Depressed mood

Question 1

Key history in depressed mood

Answer 1

Onset
Duration
SIG E CAPS
Drug and alcohol use
Life stresses
FHx of mood disorders
Prior episodes
Medications

Question 2

Key physical exam in depressed mood

Answer 2

Vital signs
Head and neck exam
Neurologic exam
MMSE
Insight and judgment

Question 3

68 yo M with 2-month history of crying spells, excessive sleep, poor hygiene and 15 pound weight loss after wife’s death
+ cannot enjoy time with grandchildren
+ has seen dead wife at supermarket and in kitchen

Answer 3

Normal bereavement
Adjustment disorder with depressed mood
Major depressive disorder with psychotic features

Physical exam, TSH, CBC, urine toxicology, Beck Depression Inventory

Question 4

42 yo F with 4-week history of excessive fatigue, insomnia, anhedonia, thoughts of death
+ similar episodes in past with prior suicide attempts
+ increased alcohol use

Answer 4

Major depressive disorder
Substance-induced mood disorder
Dysthymic disorder

Physical exam, MMSE, Beck Depression Inventory, blood alcohol level, TSH, CBC, urine toxicology

Question 5

26 yo F with 7 pound weight loss over last 2 months
+ SIG E CAPS
+ Several weeks of increased energy, promiscuity, spending and racing thoughts about 6 months ago

Answer 5

Bipolar I disorder
Bipolar II disorder
Cyclothymic disorder

Physical exam, MMSE, urine toxicology