RT Book, Section A1 Wolfe, David A1 Erb, Jane A1 Biswas, Jhilam A2 Barsky, Arthur J. A2 Silbersweig, David A. A2 Boland, Robert J. SR Print(0) ID 1138124349 T1 Assessment of Depression in Patients with Medical Illnesses T2 Depression in Medical Illness YR 2016 FD 2016 PB McGraw-Hill Education PP New York, NY SN 9780071819084 LK neurology.mhmedical.com/content.aspx?aid=1138124349 RD 2024/03/28 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.