#75 - THE WEEKLY USMLE TIMES
Highlights for the week of May 13, 2024
Welcome to issue #75 of The USMLE Times… A special welcome to the 321 new members who have joined our community this week and a special thanks to the 22 students who booked their 1-on-1 sessions with me over the past week.
Here’s what’s on tap for issue #75 of the USMLE Times:
Question of the Week (Behavioral)
Biochemistry Drill Session
Our tweet thread of the week
Question deep-dive & breakdown
Let’s dive in!
A 25-year-old female visits her primary care physician, accompanied by her husband, due to the onset of persistent low mood and decreased energy over the past four weeks. The patient reports no prior history of mood disorders or changes in medication. She attributes her symptoms to a perception of being disliked by her coworkers at her recently acquired job, despite lacking concrete evidence for this belief. The patient exhibits increased appetite and weight gain, and her husband reports that she is sleeping more than usual. Her husband mentioned that she displayed an episode of euphoria upon learning of her favorite actor's recent Academy Award nomination. Physical examination and laboratory evaluations were unremarkable, except for the patient's complaint of heaviness in her extremities. Which of the following is the most likely diagnosis?
A. Minor depressive disorder
B. Major depressive disorder
C. Adjustment disorder
D. Major depressive disorder with atypical features
E. Major depressive disorder with psychotic features
F. Persistent depressive disorder
The answer & question breakdown is at the bottom of the post.
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USMLE Times Issue #74 - CLICK HERE
USMLE Times Issue #73 - CLICK HERE
USMLE Times Issue #72 - CLICK HERE
ANSWER + QUESTION BREAKDOWN
The question presents a 25-year-old female with recent onset of low mood, decreased energy, and changes in appetite and sleep patterns. The patient's symptoms are attributed to a perceived negative perception by her coworkers, despite lack of evidence. Additionally, she experienced an episode of euphoria and heaviness in her extremities. To answer this question correctly, you should be familiar with the diagnostic criteria for various depressive disorders and their distinguishing features.
ANSWER CHOICES:
ANSWER CHOICE A: Minor depressive disorder
Minor depressive disorder is characterized by the presence of depressive symptoms that do not meet the full criteria for major depressive disorder. While the patient's symptoms are significant, the presence of atypical features and the duration of symptoms suggest a different diagnosis.
ANSWER CHOICE B: Major depressive disorder
Major depressive disorder is characterized by a persistent low mood and loss of interest or pleasure in activities, along with other symptoms such as changes in appetite, sleep, and energy levels. While the patient exhibits some of these symptoms, atypical features and the specific nature of her symptoms point toward a more specific diagnosis.
ANSWER CHOICE C: Adjustment Disorder
Adjustment disorder is characterized by the development of emotional or behavioral symptoms in response to an identifiable stressor. Although the patient's symptoms are attributed to a perceived stressor (coworkers disliking her), the presence of atypical features and the severity of her symptoms suggest a more severe depressive disorder.
ANSWER CHOICE D: Major depressive disorder with atypical features
Major depressive disorder with atypical features is characterized by the presence of depressive symptoms along with specific atypical features, such as increased appetite, hypersomnia, leaden paralysis (heaviness in extremities), and mood reactivity. The patient's presentation, including increased appetite, excessive sleep, heaviness in extremities, and mood reactivity (euphoria in response to news), strongly suggests this diagnosis.
ANSWER CHOICE E: Major depressive disorder with psychotic features
Major depressive disorder with psychotic features involves the presence of delusions or hallucinations in addition to depressive symptoms. Although the patient exhibits a perception of being disliked by coworkers, this belief does not appear to reach delusional intensity, and no hallucinations are reported.
ANSWER CHOICE F: Persistent depressive disorder
Persistent depressive disorder, also known as dysthymia, is characterized by a chronic low mood lasting for at least two years. The patient's symptoms have only been present for four weeks, which is inconsistent with this diagnosis.
THE VERDICT: The most likely diagnosis is D. Major depressive disorder with atypical features.
The patient's presentation meets the criteria for major depressive disorder, as she experiences persistent low mood, decreased energy, and changes in appetite and sleep patterns. Additionally, she exhibits several atypical features that are characteristic of this subtype of depression:
Increased appetite and weight gain
Hypersomnia (sleeping more than usual)
Leaden paralysis (sensation of heaviness in extremities)
Mood reactivity (episode of euphoria in response to positive news)
The presence of these atypical features, along with the patient's depressive symptoms, strongly supports the diagnosis of major depressive disorder with atypical features. This subtype of depression is important to recognize, as it may respond differently to treatment compared to other forms of depression.
FINAL ANSWER: D: Major depressive disorder with atypical features
That’s it for issue #75 of The USMLE Times!
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