Question

Differential diagnosis of pre-menstrual tension includes all of the following except:

• A. Psychiatric depressive disorder
• B. Panic disorder
• C. General anxiety disorder
• D. Chronic fatigue syndrome

Hint:

Core psychiatric differentials for PMT are depression, panic disorder, and GAD; CFS is a separate general medical diagnosis.

Answer 1

The Correct Option is D

Premenstrual tension (PMT, also called PMS or in its severe form PMDD) causes mood and physical symptoms tied tightly to the days before a period and clearing soon after it starts. The differential diagnosis is the list of other conditions that can mimic it, mainly conditions that share mood or fatigue symptoms but are NOT tied to the menstrual cycle.

1. Psychiatric depressive disorder: major depression can look similar to PMT, but depression symptoms persist through the whole cycle rather than clearing after the period starts. It is a standard item on the differential list.
2. Panic disorder: recurrent panic attacks can cause irritability and physical symptoms that overlap with PMT, and it is commonly listed as a differential to rule out.
3. General anxiety disorder: chronic, cycle independent worry and tension can be confused with the anxiety seen before periods, so this is also a standard differential.
4. Chronic fatigue syndrome: this is a distinct medical diagnosis of unexplained, persistent fatigue lasting months, unrelated to the menstrual cycle. While tiredness overlaps with PMT, CFS is defined by fixed diagnostic criteria of its own and sits apart from the core psychiatric mood and anxiety differentials that are classically taught alongside PMT.

Note: the original 2002 answer key did not print an answer for this question, so there is no official key to check against here. The reasoning above follows the standard teaching grouping, where PMT is chiefly differentiated from other cycle-independent psychiatric mood and anxiety disorders (depression, panic disorder, generalised anxiety disorder), while chronic fatigue syndrome is usually taught as a separate general medical exclusion rather than a core psychiatric differential.

Let's summarize:

• Classic psychiatric differentials for PMT: depressive disorder, panic disorder, generalised anxiety disorder.
• Chronic fatigue syndrome is a distinct medical diagnosis, less commonly grouped with these core psychiatric differentials.

So the exception here is chronic fatigue syndrome.