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Discussion Starter · #1 ·
A 25-year-old moderately obese woman with a history of bipolar disorder diagnosed at age 19 complains to her physician that her recent struggles with her weight and eating have caused her to feel depressed. She states that she has recently had increased difficulty sleeping, has felt excessively anxious and agitated, and has had increasing thoughts of suicide. She often finds herself fidgety and unable to sit still for extended periods of time. Her family tells her that she is increasingly irritable. She has never previously attempted suicide. Her current medications include lithium carbonate and zolpidem as needed for sleep. Which of the following is more consistent with a diagnosis of major depressive disorder than bipolar depression in this patient during this episode?

A. Early onset of bipolar disorder
B. Increased appetite
C. Insomnia
D. Increased thoughts of suicide
E. Psychomotor agitation
 

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Discussion Starter · #3 ·
It's the psychomotor agitation

The correct answer is E. Major depressive disorder is a syndrome that requires a depressed mood or loss of interest or pleasure and causes clinically significant distress or impairment in occupational, social, or other important areas of functioning. The diagnosis of bipolar depression requires that the patient have also had a manic episode of bipolar disorder. Bipolar depression is associated with less psychomotor agitation compared to unipolar depression (major depressive disorder), and thus the patient's agitation is more consistent with a major depressive disorder diagnosis than
with the depression of bipolar disorder.

Early onset of bipolar disorder (choice A) is a risk factor for the development of bipolar, rather than unipolar depression in later life.

Increased appetite (choice B) is more a symptom of the depression of bipolar disorder than major depressive disorder, as one of the criteria for major depressive disorder is loss of appetite or anorexia.

Insomnia (choice C) is found more often in bipolar depression than major depressive disorder.

Increased thoughts of suicide (choice D) is incorrect because bipolar depression carries a greater risk of suicide than major depressive disorder.
 
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