Depressed Mood Flashcards
What key history would you obtain from a patient that complains of a depressed mood?
Onset Duration Sleep patterns Appetite Weight change Drug and alcohol use Life stressors Excessive guilt Suicidality Social function Family history of mood disorders Prior episodes Medications
What key physical exam would you do for a patient who complains of a depressed mood?
Vital signs
Head and neck exam
Neurologic exam
Mental status exam (appearance, behavior, speech, mood, affect, thought process, thought content, cognition [30 point mini-mental status exam] insight and judgment
68 yo M presents with a two-month history of crying spells, excessive sleep, poor hygiene and a 7 kg weight loss all following his wife’s death. He cannot enjoy time with his grandchildren and reluctantly admits to thinking he has seen his dead wife in line at the supermarket or standing in the kitchen making dinner. Differentials?
Normal bereavement
Adjustment disorder with depressed mood (symptoms must occur within 3 months of stressor)
Major depressive disorder with psychotic features
Schizoaffective disorder
Depressive disorder not otherwise specified (NOS)
68 yo M presents with a two-month history of crying spells, excessive sleep, poor hygiene and a 7 kg weight loss all following his wife’s death. He cannot enjoy time with his grandchildren and reluctantly admits to thinking he has seen his dead wife in line at the supermarket or standing in the kitchen making dinner. Differentials: normal bereavement, adjustment disorder with depressed mood, major depressive disorder with psychotic features, schizoaffective disorder and depressive disorder not otherwise specified (NOS). Workup?
Physical exam Mental status exam TSH CBC Urine toxicology
42 yo F presents with a four-week history of excessive fatigue, insomnia, and anhedonia (inability to feel pleasure). She states that she thinks constantly about death. She has suffered five similar episodes in the past, the first in her 20s and has made two previous suicide attempts. She further admits to increased alcohol use in the past month. Differentials?
Major depressive disorder
Substance-induced mood disorder
Persistent depressive disorder (Dysthymic disorder)
42 yo F presents with a four-week history of excessive fatigue, insomnia, and anhedonia (inability to feel pleasure). She states that she thinks constantly about death. She has suffered five similar episodes in the past, the first in her 20s and has made two previous suicide attempts. She further admits to increased alcohol use in the past month. Differentials: major depressive disorder, substance-induced mood disorder, persistent depressive disorder (dysthymic disorder). Workup?
Physical exam Mental status exam Blood alcohol level TSH CBC Urine toxicology
26 yo F presents with a 3 kg weight loss over the past two months, accompanied by early-morning awakening, excessive guilt and psychomotor retardation. She does not identify a trigger for the depressive episode but reports several weeks of increased energy, sexual promiscuity, irresponsible spending and racing thoughts approximately six months before her presentation. Differentials?
Bipolar I disorder Bipolar II disorder Cyclothymic disorder Major depressive disorder Schizoaffective disorder
26 yo F presents with a 3 kg weight loss over the past two months, accompanied by early-morning awakening, excessive guilt and psychomotor retardation. She does not identify a trigger for the depressive episode but reports several weeks of increased energy, sexual promiscuity, irresponsible spending and racing thoughts approximately six months before her presentation. Differentials: bipolar I disorder, bipolar II disorder, cyclothymic disorder, major depressive disorder, schizoaffective disorder. Workup?
Physical exam
Mental status exam
Urine toxicology
