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Atypical Depression Vs Melancholia

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Atypical Depression Vs Melancholia

Post  Admin on Sat Jul 28, 2012 4:00 pm

Atypical Depression Vs Melancholia

Atypical Depression Melancholia
Mood Reactivity Reactive Pervasive anhedonia
Appetite Increased Decreased
Sleep Increased Decreased
Energy Leaden Paralysis Low without Leaden Paralysis
Premorbid Personality Rejection Sensitive Normal Sensitivity

Q. Young female pt
C/C: fatigue
HOPI: For past 2-3 weeks, c/o profound tiredness, increased need for sleep & increased appetite. These symptoms started after a break up with her boyfriend.
Pt's symptoms rapidly improved after she reunited with her boyfriend.

What is the diagnosis:
(a) Bipolar disorder with rapid cycling
(b) Borderline personality disorder
(c) Major depression with Atypical features.


Answer: Major depression with Atypical features

This is an important question, because "Major depression with Atypical features" is the most common subtype of depression (so more chances of questions on this topic on PRITE & related exams).

Look for following points:
(1) Mood brightens in response to actual or potential positive events (Compared to Melancholic subtype: mood doesn't brighten even in response to positive events).
(2) 2 or more of following features:
- Significant weight gain/increase in appetite
- Hypersomnia
- Leaden paralysis (heavy, leaden feelings in arms & legs)
- Long standing pattern of interpersonal rejection sensitivity that results in significant social & occupational impairment.

DSM IV Criteria for Atypical Depression:
(a) Meets criteria for major depression or dysthymia
(b) Significant mood reactivity
(c) >2 of the following:
- Hyperphagia
- Hypersominia
- Mood reactivity
- Leaden Paralysis
(d) Does not meet criteria for Melancholia or Catatonic features.

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