Developing a Diagnostic Impression Flashcards
When using the DSM-5, level of severity of Intellectual Disability is based on:
Select one:
A.
the individual’s score on a standardized intelligence test.
B.
the individual’s adaptive functioning in conceptual, social, and practical domains.
C.
the degree of discrepancy between the individual’s cognitive and adaptive functioning.
D.
the degree of discrepancy between the individual’s IQ and academic achievement.
B.
the individual’s adaptive functioning in conceptual, social, and practical domains.
The DSM-5 distinguishes between four levels of severity for Intellectual Disability - mild, moderate, severe, and profound - and bases them on level of adaptive functioning in conceptual, social, and practical domains.
Answer A is incorrect: IQ score was the primary determinant of severity for Mental Retardation in DSM-IV-TR. In DSM-5, Mental Retardation has been renamed Intellectual Disability and severity is based on adaptive functioning.
The victim of a train accident tells you during his first session that, since the accident, he feels anxious whenever he even thinks about riding in a train and has difficulty leaving his home because he usually has to take the train to get to places around the city. During the interview, you learn that he’s not having nightmares or otherwise “reliving” the train accident and that his primary symptoms are the anxiety and avoidance he has described. The most likely DSM diagnosis for this man is:
Select one:
A.
Adjustment Disorder
B.
Agoraphobia.
C.
Specific Phobia.
D.
PTSD.
Answer C is correct: Specific Phobia involves marked and persistent fear of a clearly discernible, circumscribed object or situation. The phobic situation is either avoided or endured with intense anxiety or distress. This man’s fear is clearly related to riding in a train.
Answer A is incorrect: Adjustment Disorder is diagnosed when the individual’s symptoms do not meet the criteria for another mental disorder.
Answer B is incorrect: You might have been tempted to choose this as the correct answer since the vignette states the man is having trouble leaving home. Many people with Agoraphobia have difficulty leaving home, especially by themselves. However, they’re afraid to leave home because they’re concerned that escape might not be possible or that help won’t be available if they develop panic-like or embarrassing symptoms, which is not the case in this situation.
Answer D is incorrect: Although the man’s problem was triggered by a train accident, he is not having nightmares or otherwise reliving the event or exhibiting any of the other symptoms that are characteristic of PTSD.
The correct answer is: Specific Phobia.
Your new clients are a young couple and their five-year-old daughter. The parents tell you that the child cries hysterically whenever she is dropped off at school and that this has been taking place for the last month and a half. They also tell you that, lately, the child has been crawling into bed with them at night and insisting that they allow her to sleep with them. They tell you that this behavior has been occurring ever since the girl’s pet cat died after being run over by a car. Your provisional DSM diagnosis for the five-year-old would be?
Select one:
A.
Generalized Anxiety Disorder
B.
Separation Anxiety Disorder
C.
Posttraumatic Stress Disorder
D.
School Anxiety Disorder
B.
Separation Anxiety Disorder
The girl’s symptoms meet the diagnostic criteria for Separation Anxiety Disorder, which is characterized by excessive fear or anxiety related to separation from attachment figures. It may take the form of school refusal and often follows exposure to a life stress such as the death of a family member or pet.
Answer A is incorrect: Although this girl appears to be experiencing anxiety about being separated from her parents, she does not appear to be experiencing fear or anxiety related to other situations or activities, which is required for a diagnosis of Generalized Anxiety Disorder.
Answer C is incorrect: Although the death of the pet cat may have been a traumatic event, the girl is not exhibiting the characteristic symptoms of PTSD.
Answer D is incorrect: School Anxiety Disorder is not a DSM diagnosis. As noted above, school anxiety (also known as school phobia or school refusal) is often associated with Separation Anxiety Disorder.
You frequently work with older adults who are living alone. You always try to do a complete assessment before beginning therapy and making referrals. Which of the following would be LEAST relevant for diagnosing a drinking problem in an older adult?
Select one:
A.
loneliness or depression
B.
social isolation
C.
physical withdrawal symptoms when drinking is stopped
D.
blood alcohol level
D.
blood alcohol level
An older (or any) individual may have a measurable alcohol level in his or her blood after only one drink and this would not necessarily indicate a drinking problem.
Answer A is incorrect: This is a relevant factor. Older individuals who are lonely or depressed are more likely to misuse alcohol than those who have support systems.
Answer B is incorrect: Socially isolated older people are more likely to have problems with alcohol. Notice that you could pretty much eliminate answers A and B without knowing for certain whether they are relevant factors because they say essentially the same thing and you cannot choose both of them.
Answer C is incorrect: Physical withdrawal symptoms when drinking is stopped is a symptom of physical dependence and, thus, would be relevant for diagnosing a drinking problem in any individual, regardless of his or her age.
Clementine, an 18-year-old high school senior, is referred for therapy by her physician. She went to see her doctor due to constipation and menstrual irregularity. Though slightly underweight, Clementine talks excessively about being fat and unattractive. When prompted by the MFT, she admits to thinking that food is a “tyrant” in her life. She also discloses that she sometimes “gorges on food” to a point where she feels sick and throws up, but is quick to add that she does this no more than a couple of times a week. Based on this information, the most likely diagnosis for Clementine is which of the following?
Select one:
A.
Anorexia Nervosa, binge-eating or purging type
B.
Bulimia Nervosa
C.
Major Depressive Disorder with atypical features
D.
Body Dysmorphic Disorder
Answer B is correct: The primary clue indicating that Clementine has Bulimia Nervosa, rather than Anorexia Nervosa, is that she is only somewhat underweight. Other signs of Bulimia Nervosa include her lack of control over eating (“food is a tyrant”); her preoccupation with her body shape and weight; and her gorging on food and vomiting. Finally, menstrual irregularity (and even amenorrhea) occurs in some females with Bulimia Nervosa and constipation can develop in individuals who chronically abuse laxatives.
Answer A is incorrect: Anorexia Nervosa and Bulimia Nervosa share some features (e.g., disturbed body image), but a person with Anorexia Nervosa refuses to maintain weight over a minimal normal level for her height and age.
Answer C is incorrect: Major Depressive Disorder with atypical features often includes overeating, but this client is not exhibiting other symptoms of depression.
Answer D is incorrect: You can rule this out since Clementine clearly seems to have an eating disorder. The essential feature of Body Dysmorphic Disorder is a preoccupation with an imagined or minor physical flaw.
The correct answer is: Bulimia Nervosa
A child has been referred to you by his doctor who suspects that the boy has Oppositional Defiant Disorder and would like you to make a definitive diagnosis. The boy is LEAST likely to exhibit which of the following?
Select one:
A.
frequent arguments and conflicts with his or her parents
B.
frequent physical aggression toward his or her peers
C.
consistently blames others for his or her mistakes
D.
is easily annoyed by others
Answer B is correct: Oppositional Defiant Disorder (ODD) is characterized by a pattern of angry or irritable mood, argumentative or defiant behavior, and vindictiveness. Although children with this disorder may exhibit verbal aggression, physical aggression (especially frequent physical aggression) is not characteristic of ODD.
Answers A, C, & D are incorrect: These behaviors are consistent with ODD.
The correct answer is: frequent physical aggression toward his or her peers
The DSM-5 requires which of the following for a diagnosis of Autism Spectrum Disorder?
Select one:
A.
an onset of symptoms prior to three years of age
B.
an onset of symptoms during the early developmental period
C.
apparent normal development for at least six months followed by a loss of previously acquired skills
D.
apparent normal development for at least two years followed by a loss of previously acquired skills
Answer B is correct: For the diagnosis of Autism Spectrum Disorder, the DSM-5 requires that “symptoms must be present in the early developmental period.”
The correct answer is: an onset of symptoms during the early developmental period
The DSM is useful for all of the following purposes except:
Select one:
A.
helping therapists communicate with each other.
B.
finding ICD codes for medical conditions.
C.
formulating a treatment plan once a diagnosis is made.
D.
facilitating decision making in forensic settings.
Answer C is correct: The DSM provides a means of diagnosing mental disorders but does not include information about treatment planning for these disorders.
Answer A is incorrect: The DSM is useful for this purpose because it provides a “universal language” for communicating about a patient’s mental disorder.
Answer B is incorrect: The DSM includes ICD codes.
Answer D is incorrect: The DSM may be used to facilitate decision making in forensic situations, such as determining competence to stand trial or criminal responsibility, as long as doing so is informed by a full awareness of the limitations described in the manual. For example, the presence of a mental disorder doesn’t automatically suggest that a person is unable to distinguish right from wrong.
The correct answer is: formulating a treatment plan once a diagnosis is made.
Which of the following diagnoses would you be most likely to assign to a client with the following symptoms: intense relationships characterized by over-idealization and then devaluation, a persistent sense of emptiness, unpredictable and intense anger, impulsivity, and recurrent suicidal threats?
Select one:
A.
Histrionic Personality Disorder
B.
Major Depressive Disorder
C.
Borderline Personality Disorder
D.
Antisocial Personality Disorder
Answer C is correct: The essential feature of Borderline Personality Disorder is a pervasive pattern of instability in interpersonal relationships, self-image, and affects and marked impulsivity.
Answer A is incorrect: Histrionic Personality Disorder is characterized by a pervasive pattern of emotionality and attention-seeking.
Answer B is incorrect: While Major Depressive Disorder may involve suicidal ideation or a suicide attempt, it does not include the other symptoms this client has.
Answer D is incorrect: Antisocial Personality Disorder is characterized by a pattern of disregard for and violation of the rights of others since the age of 15.
The correct answer is: Borderline Personality Disorder
Which of the following suggests that a DSM-5 diagnosis of Anorexia Nervosa is more appropriate than a diagnosis of Bulimia Nervosa?
Select one:
A.
the presence of episodes of binge-eating and purging
B.
a disturbance in body image
C.
menstrual irregularities
D.
persistent restriction of energy intake, with a significantly low body weight
Answer D is correct: This question is asking which symptom is characteristic of Anorexia but not Bulimia. One of the DSM-5 diagnostic criteria for Anorexia (but not Bulimia) is a “restriction of energy intake relative to requirements, leading to a significantly low body weight” (p. 338).
Answer A is incorrect: While bingeing and purging are classic signs of Bulimia Nervosa, some individuals with Anorexia engage in binging and purging, and the DSM-5 includes binge-eating or purging type as a specifier for Anorexia.
Answer B is incorrect: Anorexia Nervosa and Bulimia Nervosa both involve a disturbance in the perception of one’s body weight or shape. Answer C: Menstrual irregularity is an associated feature of both disorders. (In the DSM-IV-TR, amenorrhea was a diagnostic criterion for Anorexia Nervosa for females but has been removed as a criterion in the DSM-5).
The correct answer is: persistent restriction of energy intake, with a significantly low body weight
Your new client recently survived a terrible accident in which her motor home spontaneously exploded, destroying her garage and injuring her cat. Your initial diagnosis for this woman was Adjustment Disorder with depressed mood. Which of the following would cause you to change the initial diagnosis to Major Depressive Disorder?
Select one:
A.
The client reports she has experienced psychotic symptoms for at least two weeks.
B.
The client reports significant difficulty eating and sleeping.
C.
The client’s symptoms persist for more than six months and she reports having difficulty concentrating at work.
D.
This is the first time the client has experienced symptoms of depression.
Answer A is correct: The presence of psychotic symptoms would eliminate Adjustment Disorder as a diagnosis. However, psychotic symptoms may accompany Major Depressive Disorder.
Answer B is incorrect: Significant difficulty eating and sleeping would not be sufficient to change the diagnosis.
Answer C is incorrect: Initially, this looks like a good choice: Ordinarily, Adjustment Disorder is diagnosed only when symptoms remit within six months after the stressor or its consequences have ended. However, the diagnosis can also be assigned (or retained) when symptoms persist for longer than six months if the stressor is chronic or has enduring consequences. Also, impaired concentration at work would not necessarily support a change in diagnosis.
Answer D is incorrect: The fact this the woman has not experienced symptoms of depression in the past would not support a change in the initial diagnosis.
The correct answer is: The client reports she has experienced psychotic symptoms for at least two weeks.
The parents of a 15-year-old report that he is extremely disrespectful at home and frequently uses profanity, is easily annoyed and often argumentative, and continually avoids family responsibilities. Although he is occasionally truant from school, he has many friends and his teachers say he is a basically a “good kid.” The MOST likely diagnosis is:
Select one:
A.
Oppositional Defiant Disorder.
B.
Conduct Disorder.
C.
Parent-Child Relational Problem.
D.
Adjustment Disorder.
Answer A is correct: The boy’s symptoms (negativity and argumentativeness) are most consistent with a diagnosis of Oppositional Defiant Disorder. Note that symptoms of this disorder often emerge at home initially but, over time, may appear in other settings as well.
Answer B is incorrect: Conduct Disorder is characterized by violation of the basic rights of others and major age-appropriate societal norms or rules. This boy’s symptoms are not sufficiently severe to warrant a diagnosis of Conduct Disorder.
Answer C is incorrect: The problematic behaviors associated with parent-child relational problems are not usually described in such negative terms as those used in this question. Also, no information is provided about how the parents interact with their son.
Answer D is incorrect: There is no mention of a psychosocial or environmental stressor that triggered the boy’s behavior, so Adjustment Disorder is not the most likely diagnosis.
The correct answer is: Oppositional Defiant Disorder.
Your new client, Joseph, complains of problems at work. He says he’s afraid to go to staff meetings due to a fear of being criticized and he hates giving presentations because he’s afraid his co-workers will think he’s stupid. Joseph also says that he doesn’t like socializing with his co-workers and hasn’t contacted any of his friends lately. The most likely DSM-5 diagnosis for Joseph is which of the following?
Select one:
A.
Panic Disorder
B.
Social Anxiety Disorder
C.
Agoraphobia
D.
Generalized Anxiety Disorder
Answer B is correct: This case includes some symptoms that are not characteristic of any of the disorders listed in the answers (e.g., the client hasn’t contacted any of his friends lately) However, Joseph’s fear and anxiety are related to specific social situations and are due to concerns about being evaluated by others, which is consistent with a diagnosis of Social Anxiety Disorder.
Answer A is incorrect: No information is provided in the question indicating that Joseph is experiencing unexpected panic attacks, which is a requirement for the diagnosis of Panic Disorder.
Answer C is incorrect: The diagnosis of Agoraphobia requires the presence of marked fear or anxiety about at least two of five designated situations (e.g., using public transportation, being in enclosed spaces). 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 symptoms.
Answer D is incorrect: Generalized Anxiety Disorder involves excessive anxiety and worry about multiple events or activities. In contrast to Social Anxiety Disorder, anxiety associated with Generalized Anxiety Disorder is not related to a fear of being evaluated.
The correct answer is: Social Anxiety Disorder
Your client is a 45-year-old woman who says she has not been feeling like her “usual self” lately. She was recently divorced and has gone back to school to get a Master’s degree in marriage and family counseling. Which of the following symptoms would MOST clearly indicate a diagnosis of Major Depressive Disorder for this woman?
Select one:
A.
sleeplessness, difficulty concentrating, loss of appetite
B.
loss of interest in normal activities, agitation, feelings of worthlessness
C.
loss of appetite, agitation, feelings of worthlessness
D.
weight loss, difficulty concentrating, hypersomnia
Your client is a 45-year-old woman who says she has not been feeling like her “usual self” lately. She was recently divorced and has gone back to school to get a Master’s degree in marriage and family counseling. Which of the following symptoms would MOST clearly indicate a diagnosis of Major Depressive Disorder for this woman?
Select one:
A.
sleeplessness, difficulty concentrating, loss of appetite
B.
loss of interest in normal activities, agitation, feelings of worthlessness
Correct
C.
loss of appetite, agitation, feelings of worthlessness
D.
weight loss, difficulty concentrating, hypersomnia
Joe came to therapy for help getting “off the bottle.” He attends Alcoholics Anonymous several times a week but rarely stays sober for more than a few days. You would be concerned that he is going through alcohol withdrawal and may require medically supervised detoxification if he has experienced which of the following?
Select one:
A.
dysphoric mood, vivid dreams, insomnia, and increased appetite
B.
hand tremor, insomnia, hallucinations, and seizures
C.
poor coordination, nystagmus, impaired memory, and mood lability
D.
dysphoric mood, restlessness, insomnia, and fever
Answer B is correct: A diagnosis of alcohol withdrawal is made when cessation of or reduction in heavy, prolonged alcohol use results in at least two characteristic symptoms. The symptoms listed in this answer are characteristics of alcohol withdrawal.
Answer A is incorrect: These are symptoms of stimulant withdrawal.
Answer C is incorrect: These are symptoms of alcohol intoxication.
Answer D is incorrect: These symptoms are associated with opioid withdrawal.
The correct answer is: hand tremor, insomnia, hallucinations, and seizures
