Question

A 72 year old man comes to his physician because he has been feeling sad and ""thinks he needs help."" For the past several weeks, he has noted decreased appetite and an 8 lb weight loss, and he has seldom left his house, even to participate in his weekly bowling league. While he is able to fall asleep normally, he awakens after 3-4 hours and is unable to fall asleep again. He has also had increasing difficulty balancing his checkbook and writing his Christmas cards, and believes that he just can't stay focused enough to complete these tasks. Six months ago, his wife of fifty years died, and he often feels guilty that he did not treat her as kindly as he should have. When he thinks about his wife, he thinks that he would rather be dead than without her, although he denies having a plan to harm himself. Past medical history includes coronary artery disease and gout. Medications include lisinopril, allopurinol, metoprolol, furosemide, and aspirin. Which of the following is the most likely diagnosis in this patient?

A. Adjustment disorder
B. Bereavement
C. Major depressive disorder
D. Dysthymic disorder
E. Alzheimer's dementia

Answer 1

Past medical history includes coronary artery disease and gout. Medications include lisinopril, allopurinol, metoprolol, furosemide, and aspirin the most likely diagnosis in this patient is depressive disorder. So, the correct option is C. Major depressive disorder.

Step-by-step explanation:

The patient’s symptoms align closely with the criteria for major depressive disorder (MDD). The presence of sustained sadness, significant weight loss, sleep disturbances, cognitive impairment affecting tasks, feelings of guilt, and thoughts about death, all lasting for weeks, points toward a clinical diagnosis of MDD.

In this scenario, the patient's symptoms exceed the typical manifestations of bereavement. While bereavement involves feelings of sadness and loss after the death of a loved one, the intensity and duration of the patient's symptoms, coupled with functional impairment and cognitive changes, suggest a more severe condition like MDD rather than mere bereavement.

The symptoms also don't fully correspond to an adjustment disorder, which typically arises within three months of a stressor and tends to resolve once the stressor diminishes. In contrast, this patient's symptoms have persisted and intensified over several weeks, affecting his daily functioning significantly.

Dysthymic disorder involves milder, chronic depressive symptoms lasting for years, which doesn't encapsulate the acute and severe nature of the patient's presentation.

Alzheimer's dementia involves progressive cognitive decline, which may lead to depressive symptoms, but the patient's depressive symptoms here appear to be more acute and related to the recent loss and associated changes in mood, appetite, sleep, and concentration.

In summary, considering the intensity, duration, and impact of symptoms, coupled with the patient's history and presentation, the most fitting diagnosis is Major Depressive Disorder.

So, the correct option is C. Major depressive disorder