Persistent depressive disorder (dysthymia) — MCQs

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 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 24-year-old woman comes to the physician because she feels sad and has had frequent, brief episodes of crying for the last month. During this period, she sleeps in every morning and spends most of her time in bed playing video games or reading. She has not been spending time with friends but still attends a weekly book club and continues to plan her annual family reunion. She stopped going to the gym, eats more, and has gained 4 kg (8.8 lb) over the past 4 weeks. Three weeks ago, she also started to smoke marijuana a few times a week. She drinks one glass of wine daily and does not smoke cigarettes. She is currently unemployed; she lost her job as a physical therapist 3 months ago. Her vital signs are within normal limits. On mental status examination, she is calm, alert, and oriented to person, place, and time. Her mood is depressed; her speech is organized, logical, and coherent. She denies suicidal thoughts. Which of the following is the most likely diagnosis?

A 27-year-old man comes to the physician for a follow-up examination. Paroxetine therapy was initiated 6 weeks ago for a major depressive episode. He now feels much better and says he is delighted with his newfound energy. He gets around 8 hours of sleep nightly. His appetite has increased. Last year, he had two episodes of depressed mood, insomnia, and low energy during which he had interrupted his job training and stopped going to the gym. Now, he has been able to resume his job at a local bank. He also goes to the gym three times a week to work out and enjoys reading books again. His temperature is 36.5°C (97.7°F), pulse is 70/min, and blood pressure is 128/66 mm Hg. Physical and neurologic examinations show no abnormalities. On mental status examination, he describes his mood as "good." Which of the following is the most appropriate next step in management?

A 55-year-old man presents to his primary care physician with complaints of fluctuating mood for the past 2 years. He feels great and full of energy for some months when he is very creative with tons of ideas just racing through his mind. He is noted to be very talkative and distracted by his different ideas. During these times, he is very productive and able to accomplish much at work and home. However, these periods are frequently followed by a prolonged depressed mood. During this time, he has low energy, poor concentration, and low self-esteem. The accompanying feeling of hopelessness from these cycling “ups” and “downs” have him eating and sleeping more during the “downs.” He does not remember a period within the last 2 years where he felt “normal.” What is the most likely diagnosis?

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 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 16-year-old boy comes to the physician for the evaluation of fatigue over the past month. He reports that his energy levels are low and that he spends most of his time in his room. He also states that he is not in the mood for meeting friends. He used to enjoy playing soccer and going to the shooting range with his father, but recently stopped showing interest in these activities. He has been having difficulties at school due to concentration problems. His appetite is low. He has problems falling asleep. He states that he has thought about ending his life, but he has no specific plan. He lives with his parents, who frequently fight due to financial problems. He does not smoke. He drinks 2–3 cans of beer on the weekends. He does not use illicit drugs. He takes no medications. His vital signs are within normal limits. On mental status examination, he is oriented to person, place, and time. Physical examination shows no abnormalities. In addition to the administration of an appropriate medication, which of the following is the most appropriate next step in management?

A 51-year-old male presents to his primary care provider for a normal check-up. He reports that he “hasn’t felt like himself” recently. He describes feeling down for the past 8 months since his mother passed away. He has had trouble sleeping and has unintentionally lost 15 pounds. He feels guilty about his mother’s death but cannot articulate why. His performance at work has declined and he has stopped running, an activity he used to enjoy. He has not thought about hurting himself or others. Of note, he also complains of numbness in his feet and fingers and inability to maintain an erection. His past medical history is notable for diabetes. He is on metformin. His temperature is 98.6°F (37°C), blood pressure is 125/65 mmHg, pulse is 90/min, and respirations are 16/min. On exam, he is alert and oriented with intact memory and normal speech. He appears tired with a somewhat flattened affect. The best medication for this patient inhibits which of the following processes?

A 22-year-old man comes to the physician because of generalized fatigue for the past 3 months. During this time, his grades have declined in his college courses because he has had difficulty focusing on assignments and sometimes sleeps in class. He no longer plays the drums for his band and has stopped attending family events. His temperature is 37°C (98.6°F), pulse is 60/min, and blood pressure is 130/80 mm Hg. Physical examination shows no abnormalities. On mental status examination, he describes his mood as “ok.” He has a flat affect. There is no evidence of suicidal ideation. His speech is slow in rate and monotone in rhythm, and his thought process is organized. He has no delusions or hallucinations. Which of the following is the most appropriate next step in treatment?