Lighter FlameSome 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
Substance abuse or dependence

4. Bipolar I Disorder
Brief Psychotic Disorder
Substance withdrawal delirium
R/O Cocaine Dependence

August 9, 2009
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