Persistent Depressive Disorder Persistent Depressive Disorder MCQ 4 — Questions and Answers
Question 1: A clinician notices a patient has had depressed mood for 2.5 years but also experienced a 10-week period of full euthymia. Can PDD still be diagnosed?
- Yes, because the overall duration exceeds 2 years
- No, because the symptom-free period exceeded 2 months (Correct answer)
- Yes, if the patient had a major depressive episode before the gap
- No, because PDD requires continuous daily symptoms
Correct answer: No, because the symptom-free period exceeded 2 months
DSM-5 excludes PDD when the patient has been symptom-free for 2 or more consecutive months during the required 2-year period.
Question 2: Which of the following medical conditions is most important to rule out when a patient presents with chronic low mood, fatigue, and cognitive slowing?
- Type 2 diabetes mellitus
- Hypothyroidism (Correct answer)
- Hypertension
- Osteoarthritis
Correct answer: Hypothyroidism
Hypothyroidism closely mimics the presentation of PDD and must be excluded with thyroid function tests before assigning a psychiatric diagnosis.
Question 3: A patient with PDD reports that their mood briefly improves after receiving good news. What does this indicate about mood reactivity?
- This rules out PDD entirely
- This suggests the atypical features specifier may apply (Correct answer)
- This confirms melancholic features
- This indicates the patient is malingering
Correct answer: This suggests the atypical features specifier may apply
Mood reactivity—brightening in response to positive events—is a hallmark of atypical features, which can be a PDD specifier.
Question 4: Which of the following is a DSM-5 B-criterion symptom of Persistent Depressive Disorder?
- Psychomotor agitation or retardation
- Suicidal ideation with a specific plan
- Feelings of hopelessness (Correct answer)
- Hallucinations or delusions
Correct answer: Feelings of hopelessness
Hopelessness is one of the six B-criterion symptoms of PDD listed in DSM-5, along with poor appetite, insomnia, low energy, low self-esteem, and poor concentration.
Question 5: How does the rate of full recovery from PDD compare to that of major depressive disorder?
- PDD has a higher full recovery rate
- PDD and MDD have equivalent recovery rates
- PDD has a lower full recovery rate and is more treatment-resistant (Correct answer)
- PDD always resolves within 5 years without treatment
Correct answer: PDD has a lower full recovery rate and is more treatment-resistant
PDD is associated with a lower rate of full recovery, greater treatment resistance, and higher relapse rates compared to episodic MDD.
Question 6: A patient on an SSRI for PDD develops sexual dysfunction. Which antidepressant class would be a reasonable alternative with lower rates of sexual side effects?
- A second SSRI at higher dose
- Bupropion (Correct answer)
- A tricyclic antidepressant
- Paroxetine
Correct answer: Bupropion
Bupropion (an NDRI) has a much lower rate of sexual side effects compared to SSRIs and SNRIs.
Question 7: Which family history finding most increases a patient's risk for developing Persistent Depressive Disorder?
- A first-degree relative with schizophrenia
- A first-degree relative with major depressive disorder or dysthymia (Correct answer)
- A first-degree relative with bipolar I disorder only
- No family history increases PDD risk
Correct answer: A first-degree relative with major depressive disorder or dysthymia
A first-degree family history of major depression or dysthymia is the strongest familial risk factor for PDD.
Persistent Depressive Disorder Persistent Depressive Disorder MCQ 4
A clinician notices a patient has had depressed mood for 2.5 years but also experienced a 10-week period of full euthymia.
Can PDD still be diagnosed?