insomnia of 3-month duration

Mental health disorders

A 38-year-old woman presents to the office with complaints of weight

loss, fatigue, and insomnia of 3-month duration. She reports that she has

been feeling gradually more tired and staying up late at night because

she can’t sleep. She does not feel that she is doing as well in her occupation

as a secretary and states that she has trouble remembering things.

She does not go outdoors as much as she used to and cannot recall the

last time she went out with friends or enjoyed a social gathering. She

feels tired most of the week and states she feels that she wants to go to

sleep and frequently does not want to get out of bed. She denies any

recent medication, illicit drug, or alcohol use. She feels intense guilt

regarding past failed relationships because she perceives them as faults.

She states she has never thought of suicide, but has begun to feel increasingly

worthless.

Her vital signs and general physical examination are normal, although

she becomes tearful while talking. Her mental status examination is significant

for depressed mood, psychomotor retardation, and difficulty attending

to questions. Laboratory studies reveal a normal metabolic panel, normal

complete blood count, and normal thyroid functions.

➤ What is the most likely diagnosis?

➤ What is your next step?

➤ What are important considerations and potential complications of

management?