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Answer 1
  1. Major depression. The patient’s symptoms (psychomotor retardation, anhedonia, fatigue, hypersomia, and diminished ability to think and concentrate) meet DSM-IV-TR criteria for a major depressive episode.1 This case illustrates that major depression can present with symptoms similar to those of Parkinson’s disease, such as loss of facial expression and decreased voluntary activity.2 Thus, depression must always be considered in the differential diagnosis when evaluating a patient who may have mild Parkinson’s disease. This patient’s age (45 yr) makes a diagnosis of dementia or Parkinson’s disease less likely, as both rarely present prior to age 50 years. The patient’s symptoms are not suggestive of schizoaffective disorder.

     American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed., text revision. Washington (DC): The Association; 2000.

    2. Schrag A, Barone P, Brown RG, et al. Depression rating scales in Parkinson’s disease: critique and recommendations. Mov Disord 2007;22:1077-92.

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