Part 2 book “Pathophysiology flash cards” has contents: Endocrine system, reproductive system and urologic disorders, immune system, hematologic disorders, oncologic disorders, musculoskeletal, integumentary, and connective tissue disorders. | A 46-year-old male presents to his primary care physician with a complaint of trouble sleeping. He states that he lies in bed for up to 3 hours before falling asleep but does not have problems staying asleep. Further questioning reveals that the patient lost his job 5 months ago and his family has been relying on his wife’s part-time income. He states that he has been feeling depressed for the past several months, as he has not been able to find another source of employment to support his family. He feels it is hopeless to continue to find a job, and now spends most of his time now on the couch watching TV. He has no interest in activities he used to enjoy. He reports a decreased appetite but denies weight loss, problems concentrating, substance abuse, or suicidal ideations. His only past medical history includes stage I hypertension well controlled with hydrochlorothiazide. Physical examination reveals an appropriately dressed male with a restricted affect and linear thought process. Major Depressive Disorder This patient has major depressive disorder. Although there are often several criteria for many diagnoses in psychiatry, it is important to first commit to memory the time requirements and number of symptoms. For major depressive disorder, five symptoms must be present, one of which must be either depressed mood or anhedonia (lack of Interest), for a minimum of 2 weeks. The rest of the nine possible symptoms are Sleep disturbance, feelings of worthlessness or inappropriate Guilt, lack of Energy, diminished Concentration, change in Appetite or weight, Psychomotor agitation or retardation, and Suicidal ideations. A useful mnemonic is SIG E CAPS. The vignette does not describe any history of manic episodes that could indicate bipolar disorder. If the patient had not met at least five criteria, a diagnosis of adjustment disorder could be considered as his symptoms were precipitated by a major life stressor that was initiated within 3 months of the stressor .
