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A 71-year-old man is three months into rehabilitation after a left middle cerebral artery infarct. He eats little and has lost 4 kg. He wakes at 4 am and cannot get back to sleep. His movements and his speech are slow, and he loses the thread of a conversation. He has stopped asking to go to the gymnasium. He is fully orientated and his alertness does not fluctuate. His wife says he tells her repeatedly that she should have let him die and that he has ruined the family. Which one of the following features most strongly supports a depressive illness rather than the expected effects of his stroke?
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