Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder?

Correct Answer: D

Rationale: Major depressive disorder (MDD) is characterized by persistent sadness, anhedonia, and neurovegetative symptoms like sleep disturbances, appetite changes, and psychomotor agitation or retardation. The correct response is D because early morning awakening with inability to return to sleep (terminal insomnia) is a hallmark symptom of MDD, reflecting disruptions in circadian rhythms and hypothalamic-pituitary-adrenal axis dysfunction commonly seen in depression. This symptom is more severe than general insomnia and specifically linked to the melancholic features of depression. Option A describes psychomotor agitation, which can occur in MDD but is less specific and more characteristic of mixed features or comorbid conditions like anxiety disorders. Restlessness alone lacks the diagnostic specificity of sleep disturbances for MDD. Option B reflects excessive focus on goals, which may suggest anxiety or perfectionism but does not align with core depressive symptoms like anhedonia or hopelessness. While stress can contribute to depression, this behavior alone is not pathognomonic. Option C mentions unintended weight loss, which is a recognized symptom of MDD, but the timeframe (5 lbs over 5 months) is less clinically significant unless paired with other criteria. The DSM-5 requires "significant" weight change (e.g., >5% body weight in a month), making this example subtler and less definitive than the sleep disturbance in D. In contrast, option D’s description of early morning insomnia is a classic neurovegetative sign of MDD, often accompanied by diurnal mood variation (worse mood in mornings). Its inclusion in diagnostic criteria and strong association with biological markers (e.g., cortisol dysregulation) make it a more robust indicator of MDD than the other options. The other choices either lack specificity (A, B) or clinical severity (C) to stand alone as definitive symptoms.

Correct Answer: A

Rationale: **Rationale:** **Correct Answer (A): Conducting routine suicide screenings at a senior center.** Suicide risk is a critical concern in older adults with major depressive disorder (MDD), as this population has one of the highest suicide rates, particularly among older white males. Depression in older adults is often underdiagnosed due to overlapping symptoms with medical conditions or the misconception that sadness is normal in aging. Routine suicide screenings proactively identify at-risk individuals, allowing for timely interventions such as therapy, medication, or social support. This approach addresses a life-threatening complication of MDD and aligns with evidence-based practices for geriatric mental health. By contrast, the other options either perpetuate myths or overlook actionable strategies. **Incorrect Answers:** **B: Identifying depression as a natural, but treatable outcome of aging.** This choice is problematic because it reinforces the harmful stereotype that depression is an inevitable part of aging. While older adults face unique stressors (e.g., chronic illness, bereavement), depression is never "natural" and always warrants clinical attention. Framing it as such may discourage individuals from seeking help, exacerbating isolation and untreated symptoms. Effective interventions must challenge this myth and emphasize depression as a medical condition requiring targeted treatment, not a normative experience. **C: Identifying males as at a greater risk for developing depression.** This is factually incorrect. While older males have higher suicide *completion* rates, women are statistically more likely to *develop* depression due to biological, hormonal, and social factors. Misidentifying risk groups could lead to inadequate screening for women or misplaced focus in prevention efforts. Accurate risk assessment must distinguish between prevalence (higher in women) and lethality (higher in men) to tailor interventions appropriately. **D: Stressing that most individuals experience only a single episode of major depression in a lifetime.** This statement is misleading and contradicts clinical evidence. MDD is often recurrent, with ~50% of patients experiencing a second episode after their first. Older adults are especially vulnerable to recurrence due to cumulative stressors and comorbidities. Promoting this misconception could result in poor long-term monitoring, reduced adherence to maintenance therapy, and unrealistic expectations about prognosis. Effective management requires preparing patients for potential relapse and emphasizing sustained care. **Key Takeaways:** Answer A stands out as the only intervention directly addressing a high-priority, actionable aspect of geriatric depression (suicide prevention). The incorrect options either misrepresent risk factors (C), minimize the severity of depression (B), or provide inaccurate prognostic information (D). Effective care for older adults with MDD requires precise risk assessment, myth dispelling, and proactive measures to mitigate the most severe outcomes.

Correct Answer: C

Rationale: Characteristics such as age, frequency of outbursts, and occurrence in multiple settings support a diagnosis of disruptive mood dysregulation disorder. While comorbid conditions like autism can coexist with disruptive mood dysregulation disorder, it is not a characteristic that serves to support a diagnosis of this specific disorder.

Correct Answer: A

Rationale: Chronic medical conditions can significantly impact mental health, often serving as triggers for major depressive disorder (MDD). The correct answer is **A: Pain**, as chronic pain is one of the most well-documented and clinically established conditions linked to the development of depression. The relationship between chronic pain and depression is bidirectional and multifaceted. Persistent pain disrupts daily functioning, limits mobility, and reduces quality of life, leading to feelings of hopelessness, helplessness, and social isolation—key contributors to depressive symptoms. Neurobiological mechanisms also play a role; chronic pain alters neurotransmitter systems (e.g., serotonin and norepinephrine) and activates inflammatory pathways, which are also implicated in depression. Studies show that up to 50% of chronic pain patients experience comorbid depression, highlighting the strength of this association. **B: Hypertension** is incorrect because, while it is a common chronic condition, its direct link to MDD is weaker. Hypertension may contribute to stress or anxiety, but it does not inherently involve the same profound disruption to daily life or neurochemical pathways as chronic pain. Some studies suggest a correlation between hypertension and depression, but this is often confounded by lifestyle factors (e.g., poor diet, lack of exercise) rather than a direct causal relationship. **C: Hypothyroidism** is incorrect as a *common* trigger for MDD, though it can mimic depressive symptoms (e.g., fatigue, low mood). However, hypothyroidism is less prevalent than chronic pain, and its depressive-like symptoms are typically resolved with thyroid hormone replacement therapy. While untreated hypothyroidism can contribute to mood disturbances, it is not among the leading chronic conditions *proven* to trigger MDD in the same way chronic pain does. **D: Crohn's disease** is incorrect because, although it is a chronic inflammatory condition that can affect mood, its association with depression is more indirect. The psychological burden of managing a gastrointestinal disorder (e.g., embarrassment, dietary restrictions) may contribute to depression, but the condition itself does not universally or directly trigger MDD to the same extent as chronic pain. The inflammatory component of Crohn's may play a role, but the evidence is not as robust as for pain-related depression. In summary, chronic pain stands out due to its high prevalence, profound impact on daily functioning, and direct neurobiological overlap with depressive mechanisms, making it the most compelling choice among the options provided. The other conditions, while relevant to mental health, lack the same breadth and depth of evidence linking them to MDD.

Correct Answer: A

Rationale: Fluoxetine (Prozac) is a suitable alternative antidepressant for Tammy due to its approval for the treatment of bulimia nervosa. It belongs to the selective serotonin reuptake inhibitor (SSRI) class of antidepressants, similar to citalopram, which Tammy is already taking. Fluoxetine has shown efficacy in treating bulimia nervosa and can be a beneficial choice for individuals with this condition.