A 42-year-old woman with major depressive disorder presents with early morning waking, marked psychomotor retardation, loss of appetite with 6 kg weight loss, and excessive guilt. She reports her mood is uniformly low and does not improve even when good news arrives. Which specifier best describes this clinical picture?
- A With melancholic features ✓
- B With atypical features
- C With catatonic features
- D With anxious distress
Correct answer: A. With melancholic features
Explanation
Melancholic features include loss of pleasure or lack of reactivity to usually pleasurable stimuli, plus three of: distinct quality of depressed mood, depression worse in the morning, early morning waking, marked psychomotor retardation, significant anorexia or weight loss, and excessive guilt. Atypical features involve mood reactivity with hypersomnia, hyperphagia, leaden paralysis, and rejection sensitivity. Catatonia involves motor signs. Anxious distress is a separate specifier.
Reference: Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 11th ed.
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