Journal of General Internal Medicine

, Volume 22, Issue 5, pp 677–680

A Shot in the Dark: Failing to Recognize the Link Between Physical and Mental Illness

  • Tammy R. Copsey Spring
  • Leanne M. Yanni
  • James L. Levenson
Case Reports/Clinical Vignettes

DOI: 10.1007/s11606-006-0089-9

Cite this article as:
Copsey Spring, T.R., Yanni, L.M. & Levenson, J.L. J GEN INTERN MED (2007) 22: 677. doi:10.1007/s11606-006-0089-9

A 74-year-old widowed white man with chronic rheumatoid arthritis presented with nausea and weight loss. He was diagnosed with failure to thrive and admitted for hydration. Misoprostol was determined to be the etiology of his symptoms and he was discharged home. Three days later, he killed himself with a gunshot to the head. Clinicians often fail to recognize those at high risk for suicide. Suicidal risk is increased in both psychiatric and physical illness, and particularly when both are present. Psychiatric illness, particularly depression, often underlies chronic medical illness. The purpose of this case report is to remind health care providers of the strong association between depression and chronic medical illness, and to consider this in all patients, including those who present solely with physical symptoms. Recognizing this association and screening for it, as recommended by the U.S. Preventive Services Task Force, may prevent the unnecessary tragedy of suicide.

Key words

depression chronic disease risk assessment screening 

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Tammy R. Copsey Spring
    • 1
  • Leanne M. Yanni
    • 1
  • James L. Levenson
    • 2
  1. 1.Division of General Internal MedicineVirginia Commonwealth University (VCU) Medical CenterRichmondUSA
  2. 2.Department of PsychiatryVirginia Commonwealth University (VCU) Medical CenterRichmondUSA

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