Omar is an eighteen year old university student who presents with a three week history of increasing depression. He says he feels as though he has no personal initiative or volition whatsoever.

He says he wakes early in the morning and ruminates over and over about his worthlessness. He has been constipated for over a week and has lost his appetite. He cannot identify any recent changes in his life to account for these feelings but is consumed by guilt because he knows he must be responsible.

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