Clinical mastery, Psychiatry form 2 Q - seonsaeng

[ArchivalUser]

A previously healthy 27 year old woman comes to the physician because of a 2 month history of crying spells, poor concentration, fatigue & lethargy. she says that she sleeps at least 12 hours daily and is no longer interested in socializing.she recently broke up with her boyfriend of 10 month, and her work performance has begun to decline , she is afraid that she will lose her job if it does not improve. she does not drink alcohol or use illicit drugs. menses occur at regular 28 to 30 day intervals. her last menstrual period was 2 weeks ago. she has had a 9kg weight gain over the past 9 months. she is 168 cm tall & weighs 66 kg, BMI is 23. physical examination shows no abnormalities. mental status examination shows a sad mood and restricted affect. which of the following is the most likely diagnosis?
A. Adjustment disorder with depressed mood
B. Dysthymic disorder
C. Generalized anxiety disorder
D. Major depressive disorder
E.premenstrual dysphoric disorder.

[ArchivalUser]

i thought the answer is D.Major Depressive disorder as the pt has 2months of poor concentration, fatigue (loss of energy), hypersomnia, loss of interest, weight gain...

i have found that in UTD: weight gain (eg, a change of more than 5 percent of body weight in a month)>>> here (she has had a 9kg weight gain over the past 9 months)>>may be this one doesnt fit here. so it should be Adjustment then??

any other thoughts??

[ArchivalUser]

i would also go with major depression.she meets the criteria.what does utd stand for?

[ArchivalUser]

UTD= up to date

[ArchivalUser]

I would go with A because she has a prominent stressor (recent broke up with BF), symptoms last less than 6 months, with emotional symptoms of depression and anxiety. Adjustment disorder can have depressive symptoms like this patient has (crying spells, poor concentration, fatigue, loss of interest, etc.)
Major depressive disorder episodes usually last longer than adjustment d/o ( Step 1 FA says 6-12 months)
Any idea?

[ArchivalUser]

@fivedoves you are right.the symptoms are similar to adjustment disorder,and it is usu within 3 months of the stressor.
The question shld have stated when exactly she broke up with her bf.

[ArchivalUser]

@fivedoves yeah i think here it's more with adjustment as may be the weight gain doesnt fit the criteria of MDD....but dont forget that MDD it should be more than 2 weeks then u can diagnose it plus u should have at least 5 of SIGECAPS.....

[ArchivalUser]

I can tell you right now that adjusment is WRONG i picked it and got it wrong

[ArchivalUser]

oh @tractate thanks for replying here...u took it online?

what do you think the answer here?

[ArchivalUser]

I chose A and it was wrong...I was thinking Major depressive disorder but that whole boyfriend thing threw me off...it has to be C then