A 29-year-old woman comes to the office due to depression. Since breaking up with her boyfriend last month, she has been extremely sad and has difficulty getting out of bed. She describes sleeping 16 hours a day, increased appetite, a 4.5-kg (10-lb) weight gain, low energy, decreased concentration, and loss of interest in socializing with her friends and family. The patient had 2 similar episodes at age 23 and 27. She also describes brief periods in the past, lasting several days, when she was uncharacteristically confident and optimistic, successfully juggled 3 part-time jobs, and felt well rested and energetic despite sleeping only 3-4 hours a night. The patient drinks a glass of wine several times a week but does not use tobacco or illicit drugs. Which of the following is the most likely diagnosis?

Question

A 29-year-old woman comes to the office due to depression.  Since breaking up with her boyfriend last month, she has been extremely sad and has difficulty getting out of bed.  She describes sleeping 16 hours a day, increased appetite, a 4.5-kg (10-lb) weight gain, low energy, decreased concentration, and loss of interest in socializing with her friends and family.  The patient had 2 similar episodes at age 23 and 27.  She also describes brief periods in the past, lasting several days, when she was uncharacteristically confident and optimistic, successfully juggled 3 part-time jobs, and felt well rested and energetic despite sleeping only 3-4 hours a night.  The patient drinks a glass of wine several times a week but does not use tobacco or illicit drugs.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

11ec160b_3608_cb0b_9249_21726dcac489_MD0001_00 This patient's current major depressive episode (≥2 weeks, depressed mood, low energy, hypersomnia, increased appetite, decreased concentration, loss of interest) and history suggestive of a hypomanic episode (increased activity, energy and confidence, decreased need for sleep) are consistent with a diagnosis of bipolar II disorder. Patients with bipolar II disorder have a history of hypomanic (not manic) episodes and one or more major depressive episodes. Hypomania is differentiated from mania by a lesser degree of severity and functional impairment and the absence of psychosis. As in this patient, those experiencing hypomania exhibit a noticeable change in behavior but are often very productive despite requiring less sleep. In contrast to manic patients, those who are hypomanic are often able to work and are rarely hospitalized. (Choice A) Adjustment disorders develop in response to an identifiable stressor but are not diagnosed if the patient has sufficient symptoms to meet the criteria for another disorder. (Choice B) Bipolar I disorder is diagnosed in patients who experience manic episodes (severe symptoms causing marked impairment, possible psychotic features). Major depressive episodes are common but not required for diagnosis. (Choice D) Patients diagnosed with cyclothymic disorder experience at least 2 years of numerous periods of hypomanic and depressive symptoms that do not meet the criteria for hypomanic or major depressive episodes. (Choice E) This patient's history of a distinct change in behavior (elevated mood, excess energy, hyperactivity, decreased need for sleep, inflated self-esteem) is consistent with hypomania, ruling out unipolar major depressive disorder. Educational objective: Patients who experience major depressive and hypomanic episodes are diagnosed with bipolar II disorder. In contrast to manic episodes, hypomanic episodes are less severe, do not involve psychosis, and cause a lesser degree of functional impairment. __________ References: Bipolar disorder diagnosis: challenges and future directions. (http://www.ncbi.nlm.nih.gov/pubmed/23663952)

A 29-Year-Old Woman Comes to the Office Due to Depression