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Major depressive disorder
54%
27/50
Dysthymia
32%
16/50
Bipolar I disorder
6%
3/50
Grief response
Schizoaffective disorder
0%
0/50
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This patient's presentation is consistent with major depressive disorder. The diagnosis can be made with 5 of the SIGECAPS criteria: 1. Sleep 2. Interest 3. Guilt 4. Energy 5. Concentration 6. Appetite 7. Psychomotor 8. Suicidal This patient has 5 of the criteria (sleep, interest, energy, concentration, appetitie +/- suicide). Given that these criteria are met and there is no acute stressor that could explain this patient's symptoms the diagnosis is major depression. The treatment of choice for this patient is SSRI's and CBT. Incorrect Answers: Answer 2: The diagnosis of dysthymia requires a low-grade depression for more than two years, without a major depression episode. Patients who present with a major depressive episode, and then present with low-grade depression within two years, should be diagnosed with major depressive disorder. A diagnosis of dysthymia also requires that a physician rule out medical causes of depression, including hypothyroidism, and Cushing's syndrome. The treatments of both major depression and dysthymia include psychotherapy and antidepressants. Answer 3: Bipolar I disorder is characterized by at least 1 full-blown manic episode mixed in with depression, typically at baseline. It is important to rule out mania before beginning SSRI's as this could push the patient into a manic episode. Answer 4: Grief response is important to keep in mind and certainly could be the diagnosis in this case. The patient's boyfriend did die in a meat-grinding accident, however this occurred 2 years ago. The patient may have had a visual hallucination in the past during her grief response, however this is not going on currently. Typically a grief response does not last longer than a year (it can but this is less likely) and a return to function is typically seen a few months after the initial episode. Answer 5: Schizoaffective disorder is characterized by schizophrenia with at least one episode of co-occurring major depression. Think of it as schizophrenia with a depressive affect per the name.
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