Match each patient's comprehensive clinical vignette to the most accurate psychiatric diagnosis.
- A 19-year-old college freshman reports feeling tearful and having difficulty sleeping for the past 2 months since moving away from home. She feels overwhelmed by classes but denies anhedonia, guilt, or suicidal ideation. She is able to attend classes and feels her mood improve significantly when visiting her family.Adjustment disorder with depressed mood
- A 28-year-old man presents with a 4-week history of severe anhedonia, hypersomnia, and feelings of worthlessness. Upon detailed screening, he reports a distinct 6-day period last year where he felt uncharacteristically energetic, slept only 3 hours a night without feeling tired, and impulsively bought a sports car he could not afford.Bipolar disorder, currently depressed
- A 45-year-old woman develops severe depressed mood, emotional lability, and profound insomnia. These symptoms began two weeks after she was prescribed high-dose oral prednisone to manage a severe systemic lupus erythematosus flare. Prior to this, she had no history of psychiatric illness.Substance/medication-induced depressive disorder
- A 35-year-old woman presents with a 6-week history of pervasive sadness, inability to enjoy her usual hobbies, early morning awakenings, a 5-kg (11-lb) weight loss, and difficulty concentrating at work. She reports feeling guilty over minor past mistakes and states her performance at work has severely declined.Major depressive disorder
Answer
The college student with homesickness has an adjustment disorder. The man with current depression and past hypomania has bipolar disorder. The woman on prednisone has a medication-induced depressive disorder. The woman with 6 weeks of pervasive anhedonia and somatic symptoms has major depressive disorder.
Correct diagnosis in depressive disorders relies on precise pattern recognition: distinguishing the sub-threshold, stressor-related presentation of adjustment disorder; identifying past hypomanic episodes that define bipolar disorder; recognizing temporal associations with offending agents like glucocorticoids; and confirming the full symptom cluster required for major depressive disorder.
Step-by-Step Solution
Key Concept
Discrimination between unipolar major depressive disorder, bipolar depression, adjustment disorder, and substance/medication-induced depressive disorder based on clinical history and timeline.