An 80-year-old woman comes to the office to request a prescr…
Questions
An 80-yeаr-оld wоmаn cоmes to the office to request а prescription for an antidepressant. Over the past 2 months she has been sleeping poorly, and her appetite has decreased. She describes feeling miserable all the time, crying often, and fighting with everybody. She has no somatic symptoms. History includes obesity, hypothyroidism, osteoarthritis, and longstanding bipolar disorder. Medications include levothyroxine and acetaminophen as needed. She has been asymptomatic off medication for bipolar disorder for 2 years; shortly before she stopped, she experienced lithium toxicity and was hospitalized. The patient and her family believe that the bipolar disorder has abated because of her age. Physical examination is unremarkable. She appears restless, starts to talk of a new hobby, but then switches topic. There is a substantial change from her baseline cognition: she is not sure of the date, and she makes mistakes about events that are familiar to her. CBC and basic chemistry panel are within normal limits. During the past week, she has become increasingly tearful, confused, and restless. Which of the following is most likely to be true?