6665 Final Exam Walden University
PMHNP Across the Lifespan
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Question 1
Which of the following supports a good prognosis for a person with a conversion disorder?
- Insidious onset
- Clearly identifiable stressors at time of onset
- Average intelligence
- B and C
Question 2
Discrete episodes of losing control of aggressive impulses grossly out of proportion to any stressors, which can result in serious assault tor destruction of property are symptoms consistent with which of the following disorders?
- Conduct disorder
- Anti-social personality disorder
- Borderline personality disorder
- Intermittent explosive disorder
Question 3
Persons who continually use the internet to play games to the extent that it interferes with social relations and work performance are exhibiting symptoms most specifically consistent with which of the following conditions?
- Obsessive gaming disorder
- Internet gaming disorder
- Internet use
- Internet abuse
Question 4
Which of the following is consistent with what is known about kleptomania?
- The stealing is well planned.
- The stealing often involves others.
- Risk of consequences of being caught are typically carefully considered.
- The goal for the person with kleptomania is the act of stealing.
Question 5
Which of the following speech and language skills are consistent with normal developmental milestones of a 3-year-old?
- Uses three-word sentences; names body parts.
- Uses two-word sentences; understands me and you
- Follows three-step request; tells stories
- Responds to “why?”; likes rhyming words
Question 6
Which of the following questions would be important when differentiating pyromania from conduct disorder or antisocial personality disorder? Check all that apply.
- Was the fire set in response to a delusion or hallucination?
- Was the fire set deliberately, not a failure to resist an impulse?
- Was the fire set as an act of sabotage?
- Was the fire set with a failure to appreciate the consequences of the act?
Question 7
Which of the following would not be included in the treatment plan for a patient with illness anxiety disorder?
- Behavioral therapy
- Group psychotherapy
- Insight oriented psychotherapy
- Exploratory invasive procedures to obtain diagnosis
Question 8
Difficulty with immediate memory is attributed to impairment in which of the following regions of the brain? Select all that apply.
- Broca
- Wernicke
- Occipital
- Temporal
Question 9
A tension state that can exist without an action is known as which of the following?
- An obsession
- A compulsion
- An impulse
- Ego dystonic
Question 10
The Confusion Assessment Methods Instrument (CAMI) is a standardized assessment tool for which of the following disorders?
- Dementia
- Delirium
- Pick’s disease
- A and C
Question 11
The second-most common type of dementia caused by cardiovascular and cerebrovascular disease with progressive cognitive decline in stepwise fashion is known as which of the following?
- Pick’s disease
- HIV dementia
- Vascular dementia
- Lewy-body dementia
Question 12
Which of the following is an example of a medical complication of psychiatric conditions or treatment?
- Dementia
- Neuroleptic Malignant syndrome
- Depression related to limb amputation
- Recurrence of depressive disorder in setting of cancer treatment
Question 13
Which of the following conditions associated with childhood are part of the five conditions which comprise disruptive, impulse-control, and conduct disorders?
- Autism spectrum disorder
- Reactive attachment disorder
- Oppositional defiant disorder
- Attention-deficit/hyperactivity disorder
Question 14
A precipitous onset prion disease, with rapid decline, progressing to death within 6 months of onset is known as which of the following?
- Pick’s disease
- Lewy body dementia
- Kluver-Bucy syndrome
- Creutzfeldt-Jakob disease
Question 15
A person reveals to the ARNP that they steal to get the things they want and cannot afford. The person says they just can’t help themselves, because they have kleptomania. The ARNP realizes the following:
- This presentation is consistent with kleptomania.
- This presentation is not consistent with kleptomania because a person with kleptomania does not realize they have kleptomania.
- The person likely does not have kleptomania because a person with kleptomania is more concerned with the act of stealing rather than the obtaining the object which has been stolen.
- The presentation is consistent with kleptomania because the person is stealing things they need.
Question 16
The ARNP evaluates a 4-year-old who cannot balance on one foot for 3 seconds, cannot copy a circle and realizes which of the following?
- This is normal for a 4-year-old.
- This is a developmental red flag for a 4-year-old that should trigger a specialized assessment.
- This is a developmental red flag for a 5-year-old so do nothing at this point.
- This is a minor concern, the APRN advises to enroll the child in gymnastics for balance and an art class to learn to draw better.
Question 17
A person erroneously believes they sustained an emotional or physical trauma in early life is known as which of the following?
- Ganser syndrome
- False memory syndrome
- Factitious dissociative identity disorder
- Imitative dissociative identity disorder
Question 18
A major neurocognitive disorder with severe impairment in memory, judgment, orientation, and cognition is known as which of the following?
- Delirium
- Dementia
- Psychosis
- Amnesia
Question 19
The diagnosis formerly known as multiple personality disorder is now known as which of the following?
- Dissociative fugue
- Dissociative identity disorder
- Factitious dissociative identity disorder
- None of the above
Question 20
A patient expresses feelings of unreality or of being detached from their environment, describing the perception of the outside world as unreal, dreamlike, and visually distorted. The ARNP recognizes this as which of the following?
- Derealization
- Depersonalization
- Generalized amnesia
- Dissociative identity disorder
Question 22
Patients who simulate, induce, or aggravate illness to receive medical attention, regardless of whether or not they are ill, would be diagnosed with which of the following disorders?
- Factitious disorder
- Conversion disorder
- Somatization disorder
- Illness anxiety disorder
Question 23
Which of the following is true about compulsions?
- The person feels compelled to act out their pathological behavior.
- Compulsions are usually ego-dystonic.
- Compulsions are acted upon with the expectation of receiving pleasure.
- A and B only
Question 24
Which of the following is a common sensory deficit of conversion disorder? Check all that apply.
- Blindness
- Tunnel vision
- Blindness
- Deafness
Question 25
Which of the following statements is consistent with literature about the epidemiology of pyromania?
- Pyromania is more frequently seen in men rather than women.
- Most patients who set fires can be classified as having pyromania.
- More than 40 percent of people with pyromania are younger than 18 years of age.
- A and C
Question 26
Which of the following conversion disorder symptoms are associated with a good prognosis?
- Tremors and aphonia
- Tremors and seizures
- Paralysis and seizures
- Paralysis and blindness
Question 27
Data supports which of the following demographics of persons with conversions disorder?
- Conversion disorder is most common among rural people.
- Conversion disorder is most common among persons in higher socioeconomic groups
- Conversion disorder is most common among persons with higher education
- Conversion disorder is most common in civilian populations
Question 28
The ARNP notices that a patient with a conversion disorder unable to walk has an inappropriately cavalier attitude toward what seems to be a major impairment and recognizes this an associated psychological symptom known as which of the following?
- Identification
- Primary gain
- Secondary gain
- La belle indifference
Question 29
A neurodevelopmental disorder characterized by impairment confined to a specific area of academic achievement (i.e., reading, writing, arithmetic, spelling) without deficits in intellectual and adaptive behaviors is
- Intellectual disability
- Communication disorder
- Specific learning disorder
- Autism spectrum disorder
Question 30
According to the DSM-5 which of the following symptoms differentiates illness anxiety disorder from somatic symptom disorder?
- In somatic symptom disorder, persons are primarily concerned with the idea they are ill, with few or no somatic symptoms.
- In illness anxiety disorder, persons are primarily concerned with the idea they are ill with few or no somatic symptoms.
- In illness anxiety disorder, the patient may have a medical illness but their anxiety is out of proportion to their diagnosis.
- B and C
Question 31
Which of the following is consistent with what is known about electroconvulsive therapy (ECT) use in patients with Dissociative Identity Disorder (DID)?
- ECT is helpful in joining various personality identities/altered states.
- ECT crosses all personality/altered states equally and typically leads to a full recovery.
- ECT is helpful in ameliorating refractory mood disorders and does not worsen dissociative memory problems.
- ECT should not be used in patients with Dissociative Identity Disorder as it can cause further confusion and refraction.
Question 32
A patient presents reporting acute amnesia and fugue episodes in addition to recurrent blackouts, unexplained possessions, and fluctuations in skills, habits, and knowledge. The ARNP recognizes this is consistent with which of the following?
- Systematized Amnesia
- Post-traumatic Amnesia
- Transient Global Amnesia
- Dissociative Identify Disorder
Question 33
A child 0–3 months would be expected to be able to do which of the following?
- Develop social smile
- React and turn toward sounds
- Watch faces, follows objects
- All the above
Question 34
Which of the following are common disorders that must be differentiated from dissociative identity disorder? Check all that apply.
- Perimenstrual disorders
- Posttraumatic stress disorder
- Obsessive-compulsive disorder
- B and C only
Question 35
Anxiety related to chemotherapy is an example of which type of clinical problem in psychosomatic medicine?
- Psychological factors precipitating medical symptoms
- Psychiatric symptoms as a reaction to a medical condition or treatment
- Co-occurring medical and psychiatric conditions
- Psychiatric complications of medical conditions and treatments
Question 36
Which of the following are behavioral red flags for a 6–12-year-old?
- Indecisive
- Sets unrealistic grandiose goals.
- Fails to plan or set future goals.
- None of the above
Question 37
Neuropsychiatric testing is defined as which of the following?
- A comprehensive mental status exam
- A neurological evaluation of brain function
- Standardized quantitative reproducible evaluation of a patient’s cognitive abilities.
- A non-invasive test of brain function which analyzes electrical rhythms in the brain.
Question 38
The primary causative factor of disruptive, impulse-control, and conduct disorders is which of the following?
- Biological
- Psychosocial
- Psychodynamic
- Unknown
Question 39
The term psychosomatic literally refers to which of the following?
- Imaginary illness
- Psychiatric illness
- How the mind effects the body
- How the body effects the mind
Question 40
Which of the following shows normal developmental visual motor skill for an 18-month-old?
- Runs well: stands for ball throw.
- Points to self; uses 10 – 25 words.
- Scribbles on own; makes 3-cube tower
- Has fine pincer grasp; scribbles if shown
Question 41
A type of delirium characterized by cycling through psychomotor agitation and retardation, from apathy to hypervigilance is known as which of the following?
- Mixed delirium
- Bipolar delirium
- Hyperactive delirium
- A and B
Question 42
An increase in depersonalization is seen with the depletion of which of the following?
- GABA
- Serotonin
- L-tryptophan
- Norepinephrine
Question 43
Which of the following statements is consistent with literature about the epidemiology of pyromania?
- Pyromania is more frequently seen in men rather than women.
- Most patients who set fires can be classified as having pyromania.
- More than 40 percent of people with pyromania are younger than 18 years of age.
- A and C
Question 44
The ARNP in working with a parent of a 6-month-old would offer which of the following in anticipatory guidance?
- Give baby much attention.
- Attune to baby’s needs for hunger, fatigue, diaper change.
- Provide supervised time for crawling, sitting, and rolling.
- All the above
Question 45
A disorder characterized by 6 or more months of general and no delusional preoccupations with fears of having a serious disease based on a person’s misinterpretation of bodily symptoms that causes significant distress and impairment in one’s life is
- Factitious disorder
- Conversion disorder
- Illness anxiety disorder
- Somatic symptom disorder
Question 46
Which of the following is true about impulses? Check all that apply.
- Impulses are acted upon with the expectation of receiving pleasure
- Impulses are usually ego-dystonic.
- Impulsive behaviors are characterized by their repetitive nature.
- The repeated acting out of impulses leads to psychological impairment.
Question 47
A process by which repressed material is brought back to consciousness and the person relives the repressed material accompanied ty the appropriate affective response.
- Abulia
- Abreaction
- Adynamia
- Alexithymia
Question 48
The Confusion Assessment Methods Instrument (CAMI) is a standardized assessment tool for which of the following disorders?
- Dementia
- Delirium
- Pick’s disease
- A and C
Question 49
Which of the following is consistent with dementia in HIV?
- The individual’s decline is very slow and may take years to progress.
- The individual’s decline is progressive in nature with motoric and behavioral abnormalities.
- The individual’s decline is in a stepwise fashion with motoric and behavioral abnormalities.
- The individual’s decline has marked variability and fluctuating motoric and behavioral abnormalities.
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Question 50
Which of the following are included in the clinical features of anxiety illness disorder? Check all that apply.
- Persons maintain they have a particular disease or as time progresses their belief may transfer to another disease.
- Lab results, lack of progression of the disease, and appropriate reassurances from the provider are helpful treatments for the person with the disease.
- Preoccupation with illness may or may not interfere with their interaction with family, friends, and co-workers.
- They are often addicted to internet search about their feared illness, inferring the worst from the information.
Question 51
An episode of acute violent behavior for which the person claims amnesia is known as which of the following?
- Amok
- Abulia
- Akathisias
- Abreaction
Question 52
Which of the following persons hypothesized that the symptoms of conversion disorder reflect unconscious conflict?
- Anna Freud
- Paul Briquet
- Sigmund Freud
- Jean-Martin Charcot
Question 53
Which of the following statements is consistent with literature about the epidemiology of pyromania?
- Pyromania is more frequently seen in men rather than women.
- Most patients who set fires can be classified as having pyromania.
- More than 40 percent of people with pyromania are younger than 18 years of age.
- A and C
Question 54
Which of the following is NOT considered a nonpathological form of amnesia?
- Hypnotic amnesia
- Generalized amnesia
- Infantile and childhood amnesia
- Amnesia for sleep and dreaming
Question 55
Which of the following social interactions indicates progression into the normal range, meeting developmental milestones for a 5-year-old?
- Shares on own
- Engages in imaginative play
- Group play; has a preferred friend
- Has a group of friends, apologizes for errors
Question 56
N-Methyl D-aspartate glutamate receptor antagonists are used to treat dementia by doing which of the following?
- Stall the neurodegenerative processes
- Promotes synaptic plasticity
- Prevent over excitation of glutamate receptors
- All of the above
Question 57
Which of the following are common disorders that must be differentiated from dissociative identity disorder? Check all that apply.
- Perimenstrual disorders
- Posttraumatic stress disorder
- Obsessive-compulsive disorder
- B and C only
Question 58
A type of delirium characterized by cycling through psychomotor agitation and retardation, from apathy to hypervigilance is known as which of the following?
- Mixed delirium
- Bipolar delirium
- Hyperactive delirium
- A and B
Question 59
The ARNP is doing a physical exam on a patient that has a paralyzed hand of unknown etiology in which the patient’s hand is raised and dropped into the patient’s face. Which of the following patient responses support the finding of a conversion disorder?
- The patient’s hand drops onto the patient’s face.
- The patient’s hand falls next to the patient’s face.
- The patient’s hand stays in the air when dropped.
- This would not be an appropriate test for conversion disorder.
Question 60
The patient with an illness anxiety disorder is requesting medication only from the ARNP. The ARNPs response about pharmacotherapy in illness anxiety disorder would include which of the following?
- Pharmacotherapy is never recommended.
- Pharmacotherapy provides long term relief from anxiety
- Psychotherapy is the most effective treatment of anxiety illness disorder.
- Pharmacotherapy helps alleviating symptoms but cannot provide lasting relief.
Question 61
A congenital neurodevelopmental disorder primarily occurring in females, characterized by specific deficits following a period of normal function growth and development is
PANDAS
Rett syndrome
Reye’s syndrome
Kluver-Bucy syndrome
Question 62
A capacity evaluation prior to an organ transplantation is an example of which of the following clinical problems in psychosomatic medicine?
- Psychiatric symptoms secondary to a medical condition
- Medical complications of psychiatric treatments
- Psychological factors precipitating medical conditions
- Psychiatric/psychosocial assessment
Question 63
Which of the following is consistent with current literature about the relationship between obstetrical complications and Autism Spectrum Disorders (ASD)?
- Research is unclear whether obstetric complications are a true risk factor for ASD.
- Research proves there is a negative correlation between obstetrical complications and ASD.
- Research proves there is a positive correlation between obstetrical complications and ASD.
- Research strongly supports a positive relationship between obstetric complications and ASD.
Question 64
Interest in fires and deliberate setting of fires for financial gain is known as which of the following?
- Arson
- Pyromania
- Intermittent explosive disorder
- Impulse control disorder
Question 65
Which of the following questions are recommended to assess sexual identity in a male adolescent?
- Do you have or have you had a girlfriend?
- Do you have or have you had a boyfriend?
- Do you have, or have you had romantic feelings toward anyone?
- A and C only
Question 66
A category of disorders characterized by the inability to resist an intense impulse, drive, or temptation to perform a particular act that is obviously harmful to self or others or both is known as which of the following?
- Dissociative disorders
- Psychosomatic disorders
- Trauma and stressor related disorders
- Disruptive, impulse-control and conduct disorders
Question 67
There is significant overlap in symptoms of dementia and delirium, however the distinguishing feature is which of the following?
- Memory
- Orientation
- Appearance
- Duration of onset of symptoms
Question 68
Acute withdrawal from alcohol represents which type of clinical problem in psychosomatic medicine?
- Medical complications of psychiatric conditions or treatments
- Psychiatric complications of medical conditions and treatments
- Psychiatric symptoms as a reaction to medical treatments.
- Co-occurring medical and psychiatric conditions.
Question 69
A tension state that always has an action component is known as which of the following?
- An impulse
- An obsession
- A compulsion
- Acting out
Question 70
Which of the following stimulants are difficult to abuse?
- Atomoxetine
- Dexamfetamine
- Methylphenidate
- Oros-methylphenidate
Question 71
An acute onset, short-term confusion, with changes in cognition and level of awareness due to a physiological cause is known as which of the following?
- Delirium
- Dementia
- Psychosis
- Traumatic brain injury
Question 72
Which of the following treatments is NOT recommended in treating Dissociative Identity Disorder?
- Cognitive Therapy
- Hypnosis
- Antidepressants
- Group Psychotherapy
Question 73
Depersonalization can result from which of the following conditions? Check all that apply.
- Seizure disorders
- Brain tumors
- Vertigo
- Meniere’s disease
Question 74
A dementia which usually occurs in the sixth decade of life, characterized by gradual onset and progressive decline without focal neurological deficits is known as which of the following?
- HIV dementia
- Vascular dementia
- Lewy-body dementia
- Alzheimer’s type dementia (DAT)
Question 75
Somatoform disorders represent which type of clinical problem in psychosomatic Medicine?
- Co-occurring medical and psychiatric conditions.
- Psychiatric complications of medical conditions and treatments.
- Psychiatric symptoms secondary to a medical condition.
- Psychological factors precipitating medical symptoms.
Question 76
The ARNP is working with the family of a patient with Alzheimer’s Disease who keeps stating the family is plotting against her, trying to have her “snuffed out.” The family is distraught because they state they are doing their best to make sure their family member is safe. The ARNP explains which of the following in educating the patient about the patient’s
- The patient is hallucinating. An estimated 20–30 percent of patient with dementia have hallucinations.
- The patient is delusional. An estimated 30–40 percent of patients with dementia have delusions.
- The patient likely has valid concerns and adult protective services needs to be called.
- Disturbance in perception is common in patients with Alzheimer ’s disease and patient needs to be hospitalized immediately.
Question 77
Which of the following approaches/treatments are recommended in working with patients with a conversion disorder?
- After a very thorough evaluation to r/o any medical cause, tell the patient that the symptoms are imaginary.
- Recommend psychotherapy to focus on issues of stress and coping.
- Recommend psychoanalysis to explore intrapsychic conflicts.
- B and C only
Question 78
A cognitive assessment should include which of the following?
- Baseline cognitive functioning
- Changes from baseline functioning
- Speed of onset of cognitive changes
- All of the above
Question 79
Which of the following diagnostic instruments for Autism Spectrum Disorder is recommended for universal clinical practice?
- Autism Diagnostic Interview -Revised (ADI – R)
- Diagnostic Interview for Social and Communication Disorder (DISCO)
- Development, Dimensional and Diagnostic Interview
- None of the above
Question 80
The ARNP recognizes which of the following when the 2-month-old opens her mouth when she sees a bottle.
- The 2-month-old must be quite advanced as this is a visual motor skill normally seen in a 4 month old.
- The 2-month-old is demonstrating a normal developmental adaptive skill.
- The 2-month-old is demonstrating a normal developmental visual motor skill.
- The 2-month-old is demonstrating an advanced developmental gross motor skill.
Question 81
A subcortical dementia with parenchymal abnormalities which can be visualized on MRI is known as which of the following?
- HIV dementia
- Kluver-Bucy syndrome
- Alzheimer’s type dementia
- Creutzfeldt-Jakob disease
Question 82
Recognizable skills or abilities that have an expected range and order of appearance such as a child taking his first step around the time of his first birthday is known as which of the following?
- Life skills
- Motor development
- Developmental history
- Developmental milestones
Question 83
A subcortical dementia characterized by motor abnormalities including psychomotor slowing, choreoathetoid movements, executive dysfunction complicated by impaired language, memory, and insight later in the disease process is
- Vascular dementia
- Huntington’s disease
- Creutzfeldt-Jakob disease
- Alzheimer’s type dementia
Question 84
Deficits in attention and the ability to complete multi-step commands are associated with impairment in which of the following regions of the brain?
- Frontal
- Prefrontal
- Cingulate gyrus
- All the above
Question 85
The principal theoretician to bring psyche and soma together was which of the following?
- Sigmund Freud
- Anna Freud
- Karl Abraham
- Georg Groddeck
Question 86
Which of the following would be a cause of concern for the ARNP working with parents of a 0–3 month old?
- The parent talks with the baby as if there is a mutual understanding.
- The parent appears to spoil the baby, always holding, cuddling, comforting.
- The parent becomes upset whenever the baby cries.
- The parent responds promptly whenever the baby cries.
Question 87
An illness of symptoms or deficits that affect voluntary motor or sensory functions, which suggest another medical condition but that is judged to be caused by psychological factors because the illness is preceded by conflicts or other stressors in known as which of the following?
- Factitious disorder
- Illness anxiety disorder
- Somatic symptom disorder
- Functional neurological symptom disorder
Question 88
Which of the following would be a developmental red flag that would trigger further assessment for a 2-year-old?
- Cannot jump; cannot throw object overhand.
- Cannot use a three-word sentence; speech only 50% understandable
- Cannot use a meaningful two-word phrase; lack of empathy (looking sad if a child cries)
- Never imitates adult activities; cannot do parallel play.
Question 89
Which of the following symptoms assist in differentiating a seizure from a pseudoseizure?
- Tongue biting is typically not present in a pseudoseizure
- Urinary incontinence is typically not present in a pseudoseizure
- Injuries from falling are typically not present in a pseudoseizure
- All the above
Question 90
The symptom of giving approximate answers is known as which of the following?
- Alogia
- Paralogia
- Analogia
- Symlogia
Question 91
Which of the following medications have been reported to beneficial in Ganser syndrome?
- Anxiolytic
- Antidepressants; particularly SSRIs
- Low doses of antipsychotic medications
- Non-benzodiazepine anxiolytic medications
Question 92
Which of the following can lower a person’s resistance to control impulses?
- Fatigue
- Incessant stimulation
- Psychic trauma
- All of the above
Question 93
Depression secondary to interferon treatments represents which of the following clinical problems in psychosomatic medicine?
- Psychiatric complications of medical conditions and treatments.
- Psychiatric symptoms secondary to a medical condition.
- Psychological factors precipitating medical symptoms.
- Psychiatric symptoms as a reaction to medical condition or treatments.
Question 94
Which of the following is NOT consistent with what is known about intermittent explosive disorder across the lifespan?
- Intermittent explosive disorder may appear at any stage of life.
- Intermittent explosive disorder usually appears between late adolescence and early adulthood.
- Intermittent explosive disorder typically increases in severity with the onset of middle age.
- The onset of intermittent explosive disorder may be acute or insidious.
Question 95
A temporary marked alteration in the state of consciousness or by the customary sense of personal identity without the replacement by an alternate sense of identity is known as which of the following?
- Ganser Syndrome
- Dissociative Trance Disorder
- Dissociative Identity Disorder
- Factitious Dissociative Identity Disorder
Question 96
Which of the following is consistent with normal range gross motor developmental milestones for a 4 year old?
- Walks down stairs, jumps backwards
- Balances on one foot for 4 seconds, can broad jump 1 foot
- Writes part of name; copies a square.
- Eats independently, unbuttons items
Question 97
MRI findings in patients with intermittent explosive disorder may reveal changes to which area of the brain that is associated with loss of impulse control?
- Cerebellum
- Prefrontal cortex
- Temporal lobe
- Parietal lobe
Question 98
Which of the following are included in the five different milestone skill areas that should be evaluated?
- Social/emotional skills
- Gross/fine motor skills
- Speech and language skills
- All the above
Question 99
An unconscious defense mechanism involving the segregation of any group of mental or behavioral processes from the rest of the person’s psychic activity is known as which of the following?
- Repression
- Dissociation
- Displacement
- Reaction formation
Question 100
A new diagnosis in the DSM-5 characterized by persons preoccupied with being sick or developing a disease of some kind is known as which of the following?
- Conversion disorder
- Illness anxiety disorder
- Somatic symptom disorder
- Functional neurological symptom disorder
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