Reference no: EM133228007
Case:
Kevin, a 60 year old businessman, returned to see his longtime psychiatrist two weeks after the death of his 24 year old son. The young man, who had struggled with major depression and substance abuse, had been found surrounded by several emptied pill bottles and an incoherent suicide note.
Kevin had been very close to his troubled son, and he immediately felt crushed, like his life had lost its meaning. In the ensuing 2 weeks, he had constant images of his son and was "obsessed" with how he might have prevented the substance abuse and suicide. He worried that he had been a bad father and that he had spent too much time on his own career and too little time with his son. He felt constantly sad, withdrew from his usual social life, and was unable to concentrate on his work. Although he had previously drunk more than a few glasses of wine per week, he increased his alcohol intake to half a bottle of wine each night. At that time, his psychiatrist told him that he was struggling with grief and that such a reaction was normal. They agreed to meet for support and to assess the ongoing clinical situation.
Kevin returned to see his psychiatrist weekly. By the sixth week after the suicide, his symptoms had worsened. Instead of thinking about what he might have done differently, he became preoccupied that he should have been the one to die, not his young son. He continued to have trouble falling asleep, but he also tended to awake at 4:30 A.M. and just stare at the ceiling, feeling overwhelmed with fatigue, sadness, and feelings of worthlessness. These symptoms improved during the day, but he also felt a persistent and uncharacteristic loss of self-confidence, sexual interest, and enthusiasm. He asked his psychiatrist whether he still had normal grief or had a major depression.
Kevin had a history of two prior major depressive episodes that improved with psychotherapy and antidepressant medication, but no significant depressive episodes since his 30s. He denied a history of alcohol or substance abuse. Both of his parents had been "depressive" but without treatment. No one in the family had previously committed suicide.
Please indicate a diagnosis you would make at this time and what information was used to decide.
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