Download 1 - U-System

Lisa Marii Cookingham
Social & Behavioral Sciences
Practice Midterm Answers
1. B. Poor appetite, early morning awakening, and lack of interest in normal activities characterize patients
with major depression. In this depressed man, the dexamethasone suppression test is likely to be positive. A
positive result is seen when the synthetic glucocorticoid dexamethasone fails to suppress the secretion of
cortisol as it would in a normal patient. Also, depressed patients can experience a reduced response to a
challenge with thyrotropin-releasing hormone. Hypothyroidism often results in symptoms of depression;
hyperthyroidism is more commonly associated with symptoms of anxiety. Agranulocytosis is a blood
disorder seen in patients taking clozapine or carbamazepine.
2. C. A score of less than 20 on the Folstein Mini-Mental State Examination indicates significant cognitive
impairment, and this patient had a score of 18. This test does not measure IQ, reading ability, or whether the
patient is purposely trying to look more ill than he is (“faking bad”).
3. A. Positron emission tomography (PET) localizes physiologically active brain areas by measuring glucose
metabolism. Thus, this test can be used to determine which brain area is being used during a specific task,
such as calculating.
4. E. The auditory evoked electroencephalogram (EEG) can be used to assess whether a 5-month old child can
hear. Evoked EEGs measure electrical activity in the cortex in response to sensory stimulation. The EEG,
which measures electrical activity in the cortex, is useful in diagnosing epilepsy and in differentiating
delirium from dementia.
5. F. Intravenous administration of sodium lactate can help identify individuals with panic disorder because it
can provoke a panic attack in such patients. The sodium amobarbital (Amytal) interview is used to determine
whether psychological factors are responsible for physical symptoms and computed tomography (CT)
identifies anatomical brain changes.
6. B. The mental age of a 12-year old child with an IQ of 25 is 3 years. The MA is calculated using the
formula: IQ = MA/CA x 100; that is, 25 = MA/12 x 100; x = 3. Thus, this child may be severely mentally
retarded.
7. B. The Beck Depression Inventory is an objective test that can be used by primary care physicians. Primary
care physicians probably cannot administer and interpret the results of projective personality tests, such as the
Thematic Apperception Test (TAT) and Rorschach Test. Intelligence, including general information and
reading comprehension, can be tested using the Wechsler Adult Intelligence Scale – Revised (WAIS-R). The
Folstein Mini-Mental State Examination is used to evaluate a person’s current state of mental functioning.
8. E. This severely depressed woman is showing anhedonia (the inability to feel pleasure) and suicidality. Both
are characteristics of severe depression. Despite her placement in a nursing home, she should be able to enjoy
some aspects of her life. Antidepressant medication and counseling can help this woman to enjoy the
remainder of her life. Euphoric mood is an elated mood and euthymic mood is a normal mood with no
significant depression or elevation. Dysphoric mood is a subjectively unpleasant feeling. Labile moods
(mood swings) are alterations between euphoric and dysthymic moods.
9. B. The Vineland Social Maturity Scale is the most appropriate test for evaluating the self-care skills of
mentally retarded individuals like this man.
10. D. Feelings of guilt that he has caused his illness are more characteristic of depression than sadness about
being very ill. The other symptoms that the patient shows (e.g. weight loss, decreased energy, and sleep
problems) are characteristic symptoms of advanced cancer itself. Fear of dying is normal in patients with
serious illnesses.
Lisa Marii Cookingham
Social & Behavioral Sciences
Practice Midterm Answers
11. B. When compared with a man’s risk, the risk that an American woman will develop MDD over the course
of her lifetime is higher and the risk that she will develop bipolar disorder is equal.
12. A. In this depressed patient, the antidepressant fluoxetine has precipitated a manic episode (e.g. greatly
increased activity level, flight of ideas, and pressured speech). This reaction indicates that the patient has
bipolar disorder rather than major depressive disorder. There is no evidence of increased depression,
increased anxiety, or a delayed or toxic effect in this patient.
13. D. This patient’s physical complaints were relieved and weight loss reversed by antidepressant medication.
This indicates that these symptoms were manifestations of hidden or masked depression. Bipolar disorder
involves episodes of mania and depression. Cyclothymic disorder involves episodes of hypomania and
dysthymia occurring over a 2-year period with no discrete episodes of illness. In hypochondriasis, patients
believe that normal body functions or minor illnesses are serious or life threatening. There is no evidence in
this patient of bipolar disorder, dysthymic disorder, cyclothymic disorder, or malingering (i.e. fabricating
symptoms for gain).
14. E. While not used diagnostically, analysis of neurotransmitter availability in this depressed patient is most
likely to reveal decreased serotonin, commonly reflected in decreased plasma levels of its major metabolite 5HIAA. Increased dopamine is associated with schizophrenia, and decreased acetylcholine is associated with
Alzheimer’s disease.
15. B. Because she poses an immediate threat to her own life, the patient can be held involuntarily for 24 to 48
hours (depending on state law) until a court hearing can be conducted. At the hearing it will be determined
whether the patient will be held for a longer period (i.e. “committed” for her own protection). Simply
removing access to the gun will not prevent suicide in this patient. She will simply find another means of
accomplishing this goal. Outpatient counseling alone is not appropriate for this suicidal patient.
16. A. This woman’s highest risk factor for suicide is alcohol abuse. Her sex, age, marital status, and religion
are not risk factors for suicide.
17. E. Professionals are at higher suicide risk than nonprofessionals; among the professions listed, physicians
are at highest risk.
18. C. The method of suicide most likely to fail is slashing her wrists. Shooting, crashing a car, jumping from a
high place, and hanging are more lethal methods of committing suicide.
19. A. Statements like “maybe my time is up” may or may not indicate suicidal intent. However, when made to
a physician by a physically ill patient, a statement like this must me taken seriously. “Please tell me what you
mean by that” can help clarify the patient’s intent. The statements “it’s not so bad” and “don’t worry” are
patronizing and do not address the issue of suicidality. Specific questions like “how long have you felt
suicidal” and “have you ever tried to kill yourself” can be asked if the doctor determines that the patient’s
statement indicated suicidal intent.
20. B. During the anger stage of dying, the patient is likely to blame the physician.
21. C. This student is showing the symptoms of panic disorder. This condition is characterized by panic attacks,
which consist of increased heart rate, dizziness, sweating, shortness of breath, fainting, and the conviction that
one is about to die. Attacks commonly occur twice weekly and last about 30 minutes and are most common
in young women. The most effective immediate treatment for this patient is a benzodiazepine because it
works quickly.
Lisa Marii Cookingham
Social & Behavioral Sciences
Practice Midterm Answers
22. A. The most effective long-term (maintenance) treatment for this patient is an antidepressant, particularly a
selective serotonin-reuptake inhibitor (SSRI) such as paroxetine (Paxil).
23. B. This student’s symptoms suggest obsessive-compulsive disorder (OCD). Recurrent, unwanted thoughts
like killing a patient are typical obsessions of OCD. The finger snapping is a compulsion that relieves his
anxiety. The most effective long-term treatment for OCD is an antidepressant, particularly a selective
serotonin reuptake inhibitor (SSRI), such as fluvoxamine.
24. E. Robbery, a life-threatening event, is most likely to result in PTSD. Although life events such as divorce,
bankruptcy, illness, and changing residence are stressful, they are rarely life threatening. Psychological
symptoms occurring after events such as these are more likely to be evidence of adjustment disorder, not
PTSD or acute stress disorder.
25. D. This student’s symptoms of anxiety in a public situation (such as using public restrooms) but not in other
situations suggest social phobia (social anxiety disorder). This phobia has limited the patient’s ability to
socialize freely. Of the listed agents, venlafaxine (Effexor) is FDA approved to treat social phobia.
Heterocyclic antidepressants such as imipramine and clomipramine, benzodiazepines such as
chlordiazepoxide, and clonazepam may be helpful. However, they are less likely to be used for the long-term
treatment of this disorder.
26. B. This woman is showing evidence of pseudodementia, depression that mimics dementia. Although
common in the elderly, depression is an illness, not a natural consequence of aging. In the elderly, depression
is often associated with cognitive problems as well as sleep and eating problems. Evidence of depression is
provided by the fact that this patient’s symptoms began with the loss of an important relationship (i.e., the
death of her pet). Delirium and dementia are caused by physiological abnormalities. Dissociative fugue
involves wandering from home, and amnestic disorder is usually associated with a history of alcoholism.
Depersonalization disorder is associated with feelings of detachment from the social situation.
27. C. The most effective intervention for this depressed patient is antidepressant medication. When the
medication relieves the depressive symptoms, her memory will improve. Antipsychotic medication,
provision of a structured environment, tacrine, and simple reassurance are not appropriate for this depressed
patient.
28. D. This patient with mild mental retardation and unusual facial features has Down’s syndrome. If they live
to middle age, Down’s syndrome patients commonly develop Alzheimer’s disease. Chromosome 21 is
associated with both Down’s syndrome and Alzheimer’s disease.
29. A. This clinical presentation, including sudden onset of impaired consciousness and illusions (believing the
doctor is her nephew) in the presence of serious illness is suggestive of delirium.
30. F. This clinical picture of feelings of being in a dream or performance that worsens during stress is most
suggestive of depersonalization disorder. Typically, the patient with this disorder has insight and knows these
perceptions are not real.
31. C. Of the choices, the most important factor in determining whether this patient will live with an adult child
or enter a nursing home is the level of her dementia. As she becomes more debilitated, she increases the
danger of self-injury, making nursing home placement more likely. The sex of the adult child, responsibilities
of the adult child outside the home, the age of the grandchildren in the home, and the proximity of the nursing
home are all less important than the patient’s cognitive condition.
Lisa Marii Cookingham
Social & Behavioral Sciences
Practice Midterm Answers
32. A. This clinical presentation is an example of factitious disorder. In contrast to patients with somatoform
disorders such as conversion, somatization, and hypochondriasis who really believe that they are ill, patients
with factitious disorder are conscious of the fact that they are faking their illness. Abdominal pain is one of
the most commonly feigned symptoms, and this patient’s nighttime reading is providing her with specific
knowledge of how to fake the illness realistically. Like this patient, factitious disorder patients commonly
have an interest in or have worked in the medical field.
33. C. Although she is consciously producing her abdominal symptoms, she is not receiving tangible benefit for
her behavior. Thus, in contrast to individuals who are consciously faking illness for obvious gain (i.e.,
malingering), the motivation for this patient’s faking behavior is primarily unconscious.
34. E. The sweating and agitation that this woman shows are symptoms of opiate withdrawal. She is feigning
pain symptoms to obtain opiates (obvious gain for this addicted woman), and thus is malingering. In
conversion disorder, somatization disorder, factitious disorder, and factitious disorder by proxy, there is no
obvious gain related to physical or mental symptoms.
35. F. This student, who continues to believe that he is ill despite reassurance from medical personnel, is
demonstrating hypochondriasis – exaggerated concern over normal physical sensations (e.g., a tight feeling in
the abdomen after eating) and minor ailments which affect his ability to function socially and at school.
36. E. This presentation is an example of malingering – feigning illness (mental illness in this case) for obvious
gain. The obvious gain here is avoiding a prison sentence for robbery.
37. D. Antidepressants, analgesics, and counseling all may be beneficial to this patient with unexplained
physical symptoms. Therefore, the primary care doctor’s most effective recommendation is to establish a
multidisciplinary approach to her treatment, including mental health and medical professionals. Explaining
that her symptoms are not real will not help, and terminating treatment is not appropriate, even though this
patient’s symptoms are probably not caused by physical illness.
38. A. This woman who has always felt empty and alone (not merely loneliness) but shows no evidence of a
thought disorder shows a borderline personality type. Self-injurious behavior and suicide attempts are also
characteristic of this personality type.
39. C. This man is showing evidence of kleptomania, the impulse to take things without paying for them. He
can easily afford the CD player, so it is unlikely that he is seeking attention or faking kleptomania to avoid
prosecution for stealing. The persistent nature of this behavior and absence of other psychiatric symptoms
indicate that the singer has kleptomania rather than a dissociative disorder or antisocial personality disorder.
40. A. This patient is describing an illusion, a misperception of a real external stimulus (the desk as a man).
Both normal and psychotic people experience illusions. A neologism is an invented new word; a
hallucination is a false perception; and an idea of reference is the false belief of being referred to by others.
Tangentiality involves verbally getting further and further from the point one is making as speech continues.
The latter four symptoms are characteristically seen in psychotic patients.
41. E. An idea of reference is the false belief of being referred to by others (e.g., another patient is talking about
this woman).
42. E. This patient demonstrates symptoms of delusional disorder. In the persecutory type of the disorder, there
is a fixed, nonbizarre delusional system (paranoid in this subtype); few if any other thought disorders; and
relatively normal occupational and social functioning (e.g., this patient is employed and has been married for
25 years). In schizophrenia, psychotic and residual symptoms last at least 6 months, and there is lifelong
Lisa Marii Cookingham
Social & Behavioral Sciences
Practice Midterm Answers
social and occupational impairment. Schizoaffective disorder is characterized by symptoms of a mood
disorder, psychotic symptoms, and lifelong social and occupational impairment. Schizophreniform disorder
is characterized by psychotic and residual symptoms lasting 1 to 6 months. In share delusional disorder, a
person develops the same delusion as a person with delusional disorder with whom they are in a close
relationship.
43. B. This patient has the symptoms of schizoaffective disorder with characteristics of both a mood disorder
and schizophrenia.
44. G. Because of the abnormal physical findings, the most probably diagnosis for this patient is psychosis
caused by a general medical condition. The age of the patient and her family history strongly suggest
Huntington’s chorea, which can present with psychiatric symptoms such as psychosis and depression.
45. E. This type of therapy is best described as group therapy, a treatment technique in which people with a
common problem (e.g., gamblers) meet with a psychotherapist. In supportive therapy, a therapist helps a
person feel protected and supported during a specific life crisis, such as a job loss. Implosion is a behavioral
therapy technique in which a person is exposed to an imagined overwhelming dose of a feared stimulus or
situation. Brief dynamic psychotherapy is a form of psychoanalytically oriented therapy in which a person
works with a therapist to gain insight into the cause of his problems. In systematic desensitization, increasing
doses of the frightening stimulus are paired with a relaxing stimulus to provoke a relaxation response in
situations involving the frightening stimulus.
46. D. The treatment technique described here is biofeedback, a technique based primarily on operant
conditioning. Reciprocal inhibition is the mechanism that prevents one from feeling two opposing emotions
at the same time (e.g., relaxation and fear) and is associated with systematic desensitization. In aversive
conditioning, classical conditioning is used to pair a maladaptive but pleasurable stimulus with an aversive or
painful stimulus so that the two become associated and the person stops engaging in the maladaptive
behavior.
47. C. The treatment technique described here is aversive conditioning, in which a maladaptive but pleasurable
stimulus is paired with a painful stimulus so that the two become associated. The man then associates sexual
interest in children with pain and stops this maladaptive behavior. In flooding, a treatment technique used
primarily to treat phobias, a person is exposed to an overwhelming dose of the feared stimulus or situation. In
implosion, a person is exposed to an imagined, rather than actual, overwhelming dose of a feared stimulus or
situation. In systematic desensitization, increasing doses of the frightening stimulus are paired with a relaxing
stimulus to provoke a relaxation response in situations involving the frightening stimulus. In cognitivebehavioral therapy, a person is helped to identify distorted, negative thoughts and to replace them with
positive, self-assuring thoughts. In token economy, a person’s desired behavior is reinforced by a reward or
positive reinforcement; the person then increases the desired behavior to get the reward.
48. G. The treatment technique described here is most closely related to cognitive-behavioral therapy. In this
short-term behavioral treatment technique, the patient is instructed to replace each negative thought with a
positive mental image. Here, the patient is helped to identify her expectation of failure as an automatic
thought that, when it surfaces, is replaced with a mental image of success and praise.
49. D. This family therapist is using the technique known as mutual accommodation. This technique encourages
family members to try to meet the needs of other family members. A triangle is an abnormal relationship
between family members that crosses boundaries; normalizing boundaries between subsystems is another
technique used in family therapy. In redefining blame, family members review their own responsibility for
another member’s (the boy in this case) behavioral problems.
Lisa Marii Cookingham
Social & Behavioral Sciences
Practice Midterm Answers
50. E. Although not diagnostic, increased body fluid concentrations of homovanillic acid (HVA), a major
metabolite of dopamine, are more likely to be seen in unmedicated schizophrenic patients. Decreased HVA is
more likely to be seen in Parkinson’s disease, depression, and in medicated schizophrenic patients. Increased
vanillylmandelic acid (VMA), a metabolite of norepinephrine, is characteristic of pheochromocytoma.
Decreased body fluid concentrations of 5-HIAA, a metabolite of serotonin, are more likely to be seen in
depression.
51. A. Although neuroimagining cannot be used to diagnose psychiatric illness, the brains of schizophrenics
show increased size of cerebral ventricles; decreased size of the hippocampus and limbic structures such as
the amygdala; and decreased glucose usage in the frontal lobes.
52. F. Of the listed brain areas, depression is most likely to be associated with damage to the left frontal lobe.
53. D. Decreased body fluid concentrations of 5-HIAA, a metabolite of serotonin, as well as decreased HVA and
MHPG, metabolites of dopamine and norepinephrine, respectively, are seen in depression.
54. D. Sedation, increased appetite, and weight gain are side effects of treatment with certain antipsychotic
agents. The mechanism most closely associated with these side effects is blockade of histamine receptors.
Blockade of dopamine receptors by these antipsychotic medications is associated with side effects such as
parkinsonism-like symptoms and elevated prolactin levels.
55. C. This patient probably has dementia of the Alzheimer type. Of the listed brain areas, the ones most closely
implicated in this disorder are the hippocampus and nucleus basalis of Meynert.
56. C. The lifetime prevalence of bipolar disorder is about equal in men and women. Major depressive disorder
(a unipolar disorder) occurs two times more often in women than men. Among bipolar monozygotic twins
the concordance rate is 65-85%; for dizygotic twins it is 19-20%. For unipolars the figures are 55% and 20%,
respectively.
57. E. Alcoholism is seen among relatives of patients with antisocial personality disorders.
58. C. Parkinson’s disease is associated with damage to the basal ganglia.
59. C. The major area of the brain implicated in Alzheimer’s disease and amnestic disorders is the hippocampus.
60. B. ECT involves induction of a seizure. It is most commonly indicated in the treatment of major depression.
61. E. Cardiac conduction abnormalities, gastric distress, and tremor are common adverse effects of lithium
treatment. Food allergy is not an adverse effect of lithium use.
62. C. Dopamine is the major neurotransmitter believed to be involved in the development of schizophrenia.
63. D. Prodromal signs of schizophrenia include somatic complaints such as headache, anxiety, abnormal affect,
and strange behavior and perceptual experiences.
64. B. Auditory hallucinations are the most common type of hallucination seen in schizophrenia.
65. B. Disorders of content of thought include delusions. Disorders of thought processes in schizophrenia
include flight of ideas, thought blocking, short attention span, and clang associations.
Lisa Marii Cookingham
Social & Behavioral Sciences
Practice Midterm Answers
66. A. Flattening of affect, deficiencies in speech content, thought blocking, and social withdrawal are negative
symptoms of schizophrenia; hallucinations are positive symptoms.
67. B. Hallucinations, talkativeness, loose associations, and strange behavior are positive symptoms of
schizophrenia. Cognitive deficits are negative symptoms of schizophrenia.
68. B. Bipolar is more common in higher (not lower) socioeconomic groups.
69. B. In depression, the mood has a different quality than that of sadness. Although biologic factors are
involved, stressful life events are also related to clinical depression.
70. A. In major depressive disorder, orientation with respect to persons, place, and time is usually normal.
Although severely depressed patients may not have enough energy to commit suicide, as the depression lifts
the risk of suicide increases. Psychomotor retardation is seen in depressed elderly patients.
71. C. Tingling in the extremities is a physical manifestation of anxiety.
72. A. Symptoms of panic attacks include dizziness, sweating, and fainting, which commonly occur twice
weekly and last about 30 minutes. Panic attacks are most common in young women and are effectively
treated with antidepressant medication.
73. B. Obsessive-compulsive disorder is characterized by recurrent feelings and repetitive actions.
74. A. Flashbacks that occur after a very stressful life event indicate post-traumatic stress disorder.
75. C. Repetitive actions or compulsions such as checking locks indicate that this patient is suffering from
obsessive-compulsive disorder.
76. B. Chronic feelings of anxiety with no specific cause indicate generalized anxiety disorder.
77. E. Alzheimer’s disease is a common cause of dementia. Brain trauma, encephalitis, meningitis, and epilepsy
are common causes of delirium.
78. C. Pseudodementia includes cognitive problems such as memory loss, occurs in elderly patients, and may
mimic dementia. It is characterized by depression and is treatable.
79. C. Conversion disorder involves changes in body functions including loss of motor or sensory function with
no medical cause.
80. E. A lifelong pattern of social withdrawal is seen in schizoid personality disorder.
81. D. Peculiar appearance, thinking, and behavior are seen in schizotypal personality disorder.
82. C. Individuals with paranoid personality disorders show suspiciousness and mistrust.
83. B. The avoidant personality is sensitive to rejection, socially withdrawn, shy and may have an inferiority
complex.
84. A. The inability to conform to social norms, as well as criminality, is seen in individuals with antisocial
personality disorder.
Lisa Marii Cookingham
Social & Behavioral Sciences
Practice Midterm Answers
85. D. Sodium lactate administration can help identify individuals with panic disorder.
86. C. The DST has been used in the diagnosis of depression, is abnormal in about half of depressed patients,
and may be abnormal in patients with other psychiatric and medical conditions.
87. G. In depersonalization disorder, the patient feels detached from her social situation.
88. D. In malingering, the patient pretends that she is ill in order to gain financially.
89. C. In factitious disorder, the patient simulates illness for attention. The gain to this patient is not as obvious
as it is in the malingering patient.
90. C. In persons with antisocial personality disorder, the electroencephalogram is often abnormal because there
is a high incidence of early head injury in these individuals.
91. E. Patients with schizoid personality disorder show lifelong social withdrawal and little interest in others.
92. G. Because this patient is oversensitive to rejection, she has become socially withdrawn. In contrast to the
schizoid patient, this patient with an avoidant personality disorder is interested in meeting people but is
unable to do so because of her shyness, inferiority complex, and timidity.
93. A. Individuals with passive-aggressive personality disorders appear to be agreeable to changes in their
behavior, but frequently have an underlying anger at the physician and do not comply with advice given.
94. B. A hyperdopaminergic state may be involved in the etiology of schizophrenia.
95. A. Reduced availability of serotonin may be involved in the pathophysiology of affective disorders.
96. D. Decreased GABA activity is thought to be involved in the patholophysiology of anxiety.
97. C. Degeneration of cholinergic neurons is involved in Alzheimer’s disease.