Put your knowledge and skills to the test with the case of a 64 year old man who presents as tearful and depressed, and states he is "tired" of his family issues and medical conditions and has been feeling this way for the last year, but increasingly so in the last few days. While the patient explains that 3 of his children are affected by substance abuse and relationship problems, he is particularly fixated on one of his daughter's partners who struggles with addiction and also abuses her and her children. The patient describes a plan to shoot this man and then kill himself.
During his visit, the patient also describes a complex medical history including: poorly controlled type 2 diabetes, a stroke 18 months ago that resulted in left homonymous heamianopsia and vertical gaze paralysis, adenocarcinoma in the colon that was treated surgically, as well as cryptogenic cirrhosis, splenomegaly and portal gastropathy. At the time he presents his serum glucose is 650 mg/dL (36 mmol/L) and his A1C is 10.9%.
The patient does not endorse any symptoms of psychosis, and denies any personal or family psychiatric history, or personal history of substance abuse. While he is alert and oriented, his judgment and insight are found to be impaired.
Can you come up with a diagnosis or treatment plan?
"Diabetic and Depressed'" by Magdalena Romanowicz, Christopher L. Sola, and John H. Davidson (Current Psychiatry).
During his visit, the patient also describes a complex medical history including: poorly controlled type 2 diabetes, a stroke 18 months ago that resulted in left homonymous heamianopsia and vertical gaze paralysis, adenocarcinoma in the colon that was treated surgically, as well as cryptogenic cirrhosis, splenomegaly and portal gastropathy. At the time he presents his serum glucose is 650 mg/dL (36 mmol/L) and his A1C is 10.9%.
The patient does not endorse any symptoms of psychosis, and denies any personal or family psychiatric history, or personal history of substance abuse. While he is alert and oriented, his judgment and insight are found to be impaired.
Can you come up with a diagnosis or treatment plan?
"Diabetic and Depressed'" by Magdalena Romanowicz, Christopher L. Sola, and John H. Davidson (Current Psychiatry).
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