Eating and Sleep Wake Disorders

D. Restless legs syndrome.

A 28-year-old woman who is in her thirty-fourth week of pregnancy reports that for the past few weeks she has experienced restlessness and difficulty fall ing asleep at the onset of the sleep period, as well as daytime fatigue. She works during the day and has not changed her schedule. She states that as she becomes increasingly tired, she feels more irritable and depressed. What sleep disorder is suggested by the onset of these symptoms in the third trimester of pregnancy? A. Circadian rhythm sleep-wake disorder, delayed sleep phase type. B. Insomnia disorder. C. Rapid eye movement (REM) sleep behavior disorder. D. Restless legs syndrome. E. Hypersomnolence disorder.

C. Avoidant/restrictive food intake disorder.

A 45-year-old woman had a choking episode 3 years ago after eating salad. Since that time she has been afraid to eat a wide range of foods, fearing that she will choke. This fear has affected her functionality and her ability to eat out with friends and has contributed to weight loss. Which diagnosis best fits this clinical picture? A. Bulimia nervosa. B. Schizophrenia. C. Avoidant/restrictive food intake disorder D. Binge-eating disorder. E. Adjustment disorder.

B. Circadian rhythm sleep-wake disorder, irregular sleep wake type, and unspecified NCD.

A 67-year-old woman complains of insomnia. She does not have trouble falling asleep between 10 and 11 P.M., but after 1-2 hours she awakens for several hours in the middle of the night, sleeps again for 2-4 hours in the early morn ing, and then naps three or four times during the day for 1-3 hours at a time. She has a family history of dementia. On exam she appears fatigued and has deficits in short-term memory, calculation, and abstraction. What is the most likely diagnosis? A. Major neurocognitive disorder (NCD). B. Circadian rhythm sleep-wake disorder, irregular sleep-wake type, and unspecified NCD. C. Narcolepsy. D. Insomnia disorder. E. Major depressive disorder.

a. belief that her weight and body shape influence her popularity.

Amy is a young woman who is very competitive and comes from a high-achieving, wealthy family. She is very social and likes the fact that she is quite popular. She believes that her popularity is dependent on the weight and shape of her body. Amy has a boyfriend but worries that she may care more about their relationship than he does. The feature that puts Amy most at risk for an eating disorder such as bulimia nervosa is her a. belief that her weight and body shape influence her popularity. b. belief that her boyfriend cares less about the relationship than she does. c. successful family. d. competitive nature.

C. Circadian rhythm sleep-wake disorder, non-24-hour sleep-wake type.

Following a traumatic brain injury resulting in blindness, a 50-year-old man develops waxing and waning daytime sleepiness interfering with daytime ac tivity. Serial actigraphy (a method of measuring human activity/rest cycles) demonstrates that the time of onset of the major sleep period occurs progressively later day after day, with a normal duration of the major sleep period. What is the most likely diagnosis? A. Circadian rhythm sleep-wake disorder, unspecified type. B. Circadian rhythm sleep-wake disorder, delayed sleep phase type. C. Circadian rhythm sleep-wake disorder, non-24-hour sleep-wake type. D. Pineal gland injury. E. Malingering.

d. is extremely common since sleep problems can be both a cause and a result of anxiety.

Fred has been having a great deal of trouble initiating and maintaining sleep. He guesses that he is sleeping for an average of about 3 hours each night and complains that he feels terrible during the day. In addition, Fred has always experienced some anxiety but has recently felt a tremendous increase in his overall anxiety level. The existence of both a sleep disorder and anxiety a. makes the diagnosis of primary insomnia incorrect. b. increases our confidence that primary insomnia is the correct diagnosis. c. indicates that the insomnia is a result of the anxiety rather than a cause of the anxiety. d. is extremely common since sleep problems can be both a cause and a result of anxiety.

b. have difficulty initiating or maintaining sleep.

Individuals suffering from primary insomnia a. do not sleep at all. b. have difficulty initiating or maintaining sleep. c. wake up during their sleep cycle with severe nightmares. d. frequently sleepwalk.

b. binge-eating disorder.

Individuals who experience loss of control of their eating and consume great quantities of food but do not engage in any attempts to compensate for their binge would be diagnosed with a. bulimia nervosa. b. binge-eating disorder. c. obsessive-compulsive disorder. d. anorexia nervosa.

b. dyssomnia

Individuals who feel tired and cranky all day despite falling asleep at a normal hour and awakening at their usual time are most likely suffering from a(n) . a. parasomnia b. dyssomnia c. type of REM sleep deprivation d. anxiety problem

a. within 10% of their "normal" weight.

Individuals with bulimia nervosa are typically a. within 10% of their "normal" weight. b. very overweight. c. very underweight. d. overweight during the development of the disorder but become underweight as the disorder progresses.

b. higher body temperature

One biological factor that has been related to individuals who experience insomnia is . a. genetics b. higher body temperature c. low body weight d. percentage of body fat

b. the beneficial effects of the medication may be short-term.

One major problem with the use of medication in the treatment of bulimia nervosa is that a. well-controlled studies have not found medication more effective than a placebo. b. the beneficial effects of the medication may be short-term. c. side effects make most patients discontinue the medication. d. patients refuse to take their medication.

a. hypersomnolence disorder

Sam sleeps for 8 or more hours every night but never feels rested. He can't understand why he is always tired despite the fact that he reports no difficulties with the quality or quantity of his sleep. Of the following, Sam's most likely diagnosis is . a. hypersomnolence disorder b. sleep apnea c. narcolepsy d. non-specific parasomnia

c. learning

Samantha started having difficulty falling asleep during final exam week. Although exams are over, she now starts to worry about sleep right after dinner. Even the sight of her bed makes her very anxious. The fact that Samantha's insomnia continues long after the stress of exams is over points to the role of ________ in the maintenance of sleep disorders. a. biology b. other medical conditions c. learning d. unknown factors

a. quality and quantity of sleep as well as daytime sequelae (how the individual feels when awake).

Sleep disorders are appropriately diagnosed based on the a. quality and quantity of sleep as well as daytime sequelae (how the individual feels when awake). b. quality and quantity of sleep only. c. quantity of sleep plus the amount of sleep time the individual believes is appropriate. d. subjective judgment of the clinician.

c. homosexual

The males most likely to develop an eating disorder such as bulimia nervosa are those who are . a. overweight b. depressed c. homosexual d. only children

b. 18 to 21

The median age of onset for all eating disorders is years of age. a. 13 to 19 b. 18 to 21 c. 20 to 26 d. 10 to 14

c. do not truly believe that they are too thin.

The most common reason that anorexic individuals generally do not seek treatment on their own is that they a. are ashamed of their disorder. b. fear that they will be hospitalized. c. do not truly believe that they are too thin. d. have little desire for food.

a. polysomnographic

The most comprehensive evaluation of sleep is performed by a(n) evaluation. a. polysomnographic b. actigraphic c. electromyographic d. electroencephalographic

a. Anorexia nervosa

Which of the following diagnoses would require the noticeable loss of weight? a. Anorexia nervosa b. Bulimia nervosa c. Binge-eating disorder d. Body dysmorphic disorder

b. Sleep terrors

Which of the following is a type of non-rapid eye movement (REM) sleep arousal disorder in DSM-5? A. REM sleep behavior disorder. B. Sleep terrors. C. Nightmare disorder. D. Fugue. E. Obstructive sleep apnea hypopnea.

c. Eating large quantities of food at one time

Which of the following is not a symptom of anorexia nervosa? a. Eating minimal amounts of food b. Vigorous exercise to offset food intake c. Eating large quantities of food at one time d. Overwhelming desire to be thin

B. Insomnia.

Which of the following sleep disturbances is associated with chronic opiate use? A. Excessive daytime sleepiness. B. Insomnia. C. Periodic limb movements in sleep. D. Obstructive sleep apnea hypopnea. E. Parasomnias.

a. Medications have not generally been found to be effective for the treatment of anorexia nervosa.

Which of the following statements is TRUE with regard to drug treatments for patients with anorexia nervosa? a. Medications have not generally been found to be effective for the treatment of anorexia nervosa. b. Antidepressants have some effectiveness in the treatment of anorexia nervosa. c. Anti-anxiety medications have some effectiveness in the treatment of anorexia nervosa. d. Anti-psychotic mediations have been found to be effective for the treatment of anorexia nervosa.

b. Once bulimia nervosa develops, it tends to be chronic if untreated.

Which of the following statements is TRUE? a. Anorexia nervosa typically occurs at a much earlier age than bulimia nervosa. b. Once bulimia nervosa develops, it tends to be chronic if untreated. c. Bulimic individuals eventually shift to symptoms of other eating disorders. d. Bulimia nervosa is more resistant to treatment than anorexia nervosa.

d. metabolic rate

While a patient sleeps, a polysomnographic evaluation collects data on all of the following characteristics EXCEPT _________. a. respiration b. muscle movements c. brain waves d. metabolic rate

d. narcolepsy

While suddenly and unexpectedly falling asleep during normal waking hours, Sarah experiences vivid hallucinations of being in a horrible car crash. The experience is so realistic that she actually feels physical sensations as if the hallucination were real. Sarah's most likely diagnosis is . a. sleep apnea b. hypersomnia c. schizophrenia d. narcolepsy

a. acting out a dream.

Sleepwalking is characterized by all of the following EXCEPT a. acting out a dream. b. occurrence during NREM stages of sleep. c. no memory of the sleepwalking event. d. occurrence primarily in children.

a. might be diagnosed with bulimia nervosa.

Susan, a woman of relatively normal weight, sometimes eats huge quantities of junk food with no ability to stop herself. She follows this with long periods of complete fasting. Based on this information, Susan a. might be diagnosed with bulimia nervosa. b. should be diagnosed with anorexia nervosa. c. will not be diagnosed with any disorder because she is of normal weight. d. cannot be diagnosed with bulimia nervosa because she is not purging.

c. an overwhelming urge to be thin.

The chief motivating factor in both anorexia nervosa and bulimia nervosa is a. desire to purge. b. an overwhelming drive to eat. c. an overwhelming urge to be thin. d. a desire to starve oneself.

c. higher than that any psychological disorder reviewed in your text.

The death rate (including suicide) due to anorexia nervosa is a. higher than for any other psychological disorder except depression. b. lower than that of most psychological disorders. c. higher than that any psychological disorder reviewed in your text. d. the highest of all of the psychological disorders.

a. obstructive, central, and sleep-related hypoventilation.

The different types of sleep apnea are a. obstructive, central, and sleep-related hypoventilation. b. obstructive, chronic, and sleep-related hypoventilation. c. central, chronic, and mixed. d. hypersomnolent, chronic, and parasomnic

a. electrolyte imbalance

The most serious medical consequence of bulimia nervosa is potential ______. a. electrolyte imbalance b. salivary gland damage c. starvation d. tooth erosion

d. binge eating followed by compensatory behavior

The most significant feature of bulimia nervosa is . a. purging b. overeating c. overeating followed by an urge to vomit d. binge eating followed by compensatory behavior

d. sociocultural

The strongest contributions to etiology of eating disorders seem to be . a. genetic b. psychological c. somatogenic d. sociocultural

D. Persistent restriction of energy intake, intense fear of becoming fat, and dis turbance in self-perceived weight or shape.

What are the three essential diagnostic features of anorexia nervosa? A. Persistently low self-confidence, intense fear of becoming fat, and distur bance in motivation. B. Low self-esteem, disturbance in self-perceived weight or shape, and persis tent energy restriction. C. Restricted affect, disturbance in motivation, and low calorie intake. D. Persistent restriction of energy intake, intense fear of becoming fat, and dis turbance in self-perceived weight or shape. E. Persistent lack of weight gain, disturbance in motivation, and restricted affect.

A. At least once a week for 3 months.

What minimum average frequency of binge eating is required to qualify for a diagnosis of binge-eating disorder? A. At least once a week for 3 months. B. At least twice a week for 3 months. C. At least once a week for 6 months. D. At least twice a week for 6 months. E. None of the above.

A. Selective serotonin reuptake inhibitors.

Which of the following classes of psychotropic drugs may result in rapid eye movement (REM) sleep without atonia and REM sleep behavior disorder? A. Selective serotonin reuptake inhibitors. B. Benzodiazepines. C. Phenothiazines. D. Second-generation antipsychotics. E. Monoamine oxidase inhibitors.

c. Hypnagogic hallucinations

Which of the following conditions is thought to be a potential explanation for UFO experiences? a. Sleep paralysis b. Cataplexy c. Hypnagogic hallucinations d. Sleep apnea

d. all of these.

With respect to eating disorders, drug treatments a. have not been found to be effective in the treating of anorexia nervosa. b. had no benefit in preventing relapse in patients with anorexia nervosa. c. do not have long-lasting effects on bulimia nervosa. d. all of these.

E. Nightmare disorder

A 14-year-old girl frequently wakes in the morning with clear recollection of very frightening dreams. Once she awakens, she is normally alert and ori ented, but the dreams are a persistent source of distress. Her mother reports that the girl sometimes murmurs or groans but does not talk or move during the period before waking. Her history is otherwise notable for having been homeless and living with her mother in a series of temporary shelter accom modations for 1 year when she was 10 years old. What is the most likely diagnosis? A. Unspecified anxiety disorder. B. Rapid eye movement (REM) sleep behavior disorder. C. Non-rapid eye movement sleep arousal disorders. D. Posttraumatic stress disorder. E. Nightmare disorder.

d. cessation of menstrual cycle

A common medical complication found in both bulimia nervosa and anorexia nervosa is . a. brittle hair b. downy hair on limbs c. electrolyte imbalance d. cessation of menstrual cycle

a. circadian rhythm sleep disorder

A severe difficulty in regulating sleep that is induced by jet lag or by working rotating shifts is an example of ___________. a. circadian rhythm sleep disorder b. sleep apnea c. hypersomnolence disorder d. narcolepsy

a. parasomnias

Abnormal events such as nightmares, sleep terrors, and sleepwalking that occur during sleep or during the twilight time between sleep and waking are classified as . a. parasomnias b. dyssomnias c. narcolepsy d. REM disorders

b. CBT-E

According to your textbook, which of the following treatments is considered MOST effective for bulimia in adults: a. IPT b. CBT-E c. Family therapy d. Guided self-help

a. decreases

As we grow older, it seems that the amount of sleep that we require . a. decreases b. increases c. stays the same d. decreases until early adulthood and then begins to increase again

d. all of these.

Benzodiazepine medication is not recommended as a long-term solution for the treatment of insomnia because of a. the addictive properties of these medications. b. rebound insomnia that occurs after the medication is discontinued. c. excessive sleepiness that may persist during the day. d. all of these.

c. a lack of compensatory behaviors

Binge-eating disorder is characterized by . a. laxative use b. purging c. a lack of compensatory behaviors d. emaciation

d. any of these

Cataplexy as experienced by patients with narcolepsy can be characterized by a. sudden, minor loss of muscle tone. b. physical collapse. c. slight muscle weakness. d. any of these

d. While jumping up and cheering for his favorite team

In which of the following situations is Bill, who has narcolepsy, most likely to experience cataplexy? a. Immediately upon waking up after a long, restful sleep b. At any random moment c. Under hypnosis d. While jumping up and cheering for his favorite team

c. Use scheduled awakenings to briefly awaken Martin before an attack occurs.

Martin sits up every night screaming. He does not remember these terrors nor is he easily awakened or comforted. What should Martin's mother do? a. Wake Martin up during the attack. b. Make sure that Martin is very tired before going to bed. c. Use scheduled awakenings to briefly awaken Martin before an attack occurs. d. All of these have been demonstrated to reduce the frequency and duration of sleep terrors

a. surgery

Medical treatments for severe sleep apnea include medication, mechanical devices, and . a. surgery b. exercise of the neck muscles c. a high protein diet d. changing the patient's sleep schedule

d. none of the answers are correct.

Obesity is not classified as a disorder in the DSM-5 because a. very few Americans suffer from it. b. many Americans suffer from it, therefore it is not a "disorder. c. it is related to too many other health concerns. d. none of the answers are correct.

c. interruption of air flow without cessation of respiratory activity.

Obstructive sleep apnea is characterized by... a. complete cessation of respiratory activity for brief periods. b. interruption of air flow and brief cessation of respiratory activity. c. interruption of air flow without cessation of respiratory activity. d. central nervous system disorders and trauma.

b. dyssomnia - inability to fall asleep

Of the following, the correct pairing is . a. dyssomnia - sleepwalking b. dyssomnia - inability to fall asleep c. parasomnia - waking up after 3 or 4 hours of sleep and then being unable to fall back to sleep d. parasomnia - lack of REM sleep

a. falling asleep during normal waking hours.

Of the following, the only symptom that both patients with narcolepsy and patients with hypersomnolence disorder experience is a. falling asleep during normal waking hours. b. sudden loss of muscle tone. c. sleep paralysis. d. hypnagogic hallucinations.

c. anxiety disorders; mood disorders

People with bulimia nervosa often present with additional psychological disorders, particularly ________ and _________. a. body dysmorphic disorder; substance disorders b. mood disorders; sexual disorders c. anxiety disorders; mood disorders d. obsessive compulsive disorder; sexual disorders

a. changing patients' dysfunctional thoughts regarding their weight and previous weight control strategies.

An important aspect of the cognitive-behavioral approach to the treatment of bulimia nervosa involves a. changing patients' dysfunctional thoughts regarding their weight and previous weight control strategies. b. helping the patient's family learn new ways of interacting with each other and with the patient. c. changing the type and frequency of reinforcement associated with being an identified patient. d. making sure that the patient has a lot of quiet time where she can be alone.

c. sleep paralysis and hypnagogic hallucinations associated with narcolepsy.

An individual who wakes up feeling that there are other people in the room but is unable to move or say anything may be experiencing a. cataplexy associated with sleep apnea. b. hypnagogic hallucinations associated with hypersomnia. c. sleep paralysis and hypnagogic hallucinations associated with narcolepsy. d. sleep paralysis and hypnogogic hallucinations associated with hypersomnia.

c. whether eating gets to be out of her control.

Jody sometimes eats more than just about any other girl that you know. You wonder if her eating sometimes could be considered bingeing. In order to determine this, you would have to know a. the caloric intake of the foods. b. whether she is eating junk foods. c. whether eating gets to be out of her control. d. the situations under which she eats a great deal.

d. all of these choices

Lack of adequate sleep has a negative effect on . a. health b. productivity c. clarity of thought d. all of these choices

c. melatonin and light.

Two factors that help regulate our natural sleep/wake cycles are a. melanin and auditory stimulation. b. melatonin and auditory stimulation. c. melatonin and light. d. light and blood sugar levels.