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72 Cards in this Set
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A 72 y/o female was recently admitted after herdaughter informed the doctor that she had been doing very poorly since herhusband’s death many months ago. Sincethen, the pt reports a 20 lb weight loss, decrease concentrations, feeling ofhopelessness, lacking of energy, depressed mood and early morning waking. Pt denied using alcohol or other illicitdrugs and her urine drug screen was negative. All of her labs and images were within normal limits. The most likely diagnosis is: A. bipolar type 1, most recent manic B. schizophreniaC. substances induced mood disorder D. major depressive disorder |
D major depressive disorder |
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major depressive disorder: diagnostic criteris |
one of more MDD episodes in the absence of mania or hypomania; A. mood sx at least one of the symptoms is either 1. depressed mood as indicated by either subjective report of observation made by others (in children and adolescents can be irritable mood) or 2. markedly diminished interest or pleasure in all or almost all activities; B neurovegatative signs= 1. signifiicant weight loss or weight gain 2. insomnia or hypersomnia 3. psychomotor agitation or retardation 4. fatigue or loss of energy nearly every day 5. diminished ability concentration; C thought contents= 1. feelings of guilt, hopelessness, or worthlessness 2. passive suicidal or active SI/behavior; D duration= 2 weeks most of the day, nearly every day; E dysfunction= the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning; F exclusion criteria= NOT DUE TO 1. GMC 2. substances induced or 3. another mental D/O |
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An 85 y/o pt presents to the doctor complaining “I think I have a venereal disease”. The patient explains that he had an affair and thinks that he contracted a sexual transmitted disease as a result. The patient reports poor appetite, sleep and energy for the last year, saying,these are only because I feel miserable and guilty I cannot stop thinking about it. The patient's spouse, who is present seem surprised by the patient concern,saying that the affair the patient describes occurred many years ago and the spouse has long since forgiven the patient. Physical examination showed no evidence of infection. Mental status examination is significant for sad affect and psychomotor retardation, cognitive exam was within normal limits. Which of the following is the most likely diagnosis for this patient? a. hypochondriasis b. delusional disorder c. intermittent explosive disorder d. major depression with psychosis e. obsessive compulsive disorder (OCD) |
D major depression with psychosis |
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characteristics of mood episodes with psychotic features |
delusions or hallucination are present during mood episode, usually are congruent with the mood; delusion is usually of guilt; delusions are more common than hallucination; treatment= with antidepressant and antipsychotic meds or with electroconvulsive therapy (ECT) |
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characteristics of mood disorders with catatonic features |
3 or more= catalepsy (motoric immobility) and waxy flexibility, excessive motor activity (purposeless and independent of external stimuli), negativism (motiveless or resistance to instructions or maintained of rigid posture), mute, peculiarities of voluntary movement, echolalia or echopraxia |
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characteristics of mood disorders with melancholic features |
extreme anhedonia w/o mood reactivity, +3 or more of the following= depression worse in AM, early AM awaking, marked psychomotor retardation, anorexia or weight loss, excessive guilt; classically responds to tricyclic antidepressant |
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characteristics of mood disorders with atypical features |
characterized by mood reactivity, 2+ or more of the following= hypersomnia, increase appetite or weight gain, leaden paralysis, sensitivity to interpersonal rejection; classically responds to monoamine oxidase inhibitors (MAO-I) (SSRI also a good choice) |
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A young man from Minnesota complains ofdepressed mood and hypersomnia every winter. His symptoms resolve in the spring and summer. Which of the following is most likely hisdiagnosis: a. bipolar type 1 MRE mixed episode b. seasonal affective disorder c. normal d. delusional d/o e. adjustment d/o with depressed mood |
B seasonal affective disorder |
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characteristics of MDD with seasonal pattern |
a disorder characterized by depressive sx found during winter months and absent during summer months; believed to be caused by abnormal melatonin metabolism; treatment= phototherapy or sleep deprivation |
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characteristics of MDD with post partum onset |
severe depression that begins within 1 month of birth, mother may have thoughts about hurting the baby; psychiatrist should screen for bipolar d/o; prevalence 10-15%, risk factors including prior psychiatric illness, family history, limited social support, conflict with baby's father, infant illness, depression during pregnancy |
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characteristics of MDD with anxious distress |
anxious distress symptoms during majority of days of an episode; >/= 2 needed= feeling keyed up or tense, feeling unusually restless, difficulty concentrating because of worry, fear that something awful will happen |
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characteristics of MDD with peripartum onset |
occurring during pregnancy or in 4 weeks following delivery; 5% of all pregnancies; anxiety and panic symptoms common; observe for psychosis and bipolar conversion and fear that they may lose control over themselves |
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characteristics of MDD with mixed features |
full criteria are met for MDE= manic/hypomanic symptoms present during majority of days, a change from baseline and observable by others, >/=3 needed= elevated, expansive mood, inflated self esteem or grandiosity, more talkative or pressure to keep talking, flight of ideas or subjective sense of racing thoughts, increased energy or goal directed activity, increased involvement in activities with high risk or painful consequences, decreased need for sleep; note= cannot meet criteria for mania/hypomania |
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postpartum blues of "baby blue" |
any baby (1st, 2nd, etc); begins after birth and lasts up to 2 weeks; more cares about the baby; mild depression; self limited and no tx needed |
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postpartum depression |
usually 2nd baby; begins within 1 month of birth and symptoms may continue; many have thoughts about hurting the baby; severe depression; treat with antidepressant |
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postpartum psychosis |
usually 1st baby; begins within 1 month of birth and symptoms may continue; may have thoughts about hurting baby; severe depression and psychotic symptoms; antidepressant and mood stabilizers or antipsychotics needed |
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Mr. G complains of poor appetite, low energy,poor concentration and difficulty in making decision, which is affecting hisability to complete his duties at work. These symptoms have occurred for morethan 4 years. He denied any prior psychiatric hospitalization and has no priorhistory of suicidal attempts. He denied prior history of mania or hypomania. Hedenied using alcohol as well as other illicit drugs. He was sexually abused bya stranger when he was 8 YO. During the assessment, he appeared cooperative, attentive,oriented and well groomed with reactive affect. His speech and psychomotor were within normal limits. What is the mostlikely diagnosis: a. Bipolar type 1, MRE depression b. MDD with catatonic features c. Dysthymic d/o d. PTSD e. Substances induced mood d/o |
C dysthymic disorder |
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characteristics of minor depressive d/o: dysthymic d/o |
a chronic disorder characterized by a depressed mood that lasts most of the time during the day and present on most days for at least 2 yrs (children 1 yr) in addition to disturbed concentration, hopelessness, appetite, sleep, and self esteem; exclusions= no MDD in first 2 yrs, NO mania of hypomania, not 2nd to GMC; tx= hospitalization is usually not indicated, pts may benefit from long term individual insight oriented psychotherapy to help them overcome their long term sense of despair and resolve conflicts from childhood; meds are SSRI, TCA, or MAOI |
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characteristics of minor depressive d/o: PMDD (pre menstrual dysthymic disorder) |
SX of depressed mood and anxiety that occur in last week of luteal phase and resolve in follicular phase for 2 consecutive cycles; Sx interfere with functioning; affects 3-8% of women; risk factors= HX of depression, increasing age, lack of exercise, diet low in Ca, Mg, B12; pathophysiology= fluctuations in estrogen and progesterone levels lead to serotonin deficiency; tx= SSRIs (FLUOXETINE daily dosing preferred approach), calcium, B12, OCP, diuretics, light therapy, CBT |
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characteristics of persistent depressive disorder diagnosis |
MDD chronic type and dysthymic disorder; duration 2 yrs depressed; in children/adolescents mood can be irritable and duration must be at least 1 yr; symptoms= presence of >2 yrs needed, poor appetite or overeating, insomnia or hypersomnia, low energy of fatigue, low self esteem, poor concentration or difficulty making decisions, hopelessness; during the 2 yrs of disturbance (1 yr in children/adolescents), never without symptoms for more than 2 months at a time; criteria for a major depressive disorder may be continuously present for 2 yrs; SIGNIFICANT DISTRESS OR IMPAIRMENT; exclusionary criteria= no mani episodes, hypomanic episode or cyclothymic disorder, not better explained by schizophrenia or other psychotic disorder, not due to a substance, note= treat as treatment resistant depression |
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A66-year-old man comes to the physician for a follow-up examination after theresults of a colonoscopy showed colon cancer. When the physician tells thepatient the diagnosis, the patient becomes tearful and responds, “No, you’rewrong! This must be a mistake. This can’t happen to me. Let’s do more tests.”This patient is most likely at which of the following stages of grief? a. anger b. bargaining c. denial d. depression |
C denial |
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the 5 stages of death and dying |
shock and denial; anger; bargaining; depression; acceptance |
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Thechildren of a 66-year-old male ask their family physician for advice abouttheir father’s behavior 2 weeks after the death of his wife of 40 years. Theyare concerned because he weeps whenever he comes upon an object in his homethat he associates with her. His appetite has decreased, and he has had a 5-lbweight loss. He awakens 1 hour before the alarm goes off each morning. He isable to care for himself. Although he does not leave his home for any socialactivities, he does enjoy visits from her family. Which of the following is themost likely explanation and appropriate management? A. Normalgrief reaction, and herequiresno medical attention B. Normalgriefreaction, and hewouldbenefit from diazepam therapy C. Pathologicgriefreaction, and heshouldbe treated with an antidepressant D. Pathologicgriefreaction, and heshouldbe treated with psychotherapy E. Pathologicgriefreaction, and heshouldbe encouraged to move in with one of his children |
A
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bereavement: common sx |
sadness, poor appetite or sleep, person views these as normal and may seek symptomatic relief e.g. insomnia |
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bereavement: sx suggesting MDD not grief |
insomnia, anorexia, weight loss for more than 2 months; pathological guild (different than "I should have done more", +SI different than "survivor feeling", psychomotor retardation, severe functional impairment, hallucination (other than of the deceased) which is sustained; SYMPTOMS ARE PERVASIVE AND UNREMITTING |
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A72-year-old female was recently admitted after her daughter informed the doctorthat she had been doing very poorly since her husband's death many months ago.Since then, the patient reports a 20-pound weight loss, decrease concentration,feeling of hopelessness , lacking of energy, depressed mood and early morningwakening. Also, she reported suicidal ideation with a plan to overdose so shecan join his wife. Patient denied using alcohol or other illicit drugs and herurine drug screen is negative. All of her labs and imageswere within normal limits. The most likely diagnosis is: A. Bipolartype 1, most recent manicB. NormalgriefC. Substancesinduced mood disorderD. Majordepressive disorder |
D major depressive disorder |
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grief versus MDD |
grief= sx <2 months, wax and wane, usually return to baseline of functioning within 2 months, threaten suicide absent or less often, feeling of loss, crying, transient; MDD or pathological grief= sx >2 months, pervasive and unremitting, pt doesn't return to baseline level of functioning, threaten suicide more often, feeling worthless and blaming self, sustained |
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depression due to GMC or use substances |
late onset of depression more commonly secondary to Alzheimer's disease, HTN, stroke; medial illness associated with development of depression= stoke, CAD, parkinson's; substance induced mood D/O= sx developed during or within a month of substance intoxication or withdrawal, med use is etiologically relate to disturbances (e.g. anabolic steroid, beta blocker, interferon, opioid, etc) |
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MDD risk factors |
seen more in women due to hormonal differences, great stress, or simply a bias in the diagnosis; losing parent before age 11; childhood abuse; unemployment; retirement; loss of spouse; the typical onset of age is 40 y/o; higher incidence in those who have no close interpersonal relationship or divorced or separated; other risk factors include family history and behavioral reason such as learned helplessness; 15% COMMIT SUICIDE |
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MDD pathogensis |
genetic; low monoamines or serotonin; REDUCED REM LATENCY AND INCREASED REM DENSITY; hypothalamic pit adrenal/thyroid axis dysregulation; more hyperintense (white) regions on MRI |
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A59-year-old woman is brought to the physician by her husband because of bizarrebehavior for 1 week. Her husband says that she makes no sense when she speaksand seems to be seeing things. She also has had difficulty sleeping for 2months and has gained approximately 30 LB during the past 6 months. During thistime, she has been moody and easily fatigued. He also notes that the shape ofher face has become increasingly round and out of proportion with the rest ofher body despite her weight gain. She has no history of psychiatric or medicalillness. She is 160 cm (5 ft 3 in) tall and weighs 70 kg (155 lb);BMI is 28 kg/m2. Her pulse is 99/min, respirations are 9/min, and bloodpressure is 159/98 mm Hg. Physical examination shows truncalobesity and ecchymosis over the upper and lower extremities. Neurologicexamination shows no focal findings. Mental status examination shows pressuredspeech and flight of ideas, and she seemed to respond to internal stimuli.Urine toxicology screening is negative. Which of the following is the mostlikely diagnosis? A. Briefpsychotic disorder B. Majordepressive disorder with psychotic features C. Mooddisorder due to a general medical condition D. SchizophreniaE. Schizoidpersonality disorder |
C mood disorder due to a general medical condition (Cushing's) |
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A69 y.o.female patient is brought to clinic by her husband. She is weepy, respondsslowly to queries, has poor hygiene, and has urine stains on herpants. Sheis oriented x 3 but does not respond to other cognitive screening questions.Her husband reports she’s never had a depressive episode or any otherpsychiatric D/O earlier in her life. What is your next clinical step? A. Completefull medical workup B. StartAmitriptylineC. StartcitalopramD. Scheduleafollow up visit without starting medication |
A complete full medical workup |
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assessment of MDD: what is found in PE |
usually within normal limits however may find evidence of psychomotor retardation such as stooped posture, slowing of movements, slowed speech, etc; may also find evidence of cognitive impairment such as decreased concentration and forgetfulness; look for sx of hypo or hyperthyroidism, addison's disease, DM, and Cushing's |
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assessment of MDD: what is found in labs/imageing |
lab tests are not diagnostic but may find abnormal dexamethasone test or thyrotropin releasing hormone test; obtain CBCD, CMP, thyroid, B12, RPR, HIV, UDS, MRI, UA, pregnancy test, EKG, sleep study |
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treatment of MDD |
must first secure the safety of the pts given that suicide is such a high risk; biological treatments= SSRI, serotonin norepi re uptake inhibitors (SNRIs), tricyclic antidepressant, MAOI, bupropion mirtazapine and trazodone, augmentation; somatic treatments= electroconvulsive therapy, vagal nerve stimulation, light therapy; psychotherapy= cognitive behavioral therapy (CBT), intrapersonal therapy, brief psychodynamic therapy |
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treatment of MDD without psychotic features |
SSRI, SNRI, mirtazapine, buproprion; switch to antidepressant, augmentation, or use electroconvulsive therapy (ECT) |
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treatment of MDD with psychotic features |
antidepressant+ antipsychotic; ECT |
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augmentation of the antidepressant with what |
lithium, T3, aripiprazole, quetiapine, SSRI and SNRI+ mirtazapine, stimulant, bright light, vagal nerve stimulation (VNS) |
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what are the 6 SSRIs |
HE SKIPPED; fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram |
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SSRIs: common side effects |
HE SKIPPED; headache, anxiety, diarrhea, N/V (transient); all have sexual side effects |
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SSRIs: serotonin syndrome |
HE SKIPPED; confusion, agitation, delirium, hyperreflexia, myoclonus, ocular clonus, mydrisias; diaphoresis, increased GI mobility (diarrhea), fever, rhabdomyolysis, renal failure |
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SSRIs: precipitating meds |
HE SKIPPED; SSRI, SNRI, TCA, MAOIS, TRIPTAN, MEDPERIDINE, FENTANYL, ANDANSTERON, METOCLOPRAMIDE, ST JOWNS WART, DEXOMETHOROPHAN, MDMA, LSD |
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SSRIs: differential of serotonin syndrome |
HE SKIPPED; SS vs NMS= more rapid onset, hyperkinetic rather than hypokinetic; SS vs anticholinergic delirium= skin is diaphoretic and of normal color rather than hot, flushed, and dry, also hyperactive rather than hypoactive bowel sounds |
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MDD and pregnancy: management of pt
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ask for family meeting, prepare written material to take home, explain the risks/benefits, obtain consent form; risk of untreated depression in pregnancy= increased risk for substance abuse, miscarriage, low birth weight, small head circumference, premature delivery; SSRI in 1st TM= no overall increase risk of birth defect, avoid Paxil (cardiac defect) and bupropion; SSRI in late TM= lead to premature delivery, respiratory distress syndrome (PPHN), withdrawal syndrome; other side effects include= LOW BIRTH WEIGHT, SMALL HEAD CIRCUMFERENCE, premature labor |
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Afterremission from a third major depressive episode, antidepressant medicationshould be continued for: A. 3-5months at the same dose B. 3-5 monthsat 50% of the dose C. 6-12 monthsat the same dose D. 6-12 monthsat 50% the dose E. Indefinitely |
E indefinitely (after each relapse their hippocampus shrinks and becomes more resistant to meds so just keep their dose in order to prevent another relapse) |
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who needs maintenance treatment |
very recommended for 3 or more episodes of MDD; strongly recommended for 2 episodes and other factors; should be at the same dose as was in acute and continuation treatment |
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treatment resistant depression |
10-33% of depressed pts; commonly accepted definition= failure to respond to at least 2 antidepressant treatments of adequate dose and duration from 2 distinct classes; treat= comorbid axis 1 disorder (pain, anxiety, substance abuse, etc), address domestic violence or complicated grief, think about bipolar disorder |
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MDD course of illness |
risk of relapse after one episode is 50% and 80% after 3rd episode; 20% will continue to feel depressed after 2 yrs; 30% will remit within 6-24 months; average length of episode= 4-5 months, 6 months after episode about 50% will have or achieved full recovery |
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A19-Year-old college student is taken to the school counselor after he failedseveral classes. The patient is enrolled in numerous classes, most of whichhave conflicting times. His grades are poor and seems undisturbed by this. Heis also enrolled in numerous organization, such as the chess club, studentgovernment, sport. His speech is rapidand pressured. He is having flight of idea and psychomotor agitated: A. BipolarD/OB. DelusionalD/O, erotomanic type, C. Marijuana-inducedpsychotic disorderD. SchizoaffectiveD/O, Bipolar typeE. Schizophrenia |
A bipolar disorder |
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bipolar I diagnosis: mania? hypomania? depression? |
just need evidence of mania
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bipolar II diagnosis: mania? hypomania? depression? |
just need evidence of hypomania and depression |
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cyclothymia diagnosis: mania? hypomania? depression? |
hypomania sx for 2 yrs; depression sx for 2 yrs |
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bipolar NOS (not otherwise specified) diagnosis: mania? hypomania? depression? |
hypomania sx present |
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manic episode criteria |
mood symptoms= a distinct period of abnormal persistent elevated or irritable mood; abnormal persistent increased goal directed activity or energy; neurovegetative signs= decrease need for sleep, increase goal directed activity, distractibility, psychomotor agitation, increased sexual activities; thought form and contents= racing thoughts or flight of idea with grandiosity contents; duration= one week; dysfunction= marked impairment or hospitalization; exclusions= not GMC or substances induced |
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bipolar 1 epidemiology and course of illness |
epidemiology= life time prevalence of 1%, M=F, age of onset 19, no racial difference, 19% commit suicide, 50% have psychotic symptoms at some point, substance abuse and anxiety and seasonal pattern are common, considered to be the illness with the greatest genetic linkage; course of illness= recurrence is the rule, average duration of untreated episode depression 6-12 months and mania 3-6 months, seasonal pattern is common |
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Themost common misdiagnosis of bipolar depression: A. AnxietyD/OB. SubstanceabuseC. SchizophreniaD. Unipolar depression |
D unipolar depression |
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A 37 y.o. mother of two youngchildren presentsto her primary care physicianfor annualcheck-up. She is “fidgety,” irritable, and saysshe only sleeps 3 hours a night for the past week. She enjoys having increased energyand hasstarted to repaint the interior of her house. She endorses racing thoughts and beingmore talkative.The most likely diagnosis iswhich of the following? A. Histrionic personality disorderB. Bipolar II disorderC. CyclothymiaD. Minor depressive disorderE. Impulse control disorder NOS |
B bipolar II disorder |
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bipolar II diagnosis and features |
hypomanic and depressive episodes requires, no manic episodes; lifetime prevalence 1.1%; total bipolar spectrum prevalence 4.4%; differences with bipolar I disorder= depression is more prominent, hypomania make up small proportion of mood destabilizations, suicide rates are comparable to bipolar I disorder, rapid cycling is common |
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hypomanic episode criteria |
symptoms= elevated, expansive, or irritable mood and persistently increased goal directed or energy; plus 3 or more sx= increased self esteem, decreased need for sleep, flight of idea, increased pleasure seeking, talkative, distractibility; no psychotic feature; duration 4 days; dysfunction= change in function that uncharacteristic when individual is not symptomatic, no impairment or hospitalization; exclusions= not due to GMC or substance induced; features= hypomania and depressive episodes are required, prevalence 1%, depression is more prominent, rapid cycling is common |
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Hypomaniacan be differentiated from mania by all the following except: A. DurationB. Numberof symptomsC. social/occupationaldysfunctionD. HospitalizationE. severityof illness |
B number of symptoms |
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rapid cycling bipolar specifiers |
can be BP 1 of 2; defined as >4 mood episodes/yr; more common in women; tends to respond better to valporic acid then lithium |
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Mrs. M has experienced a 10-year historyof periods of feeling great followed by periods of feeling down. During herfeeling-great periods, she experiences increase sexual drive, elevated mood,and increased irritability. During her feeling down-periods, she experiencesinsomnia, lack of energy and low self-esteem. She has never had manic episode .Patient is physically healthy. Whichofthe following is the most likely diagnosis? a Attention-deficit/hyperactivitydisorderb Cyclothymicdisorderc Dysthymicdisorderd Majordepressivedisorder e Mood disorderdue to a general medical condition |
B cyclothymic disorder |
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A 20 y.o. college student presents forpsychiatric evaluation,stating, “I have moodswings.”She describes daily mood fluctuationsfor thelast 2 years, from moderately depressed to happyand energetic, interfering with her ability tosucceed in her studies. She has never had a manic episode. The best diagnosis is whichof thefollowing? A. Major depressive disorderB. CyclothymiaC. Bipolar II disorder, with rapidcyclingD. Borderline personality disorderE. Bipolar I disorder, with rapid cycling |
B cyclothymia |
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cyclothymia: dx, risk factors/epidemiology |
a chronic disorder characterized by many periods of hypomania; sx that don't meet criteria of a hypomanic episode and many periods of depressive sx that don't meet criteria of MDD over 2 yrs; pt has not been without symptoms for more than 2 months at a time; a milder form of bipolar II d/o; NO MDD, mania, or mixed episodes during the first 2 yrs; risk factors/epidemiology= many of the pts have interpersonal and marital difficulties, it frequently coexists with borderline personality d/o, prevalence 1%, males more than females, age of onset 19 |
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Whichof the following factors increases suspicion of a manic episode being secondaryto a medical etiology? A. Familyhistory of bipolar disorder B. Lateage of onset C. Good response to treatment withlithium D. History of earlier mood episodes |
B late age on onset |
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orbital frontal syndrome (OFS): caused by what, sx |
infarct in the orbital frontal region causing sx; disinhibition behaviors= sexually disinhibition, aggressive, impulse dyscontrolled, language incoherency, socially inappropriate; sx= mood irritability, delusions, confabulation |
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key points of neurobiology of bipolar disorder |
progressive gray matter loss may explain illness progression; post mortem abnormalities support loss of gray matter in limbic structures; lithium and VPA= may have therapeutic effects in bipolar disorder by inhibiting GSK-3 thus promoting neuronal viability and survival, lithium has direct inhibitory effects on GSK-3 |
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Lithiumexposure during first trimester of pregnancy increases the risk of congenitalabnormalities of: A. BrainB. Heart(Epstein'sanomaly-tricuspid valve malformation)C. lungD. KidneyE. liver |
B heart (HE DIDN'T GO OVER THIS ONE) |
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A32-year- old female presented the emergency room complaining of diarrhea of twoweeks duration. On examination she appeared anxious and tremulous and is notoriented to date or time of day. The patient state she is taking “some drug”for bipolar disorder and add that she doubled her dose a month ago because she”wasn't getting better fast enough”. She denied the use of alcohol or otherdrugs. which of the following medication would most likely cause the symptomdescribed? A. carbamazepineB. Valproic acidC. LithiumD. LamotrigineE. Topiramate |
C lithium (HE DIDN'T GO OVER THIS ONE) |
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A16 year-old-female received treatment for bipolar disorder, When she becamepregnant, her infant was born with spina bifida and neural tube abnormalities.Which of the following medications she was most likely taking? A. FluoxetineB. HaloperidolC. Valproic acidD. LithiumE. Lamotrigine |
C valproic acid (HE DIDN'T GO OVER THIS ONE) |
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A77-year-old retired police officer comes to the clinic for his annual physicalexamination. He has no complaints, but you notice that he is not his usualself. He appears distraught and distant, speaks in a low voice, and avoids eyecontact. He seems to have lost some weight, and admits to not caring about hismeals. The physical examination and routine laboratory tests are unremarkable.On further questioning the patient shares that his wife had died several monthsago. He lives alone, has no children, and misses her a lot. He rarely sees hisfellow officers or friends any more. The most important next step is evaluationfor: A. Alzheimer'sdementiaB. feelingsof guiltC. religiouspreferenceD. suicidalideationE. weightloss |
D suicidal ideation |
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Whichof the following is the best predictor of the likelihood of attempting suicidein the future: A. AlcoholB. GenderC. PriorSuicideattemptD. Recentdivorce |
C prior suicide attempt |
