Match each patient's clinical presentation with the most appropriate tailored pharmacotherapy or neuromodulation therapy.
- A 28-year-old woman, 3 weeks postpartum, presenting with mutism, refusal to eat or drink, and delusions that her internal organs are rotting.Electroconvulsive therapy (ECT)
- A 65-year-old man, 4 weeks post-myocardial infarction, with pervasive low mood and anhedonia; recent ECG shows a QTc interval of 470 ms.Initiate sertraline
- A 34-year-old woman with major depressive disorder on a maximum dose of venlafaxine, reporting resolved tearfulness but persistent profound fatigue, hypersomnia, and a 5-kg (11-lb) weight gain.Augment with bupropion
- A 42-year-old man with a major depressive episode characterized by prominent early morning awakenings, severe anorexia with a 6-kg (13-lb) weight loss, and marked agitation.Initiate mirtazapine
- A 24-year-old man presenting with severe low mood and psychomotor retardation; history reveals a distinct 5-day period last year of decreased need for sleep, pressured speech, and grandiose spending sprees.Initiate quetiapine
Answer
Clinical profiles are matched to specific treatments based on symptom clusters (e.g., mirtazapine for insomnia/anorexia, bupropion for fatigue/weight gain), medical comorbidities (sertraline for post-MI with prolonged QTc), acuity (ECT for life-threatening psychosis/inanition), and underlying diagnosis (quetiapine for bipolar depression).
Each correct match optimizes the therapeutic index by utilizing the specific side effect profile or mechanism of action of a psychiatric intervention to address the patient's unique comorbidities and symptom presentation.
Step-by-Step Solution
Key Concept
Tailored pharmacotherapy and neuromodulation in depressive disorders based on side effect profiles, medical comorbidities, and diagnostic history.