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Delirium in depression mimic — MCCQE Part 1 MCQ

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HardCognitive ChangeDelirium in depression mimicMCCQE Part 1

A 74-year-old man is brought for low mood and poor appetite after his wife's death. During the interview he is disoriented, cannot sustain attention, and symptoms fluctuate over hours. He was started on diphenhydramine for sleep 3 days ago. What is the most likely diagnosis?

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Correct answer: E — Delirium

Fluctuating inattention and disorientation over hours indicate delirium, with diphenhydramine as a possible anticholinergic precipitant. Grief and depression can impair concentration but should not cause fluctuating consciousness and disorientation. Dementia usually develops more gradually.

Reference: Canadian Coalition for Seniors' Mental Health delirium guidance