PSYCHIATRY 1

A 26-year-old lady is brought in by her husband with complaints of crying spells, since 1 month. She also has decreased appetite and has lost 15lbs(6.8kg)in the above span of time. In addition to these symptoms, she has disturbed sleep and easy fatigability. She has developed these symptoms after the death of their 2-year-old son. Although she continues to go to work, she does not feel as enthusiastic about it anymore. She denies any suicidal thoughts, but does admit to passive thoughts of death “in order to be with her son”. The diagnosis most likely in this case is:


A. Major depressive episode
B. Cyclothymia
C. Dysthymic disorder
D. Normal bereavement
E. Adjustment disorder


Explanation:

Bereavement is a normal reaction to the death of a loved one. Some grieving individuals present with classic symptoms of Major depression but the symptoms are not as pronounced as in Major depression. Besides, Normal bereavement rarely lasts beyond 2 months, though a Major depressive epiosde can. Also, bereavement does not cause as much functional impairment, as a depressive episode.

Choice A. According to DSM-1V criteria, Major depressive episode require the presence of 5 or more of the following symptoms for at least 2 weeks:
1. Depressed mood most of the day
2. Markedly diminished interest in all activities
3. Insomnia or hypersomnia
4. Significant weight loss or weight gain
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive guilt
8. Decreased concentration
9. Recurrent thoughts of death or suicidal ideations

Although, this patient does have some of the symptoms of Major depression, the presence of her symptoms, in the setting of recent loss of a loved one, make Bereavement a more likely diagnosis.


Choice B. Cyclothymia is the presence of numerous episodes of hypomanic symptoms and numerous episodes of depressive symptoms (that do not meet the criteria for Major depression) for a period of at least 2 years.

Choice C. Dysthymia is the presence of depressed mood for most of the time, for at least 2 years. In addition, it also includes the presence of 2 or more of the following: 1. Poor appetite or overeating, 2. Insomnia or hypersomnia, 3. Low self-esteem, 4. Low energy, 5. Feelings of hopelessness, 6. Poor concentration.

Choice E. Adjustment disorder is the development of behavioral symptoms in response to a stressor occurring within 3 months of the onset of the stressor. The distress is usually in excess to what would be expected from exposure to the stressor. It usually causes significant impairment in social or occupational functioning.