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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
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whats double depression
anyone know?
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cc. she has the criteria for Melancolic depression, but as she has had Dysthymic disorder before, it is double depression
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whats melancholic depression
nakhsha
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awesome! jorj nakhsha !!
The correct answer is C. 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 inappropriate guilt.
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