LMHC Intake, Assessment, and Diagnosis 2 — Questions and Answers
Question 1: A client presents with a 2-week history of depressed mood, anhedonia, significant weight loss, insomnia, and feelings of worthlessness. Which DSM-5 diagnosis is MOST appropriate?
- Persistent Depressive Disorder
- Major Depressive Disorder (Correct answer)
- Adjustment Disorder with Depressed Mood
- Bipolar II Disorder, Depressive Episode
Correct answer: Major Depressive Disorder
Major Depressive Disorder requires 5+ symptoms including depressed mood or anhedonia lasting at least 2 weeks, which this client meets.
Question 2: During the intake interview, a client discloses that they recently lost their job and are struggling financially. The BEST way to document this information is under which assessment domain?
- Axis I clinical disorders
- Psychological stressors and support systems (Correct answer)
- Mental status examination findings
- Presenting problem and chief complaint
Correct answer: Psychological stressors and support systems
Financial stress and job loss are psychosocial stressors captured under the social history and stressors domain of a biopsychosocial assessment.
Question 3: Which structured clinical interview is widely considered the gold standard for establishing DSM-5 diagnoses in research and clinical settings?
- Hamilton Rating Scale for Depression (HAM-D)
- Structured Clinical Interview for DSM-5 (SCID-5) (Correct answer)
- Beck Depression Inventory-II (BDI-II)
- Global Assessment of Functioning (GAF)
Correct answer: Structured Clinical Interview for DSM-5 (SCID-5)
The SCID-5 is a semi-structured interview designed to yield reliable DSM-5 diagnoses and is considered the gold standard diagnostic tool.
Question 4: A counselor is assessing a 16-year-old client who reports using alcohol on weekends but denies it causes problems. What is the MOST appropriate next step?
- Accept the client's self-report and document no substance use disorder
- Administer a validated adolescent substance use screening tool such as the CRAFFT (Correct answer)
- Immediately refer to a substance abuse treatment program
- Diagnose Alcohol Use Disorder, Mild based on self-reported use
Correct answer: Administer a validated adolescent substance use screening tool such as the CRAFFT
The CRAFFT is a validated screening tool for adolescent substance use that goes beyond self-report to identify risk and problem patterns.
Question 5: A client scores 15 on the PHQ-9. What level of depression severity does this indicate?
- Mild depression
- Moderate depression
- Moderately severe depression (Correct answer)
- Severe depression
Correct answer: Moderately severe depression
PHQ-9 scores of 15–19 indicate moderately severe depression, guiding treatment planning decisions.
Question 6: Which of the following BEST describes the purpose of a mental status examination (MSE) during intake?
- To gather a detailed developmental and social history
- To obtain a systematic snapshot of the client's current cognitive and emotional functioning (Correct answer)
- To administer standardized psychometric tests for diagnosis
- To evaluate the client's readiness for change using motivational interviewing
Correct answer: To obtain a systematic snapshot of the client's current cognitive and emotional functioning
The MSE provides a structured assessment of appearance, behavior, speech, affect, thought, cognition, insight, and judgment at the time of the interview.
Question 7: A client reports experiencing intense fear of social situations and avoids them due to worry about embarrassing themselves for more than 6 months. Which diagnosis should the counselor consider FIRST?
- Specific Phobia
- Panic Disorder
- Social Anxiety Disorder (Social Phobia) (Correct answer)
- Agoraphobia
Correct answer: Social Anxiety Disorder (Social Phobia)
Social Anxiety Disorder is characterized by marked fear of social situations due to fear of scrutiny or embarrassment, lasting 6+ months and causing functional impairment.
LMHC Intake, Assessment, and Diagnosis 2
A client presents with a 2-week history of depressed mood, anhedonia, significant weight loss, insomnia, and feelings of worthlessness.
Which DSM-5 diagnosis is MOST appropriate?