71 The PMHNP has completed the initial assessment of Bruce, a 14-year-old

boy who was initially presented to care by his parents because of progressive social withdrawal. Upon completion of the patient interview, mental status exam, and family assessment, review of all information reveals that for the past 15 months Bruce has been progressively “moody.” His parents say that he has become so irritable that his little brother and sister are afraid to talk to him anymore. Additionally, he has become socially withdrawn, now not even wanting to go to school. Bruce says he is tired all the time and just doesn’t feel like doing anything. He often does not complete homework assignments. When considering a diagnosis of dysthymic disorder, the PMHNP knows that which other history finding must be present?

A. Depressed mood most of the time for at least 2 weeks
B. Symptoms not resolved for more than 2 months at a time
C. Intermittent episodes of anger disproportionate to the stimulus
D. negative symptoms before age 5