A 52-year-old woman comes to the office for a checkup. Her medical problems include hypertension and hypercholesterolemia. The patient has a long-standing relationship with her primary care physician, who has treated her children as well. During the examination, she confides that she has been "down" since her youngest child left for college 2 months ago. The patient is worried about her daughter being away from home for the first time and whether she will be successful at school. At work, the patient occasionally has lapses of concentration when worrying about whether her daughter is okay, but it has not affected her productivity. She says, "I still enjoy going out with my husband but all we do is talk about our kids." The patient has occasional insomnia and tension headaches but notes that these are nothing new. Physical examination is normal. Which of the following is the most likely explanation for this patient's condition?

Question

A 52-year-old woman comes to the office for a checkup.  Her medical problems include hypertension and hypercholesterolemia.  The patient has a long-standing relationship with her primary care physician, who has treated her children as well.  During the examination, she confides that she has been "down" since her youngest child left for college 2 months ago.  The patient is worried about her daughter being away from home for the first time and whether she will be successful at school.  At work, the patient occasionally has lapses of concentration when worrying about whether her daughter is okay, but it has not affected her productivity.  She says, "I still enjoy going out with my husband but all we do is talk about our kids."  The patient has occasional insomnia and tension headaches but notes that these are nothing new.  Physical examination is normal.  Which of the following is the most likely explanation for this patient's condition?

Quizplus · Accepted Answer

11ec160b_35fd_0c2d_9249_53c6729f61c2_MD0001_00 Periods of sadness are a normal part of human experience and should not be diagnosed as a psychiatric disorder unless criteria are met for severity, duration, and clinically significant distress or impairment. This patient's mild depression in response to life changes is consistent with normal sadness. She does not meet the full criteria for any disorder. In addition, her insomnia and headaches are no different from her baseline. Significantly, her social and occupational functioning is not impaired, which is a DSM-5 requirement for the diagnosis of most psychiatric disorders, including adjustment disorders. (Choice A) Adjustment disorder involves the development of anxiety and/or depression symptoms within 3 months of the onset of the stressor with associated marked distress (exceeding what would normally be expected) and/or significant functional impairment. (Choice B) The duration and severity of this patient's worry about her daughter are not sufficient for a diagnosis of generalized anxiety disorder. This disorder requires ≥6 months of excessive worry and anxiety about multiple issues. (Choices C and E) A diagnosis of major depressive disorder requires a 2-week period of ≥5 of 9 symptoms; depressed mood, decreased interest/pleasure, appetite disturbance, sleep disturbance, psychomotor agitation/retardation, loss of energy, excessive guilt, impaired concentration, and suicidal ideation. In persistent depressive disorder, depressive symptoms last ≥2 years. Educational objective: Evaluation of depressive symptoms occurring in response to psychosocial stressors must take into account the severity, duration, and degree of functional impairment. Mild or brief sadness without significant interference in psychosocial functioning is consistent with normal sadness. __________ References: Uncomplicated depression is normal sadness, not depressive disorder: further evidence from the NESARC. (http://www.ncbi.nlm.nih.gov/pubmed/25273307) Depression and the medicalization of sadness: conceptualization and recommended help-seeking. (http://www.ncbi.nlm.nih.gov/pubmed/22187003)

A 52-Year-Old Woman Comes to the Office for a Checkup