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?
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?
💡 Explanation
**Core Concept**
The question requires the identification of a psychiatric disorder in an elderly woman experiencing grief and emotional distress following the loss of her husband. The underlying principle being tested is the differentiation between normal bereavement and a psychiatric disorder, specifically Major Depressive Disorder (MDD) with psychotic features.
**Why the Correct Answer is Right**
The patient's symptoms, including tearfulness, preoccupation with her dead husband, hearing his voice, self-blame, and guilt, suggest a depressive disorder. The presence of psychotic features, such as hearing her husband's voice, is a red flag for a more severe depressive disorder. This is consistent with Major Depressive Disorder with psychotic features, which is characterized by the presence of one or more psychotic symptoms (e.g., hallucinations, delusions) in addition to depressive symptoms. The patient's age, recent loss, and lack of previous psychiatric history also support this diagnosis.
**Why Each Wrong Option is Incorrect**
**Option A:** Adjustment Disorder is a less severe condition that is typically characterized by a shorter duration of symptoms and a more direct response to a stressful event. The patient's symptoms and duration suggest a more severe disorder.
**Option B:** Dementia with Depressive Features is unlikely, as there is no mention of cognitive decline or memory loss, which are typical features of dementia.
**Option C:** Post-Traumatic Stress Disorder (PTSD) is not the primary diagnosis, as the patient's symptoms are not related to a traumatic event but rather to a loss.
**Clinical Pearl / High-Yield Fact**
It's essential to differentiate between normal bereavement and a psychiatric disorder in elderly patients, as the latter requires timely treatment to prevent complications and improve outcomes.
**Correct Answer:** C. Major Depressive Disorder with Psychotic Features
✓ Correct Answer: C. Grief reaction
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