nbme 4 b4 q6 - stranger016

[ArchivalUser]

A 42-year pld woman comes to the physician b/c of decreased energy, apathy and difficulty sleeping since being fired from her job 3 weeks ago.Since then, she has awakened at 4 AM daily and has been unable to fall back asleep.She also has crying spells every morning.During the past 6 months, she has had a 3.2-kg(7-lb) weight loss.She has no history of serious illness and takes no medications.Her father committed suicide at the age of 52yrs.The Patient is 170 cm(5ft 7in) tall and weighs 69Kg(152 lb);BMI is 24Kg/m2.Physical exam shows no abnormalities. On mental status exam, she is sad and tearful.Her speech is soft and goal directed.She says that she has not thought about suicide and does wan to die.Lab findings ,including CBC, serum electrolyte concetrations and serum thyroid stimulating hormone concentration, are within reference range. Which of the following is the most app. next step in managment?

A)Psychodyamic psychotherapy
B)Citalopram
C)Lithium carbonate therapy
D)Zolpidem Therapy
E)Electroconclusive therapy


Isnt this adjustment disorder????

[ArchivalUser]

ssri I guess. lithium for bipolar- no. psycho therapy- sure but that wont help her today, ect- not yet zolpidem-- not helpful for maintaining sleep, just initiation

so ssri? citalopram?

[ArchivalUser]

but what is the diagnosis??

[ArchivalUser]

PTSD ? after job loss.

[ArchivalUser]

B. Diagnosis is Major depressive disorder : Sleep disturbance, Appetite change (wt loss ), depressed mood, loss of Energy)

[ArchivalUser]

for major depressive disorder
it should be depressed mood or anhedonia+ any 4 of the SIGECAPS(this stem has depressed mood+only 3)so
i think the diagnosis here is adjustment disorder then why not consider psychotherapy????

[ArchivalUser]

One question- does she wanna or she doesnt wanna die??

[ArchivalUser]

nope, she does not has suicidal ideation clearly mentioned in the stem