Psychosocial Disorders Answers 543period: loss of interest in usual activities, depressed or irritable mood, changes
in weight or appetite, insomnia or hypersomnia, psychomotor agitation or
retardation, loss of energy, difficulty concentrating, recurrent thoughts of death,
and suicidal ideation. This particular patient has three of these symptoms,
including excessive sleeping patterns, difficulty concentrating, and a decreased
appetite. The danger is that the patient’s feelings may be so intensely painful
that suicide may be seen as the only way to cope. Some patients may also
complain of generalized physical pain, without any clear medical diagnosis
able to be made. The cardinal symptom of depression is a sad or dysphoric
mood.
Hypothyroidism (a)and Cushing syndrome (e)may also be exhibited in
patients that appear to be depressed. A simple thyroid stimulating hormone
and cortisol level may be drawn to differentiate a medical etiology for these
symptoms. Hyperthyroidism also presents as generalized sluggishness, dif-
ficulty concentrating, constipation, cold intolerance, hair loss of the distal
one-third of both eyebrows, dysphagia, and myalgias. Fingerstick glucose
should also be performed to evaluate for diabetes mellitus (c), which may
present as sluggishness, paresthesias, and general malaise. It is also impor-
tant to keep in mind traumatic causes to this patient’s symptoms, given that
he lives alone without witnesses to report a fall that may result in a subdural
hematoma(d).Intracerebral bleeding may present with sluggishness, espe-
cially in subdurals where there is a relatively slower bleed of the bridging
veins.
493.The answer is c.(Rosen, pp 1549-1583.) Steroid psychosisis
described as a constellation of psychiatric symptoms within the first 5 days
of treatment with a corticosteroid. Studies indicate that the amount needed
to produce this effect is greater than 40 mg of prednisone, or its equivalent,
prescribed daily. Symptoms include emotional lability, anxiety, distractibility,
pressured speech, sensory flooding, insomnia, depression, agitation, auditory
and visual hallucinations, intermittent memory impairment, mutism, distur-
bances of body image, and delusions and hypomania. It is important to note
that previous history of psychologic difficulties does not predict the devel-
opment of steroid psychosis. Symptoms can be very severe and should be
taken into account when prescribing this medication to patients. Three percent
of patients with steroid psychosis commit suicide.
The most common side effect of β-blockers(a)is a depressed mood,
owing to its sympatholytic effects; however, these are generally mild and do
not require treatment. Oral contraceptives (b), although hormonal in nature,