Quiz or MCQ

A 59-year-old woman, who was diagnosed with advanced lung cancer 3-months ago, has lost 20 pounds, wakes frequently during the night, and has very little energy. Over the past month she has been preoccupied with feelings of guilt about “people I have hurt in my life” and expresses concern that she will die in pain. The sign or symptoms most likely to indicate that this patient is experiencing a major depressive episode rather than a normal reaction to serious illness is
A. weight loss
B. difficulty sleeping
C. decreased energy
D. concern about dying in pain
E. preoccupation with feelings of guilt