WBR0040

Author	PageAuthor::Gonzalo Romero
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Behavioral Science/Psychiatry
Sub Category	SubCategory::Neurology, SubCategory::General Principles
Prompt	[[Prompt::A 47 year old male comes to the outpatient clinic for follow up with his Primary Care doctor after being concerned about his current state of mind. He started developing extreme tiredness level 3 weeks ago after his dog passed away, which he considered his "best buddy" for 15 years. He never got married and has had a girlfriend for 5 years. He mentions that he is not interested in swimming which is something that he really enjoys to do every other day, has had trouble going to sleep at night and wakes up extremely early (2 hours earlier) being unable to go back to sleep. He runs a company department; his boss and clients have complained that he does not pay attention or seem to lack concentration at work. Sometimes he has had thoughts of worthlessness. He cries inconsolably when the doctor asks about the dog and says “I just can’t stop seeing my dog everywhere I go, I have thought and planned about terminating my life”. He denies taking any medication or taking any illegal substances. On Physical exam vitals are stable, looks sad, not well dressed and has a flat affect. What is the most likely diagnosis?]]
Answer A	AnswerA::Normal Grief
Answer A Explanation	[[AnswerAExp::Incorrect. Normal Grief is incorrect because this patient is experiencing severe symptoms after his dog’s death. The treatment includes psychotherapy, medication is not needed.]]
Answer B	AnswerB::Major depression
Answer B Explanation	[[AnswerBExp::Correct. Major depression or unipolar disorder lasts for at least 2 weeks and they are severe. They include anhedonia, lack of motivation, intense sadness, sleep changes, feeling of worthlessness, weight or appetite changes, psychomotor retardation, delusions or hallucinations. The treatment includes psychotherapy and antidepressants (usually SSRIs). [1]]]
Answer C	AnswerC::Bipolar disorder
Answer C Explanation	[[AnswerCExp::Incorrect. Bipolar disorder or Manic-depression: include symptoms of major depression in addition to manic episodes (elevated persistent mood, grandiose thoughts, low frustration tolerance, increased energy levels, appetite and weight loss, uninhibited behavior, increased libido, flight of thoughts). It alternates between depression and mania. The depression phase is what disables the patient.]]
Answer D	AnswerD::Dysthymia
Answer D Explanation	[[AnswerDExp::Incorrect. Dysthymia it is a mild form of depression that usually lasts at least 2 years (chronic). It includes depressed mood, loss or interest in regular activities. It does not require pharmacological treatment.]]
Answer E	AnswerE::Cyclothymia
Answer E Explanation	[[AnswerEExp::Incorrect. Cyclothymia it is chronic (at least 2 years) and milder form of bipolar. Often the patient does not identify the condition. As with bipolar, the patient alternates between manic and depressive symptoms. It does not require pharmacological treatment.]]
Right Answer	RightAnswer::B
Explanation	[[Explanation::This behavioral science question brings to the attention diverse differential diagnosis as answer choices so it is important to be able to identify the criteria that defines each ot these mood disorders in order to select a correct choice. Intensity of symptoms, onset of symptoms and the presence of manic episodes are the crucial elements that direct towards the correct answer. This middle aged man experiences a constellation of symptoms after the recent death of a relative or friend as he described his dog. The onset was 3 weeks ago and the symptoms have been severely intense which have made him think to commit suicide. All of these criteria help to diagnosis Unipolar or major depression. Educational Objective: References: ]]
Approved	Approved::No
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