NCMHCE COMPREHENSIVE EXAM 2026 QUESTIONS AND
SOLUTIONS RATED A+
✔✔HIV vs. Neurocognitive Disorder
(Diagnosis) - ✔✔- in early stages can cause neurocognitive disorder
> forgetfulness
> impaired attention & concentration
> decelerated mental processes
> apathy
> social withdrawal
> loss of initiative
> tremor
> saccadic eye movements
> clumsiness
> problem-solving deficits
- distinguished as NCD due to HIV: severe depression & anxiety, lack of aphasia, and
motor slowness
✔✔NCD due to Vascular Disease
(Diagnosis) - ✔✔- progressive cognitive impairment caused by blockage of blood flow to
the brain
- need focal neurological signs or lab evidence of cerebrovascular disease
- SYMPTOMS:
> exaggerated reflex > weakness in extremities
> abnormal gait
✔✔NCD due to Huntington's disease
(Diagnosis) - ✔✔- Damage seen in basal ganglia & cerebral cortex due to degeneration
of GABA
- Present between ages of 30-50 and is inherited
- Client usually declines into profound ataxia
- AFFECTIVE SYMPTOMS: irritable, depression, apathy
- COGNITIVE SYMPTOMS: forgetful, dementia
- MOTOR SYMPTOMS: fidgeting, clumsiness, chorea (involuntary jerks), and athetosis
(slow movements)
✔✔NCD due to Parkinson's disease
(Diagnosis) - ✔✔- deficiency of DA and presence of Lewy bodies in substantia nigra
- 20-60% will develop NCD and most will suffer from depression
- SYMPTOMS:
> bradykinesia (slowness of movement)
> resting tremor
> stoic and unmoving facial expression
> balance/coordination problems
> involuntary pill-rolling movement of thumb and forefinger
,> akathisia (violent restlessness)
✔✔Substance Use Disorders
(Diagnosis) - ✔✔- caffeine, hallucinogens, alcohol, cannabis, stimulants, tobacco,
inhalants, opioids, sedatives/hypnotics/anxiolytics, and other
- Severity depends on # of symptoms
- many unable to avoid relapse
- abstinence violation effect
- types of remissions
- TREATMENT
> aversion therapy > multicomponent interventions
> rapid opiate detoxification > 12-step programs
> self-control learning strategies >quit cold turkey
✔✔abstinence violation effect
(Diagnosis) - ✔✔feeling of loss of control that results when a person has violated self-
imposed rules manifested in self-blame, shame, and increased susceptibility to relapse
✔✔3 types of remission
(Diagnosis) - ✔✔1. Early = no criteria of substance use disorder are fulfilled except for
cravings for at least 3 months, but not longer than 1 year
2. Sustained = No substance use disorder criteria are fulfilled except for cravings
following for 1 year
3. Maintenance Therapy = replacement medication that can be taken to avoid
withdrawal symptoms and still considered in remission (i.e. methadone)
✔✔Alcohol Intoxication & Withdrawal
(Diagnosis) - ✔✔INTOXICATION:
- maladaptive bx and psychological changes
- slurred speech
- poor coordination
- unsteady gait
- nystagmus (uncontrolled eye movements)
- stupor or coma
- impaired attention and memory
- inappropriate sexual or aggressive bx
- impaired judgment
- emotional lability
WITHDRAWAL:
- autonomic hyperactivity (diaphoresis & tachycardia)
- hand tremors
- insomnia
- nausea/vomiting
- transient illusions or hallucinations
,- anxiety
- psychomotor agitation
- tonic/clonic seizures
- delirium
✔✔Korsakoff's Syndrome
(Diagnosis) - ✔✔- retrograde and anterograde amnesia with confabulation due to
thiamine deficiency
- often seen in heavy drinkers
✔✔Wernicke's syndrome
(Diagnosis) - ✔✔condition characterized by loss of memory and disorientation,
associated with chronic alcohol intake and a diet deficient in thiamine.
✔✔Cocaine or Amphetamine Intoxication and Withdrawal
(Diagnosis) - ✔✔INTOXICATION:
- euphoria, hyperactivity, grandiosity, confusion, anger, paranoid ideation
- auditory hallucinations
- tachycardia
- hyper/hypotension
- dilated pupils
- perspiration/chills
- nausea/vomiting
- weight loss
- muscular weakness
- confusions
- seizures
WITHDRAWAL:
- dysphoric mood
- fatigue
- vivid and unpleasant dreams
- insomnia or hypersomnia
- increased appetite
- psychomotor agitation or retardation
- intense depression
✔✔Schizophrenia
(Diagnosis) - ✔✔Criteria A: requires *at least 2 of the following*, and at least 1 of these
should be core positive symptom (first 4 are "positive symptoms"):
1. Delusions
> persecutory = person believes someone/something is out to get them
> referential = messages in public (song lyrics, news, etc.) are specifically directed at
them
> bizarre = person imagines something impossible has happened
, 2. Hallucinations—often auditory
3. Disorganized speech
> incoherence, free associations that make little sense, and random responses to direct
questions
4. Disorganized behavior
> unkempt appearance, inappropriate sexual appearance, unpredictable agitation,
decreased motor activity
> catatonia = at least *3* of: defying or refusing to acknowledge instruction, echolalia,
echopraxia, agitation, little to no verbal response, grimacing,
5. Negative symptoms
> restricted range of emotions
> reduced body language and facial expression
> lack of coherent thoughts and inability to make conversation
> avolition = inability to set goals or work in a rational manner
Criteria B: *marked decline in functioning* in work, interpersonal relations, and self-care
markedly below pre-morbid level
Criteria C: lasting *> 6 months*
- associated features: anhedonia, inappropriate affect, dysphoric mood, abnormal motor
bx, somatic complaints
- genetic component
- structural abnormalities = enlarged ventricles and diminished hippocampus, amygdala,
and globus pallidus; diminished prefrontal cortex activity; excess DA
- possible link with influenza b/c abnormal amount of schizophrenics were born in late
winter/early spring
*Treatment*:
- often have little insight so are less likely to be medically compliant
> improved prognosis if patient has acute and late onset, is female, has brief active-
phase symptoms, insight, and no family history of schizophren
✔✔schizophreniform disorder
(Diagnosis) - ✔✔Psychotic disorder involving the symptoms of schizophrenia but lasting
less than 6 months.
✔✔brief psychotic disorder
(Diagnosis) - ✔✔Psychotic disturbance involving delusions, hallucinations, or
disorganized speech or behavior but lasting less than 1 month; often occurs in reaction
to a stressor.
✔✔delusional disorder
(Diagnosis) - ✔✔Psychotic disorder featuring a persistent (1+ month) belief contrary to
reality (delusion) but no other symptoms of schizophrenia. Person is functional except
with bx related to delusion
- persecutory, jealous, erotomanic, somatic, grandiose, or mixed
SOLUTIONS RATED A+
✔✔HIV vs. Neurocognitive Disorder
(Diagnosis) - ✔✔- in early stages can cause neurocognitive disorder
> forgetfulness
> impaired attention & concentration
> decelerated mental processes
> apathy
> social withdrawal
> loss of initiative
> tremor
> saccadic eye movements
> clumsiness
> problem-solving deficits
- distinguished as NCD due to HIV: severe depression & anxiety, lack of aphasia, and
motor slowness
✔✔NCD due to Vascular Disease
(Diagnosis) - ✔✔- progressive cognitive impairment caused by blockage of blood flow to
the brain
- need focal neurological signs or lab evidence of cerebrovascular disease
- SYMPTOMS:
> exaggerated reflex > weakness in extremities
> abnormal gait
✔✔NCD due to Huntington's disease
(Diagnosis) - ✔✔- Damage seen in basal ganglia & cerebral cortex due to degeneration
of GABA
- Present between ages of 30-50 and is inherited
- Client usually declines into profound ataxia
- AFFECTIVE SYMPTOMS: irritable, depression, apathy
- COGNITIVE SYMPTOMS: forgetful, dementia
- MOTOR SYMPTOMS: fidgeting, clumsiness, chorea (involuntary jerks), and athetosis
(slow movements)
✔✔NCD due to Parkinson's disease
(Diagnosis) - ✔✔- deficiency of DA and presence of Lewy bodies in substantia nigra
- 20-60% will develop NCD and most will suffer from depression
- SYMPTOMS:
> bradykinesia (slowness of movement)
> resting tremor
> stoic and unmoving facial expression
> balance/coordination problems
> involuntary pill-rolling movement of thumb and forefinger
,> akathisia (violent restlessness)
✔✔Substance Use Disorders
(Diagnosis) - ✔✔- caffeine, hallucinogens, alcohol, cannabis, stimulants, tobacco,
inhalants, opioids, sedatives/hypnotics/anxiolytics, and other
- Severity depends on # of symptoms
- many unable to avoid relapse
- abstinence violation effect
- types of remissions
- TREATMENT
> aversion therapy > multicomponent interventions
> rapid opiate detoxification > 12-step programs
> self-control learning strategies >quit cold turkey
✔✔abstinence violation effect
(Diagnosis) - ✔✔feeling of loss of control that results when a person has violated self-
imposed rules manifested in self-blame, shame, and increased susceptibility to relapse
✔✔3 types of remission
(Diagnosis) - ✔✔1. Early = no criteria of substance use disorder are fulfilled except for
cravings for at least 3 months, but not longer than 1 year
2. Sustained = No substance use disorder criteria are fulfilled except for cravings
following for 1 year
3. Maintenance Therapy = replacement medication that can be taken to avoid
withdrawal symptoms and still considered in remission (i.e. methadone)
✔✔Alcohol Intoxication & Withdrawal
(Diagnosis) - ✔✔INTOXICATION:
- maladaptive bx and psychological changes
- slurred speech
- poor coordination
- unsteady gait
- nystagmus (uncontrolled eye movements)
- stupor or coma
- impaired attention and memory
- inappropriate sexual or aggressive bx
- impaired judgment
- emotional lability
WITHDRAWAL:
- autonomic hyperactivity (diaphoresis & tachycardia)
- hand tremors
- insomnia
- nausea/vomiting
- transient illusions or hallucinations
,- anxiety
- psychomotor agitation
- tonic/clonic seizures
- delirium
✔✔Korsakoff's Syndrome
(Diagnosis) - ✔✔- retrograde and anterograde amnesia with confabulation due to
thiamine deficiency
- often seen in heavy drinkers
✔✔Wernicke's syndrome
(Diagnosis) - ✔✔condition characterized by loss of memory and disorientation,
associated with chronic alcohol intake and a diet deficient in thiamine.
✔✔Cocaine or Amphetamine Intoxication and Withdrawal
(Diagnosis) - ✔✔INTOXICATION:
- euphoria, hyperactivity, grandiosity, confusion, anger, paranoid ideation
- auditory hallucinations
- tachycardia
- hyper/hypotension
- dilated pupils
- perspiration/chills
- nausea/vomiting
- weight loss
- muscular weakness
- confusions
- seizures
WITHDRAWAL:
- dysphoric mood
- fatigue
- vivid and unpleasant dreams
- insomnia or hypersomnia
- increased appetite
- psychomotor agitation or retardation
- intense depression
✔✔Schizophrenia
(Diagnosis) - ✔✔Criteria A: requires *at least 2 of the following*, and at least 1 of these
should be core positive symptom (first 4 are "positive symptoms"):
1. Delusions
> persecutory = person believes someone/something is out to get them
> referential = messages in public (song lyrics, news, etc.) are specifically directed at
them
> bizarre = person imagines something impossible has happened
, 2. Hallucinations—often auditory
3. Disorganized speech
> incoherence, free associations that make little sense, and random responses to direct
questions
4. Disorganized behavior
> unkempt appearance, inappropriate sexual appearance, unpredictable agitation,
decreased motor activity
> catatonia = at least *3* of: defying or refusing to acknowledge instruction, echolalia,
echopraxia, agitation, little to no verbal response, grimacing,
5. Negative symptoms
> restricted range of emotions
> reduced body language and facial expression
> lack of coherent thoughts and inability to make conversation
> avolition = inability to set goals or work in a rational manner
Criteria B: *marked decline in functioning* in work, interpersonal relations, and self-care
markedly below pre-morbid level
Criteria C: lasting *> 6 months*
- associated features: anhedonia, inappropriate affect, dysphoric mood, abnormal motor
bx, somatic complaints
- genetic component
- structural abnormalities = enlarged ventricles and diminished hippocampus, amygdala,
and globus pallidus; diminished prefrontal cortex activity; excess DA
- possible link with influenza b/c abnormal amount of schizophrenics were born in late
winter/early spring
*Treatment*:
- often have little insight so are less likely to be medically compliant
> improved prognosis if patient has acute and late onset, is female, has brief active-
phase symptoms, insight, and no family history of schizophren
✔✔schizophreniform disorder
(Diagnosis) - ✔✔Psychotic disorder involving the symptoms of schizophrenia but lasting
less than 6 months.
✔✔brief psychotic disorder
(Diagnosis) - ✔✔Psychotic disturbance involving delusions, hallucinations, or
disorganized speech or behavior but lasting less than 1 month; often occurs in reaction
to a stressor.
✔✔delusional disorder
(Diagnosis) - ✔✔Psychotic disorder featuring a persistent (1+ month) belief contrary to
reality (delusion) but no other symptoms of schizophrenia. Person is functional except
with bx related to delusion
- persecutory, jealous, erotomanic, somatic, grandiose, or mixed
