DSM-5 Questions

Match each time criterion with the most appropriate diagnoses (each time criterion may be used once, more than once, or not at all): A. Symptoms persist less than 1 month. B. Symptoms persist more than 1 month. ___ Acute stress disorder. ___ Delusional disorder. ___ Posttraumatic stress disorder. ___ Brief psychotic disorder.

A. Acute stress disorder - Symptoms persist less than 1 month. B. Delusional disorder - Symptoms persist more than 1 month. B. Posttraumatic stress disorder - Symptoms persist more than 1 month. A. Brief psychotic disorder - Symptoms persist less than 1 month.

Police arrest a 26-year-old man who got into a fight in a bar after he was discovered in the act of stealing the wallet of another customer. He defended his behavior to the police, stating that the other man had provoked him earlier in the evening by calling him a profane name. Review of his criminal record reveals charges, including some as a minor, for credit card fraud and selling cocaine. He lives alone and is currently unemployed. He has no psychiatric history. He does not report any recent hallucinations or changes in his mood or sleep. What is the likely diagnosis? A. Antisocial personality disorder. B. Conduct disorder. C. Moderate cocaine use disorder. D. Narcissistic personality disorder.

A. Antisocial personality disorder.

Match each description with the most appropriate diagnosis (each disorder may be used once, more than once, or not at all): A. Bipolar I. B. Bipolar II. C. Cyclothymia. ___ Meets criteria for mania. ___ Meets criteria for hypomania but not mania. ___ Does not meet criteria for hypomania or mania.

A. Bipolar I - Meets criteria for mania. B. Bipolar II - Meets criteria for hypomania but not mania. C. Cyclothymia - Does not meet criteria for hypomania or mania.

The neurology department refers a 39-year-old woman to psychiatry because she has been experiencing tonic-clonic movements on extremities without loss of consciousness for the past 2 months. An extensive neurological workup has been performed and no abnormalities are evident. The patient is cooperative throughout the session but shows restricted range of affect. Her husband says that she has been under treatment for infertility for many years and miscarried during a much desired pregnancy about 3 months ago. She does not show significant changes in her affect in reaction to this information from her husband. What is the likely diagnosis? A. Conversion disorder (functional neurological symptom disorder). B. Depressive disorder due to another medical condition. C. Factitious disorder. D. Somatic symptom disorder.

A. Conversion disorder (functional neurological symptom disorder).

Partners in a long-term affectionate and intimate relationship have recently begun to "experiment" with wearing costumes with especially soft fabrics and engaging in role-playing during their sexual encounters. They are enjoying this practice and find that it enriches their sexual life together. Does this pattern meet criteria for fetishistic disorder? A. No, because neither partner is experiencing distress. B. No, because soft fabrics do not represent a fetishistic object. C. Yes, because role-playing represents a fetish. D. Yes, because this "experimentation" is new.

A. No, because neither partner is experiencing distress.

A child is struggling in second grade. Her teacher called her parents for a conference due to concerns that she has become forgetful in class, is often seen to be daydreaming, and has serious difficulty following multistep directions. Her mother noted that "in second grade there is some real homework and she cannot sit down and focus on dong it. Half the time she even forgets it at home in the morning." Her teacher recalls careless errors on simple mathematics assignments. The child's father reminds them, "She has been this way for years. You cannot get her to focus, even if it is on making her bed or brushing her teeth". What is the likely diagnosis? A. Attention-deficit/hyperactivity disorder, predominantly hyperactive-impulsive presentation. B. Attention-deficit/hyperactivity disorder, predominantly inattentive presentation. C. Conduct disorder. D. Major depressive disorder.

B. Attention-deficit/hyperactivity disorder, predominantly inattentive presentation.

The hematology service requests a psychiatric consult for a-year-old woman with generalized bruising. The hematology team cannot find a cause for her physical findings, which have led to three hospital admissions in the past 5 months. The patient is a nurse at the hospital. On interview she is very tearful. Bruising is predominantly circumferential on her arms and legs, with none on her face or torso. She does have some venipuncture marks on her abdomen, however, as well as a wristband from another hospital. She appreciates the consult but asks the psychiatrist to leave when her ex-husband comes for his daily visit to watch videos of their daughter. She . explains that they lost their daughter to a chronic illness at age 8. What is the likely diagnosis? A. Conversion disorder (functional neurological symptom disorder). B. Factitious disorder. C. Malingering. D. Somatic symptom disorder.

B. Factitious disorder.

A 37-year-old single mother divorced her husband about 8 months ago and has custody of their two 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 workup was performed and no underlying medical cause was identified. Within 1 week, she has another attack at the local grocery store and felt embarrassed because she had to lie down on the floor for about 10 minutes while she was surrounded by the store's concerned customers until the 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? A. Generalized anxiety disorder. B. Panic disorder. C. Social anxiety disorder (social phobia). D. Specific phobia.

B. Panic disorder.

A 29-year-old graduate student is accompanied by her parents for an initial appointment with a psychiatrist. The student reports that her boyfriend broke up with her 2 months ago, and she continues to feel devastated. She immediately moved back into her parents' home for support. Her parents are used to this, she says, because "this happens all the time". Her parents help her with everything, including choosing her clothes each morning, washing her laundry, and making all of her meals. The recall, "Her boyfriends would always pay her bills and even choose her friends for her. She has never made it on her own." Despite their concerns, in many ways her parents like having her at home because she is always agreeable and respectful. She even volunteers to scrub all the bathrooms from top to bottom; she says, "Whatever I have to do so they will let me stay there until I find a new boyfriend." What is the likely diagnosis? A. Avoidant personality disorder. B. Borderline personality disorder. C. Dependent personality disorder. D. Generalized anxiety disorder.

C. Dependent personality disorder.

Police bring a woman to the hospital after they find her in an alley behind a restaurant. She appears to be in her late 20s. She cannot say who she is or where she lives. When asked what she was doing earlier, she recounts a reasonable story about having dinner at a restaurant and then having a few drinks. However, she looks worn, as though she has been living on the streets and exposed to the elements for hours or days. She is negative for alcohol and drugs on laboratory testing. Aside from mild dehydration, she is medically stable. Physical exam shows no neurological abnormalities. Finally, staff members find in her belongings an employee identification card from a mall where a shooting occurred 2 days earlier. When asked about that event, she has no recollection of it and seems unbothered. Her speech is clear and fluent, and she denies any perceptual changes. Police match her to a missing person report that her mother placed the previous day. What is the likely diagnosis? A. Bipolar I disorder. B. Depersonalization/derealization disorder. C. Dissociative amnesia with dissociative fugue. D. Schizophrenia.

C. Dissociative amnesia with dissociative fugue.

For a diagnosis of bipolar I disorder, an individual must have experienced in the past which of the following events, even if the event was not formally documented or diagnosed and did not lead to an episode of clinical care? A. Depressive episode. B. Head injury. C. Manic episode. D. Psychological trauma.

C. Manic episode.

A young girl is in second grade. Last year her paternal grandfather died from cancer. Since then her parents have become increasingly concerned about her. Last week a babysitter said that the girl sat starting at the front door almost the entire night, waiting for her parents to return from their date night. Their daughter keeps asking to stay home from school. She pleads for her mother to stay home with her, stating, "I do not want you to drive to work. What if you get in an accident? Just stay home with me". Before she goes to bed at night, she complains of headaches, which only seem to subside if she sleeps in her parents' room. They have stopped allowing her to sleep in their room, but some mornings they find her sleeping in the hallway right outside their bedroom door. She refuses to attend sleepovers with friends because she always feels "sick" while she is there. What is the likely diagnosis? A. Major depressive disorder. B. Panic disorder and agoraphobia. C. Separation anxiety disorder. D. Social anxiety disorder.

C. Separation anxiety disorder.

A 19-year-old college student is brought to the psychiatric emergency department by his friends because he has not slept for 4 days, was speaking loudly, felt "exuberant" and "on top of the world", and because he had attempted to lift a car with his "bare hands". He was an avid weight lifter and recently had started taking steroids (purchased "on the streets") to help him "bulk up". What is the most appropriate diagnosis? A. Bipolar I. B. Bipolar II. C. Substance/medication-induced bipolar and related disorder. D. Substance/medication-induced psychotic disorder.

C. Substance/medication-induced bipolar and related disorder.

Which of the following has been eliminated from the criteria for the diagnosis of schizophrenia in DSM-5 in comparison with earlier of DSM? A. The duration criteria. B. The negative symptom criteria. C. The paranoid subtype. D. The requirement for a delusion, hallucination, or disorganized speech.

C. The paranoid subtype.

Which statement is correct regarding the depressive disorders diagnostic class of DSM-5 in comparison with earlier versions of DSM? A. Brief depressive disorder has been added as a new diagnosis. B. Disruptive mood dysregulation disorder has been eliminated as a diagnosis. C. Persistent depressive disorder has been eliminated as a diagnosis. D. Premenstrual dysphoric disorder has been added as a new diagnosis.

D. Premenstrual dysphoric disorder has been added as a new diagnosis.

A 12-year-old boy feels tired of "standing out so much" at school. Several times a day he feels an uncomfortable sensation in his throat and then feels he "has to" cough or grunt, which temporarily makes the uncomfortable sensation go away. He also repeatedly shrugs his shoulders and stomps his feet at what appear to be random moments throughout the day. The other students no longer make fun of him the way they did when they were younger, but he still feels demoralized because he just wants to fit in with them. What is the likely diagnosis? A. Obsessive-compulsive disorder. B. Obsessive-compulsive personality disorder. C. Persistent motor or vocal tic disorder. D. Tourette's disorder.

D. Tourette's disorder.

A diagnosis of conduct disorder, childhood-onset type, has been associated with preceding which of the following disorders? A. Antisocial personality disorder. B. Attention-deficit/hyperactivity disorder. C. Narcissistic personality disorder. D. Oppositional defiant disorder.

A. Antisocial personality disorder.

A mother has learned during a conference with her 6-year-old son's teacher that her son tends to blurt out answers when students are asked to raise their hands. Also, he often intrudes on other children's activities during playtime, which has caused some disputes with his classmates. The mother notes that he often forgets to bring home his schoolwork. In addition, he often willingly starts a chore around the house, such as cleaning his room, but often switches to another activity and fails to finish the original task. What is the likely diagnosis? A. Attention-deficit/hyperactivity disorder. B. Obsessive-compulsive disorder. C. Oppositional defiant disorder. D. Tourette's disorder.

A. Attention-deficit/hyperactivity disorder.

A 34-month-old boy rarely initiates eye contact with his mother and does not seem to engage in play with other children in his peer group at day care. At times, he behaves aggressively toward the other children. He is only minimally communicative with speech but, when vocal, is prone to repetitively use only single words. He gets upset when his mother varies his morning clothing routine, always insisting, for example, that she put on his right sock first, before any other piece of clothing. What is the likely diagnosis? A. Autism spectrum disorder. B. Global developmental delay. C. Intellectual disability (intellectual developmental disorder). D. Major depressive disorder.

A. Autism spectrum disorder.

A mother reports that her son, who is now in first grade, has not seemed to fit in with his classmates since he was in kindergarten. He has a difficult time fully engaging in conversations with them. Instead, he seems to talk "at" them. For example, in a monotone voice he persistently shares elaborate and detailed information about his favorite subject, classic cars, even when the other children are very disinterested. Although this child met all motor milestones appropriately, he often exhibits a repetitive behavior of stacking his cars in a line. He does not have auditory problems. What is the likely diagnosis? A. Autism spectrum disorder. B. Global developmental delay. C. Language disorder. D. Social anxiety disorder (social phobia).

A. Autism spectrum disorder.

A man brings his 35-year-old wife, who has a history of previous psychiatric hospitalizations, to the emergency department because of her unusual behavior. He states that she just spent $3,000 on a shopping spree. She speaks animatedly and loudly: "I just remembered all these things I wanted to buy!" She looks down at her hand and says, "I need this ring on my finger for good luck". She has been sleeping 5 hours per night, and her days are "packed with events, booked from morning to evening!" She describes her mood as "stressed" and her affect is labile. Her mental status examination is notable for a slender well-groomed woman with meticulous makeup and good eye contact. She is cooperative on interview, but is difficult to interrupt. Her thought process is occasionally tangential, and her speech is fluent, with rapid rate. She denies any hallucinations. There is no evidence of psychomotor abnormalities or neurological deficits. Her urine toxicology screen is negative for illicit substances. What is the likely diagnosis? A. Bipolar I disorder. B. Borderline personality disorder. C. Obsessive-compulsive disorder. D. Schizophrenia.

A. Bipolar I disorder.

A man with schizophrenia manifests a failure to express feelings either verbally or nonverbally, even when talking about issues that would be expected to engage in emotions. His expressive gestures are very limited, and there is little animation in his facial expression or vocal inflections. Which term best describes that man's affect? A. Blunt. B. Depressed. C. Inappropriate. D. Labile.

A. Blunt.

A 47-year-old police officer presents in an outpatient clinic for evaluations of a "weird experience". He says he was "out of my mind, really paranoid" for a full 2 weeks, but then completely recovered. His symptoms began shortly after one of his colleagues was inexplicably shot during a routine traffic stop. Although everyone in the department had been upset by the event,, the patient found himself increasingly preoccupied with what he called "mysterious signs and circumstances" around the time of the tragedy and what he felt was the police chief's desire to "sweep it all under the carpet". Two days after the event, he began to hear voices on his car radio warning him about surveillance by "corrupt" m embers of the police department, who were "trying to bring him over" to their side with "brainwashing KGB techniques". Soon after, he began to hear a "whine" from his earpiece, which he recognized as the brainwashing. Unable to bear it any longer, he crushed the earpiece. Although he was able to pass this off as an accident at the time, he remains terrified that he might "lose it" again. Subsequently, he returned to his usual state and did not experience further psychotic symptoms. What is the likely diagnosis? A. Brief psychotic disorder. B. Delusional disorder, persecutory type. C. Schizophrenia. D. Schizophreniform disorder.

A. Brief psychotic disorder.

Women account for more than 90% of the diagnoses for which of the following disorders? A. Bulimia nervosa. B. Major depressive disorder. C. Obsessive-compulsive disorder. D. Schizophrenia.

A. Bulimia nervosa.

Match each term with the correct definition (each term may be used once, more than once, or not at all): A. Compulsion. B. Obsession. C. Phobia. D. Somatization. ___ Repeated behavior that a person feels driven to perform. ___ Repeated expression of psychological issues through physical symptoms, concerns, or complaints. ___ Repeated, irrational, and enduring fear of an object or situation. ___ Repeated thought or image that provokes anxiety.

A. Compulsion - Repeated behavior that a person feels driven to perform. D. Somatization - Repeated expression of psychological issues through physical symptoms, concerns, or complaints. C. Phobia - Repeated, irrational, and enduring fear of an object or situation. B. Obsession - Repeated thought or image that provokes anxiety.

A woman takes her 32-year-old roommate, who has a history of migraines, to the hospital after the roommate experienced sudden-onset blindness in both eyes. Her last migraine was 1 month ago, and she was not experiencing any headache symptoms at the time of exam. The preliminary visual exam revealed no blink to visual threat in either eye. The woman was unable to describe colors or identify people standing near her bed. Her CT and MRI were normal, and a cerebral vascular accident was ruled out. Ophthalmological exam revealed no abnormal findings. The blindness persisted for 3 days, during which time she was hospitalized. Further discussion with medical providers revealed that her boyfriend broke up with her the night before admission. What is the likely diagnosis? A. Conversion disorder (functional neurological symptom disorder). B. Dissociative identity disorder. C. Major depressive disorder. D. Somatic symptom disorder.

A. Conversion disorder (functional neurological symptom disorder).

Police bring a 30-year-old homeless man to the psychiatric emergency department after he called 911 because he though people were controlling his mind through "microwaves". He has no previous psychiatric or medical history, and his urine toxicology screen is negative for illicit substances. On interview, he appears very guarded, with limited cooperation, because he feels that he does not belong on a psychiatric unit. "I am not the problem", he says. "These microwaves are all around us, even if you cannot feel them". He denies any mood symptoms. Until a few years ago he was working full time, but he refuses to divulge his occupation "because I do not trust anyone". On examination, his speech is fluent with normal volume and rate, but his though process is occasionally disorganized. His affect is blunted, and no psychomotor abnormalities are noted. He denies any hallucinations, but during the interview he occasionally stares behind the interviewer intently, without responding to any questions. Which term best describes the man's experience of "microwaves"? A. Delusion. B. Hallucination. C. Ideas of reference. D. Illusion.

A. Delusion.

A 26-year-old man seen in the emergency department acknowledges persistent substance use until about the last 2 days, when he was evicted from his apartment. Which cluster of symptoms is typical of stimulant withdrawal? A. Depression, fatigue, insomnia. B. Diarrhea, nausea, anxiety. C. Hypertension, tachycardia, seizures. D. Vivid dreaming, nightmares, confusion.

A. Depression, fatigue, insomnia.

Match each description with the sexual dysfunction diagnosis for which it is most highly characteristic (each disorder may be used once, more than once, or not at all): A. Erectile disorder. B. Female organismic disorder. C. Genito-pelvic pain/penetration disorder. D. Premature (early) ejaculation. ___ Involves inability to attain and maintain arousal. ___ Involves inability to have vaginal intercourse or penetration. ___ Involves inorgasmia or delayed orgasm. ___ Involves orgasm before the person desires.

A. Erectile disorder - Involves inability to attain and maintain arousal. C. Genito-pelvic pain/penetration disorder - Involves inability to have vaginal intercourse or penetration. B. Female orgasmic disorder - Involves inorgasmia or delayed orgasm. D. Premature (early) ejaculation - Involves orgasm before the person desires.

Match each description with the paraphilic disorder for which is most highly characteristic (each disorder may be used once, more than once, or not at all): A. Exhibitionistic disorder. B. Fetishistic disorder. C. Pedophilic disorder. D. Sexual sadism disorder. E. Voyeuristic disorder. ___ Involves exposing one's genitalia to unsuspecting people. ___ Involves intense sexual arousal from observing an unsuspecting person disrobing or being naked. ___ Involves intense sexual arousal from prepubescent children. ___ Involves intense sexual arousal from the significant physical or psychological suffering of another person.

A. Exhibitionistic disorder - Involves exposing one's genitalia to unsuspecting people. E. Voyeuristic disorder - Involves intense sexual arousal from observing an unsuspecting person disrobing or being naked. C. Pedophilic disorder - Involves intense sexual arousal from prepubescent children. D. Sexual sadism disorder - Involves intense sexual arousal from the significant physical or psychological suffering of another person.

A 21-year-old college student complains that he had developed "an uncomfortable relationship with food". His current symptoms seem to be consistent with an eating disorder. Which of the following pieces of information would help distinguish between anorexia nervosa and bulimia nervosa? A. He has lost significant weight and appears emaciated. B. He is highly critical of his body. C. He regularly binges on high-calorie, high-fat foods. D. He uses large quantities of laxative tablets each day.

A. He has lost significant weight and appears emaciated.

A 53-year-old woman presents for a psychiatric evaluation for her long-standing depression. She has had several depressive episodes and was once hospitalized after a serious suicide attempt. She describes sexual abuse by her father and neglect by her mother during her teenage years. During the interview, while talking about her childhood, she suddenly switches to talking in a child-like, high-pitched voice, while pulling her legs under her in a chair and starting to rock backward and forward. While rocking, she says, "Don't hurt me, don't hurt me". Later during the interview, when she is talking and behaving in her original manner, she endorses not being able to recount her activities during several hours per day on a number of occasions in the past year. What is the likely diagnosis? A. Major depressive disorder and dissociative identity disorder. B. Major depressive disorder and schizoaffective disorder. C. Major depressive disorder and schizophrenia. D. Major depressive disorder and somatic symptom disorder.

A. Major depressive disorder and dissociative identity disorder.

A 33-year-old man presents to a psychiatrist with concern about his excessive hand washing. He reports that he has a ritualistic washing routine that takes at least 20 minutes, which he performs multiple times per day for fear of contamination with infectious disease. When further interviewed, he states that he has recurrent and persistent thoughts about hand washing and risk of contamination, which he tries unsuccessfully to suppress. He reports an overwhelming sense of anxiety if he does not wash his hands or if he does not complete the "ritual". He says the behavior is "out of control". He recognizes these thoughts as functions of his own mind. He has no other symptoms. What is the likely diagnosis? A. Obsessive-compulsive disorder. B. Obsessive-compulsive personality disorder. C. Schizophrenia. D. Specific phobia.

A. Obsessive-compulsive disorder.

DSM-5 assigned to new diagnostic classes some diagnoses that DSM-IV included in disorders usually first diagnosed in infancy, childhood, or adolescence. Which of the following statements is correct regarding these changes? A. Selective mutism was added to anxiety disorders. B. Selective mutism was added to depressive disorders. C. Separation anxiety disorder was added to dissociative disorders. D. Separation anxiety disorder was added to schizophrenia spectrum and other psychotic disorders.

A. Selective mutism was added to anxiety disorders.

Match each mental disorder with the age at onset noted in the diagnostic criteria: A. Age at onset under 5 years. B. Age at onset under 18 years. C. Age at onset not specified. ___ Tourette's disorder. ___ Separation anxiety disorder. ___ Global developmental delay.

B. Age at onset under 18 years - Tourette's disorder. C. Age at onset not specified - Separation anxiety disorder. D. Age at onset under 5 years - Global developmental delay.

A 20-year-old college freshman is brought to the attention of the dormitory resident assistant because she is not attending meals in the dining hall. The student says she feels anxious about being in the crowded kitchen and dining hall. Similarly, she has ordered all of her schoolbooks online to avoid being in the bookstore because "it is too overwhelming". She also has not attended some of her crowded lectures. The student is able to have a good conversation in the hall of the dormitory with the resident assistant. The student denies fearing scrutiny by others. She explains that she avoids some places because she found that in malls or other crowded areas, she feels very worried, faint, sweaty, and dizzy. She is afraid of losing control and in being in situations where she cannot escape. What is the likely diagnosis? A. Acute stress disorder. B. Agoraphobia. C. Posttraumatic stress disorder. D. Social anxiety disorder.

B. Agoraphobia.

Match each term with the correct definition (each term may be used once, more than one, or not at all): A. Anhedonia. B. Anorexia. C. Cataplexy. D. Catatonia. ___ Loss of appetite. ___ Loss of interest or pleasure. ___ Loss of muscle tone, with weakness. ___ Loss of response to outside stimuli and muscular rigidity.

B. Anorexia - Loss of appetite. A. Anhedonia - Loss of interest or pleasure. C. Cataplexy - Loss of muscle tone, with weakness. D. Catatonia - Loss of response to outside stimuli and muscular rigidity.

A 30-year-old retail manager at a cosmetics store with no previous psychiatric history finds herself experiencing distinct periods of intense anxiety two to three times per day. She is concerned because she has never experienced anything like this in the past. During the episodes she feels tremulous, hot, and faint, with palpitations and fear of loss of control. She denies any drug use and any recent stressors. This problem has been getting worse over the past few months and has affected her ability to function at work. She also has been losing weight and eating more. She is worried that her health has affected her appearance because her skin looks different, her hair is thinning, and she has swelling in her neck. What is the likely diagnosis? A. Agoraphobia. B. Anxiety disorder due to another medical condition. C. Generalized anxiety disorder. D. Social anxiety disorder (social phobia).

B. Anxiety disorder due to another medical condition.

A woman brings her 32-year-old husband to a psychiatrist for "unusual behavior". She says that for the past 5 days he has been cleaning the house extensively, often late into the night. He wakes up 2 hours earlier than usual the next morning but does not appear tired. He says he feels "very happy and productive - the best I have ever been!" His wife denies any dangerous behaviors at home and reports he is able to continue working at his current job, albeit more productively than before. She recalls that 6 months ago, he seemed very depressed, with loss of interest, poor sleep, low energy, and impaired concentration and lasted 1 month. The patient has not been hospitalized previously. On interview, he is pleasant and cooperative. His speech is pressured but redirectable. His thought process is linear, and he denies any hallucinations. His urine toxicology screen is negative. What is likely diagnosis? A. Bipolar I disorder. B. Bipolar II disorder. C. Schizophrenia. D. Substance/medication-induced bipolar and related disorder.

B. Bipolar II disorder.

A man brings his 36-year-old wife to a new primary care doctor because has lost patches of her hair recently. He notes that her last doctor sent her to a dermatologist, who felt that an underlying skin condition was unlikely. In a private exam room without her husband present, she says that she secretly pulls out her hair in clumps to relieve tension. The act of pulling her hair brings her relief. She denies changes in mood, sleep, concentration, or energy level. What is the likely diagnosis? A. Generalized anxiety disorder. B. Major depressive disorder. C. Tic disorder. D. Trichotillomania.

D. Trichotillomania.

A 21-year-old college student is preoccupied with the appearance of her nose. She has a small, 0.2-cm tissue nodule from a biking accident many years ago, but the area is well healed. She feels it is a serious flaw on her face, however, and is thinking about plastic surgery to correct the defect. She is concerned about dating anyone as long as she has this nodule on her nose, although she continues to enjoy spending time with friends. She denies any pain or discomfort, and she has no concerns about her body weight, which is average for her height. She continues to bike the same route daily at school. What is the likely diagnosis? A. Anorexia. B. Body dysmorphic disorder. C. Posttraumatic stress disorder. D. Somatic symptom disorder.

B. Body dysmorphic disorder.

A 33-year-old man arrives at the hospital by ambulance after his girlfriend called the police during a dispute. While arguing with his girlfriend, the patient had locked himself in a bathroom and swallowed a dozen tablets from the medicine cabinet. On evaluation, the patient is drowsy but responsive to voice. He has thin, linear, parallel scars on the extensor surface of his left wrist. He states that he wanted to show his girlfriend how much she was hurting him and then says, "She is probably going to leave me, just like everyone else has". What is the likely diagnosis? A. Adjustment disorder. B. Borderline personality disorder. C. Dependent personality disorder. D. Histrionic personality disorder.

B. Borderline personality disorder.

On which of the following diagnostic frameworks are the DSM-5 and ICD classification systems based? A. Binary. B. Categorical. C. Fuzzy. D. Probabilistic.

B. Categorical.

A 16-year-old boy presents to his high school counselor after running out of his programming class because he was asked to explain a piece of code. He had trouble answering and had felt this sort of difficulty in the past, but today it was worse. He is not able to explain clearly to the counselor what happened because he is still having the same speaking problems that he has in class. He speaks in broken words and keeps getting stuck on sounds like "aye" and "ah". He seems to spit out words. He writes down on a piece of paper that he has been thinking about droppi9ng out of school because of his difficulty speaking; his older brother dropped out of school for similar problems. The counselor later observes him working in the computer lab and notices no abnormal behavior. What is the likely diagnosis? A. Autism spectrum disorder. B. Childhood-onset fluency disorder (stuttering). C. Social anxiety disorder (social phobia). D. Tourette's disorder.

B. Childhood-onset fluency disorder (stuttering).

A 50-year-old Iranian woman being treated for an ankle sprain casually reports having had a conversation with a deceased relative. The emergency department physician is concerned that she has had both auditory and visual hallucinations and asks the psychiatrist to rule out psychotic disorder. At the interview, the woman endorses having had, on multiple occasions, visits from her deceased mother, in which she has conversations with her and gets advice concerning psychosocial matters. She is not distressed by the incident and, in fact, finds these experiences to be spiritual blessings. She does not exhibit any other symptoms of psychotic disorder. Her mental status examination is remarkable for a pleasant and cooperative demeanor, normal mood, and full range of affect. Her thought process is linear. During the interview, her husband corroborates her attitude that these are real spiritual experiences and wonder why a psychiatrist has been called to interview his wife. The Farsi-speaking interpreter says that the woman's story is common among Iranian immigrants. What is the likely diagnosis? A. Brief psychotic disorder. B. Culturally appropriate behavior. C. Schizophrenia. D. Shared psychotic disorder (folie a deux).

B. Culturally appropriate behavior.

A 56-year-old biologist has had a very successful career, publishing extensive research on the aging process. Now he believes he has found the key to eternal life. For the past several months, he has been quite secretive and refuses to come to work group meetings regarding upcoming projects. He has installed a dead bolt on his office at home and insists that extra security personnel be hired to guard his research lab. He refuses to present his material to discuss it with his colleagues or family, claiming the knowledge is too powerful to be made public. He is not having any visual or auditory hallucinations, and he is able to support his statements with logical arguments. He has a history of depression. What is the likely diagnosis? A. Cocaine intoxication, without perceptual disturbances. B. Delusional disorder, grandiose type. C. Major depressive disorder with psychotic features. D. Schizophrenia.

B. Delusional disorder, grandiose type.

A 40-year-old woman sees a psychiatrist for the first time. She complains of having had low energy and fatigue for the past year and endorses additional symptoms of depressed mood, poor sleep, and decreased concentration. She exhibits significant psychomotor retardation on exam. She denies any suicidal ideation or hallucinations. She takes medication for hypothyroidism but has not seen a primary care doctor in over 10 years. Her thyroid-stimulating hormone level is 7.6, and her urine toxicology screen is negative. What is the likely diagnosis? A. Bipolar II disorder. B. Depressive disorder due to another medical condition. C. Insomnia disorder. D. Major depressive disorder.

B. Depressive disorder due to another medical condition.

A woman brings her 45-year-old husband to a neurologist for "memory and behavior" problems. She states that for the past several years, he has been alternately dependent or hostile toward her, as if he were two distinct individuals. When he is dependent, he follows her around everywhere, like a child. When he is hostile, he ignores her and will curse at her if she asks him to do household chores. He also tells her to call him by a different name. Each phase lasts for months at a time. He has forgotten important details of his childhood such as the names of his parents and the town where he grew up. His wife denies that he uses any alcohol or other substances and denies that he has a history of seizures or sleep disturbances. She has not noticed any impulsive or unsafe behaviors. On exam, the man is silent and stares blankly at the wall, without evidence of psychomotor abnormalities. He responds very briefly to questions but denies any hallucinations, changes in mood, or elevated anxiety. A thorough workup including CT and electroencephalography testing fails to reveal any clear neurological abnormalities. What is the likely diagnosis? A. Bipolar I disorder. B. Dissociative identity disorder. C. Major depressive disorder with psychotic features. D. Schizophrenia.

B. Dissociative identity disorder.

A 10-year-old boy who has severe developmental delay exhibits immediate and involuntary repetition of ambient sounds and vocalizations made by other people. What is the term for this phenomenon? A. Dysarthria. B. Echolalia. C. Echopraxia. D. Word salad.

B. Echolalia.

A mother who recently moved to a new area brings her 6-year-old son for evaluation by a pediatrician. She worries that he is having diarrhea because she finds stool stains on his underwear. She is not sure how often he goes to the bathroom or the nature of his stools because for many years she has worked two or three job and has had to leave him in day care centers. On exam, he is shy and avoidant of social interaction but appears to have no developmental delay with respect to cognition and language. The pediatrician notes a hard golf ball-sized structure on the patient's left abdomen on deep palpation. What is the likely diagnosis? A. Conduct disorder. B. Encopresis. C. Enuresis. D. Mental retardation.

B. Encopresis.

For which of the following DSM-5 diagnoses is there a far greater prevalence in men than women? A. Depersonalization/derealization disorder. B. Exhibitionistic disorder. C. Major depressive disorder. D. Narcolepsy.

B. Exhibitionistic disorder.

Match each description with the appropriate phrase (each item may be used once, more than once, or not at all): A. False negative diagnosis. B. False positive diagnosis. C. True negative diagnosis. D. True positive diagnosis. __ A woman receives the diagnosis of bipolar disorder, manic phase, when her clinical presentation was actually due to amphetamine intoxication. ___ An elderly man receives no psychiatric diagnosis 2 months after the death of his wife; he sometimes is tearful and sad and once each week has difficulty sleeping when he thinks of her.

B. False positive diagnosis - A woman receives the diagnosis of bipolar disorder, manic phase, when her clinical presentation was actually due to amphetamine intoxication. C. True negative diagnosis - An elderly man receives no psychiatric diagnosis 2 months after the death of his wife; he sometimes is tearful and sad and once each week has difficulty sleeping when he thinks of her

A 35-year-old man tells his therapist that he is having marital problems because the object of his sexual arousal is his wife's underwear. He reports that he and his wife have sexual intercourse in a limited fashion, much less often than her prefers. He does not wear women's clothing, but he fulfills his sexual desires through masturbation while holding his wife's underwear or other women's undergarments that he has purchased. This activity is his long-standing pattern of sexual behavior and has been problematic in the relationship with his wife from early on. He reports that his wife has "caught" him masturbating with women's undergarments on multiple occasions and she thinks he is "weird". What is the likely diagnosis? A. Erectile disorder. B. Fetishistic disorder. C. Gender dysphoria in adolescents and adults. D. Transvestic disorder.

B. Fetishistic disorder.

A 22-year-old college student presents to a mental health clinic for an initial visit. She has not turned in any of her papers on time this term because she worries about getting poor grades, and this worry has affected her ability to concentrate. She is also very concerned about getting a job after she graduates despite multiple meetings with a career counselor. She says that she is concerned with the sanitation of the local gym and prefers not to play recreational sports because she might be injured. She does not have any rituals or checking behaviors. She describes her mood as "irritable" and says that she feels "tense all the time". Her appetite has not changed, and she continues to enjoy watching movies. She denies low energy and has not had any thoughts of harming herself. She tried cocaine last year but has not used any illicit substances or alcohol recently. What is the likely diagnosis? A. Adjustment disorder. B. Generalized anxiety disorder. C. Major depressive disorder. D. Obsessive-compulsive disorder.

B. Generalized anxiety disorder.

A mother brings her 3-year-old daughter to a pediatrician because she "does not talk very much". Her vocabulary consists of only 10 words, and she speaks only one word at a time. Her past medical history is notable for delays in developmental milestones: she walked independently at age 2, developed a pincer grasp at 15 months, and continues to have stranger anxiety. A hearing test completed in the clinic was normal. What is the likely diagnosis? A. Autism spectrum disorder. B. Global developmental delay. C. Selective mutism. D. Tic disorder.

B. Global developmental delay.

A 45-year-old man presents to his primary care doctor, complaining of chronic chest pain for the past year. He has seen multiple specialists, who tell him the pain is from uncomplicated acid reflux; however, he thinks he must have serious heart disease. He continues to worry about his heart despite reassurance from multiple cardiologists; he acknowledges that it is possible the cardiologists are correct. He denies hallucinations, and there is no evidence of delusional content. His concern about his heart has prevented him from vacationing with his family. He denies feeling depressed or anxious or having any problems with sleep or appetite, and he continues to enjoy hobbies at home. What is the likely diagnosis? A. Generalized anxiety disorder. B. Illness anxiety disorder. C. Major depressive disorder. D. Panic disorder.

B. Illness anxiety disorder.

Match each mental disorder with the most accurate statement regarding prevalence by gender (each item may be used once, more than once, or not at all): A. More prevalent among men. B. More prevalent among women. C. Equally prevalent among men and women. ___ Restless legs syndrome. ___ Major depressive disorder. ___ Generalized anxiety disorder.

B. More prevalent among women - Restless legs syndrome B. More prevalent among women - Major depressive disorder. B. More prevalent among women - Generalized anxiety disorder.

A mother brought her 12-year-old son to the clinic. He is a pleasant student who has developed difficulty staying awake in class for the past 6 months. He is very upset that no matter how much he tries, he suddenly becomes very sleepy, even during his favorite classes, and then falls asleep and naps. He feels refreshed after these naps but feels embarrassed when other students laugh at him or when teachers notice these episodes, which happen at least three times per week. His parents ensure that he goes to sleep at a regular time and sleeps for at least 8 hours, but this regularity has not helped with his lapses into sleep during the day. Recently, he started having episodes where he suddenly loses muscle tone and falls but remains conscious. These falls usually happen when he is excited or laughs. He has had a few such falls over the past month. Last time, it happened when he got very excited because his school's basketball team won the state championship, and he felt very embarrassed in front of his classmates. He has begun avoiding social events at school because he is worried he may have one of these falls. The extensive neurological and cardiac workups were unrevealing. The nocturnal sleep polysomnography shows rapid eye movement (REM) sleep latency of less than 15 minutes. What is the likely diagnosis? A. Circadian rhythm sleep-wake disorder. B. Narcolepsy. C. Non-rapid eye movement sleep arousal disorder. D. Rapid eye movement sleep behavior disorder.

B. Narcolepsy.

An 8-year-old boy wets the bed approximately 2 nights a week. He has been invited to a weeklong summer sleep-away camp but feels afraid to go because of his bed-wetting. He is particularly upset because he did not have this problem last year. He feels a little less embarrassed when he finds out that his dad had the same problem when he was a boy. His father moved out of the home last year after marital separation. They boy does not take any medications and has no known medical problems. What is the likely diagnosis? A. Encopresis. B. Enuresis, diurnal only. C. Enuresis, nocturnal and diurnal. D. Enuresis, nocturnal only.

D. Enuresis, nocturnal only.

Concerned parents bring a 33-year-old man to the psychiatrist. He appears to be his stated age, with erythematous face and holding his reddened and chapped hands away from his body. He takes a few minutes to adjust into the seat. He appears very embarrassed during the evaluation as he shares his story. He describes being very concerned about getting sick from the germs in the environment. This concern translates into frequent hand washing and showering. He explains that he has a particular ritual for these grooming procedures and that if he feels that he made a mistake, he has to repeat the whole procedure from the start. He spends approximately 5 hours per day on his grooming rituals. He also shares that things in his room have to be in a particular order; otherwise, he feels very uncomfortable and thus spends significant time readjusting these items. Moreover, when driving, he frequently worries that he ran over someone, and he has to go back to make sure that no body is lying on the ground. This worry has led him to avoid driving. He realizes that his concerns are irrational but cannot stop his rituals because they help with the significant anxiety that accompanies his troubling thoughts. He has not worked for the past 5 y ears because his rituals and worries caused him to be late and inefficient at his job. He currently lives with and is supported by his parents. He finally agreed to come in for an evaluation at their urging. What is the likely diagnosis? A. Generalized anxiety disorder. B. Obsessive-compulsive disorder. C. Obsessive-compulsive personality disorder. D. Panic disorder.

B. Obsessive-compulsive disorder.

A 24-year-old woman experiences severe dysphoria and anhedonia affecting her ability to perform well at her job. Which of the following additional pieces of information would be more consistent with a diagnosis of major depressive disorder than a diagnosis of premenstrual dysphoric disorder? A. The patient has been feeling cognitively hazy, confused, and forgetful. B. The patient has had suicidal thoughts every day for the past 3 weeks, and yesterday she searched "how to kill yourself" on the Internet. C. The patient was very irritable and rejection sensitive for 4 days last week, followed by rapid resolution. D. The patient's symptoms have caused strain in her relationship with her boyfriend.

B. The patient has had suicidal thoughts every day for the past 3 weeks, and yesterday she searched "how to kill yourself" on the Internet.

Which statement is correct regarding the World Health Organization Disability Assessment Schedule 2.0 included in DSM-5? A. The scale assesses only the three most important domains of hallucination, delusions, and disorganized speech. B. The scale is based on symptoms experienced by the patient in the previous 30 days. C. The scale is most accurate if patients, rather than clinicians, provide the responses. D. The scale should only be completed if the clinician is certain of the symptom severity.

B. The scale is based on symptoms experienced by the patient in the previous 30 days.

Which statement is correct regarding the domains DSM-5 evaluates in the Clinician-Rated Dimensions of Psychosis Symptom Severity? A. The scale assesses only the three most important domains of hallucinations, delusions, and disorganized speech. B. The scale is based on symptoms experienced by the patient in the previous 7 days. C. The scale is most accurate if patients, rather than clinicians, provide the responses. D. The scale should only be completed if the clinician is certain of the symptom severity.

B. The scale is based on symptoms experienced by the patient in the previous 7 days.

A young woman, age 21, is a talented sophomore at a prestigious college, where she lives in a dormitory. She describes herself as "shy" and "slow to warm up" in social situations. She used to drink one or two cans of beer on social occasions. She found that drinking alcohol reduced her anxiety, so she started taking her "social lubricant" before most social events. After a difficult breakup with her boyfriend about 15 months ago, she began drinking larger amounts of alcohol to "forget him". She has become irritable and impatient with friends and lost many of them. Her mother found empty bottles of hard liquor in her room during a visit and confronted her. The daughter exploded and yelled at her mother but finally admitted that alcohol was contributing to her erratic behavior and promised to cut back. Despite her efforts, she has found it difficult to reduce her drinking. Every night, she decides to drink only one beer but craves more and eventually ends up drinking a few shots as well and fails to do her schoolwork. She has been skipping her morning classes because she feels sick and has to have a drink to prevent shaking, sweating, and anxiety. She has also stopped hiking with friends on the weekends, because she worries that she may start shaking in the middle of a hike. Once, she fell off her bike while she was drunk and broke her wrist. Her grades have started to deteriorate. An instructor asked her to see a doctor after he became aware of her drinking behavior. What is the likely diagnosis? A. Adjustment disorder. B. Alcohol intoxication. C. Alcohol use disorder. D. Alcohol withdrawal.

C. Alcohol use disorder.

Match each term with the correct definition (each term may be used once, more than once, or not at all): A. Agnosia. B. Anhedonia. C. Aphasia. D. Apraxia. ___ Problems in comprehending language despite intact sensory function. ___ Problems in performing purposeful motor activities despite intact motor function. ___ Problems in producing language despite intact motor function. ___ Problems in recognizing objects despite intact sensory function.

C. Aphasia - Problems in comprehending language despite intact sensory function. D. Apraxia - Problems in performing purposeful motor activities despite intact motor function. C. Aphasia - Problems in producing language despite intact motor function. A. Agnosia - Problem in recognizing objects despite intact sensory function.

Using the DSM-5 criteria to "diagnose" celebrities on the basis of media reports is not considered ethically acceptable in the profession for many reasons, but especially for which reason? A. Celebrities do not like to be diagnosed. B. DSM-5 diagnostic criteria do not apply to celebrities. C. DSM-5 diagnostic criteria rely on information gathered through a comprehensive evaluation. D. Media do not accurately portray celebrities.

C. DSM-5 diagnostic criteria rely on information gathered through a comprehensive evaluation.

A plastic surgeon refers a 22-year-old hairdresser with no known history of mental illness to a psychiatrist. She underwent facial reconstruction and other surgeries after a disfiguring fire at her salon. When she was seen at a 1-year follow-up appointment, the exam room mirror alarmed her. She said that she "felt apart from" her body and was markedly distressed. She described the sensation as disabling because it occurs often at work. However, she is not able to clearly characterize her symptoms, aside from feeling "outside" herself. Aside from emotional distress from her symptoms, she has intact reality testing ability. What is the likely diagnosis? A. Acute stress disorder. B. Conversion disorder (functional neurological symptom disorder). C. Depersonalization/derealization disorder. D. Dissociative amnesia with dissociative fugue.

C. Depersonalization/derealization disorder.

Match each description with the personality disorder for which it is most highly characteristic (each disorder may be used one, more than one, or not at all): A. Antisocial personality disorder. B. Borderline personality disorder. C. Histrionic personality disorder. D. Narcissistic personality disorder. ___ Consistently uses physical appearance to draw attention to oneself. ___ Failure to conform to social norms and without remorse. ___ Frantic efforts to avoid real or imagined abandonment. ___ Grandiose sense of self-importance. ___ Self-dramatization, theatricality, and exaggerated expression of emotion.

C. Histrionic personality disorder - Consistently uses physical appearance to draw attention to oneself. A. Antisocial personality disorder - Failure to conform to social norms and without remorse. B. Borderline personality disorder - Frantic efforts to avoid real or imagined abandonment. D. Narcissistic personality disorder - Grandiose sense of self-importance. C. Histrionic personality disorder - Self-dramatization, theatricality, and exaggerated expression of emotion.

A 67-year-old man has been living by himself for decades in an apartment, but his daughter is concerned about his safety there. His room has stacked to the ceilings with items such as books and souvenirs, to the point that he cannot move around without shifting items. She worries that he may trip and fall in the apartment and has offered to help discard items; however, he finds it distressing to remove anything because he thinks everything will be of use to him someday. He denies any anxiety with his current living situation and prefers that it remain this way. What is the likely diagnosis? A. Delusional disorder. B. Generalized anxiety disorder. C. Hoarding disorder. D. Obsessive-compulsive personality disorder.

C. Hoarding disorder.

A primary care physician refers a 45-year-old married man to a psychiatrist for evaluation of his anxiety. The patient explains that he worries that there is something seriously wrong within his abdomen but that his primary care doctor has not been able to identify it. He shares that he has had intermittent pain in his abdominal area. Although physical exam, laboratory work, endoscopy, imaging, and expert consultation have not revealed abnormalities, he is worried that his pain is a sign of cancer that is being missed. He relays lifelong concerns about his health. His wife shares that he is always hypervigilant about any signs of illness, and she embarrassingly chuckles that their primary care doctor "must be a very patient man" because her husband constantly e-mails and calls him with various concerns. She describes her husband as an overall healthy man. The patient denies feeling depressed but again states how anxious he is that something serious is being missed. What is the likely diagnosis? A. Body dysmorphic disorder. B. Generalized anxiety disorder. C. Illness anxiety disorder. D. Somatic symptom disorder.

C. Illness anxiety disorder.

A 22-year-old woman is brought to the hospital after being found wandering on a school playground. She is not able to read or fill out basic paperwork. On exam, she is noted to be perusing the picture books in the pediatric waiting area and laughing in a childlike manner. She is wearing a T-shirt, sweatpants, and shoes with hook-and-loop fasteners and has a wristband with her identification and her mother's contact information. The woman can say her name and address and answer simple yes/no questions but cannot answer compound or complicated questions. She begins to cry after not being able to answer many questions. A review of her records indicates that she has no psychiatric history but still sees her pediatrician, accompanied by her mother. Recent testing places her at an IQ of 50. She has no basic laboratory abnormalities and a negative urine toxicology screen. What is the likely diagnosis? A. Conduct disorder. B. Dissociative identity disorder. C. Intellectual disability (intellectual developmental disorder). D. Selective mutism.

C. Intellectual disability (intellectual developmental disorder).

Police arrest a 26-year-old man for smashing the windows of a coworker's care after an argument at work. The man's wife says that he has a history of destroying property or items of value when provoked, in a manner that is "extreme" as compared to the magnitude of the inciting trigger or event. He denies any history of head trauma, difficulty with attention, depressed or labile mood, restlessness, or any problems with sleep or appetite. When he is not provoked, he is calm and pleasant. He denies any alcohol or substance use, and his wife corroborates this information. There is no evidence of fidgeting or psychomotor agitation on exam. What is the likely diagnosis? A. Attention-deficient/hyperactivity disorder. B. Bipolar I disorder. C. Intermittent explosive disorder. D. Panic disorder.

C. Intermittent explosive disorder.

A husband brings his 35-year-old wife to a psychiatrist because he thinks she has been buying a lot of jewelry over the past few years. In private, she admits that she stole all her jewelry from the department stores. She describes feeling excited by the prospect of stealing and then gratified after each theft. She denies hallucinations or mood disturbances or any other motives for acquiring the jewelry. She denies any distress associated with the desire to steal or the act of theft. On exam, her thought process is linear with fluent, normal speech, and no evidence of psychomotor agitation. She denies any problems with sleep. What is the likely diagnosis? A. Bipolar I disorder. B. Delusional disorder. C. Kleptomania. D. Obsessive-compulsive disorder.

C. Kleptomania.

A 29-year-old woman and her new boyfriend had an unplanned pregnancy culminating in a first-trimester miscarriage last year. She has always considered herself an anxious person but has felt even more anxious after the miscarriage. She became pregnant a second time, again unplanned, and she gave birth to a healthy baby boy after an emergent C-section delivery. Their son is now 4 months old. Her boyfriend has become emotionally distant. He moved out of their apartment a couple of weeks after the birth, stating, "I am not ready for this life". For the past several weeks, she has experienced escalating low mood, irritability, tearfulness, poor sleep, and constant fatigue. The patient reports that she is frightened by what she is thinking. She states, "Sometimes I feel I could not care less about taking care of my son or, even worse, that I want to just physically push him away. It is really scary. How can I ever be a good mother to him? I am miserable. I do not know if can take it anymore." Her first psychiatric contact was at age 22, when she was treated with citalopram for a depressive episode precipitated by being laid off from her first job after college. She says, "I have never quite been happy again since then. Life has been hard." What is the likely diagnosis? A. Bipolar II disorder, current episode depressed, with peripartum onset. B. Brief psychotic disorder, with peripartum onset. C. Major depressive disorder, with peripartum onset.. D. Persistent depressive disorder.

C. Major depressive disorder, with peripartum onset.

An 18-year-old single 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 feed her 8-wee-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? A. Bipolar I disorder, current episode depressed, with peripartum onset. B. Major depressive disorder, unspecified. C. Major depressive disorder, with peripartum onset. D. Persistent depressive disorder.

C. Major depressive disorder, with peripartum onset.

A doctor sees a middle-aged homeless man who has admitted to the medical unit 24 hours earlier for a workup of heart failure. The man has received appropriate medication for his heart but reports puzzling symptoms unrelated to his cardiac condition, such as feeling very dysphoric, with nausea and vomiting, muscle aches, and insomnia overnight. On physical exam, the man is sweating profusely, and his pupils are dilated. He keeps asking the nurse for "morphine for pain". At admission he was positive for opioids. What is the likely diagnosis? A. Alcohol withdrawal. B. Factitious disorder. C. Opioid intoxication. D. Opioid withdrawal.

D. Opioid withdrawal.

A 55-year-old woman presents to the hospital for treatment of acute myeloid leukemia, which was diagnosed 1 month ago. Her husband passed away 1 year ago from a cancer that he had battled for 3 years. She reports seeing a therapist for the "past couple of years" while dealing with her husband's illness and death. Her primary care team noted that she is frequently tearful in the hospital and looked relieved when a psychiatric evaluation was suggested. On interview, she reports feeling sad much of the day but that she is trying to stay upbeat about her treatment. She also reports feelings of hopelessness. Her appetite and sleep have been pour, and she has lost 50 pounds since the death of her husband. She feels guilty - "I wish I had taken better care of my husband in the end". She reports feeling isolated from friends and family as well. She makes a vague complaint of anxiety, which "comes and goes" throughout the day and is being treated with a round-the-clock schedule of benzodiazepines. She says that she "does not care if cancer kills her too". What is the likely diagnosis? A. Adjustment disorder. B. Generalized anxiety disorder. C. Major depressive disorder. D. Uncomplicated bereavement.

C. Major depressive disorder.

For which DSM-5 diagnosis is there a greater prevalence in women than men? A. Alcohol use disorder. B. Bipolar I disorder. C. Major depressive disorder. D. Schizophrenia.

C. Major depressive disorder.

A 76-year-old widowed, retired history professor comes to the clinic with his daughter to seek help for his memory difficulties, which started about 3 years ago and have progressed gradually. He stopped driving 6 months ago after being involved in a car accident. He recently moved in with his daughter, and she has been taking him to appointments, managing his finances, and attending to his care. A recent brain CT scan shows cortical atrophy and ventricular enlargement. His thyroid-stimulating hormone and B12 levels are within normal limits. His daughter starts crying while reporting that he has had many verbal disagreements with her. Lately he has been accusing her of controlling him and becomes very agitated. What is the likely diagnosis? A. Delirium. B. Intermittent explosive disorder. C. Major neurocognitive disorder due to Alzheimer's disease. D. Major neurocognitive disorder with Lew bodies.

C. Major neurocognitive disorder due to Alzheimer's disease.

A 27-year-old man presents to a psychiatrist for evaluation of anxiety. He explains that he recently go a promotion at his job, which requires frequent traveling. Although he is excited about his new role, he is terrified about the prospect of flying. He describes that the last time he flew, 5 years ago, he felt extremely anxious, with rapid heart rate, rapid breathing, nausea, and tingling in his hands. He was terrified that the plane would crash and would die. He has avoided flying ever since, but he can also feel extremely anxious to the point of hyperventilating when even a discussion of flying comes up. Now he has a business trip in 3 weeks and he is "mortified". He is considering whether to ask for a demotion. He denies feeling anxious in any other situations. What is the likely diagnosis? A. Generalized anxiety disorder. B. Panic disorder. C. Simple phobia. D. Social anxiety disorder.

C. Simple phobia.

A 55-year-old woman is referred for psychiatric consultation. She has a history of HIV, contracted from a former sexual partner. She has bene prescribed highly active antiretroviral therapy but for years has been only intermittently adherent. Currently, her CD4 count is 200 and her HIV viral load has been escalating. She complains that over the past several months she has been less mentally agile than in the past. She says it takes her significantly longer to read the newspaper each morning. When she wants to communicate with her daughter, concentrating on writing a text message is difficult and she even finds "my fingers do not cooperate with me when I try to type". Her fine motor skills appear to be worsening. The women denies any other physical symptoms, such as fever or headache. There are no focal findings on neurological exam. Head computed tomography (CT), magnetic resonance imaging (MRI)< electroencephalography, lumbar puncture, non-HIV viral polymerase chain reaction testing, antibody screens, metabolic parameters including hepatic and renal function, and urine toxicology are all negative. Neuropsychological testing shows impairment in information processing speeds, motor skills, and attention. What is the likely diagnosis? A. Cryptococcal meningitis. B. Major depressive disorder. C. Mild neurocognitive disorder due to HIV infection. D. Vitamin B12 deficiency.

C. Mild neurocognitive disorder due to HIV infection.

A primary care physician refers a 60-year-old Cambodian man to a psychiatrist to rule out a psychotic disorder. The man was previously given a diagnosis of schizophrenia because he "hears voices". He has been prescribed a large dose of an antipsychotic medication, which he takes daily, with very little symptom relief. He states that the medicine helps him sleep. The psychiatrist learns that the man is a survivor of the Cambodian genocide of the 1970s who survived torture under the Khmer Rouge regime, witnessed executions, and endured forced labor in Communist Cambodia. The man reports that subsequent to the extremes of traumatic experience he sustained, he has had chronic symptoms of anxiety with panic attacks. He also reports a concern of "thinking too much". When asked to clarify what he means, he describes a ruminating, worried thoughts about his past traumas. He reports severe insomnia and nightmares about Cambodia at night. He describes hearing voices other people do not hear. Further questioning reveals that the voices he hears are the Khmer Rouge officers, and he "hears" them when he is remembering his experiences of violence. When the psychiatrist asks him to clarify this, he says the "voices" are more like memories than hallucinations. What is the likely diagnosis? A. Bipolar I disorder, current episode manic. B. Panic disorder. C. Posttraumatic stress disorder. D. Schizophrenia.

C. Posttraumatic stress disorder.

A young man comes to the clinic. He is a 26-year-old veteran who previously was involved in a combat in the Middle East, where he was exposed to a few explosions. Since he returned about 4 months ago, he has had difficulty sleeping and has experienced frequent nightmares. He has avoided going out, because any loud noise startles him, disturbs him significantly, and brings back memories of the explosions. He sees himself as a failure and believes that he was not strong enough to tolerate combat. When his friends have approached him, their comments and jokes irritate him, and he isolates himself more. He has not been able to concentrate well and failed to pass the online courses he has been taking for his college degree. His mother has become increasingly concerned and encouraged him to come to the clinic. What is the likely diagnosis? A. Acute stress disorder. B. Adjustment disorder. C. Posttraumatic stress disorder. D. Social anxiety disorder.

C. Posttraumatic stress disorder.

A mother brings her 11-year-old daughter for assessment. The girl's teachers are uncertain whether she should advance to the next grade level. She enjoys doing math problems and is always enthusiastic when doing experiments in the science lab. However, in English and history class, she seems like a very different student. She sits in the back of the classroom, looking distracted, and avoids reading out loud when asked. When she does read aloud, her reading lacks fluidity and is often peppered with inaccuracies. Her reading comprehension test results show that she is well below grade-level expectation. She does not make spelling mistakes in her homework assignments. What is the likely diagnosis? A. Specific learning disorder. B. Specific learning disorder, with impairment in mathematics. C. Specific learning disorder, with impairment in reading. D. Specific learning disorder, with impairment in written expression.

C. Specific learning disorder, with impairment in reading.

A woman brings her 26-year-old boyfriend, any army veteran, to a psychiatric clinic after his primary care physician refers him for evaluation of "stress". She says that after her boyfriend's return from Iraq, they moved in together, but they already need to sleep in separate beds after two episodes in which he punched her while she was sleeping. The events both occurred in the early morning and were so violent that she has bruises on her neck and arms. The man looks extremely distraught. He says he frequently dreams that he is back in the Middle East, in hand-to-hand combat, and is afraid that these dreams will cause his girlfriend to leave him. Her friends already say that he is "crazy vet" who will "end up killing her". The thought of this is deeply painful to him, because they have a supportive, caring relationship and have spoken about getting married and starting a family. A review of systems is negative, except for increasing insomnia (delayed sleep onset). A thorough history and collateral information indicate that he does not meet criteria for posttraumatic stress disorder. He works as a vendor at the local baseball stadium, a job that he says he enjoys, but he is afraid that his poor sleep is beginning to affect his performance at work. What is the likely diagnosis? A. Bipolar I disorder, current episode manic. B. Generalized anxiety disorder. C. REM sleep behavior disorder. D. Schizophrenia.

C. REM sleep behavior disorder.

A 3-year-old girl in a park attempts to sit on the lap of a homeless person. She is pulled way by her mother who recently has been out of town. While the mother was away, the girl had been under the care of a grandmother who spent little time with the girl. The girl does not respond to the affection shown to her by her mother or grandmother. The girl is indiscriminately affectionate with strangers. She has no evidence of motor abnormalities and has met all developmental milestones appropriately. What is the likely diagnosis? A. Autism spectrum disorder. B. Mental retardation. C. Reactive attachment disorder. D. Rett syndrome.

C. Reactive attachment disorder.

A man brings his 34-year-old girlfriend to the emergency department for worsening depression and suicidal thoughts. She reports feeling more depressed and isolated from her friends and family during the past month. She worries about being watched by her neighbors and thus has been avoiding going outside. She has difficulty falling asleep at night and has poor energy during the day. She has not showered in 5 days. She admits that she has been hearing voices that make derogatory statements about her. She had several previous depressive episodes and two psychiatric hospitalizations with similar presentations. Which piece of information would help diagnose schizoaffective disorder in this woman? A. She has auditory hallucinations that are present only in the context of her mood symptoms. B. She has had one manic episode. C. She has been hearing voices for weeks without depressed or elevated mood. D. She has heard similar voices before when she was depressed.

C. She has been hearing voices for weeks without depressed or elevated mood.

Each week a 52-year-old woman bakes bread using a recipe and techniques taught to h er by her grandmother. She describes this behavior as an important "ritual" to her life. When does this behavior become a symptom that would appropriately be considered a part of a diagnostic assessment? A. At all times this behavior should be considered a symptom. B. At no time should this behavior be considered a symptom. C. When engaging in this behavior is no longer of interest or is distressing to her. D. When engaging in this behavior is very time consuming for her.

C. When engaging in this behavior is no longer of interest or is distressing to her.

To meet criteria for premenstrual dysphoric disorder, how long must symptoms be present? A. 1 week. B. 1 month. C. 6 months. D. 1 year.

D. 1 year.

Which statement is correct regarding how DSM-5 diagnoses and documents personality disorders? A. DSM-5 had eliminated personality disorder diagnoses. B. DSM-5 has introduced new personality disorder subtypes. C. DSM-5 has maintained the use of the Axis II system for documenting personality disorders. D. DSM-5 has preserved the same diagnostic criteria as in DSM-IV-TR for personality disorders.

D. DSM-5 has preserved the same diagnostic criteria as in DSM-IV-TR for personality disorders.

A gynecologist refers a 32-year-old hospital employee to a psychiatry clinic, noting that the patient requested testosterone shots and also a surgical referral. From the past medical records, the psychiatrist leans that the patient has normal female development and anatomy with no known abnormalities. The patient wears bland-colored baggy clothing, has very short hair, and goes by the name "Jo". She is initially brief with her answers but, after some time, is tearful, explaining that she has never been comfortable as a woman and is positive she is "supposed" to be a man. She feels ostracized at work, and isolated socially. She has feelings of low self-worth and some depressed mood. What is the likely diagnosis? A. Adjustment disorder. B. Anorexia nervosa. C. Depersonalization/derealization disorder. D. Gender dysphoria in adolescents and adults.

D. Gender dysphoria in adolescents and adults.

A woman brings her 73-year-old father to the hospital because she is extremely concerned that he has virtually no memory of the day's events. He cannot recall where he has been or what he has done. Which additional piece of information would be more consistent with a diagnosis of dissociative amnesia than neurocognitive disorders? A. He cannot name the current president. B. He has a hand tremor and slowing on rapid-alternating-movements testing. C. He has extensive history of chronic alcohol use. D. He was the victim of a mugging that morning.

D. He was the victim of a mugging that morning.

Which statement is correct regarding the bipolar disorders diagnostic class of DSM-5 in comparison with earlier versions of DSM? A. Anxious distress has been eliminated as a feature of bipolar disorder. B. Bipolar disorders have been consolidated under the diagnostic class of depressive disorders. C. Cyclothymia has been eliminated. D. Increased activity or energy has been added as a new core mood elevation symptom.

D. Increased activity or energy has been added as a new core mood elevation symptom.

What term best describes a person's mental status when he or she is responsive to external stimuli but is unable to stay awake? A. Agitated. B. Comatose. C. Delirious. D. Lethargic.

D. Lethargic.

A 5-year-old child believes that his thought, words, and actions cause specific outcomes in nature, and these outcomes defy what are the commonly understood laws of cause and effect. What is this phenomenon called? A. Grandiosity. B. Hallucination. C. Illusion. D. Magical thinking.

D. Magical thinking.

A 66-yeawr-old moderately obese man has a long history of hypertension. He is seen by his primary care physician for a follow-up appointment after his second stroke, which happened about 2 months ago. He reports that the weakness in his right leg is improving with physical therapy, but he has had difficulty finding his way back to the rehabilitation center, which is only a few blocks from his home. His wife reports that after her husband's first stroke, which happened about 2 years ago, he started having memory difficulties. The man used to enjoy playing chess with his grandchildren, but his memory deteriorated so significantly after his second stroke that he is unable to play and even forgets their names frequently. The man is pleasant, articulates words well, but shows significant difficulty finding words. He is not oriented to time, performs poorly in calculation, and is unable to name familiar objects, such as a pen or watch. While the clinician reviews the man's medications, the man shows significant difficulty remembering the medications' names and instructions. He appears frustrated and asks for a pen to write down the instructions. What is the likely diagnosis? A. Delirium. B. Major neurocognitive disorder due to Alzheimer's disease. C. Major neurocognitive disorder due to another medical condition. D. Major vascular neurocognitive disorder.

D. Major vascular neurocognitive disorder.

A 50-year-old woman presents to the local hospital complaining of "a drug problem". She says that for the past 3 years for use of cocaine has bene uncontrollable, to the point that she has lost her housing and her job. She reports using increasing amounts of cocaine over the past year to "reach the same high". What she stops using cocaine, she experiences intense symptoms of anxiety, depression, fatigue, and nausea. She has tried multiple-times to quite using cocaine altogether, but her efforts have been unsuccessful. She suffered a transient stroke once during a cocaine binge. She denies any mood problems or hallucinations prior to using substances. What is the likely diagnosis? A. Bipolar I disorder. B. Cocaine intoxication, without perceptual disturbances. C. Cocaine withdrawal. D. Moderate cocaine use disorder.

D. Moderate cocaine use disorder

A wife brings her husband, a 55-year-old man who has chronic conditions of diabetes, obesity, and hypercholesterolemia, to his primary care doctor. She is upset that her husband has no energy to go on outings with her and that he is always tired; she says that even though he would like to do things with the family, he consistently declines to do so. She gave him her own prescription for sleeping medication ("I know I should not do that! I was just hoping it would help us!"), but all that she noticed afterwards is that he snored "more than usual". She is worried about the well-being of their marriage, given her husband's changes. The man notes that is interested in life, their marriage, going out to dinner, and so on, but he does not know why he feels so exhausted. What is the likely diagnosis? A. Adjustment disorder. B. Anorexia. C. Major depressive disorder. D. Obstructive sleep apnea hypopnea.

D. Obstructive sleep apnea hypopnea.

A 12-year-old girl is getting along poorly with her parents and teachers. She is highly argumentative and defiant at home. She has attempted to embarrass her teacher in front of other students and uses profane language. She never seems to take responsibility for her hostility that appears to be present in many o f her social interactions. Due to her constant "negativity" with her teachers, other students have begun to keep their distance from her. In the past 5 years, the girl's parents have gotten divorced. Her mother then remarried, but that marriage ended in a rapid divorce. The girl is cooperative in responding to questions during the psychiatric interview. What is the likely diagnosis? A. Antisocial personality disorder. B. Conduct disorder. C. Major depressive disorder. D. Oppositional defiant disorder.

D. Oppositional defiant disorder.

A 12-year-old girl persistently misbehaves at home. Recently she called 911, reporting that her parents were forcing her to go to school and threatening to run away. She also locked her younger siblings out of the house in cold weather. Although her parents attempt to set limits, she frequently responds with prolonged tantrums - crying and shouting, flailing her arms, and breaking objects in her home. Once she "gets her way" she settles down immediately. After one serious tantrum, her parents took her to the emergency department and the girl was admitted to the psychiatric unit. The patient was viewed as quite charming by several members of the staff, whereas others thought she was "a very, very difficult patient". What is the likely diagnosis? A. Attention-deficit/hyperactivity disorder. B. Conduct disorder. C. Intermittent explosive disorder. D. Oppositional defiant disorder.

D. Oppositional defiant disorder.

A 62-year-old veteran underwent lung transplantation for idiopathic pulmonary fibrosis 6 months ago. His postoperative course has been complicated by a prolonged stay in the intensive care unit, renal insufficiency dependent on dialysis, atrial fibrillation, pneumonia, and severe deconditioning. He has difficulty working on his strengthening with physical therapy because he becomes anxious and worries about his perceived shortness of breath. He frequently asks to avoid or postpone these sessions and has been described an noncooperative with this treatment. This behavior, in turn, impedes his recovery. On evaluation by psychiatry, the patient denies depressed mood, reports enjoying visits from his family and watching the news, and is hopeful about his recovery. What is the likely diagnosis? A. Adjustment disorder. B. Generalized anxiety disorder. C. Posttraumatic stress disorder. D. Psychological factors affecting other medical condition.

D. Psychological factors affecting other medical condition.

Which developmental stage represents the usual time of onset of pedophilic disorder in males? A. Childhood. B. Late life. C. Middle age. D. Puberty.

D. Puberty.

Police arrest a 21-year-old man for arson, and a psychiatrist evaluates him in jail. On interview, the man describes having had an intense fascination with fire since his teenage years. He feel excited whenever he lights matches and enjoys watching the flames "dance" before him. He denies a history of unstable relationships, getting into fights, or deceiving others. He denies any suicidal or homicidal ideation, attempts, or gestures. His record show no other legal charges besides arson. He denies hallucinations or unstable mood, and his though process is linear. What is the likely diagnosis? A. Borderline personality disorder. B. Conduct disorder. C. Delusional disorder. D. Pyromania.

D. Pyromania.

A 25-year-old man with no medical or psychiatric history other than anemia travels frequently for his job. He has trouble on long flights because he feels the need to move his legs about and unfasten his seat belt to do so. When he is not permitted to get up, especially on "red eye" flights, he feels symmetrical burning and tingling in his legs. He is also very exhausted and notes that his sleep is not restful. He takes no medications except a daily multivitamin. What is the likely diagnosis? A. Adjustment disorder. B. Akathisia. C. Parkinson's disease. D. Restless legs syndrome.

D. Restless legs syndrome.

The emergency department calls a psychiatrist to evaluate a 35-year-old homeless, English-speaking man, identifying him as Native American. The police brought in the man after bizarre posturing in a park while talking to himself. The man describes having a special relationships with animals. He believes that he can communicate with them through telepathy. He reports that this communication with nature is a common belief in his culture and that he has this special "gift". He says that he receives "special signals" from birds that influence his behavior and he can "hear them talk to him". Upon further exploration, he reports that he has mental powers that influence animals and nature. He insists that he is "not crazy". His hygiene is poor and he is malodorous. He has very odd habits around eating based on his auditory hallucinations, resulting in poor nutrition and weight loss. He looks emaciated. He does not have a reasonable plan for shelter and sleeps in a field. His clothes are soiled. He has odd mannerisms throughout the interview, including laughing inappropriately. His urine drug toxicology is negative for substances of abuse. He has a history of multiple hospitalizations and involuntary commitments for grave disability starting around age 22 years. What is the likely diagnosis? A. Alcohol use disorder. B. Culturally appropriate behavior. C. Major depressive disorder. D. Schizophrenia.

D. Schizophrenia.

Theravada Buddhist monks living at a temple bring a 27-year-old Laotian man to the hospital. The man apparently has fasted for 17 days. The man is acutely dehydrated and emaciated. The patient is admitted to the medicine service. He is delirious at first, but when he improves, the psychiatric consult service is called because of his "odd manner". The patient is unkempt and unshaven, which is in sharp contrast to the two other members of his order. The patient does not speak English and one of the monks translates to help the psychiatrist with the evaluation. The patient appears withdrawn and responds very briefly to the other monks, at times laughing inappropriately. The monks say that the man's family, who had recently emigrated from Laos, brought him to the order nearly 1 year ago. Although he has been withdrawn since they have known him, the monks say that this is the first time he has embarked on such a fast. He told them that he was instructed to do so by "spirits", who watch his daily activities and comment on whether he is being appropriately observant. The members of his order are familiar with the names of the spirits from Lao folk traditions, but they are not familiar with this particular tradition of fasting. They acknowledge that the man is from a remote part of Laos, of which they are unfamiliar with the customs. What is the likely diagnosis? A. Culturally appropriate behavior. B. Major depressive disorder. C. Psychotic disorder due to another medical condition. D. Schizophrenia.

D. Schizophrenia.

Match each description with the personality disorder for which it is most highly characteristic (each disorder may be used once, more than once, or not at all): A. Avoidant personality disorder. B. Paranoid personality disorder. C. Schizoid personality disorder. D. Schizotypal personality disorder. ___ Behavior that is odd, eccentric, or peculiar, with odd beliefs or magical thinking that influence behavior and are inconsistent with cultural norms. ___ Neither desires nor enjoys close relationships, with emotional coldness, detachment, or flattened affective responses to others. ___ Suspects that others are exploiting or deceiving them, and persistently bears a grudge against others for perceived insults or slights.

D. Schizotypal personality disorder - Behavior that is odd, eccentric, or peculiar, with odd beliefs or magical thinking that influence behavior and are inconsistent with cultural norms. C. Schizoid personality disorder - Neither desires nor enjoys close relationships, with emotional coldness, detachment, or flattened affective responses to others. B. Paranoid personality disorder - Suspects that others are exploiting or deceiving them, and persistently bears a grudge against others for perceived insults or slights.

A 19-year-old college freshman wears a wizard hat every day around campus. When asked why, he tells people it is because "the hat help me think better". He has had few friends but enjoys participating in medieval role-playing games. He earns excellent grades in class and grooms himself appropriately every day. His speech is fluent. His thought process is linear, although he perseverates on various wizard spells he has learned online. His affect is restricted. He denies any hallucinations or any changes in sleep, mood, appetite, or energy. His unusual "style" has interfered with his getting a job, which he needs to remain in school. What is the likely diagnosis? A. Bipolar I disorder. B. Schizoaffective disorder. C. Schizophrenia. D. Schizotypal personality disorder.

D. Schizotypal personality disorder.

A mother brings her 15-year-old daughter to a psychiatrist's office. The mother says that for the past year, her daughter has not said a word to her teachers. With her family members or friends, however, she is very talkative and engaging, without any speech impairments or language abnormalities. The mother notes that her daughter met all developmental milestones appropriately and reached puberty at age 14. She never had to repeat a grade in school, although her grades this year are faltering because she does not speak in class. She is otherwise attentive and does well on homework. The mother denies any impulsive behavior. The patient does not speak to the psychiatrist when addressed, but shakes her head no when asked if she has experienced any hallucinations, mood disturbances, or traumatic episodes in her past. She sits patiently in her chair, smiling, without any fidgeting or unusual movements. What is the likely diagnosis? A. Attention-deficit/hyperactivity disorder. B. Autism spectrum disorder. C. Schizophrenia. D. Selective mutism.

D. Selective mutism.

A 28-year-old woman seeks psychiatric consultation. She explains that 10 years ago, she had a panic attack while presenting her project at the high school science fair. Since then she has developed an intense fear of being embarrassed or humiliated in a public venue. She is constantly worried that others are scrutinizing her. She is very self-conscious and afraid that she will have heart palpitations, trembling, or stuttering or that her mind will go blank. She refuses to go on dates and is not being considered for a new job because she declined the interview. She is tired of living such an isolated life. What is the likely diagnosis? A. Avoidant personality disorder. B. Obsessive-compulsive disorder. C. Panic disorder. D. Social anxiety disorder (social phobia).

D. Social anxiety disorder (social phobia).

A 40-year-old woman says she is "very anxious about public speaking", to the point of having episodes that resemble 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 her work superiors. The anticipation of 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? A. Generalized anxiety disorder. B. Major depressive disorder. C. Obsessive-compulsive personality disorder. D. Social anxiety disorder.

D. Social anxiety disorder.

A 32-year-old woman presents to the emergency department, requesting help for back pain. She says that she has wrestled with this pain for 2 years, after a minor skiing accident, and no medications or interventions have helped. No physical evidence explains the degree of pain she reports. The pain prevents her from working as a ballerina. She loves her job but says that for the past few years, budget cuts have stressed the entire ballet company. She denies any problems with sleep, anxiety, or mood. Her body weight is 90% of expected, and she denies any problems with her weight or diet. She is cooperative, and her though process is linear. What is the likely diagnosis? A. Adjustment disorder. B. Anorexia nervosa. C. Major depressive disorder. D. Somatic symptom disorder, with predominant pain.

D. Somatic symptom disorder, with predominant pain.

A primary care doctor refers a 46-year-old woman with many physical complaints for psychological assessment after extensive medical testing reveals no evidence of physical issues. The psychologist learns that the patient has an extensive history of bodily complaints without medical basis. Her physical symptoms have been multisystemic and do not resemble the constellation of symptoms associated with specific medical illnesses. The referring doctor also reports that the patient has frustrated many primary care doctors in the past and has transitioned from one to another. The patient expresses her distress to the psychologist. She says, "None of this is in my head. It is real. I have talked to so many doctors and those doctors just can't figure it out. I have no answers, and I feel worse and worse." What is the likely diagnosis? A. Body dysmorphic disorder. B. Conversion disorder (functional neurological symptom disorder). C. Factitious disorder. D. Somatic symptom disorder.

D. Somatic symptom disorder.

A mother brings her 6-year-old son to the pediatrician because of difficulty at school. His mathematical abilities are below his grade level, but he is otherwise an average student in all his other classes. His mother denies any problems with hyperactivity or impulsivity, and he is social with peers at school. He does not have behavioral problems at school, and his teachers say he is a pleasant and attentive student. He met all his developmental milestones appropriately. What is the likely diagnosis? A. Attention-deficit/hyperactivity disorder. B. Autism spectrum disorder. C. Global developmental delay. D. Specific learning disorder.

D. Specific learning disorder.

A 41-year-old man reports to the psychiatrist that he is afraid of dentists. He has a history of extreme anxiety upon entering a dental office, to the point that he feels dizzy and nauseated. He becomes excessively anxious in the waiting room and has a very difficulty time completing visits. He is so fearful about dentists that he reports he cannot take his own children to their dentist because he has "anxiety attacks" in the office. Rather, he insists that his wife take the children. His aversion to dentists has led to his missing regular appointments for more than 6 years. He plan to go soon, only because he has severe tooth pain and believes he may need a root canal. He does not have anxiety in other contexts. What is the likely diagnosis? A. Adjustment disorder with anxiety. B. Generalized anxiety disorder. C. Posttraumatic stress disorder. D. Specific phobia.

D. Specific phobia.