Deck 14: Pediatric Bipolar Disorders and Schizophrenia

Question 1

Which is the longest lasting bipolar disorder in children?

A) bipolar I disorder
B) bipolar II disorder
C) cyclothymia
D) schizophrenia

Answer 1

cyclothymia

Question 2

Which of the following is true about mixed moods?

A) They are relatively common in adults with bipolar disorder.
B) They involve having elements of both mania and hypomania simultaneously.
C) They can involve fluctuations from mania to depression within a single 24 hour period.
D) They are relatively rare in children with bipolar disorder.

Answer 2

They can involve fluctuations from mania to depression within a single 24 hour period.

Question 3

Which of the following is a difference in bipolar disorders between men and women?

A) overall prevalence of bipolar I disorder
B) more frequent manic episodes in women than in men
C) more psychotic features in women than in men
D) later symptom onset in men than in women

Answer 3

more psychotic features in women than in men

Question 4

Sarah had a manic episode at age 6,but since then has not had another one.About a year ago,she experienced a depressive episode and more recently seems to be experiencing hypomania.Which of the following would be considered for a diagnosis for Sarah?

A) major depressive disorder
B) cyclothymia
C) bipolar I disorder
D) bipolar II disorder

Question 5

Milo decides that he will read every book in his house.He makes a tower of 50 books and starts flipping through the pages of each of them,even though many have words that he can't understand.This is most related to which symptom of mania?

A) grandiosity
B) increased activity
C) elevated or expansive mood
D) excessive involvement in activities with high potential of painful consequences

Question 6

A person can be diagnosed with cyclothymia even if ______.

A) he or she has experienced a manic episode
B) he or she has experienced a major depressive episode
C) he or she has experienced a hypomanic episode
D) he or she experiences hypomanic and depressive symptoms without meeting full criteria for either a hypomanic or depressive episode

Question 7

Alyssa is suspected of having bipolar disorder She's experiencing grandiosity,flight of ideas,and psychomotor agitation.She could be diagnosed with bipolar I disorder only if she also experienced which of the following?

A) irritability
B) changes in mood and energy
C) pressured speech and decreased need for sleep
D) excessive involvement in activities with a high potential for painful consequences and distractibility

Question 8

Mania is ______.

A) required for a diagnosis of any bipolar disorder
B) required for a diagnosis of bipolar I disorder
C) not sufficient for a diagnosis of bipolar I disorder
D) the first set of symptoms to develop in any individual's bipolar disorder

Question 9

Negative symptoms in schizophrenia have been most effectively treated by which of the following?

A) CBT
B) conventional antipsychotics
C) atypical antipsychotics
D) supportive psychotherapy

Question 10

Mindy has been diagnosed with bipolar I disorder.Lately,she's begun believing that she is actually a lost princess.This is an example of a ______ and means that her diagnosis might instead have which specifier?

A) hallucination, with mixed features
B) delusion, with mixed features
C) hallucination, with psychotic features
D) delusion, with psychotic features

Question 11

Which of the following manic symptoms is LEAST useful in identifying bipolar disorder in children?

A) pressured speech
B) grandiosity
C) decreased need for sleep
D) involvement in high-risk sexual activity

Question 12

Carl began showing irritability and difficulty thinking,symptoms of his later diagnosed bipolar disorder,about 14 months before he was first diagnosed.Then,gradually,the number and intensity of symptoms increased.Which of the following best describes Carl?

A) Fourteen months before his diagnosis, he was in the prodromal phase, and he had insidious symptom onset.
B) He cannot be diagnosed with bipolar I disorder because his symptom onset was gradual.
C) The prodromal symptoms Carl displayed were unusual for those with bipolar disorders.
D) Carl should have been diagnosed 14 months ago when the first symptom appeared.

Question 13

Complete the following statement: Skills training ______.

A) is the most effective therapy for individuals with schizophrenia
B) is the most effective therapy for individuals with schizophrenia living with their families
C) is the most effective therapy for individuals with schizophrenia living independently
D) is not an effective therapy for individuals with schizophrenia

Question 14

Billy keeps running around the classroom.Though the teacher tells him to sit down,Billy says he can't because he has to chase the magical butterflies-if he catches one,he'll become king.This symptom is most consistent with which of the following?

A) oppositional defiant disorder
B) conduct disorder
C) ADHD
D) bipolar disorder

Question 15

Which of the following is NOT a side effect of antipsychotics?

A) akathisia
B) tardive dyskinesia
C) alogia
D) sedation

Question 16

Which of the following is NOT typically part of psychosocial treatment for individuals with schizophrenia?

A) psychoeducation
B) motivational interviewing to encourage medication adherence
C) cognitive-behavioral interventions
D) adjusting to long-term hospitalization

Question 17

The Course and Outcome of Bipolar Youth (COBY)study indicated which of the following?

A) Most youths had persistent mood problems for the 4 years of the study, never experiencing full recovery.
B) Most youths had recurrent mood problems, experiencing another mood episode after the initial one within the four years of the study.
C) Most youths experienced repeated manic episodes but no depressive episodes during the course of the study.
D) The average time to initial recovery was approximately one year.

Question 18

How is the distractibility seen in mania different than the distractibility seen in ADHD?

A) The distractibility seen in mania typically has an earlier onset.
B) The distractibility seen in mania reflects a marked change in typical behavior.
C) The distractibility seen in mania is typically more long lasting.
D) The distractibility seen in mania is a relatively rare symptom of mania whereas distractibility is a common symptom in ADHD.

Question 19

Marco tells his football coach he has ideas for different and better plays.He also believes he cannot be tackled,and can kick a field goal from 80 yards away (which is impossible even for professional players).This relates to which symptom of mania?

A) grandiosity
B) flight of ideas
C) elevated or expansive mood
D) excessive involvement in activities with high potential of painful consequences

Question 20

Which of the following symptoms are most specific to bipolar disorder?

A) euphoria and an increase in energy
B) euphoria and risk-taking behaviors
C) excessive talking and flight of ideas
D) grandiosity and altered perceptions

Question 21

Which of the following is NOT a component common to all psychotherapy for bipolar disorders?

A) psychoeducation
B) family involvement
C) cognitive restructuring
D) skill building

Question 22

Hostility from parents toward children with bipolar disorders is most likely to arise in which of the following situations?

A) Parents fear the onset of another mood episode.
B) Parents attribute youths' disruptive behavior to the illness.
C) Parents have low expressed emotion.
D) Parents attribute youths' disruptive behavior to deliberate, willful acts of malice.

Question 23

Which type of psychotherapy for youths with bipolar disorders can be administered to multiple families simultaneously?

A) child-focused CBT
B) family-focused CBT
C) psychoeducational psychotherapy
D) family focused treatment

Question 24

Which of the following is NOT a component of child- and family-focused CBT?

A) teaching children to recognize and regulate strong emotions
B) teaching parents to manage stress
C) teaching parents to set firm limits
D) providing parents and children social skills training

Question 25

Coping skills associated with psychoeducational psychotherapy include all EXCEPT  which of the following?

A) creative
B) active
C) rest and relaxation
D) environment

Question 26

Which of the following comments would NOT be assessed by clinicians as a statement contributing toward "expressed emotion "?

A) I care about you and I want to do what I can to support you.
B) I am constantly worried that you won't take your medication and what will happen to you if that happens; I can't fall asleep until I know you've taken your medication.
C) When you act that way, I have to leave. I know you can do better and you're choosing this behavior.
D) I don't understand why you can't just do your chores like your brother and sister. You're using your diagnosis as an excuse.

Question 27

Which of the following best explains the relationship between cannabis use and schizophrenia?

A) All those who use cannabis are at increased risk for schizophrenia.
B) There is no relationship between the use of cannabis and the risk of schizophrenia.
C) Cannabis use is not related to increased risk of schizophrenia in those with a particular allele of the COMT gene, but is related to increased risk of schizophrenia in those with a different allele.
D) Cannabis use is related to increased risk of schizophrenia only in males with a particular allele of the COMT gene, but not in females with the same allele.

Question 28

When playing a frustrating computer game that was rigged against them,youths with bipolar disorder reacted in which of the following ways?

A) They showed blunted affect (no emotional response) and had suppressed activity in the insula.
B) They displayed more negative emotion and showed greater activation in the amygdala.
C) They demonstrated more abusive behavior toward the machine and the experimenters and increased cortisol release, but only if they were currently in a depressive state.
D) They reported more sadness and negative emotion and showed greater activity in the right superior frontal gyrus and lower activity in the insula.

Question 29

Individuals with bipolar disorders often have difficulty with emotional processing.Which of the following best describes the nature of this difficulty?

A) difficulty distinguishing happy from surprised and scared faces
B) no preference for faces, even happy faces, over objects
C) interpreting neutral faces as sad, angry, or hostile but only when in a depressive state
D) interpreting neutral faces as sad, angry, or hostile even when not experiencing mood episodes

Question 30

Compared to those whose symptoms emerge in adulthood,those whose bipolar symptoms emerge in childhood and adolescence experience ______.

A) greater frequency of depressive symptoms
B) more relapse over time
C) fewer substance use problems but more educational problems
D) greater remission of symptoms

Question 31

Complete the following statement: Anticonvulsants ______.

A) have been extensively studied for use in children with bipolar disorders
B) have few side effects
C) are vastly more effective than placebo in treating bipolar disorders
D) increase GABA and decrease glutamate

Question 32

What is the primary reason that lithium is no longer considered a first-line treatment for youths with bipolar disorders?

A) It was found to be no more effective than placebo in a randomized study on bipolar youths.
B) Its effectiveness has never been tested against the effectiveness of a placebo.
C) Almost a third of youths could not tolerate the side effects of lithium.
D) The method of action of lithium is unknown.

Question 33

Which of the following brain differences is most commonly seen in individuals with bipolar disorders?

A) larger brain overall
B) hypoactivation of the amygdala
C) hypoactivation of the prefrontal cortex
D) enlarged ventricles

Question 34

Because conventional antipsychotics bind to D2 receptors in the mesolimbic pathway,they are most effective at ______.

A) increasing motivation
B) restoring appropriate emotional expression
C) reducing hallucinations
D) eliminating all symptoms of schizophrenia

Question 35

Why are atypical antipsychotics less likely to cause extrapyramidal side effects than conventional antipsychotics?

A) because only conventional antipsychotics bind to dopamine receptors
B) because only atypical antipsychotics target positive symptoms
C) because only conventional antipsychotics have an affinity for both dopamine and serotonin receptors
D) because atypical antipsychotics bind more weakly to dopamine receptors

Question 36

Which of the following are the most commonly prescribed medications for youths with bipolar disorders?

A) antidepressants
B) mood stabilizers
C) anticonvulsants
D) atypical antipsychotics

Question 37

Expressed emotion predicts which of the following?

A) existence of bipolar disorders
B) age of onset of bipolar disorders
C) psychotic features in bipolar disorders
D) relapse in bipolar disorders

Question 38

Which of the following is one of the main differences between attenuated psychosis syndrome (APS)and schizophrenia?

A) Only schizophrenia involves hallucinations and delusions.
B) Attenuated psychosis syndrome can only be diagnosed in those under the age of 18.
C) The number of symptoms required for diagnosis is fewer for APS than for schizophrenia.
D) Only schizophrenia must cause clinically significant distress or impairment.

Question 39

Which of the following is true of the use of atypical antipsychotics to treat bipolar disorders in youths?

A) They are about equally effective as lithium, but with fewer side effects.
B) They are most useful in dealing with the depressive aspects of bipolar disorders.
C) They have high response rates, but low recovery rates.
D) Their side effects make them intolerable by the majority of people who try to use them.

Question 40

Children of adults with bipolar disorder are more likely to experience all of the following conditions EXCEPT ______.

A) bipolar disorders
B) depressive disorders
C) anxiety disorders
D) posttraumatic stress disorder

Question 41

Mary believes that the rapper Jay-Z is her real father,despite the fact that she's met her real father many times and he even has a DNA test that shows he's her father.Mary's belief is  which of the following?

A) a hallucination.
B) a delusion of control
C) a delusion of reference
D) a delusion of grandiosity

Question 42

In which of the following is schizophrenia more common?

A) in males than in females in childhood but in females than males in adulthood
B) in males than in females in childhood but equally common between males and females in adulthood
C) in females than males in childhood, but in males in adulthood
D) in females than males in childhood, but equally common between males and females in adulthood

Question 43

The best evidence that multifamily psychoeducational psychotherapy (MF-PEP)is effective in treating those with bipolar disorder comes from the fact that a large,randomized controlled trial (Fristad et al.,2009)found which of the following?

A) higher levels of effectiveness for children with bipolar disorders than for those with depressive disorders.
B) lower levels of mood symptoms in children who had participated in MF-PEP than those who participated in pharmacotherapy
C) lower levels of mood symptoms in children who had participated in MF-PEP than wait list controls and reduction in mood symptoms among wait list controls when they received the treatment
D) the 90% completion rate for the program, which is extremely high

Question 44

Which of the following is the most common modality for hallucinations?

A) auditory
B) visual
C) tactile
D) olfactory

Question 45

Which of the following is the best example of a delusion?

A) Zena believes that she is pregnant. After having multiple pregnancy tests and an ultrasound that all show no evidence of pregnancy, she still believes she will be giving birth in just a few months.
B) Elliot wants to be a professional football player when he grows up, despite the fact that he is small for his age and not particularly good at football. Any criticism about his playing just motivates him to practice more.
C) Violet sometimes hears girls in her class whispering about her. When she turns around and asks them why they were whispering, they give her a confused look and said they weren't-she must have been hearing things.
D) Tom thinks he is a very fast runner. He tries out for the track team, and only when five other kids pass him, does he realize that he's not so fast.

Question 46

What is the relationship between gray matter and schizophrenia?

A) Individuals with schizophrenia have much greater amounts of gray matter than typically developing individuals.
B) Individuals with schizophrenia showed a dramatic increase in the amount of gray matter immediately before the onset of their psychosis.
C) Individuals with schizophrenia showed a dramatic decrease in the amount of gray matter but only after experiencing multiple psychotic episodes.
D) Individuals with schizophrenia tend to show rapid, excessive neural pruning, particularly immediately before their first psychotic episode.

Question 47

Communication enhancement training in family-focused therapy typically entails  which of the following?

A) increasing expressed emotion
B) enhancing sharing of positive feelings and making positive requests
C) not voicing negative or potentially offensive emotions or requests
D) making sure emotion is part of every interaction

Question 48

Which of the following is NOT a language difference that may be seen in individuals with schizophrenia?

A) complete absence of speech/selective mutism
B) knight's move thinking
C) thought blockage
D) neologism

Question 49

Marcus sometimes sees shadows that are not really there.Would this be considered a visual hallucination?

A) Yes.
B) No, because it is not a fully formed shape.
C) No, because it doesn't happen all the time.
D) No, because light and shadow are specifically excluded from the diagnostic criteria for the disorder.

Question 50

Evidence for the premorbid stage of schizophrenia comes from all of the following sources EXCEPT ______.

A) parental retrospective report
B) blind coding of home movies
C) longitudinal studies
D) randomized, controlled trials

Question 51

Complete the following statement: The COMT gene ______.

A) is influential in the development of bipolar disorders
B) produces an enzyme which regulates norepinephrine
C) influences the pattern of dopamine overactivity and underactivity in those with schizophrenia
D) is related to mania

Question 52

Children and adolescents with bipolar disorder with mixed features tend to have worse outcomes than those with bipolar disorder without the specifier.

Question 53

Which of the following is NOT a brain abnormality often seen in those with schizophrenia?

A) enlarged lateral ventricles
B) reductions in cortical volume
C) reductions in the size of the hippocampus and thalamus
D) enlarged white matter tracts

Question 54

The combination of hypersexual behavior and elation is only associated with bipolar disorder.

Question 55

The dopamine hypothesis holds which of the following?

A) Excessive dopaminergic activation along the mesocortical pathway is responsible for the negative symptoms in schizophrenia.
B) Dampened dopaminergic activation along the mesolimbic pathway is responsible for the negative symptoms in schizophrenia.
C) Dampened dopaminergic activation along the mesolimbic pathway is responsible for the positive symptoms in schizophrenia.
D) Excessive dopaminergic activation along the mesolimbic pathway is responsible for the positive symptoms in schizophrenia.

Question 56

Disturbances in affect in schizophrenia ______.

A) are very rare among youths
B) typically involve very extreme, particularly positive, emotional displays, such as hysterical laughter
C) are typically only seen in those with comorbid mood problems
D) may include avolition

Question 57

Bipolar I disorder and bipolar II disorder cannot be comorbid.

Question 58

Can an individual with ASD be additionally diagnosed with schizophrenia?

A) No.
B) Yes, but only if he or she is above the age of 12.
C) Yes, but only if the diagnosis of schizophrenia consists of positive symptoms.
D) Yes, but only if the individual experiences negative symptoms.

Question 59

Brandon had been about a C student for most of his middle school career,but once he started ninth grade,his functioning really declined.He started failing classes and not going to school.He stopped showering on a regular basis and became much more touchy and less involved with his family.He even stopped going to the skateboard park,which he used to love.His mom had a history of depression and thought that maybe he was depressed.But 2 years later,when he started hearing whistles and songs that others did not,she realized he had been ______.

A) in the premorbid stage of schizophrenia
B) in the prodromal stage of schizophrenia
C) in the acute stage of schizophrenia
D) in the residual stage of schizophrenia

Question 60

Kelsey was age 4 when her mom noticed that she was having difficulty cutting with scissors and learning to tie her shoes.She also was just becoming potty trained,while her younger sister,age 2,was already starting to potty train successfully.Kelsey also had some difficulty forming sentences and didn't seem to take as much pleasure in being around other children or smile and laugh the way other children typically did.By the time she was 15,Kelsey was diagnosed with schizophrenia.Her clinician told Kelsey's mom that Kelsey's behavior at age 4 was evidence of which of the following?

A) the premorbid stage
B) the prodromal stage
C) the acute stage
D) the residual stage

Question 61

What might explain the premorbid stage of schizophrenia? What does its existence tell us about the causes of the disorder?

Question 62

Can an individual be diagnosed with schizophrenia if he or she never experienced delusions or hallucinations? Why or why not?

Question 63

Ricardo says,"I hate my schizophrenia.I've heard people talk about positive and negative symptoms,but to me they're all negative." How might you address Ricardo's misconception?

Question 64

How might youths with bipolar disorders actually increase the number of stressful life events and scarcity of positive life evens they experience?

Question 65

How do children with bipolar disorders differ from children with disruptive mood dysregulation disorder?

Question 66

No atypical antipsychotics are officially approved for use in those under the age of 18.

Question 67

The dopamine hypothesis holds that excessive stimulation of D2 dopamine receptors along the mesocortical pathway results in the negative symptoms of schizophrenia.

Question 68

A person can be diagnosed with schizophrenia even if he or she has no delusions or hallucinations.

Question 69

Research has indicated that providing low doses of antipsychotics and other measures to youths at greater risk of schizophrenia can reduce the emergence of the disorder.Are there any downsides to this approach?

Question 70

What is the evidence that genetics does not entirely account for schizophrenia?

Question 71

Treatment via multifamily psychoeducational psychotherapy during the prodromal phase may prevent or delay the onset of bipolar disorders.

Question 72

Explain the neurodevelopmental model for schizophrenia.

Question 73

Adults with bipolar disorders can be triggered into relapse by positive life events such as marriage or changing to a better job.

Question 74

Bipolar disorder cannot be comorbid with ADHD.

Question 75

Providing low doses of antipsychotic medication to youths at risk for schizophrenia who had not yet shown psychotic symptoms made it significantly less likely for them to develop psychotic symptoms-however,many patients were unable or unwilling to adhere to the prescribed medication for a full 12 months.

Question 76

Prodromal and early psychotic symptoms can be identified in adolescents.

Question 77

Lithium is usually regarded as a first-line treatment for youths with bipolar disorders.

Question 78

Almost no children and adolescents treated with atypical antipsychotics experience side effects.

Question 79

Most adults with bipolar disorders report that their symptoms began in childhood or adolescence.