**Question:** A 72 yr. old male lost 10kgs since last 3 months. He had profuse guilt for the mistakes he has done in life and doesn't sleep more than 4 hrs. per day. The probable diagnosis is

A. Anorexia nervosa
B. Depression
C. Anxiety disorder
D. Cancer

**Correct Answer:** .

**Core Concept:** Depression is a mental health condition characterized by persistent feelings of sadness, loss of interest or pleasure in activities, and significant impact on daily functioning. In this scenario, the patient is experiencing weight loss, insomnia, and emotional distress, which aligns with the clinical features of depression.

**Why the Correct Answer is Right:** The patient's significant weight loss and insomnia are symptoms commonly associated with depression. Furthermore, the patient's excessive guilt and inability to sleep more than 4 hours a day indicate severe emotional distress. Depression can present with various symptoms, and in this case, the patient's emotional state aligns with the diagnostic criteria for major depressive disorder.

**Why Each Wrong Option is Incorrect:**

A. **Anorexia nervosa:** This condition is characterized by an intense fear of gaining weight or obesity, excessive dieting, and avoidance of food, resulting in unintended weight loss. In this case, the patient's excessive guilt is not a core feature of anorexia nervosa, and the weight loss is attributed to depression.

B. **Anxiety disorder:** While anxiety can cause insomnia, it typically does not result in significant weight loss. Additionally, anxiety disorders usually present with excessive worry, fear, or panic attacks, which are not prominent in this patient's symptoms.

C. **Anxiety disorder:** Similar to option B, anxiety disorders typically do not lead to significant weight loss. The patient's weight loss and insomnia are more consistent with depression.

D. **Cancer:** While cancer may cause weight loss, it is unlikely to be the sole cause of the patient's symptoms without evidence of a physical mass, pain, or other cancer-related signs and symptoms.

**Clinical Pearl:** It is essential to consider mental health disorders, such as depression, in patients presenting with significant weight loss and altered sleep patterns, particularly when there are no apparent physical findings. Depression can lead to various somatic symptoms, including weight loss and insomnia, without apparent physical signs.