TIU_Psychopathology Final Exam

The best treatment for personality disorders is...

unevenly researched, with some having clear treatment protocols and others having very little research support.

According to Instructor Tillett, clinicians should use a Z-code when diagnosing for insurance reimbursement...

when they are a/the focus of clinical treatment.

Which of the following statements about Cyclothymic Disorder is FALSE?

The individual has not been without symptoms for more than three weeks.

For a pattern to meet DSM5 criteria for a personality disorder, symptoms must...

have started by early adulthood.

Which is likely the most accurate co-morbid diagnosis for Arnold?

None of these; no co-morbid diagnosis.

Most Z-codes are covered by insurance.

False

Based on his diagnosis, what is the prognosis for Arnold?

It is uncertain, but his symptoms give hope that it will resolve suddenly and not be chronic.

Which of the following medical conditions often causes a major depressive episode?

Stroke

What subtype is Chloe?

Anorexia Nervosa, Binge-eating/Purging Type

Regarding Raine's husband Ronaldo...

He should be involved with Raine's treatment, particularly in receiving psychoeducation and countering the perpetuating factors and cycle.

What is Havilah's risk for suicide, compared to the general population?

High, because she is in the midst of a depressive episode, is single, and has a bipolar disorder.

Not getting much from Sylvan, you talk to nurse. She states he had a full physical 5 months ago, and there is nothing in his chart about previous neurocognitive symptoms or schizophrenia spectrum disorders. You speak to the police officer outside the room. She reports that they had not been called to his home before, though his record shows a DUI about a month ago. She states he appeared to be divorced, lived alone in a small, decently kept house, and worked as an upper-level manager for a local mattress manufacturing company. Which of the following statements is likely TRUE regarding forming a differential diagnosis?

His legal history of a DUI indicates substance-use might be a key factor.

How should you progress in treatment, particularly regarding Barbara's initial concern of feeling agitated and anxious?

Hold off on addressing her anxiety until your diagnostic impression is confirmed or refuted by medical testing, although teaching some relaxation techniques wouldn't hurt.

______________ is a medical condition, identifiable with a thorough blood analysis, that can produce symptoms similar to a neurocognitive disorder, but with treatment those symptoms can nearly always be resolved.

Hypothyroidism

The main differential between Schizoaffective Disorder and Bipolar I Disorder with psychotic features is...

In Bipolar Disorder I, the delusions and hallucinations only occur during manic or depressive episodes, always appearing/resolving in less than two weeks before/after the mood episode.

Which of the following correctly lists the four categories of PTSD symptoms?

Intrusion, avoidance, negative mood/cognitions, arousal/reactivity

Which of the following statements about Disruptive Mood Dysregulation Disorder is FALSE?

It is commonly co-morbid with Oppositional Defiant Disorder.

Which of the following statements about specific phobias is FALSE?

It is extremely rare that a specific phobia has a known cause, such as a traumatic event or observation of a traumatic event.

During the assessment interview, Selena moves the box of tissues, the table lamp, and the fake plant on your end table to form points of a triangle. She laughs a bit at this and says, "Sorry, I know this is weird, but it just bothers me when things aren't arranged in triangles. Do you think I have OCD?" You ask for her to share more. She shares that whenever she enters a room, she likes to divide the room or connect the items in it in mental triangles. If she can't, she feels mild discomfort. You ask if there are other things like this. She says she often mentally counts things like ceiling tiles or steps. You ask how this affects her life. Selena says it is mildly amusing to her close friends, but otherwise she hasn't noticed any problems. Which of the following statements regarding a possible diagnosis of obsessive-compulsive disorder, with good insight, is TRUE?

It is not justified because there is not clinically significant distress or impairment.

Which of the following statements is NOT true of ADHD?

It must be diagnosed before age 7.

What might be an appropriate treatment and rationale for Chloe?

Family-based treatment, because Chloe is fairly young and the parents appear to be attentive, involved, and willing to help.

Given her symptoms described above, a clinician should also consider whether Sam meets criteria for a comorbid diagnosis of...

Major Depressive Disorder

Victor arrives five minutes early for his appointment. He is a 36 year-old Caucasian-American male, dressed neatly and well-groomed. Upon entering, he asks where to sit and complies with being directed to a chair. After the initial contracting conversation with the therapist and a few questions clarifying policies, Victor shares he is seeking help for difficulty focusing and staying motivated. He is an aerospace engineer with Lockheed-Martin, designing cutting-edge military aircraft and was passed over for a promotion to team leader. He was told it was due to concerns about his interpersonal skills, not his engineering or organizational competence which were outstanding. "I know there were other qualified applicants, but I believe I have been more efficient than the one who got it. I came in a full 15% below budget on the last project I worked on, primarily because I cut out all the fat like lunch reimbursement and breaks. I am not upset by what others think; I'm upset that I haven't been productive enough." Victor's affect is fairly flat, expressing mainly a sense of disappointment and sadness. When asked what he enjoys, Victor discusses new technologies he is working to incorporate into his designs. When asked for hobbies, he thinks for a bit and says, "Reading, I guess. And I volunteer with my church helping to manage the building." When asked about relationships, Victor says he dated once or twice in college but it never went very far before he became engrossed in a project and let it fizzle out. He graduated magna cum laude from a prestigious state school, participated in an engineering club, but otherwise stayed in his dorm, focused on his studies. He says his closest friend is his older brother, also an engineer. He hasn't kept up with his college roommates or any members of his high school. With regard to other friends, he pauses for a minute then mentions two co-workers and a fellow committee member at church, but denies hanging out with them outside of work or volunteering. Victor's affect changes little as he answers these questions. Victor admits he has been feeling disappointed in himself, like he's failed. He has had passing thoughts of death and even suicide but denies intent to act. He admit to difficulty concentrating, early morning waking, and gaining 15 pounds over the past two weeks. He states these symptoms began about three months ago. Which of the following is likely the most appropriate diagnoses for Victor?

Major Depressive Disorder, Obsessive-Compulsive Personality Disorder, Schizoid Personality Disorder

Cognitive decline that causes concern and impairment to independent living which is caused by major or minor strokes is diagnosed as...

Major Vascular Neurocognitive Disorder

Which of the following is NOT a difference between manic and hypomanic episodes?

Manic episodes include decreased need for sleep while hypomanic episodes do not alter typical sleep patterns.

Which of the following statements about the human sexual response cycle is FALSE?

Masters and Johnson found that most males take longer to reach orgasm than most females.

In which of the following five major symptom categories does Elona NOT display disturbance?

Motor behavior

What is the difference between neurodevelopmental and neurocognitive disorders?

Neurocognitive disorders involve regression, a loss of ability one once had; neurodevelopmental does not.

Which of the following is NOT a symptom of Oppositional Defiant Disorder in children and youth?

Has been physically cruel to animals.

The case of Victor illustrates the following truth about personality disorders

They are frequently co-morbid, with other personality disorders and other mental disorders.

According to the three phase meta-model of treating trauma/stress-related disorders, the next step the counselor should take is...

work with Saleema to achieve safety, stability, and health coping.

For Selena, which of the following differential diagnosis statements are FALSE?

Selena has co-morbid alcohol/cannabis-induced sleep disorder, insomnia type since these substances are being used to help regulate sleep.

(c. 2014) Mihn is a 24 year-old infantryman serving in Afghanistan. He is brought into the field hospital, led by one of his squad. Mihn explains that recently on a routine patrol, they stopped their humvee due to what looked like a roadside bomb. They got out and insurgents starting firing on them. Mihn hit the ground, crawled under the humvee for protection, and fired back, helping to cover others advancing on the enemy. However, as he came out, he said he was blind. His squad was confused, since the bomb hadn't detonated, and Mihn hadn't been hit or hit his head. The medic couldn't find anything physically wrong with him, so he sent Mihn to the field hospital two days later for further assessment. The doctor finds nothing. Mihn denies nightmares or invasive thoughts. He says he feels bad that he let his squad down, "a little unnerved" by the incident, and embarrassed that he seems to be "loosing it." He says he wants to get back out there with his squad, but just can't with his blindness. What is a likely diagnosis for Mihn?

(F44.6) Conversion disorder, visual disturbance

According to McRay, Yarhouse, and Butman, a counselor who is seeing someone with a Bipolar Disorder should...

Use interpersonal or CBT-type interventions, such as helping the client determine stressors, triggers, consequences, and coping strategies, and keeping a mood chart.

Match the intoxication syndrome to the substance that induces it. Be careful; there is substantial overlap. Look for distinctive features. 1. Anxiety, depression, fear of "losing one's mind," paranoia, perceptual disturbance, dilated pupils, sweating, tremors, incoordination 2. Restlessness, nervousness, excitement, flushed face, rambling flow of speech, muscle twitching, insomnia. 3. Impaired motor coordination, anxiety, euphoria, time seems slowed, social withdrawal, increased appetite, dry mouth, tachycardia. 4. inappropriate sexual behavior, aggressive behavior, quickly fluctuating mood, slurred speech, unsteady gait, nystagmus, impairment of memory and attention, stupor. 5. Euphoria, changes in sociability, hypervigilance, interpersonal sensitivity, anxiety, anger, stereotyped behaviors, dilated pupils, rapid heartbeat or breathing, nausea, weight loss, muscular weakness, confusion, seizures, dyskinesias 6. Belligerence, apathy, impaired judgment, dizziness, nystagmus, incoordination, slurred speech, unsteady gait, slowed reflexes, tremor, lethargy, stupor, blurred vision, euphoria

1. Hallucinogen (but not pcp) 2. Caffeine 3. Cannabis 4. Alcohol, Sedative, Hypnotic, or Anxiolytic 5. Stimulant 6. Inhalant

Match the description of the withdrawal syndrome to the substance it is associated with. 1. No withdrawal syndrome 2. Autonomic hyperactivity (pulse 100+, sweating), hand tremor, insomnia, nausea, transient hallucinations, agitation, anxiety, possible seizures. 3. Dysphoric mood, nausea, muscle aches, dilated pupils, body hair standing on end, sweating, diarrhea, fever, insomnia, yawning 4. Irritability, anger, nervousness, insomnia or disturbing dreams, decreased appetite and weight loss, restlessness, depressed mood, abdominal pain, tremors, sweating, fever, chills, headache. 5. Dysphoric mood, fatigue, vivid and unpleasant dreams, insomnia/hypersomnia, increased appetite, psychomotor retardation or agitation. 6. Irritability, frustration, anxiety, difficulty concentrating, increased appetite, restlessness, depressed mood, insomnia.

1. Inhalants, Hallucinogens 2. Sedatives, Hypnotics, Anxiolytics, or Alcohol 3. Opioids 4. Cannabis 5. Stimulants 6. Tobacco, Nicotine

Match the symptom to the personality disorder of which it is most characteristic. 1. Odd beliefs, magical thinking, or culturally divergent superstitiousness 2. Grandiose, lack of true empathy, requiring excessive admiration 3. Pattern of unstable and intense interpersonal relationships and intense avoidance of perceived abandonment. 4. Little interest or enjoyment in close relationships. 5. Difficulty delegating, miserly spending, stubbornness, excessive devotion to productivity. 6. Deceitfulness, impulsivity, irritability, and lack of remorse

1. Schizotypal 2. Narcissistic 3.Borderline 4. Schizoid 5. Obsessive-compulsive 6. Antisocial

The age range in which substance use disorders are most common is...

18-24

(Based on Morrison, 2014, p. 77-78) Arnold presents at the college counseling center as a slim, 5'10", hygienic and appropriately dressed. He is a 23 year-first year medical student. He presents asking for help with anxiety and at the urging of his roommate and family. During the history, he reports he grew up in a "normal-looking family" but shares they were actually part of the witness protection program. He reports he grew up around Boston, his original last name was Italian, and his dad worked for the Italian Mob. Arnold says his father turn against the Mob and they moved to western Ohio when he was three, where they lived a "normal" life. He reports he struggled in elementary school with attentiveness and behavior issues, and faced significant bullying in middle school. But he really excelled in High School and college, eventually getting into a good medical school. He has been doing well academically up until recently. He says he had a group of friends in high school, dated a bit in college, and keeps up with some guys he met at college. About two months ago, while studying in his room, Arnold was startled by a voice. He looked around the room and there was no one present, and none of his devices were playing anything. She told him to stop what he was doing and to start "covering his tracks." He recognized the voice, but said, "I can't tell you who; she told me not to." He noted the voice did move a lot, from inside the room, to outside the door, to behind him. He reports trying to ignore her, but she becomes very angry and emphatic that he listen to her and do what she's asking or something very bad will happen. "At first, I thought I was losing my mind, but then she pointed out that my last name before we moved was Italian. We talked it over more with her. She makes good sense; it is all becoming clear." He complains he can't seem to concentrate like he used to, largely because she keeps interrupting, but also when she is "quiet." He denies hearing more than one voice or seeing her. Arnold reports no use of medication, drugs, or alcohol. He reports good health, getting a "clean bill of health" at his physical 5 months ago. He makes good to intense eye-contact, speaks in a normal pace and tone and with typical gestures. No tics or odd motor movements are apparent. His affect changes as he talks, sad when discussion the move to happy about college, to concerned about the present. He says he feels good about himself and looks forward to becoming a doctor. He denies any periods of needing less sleep or feeling grandiose or highly irritable. A call to roommate indicates Arnold does not use substances much, and that his behavior underwent a dramatic change two months ago, including increased suspiciousness of him and more clutter and odd schedules. A call to his dad provides more insight. Dad denies ever having been part of the Mob, noting he was an investment banker, and that he had adopted Arnold when he was three. He and Arnold's mom decided to move out of Boston to live a slower, simpler life. Dad does agree with Arnold's report of his school years and sociability. Dad reports he has not known Arnold to drink or use substances. Which of the following is likely the best principal diagnosis for Arnold?

295.40 (F20.81) Schizophreniform Disorder, with good prognostic features (hallucinations 4; delusions 3; language 0; motor 0; negative 0)

Elona is a 45 year old African-American. She specifically chose to work with you because she heard you were a Christian. She says demons have been trying to possess her for the last year and she hopes you can help.She told her pastor about it after she'd been struggling for a month, and he prayed over her. As (later) did the elders and a few other specially gifted individuals, but to no avail. She only got angry at the time and worse afterwards. It's now been three months. She says the demons often appear corners of rooms or under or behind things. They usually command her to give up on her work, to "curse God and die," or to do some sexual act. Occasionally they jump at her and attack her, trying to enter her body and then cause her to hurt herself. She says they are targeting her because she stopped serving on the building maintenance team and her poor care for her husband and children. She denies abusing or neglecting them, and the children are doing well academically with no behavior issues. Elona presents with unkempt hair and clothes, with flat affect with moments of panic/fear, and low energy. Her speech slow, quiet, and flat, with short answers, as if talking required extensive effort. She flinched three or four times during the 50 minute interview, as if someone was jumping at her. She reports that she lost her job about 3 months back, and her husband has been urging her to see a therapist. A call to her husband substantiates much of her timeline. He is tired and nearly begs you to help. He reports that she began getting worse about it as 4 months ago, having difficulty going to work, getting out of bed, taking care of herself. After a month, she was fired from her job. Some days she would cry for hours on end. When he tried to comfort her, she often berated herself for being a terrible wife and mother. He reports she often wakes up early in the morning, and just lies there. She does not move much, and has lost interest in the children's activities, her shows, and pretty much everything else. The husband states she had bouts of feeling down throughout their marriage, and more than once she missed work for a week to a month. But he claims she was over all a very supportive and caring and affectionate wife most of the time and a very attentive, almost perfectionistic, mother. He denies any periods where she appeared to feel a heightened sense of importance or unusual productivity. "After about two months of her being down, she started saying the demons were after her. That was the first time she said anything crazy like that. It was like she was loosing touch with reality. It freaked me out. The church doesn't seem to know what to do with her." What is likely the best principal diagnosis for Elona?

296.24 (F32.3) Major Depressive Disorder, recurrent episode, with psychotic features, with melancholic features

Havilah reports that earlier this year she was assigned a marketing project by her boss. She felt encouraged and was super confident that she would show just how superior a marketer she really was. She worked lots of overtime on it over the course of two weeks, getting little sleep but still feeling good. She felt so good, she started planning to start her own marketing company and consulted a lawyer about how to set it up legally. Two of her co-workers pulled her aside and expressed concern for her, but at the time she figured they were just jealous of how well she was doing. A few others started avoiding her, saying they didn't have time to talk with her, so she'd find others to talk to. In the end, the boss praised her in front of the department, and gave her credit to his superiors. She felt great. But the next week, her enthusiasm for her own business waned and seemed illogical at this point in her career, and her need for sleep returned. She notes shortly thereafter her headaches and lack of energy began. She'd like to get back to that sort of productivity. Given this new information, what seems like the current principal diagnosis for Havilah?

296.89 (F31.81) Bipolar II Disorder, current episode depressed, mild.

Rita requests to meet with the counselor at a women's shelter in Chicago. She appears a bit out of place. She is 43 and wearing clean, newish, moderately stylish clothes. Her hair is a bit disheveled and unwashed, but showing signs of highlighting and a styled cut. She says she's worried because she just found herself in the city today and didn't know what she was doing there. She approached a police officer who took her to the shelter for help. When asked where home was, she became confused and more agitated. When asked for identification, she produced a purse but said it wasn't hers. The therapist asked if this had happened before. She couldn't recall. The likely primary diagnosis for Rita would be...

300.12 (F44.0) Dissociative Amnesia, with dissociative fugue

Horatio comes to you for help. He failed his college speech course last semester because he had a panic attack during his first formal speech, had to sit down, and never returned for other class sessions. He worries that if he tries to give another speech, he will have another panic attack. Horatio's academic advisor told him has to pass the course to graduate and advised he seek counseling or other support. Horatio doesn't want to take medication for this, since he doesn't want to have to use medication in the future whenever he has to give a presentation or speech. Which is likely the most appropriate diagnosis?

300.23 (F40.10) Social Anxiety Disorder, performance only, with panic attacks.

Don was referred to you by the courts after he had been fined numerous times for being "a public nuisance." The neighbors complain he keeps dozens of cats which roam the neighborhood, fight loudly at night, and run around their yards. One neighbor alleged sometimes his house smelled of ammonia from cat urine so badly it could be smelled from the sidewalk in front of his house. When police investigated, they counted 27 cats in the house, and several roaming nearby. Although there were numerous litter boxes in the house, they were all very full, and though there were many feeding bowls, they were all empty. Several cats appeared to have scratches on their ears or necks from fights, and some looked diseased. Only a few were properly licensed. When you ask Don about what brings him to see you, he looks sad and distraught, saying, "They're taking them away, my cats. What if they don't care for them properly?" When you ask further, about why he keeps so many cats, he says, "They just come to me, and I feel awful if I turn them away. What if they have no where else to go? What if they die on a cold night or get taken to the animal shelter and are put down? I'd be at fault for it." Which of the following principal diagnoses best fits Don's presentation?

300.3 (F42) Hoarding Disorder, with poor insight.

Sam, a 25 year old Chinese-Korean-American, enters the counseling office looking downcast and fatigued, making almost no eye-contact, and saying little. The initial paperwork indicates she/her/hers are the preferred pronouns. She is dressed rather stylishly in tight jeans and a baggy, colorful V-neck sweater and muslin scarf. She states that she is currently experimenting with living fully as a woman. She reports recently she went clubbing and went home with a woman named Elissa. As they were engaged in foreplay, Elissa became aggressive, even to the point of hitting, belittling language, and demanding/forcing Sam to perform certain sexual acts. When Elissa discovered that Sam was a natal male, she further verbally abused her and forced additional degrading sexual acts, during which Sam orgasmed. As Sam prepared to leave, Elissa tossed Sam's phone back to her and told Sam to not to leave and to come back after work, suggesting there'd be repercussions if she didn't. Fearing social humiliation and aroused by Elissa's dominance, Sam returned, and has been living with Elissa the last two months. Now Sam feels she cannot win. Her family was not supportive of her transition, and cut off communication with her. Her father said, "You're no child of mine." Sam is also concerned that getting sex reassignment surgery would alter her relationship with Elissa. She is worried that the procedure will not go well, and that even after she will not be accepted at work and with her family. She reports early morning waking, loss of appetite, and recurrent thoughts of suicide with a vague plan. She is having trouble focusing at work, and her supervisor has met with her about it several times in the last few months, and is showing frustration at her frequent absences for appointments. When asked about her gender identity, Sam reports she always enjoyed, even as a child, dressing as a woman, and this continued into puberty as she experimented with her mom's clothing when her parents weren't home. She felt more herself when dressed in such a way. She denied that it was sexually arousing, but rather calming. She described herself as a "loner" in high school, not really fitting in with anyone, except a few close female friends who liked social gossip television like her. When Sam went to college, she found great acceptance and clarity in the LGBTQ communities on campus. She told her family her junior year, and they disregarded it as a passing phase brought on by "liberal education" which would soon be remedied by the "demands of real life and your first job." During college, she dated several others, and found she enjoyed "rough sex." Elissa took this to a greater degree, including asphyxiophilia. Still, Sam said she enjoyed how intense their relationship was and the attention and care Elissa gave her, and she felt sexually attracted to Elissa. Sam robustly argued that Elissa was not endangering her life nor long-term physical health. Sam is coming to therapy for help in feeling better about herself, in clarifying her identity, in her relationship with her family of origin, and improving her relationship with Elissa. With regard to cross-dressing, Sam most likely meets criteria for...

302.6 (F64.2) Gender Dysphoria

Raine, a 27-year-old South-Asian-American, was referred to you from her primary care physician after a thorough physical failed to explain pain she was experiencing around her her genitals during coitus with her husband Ronaldo. Raine states that she felt pain during their first intercourse together and it has persisted the last two years they've been together. She, though she finds Ronaldo sexually attractive and arousing, frequently avoids sex and resists his advances. She is concerned Ronaldo will get fed up and have an affair or divorce her. She says that Ronaldo has been very understanding and patient, not often pressuring her, and has been gentle the times they have had sex. Often, she asks him to stop soon after penetration and well before she reaches orgasm. Sometimes they each finish bringing each other to orgasm through direct genital stimulation. She states otherwise their relationship has been good, with him continuing to take her on dates and be romantic at times. She says she feels cherished and loved, but this dynamic is threatening to destroy what they have. Raine likely meets the diagnostic criteria for...

302.76 (F52.6) Genito-Pelvic Pain/ Penetration Disorder

Selena is a 28 year-old Chinese-American single homosexual female seeking help with sleep issues. Ever since the daylight savings time shift, she hasn't been sleeping well. For a week after "springing forward" one hour, she couldn't adjust her "internal clock" and couldn't fall asleep until an hour later than she intended. After that, she started not falling asleep until later and later instead of earlier and earlier. You ask her to walk you through her typical bedtime routine right now. She says she watches YouTube and connects via social media until around 9:30. Then she takes a shower, gets dressed for bed, and starts to read. Typically, she's wondering "Am I going to be able to sleep tonight?" She turns off the light around 10:45, and then lays there for 90 minutes, tossing and turning, dreading how being tired will affect her tomorrow, and calculating the amount of sleep she'll get if she falls asleep now. Often, after 30 minutes, she'll get up and drink a glass of wine or eat a THC edible to help her "chill" and fall asleep faster; those nights she falls asleep, but awakes not feeling refreshed, or wakes up several times a few hours later. Other times she just lays in bed until 12 or 1 when she's exhausted. The next day she wakes up at 7, feels groggy and tired, and often takes a nap over lunch break just to make it through the day. Sometimes she'll feel an irresistible urge to sleep while working at her computer or reading. You ask how it's affecting her work and relationships. She said her supervisor has noted her tiredness and impaired performance, and she isn't going out as much because she's tired. When asked, she denies any family history of the issue. What is likely the most appropriate current principal diagnosis for Selena?

307.45 (G47.21) Circadian Rhythm Sleep-Wake Disorder, delayed sleep phase type

Which of the following diagnoses is Maddie likely to meet diagnostic criteria?

312.23 (F94.0) Selective Mutism

Use the following case sketch to answer three questions below. Rose is a 12 year-old Caucasian-American female, third of five children, who is brought in by her mother for concerns regarding Rose's behavior in the last few months. Mom reports Rose frequently refuses to comply with requests from parents or teachers or coaches, was kicked off the volleyball team, has been suspended for threatening to hit two fellow students with a janitor's broom stick, is often truant, and frequently breaks her siblings things when angry. Mom reports money missing from her purse and suspects Rose. Mom denies Rose starting fires or harming animals. Mom describes Rose as "a congenital liar." Rose met developmental milestones on time, and, when engaged, does well on school work. Her teachers describe her as "bright, but troubled." Sleep and appetite are normal, though Rose likes to stay up late. Rose has withdrawn more from her usual friends and started texting a new group. Mom is surprised by this recent change in behavior, as Rose showed no such behaviors as a child. Mom thinks it might be related to her husband having to work far longer hours and tension in the home. Which of the following would likely be the principal diagnosis?

312.82 (F91.2) Conduct Disorder, Adolescent-onset type, moderate

Barbara is a 72 year old woman who comes to see you. Barbara complains of increasing anxiousness and agitation. She'd like to learn how to decrease her anxiety about what the future holds for her and her children. When you ask about the content of the worries, she says she worries about things like developing health issues and becoming a burden to her daughter Kathy (48) and Kathy's family. You ask if she has experienced symptoms or received news to evoke such concern, she says she's concerned by "brain fog." She describes it as periods where she feels "out of it" and "dull" and "loopy, like I can't focus on anything." She says sometimes she can really focus on her reading or chores or conversations, but other times she is very distractible and unaware. "My daughter says its kinda like I'm drunk, but I'm not slurring my speech or anything; I'm just kinda out of it. At other times, and sometimes at the same time, I've seen my dog Pepper, who died 12 years ago... seen her as clear as I'm seeing you, just laying on her favorite spot of the sofa. That really freaked my daughter out. I'm just getting old; that's part of it." You don't notice any physical symptoms (no tremors or changed gait). Barbara says the brain fog started getting quite noticeable about 7 months ago, and started seeing Pepper about 2 months ago. She says Kathy is starting to talk about getting in-home care for her, or having her move into Kathy's home. Barbara said that was due to some missed bills that she had spaced and burning a few meals when the brain fog distracted her and she forgot what she was doing. What is the most likely diagnosis for Barbara?

331.82 Lewy Body Disease; 294.11 (F02.81) Major Cognitive Disorder with probable Lewy Body Disease, with behavioral disturbance (anxiety, agitation), mild.

The client's symptoms do not meet full criteria for encopresis, yet the client still experiences clinically significant impairment due to inappropriate elimination of feces. The counselor chooses to specify in the diagnosis the manner in which the full criteria were not met. The counselor should diagnose...

787.60 (R15.9) Other Specified Elimination Disorder with fecal symptoms, frequency criterion not fully met (2x/3mon).

Which of the following is believed to be the most effective treatment for ADHD in children and young adolescents?

A combination of medication and parent training

Use the following case study to answer the following 3 questions. Maddie's preschool teacher consults with you as a professional counselor regarding her behavior. Maddie does well on her work (writing letters, making letter sounds, cutting, pasting, colors, coloring, etc.) is eager to please her adult instructors, and answers their questions aloud. But when it comes time to play, she "clams" up and doesn't speak. She prefers to play on her own, but will sometimes participate with peers, but still will not talk, even when they address her. Maddie does have a slight speech impediment with R's and L's and S's, but the teacher's colleagues assure her that it is developmentally appropriate and will be addressed through elementary school speech resources should it persist that long. The teacher isn't sure; she's concerned Maddie might have Autism and needs early intervention. When you ask about eye contact and how she plays with others, the teacher says she makes good eye contact and they are bright and eager when answering a teacher's question, and makes some eye contact with peers. When playing with friends, she cooperates (having her doll be part of the group's family) and shows empathy when someone gets hurt or is frustrated. When you ask about repetitive behaviors, the teacher says she hasn't noticed any other than liking to color whenever she can, and physically withdrawing when overwhelmed, usually by peers arguing or being overly assertive towards her. The teacher has expressed her general concern to Maddie's parents, but while ready to address speaking with peers, they noted she spoke with siblings fine, though without certain letter sounds. What would you say regarding her suspicion of ASD?

ASD is unlikely due to appropriate eye contact and developmentally appropriate social interactions with adults and peers (minus speaking with peers).

Current consensus thinking on Dissociative Identity Disorder is that...

Alternate "personalities" are really differing "personality states" with one shared core personality.

Parents bring their 15 year-old daughter Chloe to you, fearing an eating disorder. Her parents report that the last time she was at the doctor (two weeks ago), Chloe was 5'5' and weigh 97 pounds (BMI = 16.1). Since Chloe had not gained weight, but had gained height since her last appointment six months ago, Her doctor recommended she begin attending counseling. Chloe asserts that she is just trying to "eat clean" and "look good." She says is not hungry in the mornings, and she has veggies for lunch and eats dinner. Her parents note that they cannot track her eating at school, and that she does eat dinner, but small portions and takes a long time. They have noticed that when they have one of her favorite meals that is heavier, she will often eat a surprising amount even for them, but then goes to the bathroom. Mom suspects but has no proof that Chloe is purging. Chloe recently did not sign up for the next year of field hockey, which she had loved previously, and seems to hang out in her room nearly every day, except when she visits her friends Megan and Raya, usually on Saturdays. When you talk with Chloe about gaining weight, she becomes quiet, withdrawn, and agitated. You ask what's she thinking and feeling. She says, "If I don't eat like this, I won't be able to stop. I'll be fat. I don't see why this is a problem; Mia is a lot thinner than I am." What is likely the best diagnosis for Chloe?

Anorexia Nervosa

Six months later, Barbara's daughter Kathy comes to see you, since you know about Barbara's condition. Kathy appears tired and frustrated. She reports Kathy's hallucinations have worsened and her "brain fog" has become more frequent and severe. Kathy reports she is now needing to help Barbara with dressing, bathing, and sometimes eating. Kathy is concerned that she doesn't have the emotional energy to parent her own children well and is becoming impatient with Barbara's behaviors. Kathy has not had time for any of her usual hobbies and has not gone out with her husband in 5 months. She asks you if you could help Barbara with some behaviors, like getting and staying asleep or forgetting to take her medicine. With regard to Barbara's diagnosis, this new information suggests that...

Barbara's NCD is no longer major, mild but major, moderate.

Victor comes in for counseling because he can't loose weight. He's hoping you can coach him through a weight-loss program. He is 5'8' and weighs 240 (BMI = 36.5). He has tried various weight-loss programs: points, shakes, prepared meal plans, fad diets etc. He says the problem is that he will be good for awhile, then break from his program. You press for more detail about what "break from his program" has looked like. He says one time, he ordered an extra large pizza from Papa Johns and ate it all himself in one hour. Another time, he'd pull out the ice cream from his freeze and eat half a gallon. Another time, he went to a buffet and had four full plates. Usually after such a "break" he'll go right back to the diet, but a few days to a week later he'll do it again. Victor denies making himself vomit, using laxatives, using diuretics, using enemas, or exercising excessively. There are no physical signs that contradict his claim. What is likely the best diagnosis for Victor?

Binge-Eating Disorder, mild

The main difference between Bipolar I Disorder and Bipolar II Disorder is...

Bipolar I Disorder involves at least one manic episode while Bipolar II Disorder involves only hypomanic episodes.

A woman in her late twenties walks in asking for Sylvan. She is his daughter and is willing to talk with you. She reports having spoken with Sylvan a week ago, in which they discussed her job, the housing market, and a few other things. You ask about his substance use. She says he was always a big drinker, having several most nights. "He was a happy drunk, becoming very social and funny. He sometimes took it too far, particularly on weekends or at parties, but I rarely saw it. I think I bothered Mom pretty bad and was a key factor in why they split. He did mention last week that he was considering stopping, but I didn't think much of it. He'd said that several times before, but never did anything about it." Given this new information, what would likely be the best diagnosis for Sylvan?

F10.231 (303.90, 291.0) Severe alcohol use disorder, with acute alcohol withdrawal delirium, hyperactive.

The majority of people will develop a major neurocognitive disorder in their lifetime.

False

Should Rose also be diagnosed with co-morbid 312.32 (F63.3) Kleptomania?

No, the stealing is better explained by the principle diagnosis, since it appears to aimed at getting something rather than relieving tension from the impulse to steal.

Which of the following is TRUE regarding the diagnostic criteria for Major Depressive Disorder?

One of the symptoms must be either depressed mood or loss of interest or pleasure.

Saleema is a 32 year-old Syrian refugee, relocated to northern Chicago about 5 years ago. She comes to the agency for help with poor memory, sleep issues, and tension headaches that border on migraines. She reports having stretches of time when she cannot recall how she spent it, though she was doing something such as work or chores. She describes her sleep as unrestful, and she frequently delayed going to bed to avoid the restlessness of it. When pressed further, she states that she often awakes due to "bad dreams," at which point she zones out for about 20 seconds while the therapist explains why she's asking about dreams anyway. When asked about energy, Saleema says she always feels tired, like she doesn't have the energy she used to have yet still feels agitated and on edge though she isn't sure why. She says her tension headaches get worse when her husband is upset with her. When asked what upsets him, she looks away. The therapist sits in silence a bit, and asks if she's safe at home. She quickly says she is, and adds slowly and deliberately that she finds it hard to "be a wife to him" recently. The therapists asks how attempting to be a wife to him affects her. She says it makes her dreams worse and more frequent, that she doesn't enjoy it but operates "as if I were on autopilot, like a robot," and that sometimes she doesn't even remember what happened. When asked how long this was happening, she said it started about 4 years ago and has been getting worse recently. The therapist notes that her file stated that she had come from Syria as part of a refugee resettlement program, and asks how she came from her home in Syria to her current home. Saleema tells her story, but when she gets to the refugee camp, her story becomes less linear and the details are sparse. "It wasn't safe there. We weren't safe there," she says looking directly at the therapist. The therapist says, "It sounds like something significant happened there, but that you're not quite ready to share that right now. Am I close?" Saleema nods slightly and looks away. Which is likely the most accurate principal diagnosis for Saleema?

Post-Traumatic Stress Disorder, with depersonalization

When responding to someone in an agitated state of psychosis, which of the following is NOT advised?

Present and discuss evidence that conflicts with the delusions or hallucinations.

Which of the following is NOT something counselors can responsibly offer to someone who is struggling with a Schizophrenia spectrum disorder?

Psychodynamic therapy without medication to resolve the intrapsychic conflicts causing the disorder.

When you ask Horatio to describe his panic attack, he says his heart started to pound and race, he started to sweat, his throat constricted like he was choking, he felt light-headed, and he feared he was going to die. You ask if there were other symptoms, and he says no. He denies shaking, shortness of breath, chest pain, nausea, chilled/hot, numbness/tingling, derealization/depersonalization, or fear of loosing control. Horatio likely had a...

a full panic attack, because he does meet the required 4 symptoms.

The difference between a paraphilia and a paraphilic disorder is...

a paraphilic disorder includes clinically significant distress or impairment in oneself or one's sexual targets.

For a difficulty to be an adjustment disorder, it must...

be caused by an identifiable stressor (or set of stressors).

Use the following case to answer the following 3 questions. Havilah is a 28 year-old Russian Jewish immigrant who has live in the US since she was 8. Upon entering your office, you notice her affect flat, her movements are slow, and she is slow to talk. She complains of headaches and low energy, and was referred to you by her primary care physician. You ask about her sleep. She says she's felt tired most days, and often wakes in the middle of the night and has trouble falling back asleep. You ask about her appetite, and she says it's normal, though food doesn't taste quite a good. You ask about her mood, and she says she feels down, but attributes that to her difficulty sleeping. You ask how she thinks and feels about herself these days. She says she feels guilty for having so little energy, dreads how this will hamper her career, and states its just one more way she's failed. You ask about what she enjoys. She says, "Not much these days." You ask when these symptoms began. Havilah says, "About 6 weeks ago." You ask if she is having thoughts of killing herself, hurting herself, or dying. She says that death looks appealing at times, but that she has no intent or plan to kill herself. Which of the following questions should you ask in this assessment interview?

a. "Have you ever had a time when you needed less sleep, were especially productive, or engaged in a lot of damaging activities (like buying sprees or sexual indiscretions)?" b. "Is this the first time you've felt this way or have there been other periods in your life similar to this?" c. "Have you experienced any major losses recently, such as the passing of a loved one or loss of a job?" d. "Are you using any medications, drugs, or other substances?" e. Any and all of the above.*****

With regard to her pattern of sexual activity so clearly evidenced with Elissa, Sam most likely meets the criteria for...

a. 302.3 (F65.1) Transvestic Disorder b. 302.83 (F65.51) Sexual Masochism Disorder c. 302.84 (F65.52) Sexual Sadism Disorder d. Frotteuristic Paraphilia e. None of the above.********

How might you as a counselor help Kathy?

a. Brainstorm, research, and evaluate options for providing Barbara care that is sustainable. b. Agree to meet with Barbara to go over tips for improving procedural memory. c. Help Kathy identify and evaluate expectations and values around taking care of a senior parent with an NCD. d. Help Kathy identify local resources for caregivers, such as adult day care or in-home care. e. A, C, and/or D.*****

Which of the following is NOT a consequence of being significantly underweight?

a. Decreased heart muscle tissue, increasing chances of arrhythmias. b. Decreased bone density, increasing risk of fractures and osteoporosis. c. Increased obsessive thinking and decreased ability to concentrate. d. Social isolation due to desire for routine, avoiding eating opportunities, reduced spontaneity. e. All of these can be consequences.****

Why is the presence Autism Spectrum Disorder unlikely?

a. Rose met all developmental milestones on time, including speech. b. Rose appears to have friends and function well socially. c. Rose does not appear to have restricted interests, repetitive motor movements, or insist on routines. d. Such marked aggressiveness and truancy are not commonly associated with ASD. e. All of the above.*****

Sylvan was brought in to the Emergency Room of the hospital by the local police after his neighbors called concerned about him acting erratically in his front yard. As you approach him, you guess he is about 50 years old and notice he is a bit sloppily dressed, talking to himself, bouncing his leg vigorously, and frequently standing up and pacing the room. You introduce yourself to Sylvan and attempt to engage him in conversation. He acknowledges you but does not answer you greeting, but begins talking about Miguel showing Sylvan his rifle. There is no one else in the room. You get his attention for a moment and ask Sylvan if he knows where he is. He replies, "...Medical tent? You remind me of... There's Miguel. I hate it when he looks at me like that. He's no better shot than I am." You notice as he reaches for a cup of water that his hand is shaking. He has difficulty drinking without splashing his face with the water. At this point in the interview, what might you be considering as diagnoses to explore?

a. Schizophrenia b. Delirium c. Major Neurocognitive Disorder d. Bipolar 1 Disorder e. All of the above.****

Which of the following statements is true regarding Maddie meeting the diagnostic for Social Anxiety Disorder?

a. She expresses significant fear or anxiety about at least one social situation in which she is exposed to possible scrutiny. b. She expresses fear that her anxiety will show and others will think less of her for it. c. She avoids social situations in which she thinks she will be evaluated. d. All of the above. e. None of the above.*****

Saleema's apparent reluctance to discuss her emotions and her experiences and her focus on her physical and cognitive symptoms should be viewed as...

a. a sign of a somatic disorder, likely "not otherwise specified." b. a sign of avoidance of thinking about the traumatic experience. c. a cultural phenomenon. d. both A and B. e. both B and C.*****

When diagnosing someone displaying signs of psychosis, as with most other disorders, the clinician should consider...

a. whether the person has taken illicit drugs and is intoxicated or in withdrawal. b. whether the person is on medication or has a medical condition which is known to cause psychotic symptoms. c.whether the symptoms would be understood and accepted within the person's culture and religious tradition. d. whether the symptoms are causing clinical distress or impairment. e. all of the above.*****

Given associated features of Raine's disorder, her therapist should take extra care to ask about...

abuse and trauma history.

According to McRay, Yarhouse, and Butman, the mental health system's care for those with schizophrenia spectrum disorders...

displays significant social injustices, as even psychopharmacological care is often denied to those with sub-moderate insurance.

In the DSM-5, sex addiction...

does not have a related diagnostic category, but will likely have one in the DSM-6.

Which of the following is NOT part of the diagnostic criteria for a substance use disorder?

evidence of tolerance and withdrawal must be present.

Which of the following statements is FALSE:

individuals with Somatic Symptom Disorder have a symptom but a disproportionate response to it., individuals with a Factitious Disorder Imposed on Another truly believe the other has an illness.

Which of the following is not one of the major diagnostic criteria for Autism Spectrum Disorder?

intellectual impairment

McRay, Jones, and Butman use eating disorders as an example of a diagnosis that...

is much more frequent and resistant to treatment due to unhealthy cultural values and messages.

Britney is an 18-year-old high school senior, who comes concerned about her anxiety. She reports feeling tense, driven, and worried most of the day on most days. The object of her worries varies, though she is particularly concerned about others judging her and of being assaulted. She feels most relaxed at home in her room or hanging out with friends at their houses. The past few years, she has decreased her number of friends and her social outings. When asked about her substance use history, Britney reports "being a pot-head" her sophomore year, though now she only uses on the weekends when with friends. When pressed for the amount, she says she doesn't know, as she uses a vape pen rather than smoking joints. She does note she spends the bulk of her paycheck on cannabis-related products. She also drinks heavily on Friday and Saturday nights, usually with friends. Her parents know and supply the alcohol and supervision, asking only that they stay in the house until sober. She reports being hung over most weekend mornings, and mentions a few times she doesn't really remember what happened at the party. Britney has not had any legal issues with drinking or cannabis. She stopped playing volleyball her after her freshman year because she didn't want to be drug tested the next year. She notes that she really only enjoys hanging out with her friends who also come over to drink and use. She really looks forward to these weekend gatherings, "to get wasted." The rest of the week she goes to school and her part-time job, but not much else. Her grades have dropped and she isn't motivated to do much about it. Britney denies using other substances, though she tried LSD once and vowed never to again. Britney is moderately underweight. In discussing her eating habits, she reports that during the early part of the week, she often doesn't feel hungry and her stomach hurts. She says during those days she feels irritable, especially anxious, and difficulty falling asleep. She says she eats well over the weekends with friends, and her stomach doesn't bother her then. With regard to Britney's cannabis use, she likely...

meets criteria for 304.30 (F12.20) Cannabis Use Disorder, moderate.

With regard to her alcohol consumption, Britney likely...

meets criteria for 305.00 (F10.10) Alcohol Use Disorder, mild

Tourette's Disorder is a subtype of tic disorder that involves...

motor tics and at least one verbal tic

Given the nature of her diagnosis and its associated features, the therapist should...

screen thoroughly for co-morbid disorders, especially anxiety and substance use/abuse.

The change in from the DSM-IV's "Gender Identity Disorder" to the DSM-5's "Gender Dysphoria" reflects...

that the problem is the distress caused by the incongruence between natal gender and experienced gender, not the incongruence itself.

There are no diagnostic codes for interpersonal conflict, within a marriage or a family or otherwise; there are only Z-codes for them. Some in the mental health fields argue that this is a demonstration of...

the bias of the DSM towards individualism and the medical model.