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Question

Difficulty: MediumDepressive Disorders

Match each patient's clinical vignette to the most accurate psychiatric diagnosis.

  • A 32-year-old woman reports feeling low and hopeless for most of her life. For the past three years, she has experienced poor energy and low self-esteem on most days, without any symptom-free periods lasting more than a month.Persistent depressive disorder
  • A 24-year-old man presents with depressed mood and anxiety that started one month after his fiancée ended their engagement. He continues to work but feels highly distressed; he does not meet full criteria for a major depressive episode.Adjustment disorder with depressed mood
  • A 45-year-old woman with systemic lupus erythematosus presents with acute onset of severe depression and anhedonia two weeks after starting a high-dose oral glucocorticoid regimen for a recent disease flare.Substance/medication-induced depressive disorder
  • A 29-year-old woman reports marked affective lability, irritability, and increased appetite that repeatedly occur during the week prior to menstruation and reliably resolve within a few days of follicular phase onset.Premenstrual dysphoric disorder

Answer

Match the 32-year-old with chronic symptoms to persistent depressive disorder, the 24-year-old with recent stress to adjustment disorder, the 45-year-old on steroids to medication-induced depressive disorder, and the 29-year-old with cyclical symptoms to premenstrual dysphoric disorder.
Each diagnosis in the differential of depressive disorders has distinct requirements regarding timeline, triggers, and severity. Persistent depressive disorder requires at least 2 years of symptoms. Adjustment disorder requires an identifiable stressor within 3 months and sub-threshold symptoms for a major depressive episode. Medication-induced depressive disorder requires a plausible pharmacological trigger, such as systemic corticosteroids. Premenstrual dysphoric disorder requires symptoms strictly linked to the luteal phase of the menstrual cycle.

Step-by-Step Solution

1
Analyze the first vignette's timeline.
The patient has 3 years of chronic depressive symptoms without a 2-month break.
Chronicity of 2 or more years is the defining feature of persistent depressive disorder.
2
Evaluate the second vignette's inciting event and symptom severity.
Symptoms began shortly after a breakup and do not meet major depressive disorder criteria.
This presentation meets the criteria for adjustment disorder with depressed mood.
3
Assess the third vignette's clinical context.
Severe depressive symptoms emerged shortly after initiating high-dose glucocorticoids.
Corticosteroids are a classic trigger for medication-induced depressive or psychotic symptoms.
4
Review the fourth vignette's symptom pattern.
Mood lability and irritability are strictly tied to the luteal phase of the menstrual cycle.
This cyclical pattern is the absolute requirement for diagnosing premenstrual dysphoric disorder.

Key Concept

Differential diagnosis of depressive disorders based on symptom duration, inciting stressors, and cyclical patterns.
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Topics

Depressive Disorders

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