Which of the following represents one of the key changes from the DSM-4 to the DSM-5?
DSM-4 considered homosexuality a psychiatric illness
DSM-5 no longer considers psychosocial and environmental issues when assessing a patient
DSM-5 uses two axes instead of five
DSM-4 used a multiaxial approach to psychiatric assessment
The Correct Answer is D
Choice A reason: This choice is incorrect because DSM-4 had already removed homosexuality as a psychiatric disorder in 1973, long before DSM-4 or DSM-5. Therefore, this does not represent a change between DSM-4 and DSM-5.
Choice B reason: This choice is incorrect because DSM-5 actually emphasizes consideration of psychosocial and contextual factors in diagnosis, rather than eliminating them. The assessment still incorporates these factors in clinical formulation.
Choice C reason: This choice is incorrect because DSM-5 eliminated the multiaxial system, which had five axes in DSM-4, and did not replace it with a two-axis system. The DSM-5 uses a single-axis approach with dimensional assessments.
Choice D reason: This choice is correct because DSM-5 removed the multiaxial assessment system that was used in DSM-4, which included five separate axes for diagnosis. This is one of the primary structural changes between the two editions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Bipolar I disorder requires at least one manic episode, not just hypomania, making this inconsistent with the presentation.
Choice B reason: Bipolar II disorder is characterized by at least one hypomanic episode and at least one major depressive episode without a history of full mania, matching the client’s symptoms.
Choice C reason: Cyclothymic disorder involves chronic, milder mood fluctuations but does not meet criteria for full hypomanic or major depressive episodes.
Choice D reason: Schizoaffective disorder includes mood episodes along with psychotic symptoms, which are not reported in this client’s history.
Correct Answer is B
Explanation
Choice A reason: Rapid cycling is associated with a poorer response to lithium, often requiring alternative or adjunctive therapies.
Choice B reason: Clear euthymic intervals between episodes are associated with classic bipolar disorder, which predicts a favorable response to lithium treatment.
Choice C reason: Psychotic symptoms do not reliably predict lithium response; these patients may require additional antipsychotic therapy.
Choice D reason: Mixed episodes often respond less predictably to lithium alone and may need combination therapy.
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