Multiple Choice
Identify the
letter of the choice that best completes the statement or answers the question.
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1.
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Before counselors can diagnosis a Mood disorder, they must understand:
a. | Major Depressive Episodes | b. | Manic and Mixed Episodes | c. | Hypomania
Episodes | d. | All of the above |
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2.
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An episode that is characterized by abnormally elevated, expansive, or irritable
moods is a(n) ______________ Episode.
a. | Anxiety | b. | Manic | c. | Mixed | d. | Hypomanic |
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3.
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Concerning Anxiety Disorders, a brief period where the client feels intense
apprehension, fearfulness, or terror is called a(n):
a. | Panic Attack | b. | Agoraphobic Attack | c. | Anxiety
attack | d. | Panic Disorder |
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4.
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With Agoraphobia, the client is fearful of places or situations where they may
have trouble coping and:
a. | has a panic attack whenever they are at that place or involved in that
situation | b. | avoids these places or situations | c. | has a feeling of impending doom in those places
and situations | d. | become obsessed with rituals to decrease the anxiety |
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5.
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Recurrent obsessions or compulsions that are severe enough to be time consuming
or cause marked distress or impairment is characteristics of a(n) _______________ Disorder
a. | Agoraphobia | b. | Panic | c. | Obsessive Compulsive
Disorder | d. | Posttraumatic Stress |
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6.
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Generalized Anxiety Disorder:
a. | is the umbrella category for the disorders of Posttraumatic Stress Disorder, Acute
Stress Disorder, and Obsessive Compulsive disorder | b. | is similar to acute Stress Disorder except the
reactions are to more than one incident | c. | concerns a feeling of doom about numerous
places and situations | d. | involves a more generalized anxiety and worry
that tends to persist |
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7.
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All of the ____________ Disorders have the feature of the presence of physical
symptoms but these physical symptoms cannot be fully explained by a general medical condition
a. | Imitation | b. | Hypochondria | c. | Somatoform | d. | Morbid
Melancholia |
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8.
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The inability to maintain a minimally normal body weight is the central feature
of:
a. | Anorexia Nervosa | b. | Bulimia Nervosa | c. | Primary Eating
disorder | d. | Intermittent Eating Disorder |
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9.
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Bulimia Nervosa is characterized by:
a. | the inability to eat almost all types of food | b. | severely restricting
food intake and low body weight | c. | binge eating on a regular basis (e.g., twice a
week) | d. | binge eating and inappropriate compensatory behaviors to prevent weight
gain |
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10.
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Which of the following involves the development of clinically significant
symptoms in response to an identifiable psychosocial stressor(s)?
a. | Stress-related disorders | b. | Stress Alleviation
disorders | c. | Adjustment disorders | d. | V-Codes |
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11.
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In the DSM-IV, the category of other Conditions That May Be a Focus of Clinical
Attention is commonly referred to as:
a. | C-Codes | b. | V-Codes | c. | Adjustment
Disorders | d. | Relational Problems |
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12.
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A counselor typically seeing clients with issues such as parent-child relational
problems, partner relational problems, bereavement, and occupational issues would most commonly
use:
a. | Axis I codes | b. | Axis II codes | c. | Axis III
codes | d. | V-Codes |
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13.
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On which axis is maladaptive personality disorders diagnosed?
a. | Axis I | b. | Axis II | c. | Axis
III | d. | Axis IV |
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14.
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Personality Disorders are:
a. | persistent and pervasive long-term functioning difficulties | b. | an integral part of
the "self" of the client | c. | significant impairments in social and/or
occupational functioning | d. | all of the
above |
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15.
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Concerning Personality Disorders, Cluster B involves disorders with:
a. | odd and eccentric dimensions | b. | dramatic and emotional
features | c. | anxious-fearful characteristics | d. | all of the
above |
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16.
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On Axis V, the clinician reports:
a. | the amount of time expected for treatment | b. | the client's
general medical condition | c. | the client's overall functioning level
using the GAF | d. | V-Codes |
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17.
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Which of the following is best described by phobias
involving flying, escalators, and bridges, and usually begins in one's middle
twenties:
a. | natural environmental type | b. | animal type | c. | blood-injection injury
type | d. | situational type |
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18.
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Repeated mood swings, not severe enough to be considered with Major Depressive
or Manic Episodes and present for at least two years is consistent with an Axis I diagnosis
of:
a. | Bipolar I Disorder | b. | Bipolar II Disorder | c. | Dysthymic
Disorder | d. | Cyclothymic Disorder |
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19.
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During the completion of a mental status examination, which of the following
might be used as indicators of mood: I
Hygiene
II Hallucinations
III
Short term memory
IV
Depersonalization a. | I only | b. | II, III | c. | I,
III | d. | I, II, IV |
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20.
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A diagnosis of Bipolar I Disorder will be consistent with which of the
following: I A
concurrent diagnosis of Schizoaffective Disorder
II At least one
Manic Episode
III A concurrent Axis III
diagnosis
IV Unremitting Dysthymia a. | II only | b. | I, IV | c. | II,
III | d. | None of the above |
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21.
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An Axis I diagnosis of Major Depressive Disorder should not be made without
serious consideration when symptoms are observed in the presence of the following: I.
Bereavement
II. General medical
conditions
III. Substance Abuse
IV.
Mild mental retardation a. | I only | b. | II, III | c. | III,
IV | d. | I, II, & III |
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22.
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A lasting pattern of behavior and inner experiences that markedly deviates from
norms of the patient's culture most accurately describes:
a. | An Axis I diagnosis of a Mood Disorder | b. | An Axis II diagnosis of a Personality
Disorder | c. | An Axis III diagnosis of Hypoglycemia | d. | An Axis diagnosis cannot be established from
the above definition |
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23.
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If the patient has psychotic symptoms that only occur in the presence of the
mood symptoms, the diagnosis is:
a. | Major Depressive Disorder | b. | Depressive Disorder NOS | c. | Bipolar I
Disorder | d. | Bipolar Disorder NOS |
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24.
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Which of the following are considered components associated with antisocial
personality disorder.
I
Deceitfulness
II Suicidal
ideation
III
Irritability/Aggressively
IV Lack of Remorse a. | I, II | b. | II, III, IV | c. | I, II, III,
IV | d. | I, III, IV |
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25.
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Senseless repeated thoughts and behaviors usually chronic and debilitating and
beginning in the teens would be consistent with a
a. | Axis I diagnosis Major Depressive Disorder | b. | Axis II diagnosis of
Narcissistic Personality Disorder | c. | Axis I diagnosis of Generalized Anxiety
Disorder, Principal Disorder | d. | Axis I diagnosis of Obsessive Compulsive
Disorder |
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26.
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When giving the diagnosis of Intermittent Explosive Disorder, which of the
following does the DSM-IV-TR state specifically must be ruled out:
a. | antisocial personality disorder | b. | borderline personality
disorder | c. | psychotic disorders | d. | all of the
above |
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27.
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Which of the following is NOT one of the criteria for Sleep Terror
Disorder:
a. | On numerous occasions, the client awakens abruptly, usually during the third sleep
phase and usually beginning with a scream of panic | b. | The client cannot recall any dream in detail at
the time and cannot recall the whole episode later | c. | The client quickly becomes alert and oriented
upon wakening | d. | During the episode, the client responds poorly to the efforts of others to provide
comfort |
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28.
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If an individual has been worried (non-delusional) that he is seriously ill for
more than 6 months despite medical reassurance to the contrary, you would consider the diagnosis
of
a. | Conversion Disorder | b. | Hypochondriasis | c. | Undifferentiated
Somatoform Disorder | d. | Insufficient information to make
diagnosis |
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29.
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Maladaptive personality behaviors run along a continuum of normalcy. Which of
the following behaviors are abnormal whenever they occur: I.
envy of others
II.
suggestibility
III. suicidal
behavior
IV. reckless disregard for
safety
V. suspiciousness a. | I, II, III | b. | II, III, IV, V | c. | III,
IV | d. | III, IV, V |
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30.
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People with this type of Adjustment Disorder may have feelings of hopelessness,
nervousness, sadness and may worry or cry a lot or experience jitteriness:
a. | Adjustment Disorder with depressed mood | b. | Adjustment Disorder
with anxiety | c. | Adjustment Disorder with disturbance of conduct | d. | Adjustment Disorder
with mixed anxiety and depressed mood |
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31.
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Adjustment Disorders are considered_________ if they have lasted less than______
months and considered______ if they have lasted more than________ months.
a. | acute, 6 months; chronic, 6 months | b. | chronic, 6 months; acute, 6
months | c. | acute, 6 months; chronic, 3 months | d. | chronic, 3 months; acute, 6
months |
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32.
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The diagnosis of Dyspareunia in a woman cannot be made if the disturbance is
caused exclusively by
a. | pain before sexual intercourse | b. | a lack of vaginal
lubrication | c. | pain after sexual intercourse | d. | thinking about having sexual
intercourse |
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33.
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Which of the following is/are disorder(s) of the object of
sexuality: I
Exhibitionism
II Pedophilia
III
Sexual Masochism
IV Transvestic
Fetishism
V Vaginismus a. | I, II, III | b. | II, III, IV | c. | II, IV,
V | d. | I, II, III, IV |
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34.
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The normal sexual cycle includes four phases. Which one of the following lists
these stages in their correct developmental order:
a. | desire, excitement, orgasm, resolution | b. | excitement, desire, orgasm,
resolution | c. | excitement, orgasm, desire, resolution | d. | none of the
above |
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35.
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These patients make up symptoms for the purpose of assuming a sick role. They do
not appear to have material gain in mind.
a. | Malingering | b. | Conversion Disorder | c. | Factitious
Disorder | d. | Somatization Disorder |
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36.
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If you noted that your client frequently uses defense
mechanisms, you may note this on
a. | Axis I | b. | Axis
II | c. | Axis IV | d. | Axis
V |
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37.
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People with Cluster C personality disorders tend to
be
a. | withdrawn, cold, suspicious | b. | irrational and dramatic | c. | tense, and often
over-controlled | d. | emotional,
attention-seeking |
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38.
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Hypersomnia is
I noted in clients who
sleep too much
II drowsiness at a time when the client should be
alert
III noted in clients who sleep too
little
IV may be included in the criteria for Major Depressive
Episode
a. | I only | b. | II, III,
IV | c. | I, II, IV | d. | II
only |
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39.
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Anthony recently developed chest pain and discomfort 2 weeks
after the death of his father from a heart attack. He has no signs of abnormal cardiac function. What
diagnosis(es), if any, should Anthony receive:
a. | Hypochondriasis | b. | Facticious Disorder | c. | Adjustment Disorder due to
grief | d. | Acute Pain Disorder associated with Psychological
Factors |
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40.
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The diagnosis of Somatization Disorder requires a history of
pain in at least ____ sites or functions.
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41.
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The following is necessary or useful clinical information about Factitious
Disorders. I Multiple surgical
scars, especially on the abdomen
II Experienced a serious illness as
a child
III Evidence that client is lying about some part of his/her
history
IV Repeated tests and evaluations yield no identifiable
cause for the symptoms
V History of several previous inconclusive
hospitalizations a. | I, II | b. | II, III, IV, V | c. | II, III,
V | d. | I, II, III, IV, V |
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42.
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The diagnostic criteria for Paraphilias require that the individual
a. | have intense sexual urges | b. | have sexually arousing
fantasies | c. | fantasies are markedly distressing | d. | all of the
above |
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43.
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Hank is a 31-year-old man who likes to begin sexual relations with his wife by
sneaking up on her and then exposing himself. She looks at his penis and responds with mock awe
saying. "Oh my God, it's so big!" The couple then has sexual intercourse. What
diagnosis would you give Hank?
a. | Exhibitionism | b. | Sexual Sadism | c. | Hypersexual Fantasy
Disorder | d. | None, as this appears to be within the realm of normal sexual
activity |
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44.
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The symptoms of Adjustment Disorder must occur within _____ months of the onset
of a stressor
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45.
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If the client's most prominent symptoms are grandiosity, a sense of
entitlement, a need for excessive admiration, exploitation of others, consider a diagnosis of
a. | Borderline Personality Disorder | b. | Histrionic Personality
Disorder | c. | Narcissistic Personality Disorder | d. | Schizotypal Personality
Disorder |
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46.
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Which of the following is not an area of uncertainty in the diagnosis of
Personality Disorders:
a. | some clients have significant personality traits but don't quite fit the full
criteria | b. | symptoms of various disorders often overlap | c. | many behaviors and
thoughts characteristic of specific personality disorder may also be seen in Axis I
disorders | d. | all of above |
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47.
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Which of the following is a classical conversion symptom:
a. | stuttering | b. | sexual dysfunction | c. | hypersomnia | d. | pain |
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48.
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What is the first step in formulating a rational diagnosis:
a. | try to explain all the symptoms with the fewest diagnoses
possible | b. | consider first disorders that have been present longer | c. | rule out general
medical, cognitive disorders and substance abuse | d. | obtaining a thorough family
history |
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49.
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For a Major Depressive Episode, how long must a client be in a depressed mood or
have lost interest or pleasure in nearly all activities?
a. | two weeks | b. | one month | c. | two
months | d. | six months |
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50.
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The difference between a Hypomanic Episode and a Manic Episode is:
a. | the Hypomanic Episode is more intense and lasts longer | b. | there is more
delusion in the Hypomanic episode as compared to the Manic Episode | c. | the Hypomanic
Episode only has to last four days as compared to a week for a Manic Episode | d. | the Hypomanic
Episode has periods of depression while the Manic Episode does not |
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Short Answer
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51.
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Mr. Z is a 45-year-old married business
administrator who is admitted to a psychiatric unit at a teaching hospital for evaluation. He has had
two psychiatric hospitalizations elsewhere for depression and suicidal ideation during the preceding
2 years. At the time of this admission, as in his earlier admissions, he denies having any
psychiatric illness but claims that he is dying from a mysterious disease of aging that no one has
been able to diagnose. His admission complaints include, “I'm dying'”
"I'm mentally retarded," "I'm going blind," "My bowels are shut
down," "My skin is coming off in clumps,”, and "I'm losing my hair."
During the 2 weeks before this admission, Mr. Z has spent most of his time lying in bed
("because of his illness") and has refused to go to work or participate in his
family's life in any way. His wife reports that his mood has been persistently gloomy and
pessimistic and that he has frequently become irritable with her when she suggested possible courses
of action that might be helpful to him.
According to his wife, throughout their marriage Mr. Z has
always fluctuated between periods of dejection and depression in which he seems to have a hard tine
doing anything and sudden bursts of excessive energy that usually last from a few days to several
weeks. During his energetic periods, he stays late at work, often keeping several secretaries busy
with his productivity. He also plunges into volunteer activities -- most recently, writing speeches
for local politicians -- and designs and begins elaborate exercise programs. During some of these
episodes, Mr. Z has suddenly announced that he has planned an exotic and elaborate family vacation
for which they are to leave almost immediately. Although his wife and daughter always agree to
accompany him on these daunts, he vacations at such a vigorous pace -- mountain climbing in Europe or
scuba diving in the Caribbean - -that his family struggles unsuccessfully to keep up with him. It was
after returning from one of these whirlwind excursions that Mr. Z impulsively bought an expensive
piece of land because it was similar to an Austrian farm he had admired. Mr. Z's wife estimates
that he has five or six of these energetic episodes a year, each lasting between 3 days and 2 weeks.
She also reports that this pattern of behavior was already established when she first met Mr. Z in
college. He did fairly well in school but would fluctuate between irritable "glum"
periods, when he would sleep in and miss classes, and marathon 2-or 3-day study binges.
Mr.
Z's wife says that his brief bursts of energy tend to vanish as suddenly as they come and that
Mr. Z then lets his projects lapse, often becoming gloomy and pessimistic about them. Beginning when
he was 32 years old, Mr. Z has been treated on four occasions for a full Major Depressive Episode,
each of which lasted approximately 4 to 5 months. He was hospitalized for two of these episodes in
the past 2 years, on one occasion following a serious car accident that was judged to be a suicide
attempt, although he denied this.
His wife reports that his severe depressions have always
occurred in the fall and winter, whereas his really energetic periods have been especially common in
spring and summer. She says that she has come to dread the winter, which she associates with the
possibility of her husband having yet another depressive episode.
When questioned about his
energetic periods, Mr. Z says that, although he realizes that he sometimes goes too far and loses
control, he much prefers these times because he feels so intensely alive, has so much fun, and
accomplishes so much. He says that he can remember having such brief bursts of productivity since he
was in his early teens or even earlier and that he has always been a flighty person whose moods
fluctuate quickly.
What is/are the Axis I
diagnosis(es)?
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52.
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What is/are the Axis II Diagnosis(es)?
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53.
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What is/are the Axis III diagnosis(es)?
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54.
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What are the Axis IV diagnosis(es)?
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55.
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What is the Axis V diagnosis?
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56.
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Marvin, a 35-year-old journalist, went to his
internist because of fatigue, sore throat, and headaches. These symptoms had developed 3 months
earlier, a few weeks after he learned that he was positive for the human immunodeficiency virus
(i.e.. his blood test indicated the presence of anti-bodies to HIV). He was given a complete physical
examination and was told that he was in otherwise good health, except for mild allergies
that accounted for his sore throat, and that the results of the routine laboratory examinations of
blood and urine were all negative. Nevertheless, he worried that his symptoms of fatigue, sore
throat, and headaches might he the prodrome of acquired immunodeficiency syndrome (AIDS). He began to
have frequent and intrusive thoughts about dying and had recurrent fantasies of cancerous
disfigurement, protracted illness, and complete dependence on others. Having followed the news
coverage about AIDS, he understood that a positive test did not indicate that he would necessarily
get AIDS, but this did not prevent him from ruminating about a painful and prolonged death. His
internist suggested that he see a psychiatrist.
Marvin describes his physical symptoms to the
psychiatrist and relates them to his constant and increasing anxiety. He says that he is now having
trouble concentrating at work. He has begun to question the value of his career compared with the
pursuit of other interests. He has become increasingly concerned about the possible debilitating
effects of job-related stress and worries that such stress may itself compromise his immune system.
He contemplates quitting his job and retiring to his country home, where life would be
simpler.
Last week his anxiety escalated when he heard that two acquaintances had recently
been diagnosed as having AIDS. He now finds that he avoids reading anything in the newspaper about
AIDS and being in any social situations in which this topic is likely to be
discussed.
When he is in a
situation that takes his mind off his problems, such as an engrossing movie or concert, Marvin can
experience pleasure. His appetite and sleep has remained unchanged except for the recurrence of a
nightmare in which he has a mysterious illness and is left alone to die in a hospital.
Marvin
has never sought psychiatric help before and says that until now he always regarded himself as a
happy person, proud of his professional achievements and fulfilled in his long-term relationship with
his male lover. He hopes that therapy will help reduce "stress," which will "help my
immune system fight off AIDS."
What is/are the Axis I Diagnosis(es)?
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57.
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What is/are the Axis II Diagnosis(es)?
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58.
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What is/are the Axis III Diagnosis(es)?
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59.
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What is/are the Axis IV Diagnosis(es)?
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60.
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What is/are the Axis VDiagnosis(es)?
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61.
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Mr. Y, a
30-year-old married real estate investment company owner, goes to a local outpatient psychiatric
clinic saying that he "is on the verge of a nervous breakdown." He reports that he has
always been a "worrier" but not to the extent that his life was affected in any noticeable
way. However, over the past year he has been experiencing a "tweaked" feeling of inner
agitation and "stays keyed up" most of the time. Mr. Y has frequently complained of stomach
upsets and diarrhea over the past 6 months as well as a decreased ability to concentrate at work. His
wife, an attractive and well-educated woman in her mid-20s, accompanies her husband to the clinic and
says that he tosses and turns in bed until about 2 or 3 A.-M. and frequently gets up to urinate. She
goes on to complain that her husband has gotten very irritable in the past 6-8 months and frequently
yells at people, even at their 5-year-old daughter.
The oldest and only male in a family of
four children, Mr. Y is from an affluent and well-educated family steeped in tradition. His father,
grandfather, and several other men in the family attended the same northeastern Ivy League
university. Mr. Y felt compelled to continue this tradition, but he was apprehensive that his
academic skills were not refined enough, although he was in the 90th percentile of his graduating
class. Once he was accepted to this prestigious university, he began to feel the pressure to perform
exceedingly well. Despite experiencing tremendous anxiety and tension around exam time, Mr. Y
graduated from the university with distinction. While in college, Mr. Y began dating his wife and
recalls that he would worry for days about whether he had picked the right restaurant for the date,
whether he had selected the right flowers, or whether his car, which had recently undergone a minor
repair, would break down on the date. He notes that although he worried a lot about something or
other not working right, he never had difficulty asking women out on dates or having them accept. He
describes himself as driven and generally on the extroverted side.
Three years before the
current evaluation, Mr. Y's parents separated and his real estate investment company came close
to bankruptcy. Although he has been successful at gradually rebuilding the company over the ensuing
years and "getting his feet back on the ground," he has been unable to suppress his
nervousness and tension. At night, he lays awake staring at the ceiling and worrying about routine
work issues, what the future holds for him, and how he would support himself and his family if his
company went bankrupt. It makes him sick to his stomach to think about losing his business and not
having health insurance to cover the allergy shots his daughter needs. Mr. Y went to see an internist
and a gastroenterologist, but his exams were normal and his symptoms were thought to be "anxiety
related." He calms himself down occasionally with a beer or two but denies any alcohol-related
problems. He tried cocaine a couple of times in his early 20s but did not like the feeling and denies
using any other street drugs. He feels sad but denies feelings of worthlessness or suicidal
thoughts.
What is/sre
the Axis I Diagnosis(es)?
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62.
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What is/sre the Axis II Diagnosis(es)?
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63.
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What is/sre the Axis III Diagnosis(es)?
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64.
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What is/sre the Axis IV Diagnosis(es)?
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65.
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What is/sre the Axis V Diagnosis(es)?
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66.
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Lois Pitman was admitted to a psychiatric unit in a
university hospital because she was depressed and suicidal. She is a divorced 41-year-old African
American mother of three adolescents. She says she has been using an increasing amount of cocaine in
the preceding weeks, because cocaine makes her "feel numb so that nothing matters." This
escalation in drug use and thoughts of suicide coincided with an investigation of the family by child
protective services, initiated after Ms. Pitman's older daughter made charges of sexual
molestation against her mother's live-in boyfriend. The boyfriend denied the charges. Ms. Pitman
was devastated by the accusation and unsure about whom to believe. She did not understand how her
boyfriend could have done such a thing.
Although she is a
registered nurse, Ms. Pitman's license was suspended 5 years ago because of drug use, and she
has been unemployed since then. She has completed a number of drug treatment programs, but has been
unable to stay sober. She has had a series of stormy relationships with boyfriends. The family lives
in a neighborhood characterized by frequent violence and heavy drug trafficking. Ms. Pitman has been
mugged several times and nearly raped on several other occasions. Her son was once grazed by a bullet
as a result of a "drive-by" shooting.
In
addition to two previous hospitalizations precipitated by suicide threats, Ms. Pitman has an
extensive history of outpatient treatment with a variety of therapists. She has often been
noncompliant with treatment recommendations, frequently “acted out” strong feelings
toward her therapists with suicide gestures and sexual promiscuity, and repeatedly abused substances.
Various therapists have described her as "untrusting, bordering on paranoid, hostile, and
dependent.”
Over the course of several years, Ms.
Pitman has reported myriad symptoms and has been given a variety of diagnoses by different
therapists. She has described frequent episodes characterized by sad and irritable mood, sleep
disturbance (difficulty falling asleep, awakening frequently during the night), weight loss, loss of
interest and pleasure, decreased energy, restlessness, free-floating anxiety, low self-esteem, and a
sense of futility, guilty ruminations, a number of somatic complaints, and frequent suicide attempts,
usually with the expectation of rescue.
On some occasions she has reported feeling
"paranoid" and having the sensation that her vaginal area was emitting a foul odor.
Throughout this time his, Ms. Pitman has abused a variety of drugs. Until a year ago she had used
benzodiazepines, alcohol, and cocaine indiscriminately. For the past year, she has used only
cocaine.
A wide range of medications has been prescribed,
including antidepressants, anxioltitics, and, occasionally, neuroleptics, without any significant
benefits. During her last hospitalization, Ms. Pitman was described as particularly difficult. She
hurled racial epithets at the staff and precipitated an explosion of racial tensions on the ward. She
would speak only to African American personnel and would dismiss suggestions made by white
clinicians.
Several weeks
into the current hospitalization, Ms. Pitman began having intense flashbacks of being sexually abused
by her father. She admitted having had flashbacks of sexual abuse in the Past, but had not told
anyone about them because she felt "no one would believe" her. She eventually reported that
this abuse began when she was age 7 and ended shortly after she began to menstruate, when she was age
12.
What is/are the Axis I Diagnosis(es)?
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67.
|
What is/are the Axis II
Diagnosis(es)?
|
|
|
68.
|
What is/are the Axis III
Diagnosis(es)?
|
|
|
69.
|
What is/are the Axis IV
Diagnosis(es)?
|
|
|
70.
|
What is/are the Axis V
Diagnosis(es)?
|