Persistent Depressive Disorder

Question 1

criterion A for PDD

Answer 1

depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others

for at least TWO YEARS

(in kids and teens, mood can be irritable and duration must be ONE year)

Question 2

criterion B for PDD

Answer 2

presence, while depressed, of TWO (or more) of the following:

1. poor appetite or overeating
2. insomnia or hypersomnia
3. low energy or fatigue
4. low self esteem
5. poor concentration or difficulty making decisions
6. feelings of hopelessness

Question 3

criterion C for PDD

Answer 3

during the two year period of the disturbance, the invdividual has never been without symptoms in criteria A and B for more than TWO MONTHS at a time

Question 4

criterion D for PDD

Answer 4

criteria for a MDD MAY be continuously present for two years

Question 5

criterion E for PDD

Answer 5

there has never been a manic episode or a hypomanic episode and criteria have never been met for cyclothymic disorder

Question 6

criterion F for PDD

Answer 6

disturbance is not better explained by persistent schizoaffective disorder, schizophrenia, delusional disorder, other other specified or unspecified schizophrenia spectrum or other psychotic disorder

Question 7

criterion G for PDD

Answer 7

sx not attributable to physiological effects of a substance or another medical condition

Question 8

criterion H for PDD

Answer 8

symptoms cause clinically significant distress/impairment in social/occupational or other important areas of functioning

Question 9

can you have depressive sx that have persisted longer than 2 years but not meet symptom criteria for PDD

Answer 9

yes–> because criteria for MDE/MDD include foud symptoms that are absent from symptom list for PDD

in this case, if full criteria for MDD have been met at some point in the two years then the diagnosis would be MDD not PDD

otherwise could give dx of “other specified depressive disorder” or “unspecified depressive disorder”

Question 10

what types of things should you specify when coding PDD in the diagnosis?

Answer 10

1. symptom specifiers (i.e with anxious distress, with atypical features etc)
2. remission (current, partial remission, full remission)
3. age at onset (onset before age 21 or after age 21)
4. whether there is PDD + MDE sx or no
   (i.e with pure dysthymic syndrome; with persistent MDE; with intermittent MDEs, with current episode; with intermittent MDEs, without current episode)
5. severity (mild, moderate, severe)

Question 11

what is PDD “with pure dysthymic syndrome”

Answer 11

full criteria for an MDE have NOT been met in at least the preceeding two years

Question 12

what is PDD “with persistent MDE”

Answer 12

full criteria for an MDE have been met throughout the preceeding two year period

Question 13

what is PDD “with intermittent depressive episodes, with current episode”

Answer 13

full criteria for MDE are currently met, but there have been periods of at least 8 weeks in at least the preceeding two years with symptoms below the threshold for full MDE

Question 14

what is PDD “with intermittent major depressive episodes, without current episodes”

Answer 14

full criteria for an MDE are not currently met, but there has been one or more MDEs in the preceding 2 years

Question 15

how does PDD usually start

Answer 15

often has EARLY and INSIDIOUS onset (in childhood, adolescence or early adult life)

Question 16

early onset (before age 21) is associated with risk of what other comorbidities

Answer 16

higher likelihood of comorbid personality disorders and substance use disorders

Question 17

list factors that are predictive of poorer long term outcome in PDD

Answer 17

higher levels of neuroticism

greater symptom severity

poorer glocal functioning

presence of anxiety disorders or conduct disorder

Question 18

name childhood risk factor for PDD

Answer 18

parental loss or separation

Question 19

name 4 brain areas that have been implicated in PDD

Answer 19

anterior cingulate

amygdala

hippocampus

prefrontal cortex

Question 20

ddx for PDD

Answer 20

MDD

psychotic disorders

depressive/bipolar illness due to another medical condition

sub/med induced depressive or bpolar disorders

personality disorders

Question 21

can someone have dx of both PDD and MDD

Answer 21

yes–when criteria are met for MDD you make that diagnosis as well and then you use the MDE specifiers with the PDD diagosis

Question 22

when compared to MDD, do those with PDD tend to have higher or lower rates of comorbidity in general

Answer 22

those with PDD tend ot have higher rates of comorbidity

Question 23

those with PDD have higher rates of comorbidity with what disorders in particular

Answer 23

anxiety

substance use disorders

Question 24

early onset PDD (before age 21) is particularly associated with what DSM diagnoses

Answer 24

cluster B and C personality disorders

Question 25

what is the estimated prevalence for PDD

Answer 25

0.5% in the USA

Question 26

what is a mnemonic for the symptoms of PDD

Answer 26

HE’S 2 SAD

Hopelessness
Energy Low
Self esteem is low

2 year of sx; not symptom free for more than 2 months

Sleep disturbed (increase or decrease)
Appetite disturbed (eat more or less)
Difficulty making decisions

Question 27

what are nonpharmacologic treatment options for PMDD

Answer 27

CBT is an effective treatment for PMDD

Question 28

what pharmacotherapy is recommended in the treatment of PMDD

Answer 28

SSRIs are the most studied pharmacologic treatments –> in particular:
sertraline
fluoxetine
paroxetine

SNRIs have also been shown to be effective