DO Psychiatry and Behavioral Medicine 1 — Questions and Answers
Question 1: A 35-year-old woman presents with persistent sadness, anhedonia, insomnia, fatigue, difficulty concentrating, and feelings of worthlessness for 3 weeks. What is the minimum number of symptoms required to diagnose Major Depressive Disorder per DSM-5?
- 3 symptoms for at least 1 week
- 4 symptoms for at least 1 week
- 5 symptoms for at least 2 weeks (Correct answer)
- 7 symptoms for at least 2 weeks
Correct answer: 5 symptoms for at least 2 weeks
DSM-5 requires at least 5 of 9 specified symptoms present for at least 2 weeks, with depressed mood or anhedonia being mandatory.
Question 2: A 22-year-old man with schizophrenia has persistent auditory hallucinations and delusions despite adequate trials of two second-generation antipsychotics. Which medication is most appropriate for treatment-resistant schizophrenia?
- Risperidone
- Clozapine (Correct answer)
- Haloperidol
- Quetiapine
Correct answer: Clozapine
Clozapine is the only FDA-approved medication for treatment-resistant schizophrenia, defined as failure of at least two adequate antipsychotic trials.
Question 3: Which feature best distinguishes Bipolar I disorder from Bipolar II disorder?
- Presence of at least one major depressive episode
- At least one full manic episode lasting 7 or more days (Correct answer)
- Hypomanic episodes lasting at least 4 days without a full manic episode
- Rapid cycling between four or more mood episodes per year
Correct answer: At least one full manic episode lasting 7 or more days
Bipolar I requires at least one full manic episode lasting ≥7 days (or any duration requiring hospitalization), while Bipolar II involves hypomania but never full mania.
Question 4: A 28-year-old woman reports recurrent, unexpected episodes of intense fear with palpitations, dyspnea, chest pain, and fear of dying peaking within 10 minutes. She now avoids crowded places. What is the most likely diagnosis?
- Generalized Anxiety Disorder
- Social Anxiety Disorder
- Panic Disorder with Agoraphobia (Correct answer)
- Specific Phobia
Correct answer: Panic Disorder with Agoraphobia
Panic Disorder with Agoraphobia presents with recurrent unexpected panic attacks plus avoidance of situations where escape might be difficult if an attack occurs.
Question 5: A 32-year-old veteran presents with intrusive flashbacks, nightmares, hypervigilance, emotional numbing, and avoidance of combat-related stimuli persisting for 6 months post-deployment. What is the first-line pharmacological treatment?
- Benzodiazepines
- Sertraline or paroxetine (Correct answer)
- Risperidone
- Propranolol
Correct answer: Sertraline or paroxetine
SSRIs (sertraline and paroxetine) are the only FDA-approved medications for PTSD, and are recommended as first-line pharmacotherapy.
Question 6: A 68-year-old man continues to experience intense longing, difficulty accepting his wife's death, and significant functional impairment 14 months after her passing. He does not meet criteria for Major Depressive Disorder. What is the most likely diagnosis?
- Major Depressive Disorder
- Adjustment Disorder
- Prolonged Grief Disorder (Correct answer)
- Normal bereavement
Correct answer: Prolonged Grief Disorder
Prolonged Grief Disorder (DSM-5-TR) is diagnosed when intense grief with functional impairment persists beyond 12 months in adults following bereavement.
Question 7: A physician is assessing suicide risk in a 45-year-old man with depression. Which factor is the single strongest predictor of completed suicide?
- Verbal expression of suicidal ideation
- Prior suicide attempt (Correct answer)
- Diagnosis of Major Depressive Disorder
- Social isolation
Correct answer: Prior suicide attempt
A prior suicide attempt is the single strongest predictor of future completed suicide, increasing risk approximately 30-40 times compared to the general population.
DO Psychiatry and Behavioral Medicine 1
A 35-year-old woman presents with persistent sadness, anhedonia, insomnia, fatigue, difficulty concentrating, and feelings of worthlessness for 3 weeks.
What is the minimum number of symptoms required to diagnose Major Depressive Disorder per DSM-5?