Persistent Depressive Disorder Persistent Depressive Disorder MCQ 3 — Questions and Answers
Question 1: A 45-year-old patient has been on an SSRI for PDD for 8 weeks with minimal improvement. What is the most appropriate next step?
- Immediately switch to a tricyclic antidepressant
- Augment with lithium or an atypical antipsychotic
- Discontinue all medications and begin psychotherapy only
- Increase the SSRI to the maximum labeled dose or consider augmentation/switch (Correct answer)
Correct answer: Increase the SSRI to the maximum labeled dose or consider augmentation/switch
After an adequate trial (typically 6–8 weeks at therapeutic dose), the next step is dose optimization, augmentation, or switching to another agent.
Question 2: Which psychotherapy modality has the strongest evidence base specifically for Persistent Depressive Disorder?
- Psychoanalysis
- Cognitive Behavioral Analysis System of Psychotherapy (CBASP) (Correct answer)
- Eye Movement Desensitization and Reprocessing (EMDR)
- Dialectical Behavior Therapy (DBT)
Correct answer: Cognitive Behavioral Analysis System of Psychotherapy (CBASP)
CBASP was specifically developed for chronic depression and has the most robust evidence for PDD treatment.
Question 3: A patient with PDD also meets criteria for Social Anxiety Disorder. How does this comorbidity typically affect prognosis?
- It generally improves outcomes by increasing treatment-seeking behavior
- It worsens prognosis and may require integrated treatment (Correct answer)
- It has no effect on the course of PDD
- It typically resolves once PDD is treated
Correct answer: It worsens prognosis and may require integrated treatment
Comorbid anxiety disorders worsen the prognosis of PDD, reduce treatment response, and often require targeted integrated interventions.
Question 4: Which of the following cognitive patterns is most characteristic of patients with Persistent Depressive Disorder compared to episodic MDD?
- Episodic catastrophic thinking that fully remits between episodes
- Rigid, trait-like negative self-schemas that persist even during relative wellness (Correct answer)
- Primarily somatic rumination without cognitive distortions
- Grandiose thinking alternating with depressive cognition
Correct answer: Rigid, trait-like negative self-schemas that persist even during relative wellness
PDD patients typically exhibit stable, deeply entrenched negative self-schemas rather than episodic cognitive distortions.
Question 5: What is the estimated lifetime prevalence of Persistent Depressive Disorder in the United States?
- Less than 1%
- Approximately 2–4% (Correct answer)
- Approximately 10–12%
- Greater than 15%
Correct answer: Approximately 2–4%
Lifetime prevalence of PDD is estimated at approximately 2–4% in the US general population.
Question 6: A patient's PDD symptoms began insidiously at age 16 and have persisted. Which course specifier applies?
- With late-onset pure dysthymic syndrome
- With persistent major depressive episode
- Early onset (Correct answer)
- With anxious distress
Correct answer: Early onset
DSM-5 specifies 'early onset' when PDD begins before age 21.
Question 7: Which finding on sleep studies is most commonly associated with Persistent Depressive Disorder?
- Increased slow-wave (delta) sleep
- Reduced REM latency and increased REM density (Correct answer)
- Obstructive sleep apnea pattern
- Normal polysomnography
Correct answer: Reduced REM latency and increased REM density
Like MDD, PDD is associated with shortened REM latency and increased REM density on polysomnography.
Persistent Depressive Disorder Persistent Depressive Disorder MCQ 3
A 45-year-old patient has been on an SSRI for PDD for 8 weeks with minimal improvement.
What is the most appropriate next step?