A 60-year-old woman with newly diagnosed pancreatic cancer requests psychiatric consultation for persistent low mood, anhedonia, and 'a feeling of complete hopelessness about the future.' She scores 18 on PHQ-9. Which feature in this oncology consultation setting is most important to distinguish Major Depressive Disorder from understandable grief/sadness?
- A Guilt, worthlessness, and suicidal ideation beyond the illness context ✓
- B Presence of hopelessness
- C Anhedonia
- D Sleep disturbance
Explanation
In medically ill patients, distinguishing MDD from illness-related sadness is guided by the presence of 'psychological' rather than 'somatic' DSM criteria. Guilt, worthlessness, and suicidal ideation that extend beyond the illness context (e.g., 'I am fundamentally a bad person' or active suicidal planning) are strong indicators of clinical MDD requiring treatment. Hopelessness, anhedonia, and sleep disturbance are confounded by the illness itself. The 'inclusive' approach counts all symptoms regardless of aetiology, while the 'exclusive' approach deducts somatic symptoms; most CL psychiatry protocols use an inclusive approach. A PHQ-9 >10 in the oncology setting meets criteria for intervention.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.