Question 1

Sarah is a teenager who presents as very depressed. When you ask her how long she has felt the same way, she says, "It comes and goes." She tells you that she first noticed it when she was nine. Before making a diagnosis, what will you need to examine?

Accepted Answer

Before making a diagnosis, you'll need to examine how long the symptoms normally last. Once you have that information, you will be able to discern whether or not there are single or recurrent episodes and whether or not cyclothymic or dysthymic disorders are more appropriate.

Question 2

Herb is a seventy-year-old white male. During the intake session, he reveals that he is a recent widower, lives alone, and has a son who lives on the other side of the country. Herb is most at risk for which of the following?

Accepted Answer

Herb is most at risk for suicide. Demographics for suicide risk include males who live alone and who have a small or reduced support network. While Herb does not have any past suicidal ideation, there are still enough significant factors to generate a safety contract.

Question 3

Six years ago, Brian was in a car accident. Six months later, he was in another accident, just before moving to San Francisco. He has never driven a car since. Brian takes the streetcar to work every morning and home every night. What appears to be a classic case of post-traumatic stress might not be a problem at all, because:

Accepted Answer

PTSD can sometimes appear to be no problem if it does not interrupt or distress the client's daily living or ability to maintain social and vocational competence. If Brian has not needed a car, his daily living would not be interrupted. However, when he went to return to pre-accident function at a later time, he may find himself incapacitated with fear or agitation.

Question 4

Ethical Emma and Safety Sam are great people to have around in your practice. Still, every now and then, like any old married couple, they can get into a heated debate. You work with a sixteen-year-old who shares that he smokes a little and drinks a little. To keep your internal therapist couple happy, you would choose to:

Accepted Answer

Keeping the therapist couple happy would mean assessing for safety by evaluating for context, while keeping in mind that your obligation to keep things confidential ends when his safety is threatened. So long as he understands this, you will be able to continue building a relationship with him, even when assessing for danger.

Question 5

Which of the following is not considered a psychosocial stressor?

Accepted Answer

Misbehaving children are not considered to be psychosocial stressors, since the children are part of the family system and can be addressed independently or as part of the whole family. Psychosocial stressors are external and may be beyond the client's control in their current context. For example, a lack of vocational support may come from an inadequate state employee system and cannot be helped.

Question 6

You have seen the Sopranos, who were referred for their out of control kids, for a number of weeks. As you continue your appointments, you begin to restructure your appointments so that the couple is given more time with each other. In doing this, you are also:

Accepted Answer

By giving the couple more time together, they are able to build a stronger coalition, which may be more helpful in working with any children that are out of control. Still, the first rule is to let the parents know that they deserve to be a united front. That way, they will be able to support one another when they head home.

Question 7

Sam presents as a 35-year-old male who is having trouble relating to his ten-year-old son Ryan. The difficulty does not extend to the rest of the family, but is especially heightened around issues of sports, achievement, and athletic expectations. Treating the entire family could be useful because:

Accepted Answer

Sam may have expectations of others that go unspoken and they may not be revealed unless the whole family is seen together. For example, there may be an expectation that Sean get straight As, Ryan be really good at sports, and Gwen goes to ballet school. Without the whole family together, underlying themes go unnoticed.

Question 8

"The client was oriented x 3, made appropriate eye contact, but had pressured speech and poor insight." The preceding summary might very well have been taken from:

Accepted Answer

The Mental Status Exam is the source of the summary, since it contains questions pertaining to orientation, insight, movement, speech, and thought content. While these other inventories and summaries can be helpful in providing essential information, only the status exam contains questions regarding orientation. While it might also be common to find the status exam incorporated into summaries, it may be less accurate, since they are only taken in the beginning.

Question 9

Assessment tools are often used during the first few sessions to obtain a clearer picture of the presenting problem. When using these assessment tools, one important consideration is:

Accepted Answer

Human nature best informs therapists that it pays to be skeptical, particularly when it comes to information reported by identified patients and their family members, given the inclination of an individual to have sought therapy. While people are programmed to get themselves necessary help, they are also programmed to keep themselves in the best possible light possible. Seeking therapy is no exception; it pays to be skeptical.

Question 10

Jennifer has been experiencing shortness of breath, helplessness, disorientation, and thoughts of impending death. Diagnostically, panic disorder seems to be the most appropriate diagnosis. However, in order to complete the diagnosis, you must specify whether or not it occurs with or without:

Accepted Answer

A complete diagnosis of panic disorder includes whether or not Agoraphobia is an included piece of the diagnostic impression. Agoraphobia is used to determine whether or not an individual has symptoms only in the presence of outside, unknown stimuli.

Question 11

Paul the Personality has three different settings: dramatic, emotional, and attention-seeking. As he is sitting in your office, he begins telling you about how much he appreciates you listening to him, but that he isn't sure that you appreciate the gravity of his situation. He is unique in his problems and needs someone with a more unique perspective. In which Cluster does Paul's personality disorder belong?

Accepted Answer

Paul's personality disorder belongs in Cluster B. Paul's disorder may be characterized by intense interpersonal conflict and may include diagnoses such as: Antisocial Personality Disorder, Borderline Personality Disorder, or Narcissistic Personality Disorder.

Question 12

You begin to notice that your practice is filling up with a number of personality disorder diagnoses, and you wonder if you are diagnosing correctly. Some important considerations are:

Accepted Answer

All of these are important considerations when making personality disorder diagnoses. Borderline Personality Disorder is one disorder that is characteristically overdiagnosed, while other personality disorders have developed poor prognoses over time. It is also critical that the impairments to the client do not originate solely due to medical conditions (such as head trauma) or substance abuse (such as steroid usage).

Question 13

Walter the Worrier is getting between three and four hours sleep each night. He feels as if he is moving at a snail's pace and has lost the ability to concentrate for more than a few minutes at a time. He finally made an appointment with you after his wife noticed that he wouldn't even go out for his Wednesday night bowling game. Before diagnosing Walter with a mood disorder, you must first rule out:

Accepted Answer

Any mood disorders require that you first rule out the presence or use of any substances, including alcohol. When and if substances are found to be an important issue, treating them would be another matter entirely and would require different tactics from a mood disorder alone for the most appropriate treatment. While it is not necessary to refer out for service if you are appropriately trained, you must also encourage your client to treat their dual diagnosis.

Question 14

Manic Molly has been symptomatic over the last five days. When she arrived at work, her coworkers noticed that her mood was __________, and that she was especially __________. Her supervisor is beginning to notice that she has been very ________ with the company charge account. When confronted about her behavior, Molly becomes ___________.

Accepted Answer

Answer A demonstrates many of the tendencies that are present in those clients coping with bipolar disorders. Especially common are the labile moods and frivolous spending when experiencing a manic phase. Becoming defensive, while common for many, is even more common for those with bipolar issues. It is the most fitting of all options to clearly describe Bipolar I.

Question 15

Glen is presenting in your office on referral and reports that he has certain obsessive thoughts, including thoughts of bodily injury. The further you examine, the more you see that these obsessions are beginning to intrude into Glen's personal and professional life. In the end, Glen also adds that the thoughts come from one of the overbearing male voices that he hears regularly. Your diagnosis would be:

Accepted Answer

While Glen's presentation is certainly that of an OCD client, what makes the case unique is the fact that Glen hears voices. Obsessions, as defined by the diagnosis, must be known to come from the client's own mind. Further reality testing may be necessary to help Glen understand whether or not he can see the voices as part of his disorder. The voices also rule out PTSD or GAD as potential diagnoses, since neither of them involve auditory hallucinations.

Question 16

Yolanda Yearly sees a therapist once every ten years. She reports that every year, around the time of her "tenth birthday" (20, 30, 40, 50), she gets very sad, sometimes irritable and upset, and spends between ten and twelve months in therapy. You know from the client's report that she presents every ten years, but do not have any of the records. When considering diagnosis for her, which might be most appropriate?

Accepted Answer

Major Depressive Disorder, Recurrent would be the most appropriate diagnosis. Records or no records, you know that this client is no stranger to therapy, and that once a depressive disorder is revisited, it is considered recurrent. Adjustment disorder would not be an appropriate fit since symptoms last longer than six months, on average. While she may be grieving her age, bereavement is only appropriate in the context of losing people.

Question 17

George had an experience of auditory hallucinations for about a week that told him that he was the King of Spain. Within two weeks, George was able to return to work full-time and had been able to successfully give up finding the buried treasure from the discovery of California. He has not had any symptoms since the one episode. Still, he is seeking out some help for any remaining issues. Currently, George meets criteria for:

Accepted Answer

George currently meets criteria for Brief Psychotic Disorder. Schizophrenia and Major Depressive Disorder both have longer timeframes than are fulfilled by George's symptoms. George also displayed no difficulty adjusting to the reality that he came back to: that he was not the King of Spain. Time frame and full recovery are largely what rule out other diagnoses.

Question 18

Sammy Sickerson presents in your office immediately behind your last appointment with Frank the Faker. You're having a hard time telling the two of them apart. Working with Sammy, you begin to notice that he is in search of excessive prescription drug refills and referrals to other more specialized providers. Sammy should be diagnosed with:

Accepted Answer

Sammy should be diagnosed with Malingering, because it is the only disorder that involves gaining extra outside resources, attention, or additional gain. While all of the others are still attached to medically inappropriate behavior, they have separate criteria that do not include an aspect of personal gain.

Question 19

Mark is a sixth grader who has difficulty concentrating in class, difficulty following directions, and who is easily distracted. Considering that Mark is an elementary school-aged boy, there is a good chance that he could be labeled with:

Accepted Answer

Mark could very well be labeled with Attention Deficit Disorder because of how he presents in class. While he fits some of the criteria, it is especially important to use essential rule-out features to make sure that the issues aren't better explained by a transition, adjustment, or family change. As the question suggests, there is also a predisposition for young school-aged boys to be diagnosed with the disorder.

Question 20

Hope is a seventy-year-old woman, just recently referred to your practice. In order to get a sense of whether or not Hope is "all there," you perform:

Accepted Answer

When first evaluating a patient for treatment, it is always a good idea to perform a mental status exam to check all of the patient's areas of orientation, speech, thought content, and mood. It can be the key in building an effective treatment plan. All of the other assessments mentioned are a part of a suicide assessment or depression assessment.

Quiz 1: Assessment