Depression clinical presentation

True Cushing s syndrome also must be distinguished from other conditions that share some clinical presentations (as well as elevated plasma cortisol concentrations), such as depression, alcoholism, obesity, and chronic illness—the so-called pseudo-Cushing s states. 

The differential diagnosis of depression is organized along both symptomatic and causative lines. Symptomatically, major depression is differentiated from other disorders by its clinical presentation or its long-term history. This is, of course, the primary means of distinguishing psychiatric disorders in DSM-1V. The symptomatic differential of major depression includes other mood disorders such as dysthymic disorder and bipolar disorder, other disorders that frequently manifest depressed mood including schizoaffective disorder, schizophrenia, dementia, adjustment disorder, and post-traumatic stress disorder, and, finally, other nonpsychiatric conditions that resemble depression such as bereavement and medical illnesses like cancer or AIDS. 

Phases of Bipolar Illness. The depressive phase of bipolar illness is virtually indistinguishable from unipolar MDD and the diagnostic criteria for a major depressive episode (refer to Table 3.2) are used to diagnose bipolar depression as well. The clinical presentation of bipolar depression often resembles atypical depression, which is characterized by severe fatigue and oversleeping. 

It is still debated whether patients with two previous episodes should receive maintenance treatment. Overall, maintenance treatment has been recommended for adult depressed patients with two episodes who have one or more of the following criteria (Depression Guideline Panel, 1993) (1) a family history of bipolar disorder or recurrent depression, (2) early onset of the first depressive episode (before age 20), and (3) both episodes were severe or life threatening and occurred during the past 3 years. Given that depression in youth has similar clinical presentation, sequelae, and natural course as in adults, these guidelines should probably be applied for youth with two previous major depressive episodes. 

Atypical (Nonclassic Depression). Another subtype has been termed atypical MDD to denote that the clinical presentation is different from that of the classic form, as follows ... 

In 1997, a large epidemiological study found that 11.3% of individuals with lifetime major depression had only episodes meeting atypical criteria ( 11). These patients (especially male patients) may also be at greater risk for sedative-hypnotic abuse. If the clinician is cognizant of these probabilities, preventive steps can be taken (e g., education about sedative-hypnotics). The identification of the nonclassic forms, as well as their differences in clinical presentation, has substantial implications for their differential treatment (see Chapter 7). 

Bipolar disorder (manic-depressive illness) represents one of the most dramatic presentations in all of medicine and simultaneously poses one of the more difficult therapeutic challenges. It is characterized by mania or hypomania, alternating irregularly or intermingling with episodes of depression however, a small group (approximately 1%) may only experience recurrent manic episodes (i.e., unipolar mania). The estimated risk of developing a bipolar disorder is 0.5% to 1%, and the incidence of new cases per year is in the range of 0.01 % for men and 0.01 % to 0.03% for women (1). Bipolar spectrum can be conceived of as a continuum of more to less severe clinical presentations ... 

Zinc deficiency is clinically characterized by the development of a moist eczematous dermatitis most apparent in the nasolabial folds and around orifices. Other presenting signs and symptoms may include hypogeusia (blunted sense of taste), alopecia, diarrhea, rash (which may vary from papular, scaly lesions to weeping, open erosions), apathy, and depression. Clinical zinc deficiency occurs most frequently in the setting of abnormal losses, such as in Crohn s disease, malabsorption states, and fistula losses, or from prolonged inadequate intake, such as with zinc-free parenteral nutrition. 

Humans were not untouched by this disaster. Visits to community clinics for primary care and mental health services in the affected area increased dramatically after the spill (Impact Assessments, 1990). Exposure to the incident was shown to have a profound impact on the prevalence of psychiatric disorders with increased rates of generalized anxiety disorder, posttraumatic stress disorder, and depressive symptoms present in the population (Palinkas, Petterson, Russell, Downs, 1993). 

Muscarinic hyperstimulation leads to a clinical presentation of miosis, lacrimation, salivation, bradyarrhythmias, urinary incontinence, and intestinal hypermotility (Levy-Khademi et al, 2007). Nicotinic hyperstimulation leads to fasciculations, weakness, and paralysis of skeletal muscles. CNS effects include depression and agitation with coma and... 

The sCJDMMl/sCJDMVl subtype displays either MM or MV at PrP codon 129 and type 1 PrP It is the most common subtype and accounts for 60-70% of all sporadic human prion disease. This sCJD subtype has a mean age at clinical onset of 65 years of age and the mean duration of clinical symptoms prior to death is approximately four months. The symptoms at clinical presentation can include cognitive impairment, widened gait or ataxia, behavioral signs (including depression, anxiety. 

Developing an animal model of bipolar disorder is challenging, due to the dramatically different clinical presentations of mania and depression. Animal models of depression are described above, and can be considered to model the depres-... 

Infectious diseases are common and result in significant morbidity and mortality in patients with ESKD. Although multiple abnormalities in host defenses and an increased susceptibility to infection have been described, the causal link between these observations remains speculative. Absolute lymphopenia and impaired cell-mediated immunity are common in ESKD patients and may be caused by uremic toxins or protein-calorie malnutrition. Although plasma concentrations of IgG, IgM, and IgA are usually normal, antibody responses appear to be significantly depressed. Patients requiring dialysis have many problems with vascular access which puts them at higher risk for exposure to infectious sources. The risk of infections in patients with CKD, and particularly ESKD, is an important consideration when reviewing the clinical presentation of a patient, as hospitalization rates for infection and sepsis have increased dramatically in the last 10 years. ... 

Bipolar mixed episode (previously known as mixed state, dysphoric mania, or depressive mania) is defined as the simultaneous occurrence of manic and depressive symptoms. Mixed mood states occur in up to 40% of all episodes, and are more common in younger and older patients and in females. Mixed episodes are often difficult to diagnose and treat because of the fluctuating clinical presentation. Patients with mixed states often have comorbid alcohol and substance abuse, severe anxiety symptoms, a higher suicide rate, and a poorer... 

Patients with lung cancer frequently have numerous concurrent medical problems. Such problems may be related to invasion of the primary tumor and its metastases, paraneoplastic syndromes (see clinical presentation, above), chemotherapy and radiotherapy toxicity, or concomitant disease states (e.g., cardiac disease, renal dysfunction, chronic obstructive pulmonary disease, asthma, or diabetes). Depression is also common and sometimes persistent in patients with SCLC and NSCLC and should be treated. Identification, diagnosis, and treatment of the patient as a whole may improve the patient s overall quality of life and tolerance to cancer treatments. 

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