Making The Right Diagnosis

Question 1

A 25-year-old man comes to the psychiatrist with a chief complaint of depressed mood for one month. His mother, to whom he was very close, died one month ago, and since that time he has felt sad and been very tearful. He has difficulty concentrating, has lost 3 lbs and is not sleeping soundly through the night. Which of the following is the most likely diagnosis?

1. Major depression
   
2. Dysthymia
3. Posttraumatic stress disorder
   
4. Adjustment disorder
   
5. Uncomplicated bereavement

Question 2

A 32-year-old woman is brought to the emergency room by the police after she was found standing in the middle of a busy highway, naked, commanding the traffic to stop. In the

emergency room she is agitated and restless, with pressured speech and an affect that alternates between euphoric and irritable. Her father is contacted and states that this kind of behavior runs in the family. Which of the following is the most likely diagnosis?

1. Delirium
   
2. Bipolar disorder, manic
3. Bipolar disorder, mixed state
   
4. Cyclothymia
5. Schizophrenia

Question 3

The resident on call decides to start the patient on a medication to control this disease. The patient refuses the medication, stating that she has taken it in the past and it causes her to be constantly thirsty and break out in pimples and makes her food taste funny. Which of the following medications is being discussed?

1. Valproic acid
2. Haloperidol
   
3. Carbamazepine
4. Lithium
   
5. Sertraline

So doctors-to-be, what are the diagnosis?

Question 1: e, Uncomplicated bereavement

The loss of a loved one is often accompanied by symptoms reminiscent of major depression, such as sadness, weepiness, insomnia, reduced appetite, and weight loss. When these symptoms do not persist beyond two months after the loss, they are considered a normal manifestation of bereavement. A diagnosis of major depression in these circumstances requires the presence of marked functional impairment, morbid preoccupations with unrealistic guilt or worthlessness, suicidal ideation, marked psychomotor retardation, and psychotic symptoms.

Question 2: b, Bipolar disorder, manic

Mood elevation, mood lability, irritability, expansive behavior, increased energy, decreased need for sleep, lack of insight, poor judgment, disinhibition, impulsivity, and pressured speech are characteristic symptoms of elated acute mania. In more severe cases, mood-congruent delusional ideations and hallucinations are present.

Question 3: d, Lithium

Lithium is still the treatment of choice for acute mania and maintenance, although anticonvulsants such as valproate and carbamazepine have been proven effective. Newer anticonvulsants, such as gabapentin, topiramate, and lamotrigine, have also proved to have mood-stabilizing properties, although these medications have not been extensively studied yet. Weight gain, metallic taste, acne, hypothyroidism, and polyuria are common complaints with long-term lithium treatment.