A patient complaints of sadness of mood, increased letharg, early morning awakening, loss of interest and repos no will to live and hears voices asking her to kill self. What is the diagnosis?
The symptoms of depression are there plus adding psychotic symptoms of hallucinations make it a diagnosis of MDD PLUS PSYCHOSIS. SymptomsOF DEPRESSION -(SIGECAPSS) S- Sadness of mood/ depressed mood (persistent & pervasive) I- Loss of interest / pleasure (Anhedonia) G- Guilt/ Feeling of wohlessness . E- Energy (loss)/ Fatigue C- Concentration loss, cognition (negative thoughts) A- Appetite (loss/ gain) with significant weight changes (>5% change in 1 month) P- Psychomotor Agitation/ Retardation S- Suicidal thoughts Note:Suicidal thoughts are fuher classified into 3: Death wishes (patient feels death should come to me ) - GRADE 1 Suicidal wish (patient says I wish I could commit suicide ) - GRADE 2 Suicidal intent (patient says I would be killing myself ) - GRADE 3 S - Sleep abnormalities (decreased/ increased) Early morning insomnia ( getting up >2 hrs earlier than the usual waking time ) Reduced latency of REM sleep Sleep is usually decreased but it might be increased also. Criteria for defining depression ( according to DSM - 5 ) : From the above 9 symptoms 5 must be present & at least 1 must be present out of first 2 for at least 2 weeks duration.
Schizophrenia
Major depressive disorder plus psychosis
Schizoaffective disorder
Schizotypal personality disorder
NEET Jan 2020