Anxiety & Trauma Disorders
What following are overlapping symptoms between bipolar disorder, PTSD, and BPD, except -
a. Irritability, poor sleep, impulsivity
b. Rapid mood shift
c. Emotional reactivity and trauma history
d. Negative self-identity
d. Negative self-identity
A hypomanic episode must last:
a. at least 4 days.
b. most of the day.
c. nearly every day.
d. All of the above.
e. Only A and C above
D. All of the above
Which of the following presentations is characteristic of borderline personality disorder?
A. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.
B. A pattern of submissive and clinging behavior related to an excessive need to be taken care of.
C. A pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity.
D. A pattern of grandiosity, need for admiration, and lack of empathy.
E. A pattern of excessive emotionality and attention seeking.
c. A pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity.
For a diagnosis of schizophrenia, symptoms must be present for a significant portion of time during what period of time?
a. 2 weeks.
b. 1 month.
c. 6 weeks.
d. 6 months.
b. 1 month.
Which of the following symptoms is a recognized consequence of the abrupt
termination of daily or near-daily cannabis use?
A. Hallucinations.
B. Delusions.
C. Hunger.
D. Irritability.
E. Apathy.
D. Irritability
Which of the following is a required symptoms for a diagnosis of PTSD.
a. Recurrent, involuntary, and intrusive memories of the traumatic event.
b. Persistent avoidance of stimuli associated with the traumatic event.
c. Directly experiencing the traumatic event.
d. Problems with concentration
Correct answer: B. Avoidance can present as efforts to avoid distressing memories/thoughts or feelings or external reminders, but avoidance behaviors must be present. Answers A, C, and D are one of several symptoms the may be present as representative of a criterion, but full criteria for the diagnosis may be present without any of these specific manifestations.
A Hypomanic episode in Bipolar II disorder is characterized by the following, except:
a. An episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization.
b. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.
c. Potentially engaging in risky behaviors
d. Engaging in nonsuicidal self-injurious behavior
d. Engaging in nonsuicidal self-injurious behavior
One change from DSM-IV-TR to DSM-5 is the removal of the age limit, except for the following that should not be diagnosed before 18 years old:
a. Borderline personality disorder
b. Antisocial personality disorder
c. Schizotypal personality disorder
d. Obsessive-compulsive personality disorder
b. Antisocial Personality Disorder
Which of the following psychotic symptom presentations would not be appropriately diagnosed as “other specified schizophrenia spectrum and other psychotic disorder”?
A. Psychotic symptoms that have lasted for less than 1 month but have not yet remitted, so that the criteria for brief psychotic disorder are not met.
B. Persistent auditory hallucinations occurring in the absence of any other features.
C. Postpartum psychosis that does not meet criteria for a depressive or bipolar disorder with psychotic features, brief psychotic disorder, psychotic disorder due to another medical condition, or substance/medication-induced psychotic disorder.
D. Psychotic symptoms that are temporally related to use of a substance.
E. Persistent delusions with periods of overlapping mood episodes that are present for a substantial portion of the delusional disturbance.
D. Psychotic symptoms that are temporally related to use of a substance.
In diagnosing a medication/substance induced disorder,
a. The prominent and persistent disturbance in mood/thought should predominate the medication/substance intoxication or withdrawal.
b. There is not evidence of the disorder preceded by the onset of the medication/substance use.
c. There is evidence the symptoms continue about 2 weeks after cession of the acute withdrawal or severe intoxication.
d. The disturbance occurs exclusively during the course of a delirium
Correct answer: A. C is incorrect – evidence of symptoms must continue approximately 1 month after cession of the acute withdrawal or severe intoxication
A woman complains of sad mood and feeling hopeless 3 months after her husband files for divorce. She finds it difficult to take care of her home or make meals for her family but has continued to fulfill her responsibilities. She denies suicidal ideation, feels she was a good wife who “has nothing to feel guilty about,” and wishes she could “forget about the whole thing.” She cannot stop thinking about her situation. Which diagnosis best fits this symptom picture?
a. Adjustment disorder, with depressed mood.
b. Adjustment disorder, with disturbance of conduct.
c. Adjustment disorder, with anxiety.
d. Adjustment disorder, with mixed disturbance of emotions and conduct.
e. Adjustment disorder, unspecified.
Adjustment disorder, with depressed mood.
Patient reports 6 weeks of depressed mood, inability to sleep throughout the night and explained that he does not have the energy to exercise. He is having challenges with focusing, and missing meals because “he rather stay in bed” and experiencing ruminating thoughts and feelings of worthlessness. He no longer participates in chess group, endorses passive thoughts of death but denies plan or intent. Patient last used cannabis 90 days ago.
Which of the following is the most appropriate diagnosis?
A. Persistent Depressive Disorder (Dysthymia)
B. Adjustment Disorder with Depressed Mood
C. Major Depressive Disorder
D. Bipolar II Disorder
E. Substance/Medication-Induced Depressive Disorder
Symptoms meet DSM-5 criteria (≥5 symptoms for ≥2 weeks, including depressed mood/anhedonia, with impairment). No history of mania/hypomania and no substance involvement.
Which of the following Cluster of Personality Disorders do NOT require the patient experience clinically significant distress or impairment in social, occupational, or other important areas of functioning?
A. Cluster A.
B. Cluster B.
C. Cluster C.
D. It is required of all Clusters.
E. Personality Disorders do not require this criterion.
It is required of all Clusters.
A diagnosis of Schizoaffective Disorder includes:
a. An uninterrupted period during which there is a depressive or manic/hypomanic episode concurrent with at least three criterions of schizophrenia.
b. Delusions, hallucinations or disorganized speech for 2 or more weeks in the absence of a major mood episode.
c. Symptoms that meet the criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness.
d. Symptoms of Schizophrenia are present for at least 2 weeks.
Correct answer: C. The major mood disorder must be a depressive or manic episode. A hypomanic episode is insufficient. Delusions or hallucinations (but not disorganized speech) must be present for 2 weeks. To meet the criteria for Schizophrenia, symptoms must be present for approximately one month.
What is the specifier that can be used as a further specifier of remission if the individual is in remission and in a controlled environment, such as a closely supervised and substance-free jails, therapeutic communities, and locked hospital units?
a. In a supervised environment
b. In a controlled environment
c. In remission
d. In supervised remission
B. In a controlled environment
This disorder is characterized by excessive anxiety and worry about a number of events or activities for at least 6 months with difficulty controlling the worry, restlessness, concentration difficulty, irritability, often without a specific trigger.
A. Bipolar disorder
B. Separation anxiety disorder
C. Generalized anxiety disorder
D. Anorexia nervosa
C. Generalized anxiety disorder
A patient reports 1 week of feeling unusually irritable. During this time, he has increased energy and activity, sleeps less, and finds it difficult to sit still. He also is more talkative than usual and is easily distractible, to the point of finding it difficult to read his comic books. What diagnosis best fits this clinical picture?
A. Manic episode.
B. Hypomanic episode.
C. Bipolar I disorder, with mixed features.
D. Major depressive episode.
E. Cyclothymic disorder.
A. Manic Episode.
In DSM-5, the definition of a manic episode has been broadened to include both an abnormal mood (elevated, expansive, or irritable) and increased activity for at least 1 week. The person must also experience at least three (four if the mood is irritable) of the following symptoms: 1) inflated self-esteem or grandiosity, 2) decreased need for sleep, 3) more talkative than usual or pressure to keep talking, 4) flight of ideas or subjective experience that thoughts are racing, 5) distractibility, 6) increase in goal-directed activity or psychomotor agitation, and 7) excessive involvement in activities that have a high potential for painful consequences.
Which of the following cognitive or perceptual disturbances are associated with borderline personality disorder?
A. Odd thinking and speech.
B. Ideas of reference.
C. Odd beliefs.
D. Transient, stress-related paranoid ideation.
D. Transient, stress-related paranoid ideation.
Compared to females, men diagnosed with schizophrenia tend to:
a. have more favorable outcomes
b. have more positive symptoms
c. have earlier age of onset
d. have better preserved social functioning.
C. The peak onset age occurs in the early- to mid-20s for men and in the late-20s for women
Which of the following statements is NOT true?
a. DSM diagnosis are based on the individual’s current presentation.
b. “Other specified” disorders should be documented with the specific reason the full criteria for the disorder is not met.
c. Specifiers are mutually exclusive and jointly exhaustive.
d. The diagnosis of a mental disorder should have a clinical utility.
C. Specifiers are not mutually exclusive and jointly exhaustive. (Subtypes are).
In PTSD, learning that a traumatic event(s) occurred to a family member or close friend, is sufficient to meet the exposure criteria, if:
a. the event was violent or accidental.
b. the event was distressing to the family member or friend.
c. The event family member or friend also meet the criteria for a trauma- related diagnosis.
d. All of the above
e. None of the above
Correct answer: A. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental. Many adverse life events experienced by family members and learned about later by a patient, may not meet this criterion if the event was not exposure of the individual to actual or threatened death, serious injury or sexual violence AND that event was violent or accidental.
A 42-year-old patient reports 1 week of increased activity associated with an elevated mood, a decreased need for sleep, and inflated self-esteem. Although the man does not object to his current state (“I’m getting a lot done!”), he is concerned because he recalls a similar episode 10 years ago during which he began to make reckless decisions. A physical examination and laboratory work are unrevealing for any medical cause of his symptoms. He had taken fluoxetine for a depressive episode but self-discontinued it 3 months ago because he felt that his mood was stable. Which diagnosis best fits this clinical picture?
A. Bipolar I disorder.
B. Bipolar II disorder.
C. Cyclothymic disorder.
D. Other specified bipolar disorder and related disorder.
E. Substance/medication-induced bipolar disorder.
This patient most likely meets criteria for bipolar I disorder, current episode hypomanic, which is defined as a current hypomanic episode in an individual with a previous history of at least one manic episode. The history of a past manic episode rules out bipolar II disorder, and the time course and absence of numerous episodes of hypomania rule out cyclothymic disorder.
Although antidepressants can precipitate manic episodes, the long period since medication discontinuation (more than 5 half-lives) makes this episode unlikely to be medication induced.
It is well known that exposure to adverse childhood events (ACEs) can disrupt and impede healthy development in self-organization, emotional-regulation, interpersonal attachment, and impulse control. The dysregulations of the above can mimic personality disorders. Which statement is true about C-PTSD vs. BPD?
a. The sense of self is persistently negative in people with C-PTSD, whereas the sense of self is unstable in people with BPD.
b. People with both BPD and C-PTSD resort to extreme strategies to regulate affect (e.g., suicidal or self-harming behaviors).
c. People with C-PTSD’s relationships are marked by volatility, whereas people with BPD tend to avoid and disconnect.
d. Both people with C-PTSD and BPD fear abandonment.
a. The sense of self is persistently negative in people with C-PTSD, whereas the sense of self is unstable in people with BPD.
People with BPD tend to use extreme strategies to regulate affect that you don’t see people with complex trauma engage in. People with C-PTSD tend to avoid and disconnect from relationships and BPD patients tend to have volatile relationships. People with BPD make frantic effort to avoid real or imagined abandonment.
Research has shown that Black patients are consistently more likely to be diagnosed with _____________ and less likely to be diagnosed with ____________ compared to white patients, leading to misdiagnosis and disparities in treatment.
a. Schizophrenia; bipolar
b. Depression; conduct disorders
c. ADHD; conduct disorders
c. Bipolar; PTSD
a. Schizophrenia; bipolar
A 27 yo man is brought to the ED by his best friend. As per his friend the patient was found this morning wandering the streets and appeared to have been robbed. Friend states patient seems very odd, and at times appears to be "listening to something". You evaluate the patient and observe a drowsy disoriented man with a BP of 110/80 Pulse 89 bpm pupils are mildly dilated, mucous membranes appear to be dry. During your evaluation you notice that the patient is very subdued and follows all the instructions that you give him without any opposition, even uncomfortable aspects of the exam are followed without questioning, you find this interesting and decide to ask the patient to get one one leg and jump, patient immediately does this, you attribute this odd finding to his current condition and begin supportive treatment. A few hours later the patient is reevaluated he is now appearing to be normal and states he does not remember anything from the previous night or earlier this morning, he does however state he can remember getting ready to go out for drinks with some friends the night before. With this information which is the best diagnosis you can give at this time?
a. Cannabis intoxication
b. Opioid intoxication
c. Other (or unknown) substance intoxication
d. Stimulant intoxication
e. Hallucinogen intoxication
C. In order to answer this question you must go through a process of elimination. Cannabis intoxication: you can see motor impairment, euphoria and anxiety, on physical exam you may see conjunctival injection and tachycardia which our patient does not have, and you can find dry mouth, cannabis would not explain the lack of “free will” that our patient shows and it would not impair memory. Opioid intoxication you would see myosis, rarely mydriasis, drowsiness and slurred speech. You may see impairment in memory and rarely hallucinations. In stimulant intoxication: psychomotor agitation, nausea or vomiting, bradycardia or tachycardia, elevated or low blood pressure, you may see confusion but again not behavior as presented by this patient. Hallucinogen intoxication you can appreciate anxiety, paranoia, pupillary dilation, tachycardia tremors and incoordination. The patient from our case presents with some anticholinergic symptoms, impaired memory, questionable hallucinations and odd behavior, the diagnosis is Scopolamine intoxication. Scopolamine is not a well known substance in US, it has medical indications for Nausea and is available by transdermal patches. In South America specially in Colombia Scopolamine is used as a drug to commit crime and is usually either blown to a persons face or administered in their drinks. It is a drug of choice for robbery as patients present total lack of free will and obey every command that is given, facilitating crime. Scopolamine intoxication may present also with some anticholinergic side effects and at large doses these will be more prominent. Hallucinations may also occur. As this substance is not well known and not part of the substances listed in DSM 5 the correct answer will be Other (or unknown) substance intoxication. The importance of this question is to be aware of some of the most popular drug intoxication side effects but at the same time be cognizant of the possibility of rare or unknown drugs.