Free Forensic Psychiatry Practice Questions

Question 1

During a restoration admission, a defendant continues to hear a voice criticizing him. He accurately describes the charge and sentencing exposure, identifies a weakness in an eyewitness's account, and gives his attorney a consistent account of his whereabouts. He recognizes the voice as a symptom and says it does not concern the court or his attorney. He can compare a plea offer with going to trial. Counsel reports that they can now work together. What should carry the greatest weight in the psychiatrist's opinion about trial competence?

Accepted Answer

His present ability to understand the proceedings rationally and assist counsel.

Answer

His continuing need for supervised antipsychotic treatment.

Answer

Whether the remaining hallucination has resolved before the criminal proceedings resume.

Answer

Whether his choice between a plea and trial agrees with counsel's preferred strategy.

Question 2

A hospitalized man with schizophrenia refuses surgery for a bowel obstruction. He correctly explains the operation, its risks, the alternatives, and the possibility of death without treatment. His refusal rests on a fixed delusion that the hospital fabricates all of his test results: 'The danger is real for someone with an obstruction, but I cannot have one.' He maintains this belief after reviewing the findings with the team. He communicates a stable choice and compares the benefits and burdens accurately when discussing a hypothetical patient. Which decision-making ability is most directly impaired?

Accepted Answer

Appreciation

Answer

Understanding

Answer

Reasoning

Answer

Expression of a choice

Question 3

In a civil evaluation after a documented mild head injury, an adult seeking wage-loss compensation completes two independently administered forms of a 50-item, two-choice recognition task. He gives 9 and 11 correct responses; both results are statistically below chance. Vision and language comprehension are adequate, and he correctly demonstrates the task before each administration. No confounding severe cognitive disorder is identified. What does this pattern most strongly support?

Accepted Answer

The pattern strongly supports deliberate underperformance on these tasks, but does not exclude genuine cognitive impairment.

Answer

A valid estimate of profound recognition-memory impairment attributable to the documented injury.

Answer

Intentional underperformance establishes that all reported cognitive and psychiatric symptoms are fabricated.

Answer

The scores are inconclusive for response validity unless a symptom-report inventory also shows overreporting.

Question 4

On his third day in jail, a 46-year-old man becomes disoriented and repeatedly picks at insects that staff cannot see. His attention fluctuates, pulse is 128/min, blood pressure is 176/104 mm Hg, temperature is 38.1 °C, and his hands have a coarse tremor. Although he denied alcohol use at booking, a recent hospital record documents daily consumption of about 750 mL of vodka. He has had no access to alcohol since arrest. Staff request medication to settle his behavior. Which diagnosis-treatment pairing should guide immediate care?

Accepted Answer

Alcohol withdrawal delirium - benzodiazepines and urgent transfer for monitored medical care.

Answer

Alcohol-induced hallucinosis - antipsychotic monotherapy in the jail infirmary.

Answer

Opioid withdrawal - buprenorphine after confirming objective withdrawal.

Answer

Stimulant-induced psychosis - antipsychotic treatment with hydration and observation in the jail infirmary.

Question 5

A warehouse employee with bipolar disorder is referred for fitness-for-duty assessment after two forklift near misses. His mood symptoms are in remission, but a recent increase in nighttime quetiapine has produced marked morning drowsiness, corroborated by the supervisor and examination. He performs inventory and scheduling tasks accurately when alert. The employer can temporarily assign those nonsafety-sensitive duties, and the treating psychiatrist is addressing the sedation. What work recommendation best matches the findings?

Accepted Answer

Temporarily restrict forklift operation while sedation is addressed; permit suitable nonsafety-sensitive duties.

Answer

Clear him for unrestricted work based on mood remission.

Answer

Recommend complete medical leave until the sedation resolves, even though suitable alternative duties are available.

Answer

Allow forklift operation with a coworker's alertness check before each shift.

Question 6

A mother's attorney asks her treating psychiatrist to recommend sole custody in a contested divorce. The mother has authorized disclosure. The psychiatrist has treated her for three years but has never interviewed the father or child and has not reviewed the child's school, pediatric, or custody records. The attorney argues that the long treatment relationship provides a sufficient basis. Which response appropriately defines the psychiatrist's contribution?

Accepted Answer

I can describe her treatment and observed functioning, but cannot offer a comparative custody opinion from this information.

Answer

I can recommend sole custody if I clearly identify the mother's reports as my source of information about the father.

Answer

I should decline all testimony, even with authorization, because treating psychiatrists cannot participate in custody proceedings.

Answer

I can give a provisional custody recommendation and let cross-examination address the missing information.

Question 7

An outpatient psychiatrist receives a verified request from a hospital psychiatrist who is now treating the same patient. The requested material includes medication history, adverse drug reactions, diagnoses, and separately maintained psychotherapy process notes. There is no patient authorization, no applicable special exception for the psychotherapy notes, and no additional restriction under state law or substance-use-record regulations. Under HIPAA, which material may be disclosed now for treatment?

Accepted Answer

The medication history, adverse reactions, and diagnoses, but not the separately maintained psychotherapy notes.

Answer

All requested material, because the treatment exception applies equally to ordinary records and separately maintained psychotherapy notes.

Answer

None of the requested psychiatric information without a signed patient authorization.

Answer

The medication information, but not the diagnoses or psychotherapy notes.

Question 8

For a federal prosecution, a psychiatrist reconstructs a defendant's mental state during an assault. The defendant had a severe psychotic disorder and experienced an overwhelming command to attack. Nevertheless, the evaluation establishes that he appreciated both the nature of his actions and their wrongfulness. The psychiatrist believes his ability to resist the command was substantially impaired. Assuming this reconstruction is accurate, how does it bear on the federal insanity defense?

Accepted Answer

Impaired behavioral control does not satisfy the defense when appreciation of the act and its wrongfulness is preserved.

Answer

Substantial inability to conform conduct to law satisfies the defense when the impairment results from a severe mental disease.

Answer

The psychosis caused the assault, which is sufficient to establish the federal insanity defense.

Answer

Current incompetence to stand trial would also establish insanity at the time of the assault.

Question 9

A prisoner under a death sentence has an obtained IQ score of 74, with a reported 95% confidence interval of 69-79. School records describe longstanding difficulties with basic academic skills and independent functioning, and family accounts suggest that adaptive limitations began during childhood. A court declines to consider the adaptive evidence because the obtained IQ exceeds 70. Under Hall v. Florida, the central problem with that approach is that it:

Accepted Answer

Treats the obtained IQ as exact and forecloses consideration of measurement error and adaptive functioning.

Answer

Uses the obtained score rather than the upper confidence limit to determine eligibility for an intellectual-disability hearing.

Answer

Fails to recognize that a confidence interval extending below 70 establishes intellectual disability without further evaluation.

Answer

Considers childhood limitations when the constitutional inquiry is confined to the prisoner's functioning at the time of execution.

Question 10

In a federal personal-injury action, a neuropsychiatrist uses a well-studied imaging technique to attribute a claimant's symptoms to a collision. The challenge concerns whether the technique was reliably applied to this claimant, not the expert's qualifications or the technique's general acceptance. Retaining counsel argues that problems with application are for the jury to weigh. Under Federal Rule of Evidence 702, how must the court address the challenge?

Accepted Answer

Require the proponent to show, more likely than not, that the opinion reflects a reliable application to this claimant.

Answer

Admit the opinion once general acceptance is shown and reserve questions about application for cross-examination.

Answer

Require the opposing party to demonstrate unreliable application before the proponent must establish an adequate foundation.

Answer

Accept the expert's assurance of reasonable medical certainty as sufficient to establish reliable application.

Free Forensic Psychiatry Practice Questions

Domain 1: Legal regulation of psychiatry (17-21%)

Question 1

Question 2

Domain 2: Civil (16-20%)

Question 3

Domain 3: Criminal (16-20%)

Question 4

Question 5

Domain 4: Death penalty (4-6%)

Question 6

Domain 5: Corrections/correctional health care (8-12%)

Question 7

Domain 6: Legal systems/basic law (8-12%)

Question 8

Domain 7: Children/families (8-10%)

Question 9

Domain 8: Special issues in forensic psychiatry (9-13%)

Question 10

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