Mood disorders: Clinical

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Mood disorders: Clinical

USMLE® Step 2 questions

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USMLE® Step 2 style questions USMLE

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A 47-year-old man is brought to the emergency department by his partner for evaluation of erratic behavior. According to the partner, the patient recently lost his job as a software developer. She states, “He’s been drinking so much, I am not sure if he has been doing other drugs too. He spends all day watching television. I recently moved out because of his behavior. I became especially worried this afternoon when I went to check on him, and he told me was going to shoot himself in the head and saw a loaded gun on the kitchen table.” The patient has been previously hospitalized for depression with suicidal ideation. He was treated with fluoxetine but stopped taking the medication several years ago. On evaluation, the patient appears linear and coherent. The patient states, “Doc, I won’t lie. I am feeling pretty hopeless right now, and there is nobody to help me, but I don’t need to be here. My wife is worried for no reason, I’m just going through a rough patch, I’m going to be fine, I promise.” The remainder of the patient’s mental status exam does not demonstrate evidence of hallucinations, delusions, or homicidal ideation. Which of the following is the most appropriate intervention given this patient’s clinical presentation?


Mood disorders are a group of illnesses that describe serious changes in the emotional status that can interfere with day-to- day activities like working, studying, eating, and sleeping. Mood disorders can precipitate a substance addiction, and in some cases can lead to suicide.

Risk factors for mood disorders include a family history and personal trauma. However, the underlying cause is poorly understood. There’s usually an imbalance of serotonin, norepinephrine, and dopamine, which are neurotransmitters that help regulate mood, reward-motivated behavior, appetite, and sleep

Each of these neurotransmitters is thought to have an impact on specific symptoms, like norepinephrine on anxiety or attention, serotonin on obsessions and compulsions, and dopamine on attention, motivation, and pleasure.

Now, depression has also been associated with hyperactivity of the hypothalamicpituitaryadrenal or HPA axis, leading to increased cortisol levels, as well as decreased hippocampal and frontal lobe volumes, decreased sleep latency and slow-wave sleep.

Mood disorders can be seen as a spectrum. At one end of the spectrum we have depressive disorders which include major depressive disorder; substance or medication-induced depressive disorder, depressive disorder due to another medical condition, adjustment disorder with depressed mood, premenstrual dysphoric disorder and persistent depressive disorder (previously known as dysthymia).


Mood disorders are a group of mental health conditions characterized by persistent changes in a person's mood, which can include feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. These conditions can have a significant impact on a person's daily life and can interfere with their ability to work, maintain relationships, and engage in enjoyable activities.

There are several types of mood disorders, including major depressive disorder, persistent depressive disorder, and bipolar disorder. Treatment for mood disorders usually involves a combination of medications and psychotherapy.


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