An 82 year old woman, whose husband passed away 6 weeks ago after a long illness, is admitted to the hospital for worsening of her cardiac problems. During the hospital stay, a psychiatrist is invited to consult at the request of her daughters. The daughters think their mother is depressed, because she is tearful, often talks about her dead husband, and states that she had heard his voice several times. She blames herself for not having gone with him on his last visit to his sister, and she stas crying. She has never seen a psychiatrist before and has been "strong" all her life. Which of the following is the most likely diagnosis?
A normal or uncomplicated grief reaction after the loss of a beloved person may resemble depression in some ways (e.g., changes in sleep or appetite, sadness, withdrawal). However, as the loss becomes remote, the grief-stricken person is able to re- experience joy. Self-blame is focused on what was not done in relation to the deceased person. Illusions or hallucinations of the deceased person are common. The uncomplicated grief reaction can last several months, or longer, depending on the relationship to the deceased. Depression secondary to a general medical condition can be seen in association with cardiopulmonary disease, among other disorders; however, since the symptoms are related to the precipitating event, one would have to wait till the normal grief is resolved and then reassess the presence of symptoms of depression. The main diagnostic criterion of dysthymia involves milder symptoms of depression occurring every day for at least 2 years. Major depressive disorder can be precipitated by the loss of a beloved person, but it has a distinct quality even though some symptoms are the same. Suicidal ideation, guilt related to the person alone and not to the deceased person, and feelings of wohlessness are common. Significant functional impairment is typical. Ref: Ropper A.H., Samuels M.A. (2009). Chapter 24. Fatigue, Asthenia, Anxiety, and Depressive Reactions. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.
Depression secondary to general medical condition
Dysthymia
Grief reaction
Major depressive disorder