BCPP EXAM QUESTIONS AND
ANSWERS
What is the difference between circumstantial and tangential speech? - Answer-
Circumstantial speech deviates but eventually returns to it. Tangential speech deviates
widely but never returns to it.
What are proven benefits of shared decision making? - Answer- Improved quality of
care, patient satisfaction, medication adherence
What is the YBOCS? - Answer- Yale-Brown Obsessive-Compulsive scale
Clinician rated
Used for diagnosis and to assess response
What is the onset of action of lithium? - Answer- 6-10 days; slower than VPA or APD
How to treat lithium overdose? - Answer- Sodium polystyrene sulfonate, dialysis
What are important lithium drug interactions? - Answer- NSAIDs: increase levels
ACE/ARB: increase levels
Diuretics: decrease levels
Caffeine: Decrease levels
How is VPA Dosed? - Answer- Loading dose: 20 mg/kg (25 mg/kg ER)
-OR-
30 mg/kg for 2 days then 20 mg/kg (loading dose strategy)
Titration strategy: start at 500 to 750 mg, increase to achieve 20 mg/kg
Therapeutic range: 50-125 mcg/ml
How to switch from Depakote to Depakote ER? - Answer- Serum levels expected to
decrease by 8-20%, dose increase probably required
How is the YBOCS interpreted? - Answer- 0-7 sub clinical
8-15 mild
16-23 moderate
24-31 severe
,32-40 very severe
Response: 25%
Remission: score <8
What is the GAD7? - Answer- Patient self rated screener for anxiety (doesn't measure tx
response)
What are GAD7 cutoffs? - Answer- 5= mild
10= moderate
15= severe
What is the HAM A? - Answer- Clinician rated anxiety scale
Measures tx response
What are HAM A cutoffs? - Answer- Mild: 0-17
Mod: 18-24
Severe: 25-30
Remission: 70% imp
Improved: 50% imp
Partial: 25-49%
Starting dose of sertraline in elderly and children? - Answer- 12.5-25 mg
Starting dose of venlafaxine in children and elderly? - Answer- 37.5 mg
How should BZDs be discontinued? - Answer- 25% reduction per week until 50% of
dose is reached, then reduce by 1/8 every 4-7 days
Therapy > 8 weeks: 2-3 weeks
Therapy > 6 months: 4-8 weeks
Therapy > 1 year: slow taper over 2-4 months
What is the DI between omeprazole and diazepam? - Answer- Omeprazole increases
half life and concentration of diazepam
Which SGAs can be used as augmenting agents in GAD? - Answer- Olanzapine,
quetiapine, risperidone. Quetiapine XR can be used as early as 2nd line
What are first line treatments for panic disorder - Answer- CBT: evidence does NOT
show superiority of pharm over non-pharm
SSRI
Venlafaxine
BZD
Clomipramine, imipramine
2nd line: mirtazepine
Can consider sga augmentation or MAOI after failure of ssri, Snri, and tca
,What are first line treatments for ptsd - Answer- Trauma focused psychotherapy:
exposure based, emdr, anxiety management or cbt. Emphasized in recent guidelines.
SSRI: paroxetine, sertraline and fluoxetine have strong evidence
Venlafaxine
Consider alternative agents or augmentation after 3 failed trials: Tcas, mirtazepine,
phenelzine, AEDs
NO BZDs or SGAs
What are first line treatments for OCD? - Answer- CBT or SSRI. CBT +
pharmacotherapy not better than CBT alone, but is better than pharmacotherapy alone.
2nd line: venlafaxine XR, clomipramine, mirtazepine. Clomipramine may be more
effective, but less tolerated.
Adjunctive: aripiprazole, risperidone *esp in pts with tics!
How should SSRIs be dosed in OCD? - Answer- Dose higher than usual
At least 12 weeks needed for response
How long to continue pharmacotherapy in OCD? - Answer- 1-2 years. Life long after 2-4
relapses.
How are SGAs used in OCD? - Answer- Augmentation, hapiperidol or aripiprazole or
risperidone, after failing 2 antidepressants.
Clomipramine monitoring parameters and AES? - Answer- Cardiotoxic in overdose
Epilepsy- inc risk of seizures
Caution in hepatic and rental impairment
Which natural product may benefit OCD? - Answer- D- cycloserine
What is the difference between interval and ratio data? - Answer- Ratio has absolute 0
(values make a true ratio when divided)
What are the 2 types of continuous data? - Answer- Interval and ratio
How is SD calculated? - Answer- Square root of variance
SD percents? - Answer- 68% lie within 1 SD
95% lie within 2 SD
99.7% lie within 3 SD
How is SEM calculated? - Answer- SD/SQRTn
What is the difference between cohort and case-control studies? - Answer- Cohort sorts
based on exposure and looks forward in time for outcomes.
Case-control classifies based on outcome and looks back in time for exposure.
, Blocked random allocation - Answer- Used to ensure that at any given point in time, the
groups will be similar or equal in size. I.e. ABBA, BAAB, ABAB
cluster randomization - Answer- groups of patients are randomized rather than the
individual patients, I.e. entire hospitals or clinics are randomized to an intervention
Stratified randomization - Answer- individuals are grouped into strata (I.e. gender) and
then randomized to one treatment group
What is the kappa statistic and what score is satisfactory.? - Answer- quantitative
measure of inter-rater reliability (inter-rater concordance). -1 is perfect disagreement, +1
is perfect disagreement.
Kappa >.7 is satisfactory.
Allocation bias - Answer- Occurs when subjects or investigators can choose which
treatment group they would like. Results in groups with different characteristics
Attrition bias - Answer- Certain participants are more likely to drop out of the study than
others, leading to a final sample that differs from the initial
channeling bias - Answer- Occurs in observational studies. Occurs when clinicians
choose treatment according to pts diagnosis, I.e, pt at highest risk gets treatment
Classification bias - Answer- Bias due to a misclassification (ex. measurement error,
errors in diagnosing AD in clinical trials without a PET scan)
Confounding bias - Answer- occurs with 2 closely associated factors; the effect of 1
factor distorts or confuses the effect of the other
interviewer bias - Answer- effects of interviewers on respondents that lead to biased
answers- I.e. placebo response
observer bias - Answer- when observations may be skewed to align with observer
expectations. Control by blinding raters.
protopathic bias - Answer- When treating early symptoms of the disease may apPEAR
TO CAUSE THE response. I.e. treating the dying with anticholinergics to control
secretions, anticholinergics may appear to cause death.
recall bias - Answer- Knowledge of presence of disorder alters recall by subjects. I.e.
mothers with poor pregnancy outcomes may recall exposures more clearly.
referral bias - Answer- The systematic error due to the inconsistent recruitment of
subjects from different care settings, I.e. primary care vs subspecialty clinic
ANSWERS
What is the difference between circumstantial and tangential speech? - Answer-
Circumstantial speech deviates but eventually returns to it. Tangential speech deviates
widely but never returns to it.
What are proven benefits of shared decision making? - Answer- Improved quality of
care, patient satisfaction, medication adherence
What is the YBOCS? - Answer- Yale-Brown Obsessive-Compulsive scale
Clinician rated
Used for diagnosis and to assess response
What is the onset of action of lithium? - Answer- 6-10 days; slower than VPA or APD
How to treat lithium overdose? - Answer- Sodium polystyrene sulfonate, dialysis
What are important lithium drug interactions? - Answer- NSAIDs: increase levels
ACE/ARB: increase levels
Diuretics: decrease levels
Caffeine: Decrease levels
How is VPA Dosed? - Answer- Loading dose: 20 mg/kg (25 mg/kg ER)
-OR-
30 mg/kg for 2 days then 20 mg/kg (loading dose strategy)
Titration strategy: start at 500 to 750 mg, increase to achieve 20 mg/kg
Therapeutic range: 50-125 mcg/ml
How to switch from Depakote to Depakote ER? - Answer- Serum levels expected to
decrease by 8-20%, dose increase probably required
How is the YBOCS interpreted? - Answer- 0-7 sub clinical
8-15 mild
16-23 moderate
24-31 severe
,32-40 very severe
Response: 25%
Remission: score <8
What is the GAD7? - Answer- Patient self rated screener for anxiety (doesn't measure tx
response)
What are GAD7 cutoffs? - Answer- 5= mild
10= moderate
15= severe
What is the HAM A? - Answer- Clinician rated anxiety scale
Measures tx response
What are HAM A cutoffs? - Answer- Mild: 0-17
Mod: 18-24
Severe: 25-30
Remission: 70% imp
Improved: 50% imp
Partial: 25-49%
Starting dose of sertraline in elderly and children? - Answer- 12.5-25 mg
Starting dose of venlafaxine in children and elderly? - Answer- 37.5 mg
How should BZDs be discontinued? - Answer- 25% reduction per week until 50% of
dose is reached, then reduce by 1/8 every 4-7 days
Therapy > 8 weeks: 2-3 weeks
Therapy > 6 months: 4-8 weeks
Therapy > 1 year: slow taper over 2-4 months
What is the DI between omeprazole and diazepam? - Answer- Omeprazole increases
half life and concentration of diazepam
Which SGAs can be used as augmenting agents in GAD? - Answer- Olanzapine,
quetiapine, risperidone. Quetiapine XR can be used as early as 2nd line
What are first line treatments for panic disorder - Answer- CBT: evidence does NOT
show superiority of pharm over non-pharm
SSRI
Venlafaxine
BZD
Clomipramine, imipramine
2nd line: mirtazepine
Can consider sga augmentation or MAOI after failure of ssri, Snri, and tca
,What are first line treatments for ptsd - Answer- Trauma focused psychotherapy:
exposure based, emdr, anxiety management or cbt. Emphasized in recent guidelines.
SSRI: paroxetine, sertraline and fluoxetine have strong evidence
Venlafaxine
Consider alternative agents or augmentation after 3 failed trials: Tcas, mirtazepine,
phenelzine, AEDs
NO BZDs or SGAs
What are first line treatments for OCD? - Answer- CBT or SSRI. CBT +
pharmacotherapy not better than CBT alone, but is better than pharmacotherapy alone.
2nd line: venlafaxine XR, clomipramine, mirtazepine. Clomipramine may be more
effective, but less tolerated.
Adjunctive: aripiprazole, risperidone *esp in pts with tics!
How should SSRIs be dosed in OCD? - Answer- Dose higher than usual
At least 12 weeks needed for response
How long to continue pharmacotherapy in OCD? - Answer- 1-2 years. Life long after 2-4
relapses.
How are SGAs used in OCD? - Answer- Augmentation, hapiperidol or aripiprazole or
risperidone, after failing 2 antidepressants.
Clomipramine monitoring parameters and AES? - Answer- Cardiotoxic in overdose
Epilepsy- inc risk of seizures
Caution in hepatic and rental impairment
Which natural product may benefit OCD? - Answer- D- cycloserine
What is the difference between interval and ratio data? - Answer- Ratio has absolute 0
(values make a true ratio when divided)
What are the 2 types of continuous data? - Answer- Interval and ratio
How is SD calculated? - Answer- Square root of variance
SD percents? - Answer- 68% lie within 1 SD
95% lie within 2 SD
99.7% lie within 3 SD
How is SEM calculated? - Answer- SD/SQRTn
What is the difference between cohort and case-control studies? - Answer- Cohort sorts
based on exposure and looks forward in time for outcomes.
Case-control classifies based on outcome and looks back in time for exposure.
, Blocked random allocation - Answer- Used to ensure that at any given point in time, the
groups will be similar or equal in size. I.e. ABBA, BAAB, ABAB
cluster randomization - Answer- groups of patients are randomized rather than the
individual patients, I.e. entire hospitals or clinics are randomized to an intervention
Stratified randomization - Answer- individuals are grouped into strata (I.e. gender) and
then randomized to one treatment group
What is the kappa statistic and what score is satisfactory.? - Answer- quantitative
measure of inter-rater reliability (inter-rater concordance). -1 is perfect disagreement, +1
is perfect disagreement.
Kappa >.7 is satisfactory.
Allocation bias - Answer- Occurs when subjects or investigators can choose which
treatment group they would like. Results in groups with different characteristics
Attrition bias - Answer- Certain participants are more likely to drop out of the study than
others, leading to a final sample that differs from the initial
channeling bias - Answer- Occurs in observational studies. Occurs when clinicians
choose treatment according to pts diagnosis, I.e, pt at highest risk gets treatment
Classification bias - Answer- Bias due to a misclassification (ex. measurement error,
errors in diagnosing AD in clinical trials without a PET scan)
Confounding bias - Answer- occurs with 2 closely associated factors; the effect of 1
factor distorts or confuses the effect of the other
interviewer bias - Answer- effects of interviewers on respondents that lead to biased
answers- I.e. placebo response
observer bias - Answer- when observations may be skewed to align with observer
expectations. Control by blinding raters.
protopathic bias - Answer- When treating early symptoms of the disease may apPEAR
TO CAUSE THE response. I.e. treating the dying with anticholinergics to control
secretions, anticholinergics may appear to cause death.
recall bias - Answer- Knowledge of presence of disorder alters recall by subjects. I.e.
mothers with poor pregnancy outcomes may recall exposures more clearly.
referral bias - Answer- The systematic error due to the inconsistent recruitment of
subjects from different care settings, I.e. primary care vs subspecialty clinic
