NCMHCE CORE MAIN QUESTIONS AND ANSWERS
SET A+
✔✔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
✔✔Manic Episode
(Diagnosis) - ✔✔- Significantly elevated or irritable mood present for almost entire day
for at least one week.
- Experience 3 of the following:
++ *D*istractibility
++ *I*rresponsibility—seeks pleasure without regard to consequences (hedonistic)
++ *G*randiosity—inflated self-esteem
++ *F*light of ideas—racing thoughts
++ psychomotor *A*gitation: inc goal-directed activity
++ decreased need for *S*leep
++ *T*alkativeness or pressured speech
✔✔Hypomanic Episode
(Diagnosis) - ✔✔- severe enough to be a deviation from normal mood and functioning,
but not severe enough to cause a marked impairment in functioning or to require
hospitalization
- Experience elevated or irritable mood for most of the day lasting at least 4 days
- Experience 3 of the following:
,++ *D*istractibility
++ *I*rresponsibility—seeks pleasure without regard to consequences (hedonistic)
++ *G*randiosity—inflated self-esteem
++ *F*light of ideas—racing thoughts
++ psychomotor *A*gitation: inc goal-directed activity
++ decreased need for *S*leep
++ *T*alkativeness or pressured speech
✔✔major depressive disorder
(Diagnosis) - ✔✔*Criteria A* = experience 5 or more of the following symptoms during 2
consecutive weeks
> depressed mood > anhedonia > fatigue
> thoughts of suicide > decreased ability to think
> guilt/worthlessness > motor agitation or retardation
> weight change of 5% > hypersomnia or insomnia
*Criteria B* = causes impairment or distress
*Criteria C/D/E* = cannot be attributed to a substance or another
condition/schizophrenia or psychotic disorder/no presence of a manic or hypomanic
episode
Specifiers:
- with anxious distress - peripartum onset
- melancholic features - seasonal pattern
- w/catatonia - w/atypical features - w/mixed features
> Symptoms in children also include irritability, somatic complaints, and social
withdrawal; boys can demonstrate aggressive bx
Etiologies:
1. Learned Helplessness Model = Seligman; exposure to negative events in the past
results in a tendency to attribute negative events to internal, stable, and global factors
2. Rehm's Self-Control Model = strict standards of self-evaluation and blame problems
on internal attributions; they obsess over negative outcomes and have low rates of
reinforcement with higher rates of punishment
3. Beck's Cognitive Theory = negative and irrational thoughts and beliefs about
depressive cognitive triad (the self, the world, and the future)
4. Catecholamine Hypothesis = reduced catecholamines, specifically norepinephrine
5. Indolamine Hypothesis = deficiency in serotonin
*Treatment*
1. Medication
- Selective Serotonin Reuptake Inhibitors = lower incidence of serious adverse side
effects
- Tricyclics = often have adverse side effects
- Monoamine Oxidase Inhibitors = prescribed as a last resort
,2. Electroconvulsive Therapy = used on patients with severe depression that is resistant
to medication; can result in temporary amnesia
✔✔Persistent Depressive Disorder (Dysthymia)
(Diagnosis) - ✔✔*Criteria A* = depressed mood most of the day for at least 2 years
*Criteria B* = Experience 2+ of the following: low self-esteem, decreased/increased
appetite, hopelessness, withdrawal, difficulty concentrating, or difficulties sleeping
*Criteria C* = client has not had relief from symptoms for longer than 2 months at once
*Criteria D/E/F/G* = may meet criteria for MDD but does not meet criteria for
cyclothymic disorder, manic or hypomanic episodes/schizophrenia or other psychotic
disorders/ or substance use
*Criteria H* = cause distress or impairment
✔✔Suicidality
(Diagnosis) - ✔✔- more men successfully commit suicide due to more violent means
(guns, hanging)
- suicide rate is highest among Whites but is the 2nd leading cause of death among
young Alaskan Natives and American Indians
- suicide is highest among divorced/separated/widowed people and then single people
- At Risk:
> have previously attempted
> MDD and bipolar diagnoses
> high levels of hopelessness, perfectionism, or a traumatic life event
✔✔Bipolar I vs Bipolar II vs Cyclothymia
(Diagnosis) - ✔✔Bipolar I:
> Manic episode or mixed episode lasting 7 days, usually needing hospitalization at
least once
> Depressive episode usually lasts about 2 weeks
Bipolar II:
> Hypomanic episode
> Depressive episode usually lasts about 2 weeks
Cyclothymic:
> periods of hypomanic symptoms and depressive symptoms for 2+ years
> do not officially meet criteria for hypomanic episode or depressive disorder
✔✔Factitious Disorder (FD)
(Diagnosis) - ✔✔- manifests exaggerated physical or psychological symptoms to fill the
role of a sick person (no tangible incentive or avoidance)
- Factitious Disorder Imposed on Another (AKA Munchausen's syndrome by proxy) =
caregiver produces symptoms in another individual, typically a mother imposing on her
child
, ✔✔Malingering Disorder
(Diagnosis) - ✔✔- feigning symptoms to avoid something specific (avoid work, service,
etc.) or to gain a specific reward (disability checks)
- marked inconsistency b/w patient's complaint and the objective findings or if the
patient doesn't cooperate w/diagnostic evaluation or prescribed treatment
- often in antisocial personality disorder
✔✔Dissociative Disorders
(Diagnosis) - ✔✔- Disruption in consciousness, identity, memory, or perception of the
environment that is not due to substances or other medical conditions.
1. Dissociative Identity Disorder = 2+ personalities exist within one person with each
person being dominant at a particular time
2. Dissociative Amnesia = more than one episode of inability to recall important
personal data, more than forgetfulness. Usually related to a traumatic event.
- Localized = patient is unable to remember all events around a defined period
- Selective = patient is unable to recall some events pertaining to a circumscribed
period
- Generalized = memory loss spans the patient's entire life
> *Fugue* = purposeful travel associated w/amnesia and patient assumes new identity
to protect against extreme stressors
3. Depersonalization/Derealization Disorder = feeling detached from one's mental
processes or body, as if one is an observer
*Cultural Factors* can cause or amplify some of the symptoms
✔✔Sexual Dysfunction
(Diagnosis) - ✔✔- sexual response cycle is disturbed or there is pain during intercourse
causing distress or interpersonal difficulty
1. Delayed ejaculation
2. Erectile disorder = can be due to medical (e.g. diabetes, MS, or kidney disease) or
medication
3. Female orgasmic disorder
4. Female sexual interest/arousal disorder
5. Genito-pelvic pain/penetration disorder
6. Male hypoactive sexual desire disorder
7. Premature ejaculation = can be due to 5-HTP deficiencies
8. Substance-induced sexual dysfunction
Diagnosis:
- rule out medical problems
- Use sleep studies to determine whether cause of impotence is physical or
psychological
SET A+
✔✔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
✔✔Manic Episode
(Diagnosis) - ✔✔- Significantly elevated or irritable mood present for almost entire day
for at least one week.
- Experience 3 of the following:
++ *D*istractibility
++ *I*rresponsibility—seeks pleasure without regard to consequences (hedonistic)
++ *G*randiosity—inflated self-esteem
++ *F*light of ideas—racing thoughts
++ psychomotor *A*gitation: inc goal-directed activity
++ decreased need for *S*leep
++ *T*alkativeness or pressured speech
✔✔Hypomanic Episode
(Diagnosis) - ✔✔- severe enough to be a deviation from normal mood and functioning,
but not severe enough to cause a marked impairment in functioning or to require
hospitalization
- Experience elevated or irritable mood for most of the day lasting at least 4 days
- Experience 3 of the following:
,++ *D*istractibility
++ *I*rresponsibility—seeks pleasure without regard to consequences (hedonistic)
++ *G*randiosity—inflated self-esteem
++ *F*light of ideas—racing thoughts
++ psychomotor *A*gitation: inc goal-directed activity
++ decreased need for *S*leep
++ *T*alkativeness or pressured speech
✔✔major depressive disorder
(Diagnosis) - ✔✔*Criteria A* = experience 5 or more of the following symptoms during 2
consecutive weeks
> depressed mood > anhedonia > fatigue
> thoughts of suicide > decreased ability to think
> guilt/worthlessness > motor agitation or retardation
> weight change of 5% > hypersomnia or insomnia
*Criteria B* = causes impairment or distress
*Criteria C/D/E* = cannot be attributed to a substance or another
condition/schizophrenia or psychotic disorder/no presence of a manic or hypomanic
episode
Specifiers:
- with anxious distress - peripartum onset
- melancholic features - seasonal pattern
- w/catatonia - w/atypical features - w/mixed features
> Symptoms in children also include irritability, somatic complaints, and social
withdrawal; boys can demonstrate aggressive bx
Etiologies:
1. Learned Helplessness Model = Seligman; exposure to negative events in the past
results in a tendency to attribute negative events to internal, stable, and global factors
2. Rehm's Self-Control Model = strict standards of self-evaluation and blame problems
on internal attributions; they obsess over negative outcomes and have low rates of
reinforcement with higher rates of punishment
3. Beck's Cognitive Theory = negative and irrational thoughts and beliefs about
depressive cognitive triad (the self, the world, and the future)
4. Catecholamine Hypothesis = reduced catecholamines, specifically norepinephrine
5. Indolamine Hypothesis = deficiency in serotonin
*Treatment*
1. Medication
- Selective Serotonin Reuptake Inhibitors = lower incidence of serious adverse side
effects
- Tricyclics = often have adverse side effects
- Monoamine Oxidase Inhibitors = prescribed as a last resort
,2. Electroconvulsive Therapy = used on patients with severe depression that is resistant
to medication; can result in temporary amnesia
✔✔Persistent Depressive Disorder (Dysthymia)
(Diagnosis) - ✔✔*Criteria A* = depressed mood most of the day for at least 2 years
*Criteria B* = Experience 2+ of the following: low self-esteem, decreased/increased
appetite, hopelessness, withdrawal, difficulty concentrating, or difficulties sleeping
*Criteria C* = client has not had relief from symptoms for longer than 2 months at once
*Criteria D/E/F/G* = may meet criteria for MDD but does not meet criteria for
cyclothymic disorder, manic or hypomanic episodes/schizophrenia or other psychotic
disorders/ or substance use
*Criteria H* = cause distress or impairment
✔✔Suicidality
(Diagnosis) - ✔✔- more men successfully commit suicide due to more violent means
(guns, hanging)
- suicide rate is highest among Whites but is the 2nd leading cause of death among
young Alaskan Natives and American Indians
- suicide is highest among divorced/separated/widowed people and then single people
- At Risk:
> have previously attempted
> MDD and bipolar diagnoses
> high levels of hopelessness, perfectionism, or a traumatic life event
✔✔Bipolar I vs Bipolar II vs Cyclothymia
(Diagnosis) - ✔✔Bipolar I:
> Manic episode or mixed episode lasting 7 days, usually needing hospitalization at
least once
> Depressive episode usually lasts about 2 weeks
Bipolar II:
> Hypomanic episode
> Depressive episode usually lasts about 2 weeks
Cyclothymic:
> periods of hypomanic symptoms and depressive symptoms for 2+ years
> do not officially meet criteria for hypomanic episode or depressive disorder
✔✔Factitious Disorder (FD)
(Diagnosis) - ✔✔- manifests exaggerated physical or psychological symptoms to fill the
role of a sick person (no tangible incentive or avoidance)
- Factitious Disorder Imposed on Another (AKA Munchausen's syndrome by proxy) =
caregiver produces symptoms in another individual, typically a mother imposing on her
child
, ✔✔Malingering Disorder
(Diagnosis) - ✔✔- feigning symptoms to avoid something specific (avoid work, service,
etc.) or to gain a specific reward (disability checks)
- marked inconsistency b/w patient's complaint and the objective findings or if the
patient doesn't cooperate w/diagnostic evaluation or prescribed treatment
- often in antisocial personality disorder
✔✔Dissociative Disorders
(Diagnosis) - ✔✔- Disruption in consciousness, identity, memory, or perception of the
environment that is not due to substances or other medical conditions.
1. Dissociative Identity Disorder = 2+ personalities exist within one person with each
person being dominant at a particular time
2. Dissociative Amnesia = more than one episode of inability to recall important
personal data, more than forgetfulness. Usually related to a traumatic event.
- Localized = patient is unable to remember all events around a defined period
- Selective = patient is unable to recall some events pertaining to a circumscribed
period
- Generalized = memory loss spans the patient's entire life
> *Fugue* = purposeful travel associated w/amnesia and patient assumes new identity
to protect against extreme stressors
3. Depersonalization/Derealization Disorder = feeling detached from one's mental
processes or body, as if one is an observer
*Cultural Factors* can cause or amplify some of the symptoms
✔✔Sexual Dysfunction
(Diagnosis) - ✔✔- sexual response cycle is disturbed or there is pain during intercourse
causing distress or interpersonal difficulty
1. Delayed ejaculation
2. Erectile disorder = can be due to medical (e.g. diabetes, MS, or kidney disease) or
medication
3. Female orgasmic disorder
4. Female sexual interest/arousal disorder
5. Genito-pelvic pain/penetration disorder
6. Male hypoactive sexual desire disorder
7. Premature ejaculation = can be due to 5-HTP deficiencies
8. Substance-induced sexual dysfunction
Diagnosis:
- rule out medical problems
- Use sleep studies to determine whether cause of impotence is physical or
psychological
