Free Adolescent and Young Adult Psychiatry Practice Questions

Question 1

Since starting extended-release methylphenidate six weeks ago, a 13-year-old with ADHD has stopped leaving class impulsively and is completing assignments. His mother now notices brief eye-blinking and throat-clearing tics. A family video shows the same movements a year before treatment, and their frequency still waxes and wanes. The tics cause no pain, embarrassment, or functional interference. Growth, sleep, pulse, and blood pressure are satisfactory. His mother asks whether the stimulant must be stopped. How should the medication plan be handled?

Accepted Answer

Continue methylphenidate and monitor tic-related impairment.

Answer

Stop methylphenidate pending assessment by a neurologist.

Answer

Replace methylphenidate with atomoxetine to prevent progression of the tics.

Answer

Add an alpha-2 agonist now while keeping methylphenidate unchanged.

Question 2

The eating-disorder clinic evaluates a 16-year-old boy who has lost 18 kg in four months by restricting food and exercising compulsively. His BMI is 21.2 kg/m². He fears weight gain and minimizes the restriction. On repeated measurements while awake, his heart rate is 44/min and blood pressure is 86/42 mm Hg. Electrolytes are within reference ranges, and he denies suicidal thoughts. His parents can supervise meals and would prefer treatment at home. Which level of care fits these findings?

Accepted Answer

Medical hospitalization for monitored nutritional rehabilitation and cardiovascular assessment.

Answer

A daytime eating-disorder program with overnight supervision provided by his parents.

Answer

Weekly outpatient family-based treatment with additional telephone checks between visits.

Answer

A general psychiatric admission focused on food-related fears and behavioral containment.

Question 3

A 22-year-old seeks help for six weeks of depressed mood, anhedonia, early waking, fatigue, worthlessness, and poor concentration that have disrupted her studies. Reviewing earlier changes in mood, she recalls five consecutive days when she was unusually exuberant, slept three hours nightly without fatigue, talked much more than usual, experienced racing thoughts, and started several projects. Her roommate noticed the change, but she continued attending work without marked impairment. This occurred before any medication treatment. There has never been psychosis, hospitalization, or a more severe elevated episode; substance and medical causes are excluded. Which diagnosis should guide treatment of her current depression?

Accepted Answer

Bipolar II disorder

Answer

Major depressive disorder

Answer

Bipolar I disorder

Answer

Cyclothymic disorder

Question 4

At a college health visit, a 20-year-old has a PHQ-9 total score of 8. On item 9, concerning thoughts of being better off dead or self-harm, he selected 'several days.' No interview about that response has yet occurred. How should the clinician interpret and act on this result?

Accepted Answer

The total indicates mild symptoms, but suicide risk remains unresolved; conduct a direct safety assessment.

Answer

The total indicates mild symptoms and makes significant suicide risk unlikely; repeat screening in one month.

Answer

The positive item establishes imminent suicide risk despite mild symptoms; arrange immediate inpatient admission.

Answer

A positive item 9 overrides the numerical total; classify the depressive symptoms as severe.

Question 5

An 18-year-old with bipolar I disorder initially improved on lurasidone 40 mg daily, taken with the family evening meal. After moving to a residence hall, he began taking it at bedtime with water, five hours after dinner. Over the following month, low mood and anhedonia returned. He reports no missed doses, new medications, or substance use; there are no manic symptoms or acute safety concerns. Which adjustment addresses the most likely reason for the loss of benefit?

Accepted Answer

Take the current 40-mg dose with a 500-calorie meal.

Answer

Increase lurasidone to 80 mg while retaining the bedtime routine.

Answer

Add fluoxetine while continuing lurasidone at the same time and dose.

Answer

Cross-taper from lurasidone to quetiapine because the response was not sustained.

Question 6

'What if I suddenly hurt my brother?' asks a distressed 16-year-old. For four months he has experienced unwanted images of stabbing his brother, avoided the kitchen, mentally reviewed past behavior for evidence that he is dangerous, and sought reassurance from his mother dozens of times daily. These activities occupy more than two hours a day. Direct assessment finds no wish or intention to harm anyone, no history of aggression, and no hallucinations or delusions. Which intervention targets the process maintaining these symptoms?

Accepted Answer

Use graded exposure and response prevention, with a planned reduction in family reassurance.

Answer

Keep the siblings apart and remove kitchen access until the images have stopped.

Answer

Practice forceful thought-stopping and immediate distraction whenever an image appears.

Answer

Have his mother repeatedly explain why his past behavior proves he will not act on the images.

Question 7

Seven days after stopping a year of nightly high-potency cannabis use, a 19-year-old presents with irritability, anxiety, vivid dreams, difficulty sleeping, reduced appetite, and abdominal discomfort. Symptoms began about 48 hours after his last use. He has missed work because of exhaustion and has no grandiosity, pressured speech, or previous episodes of persistent anxiety. His nicotine and caffeine intake have not changed, and he takes no prescribed medication. Urine testing remains positive for cannabinoids. Which explanation best reconciles the clinical course with the test result?

Accepted Answer

Cannabis withdrawal

Answer

Cannabis intoxication

Answer

Generalized anxiety disorder

Answer

A hypomanic episode

Question 8

At the first family meeting for a 14-year-old with anorexia nervosa, her parents worry that taking charge of meals will undermine her independence. She remains unable to eat enough without supervision, but medical assessment supports outpatient care. Both parents are available, willing to help, and able to provide a safe home environment. In the initial phase of family-based treatment, how should responsibility for eating be assigned?

Accepted Answer

Have parents direct renourishment initially, returning eating control as recovery progresses.

Answer

Keep meal decisions with the adolescent and use parents primarily to provide encouragement.

Answer

Have the therapist prescribe meals while asking parents to avoid involvement in eating.

Answer

Resolve longstanding parent-child conflicts before asking the parents to change meal routines.

Question 9

Review of a 22-year-old's records establishes ten months of persistent delusions, daily auditory hallucinations, disorganized speech, and declining occupational functioning. During five weeks of that illness, he also met full criteria for a major depressive episode. The depression resolved, but psychotic symptoms continued. There have been no other major mood episodes, and substance and medical causes have been excluded. A previous clinician recorded schizoaffective disorder solely because psychosis occurred for more than two weeks without depression. Which diagnostic conclusion is warranted?

Accepted Answer

Schizophrenia, because major mood episodes occupy only a minority of the overall psychotic illness.

Answer

Schizoaffective disorder, because psychosis has occurred independently of a depressive episode.

Answer

Major depressive disorder with psychotic features, because depression accompanied some of the psychosis.

Answer

Schizophreniform disorder, because psychosis remained after the depressive symptoms resolved.

Question 10

A telephone message comes from the mother of a 20-year-old autistic patient treated in a U.S. outpatient clinic. The patient has decision-making capacity, has no legal guardian, and has expressly declined sharing treatment information with his mother. She pays for his care and wants to describe changes she has noticed, then asks whether he has attended appointments and taken his medication. There is no serious and imminent threat or other disclosure exception. How may the psychiatrist respond to the mother?

Accepted Answer

Hear her observations, but do not disclose his appointment attendance or treatment information.

Answer

Decline her observations because the patient's refusal also prohibits receiving information from her.

Answer

Discuss medication adherence, but not psychotherapy content, because she pays for his care.

Answer

Confirm appointment attendance only, because scheduling information is administrative rather than clinical.

Free Adolescent and Young Adult Psychiatry Practice Questions

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