WBR1135

Author	[[PageAuthor::Pratik Bahekar, MBBS [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Psychiatry
Sub Category	SubCategory::Psychiatry
Prompt	[[Prompt::A 44 year fashion coordinator, had a daughter, who suffered from major depressive disorder. She was on fluvoxamine and lorazepam. 2 weeks back daughter was found dead in her apartment with syringes and heroin by her side. She went to see a psychiatrist and started discussing suicide, she regrets being a bad mother and concentrating too much in career. She has started seeing her daughter in garage and laundry room. Psychiatrist decides to keep a close follow up and asks her to return after 1 week. On the second visit, she seems to be increasingly obsessed with suicide. She started drinking 6 beer everyday, unable to concentrate on work, and appears to be withdrawn. Psychiatrist provides reassurance and asks to visit after a week. On the third visit, she mentions difficulty in falling sleep, waking up at 3am in the morning, feeling of worthlessness, and loss of interest. She never had a problem with drugs or alcohol, but has a past history of major depressive disorder. What is the most likely diagnosis?]]
Answer A	AnswerA::Dependent personality disorder
Answer A Explanation	[[AnswerAExp::Dependent personality disorder is a personality disorder that is characterized by a pervasive psychological dependence on other people. This personality disorder is a long-term condition in which people depend on others to meet their emotional and physical needs, with only a minority achieving normal levels of independence. She does not display characteristics of dependent personality disorder.]]
Answer B	AnswerB::Schizoaffective disorder
Answer B Explanation	AnswerBExp::She does not show features of psychosis, visual hallucination of lost individuals is a common feature in a bereavement.
Answer C	AnswerC::Bipolar Disorder
Answer C Explanation	AnswerCExp::No history of mood swings or features of bipolar disorder.
Answer D	AnswerD::Major depressive disorder
Answer D Explanation	[[AnswerDExp::DSM-5 wants doctors to use their judgement to differentiate grief and major depressive disorder. Most of the times depressive symptoms in grief does not indicate major depressive disorder. The given patient has family history of depression. With a worsening of symptoms over each visit and development of cognitive and neurovegetative symptoms, diagnosis of major depressive disorder is more just. DSM-5, unlike DSM4 TR do not limit the use of an MDD diagnosis between 2 weeks and 2 months.]]
Answer E	AnswerE::Normal Grief
Answer E Explanation	AnswerEExp::With worsening of symptoms, diagnosis of grief is unlikely.
Right Answer	RightAnswer::D
Explanation	[[Explanation::DSM-5, unlike DSM4 TR do not limit the use of an MDD diagnosis between 2 weeks and 2 months. Educational Objective: References: http://www.ncbi.nlm.nih.gov/pubmed/24042244 http://www.dsm5.org/Pages/Default.aspx]]
Approved	Approved::No
Keyword	WBRKeyword::Major Depressive Disorder, WBRKeyword::Grief
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::