Which level of prevention would be most appropriate for a patient suffering from major depression with suicidal tendencies?

Choice A rationale

Although diagnostic tools (like rating scales or questionnaires) are often used to gather information from parents and teachers, the diagnosis of ADHD is fundamentally a clinical diagnosis. It is based on a structured clinical interview and the persistence and pervasiveness of symptoms, not merely confirmation by a specific psychological or diagnostic test.

Choice B rationale

While ADHD symptoms can indeed be exacerbated by severe stress, the diagnostic criteria from the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) mandate that the symptoms must be present for at least 6 months and be inconsistent with the developmental level. They must be present before age 12 and cause clinically significant impairment in functioning, not just worsen under stress.

Choice C rationale

The DSM-5 criteria for ADHD require that the symptoms of inattention, hyperactivity, and impulsivity must be present in two or more settings (e.g., home, school, work, or with friends/relatives). This cross-situational requirement is crucial because it helps to rule out a disorder whose symptoms are simply a reaction to a specific situational stressor or environmental trigger.

Choice D rationale

While clinical observations are a part of the diagnostic process, the diagnosis relies significantly on historical data and reports from parents, teachers, and the individual, using established criteria. Requiring symptoms to be confirmed only by supervised clinical observations would be impractical and insufficient, as symptoms may fluctuate and may not be consistently present during a brief observation.

Choice A rationale

Aversion therapy is a behavioral therapy that uses the principles of classical conditioning to help a client reduce or stop an undesirable behavior, such as alcohol consumption. It pairs the unwanted behavior with a noxious stimulus, which, in the case of disulfiram, is the unpleasant physical reaction (nausea, vomiting) caused by acetaldehyde accumulation from alcohol metabolism blockade. This creates a conditioned aversion to alcohol.

Choice B rationale

Biofeedback is a technique that teaches a client to control involuntary physiological responses, such as heart rate or muscle tension, by providing real-time visual or auditory feedback about these functions. It operates on the basis of operant conditioning, allowing the client to modify their responses to achieve a desired physical state, and it is not typically used to directly treat substance use disorder in this manner.

Choice C rationale

Flooding is an exposure-based behavioral therapy used primarily for anxiety disorders, such as phobias. It involves exposing the client to a maximally anxiety-provoking stimulus (the feared object or situation) for a prolonged period, preventing escape, which allows habituation and extinction of the conditioned fear response to occur. This is not the mechanism of action for disulfiram.

Choice D rationale

Dialectical behavior therapy (DBT) is a comprehensive, evidence-based psychotherapy originally developed for clients with borderline personality disorder. It combines cognitive-behavioral techniques with mindfulness and emotional regulation strategies. DBT is a structured, long-term approach focusing on skills training and is distinct from the pharmacologically-induced classical conditioning of aversion therapy.