NBOME Behavioral Health & Psychiatry 1 — Questions and Answers
Question 1: According to DSM-5, which of the following is required for a diagnosis of Major Depressive Disorder?
- At least 5 symptoms present for at least 2 weeks, including depressed mood or anhedonia (Correct answer)
- At least 3 symptoms present for at least 1 week, including psychosis
- At least 5 symptoms present for at least 1 month, including insomnia
- At least 7 symptoms present for at least 2 weeks, including suicidal ideation
Correct answer: At least 5 symptoms present for at least 2 weeks, including depressed mood or anhedonia
DSM-5 requires ≥5 depressive symptoms for ≥2 weeks, with at least one being depressed mood or anhedonia (loss of interest).
Question 2: A 25-year-old presents with disorganized speech, auditory hallucinations, and flat affect persisting for 8 months without any mood episodes. What is the most likely diagnosis?
- Schizoaffective disorder
- Schizophrenia (Correct answer)
- Brief psychotic disorder
- Schizophreniform disorder
Correct answer: Schizophrenia
Schizophrenia requires ≥2 characteristic symptoms for ≥6 months with active psychotic symptoms for ≥1 month and no prominent mood episodes.
Question 3: A 30-year-old woman has recurrent unexpected panic attacks with persistent worry about future attacks and avoidance behaviors for 3 months. Which feature would be INCONSISTENT with a panic disorder diagnosis?
- Palpitations and diaphoresis during attacks
- Fear of losing control
- Attacks triggered exclusively by social evaluation situations (Correct answer)
- Derealization during attacks
Correct answer: Attacks triggered exclusively by social evaluation situations
Panic disorder involves unexpected (uncued) panic attacks; attacks triggered exclusively by social situations are more consistent with social anxiety disorder.
Question 4: A patient on lithium presents with coarse tremor, confusion, and vomiting. His serum lithium level is 2.5 mEq/L. Which is the most appropriate immediate intervention?
- Reduce the lithium dose by 50% and recheck level in 12 hours
- Administer IV sodium bicarbonate to alkalinize the urine
- Discontinue lithium immediately and provide supportive care with IV normal saline (Correct answer)
- Add a benzodiazepine to manage the tremor and agitation
Correct answer: Discontinue lithium immediately and provide supportive care with IV normal saline
Lithium toxicity (level >2.0 mEq/L) with clinical symptoms requires immediate drug discontinuation; IV normal saline expands volume and promotes renal lithium clearance.
Question 5: Which mechanism best explains the antidepressant effect of selective serotonin reuptake inhibitors (SSRIs)?
- Blocking presynaptic dopamine D2 receptors
- Irreversibly inhibiting monoamine oxidase A and B
- Blocking the serotonin transporter (SERT) at the presynaptic terminal (Correct answer)
- Stimulating postsynaptic 5-HT1A autoreceptors directly
Correct answer: Blocking the serotonin transporter (SERT) at the presynaptic terminal
SSRIs block SERT, preventing serotonin reuptake into the presynaptic neuron and thereby increasing serotonin concentration in the synaptic cleft.
Question 6: Which feature most clearly distinguishes Bipolar I from Bipolar II disorder?
- Depressive episodes occur only in Bipolar II
- Bipolar I requires at least one full manic episode; Bipolar II involves only hypomania (Correct answer)
- Psychotic features are exclusive to Bipolar II
- Mood episodes are shorter in duration in Bipolar I
Correct answer: Bipolar I requires at least one full manic episode; Bipolar II involves only hypomania
Bipolar I requires at least one full manic episode (≥7 days or requiring hospitalization), while Bipolar II involves hypomanic episodes (≥4 days, not severe enough to cause marked impairment or require hospitalization).
Question 7: A combat veteran reports intrusive flashbacks, avoidance of war-related cues, negative cognitions about himself and the world, and hypervigilance persisting for 6 weeks following return from deployment. What is the minimum symptom duration required to diagnose PTSD per DSM-5?
- More than 1 month (Correct answer)
- More than 3 months
- More than 6 months
- More than 2 weeks
Correct answer: More than 1 month
DSM-5 requires PTSD symptoms to persist for more than 1 month; symptoms lasting 3 days to 1 month following trauma meet criteria for Acute Stress Disorder instead.
NBOME Behavioral Health & Psychiatry 1
According to DSM-5, which of the following is required for a diagnosis of Major Depressive Disorder?