Question 1

Jane is seeking therapy on the advice of her husband, who has been noticing behaviors that are unhealthy. Jane is a 45-year-old software designer who is relatively isolated at work, but who can have some social interactions. In 2001, Jane had what could be considered her first manic episode, immediately following the events of September 11th. At 35, Jane's diagnosis could use the qualifier:

Accepted Answer

Jane's diagnosis could use the qualifier for late onset, since Bipolar disorders are usually diagnosed in late teens or mid-twenties. Considering that this client also had trauma associated with a major national disaster, it could affect her presentation of what may or may not be a mood or thought disorder. However, it would certainly be specified that based on the qualifiers that you have, NOS would not be an option.

Question 2

Speaking with one of your new clients over the phone, you begin to form a diagnostic impression. Wilma Wellspring has recently become overly concerned with whether or not her medications are being administered properly, her risk of three different cancers, and ruminations over potential side effects from her latest flu vaccine. When she arrives at your office, you find that those same worries now apply to the stock market, her finances, and the safety of her home. Initially, you were thinking _________, but on closer look, this feels more like _____________:

Accepted Answer

At first, Wilma's problem has purely to do with her health issues. As your evaluation progressed, it became clear that Wilma's issues extended beyond just her health. Hypochondriasis only covers health issues, while Generalized Anxiety Disorder covers many other anxieties and is much more inclusive, particularly if more than one anxiety is occurring together. While she may have trouble adjusting and from time to time may feel "crazy," these are not appropriate diagnoses.

Question 3

Angry Austin is in your office because of the intense anger he feels toward those he's closest to. What's more, he's got rapid mood swings that are beginning to impact him at his after-school job. At fifteen, Austin is beginning to show signs of a personality disorder. Before diagnosing a personality disorder, you remember:

Accepted Answer

You should remember that personality disorders are not typically diagnosed before the age of eighteen, primarily because other adolescent issues may well explain what Austin is going through. Conduct Disorder and certain types of mood or anxiety disorders can all imitate certain diagnostic features of personality disorders in adolescents.

Question 4

When Georgeanne appears in your office, she reports that you are her third therapist and that she has been told before that she has episodes too frequently and needs to find a way to stabilize her mood. She can never identify when the episodes will come, but knows that every year for the past four years, her mood has gone through four or five changes each year without ever seeming to disappear completely. Georgeanne qualifies for which of the following specifiers?

Accepted Answer

The rapid cycling specifier applies to Georgeanne's case because her episodes occur at least four times each year and she has no sense of recovery between episodes. These episodes can be depressive, mixed, or manic, or any combination of the three.

Question 5

The DSM-5 differs significantly from the DSM-IV-TR in several ways. Under the new DSM-5, a patient's situation must satisfy at least one of two specific criteria in order to be diagnosed as having a paraphilic disorder. Those two criteria are:

Accepted Answer

To be diagnosed with a paraphilic disorder, a patient must either (1) experience personal distress (not distress due to social disapproval), or (2) cause distress or harm to others (including involving individuals who are unwilling or unable to consent). Self-disgust is not a necessary criterion for this category of disorders. Examples of paraphilic disorders include exhibitionism, voyeurism, pedophilia, and sexual sadism.

Question 6

Olivia the perfectionist comes in for her assessment. As you are getting to know Olivia, you notice that her hands are chapped, she counts her steps to your desk and back to her chair, and that she only sits down after smoothing the seat under her. In total, this routine has taken Olivia ten minutes. From her presentation so far, you can see that:

Accepted Answer

So far, what you can see is that the client has compulsions. You cannot yet be sure if they are attached to obsessions, have not yet diagnosed OCD, and since she is only here for her assessment, you do not yet have a baseline established. When a baseline is clearly established, you will have even more criteria on which to base your assessment.

Question 7

Douglas is an eight-year-old referred to you for behavior complications. He has been deliberately destroying property in his third grade classroom for several (6) months. 3 months before that, he was starting fights with his friends back home. When completing your assessment, you ask about any pertinent changes in the client's life and you find out that the family recently moved into the school district from out of state. When considering diagnoses, which would be most accurate considering the circumstances?

Accepted Answer

The most accurate diagnosis, considering the circumstances, would be Adjustment Disorder, Mixed Episode. After all, considering that Douglas just moved across the country and was made to leave his friends behind, there are likely other circumstances at play. And when he found out about needing to move at the end of second grade, he could have been acting out so that it would be easier for him to leave.

Question 8

Brenda presents as a very high-functioning client. Until last month, she had a job, owned her home, and served as one of the chaperones for her children's school events. After her trial for forgery, she is participating in counseling as part of a court mandate so that she will be able to see her children again. She has not seen or heard from any friends in three months and is currently in foreclosure on her home. Which of the following would be an appropriate list of her environmental and psychosocial factors?

Accepted Answer

An appropriate list of important contextual issues would include references to the areas of the client's life that are presently impacted by stressors. Legal (crime, court proceedings), social (friendships, relationships), support (family), and financial (financial difficulty) problems are all presently contributing to this client's situation.

Question 9

You perform a Global Assessment of Functioning (GAF) for your client Patrick and calculate a score of 70. At this level, what can be said for this client?

Accepted Answer

It might be said for Patrick that he is mildly depressed or anxious, but overall, he is maintaining his current level of functioning with people at school, home, or work. He also maintains meaningful relationships. There is no imminent danger to himself or others. You may not find that he has superior functioning, but he is moving, like many, into transparent symptoms.

Question 10

Your client has Persistent Depressive Disorder, Hypertension, Diabetes II, and poor social support. What can be said about the client's symptoms?

Accepted Answer

What can be said about the client's symptoms is that depressive symptoms have persisted for over two years with little relief, since that is a diagnostic criteria for Persistenr Depressive Disorder. Their medical conditions indicate more significant impairment, and it is unclear if their lack of social support stems from lack of family or from lack of friends or some other osurce of social support.

Question 11

Consider the following client's diagnoses and psychosocial factors: The client has Cyclothymic Disorder, financial and legal troubles, and a GAF of 70. What can be said about the client's symptoms?

Accepted Answer

If the client currently meets criteria for Cyclothymic Disorder, their moods have fluctuated between hypomanic and depressed for quite some time. Given the score of 70 on their GAF, severe impact is not found.

Question 12

When a clinician is trying to decide between two diagnoses in order to plan the proper course of treatment, they may be able to use:

Accepted Answer

Differential Diagnosis is included in the DSM-5 as a part of a clinician's reference in order to make the most appropriate diagnosis. It includes decision trees, specific timeframe specifiers, and recommendations on any underlying conditions. While ICD-9 may help you to code the other diagnoses involved, it will not help you make decisions regarding the impact. Similarly, NCLEX and PDR are great tools, but do not address ways to use diagnosis.

Question 13

Which of the following is not included in the diagnosis for categorizing substance abuse?

Accepted Answer

Tolerance is not included as an approved diagnosis. If a client was demonstrating any tolerance, it likely would not be demonstrated as a problem unless fully addressed by the client independently. Abuse, withdrawal, and dependence, on the other hand, are all addressed using diagnostic criteria, indicating a significant level of impairment of function.

Question 14

Bryan presents reporting depression and some anxiety. While he appears very anxious, you are not quite sure whether or not he fits the criteria for depression and begin searching for assessment tools. One of the assessment tools that you are able to provide and interpret as an MFT is:

Accepted Answer

The Beck Depression Inventory can help clinicians assess whether or not a client is able to recognize depressive feelings and symptoms within himself. The MMPI instead refers to a personality test, while the same could be said for MBTI. PPD is the medical term for a TB skin test and has no association with depression. BDI has long been considered the standard depression assessment tool.

Question 15

When working with acute episodes of change, many clients are able to classify Adjustment Disorder. However, when there are other factors at play, other diagnoses might be more appropriate. One of those factors may be:

Accepted Answer

If it has been more than six months since your last episode, Adjustment Disorder may fit again, but it wouldn't if it's been less. Depending upon the age and how long the episode lasts, this could well be depression or anxiety. Each of the above are excellent reasons and cause to reevaluate a diagnosis of someone who has been in therapy before.

Question 16

You are a therapist who sees many clients who are diagnosed with different types of panic and stress disorders. Pete the Pilot presents as having flashbacks, recalling the crash, showing physical signs of recall. Mandy the Mapmaker had a traumatic accident with her T-Square about ten minutes ago and is beginning to show many of the same symptoms, but no flashbacks. Considering Mandy's presentation, she would most appropriately qualify for:

Accepted Answer

Acute Stress Disorder is much like PTSD, except there are no flashbacks that would also identify it as longer term. The immediacy of her experience (ten minutes) would make her ineligible for Adjustment Disorder at the moment, since that usually takes some time to manifest. While she shows symptoms directly related to the event, Mandy is not currently showing other Mood Disorder symptoms.

Question 17

When making a diagnosis of a disorder that is primarily oriented to one of the relationships in the client's life, it would be most appropriate to use:

Accepted Answer

V Codes are allowed when indicating any type of relational issue or academic problem, including: acculturation, bereavement, Parent Child relationship, victims or perpetrators of abuse, noncompliance with treatment, etc. While some complains can be psychosomatic, there are more appropriate definitions and guidelines for applying them to each client.

Question 18

When making a diagnosis of Schizophrenia, it is important to keep in mind that Schizophrenia differs from Schizoaffective in which of the following ways:

Accepted Answer

Schizoaffective contains episodic mood disorders while both can be helped with medication, both are considered to be long-term illnesses, and both can involve hallucinations depending upon presentation. The episodic mood disorders that occur within schizoaffective are usually easily discernible from client to client.

Question 19

Which of the following can most be classified as depressive behavior?

Accepted Answer

Isolating from others is really the only behavior that could be classified as depressive. Intermittent crying could also be a depressive symptom. However, like the other options, it can also be a sign of a manic episode. Sexual and spending behavior changes can often signal manic episodes or behavior.

Question 20

You are being asked to evaluate Dylan, a seven-year-old boy who is showing signs of regression. He no longer plays with friends, can only show interest in two patterns of play, and has lost the ability to hold a conversation with his peers. Dylan fits criteria for:

Accepted Answer

There is no event that would suggest Adjustment Disorder is a cause here. His conduct is not really out of line, considering everything else that's going on for him. And if his conduct is not really out of line, the Oppositional Defiant Disorder doesn't really fit, either. Disintegrative Disorder is where children lose certain abilities that were easily learned before age 10, with intermittent recovery.

Quiz 1: Assessment