Master the board step 3

Master the Boards: USMLE Step 3
Grief and Depression
Grief
Depression
Sadness, tearfulness, decreased sleep, decreased appetite, decreased interest in the world
Symptoms wax and wane
Shame and guilt are less common
Suicidal ideation is less common
Symptoms can last up to 1–2 years
Patient usually returns to baseline level of
functioning within 2 months
Treatment includes supportive therapy
Symptoms are pervasive and unremitting
Shame and guilt are common
Suicidal ideation is more common
Symptoms continue for more than 1 year
Patient does not return to baseline functioning
Treatment includes antidepressant medications
A 32-year-old woman who gave birth 4 months ago is brought in by her husband
because of depressed mood. The husband reports that she has been depressed
since the birth of her child, refuses to eat, has trouble sleeping, and is unable
to concentrate. The woman reports that she has lost interest in everything and
sometimes can’t even get out of bed. She reports that she’s recently had visions of
seeing her deceased mother talking to her and criticizing her skills as a new mother.
She also admits that she hears her voice talk to her constantly too. She denies
homicidal or suicidal ideation. Which of the following is the best initial treatment?
a. Psychotherapy
b. Behavioral therapy
c. Sertraline
d. Risperidone
e. Phenelzine
Answer: D. Patients with both mood and psychotic symptoms respond to both
antidepressants and antipsychotic medication. However, you must treat the worst
symptom first. In this case, the antipsychotic would be most indicated to reduce her
psychotic symptoms.
A 45-year-old woman presents 2 months after the sudden loss of her son in a car
accident. She reports “not being able to cope well.” She is constantly teary, has
lost her appetite, and has decreased 2 dress sizes. She finds herself laying out a
dinner plate every night for him. Recently, she believes she has heard his voice and
every night she has nightmares about the car accident. She denies suicidal ideation.
Which of the following is the most appropriate next step in management?
a. Group therapy
b. Amitriptyline
c. Fluoxetine
d. Zolpidem
e. Supportive therapy
Answer: E. This patient is undergoing normal grief reaction. Auditory hallucinations
without other psychotic symptoms are normal in grief reaction.
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