Adjustment disorder with depressed mood US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Adjustment disorder with depressed mood. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Adjustment disorder with depressed mood US Medical PG Question 1: A 28-year-old man who works as a resident in general surgery presents feeling "burned out" for the last 2 months. He says he has been working extremely long hours under stressful conditions, which makes him irritable, edgy, unfocused, and forgetful. He says he also has severe anxiety about how these symptoms are affecting his performance at work, making it difficult for him to sleep even when he has time off. The patient is referred for counseling and is prescribed some mild sleep aids. At follow-up a few months later, he says he is feeling much improved due to improved staffing at the hospital and a more manageable workload. Which of the following is the most likely diagnosis in this patient?
- A. Adjustment disorder (Correct Answer)
- B. Normal human behavior
- C. Panic disorder
- D. Generalized anxiety disorder
- E. Anxiety disorder
Adjustment disorder with depressed mood Explanation: ***Adjustment disorder***
- This condition is characterized by the development of emotional or behavioral symptoms in response to an identifiable **stressor** (e.g., stressful work conditions), typically within **3 months of the stressor's onset**.
- The patient's symptoms (irritability, edginess, unfocused, forgetful, anxiety, sleep difficulties) are consistent with an adjustment disorder, and the **improvement with resolution of the stressor** (improved staffing, manageable workload) is the key diagnostic feature.
- Symptoms cause **clinically significant distress** or impairment but resolve when the stressor is removed.
*Normal human behavior*
- While stress and feeling "burned out" are common experiences, the severity of the patient's symptoms (profound anxiety, significant sleep disturbance, impact on work performance) suggests distress beyond **normal human emotional response**.
- The symptoms interfere with **occupational functioning** and require intervention (counseling, sleep aids), indicating a diagnosable condition rather than a typical stress reaction.
*Panic disorder*
- **Panic disorder** requires recurrent unexpected **panic attacks** (sudden onset of intense fear with physical symptoms like palpitations, sweating, chest pain, shortness of breath).
- The patient's anxiety is **chronic and situational**, directly related to work stressors, rather than episodic unexpected attacks.
*Generalized anxiety disorder*
- **GAD** requires excessive, uncontrollable worry about **multiple events or activities** for at least **6 months**, accompanied by physical symptoms (restlessness, fatigue, concentration difficulty, muscle tension).
- While the patient has anxiety, it is **time-limited (2 months)**, tied to a **specific identifiable stressor**, and resolves when the stressor is removed—hallmarks of adjustment disorder, not GAD's persistent pervasive worry pattern.
*Anxiety disorder*
- This is a **non-specific umbrella term** encompassing multiple specific diagnoses (GAD, panic disorder, social anxiety disorder, etc.).
- When a **specific stressor clearly precipitates symptoms** that resolve with stressor removal, **Adjustment Disorder with Anxious Features** is the most precise diagnosis.
- The prompt asks for the "most likely diagnosis," making the specific diagnosis (adjustment disorder) preferable to a vague category term.
Adjustment disorder with depressed mood US Medical PG Question 2: A 25-year-old woman comes to the physician because of sadness that started 3 weeks after her daughter was born. Her daughter is now 9 months old and usually sleeps through the night, but the patient still has difficulty staying asleep. She has not returned to work since the birth. She is easily distracted from normal daily tasks. She used to enjoy cooking, but only orders delivery or take-out now. She says that she always feels too exhausted to do so and does not feel hungry much anyway. The pregnancy of the patient's child was complicated by gestational diabetes. The child was born at 36-weeks' gestation and has had no medical issues. The patient has no contact with the child's father. She is not sexually active. She does not smoke, drink alcohol, or use illicit drugs. She is 157 cm (5 ft 1 in) tall and weighs 47 kg (105 lb); BMI is 20 kg/m2. Vital signs are within normal limits. She is alert and cooperative but makes little eye contact. Physical examination shows no abnormalities. Which of the following is the most likely diagnosis?
- A. Adjustment disorder
- B. Major depressive disorder
- C. Normal behavior
- D. Disruptive mood dysregulation disorder
- E. Depression with peripartum-onset (Correct Answer)
Adjustment disorder with depressed mood Explanation: ***Depression with peripartum-onset***
- The patient exhibits classic symptoms of **major depressive disorder**, including **anhedonia** (loss of enjoyment in cooking), **fatigue**, **insomnia**, and **changes in appetite/weight**, all appearing within 3 weeks post-childbirth and persisting for 9 months.
- According to **DSM-5-TR**, the **peripartum onset specifier** is applied when a major depressive episode begins during pregnancy or **within 4 weeks after delivery**.
- This patient's symptoms began at 3 weeks postpartum, meeting criteria for the peripartum onset specifier, which is clinically important for risk assessment (including infanticide risk) and treatment planning.
- The severity and duration of symptoms (persistent anhedonia, significant fatigue, insomnia despite adequate opportunity for sleep, appetite changes, functional impairment lasting months) clearly meet criteria for a **major depressive episode**.
*Adjustment disorder*
- This diagnosis involves emotional or behavioral symptoms in response to an identifiable stressor that do **not meet criteria for a major depressive episode**.
- The severity, number, and duration of symptoms (anhedonia, significant fatigue, insomnia, appetite changes, functional impairment lasting 9 months) exceed what is seen in adjustment disorder and meet full criteria for **major depressive disorder**.
*Major depressive disorder*
- While this patient's symptoms fully meet criteria for **Major Depressive Disorder (MDD)**, the onset within 4 weeks postpartum requires the addition of the **"with peripartum onset" specifier** per DSM-5-TR.
- Using the peripartum onset specifier is essential for clinical management, as it alerts clinicians to specific risks (including thoughts of harming the infant) and may influence treatment selection (e.g., considerations for breastfeeding-compatible medications).
*Normal behavior*
- The patient's symptoms—including **persistent sadness lasting 9 months**, **anhedonia**, **insomnia despite adequate sleep opportunity**, **significant fatigue**, **appetite loss**, and **inability to return to work**—represent severe functional impairment.
- These symptoms far exceed normal postpartum adjustment or transient "baby blues" (which typically resolve within 2 weeks postpartum) and indicate a serious mood disorder requiring treatment.
*Disruptive mood dysregulation disorder*
- This disorder is diagnosed **only in children and adolescents aged 6-18 years** and is characterized by persistent irritability and frequent, severe temper outbursts disproportionate to the situation.
- It is **not applicable to adults** and does not describe this patient's presentation of persistent depressed mood and neurovegetative symptoms.
Adjustment disorder with depressed mood US Medical PG Question 3: A 28-year-old woman is brought into the clinic by her husband with concerns that she might be depressed. She delivered a healthy newborn a week and a half ago without any complications. Since then, she has been having trouble sleeping, eating poorly, and has stopped playing with the baby. The patient says she feels like she is drained all the time and feels guilty for not doing more for the baby. Which of the following is the best course of treatment for this patient?
- A. Reassurance
- B. Fluoxetine (Correct Answer)
- C. Risperidone
- D. Amitriptyline
- E. No treatment
Adjustment disorder with depressed mood Explanation: ***Fluoxetine***
- This patient's symptoms (trouble sleeping, poor appetite, guilt, and anhedonia towards the baby) occurring 10 days postpartum are highly suggestive of **postpartum depression**. **SSRIs** like fluoxetine are first-line pharmacological treatments for this condition.
- Fluoxetine is a **selective serotonin reuptake inhibitor (SSRI)** that helps regulate mood by increasing serotonin levels in the brain. It is generally considered safe during breastfeeding, with a relatively low infant exposure compared to other antidepressants.
*Reassurance*
- Reassurance alone may be appropriate for **postpartum blues**, which are milder and self-limiting, typically resolving within two weeks.
- This patient's symptoms are more severe and persistent, lasting beyond typical postpartum blues and significantly impacting her functioning, indicating a need for more substantial intervention.
*Risperidone*
- Risperidone is an **atypical antipsychotic** primarily used to treat conditions like schizophrenia or bipolar disorder, or as an adjunct for severe refractory depression with psychotic features.
- There is no indication of psychosis in this patient's presentation, and the use of an antipsychotic would be disproportionate and carry unnecessary side effects.
*Amitriptyline*
- Amitriptyline is a **tricyclic antidepressant (TCA)**. While effective for depression, TCAs are generally not first-line due to a less favorable side effect profile (e.g., anticholinergic effects, cardiac conductivity issues) compared to SSRIs.
- SSRIs like fluoxetine are preferred for initial treatment of postpartum depression due to their better tolerability and safety profile.
*No treatment*
- This patient exhibits clear symptoms of **postpartum depression**, which is a serious condition that can worsen without intervention and impact both the mother's and infant's well-being.
- Untreated depression can lead to significant functional impairment, chronic suffering, and in severe cases, harm to oneself or the baby.
Adjustment disorder with depressed mood US Medical PG Question 4: A 20-year-old college student comes to the physician because she has been extremely sad for the past 3 weeks and has to cry constantly. Three weeks ago, her boyfriend left her after they were together for 4 years. She has no appetite and has had a 2.3-kg (5.1-lb) weight loss. She has missed several classes because she could not stop crying or get out of bed. She thinks about her ex-boyfriend all the time. She says that she experienced similar symptoms for about 2 months after previous relationships ended. The patient is 158 cm (5 ft 2 in) tall and weighs 45 kg (100 lb); BMI is 18 kg/m2. Her temperature is 36.1°C (97°F), pulse is 65/min, and blood pressure is 110/60 mm Hg. Physical examination shows no abnormalities. On mental status examination she appears sad and cries easily. Which of the following is the most likely diagnosis?
- A. Bereavement
- B. Anorexia nervosa
- C. Major depressive disorder
- D. Acute stress disorder
- E. Adjustment disorder with depressed mood (Correct Answer)
Adjustment disorder with depressed mood Explanation: ***Adjustment disorder with depressed mood***
- This diagnosis is most likely as the patient’s symptoms (sadness, crying, loss of appetite, weight loss, difficulty getting out of bed) developed in response to an **identifiable stressor** (breakup with boyfriend) and occurred within **3 months** of its onset.
- The patient's history of similar, time-limited reactions to previous relationship endings supports an adjustment disorder pattern, where symptoms are **maladaptive** but resolve once the stressor is removed or a new level of adaptation is achieved, making it distinct from major depression due to its direct and timely link to a stressor.
*Bereavement*
- Bereavement involves the natural and expected emotional responses to the **death of a loved one**, which is not the case here as her boyfriend left her.
- While symptoms can overlap with depression, the precipitating event (death vs. breakup) distinguishes it from adjustment disorder.
*Anorexia nervosa*
- Anorexia nervosa is characterized by an **intense fear of gaining weight** or becoming fat, a distorted body image, and a persistent restriction of energy intake leading to a significantly low body weight.
- The patient's weight loss and poor appetite are attributed to her sadness and crying spells following a breakup, not primarily driven by a desire to be thin or body image preoccupation.
*Major depressive disorder*
- Major depressive disorder requires symptoms to be present for **at least 2 weeks** and significantly impair functioning, but the key differentiator here is the **clear and recent precipitating stressor** (breakup) and the history of similar, time-limited responses to past relationship endings.
- While the symptoms are severe, they are directly and clearly linked to the stressor, and the patient's pattern of response suggests an adjustment disorder rather than an endogenous depressive episode.
*Acute stress disorder*
- Acute stress disorder occurs in response to exposure to actual or threatened **death, serious injury, or sexual violence**, either directly or indirectly.
- The patient's stressor (a breakup) does not meet the criteria for a traumatic event required for acute stress disorder.
Adjustment disorder with depressed mood US Medical PG Question 5: A 29-year-old man presents to his primary care provider complaining of not being able to get enough rest at night. He goes to bed early enough and has otherwise good sleep hygiene but feels drained the next day. He feels he is unable to perform optimally at work, but he is still a valued employee and able to complete his share of the work. About a month ago his wife of 5 years asked for a divorce and quickly moved out. He has cut out coffee after 12 pm and stopped drinking alcohol. He also exercises 3 days per week. Today, his blood pressure is 120/80 mm Hg, heart rate is 95/min, respiratory rate is 25/min, and temperature is 37.0°C (98.6°F ). On physical exam, his heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally. A CMP, CBC, and thyroid test are negative. Which of the following statements best describes this patient’s condition?
- A. Symptoms are usually self-limited and may persist for 2 years
- B. Symptoms typically resolve within 6 months after the stressor ends (Correct Answer)
- C. Symptoms develop within 3 months of the stressor
- D. Symptoms may be persistent if the stressor is chronic
- E. Symptoms represent a maladaptive response to an identifiable stressor
Adjustment disorder with depressed mood Explanation: ***Symptoms typically resolve within 6 months after the stressor ends***
- This statement accurately describes the **temporal criterion for adjustment disorder** according to DSM-5. Once the stressor or its consequences have terminated, symptoms should resolve within 6 months.
- This patient experienced a clear stressor (divorce and wife moving out ~1 month ago) and developed symptoms in response. The diagnosis of adjustment disorder requires that these symptoms resolve within 6 months of the stressor's termination.
- His symptoms (poor sleep, feeling drained, suboptimal performance) represent a significant but not incapacitating response, consistent with adjustment disorder. Normal labs rule out medical causes.
- This temporal criterion distinguishes adjustment disorder from more chronic conditions and helps guide prognosis and treatment planning.
*Symptoms are usually self-limited and may persist for 2 years*
- Adjustment disorder symptoms should resolve within **6 months**, not 2 years, after the stressor or its consequences have ended.
- If symptoms persist beyond 6 months, this suggests either ongoing stressor consequences, a persistent subtype (for chronic stressors), or an alternative diagnosis should be considered.
*Symptoms develop within 3 months of the stressor*
- While this is a **correct diagnostic criterion** (symptoms must develop within 3 months of stressor onset), it only addresses timing of onset, not the complete picture.
- The question asks for the statement that "best describes" the condition, and the resolution timeline is more distinctive and prognostically important than onset timing alone.
*Symptoms may be persistent if the stressor is chronic*
- This describes the **persistent specifier** in DSM-5, which applies when the stressor or its consequences are ongoing (chronic stressor or enduring consequences).
- However, in this case, the stressor appears to be acute (wife moved out), not chronic, making this less applicable to the specific clinical scenario presented.
*Symptoms represent a maladaptive response to an identifiable stressor*
- This is a **core defining feature** of adjustment disorder - the development of emotional/behavioral symptoms in response to an identifiable stressor with marked distress or impairment.
- While accurate, this is a general characteristic shared across the definition and doesn't capture the specific **temporal criteria** (resolution within 6 months) that is most distinctive for adjustment disorder diagnosis and prognosis.
Adjustment disorder with depressed mood US Medical PG Question 6: A previously healthy 36-year-old man is brought to the physician by a friend because of fatigue and a depressed mood for the past few weeks. During this time, he has not been going to work and did not show up to meet his friends for two bowling nights. The friend is concerned that he may lose his job. He spends most of his time alone at home watching television on the couch. He has been waking up often at night and sometimes takes 20 minutes to go back to sleep. He has also been drinking half a pint of whiskey per day for 1 week. His wife left him 4 weeks ago and moved out of their house. His vital signs are within normal limits. On mental status examination, he is oriented to person, place and time. He displays a flattened affect and says that he “doesn't know how he can live without his wife.” He denies suicidal ideation. Which of the following is the next appropriate step in management?
- A. Prescribe a short course of alprazolam
- B. Hospitalize the patient
- C. Initiate cognitive behavioral therapy (Correct Answer)
- D. Initiate disulfiram therapy
- E. Prescribe a short course of duloxetine
Adjustment disorder with depressed mood Explanation: ***Initiate cognitive behavioral therapy***
- The patient exhibits features of **adjustment disorder with depressed mood**, characterized by significant distress or impairment in functioning in response to an identifiable stressor (wife leaving).
- **Cognitive behavioral therapy (CBT)** is an effective first-line treatment for adjustment disorders, helping patients develop coping strategies and restructure negative thought patterns.
*Prescribe a short course of alprazolam*
- **Alprazolam**, a benzodiazepine, can provide temporary relief for anxiety but does not address the underlying issues of adjustment disorder and carries risks of **dependence** and withdrawal.
- It would be inappropriate as a sole initial treatment and could exacerbate his **alcohol use**.
*Hospitalize the patient*
- The patient denies **suicidal ideation** and does not present with acute psychosis or severe impairment that would warrant **hospitalization**.
- His orientation and ability to engage in conversation further suggest an outpatient approach is safe and appropriate.
*Initiate disulfiram therapy*
- **Disulfiram** is used for alcohol dependence to deter drinking, but the patient's current alcohol use is a recent development in response to stress, not necessarily full-blown **alcohol dependence** requiring disulfiram.
- Addressing the underlying **adjustment disorder** is the priority, which may in turn reduce his alcohol consumption.
*Prescribe a short course of duloxetine*
- **Duloxetine** is an antidepressant that is not indicated for **adjustment disorder** as a first-line treatment, especially given the short duration and clear precipitating factor.
- **Psychotherapy**, like CBT, is generally the preferred initial intervention for adjustment disorders.
Adjustment disorder with depressed mood US Medical PG Question 7: A previously healthy 56-year-old woman comes to the family physician for a 1-month history of sleep disturbance and sadness. The symptoms have been occurring since her husband died in a car accident. Before eventually falling asleep, she stays awake for multiple hours and has crying spells. Several times she has been woken up by the sound of her husband calling her name. She has lost 3 kg (6.6 lb) over the past month. She has 3 children with whom she still keeps regular contact and regularly attends church services with her friends. She expresses feeling a great feeling of loss over the death of her husband. She has no suicidal ideation. She is alert and oriented. Neurological exam shows no abnormalities. Which of the following is the most likely diagnosis for this patient's symptoms?
- A. Adjustment disorder with depressed mood
- B. Acute stress disorder
- C. Major depressive disorder
- D. Normal bereavement (Correct Answer)
- E. Schizoaffective disorder
Adjustment disorder with depressed mood Explanation: ***Normal bereavement***
- The patient's symptoms (sleep disturbance, sadness, weight loss, crying spells, auditory hallucinations of a loved one) are all **common and expected responses to the death of a loved one** within a short timeframe (1 month).
- Her continued social engagement and lack of suicidal ideation suggest that her grief, while intense, is within the range of **normal bereavement**, especially given the recent and traumatic loss.
*Adjustment disorder with depressed mood*
- This diagnosis is considered when symptoms in response to a stressor are **clinically significant** but do not meet criteria for a major depressive episode and cause significant impairment.
- However, in this case, the symptoms are directly related to the death of her husband, making **bereavement a more specific and appropriate diagnosis** if the symptoms are within normal grief.
*Acute stress disorder*
- This disorder typically involves exposure to actual or threatened **death, serious injury, or sexual violence**, followed by intrusive symptoms, negative mood, dissociation, avoidance, and arousal symptoms, and lasts from 3 days to 1 month.
- While there is a significant stressor (husband's death), her symptoms are more indicative of **grief and loss** rather than the specific dissociative, avoidance, and arousal symptom clusters required for acute stress disorder.
*Major depressive disorder*
- While some symptoms overlap (depressed mood, sleep disturbance, weight loss), several factors argue against MDD, such as the direct and recent link to a **major loss**, her **intact social functioning**, and the **absence of suicidal ideation** or pervasive anhedonia beyond grief.
- The **auditory hallucinations of her husband's voice** are also common in normal bereavement, especially shortly after a loss, and do not necessarily indicate a psychotic disorder or MDD with psychotic features in this context.
*Schizoaffective disorder*
- This diagnosis requires a **period of illness during which a major mood episode is present concurrently with Criterion A of schizophrenia** (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms) and delusions or hallucinations for 2 or more weeks in the absence of a major mood episode.
- The patient's isolated auditory hallucination, occurring in the context of profound grief, does not meet the extensive criteria for schizophrenia or schizoaffective disorder, and there are **no other psychotic symptoms** or a history of such.
Adjustment disorder with depressed mood US Medical PG Question 8: A 43-year-old woman is brought to the physician by her daughter because she has been intermittently crying for 6 hours and does not want to get out of bed. Her symptoms started after she was fired yesterday from her job of 20 years. She says she feels sad and does not understand what she will do with her life now. She uses an over-the-counter inhaler as needed for exercise-induced asthma, and recently started oral isotretinoin for acne. She used to smoke a pack of cigarettes per day, but for the last year she has decreased to 2 cigarettes daily. She appears sad and very upset. Her temperature is 37°C (98.6°F), pulse is 110/min, respirations are 20/min, and blood pressure is 140/80 mm Hg. Physical examination shows no other abnormalities. On mental status examination, she is oriented to person, place, and time. She maintains eye contact and follows instructions. She denies suicidal ideation. Which of the following is the most likely explanation for this finding?
- A. Drug-related depression
- B. Acute stress disorder
- C. Adjustment disorder
- D. Major depressive disorder
- E. Normal stress reaction (Correct Answer)
Adjustment disorder with depressed mood Explanation: ***Normal stress reaction***
- The patient's symptoms (crying, sadness, not wanting to get out of bed) are a direct, understandable emotional response to a significant recent stressor (being fired from a 20-year job). This type of reaction is **expected and transient** in response to acute life changes.
- The duration of symptoms is short (6 hours), and there is **no evidence of significant functional impairment** beyond the initial emotional distress, nor does she meet criteria for a mental disorder.
*Drug-related depression*
- While **isotretinoin has been associated with mood changes**, including depression, the acute onset and direct temporal relationship to a significant psychosocial stressor make a drug-related cause less likely as the primary explanation.
- There are no other features pointing to drug-induced etiology, and her symptoms are clearly linked to the job loss.
*Acute stress disorder*
- Acute stress disorder symptoms (e.g., intrusive thoughts, negative mood, dissociation, avoidance, arousal) typically involve exposure to an **actual or threatened traumatic event**, such as death or serious injury, which is not the case here.
- The symptom duration for acute stress disorder is also typically 3 days to 1 month, and the patient's symptoms are of much shorter duration and less severe.
*Adjustment disorder*
- Adjustment disorder involves significant emotional or behavioral symptoms in response to an identifiable stressor, but these symptoms must cause **marked distress in excess of what would be expected** or significant impairment in social or occupational functioning.
- Given the magnitude of the stressor (losing a 20-year job), the patient's reaction is within the range of a normal and expected emotional response, rather than excessive or impairing functionality long-term.
*Major depressive disorder*
- Major depressive disorder requires a cluster of specific symptoms (e.g., anhedonia, sleep disturbance, appetite changes, low energy, feelings of worthlessness) lasting for at least **two weeks**, causing clinically significant distress or impairment.
- The patient's symptoms are acute (6 hours), directly linked to an external event, and do not yet meet the duration or full criteria for a major depressive episode.
Adjustment disorder with depressed mood US Medical PG Question 9: A 36-year-old woman comes to the physician because of an 8-month history of occasional tremor. The tremor is accompanied by sudden restlessness and nausea, which disrupts her daily work as a professional violinist. The symptoms worsen shortly before upcoming concerts but also appear when she goes for a walk in the city. She is concerned that she might have a neurological illness and have to give up her career. The patient experiences difficulty falling asleep because she cannot stop worrying that a burglar might break into her house. Her appetite is good. She drinks one glass of wine before performances "to calm her nerves" and otherwise drinks 2–3 glasses of wine per week. The patient takes daily multivitamins as prescribed. She appears nervous. Her temperature is 36.8°C (98.2°F), pulse is 92/min, and blood pressure is 135/80 mm Hg. Mental status examination shows a full range of affect. On examination, a fine tremor on both hands is noted. She exhibits muscle tension. The remainder of the neurological exam shows no abnormalities. Which of the following is the most likely explanation for this patient's symptoms?
- A. Atypical depressive disorder
- B. Adjustment disorder
- C. Generalized anxiety disorder (Correct Answer)
- D. Panic disorder
- E. Essential tremor
Adjustment disorder with depressed mood Explanation: ***Generalized anxiety disorder***
- The patient exhibits persistent and excessive worry about various life circumstances (performance, burglaries, general anxiety), accompanied by physical symptoms like **restlessness**, muscle tension, and sleep disturbances, which are hallmark features of **Generalized Anxiety Disorder (GAD)**.
- The symptoms have been present for **8 months**, exceed the diagnostic duration for GAD (at least 6 months), and are not clearly tied to a specific stressor or episodic panic attacks.
*Atypical depressive disorder*
- Atypical depression is characterized by mood reactivity, increased appetite/weight gain, hypersomnia, leaden paralysis, and interpersonal rejection sensitivity.
- This patient reports difficulty sleeping (*insomnia*) and primarily presents with anxiety symptoms, not depressive mood.
*Adjustment disorder*
- **Adjustment disorder** involves emotional or behavioral symptoms in response to an identifiable stressor, occurring within 3 months of the stressor's onset, and usually resolving within 6 months after the stressor or its consequences have ceased.
- The patient's symptoms are chronic (8 months), excessive, and not solely linked to *one* identifiable recent stressor, but rather a pervasive pattern of worry.
*Panic disorder*
- **Panic disorder** is characterized by recurrent unexpected **panic attacks** with sudden onset of intense fear and physical symptoms (e.g., palpitations, dyspnea, dizziness).
- While she experiences sudden restlessness and nausea related to performances, these are specific triggers and not unexpected, unprovoked panic attacks. The primary pattern is persistent worry, not recurrent panic attacks.
*Essential tremor*
- **Essential tremor** is a neurological condition causing an *action tremor*, often visible when performing daily tasks, and typically improves with alcohol.
- While she has a tremor that improves with alcohol, the presence of marked and pervasive psychological symptoms like severe worrying, restlessness, and insomnia point to an underlying anxiety disorder, not solely an isolated neurological tremor.
Adjustment disorder with depressed mood US Medical PG Question 10: A 5-year-old boy is brought to the physician by his mother because he does not “listen to her” anymore. The mother also reports that her son cannot concentrate on any tasks lasting longer than just a few minutes. Teachers at his preschool report that the patient is more active compared to other preschoolers, frequently interrupts or bothers other children, and is very forgetful. Last year the patient was expelled from another preschool for hitting his teacher and his classmates when he did not get what he wanted and for being disruptive during classes. He was born at term via vaginal delivery and has been healthy except for 3 episodes of acute otitis media at the age of 2 years. He has met all developmental milestones. His mother has major depressive disorder and his father has Graves' disease. He appears healthy and well nourished. Examination shows that the patient does not seem to listen when spoken to directly. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in treatment?
- A. Methylphenidate
- B. Methimazole
- C. Behavior therapy (Correct Answer)
- D. Fluoxetine
- E. Hearing aids
Adjustment disorder with depressed mood Explanation: ***Behavior therapy***
- For **preschool-aged children (ages 4-5 years)** with ADHD symptoms, **behavior therapy** is recommended as the **first-line treatment**.
- This approach focuses on teaching parents and caregivers strategies to manage challenging behaviors and improve communication, promoting positive behavioral changes in the child.
*Methylphenidate*
- **Stimulant medications** like methylphenidate are generally considered **second-line treatment** for ADHD in preschool-aged children.
- While effective, their use in this age group is typically reserved for cases where behavior therapy alone has not yielded sufficient improvement.
*Methimazole*
- **Methimazole** is an **antithyroid medication** used to treat **hyperthyroidism**, such as **Graves' disease**.
- This medication is irrelevant to the child's behavioral symptoms and is used for the father's condition.
*Fluoxetine*
- **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)** primarily used to treat **depression** and **anxiety disorders**.
- While the mother has major depressive disorder, fluoxetine is not indicated for the child's ADHD-like symptoms.
*Hearing aids*
- Although the child has a history of recurrent **otitis media**, there is **no current evidence** of hearing impairment affecting his development or behavior.
- Furthermore, his developmental milestones were met, suggesting that any past hearing issues were transient or did not significantly impact his overall development.
More Adjustment disorder with depressed mood US Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
