DEPRESSED MOOD

Question 1

68 yo M presents with a two-month
history of crying spells, excessive sleep,
poor hygiene, and a 7-kg weight loss, all
following his wife’s death. He cannot
enjoy time with his grandchildren
and reluctantly admits to thinking he
has seen his dead wife in line at the
supermarket or standing in the kitchen
making dinner.

Answer 1

Normal bereavement Physical exam
Adjustment disorder with Mental status exam
depressed mood TSH
Major depressive disorder with CBC
psychotic features Urine toxicology
Schizoaffective disorder
Depressive disorder not
otherwise specified (NOS)

Question 2

42 yo F presents with a four-week history
of excessive fatigue, insomnia, and
anhedonia. She states that she thinks
constantly about death. She has suffered
five similar episodes in the past, the first
in her 20s, and has made two previous
suicide attempts. She further admits to
increased alcohol use in the past month.

Answer 2

Major depressive disorder Physical exam
Substance-induced mood disorder Mental status exam
Dysthymic disorder Blood alcohol level
TSH
CBC
Urine toxicology

Question 3

26 yo F presents with a 3-kg weight loss
over the past two months, accompanied
by early-morning awakening, excessive
guilt, and psychomotor retardation.
She does not identify a trigger for the
depressive episode but reports several
weeks of increased energy, sexual
promiscuity, irresponsible spending,
and racing thoughts approximately six
months before her presentation.

Answer 3

Bipolar I disorder Physical exam
Bipolar II disorder Mental status exam
Cyclothymic disorder urine toxicology
Major depressive disorder
Schizoaffective disorder