14th February 2025

An 86-year-old gentleman with hypercholesterolaemia, heart failure after an NSTEMI and gout, presents to A&E with a worsening 3-month history of low mood, suicidality, agitation, and believing that he caused the coronavirus pandemic.

An 86-year-old gentleman with hypercholesterolaemia, heart failure after an NSTEMI and gout, presents to A&E with a worsening 3-month history of low mood, suicidality, agitation, and believing that he caused the coronavirus pandemic. He regularly takes atorvastatin, ramipril, aspirin, bisoprolol, furosemide and allopurinol.

He has been dwelling on the past, feeling guilty that he was unfaithful in a previous marriage. He has been eating poorly and lost 10 kg in weight. His family reaches a crisis point when he threatens his wife with a pair of scissors.

Observations: RR 14, SaO2 99% on room air, BP 101/56, HR 62, T 36.9

After blood tests and a CT head he is medically cleared and referred to the mental health liaison team.

Which is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.