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 presents to the outpatient clinic for follow up with his primary care physician after being concerned about his current state of mind. He started developing extreme fatigue 3 weeks ago after his dog passed away, whom he considered his "best buddy" for 15 years. He never married, but has had a girlfriend for 5 years. The patient reports being an avid swimmer in the past, but no longer has any interest in it. He has had trouble falling asleep at night and wakes up early being unable to go back to sleep. He works as a regional manager for a paper company; his boss and clients have complained recently that he seems 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 ending my life”. He denies taking any medication or illegal substances. On physical exam, his vitals are stable, he appears unkempt 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 middle aged man experiences a constellation of symptoms after the recent death of his cherished 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: |
| Approved | Approved::Yes |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |