Handbook of Psychiatric Emergencies

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. Only those patients assessed as dangerous can be legally detained against their will.

a) True
b) False

2. Good clinical record keeping will help avert liability if a violent or self-destructive patient harms himself or others after discharge.

a) True
b) False

3. A carefully conducted mental status examination is important for all of the following reasons except:

a) it provides a basis for diagnosis;
b) identifies target signs or symptoms for treatment;
c) it documents what was or was not observed;
d) it provides baseline data for future comparison;
e) it is mandated by law.

4. If the patient is neat and well groomed psychosis is an unlikely diagnosis.

a) True
b) False

5. Speech patterns can be a valuable indicator of the patient's mental status.

a) True
b) False

6. What would be a likely diagnosis if the patient is unable to express or comprehend spoken or written language?

a) schizophrenia
b) depression
c) dementia
d) stimulant use

7. Which thought pattern would suggest the likelihood of schizophrenia and nothing else?

a) circumstantiality
b) tangentiality

8. When faced with a patient's delusional ideas it is best to directly challenge them.

a) True
b) False

9. What would the initial diagnosis of a patient who has delusions of a partner's infidelity?

a) schizophrenia
b) mania
c) psychotic depression
d) paranoid disorders

10. Obsessive-compulsive behavior is an indicator of anxiety disorder rather than a psychosis.

a) True
b) False

11. As an emergency psychiatric worker you must see a patient who asks to see a psychiatrist or a counselor.

a) True
b) False

12. In cases involving child abuse, you should work with the parents first, counsel them, and call a child protection agency only as a last resort.

a) True
b) False

13. If a patient is dangerous it is not necessary to obtain consent from him or from family members for treatment.

a) True
b) False

14. What is the standard of evidence used in civil commitment?

a) preponderance of evidence
b) clear and convincing evidence

15. You have a duty to protect the public from potentially dangerous acts carried out by your patients.

a) True
b) False

16. Once a patient has been discharged a psychiatric emergency service cannot be held accountable for the behavior of that patient.

a) True
b) False

17. Most patients with delirium are lethargic or stuporous and tend to drowse or fall asleep while being interviewed.

a) True
b) False

18. A patient with delirium usually experiences disorientation to time, place and person.

a) True
b) False

19. Prescription medications are often the cause of delirium.

a) True
b) False

20. When a delirious patient becomes belligerent or assaultive, you should withhold neuroleptic medication because the drug will obscure symptoms.

a) True
b) False

21. Most patients with delirium should be hospitalized.

a) True
b) False

22. While interviewing an intoxicated patient always maintain constant direct eye contact.

a) True
b) False

23. In dealing with a patient with idiosyncratic intoxication, maintain a dialogue with the patient as long as possible without challenging the patient.

a) True
b) False

24. What is the drug of choice for treating patients in alcohol withdrawal?

a) clonidine (Catapres)
b) propranolol (Inderal)
c) benzodiazepine
d) hydroxyzine (Atarax)

25. . In treating a patient suffering from alcohol withdrawal syndrome the primary pharmacologic intervention is sedation.

a) True
b) False

26. All of the following are symptoms of acute stimulant abuse: heightened sense of well being, increased sense of alertness, decreased anxiety, reduced social inhibitions, and increased talkativeness.

a) True
b) False

27. PCP abuse has no withdrawal syndrome.

a) True
b) False

28. Opioid overdose from opiates, such as heroin and morphine, is a life-threatening emergency that requires treatment by an experienced internist.

a) True
b) False

29. In treating a patient suffering from opioid withdrawal syndrome, the emergency psychiatric worker should dispense methadone.

a) True
b) False

30. Opioid withdrawal is generally not life threatening.

a) True
b) False

31. Hallucinogen abuse does not carry as high a risk of violent behavior as PCP abuse.

a) True
b) False

32. Persons who abuse inhalants (sniffing of glue, aerosols, nail polish remover, paint thinner etc.) are engaging in recreational drug abuse that's not likely to cause brain or central nervous system damage.

a) True
b) False

33. Schizophrenic patients, due to their bizarre, unkempt, loud and agitated behavior, are often ignored for their problems by emergency department personnel.

a) True
b) False

34. A definitive diagnosis of schizophrenia can be made within a few weeks of the illness.

a) True
b) False

35. Patient exhibits these symptoms: cheerful, elevated mood that quickly turns to anger and rage. What would be the likely diagnosis?

a) schizophrenia
b) mania

36. A manic patient is usually shy, withdrawing and wants to be left alone.

a) True
b) False

37. Manic patients are usually over the age of fifty.

a) True
b) False

38. A manic patient's sense of self-esteem can reach a point of grandiosity.

a) True
b) False

39. A manic patient may suffer from recurrent episodes of mania and depression, with a return to normal functioning between episodes.

a) True
b) False

40. When a patient has hallucination and delusions the best approach is to use logic to convince the patient that he is wrong.

a) True
b) False

41. Paranoid patients are generally the easiest to deal with and to evaluate of all psychiatric patients.

a) True
b) False

42. Rapid tranquilization is usually the safest and most effective way to control agitated or overtly violent patients.

a) True
b) False

43. Clinicians can be held legally accountable for harm to persons or property caused by a patient who was prematurely released, even if the harm occurs several months after discharge.

a) True
b) False

44. An uncooperative patient may pose a higher risk for violence than a patient who is outwardly hostile and angry but has his hands in his pocket or has crossed his arms.

a) True
b) False

45. When a violent patient demands controlled drugs or admittance to a hospital you should fulfill such request immediately

a) True
b) False

46. While dealing with a patient with a weapon, the clinician should assume verbally and physically aggressive posture; tills generally forces the patient to retreat.

a) True
b) False

47. While interviewing a violent patient it is best to address him using his first name to establish an immediate rapport.

a) True
b) False

48. Which approach is likely to work best when dealing with a confused or disorganized patient with a psychotic or organic disorder?

a) "I want you to sit down in this chair so we can talk."
b) "You have a choice. You can either take the medication and go to the interview room to talk, or, if you feel out of control, you can sit in a seclusion room until you feel less anxious."

49. When a clinician cannot contain the patient's behavior restraining becomes a viable option.

a) True
b) False

50. Your first priority when presented with a self-destructive patient is to ensure the clinician's safety.

a) True
b) False

51. Suicidal patients are manipulative and willful creators of their own problem.

a) True
b) False

52. When a depressed patient has symptoms that have persisted for a couple of years the patient's chances of committing suicide go up significantly

a) True
b) False

53. In a patient with severe depression which intervention is more effective?

a) interpersonal intervention
b) pharmacologic intervention
c) educational intervention

54. Antidepressants are often prescribed in an ED setting.

a) True
b) False

55. Patient with major depression could usually get better if he or she tries harder to overcome symptoms.

a) True
b) False

56. Recurring panic attacks are a good indicator of organic anxiety syndrome.

a) True
b) False

57. Medical tests done on a patient with panic disorder are generally negative.

a) True
b) False

58. What is the drug of choice for antianxiety?

a) alprazolam (Xanox)
b) diazepam (Valium)

59. Which is not a drug of choice in the treatment of anxiety in psychiatric emergency patients?

a) diazepam
b) lorazepam
c) oxazepam
d) buspirone

60. Fear of open spaces is classified as

a) simple phobia.
b) social phobia.
c) agoraphobia.

61. Obsessive compulsive disorder can be treated through standard interpersonal intervention.

a) True
b) False

62. What is the best treatment for a patient with PTSD?

a) pharmacotherapy
b) open discussion of experiences and feelings
c) time

63. Post-traumatic stress disorder (PTSD) is a favorite form of anxiety disorder for plaintiff's attorneys.

a) True
b) False

64. Most battered women who use emergency services do not get the attention from the hospital staff that they deserve.

a) True
b) False

65. Abused patient in a domestic abuse case often impedes, rather than helps, a clinician's efforts at intervention.

a) True
b) False

66. In cases of spousal abuse, the clinician is usually under no legal obligation to notify protective services.

a) True
b) False

67. Minor tranquilizers are the most commonly used phannacologic agents in the psychiatric emergency treatment of sexual assaults.

a) True
b) False

68. Select the True response from below:

a) Girls contemplate suicide three times more frequently than boys do.
b) Boys loll themselves almost three times more often than girls.
c) both of the above
d) none

69. What is the most common psychiatric emergency in children and adolescents?

a) child abuse
b) runaway behavior
c) alcohol and drug abuse
d) suicidal behavior

70. What is the pharmacologic intervention during emergency management of violent behavior?

a) benzodiazepine
b) lithium
c) hydroxyzine
d) propranolol

71. What is the main reason youths run away from home?

a) to join another person or family
b) to have a different lifestyle
c) to escape a destructive home life

72. Which type of child abuse is reported most frequently?

a) physical abuse
b) sexual abuse
c) child neglect
d) emotional abuse

73. Nearly 40% of patients with dementia have treatable or reversible forms. \

a) True
b) False

74. Which type of psychosis has an acute onset?

a) Alzheimer's disease
b) bipolar disorder
c) major depression
d) delirium

75. Every clinician has a duty to treat persons in distress, including those with AIDS.

a) True
b) False

76. Conversion hysteria is usually a case of malingering.

a) True
b) False

77. The patient with factitious disorder intentionally produces physical or psychological symptoms for economic gain.

a) True
b) False

78. Malingering is not a mental disorder.

a) True
b) False