A 41 -year-old woman presented with a history of aches and pains all over the body and generalized weakness for four years. She cannot sleep because of the illness and has lost her appetite as well. She has lack of interest in work and doesn't like to meet friends and relatives. She denies feelings of sadness. Her most likely diagnosis is
Depression:- Clinical features:- The symptoms of depression can be remembered using the pneumonic, SIGECAPS. These symptoms must last for more than two weeks, for the diagnosis of depression. A) Sleep disturbances: Usually insomnia is seen however hypersomnia can also be a symptom. The two characteristic sleep disturbances in depression are "early morning awakening" and "reduced latency of REM sleep". B) Interest (loss): Patient looses interest in the activities which used to interest him earlier (anhedonia). C) Guilt: Patient may have excessive guilt feelings and may blame himself for tril matters. D) Energy (lack): Patient may have decreased energy levels and easy fatigability. E) Cognition/Concentration: Patient may have negative cognitions (negative thoughts) and may have poor concentration. F) Appetite: Usually the appetite and weight are lost, in some patients weight gain may be seen. G) Psychomotor agitation or retardation: The term 'psychomotor' refers to the changes in motor activity secondary to psychological causes. It may be increased (e.g. in restless patients) or may be decreased (e.g. a patient who keeps on lying on the bed and rarely gets up). H) Suicidal thoughts and sadness of mood (depressed mood). Out of the above symptoms, SWAG (suicidality, weight loss, anhedonia and guilt feelings) are quite suggestive of depression. Ref:- Psychiatry by Sandeep Govil; pg num:-118,119
Somatoform pain disorder
Major depression
Somatization disorder
Dissociative disorder
Mood disorders