Criterion A for schizoaffective disorder requires an uninterrupted period of illness during which Criterion A for schizophrenia is met. Which of the following additional symptoms must be present to fulfill diagnostic criteria for schizoaffective disorder?
An anxiety episode—either panic or general anxiety.
Rapid eye movement (REM) sleep behavior disorder.
A major depressive or manic episode.
How common is schizoaffective disorder relative to schizophrenia?
Much more common.
Twice as common.
One-half as common.
One-third as common.
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?
Psychotic symptoms that precede the onset of severe intoxication or acute withdrawal.
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.
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.
Psychotic symptoms that occur during a period of sustained substance abstinence.
Psychotic symptoms that occur during a medical admission for substance 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?
Psychotic disorder associated with systemic lupus erythematosus.
Brief psychotic disorder, with marked stressor.
Which of the following statements accurately describes a change in DSM-5 from the DSM-IV criteria for bipolar disorders?
Diagnostic criteria for bipolar disorders now include both changes in mood and changes in activity or energy.
Diagnostic criteria for bipolar I disorder, mixed type, now require a patient to simultaneously meet full criteria for both mania and major depressive episode.
Subsyndromal hypomania has been removed from the allowed conditions under other specified bipolar and related disorder.
There is now a stipulation that manic or hypomanic episodes cannot be associated with recent administration of a drug known to cause similar symptoms.
The clinical symptoms associated with hypomanic episodes have been substantially changed.
Approximately what percentage of individuals who experience a single manic episode will go on to have recurrent mood episodes?
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 episodes.
He describes these symptoms as “feeling down,” having decreased energy, and more often than not having no motivation. He denies other depressive symptoms but feels that these alone have been sufficient to negatively affect his marriage. Which diagnosis best fits this presentation?
Other specified bipolar and related disorder.
Bipolar I disorder, current or most recent episode depressed.
Bipolar I disorder and persistent depressive disorder (dysthymia).
Bipolar II disorder.
A 25-year-old graduate student presents to a psychiatrist complaining of feeling 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 episode 1 year ago that lasted about 2 months before improving without treatment. 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 productive, 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 diagnosis?
Bipolar I disorder, current episode depressed.
Bipolar II disorder, current episode depressed.
Bipolar I disorder, current episode unspecified.
Major depressive disorder.
How does DSM-5 differ from DSM-IV in its classification of mood disorders?
There is no difference between the two editions.
DSM-IV separated mood disorders into different sections; DSM-5 consolidates mood disorders into one section.
DSM-IV included all mood disorders in a single section; DSM-5 places depressive and bipolar mood disorders in separate sections.
DSM-IV placed mood and anxiety disorders in separate sections; DSM-5 consolidates mood and anxiety disorders within a single section.
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.
Which of the following statements about how grief differs from a major depressive episode (MDE) is false?
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.
The pain of grief may be accompanied by positive emotions and humor that are uncharacteristic of the pervasive unhappiness and misery characteristic of MDE.
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.
In grief, feelings of worthlessness and self-loathing are common; in MDE, self-esteem is generally preserved.
If a bereaved individual thinks about death and dying, such thoughts are generally focused on the deceased and possibly about “joining” the deceased, 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.
A 45-year-old man with classic features of schizophrenia has always experienced
co-occurring symptoms of depression—including feeling “down in the
dumps,” having a poor appetite, feeling hopeless, and suffering from insomnia—
during his episodes of active psychosis. These depressive symptoms occurred
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?
Persistent depressive disorder (dysthymia).
Schizophrenia and persistent depressive disorder (dysthymia).
Unspecified schizophrenia spectrum and other psychotic disorder.
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 normal 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 depressive disorder, with seasonal pattern”?
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.
She does qualify for this diagnosis: the single episode described started in the winter and ended in the spring.
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.
She does qualify for this diagnosis: the symptoms described are related to psychosocial stressors.
She does qualify for this diagnosis: the symptoms are not related to bipolar I or bipolar II disorder.
Which of the following disorders is included in the “Anxiety Disorders” chapter of DSM-5?
Posttraumatic stress disorder.
Acute stress disorder.
Panic disorder with agoraphobia.
Separation anxiety disorder.
Which of the following statements best describes how panic attacks differ from panic disorder?
Panic attacks require fewer symptoms for a definitive diagnosis.
Panic attacks are discrete, occur suddenly, and are usually less severe.
Panic attacks are invariably unexpected.
Panic attacks represent a syndrome that can occur with a variety of other disorders.
Panic attacks cannot be secondary to a medical condition.
A 32-year-old woman reports sudden, unexpected episodes of intense anxiety, accompanied by headaches, a rapid pulse, nausea, and shortness of breath. During the episodes she fears that she is dying, and she has presented several times to emergency departments. Each time she has been told that she is medically healthy; she is usually reassured for a time, but on the occurrence of a new episode she again becomes concerned that she has some severe medical problem. She was given lorazepam once but disliked the sedating effect and has not taken it again. She abstains from all medications and alcohol in an attempt to minimize potential causes for her attacks. What is the most likely explanation for her symptoms?
Somatic symptom disorder.
Anxiety due to another medical condition.
Illness anxiety disorder.
A 35-year-old man is in danger of losing his job because it requires frequent long-range traveling and for the past year he has avoided flying. Two years earlier he was on a particularly turbulent flight, and although he was not in any real danger, he was convinced that the pilot minimized the risk and that the plane almost crashed. He flew again 1 month later and, despite having a smooth flight, the anticipation of turbulence was so distressing that he experienced a panic attack during the flight; he has not flown since. What is the most appropriate diagnosis?
Acute stress disorder.
Specific phobia, situational type.
Social anxiety disorder (social phobia).
Which of the following statements about compulsive behaviors in obsessivecompulsive disorder (OCD) is true?
Compulsions in OCD are best understood as a form of addictive behavior.
Compulsive behaviors in OCD are aimed at reducing the distress triggered by obsessions.
Examples of compulsive behaviors include paraphilias (sexual compulsions), gambling, and substance use.
Compulsions involve repetitive and persistent thoughts (e.g., of contamination), images (e.g., of violent or horrific scenes), or urges (e.g., to stab someone).
Compulsive behaviors in OCD are typically goal directed, fulfilling a realistic purpose.
A 63-year-old woman has been saving financial documents and records for many years, placing papers in piles throughout her apartment to the point where it has become unsafe. She acknowledges that the piles are a concern; however, she says that the papers include important documents and she is afraid to throw them away. She recalls several instances in which her taxes were audited and she needed certain documents to avoid a penalty. She is concerned because her landlord is threatening to evict her unless she removes the piles of papers. What is the most likely diagnosis?
Nonpathological collecting behavior.
Dementia (major neurocognitive disorder).
How does DSM-5 differ from DSM-IV in its classification of posttraumatic stress disorder (PTSD)?
In DSM-5, PTSD has been placed with the dissociative disorders.
In DSM-5, PTSD has been placed with the depressive disorders.
In DSM-5, PTSD has been placed in a newly created chapter.
In DSM-5, PTSD has been placed with “Other Conditions That May Be a Focus of Clinical Attention.”
In DSM-5, PTSD has been placed with “Conditions for Further Study” in Section III.
A 25-year-old woman, new to your practice, tells you that a little more than 3 months ago she was accosted on her way home. The attacker told her he had a gun, was going to rape her, and would shoot her if she resisted. He walked
her toward an alley. She was sure he would kill her afterward no matter what she did, and therefore she pushed away from him, aware that she might be shot. She was able to escape unharmed. She describes not being able to fall asleep for the first 2 nights after the attack and of avoiding that particular street in her neighborhood for 2 days following the event. She thinks that the attacker might have touched her breasts but cannot remember for sure. She has recently started feeling anxious all of the time and is tearful, and she has stopped going to work. She fears that something about her makes her “look like a victim.” What is the most likely diagnosis?
Posttraumatic stress disorder.
Acute stress disorder.
Somatoform Disorders in DSM-IV are referred to as Somatic Symptom and Related Disorders in DSM-5. Which of the following features characterizes the major diagnosis in this class, somatic symptom disorder?
Medically unexplained somatic symptoms.
Underlying psychic conflict.
Distressing somatic symptoms and abnormal thoughts, feelings, and behaviors in response to these symptoms.
Comorbidity with anxiety and depressive disorders.
After an airplane flight, a 60-year-old woman with a history of chronic anxiety develops deep vein thrombophlebitis and a subsequent pulmonary embolism. Over the next year, she focuses relentlessly on sensations of pleuritic chest pain
and repeatedly seeks medical attention for this symptom, which she worries is due to recurrent pulmonary emboli, despite negative test results. Review of systems reveals that she also has chronic back pain and that she has consulted
many physicians for symptoms of culture-negative cystitis. What diagnosis best fits this clinical picture?
Post–pulmonary embolism syndrome.
Chest pain syndrome.
Somatic symptom disorder.
What is the minimum average frequency of binge eating required for a diagnosis of DSM-5 binge-eating disorder?
Once weekly for the last 3 months.
Once weekly for the last 4 months.
Every other week for the last 3 months.
Every other week for the last 4 months.
Once a month for the last 3 months.
What are the subtypes of bulimia nervosa?
Restrictive and purging.
With normal weight/abnormal weight.
A 45-year-old man with a long-standing history of heavy alcohol use is referred 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 resulted in his frequently oversleeping and missing work. He has tried to moderate
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?