Rosh Psychiatry Board Practice Exam

What is the most likely diagnosis for a patient experiencing multiple mild episodes of hypomanic symptoms and mild depression over the last two years?

1. Bipolar I disorder

2. Bipolar II disorder

3. Cyclothymic disorder

4. Schizoaffective disorder

The correct answer is: Cyclothymic disorder

The most likely diagnosis in this scenario is cyclothymic disorder, which is characterized by a chronic pattern of mood instability involving numerous periods of hypomanic symptoms and mild depressive symptoms that occur over a period of at least two years in adults (or one year in children and adolescents). In cyclothymic disorder, the individual does not experience the full criteria for either a hypomanic episode or a major depressive episode, but rather has these milder symptoms that are persistent and fluctuate over time. In this case, the patient has experienced multiple mild episodes consistent with both hypomania and mild depression over the course of two years, which aligns with the symptomatology of cyclothymic disorder. The distinction from the other conditions is critical; for instance, bipolar I disorder requires at least one full manic episode, while bipolar II disorder involves at least one major depressive episode and one hypomanic episode. Schizoaffective disorder includes mood episodes concurrent with psychotic features, which is not indicated in this scenario. Thus, considering the specific nature and duration of the symptoms, cyclothymic disorder emerges as the most accurate diagnosis.