NCMHCE - National Clinical Mental Health Counseling Examination Intake, Assessment, and Diagnosis 5 — Questions and Answers
Question 1: A client reports compulsively checking door locks up to 40 times before leaving the house, causing significant distress and making them late to work daily. Which diagnosis BEST fits?
- Generalized Anxiety Disorder
- Illness Anxiety Disorder
- Obsessive-Compulsive Disorder (Correct answer)
- Obsessive-Compulsive Personality Disorder
Correct answer: Obsessive-Compulsive Disorder
OCD is characterized by obsessions and/or compulsions (such as repetitive checking) that are time-consuming and cause clinically significant distress or functional impairment.
Question 2: During intake, a client discloses they use cannabis daily and reports that attempts to cut down cause irritability and sleep disturbances. The counselor should assess for:
- Cannabis Intoxication
- Cannabis-Induced Psychotic Disorder
- Cannabis Use Disorder with Withdrawal (Correct answer)
- Substance/Medication-Induced Mood Disorder
Correct answer: Cannabis Use Disorder with Withdrawal
DSM-5 includes Cannabis Withdrawal as a specifier within Cannabis Use Disorder, evidenced by irritability, sleep difficulty, and other symptoms upon reducing use.
Question 3: A counselor uses the Columbia Suicide Severity Rating Scale (C-SSRS) during an intake session. This tool PRIMARILY assesses:
- Depression severity and functional impairment
- Suicidal ideation intensity, behavior, and lethality (Correct answer)
- History of trauma and dissociative symptoms
- Risk factors for substance use relapse
Correct answer: Suicidal ideation intensity, behavior, and lethality
The C-SSRS is a structured assessment instrument designed to measure the severity of suicidal ideation and track suicidal behavior across a spectrum from passive ideation to attempts.
Question 4: A client endorses depressed mood, fatigue, and hypersomnia during winter months for the past 4 years, with full remission each spring. The MOST accurate diagnosis is:
- Cyclothymic Disorder
- Major Depressive Disorder, recurrent
- Major Depressive Disorder with Seasonal Pattern (Correct answer)
- Persistent Depressive Disorder
Correct answer: Major Depressive Disorder with Seasonal Pattern
DSM-5 specifies 'with seasonal pattern' for MDD when depressive episodes consistently occur at a particular time of year (typically fall/winter) with full remission at other times.
Question 5: During a structured diagnostic interview, a client describes feeling detached from their own thoughts and body, as if observing themselves from outside. This experience is BEST described as:
- Derealization
- Depersonalization (Correct answer)
- Dissociative amnesia
- Thought broadcasting
Correct answer: Depersonalization
Depersonalization refers to experiences of unreality, detachment, or feeling like an outside observer of one's own thoughts, feelings, body, or actions.
Question 6: A counselor is assessing a client who recently immigrated and presents with symptoms that closely align with a recognized culture-bound syndrome. The MOST appropriate clinical response is to:
- Apply DSM-5 criteria strictly without modification
- Dismiss the cultural explanation in favor of empirically supported diagnoses
- Use the DSM-5 Cultural Formulation Interview to explore the cultural context of symptoms (Correct answer)
- Immediately refer to a cultural psychiatry specialist
Correct answer: Use the DSM-5 Cultural Formulation Interview to explore the cultural context of symptoms
The DSM-5 Cultural Formulation Interview (CFI) is a standardized tool designed to assess the cultural context of a client's symptoms, identity, and explanatory models in a culturally sensitive manner.
Question 7: Which of the following clinical presentations MOST warrants a differential diagnosis between Attention-Deficit/Hyperactivity Disorder (ADHD) and Bipolar Disorder in an adolescent?
- Chronic inattention and hyperactivity without mood episodes
- Episodic elevated mood, decreased need for sleep, and grandiosity occurring in distinct periods (Correct answer)
- Academic underperformance and frequent rule violations at school
- Separation anxiety and somatic complaints in the morning
Correct answer: Episodic elevated mood, decreased need for sleep, and grandiosity occurring in distinct periods
Episodic elevated mood with decreased sleep need and grandiosity suggests possible Bipolar Disorder; these symptoms differ from ADHD's chronic, non-episodic inattention and hyperactivity.
NCMHCE - National Clinical Mental Health Counseling Examination Intake, Assessment, and Diagnosis 5
A client reports compulsively checking door locks up to 40 times before leaving the house, causing significant distress and making them late to work daily.
Which diagnosis BEST fits?