A 37-year-old woman comes to the office due to frequent tearfu | Surgery collections Videos and quizez 2021

A 37-year-old woman comes to the office due to frequent tearfulness. The patient describes herself as "a happy person" at baseline but says that "about 6 months ago, I began to have more sad days than happy days." She frequently goes a week without leaving home and has to force
herself to eat and clean. The patient's father committed suicide at age 41, and her paternal grandfather is said to have died of a "mental disease" at age 49. The patient tearfully admits to thoughts of suicide but has no plans or intent. Temperature is 36.9 C (98.4 F), blood pressure is 121/77 mm Hg, pulse is 68/min, and respirations are 14/min. The patient has no subjective memory issues. She scores 25/30 on the Montreal Cognitive Assessment (normal: ;::26), losing points on measures of executive function. She appears restless during the examination, shifting frequently in her chair. The patient repeatedly raises her right arm in an abrupt, twisting motion that ends with smoothing her hair. Extraocular movement testing shows delayed initiation of voluntary saccades. Deep tendon reflexes are 3+ in both upper and lower extremities.