A psychiatric consult service is reviewing the charts of four newly evaluated patients who present with prominent depressive symptoms. Each patient's presentation requires a distinct pharmacological or procedural approach. Match each patient's clinical profile with the most appropriate next step in management or treatment strategy.
- 52-year-old male with a 4-week history of profound sadness, anhedonia, and the fixed false belief that he is single-handedly responsible for an impending global financial collapse.Combined antidepressant and antipsychotic pharmacotherapy, or electroconvulsive therapy (ECT).
- 26-year-old female with a 6-week history of severe low mood, hypersomnia, weight gain, and extreme sensitivity to interpersonal rejection. She reports her limbs feel 'heavy like lead'.First-line trial of an SSRI; monoamine oxidase inhibitors (MAOIs) may be considered if standard therapies fail.
- 34-year-old female with major depressive disorder who reports persistent daytime fatigue and poor concentration despite 8 weeks of adherence to maximum-dose fluoxetine. She has no history of seizures or eating disorders.Augmentation with a norepinephrine-dopamine reuptake inhibitor (NDRI).
- 21-year-old male evaluated for severe depressive symptoms. His medical record reveals a psychiatric hospitalization two years ago for acute agitation, grandiosity, and a significantly decreased need for sleep.Initiation of a mood-stabilizing atypical antipsychotic such as lurasidone; strictly avoid antidepressant monotherapy.
Answer
The clinical profiles map to major depressive disorder (MDD) with psychotic features, MDD with atypical features, SSRI-resistant MDD requiring augmentation, and bipolar I disorder currently in a depressive episode, respectively.
Matching these clinical profiles requires correctly identifying specific depressive disorder subtypes and bipolar depression, each of which has distinct evidence-based pharmacological guidelines that deviate from simple SSRI monotherapy.
Step-by-Step Solution
Key Concept
Tailoring pharmacotherapy and interventions for specific depressive disorder subtypes and related conditions.