C&L

Question 1

Which of the following situational and environmental factors is most clearly associated w/ increased inpatient assaults? (6x)

Answer 1

CHANGE OF SHIFT

Question 2

Best indication for residential treatment of substance abuse? (3x)

Answer 2

FAILURE TO MAINTAIN ABSTINENCE AFTER TREATMENT IN INPATIENT SETTINGS

Question 3

29 y/o schizophrenic frequent ER visits and hospitalizations. Hallucinating, agitated, not violent or suicidal, cooperative. Ran out of meds a few days ago. Had been doing well on olanzapine for several months and was doing fairly well in structured living environment. Denies command AH. What should the next intervention here be? (3x)

Answer 3

CONTACT CASE MANAGER TO VERIFY ENVIRONMENTAL SUPPORT

Question 4

Patient with MDD; psychiatrist prescribes antidepressant, psychologist provides interpersonal therapy. Who is responsible & accountable for what? (2x)

Answer 4

PSYCHIATRIST IS RESPONSIBLE & ACCOUNTABLE FOR ALL TREATMENT; PSYCHOLOGIST JUST FOR PSYCHOTHERAPY

Question 5

Describe the psychiatric assertive community treatment case management model: (2x)

Answer 5

INTERDISCIPLINARY TEAM, SERVICES IN SITU, HIGH STAFF/PATIENT RATIO, AND INTENSIVE OUTPATIENT RESEARCH

Question 6

29 y/o M pt with hx of CPS 8x hospitalization in 14 months, stopped his meds and is unable to take care of himself, becomes paranoid and stays on the street, eating out of garbage cans and his family is unable to support him anymore. The most appropriate intervention to decrease this pt’s risk of future hospitalizations: (2x)

Answer 6

ASSERTIVE COMMUNITY TREATMENT

Question 7

As part of comprehensive pain management team for pt w hx of narcotic abuse, a consulting psychiatrist may appropriately be asked to do which of the following? (2x)

Answer 7

RESOLVE CONFLICTS BETWEEN THE PATIENT AND THE TREATMENT TEAM

Question 8

Pt consults psychiatrist b/c former psychiatrist has retired & pt wishes to continue Tx w antidepressants. The pt is seeing a counselor for weekly psychotherapy and plans to continue. The psychiatrists eval confirms the Dx of MDD and psychiatrist feels that continuing the pt ‘s antidepressant is indicated. Next step? (2x)

Answer 8

ESTABLISH A CLEAR UNDERSTANDING OF THE DIVISION OF RESPONSIBILITIES BETWEEN PSYCHIATRIST AND COUNSELOR

Question 9

Psychiatrist sees family of a pt who is in vegetative state. All staff, except one nurse, & all of family, except one adult child, believe it is “time to let go.” But nurse & adult child claim signs of recognizing & responding to them despite all of the evidence of cortical brain death. Most appropriate next step? (x2)

Answer 9

MEET SEPARATELY WITH FAMILY AND STAFF TO EXPRESS ISSUES OF POLARIZATION

Question 10

Psych unit staff wants initiative that decreases completed suicides inpatient. Which will have the greatest effect of decreased suicides while maintaining therapeutic environment and minimizing staff burden?

Answer 10

REDESIGNING THE PHYSICAL SPACE TO ELIMINATE POTENTIAL ANCHOR POINTS FOR HANGING.

Question 11

Integrated setting with primary care and mental health, which would be population based technique to provide collaborative care?

Answer 11

TRACKING CLINIC PATIENTS IN A REGISTRY

Question 12

Existing mental health care programs that do not have the capacity to provide effective treatment to all patients in need would be a primary rationale for implementing what?

Answer 12

COLLABORATIVE CARE

Question 13

Of the following which is most effective in reducing inpatient hospital use, increasing housing stability, controlling psychiatric sx, and improving quality of life, for the severely mentally ill.

Answer 13

ASSERTIVE COMMUNITY CARE

Question 14

If interviewing an agitated patient

Answer 14

BE AWARE OF BODY POSITION OF SELF AND PT

Question 15

Evidence based treatment algorithm to maximize chances of successful consultation

Answer 15

PLAN A FOCUSED WORKSHOP FOLLOWED BY RETURN VISITS FOR FURTHER TRAINING AND PROBLEM-SOLVING SESSIONS

Question 16

Pt has phoned the ED complaining of hallucinations that command the pt to kill others. Psychiatrist’s first action:

Answer 16

OBTAIN PHONE NUMBER, ADDRESS OF PATIENT

Question 17

Major issue with maintaining severely mentally ill in community

Answer 17

INSUFFICIENT RESOURCES

Question 18

Basic concept of community psychiatry

Answer 18

CONTINUITY OF CARE

Question 19

Public mental health clinicians who follow patients through all phases of treatment

Answer 19

CASE MANAGERS

Question 20

Managed care org. asks MD to d/c a pt who still requires hospitalization. MD should:

Answer 20

CONTINUE ADMISSION AS LONG AS MEDICALLY NECESSARY

Question 21

Principal goal of wraparound services:

Answer 21

PREVENT HOSPITALIZATION OR RESIDENTIAL PLACEMENTS

Question 22

Essential element of wraparound treatment

Answer 22

FORMAL MENTAL HEALTH SERVICES AND INFORMAL COMMUNITY SUPPORT

Question 23

31 y/o postpartum F distressed by fantasies of smothering baby, tearfully describes feeling overwhelmed by the burden of the child care. She denies SI/HI, but describes feeling some evil external force taking her baby away. Requests outpt psych f/u & refuses voluntary admission> her husband says everything is fine. Next step:

Answer 23

INVOLUNTARY ADMISSION

Question 24

How to manage telephone conversation with labile patient who ended relationship with boyfriend and is having SI with plan, but is willing to stay with family and allows you to speak with family?

Answer 24

NEXT DAY OUTPATIENT FOLLOW UP WITH PSYCHIATRIST

Question 25

50yr old pt divorced and laid off from work presents to ED with SI with plan to OD on tylenol, lacks social support and has impulsive history, disposition?

Answer 25

INPATIENT HOSPITALIZATION

Question 26

What response would be based on a purely laisonal model of psychosomatic medicine give for a pt who may be depressed?

Answer 26

ADVISE THE TEAM ON HOW TO PROPERLY DIAGNOSE DEPRESSION

Question 27

C&L psych sees 58 y/o widowed pt medicine wants to discharge d/t neg workup for abd pain and nausea. Pt refuses to return home to adult kids because the food they prepare are making her sick and causing her sxs. MSE unremarkable and no past psych hx. Next step?

Answer 27

SCHEDULE MEETING WITH THE MEDICAL TEAM, PATIENT, AND FAMILY

Question 28

Psych MD sees 62 y/o pt who has been hospitalized after an acute MI because staff report that “the pt is driving us crazy.” The nurses complain that pt is constantly requesting info about his condition and treatment, and will refuse tests and medications if he feels the explanations are not sufficient. On interview pt admits that “I am a perfectionist” but is proud of this fact, saying that it is “the secret of my success.” Pt is aware of the staff’s frustration, but feels his requests for information are reasonable. The best advice to the Tx team?

Answer 28

ANSWER THE PT’S QUESTIONS AND ACTIVELY INVOLVE THE PT IN ALL PORTIONS OF HIS TREATMENT

Question 29

Psych eval requested on management of 32 y/o pt admitted by internal medicine for tx of severe gastrointestinal viral infection-dehydration, nausea, vomiting, fever. Pt has hx schizoaffective disorder, controlled w stable doses of clozapine over the past year. Staff concerned that pt might be delusional/hallucinating, as pt has appeared somewhat confused/inattentive. On exam, pt is oriented to person, place but not time. Pt somewhat slow, appears visibly ill/tired. Pt complains of stiffness, there is some rigidity to movements. Psych recommendation?

Answer 29

DISCONTINUE CLOZAPINE

Question 30

Which of the following is the principal service provided by the liaison component of consultation-liaison psychiatry?

Answer 30

TEACHING PSYCHOSOCIAL ASPECTS OF MEDICAL CARE TO OTHER HEALTHCARE WORKERS

Question 31

An effective consultation-liaison psychiatry program in a medical hospital will result in which of the following?

Answer 31

IMPROVED TREATMENT COMPLIANCE

Question 32

58 yo patient with breast cancer on the C&L service, recently put on palliative level and develops depression. She is hopeless but denies SI. What is the most appropriate response?

Answer 32

VALIDATE THE PATIENT’S FEELINGS

Question 33

Consultant evaluates patient for capacity. Patient refusing meds, procedures, yells at nurses, orders take out into hospital, threatens lawsuits if demands not met. Patient accuses doctor of being abusive, screams at doctor, when asked for explanation of behavior “you’re just another person here to abuse me!” Best response and advice for medical team is?

Answer 33

THE PATIENT IS A DIFFICULT PATIENT TO WORK WITH. LET’S TALK ABOUT WAYS TO MANAGE THE PATIENT’S BEHAVIOR.

Question 34

An effective role of C&L psychiatrist consulting on a manipulative, entitled patient?

Answer 34

MODELING AN APPROACH OF APPEALING TO THE PATIENT’S ENTITLEMENT

Question 35

27 y/o angry, agitated pt is admitted to the ER. He is evaluated during initial interview as non- psychotic and high risk for imminent violence. He refuses medication. What would be the most appropriate intervention at this time?

Answer 35

USE EXTERNAL RESTRAINT WITH CALM REASSURANCE.

Question 36

24 yo pt comes to ed with wrist cuts. pt reports having no intention to die but wanted to feel things. Admits to other self harm behaviors when stressed. Admission to psych hospital would be most supported by what in the patient’s history?

Answer 36

RECENT ALCOHOL ABUSE

Question 37

27 y/o uninsured pt was hospitalized in an intensive care unit after a near lethal OD which followed the ending of a long-term relationship. Pt is medically ready for discharge, but is ambivalent about follow-up psych care, noncommittal when asked about regretful feelings for surviving. Best approach?

Answer 37

INPATIENT HOSPITALIZATION

Question 38

What psychiatric symptom does not require pharmacologic treatment in the ER?

Answer 38

SUICIDALITY

Question 39

There are 3 primary components of “meaningful use” of electronic medical records (EMR). These include certified EMR in a meaningful manner, use of certified EMR technology to submit clinical quality measures, and which of the following?

Answer 39

ELECTRONIC EXCHANGE OF HEALTH INFORMATION TO IMPROVE QUALITY OF CARE

Question 40

Q150. Intensive case management is a program with elements of the assertive community treatment model, assertive outreach model, and case management model with a caseload of up to 20 patients. When compared to usual care, research demonstrates which desirable effects of intensive case management?

Answer 40

REDUCED LENGTH OF HOSPITALIZATION