WBR0926

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
Linked Question	Linked::
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