One More Question

December 20th, 2010 by gelenberg Leave a reply »

More than one senior colleague has advised me to include a family member as often as possible when interviewing a depressed patient. Often I’ve heard patients complain of sleeplessness or anhedonia, only to have a relative or friend present a very different picture. Such disparities should profoundly affect our diagnostic impressions and treatment decisions.

Yesterday there was only the resident and me in a room with a patient referred from a primary-care doctor for evaluation of depressive symptoms. The resident asked about low mood and anhedonia, both of which the man endorsed. But as I listened quietly, I thought I caught a spark of animation when the patient described some of his extracurricular interests. When it was my turn to ask a few questions, I inquired about what had given him pleasure over the past few days. Nothing, came the reply. There was no loved one to give collateral information, so I pursued an alternate tack. I asked the man about a few of his hobbies. As he described a team he played on and favorite spectator sports, he came alive, was engaged, passionate, and animated. His face lit up, and he smiled.  Our diagnosis and treatment recommendations shifted.

I enjoy the challenges of solving diagnostic puzzles. It’s one of the joys of medicine and psychiatry—and a reason ultra-brief visits can be costly in more ways than one.

- Alan J. Gelenberg, M.D.
Editor,
Biological Therapies in Psychiatry
Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief,
Journal of Clinical Psychiatry

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