Persistent Depressive Disorder Persistent Depressive Disorder MCQ 5 — Questions and Answers
Question 1: A patient with PDD reports chronic low self-esteem and persistent guilt about past failures that has never met full MDD criteria. Which specifier best applies?
- With persistent major depressive episode
- With intermittent major depressive episodes, with current episode
- With pure dysthymic syndrome (Correct answer)
- With melancholic features
Correct answer: With pure dysthymic syndrome
The specifier 'with pure dysthymic syndrome' applies when full MDD criteria have never been met during the course of PDD.
Question 2: Which of the following best describes the relationship between PDD and personality disorders?
- Personality disorders are a contraindication to diagnosing PDD
- PDD frequently co-occurs with cluster B and C personality disorders (Correct answer)
- Cluster A personality disorders fully explain PDD symptoms
- Personality disorders protect against developing PDD
Correct answer: PDD frequently co-occurs with cluster B and C personality disorders
Comorbid personality disorders, especially cluster B (borderline) and cluster C (avoidant, dependent), are common in patients with PDD.
Question 3: When using the PHQ-9 to monitor a patient with PDD, which total score range indicates moderate depression severity?
- 1–4
- 5–9
- 10–14 (Correct answer)
- 15–19
Correct answer: 10–14
PHQ-9 scores of 10–14 indicate moderate depression severity, a range frequently seen in monitored PDD patients.
Question 4: A clinician wants to distinguish PDD from bipolar II disorder. Which feature, if present, would most strongly argue against a PDD diagnosis?
- Persistent low energy
- Hypersomnia and hyperphagia
- Recurrent hypomania lasting at least 4 days (Correct answer)
- Chronic low self-esteem
Correct answer: Recurrent hypomania lasting at least 4 days
Hypomania lasting at least 4 consecutive days distinguishes bipolar II disorder from PDD, which by definition lacks hypomanic episodes.
Question 5: Which of the following statements about the onset of Persistent Depressive Disorder is accurate?
- PDD always begins with a discrete major depressive episode
- PDD most commonly begins in childhood or adolescence with an insidious onset (Correct answer)
- PDD typically begins after age 50 following a major life stressor
- PDD onset is always preceded by a manic episode
Correct answer: PDD most commonly begins in childhood or adolescence with an insidious onset
PDD most often begins insidiously in childhood, adolescence, or early adulthood without a clearly identifiable precipitating episode.
Question 6: A patient completing CBT for PDD notices they still feel chronically empty even after mood has improved. Which construct best explains this residual experience?
- Residual psychotic symptoms
- Anhedonia and identity disturbance from chronic depression (Correct answer)
- Emerging bipolar disorder
- Medication-induced emotional blunting
Correct answer: Anhedonia and identity disturbance from chronic depression
Chronic depression frequently leads to anhedonia and a disrupted sense of self that can persist beyond mood improvement and may require additional therapeutic focus.
Question 7: According to DSM-5, the depressed mood in PDD must be present for most of the day, more days than not, confirmed by which two sources?
- Laboratory findings and neuroimaging
- Subjective report or objective observation by others (Correct answer)
- Structured clinical interview and self-report questionnaire
- Family history and clinical record review
Correct answer: Subjective report or objective observation by others
DSM-5 criterion A requires depressed mood confirmed by either the patient's own report or observation by others, for most of the day, more days than not.
Persistent Depressive Disorder Persistent Depressive Disorder MCQ 5
A patient with PDD reports chronic low self-esteem and persistent guilt about past failures that has never met full MDD criteria.
Which specifier best applies?