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Despite negative oncologic evaluations and improved imaging, she shows severe depressive symptoms including profound hopelessness, poor intake with weight loss, minimal activity, tearfulness, and suicidal ideation with a fear that she is letting her family down. Psychiatry is requested to determine the differential and guide risk-focused, diagnostic, and treatment planning.",{"@graph":69,"@context":126},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/directors-copy-mood-disorder-clinical-vignette-1-treatment-recommendations/328849/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/directors-copy-mood-disorder-clinical-vignette-1-treatment-recommendations/328849.png","ImageObject",300,407,{"name":92,"@type":93},"Finn","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-28","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118,122],{"name":109,"@type":110,"acceptedAnswer":111},"What diagnoses are included in the differential based on the vignette?","Question",{"text":112,"@type":113},"The differential lists recurrent major depression, mood disorder due to a general medical condition, substance-induced mood disorder, adjustment disorder with depressed mood, anxiety disorder such as PTSD, and demoralization in the context of chronic medical illness.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How can major depressive disorder be differentiated from adjustment disorder and a mood disorder due to a general medical condition?",{"text":117,"@type":113},"Consider the duration of depressive symptoms (suggesting pre-hospital onset), prior history of major depression, presence of melancholic features like hopelessness and anhedonia, and whether mood improves as medical status improves. Note that acute illness can cause neurovegetative depressive symptoms, which may not clarify diagnosis on their own.",{"name":119,"@type":110,"acceptedAnswer":120},"What additional information would help clarify the differential diagnosis?",{"text":121,"@type":113},"Obtain family psychiatric history, details of prior depressive presentations and treatment responses, and history of hypomania/mania episodes, need for hospitalization, medications, or ECT. Also assess coping with past lymphoma treatment, evaluate anxiety symptoms including flashbacks or nightmares to consider PTSD, and screen for possible psychotic features such as delusional guilt or somatic delusions.",{"name":123,"@type":110,"acceptedAnswer":124},"What treatment recommendations are suggested for this patient?",{"text":125,"@type":113},"Place the patient on 1:1 observation due to suicidality and communicate this to the treatment team and nursing staff. Provide supportive psychotherapy, and consider a watch-and-wait approach.","https://schema.org",{"og:url":83,"og:type":128,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":130,"canonical":83},"index,follow",{"doc_id":132,"site_id":62},328849,1790091828,{"code":4,"msg":5,"data":135},{"doc_id":132,"user_id":136,"nickname":92,"user_avatar":137,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":138,"file_id":139,"file_url":140,"file_type":141,"file_size":142,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":143,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":144,"faqs":145,"seo_title":146,"seo_description":67,"update_tm":147,"read_time":148},34359740700684,"https://ap-avatar.wpscdn.com/avatar/1f400023980c374ae676?_k=1777273430885731487","Director’s Copy Fellow’s Name:    \nClinical Vignette 1: Mood Disorder  \nYou are asked to see a 52-year-old married woman with a history of non-Hodgkins Lymphoma 7 years ago that was treated with a combination of chemotherapy and radiation therapy. The lymphoma has been in remission since that time and she has returned to work part-time for a large bank. She was admitted to your hospital 10 days ago complaining of chest pain and shortness of breath. Evaluation revealed a right lower lobe pneumonia and she was started on IV antibiotics. At first, the pneumonia seemed to be responding to treatment but then she began spiking fevers. Blood cultures revealed gram-positive cocci and the Infectious Disease consult recommended switching the antibiotic regimen to linezolid (Zyvox) and vancomycin. Labs revealed an elevated WBC and mildly elevated LFTs. The treatment team was also concerned about a recurrence of the lymphoma and ordered several tests to evaluate her including an MRI of her chest and abdomen, a PET scan, and a bone marrow biopsy. So far all the tests have come back negative and a repeat CXR shows improvement of the pneumonia; repeat blood cultures have been negative.  \nThe team requests a psychiatry consult because even though all of the tests indicate that the patient is getting better, she hardly ever gets out of bed. The internal medicine intern reports that even when he gives her good news about her tests she starts crying. The nurses report to you that she is not eating and has lost 5 pounds in a week. She has told one of the nurses that “it would be so much easier to just be dead already.” You learn from the patient and her husband that she has been treated twice in the past for depression; once in her 20s while she was still in college, and once at age 30 for a post-partum depression after the birth of her second daughter. The husband also tells you that she “actually wasn’t doing so well before she came into the hospital.” He reports that for at least one month before she was admitted she wasn’t sleeping well and had lost about 10 pounds, she was calling in sick to work and they hadn’t socialized with any of their friends for quite awhile. He attributed this to her feeling “run down” from increased stress at work and worries about her mother’s deteriorating mental state.  \nOn interview, the patient is frequently tearful. She says she does not think she is getting better and has no hope that she will ever get out ofthe hospital. She is sure the lymphoma has returned. She feels like she is letting her whole family down. She says she has no desire to eat, and she has no desire to read or watch TV. When asked why she is not getting out of bed, she says “what’s the use?” She admits that she has had thoughts of“jumping out the window when no one is looking so I don’t have to suffer anymore.” She refuses to cooperate with a full cognitive exam but you do determine that she is fully oriented and is able to remember details about her personal history as well as what has occurred during her hospitalization.  \nQUESTIONS   \nCompetency Areas: Medical Knowledge, Patient Care  \n1. What is your differential diagnosis based on the clinical data provided in the vignette?  \n• Major depression, recurrent  \n• Mood disorder due to general medical condition  \n• Substance-induced mood disorder  \n• Adjustment disorder with depressed mood  \n• Anxiety disorder, e.g., PTSD given past history of non-Hodgkin’s Lymphoma  \n• Demoralization in the context of chronic medical illness  \nDirector’s Copy Fellow’s Name:    \nScore  \nUnacceptable: 1-3/6    \nPass: 4-5/6    \nExceptional: 6/6    \n2. How would you differentiate between major depressive disorder, adjustment disorder, and a mood disorder due to a general medical condition in this patient?  \n• Length of time patient has been depressed-history indicates that depressive symptoms may have been present prior to hospitalization  \n• Previous history of major depression  \n• Melancholic symptoms: hopele","cbCaigLoDaXHId4F","https://ap.wps.com/l/cbCaigLoDaXHId4F","pdf",31675,"English","# Differential Diagnosis\n## Major depression vs adjustment disorder vs mood disorder due to general medical condition\n## Additional Information to Clarify Diagnosis\n# Treatment Recommendations","[{\"question\":\"What diagnoses are included in the differential based on the vignette?\",\"answer\":\"The differential lists recurrent major depression, mood disorder due to a general medical condition, substance-induced mood disorder, adjustment disorder with depressed mood, anxiety disorder such as PTSD, and demoralization in the context of chronic medical illness.\"},{\"question\":\"How can major depressive disorder be differentiated from adjustment disorder and a mood disorder due to a general medical condition?\",\"answer\":\"Consider the duration of depressive symptoms (suggesting pre-hospital onset), prior history of major depression, presence of melancholic features like hopelessness and anhedonia, and whether mood improves as medical status improves. Note that acute illness can cause neurovegetative depressive symptoms, which may not clarify diagnosis on their own.\"},{\"question\":\"What additional information would help clarify the differential diagnosis?\",\"answer\":\"Obtain family psychiatric history, details of prior depressive presentations and treatment responses, and history of hypomania/mania episodes, need for hospitalization, medications, or ECT. Also assess coping with past lymphoma treatment, evaluate anxiety symptoms including flashbacks or nightmares to consider PTSD, and screen for possible psychotic features such as delusional guilt or somatic delusions.\"},{\"question\":\"What treatment recommendations are suggested for this patient?\",\"answer\":\"Place the patient on 1:1 observation due to suicidality and communicate this to the treatment team and nursing staff. Provide supportive psychotherapy, and consider a watch-and-wait approach.\"}]","Director’s Copy - Mood Disorder Clinical Vignette 1 - Treatment Recommendations | PDF",1789981350,13]