Defining fatigue and its patterns may help the doctor to discard the option of depression from the list of possible diagnoses. Even though the patient denies the feeling of sadness and depression, given the symptoms, it is necessary to study in more detail how she can describe her fatigue. At the level of subjective self-assessment, studies show a clear difference in all aspects of fatigue in people suffering from depression (Pedraz-Petrozzi et al., 2020). Thus, according to the patient’s personal opinion, it can be concluded whether it is worth delving further into this diagnosis. On a scale from 1 to 5, the importance of the question can be assessed by 4 due to a fairly clear description of the depression symptoms.
Based on the data obtained, it is worth considering anemia and fibromyalgia. These diagnoses may be manifested by pain in the body, fatigue, and even muscle weakness during the months preceding the appearance of noticeable swelling of the joints (Häuser et al., 2019). The patient’s symptoms, only developing the initial stage of fibromyalgia or anemia, may not be obvious at the first visit to the doctor. On a scale from 1 to 5, this question can be rated at 1 since it can significantly save time identifying the diagnosis and start timely treatment.
The issue of weight change is quite extensive and streamlined. Being one of the most common symptoms of many diseases, unexpected weight loss or gain can be assessed as changes in the nervous system, harmonic background, and even chronic diseases. It follows that on a scale from 1 to 5, this question can be safely estimated at 5 and, if necessary, asked only to confirm the final suspected diagnosis.
The question of episodes of increased activity will help the doctor consider or discard a possible bipolar disorder. Several population studies have reported that migraine and bipolar disorder have a strong and positive relationship (Jeyagurunathan et al., 2020). Also, during depressive episodes, people who have bipolar disorder are prone to increased fatigue and lack of motivation, which is also characteristic of the patient. On a scale from 1 to 5, this question can be evaluated by 2 due to similar but not obvious symptoms.
The possibility of suicide in the first place will help to determine the potentiality of depression in the patient since, in this case, this option remains the most obvious. Nevertheless, with a positive answer to the question, migraine should also be included in the list of possible diagnoses. Particular headaches and constant fatigue fit the definition of migraine and are independent predictors of suicidal thoughts and suicide attempts (Lin et al., 2019). On a scale from 1 to 5, this question can be rated at 3 since it will not exclude many other possible diagnoses but will prompt the direction of psychiatry in which it is worth continuing work.
From all of the above, the first and the most obvious diagnosis for the described syndromes is a depressive disorder. It should not be excluded even despite the patient’s claims that she does not feel depressed and sad. Another possible diagnosis is migraine and bipolar disorder, which may be less obvious behind depressive symptoms. Anemia and fibromyalgia are the least obvious but still possible options.
References
Jeyagurunathan, A., Abdin, E., Vaingankar, J. A., Chua, B. Y., Shafie, S., Chang, S. H. S.,… & Subramaniam, M. (2020). Prevalence and comorbidity of migraine headache: results from the Singapore Mental Health Study 2016. Social psychiatry and psychiatric epidemiology, 55(1), 33-43.
Häuser, W., Sarzi-Puttini, P., & Fitzcharles, M. A. (2019). Fibromyalgia syndrome: under-, over-and misdiagnosis. Clinical and Experimental Rheumatology, 37(116), 90-97.
Lin, Y. K., Liang, C. S., Lee, J. T., Lee, M. S., Chu, H. T., Tsai, C. L.,… & Yang, F. C. (2019). Association of suicide risk with headache frequency among migraine patients with and without aura. Frontiers in neurology, 10, 228.
Pedraz-Petrozzi, B., Neumann, E., & Sammer, G. (2020). Pro-inflammatory markers and fatigue in patients with depression: A case-control study. Scientific Reports, 10(1), 1-12.