Behavioral Science: USMLE Question No. 2

[Cardiac Arrest]

Note that this is a USMLE Step 1 Qs NOT step 2

2. A 29-year-old woman comes to the physician for a consultation 1 month after her 7-year-old daughter was killed in a motor vehicle collision. The patient is upset and restless and wrings her hands frequently. She cannot sleep at night, has lost her appetite, and cries easily and frequently. She is preoccupied with thoughts of her daughter and sometimes thinks she momentarily sees her daughter sitting in the living room. She says she wishes that she had been hit by the car, too. She denies any thoughts of killing herself. Which of the following is the best explanation for these findings?

(A) Dysthymic disorder
(B) Major depressive disorder
(C) Normal grief reaction
(D) Obsessive-compulsive disorder
(E) Schizoaffective disorder

[PeDiaTroN]

Originally posted by Cardiac Arrest
Note that this is a USMLE Step 1 Qs NOT step 2

2. A 29-year-old woman comes to the physician for a consultation 1 month after her 7-year-old daughter was killed in a motor vehicle collision. The patient is upset and restless and wrings her hands frequently. She cannot sleep at night, has lost her appetite, and cries easily and frequently. She is preoccupied with thoughts of her daughter and sometimes thinks she momentarily sees her daughter sitting in the living room. She says she wishes that she had been hit by the car, too. She denies any thoughts of killing herself.


Quite Complicated Case !!!

But If I were in that exam, I would have chose
Major depressive disorder

cuz : she feels worthless or let's say guilty,
& there is a risk of harming herself
also she's in delusions

but I'm also thinking about
OCD = cuz she wrings her hands frequently

I hope my answer is right .

[dr-kenzy]

salam ,

i think the answer is



(C) Normal grief reaction


and it become pathologic if symptoms with prolongation of the reaction beyond one year.

thanx .. Cardiac Arrest 4 ur effort ..

[Khajool]

Thank you my brother cardiac arrest

I agree your sister, major depressive disorder

Sleeping disturbance , lose appetite , guilty feeling & some psychotic symptoms ====> major depressive disorder
I think 15% of pt with depression have suicide thought , but not all.
this pt has no suicide idea


And about here hand ,I think somatic symptome which also occure with depression



THANK YOU VERY MUCH
I WAIT MORE QS

[Cardiac Arrest]

The correct answer is C. The woman in the question is experiencing a normalgrief reaction 1 month after the traumatic loss of her daughter. Uncomplicated bereavement may last for up to 3 months (longer for close relations, and in some cultures), and is typically characterized by the type of symptoms described in the question stem.

Dysthymic disorder (choice A) is characterized by a depressed mood that lasts most of the day for the majority of time over a 2-year period, with the additional qualification that no major depressive episodes have occurred during that period.

Major depressive disorder (choice B) is characterized by the occurrence of at least one major depressive episode (depressed mood, loss of interest in everyday activities, anhedonia, feelings of worthlessness, etc.), and no manic or hypomanic episodes. Because the woman is experiencing depression secondary to the loss of a loved one, the diagnosis of major depressive episode does not apply and major
depressive disorder is ruled out.

In obsessive-compulsive disorder (choice D), patients experience recurrent, intrusive thoughts (obsessions) that are relieved, to some extent, by engaging in repetitive, ritualistic behaviors (compulsions).

Schizoaffective disorder (choice E) is a psychotic disorder with prominent affective symptoms. There is no evidence to support a diagnosis of psychosis in this woman.

[Dr.wrood2004]

hi All

its really a nice case dr. cardiac arrest

:)

i tried to answer it before i see the anser and hamdullah i got the answer

thanks

[snak]

very good case
plzzz we need more question about behavior

[uday]

Is high yield behavior sc good?

[f_ameer376]

thanx a lot