All of the following symptoms present in a patient since last 2 weeks are indicative of Major Depressive Diso… - ESIC Nursing Officer-7July 2024

ESIC Nursing Officer-7July 2024

Mental Health Nursing

Easy

Appeared in: ESIC Nursing Officer-7July 2024

Explanation

Catatonic behavior is the correct answer because it is not a core diagnostic criterion for Major Depressive Disorder (MDD).
According to the DSM-5, catatonia is a 'specifier' that can be added to a diagnosis of MDD (e.g., 'MDD with catatonic features') but is not one of the nine primary symptoms required to make the initial diagnosis.
The presence of catatonia indicates a specific subtype of depression and has important implications for treatment, but a person can have MDD without any catatonic features.

Option A: This is incorrect because 'Depressed mood' is one of the two cardinal symptoms of MDD. Its presence is a fundamental requirement for the diagnosis.
Option B: This is incorrect because 'Markedly diminished interest or pleasure' (anhedonia) is the second cardinal symptom of MDD. At least one of the two cardinal symptoms must be present for diagnosis.
Option D: This is incorrect because 'Fatigue or loss of energy' is one of the nine core diagnostic symptoms for MDD listed in the DSM-5.

Visual 1: Table - A clear table listing the nine core symptoms of Major Depressive Disorder (MDD) based on DSM-5 criteria. This helps in memorizing the essential diagnostic features.
Visual 2: Infographic - An infographic that visually separates the core symptoms of MDD from the various specifiers (like 'with catatonic features', 'with anxious distress', 'with melancholic features'). This clarifies the distinction between diagnostic criteria and subtypes.

Clinical Relevance

Nursing practice connection: Use the key finding related to Diagnostic criteria for Major Depressive Disorder (MDD) as per DSM-5 to guide bedside assessment, documentation, and the next nursing action.
Accurately identifying core symptoms versus specifiers is crucial for correct diagnosis and effective treatment planning. While all patients with MDD are treated for depression, the presence of a specifier like catatonia requires specific interventions, such as benzodiazepines or electroconvulsive therapy (ECT), which are not standard for all depressive episodes.
Nurses play a key role in observing and documenting patient behavior. Recognizing signs of catatonia (e.g., immobility, mutism, waxy flexibility) in a patient with depression is a critical assessment finding that must be reported to the psychiatric team immediately.
What if? If a patient presented with depressed mood, fatigue, and three other core symptoms, but also exhibited extreme psychomotor slowing to the point of stupor (a catatonic feature), the diagnosis would be 'MDD with catatonic features'. This changes the immediate treatment priority to addressing the catatonia, which can have serious medical complications.

How to Approach the Question

First, identify the core subject of the question, which is the symptomatology of Major Depressive Disorder (MDD).
Note the keyword 'EXCEPT'. This means you are looking for the option that is NOT a standard symptom of MDD.
Mentally review or recall the core diagnostic criteria for MDD. A helpful mnemonic is 'SIGECAPS': Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidality.
Evaluate each option against these criteria.
Option A (Depressed mood), B (Diminished interest), and D (Fatigue/loss of energy) are all core symptoms of MDD.
Option C (Catatonic behaviour) is not part of the primary list of nine symptoms. It is a known 'specifier' but not a core criterion. Therefore, it is the exception.

Concept Tested & Keywords

Concept Tested: Diagnostic criteria for Major Depressive Disorder (MDD) as per DSM-5.
Stem keywords: Major Depressive Disorder, symptoms, last 2 weeks
Lead-in keywords: EXCEPT
Negative lead-in flag: Question asks for the exception

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