A 52-year-old woman presents to her primary care physician 8 weeks after her husband's death from myocardial infarction. She reports experiencing daily headaches described as a tight band around her head, occurring unpredictably without associated nausea, photophobia, or vision changes. She denies suicidal ideation, appetite changes, or sleep disturbance beyond occasional insomnia related to grief. Vital signs are normal. On examination, she becomes tearful when discussing her husband and expresses feelings that "life feels empty" and worries about managing finances alone. She states these feelings are most intense when she encounters reminders of him but she is able to attend to her job responsibilities. There is no personal or family history of psychiatric illness. Which of the following is the most appropriate next step?
- A)Provide empathic listening, validate her grief response, and schedule a follow-up visit in 2-4 weeksGABARITO
- B)Initiate a selective serotonin reuptake inhibitor for depression
- C)Refer to psychiatry for evaluation of major depressive disorder
- D)Prescribe a tricyclic antidepressant for migraine prophylaxis and mood support
- E)Refer for immediate neuroimaging to exclude secondary causes of headache
Explicação
This patient is experiencing normal bereavement at 8 weeks post-loss. Key features supporting normal grief include: absence of suicidal ideation, preserved functional capacity at work, emotional reactivity tied to grief triggers, and symptom onset directly rel... Ver explicação completa e trilha adaptativa →