A 45-year-old woman with end-stage renal disease on haemodialysis reports persistent low mood, fatigue, poor concentration, and loss of interest for the past 6 weeks. She attributes all symptoms to her kidney disease. In this consultation-liaison context, which symptom is MOST specific for a comorbid depressive disorder (rather than uraemic/medical symptoms)?
- A Persistent hopelessness, worthlessness, and suicidal ideation ✓
- B Fatigue and sleep disturbance
- C Anorexia and weight loss
- D Poor concentration and memory
Explanation
In consultation-liaison psychiatry, many neurovegetative symptoms of depression (fatigue, poor appetite, sleep disturbance, difficulty concentrating) overlap with the direct effects of medical illness (uraemia, anaemia). The inclusive approach (Endicott substitution criteria) identifies psychological and cognitive symptoms more specific to depression: persistent hopelessness, worthlessness, guilt, anhedonia, and suicidal ideation are least attributable to physical illness and most indicative of comorbid depressive disorder. These symptoms should prompt active psychiatric treatment, as untreated depression worsens adherence and outcomes in CKD.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.