pharmacological agents such as buproprion. Many different therapeutic approaches have been applied, and many have been found to be successful at least in some cases or some studies. However, of all psychosocial treatments for smoking cessation, behavioral approaches have the most support in the evidence-based literature. A number of reviews and meta-analyses have found that smokers undergoing behavioral treatments, as compared to control subjects, have about double the quit rate at a six-month follow-up. Examples of behavioral interventions include reinforcement for abstinence and withholding of reinforcement for non-abstinence; stimulus control, whereby stimuli or situations that cue smoking are identified and avoided; and aversive therapy, such as rapid smoking, whereby the person smokes to the point of discomfort or nausea. Additional Information: Treatment (Substance Use Disorders)

Answer 4

Correct Answer is: C Treatment of Gender Identity Disorder in children is moderately controversial, with some arguing that any attempt to alter a child's gender identity is sexist, and others stating that it represents a sneaky attempt to prevent the child from growing up to be homosexual. Nonetheless, a number of treatment models have been applied, even though scientific evidence of their success is limited. Typical interventions focus on social skills, self-esteem, and increasing the child's comfort with his or her biological gender. They may include positive reinforcement for gender-appropriate behavior, setting limits on cross-gender behavior, social skills training, and parental training in self-esteem enhancement.

Answer 5

Correct Answer is: B First-line medications for ADHD are stimulant medications such as methylphenidate. However if an individual does not respond to two or more first-line medications, or is unable to tolerate the side effects of the medications, then a second-line medication may be prescribed. Antidepressant drugs (e.g., imipramine) have been found to be effective second-line medications for the treatment of ADHD. (See: American Academy of Pediatrics, Clinical practice guideline: Treatment of the school-aged child with attention deficit/hyperactivity disorder, Pediatrics, 2001, 108(4), 1033-1044.) Additional Information: Treatment (ADHD)

Answer 6

Correct Answer is: B Studies of individuals who have undergone sex reassignment surgery have found the vast majority no longer expressed gender dysphoria and were psychologically, socially and sexually functioning well following surgery. Smith et al. (2005) found, post-operatively, female-to-male and homosexual transsexuals functioned better in many respects than male-to-female and non-homosexual transsexuals and non-homosexual individuals with greater psychopathology and body dissatisfaction reported the worst post-operative outcomes. (See: Smith, Y.L., Van Goozen, S.H., Kuiper, A.J., Cohen-Kettenis, P.T. (2005). Sex reassignment: Outcomes and predictors of treatment for adolescent and adult transsexuals, Psychological Medicine, 35(1), 89-99.)

Answer 7

Correct Answer is: D Avolition refers to a lack of initiative, motivation or goal-directed activities and is considered a "negative" symptom of Schizophrenia or Schizophreniform disorder when it is severe enough to prevent an individual from doing basic activities. Alogia* refers to a lack of spontaneous speech. Anhedonia* refers to the inability to experience pleasure. Akathisia* is a movement disorder characterized by a feeling of restlessness, an inability to sit or keep still, a pressing need to be in constant motion and behaviors such as fidgeting, crossing and uncrossing the legs while sitting, rocking from foot to foot, marching in place and pacing (* incorrect options).

Answer 8

Correct Answer is: A Research findings show having a biological parent with depression increases an offspring's risk for major depression. What may be surprising however is that the risk is similar whether one or both parents experience major depression. Studies also indicate maternal and paternal depression affect biological offspring similarly in terms of rates of major depression. (See: Lieb, R. et al., (2002). Parental major depression and the risk of depression and other mental disorders in offspring: A prospective-longitudinal community study, Archives of General Psychiatry, 59, 365-374.)

Answer 9

Correct Answer is: A In general, the greater the level of dependence on nicotine, the harder it is to stop smoking and the amount of smoking is typically used in order to determine dependence. In this question, however, dependence is not a factor of consideration. Research indicates there are other characteristics linked to successful smoking cessation. They include: being age 35 or older, married or living with a partner, later age when started smoking and being male. Considering these factors, a young single male who started smoking at an early age is least likely to successfully quit and most likely to relapse to smoking.

Answer 10

Correct Answer is: A Treatment for Factitious Disorder typically involves symptom management rather than eliminating or "curing" the disorder, which is associated with poor therapeutic outcome. In absence of a consistently effective treatment, establishment of a strong therapeutic relationship, use of supportive therapy and consistency of care is considered the best approach for managing Factitious Disorder symptoms. Family and group therapy can be helpful for family members coping with the client's symptoms, but it is not the most effective treatment for Factitious Disorder. Inpatient treatment is generally contraindicated given the client's underlying need "to adopt the sick role" and use of confrontational techniques, with the risk of client defensiveness, denial or therapeutic relationship termination, requires caution in the treatment of Factitious Disorder. (See: Huffman, J.C. and Stern, T.A. (2003). The diagnosis and treatment of Munchausen's syndrome, General Hospital Psychiatry, 25(5), 358-363.) Additional Information: Treatment (Factitious Disorder)

Answer 11

Correct Answer is: C ADHD in adulthood involves impaired social and occupational functioning associated with chief symptoms of inattention, distractability, restlessness and impulsivity. Given restlessness, an individual with ADHD is less inclined to prefer routine, repetitive tasks and, due to impulsivity and attention deficits, are less likely to be occupationally perfectionistic. Studies have found adults with ADHD have a greater difficulty in maintaining personal and professional relationships (correct response) than controls however, while adults with ADHD often have trouble maintaining relationships, they do not avoid them. Compared to adults without ADHD, adults with ADHD tend to participate in more impulsive or risky sexual behaviors and have more sexual partners.

Answer 12

Correct Answer is: D Laura's symptoms describe excessive attention-seeking, reactivity and emotionality which are most consistent with a diagnosis of histrionic personality disorder. While Laura's mood may be somewhat unstable, she does not demonstrate other characteristics of borderline personality disorder such as a pervasive pattern of unstable interpersonal relationships, marked impulsivity and instability of self-image and affects, as well as suicide threats. Individuals with narcissistic personality disorder display a pervasive pattern of grandiosity, a lack of empathy and tend to less involved with others than Laura exhibits. Like Laura though, individuals with narcissistic personality disorder are also oversensitive to criticism. A pattern of difficulties in interpersonal relationships and peculiarities in ideation, appearance, and behavior characterize schizotypal personality disorder.

Answer 13

Correct Answer is: C Parasuicide includes intentional, non-fatal, serious, self-harming behaviors such as cutting or burning. Reducing parasuicidal behaviors is a primary and explicit target of dialectical behavior therapy (DBT), which was developed to treat Borderline Personality Disorder as parasuicidal behaviors are frequently exhibited by individuals with BPD. The purpose of stress inoculation training* is to help people acquire the necessary skills to cope more effectively with stress. While some acquired skills may help reduce parasuicidal behaviors, they are not "a primary and explicit target" of the intervention. Self-control therapy* is a behavioral intervention that is used primarily to reverse undesirable habits (e.g., overeating, smoking) and has also been found to be an effective treatment for depression. EMDR* was initially developed as a treatment for PTSD and does not primarily target parasuicidal behaviors (* incorrect options).

Answer 14

Correct Answer is: C Parasomnias are undesirable motor, verbal, or experiential phenomena that occur as primary sleep events or secondary to systemic disease and are categorized as occurring in rapid eye movement (REM) sleep, non-rapid eye movement (NREM) sleep, or as types not related to a specific sleep state. Because it involves a partial arousal, an individual exhibits symptoms of being asleep and awake at the same time. Parasomnias are most commonly caused by biological factors, stress, depression and other related factors, they tend to be more common in children than adults, and in some cases, run in families. Sleep bruxism refers to when a person involuntarily grinds or clenches their teeth while sleeping, sometimes leading to wearing down the teeth and jaw discomfort. Treatment typically involves wearing a mouth guard during sleep. Other types of parasomnias include: somnambulism (sleepwalking), which tends to run in families; nightmares, nocturnal leg cramps, sleep talking, sleep enuresis (bedwetting), sleep paralysis, confusional arousals, sleep terrors (nigh terrors) and REM Sleep Behavior Disorder (RBD).

Answer 15

Correct Answer is: D REM sleep behavior disorder is a parasomnia that occurs later in the night than NREM disorders, usually affects middle-aged or elderly individuals, especially males, and sufferers often also have a neurological disorder. In this disorder, the temporary muscle paralysis that normally occurs during REM sleep does not occur so individuals may act out dreams through potentially violent movements or behaviors during sleep that can cause injuries to themselves or bed partners. NREM disorders occur early in the night and include somnambulism, or sleepwalking*, sleep talking*, enuresis (bed-wetting), and night, or sleep, terrors* (* incorrect options). These are all more common in children.

Answer 16

Correct Answer is: A Borderline Personality Disorder has several symptoms in common with Antisocial Personality Disorder (i.e., impulsivity); however many of the behaviors are gender-related. Consequently, women are more likely to receive a diagnosis of Borderline Personality Disorder and men a diagnosis of Antisocial Personality Disorder.

Answer 17

Correct Answer is: A Synesthesia is a condition in which an involuntary joining of one sense is accompanied by a perception in another sense. For example, hearing is simultaneously perceived by an additional sense such as sight. Another form of synesthesia joins objects such as letters, shapes, numbers or people's names with a sensory perception such as smell, color or flavor. Synesthesia can involve any of the senses. Colored letters and numbers is the most common form, in which a person sees a certain color in response to a certain letter of the alphabet or number. Other synesthetes hear sounds in response to smell, smell in response to touch, or feel something in response to sight. While extremely rare, some possess synesthesia involving three or more senses. It is hypothesized that synesthesia results from "crossed-wiring" in the brain, where neurons and synapses that are intended to be contained within one sensory system cross to another. Studies suggest the crossed connections may be present at birth in everyone and the connections are then later refined. It is hypothesized that adult synesthetes may retain the crossed connections.

Answer 18

Correct Answer is: A In both adults and children, the symptoms of schizophrenia can be divided into two broad categories -- positive symptoms and negative symptoms.The "negative symptoms" of schizophrenia include: reduction in emotional expression or emotional and social withdrawal; lack of motivation and energy; avolition (lack of goal-directed activities); alogia (lack of spontaneous speech); poverty of thought, flat affect or ambivalence, and anhedonia, or loss of enjoyment and interest in activities, including social interaction. The positive symptoms of schizophrenia include: hallucinations (often critical or threatening voices), delusions (usually fearing people are watching, harassing, or plotting against the individual), disordered thought, disorganized speech (inability to maintain a conversation, difficulty staying on topic); agitation; and disorganized or catatonic behavior (unusual and bizarre, or difficulty planning and completing activities in an organized fashion). For a diagnosis of schizophrenia, at least two of the previous symptoms must be present for at least 6 months and must be accompanied by increased difficulty in daily living in areas such as self-care, relationships and work or school.

Answer 19

Correct Answer is: C Narcolepsy is a condition in which people are overcome with irresistible sleepiness and sleep attacks of brief duration that occur unpredictably. Other distinguishing features of the condition is cataplexy, a sudden loss of partial or complete muscle tone during excitement or arousal, sleep paralysis, and hypnagogic hallucinations. Hypersomnia may be either idiopathic, secondary, or periodic. Like Narcolepsy, individuals with hypersomnia experience daytime sleepiness and sleep attacks, however the attacks last longer and are more resistible than in narcolepsy and there are no auxiliary symptoms. Typically, nocturnal sleep is disrupted in narcolepsy, is prolonged in idiopathic hypersomnia and variable in secondary hypersomnia. Although the exact causes of narcolepsy and idiopathic hypersomnia are unknown, there is evidence for genetic predisposition. Causative factors in secondary hypersomnia include: neurologic, (e.g., brain tumors, head injuries, and cerebrovascular insufficiency); general medical, such as metabolic disorders, various intoxications, and conditions leading to brain hypoxia; and psychiatric, most notably depression.

Answer 20

Correct Answer is: B Certain behaviors associated with bulimia, specifically frequent vomiting and laxative use, can lead to serious medical complications, including electrolyte disturbances. Potassium is an electrolyte that is important to the function of the nerve and muscle cells, including the heart. Hypokalemia is the name given to the condition that involves low levels of serum potassium. Hypoglycemia* is characterized by less than normal amounts of glucose in the blood. Hyperorexia* refers to excessive appetite and hypalgesia* involves a relative insensitivity to pain (* incorrect options).

Answer 21

Correct Answer is: D A common symptom resulting from head injury is post traumatic amnesia (PTA), a pattern of mental disturbance characterized by memory failure for day-to-day events, disorientation, misidentification of family and friends, impaired attention and illusions. Although PTA can vary from hour to hour and day to day, its duration is most commonly used as a guide to the extensiveness of the damage. The duration of PTA appears to be a sensitive and reliable index of severity, with the longer the PTA the stronger the probability of extensive damage. While there is currently no universal agreement that PTA is a better or more sensitive predictor of outcome after traumatic brain injury than depth and duration of unconsciousness, many consider the duration of PTA the best indicator of traumatic brain injury severity and the most dependable marker of outcome prediction, even in mild cases (i.e., duration of less than one hour). PTA impaired orientation may include retrograde and/or anterograde amnesia and researchers have suggested that PTA would be more accurately called posttraumatic confusional state. With respect to recovery, the duration of retrograde amnesia usually progressively declines while anterograde memory is frequently the last function to return especially after the recovery from loss of consciousness. Most individuals with a mild brain injury recover cognitive and behavioral functions and resolution of other symptoms within 3 to 6 months, though some continue to have symptoms for an extended period and individuals with a moderate or severe injury are likely to experience long-term symptoms and impairments in multiple areas of functioning. An increased risk for long-term impairment include: female gender, previous head trauma, and history of a neurological or psychiatric problem. (See: Ponsford, J. (2000). Factors influencing outcome following mild traumatic brain injury in adults, Journal of the International Neuropsychological Society, 6(5), 568-579.)

Answer 22

Correct Answer is: C The Galveston Orientation and Amnesia Test (GOAT), which assesses temporal orientation primarily, was developed to serially evaluate cognition during the subacute stage of recovery from closed head injury. The scale measures orientation to person, place, and time, and memory for events preceding and following the injury.

Answer 23

Correct Answer is: D Echolalia is the repetition or echoing of verbal utterances made by another person. A 1983 report indicated that up to 75% of verbal persons with autism* have some form of echolalia (Prizant, 1983), but it may also be present in Tourette syndrome*, developmental disability, and schizophrenia* (* incorrect options). When done involuntarily, it is considered a tic. (See: Prizant, B.M. (1983). Echolalia of autistic individuals: Assessment and intervention issues. Seminars in Speech and Language, 4, 63-77. Summarized from Heffner, Gary J. Echolalia and Autism, The Autism Home Page: Echolalia Facts. July 2000. Retrieved April 2007.)

Answer 24

Correct Answer is: B Many clients may report conditions that suggest vegetative symptoms associated with a mental disorder. The classic, or "vegetative," signs of depression include persistent problems with appetite, weight loss or gain, sleep difficulties, reduced energy level, and changes in sexual desire or function. These symptoms are mostly objective, as opposed to subjective and can serve as useful data for diagnostic screening purposes as vegetative symptoms sometimes suggest a serious mental disorder. In particular, it is useful to identify whether any of these symptoms reflects a change from the client's previous functioning.

Answer 25

Correct Answer is: A A panic attack is a sudden, discrete period of intense apprehension, terror, or fear, often accompanied by an urge to escape or a sense of doom. It consists of four or more symptoms such as: shortness of breath, dizziness, heart palpitations or accelerated heart rate, sweating, trembling, depersonalization, sense of choking, nausea, chest pain, numbness, chill or hot flashes, a fear of dying or going crazy. The symptoms develop abruptly, usually peak within 10 minutes, and may mimic a heart attack or hyperthyroidism. Panic attacks may occur in several of the anxiety disorders. Types of panic attacks include: Unexpected (uncued) panic attacks, which are not associated with any trigger (i.e., they occur "out of the blue" ). The diagnoses panic disorder with agoraphobia and panic disorder without agoraphobia must include two or more unexpected panic attacks, and people with panic disorder also may experience the other types of panic attacks. Situationally bound (cued) panic attacks occur almost invariably on exposure to, or in anticipation of, a situational cue or trigger and are most characteristic of social and specific phobias. Situationally predisposed panic attacks are more likely to occur on exposure to a situational cue or trigger but are not invariably associated with the cue or trigger and do not necessarily occur immediately after the person has been exposed to the cue or trigger. For example, a person may have panic attacks associated with shopping mall environments; however, the person does not have an attack every time he or she goes to a shopping mall and/or does not necessarily have the attack immediately upon entering the mall (the attack may occur after he or she has been shopping for a while). These attacks are most common in panic disorder, but can also occur in social phobia or specific phobia.

Answer 26

Correct Answer is: B Brain imaging research has found that the basal ganglia, hippocampus, and frontal lobes are most likely to be negatively impacted by repeated exposure to alcohol during prenatal development. Other commonly affected areas include the, cerebellum, corpus callosum and hypothalamus.

Answer 27

Correct Answer is: A Inappropriate affect represents a lack of congruence between an individual's feelings and expression of those feelings. Restricted affect* is a mild reduction in range or intensity of emotional expression and isn't as marked as flat affect, which is an absence of emotional expression. Labile affect* is rapid and abrupt shifts in expression. Mania is an episode of very elevated, expansive mood, and an associated feature of bipolar disorder (* incorrect options).

Answer 28

Correct Answer is: C Anhedonia is the inability to experience pleasure and a negative symptom is one in which something that should be present is missing, or is not present to a sufficient degree. The other response choices represent positive symptoms, ones in which something is present that should not be present, or is present to too great a degree.

Answer 29

Correct Answer is: A Loss of support and companionship is a stressor, but not an iatrogenic stressor. An iatrogenic condition is one that is produced by the treatment. Some conditions are obviously iatrogenic in nature, such as a practitioner who inadvertently uses a medical remedy to which the patient is allergic or administers an erroneous medication dose. Others forms of iatrogenesis are less obvious, like symptoms arising in response to therapists' suggestions, e.g., recovered memory syndrome, Dissociative Identity Disorder (DID) or unproven medical/psychological treatments.

Answer 30

Correct Answer is: C Cataplexy (the word means "to strike down") is a neurological condition that only occurs in people suffering from narcolepsy. It is characterized by a sudden loss of muscle tone and muscle weakness affecting both sides of the body. It is usually triggered by strong emotional experiences such as stress, anger, fear, and laughter. Additional Information: Narcolepsy

Answer 31

Correct Answer is: B Selye's general adaptation syndrome (GAS) attempts to explain stress reactions and characteristic responses under conditions of stress. It postulates that after a person becomes aware of the stressful situation (alarm), they summon their resources and meet the challenge (resistance). After the trauma is over, they collapse (exhaustion).

Answer 32

Correct Answer is: D Research findings on the effect of multi-component cognitive-behavior therapy (CBT) for rheumatoid arthritis indicate that CBT has positive effects on psychological and social functioning. The results of CBT for the physical symptoms of rheumatoid arthritis are inconsistent and vary by study. Some studies found CBT did reduce joint inflammation, impairment and pain intensity, therefore this response ("psychological functioning is improved and, in some cases, there is a positive effect on joint inflammation and pain intensity") is the best answer as this inconsistency is addressed by the qualifier "in some cases." (See: O'Leary, A. (1988). A cognitive-behavioral treatment for rheumatoid arthritis, Health Psychology, 1988, 7, 527-544.)

Answer 33

``` Correct Answer is: C Biofeedback is the process of identifying physiological variables, or responses, for the purpose of helping an individual develop greater sensory awareness and is achieved by using electronic instrumentation to monitor responses then providing the information to the individual to improve their physiological control of responding. Electromyogram (EMG) biofeedback, measures impulses in the muscles and indicates the degree of relaxation or contraction/tension. It is commonly used for conditions such as stress, tension headaches, chronic pain, muscle stiffness, incontinence, urinary urgency and frequency, and when muscles are healing. Electrodermal response (EDR) biofeedback, also referred to as galvinic skin response training (GSR), measures skin surface changes, giving feedback on the relation between emotional state and the activity of the sympathetic system via sweat gland activity, and is utilized for stress and hyperhidrosis (excessive sweating). Electroencephalogram (EEG) or neurofeedback provides information on brainwave activity and patterns. It is often used in the treatment of attention deficit hyperactivity disorder, depression, and epilepsy to improve attention, reduce impulsivity and promote recovery from head injuries and strokes. Heart rate variability (HRV), sometimes referred to as electrocardiogram (ECG), biofeedback monitors heart rate and cardiac reactivity from sensors placed on a person's fingers or wrist. It is useful for managing stress, high blood pressure, anxiety, and heartbeat irregularities. Other recognized types of biofeedback include: thermal or skin temperature (ST) biofeedback, which involves skin temperature and blood flow control; Respiratory Feedback (RFB), which involves control of breathing type and frequency; and Respiratory Sinus Arrhythmia (RSA); which involves the synchronous control of heart rate and respiration, in which there is a small rise in heart rate during inhalation and a corresponding decrease during exhalation. Depending on the reason for biofeedback, more than one type is often used. For example in this question, Michael might also use EDR to control his general stress response in addition to EMG to control the muscle tensing and teeth clenching responses. Behavioral skills training such as relaxation training, guided imagery and stress-coping techniques are also frequently used in addition to the actual biofeedback. ```

Answer 34

Correct Answer is: C Individuals with Bulimia-Nervosa, unlike those with Anorexia-Nervosa, Binge-Eating/Purge Type, are able to maintain body weight at or above a minimally normal weight for height and age. Anorexia-Nervosa is characterized by a refusal to maintain a minimal normal body weight, with the threshold of underweight being less than 85% of weight expected. Susan's weight falls below this threshold and her continuation of binging and purging despite weight loss meets the refusal criteria of Anorexia. It is also important to consider her fears of gaining weight* and denial of seriousness of her current weight*, especially with respect to treatment planning. Disturbances in perception of body shape and weight* (* incorrect options), and an over influence of weight and shape on self-evaluation are essential features of both disorders.

Answer 35

Correct Answer is: B The Drug Treatment Act of 2000 allows doctors to treat opioid dependence in their practices with FDA-approved opioid medication. In 2002, the FDA approved two medications for use in opioid addiction treatment: buprenorphine monotherapy (Subutex) and a buprenorphine/naloxone combination (Suboxone). Buprenorphine, an opioid partial agonist, activates receptors to a lesser degree than full agonists (i.e., morphine and heroin) and its effects reach a ceiling effect at moderate doses - not increasing, even with increases in dosage. At low doses, it has enough agonist effect to enable opioid-addicted individuals to discontinue misuse of opioids without experiencing withdrawal symptoms. Under certain circumstances and in high doses, it can block the effects of full opioid agonists and precipitate opioid withdrawal syndrome like an opioid antagonist. Buprenorphine carries a lower risk of abuse, addiction, and side effects than full agonists. Subutex (buprenorphine) is more often used at the beginning of treatment and withdrawal syndrome can be precipitated in individuals maintained on it. Suboxone, containing the opioid antagonist naloxone*, was designed to decrease the potential for abuse by injection and is more often used in maintenance treatment of opiate addiction. Both methadone*and LAAM (l-alpha-acetyl-methadol)* are effectively used to treat opioid addiction (* incorrect options); however they are not available in practice settings other than Opioid Treatment Programs (OTPs) (i.e., methadone clinics). (See: Kissin, W., McLeod, C., Sonnefeld, J., & Stanton, A. (in press). Experiences of a national sample of qualified addictions specialists who have and have not prescribed buprenorphine for opioid dependence. Journal of Addictive Diseases. http://buprenorphine.samhsa.gov/index.html)

Answer 36

Correct Answer is: C Anxiety is the most common psychiatric disorder in older adults, with generalized anxiety disorder being the most prevalent anxiety disorder according to recent findings. Research indicates comorbid symptoms of depression frequently occur in all adults with anxiety, however occurs more often in older adults. younger adults are more likely to benefit from cognitive-behavioral therapy, whereas older adults are more likely to benefit from pharmacotherapy. Older and younger adults with anxiety have been found to benefit about equally from cognitive-behavioral therapy (CBT) and pharmacotherapy. younger adults are more likely to be underdiagnosed and older adults more likely to be misdiagnosed as having an anxiety disorder. Underdiagnosis is more common among older adults, as well as undertreatment of anxiety disorders compared to younger adults. younger and older adults are equally likely to perceive symptoms as result of physical health problems. Findings show older adults are more likely than younger adults to attribute anxiety symptoms to physical health problems and therefore more likely to see a medical professional instead of a mental health professional for help. (See: Stanley, M. A. & Beck, J.G. (2000). Anxiety disorders, Clinical Psychology Review, 20, 731-754.)

Answer 37

Correct Answer is: A The Rancho Los Amigos Scale provides a descriptive guideline of the various stages a brain injury patient will experience as he/she progresses through recovery and is most helpful in assessing the patient in the first weeks or months following an injury because it is based on observations of the patient's response to external stimuli and does not require cooperation from the patient. The Rancho scale is often administered in acute rehabilitative settings following release from intensive care and evaluates eight levels of functioning. At the lowest score, or level I. No Response, a patient appears to be in a deep sleep and is unresponsive to stimuli. As recovery progresses, functioning is then reflected by the higher levels of the scale. These levels include: level II. Generalized Response: limited reflexes and often the same, regardless of stimuli presented. III. Localized Response: responses specific but inconsistent, are related to the type of stimulus presented, may follow simple commands in an inconsistent and delayed manner. IV. Confused-Agitated: heightened state of activity, severely confused, disoriented, and unaware of present events; unable to perform self-care however if physically able, may perform motor activities such as sitting and walking as part of agitated state. V. Confused-Inappropriate, Non-Agitated: appears alert and responds to simple commands; some agitated behavior in response to external stimuli; is highly distractible, difficulty learning new information; memory impaired; verbalization often inappropriate; self-care activities with assistance. VI. Confused-Appropriate: shows goal-directed behavior, relying on cueing for direction; able to relearn old skills (i.e., activities of daily living); new learning limited by memory problems; has beginning awareness of self and others. VII. Automatic-Appropriate: goes through daily routine, is robot-like with appropriate behavior and minimal confusion; has shallow recall of activities; superficial awareness of condition but lacks insight; judgment, problem solving, and planning skills are impaired, requiring some supervision. VIII. Purposeful-Appropriate: alert and oriented; able to recall and integrate past and recent events; can learn new activities and continue in home and living skills; deficits in stress tolerance, judgment, abstract reasoning, social, emotional, and intellectual capacities may persist.

Answer 38

Correct Answer is: A Due to the tendency to overestimate cognitive deficits among African Americans and other minority groups, the MMSE results in a disproportionate number of false positives. Research indicates the MMSE also overestimates cognitive deficits for individuals with lower socioeconomic backgrounds and lower levels of education. When controlling for education level and socioeconomic status, research findings have been mixed on whether the racial bias persists or can be eliminated. (See: Lampley-Dallas, V. T. (2001). Neuropsychological screening tests in African Americans, Journal of the National Medical Association, 93(9), 323-328.)

Answer 39

Correct Answer is: D Between infancy and 15 years of age, cancer is the leading cause of death by disease among U.S. children. Among the 11 major types of childhood cancers, leukemias (blood cell cancers), brain and other central nervous system (CNS) tumors account for over half of new cases. Treatment for childhood cancers can include chemotherapy, radiation, surgery and stem cell transplants. Radiation and chemotherapy affect cognitive ability in children due to damage to the tiny blood vessels that carry nutrition and oxygen to the brain, resulting in calcifications; interference with the growing and thickening of the myelin; and with the growth and development of connecting nerve structures over time. Factors that increase the risk of long-term cognitive effects include: diagnosis of cancer at a very young age, cancer treatment that results in reduced energy levels, cancer treatment that affects hearing or vision, cancer treatment that results in physical disabilities, cancer therapy that includes treatment to the central nervous system, numerous or prolonged school absences, a history of learning problems before being diagnosed with cancer. Research also indicates young girls are more vulnerable to lingering cognitive problems than boys, and children with acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma are at a higher risk of developing later cognitive problems than those who have other forms of blood cancers. In fact, as many as 40% of all pediatric ALL patients treated with chemotherapy alone will develop serious learning disabilities within two to three years following treatment and for children who receive cranial radiation, with or without chemotherapy, the percentage is 80% to 90%. The most common cognitive problems found as a result of radiation and chemotherapy are with handwriting, spelling, reading or reading comprehension, understanding math concepts, attention deficits (tend to drift off and are easily distracted), short term memory and information retrieval, planning and organizational skills, social maturity and social skills.

Answer 40

Correct Answer is: B Certain behaviors associated with bulimia, namely frequent vomiting and laxative use, can lead to serious medical complications, including electrolyte disturbances. Hypokalemia is the name given to the condition that involves low levels of serum potassium. Hyponatremia* involves less than normal concentration of sodium in the blood; hypoglycemia* is characterized by less than normal amounts of glucose in the blood; and hypercapnia* involves greater than normal amounts of carbon dioxide in the blood (* incorrect options).

Answer 41

Correct Answer is: A Insulin, which is released by the pancreas, is involved in the uptake and use of glucose and amino acids. Hypoinsulinism produces diabetes mellitus (excessive blood glucose). When untreated, diabetes mellitus results in increased appetite with weight loss, apathy, confusion, mental dullness, polyuria, polydipsia, and increased susceptibility to infection. emotional lability, memory loss, depression, obesity The symptoms listed in this option are associated with Cushing's disease, which results from hypersecretion of cortisol. accelerated heart rate, agitation, nervousness, fatigue, insomnia The symptoms listed in this option are associated with hyperthyroidism, or Grave's disease (other symptoms of this disorder include a speeded up metabolism, elevated body temperature, heat intolerance, and increased appetite with weight loss). slowed heart rate, depression, lethargy, impaired concentration and memory The symptoms listed in this option are associated with hypothyroidism (other symptoms of this disorder include a slowed metabolism, reduced appetite with weight gain, lowered body temperature, and decreased libido).

Answer 42

Correct Answer is: A It appears the prevalence rate for autism and autism spectrum disorders has increased worldwide over the past decade however whether there is an increased incidence of autism has yet to be determined partially due to confounding changes diagnostic classification, assessment and varied methodologies of surveys. In epidemiologic studies done in the 1960s, autism rates were typically based on "classical autism" or severe impairment of language, social interaction, and behavior. The studies estimated a prevalence rate of 4/10,000. Prevalence rates have been influenced by changes in diagnostic criteria, increased awareness of developmental problems, and improved assessment. A review of 32 epidemiologic studies done in 13 countries from 1987 to 2000 indicates a best estimate for the prevalence rate of autistic disorder being 10/10,000. Of these studies, 12 also provided data on other pervasive developmental disorders (PDDs) with the estimated prevalence rate for unspecified PDDs and PDD NOS being 15/10,000 and Asperger disorder (AD) estimated to be around 2.5/10,000. Taken together, the estimate for all autism spectrum disorders was estimated to be 27.5/10,000. The rates had wide ranges from study to study due to methodological inconsistencies and problems so the estimate is thought to be conservative. Although few in number, improved methods and diagnostic precision in the most recently reviewed studies indicate the prevalence rates for all PDDs, including autistic disorder, converge in the range of 60/10,000. These studies varied however in the reported rates of autistic disorder, PDD NOS, and AD, therefore, making it difficult to get a sense of prevalence rates for PDD subtypes. (See: Fombonne E. (1999). The epidemiology of autism: a review. Psychol. Med. 29:76-86; Fombonne E. (2003) Epidemiology of pervasive developmental disorders. Trends in Evidence-Based Neuropsychiatry 2003;5(1):29-36; and Fombonne E. (2003). The prevalence of autism. JAMA: Journal of the American Medical Association; 289(1):87-9.)

Answer 43

Correct Answer is: D Findings of recent studies indicate that the factors of intellectual functioning, age and somatic symptoms of depression are significant predictors of HIV progression and prognosis. Specifically, lower IQ, older age and the presence of somatic symptoms of depression are associated with a more rapid progression from HIV infection to AIDS, HIV-related dementia, and death. (See: Farinpour, R., et al., Psychosocial risk factors of HIV morbidity and mortality: Findings from the Multicenter Aids Cohort Study (MACS), Journal of Clinical and Experimental Neuropsychology, 2003, 25(5), 654-670.)

Answer 44

Correct Answer is: C Studies indicate no specific treatment has been identified as consistently effective for Factitious Disorder; however, many agree that establishing a good therapeutic relationship and providing supportive therapy and consistency of care is the best way to manage its symptoms. (See: J. C. Huffman and T. A. Stern, The diagnosis and treatment of Munchausen's syndrome, General Hospital Psychiatry, 2003, 25(5), 358-363.) confrontational therapy in an inpatient setting Inpatient treatment is often contraindicated because of the underlying need of individuals with Factitious Disorder "to adopt the sick role." individual and group therapy in an inpatient treatment Confrontational techniques may elicit denial and result in the individual terminating the therapeutic relationship so they must be used with caution. group or family therapy in an outpatient setting Family and group therapy have not been identified as the most effective treatments, although family therapy may be useful for helping family members cope with the patient's symptoms.

Answer 45

Correct Answer is: B Both Sleep Terror Disorder and Sleepwalking Disorder have been linked to a family history and are associated with amnesia for the episode upon awaking in the morning. Sleepwalking Disorder is usually associated with low levels of autonomic arousal and is characterized by prominent, organized motor activity such as walking around, talking, and eating. Both disorders do involve motor activity, although the activity associated with Sleep Terror Disorder is less organized and usually involves resisting being touched or held and sitting up.

Answer 46

Correct Answer is: D Recent research has established a biological basis for Attention Deficit/Hyperactivity Disorder (ADHD) with abnormalities in the right frontal lobe, striatum, and cerebellum most consistently implicated in this disorder. Other areas of the brain, including certain regions of the parietal lobe, have been linked to ADHD to a lesser extent. Using the core symptoms of ADHD and functions of the major brain structures, you may have determined the frontal lobes (mediates higher-order functions), the striatum (part of the basal ganglia and composed of the caudate nucleus and the putamen) and cerebellum (involved in motor activity) are the areas linked to this disorder. (See: J. Giedd et al., Brain imaging of attention deficit/hyperactivity disorder, Annals of New York Academy of Sciences, 2001, 931, 33-49.)

Answer 47

Correct Answer is: A Research on the use of light therapy for the treatment of various forms of depression has yielded the findings that for true SAD, atypical symptoms such as carbohydrate craving and hypersomnia predict a robust response, whereas melancholic symptoms such as insomnia and weight loss are generally less responsive to light (See: Terman et al., American Journal of Psychiatry, 1996, 153,:423-9). Additionally, a clear onset period with complete remission in the spring and summer months is the SAD phenotype that is most likely to respond to light. Whereas patients with more chronic forms of depression or incomplete summer remission are less likely to have a robust response, they may benefit to some extent (See: Lam et al., Journal of Affective Disorders, 2001, 63, 123-32).

Answer 48

Correct Answer is: B Although this question provides a limited amount of information, it appears that the young man may be in the midst of a Manic Episode based on his decreased need for sleep, inflated self-esteem, and excessive involvement in pleasurable activities that are likely to result in painful consequences. Another clue is that these behaviors began suddenly, which is not characteristic of the other diagnoses listed. Although ADHD and a Manic Episode are both characterized by excessive activity, impulsive behavior, and poor judgement, ADHD must begin before age 7 and has a chronic course with no clear onset. Conduct Disorder is characterized by a persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.

Answer 49

``` Correct Answer is: C Multisystemic Therapy (MST), targeting chronic, violent, or substance abusing juvenile offenders at high risk of out-of-home placement, is consistent with social-ecological models of behavior and findings from causal modeling studies of delinquency and drug use. The approach views individuals as being nested within a complex network of interconnected systems that encompass individual, family, and extrafamilial (peer, school, neighborhood) factors. MST is a goal-oriented, intensive family- and community-based treatment that addresses the multiple determinants and factors in each youth's social network that are contributing to his or her antisocial behavior. It is provided using a home-based model of services delivery with a typical treatment duration of approximately 4 months. Intervention strategies include strategic family therapy, structural family therapy, behavioral parent training, and cognitive behavior therapies. MST interventions typically aim to improve caregiver discipline practices, enhance family affective relations, decrease youth association with deviant peers, increase youth association with prosocial peers, improve youth school or vocational performance, engage youth in prosocial recreational outlets, and develop an indigenous support network of extended family, neighbors, and friends to help caregivers achieve and maintain such changes. MST has demonstrated long-term reductions in criminal activity, drug-related arrests, violent offenses, and incarceration. Controlled studies also showed that MST outcomes were similar for youths across the adolescent age range (i.e., 12-17 years), for males and females, and for African-American vs. white youths and families. (See: Curtis, N. M., Ronan, K. R., & Borduin, C. M. (2004). Multisystemic treatment: A meta-analysis of outcome studies. Journal of Family Psychology, 18, 411-419.) ```

Answer 50

Correct Answer is: C Among the diagnostic criteria are: preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms; preoccupation persists despite medicatial evaluations and reassurance; belief is not of delusional intensity; etc.

Answer 51

Correct Answer is: B When treating individuals with paraphilias, behavior therapies are used based on the reasoning that maladaptive behavior has been learned and can therefore be unlearned. Orgasmic Reconditioning Orgasmic reconditioning instructs a client to begin masturbating while fantasizing about the inappropriate stimulus then switch from the paraphilic to more appropriate fantasies at the moment of masturbatory orgasm. Systematic Desensitization Systematic desensitization pairs slow, systematic exposure to anxiety-inducing situations with relaxation training. Aversive Conditioning Aversive conditioning substitutes a negative response for a positive response to inappropriate stimuli such as through pairing paraphilic urges with negative experiences, for example electric shocks or unpleasant odors.

Answer 52

Correct Answer is: B Although learning problems are associated with the disorder, children with Tourette's Syndrome (TS) as a group have the same range of IQ as the population at large. The etiology of learning disabilities (LD), as well as the most accurate conceptualization of them as either comorbid disorders or as prevalent, variable components of the broader TS phenotype, has yet to be determined. In a recent study of more than 3100 children with Tourette's, ADHD was the most prevalent comorbid disorder occurring in 58% of subjects. Of those with TS plus learning disabilities, 80% also had a diagnosis of ADHD. The increased rates of ADHD in those diagnosed with TS + LD and the finding that only 11 % of the TS children without ADHD had a diagnosis of LD demonstrates the potential impact of ADHD on LD as a causal factor or as a confounder for the diagnosis of LD (L. Burd, L., Freeman, R.D., Klug, M.G. and Kerbeshian, J. (2005). Tourette syndrome and learning disabilities, BioMed Central Pediatrics, 5).

Answer 53

Correct Answer is: D Passive pain-coping strategies, a category described in Brown and Nicassio's (1987) dichotomy of active versus passive coping strategies, are associated with worse pain and adjustment among chronic pain patients. Passive coping strategies are those that involve giving responsibility for pain management to an outside source or allowing other areas of life to be adversely affected by pain. They may also serve as psychological enforcers of pain. Examples of passive coping strategies are focusing on where the pain is and how much it hurts, restricting or cancelling social activities, or thoughts such as " There's nothing I can do to lessen this pain," or "I wish my doctor would prescribe me better pain medication." In contrast, active coping strategies entail the patient taking responsibility for pain management including attempts to control the pain or to function in spite of it. Examples of active coping strategies include engaging in physical therapy or exercise, staying busy/active, relaxation techniques, clearing distracting thoughts and attention from the pain. Cognitive and cognitive behavior therapy has been shown to be effective in reducing the experience of pain and improving positive behavior expression, appraisal and coping in individuals with chronic pain. (See: Morley S, Eccleston C, Williams A. (1999) Systematic review and meta-analysis of randomised controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain, 80, 1-13.) Evidence supports a relationship between positive health outcomes and the use of religious coping to manage pain. Pargament (1990) identified three possible interactions between religion and coping: religion can influence the parts of the coping process (appraisal, coping activities, results, assistance, and motivation); contribute to the coping process by influencing perception (attribution of meaning and the feeling of control) and preventing certain events from happening (through a beneficiary life style); and it can be the resultant of the coping process through religious attributes. (See: Pargament, K.I. (1997) The psychology of religion and coping, Guilford, New York.)

Answer 54

Correct Answer is: A The majority of individuals diagnosed with Borderline Personality Disorder (BPD) demonstrate significant reduction or remission of symptoms by middle age or sooner. Longitudinal studies involving those diagnosed in adolescence or early adulthood indicate that symptom resolution with impulsive symptoms are the quickest to resolve, followed by cognitive and interpersonal symptoms and finally affective symptoms are the most chronic and show the least improvement with increasing age. (See: Zanarini, M.C., Frankenburg, F.R., Hennen, J. and Silk, K.R. (2003). The longitudinal course of borderline pathology: 6 year prospective follow-up of the phenomenology of borderline personality disorder, American Journal of Psychiatry, 160, 274-283).

Answer 55

Correct Answer is: B Termed after the physican who described the condition in the 1850s, Briquet's syndrome, or Somatization Disorder, is a chronic Somatoform Disorder with multiple physical symptoms that cannot be explained entirely by a general medical condition or the effects of a substance. The other three response choices are also Somatoform Disorders.

Answer 56

Correct Answer is: D All of the response choices are Paraphilic conditions identified in the DSM-IV-TR. The Paraphilias are characterized by recurrent, intense sexual urges, fantasies, or behaviors that involve unusual objects, activities, or situations and cause clinically significant distress or impairment in at least one area of functioning. Fetishism* involves the use of nonliving objects; Sexual Sadism* involves inflicting humiliation or suffering; and Frotteurism* involves touching or rubbing against a nonconsenting person for sexual excitement (* incorrect options).

Answer 57

Correct Answer is: A Symptoms of Nicotine Withdrawal have a rapid onset and are characterized by insomnia, decreased heart rate*, increased appetite* and depressed or dysphoric mood* (* incorrect options). Studies indicate that a desire to avoid negative affect, as well as the rapid withdrawal symptoms, are primary reasons nicotine dependent individuals relapse.

Answer 58

Correct Answer is: D Depression is associated with decreased slow-wave or non-REM sleep as well as, early morning waking*, decreased sleep continuity* and earlier onset of REM sleep or decreased REM latency* (* incorrect options).

Answer 59

Correct Answer is: A Studies of Schizophrenic individuals show the "positive symptoms," such as delusions, hallucinations and thought disorder, usually respond better than the "negative symptoms" to antipsychotic treatment. Alogia, or speechlessness*, avolition, or lack of initiative or goals* and affective flattening* are all negative symptoms of Schizophrenia (* incorrect options).

Answer 60

Correct Answer is: C Acute Stress Disorder, is by definition, only appropriate when the duration of symptoms last at least two days and occur within one month of the extreme stressor or traumatic event. Posttraumatic Stress Disorder requires symptoms to persist for more than a month so this diagnosis cannot be made within the initial month following the traumatic stressor.

Answer 61

Correct Answer is: C Antipsychotic drugs such as haldol (butyrophenones) are more effective for alleviating the positive symptoms of schizophrenia: hallucinations, delusions, disordered thought, and agitation, than the negative symptoms: apathy, blunted affect, autism, and social withdrawal. In clients with schizophrenia, antipsychotics induce a "neuroleptic state" characterized by emotional quieting (decreased hallucinations and delusions), psychomotor slowing (less agitation, impulsivity, and aggressiveness), and affective indifference (lower arousability and lack of concern with the external environment).

Answer 62

Correct Answer is: B Early full remission, early partial remission, sustained full remission, or sustained partial remission are specifiers used to describe a substance dependence diagnosis. "Early" means that there is more than one month but less than 12 months of remission. "Sustained" means that there is 12 months or longer of remission. "Full" means that the person no longer meets any of the criteria for substance dependence or abuse, and "partial" means that one or more of the criteria for substance dependence are still met but the full criteria are no longer met.

Answer 63

Correct Answer is: D Secondary impotence is diagnosed when a man persistently or recurrently fails to attain or maintain an erection even though in the past he has successfully achieved an erection. The erectile reflex is usually unimpaired in older men; therefore, aging alone is not likely to be a cause of impotence. The other responses are common physical causes of secondary impotence

Answer 64

Correct Answer is: C A number of theories regarding the relationship between psychological factors and the onset of cancer have been proposed. For instance, some authors have proposed that the "Type C" personality, typically described as a cooperative, unassertive patient who suppresses anger and complies with external authorities, is at a higher risk for cancer. However, most research shows that psychological factors and stressful events have a small or no effect on cancer incidence. By contrast, psychological factors do appear to be related to recovery from cancer. For instance, psychological treatments combining support and training in self-hypnosis are associated with higher survival rates and improved quality of life in cancer patients.

Answer 65

Correct Answer is: B The term "proband" refers to the index population, that is, those persons identified with a particular disorder. Studies have found that the risk for a monozygotic (identical) twin of a schizophrenic proband to be diagnosed with Schizophrenia is about 46%. The risk for dizygotic (fraternal) twins is about 17%.

Answer 66

Correct Answer is: D Nicotine replacement interventions (e.g., nicotine gum, nicotine patch) have not been found to be very effective over the long-term unless they are combined with other treatment interventions. In a meta-analysis based on over 600 smoking cessation studies, the mean quit rate (based on short-term and long-term rates) for hypnosis = .36; acupuncture = .30; aversive techniques = .27; nicotine gum = .16; and control group = .06. [C. Viswesvaran and F. L. Schmidt, A meta-analytic comparison of the effectiveness of smoking cessation methods, Journal of Applied Psychology, 1992, 77(4), 554-561]. Another meta-analysis that addressed the combination of nicotine gum with other treatment interventions but compared short-term to long-term outcomes also concluded that nicotine gum by itself is not very effective in the long-term, but is effective when combined with other treatment interventions [A. Cepeda-Benito, Meta-analytical review of the efficacy of nicotine chewing gum in smoking treatment programs, Journal of Consulting and Clinical Psychology, 1993, 61(5), 822-830]. Additional Information: Treatment (Substance Use Disorders)

Answer 67

Correct Answer is: D This is one of those questions that may drive you crazy, because all four choices describe ways in which an Alzheimer's patient can be assessed. Thus, you must choose the best answer. Because Dementia of the Alzheimer's Type is a cognitive disorder, it makes sense that the most direct way to assess it on an ongoing basis is to regularly administer cognitive assessments. The question is really as much about how Alzheimer's is defined as it is about how to assess it. Additional Information: Major or Mild Neurocognitive Disorder Due to Alzheimer's Disease

Answer 68

Correct Answer is: C Once again, cognitive-behavioral therapy (CBT) has been found to be the most effective treatment, probably because it combines a number of behavioral and cognitive interventions.

Answer 69

Correct Answer is: B The majority of women experience some depression following childbirth but, for most, these symptoms are mild. For about 10 to 20% of women, symptoms are sufficiently severe to qualify for a diagnosis of Major Depression.

Answer 70

Correct Answer is: C The combination of social avoidance, fear of humiliation, and loneliness are characteristic of Avoidant Personality Disorder. Additional Information: Avoidant Personality Disorder

Answer 71

Correct Answer is: B The key words in this question are "accurate and reliable." There is no laboratory test available which confirms definitively Alzheimer's Disease. Diagnosis of the disorder involves confirming that the diagnostic criteria are met and ruling out other possible causes of the Dementia. Diagnosis is aided by the use of neuroimaging techniques, such as computerized tomography (CT), magnetic resonance imaging (MRI), and positive-emission tomography (PET). Indeed, properly applied diagnostic techniques result in an 85% accuracy rate in diagnosing the disorder. However, at this time, the only way to absolutely confirm the diagnosis is via brain autopsy or biopsy. Additional Information: Major or Mild Neurocognitive Disorder Due to Alzheimer's Disease

Answer 72

Correct Answer is: B This question is difficult since the research on this issue has been inconsistent. However, there is evidence that a combined treatment (behavioral intervention plus nicotine replacement therapy) is best, especially in terms of long-term abstinence (abstinence for six months or more). See, for example, R. C. Klesges et al., Smoking cessation: A successful behavioral/pharmacologic interface, Clinical Psychology Review, 1996, 16(6), 479-496.

Answer 73

``` Correct Answer is: B People with Korsakoff's Syndrome (amnesia due to heavy, long-term alcohol consumption) have severe anterograde amnesia along with retrograde amnesia for events that occurred in the relatively recent past. getting dressed. Procedural memory is undisturbed. recalling her first date. Remote memories are usually intact. repeating five digits forward and backward. Short-term memory is unaffected. ```

Answer 74

Correct Answer is: C Depression is the most common neuropsychiatric problem associated with Parkinson's Disease. A review of the literature concluded that 40% of Parkinson's patients have comorbid depression (about half have Major Depressive Disorder and the other half have Dysthymic Disorder). And in 20% of these patients, the depressive symptoms preceded the onset of motor impairments (characteristic of Parkinson's Disease) by an average of five years. Contrary to what might be expected, their depression did not appear to be correlated with the extent of motor impairment, age, or duration of Parkinson symptoms. One consistent finding in Parkinson's Disease patients is a low level of dopamine. Recent research has found that they have reduced levels of serotonin as well, which is probably related to the increased incidence of depression [Lieberman, N. Depression in Parkinson's Disease. Retrieved February 2003, from http://www.parkinson.org/depression.htm ].

Answer 75

Correct Answer is: B Obsessive-Compulsive Disorder has an earlier peak onset for males than females. For males the peak onset is between ages 6 and 15, and for females it is between ages 20 and 29. Thus, gender differences for OCD begin to become apparent at 6 years. However, in adulthood the incidence is about the same for both genders.

Answer 76

Correct Answer is: C Cognitive-behavioral therapy (CBT) has been found to be the most effective treatment for Generalized Anxiety Disorder, probably because it combines a number of behavioral and cognitive interventions.

Answer 77

Correct Answer is: A Compliance with medical treatment regimens, such as those designed to manage diabetes, tends to be lower for adolescents as compared to children or adults. There are many reasons for this, including adolescents' greater desire to be similar to their peers and independent from the restrictions of their parents.

Answer 78

Correct Answer is: D Research studies have found that between 30% and 70% of children with ADHD continue to exhibit signs of the disorder throughout their lives. [See J. Biederman, et al. High risk for attention deficit hyperactivity disorder among children with parents with childhood onset of the disorder: A pilot study. American Journal of Psychiatry, 1995, 152, 431-435.]

Answer 79

Correct Answer is: C The predominant theories regarding ADHD suggest that individuals with the disorder have difficulty regulating their attention. It is not that they pay too little attention; on the contrary, they often pay too much attention to too many things, many of which are not relevant

Answer 80

Correct Answer: D The relationship between a family's level of expressed emotion (EE) and the risk of relapse among patients with Schizophrenia has been known for many years; however, recently EE has also been linked to eating disorders and mood disorders. In fact, in a meta-analysis the relationship of EE to relapse in eating disorders and mood disorders was significantly greater than the relationship found for Schizophrenia (mean effect sizes were .51, .39, and .31, respectively) [R.L. Butzlaff & J.M. Hooley, Expressed emotion and psychiatric relapse: A meta-analysis, Archives of General Psychiatry, 55, 1998, 547-552]. Additional Information: Treatment (Schizophrenia)

Answer 81

Correct Answer is: A Bipolar II Disorder is diagnosed when the person has a history of at least one major depressive episode and at least one hypomanic episode. By definition, the person has never had a manic or mixed episode (otherwise, the diagnosis would be Bipolar I Disorder). Additional Information: Bipolar II Disorder

Answer 82

Correct Answer is: A If you wanted to find the best single predictor, you'd find out about alcoholism in the natural relatives of the patient. Even if the person is adopted away from the natural parents, the genetic connection is still the strongest one we have. So, when doing an initial assessment, you could ask about alcohol/drug abuse among family members. By the way, a good guess in answering any question structured as "the best predictor of (some disorder)" is "family history of that disorder." You won't be right 100% of the time, but you will be the majority of the time.

Answer 83

Correct Answer is: D If the wetting is associated with a physical cause, then it is not diagnosed as "functional" enuresis. This disorder is not associated with dreaming REM-sleep as one might expect. It actually is not significantly correlated with any particular sleep stage, although it is most likely to occur during the first third of the night. And, while it is less common in older than in younger children, it does exist in older children and adolescents.

Answer 84

Correct Answer is: A ECT is used to treat depression that has not responded to other forms of treatment. Since the correct choice is the only one that directly refers to depression, it is the best answer. It's also a good answer since women are more likely than men to suffer from the major depressive disorders, and because it's more likely that this situation would occur in middle and late adulthood, when the symptoms become more intractable to other treatments. Dementia might have a depressive component along with it, but one wouldn't recommend ECT strictly for Dementia.

Answer 85

Correct Answer is: A | Anxiety is sometimes defined as a fear that is not understood by the individual.

Answer 86

Correct Answer is: B The three Personality Disorders listed are all characterized by dramatic, emotional, and/or erratic behaviors. Affective instability is the characteristic shared by all three disorders. Impulsivity and recurrent suicide threats are characteristics of Borderline Personality Disorder only; and a grandiose sense of self describes Narcissistic Personality Disorder, but not the other two disorders (although both do involve disturbances in the sense of self). Additional Information: Introduction (Personality Disorder)

Answer 87

Correct Answer is: C Biological relatives of individuals with Schizophrenia have an increased risk of developing the disorder. The more similar their genes are, the greater the risk. Monozygotic (identical) twins have the same genes and studies have shown that they have a 46% concordance rate for Schizophrenia. Dizygotic (fraternal) twins only have a 17% concordance rate. The likelihood of one of the parents or a non-twin sibling having or developing Schizophrenia is about 10% Additional Information: Etiology (Schizophrenia)

Answer 88

Correct Answer is: C women who have multiple roles (e.g., a job, children, a marriage) are more vulnerable to depression than women who don't. This choice is not true; women who have multiple roles appear to be at lower risk for depression. This may be because they have many different support sources and outlets for their competence -- i.e., if their life is not going well in one area, they can compensate with success in other areas. The other choices, according to the APA Task Force Report on Women and Depression, are true. gender differences in coping style apparently are a reason why women are at a greater risk for depression than men. Regarding this choice, the report states that men may be at a lower risk than women because, in response to their problems, they are more likely to employ action and mastery (e.g., work, sports, going out with friends) strategies that distract them from their worries and give them a sense of power and control. Women, on the other hand, tend to brood and dwell on their problems.

Answer 89

Correct Answer is: D Most experts believe that there is probably some genetic influence on most Personality Disorders, if for no other reason that there is some genetic influence on most aspects of personality in general. However, evidence of a genetic basis for Antisocial Personality Disorder is well-established -- prevalence rates are 5 to 10 times higher in individuals with first-degree relatives with the disorder, compared to the general population. There is also strong evidence of a genetic component in Schizoid, Schizotypal, and Paranoid Personality Disorders.

Answer 90

Correct Answer is: D In Dissociative Amnesia, memory loss is usually for information acquired after the emotional trauma that brings on the symptoms. There is typically a gap or a series of gaps in recall for the individual's life history. By contrast, in some forms of Amnestic Disorder (e.g., in Amnestic Disorder Due to a Brain Injury), memory loss is typically for information in a circumscribed period of time immediately before the injury occurs. All of the other choices describe features that typically distinguish between Dissociative Amnesia and amnesia due to known physical causes.

Answer 91

Correct Answer is: B Grand mal seizures involve a tonic phase (extension of the limbs), which is then followed by a clonic phase (violent rhythmic contractions).

Answer 92

Correct Answer is: B Reactive Attachment Disorder occurs in children below the age of 5 and is characterized by disturbed social relatedness. There are two subtypes: inhibited and disinhibited type. This question is about the former, which involves inhibition, hypervigilance, and ambivalent responses in social situations. The other subtype, disinhibited type, involves indiscriminate attachments and sociability (e.g., familiarity with strangers, lack of selectivity in choice of attachment figures). In both subtypes, evidence of pathogenic care (e.g., disregard for the child's basic physical or emotional needs) must be present before the diagnosis can be made.

Answer 93

Correct Answer is: C This is another situation in which a combined treatment is best, especially in terms of long-term outcomes. While nicotine replacement therapy is very successful alone, there is evidence that combining it with behavioral interventions produces the best long-term effects. See R. C. Klesges, K. D. Ward, and M. DeBon, Smoking cessation. Clinical Psychology Review, 1996, 16(6), 479-496. Additional Information: Treatment (Substance Use Disorders)

Answer 94

Correct Answer is: C Exposure is currently considered the best intervention for most (if not all) Anxiety Disorders. However, the best way of exposing clients to stimuli that elicit anxiety depends on the particular disorder. For Specific Phobia, brief in vivo exposure is effective for many clients, and adding a cognitive component usually does not improve the effects of the intervention substantially.

Answer 95

Correct Answer is: C Not all experts agree that children cannot experience panic attacks. However, those that do, for the most part, argue that children do not experience panic because they are cognitively incapable of making internal catastrophic interpretations (e.g., I'm going crazy) of bodily symptoms. Additional Information: Panic Disorder

Answer 96

Correct Answer is: A This one is so easy that you may have thought it was a trick question and picked the wrong answer! Depressed people are the ones who tend to focus on negative events while ignoring neutral and positive ones. Additional Information: Etiology (Major Depressive Disorder)

Answer 97

Correct Answer is: B Behavioral explanations for depression focus on the role of too little reinforcement and too much punishment. Behavioral interventions attempt to reverse this situation by, for example, helping clients develop better social skills so that they will have more pleasurable social interactions

Answer 98

Correct Answer is: C Alzheimer's Disease is often categorized into 3 stages. In Stage 1, which lasts 2-4 years, short-term memory loss begins. Patients in this stage frequently complain about forgetting where they placed things. In Stage 2, which lasts 2-10 years, there is further memory impairment (mostly explicit rather than implicit) and they begin having difficulty performing complex tasks, such as balancing a checkbook or going grocery shopping. They may get lost in familiar places and become apathetic. In the final stage -- Stage 3 -- which lasts 1-3 years, there is serious impairment in most areas. During Stage 3 they may lose the ability to speak and become unable to recognize family, friends, or even themselves. They lose all capacity to care for themselves and have difficulty walking, are incontinent, and are ultimately bedridden and often die of an opportunistic respiratory infection.

Answer 99

Correct Answer is: A Idiopathic simply means of unknown cause. Allopathic* refers to the typical biomedical treatments which are practiced by most physicians in North America and Europe today. Homeopathic* refers to a more natural approach to healing in which the patient is given small doses of substances, which in larger doses, cause the same symptoms that they are suffering from. Autoplastic* refers to adaptation through altering one's own behavior (* incorrect options).

Answer 100

Correct Answer is: B Somatization Disorder has several frequently occurring comorbid conditions. Research indicates that 61% of Somatization Disorder patients have one or more co-occurring personality disorders. The next most frequent co-diagnoses are Major Depression (55%), Generalized Anxiety Disorder (34%), and panic disorder (26%). Substance-Related Disorders are also frequently associated with Somatization Disorder, however, not as frequently as the above diagnoses. [See: G.O. Glabbard, Treatment of Psychiatric Disorders, Volume 2 (2nd ed.), Washington, DC, American Psychiatric Press, 1995].

Answer 101

Correct Answer is: C The onset for Panic Disorder typically occurs between late adolescence and the mid-30s. However, a small number of cases do begin in childhood. Although not all theorists agree on whether or not children have the cognitive ability to catastrophize, the research indicates that 6 to 12-year-olds are capable of experiencing panic attacks, typically manifested as chest pain, tachycardia, shortness of breath, and refusal to go to school.

Answer 102

Correct Answer is: A The key words in this question were "for women in general." You had to know that PMS is actually not typical of most women. While it is not uncommon for women to have mild psychological symptoms during the latter part of the luteal phase, there is no specific pattern typical of most women. Make sure you read each word in the question. the symptoms occur shortly before and terminate shortly after the onset of menses. If the question were about women who do suffer from PMS, this would be the correct answer. Additional Information: Premenstrual Syndrome (PMS)

Answer 103

Correct Answer is: D Several researchers have suggested that a general distress factor, sometimes referred to as "negative affect," is a core symptom in both anxiety and depression. Anhedonia* is unique to depression and somatic arousal* is unique to anxiety disorders. Obsessive thoughts* is a characteristic of Obsessive-Compulsive Disorder, but it is not a universal symptom in all of the anxiety disorders or the depressive disorders (* incorrect options). [See D. Burns, Why Are Depression and Anxiety Correlated? A Test of the Tripartite Model. Journal of Consulting and Clinical Psychology, 1998, 66 (3), 461-473]. Additional Information: Depression and Anxiety (Beck)

Answer 104

Correct Answer is: B Marlatt's model of substance dependence holds that addicts learn to associate substance use with relief of self-criticism and guilt through a variety of cues and reinforcers, such as advertisements depicting people feeling cheerful when drinking and social occasions in which a carefree attitude is reinforced. In other words, there are a variety of cues and mediators that serve to encourage and reinforce use. Contrary to the person's expectations, however, excessive substance use only exacerbates problems, such as interpersonal or work-related problems. This leads to more self-criticism and guilt, which the person again attempts to relieve by using. In other words, substance use is self-reinforcing -- it is the cause of and the expected solution to the same problems. And it is "over-learned" in that, due to the multiplicity of its antecedents, it becomes a strongly ingrained behavior. a relapse of dependence is likely if the person makes non-dispositional attributions for use following a "slip" (use of a drug after a period of abstinence). You might have gone for this option, since you probably knew that Marlatt is associated with a theory of relapse prevention that has to do with attributions regarding the reasons for "slips." However, according to Marlatt, a slip is likely to lead to a full-blown relapse when the person makes dispositional attributions for it, such as when the person blames him or herself. Relapse prevention involves teaching the person to make non-dispositional attributions, such as blaming the situation or the nature of the disease. So this question illustrates the importance of reading carefully and processing what you read, rather than relying on the recognition of "buzzwords."

Answer 105

Correct Answer is: A A number of possible behavioral treatment strategies for Obsessive-Compulsive Disorder have been described. Two of the most commonly employed are thought stopping and deliberate exposure with response prevention. Thought stopping, which primarily applies to obsessions, involves teaching the client to yell "STOP!" (or self-apply another aversive technique) when he or she begins to engage in obsessive rumination. Deliberate exposure with response prevention involves exposing the client to situations which evoke obsessions or compulsions and then blocking him or her from engaging in them. Other behavioral techniques used in the treatment of the disorder include relaxation training, paradoxical intent, covert sensitization, and systematic desensitization.

Answer 106

Correct Answer is: B A delusion of reference is one in which the person believes that objects or events in the immediate environment have an unusual and particular significance to him or her. In a persecutory delusion, the person feels that he or she is being mistreated in some way or conspired against; this is not the case here. Systematized delusions are organized around a coherent theme; there is no evidence that this is the case. Hearing the same song over and over again can drive one crazy, but probably not to the extent described in the question.

Answer 107

Correct Answer is: B A number of factors have been associated with a better prognosis in Schizophrenia. These include being female, a later age of onset, and positive symptoms (which are more responsive to medications), as well as good premorbid adjustment, acute onset, precipitating events, treatment with antipsychotic medication soon after onset of illness, consistent medication compliance, and no family history of Schizophrenia.

Answer 108

Correct Answer is: C Tourette's Disorder is a Tic Disorder that involves multiple motor tics (involuntary jerky movements) and vocal tics (vocal sounds such as grunts, barks, and clicks). uncontrollable outbursts of vulgar and obscene utterances are present in the majority of cases. Coprolalia, or involuntary utterances of obscenities, occurs in 10% or less of cases -- not the majority, which is why this option is correct (remember, the question is asking for the statement that isn't true). For a diagnosis to be made, onset of the disorder must be before age 18. The disorder is between 1.5 and 3 times more common in males than in females.

Answer 109

Correct Answer is: B Although some research suggests that there is no relationship between sexual abuse and Bulimia and other Eating Disorders, we have reviewed more recent research that suggests that children who are sexually abused are more at risk. Additional Information: Etiology (Bulimia Nervosa)

Answer 110

Correct Answer is: B People with deep dyslexia exhibit a number of reading errors including semantic paralexia, which involves producing a response that is similar in meaning to the target word (e.g., dog for cat or arm for leg).

Answer 111

Correct Answer is: A Foa et. al. (1999) compared prolonged exposure, stress inoculation training, combined prolonged exposure and stress inoculation training, and a waiting list control group. The results indicated that all treatments (except the waiting list) were effective; however, prolonged exposure was superior to either stress inoculation training or the combined treatment. Response prevention was not included in the study, and is typically used with disorders that include more of a behavioral component, such as obsessive-compulsive disorder (E. Foa, C. Dancu, E. Hembree, L. Jaycox, E. Meadows, & G. Street, A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. Journal of Consulting and Clinical Psychology, 1999, 67(2), 194-200).

Answer 112

Correct Answer is: D Migraine headaches are triggered and exacerbated by a number of factors including certain body movements such as those listed in the question.

Answer 113

Correct Answer is: A Studies looking at cognitive impairment due to prolonged, heavy alcohol use have found that it is more likely to involve problems in visuospatial skills than in verbal skills.

Answer 114

Correct Answer is: B James Marcia distinguishes between four identity statuses. Identity foreclosure is characterized by a commitment to an identity (e.g., career) that was defined or suggested by a parent of other significant person.

Answer 115

Correct Answer is: D Most studies have found that the best predictors of treatment outcome for substance abusers are psychiatric severity and problem severity. Other predictive factors include motivation and coping skills at baseline (J. R. McKay & R. V. Weiss, A review of temporal effects and outcome predictors in substance abuse treatment studies with long-term follow-ups: Preliminary results and methodological issues. Evaluation Review, 2001, 25(2), 113-161).

Answer 116

Correct Answer is: A The results of a meta-analysis on gender differences concluded that females (across all age groups) have a higher level of general anxiety than males. Males scored very slightly higher than females in level of social anxiety, although this difference was not significant (A. Feingold, Gender Differences in Personality: A Meta-Analysis. Psychological Bulletin, 1994, 116(3), 429-456). Additional Information: Treatment (Obsessive-Compulsive Disorder)

Answer 117

Correct Answer is: C While in vivo exposure has been found superior to exposure in imagination for Simple Phobia and Agoraphobia, the difference is less clear for OCD (both seem effective). In addition, gradual exposure and maximal exposure (flooding) seem to be about equally effective as are massed or distributed exposure sessions. However, there is evidence that the benefits of exposure are maximized when it is combined with response prevention. [For a review of the literature, see P. Emmelkamp, Behavior therapy with adults, in A. E. Bergin and S. L. Garfield (eds.), Handbook of Psychotherapy and Behavior Change, New York, John Wiley, 1994.]

Answer 118

Correct Answer is: B Even if you are unfamiliar with Wolpe's explanation of depression, you may have been able to pick the right answer to this question as long as you have him associated with systematic desensitization. Wolpe distinguished between several types of depression. He linked neurotic depression to anxiety and considered systematic desensitization to be an effective treatment. Additional Information: Systematic Desensitization

Answer 119

Correct Answer is: C The studies have consistently shown that the combination of hyperactivity and conduct problems is most associated with antisocial behavior and other serious problems in adulthood. Additional Information: Attention-Deficit/Hyperactivity Disorder (ADHD)

Answer 120

Correct Answer is: B Mood Disorder With Seasonal Pattern (better known as Seasonal Affective Disorder) is diagnosed when the person displays onset and remission of Major Depressive Episodes at characteristic times of the year. In most cases, onset is in fall or winter and remission is in spring. The depressive symptoms in Seasonal Affective Disorder most often include: decreased energy, increased sleep, overeating, weight gain, and a craving for carbohydrates. Additional Information: Major Depressive Disorder

Answer 121

Correct Answer is: B Attention-Deficit/Hyperactivity Disorder (ADHD) is highly comorbid with Conduct Disorder. Between 30% and 50% of children with ADHD also meet the criteria for Conduct Disorder, with the highest comorbidity rates among the two subtypes marked by hyperactivity-impulsivity (Hyperactive-Impulsive and Combined Types). The percentage of patients with Conduct Disorder who also have ADHD is nearly 70%. (T. P. Beauchaine, E. S. Katkin, Z. Strassberg, & J. Snarr. Disinhibitory psychopathology in male adolescents: Discriminating Conduct Disorder from Attention-Deficit/ Hyperactivity Disorder through concurrent assessment of multiple autonomic states. Journal of Abnormal Psychology, 2001, 110(4), 610-624). If you incorrectly selected Tourette's Disorder, you may have been thinking of the reverse relationship. That is, among those with Tourette's Disorder the comorbidity of ADHD is at least 50%; however, most patients with ADHD do not have Tourette's Disorder.

Answer 122

Correct Answer is: B Friedman and Rosenman (1974) described the Type A personality as someone who is competitive, achievement oriented, highly involved in his work, active, aggressive, and urgent about time and meeting deadlines. Originally, it was hypothesized that the Type A behavior pattern (TABP) increases the risk of coronary heart disease (CHD). However, recent research suggests that some but not all aspects of the TABP increase the risk of CHD. Specifically, hostility, aggression, and anger have been found to be the primary risk factors.

Answer 123

Correct Answer is: B Though the correct answer is an imprecise description of what an interpersonal therapist would do, it is the best answer available. Interpersonal therapists believe that depression is caused and maintained by disturbances in early life, especially attachment disturbances. Rather than focusing on the past, however, they focus on the connection between the presenting problem and client's current relationships -- including the current relationship with the therapist. Grief reactions are a common focus of interpersonal therapy.

Answer 124

Correct Answer is: C Questions like this are certainly frustrating, since in real life you would conduct a comprehensive assessment of the person before planning interventions. For the exam, however, you must do your best with the information you have at hand. Paranoid ideations in elderly clients are often wholly or partially due to what is happening around them. For instance, elderly people often live in high crime areas, are victimized by unscrupulous businessmen, and are plotted against in various ways by family members. If the person is mildly memory impaired, depressed, and/or hearing impaired, these events can seem even more threatening and the ideations can intensify. Thus, of the choices listed, the best option would be to alter the environment to make it seem less threatening.

Answer 125

Correct Answer is: C Yalom believes that co-leaders should not express conflict in front of the group during the early stages of therapy. However, in his book The Theory and Practice of Group Psychotherapy, he notes that mature resolution of conflict in the later stages can serve as a healthy model for the group members.

Answer 126

Correct Answer is: B The Somatoform Disorders (such as Somatization Disorder, Conversion Disorder, Somatoform Pain Disorder, Hypochondriasis, and Body Dysmorphic Disorder) are characterized by physical symptoms which have no known physical cause and are believed to be caused by psychological factors. The DSM identifies anxiety and depression as associated features of each of these disorders. You might have gone for addiction to analgesics or tranquilizers, since it seems to make sense. However, excessive use of analgesics (which are not addictive anyway) is identified as a possible associated feature of Somatoform Pain Disorder only.

Answer 127

Correct Answer is: D Mood Disorder With Seasonal Pattern (better known is Seasonal Affective Disorder) is diagnosed when the person displays onset and remission of Major Depressive Episodes at characteristic times of the year. In most cases, onset is in fall or winter and remission is in spring. It is believed that Seasonal Affective Disorder is related to abnormal regulation of melatonin secretions. The fact that Seasonal Affective Disorder often responds to light therapy (exposing the patient to bright light for about two hours either before sunrise or after sundown) lends support to this hypothesis, since melatonin levels are affected by light-dark cycles.

Answer 128

Correct Answer is: A Pharmacotherapy (specifically, Lithium therapy in most cases) is the treatment of choice for manic-depressive illnesses such as Bipolar I Disorder. Pharmacotherapy may be supplemented with adjunctive psychotherapy (e.g., to provide support and coping skills). However, psychotherapy is not considered that useful in treating the core symptoms of Bipolar I Disorder. By contrast, although the disorders in the other choices are commonly treated with medication, they also respond to psychotherapy. Additional Information: Treatment (Bipolar I Disorder)

Answer 129

Correct Answer is: B Psychological treatment of Alzheimer's focuses primarily on optimizing the patient's immediate environment and providing support for the patient and his or her family. Both these goals can be met at least to some extent through a referral to a support group.

Answer 130

Correct Answer is: B Though some individual studies have found cognitive therapy to be the most effective treatment for depression, the results of meta-analyses (such as the one conducted by the National Institute of Mental Health) indicate that cognitive therapy, interpersonal therapy, and anti-depressant medications are about equal in efficacy in the treatment of depression. All three treatments are superior to psychodynamic, or insight-oriented, therapies.

Answer 131

Correct Answer is: C Much research supports the generally accepted conclusion that in-vivo exposure with response prevention is the preferred psychological treatment for Agoraphobia.

Answer 132

Correct Answer is: A Generalized tonic-clonic seizure is the name for what was previously referred to as grand mal seizure; thus, this choice "grand mal epilepsy" is the best answer. These seizures involve episodes of violent shaking, during which the person becomes blue and stiff. There may also be an increase in heart rate and blood pressure. Generalized tonic-clonic seizures may last up to an hour, and afterward the person falls into a deep sleep.

Answer 133

Correct Answer is: A This is one of those where the right answer - extraversion - is a "rule out". The Big Five personality dimensions are extraversion, agreeableness, openness, emotional stability and conscientiousness. An antisocial personality is described as deceitful, impulsive, irritable, consistently irresponsible and with a lack or remorse. You might not always expect an antisocial person to be extroverted, but of the choices, it is what you would most expect.

Answer 134

Correct Answer is: B According to S. Shiffman et al., the most common precipitants of relapse are the presence of smoking cues and negative affect (First lapses to smoking: Within-subjects analysis of real-time reports, Journal of Consulting and Clinical Psychology, 64(2), 366-389).

Answer 135

Correct Answer is: D Older adults are less likely than younger adults to express feelings of depression or sadness. They are more willing to express feelings of hopelessness* and anxiety*. They are also more apt to have memory problems* (* incorrect options). [APA Working Group on the Older Adult, What practitioners should know about working with older clients, Professional Psychology: Research and Practice, 1998, 29(5), 413-427]

Answer 136

Correct Answer is: C The caudate nucleus appears to be overactive in people diagnosed with OCD. L.R. Baxter reports that both behavioral interventions and drug therapy affect metabolic rate in the caudate nucleus (Caudate glucose metabolic rate changes with both drug and behavior therapy for Obsessive-Compulsive Disorder, Archives of General Psychiatry, 1992, 49, 681-689). The reticular activating system*, which you should remember by now, is involved in attention and arousal. The inferior colliculus*, controls auditory reflexes, and the locus coeruleus* may be associated with Depression and Panic Disorder (* incorrect options).

Answer 137

Correct Answer is: B The greater the level of dependence on nicotine, the harder it is to stop smoking (American Psychiatric Association, Practice Guidelines for the Treatment of Nicotine Dependence, Washington, DC, 1996). In terms of gender*, and age*, females and males and older and younger adults generally do equally well in treatment. The duration of smoking* is not really a factor (* incorrect options); it is far more critical to determine the amount of smoking in order to determine dependence.

Answer 138

Correct Answer is: A These symptoms are characteristic of the third stage of Alzheimer's Dementia according to many authors. The symptoms vary considerably from person to person and may include personality, behavioral, and cognitive changes. The symptoms of depression and anomia* and irritability and anger* are often seen during the first stage. Paranoia and labile mood* are characteristic of the second.

Answer 139

Correct Answer is: B This is one of those questions that seems to be a favorite of the EPPP. The risk for an identical (monozygotic) twin to be diagnosed is about 46% and for fraternal (dizygotic) twins it is about 17%. You have to be able to do the basic math here, and realize that 46 is about two and a half times 17, and thus is the "closest" to correct. This question is also a good example of how the exam takes a straightforward finding and muddies the water with it.

Answer 140

Correct Answer is: B Dialectical behavior therapy or DBT consists of outpatient individual therapy, social skills training and follow-up telephone consultations. It also discourages the expression of overt inappropriate affect. Its combination of social skills training (usually done in group therapy settings) and outpatient individual psychotherapy has been found to decrease hospitalization and suicide attempt rates (M. Linehan and C.A. Kehrer, Borderline Personality Disorder, in D.H. Barlow, Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual, New York, Guilford, 1993).

Answer 141

Correct Answer is: A Nicotine replacement therapy seems to be most effective when it is combined with guidance and support, and social skills training that focuses on avoiding relapse.

Answer 142

Correct Answer is: C The concordance rate for Schizophrenia among siblings is about 10%. If you didn't know this, you might have been able to guess the correct answer. A rate of 60% or 45% probably should have seemed too high. And 0.5% is at the low end of estimates of the approximate lifetime prevalence rate of Schizophrenia and therefore should have seemed too low to be the concordance rate among related individuals.

Answer 143

Correct Answer is: C Hallucinogens (e.g., LSD), cocaine, and cannabis -- as well as alcohol, amphetamines, inhalants, opioids, PCP, and sedatives -- may produce Intoxication Delirium. Caffeine, however, does not cause delirium.

Answer 144

Correct Answer is: A The findings of the NIMH research project were that, on an overall level, cognitive-behavioral therapy (CBT) and antidepressant medication are about equally effective in the treatment of depression. There was some evidence that the treatments differed in the types of depression for which they are most effective. Specifically, some evidence suggested that CBT is more effective for milder forms of depression, while medication is more effective for relatively severe forms. But in terms of overall effectiveness, both treatments were found to be about equal.

Answer 145

Correct Answer is: A The International Headache Society (IHS) has developed a headache classification system that divides headaches into thirteen types -- four of which are listed by the choices here. This question best matches the description of a migraine headache. Migraines are felt on one side of the head by a majority of sufferers and are typically throbbing in nature. In addition, nausea (with or without vomiting) as well as sensitivity to light and sound often accompany migraines. Additional Information: Headaches

Answer 146

Correct Answer is: B Narcolepsy is characterized by irresistible sleep attacks occurring on a daily basis for at least three months. It also may involve cataplexy, which is a sudden loss of muscle tone, usually in association with intense emotion.

Answer 147

Correct Answer is: B Recent meta-analyses have confirmed that past behavior alone is a better predictor of future violence than clinical judgments. Past behavior is also a better predictor than test results, including multiple predictor batteries developed on the basis of discriminant analysis. Nonetheless, violence predictions that are made by mental health professionals are significantly more accurate than chance.

Answer 148

Correct Answer is: A Research suggests that the primary physical factor in maintaining smoking is avoidance of withdrawal, and the primary psychological factor is regulation of emotional states. Specifically, smoking functions to minimize negative affects and evoke positive affects. This is why the most common triggers of relapse are withdrawal symptoms and negative affects.

Answer 149

Correct Answer is: D Schizoid Personality Disorder is characterized by a pattern of indifference to social relations and a limited range of emotional expression in social situations. Avoidant Personality Disorder is characterized by social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Individuals with both these disorder are likely to avoid social relationships. However, those with Avoidant Personality Disorder do so due to timidity and fear of criticism, disapproval, or rejection. Individuals with Schizoid Personality Disorder, by contrast, do so out of indifference to social relationships and a preference for solitary activities.

Answer 150

Correct Answer is: B AIDS dementia complex occurs in about 2/3 of all AIDS patients. Usually, one of the first cognitive signs of dementia (both in AIDS and non-AIDS patients) is a loss of concentration and a mild memory loss, especially for recent events.

Answer 151

Correct Answer is: D PTSD is not usually treated with phamacotherapy unless the target symptoms of intrusive experiences, flashbacks, transient psychosis, marked derealization, and avoidance and numbing markedly interfere with daily life. With these symptoms, short-term medication is indicated. When the target symptoms of major depression, panic disorder or persistent psychotic symptoms become too intense, long term medication is indicated (Barry Pierce, R cassidy seminars, Santa Rosa CA).

Answer 152

Correct Answer is: C Memory deficits are the primary negative side effect associated with ECT. Although verbal memory deficits are reduced when ECT is delivered to the right hemisphere only, it still causes nonverbal memory problems. Further, while most memory problems are reversible, the person may continue to complain about loss of memory for personal (autobiographical) information for many months.

Answer 153

Correct Answer is: B Methylphenidate (Ritalin), a central nervous system stimulant, was originally described as having a paradoxical effect only for children and adolescents with ADHD. However, subsequent research found similar effects in normal children and adults.

Answer 154

Correct Answer is: C It makes sense that children who have serious learning problems would continue to have difficulties as adults. Also, the studies have clearly found that children with Learning Disorders are at higher risk for certain other disorders in childhood including ADHD, Oppositional Defiant Disorder, Conduct Disorder, and Major Depression.

Answer 155

Correct Answer is: A This is a difficult question unless you are a Theodore Millon fan. According to Millon, when narcissistic people experience personal failure and public humiliation, they resort to defense mechanisms -- first repression, and if that fails, then rationalization and projection.

Answer 156

Correct Answer is: A Memory impairment is one of the characteristics that is useful for distinguishing depression (pseudodementia) from dementia. In depression, recall memory is affected but recognition memory is not; in dementia, recall and recognition memory are both impaired. Additional Information: Differential Diagnosis (Major Depressive Disorder)

Answer 157

Correct Answer is: B Since the question mentions that clonidine is safer for chronic use, you'd want to look for less serious side effects, which narrows it down to two responses ("dry mouth, headache, and hypotension" and "vomiting, dizziness, and irritability"). In addition to dry mouth, headache, and hypotension, clonidine may also cause sedation and dizziness. Additional Information: Treatment (Tourette's Disorder)

Answer 158

Correct Answer is: C Many of the endocrine disorders produce symptoms that can be mistaken for a psychiatric illness. Hypoglycemia has both acute and chronic phases, which involve different symptoms. During the acute phase, which this question is asking about, symptoms include panic and anxiety. However, these are replaced during the chronic phase with depression, psychosis, and/or personality change.

Answer 159

Correct Answer is: A One of the complications of epilepsy is that repeated seizures are correlated, in some cases, with cognitive declines. This is especially true of tonic-clonic seizures regardless of whether they are idiopathic or secondary to (symptomatic of) another disorder.

Answer 160

Correct Answer is: A Bipolar Disorders have a strong genetic and biological component. Nonetheless, evidence suggests that environmental factors can trigger episodes. This is especially true in the early stages of the disorder; psychosocial stressors often trigger the initial mood episodes; they less frequently trigger subsequent episodes. Additional Information: Etiology (Bipolar I Disorder)

Answer 161

Correct Answer is: A If you were not familiar with the term "tangentiality," thinking about the phrase "going off on a tangent" might have helped you. Tangentiality is defined as responding to a question in an oblique or irrelevant way; in other words, the person avoids the point entirely. Circumstantiality, by contrast, is a pattern of speech that is delayed in reaching the point due to much irrelevant detail or many parenthetical remarks. Eventually, however, the point is reached.

Answer 162

Correct Answer is: A Alzheimer's dementia affects declarative memory which includes both episodic memory (memory of your last birthday, how you spent your last vacation) and semantic memory (red is a color).

Answer 163

Correct Answer is: C Linnehan uses dialectical behavioral therapy (DBT) in the treatment of Borderline Personality Disorder. DBT is a type of cognitive behavioral therapy that emphasizes social skills training, self-soothing exercises, and group dynamics. The patient is offered intensive individual and group sessions that are a combination of psychoeducation and cognitive therapy. DBT has been shown to reduce hospitalization and self-mutilating behavior (Linnehan, Heard, and Armstrong, 1993).

Answer 164

Correct Answer is: D In terms of the role of genetics, some studies indicate higher rates of ADHD among relatives of afflicted individuals. For example, Biederman (1995) found that when a parent had childhood-onset ADHD, the risk for this diagnosis among his or her offspring was 57%. Additionally, a review of twin studies (Stevens, 1994) indicated that the average heritability is .80 for hyperactivity and impulsivity.

Answer 165

Correct Answer is: A Bill's symptoms meet the criteria for Schizophrenia, Paranoid Type. He has one or more delusions and auditory hallucinations. He does not have the symptoms of Disorganized Type, which requires a prominence of disorganized speech, disorganized behavior, and flat affect. His symptoms have lasted for more than one month which rules out Brief Psychotic Disorder.

Answer 166

Correct Answer is: A Your friend will be diagnosed with Acute Stress Disorder. She has witnessed a traumatic event and is reexperiencing it through dreams. She is avoiding activities associated with the trauma and is experiencing a general numbing of feeling. For "Post-traumatic Stress Disorder," the same symptoms would need to continue beyond one month. For "Specific Phobia," while your friend may have phobic symptoms, it is related to a specific traumatic event rather than all cars, and for "Generalized Anxiety Disorder," again the symptoms have only been occurring for a few weeks and are specific to the traumatic situation.

Answer 167

Correct Answer is: D | Schizophrenia is the most common diagnosis for inpatients in the age 18 to 44 range.

Answer 168

Correct Answer is: A This is tough. All of the distractors mentioned predict good adaptation in our older age. But the best answer is good health, according to the research.

Answer 169

Correct Answer is: B | Hearing voices is a modal symptom of this disorder.

Answer 170

Correct Answer is: A Research has supported the general principle that the more realistic the treatment situation, the better the result with phobias and fears.

Answer 171

Correct Answer is: D This is not an easy question, as it requires knowledge that many psychologists might consider obscure. If you got it wrong, you should remind yourself that you are not going to answer all of the questions on the exam correctly, and a small percentage will be so obscure or unclear that the most you can reasonably ask of yourself is to take a good guess. The DSM identifies the following disorders as possible causes of an organically-based mood symptoms: Substances such as hallucinogens and PCP; endocrine disorders, such as hypo- or hyperthyroidism; carcinoma of the pancreas; viral illness; and structural disease of the brain, such as that caused by a stroke. Only the correct choice contains three factors that each fall into one of these categories: carcinoma of the pancreas, hallucinogen use, and viral illness.

Answer 172

Correct Answer is: A Alcohol-Induced Persisting Amnestic Disorder, also known as Korsakoff's syndrome, is one of the most common causes of amnesia and is due to thiamine deficiency associated with prolonged heavy drinking. The memory impairment usually continues even if the alcohol use has stopped. Korsakoff's syndrome is manifested by an impaired ability to learn new information (anterograde amnesia) or an inability to recall previously learned information (retrograde amnesia). However, the greatest impairment is among more recent memories, while remote memories remain relatively intact. Additional Information: Substance-Induced Disorders

Answer 173

Correct Answer is: D The research regarding the effectiveness of vocational rehabilitation programs for those with Schizophrenia and other severe mental illness is mixed; however, the most consistent finding is that past employment history is the best predictor of future employment. [See A. Lehman, Vocational Rehabilitation in Schizophrenia, Schizophrenia Bulletin, 1995, 21 (4), 645-656).]

Answer 174

Correct Answer is: B Research studies have found that between 30% and 70% of children with ADHD continue to exhibit signs of the disorder throughout their lives. Studies have also found a strong genetic basis for ADHD. One study found that the risk of a child developing ADHD is 57% if one of their parents has the disorder [See J. Biederman, et al. High risk for attention deficit hyperactivity disorder among children with parents with childhood onset of the disorder: A pilot study. American Journal of Psychiatry, 1995, 152, 431-435.] the symptoms will manifest in the same ways in those who continue to have the disorder Contrary to this choice, ADHD may look different in adults and children.

Answer 175

Correct Answer is: A Most studies have found Schizophrenia to be slightly more common in African Americans than whites, although some critics of these studies argue that the difference is due more to methodological problems than actual race-related differences in psychopathology.

Answer 176

Correct Answer is: A Some hyperactive children develop motor tics when taking methylphenidate. Leading experts warn that the drug should not be used (or should be used with caution) when a child has a pre-existing Tic Disorder or a family history of a Tic Disorder.

Answer 177

Correct Answer is: B Schizophrenia has been linked to several structural brain abnormalities, but the most consistent finding is that it is related to enlarged lateral and third ventricles. Additional Information: Etiology (Schizophrenia)

Answer 178

Correct Answer is: A It's sometimes hard to distinguish between depression and dementia because they share several symptoms, especially cognitive deficits. However, the pattern of cognitive deficits differs. For example, depression is likely to impair free recall only, while dementia affects both free recall and recognition.

Answer 179

Correct Answer is: B Usually a combined treatment is the best, but in the case of PTSD, the research suggests that prolonged exposure is the best treatment. While stress inoculation training is also effective alone, it doesn't seem to add much to prolonged exposure.

Answer 180

Correct Answer is: B Positron Emission Tomography (PET) is a functional (versus structural) brain imaging technique that provides information about the metabolic and chemical activities of the brain such as cerebral blood flow.

Answer 181

Correct Answer is: C Obsessive-Compulsive Disorder has an earlier peak onset for males than females. For males the peak onset is between ages 6 and 15, and for females it is between ages 20 and 29. The incidence is, therefore, higher among boys than girls but in adulthood the incidence is about the same.

Answer 182

Correct Answer is: C Prior to puberty the incidence of Major Depressive Disorder is about equal for boys and girls; however, at puberty the gender differences emerge with the disorder occurring twice as often in females than males [S. Nolen-Hoeksema and J.S. Girgus, The emergence of gender differences in depression during adolescence, Psychological Bulletin, 1994, 115, 424-443].

Answer 183

Correct Answer is: C In most of the Specific Phobias there is an increase in heart rate and blood pressure. However, in the Blood-Injection-Injury Type there is an initial brief acceleration in heart rate followed by a deceleration and a drop in blood pressure. This often results in vasovagal fainting. Due to this unique physiological response to the feared stimulus, the recommended treatment involves tensing muscles, rather than relaxing them, in the presence of the feared stimulus. Although the Blood-Injection-Injury Type usually does begin in childhood, so do many of the other Specific Phobias. In all Specific Phobias the person recognizes that the fear is excessive or unreasonable (except in children who may not recognize this).

Answer 184

Correct Answer is: D Individuals with Agoraphobia typically prefer to be with a trusted companion when in the feared situation, whereas, individuals with Social Phobia may feel more anxious due to the potential scrutiny by a companion. social situations are avoided due to fear of humiliation or embarrassment This choice does not adequately differentiate the disorders since in both Social Phobia and Agoraphobia there is a fear of humiliation or embarrassment and an avoidance of those situations, although in Agoraphobia the fear is not limited to social situations.

Answer 185

Correct Answer is: B The boy's symptoms meet the criteria for Conduct Disorder. There is a pattern of behavior in which major age-appropriate norms or rules are violated. Adjustment Disorder* can only be considered if the symptoms do not meet the diagnostic criteria for another disorder. His symptoms are more severe than is characteristic of Oppositional Defiant Disorder* and are not just isolated incidents of antisocial behavior as seen in Child Antisocial Behavior* (* incorrect options).

Answer 186

Correct Answer is: B Treatments for enuresis include moisture alarms (also known as the "bell and pad" method), antidepressant medications such as imipramine, hypnosis, and bladder control exercises. Of all these treatments, the moisture alarm has the highest long-term success rate and the lowest relapse rate.

Answer 187

Correct Answer is: D Moffitt's theory of antisocial behavior describes 2 types: the life-course persistent type, consisting of a smaller group that engages in antisocial behavior at every life stage, in a wider range of crimes, including more victim-oriented offenses; The adolescent-limited type, making up the majority of deviant adolescents, engage in antisocial behaviors only temporarily or in limited, less severe, offenses that represent power and autonomy from parental control. [See T. E. Moffitt, Adolescent-limited and life-course-persistent antisocial behavior: A developmental taxonomy. Psychological Reports, 1993, 100(4), 674-701.] Age of onset of puberty* and access to antisocial peers* are variables that can distinguish between adolescents who do not engage in antisocial behaviors and those who do (* incorrect options).

Answer 188

Correct Answer is: D Niarhos and Routh (1992) found that number of previous arrests was the single best predictor of recidivism. When multiple predictors are used, they found that the combination of previous arrests, school achievement, and history of drug use is most predictive of recidivism. [F. J. Niarhos and D. K. Routh, The role of clinical assessment in the juvenile court: Predictors of juvenile dispositions and recidivism, Journal of Clinical Child Psychology, 1992, 21(2), 151-159.]

1- Diagnosis and Psychopathology Flashcards

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