I would like to introduce a new column for Psychiatric News titled DSM-5 Self-Exam. The purpose of this column is to provide a series of questions concerning each of the categories of psychiatric disorders contained within DSM-5. Questions will appear in the column, and the answers and rationales will be posted at http://psychnews.org/pdfs/DSM-5_Self_Examination_QandA.pdf.
These questions were developed under the leadership of Philip Muskin, M.D., a professor of clinical psychiatry at Columbia University College of Physicians and Surgeons. Dr. Muskin and several of his colleagues at Columbia are the authors of the questions. The questions are not intended to be board-review questions but were developed to focus on particular areas that they felt were important in understanding the new diagnostic criteria for DSM-5.
If you find these questions helpful, you may preorder the book from which they come, DSM-5 Self-ExamQuestions: Test Questions for the Diagnostic Criteria, at http://www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62467.
The book will be published by American Psychiatric Publishing in August. It contains 500 questions for all the categories of psychiatric disorders and includes Section III. I believe you’ll find these resources helpful in your understanding of the disorders contained in DSM-5.
This column includes three questions concerning sleep-wake disorders. A number of changes occurred in DSM-5 concerning sleep disorders. For instance, DSM-5 removes the diagnosis of primary insomnia in favor of insomnia disorder to avoid the primary/secondary designation. DSM-5 also distinguishes narcolepsy/hypocretin deficiency from other forms of hypersomnia. Breathing-related sleep disorders are divided into obstructive versus central form subtypes. The subtypes of circadian rhythm sleep disorders are expanded to include advanced sleep-phase syndrome, irregular sleep-wake type and free-running type, while removing jet lag. These are just a few of the changes. The questions below will test your knowledge of these disorders and others contained in the manual.
The DSM-IV diagnosis of breathing-related sleep disorder would be given to an individual complaining of excessive daytime sleepiness, with nocturnal polysomnography demonstrating episodic loss of ventilatory effort and resulting apneic episodes occurring 10 to 20 times per hour, whose symptoms cannot be attributed to another mental disorder, medication, substance, or a general medical condition. In DSM-5, what would be the most likely diagnosis for the same individual?
a) Breathing-related sleep disorder
c) Obstructive sleep apnea
d) Central sleep apnea
e) Kleine-Levin syndrome
A 67-year-old woman complains of insomnia. She does not have trouble falling asleep between 10 p.m. and 11 p.m., but after one to two hours, she awakens for several hours in the middle of the night, sleeps again for two to four hours in the early morning, and then naps three or four times during the day for one to three hours at a time. She has a family history of dementia. On exam she appears fatigued and has deficits in short-term memory, calculation, and abstraction. What is her sleep disorder diagnosis?
a) Major neurocognitive disorder
b) Circadian rhythm sleep disorder, irregular sleep-wake type
c) Psychophysiological insomnia
d) Insomnia disorder
e) Major depressive disorder
Which of the following is a non-REM sleep arousal disorder in DSM-5?
a) REM sleep behavioral disorder
b) Sleep terror
c) Nightmare disorder
e) Confusional arousal ■