Cultural aspects of mood disorders US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Cultural aspects of mood disorders. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Cultural aspects of mood disorders US Medical PG Question 1: A 23-year-old man presents to the emergency department with a chief complaint of being assaulted on the street. The patient claims that he has been followed by the government for quite some time and that he was assaulted by a government agent but was able to escape. He often hears voices telling him to hide. The patient has an unknown past medical history and admits to smoking marijuana frequently. On physical exam, the patient has no signs of trauma. When interviewing the patient, he is seen conversing with an external party that is not apparent to you. The patient states that he is afraid for his life and that agents are currently pursuing him. What is the best initial response to this patient’s statement?
- A. I think you are safe from the agents here.
- B. You have a mental disorder but don’t worry we will help you.
- C. I don’t think any agents are pursuing you.
- D. What medications are you currently taking?
- E. It sounds like you have been going through some tough experiences lately. (Correct Answer)
Cultural aspects of mood disorders Explanation: ***It sounds like you have been going through some tough experiences lately.***
- This response **acknowledges the patient's distress** and experience without validating or refuting their delusional beliefs.
- It helps establish **rapport** and encourages the patient to share more about their symptoms, which is crucial for assessment in a psychiatric emergency.
*I think you are safe from the agents here.*
- While intended to reassure, directly addressing the delusion can be perceived as dismissive and may **escalate the patient's paranoia** or agitation.
- It does not validate their *feelings* of fear, which are real to them, even if the source is delusional.
*You have a mental disorder but don’t worry we will help you.*
- This statement is **confrontational** and judgmental, labeling the patient immediately with a diagnosis.
- This approach can cause the patient to become defensive, shut down, or feel stigmatized, making further assessment and trust-building very difficult in the **initial interaction**.
*I don’t think any agents are pursuing you.*
- Directly **challenging a patient's delusion** is generally unhelpful in acute settings and can lead to increased agitation.
- It invalidates their subjective reality and can make them feel misunderstood or distrustful of the healthcare provider.
*What medications are you currently taking?*
- While important information, asking about medications is too premature as an *initial response* to a patient expressing severe paranoia and fear.
- This question comes across as dismissive of their current emotional state and **prioritizes medical history over emotional support** and rapport-building.
Cultural aspects of mood disorders US Medical PG Question 2: A 19-year-old woman comes to the physician because of a 2-day history of difficulty sleeping. She worries that the lack of sleep will ruin her career prospects as a model. She has been coming to the physician multiple times over the past year for minor problems. She is dressed very extravagantly and flirts with the receptionist. When she is asked to sit down in the waiting room, she begins to cry and says that no one listens to her. When she is called to the examination room, she moves close to the physician, repeatedly intends to touch his cheek, and makes inappropriate comments. She does not have a history of self-harm or suicidal ideation. Which of the following is the most likely diagnosis?
- A. Schizotypal personality disorder
- B. Borderline personality disorder
- C. Dependent personality disorder
- D. Narcissistic personality disorder
- E. Histrionic personality disorder (Correct Answer)
Cultural aspects of mood disorders Explanation: ***Histrionic personality disorder***
- This patient displays classic features of **histrionic personality disorder**, including **attention-seeking behaviors** (flirting, extravagant dress, dramatic crying), **inappropriate sexually seductive behavior** toward the physician, and **rapidly shifting and shallow emotions** (cries that no one listens to her, then attempts to touch the physician).
- Her excessive emotionality and constant need to be the center of attention, coupled with a tendency to use physical appearance to draw attention to herself, align well with the diagnostic criteria.
*Schizotypal personality disorder*
- Characterized by a pervasive pattern of **social and interpersonal deficits** marked by acute discomfort with, and reduced capacity for, close relationships, as well as by **cognitive or perceptual distortions** and eccentricities of behavior.
- This patient does not exhibit evidence of odd beliefs, magical thinking, unusual perceptual experiences, or paranoid ideation typical of schizotypal personality disorder.
*Borderline personality disorder*
- Marked by a pervasive pattern of **instability of interpersonal relationships, self-image, and affects**, and marked impulsivity. Patients often exhibit intense fears of abandonment, chronic feelings of emptiness, and self-harming behaviors.
- While there is some emotional dysregulation and intense relationships, the patient does not report **self-harm, suicidal ideation**, or the severe identity disturbance common in borderline personality disorder.
*Dependent personality disorder*
- Individuals with dependent personality disorder exhibit an excessive need to be cared for, leading to **submissive and clinging behavior** and fears of separation. They often have difficulty making everyday decisions without excessive reassurance.
- This patient's behaviors are geared towards attracting attention and being the center of it, rather than seeking reassurance or exhibiting submissive behavior.
*Narcissistic personality disorder*
- Characterized by a pervasive pattern of **grandiosity, a need for admiration**, and a lack of empathy. Patients often believe they are special and unique and expect to be recognized as superior.
- While this patient seeks attention, her behavior is more about being dramatic and emotionally expressive rather than a sense of inflated self-importance or a deep need for admiration stemming from grandiosity.
Cultural aspects of mood disorders 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
Cultural aspects of mood disorders 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.
Cultural aspects of mood disorders US Medical PG Question 4: A 15-year-old female presents to her family physician for an annual school physical exam and check-up. She is accompanied by her mother to the visit and is present in the exam room. The patient has no complaints, and she does not have any past medical problems. She takes no medications. The patient reports that she remains active, exercising 5 times a week, and eats a healthy and varied diet. Which of the following would be the best way for the physician to obtain a more in-depth social history, including sexual history and use of alcohol, tobacco, or recreational drugs?
- A. Disallow the mother to be present in the examination room throughout the entirety of the visit
- B. Give the patient a social history questionnaire to fill out in the exam room
- C. Ask the mother to step outside into the hall for a portion of the visit (Correct Answer)
- D. Ask the patient the questions directly, with her mother still in the exam room
- E. Speak softly to the patient so that the mother does not hear and the patient is not embarrassed
Cultural aspects of mood disorders Explanation: ***Ask the mother to step outside into the hall for a portion of the visit***
- This approach allows the physician to speak with the adolescent **privately and confidentially**, which is crucial for obtaining sensitive information such as sexual history, drug use, and mental health concerns.
- Adolescents are more likely to disclose personal information when their parents are not present, fostering trust and ensuring **comprehensive history-taking** vital for their well-being.
*Disallow the mother to be present in the examination room throughout the entirety of the visit*
- This is an **overly restrictive** approach that might create tension or distrust between the physician, patient, and parent, especially at the start of the visit.
- While privacy is essential for sensitive topics, parental presence can be valuable for discussing general health, family history, and **treatment plans**, especially for younger adolescents.
*Give the patient a social history questionnaire to fill out in the exam room*
- While questionnaires can be useful for gathering basic information, they often **lack the nuance** of a direct conversation and may not prompt the patient to elaborate on sensitive issues.
- Furthermore, having the mother present while the patient fills out a questionnaire on sensitive topics still **compromises confidentiality** and may lead to incomplete or dishonest answers.
*Ask the patient the questions directly, with her mother still in the exam room*
- Asking sensitive questions with a parent present is **unlikely to yield truthful and complete answers**, as adolescents may feel embarrassed, judged, or fear parental disapproval.
- This approach compromises the **confidentiality** that is fundamental to building trust with adolescent patients.
*Speak softly to the patient so that the mother does not hear and the patient is not embarrassed*
- Speaking softly is **unprofessional** and still does not guarantee privacy, as the mother might still overhear parts of the conversation.
- This method also **fails to establish true confidentiality**, which is central to building rapport and encouraging open communication with adolescent patients about sensitive topics.
Cultural aspects of mood disorders US Medical PG Question 5: A 24-year-old male comes into the psychiatric clinic complaining of consistent sadness. He endorses feelings of worthlessness, anxiety, and anhedonia for the past couple months but denies feeling suicidal. He further denies any past episodes of feeling overly energetic with racing thoughts. Confident of the diagnosis, you recommend frequent talk therapy along with a long-term prescription of a known first-line medication for this disorder. What is the drug and what are some of the most frequently encountered side effects?
- A. Selective serotonin reuptake inhibitor; hypomania, suicidal thoughts
- B. Tricyclic antidepressants; hypomania, suicidal thoughts
- C. Selective serotonin reuptake inhibitor; anorgasmia, insomnia (Correct Answer)
- D. Monoamine oxidase inhibitors; Orthostatic hypotension, weight gain
- E. Tricyclic antidepressants; Orthostatic hypotension, anticholinergic effects
Cultural aspects of mood disorders Explanation: ***Selective serotonin reuptake inhibitor; anorgasmia, insomnia***
- The patient presents with classic symptoms of **major depressive disorder**, including persistent sadness, worthlessness, anxiety, and anhedonia, without any history of manic or hypomanic episodes. **SSRIs** are considered first-line pharmacotherapy for this condition.
- Common side effects of SSRIs include **sexual dysfunction** (e.g., anorgasmia, decreased libido) and **insomnia** or agitation, especially during the initial weeks of treatment.
*Selective serotonin reuptake inhibitor; hypomania, suicidal thoughts*
- While SSRIs are the correct drug class, **hypomania** is not a frequent side effect in patients without bipolar disorder. For patients with bipolar disorder, antidepressant monotherapy can induce hypomania or mania, but this patient denies such episodes.
- **Suicidal thoughts** can occur, particularly in young adults, during the initial phase of antidepressant treatment, but it is less common to frame it as a *frequently encountered side effect* in the general population compared to sexual dysfunction or sleep disturbances.
*Tricyclic antidepressants; hypomania, suicidal thoughts*
- **Tricyclic antidepressants (TCAs)** are generally not first-line due to their less favorable side effect profile compared to SSRIs, including significant anticholinergic effects and cardiovascular risks.
- As with SSRIs, **hypomania** is not a typical frequent side effect in unipolar depression, and while **suicidal thoughts** are a concern with antidepressants, TCAs carry a higher risk of lethality in overdose, making them less preferred initially.
*Monoamine oxidase inhibitors; Orthostatic hypotension, weight gain*
- **Monoamine oxidase inhibitors (MAOIs)** are effective but are typically reserved for **refractory depression** due to their significant drug and food interactions (e.g., tyramine-induced hypertensive crisis).
- While **orthostatic hypotension** and **weight gain** are known side effects of MAOIs, this class is not considered a first-line treatment for major depressive disorder.
*Tricyclic antidepressants; Orthostatic hypotension, anticholinergic effects*
- **TCAs** are indeed associated with side effects such as **orthostatic hypotension** and prominent **anticholinergic effects** (e.g., dry mouth, constipation, blurred vision, urinary retention).
- However, because of these more burdensome side effects and higher toxicity in overdose, TCAs are not generally considered the first-line medication choice, especially when SSRIs are available and safer.
Cultural aspects of mood disorders US Medical PG Question 6: A 42-year-old female presents to her primary care provider for an annual checkup. She reports feeling sad over the past few months for no apparent reason. She has lost interest in swimming, which she previously found enjoyable. Additionally, she has had trouble getting a full night’s sleep and has had trouble concentrating during the day. She has lost 15 pounds since her last visit one year prior. Which of the following sets of neurotransmitter levels is associated with this patient’s condition?
- A. Decreased acetylcholine, normal serotonin, normal dopamine
- B. Decreased norepinephrine, decreased serotonin, decreased dopamine (Correct Answer)
- C. Decreased GABA, decreased acetylcholine, increased dopamine
- D. Increased norepinephrine, decreased serotonin, decreased GABA
- E. Increased acetylcholine, increased serotonin, decreased dopamine
Cultural aspects of mood disorders Explanation: ***Decreased norepinephrine, decreased serotonin, decreased dopamine***
- The patient's symptoms of **sadness**, loss of interest (**anhedonia**), **insomnia**, **difficulty concentrating**, and **weight loss** are classic for **major depressive disorder**.
- **Depression** is strongly associated with deficiencies in **monoamine neurotransmitters**: **norepinephrine**, **serotonin**, and **dopamine**.
*Decreased acetylcholine, normal serotonin, normal dopamine*
- While **acetylcholine** is involved in mood regulation, its isolated decrease with normal serotonin and dopamine levels is not characteristic of generalized depression.
- More prominent roles for **acetylcholine dysfunction** are seen in conditions like **Alzheimer's disease** or **myasthenia gravis**.
*Decreased GABA, decreased acetylcholine, increased dopamine*
- **Decreased GABA** is often associated with **anxiety disorders** and seizures, not the primary presentation of depression here.
- **Increased dopamine** is more characteristic of conditions like **schizophrenia** or **mania**, which contrasts with the patient's depressive symptoms.
*Increased norepinephrine, decreased serotonin, decreased GABA*
- **Increased norepinephrine** is typically associated with **anxiety**, **stress**, or sometimes **mania**, which is inconsistent with this patient's depressive state.
- While **decreased serotonin** is correct for depression, the combination with increased norepinephrine and decreased GABA does not fit the typical neurotransmitter profile.
*Increased acetylcholine, increased serotonin, decreased dopamine*
- **Increased acetylcholine** is generally not associated with the full spectrum of depressive symptoms described.
- **Increased serotonin** is often the goal of antidepressant treatments (SSRIs), making an endogenous increase unlikely to cause depression.
Cultural aspects of mood disorders US Medical PG Question 7: A 27-year-old woman with cystic fibrosis comes to the physician for a follow-up examination. She has been hospitalized frequently for pneumonia and nephrolithiasis and is on chronic antibiotic therapy for recurrent sinusitis. The patient and her husband would like to have a child but have been unable to conceive. She feels that she can never achieve a full and happy life due to her disease and says that she is “totally frustrated” with the barriers of her illness. Although her family is supportive, she doesn't want to feel like a burden and tries to shield them from her struggles. Which of the following is the most appropriate statement by the physician?
- A. You should educate yourself about your disease or condition using credible, current sources. Knowledge can help dispel fear and anxiety.
- B. I understand that living with cystic fibrosis is not easy. You are not alone in this. I would like to recommend a support group. (Correct Answer)
- C. I see that you are frustrated, but this illness has its ups and downs. I am sure you will feel much better soon.
- D. I understand your frustration with your situation. I would like to refer you to a therapist.
- E. I think it's really important that you talk to your family more about this. I'm sure they can help you out.
Cultural aspects of mood disorders Explanation: ***"I understand that living with cystic fibrosis is not easy. You are not alone in this. I would like to recommend a support group."***
- This statement offers **empathy** and validates the patient's feelings, which is crucial for building rapport and trust.
- Recommending a support group provides a **concrete, helpful resource** for emotional support and shared experiences, addressing her feelings of isolation and burden.
*"I think it's really important that you talk to your family more about this. I'm sure they can help you out."*
- This statement can be perceived as **dismissive** of her efforts to shield her family and might add to her feeling of being a burden.
- While family support is important, simply telling her to talk to them does not offer **new strategies** or specific guidance for her unique struggles.
*"You should educate yourself about your disease or condition using credible, current sources. Knowledge can help dispel fear and anxiety."*
- This response is **intellectualizing** and does not directly address her expressed emotional distress, frustration, and feelings of being overwhelmed.
- Given her chronic illness and frequent hospitalizations, it's highly likely she is **already well-educated** about her condition; this advice might come across as belittling.
*"I see that you are frustrated, but this illness has its ups and downs. I am sure you will feel much better soon."*
- This statement **minimizes her current suffering** and offers false reassurance, which can invalidate her feelings and erode trust in the physician.
- It lacks **empathy** and does not provide any actionable advice or support for her long-term chronic condition.
*"I understand your frustration with your situation. I would like to refer you to a therapist."*
- While a therapist can be helpful, suggesting it immediately might make the patient feel her frustration is being **medicalized as a mental health issue** before exploring other avenues of support.
- Recommending a support group first can be a gentler, less stigmatizing approach that allows her to connect with others facing similar challenges.
Cultural aspects of mood disorders US Medical PG Question 8: A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?
- A. "Does the diarrhea typically precede the constipation, or vice-versa?"
- B. "Is the diarrhea foul-smelling?"
- C. "Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"
- D. "Are the symptoms worse in the morning or at night?"
- E. "Can you tell me more about the symptoms you have been experiencing?" (Correct Answer)
Cultural aspects of mood disorders Explanation: ***Can you tell me more about the symptoms you have been experiencing?***
- This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis.
- In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions.
*Does the diarrhea typically precede the constipation, or vice-versa?*
- While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience.
- It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture.
*Is the diarrhea foul-smelling?*
- Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions.
- However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed.
*Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life*
- Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time.
- However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially.
*Are the symptoms worse in the morning or at night?*
- Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related.
- This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.
Cultural aspects of mood disorders US Medical PG Question 9: A 23-year-old woman is brought to the physician by her father because of irritability, mood swings, and difficulty sleeping over the past 10 days. A few days ago, she quit her job and spent all of her savings on supplies for a “genius business plan.” She has been energetic despite sleeping only 1–2 hours each night. She was diagnosed with major depressive disorder 2 years ago. Mental status examination shows pressured speech, a labile affect, and flight of ideas. Throughout the examination, she repeatedly states “I feel great, I don't need to be here.” Urine toxicology screening is negative. Which of the following is the most likely diagnosis?
- A. Schizoaffective disorder
- B. Bipolar disorder type II
- C. Bipolar disorder type I (Correct Answer)
- D. Delusional disorder
- E. Attention-deficit hyperactivity disorder
Cultural aspects of mood disorders Explanation: ***Bipolar disorder type I***
- The patient's presentation of lasting **elevated mood**, decreased need for sleep, increased energy, pressured speech, flight of ideas, and impulsive behavior (quitting job, spending savings) are hallmark symptoms of a **manic episode**.
- A diagnosis of **Bipolar I Disorder** requires the occurrence of at least one manic episode, which is clearly evident here and distinguishes it from other mood disorders, especially given her prior history of major depressive disorder.
*Schizoaffective disorder*
- This disorder involves a period of illness during which there is an uninterrupted period of major mood episode (depressive or manic) concurrent with symptoms of **schizophrenia**, such as delusions or hallucinations, for at least 2 weeks in the absence of a major mood episode.
- The patient's symptoms are primarily mood-driven and do not include the characteristic psychotic features that persist independently of mood disturbances.
*Bipolar disorder type II*
- Bipolar II Disorder is characterized by at least one major depressive episode and at least one **hypomanic episode**.
- The patient's current symptoms, including significant impairment in social/occupational functioning, are indicative of a **manic episode**, not a hypomanic episode, which by definition does not cause marked impairment or require hospitalization.
*Delusional disorder*
- This disorder is characterized by the presence of **non-bizarre delusions** that last for at least one month, without other prominent psychotic symptoms or significant impairment in functioning.
- While the patient's "genius business plan" might seem delusional, her pervasive mood disturbance, flight of ideas, and significant functional impairment are not consistent with the primary features of delusional disorder.
*Attention-deficit hyperactivity disorder*
- ADHD is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, often presenting in childhood.
- While there is some overlap in symptoms like impulsivity and difficulty sleeping, the episodic nature, the extent of **mood disturbance**, grandiosity, and **pressured speech** are more characteristic of a manic episode than ADHD.
Cultural aspects of mood disorders US Medical PG Question 10: 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
Cultural aspects of mood disorders 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.
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