Persistent Depressive Disorder General 4 — Questions and Answers
Question 1: Which term was used in DSM-IV for what is now called Persistent Depressive Disorder in DSM-5?
- Cyclothymia
- Dysthymia (Dysthymic Disorder) (Correct answer)
- Atypical Depression
- Chronic MDD
Correct answer: Dysthymia (Dysthymic Disorder)
DSM-IV used the term 'Dysthymic Disorder,' which DSM-5 consolidated with chronic MDD into the unified category of Persistent Depressive Disorder.
Question 2: A patient reports chronic depressed mood plus two PDD symptoms for 18 months with no symptom-free period exceeding 2 months. Which diagnosis applies?
- No mood disorder diagnosis applies yet
- Major Depressive Disorder, recurrent
- Persistent Depressive Disorder cannot be diagnosed (Correct answer)
- Adjustment Disorder with depressed mood
Correct answer: Persistent Depressive Disorder cannot be diagnosed
PDD requires a minimum of 2 years in adults; at 18 months, diagnostic criteria are not yet met even if all other features are present.
Question 3: In PDD, the mood disturbance is present for most of the day, more days than not. How is this typically confirmed in clinical practice?
- Neuroimaging studies
- Patient report and clinician observation (Correct answer)
- Genetic testing
- Laboratory measurement of cortisol levels
Correct answer: Patient report and clinician observation
Consistent with DSM-5 criteria, the pervasiveness of mood in PDD is established through patient self-report supplemented by clinician observation.
Question 4: Which of the following findings is most likely in neurobiological research on Persistent Depressive Disorder compared to healthy controls?
- Increased hippocampal volume
- Hyperactivity of the prefrontal cortex
- HPA axis dysregulation and elevated cortisol (Correct answer)
- Increased serotonin transporter density
Correct answer: HPA axis dysregulation and elevated cortisol
Research consistently shows HPA axis dysregulation and chronically elevated cortisol in PDD, similar to but often less pronounced than in MDD.
Question 5: What does the term 'double depression' historically refer to?
- Concurrent PDD and Bipolar II Disorder
- Two simultaneous Major Depressive Episodes
- A Major Depressive Episode superimposed on pre-existing PDD (Correct answer)
- PDD with comorbid PTSD
Correct answer: A Major Depressive Episode superimposed on pre-existing PDD
'Double depression' refers to the co-occurrence of a Major Depressive Episode on top of pre-existing Persistent Depressive Disorder.
Question 6: Which personality disorder most commonly co-occurs with Persistent Depressive Disorder?
- Narcissistic Personality Disorder
- Borderline Personality Disorder (Correct answer)
- Paranoid Personality Disorder
- Histrionic Personality Disorder
Correct answer: Borderline Personality Disorder
Borderline Personality Disorder has the highest comorbidity rate with PDD among personality disorders, often complicating treatment.
Question 7: A clinician notes that a patient's depressive symptoms began before age 21. Which PDD specifier is appropriate?
- With late onset
- With early onset (Correct answer)
- With pure dysthymic syndrome
- With anxious distress
Correct answer: With early onset
The 'with early onset' specifier is applied when PDD begins before age 21, which is associated with a more chronic course and higher familial loading.
Persistent Depressive Disorder General 4
Which term was used in DSM-IV for what is now called Persistent Depressive Disorder in DSM-5?