Differential Diagnosis

The patient's presentation includes recent bereavement, weight loss, passive thoughts of wishing she were not around anymore, depressed affect, and a PHQ score of 9. Here's a differential diagnosis organized into the requested categories:

• Single Most Likely Diagnosis
  • Major Depressive Disorder (MDD): The patient's symptoms of depressed affect, weight loss, and passive suicidal ideation, combined with a significant life event (loss of her husband), are consistent with MDD. The PHQ score of 9 also supports this diagnosis, indicating moderate depression.
• Other Likely Diagnoses
  • Adjustment Disorder with Depressed Mood: Given the recent loss of her husband, the patient's symptoms could also be attributed to an adjustment disorder, which is characterized by a maladaptive reaction to a clearly identifiable stressful event.
  • Complicated Grief: The patient's grief following the loss of her husband could be considered complicated if her symptoms are intense and prolonged, significantly impairing her daily functioning.
• Do Not Miss Diagnoses
  • Suicidal Ideation/Intent: Although the patient reports passive thoughts of wishing she were not around, it's crucial to assess for any active suicidal ideation or intent, as this would require immediate intervention.
  • Underlying Medical Conditions: Certain medical conditions (e.g., hypothyroidism, anemia, chronic pain) can present with or exacerbate depressive symptoms. It's essential to rule out underlying medical causes for her weight loss and depressed mood.
• Rare Diagnoses
  • Dementia with Depressive Features: Although less likely, in an elderly patient, new-onset depression can sometimes be an early sign of dementia. Cognitive screening might be warranted, especially if there are concerns about cognitive decline.
  • Bereavement-related Psychotic Depression: A rare condition where grief triggers a psychotic episode, which could be considered if the patient exhibits psychotic symptoms alongside her depressive symptoms.

Each of these diagnoses should be considered in the context of a thorough clinical evaluation, including a detailed history, physical examination, and appropriate diagnostic tests to determine the underlying cause of the patient's symptoms.