40-year-old (male) with MDD-related sleep disorder

by Mohammad Hajighasemi-Ossareh, MD

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    00:03 A 40 year old male with a past medical history of major depression presents to the clinic interested in joining a research study on depression-related sleep disturbances.

    00:14 He has had two episodes of major depression within the last two years, one occuring during the summer and then the other occuring during the winter of the other year.

    00:25 He has been noncompliant with medications and has a strong desire to treat his condition with non-pharmacological methods.

    00:34 He would like to be enrolled into this study that utilizes polysomnography to record sleep-wave patterns.

    00:42 Which of the following findings is likely associated with this patient's psychiatric condition? Answer choice (A) - increased total REM sleep (B)- increased slow wave sleep (C) - late morning awakenings (D) - increased REM sleep latency and (E) - associated with a seasonal pattern Take a moment to come to your own conclusion.

    01:09 Now let's go through the question characteristics here.

    01:12 We got a patient - he's got major depression.

    01:15 This classically falls under behavioral science/psychiatry Now this is a 2-step question.

    01:21 Meaning we have to 1- come to a conclusion and then go one step deeper to come to the correct answer choice.

    01:28 And in this case, we need to use the stem to know our answer.

    01:33 We can't just read the last sentence and know what we want.

    01:36 We have to rely on components of the clinical vignette.

    01:40 Now let's walk through the answer choices here.

    01:42 Now step one, what we need to do is determine the relationship between the patient's underlying psychiatric condition and sleep.

    01:52 Okay, so this patient has major depression disorder, which is actually typically associated with either excess sleep, which is called hypersomnia or lack of sleep which is called insomnia.

    02:05 Now it's interesting, medications for major depressive disorder are actually known to cause sleep disturbances.

    02:14 Now there is no specific information in the clinical vignette that is reported regarding sleep disturbances, so we have to then make our own differential which includes sleep disturbances related to major depressive disorder, and sleep disorders related to major depressive disorder medications.

    02:38 Now this makes it a little bit easier because this patient was noted to be noncompliant with major depressive disorder medication which really narrows down our differential down to sleep disturbances related to major depressive disorder itself.

    02:53 Now step two here, we need to determine what sleep phase is most likely associated with major depressive disorder sleep disturbances.

    03:04 And we'll look at our answer choices.

    03:06 Now, what we know is that in patients that have major depressive disorder, they have increased total REM sleep, and that's the correct answer, answer choice (A) - increased total REM sleep.

    03:21 Now let's go through some high-yield facts that we learned from this question.

    03:25 Let's talk about major depressive disorder.

    03:27 Now, major depressive disorder is a psychiatric condition characterised by recurrent depressive episodes lasting at least 2 weeks each.

    03:37 During which the patient experiences, either severe depressive mood or anhedonia.

    03:44 Now, the diagnostic criteria for major depressive disorder is described in DSM-IV-TR, and it states that at least one of the two symptoms of depressive mood or anhedonia must be present for the diagnosis of major depressive disorder.

    04:03 Now, major depressive disorder affects over 200 million people globally, and is nealry twice as common in women than in men.

    04:13 Now major depressive disorder sleep disturbances are typically very early awakenings with the inability to fall back asleep - insomnia, or excessive sleepiness - hypersomnia Now, treatment of major depressive disorder is generally a combination of both psychotherapy and medication, but it really depends case to case per patient.

    04:38 Now let's talk about the phases of sleep, also another high-yield topic.

    04:43 There are 5 phases of sleep.

    04:45 The first four phases are non-rapid eye phases, which are called NREM and the fifth phase is called REM, or the rapid eye movement phase.

    04:56 The phases actually are pretty simple to understand.

    04:59 They progress cyclically from NREM1 all the way through REM, and then they begin back at NREM1.

    05:07 and each cycle lasts roughly about 90 to 120 minutes.

    05:11 Now, the phases are characterized as follows: NREM1 is light sleep, NREM2 is light sleep, NREM3 is deep sleep, NREM4 is deep sleep, and then you have REM.

    05:25 Now during REM, brain waves actually mimic activity during the waking state with your eyes closed but your eyes will actually move rapidly from side to side.

    About the Lecture

    The lecture 40-year-old (male) with MDD-related sleep disorder by Mohammad Hajighasemi-Ossareh, MD is from the course Qbank Walkthrough USMLE Step 1 Tutorials.

    Author of lecture 40-year-old (male) with MDD-related sleep disorder

     Mohammad Hajighasemi-Ossareh, MD

    Mohammad Hajighasemi-Ossareh, MD

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