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The Intelligent Clinician's Guide to DSM-5

Introduction: What DSM-5 Can and Cannot Do

1. When the DSM-III was published in 1980, it increased reliability by taking a __________ approach and allowed for diagnoses based on what professionals could see and agree on.

A. Atypical

B. Atheoretical

C. Clinical

D. Standarized

Unsolved Problems in Psychiatric Diagnosis

2. Although the DSM-5 must base diagnostic criteria on signs and symptoms, such observation should also be augmented by biological markers.

A. True

B. False

Ten Highlights of DSM-5

3. Major revisions in the DSM-5 included each of the following EXCEPT:

A. Substance use disorders now describe cases using the term addiction, and no longer distinguish between dependence and abuse

B. Autism spectrum disorders now include both classical autism and Asperger's syndrome

C. Dementias are now classified as neurocognitive disorders, rated by severity

D. Overly aggressive children can now be diagnosed as having disorderly temperament disposition

Chapter 1-Why is Diagnosis Important

4. Diagnosis is important to patients because it provides validation, explanation, and prognosis.

A. True

B. False

Why Psychiatric Diagnosis is Difficult

5. Psychiatric diagnoses are based on observation of signs and symptoms, rather than pathological process, and are therefore categorized as disorders rather than diseases.

A. True

B. False

Diagnosis and Treatment

6. Diagnosis is not necessarily a neutral and empirically based procedure, but rather driven by:

A. Academics promoting a theory or favorite diagnosis

B. Practitioners' desires for predictable clinical results

C. Patient advocacy and the media

D. All of the above

Chapter 2-Keeping Industry Out

7. When developing the DSM-5 task force, it was important to ensure that all members had only minimal involvement with pharmaceutical companies during the time of their participation in the process.

A. True

B. False


8. One of the praises of the DSM-5 process is that the task force made sure to allow a significant time period to establish the validity of any revisions.

A. True

B. False

The Structure of DSM-5

9. Which of the following are NOT classified as anxiety disorders in the DSM-5?

A. Panic disorders

B. Phobias

C. Obsessive-compulsive disorders

D. Generalized anxiety disorders

Chapter 3-The Boundary Between Illness and Life

10. Almost everything that creates trouble in human life can be found in DSM manuals, resulting in about ____ percent if the population meeting criteria for at least one disorder in a given year.

A. 15

B. 20

C. 25

D. 30

Sensitivity and Specificity

11. In psychiatric diagnosis, specificity measures the proportion of positive cases correctly identified.

A. True

B. False

Diagnosis in Childhood

12. DSM-5 makes a point of not separating adult and child psychiatry since so many disorders that begin in childhood continue into adulthood.

A. True

B. False

Chapter 4-Reliability and Validity

13. While few diagnoses are genuinely comorbid, it is generally appropriate to make such a diagnosis when substance abuse complicates a mood disorder since they will likely require separate treatment.

A. True

B. False

Interviews and Self-Report Measures

14. Interviews whose content is defined by specific areas of inquiry to be covered, but where a script is not followed are:

A. Semi-structured interviews

B. Non-systemic interviews

C. Quasi-regulated interviews

D. None of the above

Effects of Age, Gender, and Culture

15. Environmental, rather than temperamental factors tend to be most predominant in early-onset mental disorders.

A. True

B. False

16. Culture shapes mental disorders in three ways, including each of the following EXCEPT:

A. Social forces influence how vulnerabilities to psychopathology express themselves in symptoms

B. Culture can shape mental disorders by adding social stress to pre-existing biological vulnerabilities

C. Help-seeking behavior is influenced by cultural norms which also impact diagnosis and treatment

D. Social forces can shape unique disorders that are only seen in one culture or a group of cultures

Chapter 5-Dimensionality

17. Diagnostic categories in psychiatry tend to overlap and many boundaries between pathology and normality are blurred, often making diagnosis difficult.

A. True

B. False

Diagnostic Spectra

18. Overlapping diagnoses of the same pathological process may fall within spectra, with the oldest and best supported being the mood disorder spectrum.

A. True

B. False

Chapter 6-Clinical Utility

19. The most important function of diagnosis is:

A. As a bridge to treatment

B. To provide a vision for the future

C. To give relief to patients and families

D. As a means of communication

Part II-Chapter 7

20. In the DSM-5, in order to be diagnosed with schizophrenia, a patient must have at least two characteristic symptoms for at least _______, social/occupational dysfunction, and a _______ duration of illness.

A. 2 months; 9 months

B. 1 month; 6 months

C. 6 weeks; 3 months

D. 2 weeks; 1 month

Some Unresolved Problems

21. Delusional disorder is marked with delusions without thought disorder, and one study found it related to alcoholism rather than schizophrenia.

A. True

B. False

Chapter 8-The Overdiagnosis of Bipolar Disorder

22. Bipolar disorder is currently diagnosed in 2% to 5% of the general population.

A. True

B. False

23. The key issue in making a bipolar-II diagnosis is to ensure that patients meet criteria for:

A. A mixed episode

B. Agitated depression

C. Hypomania

D. Mood instability

Pediatric Bipolar Disorder

24. One study found that children of bipolar patients are at risk for ADHD rather than bipolarity.

A. True

B. False

Chapter 9-Exclusions for Diagnosis

25. In the DSM-5, clinicians are warned not to diagnose major depression if grief, even if prolonged, best accounts for symptoms.

A. True

B. False

Changes is DSM-5

26. Dysthymia has been renamed ____________________, which combines cases in which patients retain subthreshold symptoms over a two year period.

A. Chronic depressive disorder

B. Fixed depressive disorder

C. Persistent depressive disorder

D. Recurrent depressive disorder

Implications of Diagnosis for Treatment

27. Antidepressants have been shown to be consistently superior to placebo in reducing symptoms for all levels of depression, from mild to severe.

A. True

B. False

Chapter 10-Panic Disorder and Generalized Anxiety Disorder

28. Generalized anxiety disorder is retained in DSM-5 but has been renamed as general anxiety and ________ disorder.

A. Fear

B. Dread

C. Apprehension

D. Worry

Post-Traumatic Stress Disorder and Acute Stress Disorder

29. Which of the following is NOT one of the groups of symptoms characterizing PTSD?

A. Intrusion

B. Dissociative thoughts

C. Avoidance

D. Increases arousal

Obsessive-Compulsive Disorder

30. Three conditions that have been added to the OCD-spectrum are body dysmorphic disorder, hair-pulling (trichotillomania) disorder, and skin-picking (excoriation) disorder.

A. True

B. False

Chapter 11-Substance Use and Addiction in DSM-5

31. DSM-5 defines a substance use disorder as a maladaptive pattern leading to clinically significant impairment or distress for at least 6 months.

A. True

B. False

Anorexia Nervosa

32. The most significant change in the DSM-5 definition of anorexia nervosa is the deletion of the requirement for amenorrhea.

A. True

B. False


33. Although pedophilia and exhibitionism remain in the DSM-5, fetishism has been removed from the paraphilia grouping.

A. True

B. False

Chapter 12-Pervasive Developmental (Autistic Spectrum) Disorders

34. The DSM-5 offers a new category that describes milder symptoms that do not fulfill criteria for the autism spectrum, known as:

A. Verbal communication disorder

B. Social communication disorder

C. Variable communication disorder

D. Attentive communication disorder

Attention Deficit Hyperactivity Disorder

35. ADHD is now easier to diagnose in adults, with patients having to demonstrate an onset before age ____, and have ____ characteristic symptoms during childhood.

A. 12; 3

B. 11; 4

C. 10; 5

D. 9; 6

Chapter 13-Why Personality Disorders are Ignored

36. To identify a personality disorder, clinicians should focus on long-term course rather than current problems and establish whether behavior, problems in emotion, and thinking patterns:

A. Are stable over time

B. Began early in life

C. Have led to dysfunction in multiple contexts

D. All of the above


37. Most research on personality disorders is based on etiological or pathogenic mechanisms rather than on observational data.

A. True

B. False

Chapter 14-Somatic Symptom Disorder

38. The new DSM-5 category of somatic symptom disorder includes many patients previously diagnosed with somatization disorder, hypochondriasis, and pain disorder and can be coded for severity.

A. True

B. False

Dissociative Disorders

39. Dissociation is a common symptom in other mental disorders, and it is still commonly believed that Dissociative Identity Disorder results from childhood trauma.

A. True

B. False

Chapter 15-The Impact of DSM-5 on Mental Health Care

40. The most important issue for the DSM-5 is:

A. To support specific and precise diagnosis

B. To explain various types of human behavior

C. The expansion of diagnostic boundaries

D. The discouragement of over-treatment

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