Question 234

Question:

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, 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?

Correct Answer: C.  Normal grief reaction

Normal grief reaction, an emotional response to loss lasting up to 6 months, is characterized by feelings of physical pain, distress, and physical and emotional suffering. It may include symptoms such as diminished appetite, difficulty sleeping, restlessness, anhedonia, auditory and visual hallucinations, and feelings of guilt.

Although patients suffering from a normal grief reaction may be depressed, the diagnosis of major depressive disorder is reserved for a small subset with generalized feelings of hopelessness, helplessness, worthlessness, and guilt that persists for more than 6 months.

Dysthymic disorder has some features of major depressive disorder (anhedonia, sleep disturbance, etc.) but usually does not last as long and is not as disabling.

Obsessive-compulsive disorder is a mood disorder that involves distressing, intrusive thoughts (obsessions), and the ritualized repetitive behaviors (compulsions) sometimes employed to ward them off.

Schizoaffective disorder comprises features of both schizophrenia and a mood disorder, and may include delusions, disorganized thinking and/or speech, and manic and/or depressive episodes.