Persistent Depressive Disorder Persistent Depressive Disorder 5 — Questions and Answers
Question 1: Which statement best describes the DSM-5 renaming of dysthymic disorder?
- It was merged entirely into major depressive disorder
- It was renamed Persistent Depressive Disorder and consolidated with chronic MDD (Correct answer)
- It was reclassified as a personality disorder
- It was eliminated from DSM-5
Correct answer: It was renamed Persistent Depressive Disorder and consolidated with chronic MDD
DSM-5 combined dysthymic disorder and chronic MDD into a single diagnosis called Persistent Depressive Disorder.
Question 2: Which factor is associated with a poorer prognosis in Persistent Depressive Disorder?
- Late onset after age 50
- Absence of comorbid personality disorder
- Early onset before age 21 (Correct answer)
- Mild functional impairment at baseline
Correct answer: Early onset before age 21
Early onset PDD (before age 21) is associated with a more severe and treatment-resistant course.
Question 3: A clinician combines an SSRI with CBT for a patient with PDD. Compared to either treatment alone, this combination is expected to produce which outcome?
- No meaningful difference from monotherapy
- Higher response rates and greater symptom reduction (Correct answer)
- Increased risk of manic switch
- Faster onset but no improvement in remission rates
Correct answer: Higher response rates and greater symptom reduction
Research consistently shows that combined pharmacotherapy and psychotherapy produces superior outcomes to either modality alone in chronic depression/PDD.
Question 4: Which DSM-5 specifier is applied to PDD when the patient's depressed mood and related symptoms are most consistently worse in the morning?
- With anxious distress
- With melancholic features (Correct answer)
- With atypical features
- With peripartum onset
Correct answer: With melancholic features
Melancholic features specifier includes diurnal variation with morning worsening of mood as a key characteristic.
Question 5: How does substance use disorder commonly interact with Persistent Depressive Disorder?
- Substance use disorders prevent PDD from developing
- Comorbid substance use worsens prognosis and complicates treatment of PDD (Correct answer)
- PDD diagnoses automatically exclude substance use disorders
- Substance use reliably resolves PDD symptoms
Correct answer: Comorbid substance use worsens prognosis and complicates treatment of PDD
Comorbid substance use disorders are common in PDD and are associated with worse outcomes, greater chronicity, and more complex treatment needs.
Question 6: Which of the following describes an important distinction between PDD and a depressive personality disorder?
- PDD is not recognized in DSM-5 while depressive personality is
- PDD is a mood disorder with episodic features; depressive personality is a pervasive trait pattern not recognized as a separate DSM-5 diagnosis (Correct answer)
- PDD requires a personality disorder comorbidity to be diagnosed
- Depressive personality disorder requires 2 years of symptoms just like PDD
Correct answer: PDD is a mood disorder with episodic features; depressive personality is a pervasive trait pattern not recognized as a separate DSM-5 diagnosis
PDD is a formal DSM-5 mood disorder, whereas depressive personality disorder is not a separate DSM-5 category and describes trait-level pessimism and gloom.
Question 7: A patient with PDD says, 'I've always been this way — this is just my personality.' This belief most likely reflects which clinical challenge?
- Malingering symptoms for secondary gain
- Ego-syntonic perception of symptoms delaying help-seeking (Correct answer)
- Antisocial personality disorder masquerading as depression
- Correct insight indicating PDD is not present
Correct answer: Ego-syntonic perception of symptoms delaying help-seeking
In PDD, chronic symptoms often become ego-syntonic — felt as part of one's identity — which delays recognition and treatment-seeking.
Persistent Depressive Disorder Persistent Depressive Disorder 5
Which statement best describes the DSM-5 renaming of dysthymic disorder?