Match each patient's clinical presentation with the most appropriate next step in management or specific therapeutic intervention.
- An elderly individual in an acute severe depressive episode who is actively refusing food and fluids, presenting with severe dehydration and delusions of guilt.Electroconvulsive therapy
- A young adult presenting with profound sadness and psychomotor retardation, whose history includes a prior distinct episode of grandiosity, decreased need for sleep, and pressured speech lasting six days.Quetiapine monotherapy
- A patient with major depressive disorder who has shown only a partial response to an adequate 8-week trial of escitalopram, with persistent residual symptoms of fatigue and low motivation.Augmentation with bupropion
- A healthy professional with a first-time episode of mild major depressive disorder who explicitly declines the use of any psychotropic medications.Cognitive behavioral therapy
Answer
The clinical presentations map to their respective best management steps: the food-refusing elderly patient requires electroconvulsive therapy; the patient with past mania needs quetiapine monotherapy; the partial SSRI responder with fatigue benefits from bupropion augmentation; and the medication-averse patient should receive cognitive behavioral therapy.
Each matching pair accurately aligns the patient's unique clinical context (e.g., life-threatening symptoms, bipolar history, medication side effect profile, personal preference) with current psychiatric treatment guidelines.
Step-by-Step Solution
Key Concept
Treatment selection in depressive disorders depends heavily on illness severity, the presence of psychotic or bipolar features, prior treatment responses, and patient preference.