Explanations to Discrete Practice Questions

1. C
   Negative symptoms are the absence of normal or desired behavior, which include disturbance of affect and avolition. Positive symptoms are the addition of abnormal behavior, including hallucinations, (A), disorganized behavior, (B), and delusions, (D).
2. A
   Echolalia is an involuntary repetition of others’ words and utterances and may be seen in schizophrenia. Echopraxia, (B), is imitation of others’ actions. Loosening of associations, (C), is a type of disordered thought in which the patient moves between remotely related ideas. Neologisms, (D), are newly invented words.
3. A
   Focusing on details, loving routine, having a sense that there is only one right way to do things, and lack of humor suggests an obsessive–compulsive personality disorder.
4. C
   Depression is marked by a period of at least two weeks in which the patient has five of nine cardinal symptoms, one of which must be depressed mood or lack of interest (anhedonia). While decreased need for sleep is commonly seen in manic episodes, it may also appear in depression as sleep disturbance is one of the nine cardinal symptoms. Not all depressed individuals are suicidal, as in (B). In older men, depression may often manifest as anhedonia without feelings of sadness, invalidating (D).
5. C
   The central issue is the negative appraisal of his own appearance, indicating body dysmorphic disorder. Thus, it is likely that all other symptoms this patient is experiencing arise from this disorder. The other disorders listed in the answer choices cannot explain all the symptoms.
6. D
   Dissociative fugue is characterized by sudden travel or change in normal day-to-day activities and occurs in some cases of dissociative amnesia. Symptoms include an inability to recall one’s past or confusion about one’s identity.
7. D
   Agoraphobia, or a fear of places or situations in which it would be difficult to escape, is commonly seen in panic disorder. Concern about having a panic attack in public may make these individuals fearful of leaving their home.
8. B
   In illness anxiety disorder, the person is preoccupied with fears that he has—or will come down with—a serious disease, and these fears continue even after medical exams and tests have returned negative results.
9. A

   The symptoms listed indicate a major depressive episode. However, depressive episodes can be a part of bipolar disorders, which also contain manic episodes. Thus, if manic episodes have not yet been asked about, one cannot choose depression or bipolar disorder as the correct diagnosis yet.

10. B
    To determine if this patient has major depressive disorder or a bipolar disorder, the presence of manic (or hypomanic) episodes should be confirmed. Bipolar disorders contain manic (or hypomanic) episodes, while major depressive disorder does not.
11. D
    Exhibiting signs of panic and irrational fear without any instigating object present indicates panic disorder. The teenager may have diagnoses of both specific phobia (for snakes) and panic disorder.
12. B
    Splitting, the consideration of others as either “all good” or “all bad,” is characteristic of borderline personality disorder.
13. A
    Conversion disorder is marked by a motor or sensory symptom in the absence of an underlying physical or neurological cause. It is associated with an inciting event that, in this case, may have been the argument with her daughter. Her lack of concern over the deficit is referred to as la belle indifférence.
14. C
    The symptoms indicate that the woman’s father likely has Parkinson’s disease. This disease is caused by decreased dopamine production in the substantia nigra.
15. B
    Bipolar disorders have been shown to be highly heritable and are associated with increased levels of norepinephrine and serotonin in the brain. Bipolar I disorder can be diagnosed with a single manic episode and does not require a major depressive episode. Bipolar II disorder requires at least one hypomanic episode and one major depressive episode. Cyclothymic disorder contains at least one hypomanic episode and dysthymia.