schizophrenia spectrum, bipolar, depressive disorders

Criterion A for schizoaffective disorder requires an uninterrupted period of ill ness during which Criterion A for schizophrenia is met. Which of the following additional symptoms must be present to fulfill diagnostic criteria for schizoaf fective disorder?

A. An anxiety episode—either panic or general anxiety.

B. Rapid eye movement (REM) sleep behavior disorder.

C. A major depressive or manic episode.

D. Hypomania.

E. Cyclothymia.

A. An anxiety episode—either panic or general anxiety.

There is a requirement for a major depressive episode or a manic episode to be part of the symptom picture for a DSM-5 diagnosis of schizoaffective disorder. In order to separate schizoaffective disorder from depressive or bipolar disor der with psychotic features, which of the following symptoms must be present for at least 2 weeks in the absence of a major mood episode at some point dur ing the lifetime duration of the illness?

A. Delusions or hallucinations.

B. Delusions or paranoia.

C. Regressed behavior.

D. Projective identification.

E. Binge eating.

A. Delusions or hallucinations.

A 27-year-old unmarried truck driver has a 5-year history of active and resid ual symptoms of schizophrenia. He develops symptoms of depression, includ ing depressed mood and anhedonia, that last 4 months and resolve with treatment but do not meet criteria for major depression. Which diagnosis best fits this clinical presentation?

A. Schizoaffective disorder.

B. Unspecified schizophrenia spectrum and other psychotic disorder.

C. Unspecified depressive disorder.

D. Schizophrenia and unspecified depressive disorder.

E. Unspecified bipolar and related disorder.

D. Schizophrenia and unspecified depressive disorder.

How common is schizoaffective disorder relative to schizophrenia?

A. Much more common.

B. Twice as common.

C. Equally common.

D. One-half as common.

E. One-third as common.

E. One-third as common.

A 30-year-old single woman reports having experienced auditory and perse cutory delusions for 2 months, followed by a full major depressive episode with sad mood, anhedonia, and suicidal ideation lasting 3 months. Although the depressive episode resolves with pharmacotherapy and psychotherapy, the psychotic symptoms persist for another month before resolving. What di agnosis best fits this clinical picture?

A. Brief psychotic disorder.

B. Schizoaffective disorder.

C. Major depressive disorder.

D. Major depressive disorder with psychotic features.

E. Bipolar I disorder, current episode manic, with mixed features.

B. Schizoaffective disorder.

Which of the following statements about the incidence of schizoaffective disor der is true?

A. The incidence is equal in women and men.

B. The incidence is higher in men.

C. The incidence is higher in women.

D. The incidence rates are unknown.

E. The incidence rates vary based on seasonality of birth.

C. The incidence is higher in women.

Substance/medication-induced psychotic disorder cannot be diagnosed if the disturbance is better explained by an independent psychotic disorder that is not induced by a substance/medication. Which of the following psychotic symptom presentations would not be evidence of an independent psychotic disorder?

A. Psychotic symptoms that precede the onset of severe intoxication or acute withdrawal.

B. Psychotic symptoms that meet full criteria for a psychotic disorder and that persist for a substantial period after cessation of severe intoxication or acute withdrawal.

C. Psychotic symptoms that are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use.

D. Psychotic symptoms that occur during a period of sustained substance abstinence.

E. Psychotic symptoms that occur during a medical admission for substance withdrawal.

E. Psychotic symptoms that occur during a medical admission for substance withdrawal.

A 55-year-old man with a known history of alcohol dependence and schizo phrenia is brought to the emergency department because of frank delusions and visual hallucinations. Which of the following would not be a diagnostic possibility for inclusion in the differential diagnosis?

A. Schizophrenia.

B. Substance/medication-induced psychotic disorder.

C. Alcohol dependence.

D. Psychotic disorder due to another medical condition.

E. Borderline personality disorder with psychotic features.

E. Borderline personality disorder with psychotic features.

Which of the following sets of specifiers is included in the DSM-5 diagnostic criteria for substance/medication-induced psychotic disorder?

A. “With onset before intoxication” and “With onset before withdrawal.”

B. “With onset during intoxication” and “With onset during withdrawal.”

C. “With good prognostic features” and “Without good prognostic features.”

D. “With onset prior to substance use” and “With onset after substance use.”

E. “With catatonia” and Without catatonia.”

B. “With onset during intoxication” and “With onset during withdrawal.”

A 65-year-old man with systemic lupus erythematosus who is being treated with corticosteroids witnesses a serious motor vehicle accident. He begins to have disorganized speech, which lasts for several days before resolving. What diagnosis best fits this clinical picture?

A. Schizophrenia.

B. Psychotic disorder associated with systemic lupus erythematosus.

C. Steroid-induced psychosis.

D. Brief psychotic disorder, with marked stressor.

E. Schizoaffective disorder.

D. Brief psychotic disorder, with marked stressor.

Which of the following psychotic symptom presentations would not be appro priately diagnosed as “other specified schizophrenia spectrum and other psy chotic disorder”?

A. Psychotic symptoms that have lasted for less than 1 month but have not yet remitted, so that the criteria for brief psychotic disorder are not met.

B. Persistent auditory hallucinations occurring in the absence of any other features.

C. Postpartum psychosis that does not meet criteria for a depressive or bipolar disorder with psychotic features, brief psychotic disorder, psychotic disorder due to another medical condition, or substance/medication-induced psychotic disorder.

D. Psychotic symptoms that are temporally related to use of a substance.

E. Persistent delusions with periods of overlapping mood episodes that are present for a substantial portion of the delusional disturbance

D. Psychotic symptoms that are temporally related to use of a substance.

Which of the following patient presentations would not be classified as psy chotic for the purpose of diagnosing schizophrenia?

A. A patient is hearing a voice that tells him he is a special person.

B. A patient believes he is being followed by a secret police organization that is focused exclusively on him.

C. A patient has a flashback to a war experience that feels like it is happening again.

D. A patient cannot organize his thoughts and stops responding in the middle of an interview.

E. A patient presents wearing an automobile tire around his waist and gives no explanation.

C. A patient has a flashback to a war experience that feels like it is happening again.

In which of the following disorders can psychotic symptoms occur?

A. Bipolar and depressive disorders.

B. Substance use disorders.

C. Posttraumatic stress disorder.

D. Other medical conditions.

E. All of the above.

E. All of the above.

A 32-year-old man presents to the emergency department distressed and agi tated. He reports that his sister has been killed in a car accident on a trip to South America. When asked how he found out, he says that he and his sister were very close and he “just knows it.” After putting him on the phone with his sister, who was comfortably staying with friends while on her trip, the man expressed relief that she was alive. Which of the following descriptions best fits this presentation?

A. He had a delusional belief, because he believed it was true without good warrant.

B. He did not have a delusional belief, because it changed in light of new evidence.

C. He had a grandiose delusion, because he believed he could know things happening far away.

D. He had a nihilistic delusion, because it involved an untrue, imagined catastrophe.

E. He did not have a delusion, because in some cultures people believe they can know things about family members outside of ordinary communications

B. He did not have a delusional belief, because it changed in light of new evidence.

Which of the following is not a commonly recognized type of delusion?

A. Persecutory.

B. Erotomanic.

C. Alien abduction.

D. Somatic.

E. Grandiose.

C. Alien abduction.

A 64-year-old man who had been a widower for 3 months presents to the emer gency department on the advice of his primary care physician after he reports to the doctor that he hears his deceased wife’s voice calling his name when he looks through old photos, and sometimes as he is trying to fall asleep. His primary care physician tells him he is having a psychotic episode and needs to get a psychiatric evaluation. Which of the following statements correctly explains why these experiences are not considered to be psychotic?

A. The voice he hears is from a family member.

B. The experience occurs as he is falling asleep.

C. He can invoke her voice with certain activities.

D. The voice calls his name.

E. Both B and C

E. Both B and C

A 19-year-old college student is brought by ambulance to the emergency de partment. His college dorm supervisor, who called the ambulance, reports that the student was isolating himself, was pacing in his room, and was not re sponding to questions. In the emergency department, the patient gets down in a crouching position and begins making barking noises at seemingly random times. His urine toxicology report is negative, and all labs are within normal limits. What is the best description of these symptoms?

A. An animal delusion—the patient believes he is a dog.

B. Intermittent explosive rage.

C. A paranoid stance leading to self-protective aggression.

D. Catatonic behavior.

E. Formal thought disorder.

D. Catatonic behavior.

Which of the following does not represent a negative symptom of schizophrenia?

A. Affective flattening.

B. Decreased motivation.

C. Impoverished thought processes.

D. Sadness over loss of functionality.

E. Social disinterest

D. Sadness over loss of functionality.

Schizophrenia spectrum and other psychotic disorders are defined by abnormalities in one or more of five domains, four of which are also considered psychotic symptoms. Which of the following is not considered a psychotic symptom?

A. Delusions.

B. Hallucinations.

C. Disorganized thinking.

D. Disorganized or abnormal motor behavior.

E. Avolition.

E. Avolition.

What is the most common type of delusion?

A. Somatic delusion of distorted body appearance.

B. Grandiose delusion.

C. Thought insertion.

D. Persecutory delusion.

E. Former life regression

D. Persecutory delusion.

Which of the following presentations would not be classified as disorganized behavior for the purpose of diagnosing schizophrenia spectrum and other psychotic disorders?

A. Masturbating in public.

B. Wearing slacks on one’s head.

C. Responding verbally to auditory hallucinations in a conversational mode.

D. Crouching on all fours and barking.

E. Turning to face 180 degrees away from the interviewer when answering questions

C. Responding verbally to auditory hallucinations in a conversational mode.

Which of the following statements about catatonic motor behaviors is false?

A. Catatonic motor behavior is a type of grossly disorganized behavior that has historically been associated with schizophrenia spectrum and other psychotic disorders.

B. Catatonic motor behaviors may occur in many mental disorders (such as mood disorders) and in other medical conditions.

C. A behavior is considered catatonic only if it involves motoric slowing or rigidity, such as mutism, posturing, or waxy flexibility.

D. Catatonia can be diagnosed independently of another psychiatric disorder.

E. Catatonic behaviors involve markedly reduced reactivity to the environ ment.

C. A behavior is considered catatonic only if it involves motoric slowing or rigidity, such as mutism, posturing, or waxy flexibility.

Which of the following statements about negative symptoms of schizophrenia is false?

A. Negative symptoms are easily distinguished from medication side effects such as sedation.

B. Negative symptoms include diminished emotional expression.

C. Negative symptoms can be difficult to distinguish from medication side effects such as sedation.

D. Negative symptoms include reduced peer or social interaction.

E. Negative symptoms include decreased motivation for goal-directed activi ties.

A. Negative symptoms are easily distinguished from medication side effects such as sedation.

Which of the following statements correctly describes a way in which schizoaffective disorder may be differentiated from bipolar disorder?

A. Schizoaffective disorder involves only depressive episodes, never manic or hypomanic episodes.

B. In bipolar disorder, psychotic symptoms do not last longer than 1 month.

C. In bipolar disorder, psychotic symptoms are always cotemporal with mood symptoms.

D. Schizoaffective disorder never includes full-blown episodes of major de pression.

E. In bipolar disorder, psychotic symptoms are always mood congruent.

C. In bipolar disorder, psychotic symptoms are always cotemporal with mood symptoms.

Which of the following symptom combinations, if present for 1 month, would meet Criterion A for schizophrenia?

A. Prominent auditory and visual hallucinations.

B. Grossly disorganized behavior and avolition.

C. Disorganized speech and diminished emotional expression.

D. Paranoid and grandiose delusions.

E. Avolition and diminished emotional expression.

C. Disorganized speech and diminished emotional expression.

Which of the following statements about violent or suicidal behavior in schizophrenia is false?

A. About 5%–6% of individuals with schizophrenia die by suicide.

B. Persons with schizophrenia frequently assault strangers in a random fashion.

C. Compared with the general population, persons with schizophrenia are more frequently victims of violence.

D. Command hallucinations to harm oneself sometimes precede suicidal behaviors.

E. Youth, male gender, and substance abuse are factors that increase the risk for suicide among persons with schizophrenia.

B. Persons with schizophrenia frequently assault strangers in a random fashion.

Which of the following statements about childhood-onset schizophrenia is true?

A. Childhood-onset schizophrenia tends to resemble poor-outcome adult schizophrenia, with gradual onset and prominent negative symptoms.

B. Disorganized speech patterns in childhood are usually indicative of schizophrenia.

C. Because of the childhood capacity for imagination, delusions and hallucinations in childhood-onset schizophrenia are more elaborate than those in adult-onset schizophrenia.

D. In a child presenting with disorganized behavior, schizophrenia should be ruled out before other childhood diagnoses are considered.

E. Visual hallucinations are extremely rare in childhood-onset schizophrenia.

A. Childhood-onset schizophrenia tends to resemble poor-outcome adult schizophrenia, with gradual onset and prominent negative symptoms.

Which of the following statements about gender differences in schizophrenia is true?

A. Women with schizophrenia tend to have fewer psychotic symptoms than do men over the course of the illness.

B. A first onset of schizophrenia after age 40 is more likely in women than in men.

C. Psychotic symptoms in women tend to burn out with age to a greater extent than they do in men.

D. Negative symptoms and affective flattening are more frequently observed in women with schizophrenia than in men with the disorder.

E. The overall incidence of schizophrenia is higher in women than it is in men.

B. A first onset of schizophrenia after age 40 is more likely in women than in men.

A 19-year-old female college student is brought to the emergency department by her family over her objections. Three months ago, she suddenly started feel ing “odd,” and she came home from college because she could not concentrate. Two weeks after she came home, she began hearing voices telling her that she is “a sinner” and must repent. Although never a religious person, she now be lieves she must repent, but she does not know how, and feels confused. She is managing her activities of daily living despite the ongoing auditory hallucina tions and delusions, and she is affectively reactive on examination. Which di agnosis best fits this presentation?

A. Schizophreniform disorder, with good prognostic features, provisional.

B. Schizophreniform disorder, without good prognostic features, provisional.

C. Schizophreniform disorder, with good prognostic features.

D. Schizophreniform disorder, without good prognostic features.

E. Unspecified schizophrenia spectrum and other psychotic disorder.

A. Schizophreniform disorder, with good prognostic features, provisional.

A 24-year-old male college student is brought to the emergency department by the college health service team. A few weeks ago he was involved in a car ac cident in which one of his friends was critically injured and died in his arms. The man has not come out of his room or showered for the last 2 weeks. He has eaten only minimally, claimed that aliens have targeted him for abduction, and asserted that he could hear their radio transmissions. Nothing seems to con vince him that this abduction will not happen or that the transmissions are not real. Which of the following diagnoses (and justifications) is most appropriate for this man?

A. Brief psychotic disorder with a marked stressor, because the symptoms be gan after the tragic car accident.

B. Brief psychotic disorder without a marked stressor, because the content of the psychosis is unrelated to the accident.

C. Unspecified schizophrenia spectrum and other psychotic disorder, because more information is needed.

D. Schizophreniform disorder, because there are psychotic symptoms but not yet a full-blown schizophrenia picture.

E. Delusional disorder, because the central symptom is a delusion of persecu tion.

C. Unspecified schizophrenia spectrum and other psychotic disorder, because more information is needed.

Which of the following statements accurately describes a change in DSM-5 from the DSM-IV criteria for bipolar disorders?

A. Diagnostic criteria for bipolar disorders now include both changes in mood and changes in activity or energy.

B. Diagnostic criteria for bipolar I disorder, mixed type, now require a patient to simultaneously meet full criteria for both mania and major depressive episode.

C. Subsyndromal hypomania has been removed from the allowed conditions under other specified bipolar and related disorder.

D. There is now a stipulation that manic or hypomanic episodes cannot be as sociated with recent administration of a drug known to cause similar symp toms.

E. The clinical symptoms associated with hypomanic episodes have been sub stantially changed.

A. Diagnostic criteria for bipolar disorders now include both changes in mood and changes in activity or energy.

A 32-year-old man reports 1 week of feeling unusually irritable. During this time, he has increased energy and activity, sleeps less, and finds it difficult to sit still. He also is more talkative than usual and is easily distractible, to the point of finding it difficult to complete his work assignments. A physical ex amination and laboratory workup are negative for any medical cause of his symptoms and he takes no medications. What diagnosis best fits this clinical picture?

A. Manic episode.

B. Hypomanic episode.

C. Bipolar I disorder, with mixed features.

D. Major depressive episode.

E. Cyclothymic disorder.

A. Manic episode.

A 42-year-old man reports 1 week of increased activity associated with an ele vated mood, a decreased need for sleep, and inflated self-esteem. Although the man does not object to his current state (“I’m getting a lot of work done!”), he is concerned because he recalls a similar episode 10 years ago during which he began to make imprudent business decisions. A physical examination and lab oratory work are unrevealing for any medical cause of his symptoms. He had taken fluoxetine for a depressive episode but self-discontinued it 3 months ago because he felt that his mood was stable. Which diagnosis best fits this clinical picture?

A. Bipolar I disorder.

B. Bipolar II disorder.

C. Cyclothymic disorder.

D. Other specified bipolar disorder and related disorder.

E. Substance/medication-induced bipolar disorder

A. Bipolar I disorder.

Approximately what percentage of individuals who experience a single manic episode will go on to have recurrent mood episodes?

A. 90%.

B. 50%.

C. 25%.

D. 10%.

E. 1%

A. 90%.

Which of the following factors is most predictive of incomplete recovery be tween mood episodes in bipolar I disorder?

A. Being widowed.

B. Living in a higher-income country.

C. Being divorced.

D. Having a family history of bipolar disorder.

E. Having a mood episode accompanied by mood-incongruent psychotic symptoms.

E. Having a mood episode accompanied by mood-incongruent psychotic symptoms.

Which of the following is more common in men with bipolar I disorder than in women with the disorder?

A. Rapid cycling.

B. Alcohol abuse.

C. Eating disorders.

D. Anxiety disorders.

E. Mixed-state symptoms.

B. Alcohol abuse.

A patient with a history of bipolar I disorder presents with a new-onset manic episode and is successfully treated with medication adjustment. He notes chronic depressive symptoms that, on reflection, long preceded his manic epi sodes. He describes these symptoms as “feeling down,” having decreased en ergy, and more often than not having no motivation. He denies other depressive symptoms but feels that these alone have been sufficient to nega tively affect his marriage. Which diagnosis best fits this presentation?

A. Other specified bipolar and related disorder.

B. Bipolar I disorder, current or most recent episode depressed.

C. Cyclothymic disorder.

D. Bipolar I disorder and persistent depressive disorder (dysthymia).

E. Bipolar II disorder.

D. Bipolar I disorder and persistent depressive disorder (dysthymia).

In which of the following ways do manic episodes differ from attention-defi cit/hyperactivity disorder (ADHD)?

A. Manic episodes are more strongly associated with poor judgment.

B. Manic episodes are more likely to involve excessive activity.

C. Manic episodes have clearer symptomatic onsets and offsets.

D. Manic episodes are more likely to show a chronic course.

E. Manic episodes first appear at an earlier age

C. Manic episodes have clearer symptomatic onsets and offsets.

A patient with a history of bipolar disorder reports experiencing 1 week of el evated and expansive mood. Evidence of which of the following would sug gest that the patient is experiencing a hypomanic, rather than manic, episode?

A. Irritability.

B. Decreased need for sleep.

C. Increased productivity at work.

D. Psychotic symptoms.

E. Good insight into the illness.

C. Increased productivity at work.

A 25-year-old graduate student presents to a psychiatrist complaining of feel ing down and “not enjoying anything.” Her symptoms began about a month ago, along with insomnia and poor appetite. She has little interest in activities and is having difficulty attending to her schoolwork. She recalls a similar epi sode 1 year ago that lasted about 2 months before improving without treat ment. She also reports several episodes of increased energy in the past 2 years; these episodes usually last 1–2 weeks, during which time she is very produc tive, feels more social and outgoing, and tends to sleep less, although she feels energetic during the day. Friends tell her that she speaks more rapidly during these episodes but that they do not see it as off-putting and in fact think she seems more outgoing and clever. She has no medical problems and does not take any medications or abuse drugs or alcohol. What is the most likely diag nosis?

A. Bipolar I disorder, current episode depressed.

B. Bipolar II disorder, current episode depressed.

C. Bipolar I disorder, current episode unspecified.

D. Cyclothymic disorder.

E. Major depressive disorder

B. Bipolar II disorder, current episode depressed.

How do the depressive episodes associated with bipolar II disorder differ from those associated with bipolar I disorder?

A. They are less frequent than those associated with bipolar I disorder.

B. They are lengthier than those associated with bipolar I disorder.

C. They are less disabling than those associated with bipolar I disorder.

D. They are less severe than those associated with bipolar I disorder.

E. They are rarely a reason for the patient to seek treatment

B. They are lengthier than those associated with bipolar I disorder.

How does the course of bipolar II disorder differ from the course of bipolar I disorder?

A. It is more chronic than the course of bipolar I disorder.

B. It is less episodic than the course of bipolar I disorder.

C. It involves longer asymptomatic periods than the course of bipolar I disorder.

D. It involves shorter symptomatic episodes than the course of bipolar I disorder.

E. It involves a much lower number of lifetime mood episodes than the course of bipolar I disorder

A. It is more chronic than the course of bipolar I disorder.

Which of the following features confers a worse prognosis for a patient with bipolar II disorder?

A. Younger age.

B. Higher educational level.

C. Rapid-cycling pattern.

D. “Married” marital status.

E. Less severe depressive episodes.

C. Rapid-cycling pattern.

The course of bipolar II disorder would likely be worse for individuals who have an onset of the disorder at which of the following ages?

A. Age 10 years.

B. Age 20 years.

C. Age 40 years.

D. Age 70 years.

E. None of the above; there is no association between onset age and course.

A. Age 10 years.

Which of the following statements about postpartum hypomania is true?

A. It tends to occur in the late postpartum period.

B. It occurs in less than 1% of postpartum women.

C. It is a risk factor for postpartum depression.

D. It is easily distinguished from the normal adjustments to childbirth.

E. It is more common in multiparous women

C. It is a risk factor for postpartum depression.

For an adolescent who presents with distractibility, which of the following ad ditional features would suggest an association with bipolar II disorder rather than attention-deficit/hyperactivity disorder (ADHD)?

A. Rapid speech noted on examination.

B. A report of less need for sleep.

C. Complaints of racing thoughts.

D. Evidence that the symptoms are episodic.

E. Evidence that the symptoms represent the individual’s baseline behavior

D. Evidence that the symptoms are episodic.

A 50-year-old man with a history of a prior depressive episode is given an antidepressant by his family doctor to help with his depressive symptoms. Two weeks later, his doctor contacts you for a consultation because the patient now is euphoric, has increased energy, racing thoughts, psychomotor agitation, poor concentration and attention, pressured speech, and a decreased need to sleep. These symptoms began with the initiation of the patient’s new medica tion. The patient stopped the medication after 2 days, as he no longer felt de pressed; however, the symptoms have continued ever since. What is the patient’s diagnosis?

A. Substance/medication-induced bipolar and related disorder.

B. Bipolar I disorder.

C. Bipolar II disorder.

D. Cyclothymic disorder.

E. Major depressive disorder.

B. Bipolar I disorder.

In which of the following aspects does cyclothymic disorder differ from bipo lar I disorder?

A. Duration.

B. Severity.

C. Age at onset.

D. Pervasiveness.

E. All of the above

B. Severity.

How does DSM-5 differ from DSM-IV in its classification of mood disorders?

A. There is no difference between the two editions.

B. DSM-IV separated mood disorders into different sections; DSM-5 consoli dates mood disorders into one section.

C. DSM-IV included all mood disorders in a single section; DSM-5 places depressive and bipolar mood disorders in separate sections.

D. DSM-IV placed mood and anxiety disorders in separate sections; DSM-5 consolidates mood and anxiety disorders within a single section.

E. DSM-IV placed mood disorders with psychotic features in the same section as other mood disorders; DSM-5 places mood disorders with psychosis in a separate section

C. DSM-IV included all mood disorders in a single section; DSM-5 places depressive and bipolar mood disorders in separate sections.

How does DSM-5 differ from DSM-IV in its classification of premenstrual dys phoric disorder (PMDD)?

A. PMDD was in the Appendix in DSM-IV and remains in this location in DSM-5.

B. PMDD was not included in DSM-IV but is in the Appendix of DSM-5.

C. PMDD is no longer considered a valid psychiatric diagnosis.

D. PMDD is included in the “Depressive Disorders” chapter of DSM-5 but was not included in the “Mood Disorders” chapter of DSM-IV.

E. PMDD is included in DSM-5 but the name of the diagnosis has been changed.

D. PMDD is included in the “Depressive Disorders” chapter of DSM-5 but was not included in the “Mood Disorders” chapter of DSM-IV.

What DSM-5 diagnostic provision is made for depressive symptoms following the death of a loved one?

A. Depressive symptoms lasting less than 2 months after the loss of a loved one are excluded from receiving a diagnosis of major depressive episode.

B. To qualify for a diagnosis of major depressive episode, the depression must start no less than 12 weeks following the loss.

C. To qualify for a diagnosis of major depressive episode, the depressive symptoms in such individuals must include suicidal ideation.

D. Depressive symptoms following the loss of a loved one are not excluded from receiving a major depressive episode diagnosis if the symptoms otherwise fulfill the diagnostic criteria.

E. Depressive symptoms following the loss of a loved one are excluded from receiving a major depressive episode diagnosis; however, a proposed diagnostic category for postbereavement depression is included in “Conditions for Further Study” (DSM-5 Appendix) pending further research

D. Depressive symptoms following the loss of a loved one are not excluded from receiving a major depressive episode diagnosis if the symptoms otherwise fulfill the diagnostic criteria.

Which of the following statements about how grief differs from a major depres sive episode (MDE) is false?

A. In grief the predominant affect is feelings of emptiness and loss, while in MDE it is persistent depressed mood and the inability to anticipate happiness or pleasure.

B. The pain of grief may be accompanied by positive emotions and humor that are uncharacteristic of the pervasive unhappiness and misery characteristic of MDE.

C. The thought content associated with grief generally features a preoccupation with thoughts and memories of the deceased, rather than the self-critical or pessimistic ruminations seen in MDE.

D. In grief, feelings of worthlessness and self-loathing are common; in MDE, self-esteem is generally preserved.

E. If a bereaved individual thinks about death and dying, such thoughts are generally focused on the deceased and possibly about “joining” the de ceased, whereas in MDE such thoughts are focused on ending one’s own life because of feeling worthless, undeserving of life, or unable to cope with the pain of depression.

D. In grief, feelings of worthlessness and self-loathing are common; in MDE, self-esteem is generally preserved.

How do individuals with substance/medication-induced depressive disorder differ from individuals with major depressive disorder who do not have a sub stance use disorder?

A. They are more likely to be female.

B. They are more likely to have graduate school education.

C. They are more likely to be male.

D. They are more likely to be white.

E. They are less likely to report suicidal thoughts/attempts.

C. They are more likely to be male.

A 50-year-old man presents with persistently depressed mood for several weeks that interferes with his ability to work. He has insomnia and fatigue, feels guilty, has thoughts he would be better off dead, and has thought about how he could die without anyone knowing it was a suicide. His wife informs you that he requests sex several times a day and that she thinks he may be go ing to “massage parlors” regularly, both of which are changes from his typical behavior. He has told her he has ideas for a “better Internet,” and he has in vested thousands of dollars in software programs that he cannot use. She notes that he complains of fatigue but sleeps only 1 or 2 hours each night and seems to have tremendous energy during the day. Which diagnosis best fits this pa tient?

A. Manic episode.

B. Hypomanic episode.

C. Major depressive episode.

D. Major depressive episode, with mixed features.

E. Major depressive episode, with atypical features.

D. Major depressive episode, with mixed features.

A 45-year-old man with classic features of schizophrenia has always experi enced co-occurring symptoms of depression—including feeling “down in the dumps,” having a poor appetite, feeling hopeless, and suffering from insom nia—during his episodes of active psychosis. These depressive symptoms oc curred only during his psychotic episodes and only during the 2-year period when the patient was experiencing active symptoms of schizophrenia. After his psychotic episodes were successfully controlled by medication, no further symptoms of depression were present. The patient has never met full criteria for major depressive disorder at any time. What is the appropriate DSM-5 diagnosis?

A. Schizophrenia.

B. Schizoaffective disorder.

C. Persistent depressive disorder (dysthymia).

D. Schizophrenia and persistent depressive disorder (dysthymia).

E. Unspecified schizophrenia spectrum and other psychotic disorder.

A. Schizophrenia.

What are the new depressive disorder diagnoses in DSM-5?

A. Subsyndromal depressive disorder, premenstrual dysphoric disorder, and mixed anxiety and depressive disorder.

B. Disruptive mood dysregulation disorder, premenstrual dysphoric disorder, and persistent depressive disorder (dysthymia).

C. Disruptive mood dysregulation disorder, premenstrual dysphoric disorder, and subsyndromal depressive disorder.

D. Disruptive mood dysregulation disorder, postmenopausal dysphoric disor der, and persistent depressive disorder (dysthymia).

E. Mixed anxiety and depressive disorder, bereavement-induced major de pressive disorder, and postmenopausal dysphoric disorder

B. Disruptive mood dysregulation disorder, premenstrual dysphoric disorder, and persistent depressive disorder (dysthymia).

A depressed patient reports that he experiences no pleasure from his normally enjoyable activities. Which of the following additional symptoms would be re quired for this patient to qualify for a diagnosis of major depressive disorder with melancholic features?

A. Despondency, depression that is worse in the morning, and inability to fall asleep.

B. Depression that is worse in the evening, psychomotor agitation, and signif icant weight loss.

C. Inappropriate guilt, depression that is worse in the morning, and early morning awakening.

D. Significant weight gain, depression that is worse in the evening, and exces sive guilt.

E. Despondency, significant weight gain, and psychomotor retardation.

C. Inappropriate guilt, depression that is worse in the morning, and early morning awakening.

A 39-year-old woman reports that she became quite depressed in the winter last year when her company closed for the season, but she felt completely nor mal in the spring. She recalls experiencing several other episodes of depression over the past 5 years (for which she cannot identify a seasonal pattern) that would have met criteria for major depressive disorder. Which of the following correctly summarizes this patient’s eligibility for a diagnosis of “major depres sive disorder, with seasonal pattern”?

A. She does not qualify for this diagnosis: the episode must start in the fall, and the patient must have no episodes that do not have a seasonal pattern.

B. She does qualify for this diagnosis: the single episode described started in the winter and ended in the spring.

C. She does not qualify for this diagnosis: the patient must have had two episodes with a seasonal relationship in the past 2 years and no nonseasonal episodes during that period.

D. She does qualify for this diagnosis: the symptoms described are related to psychosocial stressors.

E. She does qualify for this diagnosis: the symptoms are not related to bipolar I or bipolar II disorder.

C. She does not qualify for this diagnosis: the patient must have had two episodes with a seasonal relationship in the past 2 years and no nonseasonal episodes during that period.

Which of the following statements about the prevalence of major depressive disorder in the United States is true?

A. The 12-month prevalence is 17%.

B. Females and males have equal prevalence at all ages.

C. Females have increased prevalence at all ages.

D. The prevalence in 18- to 29-year-olds is three times higher than that in 60-year-olds.

E. The prevalence in 60-year-olds is three times higher than that in 18- to 29-year-olds.

D. The prevalence in 18- to 29-year-olds is three times higher than that in 60-year-olds.

Which of the following statements about the heritability of major depressive disorder (MDD) is true?

A. Nearly 100% of people with genetic liability can be accounted for by the personality trait of dogmatism.

B. The heritability is approximately 40%, and the personality trait of neuroticism accounts for a substantial portion of this genetic liability

C. Less than 10% of people with genetic liability can be accounted for by the personality trait of perfectionism.

D. Nearly 50% of people with genetic liability can be accounted for by the per sonality trait of aggressiveness.

E. The heritability of MDD depends on whether the individual’s mother or fa ther had MDD.

B. The heritability is approximately 40%, and the personality trait of neuroticism accounts for a substantial portion of this genetic liability

Which of the following statements about diagnostic markers for major depres sive disorder (MDD) is true?

A. No laboratory test has demonstrated sufficient sensitivity and specificity to be used as a diagnostic tool for MDD.

B. Several diagnostic laboratory tests exist, but no commercial enterprise will offer them to the public.

C. Diagnostic laboratory tests have been withheld for fear that people testing positive for MDD may attempt suicide.

D. Tests that exist are adequate diagnostically but are not covered by health in surance.

E. Only functional magnetic resonance imaging (fMRI) provides absolute di agnostic reliability for MDD

A. No laboratory test has demonstrated sufficient sensitivity and specificity to be used as a diagnostic tool for MDD.

Which of the following statements about gender differences in suicide risk and suicide rates in major depressive disorder (MDD) is true?

A. The risk of suicide attempts and completions is higher for women.

B. The risk of suicide attempts and completions is higher for men.

C. The risk of suicide attempts and completions is equal for men and women.

D. The disparity in suicide rate by gender is much greater in individuals with MDD than in the general population.

E. The risk of suicide attempts is higher for women, but the risk of suicide completions is lower

E. The risk of suicide attempts is higher for women, but the risk of suicide completions is lower

A 12-year-old boy begins to have new episodes of temper outbursts that are out of proportion to the situation. Which of the following is not a diagnostic possi bility for this patient?

A. Disruptive mood dysregulation disorder.

B. Bipolar disorder.

C. Oppositional defiant disorder.

D. Conduct disorder.

E. Attention-deficit/hyperactivity disorder.

A. Disruptive mood dysregulation disorder.

Which of the following features distinguishes disruptive mood dysregulation disorder (DMDD) from bipolar disorder in children?

A. Age at onset.

B. Gender of the child.

C. Irritability.

D. Chronicity.

E. Severity.

D. Chronicity.

Children with disruptive mood dysregulation disorder are most likely to de velop which of the following disorders in adulthood?

A. Bipolar I disorder.

B. Schizophrenia.

C. Bipolar II disorder.

D. Borderline personality disorder.

E. Unipolar depressive disorders.

E. Unipolar depressive disorders.

An irritable 8-year-old child has a history of temper outbursts both at home and at school. What characteristic mood feature must be also present to qualify him for a diagnosis of disruptive mood dysregulation disorder?

A. The child’s mood between outbursts is typically euthymic.

B. The child’s mood between outbursts is typically hypomanic.

C. The child’s mood between outbursts is typically depressed.

D. The child’s mood between outbursts is typically irritable or angry.

E. The mood symptoms and temper outbursts must not have persisted for more than 6 months

D. The child’s mood between outbursts is typically irritable or angry.

Children with disruptive mood dysregulation disorder (DMDD) often meet criteria for what additional DSM-5 diagnosis?

A. Pediatric bipolar disorder.

B. Oppositional defiant disorder.

C. Schizophrenia.

D. Intermittent explosive disorder.

E. Major depressive disorder

B. Oppositional defiant disorder.

The diagnostic criteria for disruptive mood dysregulation disorder (DMDD) state that the diagnosis should not be made for the first time before age 6 years or after 18 years (Criterion G). Which of the following statements best describes the rationale for this age range restriction?

A. Validity of the diagnosis has been established only in the age group 7–18 years.

B. The restriction represents an attempt to differentiate DMDD from bipolar disorder.

C. The restriction is based on existing genetic data.

D. The restriction represents an attempt to differentiate DMDD from intermit tent explosive disorder.

E. The restriction represents an attempt to differentiate DMDD from autism spectrum disorder.

A. Validity of the diagnosis has been established only in the age group 7–18 years.

A 9-year-old boy is brought in for evaluation because of explosive outbursts when he is frustrated with schoolwork. The parents report that their son is well behaved and pleasant at other times. Which diagnosis best fits this clinical pic ture?

A. Disruptive mood dysregulation disorder.

B. Pediatric bipolar disorder.

C. Intermittent explosive disorder.

D. Major depressive disorder.

E. Persistent depressive disorder (dysthymia).

C. Intermittent explosive disorder.

A 14-year-old boy describes himself as feeling “down” all of the time for the past year. He remembers feeling better while he was at camp for 4 weeks dur ing the summer; however, the depressed mood returned when he came home. He reports poor concentration, feelings of hopelessness, and low self-esteem but denies suicidal ideation or changes in his appetite or sleep. What is the most likely diagnosis?

A. Major depressive disorder.

B. Disruptive mood dysregulation disorder.

C. Depressive episodes with short-duration hypomania.

D. Persistent depressive disorder (dysthymia), with early onset.

E. Schizoaffective disorder

D. Persistent depressive disorder (dysthymia), with early onset.

A 30-year-old woman reports 2 years of persistently depressed mood, accom panied by loss of pleasure in all activities, ruminations that she would be better off dead, feelings of guilt about “bad things” she has done, and thoughts about quitting work because of her inability to make decisions. Although she has never been treated for depression, she feels so distressed at times that she won ders if she should be hospitalized. She experiences an increased need for sleep but still feels fatigued during the day. Her overeating has led to a 12-kg weight gain. She denies drug or alcohol use, and her medical workup is completely normal, including laboratory tests for vitamins. The consultation was prompted by her worsened mood for the past several weeks. What is the most appropriate diagnosis?

A. Major depressive disorder (MDD).

B. Persistent depressive disorder (dysthymia), with persistent major depressive episode.

C. Cyclothymia.

D. Bipolar II disorder.

E. MDD, with melancholic features.

B. Persistent depressive disorder (dysthymia), with persistent major depressive episode.

A 45-year-old woman with multiple sclerosis was treated with interferon beta 1a a year ago, which resolved her physical symptoms. She now presents with depressed mood (experienced daily for the past several months), middle in somnia (of recent onset), poor appetite, trouble concentrating, and lack of in terest in sex. Although she has no physical symptoms, she is frequently absent from work. She denies any active plans to commit suicide but admits that she often thinks about it, as her mood has worsened. What is the most likely diag nosis?

A. Major depressive disorder.

B. Persistent depressive disorder (dysthymia).

C. Depressive disorder due to another medical condition.

D. Substance/medication-induced depressive disorder.

E. Persistent depressive disorder (dysthymia) and multiple sclerosis

C. Depressive disorder due to another medical condition.

An 18-year-old college student, recently arrived in the United States from Bei jing, complains to her gynecologist of irritability, problems with her room mates, increased appetite, feeling bloated, and feeling depressed for 3–4 days prior to the onset of menses. She reports that these symptoms have been pres ent since she reached menarche at age 12 (although she has never kept a mood log). The gynecologist calls you for a consultation about the correct diagnosis, because she is as yet unfamiliar with the new DSM-5 diagnostic criteria. What is your response?

A. The patient has premenstrual syndrome because she does not meet criteria for premenstrual dysphoric disorder.

B. The patient would qualify for a provisional diagnosis of premenstrual dysphoric disorder; however, the diagnosis does not exist in DSM-5.

C. The patient would qualify for a provisional diagnosis of premenstrual dysphoric disorder.

D. The patient would qualify for a provisional diagnosis of premenstrual dysphoric disorder if the diagnosis had been validated in Asian women.

E. The patient has no DSM-5 diagnosis

C. The patient would qualify for a provisional diagnosis of premenstrual dysphoric disorder.

What is the appropriate method of confirming a diagnosis of premenstrual dysphoric disorder?

A. Laboratory tests.

B. Family history.

C. Neuropsychological testing.

D. Two or more months of prospective symptom ratings on validated scales.

E. One month of scoring high on the Daily Rating of Severity of Problems or 1 month of scoring high on the Visual Analogue Scales for Premenstrual Mood Symptoms

D. Two or more months of prospective symptom ratings on validated scales.

A 29-year-old woman complains of sad mood every month in anticipation of her very painful menses. The pain begins with the start of her flow and contin ues for several days. She does not experience pain during other times of the month. She has tried a variety of treatments, none of which have given her re lief. What is the appropriate diagnosis?

A. Premenstrual dysphoric disorder.

B. Premenstrual syndrome.

C. Dysmenorrhea.

D. Factitious disorder.

E. Persistent depressive disorder (dysthymia).

C. Dysmenorrhea.

Which of the following symptoms must be present for a woman to meet criteria for premenstrual dysphoric disorder?

A. Marked affective lability.

B. Decreased interest in usual activities.

C. Physical symptoms such as breast tenderness.

D. Marked change in appetite.

E. A sense of feeling overwhelmed or out of control

A. Marked affective lability.

A 23-year-old woman reports that during every menstrual cycle she experi ences breast swelling, bloating, hypersomnia, an increased craving for sweets, poor concentration, and a feeling that she cannot handle her normal responsi bilities. She notes that she also feels somewhat more sensitive emotionally and may become tearful when hearing a sad story. She takes no oral medication but does use a drospirenone/ethinyl estradiol patch. What diagnosis best fits this clinical picture?

A. Premenstrual dysphoric disorder (PMDD).

B. Dysthymia.

C. Dysmenorrhea.

D. Premenstrual syndrome.

E. Substance/medication-induced depressive disorder

D. Premenstrual syndrome.

A 31-year-old woman with no history of mood symptoms reports that she ex periences distressing mood lability and irritability starting about 4 days before the onset of menses. She feels “on edge,” cannot concentrate, has little enjoy ment from any of her activities, and experiences bloating and swelling of her breasts. The patient reports that these symptoms started 6 months ago when she began taking oral contraceptives for the first time. If she stops the oral con traceptives and her symptoms remit, what would the diagnosis be?

A. Premenstrual dysphoric disorder.

B. Dysthymia.

C. Major depressive episode.

D. Substance/medication-induced depressive disorder.

E. Premenstrual syndrome

D. Substance/medication-induced depressive disorder.

A 45-year-old man is admitted to the hospital with profound hypothyroidism. He is depressed but does not meet full criteria for major depressive disorder (MDD), the diagnosis given to him by his internist. The patient has no prior history of a mood disorder, and all of the depressive symptoms are temporally related to the hypothyroidism. Based on this information, you determine that a change in diagnosis—to depressive disorder due to another medical condi tion—is warranted, as well as a specifier to indicate that full criteria for MDD are not met. How would the full diagnosis be recorded?

A. Hypothyroidism would be coded on Axis III in DSM-5.

B. There is no special coding procedure in DSM-5.

C. Hypothyroidism would be recorded as the name of the “other medical condition” in the DSM-5 diagnosis.

D. Medical disorders are not coded as part of a mental disorder diagnosis in DSM-5.

E. A revision to DSM-5 is planned to deal with this issue.

C. Hypothyroidism would be recorded as the name of the “other medical condition” in the DSM-5 diagnosis.