ABPN Psychiatric Assessment and Diagnosis 2 — Questions and Answers
Question 1: A patient reports depressed mood, anhedonia, insomnia, and fatigue for the past 3 weeks following the death of a spouse. Which factor most strongly favors a diagnosis of Major Depressive Disorder over normal grief?
- Presence of tearfulness when reminded of the deceased
- Persistent thoughts of worthlessness and suicidal ideation not focused on the deceased (Correct answer)
- Waves of sadness that come and go
- Ability to experience positive emotions with support
Correct answer: Persistent thoughts of worthlessness and suicidal ideation not focused on the deceased
Pervasive worthlessness and self-focused suicidal ideation are characteristic of MDD rather than uncomplicated bereavement.
Question 2: During a Mental Status Examination, a clinician notes that a patient shifts rapidly between loosely related topics without reaching a point. This is best documented as:
- Circumstantiality
- Tangentiality
- Flight of ideas (Correct answer)
- Thought blocking
Correct answer: Flight of ideas
Flight of ideas is a rapid, continuous flow of accelerated speech with abrupt shifts between related topics, often seen in mania.
Question 3: What is the minimum symptom duration required to diagnose Generalized Anxiety Disorder per DSM-5?
- 1 month
- 3 months
- 6 months (Correct answer)
- 12 months
Correct answer: 6 months
GAD requires excessive anxiety and worry occurring more days than not for at least 6 months.
Question 4: A patient believes that news anchors are sending them personal coded messages. This symptom is classified as a:
- Idea of reference / delusion of reference (Correct answer)
- Thought insertion
- Auditory hallucination
- Delusion of grandeur
Correct answer: Idea of reference / delusion of reference
Interpreting neutral external events as having special personal meaning is a delusion (or idea) of reference.
Question 5: Which screening instrument is most commonly used in primary care to assess depression severity?
- MMSE
- PHQ-9 (Correct answer)
- AUDIT
- Y-BOCS
Correct answer: PHQ-9
The PHQ-9 is a validated 9-item self-report tool that maps onto DSM depression criteria and quantifies severity.
Question 6: A patient with suspected dementia scores 22/30 on cognitive testing with deficits in delayed recall and orientation. Which bedside instrument produced this score range?
- GAD-7
- MMSE (Correct answer)
- PHQ-9
- CAGE
Correct answer: MMSE
The Mini-Mental State Examination is scored out of 30 and tests orientation, recall, attention, and language.
Question 7: When assessing suicide risk, which of the following is considered a protective factor?
- Recent discharge from a psychiatric hospital
- Access to firearms
- Strong social support and religious beliefs (Correct answer)
- History of prior attempts
Correct answer: Strong social support and religious beliefs
Robust social connectedness and moral or religious objections to suicide reduce risk.
ABPN Psychiatric Assessment and Diagnosis 2
A patient reports depressed mood, anhedonia, insomnia, and fatigue for the past 3 weeks following the death of a spouse.
Which factor most strongly favors a diagnosis of Major Depressive Disorder over normal grief?