psych 2 - maddymami

[ArchivalUser]

A 20-year-old man is brought to the emergency department by a mobile crisis unit after a call from his mother. They live in a high-rise building and she had caught him leaning over the window as if he were going to jump. According to his mother, the patient has been acting really strange in the past month. He became disinterested in his usual hobbies and became more withdrawn, basically staying in his room alone most of the time. He has repeatedly denied being sick but complains of tiredness and lack of enjoyment in any activities that he usually likes. In the previous couple of days he has become more irritable and argumentative with his parents and friends. He broke up with his girlfriend and went out with several different girls. He has been more talkative than usual and at times looks angry. He took all of his savings out of the bank and decided he was going to set up his own business, a new young-men™s apparel line. Then 2 days ago he looked tired, stayed in the room all day, refused to join the family for meals, and just sat, staring into space. He mentioned that he was œlost but did not want to talk to anybody about it. His mother is sure he is not using any drugs, and urine toxicology is negative. There is some family history on the maternal side; one of the mother™s uncles had a reputation of having œthree motors instead of one, and always making some plans. He was never treated. This patient has no prior known medical history. Given these symptoms, which of the following is the most likely diagnosis?

A. Adjustment disorder with depressed mood
B. Antisocial personality disorder
C. Bipolar disorder, mixed episode
D. Cyclothymic disorder
E. Rapid-cycling bipolar disorder

[ArchivalUser]

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[ArchivalUser]

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[ArchivalUser]

c s the ans...

[ArchivalUser]

A 27-year-old woman comes to the office for the first time. During the interview she states that she has felt unhappy most of her life, and at times has questioned whether life is worth living. She was never very confident and feels that she has nothing to offer to others. She feels that this may be because she was abused by her stepfather for several years. In the past 6 months she has become more irritable and œsnappy toward people, has been unable to hold a job, is often tearful for no reason, and is unhappy with her relationships. She notes that she has gone from size 12 to size 6 and that she does not really care if and what she eats. She has problems with her sleep; even though she is able to fall asleep, she wakes up several times, and in the morning feels terribly tired. She denies any suicidal ideation, but when asked about the guilt she becomes very tearful and shares that it is related to the past history of abuse. She feels that her energy is low and her concentration is poor. She spends most of the time in bed and has hard time forcing herself to do anything. At this time which of the following is the most likely diagnosis?

A. Atypical depression
B. Dysthymic disorder
C. Double depression
D. Major depressive disorder
E. Melancholic depression

[ArchivalUser]

dd for the second q...

maddymami...could u pls post the explanation for first q...as this patient was having cycles of mania and depression in a period of 1 mth....

another req...please post new q in different thread...thx!!

[ArchivalUser]

ans is c for 2 nd q
This patient has double depression. Initially she meets the criteria for dysthymic disorder. However, since she has more severe symptoms of depression that meet the criteria for major depressive disorder in the past 6 months, a major depressive episode is superimposed on ongoing dysthymia. This is called double depression.

Atypical depression (choice A) is defined with mood reactivity as a response to potential or actual positive events, with at least two significant symptoms present: significant weight gain or increase in appetite (cravings for sweets at times), hypersomnia, heavy feeling in arms and legs (œleaden paralysis), and increased sensitivity to interpersonal rejection resulting in social dysfunctioning.

Dysthymic disorder (choice B) is less severe depressive disorder featured by insidious onset and a chronic course, more frequently seen in women. It may often be related to losses or chronic stress. Symptoms tend to worsen later in the day. The onset is in the person™s twenties or thirties. Symptoms include at least two of the following: poor appetite, changes in sleep, low self esteem, feelings of hopelessness, and difficulties concentrating. Symptoms must be present most of the time over the past 2 years for establishment of this diagnosis.

Major depressive disorder (choice D) can be diagnosed if a person has had in the past month, for at least 2 weeks on a daily basis, depression or anhedonia accompanied by associated symptoms of changes in sleep, appetite, interest, energy, concentration, and motor activity, as well as feelings of guilt or thoughts of death.

Major depression with melancholic features (choice E) is defined as loss of pleasure most of the time and lack of reactivity to pleasurable stimuli in the current episodes. Additionally, three or more of the following criteria must be met: distinct quality of depressed mood, worse depression in the morning, early morning awakening, psychomotor retardation or agitation, weight loss, and inappropria

[ArchivalUser]

for q 1 ans is c
This patient has a mixed episode of bipolar disorder. Bipolar disorder should be strongly considered in this case, since the patient seems to have met the criteria for both manic and major depressive episode for at least a 1-week period. The disturbance is sufficiently severe to cause functional impairment and is not due to a medical condition or substance abuse.

Adjustment disorder with depressed mood (choice A) is a depressive reaction following exposure to a stressor. The depression develops within 3 months after the stressful event.

Antisocial personality disorder (choice B) occurs after age 18 and is significant for major violation and disregard of the rights of others as indicated by failure to conform to social norms, impulsivity, reckless disregard for safety of self and others, lack of remorse, and deceitfulness.

Cyclothymic disorder (choice D) requires the presence of numerous episodes of hypomanic and depressive symptoms that do not meet the criteria for major affective disorder. The person must have at least 2 continuous months of these symptoms in a 2-year period. The disorder is not due to other psychiatric disorder or medical condition.

Rapid-cycling bipolar disorder (choice E) is characterized by at least four episodes of mood disturbance in the previous 12 months that meet the criteria for a major depressive, manic mixed, or hypomanic episode

[ArchivalUser]

thx!