A 34-year-old woman reports severe irritability, affective lability, markedly depressed mood, and social withdrawal that begins 1 week before menstruation and resolves completely within a few days of onset of menses, occurring for most cycles over the past year. Her symptoms cause significant occupational impairment. The MOST appropriate diagnosis is:

• A Premenstrual syndrome (PMS)
• B Major depressive disorder with menstrual cycle patterning
• C Premenstrual Dysphoric Disorder (PMDD) ✓
• D Cyclothymic disorder

Explanation

PMDD (DSM-5) requires ≥5 symptoms in the final week before menses with at least one being marked affective lability, irritability, depressed mood, or anxiety; onset of symptoms in the luteal phase with complete remission after menses; symptoms present in most cycles over the preceding year; and clinically significant distress or functional impairment. PMS is milder and does not require functional impairment. Major depressive disorder does not remit with menstruation (it is pervasive). Cyclothymia involves chronic mood instability not tied to the menstrual cycle.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.