DSM-5 Self Exam Question PDF

**DSM-5 Introduction** I.1 DSM-IV employed a multiaxial diagnostic system. Which of the following statements best describes the multiaxial system in DSM-5? A. There is a different multiaxial system in DSM-5. B. The multiaxial system in DSM-IV has been retained in DSM-5. C. DSM-5 has moved to a no...

**DSM-5 Introduction** I.1 DSM-IV employed a multiaxial diagnostic system. Which of the following statements best describes the multiaxial system in DSM-5? A. There is a different multiaxial system in DSM-5. B. The multiaxial system in DSM-IV has been retained in DSM-5. C. DSM-5 has moved to a nonaxial documentation of diagnosis. D. Axis I (Clinical Disorders) and Axis II (Personality Disorders) have been re tained in DSM-5. E. Axis IV (Psychosocial and Environmental Problems) and Axis V (Global Assessment of Functioning) have been retained in DSM-5. I.2 True or False: The Global Assessment of Functioning (GAF) Scale (DSM-IV Axis V) remains a separate category that should be coded in DSM-5. A. True. B. False. I.3 To enhance diagnostic specificity, DSM-5 replaced the previous "not otherwise specified" (NOS) designation with two options for clinical use: Other Specified \[disorder\] and Unspecified \[disorder\]. Which of the following statements about use of the Unspecified designation is *true?* A. The Unspecified designation is used when the clinician chooses not to spec ify the reason that criteria for a specific disorder were not met. B. The Unspecified designation is used when there is no recognized Other Specified disorder (e.g., recurrent brief depression, sexual aversion). C. The Unspecified designation is used when the individual has fewer than three symptoms of any of the recognized disorders within the diagnostic class. D. The Unspecified designation is used when the individual presents with symptomatology of disorders in two or more diagnostic classes. E. The Unspecified designation is used when the clinician believes the condi tion is of a temporary nature. 2 **\|** DSM-5 Introduction---QUESTIONS CHAPTER 1 Neurodevelopmental Disorders 1.1 Which of the following is *not* required for a DSM-5 diagnosis of intellectual dis ability (intellectual developmental disorder)? A. Full-scale IQ below 70. B. Deficits in intellectual functions confirmed by clinical assessment. C. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social respon sibility. D. Symptom onset during the developmental period. E. Deficits in intellectual functions confirmed by individualized, standardized intelligence testing. 1.2 A 7-year-old boy in second grade displays significant delays in his ability to reason, solve problems, and learn from his experiences. He has been slow to develop reading, writing, and mathematics skills in school. All through devel opment, these skills lagged behind peers, although he is making slow progress. These deficits significantly impair his ability to play in an age-appropriate manner with peers and to begin to acquire independent skills at home. He re quires ongoing assistance with basic skills (dressing, feeding, and bathing him self; doing any type of schoolwork) on a daily basis. Which of the following diagnoses best fits this presentation? A. Childhood-onset major neurocognitive disorder. B. Specific learning disorder. C. Intellectual disability (intellectual developmental disorder). D. Communication disorder. E. Autism spectrum disorder. 1.3 A 7-year-old boy in second grade displays significant delays in his ability to reason, solve problems, and learn from his experiences. He has been slow to develop reading, writing, and mathematics skills in school. All through development, these skills lagged behind peers, although he is making slow progress. These deficits significantly impair his ability to play in an age-appropriate manner with peers and to begin to acquire independent skills at home. He re quires ongoing assistance with basic skills (dressing, feeding, and bathing himself; doing any type of schoolwork) on a daily basis. What is the appropriate severity rating for this patient's current presentation? A. Mild. B. Moderate. C. Severe. D. Profound. E. Cannot be determined without an IQ score. 1.4 Which of the following statements about intellectual disability (intellectual de velopmental disorder) is *false?* A. Individuals with intellectual disability have deficits in general mental abil ities and impairment in everyday adaptive functioning compared with age and gender-matched peers from the same linguistic and sociocultural group. B. For individuals with intellectual disability, the full-scale IQ score is a valid assessment of overall mental abilities and adaptive functioning, even if sub test scores are highly discrepant. C. Individuals with intellectual disability may have difficulty in managing their behavior, emotions, and interpersonal relationships and in maintain ing motivation in the learning process. D. Intellectual disability is generally associated with an IQ that is 2 standard deviations from the population mean, which equates to an IQ score of about 70 or below (ρ5 points). E. Assessment procedures for intellectual disability must take into account factors that may limit performance, such as sociocultural background, na tive language, associated communication/language disorder, and motor or sensory handicap. 1.5 Which of the following statements about the diagnosis of intellectual disability (intellectual developmental disorder) is *false?* A. An individual with an IQ of less than 70 would receive the diagnosis if there were no significant deficits in adaptive functioning. B. An individual with an IQ above 75 would not meet diagnostic criteria even if there were impairments in adaptive functioning. C. In forensic assessment, severe deficits in adaptive functioning might allow for a diagnosis with an IQ above 75. D. Adaptive functioning must take into account the three domains of concep tual, social, and practical functioning. E. The specifiers mild, moderate, severe, and profound are based on IQ scores. 1.6 Which of the following is *not* a diagnostic feature of intellectual disability (in tellectual developmental disorder)? A. A full-scale IQ of less than 70. B. Inability to perform complex daily living tasks (e.g., money management, medical decision making) without support. 4 **\|** Neurodevelopmental Disorders---QUESTIONS C. Gullibility, with naiveté in social situations and a tendency to be easily led by others. D. Lack of age-appropriate communication skills for social and interpersonal functioning. E. All of the above are diagnostic features of intellectual disability. 1.7 Which of the following statements about adaptive functioning in the diagnosis of intellectual disability (intellectual developmental disorder) is *true?* A. Adaptive functioning is based on an individual's IQ score. B. "Deficits in adaptive functioning" refers to problems with motor coordina tion. C. At least two domains of adaptive functioning must be impaired to meet Cri terion B for the diagnosis of intellectual disability. D. Adaptive functioning in intellectual disability tends to improve over time, although the threshold of cognitive capacities and associated developmen tal disorders can limit it. E. Individuals diagnosed with intellectual disability in childhood will typi cally continue to meet criteria in adulthood even if their adaptive function ing improves. 1.8 Which of the following statements about development of and risk factors for intellectual disability (intellectual developmental disorder) is *true?* A. Intellectual developmental disorder should not be diagnosed in the pres ence of a known genetic syndrome, such as Lesch-Nyhan or Prader-Willi syndrome. B. Etiologies are confined to perinatal and postnatal factors and exclude pre natal events. C. In severe acquired forms of intellectual developmental disorder, onset may be abrupt following an illness (e.g., meningitis) or head trauma occurring during the developmental period. D. When intellectual disability results from a loss of previously acquired cog nitive skills, as in severe traumatic brain injury (TBI), only the TBI diagnosis is assigned. E. Prenatal, perinatal, and postnatal etiologies of intellectual developmental disorder are demonstrable in approximately 33% of cases. 1.9 Which of the following statements about the developmental course of intellec tual disability (intellectual developmental disorder) is *true?* A. Delayed motor, language, and social milestones are not identifiable until af ter the first 2 years of life. B. Intellectual disability caused by an illness (e.g., encephalitis) or by head trauma occurring during the developmental period would be diagnosed as Neurodevelopmental Disorders---QUESTIONS **\|** 5 a neurocognitive disorder, not as intellectual disability (intellectual devel opmental disorder). C. Intellectual disability is always nonprogressive. D. Major neurocognitive disorder may co-occur with intellectual developmen tal disorder. E. Even if early and ongoing interventions throughout childhood and adult hood lead to improved adaptive and intellectual functioning, the diagnosis of intellectual disability would continue to apply. 1.10 The DSM-5 diagnosis of intellectual developmental disorder includes severity specifiers---Mild, Moderate, Severe, and Profound---with which to indicate the level of supports required in various domains of adaptive functioning. Which of the following features would *not* be characteristic of an individual with a "Severe" level of impairment? A. The individual generally has little understanding of written language or of concepts involving numbers, quantity, time, and money. B. The individual's spoken language is quite limited in terms of vocabulary and grammar. C. The individual requires support for all activities of daily living, including meals, dressing, bathing, and toileting. D. In adulthood, the individual may be able to sustain competitive employ ment in a job that does not emphasize conceptual skills. E. The individual cannot make responsible decisions regarding the well-being of self or others. 1.11 A 10-year-old boy with a history of dyslexia, who is otherwise developmen tally normal, is in a skateboarding accident in which he experiences severe traumatic brain injury. This results in significant global intellectual impairment (with a persistent reading deficit that is more pronounced than his other newly acquired but stable deficits, along with a full-scale IQ of 75). There is mild im pairment in his adaptive functioning such that he requires support in some ar eas of functioning. He is also displaying anxious and depressive symptoms in response to his accident and hospitalization. What is the *least likely* diagnosis? A. Intellectual disability (intellectual developmental disorder). B. Traumatic brain injury. C. Specific learning disorder. D. Major neurocognitive disorder due to traumatic brain injury. E. Adjustment disorder. 1.12 In which of the following situations would a diagnosis of global developmen tal delay be *inappropriate?* A. The patient is a child who is too young to fully manifest specific symptoms or to complete requisite assessments. 6 **\|** Neurodevelopmental Disorders---QUESTIONS B. The patient, a 7-year-old boy, has a full-scale IQ of 65 and severe impair ment in adaptive functioning. C. The patient's scores on psychometric tests suggest intellectual disability (in tellectual developmental disorder), but there is insufficient information about the patient's adaptive functional skills. D. The patient's impaired adaptive functioning suggests intellectual develop mental disorder, but there is insufficient information about the level of cog nitive impairment measured by standardized instruments. E. The patient's cognitive and adaptive impairments suggest intellectual de velopmental disorder, but there is insufficient information about age at on set of the condition. 1.13 Which of the following statements about global developmental delay is *true?* A. The diagnosis is typically made in children younger than 5 years of age. B. The etiology can usually be determined. C. The prevalence is estimated to be between 0.5% and 2%. D. The condition is progressive. E. The condition does not generally occur with other neurodevelopmental dis orders. 1.14 A 3½-year-old girl with a history of lead exposure and a seizure disorder dem onstrates substantial delays across multiple domains of functioning, including communication, learning, attention, and motor development, which limit her ability to interact with same-age peers and require substantial support in all ac tivities of daily living at home. Unfortunately, her mother is an extremely poor historian, and the child has received no formal psychological or learning eval uation to date. She is about to be evaluated for readiness to attend preschool. What is the most appropriate diagnosis? A. Major neurocognitive disorder. B. Developmental coordination disorder. C. Autism spectrum disorder. D. Global developmental delay. E. Specific learning disorder. 1.15 A 5-year-old boy has difficulty making friends and problems with initiating and sustaining back-and-forth conversation; reading social cues; and sharing his feelings with others. He makes good eye contact, has normal speech into nation, displays facial gestures, and has a range of affect that generally seems appropriate to the situation. He demonstrates an interest in trains that seems abnormal in intensity and focus, and he engages in little imaginative or sym bolic play. Which of the following diagnostic requirements for autism spec trum disorder are *not* met in this case? Neurodevelopmental Disorders---QUESTIONS **\|** 7 A. Deficits in social-emotional reciprocity. B. Deficits in nonverbal communicative behaviors used for social interaction. C. Deficits in developing and maintaining relationships. D. Restricted, repetitive patterns of behavior, interests, or activities as mani fested by symptoms in two of the specified four categories. E. Symptoms with onset in early childhood that cause clinically significant impairment. 1.16 Which of the following statements about the development and course of au tism spectrum disorder (ASD) is *false?* A. Symptoms of ASD are typically recognized during the second year of life (12--24 months of age). B. Symptoms of ASD are usually not noticeable until 5--6 years of age or later. C. First symptoms frequently involve delayed language development, often accompanied by lack of social interest or unusual social interactions. D. ASD is not a degenerative disorder, and it is typical for learning and com pensation to continue throughout life. E. Because many normally developing young children have strong prefer ences and enjoy repetition, distinguishing restricted and repetitive behav iors that are diagnostic of ASD can be difficult in preschoolers. 1.17 Which of the following was a criterion symptom for autistic disorder in DSM IV that was eliminated from the diagnostic criteria for autism spectrum disor der in DSM-5? A. Stereotyped or restricted patterns of interest. B. Stereotyped and repetitive motor mannerisms. C. Inflexible adherence to routines. D. Persistent preoccupation with parts of objects. E. None of the above. 1.18 A 7-year-old girl presents with a history of normal language skills (vocabulary and grammar intact) but is unable to use language in a socially pragmatic man ner to share ideas and feelings. She has never made good eye contact, and she has difficulty reading social cues. Consequently, she has had difficulty making friends, which is further complicated by her being somewhat obsessed with cartoon characters, which she repetitively scripts. She tends to excessively smell objects. Because she insists on wearing the same shirt and shorts every day, regardless of the season, getting dressed is a difficult activity. These symp toms date from early childhood and cause significant impairment in her func tioning. What diagnosis best fits this child's presentation? A. Asperger's disorder. B. Autism spectrum disorder. C. Pervasive developmental disorder not otherwise specified (NOS). 8 **\|** Neurodevelopmental Disorders---QUESTIONS D. Social (pragmatic) communication disorder. E. Rett syndrome. 1.19 A 15-year-old boy has a long history of nonverbal communication deficits. As an infant he was unable to follow someone else directing his attention by point ing. As a toddler he was not interested in sharing events, feelings, or games with his parents. From school age into adolescence, his speech was odd in to nality and phrasing, and his body language was awkward. What do these symptoms represent? A. Stereotypies. B. Restricted range of interests. C. Developmental regression. D. Prodromal schizophreniform symptoms. E. Deficits in nonverbal communicative behaviors. 1.20 A 10-year-old boy demonstrates hand-flapping and finger flicking, and he re petitively flips coins and lines up his trucks. He tends to "echo" the last several words of a question posed to him before answering, mixes up his pronouns (re fers to himself in the second person), tends to repeat phrases in a perseverative fashion, and is quite fixated on routines related to dress, eating, travel, and play. He spends hours in his garage playing with his father's tools. What do these behaviors represent? A. Restricted, repetitive patterns of behaviors, interests, or activities character istic of autism spectrum disorder. B. Symptoms of obsessive-compulsive disorder. C. Prototypical manifestations of obsessive-compulsive personality. D. Symptoms of pediatric acute-onset neuropsychiatric syndrome (PANS). E. Complex tics. 1.21 A 25-year-old man presents with long-standing nonverbal communication deficits, inability to have a back-and-forth conversation or share interests in an appropriate fashion, and a complete lack of interest in having relationships with others. His speech reflects awkward phrasing and intonation and is me chanical in nature. He has a history of sequential fixations and obsessions with various games and objects throughout childhood; however, this is not cur rently a major issue for him. This patient meets criteria for autism spectrum disorder; true or false? A. True. B. False. 1.22 A 9-year-old girl presents with a history of intellectual impairment, a structural language impairment, nonverbal communication deficits, disinterest in peers, and inability to use language in a social manner. She has extreme food and tac tile sensitivities. She is obsessed with one particular computer game that she Neurodevelopmental Disorders---QUESTIONS **\|** 9 plays for hours each day, and she scripts and imitates the characters in this game. She is clumsy, has an odd gait, and walks on her tiptoes. In the past year she has developed a seizure disorder and has begun to bang her wrists against the wall repetitively, causing bruising. On the other hand, she plays several musical instruments in an extremely precocious manner. Which feature of this child's clinical presentation fulfills a criterion symptom for DSM-5 autism spectrum disorder? A. Motor abnormalities. B. Seizures. C. Structural language impairment. D. Intellectual impairment. E. Nonverbal communicative deficits. 1.23 An 11-year-old girl with autism spectrum disorder displays no spoken lan guage and is minimally responsive to overtures from others. She can be some what inflexible, which interferes with her ability to travel, do schoolwork, and be managed in the home; she has some difficulty transitioning; and she has trouble organizing and planning activities. These problems can usually be managed with incentives and reinforcers. What severity levels should be spec ified in the DSM-5 diagnosis? A. Level 3 (requiring very substantial support) for social communication, and level 1 (requiring support) for restricted, repetitive behaviors. B. Level 1 (requiring support) for social communication, and level 3 (requiring very substantial support) for restricted, repetitive behaviors. C. Level 1 (requiring support) for social communication, and level 2 (requiring substantial support) for restricted, repetitive behaviors. D. Level 3 (requiring very substantial support) for social communication, and level 1 (requiring support) for restricted, repetitive behaviors. E. Level 2 (requiring substantial support) for social communication, and level 1 (requiring support) for restricted, repetitive behaviors. 1.24 Which of the following is *not* a specifier included in the diagnostic criteria for autism spectrum disorder? A. With or without accompanying intellectual impairment. B. With or without associated dementia. C. With or without accompanying language impairment. D. Associated with a known medical or genetic condition or environmental factor. E. Associated with another neurodevelopmental, mental, or behavioral disor der. 10 **\|** Neurodevelopmental Disorders---QUESTIONS 1.25 Which of the following is *not* characteristic of the developmental course of chil dren diagnosed with autism spectrum disorder? A. Behavioral features manifest before 3 years of age. B. The full symptom pattern does not appear until age 2--3 years. C. Developmental plateaus or regression in social-communicative behavior is frequently reported by parents. D. Regression across multiple domains occurs after age 2--3 years. E. First symptoms often include delayed language development, lack of social interest or unusual social behavior, odd play, and unusual communication patterns. 1.26 A 5-year-old girl has some mild food aversions. She enjoys having the same book read to her at night but does not become terribly upset if her mother asks her to choose a different book. She occasionally spins around excitedly when her favorite show is on. She generally likes her toys neatly arranged in bins but is only mildly upset when her sister leaves them on the floor. These behaviors should be considered suspicious for an autism spectrum disorder; true or false? A. True. B. False. 1.27 Which of the following is *not* representative of the typical developmental course for autism spectrum disorder? A. Lack of degenerative course. B. Behavioral deterioration during adolescence. C. Continued learning and compensation throughout life. D. Marked presence of symptoms in early childhood and early school years, with developmental gains in later childhood in areas such as social interac tion. E. Good psychosocial functioning in adulthood, as indexed by independent living and gainful employment. 1.28 A 21-year-old man, not previously diagnosed with a developmental disorder, presents for evaluation after taking a leave from college for psychological rea sons. He makes little eye contact, does not appear to pick up on social cues, has become disinterested in friends, spends hours each day on the computer surf ing the Internet and playing games, and has become so sensitive to smells that he keeps multiple air fresheners in all locations of the home. He reports that he has had long-standing friendships dating from childhood and high school (corroborated by his parents). He reports making many friends in his fraternity at college. His parents report good social and communication skills in child hood, although he was quite shy and was somewhat inflexible and ritualistic at home. What is the *least likely* diagnosis? Neurodevelopmental Disorders---QUESTIONS **\|** 11 A. Depression. B. Schizophreniform disorder or schizophrenia. C. Autism spectrum disorder. D. Obsessive-compulsive disorder. E. Social anxiety disorder (social phobia). 1.29 Which of the following characteristics is generally *not* associated with autism spectrum disorder? A. Anxiety, depression, and isolation as an adult. B. Catatonia. C. Poor psychosocial functioning. D. Insistence on routines and aversion to change. E. Successful adaptation in regular school settings. 1.30 Which of the following disorders is generally *not* comorbid with autism spec trum disorder (ASD)? A. Attention-deficit/hyperactivity disorder (ADHD). B. Rett syndrome. C. Selective mutism. D. Intellectual disability (intellectual developmental disorder). E. Stereotypic movement disorder. 1.31 Which of the following is *not* a criterion for the DSM-5 diagnosis of attention deficit/hyperactivity disorder (ADHD)? A. Onset of several inattentive or hyperactive-impulsive symptoms prior to age 12 years. B. Manifestation of several inattentive or hyperactive-impulsive symptoms in two or more settings (e.g., at home, school, or work; with friends or rela tives; in other activities). C. Persistence of symptoms for at least 12 months. D. Clear evidence that symptoms interfere with, or reduce the quality of, so cial, academic, or occupational functioning. E. Inability to explain symptoms as a manifestation of another mental disor der (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal). 1.32 The parents of a 15-year-old female tenth grader believe that she should be do ing better in high school, given how bright she seems and the fact that she re ceived mostly A's through eighth grade. Her papers are handed in late, and she makes careless mistakes on examinations. They have her tested, and the WAIS IV results are as follows: Verbal IQ, 125; Perceptual Reasoning Index, 122; Full Scale IQ, 123; Working Memory Index, 55th percentile; Processing Speed In dex, 50th percentile. Weaknesses in executive function are noted. During a psy 12 **\|** Neurodevelopmental Disorders---QUESTIONS chiatric evaluation, she reports a long history of failing to give close attention to details, difficulty sustaining attention while in class or doing homework, failing to finish chores and tasks, and significant difficulties with time manage ment, planning, and organization. She is forgetful, often loses things, and is easily distracted. She has no history of restlessness or impulsivity, and she is well liked by her peers. What is the most likely diagnosis? A. Adjustment disorder with anxiety. B. Specific learning disorder. C. Attention-deficit/hyperactivity disorder, predominantly inattentive. D. Developmental coordination disorder. E. Major depressive disorder. 1.33 A 7-year-old boy is having behavioral and social difficulties in his second grade class. Although he seems to be able to attend and is doing "well" from an academic standpoint (though seemingly not what he is capable of), he is constantly interrupting, fidgeting, talking excessively, and getting out of his seat. He has friends, but he sometimes annoys his peers because of his diffi culty sharing and taking turns and the fact that he is constantly talking over them. Although he seeks out play dates, his friends tire of him because he wants to play sports nonstop. At home, he can barely stay in his seat for a meal and is unable to play quietly. Although he shows remorse when the conse quences of his behavior are pointed out to him, he can become angry in re sponse and seems nevertheless unable to inhibit himself. What is the most likely diagnosis? A. Bipolar disorder. B. Autism spectrum disorder. C. Generalized anxiety disorder. D. Attention-deficit/hyperactivity disorder, predominantly hyperactive/im pulsive. E. Specific learning disorder. 1.34 A 37-year-old Wall Street trader schedules a visit after his 8-year-old son is di agnosed with attention-deficit/hyperactivity disorder (ADHD), combined in attentive and hyperactive. Although he does not currently note motor restlessness like his son, he recalls being that way when he was a boy, along with being quite inattentive, being impulsive, talking excessively, interrupting, and having problems waiting his turn. He was an underachiever in high school and college, when he inconsistently did his work and had difficulty following rules. Nevertheless, he never failed any classes, and he was never evaluated by a psychologist or psychiatrist. He works about 60--80 hours a week and often gets insufficient sleep. He tends to make impulsive business decisions, can be impatient and short-tempered, and notes that his mind tends to wander both in one-on-one interactions with associates and his wife and during business meetings, for which he is often late; he is forgetful and disorganized. Neverthe less, he tends to perform fairly well and is quite successful, although he can oc Neurodevelopmental Disorders---QUESTIONS 3 **\|** 1 casionally feel overwhelmed and demoralized. What is the most likely diagnosis? A. Major depressive disorder. B. Generalized anxiety disorder. C. Specific learning disorder. D. ADHD, in partial remission. E. Oppositional defiant disorder. 1.35 A 5-year-old hyperactive, impulsive, and inattentive boy presents with hyper telorism, highly arched palate, and low-set ears. He is uncoordinated and clumsy, he has no sense of time, and his toys and clothes are constantly strewn all over the house. He has recently developed what appears to be a motor tic involving blinking. He enjoys playing with peers, who tend to like him, al though he seems to willfully defy all requests from his parents and kindergar ten teacher, which does not seem to be due simply to inattention. He is delayed in beginning to learn how to read. What is the *least likely* diagnosis? A. Autism spectrum disorder. B. Developmental coordination disorder. C. Oppositional defiant disorder (ODD). D. Specific learning disorder. E. Attention-deficit/hyperactivity disorder (ADHD). 1.36 What is the prevalence of attention-deficit/hyperactivity disorder (ADHD) in children? A. 8%. B. 10%. C. 2%. D. 0.5%. E. 5%. 1.37 What is the prevalence of attention-deficit/hyperactivity disorder (ADHD) in adults? A. 8%. B. 10%. C. 2.5%. D. 0.5%. E. 5%. 1.38 What is the gender ratio of attention-deficit/hyperactivity disorder (ADHD) in children? A. Male:female ratio of 2:1. B. Male:female ratio of 1:1. 14 **\|** Neurodevelopmental Disorders---QUESTIONS C. Male:female ratio of 3:2. D. Male:female ratio of 5:1. E. Male:female ratio of 1:2. 1.39 Which of the following is a biological finding in individuals with attention-def icit/hyperactivity disorder (ADHD)? A. Decreased slow-wave activity on electroencephalograms. B. Reduced total brain volume on magnetic resonance imaging. C. Early posterior to anterior cortical maturation. D. Reduced thalamic volume. E. Both B and C. 1.40 Which of the following is *not* associated with attention-deficit/hyperactivity disorder (ADHD)? A. Reduced school performance. B. Poorer occupational performance and attendance. C. Higher probability of unemployment. D. Elevated interpersonal conflict. E. Reduced risk of substance use disorders. 1.41 Which of the following is *not* associated with attention-deficit/hyperactivity disorder (ADHD)? A. Social rejection. B. Increased risk of developing conduct disorder in childhood and antisocial personality disorder in adulthood. C. Increased risk of Alzheimer's disease. D. Increased frequency of traffic accidents and violations. E. Increased risk of accidental injury. 1.42 A 15-year-old boy has developed concentration problems in school that have been associated with a significant decline in grades. When interviewed, he ex plains that his mind is occupied with worrying about his mother, who has a se rious autoimmune disease. As his grades falter, he becomes increasingly demoralized and sad, and he notices that his energy level drops, further com promising his ability to pay attention in school. At the same time, he complains of feeling restless and unable to sleep. What is the most likely diagnosis? A. Bipolar disorder. B. Specific learning disorder. C. Attention-deficit/hyperactivity disorder (ADHD). D. Adjustment disorder with mixed anxiety and depressed mood. E. Separation anxiety disorder. Neurodevelopmental Disorders---QUESTIONS 15 **\|** 1.43 A 5-year-old boy is consistently moody, irritable, and intolerant of frustration. In addition, he is pervasively and chronically restless, impulsive, and inatten tive. Which diagnosis best fits his clinical picture? A. Attention-deficit/hyperactivity disorder (ADHD). B. ADHD and disruptive mood dysregulation disorder (DMDD). C. Bipolar disorder. D. Oppositional defiant disorder (ODD). E. Major depressive disorder (MDD). 1.44 Which of the following statements about comorbidity in attention-deficit/hy peractivity disorder (ADHD) is *true?* A. Oppositional defiant disorder co-occurs with ADHD in about half of chil dren with the combined presentation and about a quarter of those with the predominantly inattentive presentation. B. Most children with disruptive mood dysregulation disorder do not also meet criteria for ADHD. C. Fifteen percent of adults with ADHD have some type of anxiety disorder. D. Intermittent explosive disorder occurs in about 5% of adults with ADHD. E. Specific learning disorder very seldom co-occurs with ADHD. 1.45 Specific learning disorder is defined by persistent difficulties in learning aca demic skills, with onset during the developmental period. Which of the follow ing statements about this disorder is *true?* A. It is part of a more general learning impairment as manifested in intellec tual disability (intellectual developmental disorder). B. It can usually be attributed to a sensory, physical, or neurological disorder. C. It involves pervasive and wide-ranging deficits across multiple domains of information processing. D. It can be caused by external factors such as economic disadvantage or lack of education. E. It replaces the DSM-IV diagnoses of reading disorder, mathematics disor der, disorder of written expression, and learning disorder not otherwise specified. 1.46 In distinction to DSM-IV, DSM-5 classifies all learning disorders under the di agnosis of specific learning disorder, along with the requirement to "specify all academic domains and subskills that are impaired" at the time of assessment. Which of the following statements about specific learning disorder is *false?* A. There are persistent difficulties in the acquisition of reading, writing, arith metic, or mathematical reasoning skills during the formal years of school ing. 16 **\|** Neurodevelopmental Disorders---QUESTIONS B. Current skills in one or more of these academic areas are well below the av erage range for the individual's age, gender, cultural group, and level of ed ucation. C. There usually is a discrepancy of more than 2 standard deviations (SD) be tween achievement and IQ. D. The learning difficulties significantly interfere with academic achievement, occupational performance, or activities of daily living that require these ac ademic skills. E. The learning difficulties cannot be acquired later in life. 1.47 Which of the following statements about the diagnosis of specific learning dis order is *false?* A. Specific learning disorder is distinct from learning problems associated with a neurodegenerative cognitive disorder. B. If intellectual disability (intellectual developmental disorder) is present, the learning difficulties must be in excess of those expected. C. An uneven profile of abilities is typical in specific learning disorder. D. Attentional difficulties and motor clumsiness that are subthreshold for at tention-deficit/hyperactivity disorder or developmental coordination dis order are frequently associated with specific learning disorder. E. There are four formal subtypes of specific learning disorder. 1.48 Which of the following statements about prevalence rates for specific learning disorder is *false?* A. Prevalence rates range from 5% to 15% among school-age children across languages and cultures. B. Prevalence in adults is approximately 4%. C. Specific learning disorder is equally common among males and females. D. Prevalence rates vary according to the range of ages in the sample, selection criteria, severity of specific learning disorder, and academic domains inves tigated. E. Gender ratios cannot be attributed to factors such as ascertainment bias, definitional or measurement variation, language, race, or socioeconomic status. 1.49 Which of the following statements about comorbidity in specific learning dis order is *true?* A. Attention-deficit/hyperactivity disorder (ADHD) does not co-occur with specific learning disorder more frequently than would be expected by chance. B. Speech sound disorder and specific language impairments are not com monly comorbid with specific learning disorder. Neurodevelopmental Disorders---QUESTIONS **\|** 17 C. Identified clusters of co-occurrences include severe reading disorders; fine motor problems and handwriting problems; and problems with arithmetic, reading, and gross motor planning. D. The co-occurrence of specific learning disorder and specific language im pairments has been shown in up to 20% of children with language prob lems. E. Co-occurring disorders generally do not influence the course or treatment of specific learning disorder. 1.50 Which of the following statements about developmental coordination disorder (DCD) is *true?* A. Some children with DCD show additional (usually suppressed) motor ac tivity, such as choreiform movements of unsupported limbs or mirror movements. B. The prevalence of DCD in children ages 5--11 years is 1%--3%. C. In early adulthood, there is improvement in learning new tasks involving complex/automatic motor skills, including driving and using tools. D. DCD has no association with prenatal exposure to alcohol or with low birth weight or preterm birth. E. Impairments in underlying neurodevelopmental processes have not been found to primarily affect visuomotor skills. 1.51 Which of the following statements about developmental coordination disorder (DCD) is *true?* A. The disorder is usually not diagnosed before the age of 7 years. B. Symptoms have usually improved significantly at 1-year follow-up. C. In most cases, symptoms are no longer evident by adolescence. D. DCD has no clear relationship with prenatal alcohol exposure, preterm birth, or low birth weight. E. Cerebellar dysfunction is hypothesized to play a role in DCD. 1.52 Which of the following is *not* a criterion for the DSM-5 diagnosis of stereotypic movement disorder? A. Motor behaviors are present that are repetitive, seemingly driven, and ap parently purposeless. B. Onset of the behaviors is in the early developmental period. C. The behaviors result in self-inflicted bodily injury that requires medical treatment. D. The behaviors are not attributable to the physiological effects of a substance or neurological condition or better explained by another neurodevelop mental or mental disorder. E. The behaviors interfere with social, academic, or other activities. 18 **\|** Neurodevelopmental Disorders---QUESTIONS 1.53 Which of the following statements about the developmental course of stereo typic movement disorder is *false?* A. The presence of stereotypic movements may indicate an undetected neuro developmental problem, especially in children ages 1--3 years. B. Among typically developing children, the repetitive movements may be stopped when attention is directed to them or when the child is distracted from performing them. C. In some children, the stereotypic movements would result in self-injury if protective measures were not used. D. Whereas simple stereotypic movements (e.g., rocking) are common in young typically developing children, complex stereotypic movements are much less common (approximately 3%--4%). E. Stereotypic movements typically begin within the first year of life. 1.54 Which of the following is a DSM-5 diagnostic criterion for Tourette's disorder? A. Tics occur throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months. B. Onset is before age 5 years. C. The tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset. D. Motor tics must precede vocal tics. E. The tics may occur many times a day for at least 4 weeks, but no longer than 12 consecutive months. 1.55 At her child's third office visit, the mother of an 8-year-old boy with a 6-month history of excessive eye blinking and intermittent chirping says that she has noticed the development of grunting sounds since he started school this term. What is the most likely diagnosis? A. Tourette's disorder. B. Provisional tic disorder. C. Temporary tic disorder. D. Persistent (chronic) vocal tic disorder. E. Transient tic disorder, recurrent. 1.56 A 5-year-old girl is referred to your care with a DSM-IV diagnosis of chronic motor or vocal tic disorder. Under DSM-5, she would meet criteria for persis tent (chronic) motor or vocal tic disorder. Which of the following statements about her new diagnosis under DSM-5 is *false?* A. She may have single or multiple motor or vocal tics, but not both. B. Her tics must persist for more than 1 year since first tic onset without a tic free period for 3 consecutive months to meet diagnostic criteria. Neurodevelopmental Disorders---QUESTIONS **\|** 19 C. Her tics may wax and wane in frequency but have persisted for more than 1 year since first tic onset. D. She has never met criteria for Tourette's disorder. E. A specifier may be added to the diagnosis of persistent (chronic) motor or vocal tic disorder to indicate whether the girl has motor or vocal tics. 1.57 A highly functional 20-year-old college student with a history of anxiety symp toms and attention-deficit/hyperactivity disorder, for which she is prescribed lisdexamfetamine (Vyvanse), tells her psychiatrist that she has been research ing the side effects of her medication for one of her class projects. In addition, she says that for the past week she has been feeling stressed by her schoolwork, and her friends have been asking her why she intermittently bobs her head up and down multiple times a day. What is the most likely diagnosis? A. Provisional tic disorder. B. Unspecified tic disorder. C. Unspecified anxiety disorder. D. Obsessive-compulsive personality disorder. E. Unspecified stimulant-induced disorder. 1.58 Which of the following is *not* a DSM-5 diagnostic criterion for language disor der? A. Persistent difficulties in the acquisition and use of language across modali ties due to deficits in comprehension or production. B. Language abilities that are substantially and quantifiably below those ex pected for age. C. Symptom onset in the early developmental period. D. Inability to attribute difficulties to hearing or other sensory impairment, motor dysfunction, or another medical or neurological condition. E. Failure to meet criteria for mixed receptive-expressive language disorder or a pervasive developmental disorder. 1.59 Which of the following statements about speech sound disorder is *true?* A. Speech sound production must be present by age 2 years. B. "Failure to use developmentally expected speech sounds" is assessed by comparison of a child with his or her peers of the same age and dialect. C. The difficulties in speech sound production need not result in functional impairment to meet diagnostic criteria. D. Symptom onset is in the early developmental period. E. Both A and C are true. 1.60 A mother brings her 4-year-old son to you for an evaluation with concerns that her son has struggled with speech articulation since very young. He has not sustained any head injuries, is otherwise healthy, and has a normal IQ. His pre 20 **\|** Neurodevelopmental Disorders---QUESTIONS school teacher reports that she does not always understand what he is saying and that other children tease him by calling him a "baby" due to his difficulty with communication. He does not have trouble relating to other people or un derstanding nonverbal social cues. What is the most likely diagnosis? A. Selective mutism. B. Global developmental delay. C. Speech sound disorder. D. Avoidant personality disorder. E. Unspecified anxiety disorder. 1.61 A 6-year-old boy is failing school and continues to struggle significantly with grammar, sentence construction, and vocabulary. When he speaks, he also in terjects "and" in between all his words. His teacher reports that he requires more verbal redirection than other students in order to stay on task. He is gen erally quiet and does not cause trouble otherwise. Which of the following di agnoses would be on your differential? A. Language disorder. B. Expressive language disorder. C. Childhood-onset fluency disorder. D. Attention-deficient/hyperactivity disorder (ADHD). E. A and D. 1.62 Which of the following types of disturbance in normal speech fluency/time patterning included in the DSM-IV criteria for stuttering was omitted in the DSM-5 criteria for childhood-onset fluency disorder (stuttering)? A. Sound prolongation. B. Circumlocution. C. Interjections. D. Words produced with an excess of physical tension. E. Sound and syllable repetitions. 1.63 A 14-year-old boy in regular education tells you that he thinks a girl in class likes him. His mother is surprised to hear this, because she reports that, since a young age, he has often struggled with making inferences or understanding nuances from what other people say. The teacher has also noticed that he some times misses nonverbal cues. He tends to get along better with adults, perhaps because they are not as likely to be put off by his overly formal speech. When he makes jokes, his peers do not always find the humor appropriate. Although he enjoys spending time with his best friend, he can be talkative and struggles with taking turns in conversation. What is the most likely diagnosis? A. Social (pragmatic) communication disorder. B. Asperger's disorder. C. Autism spectrum disorder. Neurodevelopmental Disorders---QUESTIONS **\|** 21 D. Social anxiety disorder. E. Language disorder. 1.64 A 15-year-old boy with a prior diagnosis of Tourette's disorder is referred to your care. His mother tells you that during middle school he was teased for having vocal and motor tics. Since starting ninth grade, his tics have become less frequent. Currently, only mild motor tics remain. What is the appropriate DSM-5 diagnosis? A. Tourette's disorder. B. Persistent (chronic) motor tic disorder. C. Provisional tic disorder. D. Unspecified tic disorder. E. Persistent (chronic) vocal tic disorder. 1.65 Tics typically present for the first time during which developmental stage? A. Infancy. B. Prepuberty. C. Latency. D. Adolescence. E. Adulthood. 1.66 A 7-year-old boy who has speech delays presents with long-standing, repeti tive hand waving, arm flapping, and finger wiggling. His mother reports that she first noticed these symptoms when he was a toddler and wonders whether they are tics. She says that he tends to flap more when he is engrossed in activ ities, such as while watching his favorite television program, but will stop when called or distracted. Based on the mother's report, which of the following conditions would be highest on your list of possible diagnoses? A. Provisional tic disorder. B. Persistent (chronic) motor or vocal tic disorder. C. Chorea. D. Dystonia. E. Motor stereotypies. 1.67 Assessment of co-occurring conditions is important for understanding the overall functional consequence of tics on an individual. Which of the following conditions has been associated with tic disorders? A. Attention-deficit/hyperactivity disorder (ADHD). B. Obsessive-compulsive and related disorders. C. Other movement disorders. D. Depressive disorders. E. All of the above. 22 **\|** Neurodevelopmental Disorders---QUESTIONS 1.68 By what age should most children have acquired adequate speech and lan guage ability to understand and follow social rules of verbal and nonverbal communication, follow rules for conversation and storytelling, and change language according to the needs of the listener or situation? A. Ages 2--3 years. B. Ages 3--4 years. C. Ages 4--5 years. D. Ages 5--6 years. E. Ages 6--7 years. 1.69 Having a family history of which of the following psychiatric disorders in creases an individual's risk of social (pragmatic) communication disorder? A. Social anxiety disorder (social phobia). B. Autism spectrum disorder. C. Attention-deficit/hyperactivity disorder (ADHD). D. Specific learning disorder. E. Either B or D. 1.70 A 6-year-old boy with a history of mild language delay is brought to your office by his mother, who is concerned that he is being teased in school because he misinterprets nonverbal cues and speaks in overly formal language with his peers. She tells you that her son was in an early intervention program, but his written and spoken language is now at grade level. The boy does not have a history of repetitive movements, sensory issues, or ritualized behaviors. Al though he prefers constancy, he adapts fairly well to new situations. Addition ally, he has a long-standing interest in trains and cars and is able to recite for you all the car models he memorized from a book on the history of transporta tion. Which of the following disorders would be a primary consideration in the differential diagnosis? A. Social (pragmatic) communication disorder. B. Autism spectrum disorder. C. Global developmental delay. D. Language disorder. E. A and B. 1.71 Below what age is it difficult to distinguish a language disorder from normal developmental variations? A. Age 2 years. B. Age 3 years. C. Age 4 years. D. Age 5 years. E. Age 6 years. Neurodevelopmental Disorders---QUESTIONS **\|** 23 1.72 Which of the following psychiatric diagnoses is strongly associated with lan guage disorder? A. Attention-deficit/hyperactivity disorder. B. Developmental coordination disorder. C. Autism spectrum disorder. D. Social (pragmatic) communication disorder. E. All of the above. 1.73 Which of the following statements about the development of speech as it ap plies to speech sound disorder is *false?* A. Most children with speech sound disorder respond well to treatment. B. Speech sound production should be mostly intelligible by age 3 years. C. Most speech sounds should be pronounced clearly and accurately accord ing to age and community norms before age 10 years. D. Lisping may or may not be associated with speech sound disorder. E. It is abnormal for children to shorten words when they are learning to talk. 1.74 Which of the following would likely *not* be an important condition to rule out in the differential diagnosis of speech sound disorder? A. Normal variations in speech. B. Hearing or other sensory impairment. C. Dysarthria. D. Depression. E. Selective mutism. 1.75 Which of the following statements about the development of childhood-onset fluency disorder (stuttering) is *true?* A. Stuttering occurs by age 6 for 80%--90% of affected individuals. B. Stuttering always begin abruptly and is noticeable to everyone. C. Stress and anxiety do not exacerbate disfluency. D. Motor movements are not associated with this disorder. E. None of the above. 24 **\|** Neurodevelopmental Disorders---QUESTIONS CHAPTER 2 Schizophrenia Spectrum and Other Psychotic Disorders 2.1 Criterion A for schizoaffective disorder requires an uninterrupted period of ill ness during which Criterion A for schizophrenia is met. Which of the following additional symptoms must be present to fulfill diagnostic criteria for schizoaf fective disorder? A. An anxiety episode---either panic or general anxiety. B. Rapid eye movement (REM) sleep behavior disorder. C. A major depressive or manic episode. D. Hypomania. E. Cyclothymia. 2.2 There is a requirement for a major depressive episode or a manic episode to be part of the symptom picture for a DSM-5 diagnosis of schizoaffective disorder. In order to separate schizoaffective disorder from depressive or bipolar disor der with psychotic features, which of the following symptoms must be present for at least 2 weeks in the absence of a major mood episode at some point dur ing the lifetime duration of the illness? A. Delusions or hallucinations. B. Delusions or paranoia. C. Regressed behavior. D. Projective identification. E. Binge eating. 2.3 A 27-year-old unmarried truck driver has a 5-year history of active and resid ual symptoms of schizophrenia. He develops symptoms of depression, includ ing depressed mood and anhedonia, that last 4 months and resolve with treatment but do not meet criteria for major depression. Which diagnosis best fits this clinical presentation? A. Schizoaffective disorder. B. Unspecified schizophrenia spectrum and other psychotic disorder. C. Unspecified depressive disorder. Schizophrenia Spectrum and Other Psychotic Disorders---QUESTIONS **\|** 25 D. Schizophrenia and unspecified depressive disorder. E. Unspecified bipolar and related disorder. 2.4 How common is schizoaffective disorder relative to schizophrenia? A. Much more common. B. Twice as common. C. Equally common. D. One-half as common. E. One-third as common. 2.5 A 30-year-old single woman reports having experienced auditory and perse cutory delusions for 2 months, followed by a full major depressive episode with sad mood, anhedonia, and suicidal ideation lasting 3 months. Although the depressive episode resolves with pharmacotherapy and psychotherapy, the psychotic symptoms persist for another month before resolving. What di agnosis best fits this clinical picture? A. Brief psychotic disorder. B. Schizoaffective disorder. C. Major depressive disorder. D. Major depressive disorder with psychotic features. E. Bipolar I disorder, current episode manic, with mixed features. 2.6 Which of the following statements about the incidence of schizoaffective disor der is *true?* A. The incidence is equal in women and men. B. The incidence is higher in men. C. The incidence is higher in women. D. The incidence rates are unknown. E. The incidence rates vary based on seasonality of birth. 2.7 Substance/medication-induced psychotic disorder cannot be diagnosed if the disturbance is better explained by an independent psychotic disorder that is not induced by a substance/medication. Which of the following psychotic symptom presentations would *not* be evidence of an independent psychotic disorder? A. Psychotic symptoms that precede the onset of severe intoxication or acute withdrawal. B. Psychotic symptoms that meet full criteria for a psychotic disorder and that persist for a substantial period after cessation of severe intoxication or acute withdrawal. C. Psychotic symptoms that are substantially in excess of what would be ex pected given the type or amount of the substance used or the duration of use. 26 **\|** Schizophrenia Spectrum and Other Psychotic Disorders---QUESTIONS D. Psychotic symptoms that occur during a period of sustained substance ab stinence. E. Psychotic symptoms that occur during a medical admission for substance withdrawal. 2.8 A 55-year-old man with a known history of alcohol dependence and schizo phrenia is brought to the emergency department because of frank delusions and visual hallucinations. Which of the following would *not* be a diagnostic possibility for inclusion in the differential diagnosis? A. Schizophrenia. B. Substance/medication-induced psychotic disorder. C. Alcohol dependence. D. Psychotic disorder due to another medical condition. E. Borderline personality disorder with psychotic features. 2.9 Which of the following sets of specifiers is included in the DSM-5 diagnostic criteria for substance/medication-induced psychotic disorder? A. "With onset before intoxication" and "With onset before withdrawal." B. "With onset during intoxication" and "With onset during withdrawal." C. "With good prognostic features" and "Without good prognostic features." D. "With onset prior to substance use" and "With onset after substance use." E. "With catatonia" and 'Without catatonia." 2.10 A 65-year-old man with systemic lupus erythematosus who is being treated with corticosteroids witnesses a serious motor vehicle accident. He begins to have disorganized speech, which lasts for several days before resolving. What diagnosis best fits this clinical picture? A. Schizophrenia. B. Psychotic disorder associated with systemic lupus erythematosus. C. Steroid-induced psychosis. D. Brief psychotic disorder, with marked stressor. E. Schizoaffective disorder. 2.11 Which of the following psychotic symptom presentations would *not* be appro priately diagnosed as "other specified schizophrenia spectrum and other psy chotic disorder"? A. Psychotic symptoms that have lasted for less than 1 month but have not yet remitted, so that the criteria for brief psychotic disorder are not met. B. Persistent auditory hallucinations occurring in the absence of any other fea tures. C. Postpartum psychosis that does not meet criteria for a depressive or bipolar disorder with psychotic features, brief psychotic disorder, psychotic disor Schizophrenia Spectrum and Other Psychotic Disorders---QUESTIONS **\|** 27 der due to another medical condition, or substance/medication-induced psychotic disorder. D. Psychotic symptoms that are temporally related to use of a substance. E. Persistent delusions with periods of overlapping mood episodes that are present for a substantial portion of the delusional disturbance. 2.12 Which of the following patient presentations would *not* be classified as psy chotic for the purpose of diagnosing schizophrenia? A. A patient is hearing a voice that tells him he is a special person. B. A patient believes he is being followed by a secret police organization that is focused exclusively on him. C. A patient has a flashback to a war experience that feels like it is happening again. D. A patient cannot organize his thoughts and stops responding in the middle of an interview. E. A patient presents wearing an automobile tire around his waist and gives no explanation. 2.13 In which of the following disorders can psychotic symptoms occur? A. Bipolar and depressive disorders. B. Substance use disorders. C. Posttraumatic stress disorder. D. Other medical conditions. E. All of the above. 2.14 A 32-year-old man presents to the emergency department distressed and agi tated. He reports that his sister has been killed in a car accident on a trip to South America. When asked how he found out, he says that he and his sister were very close and he "just knows it." After putting him on the phone with his sister, who was comfortably staying with friends while on her trip, the man expressed relief that she was alive. Which of the following descriptions best fits this presentation? A. He had a delusional belief, because he believed it was true without good warrant. B. He did not have a delusional belief, because it changed in light of new evi dence. C. He had a grandiose delusion, because he believed he could know things happening far away. D. He had a nihilistic delusion, because it involved an untrue, imagined catas trophe. E. He did not have a delusion, because in some cultures people believe they can know things about family members outside of ordinary communica tions. 28 **\|** Schizophrenia Spectrum and Other Psychotic Disorders---QUESTIONS 2.15 Which of the following is *not* a commonly recognized type of delusion? A. Persecutory. B. Erotomanic. C. Alien abduction. D. Somatic. E. Grandiose. 2.16 A 64-year-old man who had been a widower for 3 months presents to the emer gency department on the advice of his primary care physician after he reports to the doctor that he hears his deceased wife's voice calling his name when he looks through old photos, and sometimes as he is trying to fall asleep. His pri mary care physician tells him he is having a psychotic episode and needs to get a psychiatric evaluation. Which of the following statements correctly explains why these experiences are not considered to be psychotic? A. The voice he hears is from a family member. B. The experience occurs as he is falling asleep. C. He can invoke her voice with certain activities. D. The voice calls his name. E. Both B and C. 2.17 A 19-year-old college student is brought by ambulance to the emergency de partment. His college dorm supervisor, who called the ambulance, reports that the student was isolating himself, was pacing in his room, and was not re sponding to questions. In the emergency department, the patient gets down in a crouching position and begins making barking noises at seemingly random times. His urine toxicology report is negative, and all labs are within normal limits. What is the best description of these symptoms? A. An animal delusion---the patient believes he is a dog. B. Intermittent explosive rage. C. A paranoid stance leading to self-protective aggression. D. Catatonic behavior. E. Formal thought disorder. 2.18 Which of the following does *not* represent a negative symptom of schizophre nia? A. Affective flattening. B. Decreased motivation. C. Impoverished thought processes. D. Sadness over loss of functionality. E. Social disinterest. Schizophrenia Spectrum and Other Psychotic Disorders---QUESTIONS **\|** 29 2.19 Schizophrenia spectrum and other psychotic disorders are defined by abnor malities in one or more of five domains, four of which are also considered psy chotic symptoms. Which of the following is *not* considered a psychotic symptom? A. Delusions. B. Hallucinations. C. Disorganized thinking. D. Disorganized or abnormal motor behavior. E. Avolition. 2.20 What is the most common type of delusion? A. Somatic delusion of distorted body appearance. B. Grandiose delusion. C. Thought insertion. D. Persecutory delusion. E. Former life regression. 2.21 Label each of the following beliefs as a bizarre delusion, a nonbizarre delusion, or a nondelusion. A. A 25-year-old law student believes he has uncovered the truth about JFK's assassination and that CIA agents have been dispatched to follow him and monitor his Internet communications. B. A 45-year-old homeless man presents to the psychiatric emergency room complaining of a skin rash. Upon removal of his clothes, it is seen that most of his body is wrapped in aluminum foil. The man explains that he is pro tecting himself from the electromagnetic ray guns that are constantly target ing him. C. A 47-year-old unemployed plumber believes he has been elected to the House of Representatives. When the Capitol police evict him and bring him to the emergency department, he says that they are Tea Party activists who are merely impersonating police officers. D. A 35-year-old high school physics teacher presents to your office with in somnia and tells you that he has discovered and memorized the formula for cold fusion energy, only to have the formula removed from his memory by telepathic aliens. E. An 18-year-old recent immigrant from Eastern Europe believes that wear ing certain colors will ward off the "evil eye" and prevent catastrophes that would otherwise occur. 2.22 Which of the following presentations would *not* be classified as disorganized behavior for the purpose of diagnosing schizophrenia spectrum and other psy chotic disorders? 30 **\|** Schizophrenia Spectrum and Other Psychotic Disorders---QUESTIONS A. Masturbating in public. B. Wearing slacks on one's head. C. Responding verbally to auditory hallucinations in a conversational mode. D. Crouching on all fours and barking. E. Turning to face 180 degrees away from the interviewer when answering questions. 2.23 Which of the following statements about catatonic motor behaviors is *false?* A. Catatonic motor behavior is a type of grossly disorganized behavior that has historically been associated with schizophrenia spectrum and other psychotic disorders. B. Catatonic motor behaviors may occur in many mental disorders (such as mood disorders) and in other medical conditions. C. A behavior is considered catatonic only if it involves motoric slowing or ri gidity, such as mutism, posturing, or waxy flexibility. D. Catatonia can be diagnosed independently of another psychiatric disorder. E. Catatonic behaviors involve markedly reduced reactivity to the environ ment. 2.24 Which of the following statements about negative symptoms of schizophrenia is *false*? A. Negative symptoms are easily distinguished from medication side effects such as sedation. B. Negative symptoms include diminished emotional expression. C. Negative symptoms can be difficult to distinguish from medication side ef fects such as sedation. D. Negative symptoms include reduced peer or social interaction. E. Negative symptoms include decreased motivation for goal-directed activi ties. 2.25 Which of the following statements correctly describes a way in which schizoaf fective disorder may be differentiated from bipolar disorder? A. Schizoaffective disorder involves only depressive episodes, never manic or hypomanic episodes. B. In bipolar disorder, psychotic symptoms do not last longer than 1 month. C. In bipolar disorder, psychotic symptoms are always cotemporal with mood symptoms. D. Schizoaffective disorder never includes full-blown episodes of major de pression. E. In bipolar disorder, psychotic symptoms are always mood congruent. Schizophrenia Spectrum and Other Psychotic Disorders---QUESTIONS **\|** 31 2.26 Which of the following symptom combinations, if present for 1 month, would meet Criterion A for schizophrenia? A. Prominent auditory and visual hallucinations. B. Grossly disorganized behavior and avolition. C. Disorganized speech and diminished emotional expression. D. Paranoid and grandiose delusions. E. Avolition and diminished emotional expression. 2.27 Which of the following statements about violent or suicidal behavior in schizo phrenia is *false?* A. About 5%--6% of individuals with schizophrenia die by suicide. B. Persons with schizophrenia frequently assault strangers in a random fash ion. C. Compared with the general population, persons with schizophrenia are more frequently victims of violence. D. Command hallucinations to harm oneself sometimes precede suicidal be haviors. E. Youth, male gender, and substance abuse are factors that increase the risk for suicide among persons with schizophrenia. 2.28 Which of the following statements about childhood-onset schizophrenia is *true?* A. Childhood-onset schizophrenia tends to resemble poor-outcome adult schizophrenia, with gradual onset and prominent negative symptoms. B. Disorganized speech patterns in childhood are usually indicative of schizo phrenia. C. Because of the childhood capacity for imagination, delusions and halluci nations in childhood-onset schizophrenia are more elaborate than those in adult-onset schizophrenia. D. In a child presenting with disorganized behavior, schizophrenia should be ruled out before other childhood diagnoses are considered. E. Visual hallucinations are extremely rare in childhood-onset schizophrenia. 2.29 Which of the following statements about gender differences in schizophrenia is *true?* A. Women with schizophrenia tend to have fewer psychotic symptoms than do men over the course of the illness. B. A first onset of schizophrenia after age 40 is more likely in women than in men. C. Psychotic symptoms in women tend to burn out with age to a greater extent than they do in men. 32 **\|** Schizophrenia Spectrum and Other Psychotic Disorders---QUESTIONS D. Negative symptoms and affective flattening are more frequently observed in women with schizophrenia than in men with the disorder. E. The overall incidence of schizophrenia is higher in women than it is in men. 2.30 A 19-year-old female college student is brought to the emergency department by her family over her objections. Three months ago, she suddenly started feel ing "odd," and she came home from college because she could not concentrate. Two weeks after she came home, she began hearing voices telling her that she is "a sinner" and must repent. Although never a religious person, she now be lieves she must repent, but she does not know how, and feels confused. She is managing her activities of daily living despite the ongoing auditory hallucina tions and delusions, and she is affectively reactive on examination. Which di agnosis best fits this presentation? A. Schizophreniform disorder, with good prognostic features, provisional. B. Schizophreniform disorder, without good prognostic features, provisional. C. Schizophreniform disorder, with good prognostic features. D. Schizophreniform disorder, without good prognostic features. E. Unspecified schizophrenia spectrum and other psychotic disorder. 2.31 A 24-year-old male college student is brought to the emergency department by the college health service team. A few weeks ago he was involved in a car ac cident in which one of his friends was critically injured and died in his arms. The man has not come out of his room or showered for the last 2 weeks. He has eaten only minimally, claimed that aliens have targeted him for abduction, and asserted that he could hear their radio transmissions. Nothing seems to con vince him that this abduction will not happen or that the transmissions are not real. Which of the following diagnoses (and justifications) is most appropriate for this man? A. Brief psychotic disorder with a marked stressor, because the symptoms be gan after the tragic car accident. B. Brief psychotic disorder without a marked stressor, because the content of the psychosis is unrelated to the accident. C. Unspecified schizophrenia spectrum and other psychotic disorder, because more information is needed. D. Schizophreniform disorder, because there are psychotic symptoms but not yet a full-blown schizophrenia picture. E. Delusional disorder, because the central symptom is a delusion of persecu tion. Schizophrenia Spectrum and Other Psychotic Disorders---QUESTIONS **\|** 33 CHAPTER 3 Bipolar and Related Disorders 3.1 Which of the following statements accurately describes a change in DSM-5 from the DSM-IV criteria for bipolar disorders? A. Diagnostic criteria for bipolar disorders now include both changes in mood and changes in activity or energy. B. Diagnostic criteria for bipolar I disorder, mixed type, now require a patient to simultaneously meet full criteria for both mania and major depressive episode. C. Subsyndromal hypomania has been removed from the allowed conditions under *other specified bipolar and related disorder.* D. There is now a stipulation that manic or hypomanic episodes cannot be as sociated with recent administration of a drug known to cause similar symp toms. E. The clinical symptoms associated with hypomanic episodes have been sub stantially changed. 3.2 A 32-year-old man reports 1 week of feeling unusually irritable. During this time, he has increased energy and activity, sleeps less, and finds it difficult to sit still. He also is more talkative than usual and is easily distractible, to the point of finding it difficult to complete his work assignments. A physical ex amination and laboratory workup are negative for any medical cause of his symptoms and he takes no medications. What diagnosis best fits this clinical picture? A. Manic episode. B. Hypomanic episode. C. Bipolar I disorder, with mixed features. D. Major depressive episode. E. Cyclothymic disorder. 3.3 A 42-year-old man reports 1 week of increased activity associated with an ele vated mood, a decreased need for sleep, and inflated self-esteem. Although the man does not object to his current state ("I'm getting a lot of work done!"), he is concerned because he recalls a similar episode 10 years ago during which he began to make imprudent business decisions. A physical examination and lab oratory work are unrevealing for any medical cause of his symptoms. He had 34 **\|** Bipolar and Related Disorders---QUESTIONS taken fluoxetine for a depressive episode but self-discontinued it 3 months ago because he felt that his mood was stable. Which diagnosis best fits this clinical picture? A. Bipolar I disorder. B. Bipolar II disorder. C. Cyclothymic disorder. D. Other specified bipolar disorder and related disorder. E. Substance/medication-induced bipolar disorder. 3.4 Approximately what percentage of individuals who experience a single manic episode will go on to have recurrent mood episodes? A. 90%. B. 50%. C. 25%. D. 10%. E. 1%. 3.5 Which of the following factors is most predictive of incomplete recovery be tween mood episodes in bipolar I disorder? A. Being widowed. B. Living in a higher-income country. C. Being divorced. D. Having a family history of bipolar disorder. E. Having a mood episode accompanied by mood-incongruent psychotic symptoms. 3.6 Which of the following is more common in men with bipolar I disorder than in women with the disorder? A. Rapid cycling. B. Alcohol abuse. C. Eating disorders. D. Anxiety disorders. E. Mixed-state symptoms. 3.7 A patient with a history of bipolar I disorder presents with a new-onset manic episode and is successfully treated with medication adjustment. He notes chronic depressive symptoms that, on reflection, long preceded his manic epi sodes. He describes these symptoms as "feeling down," having decreased en ergy, and more often than not having no motivation. He denies other depressive symptoms but feels that these alone have been sufficient to nega tively affect his marriage. Which diagnosis best fits this presentation? Bipolar and Related Disorders---QUESTIONS **\|** 35 A. Other specified bipolar and related disorder. B. Bipolar I disorder, current or most recent episode depressed. C. Cyclothymic disorder. D. Bipolar I disorder and persistent depressive disorder (dysthymia). E. Bipolar II disorder. 3.8 In which of the following ways do manic episodes differ from attention-defi cit/hyperactivity disorder (ADHD)? A. Manic episodes are more strongly associated with poor judgment. B. Manic episodes are more likely to involve excessive activity. C. Manic episodes have clearer symptomatic onsets and offsets. D. Manic episodes are more likely to show a chronic course. E. Manic episodes first appear at an earlier age. 3.9 A patient with a history of bipolar disorder reports experiencing 1 week of el evated and expansive mood. Evidence of which of the following would sug gest that the patient is experiencing a hypomanic, rather than manic, episode? A. Irritability. B. Decreased need for sleep. C. Increased productivity at work. D. Psychotic symptoms. E. Good insight into the illness. 3.10 A 25-year-old graduate student presents to a psychiatrist complaining of feel ing down and "not enjoying anything." Her symptoms began about a month ago, along with insomnia and poor appetite. She has little interest in activities and is having difficulty attending to her schoolwork. She recalls a similar epi sode 1 year ago that lasted about 2 months before improving without treat ment. She also reports several episodes of increased energy in the past 2 years; these episodes usually last 1--2 weeks, during which time she is very produc tive, feels more social and outgoing, and tends to sleep less, although she feels energetic during the day. Friends tell her that she speaks more rapidly during these episodes but that they do not see it as off-putting and in fact think she seems more outgoing and clever. She has no medical problems and does not take any medications or abuse drugs or alcohol. What is the most likely diag nosis? A. Bipolar I disorder, current episode depressed. B. Bipolar II disorder, current episode depressed. C. Bipolar I disorder, current episode unspecified. D. Cyclothymic disorder. E. Major depressive disorder. 36 **\|** Bipolar and Related Disorders---QUESTIONS 3.11 How do the depressive episodes associated with bipolar II disorder differ from those associated with bipolar I disorder? A. They are less frequent than those associated with bipolar I disorder. B. They are lengthier than those associated with bipolar I disorder. C. They are less disabling than those associated with bipolar I disorder. D. They are less severe than those associated with bipolar I disorder. E. They are rarely a reason for the patient to seek treatment. 3.12 How does the course of bipolar II disorder differ from the course of bipolar I disorder? A. It is more chronic than the course of bipolar I disorder. B. It is less episodic than the course of bipolar I disorder. C. It involves longer asymptomatic periods than the course of bipolar I disor der. D. It involves shorter symptomatic episodes than the course of bipolar I disor der. E. It involves a much lower number of lifetime mood episodes than the course of bipolar I disorder. 3.13 Which of the following features confers a worse prognosis for a patient with bipolar II disorder? A. Younger age. B. Higher educational level. C. Rapid-cycling pattern. D. "Married" marital status. E. Less severe depressive episodes. 3.14 The course of bipolar II disorder would likely be worse for individuals who have an onset of the disorder at which of the following ages? A. Age 10 years. B. Age 20 years. C. Age 40 years. D. Age 70 years. E. None of the above; there is no association between onset age and course. 3.15 Which of the following statements about postpartum hypomania is *true?* A. It tends to occur in the late postpartum period. B. It occurs in less than 1% of postpartum women. C. It is a risk factor for postpartum depression. D. It is easily distinguished from the normal adjustments to childbirth. E. It is more common in multiparous women. Bipolar and Related Disorders---QUESTIONS **\|** 37 3.16 For an adolescent who presents with distractibility, which of the following ad ditional features would suggest an association with bipolar II disorder rather than attention-deficit/hyperactivity disorder (ADHD)? A. Rapid speech noted on examination. B. A report of less need for sleep. C. Complaints of racing thoughts. D. Evidence that the symptoms are episodic. E. Evidence that the symptoms represent the individual's baseline behavior. 3.17 A 50-year-old man with a history of a prior depressive episode is given an an tidepressant by his family doctor to help with his depressive symptoms. Two weeks later, his doctor contacts you for a consultation because the patient now is euphoric, has increased energy, racing thoughts, psychomotor agitation, poor concentration and attention, pressured speech, and a decreased need to sleep. These symptoms began with the initiation of the patient's new medica tion. The patient stopped the medication after 2 days, as he no longer felt de pressed; however, the symptoms have continued ever since. What is the patient's diagnosis? A. Substance/medication-induced bipolar and related disorder. B. Bipolar I disorder. C. Bipolar II disorder. D. Cyclothymic disorder. E. Major depressive disorder. 3.18 In which of the following aspects does cyclothymic disorder differ from bipo lar I disorder? A. Duration. B. Severity. C. Age at onset. D. Pervasiveness. E. All of the above. 38 **\|** Bipolar and Related Disorders---QUESTIONS CHAPTER 4 Depressive Disorders 4.1 How does DSM-5 differ from DSM-IV in its classification of mood disorders? A. There is no difference between the two editions. B. DSM-IV separated mood disorders into different sections; DSM-5 consoli dates mood disorders into one section. C. DSM-IV included all mood disorders in a single section; DSM-5 places de pressive and bipolar mood disorders in separate sections. D. DSM-IV placed mood and anxiety disorders in separate sections; DSM-5 consolidates mood and anxiety disorders within a single section. E. DSM-IV placed mood disorders with psychotic features in the same section as other mood disorders; DSM-5 places mood disorders with psychosis in a separate section. 4.2 How does DSM-5 differ from DSM-IV in its classification of premenstrual dys phoric disorder (PMDD)? A. PMDD was in the Appendix in DSM-IV and remains in this location in DSM-5. B. PMDD was not included in DSM-IV but is in the Appendix of DSM-5. C. PMDD is no longer considered a valid psychiatric diagnosis. D. PMDD is included in the "Depressive Disorders" chapter of DSM-5 but was not included in the "Mood Disorders" chapter of DSM-IV. E. PMDD is included in DSM-5 but the name of the diagnosis has been changed. 4.3 What DSM-5 diagnostic provision is made for depressive symptoms following the death of a loved one? A. Depressive symptoms lasting less than 2 months after the loss of a loved one are excluded from receiving a diagnosis of major depressive episode. B. To qualify for a diagnosis of major depressive episode, the depression must start no less than 12 weeks following the loss. C. To qualify for a diagnosis of major depressive episode, the depressive symptoms in such individuals must include suicidal ideation. D. Depressive symptoms following the loss of a loved one are not excluded from receiving a major depressive episode diagnosis if the symptoms oth erwise fulfill the diagnostic criteria. Depressive Disorders---QUESTIONS **\|** 39 E. Depressive symptoms following the loss of a loved one are excluded from receiving a major depressive episode diagnosis; however, a proposed diag nostic category for postbereavement depression is included in "Conditions for Further Study" (DSM-5 Appendix) pending further research. 4.4 Which of the following statements about how grief differs from a major depres sive episode (MDE) is *false?* A. In grief the predominant affect is feelings of emptiness and loss, while in MDE it is persistent depressed mood and the inability to anticipate happi ness or pleasure. B. The pain of grief may be accompanied by positive emotions and humor that are uncharacteristic of the pervasive unhappiness and misery characteristic of MDE. C. The thought content associated with grief generally features a preoccupa tion with thoughts and memories of the deceased, rather than the self-crit ical or pessimistic ruminations seen in MDE. D. In grief, feelings of worthlessness and self-loathing are common; in MDE, self-esteem is generally preserved. E. If a bereaved individual thinks about death and dying, such thoughts are generally focused on the deceased and possibly about "joining" the de ceased, whereas in MDE such thoughts are focused on ending one's own life because of feeling worthless, undeserving of life, or unable to cope with the pain of depression. 4.5 How do individuals with substance/medication-induced depressive disorder differ from individuals with major depressive disorder who do not have a sub stance use disorder? A. They are more likely to be female. B. They are more likely to have graduate school education. C. They are more likely to be male. D. They are more likely to be white. E. They are less likely to report suicidal thoughts/attempts. 4.6 A 50-year-old man presents with persistently depressed mood for several weeks that interferes with his ability to work. He has insomnia and fatigue, feels guilty, has thoughts he would be better off dead, and has thought about how he could die without anyone knowing it was a suicide. His wife informs you that he requests sex several times a day and that she thinks he may be go ing to "massage parlors" regularly, both of which are changes from his typical behavior. He has told her he has ideas for a "better Internet," and he has in vested thousands of dollars in software programs that he cannot use. She notes that he complains of fatigue but sleeps only 1 or 2 hours each night and seems to have tremendous energy during the day. Which diagnosis best fits this pa tient? 40 **\|** Depressive Disorders---QUESTIONS A. Manic episode. B. Hypomanic episode. C. Major depressive episode. D. Major depressive episode, with mixed features. E. Major depressive episode, with atypical features. 4.7 A 45-year-old man with classic features of schizophrenia has always experi enced co-occurring symptoms of depression---including feeling "down in the dumps," having a poor appetite, feeling hopeless, and suffering from insom nia---during his episodes of active psychosis. These depressive symptoms oc curred only during his psychotic episodes and only during the 2-year period when the patient was experiencing active symptoms of schizophrenia. After his psychotic episodes were successfully controlled by medication, no further symptoms of depression were present. The patient has never met full criteria for major depressive disorder at any time. What is the appropriate DSM-5 di agnosis? A. Schizophrenia. B. Schizoaffective disorder. C. Persistent depressive disorder (dysthymia). D. Schizophrenia and persistent depressive disorder (dysthymia). E. Unspecified schizophrenia spectrum and other psychotic disorder. 4.8 What are the new depressive disorder diagnoses in DSM-5? A. Subsyndromal depressive disorder, premenstrual dysphoric disorder, and mixed anxiety and depressive disorder. B. Disruptive mood dysregulation disorder, premenstrual dysphoric disorder, and persistent depressive disorder (dysthymia). C. Disruptive mood dysregulation disorder, premenstrual dysphoric disorder, and subsyndromal depressive disorder. D. Disruptive mood dysregulation disorder, postmenopausal dysphoric disor der, and persistent depressive disorder (dysthymia). E. Mixed anxiety and depressive disorder, bereavement-induced major de pressive disorder, and postmenopausal dysphoric disorder. 4.9 A depressed patient reports that he experiences no pleasure from his normally enjoyable activities. Which of the following additional symptoms would be re quired for this patient to qualify for a diagnosis of major depressive disorder with melancholic features? A. Despondency, depression that is worse in the morning, and inability to fall asleep. B. Depression that is worse in the evening, psychomotor agitation, and signif icant weight loss. Depressive Disorders---QUESTIONS **\|** 41 C. Inappropriate guilt, depression that is worse in the morning, and early morning awakening. D. Significant weight gain, depression that is worse in the evening, and exces sive guilt. E. Despondency, significant weight gain, and psychomotor retardation. 4.10 A 39-year-old woman reports that she became quite depressed in the winter last year when her company closed for the season, but she felt completely nor mal in the spring. She recalls experiencing several other episodes of depression over the past 5 years (for which she cannot identify a seasonal pattern) that would have met criteria for major depressive disorder. Which of the following correctly summarizes this patient's eligibility for a diagnosis of "major depres sive disorder, with seasonal pattern"? A. She does *not* qualify for this diagnosis: the episode must start in the fall, and the patient must have no episodes that do not have a seasonal pattern. B. She *does* qualify for this diagnosis: the single episode described started in the winter and ended in the spring. C. She does *not* qualify for this diagnosis: the patient must have had two epi sodes with a seasonal relationship in the past 2 years and no nonseasonal episodes during that period. D. She *does* qualify for this diagnosis: the symptoms described are related to psychosocial stressors. E. She *does* qualify for this diagnosis: the symptoms are not related to bipolar I or bipolar II disorder. 4.11 Which of the following statements about the prevalence of major depressive disorder in the United States is *true?* A. The 12-month prevalence is 17%. B. Females and males have equal prevalence at all ages. C. Females have increased prevalence at all ages. D. The prevalence in 18- to 29-year-olds is three times higher than that in 60-year-olds. E. The prevalence in 60-year-olds is three times higher than that in 18- to 29-year-olds. 4.12 Which of the following statements about the heritability of major depressive disorder (MDD) is *true?* A. Nearly 100% of people with genetic liability can be accounted for by the personality trait of dogmatism. B. The heritability is approximately 40%, and the personality trait of neuroti cism accounts for a substantial portion of this genetic liability. C. Less than 10% of people with genetic liability can be accounted for by the personality trait of perfectionism. 42 **\|** Depressive Disorders---QUESTIONS D. Nearly 50% of people with genetic liability can be accounted for by the per sonality trait of aggressiveness. E. The heritability of MDD depends on whether the individual's mother or fa ther had MDD. 4.13 Which of the following statements about diagnostic markers for major depres sive disorder (MDD) is *true?* A. No laboratory test has demonstrated sufficient sensitivity and specificity to be used as a diagnostic tool for MDD. B. Several diagnostic laboratory tests exist, but no commercial enterprise will offer them to the public. C. Diagnostic laboratory tests have been withheld for fear that people testing positive for MDD may attempt suicide. D. Tests that exist are adequate diagnostically but are not covered by health in surance. E. Only functional magnetic resonance imaging (fMRI) provides absolute di agnostic reliability for MDD. 4.14 Which of the following statements about gender differences in suicide risk and suicide rates in major depressive disorder (MDD) is *true?* A. The risk of suicide attempts and completions is higher for women. B. The risk of suicide attempts and completions is higher for men. C. The risk of suicide attempts and completions is equal for men and women. D. The disparity in suicide rate by gender is much greater in individuals with MDD than in the general population. E. The risk of suicide attempts is higher for women, but the risk of suicide completions is lower. 4.15 A 12-year-old boy begins to have new episodes of temper outbursts that are out of proportion to the situation. Which of the following is *not* a diagnostic possi bility for this patient? A. Disruptive mood dysregulation disorder. B. Bipolar disorder. C. Oppositional defiant disorder. D. Conduct disorder. E. Attention-deficit/hyperactivity disorder. 4.16 Which of the following features distinguishes disruptive mood dysregulation disorder (DMDD) from bipolar disorder in children? A. Age at onset. B. Gender of the child. C. Irritability. Depressive Disorders---QUESTIONS **\|** 43 D. Chronicity. E. Severity. 4.17 Children with disruptive mood dysregulation disorder are most likely to de velop which of the following disorders in adulthood? A. Bipolar I disorder. B. Schizophrenia. C. Bipolar II disorder. D. Borderline personality disorder. E. Unipolar depressive disorders. 4.18 An irritable 8-year-old child has a history of temper outbursts both at home and at school. What characteristic mood feature must be also present to qualify him for a diagnosis of disruptive mood dysregulation disorder? A. The child's mood between outbursts is typically euthymic. B. The child's mood between outbursts is typically hypomanic. C. The child's mood between outbursts is typically depressed. D. The child's mood between outbursts is typically irritable or angry. E. The mood symptoms and temper outbursts must not have persisted for more than 6 months. 4.19 Children with disruptive mood dysregulation disorder (DMDD) often meet criteria for what additional DSM-5 diagnosis? A. Pediatric bipolar disorder. B. Oppositional defiant disorder. C. Schizophrenia. D. Intermittent explosive disorder. E. Major depressive disorder. 4.20 The diagnostic criteria for disruptive mood dysregulation disorder (DMDD) state that the diagnosis should not be made for the first time before age 6 years or after 18 years (Criterion G). Which of the following statements best describes the rationale for this age range restriction? A. Validity of the diagnosis has been established only in the age group 7--18 years. B. The restriction represents an attempt to differentiate DMDD from bipolar disorder. C. The restriction is based on existing genetic data. D. The restriction represents an attempt to differentiate DMDD from intermit tent explosive disorder. E. The restriction represents an attempt to differentiate DMDD from autism spectrum disorder. 44 **\|** Depressive Disorders---QUESTIONS 4.21 A 9-year-old boy is brought in for evaluation because of explosive outbursts when he is frustrated with schoolwork. The parents report that their son is well behaved and pleasant at other times. Which diagnosis best fits this clinical pic ture? A. Disruptive mood dysregulation disorder. B. Pediatric bipolar disorder. C. Intermittent explosive disorder. D. Major depressive disorder. E. Persistent depressive disorder (dysthymia). 4.22 A 14-year-old boy describes himself as feeling "down" all of the time for the past year. He remembers feeling better while he was at camp for 4 weeks dur ing the summer; however, the depressed mood returned when he came home. He reports poor concentration, feelings of hopelessness, and low self-esteem but denies suicidal ideation or changes in his appetite or sleep. What is the most likely diagnosis? A. Major depressive disorder. B. Disruptive mood dysregulation disorder. C. Depressive episodes with short-duration hypomania. D. Persistent depressive disorder (dysthymia), with early onset. E. Schizoaffective disorder. 4.23 A 30-year-old woman reports 2 years of persistently depressed mood, accom panied by loss of pleasure in all activities, ruminations that she would be better off dead, feelings of guilt about "bad things" she has done, and thoughts about quitting work because of her inability to make decisions. Although she has never been treated for depression, she feels so distressed at times that she won ders if she should be hospitalized. She experiences an increased need for sleep but still feels fatigued during the day. Her overeating has led to a 12-kg weight gain. She denies drug or alcohol use, and her medical workup is completely normal, including laboratory tests for vitamins. The consultation was prompted by her worsened mood for the past several weeks. What is the most appropriate diagnosis? A. Major depressive disorder (MDD). B. Persistent depressive disorder (dysthymia), with persistent major depres sive episode. C. Cyclothymia. D. Bipolar II disorder. E. MDD, with melancholic features. 4.24 A 45-year-old woman with multiple sclerosis was treated with interferon beta 1a a year ago, which resolved her physical symptoms. She now presents with depressed mood (experienced daily for the past several months), middle in somnia (of recent onset), poor appetite, trouble concentrating, and lack of in Depressive Disorders---QUESTIONS **\|** 45 terest in sex. Although she has no physical symptoms, she is frequently absent from work. She denies any active plans to commit suicide but admits that she often thinks about it, as her mood has worsened. What is the most likely diag nosis? A. Major depressive disorder. B. Persistent depressive disorder (dysthymia). C. Depressive disorder due to another medical condition. D. Substance/medication-induced depressive disorder. E. Persistent depressive disorder (dysthymia) and multiple sclerosis. 4.25 An 18-year-old college student, recently arrived in the United States from Bei jing, complains to her gynecologist of irritability, problems with her room mates, increased appetite, feeling bloated, and feeling depressed for 3--4 days prior to the onset of menses. She reports that these symptoms have been pres ent since she reached menarche at age 12 (although she has never kept a mood log). The gynecologist calls you for a consultation about the correct diagnosis, because she is as yet unfamiliar with the new DSM-5 diagnostic criteria. What is your response? A. The patient has premenstrual syndrome because she does not meet criteria for premenstrual dysphoric disorder. B. The patient would qualify for a provisional diagnosis of premenstrual dys phoric disorder; however, the diagnosis does not exist in DSM-5. C. The patient would qualify for a provisional diagnosis of premenstrual dys phoric disorder. D. The patient would qualify for a provisional diagnosis of premenstrual dys phoric disorder if the diagnosis had been validated in Asian women. E. The patient has no DSM-5 diagnosis. 4.26 What is the appropriate method of confirming a diagnosis of premenstrual dysphoric disorder? A. Laboratory tests. B. Family history. C. Neuropsychological testing. D. Two or more months of prospective symptom ratings on validated scales. E. One month of scoring high on the Daily Rating of Severity of Problems or 1 month of scoring high on the Visual Analogue Scales for Premenstrual Mood Symptoms. 4.27 A 29-year-old woman complains of sad mood every month in anticipation of her very painful menses. The pain begins with the start of her flow and contin ues for several days. She does not experience pain during other times of the month. She has tried a variety of treatments, none of which have given her re lief. What is the appropriate diagnosis? 46 **\|** Depressive Disorders---QUESTIONS A. Premenstrual dysphoric disorder. B. Premenstrual syndrome. C. Dysmenorrhea. D. Factitious disorder. E. Persistent depressive disorder (dysthymia). 4.28 Which of the following symptoms must be present for a woman to meet criteria for premenstrual dysphoric disorder? A. Marked affective lability. B. Decreased interest in usual activities. C. Physical symptoms such as breast tenderness. D. Marked change in appetite. E. A sense of feeling overwhelmed or out of control. 4.29 A 23-year-old woman reports that during every menstrual cycle she experi ences breast swelling, bloating, hypersomnia, an increased craving for sweets, poor concentration, and a feeling that she cannot handle her normal responsi bilities. She notes that she also feels somewhat more sensitive emotionally and may become tearful when hearing a sad story. She takes no oral medication but does use a drospirenone/ethinyl estradiol patch. What diagnosis best fits this clinical picture? A. Premenstrual dysphoric disorder (PMDD). B. Dysthymia. C. Dysmenorrhea. D. Premenstrual syndrome. E. Substance/medication-induced depressive disorder. 4.30 A 31-year-old woman with no history of mood symptoms reports that she ex periences distressing mood lability and irritability starting about 4 days before the onset of menses. She feels "on edge," cannot concentrate, has little enjoy ment from any of her activities, and experiences bloating and swelling of her breasts. The patient reports that these symptoms started 6 months ago when she began taking oral contraceptives for the first time. If she stops the oral con traceptives and her symptoms remit, what would the diagnosis be? A. Premenstrual dysphoric disorder. B. Dysthymia. C. Major depressive episode. D. Substance/medication-induced depressive disorder. E. Premenstrual syndrome. Depressive Disorders---QUESTIONS **\|** 47 4.31 A 45-year-old man is admitted to the hospital with profound hypothyroidism. He is depressed but does not meet full criteria for major depressive disorder (MDD), the diagnosis given to him by his internist. The patient has no prior history of a mood disorder, and all of the depressive symptoms are temporally related to the hypothyroidism. Based on this information, you determine that a change in diagnosis---to depressive disorder due to another medical condi tion---is warranted, as well as a specifier to indicate that full criteria for MDD are not met. How would the full diagnosis be recorded? A. Hypot