1.
When providing psycho-education to a client
diagnosed with Tourette’s disorder, you would be correct if you told the
client all of the following, EXCEPT:
A
the motor tics may affect any part of the body
B
the symptoms can never be voluntarily suppressed
C
periods of
stress may affect the symptoms
D there may be
remission periods lasting weeks to years
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2. The Social Worker and Ms. H. developed the a
treatment goal focusing on the reduction of fear that makes leaving home
possible, feelings of fear that Ms. H experiences in certain situations, and
eliminating the interference in normal routine that these fears create.
Therapeutic interventions include encourgaging the sharing of feelings from the
past through active listening, sharing of feeling associated with past
emotionally painful experiences from the past and differentiating real from
distorted, imagined situations? Which of the following DSMIV TR diagnosis would
be [MOST] appropriate for Ms. H.?
A
Axis I 300.01 Panic Disorder without
Agoraphobia
B Axis I 200.02 Panic Disorder with Agoraphobic
B Axis I 200.02 Panic Disorder with Agoraphobic
C
Axis I 297.01 Delusional Disorder
D Axis I 295.40 Schizophreniform Disorder
3. A mother says that her 8-year-old daughter has
been acting out lately, and she doesn’t know how to handle her behavior. A week
ago, the girl stole money from her dad’s wallet; and twice last month, she was
caught with items that she had taken from kids at her school. The social worker
should FIRST:
A. reframe the behavior as
an effort to get attention
B. reassure the mother
that stealing is normal at around age 8
C. get permission from the
mother to speak with the girl’s teachers
D. provide information on
positive parenting approaches
4. Which of these
diagnoses cannot be assigned to someone under the age of 18 years?
a. antisocial personality disorder
b. antisocial personality disorder
c dissociative identity disorder
d male erectile disorder
5. An adult client comes
to a social worker for an initial consultation on the recommendation of his
medical doctor. The client complains of headaches, dizziness, and pain in his
lower back. So far, his medical doctor has failed to find a physiological cause
for his problems. The social worker would diagnose malingering if:
A. it turned out that the
client was intentionally simulating his symptoms
B
the medical doctor confirmed through further medical testing that the
client’s symptoms have no physiological basis
C the client was faking his symptoms to
achieve an external goal
D the client demonstrated a
psychological need to be taken care of by medical professionals
6. A social worker is in
the initial session with Mary. Mary expresses concern about her 23-year-old
daughter, Melanie. Melanie does not work regularly or attend college. She lives
in Mary’s house, under an arrangement in which she is supposed to pay a small
monthly fee for room and board. Rather than paying this money, Melanie makes
excuses for being broke and asks her mother for loans. Mary admits that she
often gives her daughter money. Melanie spends most of her time out with
friends and rarely comes home before 2 in the morning. Mary says she is worried
that Melanie uses drugs. In this session with Mary, the BEST way for the social
worker to proceed is to:
A. actively redirect
Mary’s focus from her daughter to herself in an effort to better understand the
real problem needing attention
B. continue observing Mary to clarify
how she perceives and copes with her problem
C. provide psychoeducation about
substance abuse and co-dependency
D get more information about Melanie’s
drug use by asking Mary what makes her think Melanie uses drugs
7. Mental status exam
allows a social worker to observe and explore all of the following areas of
functioning, EXCEPT:
a. general knowledge
b. social relationships
c. appearance
d. activity
8. A person with schizoid
personality disorder is MOST likely to display which of the following?
A. peculiar behaviors and
thoughts
B. social detachment
C. excessive emotionality
D. impressionistic speech
9. A client reports that
she often yells at her husband and coworkers. She says her irritability is
harming her relationships, and she wants to learn how to control her temper.
The social might use a functional analysis in this case in order to determine:
A. the purpose of the
target behavior
B the frequency, magnitude, and duration
of the target behavior
C the stimuli that typically precede the
target behavior
D the unconscious determinants of the
target behavior
10. man who has narcissistic personality disorder
attends a party with his girlfriend. The man is MOST likely to be concerned
about:
A preventing his girlfriend from talking to other men
B leaving the party as soon as possible
C how his girlfriend reflects on him
D flirting with other
women when his girlfriend is not watching
11. A client has been
having difficulty completing his work and daily tasks because he is distracted
by fears and worries. He also reports having difficulty falling asleep at night
because he “can’t turn off” his thoughts. He says his friends and family are
annoyed with him because he’s been irritable and preoccupied with his own
thoughts. The man says he’s had these symptoms for many months and can’t stand
feeling this way anymore. He wants the social worker’s help because he can’t
control this problem on his own. The MOST likely diagnosis for this man is:
A bipolar I disorder
B generalized anxiety disorder
C major depressive disorder
D
adjustment disorder with anxiety
12. A single mother
reports that her 9-year-old son has been afraid of the dark since watching a scary
movie a few weeks ago. She worries that he is too sensitive and won’t be tough
enough to protect himself in their rough neighborhood. What should the social
worker MOST suspect is going on?
A. PTSD
B nightmare disorder
C acute stress disorder
D normal reaction
13
A
5 year old been wetting the bed a few times a week for a month and seems “sort
of depressed,” according to her parents. The parents report that the girl was
fully toilet trained by age 3. The FIRST thing the social worker should do is:
A.
provide psychoeducation on
the causes and treatment of enuresis
B.
remind the parents that she
is required by law to report child abuse
C.
identify family issues
causing and maintaining the symptom
D.
arrange for the girl to
undergo medical evaluations
14. Penny, who has moved
to a residence for senior citizens, comes to see a clinical social worker on
the recommendation of her priest. Penny appears depressed and has stopped
attending mass and church functions since moving to the residence. To rule out
adjustment disorder as a diagnosis for Penny, the social worker might explore
which of the following?
A when she moved into the
residence
B what, if any, physical complaints she
has had
C whether she has also been feeling
nervous or worried
D whether she has support from family or
friends
15. A man says that his
wife, who has bipolar I disorder, has become a “category 5 hurricane.” His
statement exemplifies which of the following?
A flight of ideas
B loose associations
C hyperbole
D a metaphor
16. A man is rigid in his
beliefs and preoccupied with orderliness. The social worker suspects that the
man has obsessive-compulsive personality disorder. If the man does have OCPD,
he is LEAST likely to display which of the following?
A obsessions and
compulsions
B perfectionism
C indecision
D difficulty spending
money
17.
A client who appears depressed denies having any cognitive or affective
symptoms. She reports chronic pain, insomnia, and other somatic symptoms, but
her doctor has been unable to find a physiological or physical basis for these
complaints. Based on this information, the client is MOST likely exhibiting
which of the following?
A
masked depression
B
pain disorder
C
pseudodementia
D
double depression
18. A hospital social worker is evaluating a patient
in the hospital who has cancer. Why would the social worker want to collect
information about this patient’s socioeconomic status?
A to see if problems with
accessing resources or services need to be addressed in the intervention
B to find out what federal or local
entitlement programs the patient is eligible for
C because the patient may not be able to
pay for her medical care
D to discover whether financial problems
are a stressor affecting the patient’s health
19. A teacher tells a
school social worker that a boy in his first-grade class has been sad for three
weeks and refusing to play with the other children. The social worker should
FIRST:
A talk to the boy to find
out why he’s depressed
B advise the teacher to reinforce the
boy when he plays with the other children
C reinvolve the boy in class activities
so that his school phobia stops being reinforced
D set up a meeting with the boy’s
parents
20. For seven months, a
client has been hearing voices “talking in his head” from time to time. Based
on this information, the MOST likely diagnosis is:
A. schizophreniform
disorder
B. brief psychotic
disorder
C. delusional disorder
D. schizophrenia
21.
Someone with narcissistic
personality disorder is MOST likely to:
A.
have very high self-esteem
B. need a lot of
admiration from others
C. be so
sensitive to criticism that he uncomfortable in social situations
D. switch often
from admiring others to despising them
22. A social worker is treating a 10-year-old boy
who has autistic disorder. The boy is hyperactive and aggressive and often has
tantrums. The social worker refers the boy to a psychiatrist for a medication
evaluation. To manage the boy’s symptoms, the psychiatrist is NOT likely to
prescribe:
A Fluoxetine
B Carbamazepine
C Fluvoxamine
D Risperidone
23. Which of the
following is an hallucinogen?
A heroin
B MDMA
C. cocaine
D.Valium
24. A 9-year-old girl is jumpy and easily
startled. For several months, the girl has been having nightmares on most
nights. In play therapy, she repeatedly crashes the toy cars and trucks. In
terms of a diagnosis, the social worker MOST suspects:
A ADHD
B generalized anxiety disorder
C PTSD
D autism
25. Which of the
following tests would be MOST useful for identifying the personality traits and
personal problems of a 15 year old?
A MACI
B MMPI-2
C MCMI-III
D Bender-Gestalt-II
ANSWERS
1. B You had to identify the false statement. Contrary to “b,” the
symptoms of Tourette’s can be voluntarily suppressed, at least temporarily.
Option “a” is true: Tourette’s disorder includes both motor tics and vocal
tics; and the simple and complex motor tics associated with Tourette’s may
affect any part of the body, including the face, head, torso, arms, and legs.
Option “c” is also true: According to DSM-IV-TR, tics associated with tic
disorders (including Tourette’s disorder) can be exacerbated during periods of
stress. In addition, the tics can be lessened while the person is engaged in a
directed, effortful activity, such as reading a good book. Option “d” is also
true: The course of Tourette’s can be life-long, but there may be periods of
remission lasting from weeks to years.
2. B It is clear that this is panic, and we are
told she cannot leave home with ease.
3. C When approaching a question like this one, it
can be useful to check first if there is an answer that suggests an appropriate
way of continuing to assess the problem. If so, then there’s a good chance that
the question is about assessment rather than treatment, and the “assessment”
answer is probably correct. This girl spends several hours a day at school and
has taken things from people at school. Her teacher may be able to shed
meaningful light on the potential causes and nature of the problem. (Additional
tip: When approaching questions that ask what the social worker should do
“first,” it’s often effective to examine each answer and ask yourself, “Is it
appropriate to do this first, or early, in this case?” Keep an open mind when
asking yourself this question because an answer on the exam can be correct even
if it describes something other than what you would do first if you were seeing
the clients in real life. In other words, don’t focus only on what you would do
first if you were working with the clients in real life, because focusing on
only this may cause you to eliminate the correct answer.) Answer “b” is not a
good choice: Although stealing by children is fairly common, it is also
unacceptable behavior and it could be a symptom of a broader problem. In
addition, most authorities maintain that stealing by children should not be
minimized or overlooked.
4.A Antisocial personality disorder
is one of the few diagnoses which, by definition, cannot be assigned to a
person under age 18. A minor who displays the characteristic signs of
antisocial personality disorder would receive a diagnosis of conduct disorder.
An individual under age 18 may receive a diagnosis of borderline personality
disorder if the characteristic features of this disorder have be present for at
least one year. This is true for all of the personality disorders, except
antisocial personality disorder, which cannot be diagnosed until the individual
is age 18. Similarly, someone under age 18 can receive a diagnosis of
dissociative identity disorder. In fact, DSM-IV-TR specifically notes that, in
preadolescents, therapists should be cautious in assigning this diagnosis because
its presentation may be less distinctive than it is in adolescents and adults.
Last, a sexually mature male under age 18 can receive a diagnosis of male
erectile disorder.
5. C Malingering, which is
classified in DSM-IV-TR among the conditions that may be a focus of clinical
attention (V-codes), involves the intentional production of false or grossly
exaggerated symptoms, motivated by external incentives (e.g., avoiding work,
obtaining medications or financial compensation). A malingerer is in control of
his symptoms and can stop them when they are no longer useful. The intentional
simulation of symptoms (“a”) is characteristic of malingering, but it’s also
characteristic of factitious disorder, so the social worker would need more
information than this before confirming that the client is malingering. Answer
“b” might seem correct since it’s true the physical symptoms in malingering
have no physiological basis; however, this is also true of some other mental
disorders, such as the somatoform and factitious disorders. Therefore, the
social worker would still need more information to confirm a diagnosis of
malingering. Answer “d” is a diagnostic feature of factitious disorder, not
malingering: Whereas a malingerer has an external goal for faking or exaggerating
his symptoms, a person with factitious disorder produces or fakes his symptoms
in order to assume the “sick role.”
6. B The social worker is in the initial session with this client,
and the question asks you what the social worker should do first. Before
intervening in any way with this client, the social worker needs to fully
understand the problem, including the client’s view of it, and what changes are
needed. Only “b” suggests a way of discovering this information. Option “a” may
become necessary if Mary continues to focus exclusively on her daughter
throughout the intake and assessment phases. Initially, however, the social
worker should give Mary an opportunity to describe the problem as she sees it.
7.B mental status exam does
not measure or evaluate a client’s social relationships. The components of an
MSE are as follows: Appearance (for example, overt emotional displays, general
state of physical health, manner of relating, level of cooperation); activity
(for example, increased or decreased activity, catatonia); mood and affect (for
example, affective range, affective lability, appropriateness of affect);
speech and language (for example, presence of language disturbances such as
tangential speech or derailments); thought content (for example, the experience
of ruminations, obsessions, or delusional ideas); perceptual disturbances (for
example, the experience of illusions or hallucinations); insight and judgment
(for example, apparent indifference to the problem, a denial of the illness, suicide
potential, potential to harm others); and neuropsychiatric functions. The last
category is a broad one that measures many different aspects of cognitive
functioning, including consciousness (e.g., sensorium, orientation, attention,
general awareness); language functions (e.g., fluency, comprehension, naming);
and other higher cognitive functions, such as memory, abstracting ability, and
general intelligence. General intelligence for instance can be measured on the
basis of the patient’s vocabulary and the complexity of the concepts he or she
uses. Or the therapist may also ask the patient a series of progressively more
difficult questions about current events (e.g., questions about TV programs,
sports events, the names of individuals who currently hold national or state
political offices).
8.B Schizoid personality disorder involves a pervasive pattern of
detachment from social relationships and a restricted range of emotional
expression in interpersonal settings. Option “a” is associated with schizotypal
personality disorder: People with schizotypal personality disorder show
deficits in interpersonal relationships similar to those found in schizoid
personality disorder, but they also show cognitive and perceptual distortions
(peculiarities in behavior, thinking, communication, and appearance) not found
in schizoid personality disorder. Excessive emotionality (“c”) and
impressionistic speech (“d”) are characteristic of histrionic personality
disorder.
9. C Functional analysis is a type of behavioral assessment that
includes an evaluation of the target behavior including the stimuli that
precede the behavior (antecedents) and the consequences that follow and
maintain it. The results of the analysis are used to select an appropriate
intervention and then monitor its effects. Through functional analysis, you are
able to determine how the target behavior can be predicted and controlled –
e.g., the analysis indicates what changes in antecedent stimuli would result in
occurrence or change of the behavior
10. C Option “c” is correct
because the self-esteem of people with narcissistic personality disorder is
generally enhanced (or mirrored) by the idealized value they ascribe to the
people they associate with. The essential feature of NPD is a pervasive pattern
of grandiosity, lack of empathy, and hypersensitivity to the evaluation of
others. Characteristic signs of NPD include a sense of entitlement; exploits
others for personal gain; has a grandiose sense of self-importance; believes
that he is special or unique; requires excessive admiration; lacks empathy;
envies others or believes that others envy him; is preoccupied with fantasies
of boundless success, power, or perfect love; and arrogant or haughty behavior
or attitudes.
11.
B Using only
the information given in the question, the best answer is “b.” Generalized
anxiety disorder is characterized by excessive anxiety and worry about multiple
events or activities. The anxiety and worry are relatively constant for at
least six months, and the person finds them difficult to control. In addition,
the anxiety and worry are associated with at least three symptoms: Restlessness
or feeling keyed up or on edge, being easily fatigued, difficulty
concentrating, irritability, muscle tension, and sleep disturbance. Rule out
“a” and “c” because the question emphasizes “constant worries,” rather than
symptoms more clearly associated with either mania or depression. And to choose
“d,” we would want evidence that the client has experienced a recent
psychosocial stressor.
12.D You should avoid trying to infer things about this case,
such as other symptoms the boy may have or other causes for his fear of the
dark, because “d” can be chosen without these inferences. You have no
indication from the question that the boy has any of the mental disorders
listed in the incorrect answers. Instead, it’s fairly common for children to
remain fearful for a period of time after viewing a movie that has scared them.
The fact that the question mentions the clients’ “rough” neighborhood might have
led you to suspect that the boy has experienced an unreported trauma of some
kind (“a” and “c”). In real life, you’d explore this issue, but on the exam,
you should rely on only information you’re given in a question, if that
information allows you to confidently choose one of the answers: This question
says that the boy’s symptom began after he watched a scary movie; therefore,
you don’t need to infer that he also experienced a trauma that has led to acute
stress disorder or PTSD. In addition, his symptoms have been present for only a
few weeks, and for PTSD the symptoms must last for at least one month. Rule out
option “b” because all you know is that this boy is afraid of the dark – the
question doesn’t say that he’s having nightmares. Nightmare disorder involves
repeated awakenings accompanied by detailed recollection of frightening dreams,
which causes significant distress.
13. D Bed wetting and
depression are sometimes found in children who have been abused, as “b”
suggests, but they are also found in many children who are not abused. With
only mild information pointing to abuse, it’s more appropriate initially to
have the girl examined by a pediatrician. The doctor could determine whether a
medical condition underlies her symptoms and also check for signs that she has
been abused. Indeed, with any child who suddenly begins wetting the bed, it’s
important to rule out physiological causes for the symptom, such as a medical
condition, before deciding how to diagnose and treat the case. Answer “a” is not
a good choice because the social worker wouldn’t discuss treatment alternatives
before this girl has had a complete medical examination and a diagnosis is
made. Option “c” is incorrect because physiological causes for the symptoms
should be ruled out before assuming that family dynamics underlie them. In
addition, even if the girl’s enuresis is functional (not due to a medical
condition or the use of a substance), identifying its underlying cause would
not be a focus of treatment (other than ruling out child abuse). Some experts
believe that functional enuresis is due to intrapsychic conflict stemming from
disturbed family relationships, but, in the majority of cases, the disorder can
be treated effectively using support, education (e.g., having the parents limit
the child’s fluid intake before bedtime), and behavioral modification
techniques (e.g., the bell-and-pad method).
14. A In DSM-IV-TR, the diagnostic criteria for adjustment
disorder include the development of symptoms within three months of the onset
of the stressor, and a duration of symptoms for no longer than six months
beyond the termination of the stressor or its consequences. Therefore, to rule
out adjustment disorder as a diagnosis for Penny, the social worker could
explore when the apparent psychosocial stressor (the move to the residence)
happened. Answers “b” and “c” would not allow the social worker to rule out an
adjustment disorder because adjustment disorder can include physical complaints
(e.g., adjustment disorder, unspecified) and/or symptoms of anxiety (e.g.,
adjustment disorder with anxiety or with mixed anxiety and depressed mood). As
for “d,” this would not allow the social worker to rule out an adjustment
disorder, since regardless of the support Penny has, she could be having a
maladaptive psychological response to the move.
15. D A metaphor, or implied comparison, is an analogy or figure
of speech used to describe someone or something in a nonliteral way. A social
worker may use a metaphor to describe and clarify for clients certain feelings,
behaviors, personality characteristics, etc. Flight of ideas (“a”) is
manifested as racing thoughts that don’t seem to be associated by logic, and is
characteristic of a manic episode. Although the man’s wife has bipolar I
disorder, the question asked for the term that best describes her husband’s
statement about her. Loose associations (“b”) are associated with the
disorganized speech characteristic of schizophrenia; they are marked by
haphazard jumping from one topic to another and tend to produce an incoherent
stream of speech. A hyperbole (“c”) is an exaggeration used as a figure of
speech. Although this man could be exaggerating, it is more relevant from a
clinical standpoint that he has used an implied comparison to describe how he perceives
his wife (i.e., his metaphor can help the social worker understand the wife’s
condition and the husband’s perception of her).
16. A According to DSM-IV-TR, the essential feature of
obsessive-compulsive personality disorder is “a preoccupation with orderliness,
perfectionism, and mental and interpersonal control, at the expense of
flexibility, openness, and efficiency.” Indecision and a “miserly spending
style” are characteristic of this disorder. In contrast to the anxiety
disorder, obsessive-compulsive disorder, however, OCPD does not include true
obsessions or compulsions. A person whose symptoms primarily involve recurrent
obsessions and/or compulsions would probably be diagnosed with
obsessive-compulsive disorder. Obsessions are recurrent, persistent, and
senseless ideas, thoughts, images, or impulses that are experienced as ego
dystonic; and compulsion are repetitious, deliberate behaviors or mental acts
that the person feels compelled to perform, either in response to an obsession
or according to specific rules that must be inflexibly followed. The goal of
compulsive acts is to reduce distress or to prevent a dreaded situation from
occurring, but the acts are either excessive or not connected in a logical way
to the goal.
17.A This client “appears depressed” and reports several somatic
symptoms, but no cognitive or affective symptoms. “Masked” depression is
manifested primarily as somatic complaints, without any obvious cognitive or
affective problems. The somatoform disorder pain disorder (“b”) involves a
preoccupation with complaints of pain that is not attributable to a general
medical condition and is severe enough to require clinical attention. This
client complains of not only pain, but also several other somatic symptoms; in
addition, “a” is a better choice because the question says that the client
“appears depressed.” Pseudodementia (“c”) describes depression in the elderly,
which can be mistaken for dementia because of the presence of memory loss and
other cognitive impairments. Double depression (“d”) means that a person has
both major depressive disorder and dysthymic disorder. Usually, dysthymic
disorder develops first, sometimes at an early age, and one or more major
depressive episodes then occur later in life.
18. A Information about the patient’s socioeconomic status is
primarily useful for planning an intervention that will meet the patient’s and
her family’s needs. In the evaluation, the social worker wants to identify both
strengths and deficits, including a need for help in overcoming obstacles to
obtaining and using adequate medical care, and among these obstacles may be
socioeconomic barriers. A patient with limited financial resources could lack
adequate health insurance, have trouble getting to medical appointments, have
difficulty arranging for services after she is released from the hospital, etc.
If these problems are present, the social worker will want to provide case
management services to refer and link the patient and her family to needed
services and resources. Answer “b” is not bad, but it is encompassed by “a,”
which is a more complete response – if this patient is eligible for entitlement
programs, a part of the social worker’s intervention will be to help her and
her family learn about and access these resources.
19. D The question asked you to pick the “first” step. This was
easy if you noticed that a social worker would need more information to figure
out what is going on with this boy and what needs to be done to help him. In
other words, a social worker would not suggest or use any form of intervention
in this case before gathering more information. First, he or she should meet
with the boy’s parents: Doing so would involve the parents in helping their son
and also enable the social worker to get their permission to talk with other
professionals and gather information. After this meeting, the social worker
could then determine what other types of assessment and what interventions
would be appropriate. The social worker needs to involve the parents before
doing the things listed in “a” and “b” and also needs to have more information
before concluding that the boy is depressed or that the intervention in “b”
would be useful for him. We can also rule out “c” because we don’t have
evidence of school phobia in the question (e.g., the boy isn’t anxious or
resisting going to school).
20.D The key information in this question is the duration of the
symptom (seven months) and its nature (an hallucination). Although you need
more information to conclude that this client has schizophrenia, the duration
of the symptom and its nature are most consistent with schizophrenia:
Schizophrenia includes a continuous disturbance for at least six months,
including at least one month during which there are two or more active-phase
symptoms – i.e., hallucinations, delusions, disorganized speech, grossly
disorganized or catatonic behavior, negative symptoms (flattened affect, lack
of volition, etc.). When delusions are bizarre or when hallucinations consist
of a voice that keeps a running commentary on the person’s thoughts or
behavior, only one active-phase symptom is required. Schizophrenia also
includes significant deterioration in at least one important area of
functioning or, when the onset is during childhood or adolescence, a failure to
achieve expected levels of functioning. The seven-month duration allows you to
rule out schizophreniform disorder (“a”) and brief psychotic disorder (“b”): In
schizophreniform disorder, symptoms of schizophrenia persist for at least one
month but less than six months; and in brief psychotic disorder, one or more
psychotic symptoms are present for at least one day but less than one month.
And the fact that the question describes an hallucination allows you to rule
out delusional disorder (“c”). A delusional disorder involves a nonbizarre,
organized delusion that persists for at least one month. “Nonbizzare” delusions
are ones about events that are plausible – i.e., that could conceivably occur
in real life. Delusional disorder types include the following: In the
erotomanic type, the person is convinced that he is loved by another person,
usually someone of a higher status; in the grandiose type, the person has an
exaggerated sense of self-importance and power and/or is convinced that he has
a unique but unrecognized talent or insight or has made a significant
discovery; in the jealous type, the person is convinced that his partner is
unfaithful; and in the persecutory type, the person is convinced that he or a
loved one is being cheated, poisoned, spied on, etc.
21. B Narcissistic personality disorder involves a pervasive
pattern of grandiosity in fantasy and behavior, need for admiration, and lack
of empathy that begins by early adulthood and is present in a variety of
situations. People with NPD, “have a grandiose sense of self-importance ... and
believe they are superior, special, or unique and expect others to recognize
them as such” (DSM-IV-TR, p. 714). The other answers are false: People with NPD
have a grandiose sense of self-importance and display arrogant behaviors and
attitudes, but their self-esteem is actually very vulnerable (which rules out
“a”). They are highly sensitive to injury from criticism or failure, as “c”
suggests, but they don’t display social discomfort (social discomfort is
characteristic of avoidant personality disorder). And “d” is associated with
borderline personality disorder – people with NPD have inflated judgments of
their own accomplishments and often underestimate (devalue) the achievements of
others, but they don’t “often switch” between admiring (idealizing) and
despising (devaluing) others.
22. B Of course, the
qualifier “not” was important. The psychiatrist “is not likely to prescribe”
(i.e., would not prescribe) Carbamazepine (Tegretol) to manage this boy’s
symptoms; this an anticonvulsant prescribed for people with epilepsy. It is
also effective for some people with bipolar I disorder, especially those who
cycle rapidly (change from mania to depression and back over the course of days
or hours, rather than months). Another anticonvulsant that may be used to treat
bipolar I disorder is divalproex sodium (Depakote); this medication is
effective for both rapid-cycling and non-rapid-cycling bipolar I disorders.
Regarding “a” and “c,” some antidepressants – fluoxetine (Prozac), fluvoxamine
(Luvox), and clomipramine (Anafranil) – have been shown to be effective for
reducing the frequency and intensity of repetitive behaviors in people with
autism, as well as their tantrums, irritability, and aggressive behavior. And
regarding “d,” antipsychotics – including risperidone (Risperdal), clozapine
(Clozaril), olanzapine (Zyprexa), and quetiapine (Seroquel) – can be effective
for reducing hyperactivity, aggression, stereotypical behaviors, and withdrawal
in some people with autism. Among these antipsychotics, only risperidone has
been investigated in a controlled study of adults with autism.
23. B Of the drugs listed, only MDMA (Ecstacy) is considered an
hallucinogen. MDMA’s effects are actually a combination of those produced by
amphetamines and hallucinogens — i.e., users experience both an increase in
motor activity and general arousal and a dream-like state that may include
delusions and hallucinations.
24. C Option “c” is the
best answer, even though our information is incomplete (e.g., the question does
not say that the girl has undergone a severe trauma). For a diagnosis of PTSD,
the individual must exhibit the following symptoms after exposure to a highly
traumatic event: (1) Persistent re-experiencing of the event; e.g., intrusive
and distressing recollections or dreams; flashbacks; intense distress when
exposed to cues that symbolize or resemble the trauma. (2) Persistent avoidance
of stimuli associated with the event; e.g., efforts to avoid thoughts,
activities, places, or people associated with the trauma; inability to recall a
significant aspect of the trauma; feelings of detachment or estrangement from
others; restricted range of affect; sense of foreshortened future. (3)
Persistent symptoms of increased arousal; e.g., an exaggerated startle
response, difficulty falling or staying asleep; irritability; difficulty
concentrating; hypervigilance. In children with PTSD, distressing dreams about
the event itself may change into generalized nightmares about monsters, etc. In
addition, children usually do not have the sense that they are re-living the
trauma; instead, they may re-experience the trauma through repetitive play,
such as this girl’s play behavior with the cars and trucks.
25. A The Millon Adolescent Clinical Inventory (MACI) is designed
for patients aged 13 to 19 years whose reading ability is at or above a
sixth-grade level. MACI scales are designed to identify personal problems, such
as confusion about self and peer and family difficulties, as well as to assist
clinicians in identifying patients who are likely to display acting out
behavior, anxious feelings, or suicidal tendencies. The MACI scales also focus
on broad and long-standing personality attributes. The MCMI-III, the adult
version of the MACI, is a self-report personality inventory which, like the
MACI, assesses both acute clinical states and long-standing personality traits.
Both the MACI and the MCMI-III are designed to be used in clinical,
residential, and correctional settings (e.g., with patients undergoing clinical
assessment or psychotherapy). The MMPI-2, a self-report personality inventory,
is designed for individuals aged 18 and over who have at least an eighth grade
reading comprehension level. It reports an examinee’s performance in terms of
clinical and validity scales; commonly, the patient’s personality is assessed
through “profile analysis,” a method of score interpretation that involves
examining subtest or scale score patterns. For adolescents (ages 14 to 18), a
version of the MMPI-2 called the MMPI-A is available. Finally, the
Bender-Gestalt-II can be used to assess an adolescent, but it is not as useful
as the MACI for assessing personality. The Bender-Gestalt-II is used primarily
as a brief measure of visual-motor integration and screening tool for
neuropsychological impairment for individuals aged 3 years and older.
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