Question
25-year-old woman is brought to the physician by her father because of irritability, mood swings, and difficulty sleeping over the past 10 days. A few days ago, she quit her job and spent all of her savings on supplies for a “genius business plan.” She has been energetic despite sleeping only 1–2 hours each night. She was diagnosed with major depressive disorder 2 years ago. Mental status examination shows pressured speech, a labile affect, and flight of ideas. Throughout the examination, she repeatedly states “I feel great, I don’t need to be here.” Urine toxicology screening is negative. Which of the following is the most likely diagnosis?
| A. |
Depression with atypical features
|
| B. |
Bipolar type 1
|
| C. |
Schizoaffective disorder
|
| D. |
ADHD
|
Show Answer
|
Correct Answer � B
Explanation
|
|
Bipolar type 1
Depression with atypical features
Depression with atypical features is characterized by depressive episodes accompanied by mood reactivity, hyperphagia, hypersomnia, and/or interpersonal rejection sensitivity. This patient has experienced significant functional impairment as part of a manic episode without atypical features, making a different diagnosis more likely.
Bipolar disorder type I
Bipolar disorder type I is a mood disorder characterized by the occurrence of one or more manic episodes with or without depressive episodes. In order to diagnose bipolar disorder type 1, these manic episodes must last for at least 7 consecutive days, and patients must have at least 3 of the DIG FAST changes (distractibility, impulsive behavior, grandiosity, flight of ideas, activity increase, sleep deficit, and talkativeness). These changes cannot be attributable to an organic psychic disorder or psychotropic substances.
Schizoaffective disorder
Schizoaffective disorder is characterized by psychosis (e.g., hallucinations, delusions) that is intermittently accompanied by a major mood disorder (e.g., manic or depressive symptoms). To diagnose the condition, the psychotic symptoms must be more dominant than the mood symptoms, and psychosis must have been present for at least 2 weeks in the absence of any mood disturbance. This patient does not have any signs of psychosis, making a different diagnosis more likely.
Attention-deficit hyperactivity disorder
ADHD is characterized by impulsivity, hyperactivity, and inattention that results in impairment of social skills and occupational or academic performance. Symptoms usually first appear before the age of 12 and must be present for at least 6 months in order for the condition to be diagnosed. Symptoms must occur in more than one setting (e.g., at school and at home). This patient has experienced significant functional impairment as part of a manic episode for the past 10 days and has a history of depression, making a different diagnosis more likely.
