A 34-year-old married man presents for psychiatric evaluation after almost hitting someone with his car while driving under the influence of marijuana. He reports he was prompted to seek treatment by his wife, with whom he has had several conflicts over the past few years about his ongoing marijuana use. He has continued to smoke marijuana daily since the event. He says he has smoked marijuana since he was a teenager, and now it is legal in some states. He does not see what the problem is. What is the appropriate diagnosis?
Cannabis dependence
Cannabis abuse disorder
Cannabis use disorder
Unspecified cannabis-related disorder
The Correct Answer is C
Choice A reason: Cannabis dependence was a term used in earlier diagnostic frameworks such as DSM-IV. It has since been replaced by the broader and more clinically accurate term “cannabis use disorder” in DSM-5, which encompasses both abuse and dependence.
Choice B reason: Cannabis abuse disorder is also an outdated term from DSM-IV. DSM-5 integrates abuse and dependence into a single diagnosis—cannabis use disorder—based on severity and symptom criteria.
Choice C reason: Cannabis use disorder is the correct DSM-5 diagnosis. It includes patterns of problematic use leading to significant impairment or distress, such as continued use despite interpersonal problems, legal issues, and risky behaviors like driving under the influence. The patient’s daily use, denial of the problem, and conflict with his spouse meet criteria for this diagnosis.
Choice D reason: Unspecified cannabis-related disorder is used when symptoms are present but do not meet full criteria for a specific diagnosis. In this case, the patient clearly meets criteria for cannabis use disorder, making this option inappropriate.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: While family and ethnicity are important cultural influences, this option omits socioeconomic status, which is a major determinant of health. It also lacks the broader systemic factors that shape health outcomes.
Choice B reason: Genetic predisposition is a biological determinant, not a cultural or influential one. This option mixes categories and does not accurately reflect the social determinants emphasized in public health frameworks.
Choice C reason: Community, environment, ethnicity, and socioeconomic status are widely recognized as key cultural and influential determinants of health. These factors shape access to care, exposure to risks, and overall well-being through social, economic, and environmental pathways.
Choice D reason: Physical safety is a component of environmental health but is not typically listed as a standalone determinant in major frameworks. This option omits socioeconomic status, which is essential for understanding disparities in health.
Correct Answer is A
Explanation
Choice A reason: Lorazepam is preferred in patients with hepatic impairment because it is metabolized through conjugation rather than oxidation. This makes it safer and more predictable in individuals with liver dysfunction. It is effective in managing alcohol withdrawal symptoms without accumulating toxic metabolites.
Choice B reason: Chlordiazepoxide is metabolized hepatically and has a long half-life. In patients with liver disease, it can accumulate and increase the risk of sedation and toxicity. It is generally avoided in hepatic impairment.
Choice C reason: Clonazepam is also metabolized by the liver and has a long half-life. It is not typically used for alcohol withdrawal and poses risks in hepatic disease.
Choice D reason: Diazepam is highly lipophilic and extensively metabolized by the liver. It has active metabolites that can accumulate in hepatic dysfunction, increasing the risk of oversedation and respiratory depression. It is not recommended in this context.
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