Grief/depression -

[ArchivalUser]

FFF

Bill is that Question from the Kaplan CD?? i think the answer was A. Could u please put explanation if u have it. I still agree that he needs antidepressive medication.

Please check!

[ArchivalUser]

bill

The answer is E and explanation follows:

The best treatment for uncomplicated bereavement is support from family and friends. Eventually, the symptoms improve, and the patients are able to go on with their lives.

Antidepressants (Choice A) should not be prescribed for acute grief but should be reserved for a possible subsequent major depression.

[ArchivalUser]

FFF

Bill thats very weird, which year version is your Kaplan CD??

I have the 2003 version of the simulated test (Kaplan's) and it says the following:

"The correct answer is A. Antidepressant medication is indicated because this patient seems to have major depression"

The other choices explanations:
"Long term psychodynamic psychotherapy is not indicated for a normal grief response.
A neuroleptic medication would be not of any benefit.
The best treatment for uncomplicated bereavement is support from family and friends. Eventually, the symptoms improve and patients are able to go on with their lives.
Supportive psychotherapy may be helpful if symptoms of bereavement become extended, but it is not recommended after only 4 weeks of grief."

The question is #18 from block 4 in my CD, in fact this vignette was 2 part question, and question before (#17) the correct answer was major depressive disorder and NOT normal bereavement.

So please clarify this so we could get a clear understanding

[ArchivalUser]

bill

Probably the source corrected the answers and explanations later on. Your answer and explanation should be right then.

[ArchivalUser]

Sunny

bill , FFF do you both agree that your source is same and q is also smae, and tstill the answers are different?

[ArchivalUser]

brian

1. Criteria to diagnose Major Depression
1. Two weeks of symptoms
1. One of the first two symptoms in Cluster 2
2. Four of the remaining symptoms
2. Significantly impaired social and occupation function
3. No secondary causes
1. No Bereavement
2. Not caused by general medical illness
3. Not a result of medication use
4. Not a result of Alcohol Abuse or Drug Abuse
2. Cluster 1:
1. Sleep Disturbance
2. Appetite or weight change
3. Attention or concentration problem
4. Energy level change or Fatigue
5. Psychomotor disturbance
6. Feeling of guilt
7. Suicidal thoughts
3. Cluster 2:
1. Depressed mood
2. Reduction in pleasure or interest ( anhedonia)


The patient has feeling of guilt, sleep disturbance, weight loss, irritability, concentration difficulty, but he doesn't have depressed mood nor anhedonia so he doesn't meet the criteria for major depression. Besides, there's an stressor event. So I think he is more likely having bereavement. And treatment is supportive.

[ArchivalUser]

FFF

Brian, according to Kaplan's explanation for this being major depressive disorder is the following:

""Distinguishing grief or bereavement from a major depressive episode can be difficult. In major depression, the intense symptoms usually last longer than 1-2 months; suicidal ideations may be present, as well as continous depressed mood. Additionally, grief usually responds to support from others, whereas depression usually does not. Criteria for a major depressive episode include: a 2 week period in which 5 of the following symptoms are present, in which at least one of the symptoms is either depressed mood or loss of interest or pleasure:
- Depressed mood
- Inability to experience pleasure or markedly diminished interest in pleasurable activity.
- Appetite disturbance (more than 5% change in body weight within 1 month)
- Sleep disturbance
- Psychomotor disturbance
- Fatigue or loss of energy
- Feelings of worthlessness or excessive inappropiate guilt
- Diminished ability to concentrate
- Recurrent thought of death or suicidal ideations

In normal grief the intensity of symptoms gradually abates, so that by 1 month after the death, the mourner should be able to adequately sleep, eat, and function at work and at home. Crying and feelings of longiness and emptiness do not disapear but are less intrusive. By 6-12 months, most normal life activities will have been resumed.""

I think he sure has a depressed mood, he even has social withdrawn from friends, and was once known a normal social person.

[ArchivalUser]

brian

If you think social withdrawal is depression so the diagnosis is major depression. But I'm not sure that depression mood identifies with social withdrawal. How can you convince me?

[ArchivalUser]

FFF

Brian, this question isnt worth continuing discussing, i think Kaplan planned this question in a bad way that could go either way, and i hope and think that USMLE doesnt put this kind of ambigous question, just because of different interpretations, i think a case needs clearly be either normal bereavement/grief or major depressive disorder and not such as confusing as this one. And i sure wont continue trying to convince u as i already explained. I think even a psychiatrist would have trouble with this question.

[ArchivalUser]

brian

Cool :-)