Preguntas DSM5 Depresión y Bipolaridad

Question 1

How does DSM-5 differ from DSM-IV in its classification of mood disorders?

Answer 1

DSM-IV included all mood disorders in a single section; DSM-5 places depressive and bipolar mood disorders in separate sections.

Question 2

How does DSM-5 differ from DSM-IV in its classification of premenstrual dysphoric disorder (PMDD)?

Answer 2

PMDD is included in the “Depressive Disorders” chapter of DSM-5 but was not included in the “Mood Disorders” chapter of DSM-IV.

Question 3

What DSM-5 diagnostic provision is made for depressive symptoms following the death of a loved one?

Answer 3

Depressive symptoms following the loss of a loved one are not excluded from receiving a major depressive episode diagnosis if the symptoms otherwise fulfill the diagnostic criteria.

Question 4

Which of the following statements about how grief differs from a major depressive episode (MDE) is false?

Answer 4

In grief, feelings of worthlessness and self-loathing are common; in MDE, self-esteem is generally preserved. (the opposite is true)

Question 5

How do individuals with substance/medication-induced depressive disorder differ from individuals with major depressive disorder who do not have a substance use disorder?

Answer 5

They are more likely to be male.

Question 6

A 50-year-old man presents with persistently depressed mood for several weeks that interferes with his ability to work. He has insomnia and fatigue, feels guilty, has thoughts he would be better off dead, and has thought about how he could die without anyone knowing it was a suicide. His wife informs you that he requests sex several times a day and that she thinks he may be going to “massage parlors” regularly, both of which are changes from his typical behavior. He has told her he has ideas for a “better Internet,” and he has invested thousands of dollars in software programs that he cannot use. She notes that he complains of fatigue but sleeps only 1 or 2 hours each night and seems to have tremendous energy during the day. Which diagnosis best fits this patient?

Answer 6

Major depressive episode, with mixed features.

Question 7

A 45-year-old man with classic features of schizophrenia has always experienced co-occurring symptoms of depression—including feeling “down in the dumps,” having a poor appetite, feeling hopeless, and suffering from insomnia—during his episodes of active psychosis. These depressive symptoms occurred only during his psychotic episodes and only during the 2-year period when the patient was experiencing active symptoms of schizophrenia. After his psychotic episodes were successfully controlled by medication, no further symptoms of depression were present. The patient has never met full criteria

Answer 7

Depressive symptoms are a common associated feature of chronic psychotic disorders (e.g., schizoaffective disorder, schizophrenia, delusional disorder). A separate diagnosis of persistent depressive disorder is not made if the symptoms occur only during the course of the psychotic disorder (including residual phases).

Question 8

What are the new depressive disorder diagnoses in DSM-5?

Answer 8

Disruptive mood dysregulation disorder, premenstrual dysphoric disorder, and persistent depressive disorder (dysthymia).

Question 9

A depressed patient reports that he experiences no pleasure from his normally enjoyable activities. Which of the following additional symptoms would be required for this patient to qualify for a diagnosis of major depressive disorder with melancholic features?

Answer 9

Inappropriate guilt, depression that is worse in the morning, and early-morning awakening.

Question 10

A 39-year-old woman reports that she became quite depressed in the winter last year when her company closed for the season, but she felt completely normal in the spring. She recalls experiencing several other episodes of depression over the past 5 years (for which she cannot identify a seasonal pattern) that would have met criteria for major depressive disorder. Which of the following correctly summarizes this patient’s eligibility for a diagnosis of “major depressive disorder, with seasonal pattern”?

Answer 10

She does not qualify for this diagnosis: the patient must have had two episodes with a seasonal relationship in the past 2 years and no nonseasonal episodes during that period.

Question 11

Which of the following statements about the prevalence of major depressive disorder in the United States is true?

Answer 11

The prevalence in 18- to 29-year-olds is three times higher than that in 60-year-olds.

Question 12

Which of the following statements about the heritability of major depressive disorder (MDD) is true?

Answer 12

The heritability is approximately 40%, and the personality trait of neuroticism accounts for a substantial portion of this genetic liability.

Question 13

Which of the following statements about diagnostic markers for major depressive disorder (MDD) is true?

Answer 13

No laboratory test has demonstrated sufficient sensitivity and specificity to be used as a diagnostic tool for MDD.

Question 14

Which of the following statements about gender differences in suicide risk and suicide rates in major depressive disorder (MDD) is true?

Answer 14

The risk of suicide attempts is higher for women, but the risk of suicide completions is lower.

Question 15

A 12-year-old boy begins to have new episodes of temper outbursts that are out of proportion to the situation. Which of the following is not a diagnostic possibility for this patient?

Answer 15

Disruptive mood dysregulation disorder.

Question 16

Which of the following features distinguishes disruptive mood dysregulation disorder (DMDD) from bipolar disorder in children?

Answer 16

Chronicity

Question 17

Children with disruptive mood dysregulation disorder are most likely to develop which of the following disorders in adulthood?

Answer 17

Unipolar depressive disorders.

Question 18

An irritable 8-year-old child has a history of temper outbursts both at home and at school. What characteristic mood feature must be also present to qualify him for a diagnosis of disruptive mood dysregulation disorder?

Answer 18

The child’s mood between outbursts is typically irritable or angry.

Question 19

Children with disruptive mood dysregulation disorder (DMDD) often meet criteria for what additional DSM-5 diagnosis?

Answer 19

Oppositional defiant disorder.

Question 20

The diagnostic criteria for disruptive mood dysregulation disorder (DMDD) state that the diagnosis should not be made for the first time before age 6 years or after 18 years (Criterion G). Which of the following statements best describes the rationale for this age range restriction?

Answer 20

Validity of the diagnosis has been established only in the age group 7-18 years.

Question 21

A 9-year-old boy is brought in for evaluation because of explosive outbursts when he is frustrated with schoolwork. The parents report that their son is well behaved and pleasant at other times. Which diagnosis best fits this clinical picture?

Answer 21

Intermittent explosive disorder.

Question 22

A 14-year-old boy describes himself as feeling “down” all of the time for the past year. He remembers feeling better while he was at camp for 4 weeks during the summer; however, the depressed mood returned when he came home. He reports poor concentration, feelings of hopelessness, and low self-esteem but denies suicidal ideation or changes in his appetite or sleep. What is the most likely diagnosis?

Answer 22

Persistent depressive disorder (dysthymia), with early onset.

Question 23

A 30-year-old woman reports 2 years of persistently depressed mood, accompanied by loss of pleasure in all activities, ruminations that she would be better off dead, feelings of guilt about “bad things” she has done, and thoughts about quitting work because of her inability to make decisions. Although she has never been treated for depression, she feels so distressed at times that she wonders if she should be hospitalized. She experiences an increased need for sleep but still feels fatigued during the day. Her overeating has led to a 12-kg weight

Answer 23

Persistent depressive disorder (dysthymia), with persistent major depressive episode.

Question 24

A 45-year-old woman with multiple sclerosis was treated with interferon beta-1a a year ago, which resolved her physical symptoms. She now presents with depressed mood (experienced daily for the past several months), middle insomnia (of recent onset), poor appetite, trouble concentrating, and lack of interest in sex. Although she has no physical symptoms, she is frequently absent from work. She denies any active plans to commit suicide but admits that she often thinks about it, as her mood has worsened. What is the most likely diagnosis?

Answer 24

Depressive disorder due to another medical condition.

Question 25

An 18-year-old college student, recently arrived in the United States from Beijing, complains to her gynecologist of irritability, problems with her roommates, increased appetite, feeling bloated, and feeling depressed for 3-4 days prior to the onset of menses. She reports that these symptoms have been present since she reached menarche at age 12 (although she has never kept a mood log). The gynecologist calls you for a consultation about the correct diagnosis, because she is as yet unfamiliar with the new DSM-5 diagnostic criteria. What

Answer 25

The patient would qualify for a provisional diagnosis of premenstrual dysphoric disorder.

Question 26

What is the appropriate method of confirming a diagnosis of premenstrual dysphoric disorder?

Answer 26

Two or more months of prospective symptom ratings on validated scales.

Question 27

A 29-year-old woman complains of sad mood every month in anticipation of her very painful menses. The pain begins with the start of her flow and continues for several days. She does not experience pain during other times of the month. She has tried a variety of treatments, none of which have given her relief. What is the appropriate diagnosis?

Answer 27

Dysmenorrhea

Question 28

Which of the following symptoms must be present for a woman to meet criteria for premenstrual dysphoric disorder?

Answer 28

Marked affective lability.

Question 29

A 23-year-old woman reports that during every menstrual cycle she experiences breast swelling, bloating, hypersomnia, an increased craving for sweets, poor concentration, and a feeling that she cannot handle her normal responsibilities. She notes that she also feels somewhat more sensitive emotionally and may become tearful when hearing a sad story. She takes no oral medication but does use a drospirenone/ethinyl estradiol patch. What diagnosis best fits this clinical picture?

Answer 29

Premenstrual syndrome

Question 30

A 31-year-old woman with no history of mood symptoms reports that she experiences distressing mood lability and irritability starting about 4 days before the onset of menses. She feels “on edge,” cannot concentrate, has little enjoyment from any of her activities, and experiences bloating and swelling of her breasts. The patient reports that these symptoms started 6 months ago when she began taking oral contraceptives for the first time. If she stops the oral contraceptives and her symptoms remit, what would the diagnosis be?

Answer 30

Substance/medication-induced depressive disorder.

Question 31

A 45-year-old man is admitted to the hospital with profound hypothyroidism. He is depressed but does not meet full criteria for major depressive disorder (MDD), the diagnosis given to him by his internist. The patient has no prior history of a mood disorder, and all of the depressive symptoms are temporally related to the hypothyroidism. Based on this information, you determine that a change in diagnosis—to depressive disorder due to another medical condition—is warranted, as well as a specifier to indicate that full criteria for MDD are not met. How would the full diagnosis be recorded?

Answer 31

Hypothyroidism would be recorded as the name of the “other medical condition” in the DSM-5 diagnosis.

Question 32

Which of the following statements accurately describes a change in DSM-5 From the DSM-IV criteria for bipolar disorders?

Answer 32

Diagnostic criteria for bipolar disorders now include both changes in mood and changes in activity or energy.

Question 33

A 32-year-old man reports 1 week of feeling unusually irritable. During this time, he has increased energy and activity, sleeps less, and finds it difficult to sit still. He also is more talkative than usual and is easily distractible, to the point of finding it difficult to complete his work assignments. A physical examination and laboratory workup are negative for any medical cause of his symptoms and he takes no medications. What diagnosis best fits this clinical picture?

Answer 33

Manic episode.

Question 34

A 42-year-old man reports 1 week of increased activity associated with an elevated mood, a decreased need for sleep, and inflated self-esteem. Although the man does not object to his current state (“I’m getting a lot of work done!”), he is concerned because he recalls a similar episode 10 years ago during which he began to make imprudent business decisions. A physical examination and laboratory

Answer 34

Bipolar I disorder

Question 35

Approximately what percentage of individuals who experience a single manic episode will go on to have recurrent mood episodes?

Answer 35

90%

Question 36

Which of the following factors is most predictive of incomplete recovery between mood episodes in bipolar I disorder?

Answer 36

Having a mood episode accompanied by mood-incongruent psychotic symptoms.

Question 37

Which of the following is more common in men with bipolar I disorder than in women with the disorder?

Answer 37

Alcohol abuse

Question 38

A patient with a history of bipolar I disorder presents with a new-onset manic episode and is successfully treated with medication adjustment. He notes chronic depressive symptoms that, on reflection, long preceded his manic episodes. He describes these symptoms as “feeling down,” having decreased energy, and more often than not having no motivation. He denies other depressive symptoms but feels that these alone have been sufficient to negatively affect his marriage. Which diagnosis best fits this presentation?

Answer 38

Bipolar I disorder and persistent depressive disorder
(dysthymia)

Question 39

In which of the following ways do manic episodes differ from attention-deficit/hyperactivity disorder (ADHD)?

Answer 39

Manic episodes have clearer symptomatic onsets and offsets

Question 40

A patient with a history of bipolar disorder reports experiencing 1 week of elevated and expansive mood. Evidence of which of the following would suggest that the patient is experiencing a hypomanic, rather than manic, episode?

Answer 40

Increased productivity at work

Question 41

A 25-year-old graduate student presents to a psychiatrist complaining of feeling down and “not enjoying anything.” Her symptoms began about a month ago, along with insomnia and poor appetite. She has little interest in activities and is having difficulty attending to her schoolwork. She recalls a similar episode 1 year ago that lasted about 2 months before improving without treatment

Answer 41

Bipolar II disorder, current episode depressed

Question 42

How do the depressive episodes associated with bipolar II disorder differ from those associated with bipolar I disorder?

Answer 42

They are lengthier than those associated with bipolar I disorder

Question 43

How does the course of bipolar II disorder differ from the course of bipolar I disorder?

Answer 43

It is more chronic than the course of bipolar I disorder

Question 44

Which of the following features confers a worse prognosis for a patient with bipolar II disorder?

Answer 44

Rapid-cycling pattern.

Question 45

The course of bipolar II disorder would likely be worse for individuals who have an onset of the disorder at which of the following ages?

Answer 45

Age 10 years.

Question 46

Which of the following statements about postpartum hypomania is true?

Answer 46

It is a risk factor for postpartum depression

Question 47

For an adolescent who presents with distractibility, which of the following additional features would suggest an association with bipolar II disorder rather than attention-deficit/hyperactivity disorder (ADHD)?

Answer 47

Evidence that the symptoms are episodic

Question 48

A 50-year-old man with a history of a prior depressive episode is given an antidepressant by his family doctor to help with his depressive symptoms. Two weeks later, his doctor contacts you for a consultation because the patient now is euphoric, has increased energy, racing thoughts, psychomotor agitation, poor concentration and attention, pressured speech, and a decreased need to sleep. These symptoms began with the initiation of the patient’s new medication. The patient stopped the medication after 2 days, as he no longer felt depressed; however, the symptoms have continued ever since. What is the patient’s diagnosis?

Answer 48

Bipolar I disorder

Question 49

In which of the following aspects does cyclothymic disorder differ from bipolar I disorder?

Answer 49

Severity