13 May Rita is an 18-year-old who presents to the emergency department with her parents after telling them earlier in the day that she did not want to be alive anymore.
Case scenario:
Rita is an 18-year-old who presents to the emergency department with her parents after telling them earlier in the day that she did not want to be alive anymore. Rita reports that for the past 6 months she has been “feeling down,” and she has been having thoughts of killing herself throughout the last week. She has a plan to kill herself that involves taking all of the medications in her family’s medicine cabinet.
Rita says that in the past 6 months she also has experienced a decrease in energy, saying that “it feels like I’m never able to sleep.” Her parents tell you that she was previously on the track team at her school, and that she stopped going to practice 2 months ago because she “didn’t see the point” any longer.
Despite quitting the track team, the patient reports a weight loss of 5 pounds in the past 6 months because of a decrease in her appetite. She denies fevers, chills, dizziness, lightheadedness, headache, vision changes, chest pain, palpitations, shortness of breath, cough, abdominal pain, nausea, vomiting, dysuria, auditory hallucinations, and visual hallucinations. She has no significant past medical, surgical, or psychiatric history. Upon further interview, Rita denies any history of substance use, any history of manic or hypomanic symptoms, or any identifiable recent life stressors.
Her laboratory results reveal no abnormalities in thyroid-stimulating hormone levels, comprehensive metabolic panel, or complete blood count. Her urine drug screen is negative. Vital signs show her blood pressure is 102/70 mm Hg, respiration rate is 15/min, heart rate is 72/min, and temperature is 37.1 °C (98.8 °F).
What is the diagnosis for Rita?
What is the possible differential diagnosis?
What other medical conditions can cause depressive symptoms?
What are the diagnostic criteria for major depressive disorders?
What are the evidence-based treatment options for major depressive disorders?
Will you recommend inpatient hospitalization for Rita? Explain why or why not?
What are the ethical considerations for involuntary hospitalization?
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