NCE Diagnosis and Psychopathology 1 — Questions and Answers
Question 1: According to the DSM-5, which of the following is a key distinguishing feature between Major Depressive Disorder (MDD) and Persistent Depressive Disorder (Dysthymia)?
- MDD requires psychotic features; Dysthymia does not
- MDD episodes last at least 2 weeks; Dysthymia involves persistent low mood for at least 2 years (Correct answer)
- Dysthymia can only be diagnosed in children; MDD applies to adults
- MDD requires a prior manic episode to distinguish it from Dysthymia
Correct answer: MDD episodes last at least 2 weeks; Dysthymia involves persistent low mood for at least 2 years
MDD is characterized by discrete episodes lasting at least 2 weeks with 5+ symptoms, while Persistent Depressive Disorder (Dysthymia) involves chronic, lower-level depressed mood for at least 2 years (1 year in children).
DSM-5 criteria for MDD: 5+ symptoms (including depressed mood or anhedonia) during a 2-week period. For Persistent Depressive Disorder (PDD/Dysthymia): depressed mood most of the day, more days than not, for at least 2 years, with 2+ additional symptoms (poor appetite/overeating, insomnia/hypersomnia, fatigue, low self-esteem, poor concentration, hopelessness). 'Double depression' refers to a major depressive episode superimposed on PDD. The DSM-5 merged dysthymic disorder and chronic major depressive disorder into PDD.
Question 2: A client reports hearing voices telling them they are chosen by God, believing they have special powers, going 4 days without sleep, and feeling on top of the world. Which DSM-5 diagnosis is MOST likely?
- Schizophrenia
- Major Depressive Disorder with Psychotic Features
- Bipolar I Disorder, Manic Episode (Correct answer)
- Cyclothymic Disorder
Correct answer: Bipolar I Disorder, Manic Episode
The combination of elevated/expansive mood, grandiosity, decreased need for sleep, and psychotic features (auditory hallucinations) describes a manic episode, which is the defining feature of Bipolar I Disorder.
DSM-5 Bipolar I Disorder requires at least one manic episode (7+ days or hospitalized; 3+ DIGFAST symptoms: Distractibility, Impulsivity/reckless behavior, Grandiosity, Flight of ideas, Activity increase, Sleep decrease, Talkativeness). Psychotic features during mania indicate severity. Bipolar II requires hypomanic episodes (4+ days, no psychosis) and at least one MDD episode. Correct bipolar diagnosis is critical as antidepressants alone can induce mania.
Question 3: Which of the following BEST differentiates Generalized Anxiety Disorder (GAD) from normal worry?
- GAD worries are always about physical health concerns only
- GAD involves excessive, uncontrollable worry that causes significant impairment across multiple domains (Correct answer)
- Normal worry occurs only in response to real threats; GAD worry has no identifiable trigger
- GAD requires panic attacks to distinguish it from normal anxiety
Correct answer: GAD involves excessive, uncontrollable worry that causes significant impairment across multiple domains
GAD is distinguished from normal worry by its excessive nature, the difficulty controlling it, its pervasiveness across multiple life domains, and the significant distress or impairment it causes.
DSM-5 GAD criteria: Excessive anxiety and worry about multiple topics, more days than not, for 6+ months; difficulty controlling worry; 3+ of 6 somatic symptoms (restlessness, fatigue, concentration, irritability, muscle tension, sleep disturbance); significant distress or impairment. Key differentiator from normal worry: pervasiveness (multiple domains), duration (6 months), uncontrollability, and functional impact. GAD must be differentiated from anxiety due to medical conditions, substance use, social anxiety disorder, OCD, and PTSD.
Question 4: A counselor uses the CAGE screening tool with a client. What substance use concern does CAGE primarily screen for?
- Opioid use disorder
- Alcohol use disorder (Correct answer)
- Cannabis use disorder
- Benzodiazepine dependence
Correct answer: Alcohol use disorder
The CAGE questionnaire is a 4-item brief screening tool specifically developed to identify potential alcohol use disorder. Two or more 'yes' responses suggest problematic alcohol use requiring further assessment.
CAGE acronym: C -- Have you ever felt you should Cut down on your drinking? A -- Have people Annoyed you by criticizing your drinking? G -- Have you ever felt Guilty about your drinking? E -- Have you ever had a drink first thing in the morning (Eye-opener)? Scoring: 0-1 = low risk; 2+ = likely alcohol use disorder requiring further evaluation. Limitations: CAGE does not assess frequency/quantity, is less sensitive for women and non-White populations, and does not distinguish current from lifetime problems.
Question 5: The essential feature of Somatic Symptom Disorder (SSD) in the DSM-5 is:
- Physical symptoms must be medically unexplained
- One or more distressing somatic symptoms accompanied by excessive thoughts, feelings, or behaviors related to those symptoms (Correct answer)
- The client must be feigning physical illness for external gain
- The disorder can only be diagnosed after all medical causes are ruled out
Correct answer: One or more distressing somatic symptoms accompanied by excessive thoughts, feelings, or behaviors related to those symptoms
DSM-5 SSD is defined by distressing somatic symptoms plus disproportionate thoughts, feelings (health anxiety), or behaviors related to those symptoms -- regardless of whether the symptoms have a medical explanation.
This represents a major DSM-5 change from the DSM-IV approach, which required symptoms to be 'medically unexplained.' SSD can be diagnosed even when a genuine medical condition is present. Required: 1+ somatic symptoms causing distress/disruption; excessive thoughts, feelings, or behaviors; symptoms persistent 6+ months. This shift reflects research showing that 'medically unexplained' was stigmatizing and not clinically useful.
Question 6: According to the DSM-5, Posttraumatic Stress Disorder (PTSD) is classified under which category?
- Anxiety Disorders
- Depressive Disorders
- Trauma- and Stressor-Related Disorders (Correct answer)
- Dissociative Disorders
Correct answer: Trauma- and Stressor-Related Disorders
The DSM-5 moved PTSD (along with Acute Stress Disorder and Adjustment Disorders) into a new category called 'Trauma- and Stressor-Related Disorders,' recognizing that trauma and stress are central causal factors.
DSM-5 PTSD criteria (for adults): Exposure to actual/threatened death, serious injury, or sexual violence; Intrusion symptoms (flashbacks, nightmares, intrusive memories); Avoidance (trauma-related stimuli); Negative alterations in cognitions and mood; Hyperarousal alterations (hypervigilance, exaggerated startle, sleep disturbance, irritability); Symptoms persist 1+ month; significant distress/impairment. DSM-5 added a dissociative subtype and a separate PTSD criteria set for children 6 and under.
NCE Diagnosis and Psychopathology 1
According to the DSM-5, which of the following is a key distinguishing feature between Major Depressive Disorder (MDD) and Persistent Depressive Disorder (Dysthymia)?