WBR0040
| Author | PageAuthor::Gonzalo Romero (Reviewed by Will Gibson) |
|---|---|
| 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, but is unable to go back to sleep. The patient reports difficulty concentrating at work to the extent that his supervisors are concerned. He cries inconsolably when the doctor asks about the dog and says “I just can’t stop seeing my dog everywhere I go. I feel worthless and think 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::Normal Grief is ruled out by the presence of suicidal ideation in this patient. Treatment for normal grief includes psychotherapy, medication is not recommended.]] |
| Answer B | AnswerB::Major depression |
| Answer B Explanation | [[AnswerBExp::Major depression or unipolar disorder lasts for at least 2 weeks and is characterized by severe changes in mood (see SIGECAPS below). Treatment usually includes psychotherapy and antidepressants (usually SSRIs).]] |
| Answer C | AnswerC::Bipolar disorder |
| Answer C Explanation | [[AnswerCExp::Bipolar disorder or manic-depression is characterized by symptoms of major depression that alternate with manic episodes. The episodes of mania consist of elevated mood, grandiose thoughts, low frustration tolerance, increased energy levels, decreased appetite, uninhibited behavior, increased libido, and "flight of thoughts".]] |
| Answer D | AnswerD::Dysthymia |
| Answer D Explanation | [[AnswerDExp::Dysthymia is a mild,but chronic form of depression that often lasts more than 2 years. Patients typically display depressed mood and loss of interest in regular activities. Therapy consists of psychotherapy and antidepressants, most commonly SSRIs such as fluoxetine.]] |
| Answer E | AnswerE::Cyclothymia |
| Answer E Explanation | [[AnswerEExp::Cyclothymia is a type of chronic mood disorder widely considered to be a milder or subthreshold form of bipolar disorder. Cyclothymia is characterized by numerous mood disturbances, with periods of hypomanic symptoms alternating with periods of mild or moderate depression.]] |
| Right Answer | RightAnswer::B |
| Explanation | [[Explanation::This middle aged man experiences a constellation of symptoms after the recent death of his cherished dog. While the recent onset of his symptoms raises the suspicion that he is experiencing normal grief, the severity of his depression and suicidal contemplation makes major depression the correct diagnosis. Recall the mnemonic for the diagnosis of major depression: SIGECAPS
The diagnosis of major depression requires evidence of 5 of the 9 SIGECAPS criteria with symptoms lasting greater than 2 weeks. This patient has sleep disturbances (S), anhedonia (I), feelings of worthlessness (G), loss of energy (E), decreased ability to concentrate at work (C), flat affect (P), and most importantly suicidal ideation (S). With 7 of the 9 criteria and symptoms lasting 3 weeks, this patient meets the criteria for major depression. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Psychiatry, WBRKeyword::Behavioral science, WBRKeyword::Depression, WBRKeyword::Grief, WBRKeyword::Suicide |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |