Psychopathology

Question 1

Research evaluating guided internet-delivered cognitive behavior therapy (iCBT) as a treatment for social anxiety disorder has found that iCBT is:

A) significantly less effective than in-person CBT for reducing symptoms.
B) equivalent to in-person CBT for reducing symptoms.
C) equivalent to in-person CBT for reducing symptoms but only for individuals with mild symptoms.
D) equivalent to in-person CBT in terms of short-term (but not long-term) effects on symptoms.

Answer 1

B) equivalent to in-person CBT for reducing symptoms.

Research has consistently found iCBT to be equivalent to in-person CBT for reducing the symptoms of social anxiety disorder, with studies also confirming that the beneficial effects of iCBT are short- and long-term (e.g., S. El Alaoui, E. Hedman, B. Ljotsson, & N. Lindefors, Long-term effectiveness and outcome predictors of therapist-guided internet-based cognitive-behavioural therapy for social anxiety disorder in routine psychiatric care

Question 2

Which of the following is not included in the DSM-5 as a symptom of a panic attack?

A) a sense of that one’s feelings and thoughts do not belong to oneself
B) increased sensitivity to environmental stimuli
C) concern about losing control of one’s mental functions
D) tingling or other abnormal dermal sensation

Answer 2

B) increased sensitivity to environmental stimuli

To identify the correct answer to this question, you need to notice that it’s asking which symptom is not included in the DSM-5 as a symptom of a panic attack. The symptoms listed in answers A, C, and D are all included in DSM-5, albeit with slightly different language – i.e., the symptoms listed in DSM-5 include depersonalization (being detached from oneself), fear of losing control or “going crazy,” and paresthesias (numbness or tingling sensations). Increased sensitivity to environmental stimuli is not listed as a characteristic symptom of a panic attack.

Question 3

Lewinsohn’s (1974) model of depression attributes it to:

A) a chronic boundary disturbance.
B) “depressogenic” cognitions.
C) a low rate of response-contingent reinforcement.
D) inadequate stimulus discrimination.

Answer 3

C) a low rate of response-contingent reinforcement.

Knowing that Lewinsohn’s model of depression is known as social reinforcement theory would have helped you identify the correct answer to this question. The model is based on the principles of operant conditioning and attributes depression to low rates of response-contingent reinforcement for social behaviors due to a lack of reinforcement in the environment and/or poor social skills.

Question 4

Which of the following is true about the rates of major depressive disorder among individuals from various age groups?

A) Among children, the rates are about the same for males and females but, by late-adolescence, the rate for females is about twice the rate for males.
B) Among children, the rates are about the same for males and females but, beginning in the mid- to late-20s, the rate for females is about twice the rate for males.
C) Among children, the rate for females is about twice the rate for males but, by late adolescence, the rate for females is about three to four times the rate for males.
D) Among children, the rate for males is about twice the rate for females but, beginning in the early 20s, this reverses and the rate for females becomes about twice the rate for males.

Answer 4

A) Among children, the rates are about the same for males and females but, by late-adolescence, the rate for females is about twice the rate for males.

The prevalence rates of major depressive disorder are about the same for boys and girls until puberty when there’s a substantial increase in the rates for girls and the difference begins to approach the 2:1 female-to-male ratio that is found among adults.

Question 5

Ryder and his colleagues (2008) compared the symptoms of depression of Chinese outpatients residing in China and Euro-Canadian outpatients and found that:

A) Chinese patients were more likely than Euro-Canadian patients to express somatic symptoms and less likely to express psychological symptoms.
B) Chinese patients were more likely than Euro-Canadian patients to express psychological symptoms and less likely to express somatic symptoms.
C) Chinese patients and Euro-Canadian patients expressed a similar proportion of somatic and psychological symptoms.
D) Chinese outpatients expressed both somatic and psychological symptoms while Euro-Canadian patients expressed psychological symptoms only.

Answer 5

A) Chinese patients were more likely than Euro-Canadian patients to express somatic symptoms and less likely to express psychological symptoms.

If you’re not familiar with the Ryder et al. (2008) study, knowing that patients belonging to certain ethnic and cultural groups (including Chinese patients) are more likely to express depression as somatic complaints would have helped you identify the correct answer to this question.
These investigators found that Euro-Canadian and Chinese outpatients both expressed a mixture of somatic and psychological symptoms but that Euro-Canadian patients expressed a greater proportion of psychological symptoms while Chinese patients expressed a greater proportion of somatic symptoms.
Ryder et al. attribute the propensity of Chinese patients to somaticize depression to “externally oriented thinking,” which occurs because their culture tends to discourage focusing on internal emotional states and, as a result, they’re more likely to notice somatic symptoms.

Question 6

Family-based treatment for bulimia (FB-BN) and anorexia (FB-AN) are similar, but one important difference is that FB-BN:

A) focuses less on the affected adolescent’s psychiatric comorbidity.
B) involves greater collaboration between parents and the affected adolescent.
C) focuses more on challenging the cognitive distortions that are contributing to the affected adolescent’s symptoms.
D) involves greater emphasis on the acquisition of radical acceptance and other distress tolerance skills by the affected adolescent.

Answer 6

B) involves greater collaboration between parents and the affected adolescent.

FB-BN and FB-AN differ somewhat in terms of procedures. For example, FB-BN involves greater collaboration between parents and the affected adolescent in the initial stages of therapy because, in contrast to adolescents with anorexia, those with bulimia often experience their symptoms as distressing and ego-dystonic and, as a result, are more motivated to change.
Answer A is incorrect because psychiatric comorbidity rates are higher for bulimia than anorexia and must be addressed to ensure that comorbid symptoms do not interfere with the treatment of bulimia.
Answer C is incorrect because challenging cognitive distortions is not a focus of either FB-BN or FB-AN.
Answer D is incorrect because skills are addressed in FB-BN and FB-AN, but the focus is on communication, problem-solving, and relapse prevention skills. Although tolerating distress may be addressed, it is not emphasized more in FB-BN than in FB-AN. In addition, helping clients acquire radical acceptance and other distress tolerance skills is a primary focus of dialectical behavior therapy.

Question 8

Behavioral treatments for narcolepsy are often not adequate and, consequently, are usually combined with medications. Which of the following medications is most useful for reducing daytime sleepiness, improving nighttime sleep, and reducing cataplexy?

A) modafinil
B) sodium oxybate
C) fluoxetine
D) methylphenidate

Answer 8

B) sodium oxybate

This is a difficult question because all of the drugs listed in the answers are used to treat narcolepsy. However, only sodium oxybate has been found to be effective for reducing daytime sleepiness, improving nighttime sleep, and reducing cataplexy.
Modafinal, methylphenidate, and other stimulant drugs are useful for reducing daytime sleepiness, while antidepressants (e.g., fluoxetine) are useful for reducing cataplexy.

Question 10

Your new client’s primary symptoms are aggressive outbursts that have been recurrent and impulsive but have not caused damage or destruction of property or physical injury to other people or animals. To meet the diagnostic criteria for a DSM-5 diagnosis of intermittent explosive disorder, the client’s aggressive outbursts must have occurred, on average, at least _____ weekly for at least _____ months.

A) twice; four
B) once; six
C) twice; three
D0 once; four

Answer 10

C) twice; three

The DSM-5 diagnosis of intermittent explosive disorder requires that the individual exhibit recurrent impulsive and aggressive outbursts that are manifested as either (a) verbal aggression or physical aggression for, on average, at least twice a week for at least three months, with physical aggression not causing damage or destruction of property or physical injury to other people or animals, or (b) three or more outbursts during a 12-month period that caused damage or destruction of property and/or physical injury to other people or animals.

Question 12

The ____ gene variant has been identified as a high risk factor for neurocognitive disorder due to Alzheimer’s disease.

A) APOE4
B) APOE3
C) APOE2
D) APOE1

Answer 12

A) APOE4

There are three main variants of the APOE (apolipoprotein E) gene: APOE2, APOE3, and APOE4. APOE2 is the rarest variant and its presence reduces the risk for Alzheimer’s disease, while APOE3 is the most common variant and its presence doesn’t seem to affect the risk for Alzheimer’s disease.
In contrast, APOE4 has been linked to an increased risk for Alzheimer’s disease and several other neurocognitive disorders including neurocognitive disorder due to Lewy body disease.
APOE1 is very rare and has not been linked to Alzheimer’s disease.

Question 13

The presence of which of the following core and suggestive features would help confirm a DSM-5 diagnosis of probable major or mild neurocognitive disorder with Lewy bodies?

A) absence seizures and concurrent non-REM sleep behavior disorder
B) absence seizures and concurrent REM sleep behavior disorder
C) visual hallucinations and concurrent non-REM sleep behavior disorder
D) visual hallucinations and concurrent REM sleep behavior disorder

Answer 13

D) visual hallucinations and concurrent REM sleep behavior disorder

The DSM-5 diagnosis of probable major or mild neurocognitive disorder with Lewy bodies requires that (a) the patient meet the criteria for major or mild neurocognitive disorder, (b) the patient’s symptoms had an insidious onset and gradual progression, and (c) the patient’s symptoms include at least two core features or one core feature and one suggestive feature.
Visual hallucinations are a core feature and concurrent REM sleep behavior disorder is a suggestive feature. Absence seizures are not a core or suggestive feature of this disorder.

Question 15

A person whose primary symptom is psychogenic nonepileptic seizures (PNES) is most likely to receive which of the following diagnoses?

A) dissociative fugue
B) phencyclidine use disorder
C) functional neurological symptom disorder
D) obstructive sleep apnea

Answer 15

C) functional neurological symptom disorder

Functional neurological symptom disorder (formerly conversion disorder) is characterized by one or more symptoms that involve a disturbance in voluntary motor or sensory functioning, with symptoms being incompatible with any known neurological or medical condition. It can involve psychogenic non-epileptic seizures (PNES) that resemble true epileptic seizures in terms of behavioral symptoms but are not accompanied by the brain electrical activity associated with true epileptic seizures.
[Note that obstructive sleep apnea can trigger seizures, but these seizures (unlike PNES) are true seizures that are associated with abnormal brain electrical activity.]

Question 16

Which of the following areas of the brain has been identified as “ground zero” for Alzheimer’s disease?

A) amygdala
B) thalamus
C) locus coeruleus
D) corpus callosum

Answer 16

C) locus coeruleus

To identify the correct answer to this question, you have to know that the term “ground zero” is used to refer to the starting point of an event and that the locus coeruleus (an area in the brain stem) has been identified as the first area of the brain to be affected by Alzheimer’s disease (Mather & Harley, 2016). As the disorder progresses, many other areas of the brain are affected including the amygdala, thalamus, and corpus callosum.

Question 18

According to the DSM-5, the onset of tics is usually between the ages of:

A) 4 and 6 years.
B) 6 and 8 years.
C) 8 and 10 years.
D) 10 and 12 years.

Answer 18

A) 4 and 6 years.

According to the DSM-5, the onset of tics is typically between 4 and 6 years of age, with the severity of tics ordinarily peaking between 10 and 12 years of age.

Question 19

Dyslexia is the most common reading disorder and, of the types of dyslexia, ____ is most common.

A) surface dyslexia
B) deep dyslexia
C) phonological dyslexia
D) pure alexia

Answer 19

C) phonological dyslexia

There are several types of dyslexia, and different experts use different names for them. The three types listed in answers A, B, and C are developmental forms of dyslexia. Phonological dyslexia is the most common type and is also known as dysphonic, dysphonetic, and auditory dyslexia. People with phonological dyslexia cannot sound out words very well and, as a result, have trouble pronouncing new words and pseudowords. Individuals with surface dyslexia have trouble reading words that have irregular pronunciations (e.g., chalk, steak); and individuals with deep dyslexia have trouble with function words (e.g., read “at” for “in”), and they often substitute words that have similar meanings or are related in some other way to the printed word (e.g., read “man” for “boy” and “comb” for “brush”).
Alexia is an acquired type of reading disorder that’s caused by brain pathology. It’s also known as acquired dyslexia and is characterized by an inability to read normally (e.g., to read very slowly) and to understand written language.

Question 20

Research comparing patients with schizophrenia living in Western industrialized countries and non-Western developing countries has found that these patients differ in terms of which of the following?

A) onset and course of the disorder and rate of remission
B) onset and course of the disorder but not rate of remission
C) rate of remission only
D) course of the disorder only

Answer 20

A) onset and course of the disorder and rate of remission

Studies of patients who have received a diagnosis of schizophrenia have found that patients residing in non-Western developing countries are more likely than those residing in Western industrialized countries to experience an acute onset of symptoms, a shorter course of the disorder, and a higher rate of remission

Question 21

Alvin, age 22, has experienced delusions and hallucinations for several months. The most likely diagnosis for Alvin is schizoaffective disorder if he has also experienced:

A) concurrent episodes of major depression or mania for the entire duration of the disorder.
B) concurrent episodes of major depression or mania for the duration of the disorder except for at least one month when delusions and hallucinations were present without mood episodes.
C) concurrent episodes of major depression or mania for the duration of the disorder except for at least two weeks when delusions and hallucinations were present without mood episodes.
D) concurrent episodes of major depression or mania for the duration of the disorder except for at least two weeks when mood symptoms were present without delusions or hallucinations.

Answer 21

C) concurrent episodes of major depression or mania for the duration of the disorder except for at least two weeks when delusions and hallucinations were present without mood episodes.

The DSM-5 diagnosis of schizoaffective disorder requires the presence of concurrent psychotic symptoms and mood episodes for the duration of the disorder except for two or more weeks when psychotic symptoms were present without mood symptoms.

Question 22

The first-line treatment for female orgasmic disorder (FOD) is generally considered to be which of the following?

A) orgasmic reconditioning
B) relaxation training
C) Kegel exercises
D) directed masturbation

Answer 22

D) directed masturbation

Behavioral and cognitive-behavioral techniques have been found effective for treating FOD. Of these, directed masturbation is the most empirically supported technique (especially for lifelong FOD) and is considered to be the first-line treatment for this disorder.

Question 23

Cognitive processing therapy (CPT) is a research supported treatment for posttraumatic stress disorder that combines which of the following?

A) challenging problematic cognitions related to the trauma and writing and reading a detailed description of the trauma
B) challenging dysfunctional thoughts related to the trauma and stress inoculation training
C) reality testing dysfunctional thoughts related to the trauma and prolonged exposure using an anxiety hierarchy
D) bilateral eye movements with cognitive processing of traumatic memories

Answer 23

A) challenging problematic cognitions related to the trauma and writing and reading a detailed description of the trauma

CPT has received considerable research support as a treatment for PTSD and combines cognitive therapy with exposure. The cognitive therapy component focuses on identifying and challenging negative beliefs (“stuck points”) that keep the person from recovering from the trauma. The exposure component involves writing a detailed description of the traumatic event and reading it aloud to the therapist.