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Answer 5
  1. High This patient likely has masked depression, which presents with a denial of feeling sad or depressed. Multiple somatic complaints are common in masked depression. The suicide rate increases dramatically in patients older than 65 years, especially in white males.3 Therefore, elderly patients with depression must be evaluated carefully for suicide risk. Psychiatric referral is not necessary to evaluate suicide risk. Dementia should be considered in the differential diagnosis; however, pseudodementia is more likely in this patient. Pseudodementia is a result of cognitive impairment from depression and is a common feature of masked depression.

    3. American Psychiatric Association. Diagnostic and statistcal manual of mental disorders. 4th ed., text rev. Washington (DC): The Association; 2000.

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