DIAGNOSTIC DILEMMAS IN PSYCHIATRIC-CONSULTATION LIAISON - THE PROBLEMOF DEPRESSION

We use the case of a 62-year-old retired widow, referred for psychiatr ic evaluation by the internal medicine house staff, to illustrate the complexities of diagnosing depressive syndromes in medically ill patie nts. The patient's presenting symptoms included diarrhea, severe weigh t loss, and abdominal pain. She appeared cachectic, but diagnostic fin dings did not account sufficiently for the degree of weight loss obser ved. When symptoms failed to resolve, the psychiatric consultation was requested. Chronic cognitive symptoms, including feelings of guilt, a nhedonia, and hopelessness, were noted. These symptoms had been presen t since the death of the patient's sister 2 years earlier. This case s hows the importance of processing clinical data carefully to include b oth medical and psychiatric symptoms. It also reveals the need for an ongoing evaluation to gather significant information so the diagnosis can be solidified, allowing more specificity in planning treatment: