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NBME 21 Answers

nbme21/Block 2/Question#18

A 34-year-old woman comes to the physician because ...

“I’m concerned about how bad you’ve been feeling lately. Have you had any thoughts about death or wanting to be dead?”

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 +4  upvote downvote
submitted by yotsubato(282),

Well thats a really crude way to screen for depression...

champagnesupernova3  There's really no other way to say it without using euphemisms +  

 +2  upvote downvote
submitted by neonem(263),

This is a postpartum mood disturbance, a pretty common disorder that has to have an onset within 4 weeks of delivery to be termed as such. Postpartum blues is the most mild, with a 50-85% incidence rate (per FA 2018), usually resolves within 10 days and treatment is only supportive but need to follow-up to assess for possible postpartum depression. Postpartum depression = 10-15% rate, characterized by depressed affect, anxiety, poor concentration for greater than 2 weeks and needs to be treated w/ CBT + SSRI. I think the question is getting at screening for this and a potentially more problematic complication, postpartum psychosis.

thisisfine   Found this difficult because FA characterizes "thoughts of harming baby or self" as postpartum psychosis - which is super rare, and doesn't fit this case. Also, CBT is first line treatment for postpartum depression - so I still like the offer to refer to a therapist as the best choice. +1  
d_holles  Same @thisisfine. +1  
chandlerbas  i see what youre saying but we should make sure that the mother is alive for us to refer to a therapist. remember if shes willing to harm herself most likely also willing to harm the the little cutie baby....so asking for suicidal thoughts screens for progression to post partum psychosis with the aim to prevent the sentinel event: harm to the baby +  

what I got from this question: NEVER (99% of the time) refer a patient to see anyone