Causes of depression

Many cause fatigue and depression. Depression associated with beta-blockers, reserpine, and methyldopa

Epilepsy increases depression risk, but some anticonvulsants are associated with additionally increased risk

In infected, medically ill patients, cytokine-driven sickness behavior, psychological reaction, delirium, and medication side effects must be differentiated

Some studies suggest link with depression, but well-designed large studies are lacking. Associated with progestins

Headache, Nuchal rigitity, Fever, Nausea, Vomiting, Altered LOC, Focal deficits, Seizures. more

Undulant fever - a bacterial zoonosis transmitted to humans from infected animals: septic arthritis, neurologic involvement. more

Fever, night sweats, weight loss, fatigue, loss of appetite, cough and hemoptysis. more

Prior history of infection with stupor, coma or nuchal rigidity. Excessive sleeping afterwards. Irritability and anger. Limited attention span. Typical depressive thought content not marked. more

Tropheryma whippelii infection. Rare disease that commonly starts with GI complaints, but because of multisystem involvement, presentation can be quite variable. May go undected for years. Pt may present with sx other than GI. more

• Systemic sx
• Wt loss, diarrhea, occult blood loss, jt pain, non specific abdo or chest pain, fever, glossitis and abdo fullness
• CNS sx
• Fewer than 10-15% of patients with Whipple disease eventually develop clinically significant CNS involvement. A review of patients with CNS-WD showed that by the time of CNS disease onset they often report previous systemic problems
• Fewer than 100 cases of patients with confirmed CNS-WD have been reported.
• Almost 50% of these patients had a concomitant psychiatric illness (eg, depression, hypomania, anxiety, psychosis; mostly with delusional content, or change in personality).
• Two thirds of patients with altered mentation (almost 50% of all patients with CNS-WD) had dementia.

• Hypothalamus-related problems (eg, polydipsia, hyperphagia, decreased libido, amenorrhea, change in sleep-wake cycle with insomnia
• myoclonus, opthalmoplegia, seizures

Sudden onset of persistent motor or sensory dysfunction. more

• "Based on pooled data, the overall prevalence [post-stroke] of major depression was 21.7% and minor depression was 19.5%." Post stroke depression: a review

Physical and cognitive impairment with a step-wise progression. hypertension is frequent. more

• In a study by Cummings et al, while 17% patients with DAT had depressive symptoms, 60% of patients with MID had depressive symptoms. more

Basically any disorder that causes Hypoxemia. causes of hypoxemia

a) Environmental O2 insuff; high altitude sickness
b) Pulmonary disease -> poor oxygenation of blood;

1. Pneumonia
2. Asthma
3. Chronic Obstructive Lung Disease
4. Pneumothorax
5. Pulmonary Embolism

1. MI
2. Cardiomyopathy
3. CHF

Symptoms include anorexia, weight loss, myalgia; rheumatoid nodules and small joint deformities, and pain; vasculitis, pericarditis; pleural effusions, pulmonary fibrosis; spinal cord compression, peripheral neuropathy; neuropsychiatric disorders.more

90% are women, more common in Asians and blacks. Photosensitivity, discoid or malar rash, oral ulcers; fatigue, weight loss, fevers; arthralgias and arthritis; pleuritis, pericarditis; renal disease; anemia, leucopenia. more

Widespread pain (typically in all four body quadrants) for at least 3 months and tenderness at 11+ of 18 specific sites on the body. more

Aching and morning stiffness in shoulders, hip girdle, and neck, typically in patients over 50. Also fever, malaise, fatigue, weight loss.more

Classic celiac disease present with signs and symptoms of malabsorption, including diarrhea, steatorrhea, iron-deficiency anemia, and weight loss or growth failure

Nonclassic celiac disease, patients may present with nonspecific gastrointestinal symptoms without signs of malabsorption, or with extraintestinal manifestations (without gastrointestinal symptoms). patients mainly presenting with unexplained iron-deficiency anemia.

Asymptomatic celiac disease - Many patients, especially those diagnosed during screening, report no symptoms even on detailed questioning, and despite the presence of characteristic intestinal lesions. A gluten-free diet often leads to improvement in the quality of life, even in patients who considered themselves asymptomatic at the time of diagnosis. more, symptoms

Morning stifness, oral and genital ulcers. Skin rashes, Joint pain, Neurologic changes. more

• "Some of the psychiatric Behçet patients have relatively acute onset symptoms and can be evaluated within the scope of organic confusional disorder."


• "Additionally, many Behçet patients present with chronic psychiatric problems in the absence or presence of accompanying neurological symptoms. Anxiety and depression are frequently encountered in these patients and might occasionally precede the onset of the disease."

9/10 women, middle aged. Most common [93-98% pts at presentation] - dry eyes or dry mouth. more, case report

other associations - GI symptoms, renal conditions, lymphadenopathy, arthritis, bronchitis, vasculitis, fever, fatigue

• In a cross-sectional study of primary Sjogren patients - "33.8% patients had anxiety, and 36.9% had depression" link

Can affect all organ systems. Asymptomatic initially in many patients - often diagnosed as Hilar Adenopathy on CXR. Pulmonary presentation [45%] with cough, dyspnea and non-specfic chest pain. Constutional presentation [25%] with fever, wt loss, fatigue and malaise. more

Psych manifestations reported in 5-20% patients. Case reports of neurosarcoidosis preseting as pseudodementia, depresssion, non-specific somatic c/o

Includes suspected SLE, Systemic Sclerosis, Poly/Dermatomyositis/Sjorgens/Mixed connective tissue disease. Consider referral if multiple of the following symptoms:

• Joint pain - pattern is distinctive; upper and lower extremeties tend to be symmetrically affected; Distal > Proximal; Thoracic and Lumbar spine are usually spared. Morning stiffness is usually present, but not specific. Swan-neck and ulnar subluxation are not disease-specific changes, although they are often considered rheumatoid deformities. SLE or Scleroderma pts may have joint complaints at all.
• Skin changes - Malar rash,discoid lesions, photosensitivity, alopecia, mucous membrane ulcers, skin thickening, telangiectasia, and purpura or ulcers from vasculitis may be present. If the answer to both the following questions is negative, the presence of Raynaud's phenomenon is unlikely. "Do you have any circulation problems?" -> "Do your fingers turn white or blue in the cold?"
• Chest discomfort - Serositis or esophageal dysmotility with reflux may cause chest discomfort. Defining symptom of pleurisy is a sudden sharp, stabbing, burning or dull pain in the right or left side of the chest during breathing, especially when one inhales and exhales. Pericarditis typically presents with acute onset severe, sharp retrosternal chest pain, often radiating to the neck, shoulders, or back. Positional changes are characteristic with worsening of the pain in the supine position and with inspiration; and improvement with sitting upright and leaning forward. Esophageal disease initially presents with heartburn and later dysphagia.
• Other sx
  • Anaemia, Thrombocytopenia, lymphopenia
  • Foamy urine may indicate protienuria; hematuria
  • Dry eyes / dry mouth
• Work-up
  • CBC, ESR, CRP, Creat, LFT
  • Urine R/M
  • CXR if possible polymyositis/or Respiratory system involvement
  • ANA, Complements, CK [for polymyositis] - in consultation with experts

Acute or subacute mood/behavioral changes, short-term memory problems, complex-partial seizures, cognitive dysfunction. Also hyperthermia, somnolence, and endocrine abnormalities. Most common associated malignancies - lung (small cell carcinoma; SCC), testicular, breast, ovarian, thymoma, Hodgkin lymphoma. Or there may be no malignancy [i.e. non-neoplastic]. more, cases

Common with certain anticonvulsants (e.g. valproic acid), elderly, alcoholics, eating disorders, malnourished. Symptoms include cognitive dysfunction. Signs - megaloblastic anemia. more

Megaloblastic anemia, myelopathy (subacute combined degeneration), dementia, delirium, peripheral neuropathy. Occurs in pernicious anemia, chronic peptic ulcer disease, after gastrectomy or gastric bypass, alcohol dependence, irritable bowel disorder, eating disorders, malnourished. more

Peripheral neuropathy, seizures, migraines, chronic pain, depression, psychosis. Elevated homocysteine. Many drugs act as antagonists of B6. more

Scurvy: petechiae, ecchymoses, bleeding gums, follicular hyperkeratosis, hemolytic anemia, fatigue, joint effusion, poor wound healing. more

Pellagra: pigmented rash of sun-exposed areas, bright red tongue, diarrhea, apathy, memory loss, disorientation. more

Weakness, fatigue, somnolence, cold intolerance, weight gain, constipation, hair loss, hoarseness, stiffness, muscle aches, bradycardia, facial puffiness, slowed speech. more

Symptoms include nervousness, anxiety, irritability, sweating, fatigue, heat intolerance, weight loss, muscle weakness. Signs include arrhythmias, e.g. atrial fibrillation, myxedema, proptosis. more

Increased thirst, frequent urination. Complications include cardiovascular disease, retinopathy, nephropathy, peripheral and autonomic neuropathy. more

Anorexia, thirst, frequent urination, lethargy, fatigue, muscle weakness, joint pain, constipation. Mild: personality changes, lack of spontaneity, lack of initiative. Moderate: dysphoria, anhedonia, apathy, anxiety, irritability, poor concentration. Severe: confusion, disorientation, agitation, psychosis, lethargy, coma. more

Paresthesias, muscle cramps, carpopedal spasm, rarely facial grimacing, severe - tetany and seizures. more

Anemia, anorexia, nausea, vomiting, diarrhea, abdominal pain, weight loss, muscle weakness. In Addison's disease, increased ACTH causes hyperpigmentation, especially in sun-exposed skin, scars, mucous membranes. Postural hypotension due to low mineralocorticoids; hypoglycemia when stressed or fasting; hyponatremia, hyperkalemia. more

Truncal obesity and striae, diabetes, hypertension, hyperglycemia, muscle weakness, osteopenia, skin atrophy and bruising, increased susceptibility to infections, gonadal dysfunction. Due to use of corticosteroids, excessive ACTH secretion (if by a pituitary tumor, called Cushing's disease), and adrenal tumors. more

Mood symptoms present during the week prior to menses, resolving within a few days after menses starts. Might be accompanied by breast tenderness, muscle aches, abdominal bloating, and weight gain. more

Typical onset is at 51 years. Symptoms include hot flashes, night sweats, palpitations, dizziness, fatigue, headaches, joint pains. more

Amenorrhea or oligomenorrhea, infrequent or absent ovulation, increased levels of testosterone, infertility, truncal obesity or weight gain, alopecia, hirsutism, acanthosis nigricans, hypertension, insulin resistance. more

Increase in rate and depth of breathing for a few minutes leading to dizziness or syncope due to respiratory alkalosis. Also might have carpopedal spasm, myoclonic jerks, paresthesias. more

Multi-system dysfunction, lethargy, altered mental status, seizures. more

Stages 0 [minimial hepatic enceph] and Stage 1 are likely to mimic depression. Beyond that astrexis is obvious. more 1, more 2.

Mild Disease (insidious onset) - Day-night reversal, Somnolence, Confusion, Personality change, Asterixis (Flapping Tremor)

Severe Disease - Stupor, Coma, Dementia, Extrapyramidal signs, Fetor hepaticus (Odor of breath from mercaptans)

• Stage 0. MHE (previously known as subclinical HE). Symptoms relate to disturbances in sleep, memory, attention, concentration and other areas of cognition. A classic sign of HE is a sleep disturbance. Asterixis is absent.


• Stage 1. Trivial lack of awareness. Shortened attention span. Impaired addition or subtraction. Hypersomnia, insomnia, or inversion of sleep pattern. Euphoria, depression, or irritability. Mild confusion. Slowing of ability to perform mental tasks. Asterixis can be detected.


• Stage 2. Lethargy or apathy. Minimal disorientation. Inappropriate behavior. Slurred speech. Obvious asterixis. Drowsiness, lethargy, gross deficits in ability to perform mental tasks, obvious personality changes, inappropriate behavior, and intermittent disorientation, usually regarding time.


• Stage 3. Somnolent but can be aroused, unable to perform mental tasks, gross disorientation about time and place, marked confusion, amnesia, occasional fits of rage, present but incomprehensible speech.


• Stage 4. Coma with or without response to painful stimuli. However, the terms that limit each stage of the classification are not clearly defined, and the metric characteristics of the stage are unknown. It is for this reason that other scales such as the Clinical Hepatic Encephalopathy Staging Scale (CHESS) have been proposed.16 The presence or absence of the nine items on the CHESS score may be helpful in eliminating interobserver variability and in making a distinction between the various grades of encephalopathy. This staging scale, however, requires further validation.

Higher risks for dementia in dialysis patients. Need regular dementia work-up. Might have higher risk for vascular dementia, but also associated with uremia. Aluminum toxicity now less common. more, Dialysis disequilibrium syndrome

Abdominal pain, peripheral neuropathy, and mental disturbances. Seizures, autonomic instability, dehydration, electrolyte disturbances, dermatologic changes also may occur. Physical symptoms occur in attacks, but psychological ones may persist. more, more detailed

Onset in childhood and adolescence, but can occur as late as fifth decade. Symptoms include personality and behavioral disturbances, dementia, EPS, dysarthria, liver cirrhosis. Almost all have Kayser-Fleischer rings. more

Multiple episodes; acute onset involving muscle weakness, monocular blindness, vertigo, bladder dysfunction, and incoordination. more

Tremor, bradykinesia, gait disorder, and rigidity. more

Younger age of onset (e.g. 53) than Alzheimer's disease, with prominent lability, distractibility, decrease in insight, and personality changes. more, criteria

Choreoform movements, ocular dysfunction, dementia, and frequent depression with 10% psychosis. more

Uneven cognitive decline, language and visual specific dysfunction. more

Mild extrapyramidal symptoms, sudden changes in cognition, visual hallucinations, rapid eye movement sleep disorder. more

Cognitive decline associated with signs of cortical injury, e.g. aphasia, apraxia, etc. more

Acute global disturbance of cortical functioning that causes fluctuating level of attention, consciousness, cognition, and perception. more

More salient apathy, slowed mentation, and gait dysfunction. more

Supranuclear gaze palsy, especially in vertical direction, truncal rigidity, akinesia, postural instability, early falls, dysarthria, dysphagia; subcortical dementia; pseudobulbar affect. more

Combination of upper motor (weakness, hyperreflexia, spasticity) and lower motor neuron (atrophy, fasciculations) signs. Presents with asymmetric limb weakness (80%) or bulbar disorders of dysphagia or dysarthria (20%). Might be accompanied by pseudobulbar affect, cognitive impairment, autonomic symptoms, parkinsonism, supranuclear gaze paresis, sensory loss. more

Traumatic brain injury associated with headaches, cognitive dysfunction, dizziness, and neuropsychiatric symptoms. more

• "Twenty-two percent of the sample reported minor depression, and 26% reported major depression at 1-year post-TBI." [n=1570] link


• Amongst hospitalized patients with TBI, depression rate at 1 year was 53%. [n=599] link


• Higher depression scale score at 1 week, older age and abonormal CT scan predicts depression at 3-months in Mild TBI patients. link

History of trauma: unilateral headache and pupillary enlargement, and stupor, coma, and hemiparesis if large. more

• case report 1
• case report 2
• case report 3

Headaches-classic "early morning" nausea/vomiting, seizures, syncope, neurologic deficits. more, causes of SOL

Cough, hemoptysis, chest pain, dyspnea, hoarseness. Associated with smoking. more

Abdominal pain and weight loss out of proportion to the degree of psychological symptoms. Anorexia, early satiety, back pain in more progressive disease. Diabetes might also be present. more

Acute or subacute mood/behavioral changes, short-term memory problems, complex-partial seizures, cognitive dysfunction. Also hyperthermia, somnolence, and endocrine abnormalities. Most common associated malignancies - lung (small cell carcinoma; SCC), testicular, breast, ovarian, thymoma, Hodgkin lymphoma. Or there may be no malignancy [i.e. non-neoplastic]. more, cases

Classic triad (Positive Predictive Value: 65%) Dementia (Wacky), Gait instability (Wobbly), Urinary Incontinence (Wet). more

• case report 1
• case report 2
• case report 3


• "Symptoms of depression are overrepresented in INPH patients compared with the population, despite treatment with a shunt. Screening for depression should be done in the evaluation of INPH patients in order to find and treat a coexisting depression." link

Motor (simple or complex) and vocal tics (sounds or actual words). Starts in childhood. more

Depressed mood for two weeks or more, and a loss of interest or pleasure in everyday activities, accompanied by other symptoms such as feelings of emptiness, hopelessness, anxiety, worthlessness, guilt and/or irritability, changes in appetite, problems concentrating, remembering details or making decisions, and thoughts of or attempts at suicide. more

At least 2 years of depressed mood; may co-exist with MDD. more

Affective lability, depression and/or anxiety as well as neurovegetative symptoms present in the majority of menstrual cycles in the final week before the onset of menses, improving within a few days after the onset of menses, and resolved within a week after menses. more

Emotional response to a stressful event, such as onset of illness, divorce, financial problems. Symptoms start within 3 months of the stressor and remit within 6 months of stressor removal. more

Presence of one or more somatic symptoms that are distressing or result in significant disruption of daily life with excessive thoughts, feelings, or behaviors related to these somatic symptoms. more

Excessive and uncontrollable worry about a number of anxiety-provoking events. more

Characterized by psychotic symptoms as well as presence of manic or depressed episode; psychotic symptoms must exist outside the mood symptoms for at least 2 weeks. more

Dominated by psychotic symptoms of hallucinations, delusions, disorganized thought process, speech, behavior, negative symptoms. Onset typically teens to early 20s in males and late 20s in females. more

In Bipolar I, there must be at least one manic episode. In Bipolar II, there must be presence of hypomanic AND depressive episodes. more, Unipolar v/s bipolar depression

Attenuated bipolar disorder, frequently starts before age 21; frequent short cycles of subsyndromal depression and hypomania, not meeting criteria for bipolar disorder. more

Extreme agitation, delirium, confusion, sleeplessness, hallucinations, delusions with onset usually 3-14 days postpartum. Increased risk for suicide and infanticide

Trauma-associated flashbacks, nightmares, avoidance, hyper-vigilance, and sleep disturbance. more

Poor concentration, attention and memory, difficulties with task completion. more

Occurs in response to a significant loss, such as death of loved one. In addition to depressed mood, also have sympathetic arousal and restlessness. Criteria for Major Depressive Episode not met. more