Question Bank for PMHNP Boards

Question Bank for PMHNP Boards What is true of interprofessionality? - ANS All health professionals have individual professional competencies What is the significance of an experimental p-value of 0.05 - ANS There is a 5% chance of a similar result occurring by chance alone What percentage of children with oppositional defiance disorder will develop conduct disorder? - ANS 30% In the DSM-5, selective mutism is now considered what type of disorder? - ANS anxiety disorder Symptoms of selective mutism must persist for at least - ANS 1 month Common competencies - ANS overlap more than one health care professional, although not necessarily all health care professionals, and are competencies expected of all health care professionals Complementary competencies - ANS enhance the qualities of other professions in provision of care Collaborative competencies - ANS those that each individual profession must possess to work with others, including those who practice within different specialties within a profession. Interpersonal collaboration is _______ centered - ANS patient Cognitive therapy is recommended for patients that have - ANS negative cognitive distortions irrational beliefs faulty conceptions Humanistic Therapy focuses on assisting patients with - ANS self-actualization and self-directed growth Behavioral Therapy focuses on - ANS changing maladaptive behaviors through the use of behavioral modification techniques Existential therapy is for - ANS reflection on life confronting self 120 who got diarrhea ate lettuce. 80 with diarrhea did not eat lettuce. 40 without diarrhea ate lettuce. 160 without diarrhea ate lettuce. What is the odds ratio of eating lettuce and developing diarrhea? - ANS 6 ((120X160)/(80x40)) The New Freedom Commission on Mental Health (NFCMH) released a report that suggested - ANS implementation a national campaign to reduce the stigma of seeking care Focusing on promoting recovery and building resilience The efficacy of mental health treatments was found to be well documented in - ANS influential report issued by US Surgeon General in 1999 State of high negative emotion and pessimism - ANS neuroticism Commonly known as an optimistic outlook on life They are are outgoing, like social interaction, respond to external rewards, have more active dopamine networks, and are responsive to positive reinforcement. - ANS Extraversion (high levels protect from psychiatric illness) Introverts are more likely to be _______ motivated and more likely to respond to _______ reinforcement - ANS internally negative (more likely to interact with internal motivation/self-image) Interpersonal trait of cooperation, easy going nature. Tend to have smooth relationships often at the expense of self-assertion - ANS Agreeableness Associated with self-control and a focused, organized approach to life. Are achievement-oriented goal setters who can delay immediate gratification to obtain their long term desired outcome. They are considered responsible, reliable, and dependable. - ANS conscientiousness In behavioral couples therapy, the initial sessions are spent doing a functional analysis of behavior (FAB). What is true about FAB? - ANS FAB is concerned only with observable stimuli connected to operant behavior FAB is based on operant conditioning (identifying antecedent stimuli, operant behaviors, and consequent stimuli) The goal of FAB is modifying willful operant behavior Gestalt theory deals with _____, not _____ - ANS perceptual psychology behavior Medication that can delay ejaculation in patients with premature ejaculation - ANS Paroxetine (and other SSRIs) (others include: Topical anesthetic Tramadol Phosphodiesterase-5 inhibitors) First line treatment for lithium induced diabetes insipidus - ANS Amiloride (K potassium diuretic) in addition to dc lithium when possible. Ways to reduce polyuria associated with lithium toxicity - ANS reduce lithium dose to minimum effective dose take once daily at night (may be 5-30% lower than when given in divided doses over the day) Encourage adequate fluid intake What is true about ECT in Parkinson's disease - ANS it's more likely to cause transient delirium (worsened dyskinesias induced by l-dopa) Lithium effects with Parkison's disease - ANS may worsen tremor nonselective MAOIs decrease the efficacy of ______ and increase the risk of a __________ - ANS l-dopa products hypertensive crisis Selegiline is selective for - ANS MAO-B (after 10mg there is an increase in risk of serotonin syndrome if given with other meds that increase serotonin) SSRI's can _______ Parkinsonism tremor - ANS worsen (and decrease 'off time') Process describes the mechanism by which the hippocampus stores memories - ANS long-term potentiation loss of memory relating to a particular category of information (inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting) - ANS systematized amnesia Lack of memories from a circumscribed period of time, usually immediately following a traumatic event - ANS localized amnesia Person can recall some but not all of events from a particular time period - ANS selective amnesia Lack of memory of the patient's entire life - ANS generalized amnesia The drugs that are FDA approved for GAD - ANS Paroxetine Citalopram Escitalopram Venlafaxine Duloxetine Buspar A surrogate has the right to terminate pregnancy if - ANS the pregnancy threatens her health or life or she is a genetic parent If the surrogate receives both ovum and sperm from couple, she loses the right to - ANS determine whether or not child will be aborted (this is up to the couple) Which medication is most effective for treating social phobia/social anxiety disorder, especially when refractory? - ANS Phenelzine A 55-year-old female patient has Stg II HTN. On exam, she has trace pedal edema bilaterally, but her lungs are clear. Her ECG reveals 2nd degree heart block. Which of the following BP medications should be avoided? - ANS Calcium Channel Blockers 3 Contraindications to use a calcium channel blocker - ANS 1st or second degree heart block Bradycardia CHF 4 Side effects of calcium channel blockers - ANS Headache Lower extremity edema Bradycardia Heart Block An NP is evaluating a 78 year old female with depression. She suspects the patient may have Parkinson's disease. Which of the following is consistent with that diagnosis? - ANS Postural instability Pill-rolling tremor Shuffling Gait Difficulty initiating movement Mask-like facies (difficulty initiating movement) Writhing movements occur with - ANS Huntington's chorea 10 Non-motor manifestations of Parkinsons - ANS Autonomic dysfunction Gastrointestical dysfunction Rhinorrhea Sleep disturbance Fatigue Mood disorder Cognitive dysfunction Dementia Psychosis Hallucinations What type of therapy is most useful in depressed HIV positive outpatients? - ANS Interpersonal psychotherapy What type of therapy is most useful in patients with borderline personality disorder? - ANS Dialectical behavioral therapy The NP is caring for a patient dying of lymphoma. The pt's wife states that the pt has been mismanaged and that another practitioner must be assigned to the patient for him to improve. This NP suspects that this individual is in which stage of grief according to Elizabeth Kugler-Ross? - ANS Bargaining Involves resisting or refusing to remember information that has been supplied - ANS Denial Pica and spoon shaped nails are associated with - ANS Iron-deficiency anemia (microcytic) 2 common causes of microcytic anemia - ANS iron deficiency anemia of inflammation/chronic disease (TB, HIV, endocarditis, RA, Chrohn's DM, kidney disease, CA) (Other causes: lead toxicity, alcohol/drug use, zinc excess (copper deficiency)) Initial symptoms of B12 deficiency - ANS Generalized weakness Paresthesias Possible ataxia Late symptoms of B12 deficiency - ANS Memory impairment Depressed mood 5 P's of Vitamin B12 deficiency - ANS Pancytopenia (Peripheral and Posterior spinal cord) neuropathy Pyramidal tract signs Papillary atrophy of tongue (atrophic glossitis) 2 causes of megaloblastic macrocytic anemias - ANS Vitamin B12 deficiency Folate deficiency What neurotransmitter is thought to play the most significant role in social phobia? - ANS dopamine What neurotransmitter is thought to mediate social interest, gregariousness, confidence and sensitivity to rejection? - ANS dopamine According to Gonzalez-Jaimes and Turnbull-Plaza (2003, which type of therapy with psychocorporal, cognitive, and neurolinguistic components and a holistic focus is significantly more effective in patients diagnosed with adjustment disorder? - ANS mirror psychotherapy The ________ is part of the treatment to encourage a patient to accept his physical condition - ANS mirror Discussing medical diagnoses and the reaction to it, as well as treatment modalities - ANS medical conversation Therapy that emphasizes personal responsibility, focusing on the individual's experience at the present moment, the therapist-patient relationship, the context of the person's life, and adjustments people make as a result of their overall situation - ANS Gestalt Therapy PANDAs is associated with _________ infections and results in _______ symptoms - ANS Group A beta-hemolytic strep OCD After camping trip, pt began to have a petechial rash on her legs/trunk, parts of which are turning dark red and purple, temp 102.8, HR 1115, BP 88/50, mm pain, neck stiffness, severe HA. What is the dx? - ANS meningococcemia 1 mg of Xanax = _____ mg of Ativan - ANS 2 1mg of Xanax = ____mg of phenobarbital - ANS 30 1mg Xanax = ____ mg of Clonazepam (Klonopin) - ANS 1 1mg Xanax = ____ mg of chlordiazepoxide (Librium) - ANS 25 1mg of Xanax = ____ mg of diazepam (Valium) - ANS 10 Pt wanting something immediate and non-addictive for breakthrough anxiety - ANS Hydroxyzine How long do GAD symptoms need to occur to make the diagnosis? - ANS 6 months First lab test to check for Sjogren's - ANS Anti-nuclear antibody tests To diagnose Cyclothymic disorder, it must be present for _______ in adults - ANS 2 years To diagnose Cyclothymic disorder, it must be present for _______ in pediatrics - ANS 1 year 4 physiological disturbances that may explain some of the symptoms of panic - ANS impaired lactate metabolism abnormality of locus coeruleus (Ser, NE, GABA, Dop, cholecystokinin) carbon dioxide hypersensitivity (hyperventilation) A 45-year-old man presents to the ER for "panic attack". He appears agitated, confused, and dizzy. He became more agitated and combative with staff upon further questioning. He states he was prescribed Xanax 0.5mg 3x daily by outpatient psychiatrist. His vitals are WNL. What is most likely his dx - ANS Benzodiazepine intoxication Anxiety, tremors, nightmares, insomnia, anorexia, nausea, vomiting, hypotension, seizures, delirium and hyperprexia are sx of. ______ which can result in _______ - ANS Benzodiazepine withdrawal (serious medical complications including death) Confusion, AH, VH following a period of insomnia can be a sx of - ANS withdrawal delirium Female patients with PTSD commonly have this comorbid diagnoses - ANS Major depressive disorder (50%) Percentage of people with PTSD who have alcohol use disorder - ANS male 50% female 27% Percentage of people with PTSD who have simple or social phobias - ANS 30% both male and female Percentage of people with PTSD who have persistent depressive disorder ( previously dysthymia) - ANS 20% for both male and female Treatment plan for OCD - ANS SSRI or Clomipramine Psychotherapy Normal Rinne test is for this nerve - ANS CN VIII What ethnic groups are at higher risk for social phobia - ANS Native American What ethnic groups are at lower risk for social phobia - ANS Asian Black Latino Onset of social phobia is - ANS Usually begins in late adolescence or early adulthood (13-20 years) 3 CBT techniques for social phobias - ANS exposure cognitive restructuring social skills training Medication used to help with social phobia for public speaking - ANS propranolol FDA approved SSRI for social phobia - ANS paroxetine What type of fracture is a red flag for child abuse? - ANS Spiral of long bone (caused by twisting of extremity) Bruises on the torso in different stages of healing often indicate - ANS abuse Tanner Stage: Breast buds undeveloped with papilla elevation only. Villus hair only - ANS I Tanner Stage: Breast buds palpable, straight pubic hair mostly on labia - ANS II Tanner Stage: Areola begins to enlarge and pubic hair becomes darker, coarser, and curly - ANS III Tanner Stage: Areola forms a secondary mound on the breast and hair is of adult quality - ANS IV Tenderness at McBurney's point is suggestive of - ANS appendicitis About 30% of patients with this disorder have OCD thoughts - ANS Tourette's disorder Rx that can cause anxiety - ANS Steroids (prednisone) Albuterol Amphetamines Appetite suppressants Medical conditions that can cause anxiety - ANS Adrenal tumors Alcohol use disorder Hypoglycemia Hyperthyroidism Cushing's disease Arrhythmias Parathyroid Tumors Some types of seizures Depression screening tool used specifically for pregnancy and postpartum - ANS Edinburg Depression Scale How long do symptoms have to be present to diagnose PTSD - ANS 1 month Lab value that would indicate that parathyroid was removed during thyroidectomy - ANS Low Calcium For PCOS, which medication will help with hirsutism? - ANS Spironolactone Lab that is an indicator of inflammation - ANS C-reactive protein Pain medication that inhibitis serotonin and NE reuptake (risk of serotonin syndrome if also on antidepressants) - ANS Tramadol an over-the-counter nonnarcotic drug found in cough preparations which inhibits serotonin reuptake and could cause serotonin syndrome in patients on SSRI's - ANS Dextromethorphan (Delsym) Pre-cursor for Serotonin production - ANS L-tryptophan In panic disorder, 1 of the attacks is followed by at least ______ of persistent worry about having additional attacks, worry about implications of attacks or its consequences, or significant change in behavior related to attacks. - ANS 1 month The origins of panic disorder include - ANS childhood trauma With delayed onset of PTSD, how much time must have past from trauma to onset of symptoms - ANS 6 months First line medication for polymyalgia rheumatica - ANS oral prednisone Acute stress disorder is diagnosed if the characteristic symptoms present within what period of time after experiencing the traumatic event? - ANS 1 month In what Tanner's stage will a male's penis grow more in length than width - ANS III In what Tanner's stage will a male's scrotum begins to grow and redden. Where pubic hair will be straight, fine and sparse - ANS II In what Tanner's stage will a male's pubic hair look more like an adult, but will not cover as much area. Where penis will thicken, testes and scrotum continue to grow. - ANS IV Brain structure R/T development of GAD - ANS Amygdala What circumstance(s) are often correlated to the onset of panic disorder - ANS separation from family serious illness of friend/family accident major relationship loss/change abusing substances postpartum Lifetime prevalence of anxiety disorders in the US - ANS 25-35% (18% prevalence) Buspar needs ______ to have similar efficacy to benzodiazepines - ANS 4 weeks How many panic symptoms must be present for diagnoses. - ANS 4 Part of Brain responsible for smell - ANS Limbic Part of brain (lobe) responsible for visual functions - ANS Occipital Part of brain (lobe) responsible for sensory integration and somatosensory function - ANS Parietal Part of brain (lobe) responsible for executive function, social conduct, judgement, and some motor function - ANS Frontal Occasional crossing of eyes is not normal after the infant is older than ___________ - ANS 2 months If strabismus is left untreated, what may result? - ANS ambylopia (affected eye decrease in vision) What would be the normal testosterone level of a Tanner V male - ANS 265-800 ng/dl Bactrim is contraindicated in - ANS Glucose-6-phosphatase deficiency Folate deficiency anemia patients with significant hepatic impairment pregnant patiens Pt has severe headache behind right eye with eye pain and tearing, sees halos around light fixtures. C/o N/V. R pupil fixed more oval than round, mid-dilated and cloudy. What might be happening - ANS Acute angle closure glaucoma (Emergency) What STD is not reportable in all 50 states - ANS HPV Romberg test is a test of - ANS balance A child will recognize faces and smile appropriately at familiar faces by age ____ - ANS 3 A typical _____ can count up to 20 with minimal assistance of an older child or parent - ANS 4 year old A typical _____ can run/walk up and down the stairs - ANS 21 month old A typical _____ is beginning to acquire language skills - ANS 14 month old What herbal supplement is effective for a pt with an adjustment disorder with anxiety according to RCT - ANS Kava Kava What herbal supplement is effective for somatoform disorders according to RCT - ANS St. John's Wort Recurrent spontaneous episodic vertigo, hearing loss. Must have aural fullness or tinnitis on one size to make dx. - ANS Meniere's Disease ADPIE stands for - ANS Assessment Diagnosis Planning Implementation Evaluation If diagnosed with an adjustment disorder, which dx is most guarded: that of an adult or that of an adolescent? - ANS adolescent (more likely to develop major psychiatric illness) Gastrointestinal lithium toxicity symptoms can overlap with - ANS normal side effects (N/V) What is FDA approved for suicidality in schizophrenia - ANS Clozapine Clozapine can cause this CBC abnormality - ANS leukopenia (agranulocytosis) What is the dependent variable of a study examining the effects of a certain medication on hypertension? - ANS Blood pressure What is the independent variable of a study examining the effects of a certain medication on hypertension? - ANS Medication Effect of a variable that is not controlled - ANS Confounding effect Type of error that results in the way the experiment is conducted, often due to the expectations of the researcher - ANS Bias Pharmacological treatment of alcohol use disorder - ANS Start Naltrexone at 25mg PO daily (1-hour observation for rxn). Naltrexone maintenance dose is usually 50mg PO q day or 380mg IM q 4 weeks Naltrexone side effects - ANS Elevated LFTs Mild dysthymia GI upset Resembles GABA and is possibly an NMDA antagonist - ANS Acamprosate Aldehyde dehydrogenase inhibitor - ANS Disulfiram (Antabuse) Modest efficacy, may work better in combination with Naltrexone for alcohol use disorder - ANS Acamprosate No convincing efficacy found for use of this Alcohol Use Disorder pharmacological treatment - ANS Disulfiram (Antabuse) Most commonly reported side effect of ECT - ANS Retrograde amnesia Neurodevelopmental disorder of biological origin that manifests in learning difficulties and problems in acquiring academic skills markedly below age level and manifested in the early years for at least 6 months that is not attributed to intellectual disabilities, development disorders or neurological or motor disorders - ANS Specific Learning Disorder Specific Learning Disorders can be specified as impairment in - ANS Reading Written Expression Mathematics The MOST important component when developing evidence based guidelines - ANS An evidence review How does botox improve depression? - ANS Reducing frown lines when injected into glabellar region According to a study in the 1990s mothers of anorexic pts have an increased prevalence of this disorder - ANS Obsessive-compulsive disorder The AST:ALT ratio in patients with Alcoholic liver disease - ANS <0.8 >1.5 Liver biopsy reveals fibrosis, necrosis of liver cells, and nodule formation - ANS Liver cirrhosis Acute condition with nystagmus, ataxia, confusion, and opthalmoplegia - ANS Wernicke-Korsacoff syndrome Elevated bilirubin level is often found in - ANS Alcoholic hepatitis Which drug's mechanism of action includes blockage of the voltage dependent sodium channel blockers, augmentation of gamma amino butyrate activity of GABA-A receptors, antagonism of AMPA/kainate subtype of glutamate receptor, and inhibition of carbonic anydrase enzyme? - ANS Topiramate Ex of drugs that are partial agonists at postsynaptic serotonin receptors - ANS Hallucinogens like LSD and MDMA Drug associated with inhibition of catecholamine reuptake in neurons and blockage of NMDA glutamate receptors - ANS PCP Individuals with panic disorder are most commonly affected by which other psychiatric disorder - ANS Agoraphobia When is the use of transdermal selegiline not beneficial? - ANS For patients with pheochromocytoma (excess NE can cause HTN crisis) and with planned surgery (need to dc patch for 10 days prior to elective surgery) Responsible for the catabolism of serotonin, norepinephrine and dopamine - ANS Monoamine oxidase (MAO) Medication that is an irreversible MAO inhibitor that works by selectively inhibiting both MAO-A and MAO-B in the CNS with preservation of MAO-A in the gut. Unless high dosed, little need to follow tyramine restricted diet. - ANS Selegiline Adverse effect of carbamazepine that can be an emergency - ANS hyponatremia toxic epidermal necrolysis Erythema multiform Steven's Johnson Thrombocytopenia Aplastic Anemia Agranulocytosis SLE arrhythmias Hepatitis An NP advises a patient with a significant family hx of breast cancer to perform monthly self-examinations. What term helps to identify this measure? - ANS Secondary Prevention Prevention type designed for early detection of a disease so that morbidity and mortality may be reduced - ANS Secondary Prevention Preventing the disease or condition from occurring - ANS Primary Prevention WIC and promotion of workplace safety laws designated by OSHA are this type of prevention - ANS Primary Prevention Rehabilitation and prevention of complications of disease - ANS Tertiary prevention A support group for a disease or condition is this type of prevention - ANS Tertiary Prevention Exercise for an obese patient is this type of prevention - ANS Tertiary Antisocial personality disorder criteria must show a pattern of disregard of others since age ______ - ANS 15 How many criteria does a pt who meets criteria for an Antisocial personality disorder have to have - ANS 3 of 7 Name the 7 criteria that pts with Antisocial personality disorder have (must meet 3 of them) - ANS Breaking the law Deceitfulness for personal profit or pleasure Impulsivity/failure to plan ahead Aggressiveness/Irritability (physical fights/assaults) Reckless disregard for safety of self or others Consistent irresponsibility Lack of remorse How old does an individual need to be in order to be diagnosed with antisocial personality disorder? - ANS 18 years The occurrence of antisocial behavior is not exclusively during the course of - ANS schizophrenia bipolar disorder What is a precursor for antisocial personality disorder - ANS conduct disorder List of Cluster B personality disorders - ANS antisocial borderline histrionic narcissistic List the cluster A personality disorders - ANS paranoid schizoid schizotypal List of Cluster C personality disorders - ANS avoidant dependent obsessive-compulsive pervasive pattern of excessive emotionality and attention seeking beginning in early adulthood and present in a variety of contexts - ANS Histrionic Personality Disorder A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness must last at least _______ for Oppositional Defiant Disorder diagnosis - ANS 6 months Oppositional defiant disorder does not include: - ANS aggression toward people or animals destruction of property pattern of theft or deceit Recurrent behavioral outburst representing a failure to control aggressive impulses. - ANS Intermittent Explosive Disorder In Intermittent Explosive disorder, physical aggression does not result in - ANS damage or destruction to property physical injury to animals or other individuals Kubler-Ross's stages of grief - ANS denial anger bargaining depression/sadness acceptance Symptoms can be associated with another medical condition - ANS Somatic symptom disorder Somatic symptom disorder symptoms persist for - ANS >6 months Despite frequent doctors visits and tests, this pt is rarely reassured and can feel that his/her medical care is insufficient - ANS Somatic symptom disorder In order to meet DSM V criteria for somatic symptom disorder, in addition to somatic symptoms, pts must have - ANS maladaptive thoughts, feelings, and behaviors that define the disorder, in addition to their somatic symptoms. The Mental Health Party Act (1996) provides - ANS equal lifetime and annual limits for mental health care as compared to physical health care. The zoster vaccination is recommended for _____ - ANS adults over the age of 60 The pneumococcal vaccination is recommended for _______ - ANS adults over the age of 65 The Tdap vaccination is recommended _________ - ANS every 10 years Understanding the objective reality of a situation coupled with the motivation and emotional impetus to master the situation or change behavior is: - ANS true insight Form of thinking that is logical, organized, reality oriented, and influenced by the demands of the environment - ANS second process thinking What percentage of the population meets the criteria for 1 or more personality disorders? - ANS 15% Study on daily exercise improving sleep quality in seniors. What is the dependent variable - ANS Sleep quality The federal law that allows parents to provide insurance coverage for their children up to age 26 is - ANS Affordable Care Act (ACA) Pedophiles attracted to female victims usually prefer females of what age? - ANS 8-10 years old What is true of appropriation bills? - ANS They provide for spending authority for a single fiscal year What bills establish laws or programs and although they recommend dollar amounts in some cases, do not allocate the funds or guarantee funds for the program - ANS Authorization bills What bills usually originate in the House of Representatives and provide spending authority for a single fiscal year - ANS Appropriation Bills Provide additional funding for projects as needed thought the current fiscal years - ANS Supplemental appropriations Authorization bills are funded by - ANS Appropriation Bills What is required for entry to practice as a Nurse Practitioner - ANS Competency in nine content domains The NP is caring for a 16 year old who is depressed with suicidal ideation. The pt asked the nurse NOT to tell her parents. The most appropriate intervention for the nurse to do is: - ANS Talk to parents and pt together to help the family discuss the pt's depression According to Mahler, which of the following stages of infant development is disrupted in children who develop borderline personality disorder - ANS Rapproachment According to Mahler, which of the following stages of development was disrupted int children who developed narcissistic personality disorder - ANS Symbiotic phase Phase during first weeks of life, characterized by total detachment and self-absorption, infant spends most of his or her time sleeping - ANS Autistic stage When does the symbiotic phase occur - ANS about 5 months of age According to Mahler, separation-individuation has 3 stages - ANS Hatching (5-9 months) Practicing (9-16 months) Rapproachment (15-24 months) Phase where infant explores the outside world but requires that the mother is present and able to support the child appropriately and emotionally in completing the task? - ANS Rapprochment (15-24 months) Phase in which infant develops the physical ability to separate from mother - ANS Practicing (9-16 months) Disturbance of the rapprochement subphrase is associated with - ANS persistent longing for and dread of fusion with object that is thought to be secondary to aggression or withdrawal in the mother. Thought to contribute to the development of borderline personality disorder. Phase in which infant shows increased interest in outside world - ANS Hatching Stage where infant recognizes his or her mother but lacks a sense of individuality - ANS symbiotic Narcissistic personality disorders are likely due to - ANS inadequate soothing during the symbiotic phase and inadequate refueling during the separation-individuation Describes the child's understanding that his or her mother is a separate individual and he or she is also separate - ANS Object constancy Object constancy leads to the formation of - ANS internalization, which will allow the child to have an internal representation of mother in turn allowing healthy separation, exploration, and development of self-esteem The three most common causes of secondary obesity - ANS Cushing's syndrome Hypothyroidism Genetic conditions Compassion, a desire to do good - ANS beneficence Avoidance of harm - ANS Nonmaleficence the equal and fair distribution of resources, regardless of other factors - ANS Justice Dedication, fairness, honesty, advocacy and commitment to patients. It involves an agreement to keep promises and commitments based on the virtue of caring. - ANS Fidelity Most widely used tool for assessing the healthcare safety culture within an organization - ANS Culture of Patient Safety Assessment developed by AHRQ The Iowa Model of EBP (evidence-based practice) is characterized by which statement? - ANS It is important to determine if an identified issue is a priority of the organization The trigger for change can be - ANS Knowledge focused or Problem focused Identification of a problem and determination of its priority - ANS first step in Iowa Model Review and critique of available literature - ANS Second step in Iowa Model Identification of research evidence to support a change in clinical practice - ANS 3rd stage of Iowa Model Implementation of change - ANS 4th step of Iowa Model Monitoring of Outcomes - ANS 5th and final step of Iowa Model Knowledge-focused triggers include - ANS new research practice guidelines Problem-Focused Triggers include - ANS Clinical problems Issues in risk management The first step in getting a bill to the floor is? - ANS Drafting a bill Probability results of study are due to chance - ANS P value Medicare part A coverage includes - ANS 1. hospital care and medicines received in hospital 2. SNF 3. nursing home care 4. hospice 5. home health services Sampling used when the proportion of the study population belonging to each group of interest in known, to obtain an adequate study sample from a small group in the study population. - ANS Stratified sampling Selection of groups under study is random - ANS Cluster sampling Choosing individuals at regular intervals from a sampling frame by selecting a number to determine where to begin selecting individual subjects from a list. - ANS Systematic sampling Making a numbered list of all units in a population from which you want to draw a sample, deciding on the sample size, and selecting the required number of sampling used using a table of random numbers or a lottery method - ANS Simple random sampling What is the prevalence of borderline personality disorder in psychiatry outpatients? - ANS 10% What is the prevalence of borderline personality disorder in psychiatric inpatients - ANS 20% Diagnosis of borderline personality disorder includes 5 or more of the following criteria - ANS frantic avoidance of abandonment unstable relationships disturbance of identity recurrent suicidality unstable mood/affect chronic feelings of emptiness intense bouts of difficult-to-control anger transient paranoia or dissociation Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation - ANS Avoidant Pervasive pattern of detachment from social relationships and a restricted range of expression - ANS Schizoid Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent - ANS Paranoid Pervasive pattern of social and interpersonal discomfort with, and reduced capacity for, close relationships as well as cognitive or perceptual distortions and eccentricities - ANS Schizotypical Pervasive pattern of grandiosity, need for admiration, and lack of empathy - ANS Narcissistic Pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation - ANS Dependent The prevalence of borderline personality disorder in primary care - ANS 6% The prevalence of borderline personality disorder in the general population - ANS 1.5-5.9% What best determines the effectiveness of an educational intervention? - ANS Pt's behavior modification and compliance rates After suffering the loss of a child, more than 50% of parent couples go through the following - ANS Divorce Rubbing against non-consenting people - ANS frotteurism Fantasies about watching unsuspecting individuals undressed or in sexual activity - ANS voyeurism Use of non-living objects for sexual stimulation - ANS fettishism Exposing one's genitals to strangers - ANS exhibitionism Besides therapy in Borderline Personality Disorder, impulse behavioral dyscontrol symptoms that present serious risk to patient are treated by adding - ANS an antipsychotic to an SSRI In borderline personality disorder, cognitive-perceptual symptoms respond best to - ANS low dose antipsychotics Impulsive-behavioral dyscontrol symptoms in borderline personality disorder - ANS aggression self-mutilation reckless spending promiscuity substance abuse Affective dysregulation in borderline personality disorder is treated with - ANS SSRI or venlafaxine For histrionic personality disorder, which type of therapy helps them focus on their unconscious motivations for being unable to commit to a stable and meaningful relationship, and instead seeking out disappointing partners - ANS psychodynamic Temporal lobe abnormalities and differences in the corpus callous and thalamic nuclei have been identified on MRI studies of patients with which condition - ANS schizotypical personality disorder Schizotypical personality disorder can be differentiated from schizophrenia by the absence of - ANS psychotis Prevalence of schizotypical personality - ANS 3% (more cases occur in biological relatives with schizophrenia) Affective aggression can be treated with which medication? - ANS Lithium Which personality disorder is often present with pts with anorexia-nervosa who restrict rather than binge-purge - ANS Obsessive-compulsive A type of identification that is seen often in borderline personality disorder pts - ANS projective identification 3 steps of projective identification - ANS 1. pt assigns component of self to another individual 2. pt manipulates this individual into integrating this component into his or her consciousness 3. process leads to increased feeling of closeness between parties Analyst's emotional response to pt - ANS countertransference When pt tends to identify aspects as either completely good or completely bad about a person - ANS Splitting Mental process that gives rise to lack of connection in the pt's thoughts, memory, and sense of identity - ANS Dissociation Substance that is found in lower concentrations in the CSF of impulsive, violent individuals - ANS 5-HIAA In addition to an assessment of pathological personality traits, alternate model in Section III of the DSM-5 requires an assessment of which category or a personality disorder diagnosis - ANS level of impairment in personality functioning A diagnosis of a personality disorder who require at least a level _______ impairment - ANS 2 ("moderate") What is the prevalence of obsessive-compulsive personality disorder in the general population - ANS 5-10% Which personality disorder's criteria includes magical thinking - ANS Schizotypical Females with _________ have a virilized clitoris - ANS Congenital adrenal hyperplasia (CAH) A higher degree of ________ has been reported in individuals with CAH, which correlates to the degree of virilization - ANS homosexuality A 2-year old girl with 21-hydroxylase deficiency undergoes genitoplasty. Which statement is true concerning her condition - ANS There is a correlation between virilization degree and gender dysmorphia What is the prevalence of paranoid personality disorder among psychiatric patients? - ANS 10-30% Gender identity usually begins to form by this age - ANS 2 Anti-hypertensive effects on sexuality - ANS impaired vaginal lubrication and erectile dysfunction d/t antiadrenergic effects Spironolactone effects on sexuality - ANS decreased desire secondary to decreased testosterone Estrogen effects on sexuality - ANS decreased desire secondary to decreased testosterone Steroid effects on sexuality - ANS decreased desire secondary to decreased testosterone TCA effects on sexuality - ANS erectile dysfunction or impaired vaginal lubrication secondary to anticholinergic effects MAOI effects on sexuality - ANS erectile dysfunction or impaired vaginal lubrication secondary to anticholinergic effects Antipsychotics effects on sexuality - ANS erectile dysfunction or impaired vaginal lubrication secondary to anticholinergic effects SSRI effects on sexuality - ANS inhibition of arousal and orgasm by increased serotonergic activity The diagnosis of a personality disorder requires a pattern of inner experience and behavior that deviates from the expectations of the individual's culture in 2 or more of which 4 areas? - ANS cognition affectivity impulse control interpersonal functioning Individual is only aroused by and can only achieve orgasm through a single type of sexual contact, usually relegated to a specific anatomical location - ANS Partialism Individuals who attempt to avoid penetrative sex due to a lack of interest may have what? - ANS Partialism (a type of paraphilia) Prevalence of antisocial personality disorder in females in the community - ANS 1% 2 common defense mechanisms seen in obsessive compulsive personality disorder - ANS isolation of affect intellectualization Paraphilia are almost never diagnosed in - ANS females (and rarely in a clinical setting) Age range that is typical for a person that performs frotteurism - ANS 15-25 (declines after that) Pts with a history of childhood separation are more prone to this personality disorder - ANS dependent Pts with dependent personality disorder commonly experience these 2 things from their caretaker? - ANS over-involvement intrusive behavior Childhood experience common in pts with dependent personality disorder - ANS social humiliation - leads them to doubt in their own ability to function independently of others Pts with obsessive compulsive personality disorder often had parents who were - ANS emotionally withholding overprotective over-controlling People with obsessive compulsive personality disorder develop their symptoms as a strategy to - ANS avoid punishment (they were often punished by parents and rarely rewarded) Patients with schizoid personality disorder typically from families that are - ANS emotionally reserved highly formal aloof impersonal (likely were provided inadequate affection prompting their disinterest in forming close relationships later in life) Patients with this personality disorder displayed excessive shyness and fear when confronted with new people and situations as children - ANS avoidant Many of the patients have a history of painful early experiences and chronic parental criticism - ANS avoidant personality disorder Symptoms of personality disorders are usually consistent with patient's - ANS internal sense of self, which is called ego-synodic What is the term for how easily an individual acts on an initial, emotionally based evaluation of events and people - ANS Constraint Purest expression of the biological basis of personality - ANS Temperament What are the 2 distinct temperaments Kagan and colleagues (1988) identified - ANS inhibited uninhibited Which of the following medications is the first-line treatment option for a personality change secondary to epilepsy that results in aggressive episodes? - ANS Carbamazepine What is the second-line treatment option for a personality change secondary to epilepsy that results in aggressive episodes - ANS benzodiazepines What is contraindicated in the treatment of aggressive personality changes due to epilepsy - ANS antipsychotics females that have this are usually infertile have low estrogen levels but do not have higher levels of homosexuality - ANS Turner syndrome(45XO) females with this are typically indistinguishable from other females except they are slightly taller and have increased learning difficulties and low-normal intelligence - ANS Triple X syndrome 46XY with complete androgen insensitivity have - ANS female gender identity equivalent of 46XX individuals Congenital adrenal hyperplasia is associated with increased prenatal - ANS androgen exposure 5-alpha-reductase deficiency is associated with - ANS higher rates of homosexuality in affected females a cause of pseudohermaphroditism Gender identity is generally set by age ____ and very difficult to change - ANS 3 First line agents for treating impulsivity and aggression in personality disordered patients - ANS SSRIs Explain what the following Pyramid Tract Signs result from: spasticity weakness slowing of rapid alternating movements hyper-reflexia Babinski sign - ANS Vitamin B12 deficiency The only TCA levels that can be reliably followed are for - ANS desipramine imipramine nortriptyline A transgender male is sexually attracted to men/masculinity. What is his sexual orientation? - ANS Androphilic A transgender male is sexually attracted to females/femininity. What is his sexual attraction? - ANS Gynephilic A transgender female is sexually attracted to females/femininity. What is her sexual attraction? - ANS Gynephilic A transgender female is sexually attracted to men/masculinity. What is her sexual attraction? - ANS Androphilic Attraction that is combination of androphilia and gynephilia - ANS Ambiphilia Asexual is synonymous with - ANS analophilic Part D of criteria for illness anxiety disorder - ANS performs excessive health-related behaviors or exhibits maladaptive avoidance Physical symptoms are less prominent, while anxiety era preoccupation with having or acquiring a serious medical condition is the core complaint - ANS Illness anxiety disorder In illness anxiety disorder somatic symptoms are - ANS not present or are mild in intensity In illness anxiety disorder, illness preoccupation has to be present for at least _____ months - ANS 6 Prevalence of illness anxiety disorder - ANS 1-5% What are the FDA-approved medications for personality disorders? - ANS There are none Pts with borderline personality disorder and psychotic disorders are particularly likely to have experienced - ANS victimization as a child and/or adult Repeated changes in caregivers, history of neglect, avoidance of social interactions, and resistance to comforting from others is a sign of - ANS reactive attachment disorder indiscriminate sociability and lack of selectivity in authority figures - ANS Disinhibited social engagement disorder Symptoms present for _______ are more consistent with PTSD rather than Acute Stress Disorder - ANS greater than 1 month Estimated lifetime prevalence of PTSD is - ANS 7.8% What ethnic group of combat veterans experience a higher rate of PTSD - ANS Latino especially Puerto Rican PTSD rates among Native Americans are _____ the national average - ANS 3x higher What disorder is often comorbid with body dysmorphic disorder - ANS social phobia Recovering completely within _______ is characteristic of a conversion disorder - ANS 24 hours For pediatrics with conversion disorder (psychogenic seizure), what might be found in this patient's history - ANS She argued with her parents earlier that day over a bad report card Conversions disorders do not show - ANS pain symptoms What is the typical course of illness anxiety disorder - ANS Onset in early adulthood has a chronic waxing/waning course Which medications have the strongest evidence for treatment of PTSD - ANS Paroxetine Sertaline (Venlafaxine also approved by FDA) Pts with this disorder often exhibit emotional blunting that is sometimes referred to as "la belle indifference" - ANS conversion disorder Pts with ________ PTSD typically show a more robust clinical response to SSRIs - ANS non-combat In treating pts with histrionic personality disorder, which therapy type is useful for addressing provocative and attention seeking behavior? - ANS Group therapy (pt may be unaware of behavior and it could help them if others point them out) What term represents a stable and realistic sense of self? - ANS Self-system means of interpreting social situations and understanding the relational motives and actions of others - ANS social system the capacity to observe the self as it relates to others - ANS self-in-relation system What percentage of patients with neurological problems have conversion symptoms? - ANS 1-3% Body dysmorphic disorder is associated with what risk factor and family history - ANS Childhood neglect OCD These symptoms are a sign of which drug intoxication: elation euphoria increased physical activity anxiety tachycardia arrhythmias, hypertension, mydriasis (pupil dilation), agitation cognitive impairment - ANS cocaine Most serious complications of cocaine abuse - ANS myocardial ischemia and infarction Signs of ____________: dysphoria, psychomotor slowing, fatigue, increased appetite, craving - ANS cocaine withdrawal Signs of ____________: piloerection lacrimation and rhinorrhea pain in joints and muscles dysphoria diarrhea nausea vomiting dilated pupils insomnia autonomic hyperactivity yawning - ANS Opioid withdrawal signs of ______________: euphoria drowsiness impaired coordination dizziness confusion feeling of heaviness in the body slowed or arrested breathing constipation flushing of feelings of warmth pinpoint pupils - ANS opioid intoxication Signs of ______________ Nystagmus Dissociative symptoms anxiety tremor numbness memory loss analgesia psychosis aggression violence slurred speech poor coordination hallucination - ANS Phencyclidine intoxication Signs of _________: stimulation loss of inhibition headache N/V slurred speech poor motor coordination - ANS Inhalant intoxication Signs of _________: Exhilaration loss of inhibitions slurred speech staggering gait euphoria marked motor impairment confusion stupor coma - ANS Sedative hypnotic (alcohol and benzodiazepine) intoxication Sign of ________: sweating flushed face insomnia hallucinations seizure disorientation tremors increased autonomic activity - ANS Sedative hypnotic (alcohol and benzodiazepine) withdrawal Sign of ___________: Altered states of perception and feeling hallucinations nausea increased body temperature HR and BP pupillary dilation poor appetite sweating sleeplessness numbness dizziness rapid shifts in emotion depression anxiety - ANS Hallucinogen intoxication A 30-year-old female presents to the ED with severe anxiety, palpitations, restlessness, and irritability. She reports no previous history of these symptoms. Her BP is 160/100, pulse is 115 beats/min, temperature 98 degree F, and pupils are dilated What condition explains her symptoms - ANS cocaine intoxication Which statement differentiates the actions of cocaine and amphetamines - ANS Cocaine prevents dopamine reuptake but amphetamines both slow dopamine reuptake and induces dopamine release In the COMBINE trial for alcohol dependent patients acamprosate faired ____ compared to various combinations of naltrexone and combined behavioral intervention - ANS poorly For Alcohol dependent patients, the COMBINE trial found that - ANS any combination of therapies including CBT, naltrexone, or both performed better than any combinations that did not include these interventions Buprenorphine is a ______ at mu receptors and binds with ______ - ANS partial agonist high affinity (20x stronger per gram weight of morphine) This is resistant to cases of overdose to reversal by naloxone - ANS buprenorphine d/t high binding affinity DSM-5 requires ____ of 9 criteria to be met for persistent and recurrent maladaptive gambling behavior - ANS 4 What drug should be administered to address patient's aggression on PCP - ANS Benzodiazepines What medications should be avoided d/t risk of hyperthermia, lower the seizure threshold, cause dystonia, or induce dysrhythmias when pt is intoxicated with PCP - ANS haldol chlorpromazine Which of the following is not a feature of kleptomania - ANS individual feels great pleasure and excitement leading to the theft (usually individual feels tension) Chronic alcohol use disorder reflects an _______ personality - ANS oral-dependent Excessive alcohol use is associated with ________ traits such as - ANS oral dependence and depression Men are more than _____ as likely as women to develop chronic alcohol use disorder - ANS 2x Delirium tremens usually develops _____ from the person's last drink, with an average durage of _____ - ANS 2-4 days <1 week This type of head bleed presents with headaches and confusion - ANS subdural Most common approach to managing urges to shoplift - ANS commit a self-imposed ban on shopping A 16 year old attended a rave with her friends. She presents with HTN, hyperthermia, and clinical examination indicates brisk reflexes. What conditions is her presentation consistent with - ANS Serotonin Syndrome (likely from MDMA (ecstasy)) What is the rationale behind avoiding the use of restraints in someone intoxicated on PCP - ANS Incidence of rhabdomyolysis in patients with PCP intoxication and physical restraints is much higher than baseline but can occur with PCP alone. With heavy cocaine use, patients can experience - ANS a shower of lights in their central vision, as well as visual hallucinations of black dots on their skin and in the environment (coke bugs) What is a symptom of amphetamine withdrawal - ANS fatigue vivid bad dreams insomnia/hypersomnia increased appetite psychomotor agitation/retardation A 29 year old male with yawning, perspiration, runny nose, dilated pupils, muscle twitching, no abdominal tenderness. Which drug is responsible for these withdrawal symptoms - ANS Heroin The death rate among opioid abusers is ____ greater than the non-using population - ANS 20x Sweating, flushing, sleep disturbances, hallucinations, seizures, and mild mental status changes are early symptoms of - ANS alcohol withdrawal 8-10 hours after last drink LSD is derived from which of the following - ANS Ergot fungus Cocaine is derived from the leaves of the plant - ANS erythroxylon coca A 22 yo F with cystic fibrosis (CF) presents with fatigue, dysphoria, and depression. She stopped taking her meds and is wearing a baby pacifier on her necklace. Why is the pacifier significant in this pt with possible CF exacerbation? - ANS MDMA (ecstasy) withdrawal baby pacifiers are used at "raves" to combat - ANS bruxism (teeth grinding) while on MDMA Ganja is obtained from - ANS flowering tops THC 6-20% Marijuana is obtained from - ANS leaves/flowers Bhang is obtained from - ANS dried marijuana leaves (1-3% THC) Hashish is obtained from - ANS resin (THC 6-20%) In DSM-5 how many of the 11 criteria for substance use disorder must be present to meet "severe" subclassifications? - ANS 6 In DSM-5 how many of the 11 criteria for substance use disorder must be present to meet "mild" subclassifications? - ANS 2-3 In DSM-5 how many of the 11 criteria for substance use disorder must be present to meet "moderate" subclassifications? - ANS 4-5 Sx of this type of intoxication are conjunctival infection, dry mouth and increased appetite - ANS Cannabis intoxication What is the preferred benzodiazepine for treating withdrawal patient with chronic alcohol use disorder and a history of liver disease - ANS Oxazepam MRI in Korsakoff's syndrome shows the following 6 areas of involvement - ANS midbrain pons hypothalamus thalamus mammillary bodies cerebellum What vitamin is deficient in Wernicke's encephalopathy and Korsakoff's syndrome - ANS Vitamin B1 The proposed addictive component of cannabis - ANS releases dopamine in the mesolimbic system What type of users can appear to be bipolar with mania/hypomania symptoms - ANS anabolic steroids Which drug of abuse is also a schedule III prescription for the treatment of narcoleptic cataplexy? - ANS GHB (Xyrem) Which of the following statements regarding the treatment of cocaine dependent individuals is correct - ANS contingency management has been widely accepted and is effective There are no FDA approved medications, no meds have been shown to reduce relapse Substances that belong to the "depressant" class - ANS ETOH cannabis opioids inhalants benzodiazepines Which of the following statements regarding the mechanism of action of vareniciline is accurate - ANS It has activity at Alph 4 beta 2 subtype of the nicotinic receptor It is effective for nicotine/tobacco cessation A 50 year old man with chronic alcohol use disorder ran out of ETOH and drank methyl alcohol from the factory where he is employed 18 hours ago. He presents at ER with encephalopathy, ataxia, seizures, and bilateral vision loss. Imagineer reveals an intracranial hemorrhage. What is the likely location of his hemorrhage - ANS Putamen (formic acide accumulates in this region) Long term survivors of methyl alcohol intoxication may experience - ANS Parkinsonism Chronic exposure to methyl alcohol may result in - ANS axonal polyneuropathy A 29 year old patient is having marital struggles and multiple recent arguments with her husband presents to the ED complaining of R sided weakness. A neurological evaluation, including imaging, reveals no identifiable diagnosis. Psychiatric consultation is requested. After 2 days, the patient's weakness has subsided and she is discharged home. Which of the following is a positive prognostic factor for her diagnosis - ANS Short duration of illness A 38 year old woman presents to the psychiatry clinic wearing a wig. She has no eyelashes or eyebrows. Which behavioral therapy has been shown to be particularly helpful for this patient's self-inflicted condition? - ANS Habit Reversal Treatment for trichollomania - ANS Medication and behavioral therapy (habit reversal - apply barriers such as gloves or hat) A 19 year old male presents with facial numbness and bilateral vision loss. He reports tingling, cold feet with bluish discoloration. His symptoms most likely resulted from inhalation of which substance. - ANS n-Hexane (household glues) Repeated glue inhalation may cause ______ which has a similar presentation to ______ - ANS glue sniffer neuropathy Guillain Barre Syndrome Which antidepressant with a tetracyclic structure that works by antagonism of presynaptic alpha 2 agonists and post-synaptic serotonergic receptors is of interest for a psychiatrist looking to prescribe pharmacologic treatment to a patient with chronic alcohol use disorder with a major depressive episode? - ANS Mirtazapine This would not show on the toxicology screen and is a drug of abuse, particularly in pubescent boys, that could cause a period of unconsciousness - ANS Nitrites (present in liquid incense) onanism - ANS masturbation Amnesic disorders are secondary syndromes caused by - ANS systemic medical or primary cerebral diseases substance use disorders medication adverse effects In contrast to transient global amnesia, dissociative amnesia typically does not involve - ANS deficits in learning and recalling new information Dissociative disorders are often associated with - ANS emotionally stressful life events involving the money, legal systems, or troubled events What is the lifetime suicide-attempt rate in patients with body dysmorphic disorder - ANS 22-24% Wernike's encephalopathy triad - ANS confusion ataxia ophthalmolopegia What type amnesia is classically associated with confabulation do Korsakoff disease patients have? - ANS anterograde and retrograde amnesia Xerostomia - ANS dry mouth caused by reduction or absent flow of saliva Icterus - ANS jaundice According to a recent study, the volumes of which brain structures are significantly smaller in patients with dissociative identity disorder versus healthy subjects? - ANS Hippocampus and amygdala In using the Structured Interview of Reported Symptoms (SIRS) test, when would a patient be considered to be malingering? - ANS They score in the definitive range in 1 primary subscale or probable range in 3 sub scales A 48 year old pt admitted with profuse sweating, diarrhea, abdominal cramps, vomiting, yawning, muscle aches, restlessness, and insomnia for 1 day. Physical exam reveals BP 155/105 mmHg and a temp of 100 degrees F. The patient is cold with muscle twitches and dilated pupils. She is highly motivated to detoxify. Which medication is the best choice for detox? - ANS Methadone Which of the following is useful in treating the autonomic effects of opiate withdrawal - ANS Clonidine Which of the following is useful for treating hyperthermia in opiate withdrawal - ANS cold blankets ice packs Which of the following is useful for treating seizures in cocaine overdose - ANS benzodiazepine Which of the following is useful for treating malignant hypertension in cocaine overdose - ANS IV phentolamine Which 2 medications are useful for treating agitation in cocaine overdose? - ANS lorazepam haloperidol What is the most common type of psychiatric condition in an emergency room - ANS Substance-related disorders "You have been through so much recently but you remain certain that alcohol is not a problem for you" This is an example of a - ANS reflective statement "What do you feel about all this?" is an example of - ANS open-ended question "You have done a phenomenal job staying sober in the past." is an example of - ANS affirmation "let me see if I understand you. It sounds like you've been trying to stop using for some time but are on the fence right now about stopping. Is that about right?" is an example of - ANS Summary Statement OARS stands for - ANS Open-ended questions Affirmations Reflective listening Summaries 4 core techniques for motivational interviewing include - ANS expression of empathy rolling with the resistance developing discrepancy supporting self-efficacy Successful malingerers are more likely to have which characteristic compared to unsuccessful maligerers - ANS They are more likely to report fewer symptoms Pt got Tdap 10 years ago, what is she due for - ANS Td booster Which type of group treatment affects the largest number of substance abuse patients - ANS self-help groups inability to recall autobiographical information and apparently purposeful travel associated with amnesia. Onset sudden, memory loss may be refractory - ANS dissociative amnesia with dissociative fugue Pt often feel detached from their body, as if they are watching from outside their body. There is no associated amnesia or change in personality or identity - ANS Depersonalization/derealization disorder Temporary episode of memory loss which can not be associated with a neurological cause. there is no associated change in identity. Onset is sudden, and the person is unable to recall who they are, how they got there, or what they were doing - ANS Transient global amnesia Factitious disorder involves - ANS deceptively reporting false symptoms to assume the "sick role" Dangerous dose of methadone may p