TY - CHAP M1 - Book, Section TI - Assessment of Depression in Patients with Medical Illnesses A1 - Wolfe, David A1 - Erb, Jane A1 - Biswas, Jhilam A2 - Barsky, Arthur J. A2 - Silbersweig, David A. A2 - Boland, Robert J. PY - 2016 T2 - Depression in Medical Illness AB - Like most medical complaints, a depressed mood in and of itself represents a symptom, and not a diagnosis. Indeed, depression is a relatively nonspecific complaint, that could reflect anything from the most debilitating psychiatric illness to a normal response to stress or loss (Fig. 3-1). The differential diagnosis for depression among psychiatric disorders alone is broad, requiring a thorough history, examination, and often laboratory tests to discern the underlying etiology (or at least exclude potential confounders). The assessment of mood disorders in the medically ill poses yet several additional challenges, especially since many core, neurovegetative symptoms of depression – such as fatigue, anergia, insomnia, anorexia, weight loss, and pain – often result directly from medical illnesses, themselves. Among patients with severe medical disease, assessment can be confounded by “sickness behavior,” a state of decreased motivation resulting from systemic inflammation, and characterized by malaise, anorexia, insomnia, fatigue, as well as fever.1 Similarly, delirium, especially the hypoactive subtype, can present with prominent mood symptoms, making patients appear dysphoric. Adding to the complexity in assessment, many commonly used treatments, such as steroids or interferon-α, can also lower mood as a side effect. Proper diagnosis remains critical, as the recommended treatment approaches do vary widely, depending on the etiology. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/11/07 UR - neurology.mhmedical.com/content.aspx?aid=1138124349 ER -