Abnormal Psychology Final Exam

Catatonia is…

The failure of the body to respond to its environment due to neurological or psychiatric illness.

Stereotypy refers to…

A catatonic symptom in which the person repeats a behavior almost endlessly unless stopped.

In a catatonic state, if someone has absolutely NO psychomotor activity, and do not actively relate to their environment AT ALL, you would call this…

Stupor

Repreating words and sounds is _____, whereas repeating movement is _____.

Echolalia; Echopraxia

What is the main difference between Posttraumatic Stress Disorder and Acute Stress Disorder?

Symptoms last longer in PTSD then they do in Acute Stress Disorder.

A 4-year-old child is sitting in front of the TV when a horror movie comes on. The child sees a character in the film get mutilated by a murderer. The child thereafter experiences extreme fear, does not want to be alone, and is afraid that loved ones will be killed. Can the child be diagnosed with PTSD?

No.

5-year-old Hamish has been with 6 different foster families since he was 1 year old. Before Hamish was placed in foster care, he lived with his biological mother and her boyfriend. They would frequently leave him by himself in his playpen for hours at a time, and when they did return home, they often fell asleep from the effects of opioids and forgot to care for him.

Hamish's foster parents want to adopt him but worry they can't connect with him emotionally. Hamish doesn't show happiness or excitement, even when they took him to the animal shelter to adopt a puppy and threw him a birthday party. If he is upset, he will usually just sit and look out the window, saying nothing. If they try to comfort him, he will push them away and run from the room. Sometimes, Hamish gets really irritable for no apparent reason. Which of the following is the MOST appropriate diagnosis for Hamish?

Reactive Attachment Disorder.

About 2 weeks ago, Karl was closing up his window at the bank where he works, when a masked intruder walked up, pointed a gun at him, and instructed him to take out all the cash he had in his draw. When Karl froze in fear instead of complying, the intruder fired his gun through the glass partition, narrowing missing Karl, but fatally injuring one of his coworkers.

Since this occurred, Karl has been unable to go back to work and barely leaves his apartment. When he thinks about going back to work at the bank, he immediately get cold chills and feels sick to his stomach. When Karl has to leave his apartment, he constantly looks around his surroundings. Karl tells you that he feels very numb and constantly thinks about what happened, wondering if he could have done something differently. He's been experiencing nightmares involving guns and masked intruders, which often causes him to wake up in the middle of the night and not be able to go back to sleep. Which of the following is the BEST diagnosis for Karl?

Acute Stress Disorder.

Mickey has stopped attending social events after his girlfriend of 16 years, Minnie, broke up with him. Mickey states that Minnie was his "soulmate" and "the love of [his] life" and that he "cannot move on." He states that the breakup came out of the blue and shook him "to the core." He states that "literally everything" makes him think of her and start to cry. He states that his attempts to control his emotions have been unsuccessful and that he spends all day thinking of what he could have done differently to keep her. He has lost contact with his friends because they kept telling him that it's been long enough since the breakup for him to start dating again. The breakup happened 2 years ago, and Mickey has deteriorated ever since. What is the BEST diagnosis for Mickey?

Adjustment Disorder.

All of the following are pathological forms of dissociation EXCEPT:

Daydreaming.

Dissociative Identity Disorder and ________________________ are two terms for the same thing.

Multiple Personality Disorder.

Martin returned home 9 months ago from deployment in the war. Martin was evaluated at the VA hospital for PTSD due to his multiple traumatic experiences during combat. Surprisingly, he does not demonstrate any major PTSD symptoms, but he decided to go to therapy "to help get back to civilian life." Martin has brought a copy of his paperwork from the VA hospital with him to show you. He specifically points to a section on the paperwork that says he witnessed someone being beheaded and says, "I guess I want to talk about this."

"That had to be horrifying," you say, easing him into the conversation.
Martin responds, "Yeah, it had to be. But what's scaring me now is that I don't remember it. I don't remember my two buddies dying, either. I wake up and I know they're dead, but I can't remember it! I feel like that's an insult to their honor that I can't remember... I don't know what to do."

Dissociative Amnesia

Kayla says strange things have been happening to her. One day, she was extremely stressed from homework and piled-up chores and "just didn't feel like myself." She doesn't remember what happened that evening, but her homework was done and her whole room was tidied and organized.

Kayla explains, "This is so weird, but I guess my friend called me to check on me, and I answered the phone and kept saying my name was 'Susie.' And I know what you're thinking -- no I didn't have anything to drink!"

Kayla reports other bothersome experiences where Post-It Notes seem to appear out of nowhere and actually re-clutter her room. "They say things like 'feed the dog' and 'check your spam folder.' They're all signed 'Michelle.' I kept thinking someone was breaking into my house! I don't know any Michelles or Susies. There's nobody else who would put these notes everywhere or answer my phone! I live alone, and nobody has my house key to prank me like this. My dad says my house must be haunted and made fun of me. I'm so embarrassed. It sounds nuts."

The BEST diagnosis for Kayla would be...

Disoociative Identity Disorder.

Hannah, a 15-year-old girl, is brought into your office because she reports having multiple personalities. Hannah states that she has a personality named Pacifica, a 5-year-old girl, and a personality named Mabel, a 25-year-old woman. Pacifica uses a little girl voice, and Mabel has a vaguely English accent.

Hannah can switch to her other personalities on command and frequently does so in Instagram videos. Hannah has over 8,000 Instagram followers. They regularly like her content and ask to interact with her "alters." Hannah's mother says that Hannah seems to switch to Pacifica when she doesn't get her way, and that it has become a problem at home.  What is the BEST diagnosis for Hannah?

N/A

Bradley is a 35-year-old man who lives by himself in an apartment he rents in an upscale neighborhood. He currently works as an investment broker, which is something he's always been interested in. For the past year or so, Bradley has become increasing more reluctant to go out on dates with women whom he meets at work or through friends, because his sexual performance has been a source of great embarrassment to him. About a year ago, he met a woman at a bar and went back to her apartment, where they initiated sexual contact. After about one minute of engaging in intercourse, Bradley ejaculated unexpectedly, which caused him to feel embarrassed and frustrated with himself. The next time Bradley brought a woman home a few weeks later, the same thing happened. This pattern has continued for Bradley over the past year, and has caused increasing amounts of frustration and embarrassment. It has gotten to the point where Bradley will make up excuses not to engage in sexual activity with the women he meets, by saying he's had too much to drink or he has to get up really early for work in the morning. This has really negatively impacted Bradley's self-esteem, and he is starting to believe that he is a failure as a man. Which of the following is the BEST diagnosis for Bradley?

Premature (early) Ejaculation

When Raina was born, she was biologically male, and her parents gave her the name "Ryder". From a young age, Raina insisted that she was girl and begged her parents to let her wear her sister's hand-me-down clothes. Her parents thought this might just be a normal part of growing up for Raina, because Raina has three older sisters. Raina loved building Legos as a child, along with playing house with her sisters and climbing the big tree in the backyard. One summer, Raina begged her parents to let her grow her hair out before school started in the fall, and they agreed. Raina was much happier with her long hair, but the boys at school teased her about it. As Raina got older, her biological sex caused her more and more distress. Her mom found her in the bathroom crying in front of the mirror one day before school because she felt like "her real self" was trapped in this body that didn't belong. Some of Raina's friends at school were beginning to get their first training bras, and Raina wanted to be able to get one too. She started pet-sitting for her neighbors, and told her parents that she was saving her money for surgery to look like a normal girl. Which of the following is the BEST diagnosis for Raina?

Gender Dysphoria

Mrs. Pontellier, age 28, has been married for 6 years. She comes to sex counseling distraught that she has never experienced an orgasm during sex with her husband. She reports, "No matter what, it never happens. I feel so broken, like my body's not working! I just get tired and fake it so I don't hurt his feelings."

Mrs. Pontellier says that she never communicated to her husband what she likes during sex because "I don't even know what I like. I don't want to talk about this stuff with him." She reports that she can reach orgasm if she touches herself in private, but that her husband believes penetration alone should satisfy her. The couple does not engage in much "foreplay."

What is the BEST diagnosis for Mrs. Pontellier?

Inadequate Sexual Stimulation

Matilda, 19, is referred to you by her gynecologist because she reports severe vaginal pain during intercourse. The pain also happened during Matilda's gynecologic exam. Matilda states that she feels guilty about turning down sex with her boyfriend but that it simply hurts too much. Matilda reports, "My boyfriend doesn't go rough or anything -- in fact he's been super careful -- but it hurts anyway." Matilda has tried many things to find the problem, such as inserting one finger while using a personal lubricant and getting a comprehensive STD test. She states that even her own finger hurt terribly and that her STD test came back negative (meaning healthy).

Genito-Pelvic Pain/ Penetration Disorder

Mr. Rochester, 35, has been your client for a year. Primarily, you work on anger issues together. One day, he comes in very upset and says, "Look, I never told you this, but I haven't been able to have sex." More times than not, he cannot get an erection. He reports a recent instance of losing an erection during intercourse which upset him so badly that he went into his bathroom and busted his mirror because "I didn't want to look at myself."

He states that he and his girlfriend have not had any major fights or problems. "We get along really well. The only major issue we had was when I busted the mirror. I really love her, and I can't imagine not being able to show it anymore." Mr. Rochester is not taking any medication that could lead to sexual problems. He reports extreme low self-esteem because of the issue and keeps calling himself names.

Erectile Disorder

Jafar, 21, feels anxious about his sex life lately. He remembers an instance at a party where he hit it off with a young woman there but was unable to maintain an erection. He states that he was anxious again at the next party, because he was supposed to meet a girl there whom he had been texting. Again, he was unable to maintain an erection. Very similar sexual problems have happened several more times.

He states that he had never had this issue before. To rule out a health condition, you ask if he still experiences erections in the morning when first waking up. He says, "Yeah, unless I'm extremely hungover." You ask how often he is typically hungover and he says, "I guess after parties." When you ask him how much he drinks, he says, "I lose track. Anyway, that's not the problem here, the problem is my sex life is going nowhere."

Substance/ Medication-Induced Sexual Dysfunction

Davey reports a gradual loss of interest in sex in his thirties. He has a girlfriend with whom he cohabitates but has not had sexual thoughts about her for 7 months. He has also lost desire to watch pornography. Davey reports no desire to have sex with the same sex, either.

He states he is not finding the topic of sex exciting at all. Davey and his girlfriend have not had any major fights or stressors aside from him constantly turning down sex. He still gets erections overnight and turns down sex in the morning even though his body is responsive. Although Davey is very upset about losing interest in sex, he has not lost interest in other enjoyable things and does not meet criteria for depression. He has also not undergone a sexual trauma or other serious stressors. He denies paraphilia symptoms. You review his medication list and find no medications with sexual side-effects. Davey denies drug use and states he only has 1 glass of wine with his Friday dinner.

Male Hypoactive Sexual Desire Disorder

Janet reports an active sex life. She reports being able to get aroused but not being able to orgasm. Janet remembers orgasming one time "seven years ago" when masturbating but currently cannot orgasm while masturbating or with her husband. Janet reports talking to her husband about what feels good and gets along well with him in day-to-day life as well as intimately. Janet is extremely sad that she cannot orgasm, but she states that sex still feels good and she still likes to have it: "I just never get there. I just slow down." Janet states that her husband has stimulated her clitoris in various ways "tons of times for a long time, and I still just feel good then slow down. There's no orgasm point." Janet sadly states she thinks "something is wrong with me."

Female Orgasmic Disorder

Karyn has never had much interest in sex. She does find men sexually attractive and wishes she could enjoy the thought of sex. However, she just broke up with her boyfriend because she would always turn down sex, "and it wasn't getting anywhere." Karyn denies sexual interest in women. Karyn did have sex a few times with her most recent boyfriend but reported "just doing it because" and denied experiencing pleasure. Karyn reported, "I feel like he was good at sex. He was very attractive, and I wanted to enjoy it. He touched me a lot, it just didn't do anything for me." Karyn reported her ex did manually stimulate her clitoris each time they had sex for a long time, "but it just felt kind of tingly, not really arousing or anything." Karyn denies history of sexual trauma or relationship abuse. She denies all drug use and currently only takes a multivitamin. She recently had her thyroid checked, and it was good.

Female Sexual Interest/ Arousal Disorder

John reports not being able to ejaculate during sex with his girlfriend. He can ejaculate during masturbation. He recalls ejaculating the "first couple times" with his girlfriend. He reports enjoying foreplay, but "after foreplay, there would just be 40 minutes of sex and nothing would happen, so I'd just pretend and hide the condom in the trash." John stated this has gone on for 7 months. He routinely fakes orgasms because he gets tired. He denies all alcohol use. He denies use of other drugs. He denies taking any medications that would have this side-effect. John is upset because of this and feels dishonest for faking orgasms.

Delayed Ejaculation

A shorter way of saying "neurocognitive disorder" in the medical field would be "_______."

Dementia

Why are Alzheimer's diagnoses sometimes referred to as "Probable Alzheimer's" and "Possible Alzheimer's?"

Alzheimer’s Disease can only be 100% confirmed as a diagnosis after death with an autopsy.

Earlier this week, Charice found herself unable to drive due to extreme confusion. She was having trouble focusing on traffic lights to know whether they were green or red, and narrowly missed causing an accident. She now shows up in your emergency room because her neighbor found her having a panic attack on her front lawn, saying she doesn't know where she is. As of right now, Charice still does not know where she is and is very upset. She cannot repeat words back to you as part of an evaluation task. The medical doctor informs you that none of her medical tests show signs of stroke or TBI.

Delirium.

Tony, 60, has had diabetes for 50 years and high blood pressue (hypertension) for about 20 years. Tony has not been very good about monitoring his diet, nor has he kept his A1C down by regularly monitoring his blood sugar. Tony has had a couple of scares where his sugar got too low or too high, and has been in the hospital for 1 heart attack.

Lately, Tony's short-term memory has reduced to almost nothing, and he cannot remember conversations he had minutes ago. He writes himself notes to make sure he remembers things. He has forgotten many vacations he has been on with his daughter and has trouble using complex reasoning. Most things he can remember deal with his own childhood. Sometimes he gets confused.

Mild Vascular Neurocognitive Disorder (“Vascular Dementia”)

Brandy has mild neurocognitive disorder due to substance use (alcohol). She has trouble planning her day, and spends much of it unsure of what to do next. It is very difficult and stressful for her to make any decisions. When she calls her doctor or goes shopping for food, it is usually done on impulse or a sudden strike of action rather than when she first needs an appointment or groceries. What cognitive domain does Brandy appear to struggle the most with right now?

Executive Functioning

Yvonne has major neurocognitive disorder due to frontotemporal lobe degeneration. Yvonne tends to say exactly what is on her mind, such as "I'm gonna die anyway" when her 4-year-old grandchild says "Get well soon, meemaw!" Yvonne finds it most convenient to clip her fingernails at the kitchen table, where she can always find the clippers, and usually does not clean up afterwards. Her son tries to take care of Yvonne as best he can. He has noticed that his mom assumes he has a stomach ache whenever she is trying to tell him that she has a stomach ache, which he finds strange. What cognitive domain is Yvonne struggling the MOST with?

Social Cognition

Gillian, age 27, is being assessed for a neurocognitive disorder. In order to most quickly and efficiently order the best medical tests, Dr. Kahn decides to rule out tests for certain conditions. To get to the bottom of things the quickest, Dr. Kahn should probably NOT wast time testing for.....

Neurocognitive Disorder due to Alzheimer’s disease

Sally is 60 years old and a retired pole-vaulter who has remained in-shape and healthy after her athletic career. She has no heart problems. She is being assessed for a neurocognitive disorder. In order to most quickly and efficiently order the best medical tests, Dr. Hahn decides to rule out tests for certain conditions. To get to the bottom of things the quickest, Dr. Hahn should probably NOT wast time testing for.....

Neurocognitive Disorder due to vascular disease

Michael is 8 years old. He has a lot of trouble paying attention in class and gets bad grades. Also, when he is at home or even with friends he likes to play with, he often misses what is happening around him. Michael tells you, “People are always asking me, ‘Are you paying attention?’ I feel bad.” Michael, overall, is a calm child. He even sometimes comes across as shy.

ADHD, predominately inattentive pattern

Abigail was diagnosed with Asperger’s Syndrome when she was 5 years old. She comes to you at the age of 15 because she is still having trouble in school. High school is an upsetting environment for her because she says it is, “so crowded, and I don’t understand the teacher, and I am just so stressed.” Abigail reports being made fun of for “doing a hand jive” when she is nervous. She has a few friends, but they don’t always want to hang out with her because she says, “I only talk about horses and it bores them! I don’t know what to do.”

Autism Spectrum Disorder

Fritz is referred to you by an audiologist because his hearing tests all come back normal, but he clearly does not understand what people are saying. When you ask him to repeat a phrase, Fritz does it almost perfectly. However, when you try to have a conversation with him, it becomes obvious that he does not know what you mean. Fritz demonstrates a handle of vocabulary that is lower than normal for his age. Fritz was always a friendly, sociable child, but as he gets older, it is more difficult to keep friends because children his age have increasingly verbal friendships. He demonstrates normal behaviors expected of a child, but is often frustrated by his lack of understanding what people want from him.

Language Disorder

Gary has trouble learning from his experiences. For example, his mother taught him how to write his name yesterday, but he cannot hold a pen today. He is unable to feed himself with a fork and spoon even though he is 10 years old because it is difficult for him to learn and plan his actions. He is not able to participate in a typical school environment, but he does well at his day learning facility and has made lots of friends. Similar difficulties have been happening his whole life.

Intellectual Developmental Disorder

If Chrissie stutters, and it is not due to a medical condition, she would be diagnosed with...

Childhood-Onset Fluency Disorder

If Jadon knows which words to use but has a "lisp," "slur," or "speech impediment," and it is not due to a medical condition, he would be diagnosed with...

Speech Sound Disorder

Reymundo has a lot of trouble understanding when people are joking or using sarcasm. He usually does not pick up on nonverbal cues for communication, leading to a lot of stress and teasing at his school. Reymundo does very well academically and likes learning addition and subtraction, art, and spelling. However, he feels isolated and like he doesn't understand people at all. He really wants to be included in other children's different activities at recess, but his teachers notice he is always the "odd one out."

Social (Pragnatic) Communication Disorder

Walter has a verbal and physical tic in which he will bark and raise his right shoulder suddenly. He has had the problem since childhood. The problem is not from a medical condition. Walter denies use of drugs.

Tourette’s Disorder

Paul twists his hair over and over in a seemingly endless way until he absolutely has to do something else. He does not have any delusions, hallucinations, disorganized speech, or communication problems.

Stereotypic Movement Disorder

Annetta has had trouble grasping and holding onto things since childhood. She also has a lot of trouble navigating desks in a classroom in order to sit down. She was able to get an accommodation through her high school to sit in the front because of how much she would bump into desks and get bruised otherwise. Annetta does not have a medical condition that would explain this, but it does affect her life because she typically gives up on things easily to avoid embarrassment and "doesn't even try" to achieve.

Developmental Coordination Disorder

Mrs. Orenz notices that her student, Jake, has a lot of trouble reading aloud during storytime. She has tried to call on him more often to give him practice, but he reads aloud notably slower than the other students and mispronounces so many things that the rest of the class loses focus or can't tell where he left off when it is their turn. Jake has so much trouble that he can't remember what the stories are about when it's time for the graded activity. He talks to other students and the teacher freely and without any strain when it is not time to read. Mrs. Orenz calls Jake's parents to get him evaluated. It turns out they noticed a problem, too. The evaluation comes back that Jake's IQ is within normal range except in a subcategory of reading.

Specific Learning Disorder

You can tell that Hypomania and mania apart by…

how long the symptoms last, how severe the impairment is, and if there are psychotic features (all of the above)

All of the following are symptoms of mania or hypomania EXCEPT…

Hypersomnia nearly every day.

Aaron has just been arrested for “streaking” (running naked) across the field of his old football stadium during a game. The police drug-tested him, and the tests came back negative. He was put in jail overnight, but he did not sleep. In fact, he kept his cellmates up with constant talking. Aaron was released the following morning. He then stole a bicycle (“for noble purposes”) to ride to his girlfriend’s house and propose to her. His girlfriend had seen his arrest on TV and was actually thinking of breaking up with him, not marrying him. Aaron then calls up his mom because he is upset, but his mom says, “You actually sound quite happy about the breakup.” He replies, “I am happy. Nothing can stop me, especially not other people.” However, when his mom later found out that he drained her bank account buying XBox games, she did stop him. Aaron is now in the hospital where you work. After interviewing him.

Bipolar I Disorder

Makim is a 40-year-old client who comes into your office saying, “I couldn’t take it anymore. I had to get help. I have kept it in all this time.” When you ask Makim about what is wrong, he says that for many years, he has had periods where he feels very depressed. Other times, he feels just fine, and still other times, he actually feels great. When you ask Makim about his experience of depression, he tells you that his mood gets very sad and he sleeps all day. It makes him feel bad about himself. When you ask him about times when he feels great, he says he gets a lot done at work, enjoys his family life, and starts fun, new projects in his woodworking shop. When you ask him to describe what “normal” for him looks like, he says, “Well, neither of those things. Just normal. What bothers me is I can’t figure out what causes me to be so up and down sometimes. I don’t see it coming, so it really makes me upset. I wish I could channel my emotions better. It’s been such a problem doing day-to-day tasks when I can’t see it coming. I’m embarrassed over something so minor, but I knew I had to get some help.” After more interviewing, you make sure that Makim uses no drugs that affect his mood. He also is physically healthy.

Cyclothymic Disorder

Darla’s paperwork came in this morning. She has no history of medical problems or drug abuse. You have an appointment with Darla at 1:00. She does not show up to your office. You call the front desk, and the secretary says Darla checked in 30 minutes ago. You go to the waiting room to make sure she is alright. You find Darla sitting with her head down in a chair in the waiting room and say hello. “Oh, is it time?” she says. “I’m so sorry. I’m coming.” Darla moves very slowly and seems very sad. You ask her if she was injured or had any medical problems lately, and she says “No, I am just down. I feel really bad about missing my appointment.” You tell Darla that she didn’t actually miss the appointment and that you both can get started just fine. Darla does not look at you during the session because she has tears in her eyes. You gently ask about that, and she says, “I don’t know. I just feel so bad about myself. I am the worst. I can’t do anything these days.” Fast-forwarding to your appointment with Darla later next month, you find her much more exuberant. She shows up to her appointment 30 minutes early expecting you to let her in because she has “so much to say,” even though you are working with another client. You explain to her that she will have to wait a little, and she laughs it off. She fills out 17 crosswords as she waits for her appointment. Of course, you ask Darla about her mood lately. She says it’s been great apart from having some “stern warnings” at work for being loud, bumping into people, and doing personal projects on the job. She describes her “highs and lows” as being a source of uncontrollable stress in her life.

Bipolar II Disorder

Which of the following is a possible warning sign that someone is contemplating or planning to commit suicide?

They experience drastic changes in mood and/or behavior, which can include increased agitation or anxiety.

When we conduct a suicide risk assessment, we want to collect as much information as we can about our client’s _______.

Means and opportunity to commit suicide, suicidal ideation, intent, and'/ or plan, and protective factors (all of the above)

Georgia has come to you for treatment, because she has been feeling depressed for the past 3 years. Her depressed mood lasts for most of the day, and she feels depressed more days than not. Along with feeling depressed, Georgia has also noticed that she has much less of an appetite than she used to, and has lost about 30 pounds. She has trouble falling asleep at night, and often tosses and turns for hours. Sometimes, she isn't able to fall asleep at all. Georgia also has low self-esteem and often relies on the reassurance of others to feel better.

Persistent Depressive Disorder (Dysthymia)

For the past year and a half, Riley has noticed that in the weeks before and during her period, she feels lethargic, and doesn't have as much energy as she usually does, even though she sleeps up to 14 hours a day throughout these two weeks each month. Riley also reports feeling hungry all the time, and eating more snacks than she does during the rest of the month. She has noticed that before and during her period, she is extremely irritable, which leads to conflicts with her friends and family members. Riley also experiences severe mood swings, where she can be feeling happy and smiling, and then immediately begin crying because she has been overcome with feelings of sadness. Riley reports that she really only experiences these symptoms two weeks out of the month - the week before her period, and the week during her period - and the rest of the month, she feels pretty normal.

Premenstrual Dysphoric Disorder

Ty has been referred to you for assessment by his primary care physician. Ty has a stressful job as an investment banker, and likes to drink a beer when he gets home from work to take the edge off. He reports drinking 6-8 beers, on average, every night after work, and sometimes 10-12 on the weekends. Ty also drinks a beer or two in the morning before work to prepare for his day. Ty experiences a depressed mood almost all day, nearly every day, and has lost interest in his work, which he used to be excited about. He doesn't enjoy going out with friends anymore, and has lost all interest in dating. Ty also doesn't enjoy making pottery anymore, which used to be one of his favorite pastimes.

Substance/ Medication - Induced Depressive Disorder

Which of the following BEST describes the common feature of the anxiety disorders in the DSM-5?

Excessive fear, worry, and/or anxiety and related disturbances in behavior

How is the “panic attack specifier” different from Panic Disorder?

A panic attack is not a disorder, just a symptom. Panic Disorder has many features including panic attacks.

David is a 35-year-old man who has been referred to you for a clinical assessment. He tells you that he has been working on his doctoral dissertation for five years, but has never finished the project, because he knows that he will have to give a presentation to his peers, colleagues, and professors when it is completed. He is worried that he would get so nervous that he would throw up and embarrass himself in front of all those people. David still lives with his parents because he is afraid of calling up a real estate agent and setting up a meeting. He thinks that the real estate agent will tell him that his credit score is not high enough to qualify for a home loan, which would make David feel uncomfortable and embarrassed. He also doesn't have a driver's license anymore because he couldn't bring himself to go down to the DMV to renew it. This would involve sitting in the waiting room with a lot of people, who might try to talk to him, and then having a conversation with the unfamiliar employee who would renew his license. David works at a local coffee shop part-time, but refuses to be stationed at the cash register, because he is worried that customers will criticize him for messing up their orders. Based on this information.

Social Anxiety Disorder (Social Phobia)

Phoebe has come to you for treatment because she has a persistent and severe fear of blood. She tells you that she has not been to a doctor or dentist in years, because she is worried that she will either see her own blood, or even worse, see the blood of someone else. Phoebe has even decided against having children, because she wants to avoid childbirth, and worries that the children would get hurt and bleed, and she wouldn't be able to help them. She used to work as a receptionist at a health clinic, but couldn't risk seeing blood on any of the patients, so she left her job, and hasn't worked since. Last month, Phoebe got a paper cut, and her finger started to bleed just a little bit. She tells you that she immediately froze up, and held her finger as far away from her as possible. She felt like she couldn't breathe, and it took her over an hour to be able to get up, wash off the cut, and put on a Band-aid.

Specific Phobia

Jade can't get a hold on her worries. She has had trouble getting to work on time because she stays up most of the night worrying about the next day. She worries about getting late to work, and when she is late to work, she is worried about the phonecalls she has missed. When she calls her business partners back and they don't answer, she is worried that they are dead. She then checks the news to see if there were any car crashes. Then everything on the news worries her, and she has to call home to make sure her kids are okay. Then she gets worried that her babysitter is fatigued from all her phonecalls and won't pay attention to the kids. This has gone on for a year.

Generalized Anxiety Disorder

Individuals who are diagnosed with an obsessive-compulsive or related disorder experiences obsessions, compulsions, or both. Obsessions are ___________ , and compulsions are ______________.

Persistent intrusive thoughts; repetitive behaviors.

Having good insight into your own OCD is associated with ____________.

Better outcomes for the condition.

Emma thinks that her nose is too big for her face in comparison to her other facial features. She first starting really noticing how big her nose was when she was in middle school, and began doing her own makeup for the first time. Emma's friends and family have assured her that her nose is actually on the smaller side, and fits perfectly with the rest of her small facial features, but Emma thinks that they are just trying to be nice and not hurt her feelings. Now that Emma is an adult, she spends at least 3 hours every morning doing her hair and makeup before work in ways that make her nose appear smaller and will draw other's attention away from her nose. This means that she has to wake up at 4:30am if she wants to make it to work on time, and she often feels that she is not getting enough sleep. During the work day, Emma goes to the bathroom at least once every hour to check her nose in the mirror, and will fix her hair and makeup if she thinks it is making her nose too noticeable. If Emma is not satisfied with the way her nose looks in the morning before work, she will often either come in late, or call in sick. On the weekends, she often stays home rather than going out with her friends, because she is worried that other people will only be able to focus on her nose when talking with her. Emma has maxed out several credit cards purchasing beauty products that are marketed towards people who want to make their noses appear smaller. She is considering taking out a small loan to have plastic surgery on her nose in the near future.

Body Dysmorphic Disorder.

Jonathan has a lot of trouble getting rid of items. He likes to save newspapers in case there is anything important in them, but he only gets around to reading about 5% of them. He saves 100% of them, though. Jonathan keeps food stockpiled and doesn't believe in throwing out food. However, his cupboards have spilled over onto the floor, so he doesn't shut them. A lot of the food in the back goes bad and attracts cockroaches. He buys any magazine he thinks would be interesting at the store and saves those, too, plus the receipts and shopping bags. His wife divorced him and the courts decided his kids could not come to visit him. There are bugs all over his house, which he can barely move around in, and he lives in total squalor.

Hoarding Disorder.

You meet Annette in intensive care for a bad staph infection. Her doctor wants you to evaluate for a mental problem. The source of Annette's staph infection is just behind her ears, where the skin has all been picked away and leaves open wounds for her hair to rub against. You talk to Annette about why she does this. She says it relieves her urges and has never been able to stop. Sometimes she has used tweezers to pick off "loose skin" that she has left behind her ears.

Excoriation Disorder.

What word element beans Above or more?

Hyper-

What word element beans beyond what is normal (aka abnormal)?

Para-

What word element means body?

Soma-

What word element means below or less?

Hypo-

What word element meals breathing?

-pnea or -pnoea

What word element means sleep?

Somn-

Moira is a 45-year old woman who has come to your office for a professional evaluation. Her primary care physicians has diagnosed her with mild eczema and IBS, based on her complaints of persistent itchiness and redness of the skin, and gastrointestinal issues. Moira is so worried about her stomach hurting throughout the day that she has switched to an entirely plant-based diet, because she read online that red meat and dairy can further irritate the stomach, as well as exacerbate skin sensitivity. She has also started blending most of her meals because she believes that will help her body better digest the food. Every morning, Moira wakes up, and lathers her whole body in lotion endorsed by dermatologists and the Eczema foundation, which is specifically marketed towards individuals with sensitive skin. To date, Moira has spent hundreds of dollars on skincare products, body wash, and lotion in an attempt to find one that won't exacerbate her mild eczema. When she goes outside, Moira always wears a long-sleeved shirt, long pants, and calf-high socks, even in the summertime, so that there isn't any environmental exposure to her sensitive skin. Moira is so concerned about her sensitive stomach and itchy skin that she refuses to go out to eat at restaurants with her family and friends, and will not visit her children at their houses for extended periods of time. She arranged with her employer to work from home so she can more effectively monitor her symptoms throughout the day.

Somatic Symptom Disorder.

Aspen is a young single mother to her 6-year-old daughter Arya. Arya has always been home-schooled by her mother, because of her fragile health. Arya often feels weak and fatigued, and sleeps a lot throughout the day. Beginning when Arya was 2 years old, she would periodically experience unexplained fits of vomiting, and Aspen would have to take her to the emergency room. At around age 4, Arya also began to have seizures. Aspen and Arya have spent countless hours in the hospital together while the doctors and nurses have unsuccessfully run tests to determine the nature of Arya's unexplained illnesses. Aspen has been referred to you for an evaluation from the court system, as she was recently arrested after traces of medications known to induce vomiting and cause seizures were detected in Arya's blood tests.

Factitious Disorder Imposed on Another.

Helen has chronic back pain. She has been seeing a chiropractor for years, who has done many interventions that only partially work. Helen is always deeply concerned about whether or not her back pain will be bad, and it prevents her from going out and doing things. Helen thinks about her pain all the time, which detracts from thinking anything positive about life in general. She mostly spends her time wondering if a follow-up appointment should be scheduled or if she should try to "stick it out."

Somatic Symptom Disorder.

Mitchell has become very concerned that he is going to catch RSV due to working with elementary-schoolers. He always thinks he has it every time he has a slight tickle in his throat. He does not display any symptoms of RSV, and after his wife tries to console him, he then becomes concerned about contracting COVID, measles, and later in the year, polio. He makes frequent doctor's appointments due to worrying about if he has symptoms of these illnesses. He can usually be found searching WebMD to see if his mild morning headache is indicative of a fatal infection.

Illness Anxiety Disorder

Chase is 8 years old and sleepwalks. The first time his parents realized this, they found Chase standing in front of the refrigerator at 1 AM with the door wide open and a blank stare. They were unable to wake Chase up but were able to guide him back to his bed. In the morning, when his parents asked him about what had happened the night before, Chase couldn't remember anything, not even having a dream about walking to the kitchen.

Chase's sleepwalking episodes have become increasingly more hazardous to his personal safety. During the most recent episode, Chase's parents were awakened by the sound of their dog barking. Chase had walked out the back door and was approaching the edge of their pool when they ran out and stopped him. Chase's parents have put a motion sensor on his bedroom door that alerts them whenever he walks in or out of his room, which bothers Chase because he wants to be “more grown-up.” Chase's parents reported losing sleep because they are constantly worried, which is causing strain in their marriage. Chase thinks that his parents aren't happy with each other anymore, and might even get a divorce, which he believes is all his fault.

Non-Rapid Eye Movement Sleep Arousal Disorders.

Belinda comes into therapy writing "relationship and body image problems" as her reason for referral. She tells her therapist, "My partner is always saying it's hard to sleep with me because I snore like a chainsaw and then gets worried and wakes me up when it sounds like I stop breathing." Belinda admits to being grumpy with her partner when woken up. She feels very tired during the day, and therefore even more cranky. She appears very stressed, saying she wants her relationship to work but feels "fat and grumpy" and fears she will soon be single if she does not "get it together mentally. We basically just wake each other up and end up unhappy."

Refer Belinda for a polysomnography (“sleep study”) to clarify Breathing- Related sleep diagnosis. Obtain a release of information between the sleep doctor and therapy office. Screen for diagnosable depressive and anxiety disorders that may be adding to relationship distress and begin treatment for that.

Mr. Hansen is the dad of a 16-year-old boy, Ty. Mr. Hansen walks into Ty's room one day to ask what he wants to eat and finds a hole punched into the wall by Ty's bed. Mr. Hansen loses his temper at the damage (but fortunately does not also punch the wall) and asks Ty what his problem is. Ty insists he didn't do it on purpose, that it happened in a dream last night, and he was too embarrassed to admit it. Mr. Hansen notices how close the hole is to the mattress and starts to believe his son. They repair the wall together.

Two weeks later, Ty calls for his dad at night in tears. He broke his toe by kicking the wall while asleep and cannot put any pressure on it to walk. Mr. Hansen takes his son to the hospital. If the doctor is awake enough at this hour to solve the mystery, the doctor should make a preliminary diagnosis of:

REM Sleep Behavior Disorder.

Diagnostically, _______ is to taking a substance while _______ is to suddenly not taking it.

Intoxication; withdrawal

Which is unrelated to drugs but still addictive?

Gambling Disorder & Internet/ Gaming Disorder.

There is not yet a defined, full "Use Disorder" for ______, although some research says it might be worth investigating.

Caffine

Pat has been mandated to therapy for drunk driving last year, and tells you he is "not an alcoholic and I haven't had anything to drink since the arrest because I don't need to. I only drank socially a couple times about three months ago but did not get really drunk. I don't need alcohol to have a good time, and this was a one-off thing. The last time I had a DUI was ten-fifteen years ago. I've never had any other DUIs." What substance use criterion does Pat appear to meet, if any?

Using the substance in situations where it is physically hazardous.

Based on what you know about substance use disorders and DSM criteria, what should be your MAIN concern as a clinician during Pat's interview?

It will be hard to get accurate diagnostic information through him alone because of how he inconsistently reports what is going on.

You are doing an intake interview at a drug detox (detoxification) unit for Mr. Owen, whose primary complaints involve intense muscle aches, nausea, constant yawning, and runny nose. You should start by asking Mr. Owen about his use of which drugs based on this information?

Subutex, heroin, lean, Percocet (opioids/ opiates)

Your client, Lyle, had 6 months clean of cocaine. He then informs you he has relapsed on cocaine after seeing spilled powered coffee creamer at the breakfast table. "The powder was such a strong image at the time, but now I feel so stupid," he says, and tears up due to shame. What symptom did Lyle probably have prior to his relapse?

Craving, or strong desire or urge to use the substance.

Your client, Lyle, had 6 months clean of cocaine. He then informs you he has relapsed on cocaine after seeing spilled powered coffee creamer at the breakfast table. "The powder was such a strong image at the time, but now I feel so stupid," he says, and tears up due to shame. What symptom should you add to Lyle's documentation after this relapse?

There is a persistent desire or unsuccessful efforts to cut down or control stimulant use.

Cammie has flight of ideas (extremely fast thoughts), rapid speech, high levels of risky sexual activity, grandiose delusions ("I'm the top fashion consultant for Ariana Grande"), and extremely irritable mood. This has been going on for a couple of weeks. You are getting ready to diagnose her with Bipolar I Disorder when your supervisor suggests doing a thorough drug screen to see if she meets criteria for Substance-Induced Bipolar and Related Disorder. Assuming this is the problem, what drug is she most likely to be reacting to?

Alcohol.

Guillermo is demonstrating irritability, loss of appetite, restlessness, low mood, headache, anxiousness, and nightmares. He is MOST likely withdrawing from....

Weed.

Nadja is experiencing chills, vomiting, confusion, fast heart rate, low blood pressure, and shakiness. She has MOST likely recently taken...

Cocaine.

Laszlo is having memory problems, trouble walking, and trouble calling his wife when he picks up his phone. He MOST likely has recently taken...

Alcohol.

Nandor's friend is rushing him to the emergency room. Nandor just "came to" after a grand mal seizure and immediately started screaming in fear at nothing, pointing at his feet. Nandor cannot stop trembling and quickly enters into a second seizure. When the e-Squad meets them in the parking lot, they say Nandor's pulse is extremely high and immediately take him back for treatment. Nandor is MOST likely experiencing:

Anxiolytic withdrawal.

Simon has anxiety and takes a drug for it. Whenever he is using it, though, it takes him about 3 hours to not only get up the energy to do his homework but also to complete it accurately. His grades are dropping. What symptom of substance use disorder does this represent?

Recurrent drug use resulting in a failure to fulfill major role obligations at work, school, or home.

What drug is Simon MOST likely taking?

Cannabis.

Baron is frustrated because he has relapsed for the ninth time on a drug that he was prescribed as a teenager. Baron enjoys the calm feeling the drug gives him, but he has to take more or else go to a detox facility because he could die during withdrawal if not medically supervised. What symptom of substance use disorder does this represent?

There is persistent desire or unsuccessful efforts to cut down or control drug use.

What drug did Baron MOST likely relapse on?

Xanax, an anxiolytic.

Topher brutally attacks a total stranger in a Dollar General parking lot (out of sudden anger and without motivation to rob from them).

PCP

Topher, who has not yet been caught by police, strikes again at a drive-thru, attempting to reach out from his car and strangle the cashier at the window. He does not succeed and is caught by police. This time, he admits to the following drug in his system...

Inhalants.

True or False: Men are less likely than women to have Anorexia and Bulimia.

True

Though the disorders in this category can differ substantially in prognosis, outcomes, and treatment approaches, which of the following best describes the common feature of the Feeding and Eating Disorders in the DSM-5?

Disturbances in eating-related behaviors that leads to alterations in consumption of food and significant impairments in daily functioning.

When evaluating a client for a potential diagnosis of Rumination Disorder, which of the following must be ruled out?

Medical conditions with similar symptomatology, like gastroesophageal reflux disease (GERD), and other eating disorders where regurgitation may be used as a purposeful means of controlling caloric intake, like AN or BN.

Based on what you know about Rumination Disorder, what is the word "rumination" most likely to mean clinically?

To repeat.

23-year-old Emery gets up every morning and weighs herself on the scale in her bathroom. She weights herself every night before bed too. Emery usually tries to run for 2 or 3 hours every day to burn off the calories from what she's eaten the day before. She sets a calorie limit of 1,100 per day, and tracks everything that she eats on her fitness tracker to make sure that she doesn't go over. Emery is 5'6" and weighs about 110 pounds, but she thinks that she should probably lose another 10 to 15 pounds to be at just the right weight, because she has extra fat on her thighs and stomach that she believes make her seem unappealing. When people have expressed concern over Emery's weight loss, she tells them that she is just very active and athletic, and that her metabolism is really high.

Anorexia Nervosa