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Select the ONE answer that is BEST in each case.
A 34-year-old woman suffering from severe depression and chronic renal failure is a candidate for electroconvulsive therapy (ECT). Which test listed below can be used to monitor the patient’s depressive symptoms with the greatest reliability and validity?
The Beck Depression Inventory is a widely used test that allows clinicians to follow the severity of previously diagnosed depression. The TAT, Rorschach Test, and Draw-a-Person Test are all types of projective testing. Projective tests, although useful clinical tools, often suffer low reliability and validity. Projective tests require a person skilled at this type of evaluation and often do not have rigorous empirical data and group comparison. The evaluation of depression in relation to the Halstead-Reitan Test is limited by the fact that many depressed patients fail to show deficits on such classic neuropsychological batteries. In addition, these tests, even when demonstrating deficits in cognitive domains such as attention and learning, still have very limited usefulness in evaluating the severity of the depression.
A 34-year-old woman suffering from severe depression and chronic renal failure is a candidate for electroconvulsive therapy (ECT). The most useful test to assess for memory impairments in the setting of ECT is which of the following?
The Brown-Peterson Task is a test specifically designed to evaluate short-term memory, a capacity that can be affected during ECT. The Bulimia Test—Revised and the EDI-2 are both useful for the evaluation of bulimia and eating disorders, respectively. The State-Trait Anxiety Inventory and the Beck Depression Inventory are used to evaluate anxiety disorders and depression, respectively
You admit an 83-year-old widowed White woman for further evaluation because she is no longer able to care for herself at home. She has lost 30 lb in the past year, has poor hygiene, and admits to increasing forgetfulness. A commonly administered screening test to evaluate for dementia is which of the following?
The Folstein MMSE is a frequently used screening assessment for dementia. It is a 30-point scale with deductions for incorrect answers. The Glasgow Coma Scale is an easy-toperform instrument that evaluates level of consciousness. There are three general categories that the examiner tests: eye opening, verbal response, and best motor response. Each category receives a number for patient response. Overall scores range from 3 to 15, with lower scores reflecting more severely impaired consciousness. The Geriatric Rating Scale is a rating scale for nonprofessional staff to evaluate patients’ abilities to perform their activities of daily living and interact with others. It may be most helpful in evaluation of the moderately to severely demented individual. The Blessed Rating Scale is a tool that typically asks a patient’s friends or relatives to assess the ability of the patient to function in his or her current environment. An MSE is the formal psychiatric examination that includes appearance, assessment of mood and affect, presence of psychosis, and evaluation of insight and judgment. It is not a substitute for the Folstein MMSE.
You admit an 83-year-old widowed White woman for further evaluation because she is no longer able to care for herself at home. She has lost 30 lb in the past year, has poor hygiene, and admits to increasing forgetfulness. Another psychiatric diagnosis that may mimic dementia in this patient is which of the following?
When evaluating the total score for dementia, it is critical to consider that depression (also known as pseudodementia) may produce similar scores. The other choices would not decrease the Folstein MMSE score.
A 28-year-old single African American man with a long history of schizophrenia and prominent thought disorganization asks you if there are psychological tests that would demonstrate which part of his brain “isn’t working.” You explain that no test can indicate exactly which part of his brain is different from those without schizophrenia and suggest a certain test to assess his ability to organize and correctly process information. The neuropsychological test you recommend is which of the following?
In the WCST, examinees are asked to sort cards depicting various pictures and symbols according to a variety of different criteria that change over time without the subject knowing. The WCST assesses a person’s ability to switch sets, reason abstractly, and solve problems. These capacities are also known as executive functions and are thought to be localized in the frontal lobes. Current research regarding the psychopathology of schizophrenia suggests that there are abnormalities in the frontal lobes, specifically in the dorsolateral prefrontal cortex, that are reflected in poor performance on the WCST. People with schizophrenia perform more poorly on the WCST than people without schizophrenia; however, individuals with damage to their frontal lobes from a variety of causes also show executive function deficits. The Draw-a-Person Test requires the examinee to draw a person. It was initially devised to test intelligence in children, but is now used primarily as a screening test for brain damage. The Luria-Nebraska Neuropsychological Battery is a comprehensive set of neuropsychological tests used to assess specific cortical areas and aids in assessment of hemispheric dominance. The MMSE is a commonly used scale to assess the possibility of dementia. The Bender Gestalt Test involves copying figures, which helps determine if organic brain disease is present.
A 28-year-old single African American man with a long history of schizophrenia and prominent thought disorganization asks you if there are psychological tests that would demonstrate which part of his brain “isn’t working.” You explain that no test can indicate exactly which part of his brain is different from those without schizophrenia and suggest a certain test to assess his ability to organize and correctly process information. This test assesses which of the following?
While reading a medical journal, you find an article about a new screening test that predicts a patient’s risk for suicide. The authors have shown that high scores on their screening test correlate with an increased risk for completed suicide. Nine months later, another group repeats the study and demonstrates that male patients consistently scored higher on the screening test than female patients. Furthermore, the authors of the second article state that when gender is taken into account, the previously reported correlation between the screening test and increase in suicide rate vanishes. The authors of the second study conclude that this limits the usefulness of the screening test to predict a patient’s risk of suicide. The authors of the initial article regarding the screening test suggested that their test was useful because of which of the following?
Because the screening test seemed to indicate which patients are at a higher risk for completed suicide, it has utility based on its predictive validity. Content validity is a test’s ability to cover the conceptual domain that the test intends to measure. Conceptual domain is usually established by a large group of experts through a wide review of the literature. It is unclear in this case as to whether suicide or depression, critical aspects of this test’s conceptual domain, were adequately addressed. Discriminative validity is the measure of a test’s ability to differentiate between issues that are theoretically unrelated. Reliability is a test’s ability to provide reproducible results. Test-retest reliability measures a test’s reproducibility over a short period of time in a person whose state is assumed not to have fluctuated. Internal reliability evaluates whether the questions within the test are measuring the same thing. Reliability may be a problem with this test, but it is not a concern in determining the test’s usefulness.
While reading a medical journal, you find an article about a new screening test that predicts a patient’s risk for suicide. The authors have shown that high scores on their screening test correlate with an increased risk for completed suicide. Nine months later, another group repeats the study and demonstrates that male patients consistently scored higher on the screening test than female patients. Furthermore, the authors of the second article state that when gender is taken into account, the previously reported correlation between the screening test and increase in suicide rate vanishes. The authors of the second study conclude that this limits the usefulness of the screening test to predict a patient’s risk of suicide. The authors of the second paper faulted the usefulness of this screening tool because of its lack of which of the following?
In this case, the authors of the second study show that the test fails to discriminate suicide risk when gender is removed. Knowing that men are at an increased risk for successful suicide attempts may decrease the test’s usefulness.
A patient is administered a test that consists of viewing a set of 10 inkblots sequentially. The responses to the inkblots are noted by the examiner in relationship to the content of the perception, the area of the blot that forms the basis of the response, and the aspects of the area that are used to form the response. The test being administered is which of the following?
The Rorschach Test was developed in 1921 by Hermann Rorschach. It consists of showing a subject a set of 10 inkblot stimuli in a sequential manner while noting (1) the responses in relationship to the content of the perception, (2) the area of the blot that forms the basis of the response, and (3) the aspects of the area that are used to form the response. The TAT, Sentence Completion Test, and Draw-a-Person Test are similar to the Rorschach in that they are also projective tests. The TAT was developed in the 1930s by Henry Murray and consists of 20 cards featuring ambiguous situations. The subject is asked to develop a narrative based on the scene. In the Sentence Completion Test, the answer is evaluated for its relationship with the stimulus and for content, among other criteria. The Draw-a-Person Test is evaluated in relationship to detail, size of various parts in relationship to one another, and the size of the overall picture. The MMPI-2 consists of true/false questions designed to assess personality characteristics; it is the most widely used and highly standardized test of personality structure.
A patient is administered a test that consists of viewing a set of 10 inkblots sequentially. The responses to the inkblots are noted by the examiner in relationship to the content of the perception, the area of the blot that forms the basis of the response, and the aspects of the area that are used to form the response. This type of projective test is best classified as which of the following?
In 1961, Lindzey proposed a method of classifying projective tests based on the type of activity. The Rorschach is classified in the category of associations. Another test in this category is the Word Association Test. The construction category requires the subject to construct content based on a stimulus such as a story in the TAT. The self-expression category consists of tests such as the Draw-a-Person Test in which the subject produces a response without a stimulus. Tests such as the Sentence Completion Test fall into the category of completions, in which a person completes an uncompleted stimulus. The last category is the choice of ordering in which patients place objects in a rank order with respect to preference.
n 89-year-old married African American woman is admitted to the medical service with a diagnosis of failure to thrive. The team following her has asked you to assess her. In their notes, they observe that the patient is not oriented to time. To evaluate orientation, you perform which of the following?
The Temporal Orientation Test asks the patient to identify the appropriate day, month, day of the week, and current time. Deviation from the correct response is differentially scored in each category. Total score and the data incorrectly identified separate the patients into two groups: patients with brain damage and patients without brain damage. The Temporal Orientation Test is also sensitive to cognitive abnormalities in dementing illnesses. The Spatial Orientation Memory Test evaluates the ability to immediately recall the orientation of figures and is used to evaluate immediate memory. The Stroop Test has a number of different formats, but the general concept is that it takes longer to correctly identify a color than to read words and longer yet to correctly identify a word (e.g., name of a color) when that word is in a color different from that word. This test seems to be primarily an assessment of ability to concentrate. The Fargo Map Test assesses recent and remote spatial memory and visuospatial orientation by using maps of the United States and different regions within it. Patients are asked to identify certain areas. Education level and age influence the score on this test. The WCST is used to evaluate executive functioning of the brain
A 25-year-old single African American woman who carries the diagnosis of dependent personality disorder is referred for psychological testing. Your first consideration is whether to perform a set of projective or objective tests. You decide to perform projective tests because of which of the following reasons?
Objective tests usually involve questionswith lists of possible responses. These testsprovide numerical scores on which statisticalanalyses are easily performed. Examplesinclude the United States Medical LicensingExaminations. Conversely, projective tests usu-ally involve stimuli to which there are a varietyof responses without a single correct answer.Many of these tests, including the RorschachTest, the TAT, the Sentence Completion Test,and the Draw-a-Person Test, require specifictraining in giving the test and interpreting theresults. Projective tests do not necessarily tellthe interviewer how the patient feels abouthim or her.
A 25-year-old single African American woman who carries the diagnosis of dependent personality disorder is referred for psychological testing. Your first consideration is whether to perform a set of projective or objective tests. After performing a battery of projective tests, you chose to continue testing with the MMPI-2. You chose this test because of which of the following reasons?
The MMPI and now the MMPI-2 are objective tests that have been used for over 50 years in the assessment of personality structure. They consist of more than 500 statements, which are condensed into 10 clinical scales. Additionally, questions are asked at the time of examination to evaluate attitudes when taking the test. These questions help to provide information about the validity of the examination. Interpretation of the results requires an experienced evaluator. Together with the clinical history, this test provides valuable information about personality structure. Its accuracy does not depend on the patient’s marital status, and the results do not reflect how the examinee feels about test taking
A 20-year-old college student is referred for testing to evaluate poor academic performance. He reports that he has always “struggled” to pass his classes despite studying for many hours. He attends all of his lectures and is able to pay attention, yet he does not seem to be able to adequately learn the material. While he is very frustrated, he denies significant depression. Which of the following tests would be most appropriate to determine this patient’s problem?
The Wechsler Adult Intelligence Scale was initially published in 1955 and has undergone a series of revisions to reach the current scale, the WAIS-R. The test is composed of 11 different subtests—6 verbal and 5 performance— that allow for the calculation of the full-scale IQ, performance IQ, and verbal IQ. The WAISR has high reliability, which means that in normal subjects retesting does not lead to significantly different evaluations. This means that it can be used to follow people over time. The MMPI-2 is a test used for the assessment of personality structure, and the Draw-a-Person Test is used to evaluate for organic brain disease. The WMT was designed to evaluate a variety of aspects of memory function in adults. None are useful in the determination of IQ.
A 20-year-old college student is referred for testing to evaluate poor academic performance. He reports that he has always “struggled” to pass his classes despite studying for many hours. He attends all of his lectures and is able to pay attention, yet he does not seem to be able to adequately learn the material. While he is very frustrated, he denies significant depression. The IQ is calculated by which of the following formulas?
The IQ is calculated by dividing the mental age by the chronological age and multiplying this by 100.
A 72-year-old man is suspected to have suffered a stroke in his right parietal region. The test most likely to show abnormalities is which of the following?
The Rey-Osterrieth Test is a complex figure that the patient is asked to copy while looking at the figure. The figure is then taken away and the patient is asked to draw the picture from immediate memory. The patient is again asked to draw the figure 5 minutes and 30 minutes after the figure has been removed. The tasks assess visual nonverbal memory. People with right parietal lesions usually show abnormalities in copying the figure correctly by neglecting the items in the left visual field. Conversely, a patient with a right temporal lobectomy may have no difficulty in copying the figure, but show marked abnormalities in drawing the item from memory. The WMT, WCST, MMPI-2, and the Rorschach Test would not be as useful in assessing a right parietal lesion as the ReyOsterrieth figure
A 72-year-old man is suspected to have suffered a stroke in his right parietal region. This test assesses which of the following?
A 70-year-old man with multiple medical problems is suspected to have had a stroke, affecting his ability to speak. The test most likely to adequately describe the nature of the difficulty is which of the following?
The Boston Diagnostic Aphasia Examination is a comprehensive set of tests given by a skilled interviewer to evaluate aphasic disorders and to help define further interventions to improve speech. The Stroop Test aids in the evaluation of concentration. The Folstein MMSE is used for rapid assessment of dementia and delirium. The Bender Gestalt Test is a constructional test for evaluation of brain damage and has some ability to differentiate the location of the lesion. The Sentence Completion Test is a projective test used to describe personality structure.
A compulsive gambler tells her psychiatrist that once she begins to play the slot machines, she cannot stop, particularly if she wins a few times. Which of the following reinforcement schedules best explains the phenomena?
Behavior is most difficult to extinguish when reinforced on a partial rather than continuous schedule. Gambling on a slot machine is even more likely to continue because it is reinforced on a variable-ratio schedule, that is, money is given based on a random (but unknown) number of times.
When an examiner asks a patient to count backward by 7, starting at 100 (referred to as serial sevens), what is principally being tested?
Concentration refers to the ability to sustain focus on a cognitive task. Performing serial sevens and spelling world backward are tests of concentration. Although a certain facility with the remaining choices is necessary to perform each task (no cognitive function is tested in absolute isolation), the serial sevens test provides a window on a patient’s concentration. Remote memory involves the recall of events long past, for example, information from a patient’s childhood. Recent memory is recall of events occurring in the last several minutes. Fund of knowledge is a test of information the patient readily has available to him or her; knowledge of current events is often used to assess this. The MSE often contains tests of mathematics skills, but testing mathematics skills is not the purpose of the serial sevens test. Any test of cognitive function must take into account the patient’s cultural, educational, and social background.
A 39-year-old woman presents to the outpatient mental health clinic at the request of her oncologist 3 weeks after being diagnosed with metastatic breast cancer. The patient denies strong feelings in relation to the diagnosis, but talks a great deal about the epidemiology of breast cancer and the available treatment options. Which of the following defense mechanisms is she using?
Intellectualization is the utilization of abstract thinking to deal with or cover internal or external stressors; in this case, the unacceptable feelings of having cancer. Sublimation is a defense mechanism employed to deal with unacceptable feelings or desires by channeling them into socially acceptable behaviors. Like sublimation, rationalization is a defense against undesired motivations, but in this case, the motivations are concealed by elaborate and reassuring explanations that avoid the actual underlying motives. Dissociation is a defense mechanism that deals with stressors with a breakdown of the usual integration of memory, behavior, and perception. Self-observation is a defense mechanism involving the reflection of one’s own thoughts and behavior with appropriate responses.
A 35-year-old woman presents with episodic anxiety and complains of the occasional feeling that she has heard or perceived things prior to actually hearing them. She expresses her concern that she is “going crazy.” You assure her that this can occur in anxiety disorders. What is this phenomenon called?
Déjà entendu is the feeling that one is hearing something one has heard before. It is usually associated with anxiety states or fatigue. Déjà vu is a similar experience, but refers to the sensation that something has been seen before. Jamais vu is the opposite of déjà vu in that it refers to something that should be familiar but seems quite unfamiliar. Folie à deux is a shared delusion aroused in one person by the influence of another. La belle indifférence is the indifference shown toward a deficit or loss of function classically seen in a conversion disorder.
After being severely reprimanded by his employer, a man goes home and is extremely nasty to his wife. What is his behavior an example of?
The man is naturally angry, anxious, and sensitive at being reprimanded by his employer. He has found it difficult to express his feelings toward the disturbing person, the employer. Instead of suppressing or repressing the anger, or sublimating his tension in more forceful work, he displaces his anger onto a safer target, his wife. This is an example of displacement.
A psychiatrist discovers that she is frustrated and easily angered with one of her patients for no obvious reason. While talking to a colleague, she admits that the patient reminds her of her abusive father. Which of the following best describes the clinician’s reaction?
Transference, in strict terms, is the patient’s reexperiencing of past experiences in the setting of psychoanalytic psychotherapy. Countertransference is the analyst’s (or therapist’s) response to this. These terms have come to mean the transferring of emotions and feelings that one has from one’s past to the other person; in the case of transference, the feelings are experienced in the patient and relate to how he or she feels about the therapist. In the case of countertransference, the feelings are experienced in the analyst or therapist and reflect how he or she feels about the patient. Reaction formation, displacement, and projection are all defense mechanisms used by the ego to keep potentially anxiety-provoking feelings out of awareness. Reaction formation is the formation of thoughts that are opposite to the anxietyprovoking feelings. Displacement is the transferring of a feeling toward an object that is less threatening, as in the family pet or one’s spouse or children. Projection is the false attribution of one’s own unacceptable feelings to another.
A 36-year-old woman was placed on alprazolam (Xanax) 3 years ago for panic disorder. After watching a news report on television, she became frightened about addiction. She abruptly stopped the medication and during the next 3 days experienced increased anxiety attacks, but claims that she is now doing better. She denies any tremor, sweating, increased heart rate, or uneasiness except in relation to the panic attacks. Which of the following best describes this phenomenon?
Rebound is a return of symptoms that are brief and transient and is frequently associated with the abrupt discontinuation of benzodiazepines. Recurrence is the long-term return of the original symptoms. Withdrawal is characterized by a specific set of signs and symptoms specific to a particular substance. These are not necessarily similar to the original symptoms that were being treated by the medication. Akathisia is the subjective sensation of motor and mental restlessness. A dystonic reaction is an increase in muscle rigidity and spasticity that is usually associated with the use of neuroleptics.
A 37-year-old patient presents to your office for the first time for long-term psychotherapy. You decide it would be helpful to compile a personality inventory. You place a set of 10 inkblots in front of the patient and note the responses in terms of the content of the perception and the use of the various areas of the inkblot. To score and interpret this test using a data-based system, one would rely on which of the following?
The test that is being described here is the Rorschach Test. One data-based system used to score and interpret the Rorschach Test is the Exner Comprehensive System. It is limited in its validity and requires highly trained examiners. All of the other choices are types of personality assessment not associated with the Rorschach Test. The Eysenck Personality Questionnaire constructs questions designed to assess aspects of personality predicted to exist by theoretical constructs. The MMPI-2 is the most widely used and highly standardized test of personality. The California Personality Inventory is similar to the MMPI but is used in counseling situations, rather than with pathologic populations.
You are asked to evaluate a 68-year-old man on the inpatient medicine service for increasing confusion. The patient was admitted 2 days earlier for pneumonia. After performing a mental status evaluation, you suspect delirium. The patient dropped out of school in the seventh grade. The best test to assess this patient’s ability to maintain and focus attention is which of the following?
In this instance, the Random Letter Test, which relies on concentration, cooperation, and the ability to hear, is the test of choice. The other tests rely not only on attention but also on calculation abilities and educational level. The Random Letter Test consists of telling a patient a letter and then in a monotone listing a random string of letters. The patient responds by raising a finger to indicate when he or she hears the key letter.
A 40-year-old woman who scores a 26/30 on the Folstein MMSE gave many answers of, “I don’t know, I’m too tired to answer.” You want to assess for the possibility of depression.
The Beck Depression Inventory is a 21-item test with 3 responses per item that is an easily used screening tool to evaluate for depression. Because it would be unusual for an individual so young to have dementia and because many of the answers reflect a lack of interest, the Beck Depression Inventory, in conjunction with the Folstein MMSE, may help distinguish depression from dementia
A 40-year-old woman who scores a 26/30 on the Folstein MMSE gave many answers of, “I don’t know, I’m too tired to answer.” You want to assess for the possibility of depression.
The WCST assesses executive functions of the brain such as organizational abilities, mental flexibility, and the ability to abstract and reason. These capacities are believed to be located in the frontal lobes. Damage to the frontal lobes can lead to abnormalities on this test.
The family of an 80-year-old man with mild dementia has asked you to evaluate his ability to continue to live in his current environment. You would like to ask his family and friends their assessment of how he has been doing.
The Blessed Rating Scale is a tool that asks friends or family of the patient to assess the ability of the patient to function in his or her usual environment.
A 16-year-old boy with a family history of mental retardation presents with long-standing poor school performance and aggressive behavior toward peers.
An assessment of IQ is indicated to rule out mental retardation and help better understand the individual’s level of intellectual level of functioning. IQ assessment will also aid the school in developing an individualized study program for this student. Because the patient is older than 15, the WAIS-R would be used.
A 37-year-old man has a history of avoiding social situations, no close friends, and a preference for being alone. He has been described by others as unemotional and detached. You would like to evaluate this patient with a projective test.
The Rorschach Test is a projective test that may be used to assess personality structure. The patient has characteristics of schizoid personality disorder, which may be better elucidated with further skilled assessment in the context of his clinical history.
You would like to quickly assess for dementia in a 75-year-old woman admitted to the emergency department for failure to thrive.
The Folstein MMSE is a quick, easily administered test that allows for immediate assessment of dementia. Scores of less than 24 are suggestive of a dementia.
A 45-year-old woman has a long history of unstable relationships, self-injurious behavior, and affective instability. She does not meet criteria for an Axis I disorder.
The MMPI-2 is an objective test consisting of several hundred true/false questions used to assess an individual’s personality. It is the most widely used and highly standardized test of personality.
You are asked to preoperatively evaluate hemispheric dominance in an 18-year-old lefthanded woman with a history of seizure disorder who is about to undergo surgery to remove a seizure focus in the left hemisphere
The Wada Test is used to evaluate hemispheric language dominance prior to surgical amelioration of seizure focus. Whereas most right-handed individuals show left hemispheric dominance for language, left-handed individuals may be either right or left dominant. The test consists of injecting sodium amytal into the carotid artery and observing the transient effects on speech. Injection into the left carotid artery anesthetizes the left side of the brain, and those with left hemispheric language dominance show interrupted speech. The Rey-Osterreith figure is sensitive to deficits in copying and lack of attention to detail in people with right-sided parietal lobe lesions. The appropriate test to evaluate IQ would be the WISC. The Boston Diagnostic Aphasia Examination is a series of tests given by an experienced clinician to evaluate and make treatment recommendations for individuals with aphasia. The Bender Gestalt Test involves copying figures, which helps to determine if organic brain disease is present.
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