Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient is a 29 year old female presenting to the clinic for recent fatigue. She is in no acute distress, but is clearly upset and is crying. Her chief complaint is: “I just don’t feel like doing anything anymore.”
HPI: Mrs. Mason, a previously healthy 29 year old female, presents to the clinic with complaints of fatigue for the past 3 weeks. She states that approximately three weeks ago she began to “really blue”. She denies any precipitating events or and states that she has felt sad before, but “never anything this bad”. Mrs. Mason reports that during this time she has not felt like doing anything that she previously enjoyed like playing with her 3 year old daughter or going on walks with her husband. She states that nothing seems to make it any better or worse. Patient also states that she has not been able to sleep in the past 3 weeks or concentrate at work. When questioned, she tearfully admits to thinking about committing suicide this past week multiple times. She states that she did not have any specific plans, but admits that sometimes it feels as if life is just too much to handle and that her life “has no value”. She reports an unintended weight loss of 16 pounds in the past 3 weeks.
PMH/FMH: Non contributory
SH: Patient works as an accountant at a local marketing firm. She lives with her husband and 3 year old son. She reports drinking 1-2 glasses of wine each week, but no more than that. Denies any history or prior use of tobacco products or illicit drugs. Patient reports that she used to drink caffeine, but has stopped that in the last several weeks hoping to alleviate her inability to fall asleep.
PE: Non-contributory. Patient is alert and oriented X3. Mood is dysphoric and affect is congruent with this.