American Board of Internal Medicine (ABIM) Certification Practice Exam

What distinguishes depression from anticipatory grief in terminally ill patients?

1. Feelings of excitement

2. Feelings of guilt and hopelessness

3. Thoughts of recovery

4. Increased social activity

The correct answer is: Feelings of guilt and hopelessness

Depression in terminally ill patients is characterized by pervasive feelings of sorrow, guilt, hopelessness, and worthlessness that extend beyond the context of the illness itself. These feelings can interfere significantly with a person's ability to function and often require clinical intervention. In contrast, anticipatory grief is a natural response to the prospect of loss, experienced by patients and their families as they prepare for the impending death. While it can certainly involve sadness and emotional pain, anticipatory grief is typically accompanied by moments of hope and may lead to a range of emotions, including acceptance and eventual resolution. The presence of guilt and hopelessness specifically points to the persistent and debilitating emotions seen in depression, which can manifest as disinterest in life or feelings of despair about one's situation. These feelings distinguish depression from anticipatory grief, as the latter can offer moments of connection to others and a sense of purpose in preparing for an eventual loss, which may not be present in depressive episodes. Other options do not accurately reflect the key emotional and psychological differences between the two states. Feelings of excitement usually do not pertain to either condition. Thoughts of recovery may arise in an anticipatory period but are not typically associated with clinical depression. Lastly, increased social activity can sometimes be seen in anticip