Examkin

Question

Difficulty: MediumDepressive Disorders

Match each clinical presentation of a depressive disorder to the most appropriate next step in management or targeted therapy.

  • A 74-year-old retired teacher is brought to the emergency department. She has stopped eating for the past week, stating her 'stomach has turned to dust' as punishment for her sins. She exhibits severe psychomotor retardation and significant dehydration.Electroconvulsive therapy
  • A 45-year-old executive reports a 6-week history of pervasive sadness, early morning awakenings, and a 6-kg (13-lb) weight loss. He is deeply troubled by his inability to sleep and poor appetite. He has no history of cardiac disease or seizures.Mirtazapine
  • A 28-year-old graphic designer seeks treatment for low energy, poor concentration, and depressed mood. He recently stopped taking his prescribed sertraline due to severe anorgasmia, which caused significant marital distress.Bupropion
  • A 31-year-old woman presents 8 weeks after delivering her first child. She reports feeling overwhelmed, tearful, and unable to enjoy time with her baby. She is exclusively breastfeeding and adamantly refuses all oral medications.Interpersonal psychotherapy

Answer

The correct pairings align the patient with psychotic depression and food refusal to Electroconvulsive therapy, the patient with prominent insomnia and weight loss to Mirtazapine, the patient with SSRI-induced sexual dysfunction to Bupropion, and the medication-refusing postpartum patient to Interpersonal psychotherapy.
Each treatment choice addresses the specific nuances of the depressive episode. Electroconvulsive therapy is indicated for rapid response in psychotic depression with nutritional compromise. Mirtazapine targets depression accompanied by insomnia and weight loss. Bupropion is an effective antidepressant without serotonergic sexual side effects. Interpersonal psychotherapy is an evidence-based, non-pharmacological treatment suitable for mild-to-moderate peripartum depression.

Step-by-Step Solution

1
Evaluate the severity, specific symptom profile, and side-effect intolerances of each patient's depressive episode.
Identified distinct presentations: psychotic depression with nutritional compromise, depression with insomnia/weight loss, SSRI-induced sexual dysfunction, and medication-averse peripartum depression.
Antidepressant therapy must be individualized based on clinical urgency, symptom clusters, and patient preference.
2
Match the clinical presentation to the treatment modality with the most appropriate mechanism of action or safety profile.
Matched the elderly patient to ECT, the executive to mirtazapine, the designer to bupropion, and the postpartum mother to psychotherapy.
To maximize therapeutic efficacy while minimizing adverse effects and ensuring patient safety.

Key Concept

Tailoring treatment for major depressive disorder based on symptom clusters (e.g., insomnia/weight loss, sexual dysfunction, psychotic features with imminent risk) and patient preferences (e.g., breastfeeding).
Rate this question

Topics

Depressive Disorders

More questions from this topic