LCSW PREP: DSM 5 Vignette Test Questions and Answers 2023

LCSW PREP: DSM 5 Vignette Test Questions and Answers 2023 A TINA Tina is a 10 year old girl who has a long history of school problems. She told the interviewer that she failed third grade because her teacher was "mean" and "they put me in a special class because I got into fights." Now in the fifth grade, Tina is failing at reading, english, spelling and barely passing math. Her current teacher, Ms. Henderson, reports that Tina is a slow learner with a poor memory. Tina does not do well in a group setting. She responds much better when she is given individual attention. According to her mother, Tina met all developmental landmarks within normal limits. She has no current medical problems. Tina's IQ score was in the average range. During academic testing, it was discovered that Tina performed poorly at distinguished between similar letters and shapes, and frequently reversed letters when she read. Tina's test results are indicative of which of the following diagnoses? A. Specific Learning Disorder B. Oppositional Defiant Disorder C. Conduct Disorder D. Speech Sound Disorder A RICKY Ricky is an 8-year-old boy who was referred for a psychiatric evaluation by his pediatrician. Ricky had a complete medical work-up and no medical conditions were found. Since age 5, Ricky has been fascinated with airplanes (types, performance statistics and flight routes). Given the opportunity, Ricky will talk incessantly about airplanes. Thinking he would "grow out of it," his parents were not initially concerned. They did note that Ricky has always "seemed to be in a world of his own" and engaged in repetitive behaviors like opening and closing his hands. His mother reported a normal pregnancy and Ricky made all developmental milestones within normal limits, with no language delays. At age 3, Ricky went through a short period of imitating adult instructions. Socially, Ricky never played much with his peers unless that play was related to airplanes. He does not have any friends and other children often tease him. In the interview, Ricky asked perseverative questions and made repetitive rocking movements with his upper body. He repeatedly closed and opened his hands. He was eager to talk about airplanes. When talking about airplanes his affect was quite animated, but otherwise he appeared emotionally uninterested and detached. He seemed to be immature for his age. Ricky's behaviors are indicative of: A. Autistic Spectrum Disorder B. Reactive Attachment Disorder C. Schizophrenic, early onset D. Oppositional Defiant Disorder A TOMMY Tommy is a 7-year-old boy who was referred by his pediatrician for possible hyperactivity. According to his mother, Tommy has been in "high gear: since he was a baby. Tommy was a fussy baby and required frequent soothing when he was crying. He never slept as much as her other two children at the same age. As Tommy got older, regardless of when Tommy went to bed, he always awoke at 6:30 am. He also awakened at least once during the night. Unless his mother read to him and rubbed his back, he had difficulty falling asleep. Tommy has a "difficult" temperament. He becomes angry quickly and others cannot reason with him. His mother frequently puts Tommy in "time-out" until he is able to calm down. His mother describes him as "irritable" when he returns from school. He loves playing games on his Nintendo and seems to be "hyper-focused" when playing. Her husband is not sure Tommy is hyperactive because he can focus on things when he wants. At school, Tommy is described as difficult to keep on task. He requires direction to stay on task after 3 to 5 minutes. He blurts out answers and does not raise his hand. Staying seated for more th an 10 minutes is problematic; he wanders around the room and disturbs other children. Standing in line or waiting his turn is virtually impossible. Tommy is constantly poking, teasing, or pushing other children. Tommy's education and psychological testing show him to be of above average intelligence. Which of the following diagnoses best describes Tommy's behaviors? A. Attention Deficit Hyperactivity Disorder, Combined Type B. Oppositional Defiant Disorder C. Conduct Disorder D. Attention Deficit Hyperactivity Disorder, Inattentive Type C JEREMY Jeremy is a 14-year-old boy who went to a psychiatric clinic for an evaluation for "compulsive behavior." Four years prior, Jeremy had a strange ritual of clearing his throat, blinking his eyes three times and then touching the floor. Although this was odd behavior, it didn't seem to impact Jeremy's life. Six months ago he began uttering obscene words involuntarily. Jeremy had seen his pediatrician and a neurologist who were unable to determine the cause of these behaviors. This was very disturbing to both Jeremy and his parents, Jeremy was now being tested and ridiculed by his schoolmates. During the interview, Jeremy cleared his throat multiple times, turned his head to the side and blinked his eyes three times. On two occasions he uttered an obscenity. When he did so, his face turned red from embarrassment and he stared down at the floor. Jeremy is most likely experiencing which of the following? A. Persistent (Chronic) Motor or Vocal Tic Disorder B. Provisional Tic Disorder C. Tourette's Disorder D. Speech Sound Disorder C EMILIO Emilio is a 40 year old white single male who is transported to a hospital emergency department for evaluation for a possible 12th psychiatric admission. His mother reports Emilio has never harmed her in the past and would not do so intentionally; however, his bizarre behavior makes her feel unsafe. She also reported he has not been taking care of himself. His mother reports Emilio stopped taking his medication about 1 month ago, and has since begun to hear voices and behave and dress more bizarrely. When he stopped his medications, he also stopped going to the mental health day treatment program and therapy. Emilio states, "My mother feeds me garbage and filth." Emilio is pacing around the examination room and making odd gestures with his hands and arms. When asked what he was doing, Emilio reported "I am eating wires and lighting fires." Emilio is alert and oriented (i.e. knows name, date, place and situation). He is dressed in a ragged overcoat, bedroom slippers and a baseball cap. He appears younger than his stated age. He wears several medals around his neck. He is unkempt and smells as if he has not bathed in several days. His affect ranges from anger toward his mother to giggling and flirting with the interviewer. His speech has a childlike quality and he walks with small steps and exaggerated hip movements. The content of his speech is often incoherent, disorganized and marked by frequent rhyming and clang associations. There is no organized delusional thinking. Emilio's first hospitalization occurred after he dropped out of high school at age 16. Since that time he has never been able to attend school or hold a job. He lives with his elderly mother who is his only support. His mother reports Emilio disappears for months at a time. The police eventually pick up Emilio when he is wandering in the streets without regard for his personal safety. There is no known history of drug or alcohol abuse. He has never had fixed delusions. What is Emilio's diagnosis? A. Brief Psychotic Disorder B. Schizoaffective Disorder, Bipolar Type C. Schizophrenia D. Delusional Disorder, paranoid type B CYNTHIA Cynthia is a 45-year-old white married female who began exhibiting bizarre behavior in her therapist's office. Cynthia believed gang members were after her because she had a "secret" message. She reports hearing the gang members talking outside of her home office window. She did not know why she had this "secret," but knew she could not tell anyone or she would "vanish." Cynthia reports restless/poor sleep for the past 4 days. Her husband says Cynthia has been behaving in this manner for the past 3 days. She has not been eating, fearing the "gang members" were poisoning her food. She actually has not slept more than 2 hours for the past 3 days. Cynthia has no prior history of psychotic behavior. There is no history of substance abuse. Her therapist has been treating her for anxiety. Her husband noted that 1 week before Cynthia's behavior changed their 13 year old daughter revealed her maternal uncle has been sexually abusing her for the past 4 years. What is Cynthia's diagnosis? A. Schizophrenia B. Brief Psychotic Disorder C. Delusional Disorder, Persecutory Type D. Bipolar Disorder, Manic with Psychotic Features C TOM Tom is a 65-year-old white male with no prior history of psychiatric illness who came to the emergency room at his wife's and attorney's request. Over the past several days, Tom has been binge eating and then purging in order to "rid his body of Ativan," which is an anti anxiety medication. His wife reported that Tom has ingested over 30 yogurts the day prior to his admission, and he was also going to Little America and "grazing" at the food buffet then vomiting when he felt full. Tom believed that the more he ate, the more likely he would rid his body of the "Ativan toxins" and the healthier he would become. Tom began having difficulty 4 moths ago when the stock market declined and he reportedly lost $125,000. His wife noted that he was very anxious and stressed with the loss of money. He went to see his wife's physician who prescribed him three doses of Ativan for his anxiety and inability to sleep. After taking three doses, Tom reported feeling even more sick and weak than prior to medication administration. He blamed the Ativan for impairing his immune system and causing his stomach ulcer and prostate to flare-up. In response to his concerns, Tom sought out alternative medical treatments to get rid of the Ativan and boost his immune system. He sought help from an herbalist and acupuncturist. He denied ever being depressed or experiencing anxiety or psychosis. His wife noted that after Tom was treated with sulfa (antibiotic) for a prostate infection that he believed the mediation had made him weak. He stayed in bed most of the time for 1 year and constantly talked about his health. His persistent obsessions actually made his wife leave the house for a while because he was so obsessed with his health. On the mental status exam, Tom was cooperative but very anxious. He paced around the interview room. He was disheveled with messy hair. His speech was of normal speed and he expressed himself in an articulate manner. His affect was labile. At times Tom was tearful and "begged" to not be admitted to the hospital. He stated he was not having suicidal ideation, homocidal ideation, and was not experiencing any types of hallucinations. Tom was alert and oriented, but his insight and judgment were poor. Despite being given information to the contrary, Tom continued to believe that Ativan was still not out of system. What is Tom's diagnosis? A. Schizophrenia B. Brief Psychotic Disorder C. Delusional Disorder, Somatic Type D. Unspecified Schizophrenia Spectrum and Related Psychotic Disorder D LENNY Lenny is a 30 year old Caucasian male who is married. He complains people are taunting him outside of his apartment. Lenny reports that these people are laughing at him and telling everyone he is sexually inadequate. His wife reports that the began having these symptoms 10 days ago after he witnessed an armed robbery at his place of employment. Although no one was hurt, Lenny watched the gunmen intimidate three female employees during the robbery. Lenny was the only male and felt helpless to assist his co-workers. His wife also reports Lenny has no history of mental illness. Lenny is experiencing: A. Schizophreniform Disorder B. Delusional Disorder C. Schizoaffective Disorder, depressed type D. Brief Psychotic Disorder C ALICE Alice is a 24-year-old single female who has recently moved from Colorado to New York to work as a sales representative for a large publishing firm. She made an appointment with a new psychiatrist in New York to continue her treatment with lithium. She described how 3 years previously she was a successful college student in her senior year, doing well academically and enjoying an active social life. In the middle of her first semester, she began to feel depressed, experienced a decreased appetite, lost approximately 10 pounds, had trouble falling asleep and began waking up too early. After 2 months of feeling depressed, the symptoms seemed to go away. Soon after she began to feel increasingly energetic, requiring 2 to 5 hours of sleep at night and experienced "racing thoughts." She started to see symbolic meaning in things and began to suspect innocent comments on the TV were referring to her. Over the next month, she became increasingly euphoric, irritable, and overly talkative. She began to believe there was a hole in her head through which radar messages were being sent to her. These messages were controlling her thoughts or produced emotions of anger and sadness that were beyond her control. She also believed others could lead her thoughts, which she found irritating and intrusive. She described hearing voices that sometimes spoke about her in the third person and at other times ordered her to perform various acts, particularly sexual ones. Her friends, concerned about Alice's unusual behavior, took her to an emergency room where she was evaluated and admitted to an inpatient psychiatric unit. Alice was administered an anti-psychotic and a mood stabilizer (lithium). She responded well to the medications and by discharge the anti-psychotic medication had been discontinued. She has since maintained on lithium alone and has remained symptom free. Which of the following is the most likely diagnosis for the described behaviors? A. Cyclothymic Disorder B. Bipolar II Disorder C. Bipolar I Disorder D. Schizophrenia D TONY Tony Lester is a 29-year-old single male who came to the local mental health clinic for a possible "mood disorder." Tony's girlfriend told him he needed to "get therapy" because his moods "always jump around." He was reluctant to admit he was a "moody person," but he agreed to an evaluation to prove there is nothing wrong. Tony is a car salesman. He admits to having good days and bad days. He states his good days last 7 to 10 days. During this time he is charming, hardworking and successful at selling cars. He wakes up in the morning with a positive attitude, heightened social awareness, sharp thinking and high levels of confidence. He admits to being promiscuous, indulging in alcohol to enhance experiences. He also reports that it helps him sleep. At the end of these periods he becomes irritable and hostile. He indicates he is shifting into a bad period. On bad days, which last for 4 to 7 days, Tony sleeps 10 to 14 hours a day, has no energy, confidence or motivation. He doubts his ability to sell anything. He would rather sit on the couch than go to work. He sometimes becomes argumentative with customers and loses easy sales. Tony alienates friends because he is irritable and hostile. He has never met the criteria for major depressive disorder or manic episode. His symptoms are chronic. He reports that he "never had normal days." These experiences have been occurring since Tony was 14 years old. Which of the following BEST describe Tony's symptoms? A. Bipolar I B. Borderline Personality Disorder C. Persistent Depressive Disorder D. Cyclothymic Disorder TERM A DEFINITION ELI Eli is a 34-year old part-time graduate student who was seen at her universities student counseling center for feeling of depression. Eli is completing her Master's degree in Anthropology and supports herself by working as a cashier at a local grocery store. Eli recently broke up with her boyfriend, after dating for 3 years, because he was unwilling to marry or live with her. Since the relationship ended, Eli has been increasingly depressed, with a 10-pound weight gain, increase appetite, awakening in the middle of the night, feeling worthless and hopeless and unable to concentrate. She describes similar episodes over the past 10 years where she would feel depressed, sad, hopeless and helpless. Although she is currently depressed, Eli reports periods when she is "high." She describes an elevated mood, only needing 4 to 5 hours of sleep during the night, being "highly productive" an feeling quite happy. During these times she works many hours on her master's thesis, but cannot get anything done when she feels depressed. Which of the following is the best diagnosis? A. Bipolar II Disorder B. Persistent Depressive Disorder C. Bipolar I Disorder D. Cyclothymic Disorder LOCATION A C LEON Leon is a 45-year-old postal employee who was evaluated at a clinic specializing in the treatment of Mood Disorders. He claims to have felt constantly depressed since the first grade, without a period of "normal" mood for more than a few days at a time. His depression has been accompanied by lethargy, little or no interest or pleasure in anything, trouble concentrating, and feelings of inadequacy, pessimism, and resentfulness. his only periods of normal mood occur when he is home alone, listening to music or watching TV. Upon further questioning, Leon reveals he cannot ever remember feeling happy. Even before kindergarten, if he was asked to speak in front of a group of his parents' friends, his mind would "go blank" and he saw himself as a failure. He never felt like the answers he provided in class were correct. Even if his input was requested, Leon frequently mumbled. He met new children with his eyes lowered, fearing their scrutiny because he felt they would know he was worthless. He expected to feel humiliated and embarrassed. He was convinced that everyone around him thought he was "dumb" or "a jerk." Leon remains very self-conscious and "terrified" of meeting strangers. He had trouble finding a job because he did not think anyone would hire him. He passed the Civil Service exam at age 24, and was offered a job in the post office on the evening shift. He enjoyed his job, as it involved little contact with others. Although now he supervises a number of employees, he still finds it difficult to give instructions, even to people he has known for years. Leon has tried multiple antidepressants, but they have not been effective. Leon presents with a flat affect and poor eye contact. Speech is linear and goal directed, but he speaks softly. He continues to endorse feelings of worthlessness, low energy and hopelessness. Leon has never met the criteria for a major depressive episode nor had suicidal ideation. What is Leon's diagnosis? A. Bipolar I Disorder B. Major Depressive Disorder C. Persistent Depressive Disorder (Dysthymia) D. Unspecified depressive Disorder