has gone up 2 dress sizes. She also complains that she can’t get out of bed until the afternoon.
What is the most likely dx?
a. Pseudo depression
b. Moderate depression
c. Severe depression
d. Dysthymia
e. Atypical depression
Answer: E
We are not given enough information to classify it as moderate or severe, however we are given 2 essential features of atypical depression (Hypersomnia and Increased appetite).
Symptoms/Signs
- 1. Depressed mood most of the day, nearly every day
- 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
- 3. Significant weight loss or weight gain when not dieting or decrease or increase in appetite nearly every day
- 4. Insomnia or hypersomnia nearly every day
- 5. Psychomotor agitation or retardation nearly every day
- 6. Fatigue or loss of energy nearly every day
- 7. Feelings of worthlessness or excessive or inappropriate guilt nearly every day
- 8. Diminished ability to think or concentrate, or indecisiveness nearly every day
- 9. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
| Subthreshold depression | Fewer than 5 symptoms |
|---|---|
| Mild depression | Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment |
| Moderate depression | Symptoms or functional impairment are between 'mild' and 'severe' |
| Severe depression | Most symptoms, and the symptoms markedly interfere with functioning. Can occur with or without psychotic symptoms |
Atypical Depression:
The DSM-IV-TR defines Atypical Depression as a subtype of Major Depressive Disorder with Atypical Features, characterized by: (Presence of #1 and at least two from #2)
- Mood reactivity (i.e., mood brightens in response to actual or potential positive events)
- At least two of the following:
- Significant weight gain or increase in appetite;
- Hypersomnia (sleeping too much, as opposed to the insomnia present in melancholic depression);
- Leaden paralysis (i.e., heavy, leaden feelings in arms or legs);
- Long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment.
- Criteria are not met for With Melancholic Features or With Catatonic Features during the same episode.
requires the presence of mood reactivity (criterion A) and at least 2
of 4 criterion B features (significant weight gain or hyperphagia,
hypersomnia, leaden paralysis, and interpersonal rejection sensitivity
resulting in social or occupational impairment) - See more at:
http://www.psychiatrictimes.com/major-depressive-disorder/atypical-depression-21st-century-diagnostic-and-treatment-issues#sthash.Vv99hrVV.dpuf
requires the presence of mood reactivity (criterion A) and at least 2
of 4 criterion B features (significant weight gain or hyperphagia,
hypersomnia, leaden paralysis, and interpersonal rejection sensitivity
resulting in social or occupational impairment) - See more at:
http://www.psychiatrictimes.com/major-depressive-disorder/atypical-depression-21st-century-diagnostic-and-treatment-issues#sthash.Vv99hrVV.dpuf
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