Mood disorders due to medical conditions US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Mood disorders due to medical conditions. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Mood disorders due to medical conditions US Medical PG Question 1: A mental health volunteer is interviewing locals as part of a community outreach program. A 46-year-old man discloses that he has felt sad for as long as he can remember. He feels as though his life is cursed and if something terrible can happen to him, it usually will. He has difficulty making decisions and feels hopeless. He also feels that he has had worsening suicidal ideations, guilt from past problems, decreased energy, and poor concentration over the past 2 weeks. He is otherwise getting enough sleep and able to hold a job. Which of the following statement best describes this patient's condition?
- A. The patient may have symptoms of mania or psychosis.
- B. The patient is likely to show anhedonia.
- C. The patient likely has paranoid personality disorder.
- D. The patient has double depression. (Correct Answer)
- E. The patient should be started on an SSRI.
Mood disorders due to medical conditions Explanation: ***The patient has double depression.***
- The patient describes **chronic low-grade depressive symptoms** ("felt sad for as long as he can remember," "life is cursed," "difficulty making decisions," "hopeless") consistent with **persistent depressive disorder (dysthymia)**, which requires at least 2 years of symptoms.
- The recent worsening of symptoms over the past two weeks, including "worsening suicidal ideations, guilt from past problems, decreased energy, and poor concentration," indicates an additional **major depressive episode (MDE) superimposed on dysthymia**, a condition known as **double depression**.
- This patient currently meets criteria for both conditions simultaneously, not just at risk for developing them.
*The patient may have symptoms of mania or psychosis.*
- There are no symptoms mentioned that suggest **mania**, such as elevated mood, increased energy, decreased need for sleep, grandiosity, or racing thoughts.
- While suicidal ideation is present, there is no evidence of **psychotic features** like hallucinations or delusions.
*The patient is likely to show anhedonia.*
- **Anhedonia** (inability to feel pleasure) is a common symptom of depression and may well be present in this patient.
- However, the patient's presentation specifically highlights the pattern of **chronic dysthymia with a superimposed major depressive episode**, making **double depression** a more precise, comprehensive, and diagnostically specific description of his current condition.
- While anhedonia might be present, it is a symptom rather than a diagnostic formulation.
*The patient likely has paranoid personality disorder.*
- **Paranoid personality disorder** is characterized by pervasive distrust and suspicion of others, interpreting their motives as malevolent, without sufficient basis.
- The patient's feelings of being "cursed" and that "something terrible can happen" reflect **depressive pessimism and negative cognitive distortions**, not paranoid ideation about others' intentions.
- This is consistent with the hopelessness seen in depression.
*The patient should be started on an SSRI.*
- While an **SSRI (selective serotonin reuptake inhibitor)** combined with psychotherapy would likely be appropriate treatment for double depression, making a specific treatment recommendation is premature without comprehensive clinical assessment.
- The question asks for the **best statement describing the patient's condition** (diagnosis), not for treatment recommendations.
Mood disorders due to medical conditions US Medical PG Question 2: 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
Mood disorders due to medical conditions 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.
Mood disorders due to medical conditions US Medical PG Question 3: A 29-year-old man comes to the physician with his wife because she has noticed a change in his behavior over the past 2 weeks. His wife reports that he is very distracted and irritable. His colleagues have voiced concerns that he has not been turning up for work regularly and behaves erratically when he does. Previously, her husband had been a reliable and reasonable person. The patient says that he feels “fantastic”; he only needs 4 hours of sleep each night and wakes up cheerful and full of energy each morning. He thinks that his wife is overreacting. The patient has been healthy except for a major depressive episode 5 years ago that was treated with paroxetine. He currently takes no medications. His pulse is 98/min, respirations are 12/min, and blood pressure is 128/62 mm Hg. Mental status examination shows frenzied speech and a flight of ideas. Which of the following is the strongest predisposing factor for this patient's condition?
- A. Advanced paternal age
- B. Genetic predisposition (Correct Answer)
- C. Higher socioeconomic class
- D. Maternal obstetric complications
- E. Being married
Mood disorders due to medical conditions Explanation: ***Genetic predisposition***
- A strong **genetic predisposition** is a primary predisposing factor for bipolar disorder, as evidenced by a significantly higher concordance rate in monozygotic twins compared to dizygotic twins or the general population.
- The patient's presentation with **manic symptoms** (decreased need for sleep, euphoria, irritability, frenzied speech, flight of ideas, erratic behavior) following a history of a **major depressive episode** is highly suggestive of **bipolar I disorder**.
*Advanced paternal age*
- While advanced paternal age has been associated with an increased risk of some neurodevelopmental disorders like **schizophrenia** and **autism spectrum disorder**, its link to bipolar disorder is less robust and not considered the strongest predisposing factor.
- The primary risk factor for bipolar disorder involves heritability rather than specific parental age.
*Higher socioeconomic class*
- There is **no consistent evidence** to suggest that higher socioeconomic class is a predisposing factor for bipolar disorder.
- Bipolar disorder affects individuals across all socioeconomic levels.
*Maternal obstetric complications*
- Maternal obstetric complications, such as **prenatal infections** or **hypoxia**, have been implicated in the development of certain psychiatric disorders, particularly **schizophrenia**.
- However, for bipolar disorder, genetic factors play a far more significant and direct role than obstetric complications.
*Being married*
- **Marital status** does not serve as a predisposing factor for the development of bipolar disorder.
- While relationship challenges can be a consequence or stressor for individuals with bipolar disorder, marriage itself is not a cause.
Mood disorders due to medical conditions US Medical PG Question 4: A 33-year-old woman comes to the emergency department for the evaluation of a headache and increased sweating for the last two hours. The patient also reports palpitations and nausea. Yesterday, she was started on venlafaxine for treatment-resistant depression. She took citalopram for four weeks, but stopped three days ago because her symptoms of depression did not improve. She does not smoke or drink alcohol. Her temperature is 39°C (102.2°F), pulse is 120/min, and blood pressure is 150/90 mm Hg. On mental status examination, the patient is only oriented to person, but not to place or time. Examination shows tremors in all extremities. She has impaired gait. Deep tendon reflexes are 3+ bilaterally. Which of the following is the most likely cause of this patient's symptoms?
- A. Increased CNS serotonergic activity (Correct Answer)
- B. Anticholinergic toxicity
- C. Dopamine receptor blockade
- D. Abnormal ryanodine receptor
- E. Suspected amphetamine intake
Mood disorders due to medical conditions Explanation: ***Increased CNS serotonergic activity***
- The patient's symptoms, including **headache**, **sweating**, **palpitations**, **nausea**, **fever (39°C)**, **tachycardia**, **hypertension**, **disorientation**, **tremors**, **impaired gait**, and **hyperreflexia**, are classic signs of **serotonin syndrome**.
- This syndrome is precipitated by the recent initiation of **venlafaxine** (an SNRI) after stopping **citalopram** (an SSRI) just three days prior, leading to an excessive buildup of **serotonin** in the central nervous system.
*Anticholinergic toxicity*
- This condition presents with symptoms such as **dry mouth**, **dilated pupils**, **blurred vision**, **urinary retention**, and **constipation**, which are not seen in this patient.
- While it can cause **confusion** and **tachycardia**, the prominent **sweating**, **hyperreflexia**, and **tremors** are inconsistent with anticholinergic overdose.
*Dopamine receptor blockade*
- This is typically associated with **extrapyramidal symptoms** such as **dystonia**, **akathisia**, **parkinsonism**, and **neuroleptic malignant syndrome**, rather than the specific constellation of symptoms described.
- **Neuroleptic malignant syndrome** shares some features like fever and autonomic instability, but it typically involves severe **muscle rigidity** (lead-pipe rigidity) and **bradykinesia**, in contrast to the tremors and hyperreflexia observed here.
*Abnormal ryanodine receptor*
- An abnormal ryanodine receptor is associated with **malignant hyperthermia**, a life-threatening condition triggered by certain **anesthetics** or **succinylcholine**.
- While it causes **fever**, **tachycardia**, and **muscle rigidity**, it is unlikely given the patient's medication history and the absence of anesthetic exposure.
*Suspected amphetamine intake*
- Amphetamine intoxication can cause **tachycardia**, **hypertension**, **agitation**, and **hyperthermia**, which overlap with some of the patient's symptoms.
- However, the rapid onset of symptoms immediately following a change in antidepressant medication, particularly the presence of **hyperreflexia** and **tremors**, makes **serotonin syndrome** a more direct and likely explanation in this clinical context.
Mood disorders due to medical conditions US Medical PG Question 5: A group of researchers studying the relationship between major depressive disorder and unprovoked seizures identified 36 patients via chart review who had been rehospitalized for unprovoked seizures following discharge from an inpatient psychiatric unit and 105 patients recently discharged from the same unit who did not experience unprovoked seizures. The results of the study show:
Unprovoked seizure No seizure
Major depressive disorder 20 35
No major depressive disorder 16 70
Based on this information, which of the following is the most appropriate measure of association between history of major depressive disorder (MDD) and unprovoked seizures?
- A. 1.95
- B. 2.5 (Correct Answer)
- C. 0.19
- D. 0.36
- E. 0.17
Mood disorders due to medical conditions Explanation: ***2.5***
- This is a **case-control study** because it starts with individuals who have the outcome (unprovoked seizures) and individuals who do not, then looks back at their exposure (major depressive disorder).
- For a case-control study, the appropriate measure of association is the **odds ratio (OR)**, calculated as (a/c) / (b/d) = (ad) / (bc). In this case: a = 20 (MDD with seizure), b = 35 (MDD without seizure), c = 16 (no MDD with seizure), d = 70 (no MDD without seizure). So, OR = (20 * 70) / (35 * 16) = 1400 / 560 = 2.5.
*1.95*
- This value might be a calculation error or represent a different measure of association not applicable to this study design.
- The correct calculation for the odds ratio leads to 2.5.
*0.19*
- This value is likely a **relative risk** or **risk ratio**, which is used in cohort studies where risk is directly measured.
- In a case-control study, the **incidence of the outcome** cannot be directly determined, making relative risk an inappropriate measure.
*0.36*
- This value is not derived from the appropriate statistical calculation for the odds ratio in a case-control study.
- It might represent a **proportion** or a different type of risk calculation.
*0.17*
- This value is not the correct measure of association for a case-control study.
- It could be a miscalculation of a **prevalence ratio** or a different statistical metric.
Mood disorders due to medical conditions US Medical PG Question 6: A 67-year-old woman presents to her primary care physician for memory difficulty. She states that for the past couple months she has had trouble with her memory including forgetting simple things like bills she needs to pay or locking doors. She was previously fully functional and did not make these types of mistakes. The patient has not been ill lately but came in because her daughter was concerned about her memory. She makes her own food and eats a varied diet. Review of systems is notable for a decrease in the patient’s mood for the past 2 months since her husband died and a sensation that her limbs are heavy making it difficult for her to do anything. Her temperature is 99.3°F (37.4°C), blood pressure is 112/68 mmHg, pulse is 71/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for an elderly woman. Her neurological exam is unremarkable; however, the patient struggles to recall 3 objects after a short period of time and can only recall 2 of them. The patient’s weight is unchanged from her previous visit and cardiac, pulmonary, and dermatologic exams are within normal limits. Which of the following is the most likely diagnosis?
- A. Depression (Correct Answer)
- B. Vascular dementia
- C. Alzheimer dementia
- D. Hypothyroidism
- E. Normal aging
Mood disorders due to medical conditions Explanation: ***Depression***
- The patient exhibits classic signs of depression, including a **recent decline in mood** following her husband's death, anhedonia (sensation of heavy limbs making it difficult to do anything), and **memory difficulties** that appear to be a recent change from her previous baseline.
- **Pseudodementia**, or cognitive impairment due to depression, often presents with memory complaints that resolve with treatment of the underlying mood disorder.
*Vascular dementia*
- This typically presents with a **step-wise decline** in cognitive function, often associated with a history of stroke or cardiovascular risk factors, which are not mentioned here.
- Memory impairment in vascular dementia is often characterized by **executive dysfunction** and difficulty with information processing rather than primary memory recall alone.
*Alzheimer dementia*
- Characteristically involves a more **gradual and progressive decline** in memory, especially with new learning and recall, over a longer period.
- While memory loss is a feature, the constellation of recent onset, mood disturbance, and lack of other neurological deficits points away from Alzheimer's as the initial diagnosis.
*Hypothyroidism*
- Can cause cognitive slowing and memory problems, but it typically presents with other systemic symptoms like **fatigue, weight gain, constipation, and cold intolerance**, which are not present in this patient.
- The patient's vital signs are normal, and there's no mention of thyroid-related physical exam findings.
*Normal aging*
- While some mild memory lapses are normal with aging, the patient's complaints go beyond minor issues; she is having trouble with bills and locking doors, which indicates a **significant functional impact**.
- The rapid onset of symptoms and current functional impairment suggest something beyond typical age-related cognitive changes.
Mood disorders due to medical conditions US Medical PG Question 7: 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)
Mood disorders due to medical conditions 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.
Mood disorders due to medical conditions US Medical PG Question 8: 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
Mood disorders due to medical conditions 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.
Mood disorders due to medical conditions US Medical PG Question 9: 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
Mood disorders due to medical conditions 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.
Mood disorders due to medical conditions US Medical PG Question 10: 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
Mood disorders due to medical conditions 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.
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