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Fibromyalgia
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Major depressive disorder
Osteoarthritis
Polymyalgia rheumatica
Rheumatoid arthritis
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This patient who presents with a 1-year history of low energy, loss of concentration, guilt, loss of appetite, and psychomotor pain most likely has major depressive disorder. Major depressive disorder is characterized by at least 5 of the following 9 symptoms for at least 2 weeks: sleep disturbance, loss of interest or anhedonia, guilt or feelings of worthlessness, loss of energy, loss of concentration, appetite or weight changes, psychomotor retardation or agitation, suicidal ideation, and depressed mood. Importantly, patients may present initially with subjective reports of pain that are not correlated with major anatomical structures or known pain syndromes. This pain represents a physical manifestation of psychological suffering. Oon-Arom et al. studied subjective pain symptoms in patients with major depressive disorder. They found that a large majority of Asian patients with depression also report at least one subjective pain symptom. Incorrect Answers: Answer 1: Fibromyalgia can also present with widespread muscle pain and tenderness associated with changes in sleep and mood; however, these patients classically have tender points that cause reproducible localized pain. Answer 3: Osteoarthritis can also present with debilitating pain; however this pain is usually localized to specific joints and occurs most commonly with activity and at the end of the day rather than in the morning. Answer 4: Polymyalgia rheumatica can also present with muscle pain and stiffness in the neck, shoulders, or pelvis in the morning; however, this disease classically is exacerbated with overhead activities. Patients may also have low-grade fevers and restrictions in range of motion. Answer 5: Rheumatoid arthritis can also present with diffuse joint pain that is worst in the morning; however, this disease does not typically cause other mood symptoms such as changes in appetite, concentration, and energy. Bullet Summary: Major depressive disorder can present with subjective symptoms of pain that are not correlated with anatomical structures.
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