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Below is a list of factors that may increase the chances of developing Post Traumatic Stress Disorder (PTSD). Which of these are likely to be factors?
I. Childhood neglect or abuse
II. Being threatened with a weapon
III. Witnessing traumatic events, such as death and killing
IV. Lacking a good support system
V. Having an on-going persistent chronic condition, such as heart disease or diabetes
All of these are factors that can contribute to PTSD, except for an on-going chronic physical health condition. On-going mental health conditions, such as depression and anxiety, can contribute to PTSD (usually in combination with more actue problems of experiencing or witnessing trauma), and physical conditions can increase the likelihood of depression, but alone, they do not increase the likelihood of developing PTSD.
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A person who experienced a life-threatening accident, a natural disaster, or abuse can present with __________.
Post-traumatic stress disorder occurs when a person who has gone through a significant trauma, a life-threatening accident, a natural disaster, or abuse shows stress symptoms that impair the person's ability to function. Psychosomatic disorder is a real, physical disorder that has a psychological cause. Tension headaches have real pain caused by muscle spasm, but stress and anxiety have a role in causing the symptoms. Schizophrenia is a form of psychosis in which there is a loss of contact with reality. MRI and PET scans show brain abnormalities and changes in function. Panic disorder runs in families, but whether it is due to genetics or environment is not clear. Panic disorder is characterized by sudden, brief attacks of intense fear that cause physical symptoms. Epileptic-like activity in the brain is thought to be the cause of intermittent explosive disorder which is characterized by recurrent episodes of aggression toward people or property.
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Panic disorders are considered to be one of the most frequent groups of anxiety disorders. Which of the following symptoms are characteristic of panic disorders?
Individuals with a panic disorder suffer from sudden, overwhelming and repeated attacks of terror, which can occur out of nowhere. Major changes in behavior and persistent anxiety over having further attacks are characteristic of panic disorders. Often external stimuli or internal thoughts can trigger these attacks.
The other choices are incorrect. The fear of no escape possibilities in crowded situations is considered to be one criteria of agoraphobia, not of panic disorder. The exaggerated fear of specific objects or situations is characteristic for phobic disorders, not of panic disorder. Last, generalized anxiety disorder is marked by the diffuse state of general worries and fears, which are not based on a specific object or event. This is not the best description listed to fit the characteristics for panic disorder.
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If a person were diagnosed with agoraphobia, then which of the following scenarios would best describe their behavior due to the disorder?
Agoraphobia occurs when a patient fears situations that make them feel trapped, embarrassed, or helpless. They may fear an actual event or even simply the anticipation of an event. This is more likely to occur in a crowded area, such as a subway or metro bus, than it would simply interacting with a few strangers at a given time. In other words, they may experience a lack of desire to interact with strangers to avoid embarrassment, but that is not a situation in which they would feel trapped or helpless.
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What is the most likely diagnosis in a 24-year-old man who avoids a job he really wants because of an intense fear that he will be humiliated or rejected when meeting unfamiliar people?
Social anxiety disorder is the correct answer. The fear is judged to be out of proportion to the actual risk of the social interactions and is causing significant impairment in occupational functioning, which is concerning for social phobia. Social anxiety disorder should be suspected when intense fear of social interactions, in which the individual may be scrutinized by others, is out of proportion to the actual threat of the social situation and causes significant impairment in important areas of functioning, and the fear is not better explained by some other mental disorder.
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If a patient were diagnosed with claustrophobia, then which area of their brain would show increased activity in an MRI study?
The amygdala, along with the insular cortex and the limbic system, demonstrates hyperactivity when a person experiences high levels of fear and/or anxiety, and would show hyperactivity in a patient with an anxiety disorder.
On the other hand, the other choices are incorrect. For example, Wernicke's area is associated with comprehension of spoken language, while the occipital lobe is associated with visual perception. Last, the parietal lobe helps integrate various forms of sensory input with each other to create an understanding of the world.
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A study done recently showed that several management approaches, in addition to behavioral therapy interventions, may be necessary in preschool-aged children with moderate to severe attention-deficit/hyperactivity disorder (ADHD). That is, medication and some alternative therapies may be needed for preschool-aged children with ADHD who do not respond or do not follow behavior therapy. The researchers evaluated disruptive behavior in 74 children four to five years of age who were followed for 24 months. The children were randomized to either behavior therapy plus placebo or behavior therapy plus methylphenidate, and ADHD-related behaviors were compared. Parents reported ADHD symptoms observed at 6, 12, and 24 months. The researchers also noted several signs and symptoms of adverse effects that may have been due to the medication, such as insomnia, anorexia, irritability, and reduced growth and weight gain. The researchers found the children who received behavior therapy plus methylphenidate had significant reductions in ADHD symptoms at all time points compared to children who received behavior therapy plus placebo.
Severity of ADHD was taken into account by presence of symptoms of marked impairment in social functioning. The researchers eliminated the possible role of delays in social development not specific to ADHD by analyzing children whose symptoms of social functioning impairment clearly resulted from inattention, hyperactivity, and impulsivity. Specifically, inattention was identified as the child wandering off task that was not due to lack of understanding or disobedience; hyperactivity was identified as excessive talking or fidgeting when not appropriate; and impulsivity was identified as hasty actions without forethought by the child and with significant potential to harm the child. Symptoms affecting the relationship and mental health of the child’s parents were also treated as reflective of severity of ADHD. For example, parents who experienced majorly reduced psychological well-being as a result of their child’s behavior reflected severe ADHD, and from the results, parents of children with severe ADHD who received behavior therapy plus methylphenidate reported a significant reduction in feeling unable to handle stress because of child’s behavior.
One of the researchers also found that use of some alternative therapies may be supported when combined with behavior therapy. In particular, there were decreases in hyperactive behaviors in children who were placed on additive-free diets. This finding may be of particular significance because eliminating artificial food additives may be done without risk of safety and avoids the potential adverse effects of medication.
Which conclusion is best supported by the findings in the study?
Methylphenidate shows an early response when added to behavior therapy is the correct answer. Attention-deficit/hyperactivity disorder is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity. The history must reveal that symptoms of inattention or hyperactivity and impulsivity are present in more than one setting, as symptoms may be absent when the patient is interacting in the clinician's office. Evidence-based behavior therapy should be prescribed as the first line of therapy for preschool-aged children, and stimulant medications may be prescribed for the preschooler with severe ADHD or inadequate response to behavior therapy.
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A study done recently showed that several management approaches, in addition to behavioral therapy interventions, may be necessary in preschool-aged children with moderate to severe attention-deficit/hyperactivity disorder (ADHD). That is, medication and some alternative therapies may be needed for preschool-aged children with ADHD who do not respond or do not follow behavior therapy. The researchers evaluated disruptive behavior in 74 children four to five years of age who were followed for 24 months. The children were randomized to either behavior therapy plus placebo or behavior therapy plus methylphenidate, and ADHD-related behaviors were compared. Parents reported ADHD symptoms observed at 6, 12, and 24 months. The researchers also noted several signs and symptoms of adverse effects that may have been due to the medication, such as insomnia, anorexia, irritability, and reduced growth and weight gain. The researchers found the children who received behavior therapy plus methylphenidate had significant reductions in ADHD symptoms at all time points compared to children who received behavior therapy plus placebo.
Severity of ADHD was taken into account by presence of symptoms of marked impairment in social functioning. The researchers eliminated the possible role of delays in social development not specific to ADHD by analyzing children whose symptoms of social functioning impairment clearly resulted from inattention, hyperactivity, and impulsivity. Specifically, inattention was identified as the child wandering off task that was not due to lack of understanding or disobedience; hyperactivity was identified as excessive talking or fidgeting when not appropriate; and impulsivity was identified as hasty actions without forethought by the child and with significant potential to harm the child. Symptoms affecting the relationship and mental health of the child’s parents were also treated as reflective of severity of ADHD. For example, parents who experienced majorly reduced psychological well-being as a result of their child’s behavior reflected severe ADHD, and from the results, parents of children with severe ADHD who received behavior therapy plus methylphenidate reported a significant reduction in feeling unable to handle stress because of child’s behavior.
One of the researchers also found that use of some alternative therapies may be supported when combined with behavior therapy. In particular, there were decreases in hyperactive behaviors in children who were placed on additive-free diets. This finding may be of particular significance because eliminating artificial food additives may be done without risk of safety and avoids the potential adverse effects of medication.
Which of the following is not a reasonable recommendation to provide for the management of moderate to severe ADHD?
ADHD symptoms may be associated with artificial food additives in diet, so behavior therapy may be avoided by adhering to additive-free diet is the correct answer. Behavior therapy should be prescribed for all preschool-aged children as treatment for ADHD. Stimulant medications may be prescribed for moderate to severe ADHD and when behavior therapy fails to provide improvement in ADHD symptoms.
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Lithium is a medication that is effective in the treatment of __________.
The manic and depressive phases of bipolar disorder can be treated with the mood stabilizer lithium. Lithium is used for the prevention of future depression and suicide and for the prevention of future mania. Schizophrenia is treated with antipsychotic medications. Medications to reduce nightmares, insomnia, and startle reactions are used in the treatment of post-traumatic stress disorder. Benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) are used to treat panic disorders. SSRIs are also used to treat obsessive-compulsive disorder.
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A patient goes to her primary care doctor complaining of mood swings affecting her in such a way that she often feels either very "high" or very "low." She denies any thoughts of worthlessness or of hurting herself, doesn't have trouble concentrating on tasks, and has no psychotic episodes when she is "low." When feeling "high," she has increased energy and happiness. Her symptoms are indicative of which of the following mood disorders?
Cyclothymic disorder is a mild form of bipolar disorder where a person mood swings over a period of years that go from mild depression to elevated mood and excitement.
Individuals with any form of bipolar disorder will most likely experience some psychotic episodes. During manic episodes, they will have delusions of grandeur, racing ideas and speech, distractibility and high-risk behaviors. They generally sleep and eat less often during these episodes as well. A patient with cyclothymic disorder lacks the vegetative symptoms associated with major depressive disorders. They can concentrate normally and lack both suicidal ideations and feelings of worthlessness when "low."
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The American Psychiatric Association uses the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) to __________.
The American Psychiatric Association developed the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) to uniformly classify and describe mental disorders. The DSM-IV provides a detailed description of the symptoms seen in psychiatric disorders. "Insanity" is a legal term for severe mental illness present at the time a crime was committed. It is not a mental diagnosis. The International Classification of Disease is used to assign codes to medical diagnoses that are used for reimbursement purposes. The Physician Desk Reference (PDR) provides detailed information on medication administration. The DSM-IV does not provide information about treatment.
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Normal neurodevelopment in children is typically characterized by the acquisition of personal, social, academic, and occupational functioning. These functions are often learned and developed before the child begins primary education. During this period, the child learns social skills and how to control executive functions. Neurodevelopmental disorders involve developmental deficits that are manifested as impairments in normal neurodevelopment. Impairments in intelligence and social skills are often associated with neurodevelopmental disorders, and they frequently occur together.
A child and adolescent psychiatrist wanted to further characterize children with neurodevelopmental disorders according to several protocols. The psychiatrist observed all children with any identified impairments of social skills and any associated intellectual disability The psychiatrist noted the following: communication disorder, impairment in attention, impairment in organization, motor disorder, repetitive behaviors, restricted behaviors, or other interests.
The child and adolescent psychiatrist concluded that children with repetitive and restricted interests or patterns of behavior often demonstrate impairments in social skills. Some of the children who had restricted interests, repetitive patterns of behavior, and impairments in social skills also had intellectual impairments, language impairments, associated medical conditions, or other associated mental or behavioral disorders. It was found that specifying the individual characteristics of the neurodevelopmental disorders provided the child and adolescent psychiatrist the ability to better describe the diagnosis and associated symptoms to patients and their families.
In concluding that children with repetitive, restricted interests and patterns of behavior often demonstrate impairments in social skills, the child and adolescent psychiatrist assumed that impairments in social skills are considered to be which of the following?
Symptoms that may not be accompanied by excessively repetitive behaviors is the best choice because it directly addresses that impairments in social skills may be seen in the presence or absence of restricted, repetitive behaviors. Autism spectrum disorder is characterized by social communication impairments and restricted, repetitive patterns of behavior, often in the first 2 years of life. None of the other choices discuss the association that impairments in social skills may have with restricted interests and repetitive behaviors.
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Normal neurodevelopment in children is typically characterized by the acquisition of personal, social, academic, and occupational functioning. These functions are often learned and developed before the child begins primary education. During this period, the child learns social skills and how to control executive functions. Neurodevelopmental disorders involve developmental deficits that are manifested as impairments in normal neurodevelopment. Impairments in intelligence and social skills are often associated with neurodevelopmental disorders, and they frequently occur together.
A child and adolescent psychiatrist wanted to further characterize children with neurodevelopmental disorders according to several protocols. The psychiatrist observed all children with any identified impairments of social skills and any associated intellectual disability The psychiatrist noted the following: communication disorder, impairment in attention, impairment in organization, motor disorder, repetitive behaviors, restricted behaviors, or other interests.
The child and adolescent psychiatrist concluded that children with repetitive and restricted interests or patterns of behavior often demonstrate impairments in social skills. Some of the children who had restricted interests, repetitive patterns of behavior, and impairments in social skills also had intellectual impairments, language impairments, associated medical conditions, or other associated mental or behavioral disorders. It was found that specifying the individual characteristics of the neurodevelopmental disorders provided the child and adolescent psychiatrist the ability to better describe the diagnosis and associated symptoms to patients and their families.
Impairments in intelligence and social skills seen in the neurodevelopmental disorders indicate which of the following?
Symptoms of developmental deficits may vary from specific learning disorders to gross limitations in learning intellectual and social skills. The "range of developmental deficits varies" describes the variability that may be seen in the neurodevelopmental disorders. The other choices can be eliminated because they describe specific disorders or prognosis and do not describe the range of limitations that may be seen.
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Normal neurodevelopment in children is typically characterized by the acquisition of personal, social, academic, and occupational functioning. These functions are often learned and developed before the child begins primary education. During this period, the child learns social skills and how to control executive functions. Neurodevelopmental disorders involve developmental deficits that are manifested as impairments in normal neurodevelopment. Impairments in intelligence and social skills are often associated with neurodevelopmental disorders, and they frequently occur together.
A child and adolescent psychiatrist wanted to further characterize children with neurodevelopmental disorders according to several protocols. The psychiatrist observed all children with any identified impairments of social skills and any associated intellectual disability The psychiatrist noted the following: communication disorder, impairment in attention, impairment in organization, motor disorder, repetitive behaviors, restricted behaviors, or other interests.
The child and adolescent psychiatrist concluded that children with repetitive and restricted interests or patterns of behavior often demonstrate impairments in social skills. Some of the children who had restricted interests, repetitive patterns of behavior, and impairments in social skills also had intellectual impairments, language impairments, associated medical conditions, or other associated mental or behavioral disorders. It was found that specifying the individual characteristics of the neurodevelopmental disorders provided the child and adolescent psychiatrist the ability to better describe the diagnosis and associated symptoms to patients and their families.
In addition to deficits in social skills, excessive restricted, repetitive behaviors are also seen in autism spectrum disorder. Which of the following best describes a pattern of behavior that would most likely not be seen?
The use of "you" when referring to self includes repetitive speech that may be seen in autism spectrum disorder. This repetitive speech (i.e. echolalia) may be delayed or immediate following words heard. Therefore, patients with autism spectrum disorder with symptoms of repetitive speech may use "you" when referring to self, and "use of 'you' only when not referring to self" would be the pattern of behavior least likely seen in autism spectrum disorder of the available choices and is the correct choice. In addition to repetitive speech that may be seen in autism spectrum disorder, other restricted, repetitive behaviors include patterns of nonverbal behavior ("pacing a perimeter" is wrong), abnormal intense focus ("spending hours writing out division tables" is wrong), repetitive use of object ("lining up toys" is wrong), as well as simple motor stereotypes ("finger flicking" is wrong).
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Normal neurodevelopment in children is typically characterized by the acquisition of personal, social, academic, and occupational functioning. These functions are often learned and developed before the child begins primary education. During this period, the child learns social skills and how to control executive functions. Neurodevelopmental disorders involve developmental deficits that are manifested as impairments in normal neurodevelopment. Impairments in intelligence and social skills are often associated with neurodevelopmental disorders, and they frequently occur together.
A child and adolescent psychiatrist wanted to further characterize children with neurodevelopmental disorders according to several protocols. The psychiatrist observed all children with any identified impairments of social skills and any associated intellectual disability The psychiatrist noted the following: communication disorder, impairment in attention, impairment in organization, motor disorder, repetitive behaviors, restricted behaviors, or other interests.
The child and adolescent psychiatrist concluded that children with repetitive and restricted interests or patterns of behavior often demonstrate impairments in social skills. Some of the children who had restricted interests, repetitive patterns of behavior, and impairments in social skills also had intellectual impairments, language impairments, associated medical conditions, or other associated mental or behavioral disorders. It was found that specifying the individual characteristics of the neurodevelopmental disorders provided the child and adolescent psychiatrist the ability to better describe the diagnosis and associated symptoms to patients and their families.
If impairments in social skills are caused by specific deficits in social communication, what is the most likely diagnosis in 5-year-old child who has difficulty taking turns in conversation and does not change speech when in the classroom as when on the playground?
Social (pragmatic) communication disorder is the correct answer. This patient possesses specific deficits in social communication. The history is notable for difficulties following rules for conversation and impairment of ability to change speech to match context. The prognosis for pragmatics is highly variable with some children having substantial improvement over time and others having persistent difficulties that may continue into adulthood.
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Normal neurodevelopment in children is typically characterized by the acquisition of personal, social, academic, and occupational functioning. These functions are often learned and developed before the child begins primary education. During this period, the child learns social skills and how to control executive functions. Neurodevelopmental disorders involve developmental deficits that are manifested as impairments in normal neurodevelopment. Impairments in intelligence and social skills are often associated with neurodevelopmental disorders, and they frequently occur together.
A child and adolescent psychiatrist wanted to further characterize children with neurodevelopmental disorders according to several protocols. The psychiatrist observed all children with any identified impairments of social skills and any associated intellectual disability The psychiatrist noted the following: communication disorder, impairment in attention, impairment in organization, motor disorder, repetitive behaviors, restricted behaviors, or other interests.
The child and adolescent psychiatrist concluded that children with repetitive and restricted interests or patterns of behavior often demonstrate impairments in social skills. Some of the children who had restricted interests, repetitive patterns of behavior, and impairments in social skills also had intellectual impairments, language impairments, associated medical conditions, or other associated mental or behavioral disorders. It was found that specifying the individual characteristics of the neurodevelopmental disorders provided the child and adolescent psychiatrist the ability to better describe the diagnosis and associated symptoms to patients and their families.
If a 5-year-old boy who, in comparison to the boy's matched agemates, has severe difficulties in learning skills involving reading, writing, and arithmetic and is without ongoing support, then the child will most likely exhibit which of the following?
The level of severity of intellectual disability is based on adaptive functioning (e.g. personal independence), and adaptive functioning determines the amount of support needed. In the absence of ongoing support, the adaptive deficits in children with severe intellectual disability will limit independence for all activities of daily living ("require supervision at all times"). "Need no support" is wrong since all patients with intellectual disability, dependent on adaptive functioning, require some level of support. "Be able to care for personal needs" can be eliminated since patients with severe intellectual disability require support for all activities of daily living.
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Normal neurodevelopment in children is typically characterized by the acquisition of personal, social, academic, and occupational functioning. These functions are often learned and developed before the child begins primary education. During this period, the child learns social skills and how to control executive functions. Neurodevelopmental disorders involve developmental deficits that are manifested as impairments in normal neurodevelopment. Impairments in intelligence and social skills are often associated with neurodevelopmental disorders, and they frequently occur together.
A child and adolescent psychiatrist wanted to further characterize children with neurodevelopmental disorders according to several protocols. The psychiatrist observed all children with any identified impairments of social skills and any associated intellectual disability The psychiatrist noted the following: communication disorder, impairment in attention, impairment in organization, motor disorder, repetitive behaviors, restricted behaviors, or other interests.
The child and adolescent psychiatrist concluded that children with repetitive and restricted interests or patterns of behavior often demonstrate impairments in social skills. Some of the children who had restricted interests, repetitive patterns of behavior, and impairments in social skills also had intellectual impairments, language impairments, associated medical conditions, or other associated mental or behavioral disorders. It was found that specifying the individual characteristics of the neurodevelopmental disorders provided the child and adolescent psychiatrist the ability to better describe the diagnosis and associated symptoms to patients and their families.
In order to make the diagnosis of intellectual disability, the intellectual and adaptive functioning deficits must be distinct from those characterized by autism spectrum disorder, communication disorders, specific learning disorder, and the neurocognitive disorders. To make the diagnosis of intellectual disability from the differential diagnoses, then which of the following would be the most logical action to take?
The diagnosis of intellectual disability is made when the onset of intellectual and adaptive function deficits is in the developmental period. The neurocognitive disorders are characterized by a loss of cognitive functioning and may occur with intellectual disability. Specific learning disorder is specific to the learning domains and does not show deficits in intellectual function and adaptive behaviors.
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Normal neurodevelopment in children is typically characterized by the acquisition of personal, social, academic, and occupational functioning. These functions are often learned and developed before the child begins primary education. During this period, the child learns social skills and how to control executive functions. Neurodevelopmental disorders involve developmental deficits that are manifested as impairments in normal neurodevelopment. Impairments in intelligence and social skills are often associated with neurodevelopmental disorders, and they frequently occur together.
A child and adolescent psychiatrist wanted to further characterize children with neurodevelopmental disorders according to several protocols. The psychiatrist observed all children with any identified impairments of social skills and any associated intellectual disability The psychiatrist noted the following: communication disorder, impairment in attention, impairment in organization, motor disorder, repetitive behaviors, restricted behaviors, or other interests.
The child and adolescent psychiatrist concluded that children with repetitive and restricted interests or patterns of behavior often demonstrate impairments in social skills. Some of the children who had restricted interests, repetitive patterns of behavior, and impairments in social skills also had intellectual impairments, language impairments, associated medical conditions, or other associated mental or behavioral disorders. It was found that specifying the individual characteristics of the neurodevelopmental disorders provided the child and adolescent psychiatrist the ability to better describe the diagnosis and associated symptoms to patients and their families.
A child and adolescent psychiatrist examined a 7-year-old boy and gave diagnoses of both intellectual disability and neurocognitive disorder. Which of the following clinical and study findings would be inconsistent with giving both diagnoses?
The neurocognitive disorders are characterized by a loss of intellectual function. Intellectual disability is typically not progressive, but a diagnosis of neurocognitive disorder may be made with intellectual disability when further cognitive disability develops or is lost, e.g. such as may follow infections ("increased level of adaptive function deficits following meningitis" is consistent and can be eliminated) and traumatic brain injury (both "loss of previously acquired cognitive skills following head injury" and "acute intracranial hemorrhage overlying gray matter heterotopia on computed tomography scan" are consistent and can be eliminated). Thus, "stable intellectual disability with Down syndrome" is inconsistent with giving diagnoses of both intellectual disability and neurocognitive disorder and is the correct answer choice. All other choices are consistent with the diagnoses of intellectual disability and neurocognitive disorder. Delayed milestones may be seen as early as within the first 2 years of life in children with severe intellectual disability ("delayed language milestones in the first 24 months of life" is consistent and can be eliminated).
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Magnetic Resonance Imaging (MRI) has been used to compare the brains of people who have depression with those who do not have depression. Which is the correct list of areas of the brain that show up differently on MRIs depending on whether a person has, or does not have, depression?
The correct answer is mood, thinking, sleep, appetite, and behavior. Other functions, such as speech, memory, and movement do not appear different depending on whether the patient is depressed.
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Major depression is classified as which type of disorder?
Affective disorders are a group of disorders marked by a disturbance of mood. Included in the category is major depression. People with major depression see nothing but sorrow in the future and may not wish to live anymore. Anxiety disorders are characterized by unreasonable anxiety or fear that is inappropriate to the circumstances and disrupts the person's life. Psychosomatic disorder is a real physical disorder that has a psychological cause, such as tension headaches. Dissociative disorder is a type of personality disorder that involves a disassociation of past experiences from present memory. The origin of dissociative disorders is a need to escape extreme trauma, usually some form of abuse. Impulse control disorders are an inability to resist an impulse to perform an action that is harmful to others. Includes in this category are kleptomania and pyromania.
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