Depressed mood

Rationale

Symptoms of depression and/or mood dysregulation are common. Depressed mood can lead to significant social, functional and physical impairment or death.

Causal conditions

(list not exhaustive)

1. Major depressive disorder
2. Bipolar disorder (type I, type II)
3. Persistent depressive disorder (dysthymia)
4. Cyclothymic disorder
5. Normal grief
6. Substance-induced mood disorder
7. Mood disorder secondary to a general medical condition
8. Adjustment disorder

Key Objectives

Given a patient with depressed mood, the candidate will diagnose the cause, severity and complications, and will initiate an appropriate management plan. The candidate should pay particular attention to assessment of suicide risk and the potential need for urgent care.

Enabling Objectives

Given a patient suspected of depressed mood, the candidate will

1. list and interpret critical clinical findings, including
   1. results of an appropriate history, physical examination and assessment of the patient’s mental state;
   2. a differential diagnosis based upon differentiation of clinical syndromes presenting with mood dysregulation;
   3. specific risk factors that warrant immediate intervention (e.g., suicide ideation);
2. list and interpret appropriate investigations, including appropriate laboratory investigations (e.g., toxicology screen, thyroid stimulating hormone);
3. construct an initial management plan including
   1. an assessment of safety (e.g., suicide risk, risk of harm to others);
   2. counselling of patient and family regarding psychosocial issues and prevention of further impairment;
   3. initiation of appropriate pharmacotherapy, if indicated;
   4. appropriate involvement of family and supportive resources;
   5. determination as to whether a referral for specialized care or support services is required.