DSM

Question 1

Mental Retardation
percentage of people in:
mild, moderate, severe, profound

Answer 1

modle 85%; moderat 10%; severe 3-4%; profound 1-2%

Question 2

ADHD

percentage of all kids; ratio of boys:girls; percentage of kids with ADHD that also have CD; percentage of kids with LD

Answer 2

3-5% of all kids; 4-9 times more boys; 50% of ADHD kids have Conduct Disorder; 20% of kids iwth ADHD have LD

Question 3

ADHD

neurological areas affected and problems related to ADHD

Answer 3

right frontal lobe, striatum which is part of the basal ganglia and composed of the caudate nucleus and putamen; cerebellum
smaller corpus callosum; genetic influence 57%; twins 80%, globus palladus and caudate nucleus

Question 4

Tourettes Disorder

diagnostic criteria

co morbidity

treatment

Answer 4

multiple tics, multiple times per day for 12 months
co existing diagnosis: obsession and compulsions, ADHD, LD, depression and social problems
Tx: school, individual, family, drugs: ?Haloperidol and pimozide, clonidine (hypertension)
antidepressants: clomipramine, fluxetine to decrease obsessions and compulsions

Question 5

Dementia of the Alzheimer’s Type

Stage 1

Stage 2

Stage 3

Answer 5

Alzheimers

Stage 1: 1-3 years; anterograde amnesia/declarative/explicit memory; deficits in visuospatial skills; indifference, irritability, sadness, anomia (1: MEMORY)

Stage 2: 2-10 years; increasing deficits in recent and remote recall/retrograde amnesia; falt or labile mood; restlessness and agitation; delusions; fluent aphasia, acalculia, and ideomotor apraxia/insbility to translate an idea into movement (2:COGNITIVE)

Stage 3: 8-12 years; severely deteriorated intellectual functioning; apathy; limb rigidity; urinary and fecal incontinence

Question 6

Alzheimers Dementia

Etiology
neurotransmitter
neurological abnormalities

Answer 6

linked to genetics; low levels of ACh; neurofibrilarry tangles and plaques in certain areas of the cebral cortex especially in the temproal lobes, hippocampus and other areas of the brain

Question 7

Jane smokes marijuana every weekend. She also smokes occasionally during the week, in response to a particular stressful event. Based on this informaiton, we know that Jane, in terms of DSM IV TR diagnostic classification, is suffering from

a. substance abuse
b. substance dependence
c. cannabis inducted psychotic disorder
d. none of the above

Answer 7

D - none of the above;
there is no indication from the quesion that the criteria for substance absue or dependence are met. in other words, just because someone regularly uses a substance does not mean that there is a maladaptive pattern of use leading to significant impairment or distress (the key criterion for dependence and abuse)

Question 8

Marlatt and Gordon:
an initial relapse in a recovering alcoholic is most likely to lead to further relapses if the person:

a. attributes the relapse to internal and stable causes
b. attributes the relapse to external and unstable causes

Answer 8

A - the abstinence violation effect (AVE) occurs when an initial relapse leads to feelings such as guilt and depression, which in turn lead to further relapses. the AVE is most likely to occur if the person makes internal, stable attributions for the relapse (e.g. “I am worthless”), as opposed to external, unstable attributions (e.g. “I drank because temprorary relapses are to be expected”)

Question 9

Caffeine Intoxication is associated with

Answer 9

diuresis, boundless energy, significant distress for the person who is intoxicated

Question 10

Korsakoff’s Syndrome

Answer 10

alcohol inducated persisting amnestic disorder
due to a thiamine deficiency that causes damage to the thalamus. primary sumptoms is impaired recent memory. also disorientation, lack of insight into probelms, retrograde amnesia and confabulation (filling in memory gaps randomly)

Question 11

1. SUBSTANCE ABUSE

Answer 11

: In DSM-IV, a Substance-Use Disorder characterized by a maladaptive pattern of substance use involving clinically significant impairment or distress as manifested by the presence of at least one symptom during a 12-month period.

Question 12

2. SUBSTANCE DEPENDENCE:

Answer 12

A Substance-Use Disorder involving the continued use of a substance despite significant substance-related problems, as evidenced by the presence of at least three characteristic symptoms during a 12-month period. Dependence may or may not involve tolerance and withdrawal (physiological dependence). Substance Dependence is more serious than Substance Abuse.

Question 13

3. DELIRIUM TREMENS (A.K.A. ALCOHOL WITHDRAWAL DELIRIUM):

Answer 13

3. DELIRIUM TREMENS (A.K.A. ALCOHOL WITHDRAWAL DELIRIUM): Disturbances in consciousness and other cognitive functions, autonomic hyperactivity, vivid hallucinations, delusions and/or agitation following a period of prolonged or heavy use

Question 14

Schizophrenia is a disturbance of ______or more that includes _______________of active-phase symptoms.

Active phase symptoms include ____

Answer 14

Schizophrenia is a disturbance of six months or more that includes at least one month of active-phase symptoms (one week in DSM-III-R). Active phase symptoms include delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior and/or negative symptoms (e.g., flat affect, avolition, alogia).

Question 15

Rates of Schizophrenia are:
males:females
twin studies

Answer 15

Rates of Schizophrenia are about equal for males and females.
Twins: monozygotic (identical)=48%; Dizygotic (fraternal) -16%; biological siblings -10%; unrelated/general population=1%

Question 16

Treatment of Schizophrenia

Answer 16

Rates of Schizophrenia are about equal for males and females. Treatment usually includes a neuroleptic family therapy, and social-skills training.

Question 17

etiology

Answer 17

eltiology has been linked to genetics, oversensitivity to dopamine and other neurotransmitter abnormalities, and several structural brain abnormalities including enlarged ventricles and hypofrontality

Question 18

prognosis

Answer 18

better prognosis is associated with abrupt and later onsent, a precipitating stressor, female gender, absence of anosognosia and absnence of structural brain abnormalities

Question 19

Dopamine hypothesis of schizophrenia

Answer 19

schizophrenia is linked to excess dopamine; also serotoninin, large ventricles and decreased activity in the frontal lobes, small cerebral cortex and small thalamus

Question 20

Antipsychotics:
positive symptoms
negative symptoms

Answer 20

positive symptoms - delusions, hallucinations, disorganized speech, disorganized or catatonic behavior - easier to treat + sxs; treated with typical antipsychotics

negative symptoms: alogia (restricted fluency/productivity of thought and speech), avolition (restricted initiation ofgoal directed beahvior), flat affect, anhedonia.
atypical antipsychotics treat + and - sxs w/o tardive dyskinesia

Question 21

Schizophreniform Disorder

Answer 21

same diagnostic criteria as schizophrenia EXCEPT only present for 1 month but less than 6 months and impaired functioning is not required for this diagnosis

Question 22

Brief Psychotic Disorder

Answer 22

delusions, hallucinations, disorganized speech, and/or grossly disorganized or catatonic behavior that are present for at least 1 day but less than 1 month

Question 23

Schizoaffective Disorder

Answer 23

concurrent symptoms of schizophrenia and major depressive, manic, or mixed episode except for a period of at least two weeks without prominent mood symptoms. (psychotic without mood for 2 wks)

Question 24

Paranoid Schizophrenia
vs.
Delusional Disorder

Answer 24

Paranoid Schizophrenia - bizarre delusions; “yellow men with purple feet are following me”
vs.

Delusional Disorder - persistent, non bizarre delusional systemt; “whenI slow down, all of the cars behind me slow down - I’m being followed” - the logic is off; can function much better generally and they look pretty normal.

Question 25

Factitious Diosrder
vs.
Malingering

Answer 25

Factitious Disorder - fake, not real, intentionally producing symptoms, can be physical or psychological symptoms. Just to be in sick role
vs.
Malingering - there is an external incentive - get out of work, criminal case; not a mental disorder but a v code

Question 26

Diagnosis and Psychopathology
3. Delirium may occur due to intoxication with all of the following substances except
A cocaine.

B cannabis.

C caffeine.

D LSD.

Answer 26

caffeine

Question 27

agoraphobia

Answer 27

fear of being in a place where escape may be difficult or embarrassing or help won’t be available; or a situationally predisposed panic attack

Question 28

situationally bound panic attack
vs.
situationally predisposed panic attack

Answer 28

bound - cued by a specific stimulus or situation (usually in social or specific phobia)

predisposed - do not always occur after person is exposed to the trigger

Question 29

obsession
vs
delusion

Answer 29

obsession - recurrent and persistent thoughts, impulses or images that are experienced at some time as intrusive and inappropriate and that cause marked anxiety or distress

delusion - false but firmly sustained beliefs

Question 30

Overall,‭ ‬studies investigating methods for reducing the risk for relapse for individuals with major depressive disorder have shown that:

   cognitive behavioral therapy is clearly superior to other forms of treatment for reducing the risk for relapse.   
   interpersonal therapy is clearly superior to other forms of treatment for reducing the risk for relapse.   
   relapse is best avoided through maintenance therapy with an antidepressant following termination of the initial treatment.   
   relapse is best avoided when the initial treatment combines psychosocial therapy and pharmacotherapy.

Answer 30

3. The research on this issue is, not surprisingly, far from consistent. However, it has found that maintenance therapy is often required to prevent relapse.
   a. Incorrect Although some studies have found cognitive therapy to have some advantage over other techniques for reducing relapse, others have not. Therefore, the phrase “clearly superior” eliminates this as the correct response.
   b. Incorrect Interpersonal therapy has not been found to be “clearly superior” to other treatments in terms of preventing relapse.
   c. CORRECT Most experts agree that continued maintenance treatment is the best way to reduce the risk for relapse; and, at this point, antidepressants have been the target of most of the research on maintenance therapy.
   d. Incorrect Relapse is not ameliorated by combining psychosocial and drug therapies during the initial treatment.

Question 31

. The feeling that one is an outside observer of one’s mental processes or body is referred to as:

   dissociation.   
   depersonalization.   
   delusion.   
   fugue.

Answer 31

9. This question describes feelings of detachment or estrangement from oneself.
   a. Incorrect Dissociation refers to a “disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment” (DSM-IV-TR, p. 822). Although depersonalization disorder is a type of dissociative disorder, depersonalization is a better response to this question.
   b. CORRECT Depersonalization refers to “an alteration in the perception or experience of the self so that one feels detached from, and as if one is an outside observer of, one’s mental processes or body” (DSM-IV-TR, p. 822). When depersonalization co-occurs with intact reality testing and significant distress or impaired functioning, a diagnosis of depersonalization disorder may be appropriate.
   c. Incorrect Delusions are false but firmly sustained beliefs based on incorrect inferences about external reality. Depersonalization could achieve delusional proportions, but that is not implied by the question.
   d. Incorrect Dissociative fugue is a dissociative disorder involving sudden, unexpected travel away from home with an inability to recall some or all of one’s past.

Question 32

The differential diagnosis of dementia and pseudodementia in older adults can be difficult because of the overlap in symptoms.‭ ‬However,‭ ‬the presence of which of the following suggests that pseudodementia is the appropriate diagnosis‭?

   The onset of the patient’s cognitive symptoms was insidious.   
   The severity of cognitive symptoms increases in the evening.   
   The patient seems unaware of his cognitive deficits.   
   The patient is uncooperative during cognitive testing.

Answer 32

10. Several symptoms help distinguish pseudodementia (memory and cognitive impairments associated with depression in older adults) from true dementia.
    a. Incorrect In pseudodementia, symptom onset is usually sudden; in dementia, it is typically insidious (gradual and subtle).
    b. Incorrect Increased severity of symptoms in the evening is characteristic of some forms of dementia but is uncommon in pseudodementia.
    c. Incorrect A patient with pseudodementia is likely to complain about and exaggerate his/her cognitive problems; a patient with dementia often denies problems in the early stage of the disorder and is unaware of them in the later stages.
    d. CORRECT A lack of cooperation during testing is more characteristic of patients with pseudodementia (depression) than of those with dementia. Patients with dementia are more likely to be cooperative (but inaccurate in their responses).

Question 33

26. For the past year,‭ ‬Maria M.,‭ ‬age‭ ‬47,‭ ‬has experienced several periods during which she is irritable and restless,‭ ‬has little energy,‭ ‬is unable to concentrate at work,‭ ‬and has trouble falling asleep.‭ ‬Maria says she feels‭ “‬fine‭” ‬between these episodes and is quite productive at work and socially active.‭ ‬Maria’s symptoms are most suggestive of:bipolar I disorder.
    cyclothymic disorder.
    major depressive disorder with atypical features.
    major depressive disorder,‭ ‬recurrent.

Answer 33

26. Maria seems to be experiencing fluctuating periods of depression and “normal” mood and functioning.
    a. Incorrect The diagnosis of bipolar I disorder requires the presence of at least one manic or one mixed episode.
    b. Incorrect A diagnosis of cyclothymic disorder requires the presence of hypomania and depression for at least two years.
    c. Incorrect The “atypical features” specifier is appropriate when the individual exhibits mood reactivity and at least two other characteristic symptoms (e.g., increased appetite and weight gain, hypersomnia).
    d. CORRECT Maria’s symptoms suggest she is experiencing recurrent episodes of major depression. There is no evidence that she has experienced manic or mixed episodes, which would be required for a diagnosis of bipolar I disorder, or episodes of hypomania and depression, which are characteristic of cyclothymic disorder.

Question 34

Sleep terror episodes:

   usually begin during REM sleep.   
   usually begin with a panicky scream.   
   are associated with vivid frightening dreams that the individual can recall in detail upon awakening.   
   are associated with rhythmic,‭ ‬stereotyped motor activity during the episode and upon awakening from it.

Answer 34

29. Sleep terror episodes are associated with sleep terror disorder and involve “abrupt awakenings from sleep usually beginning with a panicky scream or cry” (DSM-IV-TR, p. 634).
    a. Incorrect Sleep terrors usually begin during stage 3 or 4 NREM sleep.
    b. CORRECT As noted above, a sleep terror episode typically begins with a panicky scream or cry.
    c. Incorrect The individual usually does not have a detailed memory of a dream upon awakening but may have amnesia for the episode or may recall only fragmentary images of a dream.
    d. Incorrect Awakening from sleep with rhythmic, stereotyped motor activity is characteristic of nocturnal paroxysmal dystonia, which is diagnosed as a parasomnia NOS.

Question 35

30. A cognitive therapist is treating a‭ ‬20-year old woman who has received a diagnosis of anorexia nervosa.‭ ‬The therapist’s first priority will be to give the woman graded task assignments designed to increase her food intake.‭ ‬In addition,‭ ‬an initial intervention will be to:foster the woman’’s doubt about her belief that she is accomplishing something by staying thin.
    challenge or refute the woman’’s belief that she is‭ “‬too fat‭” ‬and that eating will make her obese.
    educate the woman about the underlying meaning of her attitudes and behaviors.
    identify ways in which family members are reinforcing the woman’’s eating behaviors.

Answer 35

Approaches to treating anorexia vary, even among cognitive therapists. However, by definition, cognitive therapy entails addressing the cognitions that underlie or support a disorder.

a. CORRECT Of the strategies given in the answers, this one is most similar to Garner and Bemis’s (1982) approach, which is based on Beck’s cognitive therapy. According to Garner and Bemis, an initial step in treatment is to foster doubt in the client about his or her assumption that it is worth the time and effort to deny one’s appetite in order to stay thin. This is followed by addressing the validity of the anorectic’s beliefs regarding the consequences of becoming fat and the conviction that thinness is a primary determinant of self-worth and personal value.