Psychosocial interventions US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Psychosocial interventions. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Psychosocial interventions US Medical PG Question 1: A 32-year-old woman is brought to the physician by her husband, who is concerned about her ability to care for herself. Three weeks ago, she quit her marketing job to start a clothing company. Since then, she has not slept more than 4 hours per night because she has been working on her business plans. She used a significant portion of their savings to fund business trips to Switzerland in order to buy “only the best quality fabrics in the world.” She has not showered and has eaten little during the past 3 days. She has had 2 similar episodes a few years back that required hospitalization and treatment in a psychiatry unit. She has also suffered from periods of depression. She is currently not taking any medications. She appears unkempt and agitated, pacing up and down the room. She speaks very fast without interruption about her business ideas. She has no suicidal ideation or ideas of self-harm. Toxicology screening is negative. Which of the following is the most appropriate pharmacotherapy for the management of this patient?
- A. Clonazepam therapy for one year
- B. Long-term lithium therapy (Correct Answer)
- C. Sertraline therapy for one year
- D. Long-term risperidone therapy
- E. Long-term clozapine therapy
Psychosocial interventions Explanation: ***Long-term lithium therapy***
- This patient presents with classic symptoms of **mania** (decreased need for sleep, grandiosity, compulsive spending, rapid speech) and a history of both manic and depressive episodes, consistent with **bipolar I disorder**.
- **Lithium** is a first-line agent for the **long-term maintenance treatment** of **bipolar I disorder**, particularly effective in preventing both manic and depressive episodes.
*Clonazepam therapy for one year*
- **Clonazepam** is a **benzodiazepine** primarily used for short-term management of acute agitation or severe insomnia, not for long-term mood stabilization in bipolar disorder.
- Long-term use of benzodiazepines carries risks of **tolerance** and **dependence**, making it inappropriate for chronic maintenance treatment.
*Sertraline therapy for one year*
- **Sertraline** is an **antidepressant** (SSRI) that, when used as monotherapy in bipolar disorder, can induce **mania** or **rapid cycling**.
- While periods of depression are mentioned, the current presentation is manic, and mood stabilizers are the priority for long-term management.
*Long-term risperidone therapy*
- **Risperidone** is a **second-generation antipsychotic** effective in treating acute mania and can be used for maintenance in bipolar disorder, often as an adjunct or in patients who cannot tolerate lithium.
- However, for long-term monotherapy in bipolar I disorder, **lithium** is generally considered more effective and is the preferred first-line agent, especially given the history of recurrent episodes.
*Long-term clozapine therapy*
- **Clozapine** is an **atypical antipsychotic** reserved for **treatment-resistant schizophrenia** and **refractory bipolar disorder**, often due to its significant side effect profile, including **agranulocytosis**.
- While it can be effective for severe or refractory cases of bipolar disorder, it is not a first-line long-term treatment given its risks and the availability of safer alternatives.
Psychosocial interventions US Medical PG Question 2: A 10-year-old child is sent to the school psychologist in May because he refuses to comply with the class rules. His teacher says this has been going on since school started back in August. He gets upset at the teacher regularly when he is told to complete a homework assignment in class. Sometimes he refuses to complete them altogether. Several of his teachers have reported that he intentionally creates noises in class to interrupt the class. He tells the psychologist that the teacher and his classmates are at fault. What is the most appropriate treatment?
- A. Cognitive-behavioral therapy (Correct Answer)
- B. Interpersonal therapy
- C. Administration of lithium
- D. Motivational interviewing
- E. Administration of clozapine
Psychosocial interventions Explanation: ***Cognitive-behavioral therapy***
- This child exhibits symptoms consistent with **Oppositional Defiant Disorder (ODD)**, including persistent refusal to comply with rules, anger outbursts, and blaming others. **CBT** is a highly effective treatment for ODD, teaching children coping skills, anger management, and problem-solving.
- CBT helps children identify and change **maladaptive thought patterns** and behaviors, which is crucial for managing the defiant and argumentative behaviors seen in ODD.
*Interpersonal therapy*
- **Interpersonal therapy (IPT)** primarily focuses on improving interpersonal relationships and communication patterns, often used for depression or eating disorders.
- While improved relationships might be a secondary benefit, IPT does not directly target the core **defiant behaviors** and **anger management** issues central to ODD.
*Administration of lithium*
- **Lithium** is a mood stabilizer primarily used in the treatment of **bipolar disorder** and severe mood dysregulation.
- There is no indication from the provided symptoms (defiance, anger, blaming others) that the child is experiencing a mood disorder that would warrant lithium.
*Motivational interviewing*
- **Motivational interviewing** is a counseling approach that helps individuals resolve ambivalence to change, often used in substance abuse or health behavior change.
- While it can be useful in encouraging willingness to engage in therapy, it is not a direct therapeutic modality for addressing the specific **behavioral challenges** and **underlying cognitive distortions** of ODD.
*Administration of clozapine*
- **Clozapine** is an antipsychotic medication reserved for severe mental illnesses like **treatment-resistant schizophrenia** due to its significant side effects.
- The child's symptoms of defiance and rule-breaking are not indicative of a psychotic disorder requiring antipsychotic medication.
Psychosocial interventions US Medical PG Question 3: A 35-year-old man comes to the Veterans Affairs hospital because of a 2-month history of anxiety. He recently returned from his third deployment to Iraq, where he served as a combat medic. He has had difficulty readjusting to civilian life. He works as a taxi driver but had to take a leave of absence because of difficulties with driving. Last week, he hit a stop sign because he swerved out of the way of a grocery bag that was in the street. He has difficulty sleeping because of nightmares about the deaths of some of the other soldiers in his unit and states, “it's my fault, I could have saved them. Please help me.” Mental status examination shows a depressed mood and a restricted affect. There is no evidence of suicidal ideation. Which of the following is the most appropriate initial step in treatment?
- A. Dialectical behavioral therapy
- B. Venlafaxine therapy
- C. Cognitive behavioral therapy (Correct Answer)
- D. Motivational interviewing
- E. Prazosin therapy
Psychosocial interventions Explanation: ***Cognitive behavioral therapy***
- **Cognitive Behavioral Therapy (CBT)** is considered a first-line psychological treatment for **Post-Traumatic Stress Disorder (PTSD)**, which the patient's symptoms (deployments, intrusive thoughts, nightmares, avoidance, guilt) strongly suggest.
- CBT helps individuals identify and challenge **maladaptive thought patterns** and behaviors related to the trauma, fostering new coping mechanisms.
*Dialectical behavioral therapy*
- **Dialectical Behavioral Therapy (DBT)** is primarily used for individuals with **Borderline Personality Disorder** or severe emotional dysregulation.
- While it can help with emotional regulation, it is not the **first-line therapy** specifically targeting trauma-related cognitive distortions and avoidance behaviors seen in PTSD.
*Venlafaxine therapy*
- **Venlafaxine**, an SNRI, is an antidepressant that can be effective for PTSD symptoms. However, current guidelines recommend **psychotherapy (like CBT)** as the initial step, especially when feasible.
- While pharmacotherapy can be used, it's typically considered **adjunctive** or for cases where psychotherapy alone is insufficient or not preferred.
*Motivational interviewing*
- **Motivational interviewing** is a patient-centered counseling style used to address ambivalence and enhance a person's **intrinsic motivation** for change.
- It is often utilized in substance abuse treatment or when patients are resistant to treatment, but it is not a primary, standalone treatment for the core symptoms of PTSD.
*Prazosin therapy*
- **Prazosin** is an alpha-1 antagonist used off-label to treat **PTSD-related nightmares** and sleep disturbances.
- While it can be helpful for a specific symptom, it does not address the broader spectrum of PTSD symptoms, such as intrusive thoughts, avoidance, or negative cognitions.
Psychosocial interventions US Medical PG Question 4: A 14-year-old girl is presented by her mother who says she has trouble focusing. The patient’s mother says that, over the past 2 months, the patient has lost interest in her normal activities and has become more withdrawn. She no longer participates in activities she enjoys and says that she has contemplated suicide. The patient’s mother says that, at other times, she is hyperactive and can’t ever seem to be still. Before the onset of her depression, she had an 8 day period where she did not sleep and was constantly on the go. She was so energetic at school that she was suspended for a month. The patient is afebrile and vitals are within normal limits. Physical examination is unremarkable. Routine laboratory tests and a noncontrast computed tomography (CT) of the head are normal. Which of the following would be the best course of treatment in this patient?
- A. Ramelteon
- B. Amitriptyline
- C. Chlorpromazine
- D. Lithium (Correct Answer)
- E. Phenobarbital
Psychosocial interventions Explanation: ***Lithium***
- This patient's presentation with alternating periods of severe depression and **hypomania**/**mania** (decreased need for sleep, hyperactivity, increased energy leading to suspension) is highly suggestive of **bipolar disorder**.
- **Lithium** is a mood stabilizer and is considered a first-line treatment for managing both manic and depressive episodes in bipolar disorder, especially in adolescents.
*Ramelteon*
- **Ramelteon** is a melatonin receptor agonist primarily used for the treatment of **insomnia**, particularly for sleep onset difficulties.
- It is not indicated for the management of bipolar disorder or its associated mood swings.
*Amitriptyline*
- **Amitriptyline** is a tricyclic antidepressant (TCA) primarily used for **major depressive disorder**, chronic pain, and sometimes insomnia.
- Administering an antidepressant alone to a patient with undiagnosed or untreated bipolar disorder can precipitate **mania** or worsen rapid cycling.
*Chlorpromazine*
- **Chlorpromazine** is a first-generation antipsychotic primarily used for the treatment of **schizophrenia** and severe behavioral problems.
- While it can help manage acute manic episodes due to its sedative properties, it is not a primary mood stabilizer for long-term bipolar disorder treatment and is associated with significant side effects.
*Phenobarbital*
- **Phenobarbital** is a barbiturate with anticonvulsant and sedative-hypnotic properties, primarily used for **epilepsy** and anxiety.
- It is not indicated for the treatment of bipolar disorder and does not have mood-stabilizing effects for this condition.
Psychosocial interventions US Medical PG Question 5: A 17-year-old high school student comes to the physician because of a 6-month history of insomnia. On school nights, he goes to bed around 11 p.m. but has had persistent problems falling asleep and instead studies at his desk until he feels sleepy around 2 a.m. He does not wake up in the middle of the night. He is worried that he does not get enough sleep. He has significant difficulties waking up on weekdays and has repeatedly been late to school. At school, he experiences daytime sleepiness and drinks 1–2 cups of coffee in the mornings. He tries to avoid daytime naps. On the weekends, he goes to bed around 2 a.m. and sleeps in until 10 a.m., after which he feels rested. He has no history of severe illness and does not take medication. Which of the following most likely explains this patient's sleep disorder?
- A. Inadequate sleep hygiene
- B. Irregular sleep-wake disorder
- C. Psychophysiologic insomnia
- D. Delayed sleep-wake disorder (Correct Answer)
- E. Advanced sleep-wake disorder
Psychosocial interventions Explanation: ***Delayed sleep-wake disorder***
- This patient exhibits a consistent pattern of **delayed sleep onset** and **delayed wake time**, particularly evident on weekends when he can follow his natural circadian rhythm (going to bed at 2 AM and waking at 10 AM).
- The symptoms, including difficulty falling asleep at conventional times, difficulty waking for school, and daytime sleepiness, are classic for **delayed sleep-wake phase disorder**, where an individual's internal clock is misaligned with societal expectations.
*Inadequate sleep hygiene*
- While aspects like studying in bed are **poor sleep hygiene**, the core issue is not simply bad habits but a fundamental misalignment of his **circadian rhythm** as evidenced by his consistent late sleep onset and wake times when allowed.
- The patient's ability to sleep well and feel rested on weekends when he can follow his natural rhythm suggests that hygiene alone isn't the primary cause.
*Irregular sleep-wake disorder*
- This disorder is characterized by a **lack of a discernible sleep-wake rhythm**, with sleep periods fragmented and scattered throughout the 24-hour day.
- The patient, however, demonstrates a clear, albeit delayed, sleep schedule; he sleeps in one consolidated block and feels rested when allowed to do so.
*Psychophysiologic insomnia*
- This condition involves heightened arousal and **anxiety surrounding sleep**, leading to difficulty falling asleep at night and often improved sleep in novel environments or away from home.
- While he expresses worry about not getting enough sleep, his sleep issues are primarily due to a shifted circadian phase, not just anxiety about sleep itself, and he sleeps restfully when allowed to follow his delayed rhythm.
*Advanced sleep-wake disorder*
- This disorder is characterized by a **habitually early sleep onset** and **early morning awakening**, typically several hours earlier than desired or conventional times.
- The patient, in contrast, consistently struggles to fall asleep until very late hours and desires a later wake time.
Psychosocial interventions US Medical PG Question 6: A 28-year-old woman is brought to the emergency department by her friends. She is naked except for a blanket and speaking rapidly and incoherently. Her friends say that she was found watering her garden naked and refused to put on any clothes when they tried to make her do so, saying that she has accepted how beautiful she is inside and out. Her friends say she has also purchased a new car she can not afford. They are concerned about her, as they have never seen her behave this way before. For the past week, she has not shown up at work and has been acting ‘strangely’. They say she was extremely excited and has been calling them at odd hours of the night to tell them about her future plans. Which of the following drug mechanisms will help with the long-term management this patient’s symptoms?
- A. Inhibition of inositol monophosphatase and inositol polyphosphate 1-phosphatase (Correct Answer)
- B. Increase the concentration of dopamine and norepinephrine at the synaptic cleft
- C. Modulate the activity of gamma-aminobutyric acid receptors
- D. Acts as an antagonist at the dopamine, serotonin and adrenergic receptors
- E. Inhibit the reuptake of norepinephrine and serotonin from the presynaptic cleft
Psychosocial interventions Explanation: ***Inhibition of inositol monophosphatase and inositol polyphosphate 1-phosphatase***
- The patient's symptoms (euphoria, grandiosity, reduced need for sleep, impulsivity, rapid speech, and unusual behavior) are classic for a **manic episode**, strongly suggesting **bipolar disorder**.
- **Lithium** is a mood stabilizer used for long-term management of bipolar disorder, and its primary molecular action is thought to involve the **inhibition of inositol phosphatases**, thereby depleting inositol and modulating intracellular signaling.
*Increase the concentration of dopamine and norepinephrine at the synaptic cleft*
- This mechanism describes the action of **stimulants** or some **antidepressants** (like TCAs or SNRIs), which could exacerbate manic symptoms in bipolar disorder.
- Increasing dopamine and norepinephrine would likely worsen the current patient's **hyperactivity**, **agitation**, and **psychosis**.
*Inhibit the reuptake norepinephrine and serotonin from the presynaptic cleft*
- This mechanism is characteristic of **antidepressants** (e.g., SSRIs, SNRIs) used to treat depression.
- Administering such drugs during a manic episode can precipitate or worsen **mania** or induce **rapid cycling** in bipolar patients.
*Modulate the activity of Ƴ-aminobutyric acid receptors*
- This describes the action of **benzodiazepines** or some **antiepileptic drugs** (e.g., valproate, lamotrigine).
- While some antiepileptic drugs (like valproate) are used as mood stabilizers, the direct modulation of GABA receptors to **increase GABAergic activity** (as with benzodiazepines) is typically for acute agitation and anxiety, not the primary long-term mood stabilization for bipolar disorder.
*Acts as an antagonist at the dopamine, serotonin, and adrenergic receptors*
- This mechanism generally describes the action of **antipsychotic medications** (e.g., olanzapine, quetiapine, risperidone).
- While antipsychotics are effective for acute mania and some are used in long-term maintenance of bipolar disorder, the question asks for the primary drug mechanism for long-term management which is **Lithium's mechanism of action**, targeting intracellular signaling rather than broad receptor antagonism.
Psychosocial interventions US Medical PG Question 7: A 23-year-old man presents to the emergency department with a chief complaint of being assaulted on the street. The patient claims that he has been followed by the government for quite some time and that he was assaulted by a government agent but was able to escape. He often hears voices telling him to hide. The patient has an unknown past medical history and admits to smoking marijuana frequently. On physical exam, the patient has no signs of trauma. When interviewing the patient, he is seen conversing with an external party that is not apparent to you. The patient states that he is afraid for his life and that agents are currently pursuing him. What is the best initial response to this patient’s statement?
- A. I think you are safe from the agents here.
- B. You have a mental disorder but don’t worry we will help you.
- C. I don’t think any agents are pursuing you.
- D. What medications are you currently taking?
- E. It sounds like you have been going through some tough experiences lately. (Correct Answer)
Psychosocial interventions Explanation: ***It sounds like you have been going through some tough experiences lately.***
- This response **acknowledges the patient's distress** and experience without validating or refuting their delusional beliefs.
- It helps establish **rapport** and encourages the patient to share more about their symptoms, which is crucial for assessment in a psychiatric emergency.
*I think you are safe from the agents here.*
- While intended to reassure, directly addressing the delusion can be perceived as dismissive and may **escalate the patient's paranoia** or agitation.
- It does not validate their *feelings* of fear, which are real to them, even if the source is delusional.
*You have a mental disorder but don’t worry we will help you.*
- This statement is **confrontational** and judgmental, labeling the patient immediately with a diagnosis.
- This approach can cause the patient to become defensive, shut down, or feel stigmatized, making further assessment and trust-building very difficult in the **initial interaction**.
*I don’t think any agents are pursuing you.*
- Directly **challenging a patient's delusion** is generally unhelpful in acute settings and can lead to increased agitation.
- It invalidates their subjective reality and can make them feel misunderstood or distrustful of the healthcare provider.
*What medications are you currently taking?*
- While important information, asking about medications is too premature as an *initial response* to a patient expressing severe paranoia and fear.
- This question comes across as dismissive of their current emotional state and **prioritizes medical history over emotional support** and rapport-building.
Psychosocial interventions US Medical PG Question 8: A 29-year-old woman presents to her primary physician with complaints of episodic late-night agitations and insomnia to an extent that her work is at stake due to her poor performance for months. Her husband reports that she has recently spent their savings on a shopping spree. He is worried that she might be taking illicit substances as her behavior changes very often. The toxicology screen comes back negative. The physician diagnoses her with bipolar disorder and prescribes her a medication. Which of the following statements best describes the prescribed therapy?
- A. She can be pregnant if she wishes to do so while on this medication
- B. The patient should be informed about the risk of thyroid function impairment (Correct Answer)
- C. Patient cannot be switched to any other therapy if this therapy fails
- D. The prescribed medication does not require therapeutic monitoring
- E. The medication can be discontinued abruptly when the patient’s symptoms ameliorate
Psychosocial interventions Explanation: ***The patient should be informed about the risk of thyroid function impairment***
- **Lithium**, a common mood stabilizer for bipolar disorder, can interfere with **thyroid hormone synthesis** and release, leading to **hypothyroidism**.
- Regular monitoring of **thyroid function tests (TFTs)** is crucial for patients on lithium therapy.
*She can be pregnant if she wishes to do so while on this medication*
- **Lithium** is known to be **teratogenic** and is associated with an increased risk of **Ebstein's anomaly** in the fetus, especially when taken in the first trimester.
- Therefore, it is generally **contraindicated or used with extreme caution** during pregnancy, and women of childbearing age should be counseled on effective contraception.
*Patient can not be switched to any other therapy if this therapy fails*
- Several other medications, such as **valproate**, **carbamazepine**, and **atypical antipsychotics**, are effective in treating bipolar disorder and can be used if initial therapy fails or is not tolerated.
- Treatment for bipolar disorder is often **individualized**, and patients may require trials of different medications or combinations to find the most effective regimen.
*The prescribed medication does not require therapeutic monitoring*
- **Lithium** has a **narrow therapeutic index**, meaning the difference between an effective dose and a toxic dose is small.
- Regular **serum lithium levels** must be monitored to ensure the drug remains within the therapeutic range (0.6-1.2 mEq/L) and to prevent toxicity.
*The medication can be discontinued abruptly when the patient’s symptoms ameliorate*
- Abrupt discontinuation of **lithium** can lead to a **relapse of mood episodes**, including both manic and depressive episodes.
- When discontinuing lithium, the dose should be **tapered gradually** under medical supervision to minimize the risk of relapse and withdrawal symptoms.
Psychosocial interventions US Medical PG Question 9: A 25-year-old woman presents to the emergency department when she was found trying to direct traffic on the highway in the middle of the night. The patient states that she has created a pooled queuing system that will drastically reduce the traffic during rush hour. When speaking with the patient, she does not answer questions directly and is highly distractible. She is speaking very rapidly in an effort to explain her ideas to you. The patient has a past medical history of depression for which she was started on a selective serotonin reuptake inhibitor (SSRI) last week. Physical exam is deferred as the patient is highly irritable. The patient’s home medications are discontinued and she is started on a mortality-lowering agent. The next morning, the patient is resting peacefully. Which of the following is the next best step in management?
- A. TSH and renal function tests (Correct Answer)
- B. Clonazepam
- C. CT head
- D. Valproic acid
- E. Restart home SSRI
Psychosocial interventions Explanation: ***TSH and renal function tests***
- The patient was already started on a **mortality-lowering agent** (most likely **lithium**, given its proven anti-suicide efficacy in bipolar disorder) and is now stabilized.
- Before continuing mood stabilizer therapy, **baseline TSH and renal function tests are essential** as they are required for safe monitoring of lithium (renal excretion) and to rule out thyroid dysfunction (which can affect mood).
- These labs guide **safe long-term management** and should be obtained as soon as the patient is stable enough to cooperate with blood draw.
- This represents appropriate **follow-up care** after acute stabilization of a manic episode.
*Valproic acid*
- While valproic acid is a first-line mood stabilizer for bipolar disorder, the question states a medication was **already started** the previous night.
- Starting another mood stabilizer when the patient is already stable and resting peacefully would not be the immediate next step.
- If valproic acid were to be considered, it would be as an alternative or adjunct after proper baseline assessment.
*Clonazepam*
- Clonazepam is a benzodiazepine useful for acute agitation during manic episodes.
- Since the patient is now **resting peacefully**, acute sedation is no longer needed.
- Benzodiazepines do not address the underlying mood disorder and are not appropriate for long-term management.
*CT head*
- A CT scan would be indicated if there were signs of organic brain pathology, focal neurological deficits, or first-episode psychosis requiring workup.
- This patient has a clear **psychiatric history** (depression) and SSRI-induced mania, making a structural brain lesion unlikely.
- The clinical picture strongly suggests **bipolar disorder** rather than a neurological cause.
*Restart home SSRI*
- Restarting an SSRI in a patient who just experienced **SSRI-induced mania** is **contraindicated**.
- SSRIs can precipitate or worsen mania in individuals with underlying bipolar disorder.
- Antidepressants in bipolar disorder should only be used cautiously with mood stabilizer coverage, if at all.
More Psychosocial interventions US Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
