Differential Diagnosis
Posted by recep on June 25th, 2009Differential Diagnosis
The differential diagnosis of major depression includes the many medical and psychiatric illnesses that may present as depression in later life. For example, an idiopathic primary sleep disorder, while mimicking the sleep difficulties found in depression, can result in a reactive (secondary) depressive affect owing to sleep deprivation. During the early stages of primary degenerative or multi-infarct dementia, a depressive affect may predominate. Major depression and dementia often coexist, with the usual course entailing remission of Ihe depressive symptoms but persistence or worsening of the cognitive deficit (see DEMENTIA in Ch. 90). Patients with major depression may also present wilh many symptoms of cognitive impairment (pseudodementia or reversible dementia). Pseudodementia may differ from true dementia in the rapidity of onset and the exaggeration (vs. the minimali/alion) of symptoms. Yet therapy is ihe only true test of whether the memory problems result from depression only. Some evidence suggests that actual dementia is more likely to follow the depressive episode in older palients who have major depression with cognitive impairment than in those who have major depression without cognitive impairment.
Hypochondriacal symptoms are also often associated wilh a depressive affect (sec Ch. 97). The gradual onset of the syndrome, coupled with ihe patient’s lack of apparent distress, helps confirm the diagnosis of hypochondriasis. Patients with certain physical illnesses (eg. hypothyroidism and occult malignancy, especially pancreatic carcinoma) frequently present with depressive symptoms. Depression secondary to pharmacologic treatment of hypertension is also often encountered.
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