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Facharzt FMH Kinder- und Jugendpsychiatrie - independent subject foundations study materials
Facharzt FMH Kinder- und Jugendpsychiatrie - independent subject foundations study resources

Facharzt FMH Kinder- und Jugendpsychiatrie - independent subject foundations practice questions

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Question 1Developmental and child-adolescent psychiatric assessment

In a comprehensive specialist autism assessment, which listed standardized instrument is designed for direct, semi-structured observation of social communication and restricted or repetitive behavior? The instrument does not independently establish a diagnosis.

  1. Child Behavior Checklist (CBCL)
  2. Conners-3 Parent and Teacher Rating Scales
  3. Wechsler Intelligence Scale for Children (WISC-V)
  4. Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) Correct answer.

Explanation

ADOS-2 is a structured direct-observation instrument used within a comprehensive specialist autism assessment. Developmental history, information across settings, clinical judgment and relevant alternatives still matter; the instrument alone does not establish the diagnosis.

Question 2Developmental and child-adolescent psychiatric assessment

A 7-year-old boy presents with frequent eye-blinking, shoulder-shrugging, and head-jerking motor movements that have been present for 14 months. Over the past 4 months, he has also developed repetitive throat-clearing and involuntary grunting sounds. The symptoms wax and wane in intensity, worsen during stress, and are preceded by an uncomfortable premonitory urge. What is the definitive diagnosis according to DSM-5-TR and ICD-11 criteria?

  1. Provisional Tic Disorder
  2. Tourette Syndrome (Combined Vocal and Multiple Motor Tic Disorder) Correct answer.
  3. Persistent (Chronic) Motor Tic Disorder
  4. Stereotypic Movement Disorder

Explanation

Tourette Syndrome (Tourette Disorder) is diagnosed when both multiple motor tics and at least one vocal/phonic tic have been present at some time during the illness (though not necessarily concurrently), persisting for more than 1 year, with onset before 18 years of age, and not attributable to physiological effects of a substance or another medical condition.

Question 3Developmental and child-adolescent psychiatric assessment

Which behavioral psychotherapy modality is established by European (ESCAP) and American (AACAP) clinical guidelines as the first-line psychosocial treatment for children with Tourette Syndrome and Chronic Tic Disorders?

  1. Psychoanalytic play therapy
  2. Systemic paradoxical intention
  3. Comprehensive Behavioral Intervention for Tics (CBIT) including Habit Reversal Training (HRT) Correct answer.
  4. Dialectical Behavior Therapy for Children (DBT-C)

Explanation

Comprehensive Behavioral Intervention for Tics (CBIT), incorporating Habit Reversal Training (HRT) and Exposure and Response Prevention (ERP), is the gold-standard, first-line behavioral therapy for tic disorders. It consists of awareness training (recognizing the premonitory urge) and competing response training (initiating a physically incompatible voluntary muscle contraction), combined with functional environmental interventions.

Question 4Developmental and child-adolescent psychiatric assessment

An 8-year-old boy of normal intelligence (WISC-V Full Scale IQ = 108) exhibits severe, persistent difficulties with word reading accuracy, slow and effortful reading rate, and poor spelling. Phonological awareness tasks show marked deficits in phonemic segmentation and blending. His vision and hearing are intact, and he has received adequate formal schooling. According to ICD-11 (code 6A03) and MAS Axis 2 classification, what is the primary diagnosis?

  1. Developmental Language Disorder with impairment of receptive language
  2. Attention-Deficit/Hyperactivity Disorder, predominantly inattentive type
  3. Developmental Learning Disorder with impairment in reading (Developmental Dyslexia) Correct answer.
  4. Mild Intellectual Developmental Disorder

Explanation

Developmental Learning Disorder with impairment in reading (Developmental Dyslexia; ICD-11: 6A03.0; MAS Axis 2) is characterized by significant and persistent difficulties in learning academic skills related to reading, such as word reading accuracy, reading fluency, and reading comprehension, that are substantially below what is expected for chronological age and general intellectual functioning, and not better explained by sensory impairment, intellectual disability, or inadequate instruction.

Question 5Developmental and child-adolescent psychiatric assessment

A 5-year-old boy speaks fluently, spontaneously, and with age-appropriate vocabulary at home with his parents and siblings. However, for the past 6 months since enrolling in kindergarten, he has never spoken a single word to teachers or peers, instead relying on nodding or pointing. His hearing and receptive language comprehension are normal. What is the most likely psychiatric diagnosis?

  1. Developmental Speech Sound Disorder
  2. Selective Mutism Correct answer.
  3. Childhood-Onset Fluency Disorder (Stuttering)
  4. Autism Spectrum Disorder

Explanation

Selective Mutism is characterized by a consistent failure to speak in specific social situations where there is an expectation to speak (e.g., school/kindergarten), despite speaking normally in other situations (e.g., at home with immediate family). The disturbance must last for at least 1 month (not limited to the first month of school) and interferes with educational or social communication.

Question 6Developmental and child-adolescent psychiatric assessment

Which behavioral psychotherapeutic technique is considered the primary evidence-based approach for treating Selective Mutism in young children?

  1. Aversive conditioning with response cost
  2. Graded exposure combined with stimulus fading and shaping in the school environment Correct answer.
  3. Deep expressive psychodynamic interpretation of unconscious family conflicts
  4. High-dose benzodiazepine maintenance monotherapy

Explanation

Graded exposure combined with stimulus fading (gradually introducing new individuals into a setting where the child is already speaking), shaping (rewarding approximations to speech such as whispering or blowing sounds), and positive reinforcement in the naturalistic school setting is the primary evidence-based cognitive-behavioral approach for selective mutism.

Question 7Developmental and child-adolescent psychiatric assessment

A 6-year-old child demonstrates significant clumsiness, difficulty tying shoelaces, buttoning clothes, using scissors, catching a ball, and frequent bumping into furniture. Neurodevelopmental testing reveals motor coordination skills substantially below expected developmental levels. Medical examination rules out cerebral palsy, muscular dystrophy, and visual impairment. Intelligence is normal. What is the diagnosis?

  1. Persistent Motor Tic Disorder
  2. Developmental Stuttering
  3. Sensory Processing Intolerance Syndrome
  4. Developmental Coordination Disorder (DCD / Dyspraxia) Correct answer.

Explanation

Developmental Coordination Disorder (DCD; ICD-11: 6A04) is diagnosed when the acquisition and execution of coordinated motor skills are substantially below what is expected given the individual's chronological age and opportunity for skill learning, manifesting as clumsiness, slowness, and inaccuracy of motor performance, which significantly interferes with activities of daily living or academic achievement, and is not attributable to an intellectual disability, neurological disorder, or visual impairment.

Question 8Developmental and child-adolescent psychiatric assessment

According to DSM-5-TR and ICD-11 criteria for Intellectual Developmental Disorder (Intellectual Disability), which factor is the primary determinant for establishing the severity level (mild, moderate, severe, profound)?

  1. Level of adaptive functioning across conceptual, social, and practical domains Correct answer.
  2. Strict numerical Full Scale IQ cutoff score without assessing daily living skills
  3. The presence and number of comorbid psychiatric diagnoses
  4. The underlying cytogenetic or metabolic etiology identified on genetic microarray

Explanation

In DSM-5-TR and ICD-11, the severity of Intellectual Developmental Disorder is defined on the basis of adaptive functioning across three domains (conceptual, social, and practical), rather than IQ scores alone, because adaptive functioning determines the level of supports required by the individual in daily life.

Question 9Developmental and child-adolescent psychiatric assessment

A 16-year-old male with mild intellectual disability and autism spectrum disorder presents with a long face, prominent ears, macroorchidism, high-arched palate, and joint hypermobility. Genetic evaluation is indicated. What is the most common inherited monogenic cause of intellectual disability and autism spectrum symptoms?

  1. Trisomy 21 (Down syndrome)
  2. Fragile X Syndrome (CGG trinucleotide repeat expansion in the FMR1 gene) Correct answer.
  3. Rett Syndrome (MECP2 gene mutation)
  4. Tuberous Sclerosis Complex (TSC1/TSC2 mutations)

Explanation

Fragile X Syndrome, caused by a CGG trinucleotide repeat expansion (>200 repeats, full mutation) leading to hypermethylation and transcriptional silencing of the FMR1 gene on the X chromosome, is the most common inherited monogenic cause of intellectual developmental disorder and autism spectrum behaviors. Typical physical features include a long narrow face, large prominent ears, joint laxity, and post-pubertal macroorchidism.

Question 10Developmental and child-adolescent psychiatric assessment

In the Multiaxial Classification Scheme (MAS / Multiaxiales Klassifikationsschema für psychische Störungen des Kindes- und Jugendalters) widely used in Switzerland and German-speaking countries, what clinical domain is evaluated specifically on Axis 5?

  1. Specific developmental disorders (speech, scholastic skills, motor)
  2. Current intellectual level (IQ)
  3. Somatic illnesses and biological medical conditions
  4. Associated abnormal psychosocial situations / psychosocial stressors Correct answer.

Explanation

In the MAS (Remschmidt, Schmidt, Poustka multiaxial system based on ICD-10), the axes are: Axis 1 = Clinical psychiatric syndrome; Axis 2 = Specific developmental disorders; Axis 3 = Intellectual level; Axis 4 = Somatic medical conditions; Axis 5 = Associated abnormal psychosocial situations (codes 0 to 9, e.g., abnormal familial relationships, parental mental illness, inadequate communication, stressful life events); Axis 6 = Global assessment of psychosocial disability/functioning.

Question 11Developmental and child-adolescent psychiatric assessment

An 11-year-old girl presents with recurrent episodes of intense, non-functional hair-pulling resulting in noticeable patchy alopecia on her scalp. She experiences tension immediately before pulling out the hair and a sense of relief or gratification afterwards. Dermatological examination confirms trichomalacia without fungal infection. What is the evidence-based first-line psychotherapeutic treatment for Trichotillomania (Hair-Pulling Disorder)?

  1. Prolonged systematic psychoanalysis
  2. Aversion therapy with electric skin shock
  3. Habit Reversal Training (HRT) combined with stimulus control and awareness training Correct answer.
  4. Maintenance high-dose electroconvulsive therapy (ECT)

Explanation

Habit Reversal Training (HRT), a specialized cognitive-behavioral therapy component, is the first-line evidence-based intervention for body-focused repetitive behaviors (BFRBs) including Trichotillomania and Excoriation (Skin-Picking) Disorder. HRT incorporates awareness training, identifying sensory/emotional triggers, stimulus control (modifying the physical environment), and implementing an incompatible competing response (e.g., clenching fists or manipulating a stress ball for 1–2 minutes upon experiencing the urge).

Question 12Developmental and child-adolescent psychiatric assessment

A 15-year-old adolescent with severe, treatment-resistant ADHD has a personal history of a generalized tonic-clonic seizure 2 years ago, though currently seizure-free on levetiracetam. Psychostimulants were poorly tolerated. The physician considers atomoxetine. What is the primary mechanism of action of atomoxetine?

  1. Selective inhibition of the presynaptic norepinephrine transporter (NET) Correct answer.
  2. Non-selective monoamine oxidase (MAO-A and MAO-B) irreversible inhibition
  3. Postsynaptic 5-HT2A serotonin receptor blockade
  4. Direct GABAA receptor positive allosteric modulation

Explanation

Atomoxetine is a potent and highly selective inhibitor of the presynaptic norepinephrine transporter (NET). By inhibiting NET in the prefrontal cortex-where dopamine transporters are sparse and dopamine is cleared largely by norepinephrine transporters-atomoxetine increases extracellular levels of both norepinephrine and dopamine in the prefrontal cortex without increasing dopamine in the nucleus accumbens, resulting in low abuse potential.

Question 13Developmental and child-adolescent psychiatric assessment

A 14-year-old girl is brought for consultation after her teacher noticed superficial linear cuts on her forearm. The patient states she cuts herself with a pencil sharpener blade when overwhelmed by emotional distress to 'feel relief' and 'release tension,' with no intention to die. How is this behavior classified according to DSM-5 and clinical consensus?

  1. Aborted suicide attempt
  2. Factitious Disorder Imposed on Self
  3. Non-Suicidal Self-Injury (NSSI) Correct answer.
  4. Psychotic self-mutilation

Explanation

Non-Suicidal Self-Injury (NSSI) is defined as the deliberate, direct destruction of body tissue (e.g., cutting, burning, scratching) without suicidal intent, most commonly engaged in for affect regulation (to relieve intense negative affect or tension), self-punishment, or communicating distress.

Question 14Developmental and child-adolescent psychiatric assessment

Which outpatient psychotherapeutic modality is recommended by European (NICE, ESCAP) guidelines as the first-line evidence-based treatment for adolescents with Anorexia Nervosa?

  1. Individual psychoanalytic psychotherapy without parental involvement
  2. Family-Based Treatment (FBT / Maudsley Model) Correct answer.
  3. Expressive movement and gestalt therapy
  4. Unilateral cognitive remediation therapy without nutritional goals

Explanation

Family-Based Treatment (FBT / Maudsley Model) is the first-line evidence-based psychotherapy for adolescent Anorexia Nervosa. FBT is a structured, three-phase outpatient model that avoids blaming the family, directly mobilizes and empowers parents to take charge of weight restoration and nutritional refeeding in Phase 1, transitions control back to the adolescent in Phase 2, and addresses adolescent developmental identity in Phase 3.

Question 15Developmental and child-adolescent psychiatric assessment

A 16-year-old girl presents with recurrent episodes of consuming objectively large quantities of food with a sense of loss of control, occurring 3 to 4 times per week for the past 6 months. Following each binge episode, she engages in self-induced vomiting and abuses stimulant laxatives. Physical exam reveals dental enamel erosion and calluses on the dorsum of her dominant hand (Russell sign). Her BMI is 21.5 kg/m² (normal range). What is the diagnosis?

  1. Anorexia Nervosa, binge-eating/purging subtype
  2. Avoidant/Restrictive Food Intake Disorder (ARFID)
  3. Bulimia Nervosa Correct answer.
  4. Binge Eating Disorder

Explanation

Bulimia Nervosa (ICD-11: 6B81 / DSM-5-TR) is characterized by recurrent episodes of binge eating accompanied by inappropriate compensatory behaviors (self-induced vomiting, laxative abuse, fasting, excessive exercise) to prevent weight gain, occurring at least once a week for 3 months, with self-evaluation unduly influenced by body shape and weight, in an individual who is not significantly underweight (unlike anorexia nervosa).

Question 16Developmental and child-adolescent psychiatric assessment

An 8-year-old boy presents with severe nutritional deficiency and failure to gain weight. He refuses to eat foods that are green or have crunchy textures, and avoids nearly all foods except white bread and specific brand crackers due to intense sensory aversion to smells, textures, and tastes. He exhibits no body image dissatisfaction, no fear of gaining weight, and no desire for thinness. What is the diagnosis?

  1. Anorexia Nervosa, restricting type
  2. Social Phobia
  3. Major Depressive Disorder
  4. Avoidant/Restrictive Food Intake Disorder (ARFID) Correct answer.

Explanation

Avoidant/Restrictive Food Intake Disorder (ARFID; ICD-11: 6B83 / DSM-5-TR) is characterized by an eating or feeding disturbance (e.g., apparent lack of interest in eating; avoidance based on sensory characteristics of food; concern about aversive consequences of eating such as choking or vomiting) leading to persistent failure to meet nutritional/energy needs (weight loss, nutritional deficiency, dependence on supplements), in the complete absence of body image distortion or weight/shape preoccupation.

Question 17Developmental and child-adolescent psychiatric assessment

A 4-year-old foster child who experienced severe emotional neglect, physical deprivation, and multiple caregiver changes during infancy presents with persistent emotional withdrawal. She rarely seeks comfort when hurt or frightened, does not respond when comfort is offered, shows minimal social responsiveness, and exhibits episodes of unexplained irritability and fearfulness during non-threatening interactions with foster parents. What is the diagnosis?

  1. Autism Spectrum Disorder
  2. Reactive Attachment Disorder (RAD) Correct answer.
  3. Disinhibited Social Engagement Disorder (DSED)
  4. Disruptive Mood Dysregulation Disorder

Explanation

Reactive Attachment Disorder (RAD; ICD-11: 6B44 / DSM-5-TR) is characterized by a consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers (the child rarely seeks comfort and rarely responds to comfort when distressed), minimal social/emotional responsiveness, and episodes of unexplained fearfulness or irritability, occurring in the context of early severe social neglect or pathogenic caregiving.

Question 18Developmental and child-adolescent psychiatric assessment

A 5-year-old child adopted from an institutional orphanage at age 3 readily approaches and hugs complete strangers in public parks, is willing to leave with unfamiliar adults without checking with adoptive parents, and displays overly familiar verbal and physical boundaries. What is the diagnosis?

  1. Attention-Deficit/Hyperactivity Disorder, hyperactive type
  2. Separation Anxiety Disorder
  3. Conduct Disorder, childhood-onset
  4. Disinhibited Social Engagement Disorder (DSED) Correct answer.

Explanation

Disinhibited Social Engagement Disorder (DSED; ICD-11: 6B45 / DSM-5-TR) is characterized by culturally inappropriate, overly familiar behavior with relative strangers (reduced reticence, overly familiar verbal/physical behavior, diminished checking back with adult caregivers), arising from a history of severe social neglect or institutional rearing with high caregiver turnover.

Question 19Developmental and child-adolescent psychiatric assessment

What is the recommended initial communication strategy when delivering the diagnosis of Functional Neurological Symptom Disorder (Conversion Disorder) to a child and their parents?

  1. Validate that the symptoms are real and distressing, explain the concept of software/functional nervous system disruption rather than structural hardware damage, demonstrate positive clinical signs (e.g., Hoover sign), and engage in multidisciplinary physical and psychological rehabilitation Correct answer.
  2. Directly confront the child and parents that the symptoms are purely imaginary or 'in their head' and refuse further medical contact
  3. Order repeated invasive diagnostic procedures and extensive imaging to reassure the family
  4. Prescribe high-dose antipsychotics and immediately place the child in long-term inpatient confinement

Explanation

Evidence-based guidelines emphasize a collaborative, transparent, and validating communication approach: affirming that the symptoms are genuine, explaining the functional nature using analogies (a software glitch rather than hardware damage), showing positive physical examination signs of reversibility, and engaging the patient in physical therapy and CBT without confrontation.

Question 20Developmental and child-adolescent psychiatric assessment

A 13-year-old boy presents with daily recurrent abdominal pain and headaches for over 6 months that lead to extensive school absenteeism. Multiple specialist evaluations (gastroenterology, neurology) reveal no organic pathology. The patient and his parents spend excessive time and energy researching rare medical conditions, visit emergency departments weekly, and exhibit extreme anxiety that a catastrophic undiagnosed disease is present. What is the diagnosis?

  1. Factitious Disorder Imposed by Another (Munchausen by proxy)
  2. Somatic Symptom Disorder (ICD-11: Bodily Distress Disorder) Correct answer.
  3. Illness Anxiety Disorder with zero physical symptoms
  4. Juvenile Idiopathic Arthritis

Explanation

Somatic Symptom Disorder (Bodily Distress Disorder in ICD-11) is characterized by one or more distressing somatic symptoms (e.g., pain, headaches, fatigue) accompanied by excessive thoughts, feelings, or behaviors related to the symptoms (disproportionate anxiety, excessive health-seeking behavior, significant life disruption) lasting more than 6 months.

Question 21Developmental and child-adolescent psychiatric assessment

Which of the following physical findings is a classic dermatological complication of chronic self-induced vomiting in patients with Bulimia Nervosa or purging-type Anorexia Nervosa?

  1. Erythema migrans
  2. Kayser-Fleischer rings
  3. Russell Sign (calluses or scars on the knuckles/dorsum of the hand from repeated friction against incisor teeth) Correct answer.
  4. Acanthosis nigricans on the axillae

Explanation

Russell Sign refers to calluses, abrasions, or hyperkeratotic scars on the dorsum of the hand or knuckles caused by repeated trauma from the incisor teeth during manual stimulation of the gag reflex to induce vomiting.

Question 22Developmental and child-adolescent psychiatric assessment

A 13-year-old girl with no prior psychiatric history presents with rapid-onset psychiatric symptoms developing over 10 days: prominent visual and auditory hallucinations, agitation, severe insomnia, emotional lability, followed by catatonia, autonomic instability (fluctuating blood pressure and tachycardia), choreoathetoid orofacial dyskinesias, and hypoventilation. What organic neuropsychiatric condition must be urgently investigated with serum and CSF antibody testing?

  1. Wilson Disease
  2. Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis Correct answer.
  3. Huntington Disease
  4. Late-onset Tay-Sachs Disease

Explanation

Anti-NMDA Receptor Encephalitis is an autoimmune disorder with a high prevalence in children and young females. It typically presents with a prodromal viral-like phase followed by acute psychiatric symptoms (hallucinations, agitation, bizarre behavior, speech reduction), progression to movement disorders (orofacial dyskinesias, choreoathetosis), autonomic instability, seizures, catatonia, and hypoventilation. Diagnosis is confirmed by identifying anti-GluN1 antibodies in CSF. Management involves immunotherapy (corticosteroids, IVIG, plasmapheresis, rituximab) and screening for underlying tumors (e.g., ovarian teratoma).

Question 23Developmental and child-adolescent psychiatric assessment

An 8-year-old boy demonstrates a persistent pattern of angry/irritable mood (often loses temper, easily annoyed), argumentative/defiant behavior (frequently argues with adults, actively refuses compliance with rules, deliberately annoys others), and vindictiveness lasting for 9 months. He does not physically harm animals, destroy property, or engage in theft. What is the diagnosis?

  1. Conduct Disorder
  2. Antisocial Personality Disorder
  3. Intermittent Explosive Disorder
  4. Oppositional Defiant Disorder (ODD) Correct answer.

Explanation

Oppositional Defiant Disorder (ODD; ICD-11: 6C90 / DSM-5-TR) is characterized by a persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months. It lacks the severe violations of the basic rights of others (aggression to people/animals, destruction of property, theft) that define Conduct Disorder.

Question 24Developmental and child-adolescent psychiatric assessment

Which psychological intervention has the strongest evidence base for the treatment of Oppositional Defiant Disorder (ODD) in school-aged children?

  1. Parent Management Training (PMT / Behavioral Parent Training such as Triple P or Incredible Years) Correct answer.
  2. Unstructured child psychodynamic play therapy
  3. Individual cognitive debriefing
  4. Peer group interaction therapy without adult supervision

Explanation

Behavioral Parent Management Training (PMT; programs like Triple P, Incredible Years, Parent-Child Interaction Therapy PCIT) is the gold-standard, first-line evidence-based intervention for Oppositional Defiant Disorder in children. It trains parents to modify coercive family cycles, establish clear consistent limits, provide positive reinforcement for prosocial behaviors, and utilize predictable non-punitive consequences.

Question 25Developmental and child-adolescent psychiatric assessment

A 15-year-old male is referred by the youth justice system following repeated arrests for breaking into houses, setting fire to school property, physically assaulting peers with weapons, and cruelty to stray animals. During clinical interview, he shows no remorse or guilt for his actions, expresses indifference regarding his victims' suffering, and boasts about his ability to deceive authorities. In DSM-5-TR and ICD-11, which specifier applies to this presentation of Conduct Disorder?

  1. With adolescent-onset benign trajectory
  2. With limited prosocial emotions (Callous-Unemotional traits) Correct answer.
  3. With secondary internalizing distress
  4. With psychotic features

Explanation

The specifier 'with limited prosocial emotions' (representing Callous-Unemotional traits) in Conduct Disorder requires at least two of the following characteristics persistently across multiple settings for at least 12 months: 1) Lack of remorse or guilt; 2) Callous-lack of empathy; 3) Unconcerned about performance at school/work; 4) Shallow or deficient affect. This subgroup has a more severe, persistent trajectory and requires tailored interventions.

Question 26Developmental and child-adolescent psychiatric assessment

A 16-year-old adolescent with daily high-potency cannabis use (THC vapes) presents to the emergency room with acute paranoid delusions (believing police drones are tracking him), auditory hallucinations, intense panic, and psychomotor agitation. His symptoms began 2 hours after smoking cannabis. Physical exam reveals bloodshot conjunctivae, tachycardia (120 bpm), and dry mouth. Urine drug screen is positive solely for tetrahydrocannabinol (THC). What is the diagnosis?

  1. Cannabis-Induced Psychotic Disorder Correct answer.
  2. Primary Early-Onset Bipolar I Mania
  3. Delirium Tremens
  4. Opiate Intoxication

Explanation

Cannabis-Induced Psychotic Disorder is diagnosed when prominent delusions or hallucinations develop during or immediately following cannabis use, exceeding typical intoxication effects, in an individual whose symptoms are physiologically attributable to the substance. High-potency THC is a potent trigger for acute transient psychosis and can accelerate the onset of primary psychotic disorders in genetically vulnerable youth.

Question 27Developmental and child-adolescent psychiatric assessment

A 15-year-old adolescent plays online multiplayer video games for 10 to 14 hours per day. Over the past 14 months, he has dropped out of school, neglected personal hygiene, had violent outbursts when parents attempt to disconnect the internet, and lost all offline peer relationships. Despite acknowledging the severe negative consequences, he is unable to control or reduce his gaming. According to ICD-11 (code 6C51), what is the formal diagnosis?

  1. Attention-Deficit/Hyperactivity Disorder alone
  2. Bipolar II Disorder
  3. Gaming Disorder (online/offline) Correct answer.
  4. Avoidant Personality Disorder

Explanation

Gaming Disorder (ICD-11: 6C51) is characterized by a persistent or recurrent gaming behavior pattern manifested by: 1) Impaired control over gaming; 2) Increasing priority given to gaming over other life interests and daily activities; and 3) Continuation or escalation of gaming despite negative consequences. The behavior pattern results in significant impairment in personal, family, social, educational, or occupational functioning for at least 12 months.

Question 28Developmental and child-adolescent psychiatric assessment

A 16-year-old female with a history of congenital heart defect repair (tetralogy of Fallot), mild intellectual disability, cleft palate repair, hypocalcemia in infancy, and recurrent infections presents with acute auditory hallucinations, persecutory delusions, and social withdrawal. Which genetic microdeletion syndrome is strongly associated with this clinical phenotype and confers an exceptionally high lifetime risk (~25–30%) of developing schizophrenia-like psychotic disorders?

  1. Williams-Beuren Syndrome (7q11.23 microdeletion)
  2. Prader-Willi Syndrome (15q11-q13 paternal deletion)
  3. Angelman Syndrome (15q11-q13 maternal deletion)
  4. 22q11.2 Deletion Syndrome (DiGeorge / Velocardiofacial Syndrome) Correct answer.

Explanation

22q11.2 Deletion Syndrome (DiGeorge syndrome / Velocardiofacial syndrome) is caused by a microdeletion on chromosome 22q11.2. Phenotypic features include conotruncal congenital heart defects, palatal anomalies, immune deficiencies, hypocalcemia (hypoparathyroidism), and characteristic facial dysmorphism. It represents one of the strongest known genetic risk factors for early-onset schizophrenia and psychosis, with up to 30% of affected individuals developing psychotic disorders in adolescence or early adulthood.

Question 29Developmental and child-adolescent psychiatric assessment

A 14-year-old boy has missed 60 days of school over the past semester. When pressed to attend, he suffers severe panic, nausea, and trembling at the school entrance, but stays at home with his parents' knowledge, studying his textbooks in his bedroom without antisocial delinquency. How is this behavior distinguished from Truancy (Schulschwänzen)?

  1. This represents Truancy, because all forms of school absenteeism are defined by conduct problems
  2. This represents School Refusal (Schulphobie / Schulangst), driven by emotional distress and anxiety where the child remains at home with parental knowledge, whereas Truancy involves unexcused absence without parental knowledge, accompanied by delinquent or antisocial peer activities Correct answer.
  3. This represents early prodromal catatonia
  4. This represents Primary Dissociative Fugue

Explanation

School Refusal (Schulverweigerung / Schulangst) is characterized by severe emotional distress (anxiety, somatic complaints, panic) regarding school attendance, where the child stays home with the parents' knowledge, without significant antisocial behavior. In contrast, Truancy (Schulschwänzen) involves skipping school without parental knowledge, typically without anxiety, and often engaging in antisocial activities away from home.

Question 30Developmental and child-adolescent psychiatric assessment

A young person with continuing mental-health needs is moving from child to adult services. Which listed approach best protects continuity of care? No universal statutory age or fixed lead time is specified here.

  1. A structured transition process beginning 6–12 months prior to the 18th birthday, including joint transition consultations (warm handover), shared medical summaries, and multidisciplinary coordination between KJP and adult services Correct answer.
  2. Abrupt discharge on the exact 18th birthday with no forwarding medical documentation
  3. Mandatory permanent retention within pediatric inpatient wards until age 30
  4. Immediate discontinuation of all psychopharmacotherapy before entering adult services

Explanation

A planned warm handover, shared clinical information and coordination between services can protect continuity for a young person with continuing needs. The option gives an example planning window, not a universal legal deadline or a claim that every service changes at exactly the same age.

Question 31Anxiety, obsessive-compulsive and trauma-related formulations

An 8-year-old child exhibits severe, developmentally inappropriate distress whenever separated from his mother. He refuses to attend school, cannot sleep alone in his bedroom, has recurrent nightmares about family kidnapping, and develops abdominal pain and vomiting every Sunday evening. Physical workup is entirely normal. Symptoms have persisted for 4 months. What is the diagnosis?

  1. Separation Anxiety Disorder Correct answer.
  2. Agoraphobia
  3. Major Depressive Disorder with psychotic features
  4. Oppositional Defiant Disorder

Explanation

Separation Anxiety Disorder (ICD-11: 6B05 / DSM-5-TR) is characterized by developmentally inappropriate and excessive fear or anxiety concerning separation from major attachment figures, manifesting as school refusal/reluctance, distress upon separation, fear of harm befalling attachment figures, nightmares with separation themes, and somatic complaints upon anticipated separation, lasting at least 4 weeks in children.

Question 32Anxiety, obsessive-compulsive and trauma-related formulations

An 11-year-old boy spends over 3 hours each day washing his hands with harsh disinfectants due to intrusive, distressing thoughts that he will contaminate his family with lethal toxins. His hands are raw and bleeding. When prevented from washing, he experiences severe panic. Which specialized psychological treatment is recognized internationally as the first-line psychotherapy of choice for pediatric Obsessive-Compulsive Disorder (OCD)?

  1. Interpersonal Psychotherapy for Adolescents (IPT-A)
  2. Cognitive Behavioral Therapy incorporating Exposure and Response Prevention (ERP) Correct answer.
  3. Supportive client-centered therapy
  4. Hypnotherapy and guided imagery

Explanation

Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP) is the established first-line psychotherapy of choice for pediatric OCD (supported by the POTS landmark trial). The patient is systematically exposed to the anxiety-provoking obsession (contamination) while strictly resisting the compulsive neutralizing ritual (hand-washing), leading to habituation and cognitive reframing.

Question 33Anxiety, obsessive-compulsive and trauma-related formulations

A 15-year-old girl is referred for evaluation of intense fears of dogs (cynophobia) that have caused her to avoid walking to school or visiting friends. Which psychological intervention provides the most rapid and enduring therapeutic benefit for specific phobias in youth?

  1. In-vivo graded exposure therapy Correct answer.
  2. Long-term systemic family therapy
  3. Daily low-dose lorazepam maintenance
  4. Expressive art therapy

Explanation

In-vivo graded exposure therapy (often conducted in a single intensive session or hierarchically over several sessions) is the treatment of choice for specific phobias in children and adolescents. It systematically exposes the patient to the feared stimulus until fear habituation and inhibitory learning occur.

Question 34Anxiety, obsessive-compulsive and trauma-related formulations

In the treatment of childhood Post-Traumatic Stress Disorder (PTSD) using Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), what core therapeutic component involves the child creating and sharing a detailed account of their traumatic experience in a safe environment?

  1. Trauma Narrative and Processing Correct answer.
  2. Systemic Paradoxical Injunction
  3. Aversive Desensitization
  4. Expressive Sublimation

Explanation

The Trauma Narrative is a central component of TF-CBT (the PRACTICE acronym: Psychoeducation, Relaxation, Affective regulation, Cognitive coping, Trauma narrative, In-vivo mastery, Conjoint sessions, Enhancing safety). It enables the child to gradually recount the traumatic memories, desensitize conditioned emotional reactivity, correct unhelpful cognitions (such as self-blame), and integrate the trauma into their broader life story.

Question 35Mood syndromes, longitudinal diagnosis and recovery planning

A 9-year-old boy presents with severe, recurrent temper outbursts (verbal rages and physical aggression toward objects) occurring 4 to 5 times per week for the past 18 months. Between outbursts, his mood is persistently and chronically irritable and angry nearly every day, observable by both parents and teachers. He has never exhibited discrete episodes of elevated mood, grandiosity, or decreased need for sleep. What is the most appropriate DSM-5-TR diagnosis?

  1. Disruptive Mood Dysregulation Disorder (DMDD) Correct answer.
  2. Bipolar I Disorder, current manic episode
  3. Intermittent Explosive Disorder (IED)
  4. Cyclothymic Disorder

Explanation

Disruptive Mood Dysregulation Disorder (DMDD) was introduced in DSM-5 to address chronic, non-episodic irritability and severe temper outbursts in children (onset before age 10, symptoms present for ≥12 months across ≥2 settings, outbursts ≥3 times/week with persistent irritable/angry mood between outbursts). It specifically distinguishes chronic irritability from classic episodic pediatric Bipolar Disorder.

Question 36Mood syndromes, longitudinal diagnosis and recovery planning

A 16-year-old boy is brought to the emergency psychiatric department displaying grandiosity, flight of ideas, pressured speech, extreme psychomotor agitation, and sleeping only 2 hours per night for the past 6 days while insisting he has been chosen to lead the Swiss national economy. Urine drug screening is negative. Which pharmacological agent is approved and recommended as first-line acute antimanic mood-stabilizing monotherapy for pediatric Bipolar I Disorder?

  1. Fluoxetine
  2. Aripiprazole (or Lithium) Correct answer.
  3. Citalopram
  4. Methylphenidate

Explanation

Second-generation antipsychotics (e.g., Aripiprazole, Quetiapine, Risperidone, Olanzapine) and Lithium carbonate are evidence-based, first-line approved mood-stabilizing treatments for acute manic or mixed episodes in adolescent Bipolar I Disorder. Antidepressants and psychostimulants are contraindicated in acute mania as they exacerbate manic psychosis and mood destabilization.

Question 37Mood syndromes, longitudinal diagnosis and recovery planning

A 12-year-old girl experiences excessive, uncontrollable worry about her school grades, her parents' health, punctuality, and natural disasters for over 8 months. She suffers from chronic muscle tension, headaches, restlessness, fatigue, and sleep-onset insomnia. What is the most likely diagnosis?

  1. Specific Phobia
  2. Social Anxiety Disorder
  3. Generalized Anxiety Disorder (GAD) Correct answer.
  4. Panic Disorder

Explanation

Generalized Anxiety Disorder (GAD; ICD-11: 6B00 / DSM-5-TR) is characterized by excessive and persistent anxiety and worry (apprehensive expectation) across multiple domains of everyday life (academic performance, family well-being, punctuality), accompanied by somatic tension symptoms (restlessness, fatigue, muscle aches, insomnia) lasting at least 6 months.

Question 38Mood syndromes, longitudinal diagnosis and recovery planning

A 13-year-old boy experiences intense fear and autonomic arousal (trembling, blushing, sweating, palpitations) whenever he has to speak in front of his class, eat in the school cafeteria, or talk to unfamiliar peers. He avoids extracurricular clubs and school presentations due to fear of being judged, embarrassed, or humiliated. Which psychotherapy modality is established as the gold-standard first-line treatment for pediatric Social Anxiety Disorder?

  1. Systemic family constellation therapy
  2. Cognitive Behavioral Therapy (CBT) with graded in-vivo social exposure and cognitive restructuring Correct answer.
  3. Supportive nondirective counseling
  4. Eye Movement Desensitization and Reprocessing (EMDR)

Explanation

Cognitive Behavioral Therapy (CBT) incorporating psychoeducation, cognitive restructuring of automatic negative thoughts, social skills training, and hierarchically graded in-vivo exposure to feared social and performance situations is the gold-standard, evidence-based psychotherapy for child and adolescent Social Anxiety Disorder.

Question 39Psychosis, differential diagnosis and ongoing care

A 15-year-old male is brought to the clinic due to a 4-month history of progressive social withdrawal, dropping school grades, blunted affect, bizarre somatic delusions (believing his organs are turning to glass), and hearing derogatory voices whispering from the walls commenting on his actions. What is the most likely diagnosis?

  1. Early-Onset Schizophrenia (EOS) Correct answer.
  2. Autism Spectrum Disorder
  3. Major Depressive Disorder with atypical features
  4. Dissociative Identity Disorder

Explanation

Early-Onset Schizophrenia (EOS, onset before age 18) is characterized by characteristic positive symptoms (delusions, auditory hallucinations), negative symptoms (blunted affect, avolition, social withdrawal), and cognitive deterioration lasting for at least 1 month (with signs of disturbance for ≥6 months under DSM-5 or 1 month under ICD-11). Organic mimics must be thoroughly ruled out.

Question 40Psychosis, differential diagnosis and ongoing care

A 17-year-old female presents with subthreshold psychotic symptoms for 5 months: occasional auditory perceptual aberrations (hearing indistinct murmurs when alone), suspiciousness that peers are mocking her, and mild magical thinking. Her reality testing is fully preserved, and symptoms do not meet threshold criteria for a psychotic disorder. Under DSM-5-TR (Section III) and clinical staging frameworks, this condition is designated as:

  1. Brief Psychotic Disorder
  2. Schizotypal Personality Disorder in remission
  3. Attenuated Psychosis Syndrome (Ultra-High Risk / Clinical High Risk for Psychosis) Correct answer.
  4. Persistent Delusional Disorder

Explanation

Attenuated Psychosis Syndrome (or the Clinical High Risk / Ultra-High Risk for Psychosis state) is defined by subthreshold positive psychotic symptoms (e.g., attenuated delusions, hallucinations, or disorganized speech) that are present at least once per week for the past month, with intact reality testing, causing distress or disability. Cognitive-behavioral therapy and supportive monitoring are first-line; preventative antipsychotics are not routinely recommended due to side effects.

Question 41Psychosis, differential diagnosis and ongoing care

Under the Chinese Classification of Mental Disorders (CCMD-3) and ICD-11, what is the minimum duration requirement for active characteristic psychotic symptoms (e.g., persecutory delusions, auditory hallucinations) to establish a diagnosis of Schizophrenia (精神分裂症)?

  1. At least 48 hours
  2. At least 1 month Correct answer.
  3. At least 6 months continuous active psychosis
  4. At least 2 years

Explanation

Under CCMD-3 and ICD-10/ICD-11, the diagnosis of Schizophrenia (精神分裂症) requires the presence of characteristic psychotic symptoms (delusions, hallucinations, formal thought disorder, or catatonic/negative symptoms) for a minimum duration of at least 1 month during the active phase. (Note: DSM-5 requires 1 month of active symptoms within an overall 6-month continuous disturbance).

Question 42Psychotherapy models, learning processes and therapeutic communication

In Cognitive Behavioral Therapy (CBT) for children and adolescents with anxiety disorders, what core conceptual mechanism explains why avoidance behaviors maintain and reinforce anxiety over time?

  1. Negative reinforcement: avoiding the feared situation immediately reduces distressing physiological arousal, which prevents new inhibitory learning and strengthens the avoidance response Correct answer.
  2. Positive punishment: the immediate punishment of confronting fear weakens the behavioral repertoire
  3. Unconscious conversion: avoidance converts psychic energy into somatic motor symptoms
  4. Classical extinction: avoidance actively extinguishes the conditioned fear response

Explanation

In behavioral learning theory (Mowrer's two-factor theory), avoidance is maintained through negative reinforcement: when the child escapes or avoids a feared stimulus, the immediate reduction of unpleasant anxiety/arousal acts as a powerful reward, maintaining the avoidance behavior and preventing the natural habituation and inhibitory learning that would demonstrate that the feared catastrophe will not occur.

Question 43Psychotherapy models, learning processes and therapeutic communication

In psychodynamic psychotherapy with a 6-year-old child, how is spontaneous play primarily understood and utilized by the psychotherapist?

  1. Solely as a recreational reward for good behavior during the session
  2. As an objective psychometric test for measuring processing speed
  3. As a diagnostic method for detecting peripheral visual acuity deficits
  4. As the child's primary symbolic medium for communicating unconscious conflicts, fantasies, affects, and defenses (the developmental equivalent of adult free association) Correct answer.

Explanation

In psychodynamic and psychoanalytic child psychotherapy, play is regarded as the child's natural language and the primary vehicle for expressing unconscious internal conflicts, wishes, anxieties, fantasies, and defense mechanisms (serving the function that free association serves in adult psychoanalysis). The therapist observes play themes, transference, and countertransference to formulate interpretations.

Question 44Psychotherapy models, learning processes and therapeutic communication

A 24-year-old has repeated self-cutting after feared rejection, rapidly shifting views of partners from idealised to hateful, chronic emptiness, intense anger, and impulsive spending. Which management plan is most appropriate as a core treatment?

  1. Structured psychotherapy such as dialectical behaviour therapy, with a collaborative crisis plan Correct answer.
  2. Indefinite high-dose benzodiazepines as the main intervention
  3. No treatment because personality disorders are untreatable
  4. Antipsychotic depot medication for all symptoms regardless of target symptoms

Explanation

Borderline personality disorder is treated primarily with structured psychological therapies such as DBT, mentalization-based therapy, or related approaches. Medication may target comorbidity or specific symptoms but is not the core treatment.

Question 45Psychotherapy models, learning processes and therapeutic communication

A patient with alcohol use disorder says, "I know drinking is damaging my liver, but it is the only way I sleep." Which response best reflects motivational interviewing?

  1. "You must stop drinking immediately or treatment will not continue."
  2. "It sounds as if alcohol feels useful in the short term, while another part of you is worried about the harm it is causing." Correct answer.
  3. "Your insomnia is irrelevant until you accept that you are addicted."
  4. "I will arrange admission today because ambivalence means you lack capacity."

Explanation

Motivational interviewing uses empathy, reflective listening, autonomy support, and exploration of ambivalence. It avoids confrontation, coercion, and premature advice-giving.

Question 46Psychotherapy models, learning processes and therapeutic communication

A man with schizophrenia hears a voice saying he is worthless. In CBT for psychosis, which therapist intervention is most consistent with the model?

  1. Tell him the voice is definitely unreal and ask him not to mention it again
  2. Explore triggers, meanings, evidence, coping responses, and alternative explanations collaboratively Correct answer.
  3. Interpret the voice as proof of unconscious sexual conflict before discussing coping
  4. Avoid discussing voices because attention to psychotic symptoms inevitably worsens them

Explanation

CBT for psychosis works collaboratively on appraisals, distress, coping, safety behaviours, and alternative explanations. It does not rely on blunt contradiction or avoidance of symptoms.

Question 47Psychotherapy models, learning processes and therapeutic communication

A 23-year-old woman with borderline personality disorder has recurrent self-harm after interpersonal crises. In dialectical behaviour therapy, what is usually the highest priority treatment target?

  1. Detailed exploration of childhood memories before any current risk work
  2. Medication adherence, because DBT is primarily a pharmacological adherence programme
  3. Avoiding discussion of self-harm to prevent reinforcement
  4. Life-threatening behaviours, analysed with chain analysis and linked to skills practice Correct answer.

Explanation

DBT prioritises life-threatening behaviours, then therapy-interfering behaviours and quality-of-life targets. Chain analysis and skills training connect triggers, vulnerabilities, behaviours, and alternatives.

Question 48Psychotherapy models, learning processes and therapeutic communication

In psychotherapy, a patient becomes intensely angry when the therapist is two minutes late and says, "You are just like my father, always abandoning me." What concept best describes this phenomenon?

  1. Thought blocking
  2. Negative reinforcement
  3. Akathisia
  4. Transference Correct answer.

Explanation

Transference refers to feelings, expectations, and relational patterns from earlier relationships being experienced in the therapeutic relationship. It can be clinically useful when handled thoughtfully.

Question 49Treatment principles, adverse effects and medication monitoring

When a specialist starts an adolescent on an SSRI for a diagnosed depressive disorder, which emerging clinical concerns require discussion and close monitoring? This question does not prescribe a universal follow-up timetable.

  1. Acute hepatic necrosis and liver failure
  2. Agranulocytosis and opportunistic infections
  3. Severe tardive dystonia and neuroleptic malignant syndrome
  4. Treatment-emergent suicidal ideation, agitation, and behavioral activation (Black Box warning) Correct answer.

Explanation

Monitoring includes possible emerging suicidal thoughts, agitation and behavioral activation, together with symptom change and other adverse effects. The clinical team should agree an individualized follow-up and escalation plan; this question does not specify a universal contact schedule.

Question 50Treatment principles, adverse effects and medication monitoring

A 16-year-old male with treatment-resistant major depression is prescribed lithium carbonate as an augmentation strategy. Which laboratory parameters are essential for baseline evaluation and routine therapeutic drug monitoring during maintenance lithium therapy?

  1. Serum lithium trough concentration, renal function (creatinine, eGFR), electrolytes, thyroid function (TSH, free T4), and baseline ECG Correct answer.
  2. Serum alpha-fetoprotein and carcinoembryonic antigen (CEA)
  3. Coagulation profile (PT/INR) and serum vitamin B12 level
  4. Serial lumbar puncture cerebrospinal fluid (CSF) protein and cell count

Explanation

Lithium has a narrow therapeutic window (target serum trough concentration typically 0.6–0.8 mmol/L for maintenance, drawn 12 hours post-dose). Mandatory baseline and ongoing monitoring includes renal function (creatinine/eGFR), serum electrolytes, thyroid function (TSH/fT4, due to risks of lithium-induced hypothyroidism), calcium, pregnancy testing in females, and baseline ECG.