Diagnoses

Question 1

An adolescent client is referred. The referral states they present with irritability, difficulties with concentration and have expressed that they are “always thinking”. The client has not experienced any traumatic events. Which diagnoses could these symptoms be linked to?

Answer 1

GAD, ADHD, bipolar disorder (need more information about baseline)

Question 2

You have a seven-year-old client. His parents are concerned as he shows no interest in his younger sibling and he has never really had any friends. He will talk to adults, mostly about planets. His mother also reports he is a picky eater, preferring “dry” foods and dislikes wearing shoes. You have done a cognitive assessment and his FSIQ is average. What diagnosis is your hypothesis?

Answer 2

ASD

Question 3

You meet a thirty-two-year-old client who is motivated to reduce the dependence on alcohol. The client reports the following:
- their manager at an actuarial firm has spoken to them about subpar performance at work
- their partner has noticed increased irritability and anxiety after more than 24 hours of no alcohol
- they have tried unsuccessfully to cut down their alcohol consumption over the last twelve months

This client meets DSM criteria for _____.

Answer 3

substance use disorder
(specifically: alcohol use disorder)

Question 4

What differentiates a diagnosis of Bulimia and Anorexia?

Answer 4

In anorexia: weight is below normal range
In anorexia: restricted eating only (i.e. no pattern of excessive eating and compensatory behaviours)

whereas

In bulimia: pattern of binge eating and purging

Question 5

What differentiates a diagnosis of binge-eating disorder and bulimia?

Answer 5

There is no purging in binge-eating disorder

Question 6

What differentiates a diagnosis of avoidant/restrictive food intake disorder and anorexia?

Answer 6

In ARFID, there is no desire for weight loss or fear of weight gain.

Question 7

In the initial interview your new client tells you that:
- they used to play a sport every weekend but lately they haven’t wanted to
- they find it difficult to get out of bed in the morning despite sleeping for over 12 hours for weeks
- they have withdrawn from friends & family
- they have been called out at work for missing deadlines
- they have gained weight
- they do not take drugs
- they noticed changes in mood over the last couple of months

The client is currently meeting diagnostic criteria for which disorder?

Answer 7

MDD

Question 8

You meet with a twenty-year-old client for the first time. They are accompanied by their older brother, who informs you that she was diagnosed with conduct disorder six years ago. Symptoms persist despite over twelve months of intervention.

What diagnosis might be appropriate at this stage?

Answer 8

antisocial personality disorder

Question 9

In OCD, what are obsessions?

Answer 9

Recurrent and persistent thoughts, urges or images that the individual has described as intrusive or unwanted; and the individual attempts to ignore, neutralise or suppress these thoughts

Question 10

In OCD, what are compulsions?

Answer 10

Repetitive behaviours or mental acts that the individual feels driven to perform in response to an obsession or according rigid rules; and these behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing a dreaded event or situation

Question 11

You meet a fifty-year-old client whose relationship of twelve years ended two months ago. They report the following symptoms:
- decreased motivation to go to work and socialise with friends
- feelings of worthlessness and guilt
- difficulty concentrating and making life decisions

This client meets DSM criteria for _____.

Answer 11

adjustment disorder

[food for thought: why not MDD?]

Question 12

For a diagnosis of schizophrenia, Criteria A states that the person must show 2 or more symptoms over a month. What are the symptoms in Criteria A?

Answer 12

Delusions
Hallucinations
Disorganised speech
- - -
Disorganised behaviour
Negative symptoms (e.g. diminished emotional expression, decrease in self-initiated purposeful activities)

(One symptom must be from above the line)

Question 13

A client tells you for the last couple of months they have been avoiding going into the office because they have been experiencing:
- intense fear and worry
shortness of breath
- chest pain
- light-headedness
- rapid heart rate
At random times and are worried that it will happen at work and they will lose their job. They tell you that there are no triggers, sometimes it will happen when getting ready to leave the house as they are scared it will happen in their day.

What diagnosis do these symptoms currently meet?

Answer 13

Panic Disorder

Question 14

For a diagnosis of antisocial personality disorder a person must be showing a pervasive pattern of disregard for and violation of the rights of others, since they were how old?

Answer 14

15 years old

Question 15

What domains do Neurocognitive disorders affect?

Answer 15

Complex attention, executive function, learning and memory, language, perceptual-motor skills, and social cognition

Question 16

How do you differentiate between a diagnosis of ODD and CD?

Answer 16

If there is emotion dysregulation then ODD. If there is evidence of aggression towards others/destruction of property/pattern of theft or deceit then CD

Question 17

What is the difference between a manic and hypomanic episode?

Answer 17

1) Duration:
4 days = hypomanic
1 week = manic

2) Manic episode if psychosis is present

3) Manic episode if disturbance is sufficiently severe to cause hospitalisation

Question 18

You have been conducting CBT with a client presenting with MDD. They come in for their 4th session and they tell you that they are feeling “on top of the world” despite only sleeping for 3 hours over the last few nights. You notice that they are continually talking and seem to be jumping from topic to topic. You ask if they have taken anything before seeing you today and they tell you that they are “high on life”.

What do you suspect the client is presenting with?

Answer 18

Hypomanic episode - Bipolar II

Question 19

You have been conducting CBT with a client presenting with MDD. In for their 5th session, you observe racing thoughts and rapid speech. They tell you that they spent all night researching cryptocurrencies and are planning to run a series of workshops about investing. They tell you that the ghost of Steve Jobs visited them while they were home; the ghost told them that they could be richer than he ever was.

What do you suspect the client is presenting with?

Answer 19

Manic episode - Bipolar I

Question 20

You have a ten-year-old male client. Two weeks ago, he called the police because his father was threatening his mother with a knife. He discloses the following symptoms:
+ intrusive memories that cause distress
+ anxiety when he spends time with his father (which is permitted under a parenting agreement)
+ belief that he should have stopped his father himself
+ inability to experience positive emotions
+ angry outbursts
+ problems concentrating
Why is a diagnosis of PTSD inappropriate for this client?

Answer 20

Duration - symptoms of PTSD must be present for more than one month

Diagnosis of ‘acute stress disorder’ may be more appropriate for this client

Question 21

In the DSM, Criteria B of PTSD lists ‘intrusive symptoms’ associated with a traumatic event. These symptoms include…

Answer 21

1) Recurrent, involuntary, and intrusive distressing memories
2) Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event
3) Dissociative reactions (e.g. flashbacks) in which the individual feels or acts as if the traumatic event were recurring
4) Intense or prolonged psychological distress at exposure to cues that symbolise or resemble an aspect of the traumatic event
5) Marked physiological reactions to abovementioned cues

Question 22

A twenty-year-old female client reports that she was mugged three months ago while overseas. She was walking to her hotel after dinner when two adolescent males approached her and grabbed her bag. She remembers that they were laughing when they approached her. She discloses the following symptoms:
+ recurrent and distressing dreams about the mugging
+ avoidance of adolescent males, esp. when they are in groups and/or laughing
She reports that these symptoms are significantly affecting her daily functioning.

What other symptoms must be present for a diagnosis of PTSD to be appropriate?

Answer 22

Criterion D: Negative alterations in cognitions and mood (e.g. diminished interest or participation in activities; inability to experience positive emotions)

and

Criterion E: Marked alterations in arousal and reactivity (e.g. persistent irritability and/or anger; problems with concentration)

Question 23

A client presents with three symptoms of hallucinogen use disorder. Which specifier would you use?

Answer 23

Mild hallucinogen use disorder

(Remember: mild = 2 or 3 symptoms)

Question 24

A client presents with five symptoms of tobacco use disorder. Which specifier would you use?

Answer 24

Moderate tobacco use disorder

(Remember: moderate = 4 or 5 symptoms)

Question 25

A client presents with seven symptoms of cannabis use disorder. Which specifier would you use?

Answer 25

Severe cannabis use disorder

(Remember: severe = 6 or more symptoms)

Question 26

You interview a nineteen-year-old male who has been charged with arson. They left the schooling system at the age of fifteen after numerous warnings about truancy and persistent insolence. They live with two friends after leaving home to escape their parents’ alcohol dependency; they themselves have never engaged in alcohol misuse.
You administer a PAI. Scores in the following scales are in the clinical range: INF, ANT, AGG, DOM.

What do you suspect the client is presenting with?

Answer 26

antisocial personality disorder

Question 27

When would you diagnose antisocial personality disorder AND substance use disorder?

Answer 27

when substance use and antisocial behaviour can both be tracked to childhood

Question 28

In the DSM-V, what four independent diagnoses (present in the DSM-IV) were combined to form the category ‘autism spectrum disorder’?

Answer 28

autistic disorder, Asperger syndrome, pervasive developmental disorder, childhood disintegrative disorder

Question 29

Which of the following is NOT one of the five diagnostic criteria for ASD?

A) Persistent deficits in social communication and social interaction across multiple contexts
B) Restricted or repetitive behaviours, interests, or activities
C) Symptoms cause clinically significant impairment in functioning
D) Reckless disregard for safety of self or others

Answer 29

D) Reckless disregard for safety of self or others

Question 30

The DSM-V recommends that practitioners use specifiers (i.e. levels) to indicate how severe ASD symptoms are in an individual. How many levels are listed?

Answer 30

three
(i.e. Level 1, Level 2, Level 3)

Question 31

Lachlan is a seven-year-old boy who is referred to a clinical psychologist due to concerns about his communication skills, socialisation skills, and emotional functioning. He was born in Fiji to English-speaking parents. He migrated to Australia when he was two and started preschool when he was three. No concerns were raised by educators there. Concerns have, however, been raised by his classroom teacher; they report that he is nonverbal and struggling to form friendships with his peers. In the clinic, Lachlan communicated with the clinical psychologist appropriately. This surprised his mother, as his classroom teacher has told her that he rarely interacts with adults at school. There is no indication of restricted or repetitive behaviours/interests in any setting.

What diagnosis is Lachlan meeting criteria for?

Answer 31

selective mutism

[Not ASD because Lachlan demonstrated age-appropriate communication skills in some settings, e.g. preschool, psychologist’s clinic - also: no restricted or repetitive behaviours/interests]

Question 32

When symptoms of ASD and ADHD are present, what does the DSM-V advise practitioners to do?

Answer 32

diagnose ASD and ADHD if attentional difficulties are excessive when compared to individuals of similar mental age