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1. The human brain is the most complex structure ever investigated by our science. Each of the following is an accurate statement about the complexity of the brain EXCEPT:
A. The organization of the brain at the cellular level involves many thousands of distinct kinds of neurons
B. At a higher integrative level, neurons form circuits for information processing determined by their patterns of synaptic connections
C. The organization of these parallel distributed circuits results in the specialization of different geographic regions of the brain for different functions
D. Damage to a particular brain region rarely yields adaptations that permit circuits spared the damage to pick up some of the functions that have been lost
2. Electrical signals within neurons are converted at synapses into chemical signals which then elicit electrical signals on the other side of the synapse. There are two major kinds of molecules that serve the function of neurotransmitters: small molecules, such as dopamine, serotonin, or norepinephrine, and larger molecules, which are essentially protein chains, called peptides.
A. True
B. False
3. The authors describe several distinct types of memory including all of the following EXCEPT:
A. Episodic memory
B. Memory of motor programs or procedures
C. Unconscious memory
D. Emotional memory
4. Mental illness is a term rooted in history that refers collectively to all of the diagnosable mental disorders, and mental disorders are characterized by abnormalities in emotion or mood, the highest integrative aspects of behavior, such as social interactions or planning of future activities, or:
A. Intellect
B. Achievement
C. Cognition
D. All of the above
5. Persons suffering from any of the severe mental disorders present with a variety of symptoms that may include inappropriate anxiety, disturbances of thought and perception, dysregulation of mood, and the ability to process information. Which of the following most accurately describes some of manifestations of mental illness?
A. High-level anxiety is a more diffuse and nonspecific kind of anxiety that is most often experienced as excessive worrying, restlessness, and tension occurring with a chronic and sustained pattern
B. Psychotic symptoms may occur in a wide variety of mental disorders. but they are most characteristically associated with the manic phase of bipolar disorder
C. The mood disorder most closely associated with persistent sadness is dysthymia, while that associated with sustained elevation or fluctuation of mood is bipolar disorder
D. Somatic or other physical symptoms and impairment of impulse control may be indicators of a mental disorder
6. In the mental health field, the term “illness” generally is reserved for conditions with known pathology, while the term “disease”, on the other hand, is reserved for clusters of symptoms and signs associated with distress and disability.
A. True
B. False
7. Epidemiological estimates have shifted over time because of changes in the definitions and diagnosis of mental health and mental illness, but the rates of mental illness estimated by epidemiologists today are far higher than those rates from the early 1950s.
A. True
B. False
8. When evaluating the extent of mental illness in the United States, which of the following is an accurate statement?
A. Studies indicate that about 28 to 30 percent of the adult U.S. adult population have either a mental or addictive disorder
B. Based on data on functional impairment, it is estimated that 12 percent of all U.S. adults have mental disorders that cause some significant functional impairment
C. Approximately 7 to 11 percent of children ages 9 to 17 have a diagnosis of serious emotional disturbance (SED)
D. Estimates conclude that 15.8 percent of the older adult population have a diagnosable mental disorder during a 1-year period
9. The costs of mental illness, both direct and indirect, are exceedingly high. Studies conducted in the 1990s indicated that:
A. The direct costs of mental health services in the United States in 1996 totaled $69.0 billion
B. An additional $15.6 billion was spent on Alzheimer’s disease and $10.3 on substance abuse in 1996
C. The indirect costs of mental illness were estimated in 1990 at $84.6 billion
D. All of the above
10. The causes of health and disease are generally viewed as a product of the interplay or interaction between biological, psychological, and sociocultural factors, and this is also true for mental health and mental illness. Each of the following is an accurate statement about these factors and mental illness EXCEPT:
A. Stressful life events, affect, personality, and gender are prominent psychological influences that may contribute to mental illness
B. The heritability of bipolar disorder, according to the most rigorous twin study, is about 59 percent, while the heritability of schizophrenia is estimated at a somewhat higher level
C. Infectious agents can penetrate into the brain where they can cause mental disorders, as evident with neurosyphilis and HIV-associated dementia
D. Biological, psychological, or social isolation will likely weigh heavily on the development of a mental disorder
11. In general, psychodynamic theories of personality assert that behavior is the product of underlying conflicts over which people often have scant awareness.
A. True
B. False
12. Operant conditioning, a process described and coined by B. F. Skinner, is a form of learning in which a voluntary response is strengthened or attenuated, depending on its association with positive or negative consequences. Each of the following is an accurate statement about operant conditioning EXCEPT:
A. The strengthening of responses occurs by positive reinforcement, such as food, pleasurable activities, and attention from others
B. The attenuation or discontinuation of responses occurs by negative reinforcement in the form of removal of a pleasurable stimulus
C. Human behavior is shaped in a trial and error way through positive and negative reinforcement that is influenced by inner conflicts or perceptions
D. Mental disorders represent maladaptive behaviors that are learned and can be unlearned through behavior modification
13. Developmental theories presented in the 1950s and 1960s, based on a huge body of theoretical and empirical research, were pivotal for the psychological and social sciences. However, with the advancements of science and the diversity of the population, these models may not apply to all groups without some adaptation for cultural context.
A. True
B. False
14. Behavior at birth consists of a repertoire of simple reflexes, that is, inborn neurological reactions that are involuntary in nature. Over time, the infant displays an expanded repertoire of fine and gross motor skills, that begin to unfold in the first twelve to eighteen months of life.
A. True
B. False
15. Theories of psychological development take into account the biological, social, and psychological environment; their interaction; and their combined effect upon the individual throughout the life span. Which of the following most accurately describes early developmental theories?
A. Sigmund Freud postulated that development proceeded through a series of stages in which children were presented with challenges arising from tension between psychosocial and psychosexual forces
B. Jean Piaget focused on the processes by which children come to know and understand the world through a process of stages, with children moving back and forth between stages during their early years
C. Erik Erikson conceived of the life course, from birth to old age, as a series of eight epigenetic stages and portrayed each stage as a crisis or conflict that needed resolution, either at the time or at a subsequent stage
D. Albert Ellis believed that with the comfort and security of a stable and routine attachment to the mother or primary caregiver, a child is able to organize other elements of development in a coherent way
16. For over a century, an intense debate among developmentalists and other scientists has pitted nature against nurture as the engine of human development and behavior. The pendulum now is coming to rest with the recognition that behavior is the product of both the environment and genetic factors, and each of the following is a true statement about this EXCEPT:
A. Nature and nurture are not necessarily independent forces but can interact with one another: nature can influence nurture, and nurture can influence nature
B. Studies comparing identical and fraternal twins have shown that for many behavioral traits, as well as mental disorders, there is a noticeable heritable component, yet only 36 percent of pairs of identical twins are concordant for schizophrenia
C. During early development, and also into adulthood, nurture influences nature, right down to detectable changes in the brain
D. Studies indicate that stress-related disorders induce possibly irreversible atrophy of the hippocampus and anxiety disorders also alter neuroendocrine systems, which indicates further how nurture influences nature
17. The term prevention has different meanings among people and also has various meanings in different health fields. The reduction in the amount of disability caused by a disease in order to achieve the highest level of function is known as:
A. Secondary prevention
B. Triennial prevention
C. Tributary prevention
D. Tertiary prevention
18. The concepts of risk and protective factors, risk reduction, and enhancement of protective factors are central to most empirically based prevention programs. Each of the following is an accurate statement about risk factors EXCEPT:
A. Risk factors are those characteristics, variables, or hazards that make it more likely that an individual, rather than someone selected at random from the general population, will develop a disorder
B. Risk factors must be present before the onset of the disorder, and in general, they are static
C. Some risks such as gender and family history are fixed; that is, they are not malleable to change
D. Risk factors such as lack of social support, inability to read, and exposure to bullying can be altered by strategic and potent interventions
19. Mental disorders are treatable, and for most mental disorders, there is generally not just one but a range of treatments of proven efficacy. Most treatments fall under two general categories, psychosocial and pharmacological, or a combination of the two which is known as:
A. Multimodal therapy
B. Combination therapy
C. Dynamic therapy
D. None of the above
20. Psychotherapy is a learning process in which mental health professionals seek to help individuals who have mental disorders and mental health problems. Each of the following is an accurate description about the various psychotherapeutic approaches EXCEPT:
A. In psychodynamic therapies, the role of the past in shaping the present is emphasized, so it is important in understanding behavior to evaluate its origins and how people come to act and feel as they do
B. Behavior modification or behavior therapy focuses on current behavior rather than on early patterns of the patient, and in its earlier form, behavior therapy dealt exclusively with what people did rather than what they thought or felt
C. Cognitive-behavioral therapy strives to alter faulty cognitions and replace them with thoughts and self-statements that promote adaptive behavior, and one critical aspect of the treatment is the relationship that is forged with the therapist, as it serves as a guide in an exploration of self-discovery
D. Humanistic therapy focuses on the immediate experience of the client and the emphasis is on the present and the potential for future development rather than on the past, and on immediate feelings rather than on thoughts or behaviors
21. Through a process known as altered drug design, researchers have become increasingly sophisticated at designing drugs by manipulating their chemical structure. This has enabled them to create more effective therapeutic agents, with fewer side effects, exquisitely targeted to correct the biochemical alterations that accompany mental disorders.
A. True
B. False
22. Pharmacotherapies that act in similar ways are grouped together into broad categories, and within each category are several chemical classes. Cholinesterase inhibitors are most commonly used for which of the following?
A. Anxiety disorders
B. Depressive disorders
C. Mania
D. Alzheimer’s Disease
23. Mental health professionals have long observed that treatments work better in the clinical research trial setting as opposed to typical clinical practice settings. The diminished level of treatment effectiveness in real-world settings is so perceptible that it even has a name, the “efficacy-effectiveness gap”, and it applies to both pharmacological therapies and to psychotherapies.
A. True
B. False
24. Over the past three centuries, the complex patchwork of mental health services in the United States has become so fragmented that it is referred to as the de facto mental health system. Which of the following is NOT one of the four sectors of this system?
A. Specialty mental health sector
B. General medical/primary care sector
C. Community outreach sector
D. Human services sector
25. The specific settings for care and treatment within the mental health system include institutional, community-based, and custodial-based programs.
A. True
B. False
26. According to recent national surveys, a total of about ___ percent of the U.S. adult population use mental health services in any given year and about ___ percent of the child and adolescent population use mental health services annually.
A. 13; 19
B. 15: 21
C. 17: 23
D. 19; 25
27. The history of mental health services in the United States indicates that the first reformers, including Dorothea Dix and Horace Mann, imported the idea that mental illness could be treated by removing the individual to an asylum to receive a mix of somatic and psychosocial treatments in a controlled environment. This was part of the first treatment movement, known as:
A. Mental hygiene treatment
B. Neuropathological treatment
C. Moral treatment
D. None of the above
28. In the beginning of the 20th century, early mental health treatment was no more successful in preventing patients from becoming chronically ill than it was in the early years of the previous century. At best, the hospitals provided humane custodial care; at worst, they neglected or abused the patients.
A. True
B. False
29. From 1975 to the present, the Community Mental Health Reform Movement , which focuses on deinstitutionalization and social integration, has called for an end to viewing and responding to chronic mental disorder only as the object of neglect, by favoring acute treatment and prevention.
A. True
B. False
30. The historical experiences of ethnic and minority groups in the United States reflected in differences in economic, social, and political status, and low socioeconomic status has been strongly linked to mental illness. The U.S. mental health system is not well equipped to meet the needs of racial and ethnic minority populations.
A. True
B. False
31. Racial and ethnic populations differ from one another and from the larger society with respect to culture. The identifiable social entity with whom a person identifies and to whom he or she looks for standards of behavior is referred to as:
A. Ethnic identity
B. Cultural identity
C. Assimilation identity
D. None of the above
32. Lower socioeconomic status-in terms of income, education, and occupation-has been strongly linked to mental illness, and it has been known for decades that people in the lowest socioeconomic strata are about three and a half times more likely than those in the highest strata to have a mental disorder.
A. True
B. False
33. One of the best ways to identify whether a minority group has problems accessing mental health services is to examine their utilization of services in relation to their need for services. Which of the following accurately describes the utilization of services by minority populations?
A. African Americans are overrepresented in some outpatient treatment populations, but underrepresented in public inpatient psychiatric care in relation to whites
B. Asian Americans/Pacific Islanders are less likely than whites to be psychiatric inpatients, and the reasons for the underutilization of services include the stigma over mental health problems, limited English proficiency, and the inability to find culturally competent services, although these factors are less pronounced for recent immigrants
C. Several studies indicate that Puerto Rican and Mexican American women with depressive symptomatology are underrepresented in general medical services and overrepresented in mental health services
D. In terms of patterns of utilization, Native Americans are overrepresented in psychiatric inpatient care in relation to whites, with the exception of private psychiatric hospitals
34. The underrepresentation in outpatient treatment of racial and ethnic minority groups appears to be the result of cultural differences as well as financial, organizational, and diagnostic factors. Which of the following is an accurate statement about these barriers to treatment?
A. Among adults, the evidence is considerable that persons from minority backgrounds are less likely than are whites to seek outpatient treatment in the specialty mental health sector, and African Americans are much less likely than whites to seek care for mental health problems in an emergency department
B. Bias in clinician judgment is thought to be reflected in overdiagnosis , misdiagnosis, and underdiagnosis among minority groups
C. While African American and report that embarrassment hinders them from seeking treatment, whites generally do not report this as an issue
D. Compared to other underrepresented populations, Asian Americans are more likely to give the following reasons for not seeking professional help in the face of depression: lack of time, fear of hospitalization, and fear of treatment
35. There is mounting awareness that ethnic and cultural influences can alter an individual’s responses to medications (pharmacotherapies), probably because of genetic and psychosocial factors
A. True
B. False
36. Advocates and policymakers have called for all mental health practitioners to recognize and to respond to cultural concerns of ethnic and racial groups, including their histories, traditions, beliefs, and value systems, and this is known as:
A. Sociocultural awareness
B. Diversity accessibility
C. Cultural competence
D. None of the above
37. The differences between rural and urban communities present another source of diversity in mental health services, and people in rural America encounter numerous barriers to the receipt of effective services. Rural economies are in decline, and the population is decreasing in most areas, so rural mental health services have been predominantly privately funded, which makes it difficult for many to access services.
A. True
B. False
38. In the 1960s, the civil rights movement inspired former mental patients to become better organized into what was then coined the mental patients’ liberation movement. Each of the following is an accurate statement about these groups EXCEPT:
A. They saw themselves as having been rejected by society and robbed of power and control over their lives, and they began to advocate for selfdetermination and basic rights
B. Groups called Alliance for the Liberation of Mental Patients, the Insane Liberation Front, and Project Release met in homes and churches, drawing their membership from those with firsthand experiences with the mental health system
C. They sustained their membership by providing peer support, education about services in the community, and advocacy to help members access services and to press for reforms
D. Although they were very pro-psychiatry, they were adamantly against laws favoring involuntary commitment, and often against interventions such as electroconvulsive therapy and antipsychotic medications
39. Since the late 1970s, mental health services continue to be transformed by the growing influence of consumer and family organizations. The book On Our Own by former patient Judi Chamberlin was a benchmark in the history of the consumer movement because consumers and others were able to read in the mainstream press what it was like to have experienced the mental health system.
A. True
B. False
40. Self-help groups are led by peers to promote mutual support, education, and growth, and they are predicated on the belief that individuals who share the same health problem can help themselves and each other to cope with their condition. Self-help groups assume three different postures toward health professionals, including each of the following EXCEPT:
A. The separatist model where there is no involvement with mental health professionals
B. The advocacy model where members allow professionals to advocate of their behalf for specific purposes only
C. The supportive model that allows professionals to aid in auxiliary roles
D. The partnership model in which professionals act as leaders alongside patients
41. Consumer organizations have had measurable impact on mental health services, legislation, and research. Consumers continue to be involved in research in several ways: as participants of clinical research; as respondents who are asked questions about conditions in their life; as partners in some aspect of the planning, designing, and conducting of the research project with professional researchers in control, and:
A. As members of an advocacy council that oversees the research projects
B. As employees in the traditional mental health system who advice on research efforts
C. As independent researchers who conduct, analyze the data, and publish the results of the research project
D. All of the above
42. The family advocacy movement is principally represented by three large organizations: the National Alliance for the Mentally Ill, the Federation of Families for Children’s Mental Health, and the National Mental Health Association. Although the target populations of these organizations are different, they are similar in their devotion to advocacy, family support, research, and ______________________.
A. Public awareness
B. Training of mental health professionals
C. Patient empowerment
D. Expansion of needed services
43. The concept of recovery is having substantial impact on consumers and families, mental health research, and service delivery, and although there is neither a single agreed-upon definition of recovery nor a single way to measure it, the primary focus is on symptom relief so that the person may begin to have a healthy and productive life.
A. True
B. False
44. About ___ percent of the U.S. adult population uses mental health services in the health sector in any year, and another ___ percent seek such services from social service agencies, schools, religious, or self-help groups. However, critical gaps exist between those who need service and those who receive service and between optimally effective treatment and what many individuals receive in actual practice settings.
A. 16; 11
B. 14; 9
C. 12; 7
D. 10; 5
45. As the life expectancy of Americans continues to extend, the sheer number and the proportions of persons experiencing mental disorders of late life will expand, confronting our society with unprecedented challenges in organizing, financing, and delivering effective mental health services for this population.
A. True
B. False
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