A 64-Year-Old Retired Man With Low Motivation and Fatigue

Heidi Moawad, MD


September 08, 2023

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 64-year-old man reports that he has had decreased motivation for several years. He has never sought medical attention for this problem before. His wife of 42 years and his adult daughter, who have accompanied him to the office visit, think he needs counseling or therapy for depression.

The patient has not worked for about 5 years since he accepted an early retirement offer from his long-time employer. He sleeps for approximately 10-12 hours a day. Although his wife likes to cook healthy meals, he primarily eats junk food on an irregular schedule. He explains that he has difficulty eating because he often feels bloated. During the past year, he has begun to have frequent constipation, which he attributes to his unhealthy diet.

He does not exercise and rarely participates in family gatherings because he is often tired. He denies feeling sad or hopeless, but he explains that he has low motivation.

The patient received a diagnosis of type 2 diabetes at age 49 years. After that diagnosis, he was able to control his blood glucose level with diet and weight loss; however, he regained the weight. Recently, he has been taking metformin, with reasonably good blood glucose control.

The patient does not smoke, drink alcohol, or use any illicit drugs. He had previously smoked when he was in his 20s but stopped when he realized that it would be unhealthy to smoke in the presence of his young children.


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