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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{TS}}
|QuestionAuthor= {{TS}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Behavioral Science/Psychiatry
|MainCategory=Behavioral Science/Psychiatry
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|MainCategory=Behavioral Science/Psychiatry
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=Neurology
|SubCategory=Neurology
|MainCategory=Behavioral Science/Psychiatry
|MainCategory=Behavioral Science/Psychiatry
|MainCategory=Behavioral Science/Psychiatry
|MainCategory=Behavioral Science/Psychiatry
|MainCategory=Behavioral Science/Psychiatry
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|MainCategory=Behavioral Science/Psychiatry
|MainCategory=Behavioral Science/Psychiatry
|SubCategory=Neurology
|SubCategory=Neurology
|Prompt=26 year old female presents with fatigue from few months which started after her husband passed away in a car crash. She complains that she is not getting enough sleep as she wakes up early in the morning and finds it difficult to sleep again.  She quit her job because she was finding it difficult to concentrate at work. She no longer feels like visiting her friends which she used to enjoy before her husband’s death and spends her entire day in the house.  Her appetite has reduced and she has lost few pounds in the past few months.  Which of the following is the most common sleep pattern found in this patient?  
|Prompt=A 26-year-old woman presents to her primary care physician for fatigue that started shortly after her husband passed away. She complains of having difficulties sleeping, waking up very early in the morning and not being able to fall asleep again.  She also reports difficulties concentrating, a general lack of interest in her old hobbies, and a constant desire to be alone. The patient reports losing 12 pounds in the past few months.  Which of the following is the most common sleep pattern expected in this patient?
|Explanation=This is a case of major depressive disorder. Diagnosis of major depressive disorder is made if at least 5 of the following symptoms are present for at least 2 weeks, depressed mood or lack of pleasure should at least be one of the 5 symptoms.<br>  
|Explanation=The patient in this vignette has classical symptoms of major depressive disorder. Sleep disturbances are very common in cases of depression. It is estimated that 90% of patients with depression complain about problems with sleep quality. Sleep pattern changes in depression include early morning awakenings, decreased REM latency, increased total REM duration, and decreased slow wave sleep. Sleep disturbances often affect disease prognosis and patient outcomes after treatment (i.e. patients with sleep disturbances have recurrent depression and may not respond to cognitive-behavioral therapy). By treating major depression, the sleep disturbances slowly improve; however, temporary administration of hypnotics may be helpful. Remember that the diagnosis of major depressive disorder is made if at least 5 of the following symptoms are present for 2 weeks or more, depressed mood or lack of pleasure should at least be one of the 5 symptoms.<br>
S- Sleep disturbance (lack or excess of sleep)<br>  
'''S''' - Sleep disturbance (lack or excess of sleep)<br>  
I- Loss of interest in previously enjoyable activities<br>  
'''I''' - Loss of interest in previously enjoyable activities<br>  
G- Feeling of excess guilt<br>
'''G''' - Feeling of excess guilt<br>
E- Loss of energy<br>  
'''E''' - Loss of energy<br>  
C- Inability to concentrate<br>
'''C''' - Inability to concentrate<br>
A- Appetite change (could be increased or decreased<br>
'''A''' - Appetite change (could be increased or decreased<br>
P- Psycho-motor agitation<br>
'''P''' - Psycho-motor agitation<br>
S- Suicidal tendency<br>  
'''S''' - Suicidal tendency<br>  


Sleep disturbance is very common in cases of depression.  Sleep pattern changes in depression  include:<br>
Early morning awakenings<br>
Decreased REM Latency<br>
Increased total REM<br>
REM is increased early in the sleep cycle.<br>
Decreased slow wave sleep


|AnswerA=↑  Total REM, ↑ Slow wave sleep
|AnswerA=↑  Total REM, ↑ Slow wave sleep
|AnswerAExp=Slow wave sleep is decreased in depression.  
|AnswerAExp=Slow wave sleep is decreased in depression.
|AnswerB=↓  Total REM, ↓ Slow wave sleep  
|AnswerB=↓  Total REM, ↓ Slow wave sleep
|AnswerBExp=Total REM is increased in depression  
|AnswerBExp=Total REM is increased in depression
|AnswerC=↑ Total REM,  ↓ Slow wave sleep  
|AnswerC=↑ Total REM,  ↓ Slow wave sleep
|AnswerCExp=Total REM is increased and slow wave sleep is decreased in depression  
|AnswerCExp=Total REM is increased and slow wave sleep is decreased in depression
|AnswerD=↓ Total REM,  ↑ Slow wave sleep  
|AnswerD=↓ Total REM,  ↑ Slow wave sleep
|AnswerDExp=Total REM is increased and slow wave sleep is decreased in depression  
|AnswerDExp=Total REM is increased and slow wave sleep is decreased in depression
|AnswerE=No change in sleep patterns  
|AnswerE=No change in sleep patterns
|AnswerEExp=Changes in sleep pattern is very common in cases of major depressive disorders.  
|AnswerEExp=Changes in sleep pattern is very common in cases of major depressive disorders.
|EducationalObjectives=Sleep pattern changes in depression include early morning awakenings, decreased REM latency, increased total REM duration, and decreased slow wave sleep.
|References=Nutt D, Wilson S, Paterson L. Sleep disorders as core symptoms of depression. Dialogues Clin Neurosci. 2008;10(3):329-36.
|RightAnswer=C
|RightAnswer=C
|WBRKeyword=Depression, Major depressive disorder  
|WBRKeyword=Depression, Major depressive disorder
|Approved=No
|Approved=Yes
}}
}}

Latest revision as of 02:05, 28 October 2020

 
Author [[PageAuthor::Twinkle Singh, M.B.B.S. [1] (Reviewed by Serge Korjian)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Behavioral Science/Psychiatry
Sub Category SubCategory::Neurology
Prompt [[Prompt::A 26-year-old woman presents to her primary care physician for fatigue that started shortly after her husband passed away. She complains of having difficulties sleeping, waking up very early in the morning and not being able to fall asleep again. She also reports difficulties concentrating, a general lack of interest in her old hobbies, and a constant desire to be alone. The patient reports losing 12 pounds in the past few months. Which of the following is the most common sleep pattern expected in this patient?]]
Answer A AnswerA::↑ Total REM, ↑ Slow wave sleep
Answer A Explanation AnswerAExp::Slow wave sleep is decreased in depression.
Answer B AnswerB::↓ Total REM, ↓ Slow wave sleep
Answer B Explanation AnswerBExp::Total REM is increased in depression
Answer C AnswerC::↑ Total REM, ↓ Slow wave sleep
Answer C Explanation AnswerCExp::Total REM is increased and slow wave sleep is decreased in depression
Answer D AnswerD::↓ Total REM, ↑ Slow wave sleep
Answer D Explanation AnswerDExp::Total REM is increased and slow wave sleep is decreased in depression
Answer E AnswerE::No change in sleep patterns
Answer E Explanation AnswerEExp::Changes in sleep pattern is very common in cases of major depressive disorders.
Right Answer RightAnswer::C
Explanation [[Explanation::The patient in this vignette has classical symptoms of major depressive disorder. Sleep disturbances are very common in cases of depression. It is estimated that 90% of patients with depression complain about problems with sleep quality. Sleep pattern changes in depression include early morning awakenings, decreased REM latency, increased total REM duration, and decreased slow wave sleep. Sleep disturbances often affect disease prognosis and patient outcomes after treatment (i.e. patients with sleep disturbances have recurrent depression and may not respond to cognitive-behavioral therapy). By treating major depression, the sleep disturbances slowly improve; however, temporary administration of hypnotics may be helpful. Remember that the diagnosis of major depressive disorder is made if at least 5 of the following symptoms are present for 2 weeks or more, depressed mood or lack of pleasure should at least be one of the 5 symptoms.

S - Sleep disturbance (lack or excess of sleep)
I - Loss of interest in previously enjoyable activities
G - Feeling of excess guilt
E - Loss of energy
C - Inability to concentrate
A - Appetite change (could be increased or decreased
P - Psycho-motor agitation
S - Suicidal tendency

Educational Objective: Sleep pattern changes in depression include early morning awakenings, decreased REM latency, increased total REM duration, and decreased slow wave sleep.
References: Nutt D, Wilson S, Paterson L. Sleep disorders as core symptoms of depression. Dialogues Clin Neurosci. 2008;10(3):329-36.]]

Approved Approved::Yes
Keyword WBRKeyword::Depression, WBRKeyword::Major depressive disorder
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