For each patient vignette describing a mood-related presentation, select the most appropriate primary treatment modality or specific medication.
- A 78-year-old retired architect presenting with profound psychomotor retardation, delusions that his organs are rotting, and complete refusal of food and water for five days.Electroconvulsive therapy
- A 54-year-old office manager who developed persistent anhedonia, early morning awakenings, and severe guilt three weeks after surviving an acute anterior myocardial infarction.Sertraline
- A 31-year-old freelance writer with current debilitating hypersomnia and low mood, whose medical records indicate a previous four-day episode of pressured speech and decreased need for sleep.Quetiapine
- A 28-year-old physical therapist with a new-onset major depressive episode who explicitly requests a medication that will not cause weight gain or sexual dysfunction.Bupropion
Answer
The correct matches align specific clinical presentations of depression with their evidence-based treatments: severe inanition/psychosis with electroconvulsive therapy, post-myocardial infarction status with sertraline, bipolar depression with quetiapine, and concern for sexual side effects with bupropion.
Each match represents the standard of care for a specific depressive presentation. Electroconvulsive therapy is rapidly acting and life-saving for psychotic depression with inanition. Sertraline has the best cardiovascular safety profile for post-myocardial infarction patients. Quetiapine effectively treats bipolar depression without the risk of a manic switch associated with SSRI monotherapy. Bupropion is a norepinephrine-dopamine reuptake inhibitor that lacks the sexual dysfunction and weight gain typical of SSRIs.
Step-by-Step Solution
Key Concept
Tailoring management of depressive disorders to patient-specific psychiatric comorbidities, medical history, and medication side effect profiles.