Therapy Questions PDF

**[THERAPY]** **Therapeutic Approaches & Frameworks** 1. **Which type of behavioral therapy focuses on replacing maladaptive behaviors with relaxation responses?** - A\) Contingency management - B\) Systematic desensitization - C\) Cognitive restructuring - D\) Exp...

**[THERAPY]** **Therapeutic Approaches & Frameworks** 1. **Which type of behavioral therapy focuses on replacing maladaptive behaviors with relaxation responses?** - A\) Contingency management - B\) Systematic desensitization - C\) Cognitive restructuring - D\) Exposure prevention **Answer: B) Systematic desensitization** *(Used for phobias, anxiety disorders.)* 2. **Which therapy is based on the principle that thoughts influence emotions, which in turn affect behavior?** - A\) Psychoanalytic therapy - B\) Cognitive Behavioral Therapy (CBT) - C\) Jungian therapy - D\) Biofeedback **Answer: B) Cognitive Behavioral Therapy (CBT)** 3. **Which therapy is most associated with the concept of archetypes such as the \"shadow\" and \"hero\"?** - A\) Psychoanalytic therapy - B\) Jungian therapy - C\) Cognitive therapy - D\) Exposure therapy **Answer: B) Jungian therapy** *(Explores unconscious themes and personality patterns.)* 4. **Which psychotherapy is primarily focused on addressing interpersonal conflicts and communication patterns within a group dynamic?** - A\) Family therapy - B\) CBT - C\) Biofeedback - D\) Exposure therapy **Answer: A) Family therapy** *(Uses systems theory to address relational issues.)* 5. **Which group therapy approach is best suited for treating substance use disorders by reinforcing abstinence?** - A\) Psychoanalysis - B\) 12-step facilitation - C\) Jungian therapy - D\) Mindfulness-based therapy **Answer: B) 12-step facilitation** *(Used in AA and NA groups.)* **Therapeutic Techniques & Mechanisms** 6. **Which psychotherapy technique involves non-directive listening, paraphrasing, and an accepting environment?** - A\) Free association - B\) Motivational interviewing - C\) Active listening - D\) Exposure therapy **Answer: C) Active listening** *(Core to Client-Centered Therapy.)* 7. **Which therapeutic concept refers to a therapist's unconscious emotional reaction to a patient?** - A\) Transference - B\) Countertransference - C\) Projection - D\) Resistance **Answer: B) Countertransference** *(A therapist's emotions directed toward a client.)* 8. **What is the primary goal of motivational interviewing?** - A\) Encourage deep unconscious exploration - B\) Reduce ambivalence and increase readiness for change - C\) Identify cognitive distortions - D\) Enhance emotional intelligence **Answer: B) Reduce ambivalence and increase readiness for change** *(Common in addiction treatment.)* 9. **Which therapy uses bilateral stimulation (e.g., eye movements, tapping) to reprocess traumatic memories?** - A\) Biofeedback - B\) EMDR - C\) CBT - D\) Jungian therapy **Answer: B) EMDR** *(Eye Movement Desensitization and Reprocessing.)* 10. **Which client-centered therapy concept emphasizes unconditional acceptance by the therapist?** - A\) Rational Emotive Therapy - B\) Unconditional Positive Regard - C\) Systematic Desensitization - D\) Exposure Therapy **Answer: B) Unconditional Positive Regard** *(Core to Carl Rogers' therapy model.)* **Therapeutic Indications & Contraindications** 11. **Which therapy is contraindicated in patients with psychosis or active hallucinations?** - A\) CBT - B\) Hypnotherapy - C\) Family therapy - D\) Group therapy **Answer: B) Hypnotherapy** *(Can exacerbate psychotic symptoms.)* 12. \*\*Which therapy is **most effective** for **borderline personality disorder (BPD)?** - A\) CBT - B\) EMDR - C\) Dialectical Behavior Therapy (DBT) - D\) Psychoanalysis **Answer: C) Dialectical Behavior Therapy (DBT)** *(Developed for BPD, includes emotional regulation skills.)* 13. **Which therapy should be used with caution in patients with a history of severe trauma to avoid re-traumatization?** - A\) Mindfulness therapy - B\) Prolonged exposure therapy - C\) Hypnotherapy - D\) Biofeedback **Answer: B) Prolonged exposure therapy** *(Can intensify PTSD symptoms if not applied correctly.)* 14. **Which therapy is the best first-line treatment for phobias?** - A\) EMDR - B\) Systematic desensitization - C\) Hypnotherapy - D\) Jungian therapy **Answer: B) Systematic desensitization** *(Gradual exposure reduces fear responses.)* 15. **Which therapy is based on systems theory and focuses on changing dysfunctional family interactions?** - A\) Biofeedback - B\) Cognitive Behavioral Therapy - C\) Desensitization Therapy - D\) Family Therapy **Answer: D) Family Therapy** **Advanced & Alternative Therapies** 16. **Which therapy uses real-time physiological monitoring to help patients gain control over bodily functions?** - A\) Hypnotherapy - B\) Biofeedback - C\) CBT - D\) EMDR **Answer: B) Biofeedback** *(Patients learn to control HR, BP, muscle tension.)* 17. **Which therapy involves guiding a patient into a relaxed, focused state to improve memory recall or behavior change?** - A\) Mindfulness - B\) Hypnosis - C\) Exposure therapy - D\) CBT **Answer: B) Hypnosis** *(Used for pain control, PTSD, and habit control.)* 18. **Which therapy method integrates physical movement (e.g., yoga, massage) into mental health treatment?** - A\) Jungian therapy - B\) Body-based therapy - C\) CBT - D\) EMDR **Answer: B) Body-based therapy** *(Uses movement, breathwork, touch.)* 19. **Which therapy is based on metaphors and symbolic storytelling to help patients process experiences?** - A\) Psychoanalysis - B\) Jungian therapy - C\) CBT - D\) Biofeedback **Answer: B) Jungian therapy** *(Symbolism and mythology play central roles.)* 20. **Which therapy is known for using guided imagery to reduce stress and anxiety?** - A\) CBT - B\) EMDR - C\) Imagery therapy - D\) Biofeedback **Answer: C) Imagery therapy** *(Uses visualization techniques.)* **Practical Application & Treatment Outcomes** 21. **Which therapy is most effective for treating insomnia?** - A\) CBT-I - B\) DBT - C\) EMDR - D\) Psychoanalysis **Answer: A) CBT-I** *(Cognitive Behavioral Therapy for Insomnia.)* 22. **Which therapy technique encourages patients to reframe their thoughts to alter emotional responses?** - A\) Systematic desensitization - B\) Rational Emotive Behavior Therapy - C\) Jungian therapy - D\) EMDR **Answer: B) Rational Emotive Behavior Therapy** *(REBT focuses on changing irrational thoughts.)* 23. **Which therapy is used as a one-time intervention to provide patients with reading material on mental health topics?** - A\) Mindfulness therapy - B\) Psychoeducation - C\) Bibliotherapy - D\) Biofeedback **Answer: C) Bibliotherapy** *(Self-guided reading as therapy.)* **Recall:** 1. **Which therapy technique is most associated with the concept of Resistance?** - A\) Psychoanalytic - B\) Humanistic - C\) Behavioral - D\) Jungian **Answer: A) Psychoanalytic** 2. **Which therapy approach emphasizes Unconditional Positive Regard?** - A\) Jungian - B\) Client-Centered - C\) CBT - D\) Psychoanalytic **Answer: B) Client-Centered** 3. **Which technique primarily focuses on Automatic Thoughts and Cognitive Distortions?** - A\) Psychoanalytic - B\) CBT - C\) Humanistic - D\) Biofeedback **Answer: B) CBT** 4. **Which therapy is based on the integration of the Shadow and Projections?** - A\) Jungian - B\) Psychoanalytic - C\) CBT - D\) Behavioral **Answer: A) Jungian** 5. **Which therapy technique relies on Free Association and Dream Analysis?** - A\) Behavioral - B\) Psychoanalytic - C\) CBT - D\) Family Therapy **Answer: B) Psychoanalytic** 6. **Which type of therapy focuses on changing behaviors rather than exploring the unconscious?** - A\) Psychoanalytic - B\) Behavioral - C\) Jungian - D\) Hypnotherapy **Answer: B) Behavioral** 7. **Which therapy technique is based on Exposure Therapy and Systematic Desensitization?** - A\) CBT - B\) Behavioral - C\) Psychoanalytic - D\) Jungian **Answer: B) Behavioral** 8. **Which therapy concept is primarily associated with Transference?** - A\) Psychoanalytic - B\) Humanistic - C\) Behavioral - D\) CBT **Answer: A) Psychoanalytic** 9. **Which therapy technique utilizes Bilateral Stimulation and Reprocessing?** - A\) Hypnotherapy - B\) EMDR - C\) Mindfulness - D\) Jungian **Answer: B) EMDR** 10. **Which therapy method is built around Systems Theory and Family Roles?** - A\) Group Therapy - B\) Family Therapy - C\) Psychoanalytic - D\) Behavioral **Answer: B) Family Therapy** 11. **Which therapy method incorporates mindfulness, meditation, and present-moment awareness?** - A\) Jungian - B\) CBT - C\) Mindfulness - D\) Hypnotherapy **Answer: C) Mindfulness** 12. **Which therapy technique is designed for Trauma Processing and PTSD?** - A\) EMDR - B\) Psychoanalytic - C\) CBT - D\) Jungian **Answer: A) EMDR** 13. **Which therapy method is most associated with Operant and Classical Conditioning?** - A\) Psychoanalytic - B\) Behavioral - C\) CBT - D\) Jungian **Answer: B) Behavioral** 14. **Which therapy method promotes Cognitive Restructuring and Thought Records?** - A\) Psychoanalytic - B\) CBT - C\) Behavioral - D\) EMDR **Answer: B) CBT** 15. **Which therapy concept involves Interpersonal Process and Shared Experience?** - A\) Psychoanalytic - B\) Group Therapy - C\) Biofeedback - D\) CBT **Answer: B) Group Therapy** **Scenario-Based Questions** 16. **A therapist notices that a client consistently jokes or changes the subject when discussing their childhood. The client also frequently arrives late to sessions and has missed multiple appointments. Which concept best explains this behavior?** - A\) Resistance - B\) Countertransference - C\) Reframing - D\) Projection **Answer: A) Resistance** 17. **During a session, a client begins to view their therapist as a father figure and seeks their approval, mirroring how they interacted with their own father. What psychological concept is this an example of?** - A\) Transference - B\) Projection - C\) Free Association - D\) Individuation **Answer: A) Transference** 18. **A therapist tells a patient, 'Imagine yourself in a safe place, where you feel calm and protected.' This statement is most likely part of which therapy technique?** - A\) Biofeedback - B\) Guided Imagery - C\) CBT - D\) Systematic Desensitization **Answer: B) Guided Imagery** 19. **A person suffering from PTSD is asked to recall a traumatic memory while following a therapist's moving fingers with their eyes. Over time, their emotional response to the memory decreases. Which therapy technique is being used?** - A\) EMDR - B\) CBT - C\) Exposure Therapy - D\) Hypnotherapy **Answer: A) EMDR** 20. **A therapist repeatedly rewards a child with a sticker each time they complete a homework assignment on time. Over weeks, the child starts completing assignments without needing reminders. This technique is an example of what?** - A\) Positive Reinforcement - B\) Cognitive Reframing - C\) Aversion Therapy - D\) Projection **Answer: A) Positive Reinforcement** 21. **A man constantly criticizes others for being dishonest, but when confronted about his own small lies, he refuses to acknowledge them. This is an example of which psychological defense mechanism?** - A\) Projection - B\) Repression - C\) Countertransference - D\) Desensitization **Answer: A) Projection** 22. **A therapist working with a socially anxious client encourages them to gradually interact in increasingly difficult social situations, starting with saying 'hello' to a stranger and building up to giving a speech. This technique is an example of what?** - A\) Systematic Desensitization - B\) Jungian Shadow Work - C\) Countertransference - D\) Mindfulness Meditation **Answer: A) Systematic Desensitization** **Detailed Definition and Conceptual Link Questions** 23. **Which therapy approach emphasizes the client's ability to heal themselves in an environment of acceptance and nonjudgment?** - A\) Client-Centered - B\) CBT - C\) Jungian - D\) Psychoanalytic **Answer: A) Client-Centered** 24. **Which therapy approach suggests that behavior is learned and can be unlearned, without necessarily focusing on unconscious processes?** - A\) Psychoanalytic - B\) Behavioral - C\) Jungian - D\) CBT **Answer: B) Behavioral** 25. **Which therapy method includes concepts like Proximity Maintenance, Secure Base, and Separation Distress?** - A\) Attachment Theory - B\) CBT - C\) Biofeedback - D\) Jungian **Answer: A) Attachment Theory** 26. **Which term describes when a therapist develops unconscious feelings, either positive or negative, toward their client?** - A\) Countertransference - B\) Transference - C\) Free Association - D\) Cognitive Distortion **Answer: A) Countertransference** 27. **A client struggling with negative self-perceptions learns to replace thoughts like 'I am worthless' with 'I have value and strengths.' This best exemplifies which therapy technique?** - A\) Cognitive Restructuring - B\) Free Association - C\) Countertransference - D\) Hypnotherapy **Answer: A) Cognitive Restructuring** 28. **A therapist suggests a client think about a distressing memory while listening to alternating sounds in their ears. What therapy is being used?** - A\) EMDR - B\) Hypnotherapy - C\) CBT - D\) Psychoanalysis **Answer: A) EMDR** **Advanced Recall and Technique Matching** 29. **Which therapy technique involves recalling past experiences to uncover repressed memories?** - A\) Psychoanalytic - B\) Behavioral - C\) Jungian - D\) CBT **Answer: A) Psychoanalytic** 30. **Which term refers to a person unconsciously attributing their unwanted feelings or traits onto someone else?** - A\) Projection - B\) Resistance - C\) Transference - D\) Desensitization **Answer: A) Projection** 31. **A patient believes that because they failed one test, they are completely incapable of succeeding in school. This thinking pattern is an example of what?** - A\) Cognitive Distortion - B\) Archetype - C\) Free Association - D\) Biofeedback **Answer: A) Cognitive Distortion** 32. **Which therapy technique uses physiological monitoring to help clients gain control over bodily functions like heart rate and muscle tension?** - A\) Biofeedback - B\) CBT - C\) Psychoanalysis - D\) Desensitization **Answer: A) Biofeedback** 33. **Which therapy method is most commonly used to help patients overcome phobias through controlled exposure?** - A\) Systematic Desensitization - B\) Free Association - C\) Hypnotherapy - D\) EMDR **Answer: A) Systematic Desensitization** 34. **Which therapy approach encourages exploring unconscious conflicts through symbols, myths, and dream interpretation?** - A\) Jungian - B\) CBT - C\) Behavioral - D\) Biofeedback **Answer: A) Jungian** 35. **A therapist encourages a client to repeat a phrase like 'I am strong' daily to reinforce a positive self-concept. This technique aligns with which therapy?** - A\) CBT - B\) Psychoanalytic - C\) Jungian - D\) Biofeedback **Answer: A) CBT** **Scenario-Based Questions** 36. **A therapist encourages a client to recognize their 'inner critic' and reframe self-defeating thoughts by identifying evidence against them. Which therapy technique is being used?** - A\) CBT - B\) Psychoanalytic - C\) Hypnotherapy - D\) Jungian **Answer: A) CBT** 37. **A therapist tells a client struggling with social anxiety, 'Think of a past situation where you felt confident and in control. Imagine yourself in that state now as you enter the social event.' This technique is an example of what?** - A\) Imagery - B\) Free Association - C\) Exposure Therapy - D\) Biofeedback **Answer: A) Imagery** 38. **A therapist notices that a client consistently responds to authority figures with hostility, similar to how they described their relationship with a strict father. What concept explains this behavior?** - A\) Transference - B\) Countertransference - C\) Systematic Desensitization - D\) Cognitive Reframing **Answer: A) Transference** 39. **A client who was abandoned as a child repeatedly tests their therapist's commitment by showing up late or missing appointments. This behavior aligns with which psychological theory?** - A\) Attachment Theory - B\) CBT - C\) Jungian Shadow Work - D\) Biofeedback **Answer: A) Attachment Theory** 40. **A therapist places a client with PTSD in a virtual reality simulation that mimics their trauma, gradually exposing them to it while monitoring their anxiety levels. This technique is an example of what?** - A\) Exposure Therapy - B\) Hypnotherapy - C\) Psychoanalysis - D\) Systematic Desensitization **Answer: A) Exposure Therapy** **Conceptual Link & Technique Matching Questions** 41. **Which therapy technique encourages confronting one's fears in a gradual, controlled manner?** - A\) Systematic Desensitization - B\) Free Association - C\) Mindfulness - D\) Transference **Answer: A) Systematic Desensitization** 42. **Which therapy is based on the belief that unconscious conflicts manifest in a person's present-day behavior?** - A\) Psychoanalytic - B\) CBT - C\) Behavioral - D\) Biofeedback **Answer: A) Psychoanalytic** 43. **Which therapy technique involves tracking bodily responses such as heart rate and muscle tension to improve self-regulation?** - A\) Biofeedback - B\) CBT - C\) Psychoanalytic - D\) Hypnotherapy **Answer: A) Biofeedback** 44. **A client undergoes therapy where they are asked to retell a traumatic event while following a moving object with their eyes. This technique is part of what therapy?** - A\) EMDR - B\) Jungian - C\) CBT - D\) Hypnotherapy **Answer: A) EMDR** 45. **A therapist uses metaphor and storytelling to help a client recognize unconscious conflicts and develop insight. Which therapy approach is most aligned with this method?** - A\) Jungian - B\) CBT - C\) Behavioral - D\) Psychoanalytic **Answer: A) Jungian** **Advanced Recall & Theory Application Questions** 46. **A client is taught to observe their thoughts and emotions without judgment while staying focused on the present moment. This aligns with which therapeutic approach?** - A\) Mindfulness - B\) CBT - C\) Jungian - D\) Psychoanalytic **Answer: A) Mindfulness** 47. **Which therapy method utilizes role-playing and 'empty chair' techniques to help clients express unresolved feelings?** - A\) Gestalt - B\) CBT - C\) Psychoanalytic - D\) Behavioral **Answer: A) Gestalt** 48. **A client is instructed to visualize a positive outcome before a stressful event to reduce anxiety. This technique is an example of what?** - A\) Guided Imagery - B\) Exposure Therapy - C\) Free Association - D\) Biofeedback **Answer: A) Guided Imagery** 49. **Which therapy focuses on breaking negative thought patterns and replacing them with healthier ways of thinking?** - A\) CBT - B\) Psychoanalytic - C\) Hypnotherapy - D\) Jungian **Answer: A) CBT** 50. **Which therapy focuses on the influence of early childhood attachment on adult relationships?** - A\) Attachment Theory - B\) Jungian - C\) CBT - D\) Behavioral **Answer: A) Attachment Theory** **Scenario-Based Critical Thinking Questions** 51. **A therapist working with a client who has PTSD encourages them to relive their traumatic event while staying grounded in the present and forming new positive associations. Which therapy technique is being used?** - A\) EMDR - B\) Psychoanalytic - C\) Biofeedback - D\) Systematic Desensitization **Answer: A) EMDR** 52. **A therapist notices they are feeling unusually irritated with a client who reminds them of a difficult past relationship. This reaction is best described as what?** - A\) Countertransference - B\) Transference - C\) Projection - D\) Free Association **Answer: A) Countertransference** 53. **A therapist asks a client to describe their earliest memory and analyze its impact on their current self-perception. This technique is most aligned with which therapy?** - A\) Psychoanalytic - B\) Behavioral - C\) CBT - D\) Biofeedback **Answer: A) Psychoanalytic** 54. **A client repeatedly expresses the belief that they will never be successful, despite multiple past achievements. The therapist challenges this belief by asking for evidence to support or refute it. This method aligns with which therapy?** - A\) CBT - B\) Psychoanalytic - C\) Jungian - D\) EMDR **Answer: A) CBT** 55. **A client describes feeling disconnected from their body and emotions after experiencing trauma. A therapist encourages grounding techniques, controlled breathing, and monitoring physical sensations to help them reconnect. This method is part of what approach?** - A\) Mindfulness - B\) Psychoanalytic - C\) CBT - D\) EMDR **Answer: A) Mindfulness** **Terminology** These questions challenge the test-taker to **connect key psychological terms to their respective therapies**, similar to those found in the exam. 5. **Which therapy method is built around Systems Theory and Family Roles?** - A\) Group Therapy - B\) Family Therapy - C\) Psychoanalytic - D\) Behavioral 6. **A client struggling with negative self-perceptions learns to replace thoughts like 'I am worthless' with 'I have value and strengths.' This best exemplifies which therapy technique?** - A\) Cognitive Restructuring - B\) Free Association - C\) Countertransference - D\) Hypnotherapy **Answer: A) Cognitive Restructuring** **[SUICIDE]** **High-Specificity Suicide Risk & Screening Questions** 1. **At what age does the U.S. Preventive Services Task Force recommend universal suicide screening?** - A\) 8 years - B\) 11 years - C\) 15 years - D\) 18 years **Answer: B) 11 years** 2. **Which psychiatric disorder has the highest suicide risk?** - A\) Bipolar Disorder - B\) Schizophrenia - C\) Eating Disorders - D\) PTSD **Answer: C) Eating Disorders** 3. **Which dynamic risk factor is specifically identified as increasing suicide risk in teenage females?** - A\) Social media - B\) Genetics - C\) Unemployment - D\) Chronic illness **Answer: A) Social media** 4. **Which suicide method is most common among men?** - A\) Hanging - B\) Poisoning - C\) Firearms - D\) Drowning **Answer: C) Firearms** 5. **Which suicide method is most common among women?** - A\) Firearms - B\) Poisoning - C\) Hanging - D\) Jumping **Answer: B) Poisoning** 6. **How much more likely is a firearm in the home to be used for suicide than for self-defense?** - A\) 3x - B\) 7x - C\) 11x - D\) 15x **Answer: C) 11x** 7. **What is the most significant predictor of a future suicide attempt?** - A\) Plan - B\) Access to means - C\) Previous attempt - D\) Family history **Answer: C) Previous attempt** **Medical & Psychiatric Suicide Risk Factors** 8. **Which medical condition is most strongly linked to increased suicide risk?** - A\) Hypertension - B\) Chronic pain - C\) Diabetes - D\) Asthma **Answer: B) Chronic pain** 9. **Which psychiatric condition presents the highest suicide risk per diagnosis?** - A\) Depression - B\) PTSD - C\) Borderline Personality - D\) Bipolar Disorder **Answer: C) Borderline Personality** 10. **What percentage of individuals who attempt suicide see a healthcare provider in the month before their attempt?** - A\) 38% - B\) 44% - C\) 64% - D\) 73% **Answer: C) 64%** 11. **What percentage of individuals who attempt suicide saw a healthcare provider within the year before?** - A\) 50% - B\) 64% - C\) 73% - D\) 95% **Answer: D) 95%** 12. **What psychiatric diagnosis has the strongest association with suicide completion?** - A\) Anxiety Disorders - B\) Schizophrenia - C\) Major Depression - D\) Bipolar Disorder **Answer: D) Bipolar Disorder** 13. **What is the most common time of year for suicides to occur?** - A\) Winter - B\) Fall - C\) Spring - D\) Summer **Answer: C) Spring** **Lethality & Risk Stratification Questions** 14. **Which of the following is considered a static suicide risk factor?** - A\) Suicidal ideation - B\) Substance abuse - C\) Family history - D\) Social isolation **Answer: C) Family history** 15. **Which of the following is considered a dynamic suicide risk factor?** - A\) Genetics - B\) Past suicide attempt - C\) Relationship stress - D\) Family history **Answer: C) Relationship stress** 16. **Which psychiatric disorder is characterized by suicide being more common early in the illness rather than later?** - A\) Major Depression - B\) Schizophrenia - C\) PTSD - D\) OCD **Answer: B) Schizophrenia** 17. **What is the leading method of suicide by mass transit?** - A\) Jumping - B\) Firearms - C\) Drowning - D\) Poisoning **Answer: A) Jumping** 18. **Which of the following conditions has been noted as a major contributor to physician suicide?** - A\) Sleep deprivation - B\) Depression - C\) Chronic pain - D\) Burnout **Answer: B) Depression** 19. **After discharge from psychiatric hospitalization, suicide risk is highest within what timeframe?** - A\) First 48 hours - B\) First week - C\) First month - D\) First year **Answer: B) First week** 20. **By how much does suicide risk increase in the first month after psychiatric hospitalization?** - A\) 50x - B\) 100x - C\) 200x - D\) 300x **Answer: C) 200x** **Legal & Intervention-Based Questions** 21. **Which U.S. law allows for involuntary psychiatric hospitalization for individuals at risk of harming themselves or others?** - A\) Tarasoff Law - B\) Baker Act - C\) HIPAA - D\) Lanterman Act **Answer: B) Baker Act** 22. **What is the maximum duration a person can be involuntarily held under the Baker Act in Florida?** - A\) 24 hours - B\) 48 hours - C\) 72 hours - D\) 96 hours **Answer: C) 72 hours** 23. **Which of the following strategies has the strongest evidence for reducing suicide risk?** - A\) \"No-Suicide\" contracts - B\) Removing access to means - C\) Social media awareness - D\) Celebrity endorsements **Answer: B) Removing access to means** 24. **Which of the following medications has been linked to increased suicide risk?** - A\) Ibuprofen - B\) Varenicline - C\) Metformin - D\) Omeprazole **Answer: B) Varenicline** *(Smoking cessation medication linked to increased suicidal behavior)* 25. **Which suicide assessment tool is the most widely researched and recommended for initial screening?** - A\) Columbia Suicide Screen - B\) PHQ-9 - C\) MMPI-2 - D\) SCID **Answer: A) Columbia Suicide Screen** 26. **What percentage of people who die by suicide had seen a healthcare provider in the week prior?** - A\) 10% - B\) 25% - C\) 38% - D\) 50% **Answer: C) 38%** **[PTSD]** **Diagnostic Criteria & Prevalence Questions** 1. **At what age must symptoms appear for a diagnosis of Reactive Attachment Disorder (RAD)?** - A\) Before 6 months - B\) Before 9 months - C\) Before 5 years - D\) Before 10 years **Answer: C) Before 5 years** 2. **What is the minimum developmental age required for a diagnosis of Disinhibited Social Engagement Disorder (DSED)?** - A\) 6 months - B\) 9 months - C\) 12 months - D\) 24 months **Answer: B) 9 months** 3. **What percentage of children in the U.S. experience at least one traumatic event by age 16?** - A\) 50% - B\) 60% - C\) 66% - D\) 75% **Answer: D) 75%** 4. **Which traumatic event carries the highest risk for developing PTSD?** - A\) War combat - B\) Rape - C\) Car accident - D\) Natural disaster **Answer: B) Rape** *(65% of men, 46% of women develop PTSD following rape)* 5. **What is the PTSD prevalence rate among Vietnam War veterans?** - A\) 9.1% - B\) 13.2% - C\) 18.7% - D\) 25.4% **Answer: C) 18.7%** *(Lifetime prevalence)* **Neurobiological & Psychological Effects of PTSD** 6. **Which brain region is primarily responsible for triggering the fight-or-flight response in PTSD?** - A\) Prefrontal cortex - B\) Amygdala - C\) Hippocampus - D\) Thalamus **Answer: B) Amygdala** 7. **Which brain structure is responsible for memory processing and is often affected in PTSD?** - A\) Amygdala - B\) Hippocampus - C\) Prefrontal cortex - D\) Basal ganglia **Answer: B) Hippocampus** 8. **Which neurotransmitter is primarily involved in hyperarousal symptoms in PTSD?** - A\) Dopamine - B\) Serotonin - C\) Norepinephrine - D\) GABA **Answer: C) Norepinephrine** 9. **Which cognitive function is often impaired in individuals with PTSD due to prefrontal cortex dysfunction?** - A\) Memory recall - B\) Emotional regulation - C\) Language processing - D\) Motor coordination **Answer: B) Emotional regulation** 10. **Which language center in the brain is affected in PTSD, making it difficult for patients to articulate their experiences?** - A\) Broca's area - B\) Wernicke's area - C\) Basal ganglia - D\) Cerebellum **Answer: A) Broca's area** **PTSD Diagnosis & Risk Factors** 11. **How long must symptoms persist for a PTSD diagnosis?** - A\) 1 week - B\) 2 weeks - C\) 1 month - D\) 3 months **Answer: C) 1 month** 12. **Which of the following is NOT a diagnostic criterion for PTSD?** - A\) Intrusive symptoms - B\) Depersonalization - C\) Avoidance behaviors - D\) Hyperarousal **Answer: B) Depersonalization** *(A feature of **Dissociative PTSD**, but not required for standard PTSD diagnosis)* 13. **Which risk factor is most associated with chronic PTSD?** - A\) Lack of social support - B\) Male gender - C\) Low emotional intelligence - D\) Frequent nightmares **Answer: A) Lack of social support** 14. **Which internal trigger is most commonly associated with PTSD flashbacks?** - A\) Loud noises - B\) Certain smells - C\) Increased heart rate - D\) Physical pain **Answer: C) Increased heart rate** *(Triggers physiological memories of trauma)* 15. **Which peritraumatic factor significantly increases the likelihood of developing PTSD?** - A\) Low education level - B\) Dissociation at the time of trauma - C\) Male gender - D\) Having pre-existing OCD **Answer: B) Dissociation at the time of trauma** **PTSD Treatments & Pharmacology** 16. **Which two SSRIs are FDA-approved for PTSD?** - A\) Sertraline & Paroxetine - B\) Fluoxetine & Escitalopram - C\) Venlafaxine & Bupropion - D\) Trazodone & Mirtazapine **Answer: A) Sertraline & Paroxetine** 17. **Which medication is most effective for treating PTSD-related nightmares?** - A\) Fluoxetine - B\) Prazosin - C\) Clonidine - D\) Trazodone **Answer: B) Prazosin** 18. **Which medication is used off-label to reduce PTSD hyperarousal if given immediately after trauma?** - A\) Propranolol - B\) Bupropion - C\) Diazepam - D\) Ketamine **Answer: A) Propranolol** *(Beta-blockers may reduce consolidation of traumatic memories)* 19. **Which psychotherapy is the most widely used trauma-focused therapy for PTSD?** - A\) DBT - B\) EMDR - C\) Psychoanalysis - D\) Exposure Therapy **Answer: D) Exposure Therapy** *(Includes **Prolonged Exposure Therapy** techniques like script reading, VR, and real-world exposure)* 20. **Which PTSD therapy involves bilateral eye movements to process trauma?** - A\) EMDR - B\) CBT - C\) Biofeedback - D\) Mindfulness **Answer: A) EMDR** **Other Trauma & Stressor-Related Disorders** 21. **How does Acute Stress Disorder differ from PTSD?** - A\) Symptoms last **less than** 1 month - B\) Symptoms appear **immediately** after trauma - C\) Symptoms include hallucinations - D\) Treatment is different from PTSD **Answer: A) Symptoms last less than 1 month** 22. **Which disorder is commonly diagnosed following a major life stressor but does not meet PTSD criteria?** - A\) Acute Stress Disorder - B\) Dissociative Disorder - C\) Adjustment Disorder - D\) Panic Disorder **Answer: C) Adjustment Disorder** 23. **What is the maximum duration for an acute Adjustment Disorder?** - A\) 3 months - B\) 6 months - C\) 12 months - D\) Indefinite **Answer: B) 6 months** *(Chronic if \>6 months)* 24. **Which therapy is most effective for treating PTSD in children?** - A\) EMDR - B\) TF-CBT - C\) DBT - D\) Exposure Therapy **Answer: B) TF-CBT** *(Trauma-Focused CBT is first-line for pediatric PTSD)* 25. **Which class of medications should be avoided after trauma due to increased PTSD risk?** - A\) SSRIs - B\) Benzodiazepines - C\) Beta-blockers - D\) Mood stabilizers **Answer: B) Benzodiazepines** *(Interferes with fear extinction & may worsen PTSD)* **Neurobiology & Pathophysiology of PTSD** 1. **Which brain structure remains \"timeless\" in PTSD?** - A\) Hippocampus - B\) Amygdala - C\) Prefrontal cortex - D\) Thalamus **Answer: B) Amygdala** 2. **Which neurotransmitter is elevated in PTSD and responsible for hypervigilance and startle response?** - A\) Dopamine - B\) Serotonin - C\) Norepinephrine - D\) GABA **Answer: C) Norepinephrine** 3. **Which brain structure is offline in PTSD?** - A\) Prefrontal cortex - B\) Amygdala - C\) Hippocampus - D\) Cerebellum **Answer: A) Prefrontal cortex** 4. **What hormone is dysregulated in PTSD, leading to chronic hyperarousal and stress reactivity?** - A\) Dopamine - B\) Cortisol - C\) Serotonin - D\) Oxytocin **Answer: B) Cortisol** 5. **Which structure in PTSD is responsible for memory fragmentation and flashbacks?** - A\) Hippocampus - B\) Amygdala - C\) Basal ganglia - D\) Prefrontal cortex **Answer: A) Hippocampus** **PTSD Triggers & Risk Factors** 6. **Which internal trigger is a hallmark of PTSD and can cause re-experiencing symptoms?** - A\) Loud noises - B\) Increased heart rate - C\) Flashing lights - D\) Specific colors **Answer: B) Increased heart rate** 7. **Which factor is the strongest predictor of PTSD development after trauma?** - A\) Severity of trauma - B\) Dissociation at the time of trauma - C\) Gender - D\) Socioeconomic status **Answer: B) Dissociation at the time of trauma** 8. **Which population is at highest risk for PTSD following trauma exposure?** - A\) Young children - B\) Combat veterans - C\) Women survivors of rape - D\) First responders **Answer: C) Women survivors of rape** *(65% of men and 46% of women who experience rape develop PTSD)* 9. **What is the lifetime prevalence of PTSD among U.S. combat veterans?** - A\) 9.1% - B\) 13.2% - C\) 18.7% - D\) 20.5% **Answer: C) 18.7%** *(Among Vietnam veterans)* 10. **Which peritraumatic factor is associated with increased PTSD risk?** - A\) High intelligence - B\) Strong emotional resilience - C\) Panic attack during trauma - D\) Military training **Answer: C) Panic attack during trauma** *(Excessive peritraumatic physiological activation increases PTSD risk)* **PTSD Diagnosis & Clinical Features** 11. **What is the minimum duration of PTSD symptoms required for diagnosis?** - A\) 1 week - B\) 2 weeks - C\) 1 month - D\) 3 months **Answer: C) 1 month** 12. **Which of the following does NOT count as a PTSD-qualifying trauma?** - A\) Witnessing a murder - B\) Repeated exposure to violent images on social media - C\) Experiencing sexual assault - D\) Being a first responder at a mass casualty event **Answer: B) Repeated exposure to violent images on social media** *(Unless work-related, like for first responders)* 13. **Which of the following is a required intrusion symptom for PTSD diagnosis?** - A\) Emotional numbness - B\) Flashbacks - C\) Sleep disturbances - D\) Social withdrawal **Answer: B) Flashbacks** 14. **What is the most common comorbid disorder in individuals with PTSD?** - A\) Bipolar disorder - B\) Substance use disorder - C\) Schizophrenia - D\) Autism spectrum disorder **Answer: B) Substance use disorder** *(PTSD patients are 3x more likely to have SUD)* 15. **Which symptom is required in PTSD to meet the negative cognition and mood criteria?** - A\) Hyperarousal - B\) Emotional detachment - C\) Increased startle response - D\) Avoidance of social situations **Answer: B) Emotional detachment** **PTSD Treatment & Management** 16. **Which first-line pharmacologic treatment is FDA-approved for PTSD?** - A\) Fluoxetine - B\) Sertraline - C\) Venlafaxine - D\) Mirtazapine **Answer: B) Sertraline** *(Along with Paroxetine, these are FDA-approved for PTSD)* 17. **Which medication is most effective for PTSD-related nightmares?** - A\) Prazosin - B\) Diazepam - C\) Gabapentin - D\) Buspirone **Answer: A) Prazosin** *(Reduces trauma-related nightmares and hyperarousal)* 18. **Which class of medication should NOT be used to treat PTSD due to worsening symptoms?** - A\) SSRIs - B\) Beta-blockers - C\) Benzodiazepines - D\) Antipsychotics **Answer: C) Benzodiazepines** *(Interfere with fear extinction and worsen PTSD prognosis)* 19. **Which non-pharmacologic therapy is considered first-line for PTSD?** - A\) Cognitive Behavioral Therapy (CBT) - B\) Dialectical Behavioral Therapy (DBT) - C\) EMDR - D\) Psychoanalysis **Answer: A) Cognitive Behavioral Therapy (CBT)** *(Specifically, Trauma-Focused CBT is first-line)* 20. **Which PTSD therapy involves bilateral eye movements to reduce trauma-related distress?** - A\) Exposure therapy - B\) EMDR - C\) Biofeedback - D\) DBT **Answer: B) EMDR** **Other Trauma & Stressor-Related Disorders** 21. **How does Acute Stress Disorder (ASD) differ from PTSD?** - A\) Symptoms last **less than** 1 month - B\) Symptoms appear **immediately** after trauma - C\) Symptoms include psychotic features - D\) ASD requires hospitalization **Answer: A) Symptoms last less than 1 month** 22. **Which disorder presents with PTSD-like symptoms but does NOT meet full PTSD criteria?** - A\) Panic disorder - B\) Generalized anxiety disorder - C\) Adjustment disorder - D\) Major depressive disorder **Answer: C) Adjustment disorder** 23. **Which treatment is most effective for treating PTSD in children?** - A\) EMDR - B\) TF-CBT - C\) Psychoanalysis - D\) Exposure therapy **Answer: B) TF-CBT** *(Trauma-Focused CBT is first-line for pediatric PTSD)* 24. **Which trauma-related disorder is most likely to develop before age 5?** - A\) PTSD - B\) Acute Stress Disorder - C\) Reactive Attachment Disorder - D\) Adjustment Disorder **Answer: C) Reactive Attachment Disorder** 25. **Which therapy is contraindicated in PTSD treatment because it may increase distress?** - A\) EMDR - B\) Group therapy - C\) Exposure therapy - D\) Mandatory debriefing **Answer: D) Mandatory debriefing** *(Required debriefing can re-traumatize patients)* **[DEPRESSION]** **Epidemiology & Risk Factors** 1. **What percentage of primary care patients present with depressive symptoms?** - A\) 10% - B\) 20% - C\) 30% - D\) 40% **Answer: C) 30%** 2. **What factor was associated with a seven-fold increase in depression in certain European and Asian communities?** - A\) War - B\) COVID-19 pandemic - C\) Economic recession - D\) Urbanization **Answer: B) COVID-19 pandemic** 3. **What financial factor was identified as a significant risk for depressive symptoms in U.S. national surveys?** - A\) Student loan debt - B\) \< \$5000 in savings - C\) Mortgage foreclosure - D\) Bankruptcy history **Answer: B) \< \$5000 in savings** 4. **Which demographic is at highest risk for completed suicide in depression?** - A\) Women under 30 - B\) Men over 50 - C\) Adolescents aged 15-19 - D\) Women with postpartum depression **Answer: B) Men over 50** 5. **Which chronic medical condition is most associated with depression?** - A\) Hypertension - B\) Diabetes - C\) Cancer - D\) Chronic pain **Answer: D) Chronic pain** **Diagnosis & Clinical Features** 6. **How many DSM-5 criteria must be met for a Major Depressive Disorder (MDD) diagnosis?** - A\) 3 - B\) 4 - C\) 5 - D\) 6 **Answer: C) 5** *(At least one must be depressed mood or anhedonia)* 7. **How long must symptoms persist to diagnose Major Depressive Disorder (MDD)?** - A\) 5 days - B\) 2 weeks - C\) 1 month - D\) 6 months **Answer: B) 2 weeks** 8. **Which feature distinguishes melancholic depression from atypical depression?** - A\) Mood reactivity - B\) Prominent anhedonia - C\) Increased appetite - D\) Increased sleep **Answer: B) Prominent anhedonia** 9. **Which tool is a validated two-question screening for depression?** - A\) PHQ-2 - B\) PHQ-9 - C\) Hamilton Rating Scale - D\) Columbia-Suicide Severity Scale **Answer: A) PHQ-2** 10. **Which depressive disorder is defined by chronic low mood lasting at least 2 years?** - A\) Bipolar disorder - B\) Cyclothymia - C\) Persistent depressive disorder - D\) Adjustment disorder **Answer: C) Persistent depressive disorder** *(Dysthymia)* **Differential Diagnosis & Medical Causes** 11. **Which endocrine disorder is most frequently mistaken for Major Depressive Disorder?** - A\) Diabetes - B\) Hypothyroidism - C\) Addison's disease - D\) Hyperparathyroidism **Answer: B) Hypothyroidism** 12. **Which psychiatric condition must be ruled out before diagnosing MDD?** - A\) Schizophrenia - B\) Bipolar disorder - C\) Panic disorder - D\) OCD **Answer: B) Bipolar disorder** *(A history of mania rules out MDD, indicating bipolar disorder instead.)* 13. **Which of the following medications is most commonly linked to drug-induced depression?** - A\) Lisinopril - B\) Metformin - C\) Corticosteroids - D\) Atorvastatin **Answer: C) Corticosteroids** 14. **Which laboratory test should be ordered to rule out organic causes of depressive symptoms?** - A\) TSH - B\) ESR - C\) CPK - D\) ANA **Answer: A) TSH** *(To rule out hypothyroidism as a cause of depressive symptoms.)* 15. **Which psychiatric condition commonly coexists with depression and increases suicide risk?** - A\) OCD - B\) PTSD - C\) Generalized Anxiety Disorder - D\) Panic Disorder **Answer: C) Generalized Anxiety Disorder** *(Frequently comorbid with MDD.)* **Treatment & Management** 16. **Which two SSRIs are considered first-line for treating Major Depressive Disorder?** - A\) Fluoxetine & Sertraline - B\) Paroxetine & Bupropion - C\) Mirtazapine & Venlafaxine - D\) Duloxetine & Trazodone **Answer: A) Fluoxetine & Sertraline** 17. **Which antidepressant is preferred for atypical depression due to its stimulating effects?** - A\) Sertraline - B\) Bupropion - C\) Mirtazapine - D\) Amitriptyline **Answer: B) Bupropion** *(Activating and does not cause weight gain or sedation.)* 18. **What is the minimum duration a patient should continue antidepressants after achieving remission?** - A\) 2 months - B\) 6 months - C\) 12 months - D\) 2 years **Answer: C) 12 months** 19. **Which class of antidepressants is associated with significant dietary restrictions due to hypertensive crisis risk?** - A\) SSRIs - B\) TCAs - C\) MAOIs - D\) SNRIs **Answer: C) MAOIs** *(Patients must avoid tyramine-rich foods.)* 20. **Which therapy has the highest remission rate for psychotic depression?** - A\) CBT - B\) SSRI + Antipsychotic - C\) Electroconvulsive therapy - D\) Transcranial magnetic stimulation **Answer: C) Electroconvulsive therapy** *(Remission rates between 60%-90%.)* **Suicide Risk & Prevention** 21. **Which antidepressant class has the highest risk of overdose-related fatality?** - A\) SSRIs - B\) SNRIs - C\) TCAs - D\) Atypical antidepressants **Answer: C) TCAs** *(Cardiotoxicity in overdose.)* 22. **Which suicide assessment tool is recommended for clinical screening?** - A\) MMSE - B\) PHQ-9 - C\) Columbia-Suicide Severity Scale - D\) Hamilton Depression Rating Scale **Answer: C) Columbia-Suicide Severity Scale** 23. **Which question is most useful in assessing imminent suicide risk?** - A\) Have you ever thought about suicide? - B\) How long do you think about suicide each day? - C\) Do you have access to firearms? - D\) Have you ever attempted suicide? **Answer: B) How long do you think about suicide each day?** *(\>1 hour per day indicates high risk.)* 24. **What is the most common method of completed suicide in men?** - A\) Poisoning - B\) Firearms - C\) Hanging - D\) Drowning **Answer: B) Firearms** 25. **What is the recommended time frame for medication follow-up after starting an antidepressant?** - A\) 3 days - B\) 1 week - C\) 2 weeks - D\) 6 weeks **Answer: C) 2 weeks** *(To monitor for side effects, suicidality, and early response.)* **Pathophysiology & Neurobiology of Depression** 1. **Which neurotransmitter is most directly linked to anhedonia in Major Depressive Disorder?** - A\) Serotonin - B\) Dopamine - C\) Norepinephrine - D\) GABA **Answer: B) Dopamine** 2. **Which brain region is most associated with dysregulated emotional processing in depression?** - A\) Amygdala - B\) Hippocampus - C\) Prefrontal cortex - D\) Basal ganglia **Answer: A) Amygdala** 3. **Which brain structure is responsible for memory formation and is often reduced in volume in depressed patients?** - A\) Prefrontal cortex - B\) Hippocampus - C\) Amygdala - D\) Hypothalamus **Answer: B) Hippocampus** 4. **Which hormonal system is dysregulated in depression, leading to increased cortisol levels?** - A\) Dopaminergic system - B\) HPA axis - C\) Mesolimbic pathway - D\) Renin-angiotensin system **Answer: B) HPA axis** 5. **Which neurotrophic factor is reduced in depression and is thought to contribute to neuronal atrophy?** - A\) NGF - B\) BDNF - C\) VEGF - D\) EGF **Answer: B) BDNF** *(Brain-Derived Neurotrophic Factor is reduced in MDD, impairing neuroplasticity.)* **Clinical Features & Diagnostic Specifics** 6. **Which subtype of major depression is associated with mood reactivity, hypersomnia, and increased appetite?** - A\) Melancholic depression - B\) Atypical depression - C\) Seasonal affective disorder - D\) Psychotic depression **Answer: B) Atypical depression** 7. **What percentage of weight change (gain or loss) in one month qualifies as a diagnostic criterion for MDD?** - A\) 2% - B\) 3% - C\) 5% - D\) 10% **Answer: C) 5%** 8. **Which depressive disorder is defined by low mood occurring for at least 2 years, with symptom-free periods never exceeding 2 months?** - A\) Adjustment disorder - B\) Major Depressive Disorder - C\) Persistent Depressive Disorder - D\) Bipolar II Disorder **Answer: C) Persistent Depressive Disorder** *(Dysthymia.)* 9. **Which subtype of depression is most responsive to Electroconvulsive Therapy (ECT)?** - A\) Melancholic depression - B\) Atypical depression - C\) Psychotic depression - D\) Seasonal affective disorder **Answer: C) Psychotic depression** *(ECT has a remission rate of 60-90% for psychotic MDD.)* 10. **What is the best clinical distinction between grief and MDD?** - A\) Duration of symptoms - B\) Presence of psychotic features - C\) Ability to experience positive emotions - D\) Degree of suicidal ideation **Answer: C) Ability to experience positive emotions** *(Grief allows intermittent positive emotions; MDD does not.)* **Differential Diagnosis & Comorbid Conditions** 11. **Which psychiatric disorder is most frequently comorbid with Major Depressive Disorder?** - A\) PTSD - B\) OCD - C\) Generalized Anxiety Disorder - D\) Bipolar Disorder **Answer: C) Generalized Anxiety Disorder** 12. **Which symptom is least likely to be seen in depression caused by hypothyroidism?** - A\) Weight gain - B\) Cold intolerance - C\) Early morning awakening - D\) Fatigue **Answer: C) Early morning awakening** *(Seen in MDD but less common in hypothyroidism.)* 13. **Which of the following medical conditions is most strongly associated with depression?** - A\) Hypertension - B\) Rheumatoid arthritis - C\) Stroke - D\) Asthma **Answer: C) Stroke** *(Post-stroke depression is common and impairs recovery.)* 14. **Which drug class is most commonly associated with medication-induced depression?** - A\) Beta-blockers - B\) Benzodiazepines - C\) Corticosteroids - D\) NSAIDs **Answer: C) Corticosteroids** *(Known to cause mood disturbances.)* 15. **Which personality disorder is most commonly associated with chronic depression?** - A\) Antisocial Personality Disorder - B\) Narcissistic Personality Disorder - C\) Borderline Personality Disorder - D\) Schizoid Personality Disorder **Answer: C) Borderline Personality Disorder** *(High rates of chronic depression and suicidality.)* **Treatment & Pharmacology** 16. **Which SSRI is the safest option in patients at high risk for drug interactions?** - A\) Fluoxetine - B\) Sertraline - C\) Paroxetine - D\) Fluvoxamine **Answer: B) Sertraline** *(Least cytochrome P450 inhibition.)* 17. **Which antidepressant is best for patients with sexual dysfunction due to SSRI use?** - A\) Venlafaxine - B\) Bupropion - C\) Mirtazapine - D\) Citalopram **Answer: B) Bupropion** *(No sexual side effects, can even enhance libido.)* 18. **Which antidepressant has the highest risk of weight gain?** - A\) Fluoxetine - B\) Bupropion - C\) Mirtazapine - D\) Sertraline **Answer: C) Mirtazapine** *(Causes increased appetite and sedation.)* 19. **Which medication class is most associated with an increased risk of suicide in children and adolescents?** - A\) SSRIs - B\) SNRIs - C\) MAOIs - D\) TCAs **Answer: A) SSRIs** *(FDA black box warning for increased suicidality in patients \< 24 years.)* 20. **Which treatment is most effective for treatment-resistant depression?** - A\) SSRI + SNRI combination - B\) TMS - C\) Electroconvulsive Therapy (ECT) - D\) High-dose Bupropion **Answer: C) Electroconvulsive Therapy (ECT)** *(Most effective for treatment-resistant cases.)* **Suicide Risk & Prevention** 21. **Which antidepressant class has the highest lethality in overdose?** - A\) SSRIs - B\) MAOIs - C\) TCAs - D\) SNRIs **Answer: C) TCAs** *(High cardiac toxicity in overdose.)* 22. **Which question is most predictive of imminent suicide risk?** - A\) Have you ever attempted suicide? - B\) How often do you think about suicide? - C\) Do you have a plan to harm yourself? - D\) How do you feel about the future? **Answer: C) Do you have a plan to harm yourself?** *(Plan + intent = highest risk.)* 23. **What percentage of individuals who die by suicide have a history of prior attempt?** - A\) 20% - B\) 30% - C\) 50% - D\) 70% **Answer: C) 50%** **[DEPRESSION]** **Epidemiology & Risk Factors** 1. **At what age range do most cases of bipolar disorder first present?** - A\) 5-10 years - B\) 15-19 years - C\) 25-30 years - D\) 35-40 years **Answer: B) 15-19 years** *(Second most common onset: 20-24 years.)* 2. **What is the relative risk of developing bipolar disorder if a first-degree relative has the condition?** - A\) 3x - B\) 5x - C\) 7x - D\) 10x **Answer: C) 7x** 3. **Which form of bipolar disorder has the highest risk of suicide?** - A\) Bipolar I - B\) Bipolar II - C\) Cyclothymia - D\) Rapid cycling bipolar **Answer: D) Rapid cycling bipolar** *(More refractory, higher risk of completed suicide.)* 4. **Which feature is associated with a higher suicide risk in bipolar disorder?** - A\) History of hospitalization - B\) Mixed episode - C\) Family history of anxiety disorder - D\) History of stimulant use **Answer: B) Mixed episode** 5. **What percentage of bipolar disorder patients have a lifetime history of substance use disorder?** - A\) 40% - B\) 50% - C\) 61% - D\) 75% **Answer: C) 61%** **Bipolar Disorder Types & Diagnosis** 6. **How long must a manic episode last to meet DSM-5 criteria for Bipolar I disorder?** - A\) 2 days - B\) 4 days - C\) 1 week - D\) 2 weeks **Answer: C) 1 week** *(Or any duration if hospitalization is required.)* 7. **What is the minimum duration for a hypomanic episode in Bipolar II disorder?** - A\) 1 day - B\) 2 days - C\) 4 days - D\) 7 days **Answer: C) 4 days** 8. **Which symptom must never be present for a Bipolar II diagnosis?** - A\) Psychotic features - B\) Increased energy - C\) Impulsivity - D\) Rapid speech **Answer: A) Psychotic features** *(Presence of psychosis classifies as Bipolar I.)* 9. **Which disorder is characterized by at least 2 years of cycling hypomanic and depressive symptoms that never meet full criteria for hypomania or major depression?** - A\) Persistent depressive disorder - B\) Cyclothymic disorder - C\) Bipolar I disorder - D\) Bipolar II disorder **Answer: B) Cyclothymic disorder** 10. **How many discrete affective episodes per year define rapid cycling bipolar disorder?** - A\) 2 - B\) 3 - C\) 4 - D\) 5 **Answer: C) 4** **Neurobiology & Pathophysiology** 11. **Which neurotransmitter is primarily responsible for elevated mood during mania?** - A\) Dopamine - B\) GABA - C\) Serotonin - D\) Acetylcholine **Answer: A) Dopamine** 12. **Which phenomenon explains why earlier and more frequent bipolar episodes lead to more severe and persistent illness?** - A\) Kindling effect - B\) Dopaminergic surge - C\) HPA axis dysfunction - D\) Genetic anticipation **Answer: A) Kindling effect** 13. **Which brain region is hyperactive in mania and hypoactive in depression?** - A\) Hippocampus - B\) Amygdala - C\) Prefrontal cortex - D\) Basal ganglia **Answer: B) Amygdala** 14. **Which factor is most strongly associated with inducing a first manic episode?** - A\) High caffeine intake - B\) Social isolation - C\) Stressful life event - D\) Antidepressant use **Answer: C) Stressful life event** *(Major triggers include university, new job, marriage, or excessive stimulation.)* 15. **Which pathway is dysregulated in bipolar neuroinflammation theory?** - A\) HPA axis - B\) Mesolimbic dopamine system - C\) Glutamatergic system - D\) TNF-alpha pathway **Answer: D) TNF-alpha pathway** *(Elevated pro-inflammatory cytokines in BPD.)* **Treatment & Pharmacology** 16. **Which mood stabilizer is considered the gold standard for Bipolar I disorder?** - A\) Valproate - B\) Carbamazepine - C\) Lamotrigine - D\) Lithium **Answer: D) Lithium** 17. **What is the target lithium serum trough level for maintenance therapy?** - A\) 0.3--0.8 mmol/L - B\) 0.6--1.2 mmol/L - C\) 1.2--1.5 mmol/L - D\) 1.5--2.0 mmol/L **Answer: B) 0.6--1.2 mmol/L** 18. **Which life-threatening cardiac defect is associated with lithium exposure in pregnancy?** - A\) Tetralogy of Fallot - B\) Coarctation of the aorta - C\) Ebstein's anomaly - D\) Hypoplastic left heart syndrome **Answer: C) Ebstein's anomaly** *(Tricuspid valve defect.)* 19. **Which mood stabilizer is preferred in rapid cycling bipolar disorder?** - A\) Lithium - B\) Valproate - C\) Lamotrigine - D\) Carbamazepine **Answer: B) Valproate** *(More effective than lithium in rapid cycling.)* 20. **Which mood stabilizer requires HLA-B\*1502 screening in Asian populations due to Stevens-Johnson Syndrome risk?** - A\) Lithium - B\) Valproate - C\) Carbamazepine - D\) Lamotrigine **Answer: C) Carbamazepine** **Adverse Effects & Drug Monitoring** 21. **Which mnemonic is used for lithium's major toxicities?** - A\) DIG FAST - B\) LMNOP - C\) SIG E CAPS - D\) ABCD **Answer: B) LMNOP** *(Lithium toxicity: Movement, Nephrotoxicity, hypOthyroidism, Pregnancy risk.)* 22. **Which anticonvulsant mood stabilizer is most associated with weight gain?** - A\) Lamotrigine - B\) Valproate - C\) Carbamazepine - D\) Lithium **Answer: B) Valproate** *(Significant weight gain and metabolic syndrome risk.)* 23. **Which drug class increases lithium levels and raises risk of toxicity?** - A\) Loop diuretics - B\) NSAIDs - C\) Beta-blockers - D\) Calcium channel blockers **Answer: B) NSAIDs** *(Except aspirin.)* 24. **Which lab test should be obtained before starting lithium therapy?** - A\) ALT - B\) TSH - C\) CK - D\) D-dimer **Answer: B) TSH** *(Lithium can induce hypothyroidism.)* **Epidemiology & Risk Factors** 1. **What percentage of the general population has Bipolar I disorder?** - A\) 0.5% - B\) 1% - C\) 2% - D\) 5% **Answer: B) 1%** 2. **Which major life event is most commonly associated with the onset of the first manic episode?** - A\) Divorce - B\) Starting college - C\) Death of a loved one - D\) Chronic illness diagnosis **Answer: B) Starting college** *(Stressful transitions trigger first manic episodes.)* 3. **Which personality disorder is most commonly comorbid with Bipolar I disorder?** - A\) Narcissistic - B\) Borderline - C\) Schizotypal - D\) Avoidant **Answer: B) Borderline** 4. **What is the strongest genetic risk factor for developing bipolar disorder?** - A\) First-degree relative with bipolar disorder - B\) Family history of schizophrenia - C\) Family history of major depressive disorder - D\) Childhood ADHD **Answer: A) First-degree relative with bipolar disorder** *(7x increased risk.)* 5. **What percentage of patients with bipolar disorder attempt suicide at least once?** - A\) 10% - B\) 25% - C\) 50% - D\) 70% **Answer: C) 50%** **Bipolar Subtypes & Diagnostic Criteria** 6. **What is the required duration of mood symptoms in cyclothymic disorder?** - A\) 6 months - B\) 1 year - C\) 2 years - D\) 5 years **Answer: C) 2 years** *(1 year in children/adolescents.)* 7. **Which bipolar subtype has the worst long-term prognosis?** - A\) Bipolar I - B\) Bipolar II - C\) Rapid cycling bipolar - D\) Cyclothymic disorder **Answer: C) Rapid cycling bipolar** *(More refractory, harder to treat.)* 8. **Which bipolar disorder specifier is characterized by 4+ affective episodes per year?** - A\) Mixed features - B\) Rapid cycling - C\) Bipolar with psychotic features - D\) Bipolar with anxious distress **Answer: B) Rapid cycling** 9. **Which symptom must be present for Bipolar I but not Bipolar II?** - A\) Impulsivity - B\) Hypersexuality - C\) Psychosis - D\) Increased energy **Answer: C) Psychosis** *(Manic episodes in Bipolar I may include psychotic symptoms.)* 10. **Which bipolar disorder is most commonly misdiagnosed as major depressive disorder?** - A\) Bipolar I - B\) Bipolar II - C\) Cyclothymic disorder - D\) Rapid cycling bipolar **Answer: B) Bipolar II** *(Often presents with recurrent depression.)* **Pathophysiology & Neurotransmitters** 11. **Which neurotransmitter is elevated in mania and depleted in depression?** - A\) Serotonin - B\) Dopamine - C\) GABA - D\) Acetylcholine **Answer: B) Dopamine** 12. **Which neurotransmitter is low in both manic and depressive episodes of bipolar disorder?** - A\) Dopamine - B\) GABA - C\) Serotonin - D\) Glutamate **Answer: C) Serotonin** 13. **Which brain region is hypoactive in depression and hyperactive in mania?** - A\) Amygdala - B\) Prefrontal cortex - C\) Hippocampus - D\) Thalamus **Answer: A) Amygdala** 14. **Which inflammatory marker is elevated in bipolar disorder?** - A\) IL-6 - B\) CRP - C\) TNF-alpha - D\) All of the above **Answer: D) All of the above** *(Neuroinflammation is a key theory in bipolar disorder.)* 15. **What is the kindling hypothesis in bipolar disorder?** - A\) Recurrent episodes become progressively severe - B\) Stress hormones trigger mood instability - C\) Dopamine surges worsen with age - D\) Sleep disruption leads to mood episodes **Answer: A) Recurrent episodes become progressively severe** **Bipolar Treatment & Medications** 16. **Which mood stabilizer has the best evidence for reducing suicide risk?** - A\) Lithium - B\) Valproate - C\) Carbamazepine - D\) Lamotrigine **Answer: A) Lithium** *(Only mood stabilizer with proven anti-suicidal effects.)* 17. **What is the therapeutic range for lithium maintenance therapy?** - A\) 0.3--0.6 mmol/L - B\) 0.6--1.2 mmol/L - C\) 1.2--1.8 mmol/L - D\) 1.8--2.2 mmol/L **Answer: B) 0.6--1.2 mmol/L** 18. **Which side effect of lithium is irreversible with long-term use?** - A\) Hypothyroidism - B\) Diabetes insipidus - C\) Tremor - D\) Nausea **Answer: B) Diabetes insipidus** *(Nephrogenic DI due to renal impairment.)* 19. **Which mood stabilizer is best for bipolar depression?** - A\) Lithium - B\) Valproate - C\) Lamotrigine - D\) Carbamazepine **Answer: C) Lamotrigine** *(Best for **bipolar depression**, NOT mania.)* 20. **Which drug class should be avoided as monotherapy in bipolar disorder due to risk of mania?** - A\) SSRIs - B\) Benzodiazepines - C\) Antipsychotics - D\) Beta-blockers **Answer: A) SSRIs** *(Antidepressant monotherapy can induce mania.)* **Drug Monitoring & Lithium Toxicity** 21. **Which drug class increases lithium levels, raising toxicity risk?** - A\) NSAIDs - B\) Beta-blockers - C\) SSRIs - D\) Calcium channel blockers **Answer: A) NSAIDs** *(Except aspirin.)* 22. **Which cardiac defect is associated with lithium exposure in pregnancy?** - A\) Tetralogy of Fallot - B\) Ebstein's anomaly - C\) Coarctation of the aorta - D\) Patent ductus arteriosus **Answer: B) Ebstein's anomaly** 23. **Which test must be routinely monitored in lithium patients?** - A\) Liver function tests - B\) Creatinine - C\) White blood cell count - D\) Hemoglobin A1c **Answer: B) Creatinine** *(Lithium can cause renal impairment.)* 24. **Which anticonvulsant mood stabilizer requires monitoring for pancreatitis?** - A\) Valproate - B\) Carbamazepine - C\) Lamotrigine - D\) Topiramate **Answer: A) Valproate** *(Monitor **lipase** and **LFTs**.)*