The following is a high-yield USMLE Step 1 Behavioral Medicine / Psychiatry question.
It is followed by a deep dive into each answer choice—the answer can be found at the bottom of the post.
Good luck!
QUESTION:
A 35-year-old woman presents to her primary care physician with a 6-week history of feeling down and persistent sadness. She reports difficulty sleeping, loss of appetite, and no interest in previously enjoyed activities. She mentions that she has difficulty concentrating and has been reprimanded at work for completing several projects past their due date. She also describes recurrent feelings of worthlessness. The patient denies any recent traumatic events or significant life changes. Based on the patient's symptoms, which of the following additional features must be present for a diagnosis of major depressive disorder?
A. Auditory hallucinations
B. Manic episodes
C. A family history of depression
D. Suicidal ideation
E. At least two years of depressive symptoms
F. Presence of symptoms for at least two weeks
G. Symptoms causing significant impairment in daily functioning
To see the answer, scroll to the bottom of the page. See the DEEP-DIVE below if you’re unsure or want to learn more about the answer choices.
DEEP-DIVE:
This question tests your knowledge of the diagnostic criteria for Major Depressive Disorder (MDD) according to the DSM-5. The key considerations are the core symptoms of depression, the required duration of symptoms, and the functional impact. The incorrect choices include symptoms or criteria that are unnecessary for diagnosing MDD.
A. Auditory hallucinations
Auditory hallucinations are not a requirement for MDD. They might indicate a more severe form of depression or a different diagnosis, such as a psychotic disorder.
B. Manic episodes
Manic episodes are indicative of bipolar disorder, not MDD. Their presence would contraindicate a diagnosis of MDD.
C. A family history of depression
A family history of depression can increase the risk of developing MDD, but this is not a diagnostic criterion.
D. Suicidal ideation
Suicidal ideation can occur in MDD but is not necessary for the diagnosis.
E. At least two years of depressive symptoms
At least two years of depressive symptoms is a criterion for persistent depressive disorder (dysthymia), not MDD.
F. Presence of symptoms for at least two weeks
The presence of symptoms for at least two weeks is a key diagnostic criterion for MDD. The DSM-5 requires that five or more symptoms, including either depressed mood or loss of interest/pleasure, be present during the same 2-week period and represent a change from previous functioning. These criteria have already been met since this patient’s symptoms have been present for six weeks.
G. Symptoms causing significant impairment in daily functioning
Symptoms causing significant impairment in daily functioning are also a requirement for MDD. The symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. It is unclear how much impairment in daily functioning is experienced in this scenario, making this the best and most likely diagnosis.
VERDICT: Based on the DSM-5 criteria for MDD, the correct answer is G. Symptoms causing significant impairment in daily functioning. Since the patient has more than five symptoms of MDD and has been present for six weeks, answer G is the most appropriate answer choice.
FINAL ANSWER: G. Symptoms causing significant impairment in daily functioning
Hello! I love good disorders. I do have a question, though. On the described case in question there are, already, symptoms of significant impairment on daily function like sleep disturbances, loss of apetite and anhedonia. So, they are not exactly additional features, right? Was the question refering to lack of personal hygene, house tasks, etc? Thank you!