A client who is restricting their food intake and refuse to maintain minimal healthy weight due to strong fear of gaining weight or being “fat” and endorses a disturbance in body image and self-esteem with a  BMI of 16 will be diagnosed with:

You are working on an inpatient psychiatry unit and one of the new registered nurses tells you that she is caring for a patient with a diagnosis of a manic episode with mixed features.  She asks you to explain what this means.  You advise the nurse that patients experiencing episodes of bipolar mania, hypomania, and major depression can also experience symptoms of opposite polarity (mixed features).  You explain that a manic episode with mixed features is defined as an episode that meets the diagnostic criteria for mania along with at least three of the defined symptoms being present on most days of the episode.  Which of the following is NOT included in the defined symptoms associated with a manic episode with mixed features? 

Which disorder is characterized by the preoccupation with one or more perceived defects or flaws in physical appearance that are not observable by others and involves performed repetitive behaviors (e.g. mirror checking, excessive grooming, skin picking, reassurance seeking).

Your new patient is a 20-year-old African American male.  Police escort recently brought him to the ER after showing up at the university that he was suspended from a few months earlier. A professor who reported that the client walked into the classroom stating, “I am the Joker, and I am looking for Batman.”  He also refused to leave the class. Until a year ago, he was very successful in school; however, his behavior has become increasingly odd during the past year. He stopped seeing his friends and spent most of his time lying in bed staring at the ceiling. He lived with several family members but rarely spoke to any of them. He had been suspended from college because of the lack of attendance. His sister said that she has seen him mumbling quietly to himself and noted that he would sometimes, at night, stand on the roof of their home and wave his arms as if he “were conducting a symphony.” He denies having any intention of jumping from the roof or having any thoughts of self-harm but claimed that he felt liberated and in tune with the music when he was on the roof. He had never seen a psychiatrist and had no prior hospitalizations. During the prior several months, He had become increasingly preoccupied with the female friend, who lives down the street. He insisted to his family that they were engaged. His sister reported that she spoke to the female friend and she reported that she had hardly spoken to the client and certainly was not dating him. His sister also reported that he had written many letters to the female friend but never mailed them. His family said that they had never known him to use of illicit substances or alcohol, and his toxicology screening was negative.  When asked about drug use he appeared angry and did not answer.  On exam, your client was a well-groomed young man who was generally uncooperative. His affect appeared constricted and guarded. He was also inattentive and preoccupied. He was noted to have grandiose, and romantic delusions. He appeared to be internally preoccupied, although he denied hallucinations. He reported feeling bad but denied depression and reported no disturbance in sleep or appetite. He was oriented and spoke articulately but refused formal cognitive testing. Insight and judgment were deemed to be poor.  Family history revealed that his grandmother had died in a state psychiatric hospital, where she had lived for 30 years. Her diagnosis was unknown. His mother was reportedly “crazy.” She had abandoned the family when he was young and his father and paternal grandmother raised him. What is the most appropriate psychiatric diagnosis?

A 12-year-old boy is referred to the psychiatric nurse practitioner in an adolescent partial hospitalization program due to repeated conflicts that have frightened both classmates and family members. According to his parents, the boy was generally “moody and irritable” with frequent episodes of “being a raging monster.” It has become almost impossible to set limits. Most recently he had smashed the closet door to gain access to a videogame that has been withheld to encourage him to do homework. At school he was noted to have a “hair-trigger temper,” and he had recently been suspended for punching another boy in the face after losing a chess match. He has been an “extremely active” young boy “running all the time,” he was also a “sensitive kid” who constantly worried that things might go wrong. His tolerance for frustration has been less than that of his peers, and his parents quit taking him shopping because he would predictably become upset whenever they did not buy him the toy he wanted. School reports indicated that he was fidgety, had wondering attention and was impulsive. When he was 10, a psychiatrist diagnosed him with ADHD combined type. He was referred to a behavioral therapist and started taking methylphenidate with an improvement in symptoms. By the fourth grade, his moodiness became more pronounced and persistent. He was generally “surly” complaining, “life is unfair.” He and his parents begin daily limit setting battles begin at breakfast, by delaying getting ready for school and the arguments continued after school about homework videogames and bedtime. The arguments often included screaming and throwing nearby objects. By the time he reached 6th grade, his parents were tired and his siblings avoided him. According to Wyatt’s parents, he had no problems with appetite, and although they fought about when he would go to bed, he did not appear to have a sleep disturbance. He appeared to find pleasure in his usual activities, maintained good energy and had no history of elation, grandiosity or decreased need for sleep lasting more than a day. Although they described him as “moody, isolated and lonely” his parents did not see him as depressed. They denied any history of hallucinations, abuse, trauma, suicidality, homicidality, or self-harm or premeditated harm to others. He and his parents denied drugs or alcohol use. His medical history was unremarkable. His family history and was notable for anxiety and depression in the father, alcoholism in the paternal grandparents, and possibly untreated ADHD in the mother. On interview, he was mildly anxious but easy to engage. His body twisted back-and-forth as he sat in the chair. In reviewing his temper outbursts and physical aggression, is said, “it’s like a can’t help myself I don’t mean to do these things but when I get mad I don’t think about any of that. It’s like my mind goes blank.” When asked how he felt about his outburst, he looked very sad and said, “I hate when I’m that way.” If he could change three things in his life he replied, “I would have more friends, I would do better in school, and I would stop getting mad so much.” What is the most appropriate primary psychiatric diagnosis?

All of the following are true regarding the course of panic disorder, except: 

Which disorder is characterized by low mood, decreased interest in activities, weight changes, sleep changes, psychomotor changes, fatique, guilt, difficulty concentrating, and thoughts of death for a period of two weeks or more?

Which of the following symptoms would NOT be classified as a positive symptom in patients with schizophrenia? 

What is the proper balance between confidentiality for an adolescent and sufficient communication with the parent?

A 24-year-old male initially presents with acute auditory hallucinations and is treated with medication. Four days later he arrives at your office for evaluation. You observe that he is neatly dressed, avoids eye contact, and give very short answers to your initial questions. Which of the following questions would be most beneficial for determining his degree of negative symptoms?