Rosh Psychiatry Board Practice Exam

A woman feels persistently sad and hopeless for three years. Which diagnosis is most likely?

1. Major depressive disorder

2. Seasonal affective disorder

3. Persistent depressive disorder

4. Premenstrual dysphoric disorder

The correct answer is: Persistent depressive disorder

The diagnosis of persistent depressive disorder (also known as dysthymia) is most fitting in this scenario because it is characterized by a chronic form of depression lasting for at least two years in adults. The patient's symptoms of feeling persistently sad and hopeless for three years align with the criteria for this disorder, highlighting the duration and consistency of her depressive symptoms. Persistent depressive disorder typically involves a low mood lasting for most of the day, more days than not, and can also include symptoms such as decreased appetite or overeating, insomnia or hypersomnia, fatigue, low self-esteem, difficulty concentrating, and feelings of hopelessness. In this case, the prolonged duration of three years without any stipulation of episodes that fully remit would further confirm this diagnosis. Major depressive disorder could be considered if the woman had distinct episodes of depression with periods of remission, but the specific emphasis on the continuous sadness and hopelessness over such a long duration points more toward persistent depressive disorder. Seasonal affective disorder is typically tied to specific seasons, resulting in a pattern that occurs at the same time each year, which does not match the continuous experience described in this case. Premenstrual dysphoric disorder involves severe emotional and physical symptoms that occur premenstrually and sub