Rosh Psychiatry Board Practice Exam

For diagnosing major depressive episode, which symptom is mandatory?

1. Feelings of worthlessness

2. Diminished ability to concentrate

3. Insomnia or hypersomnia

4. Loss of interest in daily activities

The correct answer is: Loss of interest in daily activities

In diagnosing a major depressive episode, the presence of a loss of interest in daily activities, also known as anhedonia, is essential. This symptom reflects a significant change in mood and functioning and is critical in establishing the diagnosis. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) mandates the inclusion of either depressed mood or anhedonia as one of the core symptoms required for a diagnosis of a major depressive episode. A loss of interest represents a profound inability to experience pleasure in activities that were once enjoyable, which is a hallmark of depression. This symptom often correlates with various aspects of a person’s life, including social interactions, work performance, and self-care. While feelings of worthlessness, diminished ability to concentrate, and insomnia or hypersomnia are significant symptoms that contribute to the overall clinical picture of a major depressive episode, they are not mandatory for diagnosis. Therefore, the presence of loss of interest in daily activities is crucial for establishing the diagnosis of a major depressive episode.