A 38-year-old woman presents to the psychiatry outpatient clinic with a 3-month history of persistent low mood, loss of interest in her job as a schoolteacher, and difficulty concentrating on routine tasks. She reports waking up at 4 AM daily, unable to return to sleep, and has lost 6 kg unintentionally. She denies suicidal ideation but feels life is not worth living. Her appetite is markedly reduced. Mental status examination reveals psychomotor retardation, depressed affect, and impoverished speech. There is no history of mania or hypomania. Thyroid function tests and vitamin B12 levels are normal. What is the most likely diagnosis?
A. Adjustment Disorder with depressed mood
B. Major Depressive Disorder, single episode, moderate severity
C. Bipolar II Disorder, depressed phase
D. Persistent Depressive Disorder (Dysthymia)
Explanation
Diagnostic Criteria Analysis
Key Point
Major Depressive Disorder (MDD) requires ≥5 symptoms present for ≥2 weeks (here 3 months), causing functional impairment, with no history of manic/hypomanic episodes.
Symptoms Present in This Case
1.
Depressed mood (persistent low mood)
2.
Anhedonia (loss of interest in work)
3.
Sleep disturbance (early morning awakening at 4 AM)
4.
Appetite/weight loss (6 kg unintentional loss, markedly reduced appetite)
5.
Concentration difficulty
6.
Psychomotor retardation (observed on MSE)
7.
Worthlessness/hopelessness (life not worth living)
High-YieldNEET PG
This patient meets ≥5 DSM-5 criteria for MDD. The 3-month duration exceeds the 2-week minimum. Absence of manic/hypomanic history rules out bipolar disorder.
Severity Assessment
Moderate severity is indicated by:
Functional impairment (unable to perform job duties effectively)
