Match each patient's clinical presentation with the most appropriate next step in pharmacological or procedural management.
- A 72-year-old man with a 6-week history of severe depressed mood, a 15-lb (6.8-kg) weight loss, and the steadfast conviction that his intestines are rotting as a punishment for past sins. He is currently refusing all food and fluids.Electroconvulsive therapy
- A 55-year-old man with a 4-month history of pervasive sadness, anhedonia, and poor concentration, accompanied by a 2-year history of bilateral, symmetrical burning pain in his lower extremities due to poorly controlled diabetes mellitus.Duloxetine monotherapy
- A 28-year-old woman presenting with severe depression and psychomotor retardation. Chart review reveals a past emergency department visit three years prior for a two-week period of decreased need for sleep, pressured speech, and reckless spending.Quetiapine monotherapy
- A 45-year-old woman with major depressive disorder who reports a partial (50%) improvement in symptoms after 8 weeks of escitalopram at the maximum tolerated dose. She continues to struggle with residual fatigue but denies suicidal ideation.Aripiprazole augmentation
Answer
The 72-year-old man with psychotic depression and food refusal matches with Electroconvulsive therapy. The 55-year-old man with depression and diabetic neuropathy matches with Duloxetine monotherapy. The 28-year-old woman with a history of mania matches with Quetiapine monotherapy. The 45-year-old woman with a partial response to escitalopram matches with Aripiprazole augmentation.
Each patient represents a specific clinical scenario requiring tailored psychiatric management. The elderly patient in a life-threatening state due to psychotic depression requires ECT. The patient with comorbid painful neuropathy benefits from duloxetine's dual SNRI action. The young woman with past mania requires an atypical antipsychotic approved for bipolar depression (quetiapine). The patient with a robust but incomplete response to an SSRI requires augmentation (aripiprazole).
Step-by-Step Solution
Key Concept
Tailoring management of depressive disorders based on clinical specifiers (e.g., psychotic features), comorbidities, treatment history, and bipolar risk.