Cyclothymic disorder US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Cyclothymic disorder. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Cyclothymic disorder US Medical PG Question 1: A 33-year-old woman is brought to the physician by her husband because of persistent sadness for the past 2 months. During this period, she also has had difficulty sleeping and an increased appetite. She had similar episodes that occurred 2 years ago and 9 months ago that each lasted for 4 months. Between these episodes, she reported feeling very energetic and rested after 3 hours of sleep. She often went for long periods of time without eating. She works as a stock market trader and received a promotion 5 months ago. She regularly attends yoga classes on the weekends with her friends. On mental status examination, she has a blunted affect. She denies suicidal thoughts and illicit drug use. Which of the following is the most likely diagnosis?
- A. Major depressive disorder with seasonal pattern
- B. Persistent depressive disorder
- C. Bipolar II disorder (Correct Answer)
- D. Major depressive disorder with atypical features
- E. Cyclothymic disorder
Cyclothymic disorder Explanation: ***Bipolar II disorder***
- The patient exhibits recurrent episodes of **major depression** (sadness, sleep difficulties, increased appetite) interspersed with periods of **hypomania** (energetic, reduced need for sleep, long periods without eating, successful work performance with promotion)
- This pattern is characteristic of **Bipolar II disorder**: major depressive episodes plus at least one hypomanic episode
- No evidence of **frank mania** (e.g., psychosis, severe impairment requiring hospitalization) is present, which distinguishes this from Bipolar I disorder
*Major depressive disorder with seasonal pattern*
- While the patient presents with depressive symptoms, the episodes of **hypomania** (increased energy, decreased need for sleep) rule out unipolar depression
- The history of episodes at various times (2 years ago, 9 months ago, current) does not fit a **seasonal pattern**
- The **hypomanic phases** between depressive episodes are inconsistent with any form of major depressive disorder
*Persistent depressive disorder*
- This condition involves **chronic depressive symptoms** lasting at least 2 years, but typically less severe than major depressive episodes
- The presence of distinct, severe **major depressive episodes** and recurrent **hypomanic periods** contradicts this diagnosis
- Persistent depressive disorder does not include hypomania or mood elevation
*Major depressive disorder with atypical features*
- Atypical features include **increased appetite**, **hypersomnia**, leaden paralysis, interpersonal rejection sensitivity, and mood reactivity
- While increased appetite is present during depressive phases, the alternating periods of **hypomania** exclude this from being major depressive disorder
- Any form of major depressive disorder is ruled out by the presence of hypomanic episodes
*Cyclothymic disorder*
- Cyclothymic disorder involves numerous periods of **hypomanic symptoms** and **depressive symptoms** for at least 2 years, but symptoms do not meet full criteria for major depressive or hypomanic episodes
- This patient explicitly experiences **major depressive episodes** (persistent sadness, neurovegetative symptoms lasting 4 months), which exceed the threshold for cyclothymia
- The severity and duration of depressive episodes make Bipolar II disorder the correct diagnosis
Cyclothymic disorder US Medical PG Question 2: A 38-year-old woman comes to the physician for a follow-up visit. She has a 2-year history of depressed mood and fatigue accompanied by early morning awakening. One week ago, she started feeling a decrease in her need for sleep and now feels rested after about 5 hours of sleep per night. She had two similar episodes that occurred 6 months ago and a year ago, respectively. She reports increased energy and libido. She has a 4-kg (8.8-lb) weight loss over the past month. She does not feel the need to eat and says she derives her energy ""from the universe"". She enjoys her work as a librarian. She started taking fluoxetine 3 months ago. On mental exam, she is alert and oriented to time and place; she is irritable. She does not have auditory or visual hallucinations. Physical examination shows no abnormalities. Which of the following is the most likely diagnosis?
- A. Delusional disorder
- B. Cyclothymic disorder
- C. Schizoaffective disorder
- D. Bipolar II disorder (Correct Answer)
- E. Medication-induced bipolar disorder
Cyclothymic disorder Explanation: ***Bipolar II disorder***
- The patient meets criteria for **Bipolar II disorder**: at least one **hypomanic episode** (current presentation) and at least one **major depressive episode** (2-year history with recurrent episodes).
- Current hypomanic features include: **decreased need for sleep** (feels rested after 5 hours), **increased energy and libido**, **significant weight loss** (4 kg in one month), **irritability**, and grandiose thinking ("derives energy from the universe").
- She has had **recurrent depressive episodes** over 2 years (episodes 1 year ago and 6 months ago), fulfilling the major depressive episode requirement.
- While the hypomania emerged after starting **fluoxetine**, antidepressants commonly **unmask underlying bipolar disorder** rather than cause a separate medication-induced condition. The diagnosis remains **Bipolar II disorder** per DSM-5-TR when there is evidence of an underlying mood disorder pattern.
*Medication-induced bipolar disorder*
- Substance/medication-induced bipolar disorder requires that symptoms occur **exclusively during substance use** without evidence of an independent bipolar disorder.
- This patient's **recurrent pattern** of mood episodes (multiple depressive episodes over 2 years) suggests an **underlying bipolar disorder** that was unmasked by antidepressant treatment, not a purely medication-induced condition.
- The temporal relationship with fluoxetine is significant but represents **antidepressant-induced switching** in bipolar disorder, not a separate diagnostic entity.
*Delusional disorder*
- Requires **non-bizarre delusions** persisting for at least one month as the predominant feature, without prominent mood symptoms.
- This patient's primary presentation is a **mood episode** (hypomania) with the "universe" comment being part of her elevated/expansive mood rather than a fixed, systematized delusion.
- Functioning remains relatively intact (still enjoys her work).
*Cyclothymic disorder*
- Involves numerous periods of **hypomanic and depressive symptoms** for at least 2 years, but symptoms never meet full criteria for hypomanic or major depressive episodes.
- This patient has **full hypomanic and major depressive episodes**, making Bipolar II disorder the more appropriate diagnosis.
- The severity of her current symptoms (significant sleep reduction, 4-kg weight loss, marked functional changes) exceeds cyclothymic disorder.
*Schizoaffective disorder*
- Requires a **major mood episode** concurrent with **criterion A symptoms of schizophrenia** (delusions, hallucinations) for at least 2 weeks, plus psychotic symptoms without mood symptoms for at least 2 weeks.
- This patient has **no hallucinations** and no clear psychotic symptoms independent of her mood state.
- Her elevated mood fully accounts for her presentation.
Cyclothymic disorder US Medical PG Question 3: A 38-year-old man comes to the physician because of persistent sadness and difficulty concentrating for the past 6 weeks. During this period, he has also had difficulty sleeping. He adds that he has been “feeling down” most of the time since his girlfriend broke up with him 4 years ago. Since then, he has only had a few periods of time when he did not feel that way, but none of these lasted for more than a month. He reports having no problems with appetite, weight, or energy. He does not use illicit drugs or alcohol. Mental status examination shows a depressed mood and constricted affect. Which of the following is the most likely diagnosis?
- A. Persistent depressive disorder (Correct Answer)
- B. Adjustment disorder with depressed mood
- C. Major depressive disorder
- D. Bipolar affective disorder
- E. Cyclothymic disorder
Cyclothymic disorder Explanation: ***Persistent depressive disorder***
- This condition is characterized by a **chronically depressed mood** that lasts for at least two years in adults, with symptoms not remitting for more than two consecutive months.
- The patient's history of feeling "down" for four years, with only brief periods of relief (never exceeding one month), fits this chronic pattern and meets the diagnostic criteria for persistent depressive disorder (formerly dysthymia).
- Although the patient has had worsening symptoms over the past 6 weeks, the **predominant feature** is the chronic, low-grade depression lasting 4 years, making persistent depressive disorder the most likely primary diagnosis.
*Adjustment disorder with depressed mood*
- An adjustment disorder typically involves emotional or behavioral symptoms in response to an **identifiable stressor**, occurring within 3 months of the stressor's onset and lasting no longer than 6 months after the stressor or its consequences have ceased.
- The patient's symptoms have been ongoing for 4 years, far exceeding the typical duration for an adjustment disorder, which by definition should not persist beyond 6 months after the stressor ends.
*Major depressive disorder*
- Major depressive disorder involves discrete episodes of at least 2 weeks with **five or more symptoms** including depressed mood or anhedonia, plus symptoms such as changes in appetite/weight, sleep disturbance, psychomotor changes, fatigue, worthlessness/guilt, concentration difficulty, or suicidal ideation.
- While the patient has some symptoms that could suggest a current major depressive episode (6 weeks of sadness, concentration difficulty, sleep problems), the question emphasizes the **chronic 4-year course** of low-grade depressive symptoms as the predominant pattern, which is more consistent with persistent depressive disorder.
- Note that patients can have MDD superimposed on persistent depressive disorder ("double depression"), but the chronic pattern described here makes persistent depressive disorder the primary diagnosis.
*Bipolar affective disorder*
- This disorder is characterized by distinct periods of **mood episodes** that include at least one manic or hypomanic episode, in addition to depressive episodes.
- The patient's presentation does not describe any manic or hypomanic symptoms (e.g., elevated mood, increased energy, decreased need for sleep, grandiosity, increased talkativeness, or risky behavior) that are characteristic of bipolar disorder.
*Cyclothymic disorder*
- Cyclothymic disorder involves numerous periods of **hypomanic symptoms** and numerous periods of **depressive symptoms** for at least 2 years, but these symptoms are not severe enough to meet the criteria for a hypomanic or major depressive episode.
- The patient describes chronic low mood without any mention of alternating periods of elevated mood or hypomanic symptoms, which are essential for a diagnosis of cyclothymic disorder.
Cyclothymic disorder US Medical PG Question 4: A 32-year-old woman is brought to the physician by her husband, who is concerned about her ability to care for herself. Three weeks ago, she quit her marketing job to start a clothing company. Since then, she has not slept more than 4 hours per night because she has been working on her business plans. She used a significant portion of their savings to fund business trips to Switzerland in order to buy “only the best quality fabrics in the world.” She has not showered and has eaten little during the past 3 days. She has had 2 similar episodes a few years back that required hospitalization and treatment in a psychiatry unit. She has also suffered from periods of depression. She is currently not taking any medications. She appears unkempt and agitated, pacing up and down the room. She speaks very fast without interruption about her business ideas. She has no suicidal ideation or ideas of self-harm. Toxicology screening is negative. Which of the following is the most appropriate pharmacotherapy for the management of this patient?
- A. Clonazepam therapy for one year
- B. Long-term lithium therapy (Correct Answer)
- C. Sertraline therapy for one year
- D. Long-term risperidone therapy
- E. Long-term clozapine therapy
Cyclothymic disorder Explanation: ***Long-term lithium therapy***
- This patient presents with classic symptoms of **mania** (decreased need for sleep, grandiosity, compulsive spending, rapid speech) and a history of both manic and depressive episodes, consistent with **bipolar I disorder**.
- **Lithium** is a first-line agent for the **long-term maintenance treatment** of **bipolar I disorder**, particularly effective in preventing both manic and depressive episodes.
*Clonazepam therapy for one year*
- **Clonazepam** is a **benzodiazepine** primarily used for short-term management of acute agitation or severe insomnia, not for long-term mood stabilization in bipolar disorder.
- Long-term use of benzodiazepines carries risks of **tolerance** and **dependence**, making it inappropriate for chronic maintenance treatment.
*Sertraline therapy for one year*
- **Sertraline** is an **antidepressant** (SSRI) that, when used as monotherapy in bipolar disorder, can induce **mania** or **rapid cycling**.
- While periods of depression are mentioned, the current presentation is manic, and mood stabilizers are the priority for long-term management.
*Long-term risperidone therapy*
- **Risperidone** is a **second-generation antipsychotic** effective in treating acute mania and can be used for maintenance in bipolar disorder, often as an adjunct or in patients who cannot tolerate lithium.
- However, for long-term monotherapy in bipolar I disorder, **lithium** is generally considered more effective and is the preferred first-line agent, especially given the history of recurrent episodes.
*Long-term clozapine therapy*
- **Clozapine** is an **atypical antipsychotic** reserved for **treatment-resistant schizophrenia** and **refractory bipolar disorder**, often due to its significant side effect profile, including **agranulocytosis**.
- While it can be effective for severe or refractory cases of bipolar disorder, it is not a first-line long-term treatment given its risks and the availability of safer alternatives.
Cyclothymic disorder US Medical PG Question 5: A 24-year-old woman is brought to the emergency department by her roommate because of bizarre behavior and incoherent talkativeness for the past week. Her roommate reports that the patient has been rearranging the furniture in her room at night and has ordered a variety of expensive clothes online. The patient says she feels “better than ever” and has a lot of energy. She had absence seizures as a child and remembers that valproate had to be discontinued because it damaged her liver. She has been otherwise healthy and is not taking any medication. She is sexually active with her boyfriend. She does not smoke, drink alcohol, or use illicit drugs. Physical and neurologic examinations show no abnormalities. Her pulse is 78/min, respirations are 13/min, and blood pressure is 122/60 mm Hg. Mental status examination shows pressured and disorganized speech, flight of ideas, lack of insight, and affective lability. Which of the following is the best initial step before deciding on a therapy for this patient's condition?
- A. Obtain CBC, liver function studies, and beta-HCG
- B. Obtain TSH, β-hCG, and serum creatinine concentration (Correct Answer)
- C. Obtain BMI, HbA1c, lipid levels, and prolactin levels
- D. Perform urine drug testing and begin cognitive behavior therapy
- E. Assess for suicidal ideation and obtain echocardiography
Cyclothymic disorder Explanation: ***Obtain TSH, β-hCG, and serum creatinine concentration***
- This patient presents with symptoms highly suggestive of **mania** (bizarre behavior, incoherent talkativeness, grandiosity, increased energy, pressured speech, flight of ideas). Before initiating treatment, it's crucial to rule out other medical conditions that can **mimic mania**, such as **hyperthyroidism** (TSH), **pregnancy** (β-hCG), or **kidney dysfunction** (creatinine), which can impact medication choice and dosage.
- TSH levels are essential as **hyperthyroidism** can cause symptoms like agitation, rapid speech, and increased energy, mimicking mania. A **pregnancy test (β-hCG)** is critical for women of childbearing age to ensure that any potential psychiatric medications are safe for both the mother and fetus. **Serum creatinine** helps assess kidney function, which is important for dosing many psychotropic medications eliminated by the kidneys.
*Obtain CBC, liver function studies, and beta-HCG*
- While a **β-hCG** is appropriate, **CBC** and **liver function studies (LFTs)** are typically obtained if there are specific concerns for anemia, infection, or liver damage (which the patient mentions about valproate in childhood, but there's no immediate indication for current LFTs before diagnosis confirmation).
- Although LFTs are important for certain antidepressant or mood stabilizer monitoring (e.g., valproate, carbamazepine), they are not the most immediate initial screen for ruling out medical mimics of mania in this context as **TSH** and **renal function** are more critical.
*Obtain BMI, HbA1c, lipid levels, and prolactin levels*
- These tests are important for **monitoring long-term metabolic side effects** of certain antipsychotics and mood stabilizers, but they are not the best initial steps for ruling out acute medical causes of manic symptoms.
- **BMI, HbA1c, and lipid levels** are typically assessed *after* diagnosis and initiation of treatment to establish a baseline for future metabolic monitoring. **Prolactin levels** might be checked if there is concern for hyperprolactinemia, which is a side effect of some antipsychotics, but not usually a cause of acute mania.
*Perform urine drug testing and begin cognitive behavior therapy*
- While **urine drug testing** is often performed in acute psychiatric presentations to rule out substance-induced mania, it is not listed as the *best initial step* alone, as other medical conditions also need to be ruled out concurrently.
- **Cognitive behavioral therapy (CBT)** is not an appropriate initial treatment for acute mania due to the patient's severe symptoms, lack of insight, and disorganized thought processes. **Pharmacotherapy** is the cornerstone of acute mania management.
*Assess for suicidal ideation and obtain echocardiography*
- Assessing for **suicidal ideation** is crucial in every psychiatric evaluation, but it is a mental status component rather than a diagnostic lab test. While important for patient safety, it doesn't rule out medical mimics of mania.
- **Echocardiography** is not indicated in the initial work-up of acute mania unless there are specific cardiac symptoms or a history that suggests underlying heart disease.
Cyclothymic disorder US Medical PG Question 6: A 27-year-old woman visits a psychiatrist expressing her feelings of sadness which are present on most days of the week. She says that she has been feeling this way for about 2 to 3 years. During her first pregnancy 3 years ago, the fetus died in utero, and the pregnancy was terminated at 21 weeks. Ever since then, she hasn’t been able to sleep well at night and has difficulty concentrating on her tasks most of the time. However, for the past month, she has found it more difficult to cope. She says she has no will to have another child as she still feels guilty and responsible for the previous pregnancy. Over the past few days, she has completely lost her appetite and only eats once or twice a day. She doesn’t recall a single day in the last 3 years where she has not felt this way. The patient denies any past or current smoking, alcohol, or recreational drug use. Which of the following is the most likely diagnosis in this patient?
- A. Persistent depressive disorder (Correct Answer)
- B. Bipolar disorder
- C. Schizoaffective disorder
- D. Cyclothymia
- E. Major depressive disorder
Cyclothymic disorder Explanation: ***Persistent depressive disorder***
- The patient exhibits classic symptoms of **persistent depressive disorder (dysthymia)**: chronic depressed mood for **at least two years**, accompanied by other depressive symptoms like **insomnia**, **difficulty concentrating**, and changes in appetite.
- The duration of her symptoms (2-3 years) and the consistent feeling of sadness support this diagnosis, fitting the diagnostic criteria for **dysthymia**.
*Bipolar disorder*
- Bipolar disorder involves distinct episodes of **mania or hypomania** alternating with depressive episodes.
- The patient's history does not indicate any periods of elevated mood, increased energy, or decreased need for sleep, which are characteristic of **bipolar disorder**.
*Schizoaffective disorder*
- Schizoaffective disorder is characterized by a combination of **mood symptoms** (like depression or mania) and **psychotic symptoms** (like delusions or hallucinations) occurring simultaneously or in distinct episodes.
- This patient presents with no evidence of **psychotic symptoms** such as hallucinations or delusions.
*Cyclothymia*
- Cyclothymia is a milder, chronic form of **bipolar disorder** involving numerous periods of **hypomanic symptoms** and numerous periods of **depressive symptoms** for at least two years.
- The patient's presentation lacks any history of **hypomanic episodes**, making cyclothymia an unlikely diagnosis.
*Major depressive disorder*
- While the patient is experiencing a **major depressive episode** currently (as suggested by increased severity in the last month and complete loss of appetite), the underlying chronic nature of her symptoms (2-3 years) and the fact that she has not been symptom-free for more than two months indicate **persistent depressive disorder**.
- A diagnosis of **major depressive disorder** would typically be given if the symptoms were acute (less than 2 years) and severe, without the chronic, pervasive depressive state described.
Cyclothymic disorder US Medical PG Question 7: A 28-year-old woman presents with depressed mood lasting for most days of the week for the past month. She also mentions that she has lost her appetite for the past 3 weeks. She adds that her job performance has significantly deteriorated because of these symptoms, and she feels like she will have to quit her job soon. Upon asking about her hobbies, she says that she used to enjoy dancing and music but does not have any desire to do them anymore. The patient’s husband says that she has had many sleepless nights last month. The patient denies any history of smoking, alcohol intake, or use of illicit substances. No significant past medical history. Physical examination is unremarkable. Routine laboratory tests are all within normal limits. Which of the following clinical features must be present, in addition to this patient’s current symptoms, to confirm the diagnosis of a major depressive episode?
- A. Intense fear of losing control
- B. Lack of concentration (Correct Answer)
- C. Weight loss
- D. Anterograde amnesia
- E. Nightmares
Cyclothymic disorder Explanation: ***Lack of concentration***
- The diagnostic criteria for a **major depressive episode** (DSM-5) require at least **5 out of 9 cardinal symptoms** present for at least 2 weeks, with at least one being either **depressed mood** or **anhedonia**.
- This patient currently has **4 symptoms**: (1) depressed mood, (2) anhedonia (loss of interest in dancing/music), (3) appetite disturbance (loss of appetite), and (4) sleep disturbance (insomnia).
- To meet diagnostic criteria, she needs **one more symptom** from the remaining options: fatigue, feelings of worthlessness/guilt, **diminished ability to concentrate or indecisiveness**, psychomotor changes, or suicidal ideation.
- **Lack of concentration** is one of the DSM-5 diagnostic criteria and would bring her total to 5 symptoms, confirming the diagnosis.
*Intense fear of losing control*
- This symptom is characteristic of **panic disorder** or anxiety disorders, where individuals experience sudden, intense episodes of fear with accompanying physical and cognitive symptoms.
- While anxiety can co-occur with depression, intense fear of losing control is **not a DSM-5 diagnostic criterion** for major depressive episode.
*Weight loss*
- The patient already has **loss of appetite**, which satisfies the weight/appetite criterion for major depressive episode.
- **Weight loss and appetite changes are part of the same diagnostic criterion**, not separate ones. Therefore, weight loss would not add an additional criterion to reach the required 5 symptoms.
- While clinically significant weight loss can occur in depression, it would not provide the "additional" criterion needed in this case.
*Anterograde amnesia*
- **Anterograde amnesia** (inability to form new memories) is associated with neurological conditions such as **hippocampal damage**, **Korsakoff syndrome**, or **traumatic brain injury**.
- It is **not a DSM-5 diagnostic criterion** for major depressive episode, though some cognitive impairment (concentration difficulties) may occur.
*Nightmares*
- The patient already has **insomnia** (sleep disturbance), which is one of the DSM-5 diagnostic criteria.
- While nightmares may occur in depression, they are not a separate diagnostic criterion and would not add to the symptom count since sleep disturbance is already present.
Cyclothymic disorder US Medical PG Question 8: A 24-year-old woman presents to her primary care physician for a wellness exam. She currently has no acute concerns but has been feeling hopeless, has a poor appetite, difficulty with concentration, and trouble with sleep. She says that she has poor self-esteem and that her symptoms have been occurring for the past 3 years. She has had moments where she felt better, but it lasted a few weeks out of the year. She currently lives alone and does not pursue romantic relationships because she feels she is not attractive. She has a past medical history of asthma. Her mother is alive and healthy. Her father committed suicide and suffered from major depressive disorder. On physical exam, the patient has a gloomy demeanor and appears restless and anxious. Which of the following is the most likely diagnosis?
- A. Major depressive disorder
- B. Cyclothymia
- C. Persistent depressive disorder (Correct Answer)
- D. Seasonal affective disorder
- E. Disruptive mood dysregulation disorder
Cyclothymic disorder Explanation: ***Persistent depressive disorder***
- The patient exhibits chronic symptoms of depression (poor appetite, poor self-esteem, difficulty with concentration, trouble with sleep, hopelessness) lasting for at least **2 years**, with symptom-free periods lasting no more than **2 months**.
- Her long-standing symptoms (3 years) and the intermittent improvement, but never full resolution for extended periods, are characteristic of **persistent depressive disorder** (formerly dysthymia).
*Major depressive disorder*
- While the patient has many symptoms of depression, **major depressive disorder** is characterized by distinct episodes of at least 2 weeks, with significant functional impairment. The chronic, fluctuating course over 3 years is less typical.
- The presence of depressive symptoms for 3 years, with only brief periods of improvement, points away from episodic major depressive disorder alone and more towards a chronic form.
*Cyclothymia*
- **Cyclothymia** involves numerous periods of hypomanic symptoms and numerous periods of depressive symptoms for at least 2 years, with periods of stability lasting no more than 2 months. The patient describes only depressive symptoms, not hypomanic episodes.
- There is no mention of elevated mood, increased energy, or decreased need for sleep, which are characteristic of **hypomanic episodes** in cyclothymia.
*Seasonal affective disorder*
- **Seasonal affective disorder** is a type of depressive disorder that occurs during a specific season (most commonly winter) and resolves during other seasons; the patient's symptoms are year-round and chronic.
- The patient's symptoms are not described as tied to a particular season, making this diagnosis less likely.
*Disruptive mood dysregulation disorder*
- Predominantly diagnosed in **children and adolescents**, this disorder is characterized by severe recurrent temper outbursts and persistently irritable or angry mood between outbursts.
- The patient's age (24 years old) and the absence of temper outbursts make this diagnosis inappropriate.
Cyclothymic disorder US Medical PG Question 9: A 29-year-old man is being monitored at the hospital after cutting open his left wrist. He has a long-standing history of unipolar depressive disorder and multiple trials of antidepressants. The patient expresses thoughts of self-harm and does not deny suicidal intent. A course of electroconvulsive therapy is suggested. His medical history is not significant for other organic illness. Which of the following complications of this therapy is this patient at greatest risk for?
- A. Acute kidney injury
- B. Acute coronary syndrome
- C. Anterograde amnesia
- D. Intracranial hemorrhage
- E. Retrograde amnesia (Correct Answer)
Cyclothymic disorder Explanation: ***Retrograde amnesia***
- **Retrograde amnesia**, specifically memory loss for events occurring prior to the treatment, is a common and often transient side effect of **electroconvulsive therapy (ECT)**.
- While generally temporary, it can be distressing for patients and is a significant consideration when recommending ECT, especially in patients with otherwise healthy brains.
*Acute kidney injury*
- **Acute kidney injury (AKI)** is not a typical direct complication of **ECT**.
- While fluid and electrolyte imbalances or certain medications used during ECT (e.g., muscle relaxants) could theoretically impact renal function in predisposed individuals, it is not a primary concern in a patient with no significant history of organic illness.
*Acute coronary syndrome*
- **Acute coronary syndrome (ACS)** is a potential risk associated with the physiological stress of **ECT**, which can include transient **hypertension** and **tachycardia**.
- However, in a 29-year-old with no significant medical history, the risk is considerably lower compared to older patients or those with pre-existing cardiovascular disease.
*Anterograde amnesia*
- **Anterograde amnesia**, the inability to form new memories after the treatment, is typically less common and usually milder than retrograde amnesia following **ECT**.
- While some patients may experience transient difficulty recalling new information immediately post-ECT, it is usually less pronounced than the impact on remote memories.
*Intracranial hemorrhage*
- **Intracranial hemorrhage** is an extremely rare and severe complication of **ECT**, typically associated with pre-existing cerebral vascular abnormalities or uncontrolled hypertension during the procedure.
- In a young patient with no organic illness, the risk of this complication is exceedingly low.
Cyclothymic disorder US Medical PG Question 10: A 26-year-old female college student is brought back into the university clinic for acting uncharacteristically. The patient presented to the same clinic 6 weeks ago with complaints of depressed mood, insomnia, and weightloss. She had been feeling guilty for wasting her parent’s money by doing so poorly at the university. She felt drained for at least 2 weeks before presenting to the clinic for the first time. She was placed on an antidepressant and was improving but now presents with elevated mood. She is more talkative with a flight of ideas and is easily distractible. Which of the following statements is most likely true regarding this patient’s condition?
- A. The patient may have psychotic features.
- B. Her diagnosis of unipolar depression is incorrect. (Correct Answer)
- C. The patient may have a history of mania.
- D. Antidepressants are inappropriate.
- E. Her new symptoms need to last at least 7 days.
Cyclothymic disorder Explanation: ***Correct: Her diagnosis of unipolar depression is incorrect.***
The patient initially presented with symptoms consistent with a **depressive episode**, but the subsequent emergence of **elevated mood, increased talkativeness, flight of ideas, and distractibility after antidepressant use** strongly suggests a shift to a **manic or hypomanic episode**. This antidepressant-induced mood switch is a hallmark feature revealing **bipolar disorder** that was initially misdiagnosed as unipolar depression. This statement most directly addresses **what is true about this patient's condition** - that the fundamental diagnosis is incorrect. Once we establish the correct diagnosis of bipolar disorder, all treatment and management decisions follow from this.
*Incorrect: The patient may have psychotic features.*
While patients with severe **mania** can develop **psychotic features** (e.g., delusions, hallucinations), the provided symptoms (elevated mood, increased talkativeness, flight of ideas, distractibility) do not describe psychotic symptoms. There is no information suggesting the presence of **delusions or hallucinations**, which are necessary to diagnose psychotic features. The word "may" makes this theoretically possible but not supported by the clinical presentation described.
*Incorrect: The patient may have a history of mania.*
While patients with bipolar disorder often have previous undiagnosed episodes, this statement is speculative about her **past history** rather than addressing what is most directly evident from the **current presentation**. The vignette focuses on the antidepressant-induced mood switch, which immediately reveals that the current diagnosis of unipolar depression is incorrect. Whether or not she had previous manic episodes is less relevant than recognizing the misdiagnosis now.
*Incorrect: Antidepressants are inappropriate.*
This statement is clinically **true in principle** - antidepressants as monotherapy are generally inappropriate for bipolar disorder due to the risk of inducing mania or hypomania. However, this option addresses **treatment implications** rather than directly stating what is true about **the patient's condition itself**. The more fundamental and direct truth is that **her diagnosis is wrong** (bipolar, not unipolar depression). Once the correct diagnosis is established, then the inappropriateness of antidepressant monotherapy follows. Additionally, at the time of initial presentation with pure depressive symptoms, the antidepressant prescription was reasonable based on the information available - the inappropriateness only became clear retrospectively after the mood switch occurred.
*Incorrect: Her new symptoms need to last at least 7 days.*
For a diagnosis of **mania**, symptoms must last at least **one week** (or any duration if hospitalization is required). However, for **hypomania**, symptoms need to last only **4 consecutive days**. The vignette does not specify whether this is mania or hypomania, nor does it clearly state the duration of the current symptoms beyond "now presents." Therefore, we cannot definitively say a 7-day duration is required - it could be hypomania requiring only 4 days. This statement is not necessarily true.
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