Clinical Assessment & Treatment: DSM-V

Question 1

Which of the following is considered to be a culture fair test of cognitive abilities?

A. WRAT-4
B. Leiter-3
C. ITPA-3
D. Fagan Test

Answer 1

Leiter-3

Leiter-3:

• Culture fair measure of cognitive abilities for individuals aged 3 to 75+ years
• reduced cultural content
• nonverbal format to overcome cultural loading associated with language

Question 2

Cocaine intoxication is suggested by which of the following?

A. labile mood, nystagmus, attention difficulties, respiratory distress
B. dysphoria, increased appetite, insomnia, elevated blood pressure
C. labile mood, dilated pupils, paranoia, increased respiration rate
D. apathy, dizziness, impaired coordination, blurred vision

Answer 2

labile mood, dilated pupils, paranoia, increased respiration rate

ALCOHOL INTOXICATION:
labile mood, nystagmus, attention difficulties, respiratory distress

TOBACCO WITHDRAWAL:
dysphoria, increased appetite, insomnia, elevated blood pressure

INHALANT USE:
apathy, dizziness, impaired coordination, blurred vision

Question 3

When using the DSM-5, ________ is coded when a clinician wants to indicate why a clien’t symptoms do not meet criteria for a specific disorder.

A. diagnosis deferred
B. disorder not otherwise specified
C. unspecified disorder
D. other specified disorder

Answer 3

Other specified disorder

NOTE:
OTHER SPECIFIED DISORDER

• Coded when clinician wants to indicate client’s sx’s do not meet criteria for specific diagnosis
  
  • EX: Other specified Bipolar disorder, short duration manic episodes

UNSPECFIED DISORDER:

• indicates diagnostic uncertainty
• used when clinician does not want to specify the reason why clt sx’s don’t meet criteria for a specific diagnosis

Un

Question 4

A better prognosis for patients with schizophrenia is associated with:

A. family hx of a mood disorder, early onset of sx’s, male gender
B. presence of mood disturbance, later age of onset, male gender
C. family hx of mood disorder, later age of onset, female gender
D. absence of mood sx’s, early onset of sx’s, female gender

Answer 4

Family hx of mood disorder, later age of onset, female gender

FACTORS ASSOCIATED WITH BETTER PROGNOSIS:

• acute onset of sx’s
• later age of onset
• female gender
• precipitating events
• brief duration of active phase sx’s
• an associated mood disturbance
• family hx of a mood

Question 5

A DSM-5 diagnosis of Somatic Symptom disorder requires the presence of one or more somatic sx’s that are distressing or cause significant disruption in daily life plus:

A. evidence that sx’s are not associated with a known medical condition
B. performance of excessive health-related bx’s or maladpative avoidance of medical care
C. evidence that sx’s are not being feigned or voluntarily produced
D. excessive thoughts, feelings or bx’s related to the sx’s

Answer 5

Excessive thoughts, feelings or bx’s related to the sx’s

NOTE:

• For the dx of Somatic Symptom disorder, sx’s may or may not be associated with a medical condition
• Performance of excessive health-related bx’s or maladaptive avoidance of medical care is a diagnostic criterion for Illness Anxiety Disorder

DSM-IV-TR vs. DSM-IV

• Somatization Disorder:
  
  • evidence that sx’s are not being intentionally produced or feigned is a DSM-IV-TR diagnostic criterion and no longer in DSM-V
• Somatic Symptom disorder:
  
  • new DSM-V dx
  • does not require that sx’s are intentionally produced or feigned

Question 6

The DSM-5 diagnosis of Persistent Depressive disorder requires a diagnosis of sx’s of at least _____in adults_____and____in children and adolescents.

A. three years; one year
B. three years; eighteen months
C. two years; one year
D. one year; six months

Answer 6

Two years; one year

NOTE:

• Persistent Depressive disorder (DSM-5), formerly known as Dysthymia (DSM-IV-TR) is characterized by the presence of a depressed mood on most days for at lesat two years in adults and one year in children and adolescents.

Question 7

Which of the following tests would NOT be useful for evaluation the intelligence of a 16-year-old adolescent with cerebral palsy?

A. Peabody Picture Vocabulary Test-IV
B. Leiter Performance Scales -Third Edition
C. Columbia Mental Maturity Scale
D. Raven’s Standard Progressive Matrices

Answer 7

Columbia Mental Maturity Scale

Although all of the test listed in the answers to this question would be useful for assessing the intelligence of individuals with cerebral palsy, the CMMS is 3-10 years which means that it would NOT be useful for a 16 year old

PPVT-IV:

• used for individuals over the age of 2 years and can be administered to examinees with motor and/or speech impairments.

LEITER-3:

• nonverbal measure of intelligence for individuals ages 3-75+ and can be administered to examinees who have motor and/or speech disorders

RAVEN’S:

• nonverbal measure of intelligence for indviduals ages 6 and over
• Can be administered to individuals with motor and/or speech impairments

Question 8

The marked characteristic sx’s of Tobacco Withdrawal include all of the following except:

A. irritability or anger
B. hypersomnia
C. impaired concentration
D. increased appetite

Answer 8

Hypersomnia

DSM-5 TOBACCO WITHDRAWAL:

• development of 4 characteristic sx’s within 24 hours of abrupt cessation or reduction in the use of tobacco:
  
  • irritability or anger
  • anxiety
  • impaired concentration
  • increased appetite
  • restlessness
  • depressed mood
  • insomnia

Question 9

Lip smacking, chewing, and other automatism, alterations in mood and personality, hallucinations, and impaired memory are most associated with _____lobe seizures

A. frontal
B. temporal
C. occipital
D. parietal

Answer 9

Temporal

TEMPORAL LOBE SEIZURES:

• oral-alimentary and gestural automatisms
• changes in mod and personality
  
  • EX: depression
  • irritability
  • aggresssion
• hallucinations
• deja vu (a sense of familiarity or strangeness)
• language impairments
  
  • problems related to naming and repetitions
• deficits in learning and memory

NOTE:

• Memory loss if often the most prominent sx for individuals who experience chronic seizures
  
  • Left temporal lobe seizures producing greater impairment in verbal memory
  • Right temporal lobe seizures produce greater impairment in nonverbal (visual memory)

Question 10

The intentional production of symptoms for the purpose of obtaining an external reward is characteristic of which of the following?

A. Factitious Disorder
B. Malingering
C. Somatic Symptom Disorder
D. Ilness Anxiety Disorder

Answer 10

Malingering

MALINGERING:

• intentional production of physical or psychological sx’s for the purpose of obtaining an external reward
  
  • EX: avoiding work, receiving financial compensation, obtaining drugs

SOMATIC SYMPTOM DISORDER:

• one or more somatic sx’s that cause distress or a significant disruption in daily life
• Accompanied by excessive thoughts, feelings, or behaviors related to the sx’s

ILLNESS ANXIETY DISORDER:

• preoccupation with having a serious illness
• absence of somatic sx’s
• mild somatic sx’s
• high level of anxiety about one’s health
• performance of excessive health-related bx’s or maladaptive avoidance of doctors and hospitals
• DSM-5 does NOT require sx’s to be linked to a desire to obtain an external award

FACITIOUS DISORDER:

• Individuals with Factitious disorder imposed on self falsify physical or psychological sx’s that are associated with their deception
• present themselves to other as being ill or impaired
• engage inthe deceptive behavior even in the absence of an obvious external reward for doing so

Question 11

On the MMPI-2, a three-point code of 6-7-8, with scores on Scales 6 and 8 being higher than the score on Scale 7, is most associated with which of the following?

A. conversion symptoms
B. delusion, hallucinations, and paranoia
C. passive-aggressive bx’s with substance abuse
D. depression with psychotic and somaticizing features

Answer 11

delusion, hallucinations, and paranoia

NOTE:
Three point code of 6-7-8:

• scores on Scales 8 and Scale 8 being higher than Scale 7 score is referred to as the psychotic valley
• Psychotic valley is associated with psychotic sx’s and with a dx of Schizophrenia, Paranoid Type

Three-point code of 1/3-2/3-1/2:

• in which scores on Scales 1 and 3 are higher than the score on Scale 2
• associated with Somatization & Conversion sx’s

Three-point code of 2-4-7:

• suggests passive-aggressive tendencies with comorbid substance abuse

A three-point-code of 1-2-8:

• suggestive of depression with psychotic features and physical complaints.

Question 12

Alcohol Withdrawal is characterized by:

A. dysphoric mood, vivid dreams, insomnia or hypersomnia, and increased appetite
B. hand tremor, insomnia, hallucinations, and seizures
C. incoordination, nystagmus, impaired memory, and mood lability
D. dysphoric mood, pupillary dilation, insomnia, and fever

Answer 12

Hand tremor, insomnia, hallucinations, and seizures

NOTE:

STIMULANT WITHDRAWAL:

• dysphoric mood, vivid dreams, insomnia or hypersomnia, and increased appetite

ALCOHOL INTOXICATION:

• incoordination, nystagmus, impaired memory, and mood lability

OPIOID WITHDRAWAL:
dysphoric mood, pupillary dilation, insomnia, and fever

Question 13

A DSM-5 diagnosis of Agoraphobia requires which of the following?

A. the presence of chracteristic sx’s in at least two of five designated situations
B. the duration of sx’s for at least 3 months
C. a history of at least one unexpected panic attack
D. recognition by the person that his/her fear and anxiety are excessive or unreasonable

Answer 13

The presence of chracteristic sx’s in at least two of five designated situations

DIAGNOSIS OF AGORAPHOBIA:

• presence of marked fear or anxiety in at least 2of 5 situations:
  
  • using public transportation
  • being in open spaces
  • being in enclosed spaces
  • standing in line or being part of a crowd
  • being outside the home alone
• requires presence of 6 months
• does NOT require recognition by the person that his/her fear and anxiety are excessive or unreasonable

Question 14

The Brief Symptom Inventory (BSI) is most useful for which of the following purposes?

A. identifying risk and protective factors related to a client’s presenting problem
B. tracking a client’s progress during the course of therapy
C. identifying the affective, cognitive, and behavioral features of a client’s presenting problem
D. making a differential diagnosis between disorders that have similar sx’s.

Answer 14

Tracking a client’s progress during the course of therapy

NOTE:

• BSI is a brief version of the SCL-90R.
• provides information about the type and severity of a client’s sx’s
• Useful for monitoring a clt’s progress in therapy & assessing tx outcomes

Question 15

Which of the following are the most common co-morbid disorders for children with ADHD?

A. Anxiety Disorders & Mood disorder
B. Anxiety Disorders & Factitious disorder
C. Tic Disorders & Sleep Disorders
D. Tic Disorders and Communcation Disorders

Answer 15

Anxiety Disorders & Mood disorder

NOTE:

• ODD is the most frequent co-occurring disorder for ADHD
• 60% of children with ADHD also have ODD, however this is not listed in any of the answers, so the next most frequent disorder is Mood & Anxiety disorder
• 30% of children with ADHD also have an Anxiety disorder
• 30% or more of children witih ADHD also have a Mood D/O, most often depression
• Although many children with a Tic D/O also have sx’s of ADHD, the reported rates of a Tic Disorder in children is somewhat lower than the rates of Anxiety and Mood disorders

Question 16

A mental status examination is LEAST useful for which of the following purposes?

A. establishing a provisional diagnosis
B. evaluating a client’s current mental functioning
C. determining the need or more formal psychologial testing
D. determining how a client’s problem “fits” in the wider context of his or her life.

Answer 16

Determining how a client’s problem “fits” in the wider context of his or her life.

Question 17

Which of the following is true about the prevalence of Major Depressive Disorder in adolescents and adults?

A. The rates for males and females are about equal
B. The rate for females is one and one-half to three times the rate for males
C. The rate for males is one and one-half to three times the rate for females
D. The rate for females is four to five times the ratefor males

Answer 17

The rate for females is one and one-half to three times the rate for males

NOTE:

• Prior to puberty, the rates of MDD is about equal for males and females
• Beginning in adolescence, the rate for females become 1 and 1/2 to 3x the rate for males

Question 18

Which of the following is NOT appropriate when preparing a psychological report?

A. maintaining a close focus and emphasis on the test data
B. emphasizing what is unique about the client
C. including speculations concerning the client
D. discussing inconsistencies in the assessment data

Answer 18

Maintaining a close focus and emphasis on the test data

NOTE:

• A psychological report should focus on the client you evaluated and the problems of concern, not the test data only
• The reader is not interested in the test data itself, but in what the data signify about the client
• The report should be individualized and specific to the client by drawing conclusions based on an integration of background information, behavioral observations, and test data
• Use language of conjecture
  
  • EX: “it appears, tend to, probably”
• Address consistencies & inconsistencies
• Explain contradictions
  
  • EX: faking good VS. faking bad
• If cannot explain inconsistencies, suggest ways to resolve them, such as additional testing

Question 19

Allan A, age 27, is a graduate student in the mathematics department at a local university. During his first session with you, he states that he has lost interest in his academic work as well as in spending time with his family and friend and that he feels worthless, discouraged, and “down in the dumps.” He also states that he has been having trouble sleeping, hasn’t been very hungry, and is unable to concentrate. Allan says that he thinks his fellow graduate student are trying to get him removed from his program and that his roommate is trying to poison him. His symptoms began about six months ago. A diagnosis of Schizoaffective Disorder might be appropriate in this case if:

A. Allan’s mood symptoms have occurred for at least two weeks in the absence of delusion or hallucinations
B. Allan’s paranoid delusions have occurred for at least two weeks now in the absence of prominent mood symptoms
C. Allan’s paranoid delusions have occurred exclusively during period of mood symptoms
D. Allan’s mood symptoms have had a longer duration than his paranoid delusions

Answer 19

Allan’s paranoid delusions have occurred for at least two weeks now in the absence of prominent mood symptoms

NOTE:

• D (delusions) before M (mood)

Question 20

The research has identified a number of gender differences in the characteristics of depression. For example, the studie have found that, for females, all of the following are true, EXCEPT:

A. an earlier age of onset
B. a greater seasonal effect on mood
C. less frequent atypical symptoms (e.g., hypersomnia and increased appetite)
D. greater co-occurence with anxiety disorders (especially panic and phobic disorders)

Answer 20

Less frequent atypical symptoms (e.g., hypersomnia and increased appetite)

NOTE:

• Depression occurs more frequently in women than in men
• Women is more often associated with the symptoms including:
  
  • an earlier age of onset
  • greater co-occurence with anxiety disorders (especially panic and phobic disorders)
  • a greater seasonal effect on mood
• Women are MORE LIKELY than men to exhibit atypical symptoms of depression including:
  
  • hypersomnia
  • increased appetite
  • weight gain
  • leaden paralysis

Question 21

According to Gonsalves (1992), refugees often experience a similar series of stages while adjusting to life in the United States. According to his resettlement stage model, the destabilization stage encompasses the period extending from six months to three years after arriving in the United States; and treatment issues for refugees in this stage most often center on:

A. isolation and fear of failure
B. grief and depression
C. sadness guilt
D. hostility and resistance

Answer 21

Hostility and resistance

NOTE:

• According to Gonsalves, the primary issues for refugees in the destabilization stage are:
  
  • hostility and resistance
    
    • which stems from feelings of nostalgia about their homeland
• the sense that no one in the US care about them
• or the tendency to deny their own problems

Question 22

For the diagnosis of Schizophrenia, the DSM-5 requires the presence of two or more active phase symptoms for at least two months with at least one symptom being:

A. hallucinations, delusions, or disorganized speech
B. hallucinations, delusions, or grossly disorganized behavior
C. anhedonia, avolition, or other negative symptom
D. depersonalization or derealization

Answer 22

Hallucinations, delusions, or disorganized speech

DSM-5 SCHIZOPHRENIA:

• 2 or more active phase sx’s for at least 1 month
• continuous signs of the disturbance for at least 6 months
• Requires at least 1 active phase symptom to be hallucinations, delusions, or disorganized speech

Question 23

Two weeks ago, Amy A. age 17, suddenly began experencing weakness in both legs and a loss of balance, which causes her to fall down when she tries to walk. Amy hasn’t been able to go to school because of her symptoms and says she thinks they started after she had an argument with her best friend. A thorough physical examination has not found a medical explanation for her symptoms, and the symptoms are not compatible with any known neurological or medical condition. The most likely diagnosis for Amy is:

A. Conversion Disorder
B. Somatic symptom disorder
C. Body Dysmorphic Disorder
D. Acute Stress Disorder

Answer 23

Conversion Disorder

CONVERSION DISORDER:

• 1 or more sx’s involving motor or sensory functioning that are incompatible with recognized neurological or medical conditions
• Cannot be better explained by a medical disorder or other mental disorder

SOMATIC SYMPTOM DISORDER:

• 1 or more somatic sx’s that are distressing, or result in significant disruption of daily life
• Excessive thoughts, feelings, or bx’s related to the somatic sx’s or associated health concerns by at least one of the following:
  
  • disproportionate and persistent thoughts about the seriousness of one’s sx’s
    persistently high level of anxiety about health or sx’s
  • excessive time and energy devoted to these symptoms or health concerns
    
    • There is no information provided in the question indicating Amy is having excessive thoughts and feelings about the sx’s, which is required for the dx
    • The incompatibility of Amy’s sx’s with any known medical or neurological conditions is more characteristic of Conversion disorder than Somatic Sx Disorder

Question 24

The specifier “with delayed expression” is appropriate for a DSM-5 diagnosis of PTSD when the individual’s symptoms do not meet all of the diagnostic criteria for the disorder until at least _____after his/her exposure to the traumatic event.

A. 30 days
B. 90 days
C. 6 months
D. 12 months

Answer 24

6 months

Question 25

Because they share several symptoms, ADHD and Bipolar disorder are often difficult to distinguish, especially in children. However, which of the following symptoms is more indicative of ADHD than of Bipolar disorder?

A. The child’s destructive acts are usually deliberate (rather than the result of carelessness).
B. The child has episodes of anger that sometimes last for as long asthree or four hours
C. The child is usually irritable and slow to wake up in the morning
D. The child’s academic problems are due to a learning disorder (rather than to a lack of motivation).

Answer 25

The child’s academic problems are due to a learning disorder (rather than to a lack of motivation).

NOTE:
In children, ADHD and Bipolar disorder share a number of symptoms including:

• hyperactivity
• distractibility
• temper tantrums
• irritability
• decreased need for sleep

MORE CHARACTERISTIC OF BIPOLAR D/O:

• The child’s destructive acts are usually deliberate (rather than the result of carelessness).
• The child has episodes of anger that sometimes last for as long asthree or four hours
• The child is usually irritable and slow to wake up in the morning

Question 26

Among individuals with schizophrenia, the most common comorbid disorders are:

A. substance-related disorders and anxiety disorders, especially panic disorder and obsessive-compulsive disorder
B. substance-related disorders, eating disorders, and major depressive disorder
C. major depressive disorder and anxiety disorders, especially panic disorder and obsessive-compulsive disorder
D. substance-related disorders, bipolar I disorder, and social phobia

Answer 26

Substance-related disorders and anxiety disorders, especially panic disorder and obsessive-compulsive disorder

NOTE:

• Schizotypal, schizoid, or Paranoid PD may precede the onset of schizoprehnia

Question 27

During her first session with Dr. Hank Horvat, Stephanie S. tells him that she experiences severe anxiety whenever she’s in an elevator or other enclosed space because she’s afraid she won’t be able to escape or get help if she develops a panic attack. Which of the following would help confirm a DSM-5 diagnosis of Agoraphobia for Stephanie?

A. She tells Dr. Horvat that she also experiences severe anxiety when using public transportation which has restricted her ability to visit friends and family members who don’t live in her neighborhood.
B. She tells Dr. Horvat that her panic attacks make her feel like she’s having a heart attack but that her physician has reassured her that she has a healthy heart
C. She tells Dr. Horvat that her fear of elevators began after a crowded elevator she was in was stuck between floor for over an hour
D. She tells Dr. Horvat that she often experiences panic attacks at unexpected times and unexpected places

Answer 27

She tells Dr. Horvat that she also experiences severe anxiety when using public transportation which has restricted her ability to visit friends and family members who don’t live in her neighborhood

NOTE:
DSM-5 diagnosis of Agoraphobia requires that the individual experience marked anxiety in at least 2 of the following situations:

• using public transportations
• being in open spaces
• being in enclosed spaces
• standing in line or being part of a crowd
• being outside home alone
  
  • the individual MUST fear or avoid these situations due to a concern that escape might be difficult or help will be unavailable in case he or she develops panic-like, incapacitating or embarrassing sx’s

PANIC DISORDER:

• She tells Dr. Horvat that her panic attacks make her feel like she’s having a heart attack but that her physician has reassured her that she has a healthy heart
• these sx’s are not required for a dx of Agoraphobia
• Unexpected panic attacks are REQUIRED for Panic disorder but not for a diagnosis of Agoraphobia

SPECIFIC PHOBIA, SITUATIONAL TYPE:

• She tells Dr. Horvat that her fear of elevators began after a crowded elevator she was in was stuck between floor for over an hour

Question 28

Using an actuarial approach to clinical decision making is particularly useful when:

A. the outcome you are predicting is objective and specific
B. you are juding or predicting rare events of a highly individualized nature
C. you are primarily concerned with outcomes for a specific individual
D. specific client data negate the efficiency of a statistical formula

Answer 28

The outcome you are predicting is objective and specific

NOTE:
ACTUARIAL (STATISTICAL) APPROACH:

• statistical rules are applied to the results of an assessment
• a formula is also applied (e..g, a regression equation) to make the decision about whether a client has a particular characteristic or condition that is likely to behave in a particular way in the future
• This approach is particularly useful when the outcome you are predicting is:
  
  • objective and specific (e.g., vocational success)
  • primarily concerned with outcomes for large, heterogenous samples rather than outcomes for a specific individual
  • when you have reason to be particularly concerned about the effect of human error or bias on the decision making

CLINICAL APPROACH:

• decisions regarding clients are based on clinical impressions, experience, knowledge
• You evaluate and integrate multiple sources of information to form a coherent description of the client as a unique individual involved in a unique situation
• Useful for when you are making decision for which no statistical equations have been developed
• this includes the majority of clinical decisions psychologists face
• when you need information about areas or events for which no adequate tests are available
• when you are judging or predicting rare events of a highly individualized nature
• when specific client data negate the efficiency of a statistical formula

Question 29

Among adults, which of the following disorders is about equally common in males and females?

A. borderline personality disorder
B. substance-related disorders
C. obsessive-compulsive disorder
D. major depressive disorder

Answer 29

Obsessive-compulsive disorder

NOTE:

• OCD is equally common in males and females
  
  • Average age onset is EARLIER for MALES
  • for CHILDREN and ADOLESCENTS, OCD is more prevalent in males
• Females up make up about 75% of cases of Borderline personality disorder
  
  • Substance-related D/O are usually diagnosied more commonly in males than females
• MDD is at least twice as common in adolescence and adult females
  
  • Before adolescence, however, MDD rates are about equal for males and females

Question 30

On the MMPI-2, Clifford C., age 32, obtains an elevated score on the F scale (T = 98) and a moderate score on the VRIN scale (T = 63). This combination of scores suggests that Clifford:

A. is independent and self-reliant and has moderate levels of defensiveness
B. has significant pathology or deliberately tried to exaggerate the severity of his sx’s.
C. answered items randomly or in a deliberately inconsistent manner
D. tried to present items in an unrealistically positive manner

Answer 30

Has significant pathology or deliberately tried to exaggerate the severity of his sx’s.

NOTE:
HIGH F-SCALE, MODERATE VRIN scale:

• excessive endorsement of pathological items
• suggests that he is either severely disturbed
• OR intentionally trying to “fake bad”

MODERATE K-SCORE:

• suggests independence
• self-reliance
• moderate level of defensiveness
• Good ego-strength

ELEVATED F, ELEVATED VRIN SCALES:

• inconsistent responding

Question 31

Othmer and Othmer (1994) have suggested five steps for maximizing the reliability and the validity of unstructured diagnostic interviews. The first step is to:

A. ask closed-ended questions related to specific diagnostic criteria in order to develop lists of possible mental disorders, excluded disorders, and unexplored disorders
B. listen to and observe the client to identify diagnostic clues and use the clues to develop lists of possible mental disorders, excluded disorders,and unexplored disorders
C. obtain the client’s psychiatric history
D. gather information about the client’s premorbid functioning and family hx

Answer 31

Listen to and observe the client to identify diagnostic clues and use the clues to develop lists of possible mental disorders, excluded disorders,and unexplored disorders.

NOTE:

• *5 steps** for maximizing the reliability and the validity of unstructured diagnostic interviews:
  (1) listen to and observe the client to identify diagnostic clues,
• use these clues to develop lists of possible mental disorders, excluded disorders, and unexplored disorder
• ask primarily for open-ended questions at this time to allow client lee-way in reporting sx’s and other problems

(2) Ask primarily close-ended questions relating to specific diagnostic critiera

• these questions are based upon the diagnostic clues you derived in step No. 1
• As you continue asking relevant questions, your list of possible and unexplored disorders become shorter and your list excluded disorders becomes longer

(3) Get a psychiatric history, find out whether your clt received mental health tx in the past, and if so, for what and the outcome

Question 32

A 31-year old male client presents with delusions and auditory hallucinations. His wife says that his symptoms developed soon after the sudden death of his mother nearly three weeks ago. The tentative diagnosis is:

A. Schizophrenia
B. Schizophreniform Disorder
C. Brief Psychotic Disorder
D. Schizoaffective Disorder

Answer 32

Brief Psychotic Disorder

NOTE:
BRIEF PSYCHOTIC DISORDER:

• 1 or more 4 characteristic sx’s, at least 1 sx being delusions, hallucinations or disorganized speech
• Sx’s being present for at least 1 day but LESS than 1 month

SCHIZOPHRENIA:

• 2 active-phase sx’s for at least 1 month, at least 1 sx being delusions, hallucinations or disorganized speech
• Continuous signs of the D/O for at least 6 months

SCHIZOPHRENIFORM:

• at least 1 sx being delusions, hallucinations or disorganized speech
• sx’s present between 1 and 6 months

SCHIZOAFFECTIVE:

• hx of concurrent sx’s of Schizophrenia & a manic or major depressive episode
• at least 2 weeks without prominent mood sx’s

Question 33

Milly M., age 22, is brought to therapy by her mother who is concerned because Milly “has not been herself” recently. You learn that Milly has experienced transient hallucinations for several weeks, and during the interview, she is sometimes incoherent and smiles and giggles inappropriately. Consequently, your initial impression is that Milly has a psychotic disorder. If you subsequently focus on assessment results that confirm this impression and ignore contradictory information, you wil be exhibiting which of the following?

A. hindsight bias
B. Hawthorne effect
C. confirmation bias
D. John Henryism

Answer 33

Confirmation bias

NOTE:
HINDSIGHT BIAS:

• tendency to view events that have already happened as predictable or inevitable

HAWTHORNE EFFECT:

• occurs when participants in a research study exhibit improved performance because of the special attention they are receiving as research participants

JOHN HENRYISM:

• tendency to exert a great deal of effort in order to cope with difficult psychological & environmental stressors
• identified as a personality trait of African-Americans that may have a genetic bias
• it has been linked to negative health outcomes for people who do not have adequate resources (e.g., inadequate social support) for achieving their goals

Question 34

Alcohol Withdrawal is characterized by:

A. dysphoric mood, vivid dreams, insomnia or hypersomnia, and increased appetite
B. hand tremor, insomnia, hallucinations, and seizures
C. incoordination, nystagmus, impaired memory, and mood lability
D. dysphoric mood, pupillary dilation, insomnia, and fever

Answer 34

Hand tremor, insomnia, transient hallucinations (or illusions), and seizures (e.g., generalized tonic-clonic)

NOTE:

STIMULANT WITHDRAWAL:

• dysphoric mood, vivid dreams, insomnia or hypersomnia, and increased appetite

ALCOHOL INTOXICATION:

• incoordination, nystagmus, impaired memory, and mood lability

OPIOID WITHDRAWAL:

• dysphoric mood, pupillary dilation, insomnia, and fever

Question 35

When using the WAIS-IV, a GAI can be derived from the examinee’s scores on which of the following Indexes?

A. Processing Speed and Perceptual Reasoning
B. Working Memory and Processing Speed
C. Verbal Comprehension and Perceptual Reasoning
D. Verbal Comprehension and Working Memory

Answer 35

Verbal Comprehension and Perceptual Reasoning

Question 36

During the mental status exam of a new client, the psychologist asks the client what factors led him to decide to quit his job two weeks ago. Apparently, the psychologist is interested in evaluating the client’s:

A. concentration
B. judgment
C. abstraction
D. registration

Answer 36

Judgment

NOTE:
JUDGMENT:

• ability to evaluate alternatives
• assessed with MSE by asking the client to discuss past choices or decisions to say what he/she would do in an imaginary situation
  
  • EX: If he/she found an unsigned paycheck lying on the sidewalk

CONCENTRATION:

• attentiveness
• distractibility
• Often evaluated with a specific task
  
  • EX: having the client name the months or days of the week backward

ABSTRACTION:

• higher-order cognitive function that is typically assessed by having the client identify similarities between the pairs objects
• OR explaining the meaning of well-known proverbs

REGISTRATION:

• refers to immediate memory
• assessed by asking the client to immediately repeat a short list of words, numbers, or other information

Question 37

A depressed and anxious client has been referred to a psychologist by a social worker who has asked the psychologist to adminster a personality test to the client. Before accepting this referral, the psychologist should first:

A. find out whether the social worker is required to interpret the results of a personality test; if not the psychologist will need to withhold the raw test results from him
B. discuss with the social worker the appropriate uses and limitations of psychological testing
C. find out what the social worker wants to learn about the client through personality testing
D. select a test that is appropriate, given the client’s age and other characteristics

Answer 37

Find out what the social worker wants to learn about the client through personality testing

Question 38

Your new client exhibits many symptoms of major depression, including loss of interest, loss of appetite, and fatigue. It would be most important to obtain collateral information from which of the following sources?

A. family members
B. mental health records
C. any informants who have regular contact with the client
D. medical professionals

Answer 38

Medical professionals

Question 39

A psychologist observes that a client is somewhat disoriented during the clinical interview. The client has difficulty following the interview and frequently repeats herself. What should the psychologist do?

A. Complete the clinical interview and then decide whether to administer the psycholoical tests
B. Integrate the mental status exam questions into the interview and determine whether to refer the client to a neurologist for evaluation
C. Ask the client a series of questions that assess her mental status, observe her nonverbal behavior, and then refer to a medical professional
D. Structure the interview by asking close-ended questions to compile data about all dimensions of functioning and factors that impinge on the client’s functioning

Answer 39

Integrate the mental status exam questions into the interview and determine whether to refer the client to a neurologist for evaluation

Question 40

Which of the following is NOT a sign of Malingering?

A. The client obtains a low score on F-scale of the MMPI-2
B. The client obtains low scores on the L and K scales of the MMPI-2
C. The client has responded within the normal range on some portions of a personality tests but in a very disturbed manner on other portions of the same test
D. The client gives responses suggesting a psychological disturbance, but has never been viewed by his family member as having any psychological problems

Answer 40

The client obtains a low score on F-scale of the MMPI-2

Question 41

A 3-year-old has no interest in relationships, engages in highly unusual play behavior on his own, and is preoccupied with parts of objects. The child has no cognitive or language impairments. Based on this information, the most likely DSM-5 diagnosis for this child is:

A. autism spectrum disorder
B. intellectual disability
C. pervasive developmental disorder NOS
D. schizoid personality disorder

Answer 41

Autism spectrum disorder

Question 42

Your new client is a 19 year old who lives at home with his parents. The client has been uncharacteristically hostile towards his parents lately and has seemed confused. You note that he is thin and that his speech is rambling, and he complains of headaches and ringing in his ears. What diagnosis should be considered first?

A. stimulant use disorder
B. major depressive disorder
C. schizophrenia
D. opioid use disorder

Answer 42

Stimulant use disorder

Question 43

Christine, age 24, is very underweight but thinks she’s fat and disgusting and regularly engages in binge eating and purging. The most likely diagnosis for Christine is:

A. unspecified eating disorder
B. binge-eating disorder
C. anorexia nervosa, binge eating/purging type
D. bulimia nervosa

Answer 43

Anorexia nervosa, binge eating/purging type

Question 44

A DSM-5 diagnosis of Agoraphobia requires which of the following?

A. the duration of symptoms for at least 3 months
B. a history of at least one unexpected panic attack
C. the presence of characteristic symptoms in at least 2 of 5 designated situations
D. recognition by the person that his/her fear and anxiety are excessive or unreasonable

Answer 44

The presence of characteristic symptoms in at least 2 of 5 designated situations

Question 45

An examinee’s TRIN score on the MMPI-2 is useful for identifying:

A. defensiveness or denial
B. exaggeration of negative characteristics
C. deviant responding to items at the end of the test
D. an acquiescent or non-acquiescent response style

Answer 45

An acquiescent or non-acquiescent response style

Question 46

For a person with Bipolar I disorder who is intolerant of or nonresponsive to lithium carbonate, the most appropriate medication would most likely be which of the following?

A. propranolol
B. carbamazepine
C. lorazepam
D. donepezil

Answer 46

Carbamazepine

Question 47

Research by Norcross (2004) and others has found that highly resistant clients benefit from which of the following?

A. self-control strategies, lower levels of therapist directiveness, and paradoxical interventions
B. more intensive treatments and explicit guidance from the therapist
C. insight-oriented therapist that address the extensive use of particular defense mechanisms
D. interventions that provide opportunities for personal interaction and relatedness

Answer 47

Self-control strategies, lower levels of therapist directiveness, and paradoxical interventions

Question 48

Alcohol Withdrawal is characterized by:

A. dysphoric mood, vivid dreams, insomnia or hypersomnia, and increased appetite
B. hand tremor, insomnia, hallucinations, and seizures
C. incoordination, nystagmus, impaired memory, and mood lability
D. dysphoric mood, pupillary dilation, insomnia, fever

Answer 48

Hand tremor, insomnia, hallucinations, and seizures

NOTE:

STIMULANT WITHDRAWAL:

• dysphoric mood
• vivid dreams
• insomnia or hypersomnia
• increased appetite

ALCOHOL INTOXICATION:

• incoordination
• nystagmus
• impaired memory
• mood lability

OPIOID WITHDRAWAL:

• dysphoric mood
• pupillary dilation
• insomnia
• fever

Question 49

A diagnosis of bipolar II disorder is the appropriate diagnosis when the individual has a history of:

A. major depressive and hypomanic episodes
B. major depressive and manic episodes
C. major depressive and mixed episodes
D. mixed episodes only

Answer 49

Major depressive and hypomanic episodes

NOTE:

• No changes from DSM-IV to DSM-V
• The diagnosis of bipolar II disorder requires the presence of:
  
  • at least one major depressive episode AND at least one hypomanic episode
• The presence of manic or mixed episodes (answers 2, 3, and 4) is characteristic of bipolar I disorder.

Question 50

A DSM-5 diagnosis of Somatic symptom disorder requires the presence of one or more somatic symptoms that are distressing or cause significant disruption in one’s daily life plus:

A. evidence that symptoms are not associated with a medical condition
B. performance of excessive health-related behaviors or maladaptive avoidance of medical care
C. evidence that symptoms are not being feigned or intentionally produced
D. excessive thoughts, feelings, or behaviors related to the symptoms

Answer 50

Excessive thoughts, feelings, or behaviors related to the symptoms

NOTE:

ILLNESS ANXIETY D/O:

• performance of excessive health-related behaviors or maladaptive avoidance of medical care

Question 51

Comparing an examinee’s scores on the WAIS-IV and the WMS-IV would be the most useful for assisting in the diagnosis of which of the following?

A. Specific learning disorder
B. Intellectual disability
C. Mild/Major Neurocognitive disorder due to Alzheimer’s disease
D. Factitious disorder

Answer 51

Mild/Major Neurocognitive disorder due to Alzheimer’s disease

Question 52

Sam Smith, age 8, is brought to therapy by his mother who says he speaks only in short phrases, has a very limited vocabulary, and seems to have trouble recalling words. His mother says Sam doesn’t have very many friends and is doing poorly in school and that his problems with language were apparent by the time he was about three years old. When you talk to Sam, he doesn’t make eye contact and doesn’t seem to want to answer your questions. Based on this information, the most likely diagnosis is:

A. Autism Spectrum disorder
B. Selective mutism
C. Intellectual disability
D. Language disorder

Answer 52

Language disorder

NOTE:

• For this question, you wouldn’t want to over-focus on Sam’s problems with eye contact during the interview
• Instead, itis important to consider ALL the symptoms listed, which (with the exception of the lack of the eye contact), are consistent with a diagnosis of a Language disorder

Question 53

Craig C., age 10 1/2 is brought to see you by his mother because of the problems he has been having at home and school for the past year. She says that Craig is disrespectful and defiant, gets angry and loses his temper very easily, argues with her whenever she tries to get him to do anything, often lies to avoid getting into trouble, and doesn’t pay attention to his teacher or do what she asks him to do. She also tells you that Craig has been kicked off the school bus because he consistently teases and annoys the other children and that she’s tried withholding privileges to change his behavior but it doesn’t seem to work. Based on these symptoms, the most likely diagnosis for Craig is:

A. Oppositional defiant disorder
B. Conduct disorder
C. Attention Deficit Hyperactivity disorder
D. Other specified disruptive, Impulse-Control, and Conduct disorder

Answer 53

Oppositional defiant disorder

DSM-V ODD diagnosis requires:

• a pattern of angry/irritable mood
• argumentative/defiant behavior, or vindictiveness lasting at least 6 months
• Involving at least 4 characteristic symptoms directed towards a person who is NOT their sibling
  
  • Craig is disrespectful and defiant, doesn’t do what his mother and teacher asks him to do, gets angry and loses his temper easily.
  • He also teases and annoys his peers
  • While Craig “often lies to avoid getting in trouble,” his behaviors do not reflect a “repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated (which is required for a diagnosis of CD)
  • Craig doesn’t meet criteria for ADHD because he doesn’t pay attn to his teacher, but none of the other criteria suggestive of ADHD are indicated in the vignette

Question 54

The research suggests that _____has the highest premature mortality rate of any psychiatric disorder.

A. Schizophrenia
B. Major depressive disorder
C. Bipolar I disorder
D. Anorexia Nervosa

Answer 54

Anorexia Nervosa

Question 55

Your new client, Denise D., says she started experiencing lower back pain after a car accident six months ago and, despite numerous physical tests and examinations, her doctor can find no reason for it. You learn that a week before the car accident, Denise found out that her husband had just ended a brief affair with a co-worker and that, since the accident, she has avoided sex with her husband because doing so “makes the pain worse.” Denise also notes that she can think of little other than the pain since the accident and that she’s concerned that, eventually, she will become incapacitated because of it. Denise’s back pain seems to be genuine and there is no evidence that she is voluntarily producing or faking it. The most likely diagnosis for Denise is:

A. Illness Anxiety disorder
B. Somatic symptoms disorder
C. Female sexual interest/Arousal disorder
D. Conversion disorder

Answer 55

Somatic symptoms disorder

NOTE:

• Denise meets criteria for Somatic symptoms disorder because:
  
  • she has a somatic symptom (back pain)
  • the pain is distressing and interferes with normal functioning
  • she also has persistent thoughts about the seriousness of her symptom
• Ilness anxiety disorder can be ruled out because she is experiencing significant back pain and it’s diagnosis requires a lack of somatic symptoms or the presence of only mild symptoms
• Conversion disorder can be ruled out because she does not have an impairment in voluntary motor or sensory functioning

Question 56

Which of the following is NOT a sign of Malingering?

A. The client obtains a low score on the F-scale of the MMPI-2
B. The client obtains low scores on the L and K scales of the MMPI-2
C. The client has responded within the normal range on some portions of a personality inventory but in a very disturbed manner on other portions of the same test
D. The client gives responses suggesting a psychological disturbance, but has never been viewed by his family members as having any psychological problems

Answer 56

The client obtains a low score on the F-scale of the MMPI-2

Question 57

The primary feature of what DSM-5 diagnosis is a preoccupation with a fear of having a serious disease despite absence of symptoms of the disease?

A. Somatic symptom disorder
B. hypochondriasis
C. Factitious disorder
D. Illness Anxiety disorder

Answer 57

Illness Anxiety disorder

NOTE:
There is NO LONGER “hypochondriasis” in the DSM-5

Question 58

An examinee’s TRIN score on the MMPI-2 is useful for identifying:

A. defensiveness or denial
B. exaggeration of negative characteristics
C. deviant responding to items at the end of the test
D. an acquiescent or non-acquiescent response style

Answer 58

An acquiescent or non-acquiescent response style

NOTE:
Fb (high score): deviant responding to items at the end of the test
_F (high score):_exaggeration of negative characteristics
K (high score): defensiveness or denial
VRIN (high score): variable responding, inconsistent responding to similar items

Question 59

The research has confirmed a link between Major Depressive Disorder and memory impairment, with _____ usually being the most adversely affected by this disorder.

A. prospective memory
B. remote long-term memory
C. working (short-term) memory
D. sensory memory

Answer 59

Working (short-term) memory

NOTE:

• Depression has an adverse affect on memory, especially the working memory of short-term memory
• The impact on working memory can be attributed to several factors including deficits in attention and concentration and decreased processing speed

Question 60

Mike M., age 6 1/2 is brought to therapy by his parents who are concerned because, for the past eight months, Mike has been having increasing problems at school and at home. His teacher has told Mike’s parents that Mike is not getting his school work done, and has trouble staying in his seat, doesn’t wait for his turn when playing games, and is disrespectful to teachers and other students. At home, Mike talks constantly and interrupts others when they’re talking, grabs toys and objects from his younger brother’s hands, runs in the house even when he’s reminded no to, and sometimes he hits his brother or the dog when he’s frustrated. Based on these symptoms, the most likely diagnosis for Mike is:

A. Oppositional Defiant disorder
B. Conduct disorder, Childhood-onset type
C. ADHD, Combined presentation
D. ADHD, Predominantly Hyperactive-impulsive presentation

Answer 60

ADHD, Predominantly Hyperactive-impulsive presentation

NOTE:

• Mike meets criteria for ADHD because:
• symptoms began prior to age 12
• sx’s have persisted for more than 6 months in at least 2 settings

Appropriate specifier is “predominantly hyperactive-impulsive type because he has:

• 6 sx’s of hyperactivity-impulsivity
  
  • EX: doesn’t stay in his seat, wait for his turn, talks constantly, interrupts others, grabs toys, runs in house
  • ONLY 1 sx of inattention
    
    • EX: doesn’t complete his work
• Combined presentation requires 6 sx’s of BOTH inattention and hyperactivity

Question 61

Your new client is a 27-year old woman who was referred to you by her physician. The woman says that, for the past six or seven months, she has experienced chronic stomachaches and loss of appetite and often feels nauseous and that her sx’s have interfered with her ability to work. Despite extensive tests, her physician was unable to find a medical explanation for her sx’s. The woman also tells you that her husband started talking about getting a divorce a few weeks before her sx’s began. Based on this information, the most likely diagnosis for this woman is:

A. Somatic symptom disorder
B. Other specified somatic symptom disorder and related disorder
C. Illness Anxiety disorder
D. Facititious disorder

Answer 61

Other specified somatic symptom disorder and related disorder

NOTE:
Somatic symptom disorder:

• requires “excessive thoughts, feelings, or bx’s related to the somatic sx’s or associated health concerns”
• this is NOT indicated for the woman

Other specified somatic symptom disorder and related disorder:

• this is diagnosed when:
  
  • sx’s characteristic of a somatic sx and related disorder that cause clinically significant distress or impairment…but do not meet full criteria for any of the disorders in the somatic sx and related disorders diagnostic class

Question 62

A psychologist is conducting an intake on a 40-year old male who is seeking mental health treatment for the first time. He was just laid off from his job and is furious with management. He reveals he has been thinking about shooting his immediate supervisor. He states he owns a gun, but adds that he won’t act on his thoughts because he doesn’t want to go to prison. Initially, the psychologist should do all of the following except:

A. further assess past agressive ideation and behavior
B. establish a therapeutic alliance and agree on therapy goals
C. establish the patient’s diagnosis
D. determine appropriate outcome measures

Answer 62

Determine appropriate outcome measures

NOTE:

• It is good practice to decide upon outcome measures in early treatment
• Typically such measures can be given at the beginning, middle, and end of treatment

VERY IMPORTANT TO DETERMINE RISK BY:

• further assessing past aggressive ideation & bx
• establishing the patient’s diagnosis
• establishing a therapeutic alliance
• agree on therapy goals

Question 63

A junior in college reports that he wonders if he uses marijuana too much and he is very anxious because his grades have been slipping. Further assessment indicates that nine months ago he quit for 4 months, but he now smokes almost daily. On days he doesn’t smoke he notes difficulty sleeping, decreased appetite, restlessness, and depressed mood. At times, he has difficulty completing his assignments and getting to class on time. Based on thisinformation, his most likely diagnosis would be:

A. cannabis use disorder
B. cannabis use disorder, in early remission
C. cannabis withdrawal
D. cannabis-induced anxiety disorder

Answer 63

Cannabis use disorder

CANNABIS USE DISORDER:

• problematic pattern of use leading to significant impairment or distress with at least two additional criteria met
  
  • Pt fails to meet major role obligations:
    
    • attend classes, complete his assignments, unsuccessful attempt to quit
• He demonstrates characteristic sx’s of Cannabis withdrawal on days he does not smoke marijuana
• He is currently using and not in remission
• There are insufficient anxiety sx’s to indicate cannabis-induced anxiety disorder

Question 64

A 23-year-old man, Bob comes to see you. He is a veteran who has not been able to work for the past few years. He reports hypervigilance, guilt, numbing, and flashbacks ever sincehe got back from Afghanistan. Additionally, he drinks a six-pack or two of beer daily to get rid of the flashbacks. He is concerned that the relatives he is staying with may kick him out because he is spooking them with his problem. What suggests that Bob may be in crisis?

A. He is an Afghanistan war veteran with sx’s of PTSD
B. He has sx’s of PTSD, is unemployed, and may lose his living arrangements
C. He has sx’s of PTSD and Alcohol use disorder
D. He is bothered by flashbacks, and his relatives finds his behavior spooky

Answer 64

He has sx’s of PTSD, is unemployed, and may lose his living arrangements

NOTE:
The question specifically asks what suggests that Bob may be in crisis at the moment

SX’S SUGGESTIVE OF CRISIS:

• Bob’s PTSD sx’s
• lack of employment
• inability to work for the past few years
• possibility that he may lose his housing consitutes a crisis

NOT SUGGESTIVE OF A CRISIS: (necessarily)
Being a war veteran, having an Alcohol use disorder, and the fact that Bob’s relatives find him spooky does not in of itself suggest a crisis

Question 65

You are treating a 36-year old man who is diagnosed with adjustment disorder with depressed mood. As you further explore his childhood, you learn that he was sexually and physically abused by his father over a period of many years. When he visits his father (a few times a year), he feels depressed and “drinks too much.” Given this new information, what would your diagnosis of the patient be?

A. Major Depressive disorder
B. Adjustment disorder and alcohol use disorder
C. PTSD
D. No changes would be indicated at this time

Answer 65

No changes would be indicated at this time

NOTE:

• The questions asks about diagnoss based on new information regarding pt’s past hx as well as his experience when he visits his father
  
  • He notes that he feels depressed and “drinks too much” whenever he visits his father which would not qualify him for a diagnosis of MDD or an additional diagnosis of Alcohol use disorder
  • While PTSD may be a possible diagnosis given his hx of abuse, you would need more information about his sx’s to make this diagnosis

Question 66

Karen K., age 28, comes to therapy two weeks after witnessing a robbery at a convenience store in which the store owner was shot. Karen tells you that, since the incident, she’s had trouble sleeping, feels as though she is in a daze, cannot concentrate, and has been unable to return to work. Karen also says that she deliberately stays away from the convenience store where the incident occurred but feels like she’s “living the event all over again” every time she walks or drives past any other convenience store. Karen’s reaction to the incident could be interpreted as either a nonpathological reaction to an extreme stressor or as acute stress disorder. Which of the following indicates that her reaction warrants a diagnosis of acute stress disorder?

A. Karen’s inability to return to work since the incident.
B. Karen’s sleep problems and lack of concentration
C. Karen’s feeling like she is in a daze
D. Karen’s feeling that she’s “living the event all over again” whenever she passes a convenience store.

Answer 66

Karen’s inability to return to work since the incident.

NOTE:

• According to the DSM-V, consider acute stress disorder following exposure to an extreme stressor: if the symptoms last at least 3 days and up to a month and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning or impair the individual’s ability to pursue some necessary task
• Although the symptoms listed in answers “2,” “3,” and “4” are diagnostic criteria for acute stress disorder, they are also characteristic of a “normal” reaction to a severe stressor

Question 67

When a psychologist’s license has been revoked by the Board of Psychology, the psychologist must wait for at least _____ years before petitioning for reinstatement.

A. two
B. three
C. five
D. seven

Answer 67

3 years

NOTE:

Those whose l_icenses are revoked_ must wait three years before petitioning the BOP for reinstatement of licensure

Question 68

Pam, age 39, is recently divorced after 15 years of marriage and has sole legal custody of her children, ages 8 and 13. During her initial interview with you she is clearly distressed. Pam says she is “heartbroken” over the break-up with her boyfriend one month ago and sometimes feels as though she “just can’t go on.” She says she hopes her boyfriend comes back and that he might do so if he finds out how distraught she is. Pam tells you that she never worked steadily while she was married because her husband supported the family and that she is currently unemployed. She states that she manages to “get by” on the money her ex-husband sends her. Although his payments are not regular, they allow her to “survive.” Pam says she has been drinking wine every night so that she can fall asleep. She also says her appetite has decreased since the break-up but that the wine helps her eat a little bit more.

What are the most important initial assessment issues in the case presented in this exhibit?

A.

• Pam’s medical status
• Pam’s potential danger to herself
• The potential for child maltreatment
• The ability of Pam to maintain adequate housing, nutrition, and medical care for herself and her children

B.

• Pam’s medical status
• Pam’s potential danger to herself
• Pam’s motivation for seeking therapy
• Pam’s ability to participate in a meaningful way in therapy

C.

• Pam’s potential danger to herself
• The potential for child maltreatment
• Pam’s motivation for seeking therapy
• Pam’s willingness to cease all alcohol use

D.

• Pam’s potential danger to herself
• The potential for child maltreatment
• The ability of Pam to maintain adequate housing, nutrition, and medical care for herself and her children
• Pam’s willingness to cease all alcohol use

Answer 68

Pam’s medical status
Pam’s potential danger to herself
The potential for child maltreatment
The ability of Pam to maintain adequate housing, nutrition, and medical care for herself and her children

NOTE:

• Checking on Pam’s motivation for seeking therapy is important, however this is lessof a priority than the other issue’s in this case
• Her behavior during the interview sounds like she is capable of interacting and communicating with you, it does not seem that Pam’s ability to participate in therapy will not likely intefere to the extent the other factors above will
• Given Pam’s distressed condition and nightly use of alcohol, you should determine whether Pam is adequately caring for her children at this time
• The only information you have so far is that Pam drinks at night to help her sleep. This suggests the possibility of an alcohol use disorder but it does not allow you to conclude that she needs or would be unwilling to cease all alcohol use

Question 69

Maria is a 53-year-old woman who was referred by her physician. Maria recently spent time in the hospital after complaining of shortness of breath and painful swelling in her legs. The doctors diagnosed early stage heart failure, prescribed medication, and recommended lifestyle changes, including weight loss and reduced stress. Maria’s husband is angry at her for letting herself gain weight and get sick. He is upset that she can’t work now because he already works hard to support them. At night, Maria wakes up feeling as though she can’t breathe and then can’t fall back asleep because her worries and sense of guilt keep her awake. She blames herself for her illness and wonders whether she should bother following her doctor’s advice. Maria is weepy. She asks whether you believe what her doctors have said about her having a “bad heart.” When you ask her what she believes, she begins crying uncontrollably.

What collateral information is needed to develop a clinical assessment based on the case presented in the exhibit?

A.

• Medical records regarding Maria’s medical condition and its treatment and prognosis
• Maria’s employment history
• Husband’s employment history, if signed permission is given
• Interview Maria’s husband regarding his perceptions of Maria’s medical condition

B.

• Medical records regarding Maria’s medical condition and its treatment and prognosis
• Husband’s employment history, if signed permission is given
• Interview Maria’s husband regarding her health history and lifestyle
• Consult with the physician regarding his referral

C.

• Medical records regarding Maria’s medical condition and its treatment and prognosis
• Medical records pertaining to Maria’s health history
• Interview Maria’s husband regarding his perceptions of Maria’s medical condition
• Consult with the physician regarding his referral

D.

• Medical records pertaining to Maria’s health history
• Consult with the physician regarding the medication Maria is taking
• Interview Maria’s husband regarding her health history and lifestyle
• Interview Maria’s husband regarding his perceptions of Maria’s medical condition

Answer 69

• Medical records regarding Maria’s medical condition and its treatment and prognosis
• Medical records pertaining to Maria’s health history
• Interview Maria’s husband regarding his perceptions of Maria’s medical condition
• Consult with the physician regarding his referral

NOTE:

1. Maria’s employment history
   * This is not relevant. The case indicates that Maria cannot workat this time.
2. Husband’s employment history, if signed permission is given

• His employment history is not needed
• The more relevant issue is how he has responded to this crisis event and how his response is affecting Maria’s ability to cope with her illness.

2. Interview Maria’s husband regarding his perceptions of Maria’s medical condition

• A person’s ability to cope with a stressful event is usually affected by his/her family’s response to and interpretation of the event; these factors often play a role in activating or prolonging a crisis state
• This interview can help you to better understand the source of the crisis for Maria and enable you to determine what alternatives she has that would resolve the crisis and restore her to a precrisis state of mobility.

3. Consult with the physician regarding his referral
   * You should consult with the referral source to clarify the purpose of the referral and his/her impressions of the client’s difficulties.
4. Consult with the physician regarding the medication Maria is taking

• Seeking this information is appropriate, in part, because some of Maria’s symptoms could be side effects of the medication she is taking BUT IT IS NOT THE BEST ANSWER
• Reviewing medical records regarding Maria’s medical condition, its treatment and prognosis and consulting with her physician is a BETTER answer because it would also get the information as to what medication she is taking

Question 70

You are conducting a neuropsychological evaluation of a patient who suffered a moderate head injury. After the evaluation is complete the patient states he wants to know his IQ score. You should:

A. discuss why this is important to the patient, explain the results further, and if the patient insists, give him his IQ score.
B. discuss why this is important to the patinet, explain the results further, and if the patient insists, give him his IQ range only.
C. tell him that you cannot give him his exact IQ score (due to measurement error) and explain the results further.
D. give the patient his IQ score.

Answer 70

Dscuss why this is important to the patient, explain the results further, and if the patient insists, give him his IQ score.

NOTE:

• The Ethics Code stipulates that test data (including raw test data) should be released when requested.
  
  • Patients are entitled to their test data unless releasing the data would cause “substantial harm, or the misuse or misinterpretation of test data”
• In this situation, the FIRST STEP would be to _discuss why it is important t_o the patient that he learns his exact IQ score
• THEN, the psychologist should clarify with him the meaning and implications of his results.
• If the patient STILL WANTS his exact IQ score, he is entitled to it
• NEVERTHELESS, the psychologist should also discuss with the patient the measurement error and the concept of confidence intervals (range of IQ scores)

Question 71

You are conducting an intake on a 30-year old woman, Yvette, referred to treatment for an alcohol use disorder. She notes that her heavy drinking began while she was in the military, when she was 21 years old, after an incident in which she was raped by one of her superiors. At the time she experienced hallucinations for about 3 weeks, but they went away and have not returned since. In addition to alcohol use disorder, you would diagnose Yvette with:

A. acute stress disorder
B. posttraumatic stress disorder
C. brief psychotic disorder
D. unspecified schizophrenia spectrum and other psychotic disorder

Answer 71

Brief psychotic disorder

NOTE:

BRIEF PSYCHOTIC DISORDER:

• requires 1 day - 1 month duration of sx’s
• requires ONLY ONE (or more) of the following sx’s:
  
  • delusions
  • hallucinations
  • disorganized speech
  • catatonic behavior or grossly disorganized behavior
• WITH EVENTUAL RETURN TO PREMORBID LEVELS OF FUNCTIONING
• While Yvette certainly experienced a significant trauma, she did not at the time, nor is she at present reporting symptoms consistent with a diagnosis of Acute stress disorder or PTSD

SCHIZOPHRENIA:

• greater than 6 months of sx’s
• 2 OR MORE present for at least 1 MONTH
• at least ONE of the sx’s MUST BE:
  
  • delusions
  • hallucinations
  • disorganized speech

Question 72

A patient witnessed a shooting in her neighborhood four months ago. She immediately began exhibiting severe anxiey, fear, including the inability to stop think about and visualizing the shooting, being keyed up, and refusing to drive or walk by the street where the shooting occurred. Additionally, she experiences panic attacks whenever she hears or sees any mention of violence (e.g., on the news). Her symptoms have become so severe over the past week that you arrange hospitalizatio for her. You have most likely diagnosed her as having:

A. adjustment disorder with anxiety
B. both acute stress disorderand panic disorder
C. post PTSD and panic disorder
D. PTSD

Answer 72

PTSD

NOTE:

• DSM-5 generally allows for the diagnosis of 2 or more mental disorders when both exist
  
  • Anxiety disorders are frequently comorbid
• The patient meets criteria for PTSD since the event happened because:
  
  • exposed to a traumatic event
  • describes the intrusive sx’s
  • avoidance of stimuli associated with the trauma
  • negative alterations in cognition and mood
  • increased arousal
  • When she sees or hears about violence, she develops panic attacks.

She DOES NOT HOWEVER, MEET CRITERIA FOR PANIC DISORDER

PANIC DISORDER:

• characterized by recurrent UNEXPECTED panic attacks
  
  • her panic attacks are not unexpected, but have a specific cue or trigger related to her trauma
    
    • Thus, the SPECIFIER “WITH PANIC ATTACKS” should be included with her PTSD dx

ACUTE STRESS DISORDER:

• 3 days - 1 month

PTSD:

• greater than 1 month

ADJUSTMENT DISORDER:

• D/O develops within 3 MONTHS of the stressor
• remits within 6 MONTHS of the stressor’s termination
• presence of emotional or behavioral sx’s in response to an identifiable psychosocial stressor
  
  • HOWEVER, adjustment disorder is ONLY ded if the stress-related disturbance does NOT qualify for another mental disorder

Question 73

You are conducting an intake with Maria. Through your interview, you determine that she constantly experiences reoccuring thoughts about being a goodmother, such as “you can’t fail your children,” “you should have never had them, “ and “you will probably screw them up for life.” She tries to supress the thoughts, but can’t seem todo it, even though she knows the thoughts are ridiculous and that in fact, she is a good mother. She doesn’t, however, perform any tasks or rituals to try to lessen the thoughts. Which diagnosis is most likely to be appropriate for Maria?

A. GAD
B. OCD
C. specific phobia
D. delusional disorder

Answer 73

OCD

NOTE:

• Maria is presenting with obsessive thoughts and worries that she knows are unrealistic
• The fact that her worries center around ONE ISSUE (being a good mother) as well as the lack of physiological symptoms (e.g., restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance) rule out GAD
• Her reoccuring thoughts d_o not suggest a specific phobia._ which is characterized by persistent fear cued by an object or situation that provokes an immediate anxiety response
• Maria presents with OBSESSIONS BUT NO COMPULSIONS and therefore, MEETS CRITERIA FOR OCD

OCD:

• both obsessions and compulsions MAY BOTH be present
• BUT BOTH OBSESSIONS & COMPULSIONS ARE NOT REQUIRED FOR OCD DX

Even if her obsessive thoughts were of delusional proportion, the DSM-5 diagnosis for Maria would still be OCD, absent insight/delusional beliefs, ruling out Delusional disorder

Question 74

An Asian woman, Yuka, presents for treatment with her seven-year-old daughter, Kumiko and her primary complaint is that lately Kumiko has not wanted to go to school. Yuka feels that Kumiko’s problems might be related to recent changes in her husband’s Shinobu’s behavior. She states that she doesn’t know what has come over him lately, as he has become unpredictable and is not acting rationally at all. During your initial session, you notice that Kumiko is generally anxious, withdrawn, and extremely quiet. When you attempt to speak with her, she hides behind her mother and looks very apprehensive, almost on the brink of tears. DSM-5 diagnostic considerations for Kumiko might include all of the following EXCEPT:

A. persistent depressive disorder
B. separation anxiety disorder
C. child physical abuse
D. adjustment disorder

Answer 74

Persistent depressive disorder

NOTE:

• this question is asking which dx would NOT be a diagnostic possibility

PERSISTENT DEPRESSIVE DISORDER:

• 1 year in children
• 2 years in adults
• chronically depressed mood that occurs for most of the day, more days than not
  
  • Kumiko’s problems have only begun lately, therefore doesn’t meet diagnostic criteria for PDD
• Kumiko MAY be exeriencing a separation anxiety disorder as she does not want to go to school and appears to have excessive anxiety about being away from her mother
  
  • Sx’s would have to be **present for at least 4 weeks ** for Separation anxiety D/O dx
• She may be a victim of physical abuse at the hands of her recently irrational and unpredictable father
• Finally, Kumiko’s sx’s could also be the result of an adjustment disorder in that she may be experiencing a reaction to the psychosocial stressor of the dramatic change in her father’s behavior

Question 75

You are a member of a referral service for clinical psychologists in private praactice (1-800-THERAPY). Bruce, a forty-year-old married White male, receives your name and number fromthe service and makes an appointmentwith you. In the first session, he tells you that he is worried that a female co-worker might “get me in trouble,” When you ask him what he means by this, he abruptly tells you, “Let me finish.” he then explains in an irritated fashion that they had sex last week after a few drinks and he tinks htat she might “exaggerate and say i was too ‘assertive or something.” He goes on to say that he doesn’t want to lose his present job since he has had to change jobs several times in the past few years due to conflicts with his superiors. Your diagnostic considerations for Bruce might include:

A. bipolar disorder, narcissistic personality disorder, and adjustment disorder with disturbance of conduct
B. narcisstic personality disorder, relationship distress with partner, a paraphilic disorder.
C. bipolar disorder, a substance use disorder, and antisocial personality disorder
D. substance use disorder, antisocial personality disorder, and a paraphilic disorder

Answer 75

a substance use disorder, bipolar disorder, and antisocial personality disorder

NOTE:

• Bruce’s difficulties may be accounted for by a personality disorder
  
  • either Narcissistic or Antisocial PD
• A SUD may also be contributing to his mood presentation
• there is also the possibility of a Bipolar DIsorder (e.g., irritability, grandiosity, sexual indiscretions)
• The man does not meet criteria for a Paraphilic disorder, which spoils some of the answer choices where Narcissistic PD was included
• Although Bruce may have raped his co-worker, rape is NOT considered a paraphilic disorder

PARAPHILIC DISORDER:

• recurrent, intense, sexual urges, fantasies or behaviors that involve nonhuman, suffering or humiliation
• OR children OR non-consenting persons
• involves a paraphilia that causes distress or impairment to the individual or whose satisfaction involves a paraphilia that causes distress or impairment to the individual
• OR whose satisfaction involves harm to self or another
  
  • pedophilic disorder
  • exhibitionistic disorder
  • fetishistic disorder)

Bruce’s presentation also does not fit the clinical picture for adjustment disorder

AJDUSTMENT DISORDER:

• emotional or behavioral symptoms in response to an identifiable psychosocial stressor occurring with 3 MONTHS of the onset of the stressor
  
  • There isn’t any indication that Bruce has experienced such a stressor; in fact his problems appear to be relatively longstanding

Question 76

You are a psychologist in private practice. A 27-year-old Latino police officer, Jose, comes to see you because he is worried that he might lose his job. Jose states that while he loves his job, he finds it very stressful. Not only does he get tense when he is in the line of duty, but he finds office politics and personalities very difficult to deal with. He feels he is singled out at times, and wonders if others suspect he might be gay. Jose admits that he is struggling with whether or not he might be gay. Additionally, Jose reports problems with sleep, muscle tension, gastrointestinal distress, weight loss, and headaches, and consequently he does not get to work on some days. DSM-5 diagnostic considerations in this case might include all of the following EXCEPT:

A. gender dysphoria
B. adjustment disorder
C. a substance use disorder
D. generalized anxiety disorder

Answer 76

Gender dysphoria

NOTE:

• the question is asking which would NOT be a DSM-5 diagnostic consideration
• The fact that Jose is questioning his sexual orientation does NOT suggest a gender dysphoria

GENDER DYSPHORIA:

• marked incongruence between one’s experienced/expressed gender and assigned gender as defined by:
• a strong desire to be OR the insistence that one that one is the other gender
• Jose MAY be suffering from GAD in that he:
• expresses anxiety and worry, accompanied by a number of physiological symptoms (e.g., muscle tension, sleep disturbance, etc).
• Jose COULD ALSO be suffering from an adjustment disorder:
• ongoing stress at work may be triggering his sx’s
• Adjustment D/O is TIME-LIMITED, but only in the sense that the sx’s persist for 6 MONTHS AFTER THE TERMINATION OF THE STRESSOR(S)
  
  • In Jose’s situation, it appears that his stressors are ongoing.
• Jose’s symptoms and difficulty functioning & not getting to work on some days might also be accounted for by an SUD

Question 77

You are seeing a couple for an intake evaluation. The husband, who is 32 years old old notes hisi 29-year old wife, Esther, has deteriorated over the past three months since being fired from her job as a paralegal. She was recently thrown out of the local grocery store for bothering customers - she was incoherently preaching the gospel using a megaphone. Esther reports that things are “fine.” Based on this information, her most likely diagnosis is:

A. major depressive disorder with psychotic features
B. schizophrenia
C. schizophreniform
D. adjustment disorder

Answer 77

Schizophreniform

NOTE:

• Although the wife’s deterioration appears linked to the psychosocial stressor of being fired from her job, her presenting sx’s are too severe to warrant a diagnosis of adjustment disorder
• There is NO mention of depressive sx’s despite being fired from her job 3 months ago
  • the patient reports being “fine” so major depressive disorder w/ psychotic features can be ruled out as with that disorder, depressive sx’s are predominate AND there are also delusions and/or hallucinations present
    
    • Incoherently preaching the gospel using a megaphone in a grocery store is highly suggestive of a psychotic process

SCHIZOPHRENIFORM:

• 1 day - 6 months
• She has had her sx’s for 3 months and her sx’s are consistent with this dx

SCHIZOPHRENIA:

• more than 6 months
• 2 sx’s, with at least 1 of the sx’s being either:
  
  • delusions
  • hallucinations
  • disorganized speech