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Depression and the Influence of life stress
Mental status exam:
Past Psychiatric history: Patient has never been diagnosed or treated for a psychiatric illness
Inflence of Life Stress on Depression: Moderation by a Polymorphism in the 5-HTT gene
This guys seemed perfectly normal, but he was depressed
Medical History: 1.5 week history of rectal bleeding. History of recurrent hemorrhoids.
- HGB: 8.5
- Candidate gene on 5-HTT transporter
- Maybe Serotonin system plays a direct role on how we handle stress
- Rats, Monkey.........Humans
- Humans with one or two copies of the gene in question had greater amygdala neuronal activity under stress
The Study
Family history: Non-contributory
- 847 subjects separated into 3 Groups
Group 1: Homozygotes for the gene in question
Group 2: Heterozygous
Group 3: Ain't got no gene
Result: Having the gene + Stress = Depression
Substance abuse history: None, Drinks socially
CC: “Came to the ER because I overdosed on pills”
Treatment:
1. SSRI's: Lexapro
2. Family Counseling
3. Treat the patient's anemia
HPI: A 44 year old african american male was Baker acted after he took an overdose of ibprofen, baclofen, and percocet. Patient states he has had marital problems in for the past several months and that his wife's current infidelity lead to this suicide attempt.
S I G E C A P S
Anxiety
Differential Diagnosis
1a. Major Depressive Disorder
1b. Adjustment Disorder
3. Generalized Anxiety Disorder
4. Major Depressive Disorder secondary to other medical condition
5. Major Depressive Disorder secondary to Substance dependence/abuse
6. Paranoid Personality Disorder
7. Dependent Personality Disorder