Persistent Depressive Disorder Case Studies & Practical Application 2 — Questions and Answers
Question 1: A 35-year-old woman reports feeling low-grade depression for the past 3 years, during which she has never felt well for more than 2 months at a time. She denies any manic or hypomanic episodes. What is the most appropriate diagnosis?
- Major Depressive Disorder, recurrent
- Persistent Depressive Disorder (Dysthymia) (Correct answer)
- Cyclothymic Disorder
- Adjustment Disorder with Depressed Mood
Correct answer: Persistent Depressive Disorder (Dysthymia)
PDD requires depressed mood for at least 2 years with no symptom-free period longer than 2 months, which matches this presentation.
Question 2: A patient with confirmed PDD develops a full major depressive episode. How should this be documented diagnostically?
- Replace PDD diagnosis with MDD
- Document only MDD, as PDD is subsumed
- Diagnose PDD with concurrent MDD (double depression) (Correct answer)
- Record as Bipolar II Disorder with dysthymic features
Correct answer: Diagnose PDD with concurrent MDD (double depression)
When a major depressive episode occurs in the context of PDD, the appropriate term is 'double depression,' and both diagnoses can be documented.
Question 3: A clinician is treating a 42-year-old man with PDD using CBT. After 12 sessions he reports no change. What is the most evidence-based next step?
- Continue CBT for 12 more sessions before reassessing
- Discontinue psychotherapy and start an SSRI
- Add pharmacotherapy (SSRI) to ongoing psychotherapy (Correct answer)
- Switch to psychodynamic therapy only
Correct answer: Add pharmacotherapy (SSRI) to ongoing psychotherapy
Combined treatment (psychotherapy plus antidepressant medication) shows superior outcomes for PDD compared to either modality alone.
Question 4: A 28-year-old presents with depressed mood since age 18, poor concentration, low self-esteem, and hopelessness. She says, 'This is just who I am.' This statement most likely reflects which PDD characteristic?
- Symptom exaggeration for secondary gain
- Ego-syntonic nature of long-standing PDD (Correct answer)
- Comorbid narcissistic personality disorder
- Insight deficit due to psychosis
Correct answer: Ego-syntonic nature of long-standing PDD
Patients with chronic PDD often experience their symptoms as part of their personality (ego-syntonic), making them less likely to seek help.
Question 5: Which medication class has the strongest evidence base for treating Persistent Depressive Disorder in adults?
- Benzodiazepines
- Atypical antipsychotics as monotherapy
- SSRIs and SNRIs (Correct answer)
- Mood stabilizers such as lithium
Correct answer: SSRIs and SNRIs
SSRIs and SNRIs are first-line pharmacological treatments for PDD, supported by multiple randomized controlled trials.
Question 6: A teenager has experienced low-grade depressed mood for 14 months with associated fatigue and poor concentration. Her symptom duration falls short of the 2-year adult PDD threshold. What DSM-5 specifier applies?
- Specify 'with early onset' and defer diagnosis until 2 years
- The diagnosis cannot be made before 2 years in any age group
- In children and adolescents, 1 year of symptoms satisfies the duration criterion (Correct answer)
- Diagnose as Adjustment Disorder pending further evaluation
Correct answer: In children and adolescents, 1 year of symptoms satisfies the duration criterion
DSM-5 allows the PDD duration criterion to be met with 1 year (rather than 2) in children and adolescents.
Question 7: A patient with PDD also meets criteria for Generalized Anxiety Disorder. Which treatment approach is most appropriate?
- Treat anxiety first and re-evaluate PDD after remission
- Treat PDD only, as anxiety is a secondary symptom
- Address both disorders concurrently with integrated treatment (Correct answer)
- Defer treatment until diagnostic clarity is established
Correct answer: Address both disorders concurrently with integrated treatment
Comorbid anxiety and PDD frequently co-occur and should be addressed concurrently because untreated comorbidities worsen outcomes for both conditions.
Persistent Depressive Disorder Case Studies & Practical Application 2
A 35-year-old woman reports feeling low-grade depression for the past 3 years, during which she has never felt well for more than 2 months at a time.
She denies any manic or hypomanic episodes.
What is the most appropriate diagnosis?