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Difficulty: EasyDepressive Disorders

Match each patient's presentation of a depressive disorder or related mood disturbance with the most appropriate therapeutic intervention.

  • A female patient in her early thirties is evaluated for profound sadness. Her psychiatric history includes a distinct 6-day period of reduced sleep, rapid speech, and impulsive behavior.Initiate a mood stabilizer and avoid antidepressant monotherapy
  • A male patient in his late sixties is admitted for a severe mood disorder. He refuses all oral intake, claiming his internal organs have decayed, leading to rapid physiological decline.Prepare the patient for urgent electroconvulsive therapy (ECT)
  • A young man who began taking sertraline for a first-episode major depressive disorder reports complete resolution of his symptoms after 6 weeks. He now strongly desires to stop taking the medication immediately.Advise continuing current pharmacotherapy for an additional 4 to 9 months
  • A middle-aged woman with unipolar depression notes only a partial reduction in her symptoms despite completing an 8-week trial of fluoxetine at the maximum tolerated dosage.Augment the current regimen with bupropion or an atypical antipsychotic

Answer

The correct pairings match each distinct clinical scenario to its evidence-based management: avoiding SSRI monotherapy for bipolar depression, utilizing ECT for life-threatening psychotic depression, ensuring a 4-to-9-month continuation phase to prevent early relapse, and utilizing augmentation for a partial SSRI response.
Each correct pairing applies foundational psychiatric management principles. Recognizing bipolar depression prevents the error of antidepressant monotherapy. Identifying life-threatening psychotic depression correctly prompts urgent ECT. Understanding the continuation phase of treatment prevents premature discontinuation. Recognizing partial response guides the choice of augmentation.

Step-by-Step Solution

1
Analyze the history of the female patient with reduced sleep and rapid speech.
The history confirms bipolar disorder rather than unipolar depression.
Screening for past hypomanic episodes is critical to avoid inappropriate antidepressant monotherapy.
2
Assess the severity and features of the older male patient's condition.
He exhibits psychotic features (somatic delusions) and life-threatening oral refusal.
These severe features mandate rapid intervention with ECT rather than waiting weeks for pharmacotherapy to take effect.
3
Determine the appropriate duration of therapy for the young man in remission.
Therapy must continue for 4 to 9 months beyond acute remission.
Premature discontinuation significantly increases the risk of an early relapse.
4
Formulate a plan for the middle-aged woman with partial SSRI response.
Augmentation is chosen over switching because she has shown some response and tolerates the medication.
Augmentation builds on the partial response without losing the progress already achieved.

Key Concept

Management of Depressive Disorders and Complications
Estimated Time:1m 30s
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Topics

Depressive Disorders

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