NCMHCE Intake, Assessment, and Diagnosis 3 — Questions and Answers
Question 1: A counselor uses the PHQ-9 during intake. A client scores 18. This score indicates:
- Minimal depression
- Moderate depression
- Moderately severe depression (Correct answer)
- Severe depression
Correct answer: Moderately severe depression
PHQ-9 scores of 15–19 indicate moderately severe depression, warranting active treatment planning.
Question 2: During intake, a client discloses ongoing domestic violence at home. The counselor's FIRST clinical obligation is to:
- Contact law enforcement immediately
- Assess the client's immediate safety (Correct answer)
- File a mandatory abuse report
- Refer the client to a shelter
Correct answer: Assess the client's immediate safety
Before any action, the counselor must assess the client's immediate safety level to guide appropriate next steps.
Question 3: Which of the following is NOT a specifier used with Major Depressive Disorder in the DSM-5?
- With melancholic features
- With psychotic features
- With rapid cycling (Correct answer)
- With anxious distress
Correct answer: With rapid cycling
Rapid cycling is a specifier for Bipolar Disorder, not Major Depressive Disorder.
Question 4: A client presents with a 2-year history of depressed mood more days than not, accompanied by poor concentration and low self-esteem. No Major Depressive Episodes are identified. The MOST likely diagnosis is:
- Major Depressive Disorder, recurrent
- Cyclothymic Disorder
- Persistent Depressive Disorder (Dysthymia) (Correct answer)
- Adjustment Disorder with Depressed Mood
Correct answer: Persistent Depressive Disorder (Dysthymia)
Persistent Depressive Disorder requires a depressed mood for at least 2 years in adults without meeting full MDD criteria.
Question 5: Which screening tool is MOST appropriate for initial assessment of alcohol use disorder severity?
- CAGE questionnaire (Correct answer)
- Beck Depression Inventory
- Columbia Suicide Severity Rating Scale
- GAD-7
Correct answer: CAGE questionnaire
The CAGE questionnaire is a validated, brief 4-item tool specifically designed to screen for problematic alcohol use.
Question 6: A client reports that for the past 5 months they have felt 'on top of the world,' needed only 3 hours of sleep, spent $40,000 impulsively, and started three businesses. This pattern MOST suggests:
- Hypomanic episode
- Manic episode (Correct answer)
- Major Depressive Episode with mixed features
- Cyclothymic Disorder
Correct answer: Manic episode
A manic episode lasts at least 7 days with marked impairment; this client's duration and functional impact meet manic, not hypomanic, criteria.
Question 7: In a clinical intake with a refugee client, the counselor observes culturally specific expressions of distress unfamiliar in Western diagnostic frameworks. The counselor should FIRST:
- Apply DSM-5 criteria strictly without modification
- Consult the DSM-5 Cultural Formulation Interview (CFI) (Correct answer)
- Refer the client to a cultural specialist
- Document the presentation as 'unspecified'
Correct answer: Consult the DSM-5 Cultural Formulation Interview (CFI)
The DSM-5's Cultural Formulation Interview helps clinicians explore cultural context, identity, and explanatory models before diagnosis.
NCMHCE Intake, Assessment, and Diagnosis 3
A counselor uses the PHQ-9 during intake.
A client scores 18.
This score indicates: