Final Review

Question 1

1. In the treatment of depressive episodes, ongoing assessment of suicide risk is essential. Which of the following are associated with an increased risk of completed suicide?

Answer 1

A. Male sex, being single, living alone
B. Female sex, being single, living alone
C. Male sex, being single, living with family members
D. Male sex, being married, living alone

A

Question 2

Skipping from one topic to another in fragmented, often rapid fashion; an illogical group of associations

Answer 2

Flight of ideas

Question 3

Train of thought and response that misses the question asked/person never gets to the pint; only initially responding to a question

Answer 3

Tangential speech

Question 4

The emotional state which is sustained throughout the encounter

Answer 4

Affect

Question 5

Providing unnecessary details but eventually answering a question

Answer 5

Circumstantial

Question 6

3. A 33-year-old female presents for an initial evaluation. She reports high anxiety daily, particularly when going to grocery stores, annual meetings at work, and her children’s parent teacher conferences. She reports an incident when she was 17-years-old: she was giving a speech and burped while speaking, making the class laugh. She avoids these situations as much as possible because she fears “doing something stupid again” that will make others ridicule her. Based on this information alone, which of the following is the most likely diagnosis?

Answer 6

Social anxiety disorder

Question 7

4. Which of the following is not a step in the process of DSM-5 differential diagnosis:

Answer 7

A. Differentiate Other Mental Disorders from the Other Specified and Unspecified conditions.
B. Determine the specific primary disorder and subsequent disorders
C. Rule out etiological medical condition
D. Rule out malingering and factitious disorder
E. Rule out a substance etiology, including drugs, alcohol, and medications

A

Question 8

5. A new patient reports sudden and unexpected awakenings from sleep. During this time, he has an intense fear of “I don’t know what.” He experiences shortness of breath, hypohydrosis, and heart palpitations. As a result of these symptoms, he has begun to have anticipatory anxiety associated with going to sleep. His medical history is positive for hypertension, which is well-controlled with hydrochlorothiazide. A recent stress test shows no new cardiac issues. What is the most likely diagnosis?

Answer 8

A. Panic attacks
B. Panic disorder
C. Anxiety disorder due to a medical condition
D. Nightmare disorder

B

Question 9

6. A 24-year-old female presents for initial evaluation. She is a stay-at home mother of 2 daughters, ages 3 years and 8 months. She has “always been happy,” but started experiencing daily sadness, decreased energy, poor concentration, and increased need for sleep 2 months ago. She also reports helplessness and denies history of a current suicidal ideations. These symptoms are affecting her relationship with her husband and abilities to do the housework. Which of the following is the most appropriate diagnosis?

Answer 9

A. Premenstrual dysphoric disorder
B. Major depressive disorder, with seasonal pattern
C. Major depressive disorder, with Peripartum onset
D. Major depressive disorder, single episode, moderate

C.

Question 10

7. At least Of the 9 symptoms of a depressive episode must be present during the same Period in order to diagnose Major Depressive Disorder.

Answer 10

5; 2-week

Question 11

8. Full remission can be indicated once a patient has been without significant signs or symptoms of the disturbance for:

Answer 11

2 months

Question 12

9. In social anxiety disorder, the object of an individual’s fear is the potential for which of the following?

Answer 12

A. Embarrassment
B. Harm to self or others
C. Incapacitating symptoms
D. Social or occupational impairment
E. Separation from objects of attachment

A.

Question 13

A 47-year-old male patient had an acute myocardial infarction 3 weeks ago. He reports “always being a worrier,” but since the incident, “things haven’t been the same. I feel pretty hopeless… like things will never get back to normal.” He reports decreased appetite, hypervigilance, excessive worrying, insomnia, fatigue, poor focus, muscle tension, and loss of interest in cycling and working out. Based on this list of symptoms alone, which of the following diagnoses are included in your differential diagnosis?

Answer 13

A. Generalized anxiety disorder, panic disorder, insomnia
B. Major depressive anxiety, attention-deficit hyperactivity, generalized anxiety disorder
C. MDD, Cyclothymic disorder, panic disorder
D. PTSD, MDD, GAD

D.

Question 14

Which of the following are diagnostic criteria for a specific phobia disorder? (Select all that apply)

Answer 14

a. Marked fear or anxiety about a specific object or situation.
b. The phobic object or situation almost always provokes immediate fear or anxiety.
c. The phobic object or situation is actively avoided or endured with intense fear or anxiety.
d. The fear or anxiety is out of proportion to the actual danger posed by the object or situation.
e. Marked fear or anxiety about a specific object or situation.
f. The phobic object or situation almost always provokes immediate fear or anxiety.
g. The phobic object or situation is actively avoided or endured with intense fear or anxiety.
h. The fear or anxiety is out of proportion to the actual danger posed by the object or situation.
I. The fear, anxiety, or avoidance is persistent, lasting at least three months or more.
J. May include diagnosis such as social phobia an agoraphobia.

A-H are correct

Question 15

12. An 18-year-old sing mother presents to the clinic after 6 weeks of low mood and trouble sleeping. At first, she attributed her poor sleep to getting up every 2 hours to fee her 8-week-old daughter, but more recently her mother has been caring for the baby at night. Despite this, the patient reports continuing poor sleep, with low energy and poor concentration. She is less interested in leaving the house and seeing others and less excited about playing with her daughter. She is not very interested in eating but pushes herself to eat, “because I want to make good milk for the baby.” She denies wanting to harm herself or others and feels that, with her mother’s help, she is able to care for the baby well. What is the likely diagnosis?

Answer 15

A. MDD with peripartum onset
B. MDD, unspecified
C. Adjustment disorder
D. Bipolar I disorder, current episode depressed, with peripartum onset

A.

Question 16

13. The 14-year-old boy describes himself as feeling “down” all of the time for the past year. He remembers feeling better while he was at camp for 4 weeks during the summer; however, the depressed mood returned when he came home. He reports poor concentration, feelings of hopelessness, and low self-esteem but denies suicidal ideation or changes in appetite or sleep. What is the most likely diagnosis?

Answer 16

A. Persistent depressive disorder (dysthymia) with early onset
B. MDD
C. Disruptive mood dysregulation disorder
D. Depressive episodes with short-duration hypomani

A.

Question 17

14. Generalized anxiety disorder includes excessive anxiety and worry occurring more days than not for at least

Answer 17

a. 6 months
b. 4 weeks
c. 3 months
d. 1 year

A

Question 18

15. According to the DSM-5, a major depressive episode consists of either depressed mood or loss of interest and at least four additional criteria. Which is not one of the additional criteria?

Answer 18

a. Decreased need for sleep
b. Appetite/weight changes
c. Guilt or worthlessness
d. Suicidal ideation

A

Question 19

16. In the mental status exam, tangential, circumstantial, linear are all examples of

Answer 19

a. Thought process
b. Thought content
c. Speech
d. Language

A

Question 20

17. Which of the following symptoms must be present for a woman to meet criteria for premenstrual dysphoric disorder?

Answer 20

a. Marked affective lability
b. Decreased interest in usual activities
c. Physical symptoms such as breast tenderness
d. Marked change in appetite
e. A sense of feeling overwhelmed or out of control

A

Question 21

18. A patient diagnosed with MDD and currently prescribed fluoxetine 40 mg daily. To effectively monitor medication effects, which of the following should be included in follow-up assessments?

Answer 21

a. Patient health questionnaire to continue screening of depressive symptoms
b. Laboratory tests of renal function
c. EKG to monitor for cardiac side effects
d. Monitoring for serum serotonin levels to assess therapeutic level

A

Question 22

19. Differential diagnosis for factitious disorder include all of the following except:

Answer 22

a. Borderline personality disorder
b. Conversion disorder
c. Depressive disorder
d. Malingering
e. Somatic symptom disorder

C

Question 23

20. Psychomotor retardation is characterized by all of the following except:

Answer 23

a. Paucity of spontaneous movements
b. Reduced speech amplitude and flow
c. Indecisiveness
d. Poor concentration
e. Restlessness

E

Question 24

21. Agoraphobia includes marked fear or anxiety about two or more of which of the following situations: (Select all that apply)

Answer 24

a. Being in open spaces
b. Standing in line or being in a crowd
c. Being outside of the home alone
d. Using public transportation
e. Being in enclosed spaces

ALL

Question 25

22. A 39-year-old woman reports that she became quite depressed in the winter last year when her company closed for the season, but she felt completely normal in the spring. She recalls experiencing several other episodes of depression over the past 5 years (for which she cannot identify a seasonal pattern) that would have met criteria for MDD. Which of the following correctly summarizes this patient’s eligibility for a diagnosis of “major depressive disorder, with seasonal pattern”

Answer 25

a. She does not qualify for this diagnosis: the patient must have two episodes with a seasonal relationship in the past 2 years and no no seasonal episodes during that period

Question 26

23. A 36-year-old female presents for an initial psychiatric evaluation. She reports depressed mood, insomnia, difficulty concentrating, and decreased interests in things she used to enjoy. Her symptoms began after discovering her husband was having an extramarital affair, approximately 2 months ago. She carries a lot of personal blame, barely eats, and has not returned phone calls of her family and friends. What would be the most appropriate next step in your assessment?

Answer 26

a. Ask to talk to her husband for corroborative information
b. Educate her about the benefits of starting an antidepressant medication
c. Recommend supportive psychotherapy
d. Inquire about history of and current suicidal thoughts

D

Question 27

24. A 65-year-old woman reports being housebound despite feeling physically healthy. Several years ago, she fell while shopping; although she sustained no injuries, the situation was so upsetting that she became extremely nervous when she had to leave her house unaccompanied. Because she has no children and few friends whom she can ask to accompany her, she is very distressed that she has few opportunities to venture outside her home. What is the most likely diagnosis?

Answer 27

a. Specific phobia, situational type
b. Agoraphobia
c. Social anxiety disorder (social phobia)
d. Post traumatic stress disorder

B

Question 28

25. When using the specifier “with mixed features”, how many symptoms of mania/hypomania must be present during the majority of days of the depressive episode?

Answer 28

a. Two
b. Three
c. Four
d. Five

B

Question 29

26. A 37-year-old single mother divorced her husband about 8 months ago and has custody of their to daughters. She went back to work full-time “to make ends meet.” About 2 months ago, while at work, she began to feel extremely anxious. Within a few minutes, she had heart palpitations and difficulty breathing and almost fainted. Her coworkers rushed her to the hospital. A thorough medical work up was performed and no underlying medical cause was identified. Within 1 week, she had another attack at the local grocery store and felt embarrassed because she had to led down on the floor for about 10 minutes while she was surrounded by the store’s concerned customers until she symptoms subsided. She has had two other “freak outs” in different situations. She has constant concern that the problem will “happen again”. She has been skipping meetings at work to avoid embarrassment in front of her coworkers in case she “goes crazy” again. What is the likely diagnosis?

Answer 29

a. Panic disorder
b. Social anxiety disorder (social phobia)
c. Generalized anxiety disorder
d. Adjustment disorder with anxious features

A

Question 30

27. A 40-year-old female presents with active suicidal ideations and a plan to overdose. Her husband locked away all firearms and medications in the house and took off work for 2 weeks to stay home with her. She agreed to start aripiprazole 5 mg daily; she has tolerated the medication well and has been adherent. At the 2-week follow-up, she denies SI and reports improved mood. Which of the following would help confirm that her risk for suicide has significantly decreased?

Answer 30

a. Actively planning her daughter’s wedding this summer
b. Sudden bright mood and increased energy
c. Organizing estate and financial affairs
d. Isolation and irritability

A

Question 31

28. In order to diagnose a panic disorder, recurrent unexpected panic attacks must also be accompanied by one or both of which of the following? (Select all that apply)

Answer 31

a. At least 1 month of persistent concern or worry about additional panic attacks or their consequences
b. A significant maladaptive change in behavior related to the attacks, such as avoidance

Question 32

29. A 40-year-old woman says she is “very anxious about public speaking,” to the point of having episodes that resent panic attacks when she faces speaking before even small groups of familiar coworkers. Her division chief expects that employees will present at conferences before he will promote them. She is not only unable to give presentations to large audiences but also avoids most social events related to her work. She feels as if she is “acting like an idiot” when she is with colleagues, especially work superiors. The anticipation of a meeting with her boss can cause her to worry and lose sleep for days. She does not have anxiety in other contexts. What is the likely diagnosis?

Answer 32

a. Social anxiety disorder
b. Generalized anxiety disorder
c. Major depressive disorder
d. Obsessive-compulsive personality disorder

A

Question 33

30. Medical history includes all except which of the following:

Answer 33

a. A father’s history of major depressive disorder
b. Surgeries and other hospitalizations
c. Past and current medications
d. Meeting developmental milestones
e. Mother’s pregnancy and term of birth

A

Question 34

31. In order to diagnose adults with generalized anxiety disorder, Of the following symptoms must be present, but only Is required in children: restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbance.

Answer 34

a. 3;2
b. 4;3
c. 3;1
d. 4;2

C

Question 35

32. In addition to feeling restless or “keyed up”, individuals with generalized anxiety disorder are most likely to experience which of the following symptoms?

Answer 35

a. Panic attacks
b. Obsessions
c. Social anxiety
d. Muscle tension
e. Multiple somatic complaints

D

Question 36

33. A 35-year-old female presents with frequent worries. Since she was young, she has worked her parents would die in an accident; (they did not). As she got older, worry was exacerbated by fear that she would die without telling her friends and family she loves them. Since having children, she worries for their safety and rarely lets them leave the house without her. She reports frequently feeling “tense, tired, and irritable”, and recently experienced her first panic attack. Her Adverse Childhood Experiences (ACEs) score is 1 and her PHQ-9 score is 6. What is the most likely diagnosis?

Answer 36

a. Agoraphobia
b. Generalized anxiety disorder
c. MDD moderate, with anxious features
d. Panic disorder

B

Question 37

34. Adults with persistent depressive disorder (dysthymia) present with a depressed mood for more days than not for a period of at least?

Answer 37

a. 2 years
b. 5 years
c. 1 year
d. 18 months

A

Question 38

35. Which of the following does not belong in the mental status exam section of your psychiatric evaluation?

Answer 38

a. Substance use
b. Though process
c. Behavior
d. General appearance

A

Question 39

36. According to the SAD PERSONS assessment tool, which of the following is not true regarding increased risk for suicide?

Answer 39

a. Previous attempts
b. Lacking social support, no spouse/partner
c. Sex: females are more likely to complete suicide attempts
d. Age: 15-24 years old or men 75 years and older

C