Practice Quiz Questions
A client comes into the office to be evaluated for Major Depressive Disorder (MDD). Which of the following symptoms are not indicative of MDD?
Hopeless
Indecisiveness
Sleep disturbance
Increased interest in hobbies
Increased interest in hobbies
Review pages 160-161 of DSM-5 and page 169 of Carlat. Common symptoms: depressed mood nearly every day (hopeless, sad, empty, etc.), diminished interest in pleasurable activities, such as hobbies (not increased interest), weight change, sleep disturbance, attention and focus issues or indecisiveness, psychomotor agitation or retardation, loss of energy, feeling worthless or inappropriate guilt, and/or recurrent thoughts of death. Increased interest in hobbies is not a symptom of MDD. Five or more symptoms are present during the same 2 week period of time and represent a change from previous functioning.
In order to diagnose bipolar I disorder, the client must display mania for a period of
time.
4 days
2 weeks
1 week
1 month
1 week
Correct answer is one week or 7 days. Review page 124 of DSM-5. To diagnose bipolar I manic episode must last at least a week or they must be hospitalized because of same, hypomanic episode for at least 4 days, and/or Major depression for at least a two week period of time.
There are some psychiatric disorders with a significant evidence of familial transmission. Because of this, a thorough family history is needed becaus this information can aide in the formulation of an accurate diagnosis.
Which of the following psychiatric disorders has the highest familial transmission?
Post-traumatic stress disorder
Schizophrenia
Substance Induced Neurocognitive Disorder
Seasonal Affective Disorder
Schizophrenia
Look on page 112 of Carlat. If a patient's father has schizophrenia, the patient has a 19 times more likely chance of having schizophrenia.
Schizophrenia has the second highest familial transmission, bipolar disorder is the only disorder which has a higher familial transmission at 25 times more likely.
Post-traumatic stress disorder is generally caused by suffering a trauma or multiple traumas. While newer research is showing there may be a genetic predisposition that when suffering a trauma, a patient with a family history is more likely to suffer from PTSD. Generally it is still considered a mental illness caused by a reaction to trauma. PTSD falls under the umbrella of trauma and stress related disorders and per DSM-5 (page 265), exposure to a traumatic or stressful even is listed explicitly as a diagnostic criteria.
Substance Induced Major Neurocognitive Disorder is not genetic in nature but rather caused by a substance, such a ETOH, an inhalant, etc. See page 627-629 DSM-5.
Seasonal Affective Disorder, see page 360 of Saddock is actually a term to describe a worsening of depressive or mood symptoms during certain times of the year (generally fall and winter). When the amount of sunlight is lessened and clients are generally indoors a great
Rebecca is an inpatient schizophrenic client at a state hospital. She insists that all the staff and other clients call her Elizabeth, Queen of England.
What type of delusions is the client suffering from?
Paranoid Delusions
Paranoid Delusi
Religious Delusions
Delusions of Control
Grandiose Delusions
Grandiose Delusions
The client is suffering from grandiose delusions. Grandiose delusions can involve them thinking they are a famous person or they have magical powers. Often grandiose and religious delusions can have some overlap. Paranoid delusions involve a thought process of someone/something being out to kill or harm them, or can be about someone talking about them, and can involve a radio or television.
Delusions of control is a belief that someone/something is trying to control them. Religious delusions may be they think they are God or an Angel or for example have power over death. Review page 214 of Carlat.
Harold, a schizophrenic client comes into the clinic for a medication management appointment. He tells the provider that he is having a lot of problems with feeling "jittery" since he started on aripiprazole. The nurse practitioner notes he is pacing around the room, will sit still for just a moment, stand up and pace again. The correct term for this movement disorder would be...
Parkinsonism
Restless Leg Syndrome
Tardive Dyskinesia
Akathisia
Akathisia
Akathisia is the correct answer. See pages 924-927 in the Saddock book. Akathisia is extreme motor restlessness with an inability to relax, feeling jittery, moving and pacing and changing positions frequently and include a sense of anxiety. Tardive dyskinesia and can include choreiform movement of the tongue, fingers, toes, puckering movements of the mouth, etc. and are screened via an AIMS exam.
Parkinsonism includes muscle stiffness, drooling, shuffling gait, cogwheel rigidity, pill rolling movements, etc. Restless leg syndrome is a creeping sensation of the calves and an irresistible urge to move the legs particularly during sleep. Based on the vignette the client did not share there were issues with sleep or specific issues with just the legs.
There are certain specifiers for bipolar and related disorders. One of the specifiers can be with melancholic features. Which of the following would be a symptom of melancholic features?
Weight Gain
Early morning awakening
Depression is worse in the evening
Increased participation in hobbies
Early morning awakening
Correct answer is early morning awakening. See page 151 of DSM-5.
Melancholic features can include: loss of pleasure in almost all activities, lack of reactivity to usually pleasurable stimuli, profound despondency, worsened depression in the morning, early morning awakening (usually 2 hours earlier), psychomotor agitation or retardation, significant anorexia or weight loss, and excessive or inappropriate guilt.
A differential diagnosis for Bipolar I disorder would be Attention Deficit Hyperactivity Disorder.
True
False
True, differential diagnoses for Bipolar I disorder include Major Depressive Disorder, Generalized Anxiety disorder, Post Traumatic Stress Disorder, Attention Deficit Hyperactivity Disorder, Panic Disorder, other bipolar disorders, substance/medication induced bipolar disorder, and Personality Disorders. Review page 131 of DSM-
Schizophrenia is a mental illness with a clinical presentation which can vary among individuals. Which statement is false regarding schizophrenia?
The peak age of onset for men is 25 to 35 years of age.
Women display a bimodal peak onset age distribution
Urban settings increases the incidence rates
Nicotine dependence is common
The peak age of onset for men is 25 to 35 years of age.
The peak age of onset for men is 10 to 25 years of age. The peak age of onset of women is 25 to 35 years of age and after 40 years of age.
Men are unimodal age distribution and women are a bimodal (two periods of time) age distribution. Urban settings have higher rates of schizophrenia over rural settings. In addition, clients with schizophrenia have higher mortality rates from accidents and natural causes and frequently have nicotine dependence. See pages 301-302 of Saddock for additional information
Daisy comes into the clinic and relays a history of hypomanic episodes lasting 1-2 days and depressive episodes lasting 2-3 days for most of her life. She is here today for diagnosis and treatment. What is the most likely diagnosis for Daisy?
Cyclothymic Disorder
Bipolar I disorder
Bipolar Il disorder
Personality Disorder
Cyclothymic Disorder
Review page 123 of DSM-5. Cyclothymia is diagnosed if a client has never met the criteria for hypomanic episodes (must last at least 4 consecutive days), or depression (must last two weeks). Bipolar I disorder or bipolar Il disorder criteria is not met for the same reasons because of the length of time of the symptoms. There is no indication of egocentric thinking from the vignette above to support personality disorders.
The symptoms for Schizophreniform are between a time frame of one month to three months.
True
False
False
see page 328 of Saddock. Schizophreniform has the appearance of schizophrenia (delusions, hallucinations, disorganized thinking, disorganized speech, diminished emotional response, etc) but the symptoms are the first manifestation and are between a time frame of one month to six months. Schizophrenia (even acute) must be present for at least six months for diagnosis (see page 307 Saddock).