Persistent Depressive Disorder Case Studies & Practical Application 5

Question 1

A patient with PDD reports that despite treatment, she still feels 'not quite right' and functions below her premorbid level. This residual impairment is best described as which PDD treatment challenge?

Accepted Answer

Partial remission with residual symptoms, common in PDD

Answer

Partial remission with lingering residual symptoms is a common and clinically significant challenge in PDD, often requiring augmentation or combined treatment strategies.

Question 2

A therapist is using CBASP (Cognitive Behavioral Analysis System of Psychotherapy) with a PDD patient. What is the core mechanism that CBASP targets?

Accepted Answer

Learned helplessness and disconnection between behavior and interpersonal outcomes

Answer

CBASP targets the perceived functional disconnection between a patient's behavior and its real-world interpersonal consequences, which is central to chronic depression.

Question 3

A 60-year-old man has had PDD for 20 years and has tried three different SSRIs without adequate response. What augmentation strategy has the most evidence in treatment-resistant chronic depression?

Accepted Answer

Augmenting with an atypical antipsychotic such as aripiprazole

Answer

Augmentation with atypical antipsychotics (e.g., aripiprazole, quetiapine) has evidence supporting their use in antidepressant-refractory chronic depression.

Question 4

A patient meeting PDD criteria reports her symptoms began 3 months after losing her job and have persisted ever since (now 2.5 years). The clinician must differentiate PDD from prolonged grief or adjustment disorder. What feature most supports PDD?

Accepted Answer

Persistence beyond 2 years with required symptom criteria supports PDD regardless of initial stressor

Answer

PDD can be precipitated by a stressor; once symptoms persist beyond 2 years with required criteria met, PDD is the appropriate diagnosis regardless of the initial trigger.

Question 5

A clinician reviews a patient's PHQ-9 scores over 18 months and finds consistently mild scores (8–10) with no score-free intervals. Which finding on structured interview would best confirm a PDD diagnosis?

Accepted Answer

Persistent depressed mood plus at least 2 of: poor appetite/overeating, insomnia/hypersomnia, low energy, low self-esteem, poor concentration, or hopelessness

Answer

DSM-5 PDD requires chronically depressed mood plus at least two of the six specified associated symptoms for at least 2 years.

Persistent Depressive Disorder Practice Test

Persistent Depressive Disorder Practice Test

Persistent Depressive Disorder Case Studies & Practical Application 5