Depressed Mood

Question 1

When to add SIGECAPS into the HPI?

Answer 1

During the Characteristics (oldCarts)

Question 2

What to ask in the Characteristics (oldCarts) of Depressed mood pt?

Answer 2

SIGECAPS

Sleep Changes
Interest lost (anehedonia)
Guilt
Energy Change
Cognitive/Memory
Appetite Changes
Psychomotor
Suicide Ideation/Plans
- Hallucinations (auditory, visual) -- or ask this in the mental exam

Question 3

what to ask in “associated” symptoms of HPI for depressed mood pt

Answer 3

“SAD”

Stress
Alcohol
Drugs

can also be addressed via social hx

Question 4

For severity you can ask about mood on a 0-10 scale

Answer 4

pearl

Question 5

PMH for Depressed mood - divide it into psych and medical – give examples:

Answer 5

Psych

• Dx: psych (depression, schizo, bipolar)
• Hospital for psych issues
• Suicide attempts

Medical

• Dx (HTN, DM, etc)
• Hospitalizations
• Sx:

Question 6

Physical/Mental Exam for Psych
(it may not be necc to do a full PE, so you can focus on Mental –> note: this is more of your observation –> so you dont have to actually do anything for this with the pt –> but use it as documentation in your note:

Answer 6

ABS MATT JOI

• Appearance: thin/obese/stated age/dishelved
• Behavior: appropriate/bizzar/cooperative/good eye cont
• Speech:RRR, spontaneous, approp, increased volume
• Mood: euthymic/dysthymic/manic/appropriate
• Affect: blunted/flat/empty
• Thought: content and perception - SI/HI/AVH
• Thought: process - linear/logical/coherent
  
  • circumstantial/tangential
  • concrete/abstract

Judgment: acts appropriate with “what would you do if a fire broke out in a theatre”

Orientation: AAOx4
Insight: aware of their condition? Have plans about tx, work, finances, future

Question 7

Areas of focus for PE in a depressed mood pt

Answer 7

Neuro

• full neuro exam
• focus on head and neck more than foot sensory

Mental Status (FA CS book - page 85 made it a point to document the ABS MATT OIJ of the mental status exam!)

Question 8

Standard workups for depressed mood pt

Answer 8

CUT PM
CBC
Urine Toxicology or blood alcohol
TSH

Physical Exam
Mini Mental Exam

Question 9

DDx for depression

Answer 9

MDD
Dysthmic Dzd
Schizoaffective
Adjustment Dzd
Substance Induced Mood Dzd

Question 10

DDx for bipolar

Answer 10

Bipolar I
Bipolar II
Cyclothymic Dzd
MDD
Schizoaffective Dzd

Question 11

68 yo - 2 month h/o crying spells – excessive sleep, poor hygiene, and a 7 kg wt loss, all followoing his wife’s death (triggering event) – does not enjoy time with grandchildren (anhedonia)

Answer 11

Normal bereavement

ddx:
- adjustment dzd with depressive mood
- MDD
- shizoaffective
- depressive dzd not otherwise specified

Question 12

42 yo F – 4 week h/o excessive fatigue – insomnia, anhedonia – she constantly thinks about death – suffered 5 similar episodes in past, first in her 20’s and has made 2 prior attempts of suicide – admits to increased etoh use in past month

Dx?
Ddx?

Answer 12

MDD

Ddx

• substance induced mood dzd
• dysthymic dzd

Question 13

What to put in characteristics (oldCarts) for Bipolar?

Answer 13

DIGFAST

Question 14

DIGFAST

Answer 14

Distractability/Frustration
Irresponsible, erratic, 
Grandiosity
Flight of Ideas
Activity Increased with wt loss and Increased Libido