Differentials

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

Clinical examination using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria establishes differentiating symptoms and signs.

Elevated mood, decreased need for sleep, inflated self-esteem or grandiosity, increased goal-directed activities, racing thoughts, pressured speech, and reckless pleasurable behaviour are all characteristics of hypomanic or manic episodes of a bipolar illness. A child, particularly an adolescent, who presents with a history or concurrent manic or hypomanic symptoms needs to be assessed carefully to exclude the possibility of a bipolar illness.

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No differentiating test.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

Clinical examination using the DSM-5 criteria establishes differentiating symptoms and signs. Dysphoria associated with anxiety will dissipate in the absence of an anxiogenic situation.

Anxiety disorders that meet diagnostic criteria will usually precede depressive symptoms. Anxiety disorders do not occur exclusively during a mood disorder; rather, symptoms of anxiety are present even in the absence of mood symptoms.

However, anxiety disorders are highly comorbid with depressive disorders, and assessment and management of both disorders will improve outcome.

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No differentiating test.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

Clinical examination using the DSM-5 criteria establishes differentiating symptoms and signs. Mood changes due to ADHD can be either due to a side effect of stimulants, or demoralisation as a result of difficulties in school, with family, or with peers.

ADHD is diagnosed when full diagnostic criteria are met prior to age 7 years. In patients with ADHD only, poor concentration is a chronic symptom that precedes depressive symptoms. ADHD, however, is highly comorbid with depressive disorders, and assessment and management of both disorders will improve outcome.

INVESTIGATIONS

No differentiating test.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

Clinical examination using the DSM-5 criteria helps to establish differentiating symptoms and signs.

Substance abuse may precede depressive symptoms or occur as a consequence of depression.

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Urine drug screen confirms concomitant use of substance.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

A stressor always precedes the depressive symptoms.

In addition, the depressive symptoms should not meet full DSM-5 criteria for major depressive disorder.

INVESTIGATIONS

No differentiating test.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

A recent loss of a loved one always precedes the depressive symptoms.

INVESTIGATIONS

No differentiating test.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

A recent exposure to a traumatic event, by experiencing, witnessing, or confronting, which causes intense fear, helplessness, or horror.

In addition, a child has dissociative symptoms, re-experiencing of the trauma, avoidance behaviour, and increased anxiety or arousal.

INVESTIGATIONS

No differentiating test.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

Exposure to a traumatic event, by experiencing, witnessing, or confronting, which causes intense fear, helplessness, or horror for at least 1 month after the event.

In addition, the child has dissociative symptoms, re-experiencing of the trauma, avoidance behaviour, and increased anxiety or arousal.

INVESTIGATIONS

No differentiating test.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

Clinical examination using the DSM-5 criteria helps to establish differentiating symptoms and signs.

Irritability and defiance without other symptoms of depression, although epidemiological studies show that oppositional defiant disorder is a risk factor for eventual development of depression.

Behavioural problems are more chronic and present without concurrent mood symptoms.

INVESTIGATIONS

No differentiating test.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Clinical examination using the DSM-5 criteria helps to establish differentiating symptoms and signs. Difficult to assess depressive status unless nutritional and weight deficiencies are restored.

Additional symptoms, such as body image distortions and fear of gaining weight, occur without mood symptoms.

However, eating disorders and depression can be comorbid.

INVESTIGATIONS

No differentiating test.

SIGNS / SYMPTOMS
INVESTIGATIONS
SIGNS / SYMPTOMS

Clinical examination using the DSM-5 criteria helps to establish differentiating symptoms and signs.

Additional symptoms, such as body image distortions and over-eating, occur without mood symptoms.

However, eating disorders and depression can be comorbid.

INVESTIGATIONS

No differentiating test.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

Hypothyroidism may be associated with weight gain and constipation. On examination there may be dry, coarse skin, goitre, bradycardia, facial puffiness, slow return of deep tendon reflexes, or tongue thickening.

Hyperthyroidism may be associated with weight loss, increased appetite, sweating, and nervousness. On examination there may be goitre, rapid return of deep tendon reflexes, or tremor.

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In primary hypothyroidism, thyroid-stimulating hormone (TSH) is elevated and free thyroxine (T4) is low.

In central hypothyroidism, TSH is inappropriately low or normal for the free T4 level, and free T4 is low.

In hyperthyroidism, TSH is suppressed and serum free T4 and/or T3 are elevated.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

May be associated with a history of poor nutrition, pallor, and prominent fatigue.

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Full blood count reveals low haemoglobin.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

History of initial symptoms of fever, fatigue, malaise, pharyngitis, and cervical or generalised lymphadenopathy.

INVESTIGATIONS

Positive agglutination test (e.g., monospot) showing heterophile antibodies.

Serological test demonstrating Epstein-Barr virus-specific antibodies.

Full blood count with differential may demonstrate lymphocytosis, atypical lymphocytosis, anaemia, and reticulocytosis.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

May be associated with a history of poor nutrition, pallor, and prominent fatigue.

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Full blood count may reveal anaemia.

Blood levels of vitamins may be low. However, tests would only usually be performed if vitamin deficiency were considered a likely cause of symptoms.

Further specific tests of vitamin deficiency may be used to confirm deficiency.

SIGNS / SYMPTOMS
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SIGNS / SYMPTOMS

History of recurrent and chronic focal seizures.

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Electroencephalogram reveals spikes or sharp waves in the temporal lobe area. This would only usually be performed if temporal lobe epilepsy were considered a likely cause of symptoms.

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