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A 77 yo man comes to the physcian because a 3 month history of fatigue and decreased apetite resulting in a4.5 Kg weight loss. He also has depressed mood and decreased concentration. He is no longer interested in participating in his weekly golf outing and rarely attemps to visit with friends. He is no longer motivated to clean the house and keep up with his bills. He says he can hear his wife who has been dead for 4 years telling him that his lost of appetite is due to cancer and he should end his life before he suffers a painful death like she did. Physical examination shows no abnormalities. Mental status examination shows depressed mood. He is able to recall 3/5 objects after 5 min. There is no evidence of suicide ideation. Which of the following is the most likely diagnosis:
a. Adjustment disorder with depressed mood
b. Dysthymic disorder
c. Major depressive disorder with psychotic features
d. Pathological bereavement
e. Schizoaffective disorder
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C
sigecaps
but A and E are a close tie.
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point against A- no definite stress factor within 3 mo of current illness.
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thinking unipolar(depression) disorder. but the patient, has no psychotic features. the only psychotic feature is see is, his auditory hallucinations. which can also be seen in a depressed patient.
not a adjustment disorder, adjustment disorder is almost always a diagnosis of exclusion of all other axis 1 disorders. the patient seems to have grievance for loss of his wife.
so the answer is C ????
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pathological bereavement,this is a delayed bereavement and since it is not up to 6mths it does fit in into major depression
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in major depresion with psychosis, patient will have met the criteria for depression ie 5 or more symptoms of SIGECAPS, and then in addition to that has hallucinations or delusions.
However is schizoaffective disorder, patient will have background psychosis in which mood symptoms will be superimoposed upon. Note that in this case, this might be just 2 or 3 mood symptoms so the mood symptoms is not enough to diagnose major depression.
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then what is the correct answer
