neurocognitive, substance, personality disorders

The essential feature of the DSM-5 diagnosis of delirium is a disturbance in at tention/awareness and in cognition that develops over a short period of time, represents a change from baseline, and tends to fluctuate in severity during the course of a day. Which of the following additional conditions must apply?

A. There must be laboratory evidence of an evolving dementia.

B. The disturbance must be associated with a disruption of the sleep-wake cy cle.

C. The disturbance must not occur in the context of a severely reduced level of arousal, such as coma.

D. The disturbance must be a direct physiological consequence of a substance use disorder.

E. The disturbance must not be superimposed on a preexisting neurocognitive disorder.

C. The disturbance must not occur in the context of a se verely reduced level of arousal, such as coma.

Both major and mild neurocognitive disorders can increase the risk of delirium and complicate its course. Traditionally, delirium is distinguished from de mentia on the basis of the key features of acute onset, impairment in attention, and which of the following?

A. Fluctuating course.

B. Steady course.

C. Presence of mania.

D. Presence of depression.

E. Cogwheeling movements.

A. Fluctuating course.

A 79-year-old woman with a history of depression is being evaluated at a nurs ing home for a suspected urinary tract infection. She is easily distracted, perse verates on answers to questions, asks the same question repeatedly, is unable to focus, and cannot answer questions regarding orientation. The mental status changes evolved over a single day. Her family reports that they thought she “wasn’t herself” when they saw her the previous evening, but the nursing re port this morning indicates that the patient was cordial and appropriate. What is the most likely diagnosis?

A. Major depressive disorder, recurrent episode.

B. Depressive disorder due to another medical condition.

C. Delirium.

D. Major depressive disorder, with anxious distress.

E. Obsessive-compulsive disorder.

C. Delirium.

The diagnostic criteria for major or mild neurocognitive disorder with Lewy bodies (NCDLB) include fulfillment of criteria for major or mild neurocogni tive disorder and presence of “a combination of core diagnostic features and suggested diagnostic features for either probable or possible neurocognitive disorder with Lewy bodies.” Another feature necessary for the diagnosis is that “the disturbance is not better explained by cerebrovascular disease, an other neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder.” Which of the following completes the list of features necessary for the diagnosis?

A. An acute onset and rapid progression.

B. An insidious onset and gradual progression.

C. An insidious onset and rapid progression. D. A waxing and waning presentation.

E. A characteristic finding on ultrasound of the neck.

B. An insidious onset and gradual progression

Which of the following is not a diagnostic criterion, feature, or marker of major or mild neurocognitive disorder with Lewy bodies (NCDLB)?

A. Concurrent symptoms of rapid eye movement (REM) sleep behavior disor der.

B. High striatal dopamine transporter uptake in basal ganglia demonstrated by single-photon emission computed tomography (SPECT) or positron emission tomography (PET) imaging.

C. Low striatal dopamine transporter uptake in basal ganglia demonstrated by SPECT or PET imaging.

D. Severe neuroleptic sensitivity.

E. Insidious onset and gradual progression.

B. High striatal dopamine transporter uptake in basal ganglia demonstrated by single-photon emission computed tomography (SPECT) or positron emission tomography (PET) imaging.

A 72-year-old man with no history of alcohol or other substance use disorders and no psychiatric history is brought to the emergency department (ED) be cause of transient episodes of unexplained loss of consciousness. His wife re ports that he has experienced repeated falls and syncope over the past year, as well as auditory and visual hallucinations. A thorough workup for cardiac dis ease has found no evidence of structural heart disease or arrhythmias. In the ED, he is found to have severe autonomic dysfunction, including orthostatic hypotension and urinary incontinence. What is the best provisional diagnosis for this patient?

A. New-onset schizophrenia.

B. New-onset schizoaffective disorder.

C. Possible major or mild neurocognitive disorder with Lewy bodies.

D. Possible major or mild neurocognitive disorder due to Alzheimer’s disease.

E. New-onset seizure disorder.

C. Possible major or mild neurocognitive disorder with Lewy bodies

The diagnostic criteria for neurocognitive disorder (NCD) due to HIV infection include fulfillment of criteria for major or mild NCD and documented infec tion with human immunodeficiency virus (as confirmed by established labora tory methods). Which of the following is a prominent feature of NCD due to HIV infection?

A. Impairment in executive functioning.

B. Conspicuous aphasia.

C. Significant delusions and hallucinations at onset of the disorder.

D. Marked difficulty with recall of learned information.

E. Rapid progression to profound neurocognitive impairment.

A. Impairment in executive functioning.

In addition to documented infection with HIV and fulfillment of criteria for major or mild neurocognitive disorder (NCD), what other requirement must be met to qualify for a diagnosis of major or mild NCD due to HIV infection?

A. Presence of HIV in the cerebrospinal fluid.

B. A pattern of cognitive impairment characterized by early predominance of aphasia and impaired memory for previously learned information.

C. Presence of progressive multifocal leukoencephalopathy.

D. Inability to attribute the NCD to non-HIV conditions (including secondary brain diseases), another medical condition, or a mental disorder.

E. Presence of Kayser-Fleisher rings.

D. Inability to attribute the NCD to non-HIV conditions (in cluding secondary brain diseases), another medical condition, or a mental disorder

Which of the following features characterizes alcohol-induced major or mild neurocognitive disorder, amnestic-confabulatory type?

A. Amnesia for new information and confabulation.

B. Seizures.

C. Amnesia for previously learned information and downward gaze paraly sis.

D. Aphasia.

E. Anosognosia and apraxia.

A. Amnesia for new information and confabulation.

Which of the following statements about the diagnosis of neurocognitive dis order due to Huntington's disease (NCDHD) is true?

A. NCDHD is a laboratory-based diagnosis/disorder.

B. NCDHD is a disorder that requires positive neuroimaging for diagnosis.

C. NCDHD is a clinical diagnosis based on abnormal physical findings and family history/genetic findings.

D. NCDHD is a diagnosis that is best defined as patients who have a pill rolling tremor.

E. NCDHD is a diagnosis mostly based on radiological examination.

C. NCDHD is a clinical diagnosis based on abnormal phys ical findings and family history/genetic findings

Depression, irritability, anxiety, obsessive-compulsive symptoms, and apathy are frequently associated with Huntington’s disease and often precede the on set of motor symptoms. Psychosis more rarely precedes the onset of motor symptoms. Which of the following is a core feature of major or mild neurocog nitive disorder due to Huntington’s disease?

A. Progressive cognitive impairment with early changes in executive function.

B. Prominent early memory impairment, mostly affecting short-term memory.

C. Psychosis in the early stages, with marked olfactory hallucinations.

D. Voluntary jerking movements.

E. Diminished hearing and smell

A. Progressive cognitive impairment with early changes in executive function

Genetic testing is the primary laboratory test for the determination of Hunting ton’s disease. Which of the following best characterizes the genetic nature of Huntington’s disease?

A. X-linked recessive inheritance with incomplete penetrance.

B. Autosomal recessive inheritance with complete penetrance.

C. Autosomal dominant inheritance with complete penetrance.

D. Random mutation.

E. X-linked dominant inheritance.

C. Autosomal dominant inheritance with complete pene trance

Major or mild neurocognitive disorder (NCD) due to prion disease encom passes NCDs associated with a group of subacute spongiform encephalopa thies caused by transmissible agents known as prions. What is the most common prion disease?

A. Creutzfeldt-Jakob disease.

B. Wernicke-Korsakoff syndrome.

C. Bovine spongiform encephalopathy.

D. Huntington’s disease.

E. Neurosyphilis.

A. Creutzfeldt-Jakob disease.

Prion disease has been reported to occur in individuals of all ages, from the teenage years to late life. Which of the following best characterizes the time frame of disease progression?

A. Over a few months.

B. Over several days.

C. Over several weeks.

D. Over 5 years.

E. Over 10 years.

A. Over a few months.

Major and mild neurocognitive disorders (NCDs) exist on a spectrum of cognitive and functional impairment. Which of the following constitutes an important threshold differentiating the two diagnoses?

A. Whether or not the individual is concerned about the decline in cognitive function.

B. Whether or not there is impairment in cognitive performance as measured by standardized testing or clinical assessment.

C. Whether or not the cognitive impairment is sufficient to interfere with independent completion of activities of daily living.

D. Whether or not the cognitive deficits occur exclusively in the context of a delirium.

E. Whether or not the cognitive deficits are better explained by another mental disorder

C. Whether or not the cognitive impairment is sufficient to interfere with independent completion of activities of daily living.

Expressed as a percentile, what is the typical performance on neuropsycholog ical testing of individuals with major neurocognitive disorder (NCD)?

A. Sixtieth percentile or below.

B. Fiftieth percentile or below.

C. Twenty-fifth percentile or below.

D. Sixteenth percentile or below.

E. Third percentile or below.

E. Third percentile or below

A 68-year-old semiretired cardiologist with responsibility for electrocardio gram (ECG) interpretation at his community hospital is referred by the hospi tal’s Employee Assistance Program for clinical evaluation because of concerns expressed by other clinicians that he has been making many mistakes in his ECG interpretations over the past few months. The patient discloses symptoms of persistent sadness since the death of his wife 6 months prior to the evalua tion, with frequent thoughts of death, trouble sleeping, and escalating usage of sedative-hypnotics and alcohol. He has some trouble concentrating, but he has been able to maintain his household, pay his bills, shop, and prepare meals by himself without difficulty. He scores 28/30 on the Mini-Mental State Examina tion (MMSE). Which of the following would be the primary consideration in the differential diagnosis?

A. Major neurocognitive disorder (NCD).

B. Mild NCD.

C. Adjustment disorder.

D. Major depressive disorder.

E. No diagnosis.

D. Major depressive disorder

A 69-year-old semiretired radiologist with responsibility for chest x-ray inter pretation at his academic medical center has been referred by the hospital’s Employee Assistance Program for clinical evaluation because of concerns ex pressed by other clinicians that he has been making many mistakes in his x-ray interpretations over the past few months. Evaluation discloses a remote history of alcohol dependence with sobriety for the past 20 years, and a depressive ep isode following the death of his wife 9 years before the current problem, treated with cognitive-behavioral therapy with full resolution of symptoms af ter 6 months and no recurrence. He acknowledges some trouble concentrating but no other symptoms, and he minimizes the alleged x-ray interpretation problems. He cannot state the correct date or day of the week and cannot recall the previous day’s news events, but he can describe highlights of his long ca reer in medicine in great detail. Collateral history from his children reveals that on several occasions in the past year neighbors in his apartment building had complained that he forgot to turn off his stove while cooking, resulting in a smoke-filled apartment. He scores 21/30 on the Mini-Mental State Examina tion. What diagnosis best fits this clinical picture?

A. Major neurocognitive disorder (NCD).

B. Mild NCD.

C. Adjustment disorder.

D. Major depressive disorder.

E. No diagnosis

A. Major neurocognitive disorder (NCD).

In a patient with mild neurocognitive disorder (NCD), which of the following would distinguish probable from possible Alzheimer’s disease?

A. Evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history.

B. Clear evidence of decline in memory and learning.

C. Steadily progressive, gradual decline in cognition, without extended pla teaus.

D. No evidence of mixed etiology.

E. Onset after age 80.

A. Evidence of a causative Alzheimers disease genetic mu tation from either genetic testing or family history.

In major or mild frontotemporal neurocognitive disorder, which of the follow ing is a diagnostic feature of the language variant?

A. Severe semantic memory impairment.

B. Severe deficits in perceptual-motor function.

C. Receptive aphasia.

D. Grammar, word-finding, or word-generation difficulty.

E. Hyperorality.

D. Grammar, word-finding, or word-generation difficulty.

Which of the following neurocognitive disorders (NCDs) is especially charac terized by deficits in domains such as speech production, word finding, object naming, or word comprehension, whereas episodic memory, perceptual-motor abilities, and executive function are relatively preserved?

A. Major or mild NCD due to Alzheimer’s disease.

B. Major or mild NCD with Lewy bodies.

C. Major or mild vascular NCD.

D. Behavioral-variant major or mild frontotemporal NCD.

E. Language-variant major or mild frontotemporal NCD.

E. Language-variant major or mild frontotemporal NCD.

Which of the following is a core feature of major or mild neurocognitive disor der with Lewy bodies?

A. Fluctuating cognition with pronounced variations in attention and alertness.

B. Recurrent auditory hallucinations.

C. Spontaneous features of parkinsonism, with onset at least 1 year prior to development of cognitive decline.

D. Fulfillment of criteria for rapid eye movement (REM) sleep behavior disorder.

E. Evidence of low striatal dopamine transporter uptake in basal ganglia as demonstrated by single photon emission computed tomography (SPECT) or positron emission tomography (PET) imaging.

A. Fluctuating cognition with pronounced variations in attention and alertness

A previously healthy 67-year-old man, who is experiencing an acute change in mental status, is brought to the emergency department by his family. There is no evidence in the initial history, physical examination, and laboratory studies to indicate substance intoxication or withdrawal, or to suggest another medical problem as the cause of his altered mental state. Over the course of 1 hour of observation, his level of alertness varies from alert but distractible, with appar ent auditory and visual hallucinations, to somnolent; he has difficulty sustain ing attention to an examiner, and he cannot perform simple tasks such as serial subtractions or spelling words backwards. What is the most appropriate diag nosis?

A. Delirium.

B. Delirium due to another medical condition.

C. Delirium due to substance intoxication.

D. Delirium due to multiple etiologies.

E. Unspecified delirium.

E. Unspecified delirium

A 35-year-old man brings his 60-year-old father for evaluation of cognitive and functional decline, stating that he thinks his father has dementia; the son is also worried about the possibility of a hereditary illness. The physician notes to her self that the patient has substantial cognitive impairment and features sugges tive of the diagnosis of major neurocognitive disorder due to Huntington’s disease, but she is not sure about the cause of the neurocognitive disorder. She also notes that the patient’s son appears extremely anxious. She has a tight schedule and cannot provide a counseling session for the patient’s son until the next day. What is the most appropriate diagnosis to record on the insurance claim form that the patient’s son will submit on his father’s behalf?

A. Unspecified central nervous system (CNS) disorder.

B. Unspecified neurocognitive disorder.

C. Unspecified mild neurocognitive disorder.

D. Huntington’s disease.

E. Problem related to living alone (V code category reflecting other problems related to the social environment)

B. Unspecified neurocognitive disorder

The diagnostic criteria for substance abuse, substance dependence, substance intoxication, and substance withdrawal were not equally applicable to all sub stances in DSM-IV. In DSM-5, this remains true, although substance use disorder now replaces the diagnoses of substance abuse and substance dependence. For which of the following substance classes is there adequate evidence to support diagnostic criteria in DSM-5 for the three major categories of use disorder, intox ication, and withdrawal?

A. Caffeine.

B. Cannabis.

C. Tobacco.

D. Hallucinogen.

E. Inhalant

B. Cannabis

Almost all of the possible physical and behavioral symptom criteria included in the DSM-IV definitions of substance abuse and substance dependence are in cluded in the DSM-5 definition of substance use disorder. Which of the following possible criteria included in DSM-IV were intentionally omitted in DSM-5?

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

B. The substance is often taken in larger amounts or over a longer period than was intended.

C. The recurrent substance use results in a failure to fulfill major role obliga tions at work, school, or home.

D. There is continued substance use despite having persistent or recurrent so cial or interpersonal problems caused or exacerbated by the effects of the substance.

E. There are recurrent substance-related legal problems

E. There are recurrent substance-related legal problems.

Whereas in DSM-IV, there were 11 recognized substance classes, DSM-5 has only 10, because certain related substances have been combined into a single class. Which of the following pairs of drugs falls into a single class in DSM-5?

A. Cocaine and phencyclidine (PCP).

B. Cocaine and methamphetamine.

C. 3,4-Methylenedioxymethamphetamine (MDMA [Ecstasy]) and metham phetamine.

D. Lorazepam and alcohol.

E. Lorazepam and oxycodone

B. Cocaine and methamphetamine.

Tolerance and withdrawal were each considered valid criteria for the diagnosis of substance dependence in DSM-IV, although neither was required. Which of the following statements about tolerance and withdrawal in the DSM-5 diag nosis of substance use disorder is true?

A. Tolerance and withdrawal are no longer considered to be valid diagnostic symptoms of substance use disorder.

B. The definitions of tolerance and withdrawal have been updated because the previous definitions had poor interrater reliability.

C. The presence of either tolerance or withdrawal is now required to make a diagnosis of substance use disorder.

D. The presence of either tolerance or withdrawal is now required to make a substance use disorder diagnosis for some but not all classes of substances.

E. Both tolerance and withdrawal are still listed as possible criteria, but if they occur during appropriate medically supervised treatment, they may not be counted toward the diagnosis of a substance use disorder

E. Both tolerance and withdrawal are still listed as possible criteria, but if they occur during appropriate medically supervised treatment, they may not be counted toward the diagnosis of a substance use disorder

Which of the following is not a recognized alcohol-related disorder in DSM-5?

A. Alcohol dependence.

B. Alcohol use disorder.

C. Alcohol intoxication.

D. Alcohol withdrawal.

E. Alcohol-induced sexual dysfunction

A. Alcohol dependence.

Which of the following statements about caffeine-related disorders is true?

A. Culturally appropriate levels of caffeine intake should be considered when making the diagnosis of caffeine intoxication.

B. In order to diagnose caffeine intoxication, at least one symptom must begin during caffeine use.

C. The diagnosis of caffeine withdrawal requires the preceding use of caffeine on a daily basis.

D. Caffeine withdrawal may be diagnosed even in the absence of clinically sig nificant distress or impairment in social, occupational, or other important areas of functioning.

E. Extensive data are available regarding the prevalence of caffeine use disor der.

C. The diagnosis of caffeine withdrawal requires the preced ing use of caffeine on a daily basis

Which of the following symptoms is a recognized consequence of the abrupt termination of daily or near-daily cannabis use?

A. Hallucinations.

B. Delusions.

C. Hunger.

D. Irritability.

E. Apathy.

D. Irritability.

The Criterion A symptoms listed for other hallucinogen use disorder are the same as those listed for use disorders of most other substance classes, with one ex ception. Which of the following is not a recognized symptom associated with hallucinogen use?

A. Withdrawal.

B. Tolerance.

C. A persistent desire or unsuccessful efforts to cut down or control use of the substance.

D. Recurrent use of the substance in situations in which it is physically hazard ous.

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

A. Withdrawal

To meet proposed criteria for the Section III condition neurobehavioral disorder associated with prenatal alcohol exposure, an individual’s prenatal alcohol expo sure must have been “more than minimal.” How is “more than minimal” ex posure defined, in terms of how much alcohol was used by the mother during gestation?

A. Fewer than 7 drinks per month, and no more than 1 drink per drinking oc casion.

B. Fewer than 7 drinks per month, and no more than 2 drinks per drinking oc casion.

C. Fewer than 7 drinks per month, and no more than 3 drinks per drinking oc casion.

D. Fewer than 14 drinks per month, and no more than 1 drink per drinking oc casion.

E. Fewer than 14 drinks per month, and no more than 2 drinks per drinking occasion.

E. Fewer than 14 drinks per month, and no more than 2 drinks per drinking occasion.

Which of the following is the only non-substance-related disorder to be in cluded in the DSM-5 chapter “Substance-Related and Addictive Disorders”?

A. Gambling disorder.

B. Internet gaming disorder.

C. Electronic communication addiction disorder

D. Compulsive computer use disorder.

E. Compulsive shopping

A. Gambling disorder

In most substance/medication-induced mental disorders (with the exception of substance/medication-induced major or mild neurocognitive disorder and hallucinogen persisting perception disorder), if the person abstains from sub stance use, the disorder will eventually disappear or no longer be clinically rel evant even without formal treatment. In what time frame is this likely to happen?

A. One hour.

B. One month.

C. Three months.

D. One year.

E. “Relatively quickly” but no specific period of time.

B. One month

Because opioid withdrawal and sedative, hypnotic, or anxiolytic withdrawal can involve very similar symptoms, distinguishing between the two can be dif ficult. Which of the following presenting symptoms would aid in making the correct diagnosis?

A. Nausea or vomiting.

B. Anxiety.

C. Yawning.

D. Restlessness or agitation.

E. Insomnia.

C. Yawning.

In DSM-5, the sedative, hypnotic, or anxiolytic class contains all prescription sleeping medications and almost all prescription antianxiety medications. What is the reason that nonbenzodiazepine antianxiety agents (e.g., buspirone, gepirone) are not included in this class?

A. They are not generally available in nonparenteral (intravenous or intramus cular) formulations.

B. They do not appear to be associated with significant misuse.

C. They are not associated with illicit manufacturing or diversion (e.g., Sched ule I–V drugs in the United States, or included in the list of psychotropic substances recognized by the International Narcotics Control Board and the United Nations).

D. They are not respiratory depressants.

E. They do not appear to be associated with cravings or tolerance.

B. They do not appear to be associated with significant misuse

Which of the following criteria for substance use disorder in DSM-5 was not one of the criteria for either substance abuse or substance dependence in DSM-IV?

A. Important social, occupational, or recreational activities are given up or re duced because of substance use.

B. The substance is often taken in larger amounts or over a longer period than was intended.

C. Craving, or a strong desire or urge to use the substance, is present.

D. Recurrent substance use results in a failure to fulfill major role obligations at work, school, or home.

E. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects

C. Craving, or a strong desire or urge to use the substance, is present

A 27-year-old woman presents for psychiatric evaluation after almost hitting someone with her car while driving under the influence of marijuana. She re ports that she was prompted to seek treatment by her husband, with whom she has had several conflicts over the past year about her ongoing marijuana use. She has continued to smoke two joints daily and drive while under the influ ence of marijuana since this event. What is the appropriate diagnosis?

A. Cannabis abuse.

B. Cannabis dependence.

C. Cannabis intoxication.

D. Cannabis use disorder.

E. Unspecified cannabis-related disorder

D. Cannabis use disorder.

A 45-year-old man with a long-standing history of heavy alcohol use is re ferred for psychiatric evaluation after his recent admission to the hospital for acute hepatitis. The patient reports that he drank almost daily in college. Over the past 10 years, he has gradually increased his nightly alcohol intake from a single 6-pack to two 12-packs of beer, and this nightly drinking habit has re sulted in his frequently oversleeping and missing work. He has tried to mod erate his alcohol use on numerous occasions with little success, particularly after developing complications associated with alcoholic cirrhosis. The patient admits that he becomes anxious and gets hand tremors when he doesn’t drink. This patient meets the criteria for which of the following diagnoses?

A. Alcohol abuse.

B. Alcohol dependence.

C. Alcohol use disorder, mild.

D. Alcohol use disorder, moderate.

E. Alcohol use disorder, severe.

E. Alcohol use disorder, severe

Which of the following statements about alcohol withdrawal is true?

A. Fewer than 10% of individuals undergoing alcohol withdrawal experience dramatic symptoms such as severe autonomic hyperactivity, tremors, or alcohol withdrawal delirium.

B. Delirium occurs in the majority of individuals who meet criteria for alcohol withdrawal.

C. Approximately 80% of all patients with alcohol use disorder will experience alcohol withdrawal.

D. Tonic-clonic seizures occur in about 15% of individuals who meet criteria for alcohol withdrawal.

E. Alcohol withdrawal symptoms typically begin between 24 and 48 hours after alcohol use has been stopped or reduced.

A. Fewer than 10% of individuals undergoing alcohol withdrawal experience dramatic symptoms such as severe autonomic hyperactivity, tremors, or alcohol withdrawal delirium.

How many remission specifiers are included in the DSM-5 diagnostic criteria for substance use disorders?

A. One.

B. Two.

C. Three.

D. Four.

E. Five

B. Two

A 25-year-old woman is brought to the emergency department by her friends after a party. They report that the woman had been seen ingesting some un known pills earlier in the evening. She became increasingly confused through out the course of the night. She eventually had a witnessed seizure on the street, prompting activation of emergency medical services. Vital signs indicate that the patient is tachycardic and hypertensive. On evaluation, the patient is observed to be thin with dilated pupils. She is smiling to herself, is fidgety, and is oriented to self, place, and date. When queried about auditory hallucina tions, the patient admits that she is hearing voices but is unconcerned, stating, “I only hear them while I’m partying, Doc.” Which diagnosis best fits this clin ical presentation?

A. Stimulant-induced manic episode.

B. Stimulant-induced psychotic disorder.

C. Stimulant intoxication, with perceptual disturbances.

D. Other hallucinogen-induced psychotic disorder.

E. Other hallucinogen intoxication

C. Stimulant intoxication, with perceptual disturbances.

Which of the following substances is most likely to be associated with poly drug use?

A. Cannabis.

B. Tobacco.

C. 3,4-Methylenedioxymethamphetamine (MDMA [Ecstasy]).

D. Methamphetamine.

E. Alcohol

C. 3,4-Methylenedioxymethamphetamine (MDMA [Ec stasy]).

Alcohol intoxication, inhalant intoxication, and sedative, hypnotic, or anxio lytic intoxication have which of the following Criterion C signs/symptoms in common?

A. Depressed reflexes.

B. Generalized muscle weakness.

C. Blurred vision.

D. Impairment in attention or memory.

E. Nystagmus

E. Nystagmus

In DSM-IV, caffeine withdrawal was included in Appendix B as a criteria set provided for further study. Which of the following statements correctly de scribes how caffeine withdrawal is classified in DSM-5?

A. Caffeine withdrawal is no longer considered a valid psychiatric diagnosis.

B. Caffeine withdrawal remains a proposed diagnosis in DSM-5 and is in cluded in “Conditions for Further Study” in Section III.

C. Caffeine withdrawal is classified under other (or unknown) substance with drawal in DSM-5.

D. Caffeine withdrawal is classified under stimulant withdrawal in DSM-5.

E. Caffeine withdrawal was moved to the main body of DSM-5 and is now in cluded in the “Substance-Related and Addictive Disorders” chapter.

E. Caffeine withdrawal was moved to the main body of DSM-5 and is now included in the “Substance-Related and Addictive Disor ders” chapter

A 25-year-old medical student presents to the student health service at 7 A.M. complaining of having a “panic attack.” He reports that he stayed up all night studying for his final gross anatomy exam, which starts in an hour, but he feels too anxious to go. He reports vomiting twice. The patient is restless and ap pears flushed, with visible muscle twitching. He is urinating excessively, has tachycardia, and his electrocardiogram shows premature ventricular com plexes. His thoughts and speech appear to be rambling in nature. His urine tox icology screen is negative. What is the most likely diagnosis?

A. Panic disorder.

B. Amphetamine intoxication, amphetamine-like substance.

C. Caffeine intoxication.

D. Cocaine intoxication.

E. Alcohol withdrawal.

C. Caffeine intoxication.

Which substance use disorder of an illicit substance is the most prevalent in the United States?

A. Alcohol use disorder.

B. Caffeine use disorder.

C. Cannabis use disorder.

D. Opioid use disorder.

E. Stimulant use disorder.

C. Cannabis use disorder.

Which of the following laboratory tests can be used in combination with gamma-glutamyltransferase (GGT) to monitor abstinence from alcohol?

A. Alanine aminotransferase (ALT).

B. Alkaline phosphatase.

C. Carbohydrate-deficient transferrin (CDT).

D. Mean corpuscular volume (MCV).

E. Triglycerides

C. Carbohydrate-deficient transferrin (CDT)

Which substance or class of substances in the Substance-Related and Addictive Disorders chapter of DSM-5 is not associated with a substance use disorder?

A. Caffeine.

B. Hallucinogens.

C. Inhalants.

D. Stimulants.

E. Tobacco.

A. Caffeine

What is the hallmark feature of caffeine withdrawal?

A. Vomiting.

B. Drowsiness.

C. Flu-like symptoms.

D. Headache.

E. Dysphoria.

D. Headache

Which mental disorder or disorder class has the highest prevalence among in dividuals with cannabis use disorder?

A. Major depressive disorder.

B. Bipolar I disorder.

C. Anxiety disorders.

D. Schizophrenia spectrum and other psychotic disorders.

E. Conduct disorder.

C. Anxiety disorders.

Which personality disorder has the highest prevalence among individuals with cannabis use disorder?

A. Obsessive-compulsive personality disorder.

B. Paranoid personality disorder.

C. Schizotypal personality disorder.

D. Borderline personality disorder.

E. Antisocial personality disorder

E. Antisocial personality disorder

Which of the following statements about 3,4-methylenedioxymethamphet amine (MDMA [Ecstasy]) is false?

A. Relative to use of other hallucinogenic drugs, use of MDMA increases the risk of developing a hallucinogen use disorder.

B. MDMA has both hallucinogenic and stimulant properties.

C. MDMA is more likely than other drugs in this class to be associated with withdrawal symptoms.

D. MDMA has a shorter half-life relative to other hallucinogens.

E. MDMA can be administered via inhalation and injection whereas most other hallucinogens are ingested orally and occasionally smoked.

D. MDMA has a shorter half-life relative to other hallucino gens

Which of the following substance use disorders is more common among ado lescent males than among adolescent females?

A. Other hallucinogen use disorder.

B. Inhalant use disorder.

C. Sedative, hypnotic, or anxiolytic use disorder.

D. Stimulant use disorder, cocaine subtype.

E. Stimulant use disorder, amphetamine-type substance subtype.

D. Stimulant use disorder, cocaine subtype.

Which two groups of inhalant agents are not among the recognized substances qualifying for the DSM-5 inhalant use disorder diagnosis?

A. Butane lighters and toluene.

B. Xylene and butane.

C. Trichloroethane and hexane.

D. Nitrous oxide and nitrite gases.

E. Gasoline and cleaning compounds.

D. Nitrous oxide and nitrite gases

A 22-year-old university student presents to his primary care physician com plaining of progressive worsening of numbness, tingling, and weakness in both of his legs over the past several weeks. His gait is unsteady, and he has difficulty grasping objects in his hands. He did not use any substances on the day of presentation but admits that over the past 3 months he has been consis tently using one particular substance on a daily basis. Which substance use dis order most likely accounts for this patient’s symptoms?

A. Cannabis use disorder.

B. Other hallucinogen use disorder.

C. Inhalant use disorder.

D. Opioid use disorder.

E. Other (or unknown) substance use disorder.

E. Other (or unknown) substance use disorder

Which organ system or anatomical function is most commonly affected by chronic use of 3,4-methylenedioxymethamphetamine (MDMA [Ecstasy])?

A. Neurological.

B. Respiratory.

C. Cardiopulmonary.

D. Oral cavity.

E. Immunological/infectious

A. Neurological.

Which route of stimulant use is most prevalent among individuals who are in treatment for a stimulant use disorder?

A. Oral.

B. Intranasal

C. Smoking.

D. Intravenous.

E. Mixed routes

C. Smoking.

What is the most common co-occurring psychiatric diagnosis among individ uals with a history of significant prenatal alcohol exposure?

A. Major depressive disorder.

B. Generalized anxiety disorder.

C. Attention-deficit/hyperactivity disorder.

D. Oppositional defiant disorder.

E. Substance use disorder

C. Attention-deficit/hyperactivity disorder

Which of the following DSM-IV personality disorder diagnoses is no longer present in DSM-5?

A. Antisocial personality disorder.

B. Avoidant personality disorder.

C. Borderline personality disorder.

D. Personality disorder not otherwise specified (NOS).

E. Schizotypal personality disorder.

D. Personality disorder not otherwise specified (NOS).

While collaborating on a presentation to their customers, the members of a sales team become increasingly frustrated with their team leader. The leader insists that the members of the team adhere to his strict rules for developing the project. This involves approaching the task in sequential manner such that no new task can be begun until the prior one is perfected. When other members suggest alternative approaches, the leader becomes frustrated and insists that the team stick to his approach. Although the results are inarguably of high quality, the team is convinced that they will not finish in time for the scheduled presentation. When voicing these concerns to the leader, he suggests that the real problem is that the other members of the team simply don’t share his high standards. Which of the following disorders would best explain the behavior of this team leader?

A. Narcissistic personality disorder.

B. Obsessive-compulsive disorder (OCD).

C. Avoidant personality disorder.

D. Obsessive-compulsive personality disorder (OCPD).

E. Unspecified personality disorder

D. Obsessive-compulsive personality disorder (OCPD).

Individuals with obsessive-compulsive personality disorder are primarily mo tivated by a need for which of the following?

A. Efficiency.

B. Admiration.

C. Control.

D. Intimacy.

E. Autonomy

C. Control.

A 36-year-old woman is approached by her new boss, who has noticed that de spite working for her employer for many years, she has not advanced beyond an entry level position. The boss hears that she is a good employee who works long hours. The woman explains that she has not asked for a promotion be cause she knows she’s not as good as other employees and doesn’t think she deserves it. She explains her long hours by saying that she is not very smart and has to check over all her work, because she’s afraid that people will laugh at her if she makes any mistakes. On reviewing her past evaluations, her boss notes that there are only minor critiques and her overall evaluations have been very positive. Which of the following personality disorders would best explain this woman’s lack of job advancement?

A. Narcissistic personality disorder.

B. Avoidant personality disorder.

C. Obsessive-compulsive personality disorder.

D. Schizoid personality disorder.

E. Borderline personality disorder

B. Avoidant personality disorder.

A cardiologist requests a psychiatric consultation for her patient, a 46-year-old man, because even though he is adherent to treatment, she is concerned that he “seems crazy.” On evaluation, the patient makes poor eye contact, tends to ramble, and makes unusual word choices. He is modestly disheveled and wears clothes with mismatched colors. He expresses odd beliefs about super natural phenomena, but these beliefs do not seem to be of delusional intensity. Collateral information from his sister elicits the observation that “He’s always been like this—weird. He keeps to himself, and likes it that way.” Which of the following conditions best explains this man’s odd behaviors and beliefs?

A. Schizoid personality disorder.

B. Schizotypal personality disorder.

C. Paranoid personality disorder.

D. Delusional disorder.

E. Schizophrenia

B. Schizotypal personality disorder

Which of the following statements about the development, course, and prog nosis of borderline personality disorder (BPD) is true?

A. The risk of suicide in individuals with BPD increases with age.

B. A childhood history of neglect, rather than abuse, is unusual in individuals with BPD.

C. Follow-up studies of individuals with BPD identified in outpatient clinics have shown that 10 years later, as many as half of these individuals no lon ger meet full criteria for the disorder.

D. Individuals with BPD have relatively low rates of improvement in social or occupational functioning.

E. There is little variability in the course of BPD.

C. Follow-up studies of individuals with BPD identified in outpatient clinics have shown that 10 years later, as many as half of these in dividuals no longer meet full criteria for the disorder.

Which of the following is not a characteristic of narcissistic personality disorder (NPD)?

A. Excessive reference to others for self-definition and self-esteem regulation.

B. Impaired ability to recognize or identify with the feelings and needs of oth ers.

C. Excessive attempts to attract and be the focus of the attention of others.

D. Persistence at tasks long after the behavior has ceased to be functional or ef fective.

E. Preoccupation with fantasies of unlimited success or power

D. Persistence at tasks long after the behavior has ceased to be functional or effective

Which of the following cognitive or perceptual disturbances are associated with borderline personality disorder?

A. Odd thinking and speech.

B. Ideas of reference.

C. Odd beliefs.

D. Transient, stress-related paranoid ideation.

E. Superstitiousness.

D. Transient, stress-related paranoid ideation

A 43-year-old warehouse security guard comes to your office complaining of vague feelings of depression for the last few months. He denies any particular sense of fear or anxiety. As he gets older, he wonders if he should try harder to form relationships with other people. He feels little desire for this but notes that his coworkers seem happier than he, and they have many relationships. He has never felt comfortable with other people, not even with his own family. He has lived alone since early adulthood and has been self-sufficient. He al most always works night shifts to avoid interactions with others. He tries to re main low-key and undistinguished to discourage others from striking up conversations with him, as he does not understand what they want when they talk to him. Which personality disorder would best fit with this presentation?

A. Paranoid.

B. Schizoid.

C. Schizotypal.

D. Avoidant.

E. Dependent.

B. Schizoid

Which of the following behaviors or states would be highly unusual in an in dividual with schizoid personality disorder?

A. An angry outburst at a colleague who criticizes his work.

B. Turning down an invitation to a party.

C. Lacking desire for sexual experiences.

D. Drifting with regard to life goals.

E. Difficulty working in a collaborative work environment

A. An angry outburst at a colleague who criticizes his work

What is the relationship between a history of conduct disorder before age 15 and the diagnosis of antisocial personality after age 18?

A. A history of some conduct disorder symptoms before age 15 is one of the required criteria for a diagnosis of antisocial personality disorder in adult hood.

B. All children with conduct disorder will go on to receive a diagnosis of anti social personality disorder in adulthood.

C. Antisocial personality disorder diagnosis is independent of conduct disor der.

D. Conduct disorder is the same as antisocial personality disorder, except that financial irresponsibility is also a required feature of antisocial personality disorder.

E. Conduct disorder is the same as antisocial personality disorder except that remorse is present in conduct disorder.

A. A history of some conduct disorder symptoms before age 15 is one of the required criteria for a diagnosis of antisocial personality dis order in adulthood.

A 25-year-old man has a childhood history of repeated instances of torturing animals, setting fires, stealing, running away from home, and school truancy, beginning at the age of 9 years. As an adult he has a history of repeatedly lying to others; engaging in petty thefts, con games, and frequent fights (including episodes in which he used objects at hand—pipe wrenches, chairs, steak knives—to injure others); and using aliases to avoid paying child support. There is no history of manic, depressive, or psychotic symptoms. He is dressed in expensive clothing and displays an expensive wristwatch for which he de mands admiration; he expresses feelings of specialness and entitlement; the be lief that he deserves exemption from ordinary rules; feelings of anger that his special talents have not been adequately recognized by others; devaluation, contempt, and lack of empathy for others; and lack of remorse for his behavior. There is no sign of psychosis. What is the appropriate diagnosis?

A. Antisocial personality disorder.

B. Malignant narcissism.

C. Narcissistic personality disorder

D. Antisocial personality disorder and narcissistic personality disorder.

E. Other specified personality disorder (mixed personality features)

D. Antisocial personality disorder and narcissistic personal ity disorder

Which of the following is one of the general criteria for a personality disorder in DSM-5?

A. An enduring pattern of inner experience that deviates markedly from the expectations of the individual’s culture.

B. The pattern is flexible and confined to a single personal or social situation.

C. The pattern is fluctuating and of short duration.

D. The pattern leads to occasional mild distress.

E. The pattern’s onset can be traced to a specific traumatic event in the indi vidual’s recent history.

A. An enduring pattern of inner experience that deviates markedly from the expectations of the individuals culture

Which of the following presentations is characteristic of histrionic personality disorder?

A. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.

B. A pattern of submissive and clinging behavior related to an excessive need to be taken care of.

C. A pattern of instability in interpersonal relationships, self-image, and af fects, and marked impulsivity.

D. A pattern of grandiosity, need for admiration, and lack of empathy.

E. A pattern of excessive emotionality and attention seeking

E. A pattern of excessive emotionality and attention seeking

Which of the following presentations is characteristic of borderline personality disorder?

A. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.

B. A pattern of submissive and clinging behavior related to an excessive need to be taken care of.

C. A pattern of instability in interpersonal relationships, self-image, and af fects, and marked impulsivity.

D. A pattern of grandiosity, need for admiration, and lack of empathy.

E. A pattern of excessive emotionality and attention seeking.

C. A pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity.

Which of the following presentations is characteristic of dependent personality disorder?

A. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.

B. A pattern of submissive and clinging behavior related to an excessive need to be taken care of.

C. A pattern of instability in interpersonal relationships, self-image, and af fects, and marked impulsivity.

D. A pattern of grandiosity, need for admiration, and lack of empathy.

E. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

B. A pattern of submission and clinging behavior related to an excessive need to be taken care of

Which of the following presentations is characteristic of avoidant personality disorder?

A. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

B. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.

C. A pattern of submissive and clinging behavior related to an excessive need to be taken care of.

D. A pattern of instability in interpersonal relationships, self-image, and af fects, and marked impulsivity.

E. A pattern of grandiosity, need for admiration, and lack of empathy

A. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

Which of the following presentations is characteristic of schizotypal personal ity disorder?

A. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

B. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.

C. A pattern of submissive and clinging behavior related to an excessive need to be taken care of.

D. A pattern of instability in interpersonal relationships, self-image, and af fects, and marked impulsivity.

E. A pattern of grandiosity, need for admiration, and lack of empathy

B. A pattern of acute discomfort in close relationships, cog nitive or perceptual distortions, and eccentricities of behavior.

Which of the following presentations is characteristic of paranoid personality disorder?

A. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

B. A pattern of distrust and suspiciousness such that others’ motives are inter preted as malevolent.

C. A pattern of submissive and clinging behavior related to an excessive need to be taken care of.

D. A pattern of instability in interpersonal relationships, self-image, and af fects, and marked impulsivity.

E. A pattern of grandiosity, need for admiration, and lack of empathy.

B. A pattern of distrust and suspiciousness such that others motives are interpreted as malevolent

Which of the following presentations is characteristic of narcissistic personality disorder?

A. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

B. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.

C. A pattern of submissive and clinging behavior related to an excessive need to be taken care of.

D. A pattern of instability in interpersonal relationships, self-image, and af fects, and marked impulsivity.

E. A pattern of grandiosity, need for admiration, and lack of empathy.

E. A pattern of grandiosity, need for admiration, and lack of empathy

Which of the following presentations is characteristic of schizoid personality disorder?

A. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

B. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.

C. A pattern of detachment from social relationships and a restricted range of emotional expression.

D. A pattern of instability in interpersonal relationships, self-image, and af fects, and marked impulsivity.

E. A pattern of grandiosity, need for admiration, and lack of empathy.

C. A pattern of detachment from social relationships and a restricted range of emotional expression

Which of the following presentations is characteristic of antisocial personality disorder?

A. A pattern of preoccupation with orderliness, perfectionism, and control.

B. A pattern of detachment from social relationships and a restricted range of emotional expression.

C. A pattern of distrust and suspiciousness such that others’ motives are inter preted as malevolent.

D. A pattern of disregard for, and violation of, the rights of others.

E. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

D. A pattern of disregard for, and violation of, the rights of others

Which of the following presentations is characteristic of obsessive-compulsive personality disorder?

A. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

B. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.

C. A pattern of preoccupation with orderliness, perfectionism, and control.

D. A pattern of detachment from social relationships and a restricted range of emotional expression.

E. A pattern of grandiosity, need for admiration, and lack of empathy.

C. A pattern of preoccupation with orderliness, perfection ism, and control.

Which of the following findings would rule out the diagnosis of obsessive compulsive personality disorder (OCPD)?

A. A concurrent diagnosis of obsessive-compulsive disorder.

B. A concurrent diagnosis of antisocial personality disorder.

C. Evidence of psychotic symptoms.

D. Evidence that the behavioral patterns reflect culturally sanctioned interper sonal styles.

E. A concurrent diagnosis of cocaine use disorder

D. Evidence that the behavioral patterns reflect culturally sanctioned interpersonal styles.