Final Exam: NR607 / NR 607 (Latest
Update ) Diagnosis &
Management in Psychiatric-Mental
Health III Practicum | Review
Questions & Answers | 100%
Correct | Grade A - Chamberlain
Question:
Arisa is a 47-year-old inmate who began a 3-year incarceration sentence two
weeks ago. She presents to the prison dispensary with complaints of dizziness.
She states that she has been experiencing dizziness when she bends over, and
she is always tired regardless of how long she sleeps or rests. She states that
these symptoms have been occurring since her incarceration; she has been
evaluated by both a primary provider and a neurologist. Her medical records
indicate that she has had a CT scan, magnetic resonance imaging (MRI) of
the head and neck, and vestibular testing, all of which were negative. Arisa
states "I hope someone here will take me seriously since nobody on the
outside would. I know I must have multiple sclerosis; a friend of mine was
diagnosed two years ago, and I have the same symptoms." She endorses
spending her free time using the library computers to look up symptoms and
worries about the symptom
Answer:
illness anxiety disorder
,Rationale: The most likely diagnosis for Arisa is illness anxiety disorder. her
primary symptom is dizziness when bending over, which is not pathologic.
Her fatigue may have multiple origins. She spends large amounts of time and
energy worrying about and researching her symptoms and the symptoms
have been present for several months. Because she experiences vague somatic
symptoms, the diagnosis of somatic symptom disorder is not appropriate.
Although there may be a concern that Arisa is feigning symptoms due to her
recent incarceration, there is evidence that her symptoms were present before
entering the prison environment; a diagnosis of malingering or factitious
disorder is not appropriate.
Question:
Saoirse is a 36-year-old who presents with a new onset of paralysis in her right
arm. She denies recent illness or injury. When the strength in her arm is
tested, there is evidence of give-away weakness. She reports that her
relationship with her significant other is contentious and stressful. She states
that she sometimes gets so angry with him that she wants to hit him, which
upsets her as she does not believe in using violence against others. She has a
history of depersonalization/derealization disorder. Despite the apparent
seriousness of the situation, she does not seem particularly concerned by the
paralysis. Which of the following is the most likely diagnosis for Saoirse?
-somatic symptom disorder
-factitious disorder
-functional neurological symptom disorder
-malingering
Answer:
functional neurological symptom disorder
,Rationale: The most likely diagnosis for Saoirse is functional neurological
symptom disorder. Saoirse presents with acute onset of a neurological
symptom in the absence of neurological disease or injury. She reports a
stressful relationship with a recent conflict with her significant other and has
a history of other psychological issues. Paralysis is a common presentation of
functional neurological symptom disorder (conversion disorder). She also
evidences la belle indifference as she seems unconcerned about the
impairment, which is common with functional neurological symptom
disorder.
Question:
What happens in the brain during a potentially traumatic event
Answer:
-brain stem is critical in fast, defensive responses. It's directly connected with
the retina
• retina sends visual info to the brain stem immediately, before higher levels of
brain are even aware of threat.
-If predator moves closer, periaqueductal gray initiates a fight or flight
response.
• periaqueductal gray activates the sympathetic nervous system
➣HR goes up, Blood flow to muscles increases, BP increases, Pupils dilate.
-Not always safe or possible to fight or escape.
• may enter the freeze response, or feigned death.
• periaqueductal gray activates the parasympathetic nervous system as well.
➣Muscles get tight & freeze, Both gaze & breath may freeze, not cognitive
choice
-"decisions" made at the level of the brain stem & nervous system
, -Predator doesn't move away, the person may shutdown completely
• Hr drops. RR drops. Some people stop breathing. Muscles become limp.
Metabolism shuts down. Endorphins released.
• person enters state of "no pain", no longer aware of their surroundings.
• During inescapable trauma, this is a very adaptive way for the brain and
body to respond.
Question:
Four Key Ways Collapse/Submit Can Present in a Client
Answer:
1. Compliance / Obedience
2. Treatment-Resistant Depression
3. Interpersonal Conflict
4. Social Avoidance / Desire to Isolate
Question:
Brain-based approaches to trauma
Answer:
-Top-down approaches
• Encourage different ways of thinking
• Cognitive-Behavioral Therapy (CBT)
• Dialectical-Behavior Therapy (DBT)
• Mindfulness-based Cognitive Therapy (MBCT)
Update ) Diagnosis &
Management in Psychiatric-Mental
Health III Practicum | Review
Questions & Answers | 100%
Correct | Grade A - Chamberlain
Question:
Arisa is a 47-year-old inmate who began a 3-year incarceration sentence two
weeks ago. She presents to the prison dispensary with complaints of dizziness.
She states that she has been experiencing dizziness when she bends over, and
she is always tired regardless of how long she sleeps or rests. She states that
these symptoms have been occurring since her incarceration; she has been
evaluated by both a primary provider and a neurologist. Her medical records
indicate that she has had a CT scan, magnetic resonance imaging (MRI) of
the head and neck, and vestibular testing, all of which were negative. Arisa
states "I hope someone here will take me seriously since nobody on the
outside would. I know I must have multiple sclerosis; a friend of mine was
diagnosed two years ago, and I have the same symptoms." She endorses
spending her free time using the library computers to look up symptoms and
worries about the symptom
Answer:
illness anxiety disorder
,Rationale: The most likely diagnosis for Arisa is illness anxiety disorder. her
primary symptom is dizziness when bending over, which is not pathologic.
Her fatigue may have multiple origins. She spends large amounts of time and
energy worrying about and researching her symptoms and the symptoms
have been present for several months. Because she experiences vague somatic
symptoms, the diagnosis of somatic symptom disorder is not appropriate.
Although there may be a concern that Arisa is feigning symptoms due to her
recent incarceration, there is evidence that her symptoms were present before
entering the prison environment; a diagnosis of malingering or factitious
disorder is not appropriate.
Question:
Saoirse is a 36-year-old who presents with a new onset of paralysis in her right
arm. She denies recent illness or injury. When the strength in her arm is
tested, there is evidence of give-away weakness. She reports that her
relationship with her significant other is contentious and stressful. She states
that she sometimes gets so angry with him that she wants to hit him, which
upsets her as she does not believe in using violence against others. She has a
history of depersonalization/derealization disorder. Despite the apparent
seriousness of the situation, she does not seem particularly concerned by the
paralysis. Which of the following is the most likely diagnosis for Saoirse?
-somatic symptom disorder
-factitious disorder
-functional neurological symptom disorder
-malingering
Answer:
functional neurological symptom disorder
,Rationale: The most likely diagnosis for Saoirse is functional neurological
symptom disorder. Saoirse presents with acute onset of a neurological
symptom in the absence of neurological disease or injury. She reports a
stressful relationship with a recent conflict with her significant other and has
a history of other psychological issues. Paralysis is a common presentation of
functional neurological symptom disorder (conversion disorder). She also
evidences la belle indifference as she seems unconcerned about the
impairment, which is common with functional neurological symptom
disorder.
Question:
What happens in the brain during a potentially traumatic event
Answer:
-brain stem is critical in fast, defensive responses. It's directly connected with
the retina
• retina sends visual info to the brain stem immediately, before higher levels of
brain are even aware of threat.
-If predator moves closer, periaqueductal gray initiates a fight or flight
response.
• periaqueductal gray activates the sympathetic nervous system
➣HR goes up, Blood flow to muscles increases, BP increases, Pupils dilate.
-Not always safe or possible to fight or escape.
• may enter the freeze response, or feigned death.
• periaqueductal gray activates the parasympathetic nervous system as well.
➣Muscles get tight & freeze, Both gaze & breath may freeze, not cognitive
choice
-"decisions" made at the level of the brain stem & nervous system
, -Predator doesn't move away, the person may shutdown completely
• Hr drops. RR drops. Some people stop breathing. Muscles become limp.
Metabolism shuts down. Endorphins released.
• person enters state of "no pain", no longer aware of their surroundings.
• During inescapable trauma, this is a very adaptive way for the brain and
body to respond.
Question:
Four Key Ways Collapse/Submit Can Present in a Client
Answer:
1. Compliance / Obedience
2. Treatment-Resistant Depression
3. Interpersonal Conflict
4. Social Avoidance / Desire to Isolate
Question:
Brain-based approaches to trauma
Answer:
-Top-down approaches
• Encourage different ways of thinking
• Cognitive-Behavioral Therapy (CBT)
• Dialectical-Behavior Therapy (DBT)
• Mindfulness-based Cognitive Therapy (MBCT)
