Some test materials for the vignette exam suggest writing questions yourself to get a behind-the-scenes view of the process. So I did. Here’s the first of several questions for the following exhibit. Who knows what the test really looks like?–this is based on samples from AATBS and the BBS. Not studying for the vignette? Try this anyway–it’s the same materials more-or-less, just tested in a different form. My answer and explanation are in comments.
In your first meeting with Kevin, 47, he tells you that he’s been “feeling funny” lately, having trouble getting up in the morning, sleeping “too much.” Kevin says he has “occasionally” used crack cocaine in the past, but says “I haven’t hit the pipe in a week.” Kevin has been homeless in the past. He currently lives in a sober living house downtown. Kevin tells you he sometimes thinks people are talking about him and laughing about him, “but it doesn’t bother me much.” Kevin says he has not worked since being laid off two years ago.
1. What are the major diagnostic considerations for this case?
1. Substance-induced psychosis
Major Depression
Schizoaffective Disorder
R/O Cocaine Dependence
2. Psychotic Disorder
R/O Substance induced psychosis
Major Depressive Disorder
Substance Abuse or Dependence
3. Schizophrenia, Paranoid Type
Depression NOS
PTSD
Substance abuse or dependence
4. Bipolar I Disorder
Brief Psychotic Disorder
Substance withdrawal delirium
R/O Cocaine Dependence
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Note: SWP a "he."
Anon. is right, provided the BBS is strict about getting dx wording right on the test (hope they are–makes it simpler). If #2 had read "A psychotic disorder" or "Psychotic Disorder NOS" than it'd be a sure winner. Many thanks.
I really agree that with this vignette you are stuck picking the best of the worst. Here it is using AATBS scoring.
1+1+1+2=5 Gets the nod because the BBS will never use a non-Dx
0+1+1+2=4 Must have meant Psychotic D/O NOS. Substance Abuse or Dependence is the one known slam dunk correct element. SWP is a smart cookie but she missed the scoring on that.
0+1+0+2=3 I see so little thought D/O or mood D/O that these get only one point as possible not probable. There is more evidence for depression than psychosis. The vignette takes pains to eliminate paranoia.
0+.5+0+2=2.5 No mania no delirium…
MY ANSWER: #2. HERE'S WHY:
1. Substance-induced psychosis (COULD BE)
Major Depression (COULD BE)
Schizoaffective Disorder (TOO LITTLE INFO IN EXHIBIT)
R/O Cocaine Dependence (COULD BE)
2. Psychotic Disorder (COULD BE)
R/O Substance induced psychosis (COULD BE)
Major Depressive Disorder (COULD BE)
Substance Abuse or Dependence (COULD BE)
3. Schizophrenia, Paranoid Type (COULD BE)
Depression NOS(COULD BE)
PTSD (NO EVIDENCE FOR PTSD IN EXHIBIT)
Substance abuse or dependence (COULD BE)
4. Bipolar I Disorder (NO EVIDENCE IN EXHIBIT)
Brief Psychotic Disorder (TIMELINE UNCLEAR)
Substance withdrawal delirium (COULD BE, BUT MADE-UP DX)
R/O Cocaine Dependence (COULD BE)
ANSWER (2) IS ALL "COULD BE" AND THEREFORE THE BEST OF THE ANSWER SETS PROVIDED.