A psychiatry resident is evaluating five different patients presenting with depressive symptoms in various clinical settings. Match each patient's clinical vignette with the most appropriate best next step in management or definitive diagnosis.
- A 68-year-old male, recovering 3 weeks post-myocardial infarction, exhibits a 3-week history of persistently depressed mood, early morning awakenings, and loss of interest in his family.Start pharmacotherapy with sertraline
- A 42-year-old female with severe major depressive disorder has refused all food and water for 5 days, expressing steadfast delusions that her internal organs have turned to dust.Refer for urgent electroconvulsive therapy (ECT)
- A 29-year-old male presents with severe depression and hypersomnia. His medical history includes a distinct 2-week period last year of decreased need for sleep, intense grandiosity, and reckless spending.Begin treatment with lurasidone
- A 31-year-old female describes chronic low mood, fatigue, and poor self-esteem persisting for the past 3 years. These symptoms have never abated for more than a month at a time.Establish a diagnosis of persistent depressive disorder
- A 26-year-old female, 3 weeks postpartum, reports severe depression, crying spells, and intrusive, terrifying thoughts of intentionally drowning her newborn during bath time.Admit for inpatient psychiatric hospitalization
Cevap
Match each vignette to its specific targeted intervention: post-myocardial infarction depression requires sertraline; psychotic depression with starvation requires ECT; bipolar depression requires an atypical antipsychotic like lurasidone; chronic subthreshold depressive symptoms lasting over 2 years indicate persistent depressive disorder; and postpartum depression with infanticidal ideation demands immediate inpatient hospitalization.
Each patient presentation contains specific high-yield clinical clues that dictate a unique management pathway. Post-MI patients need cardiac-safe SSRIs (sertraline). Life-threatening psychotic depression requires rapid intervention (ECT). Bipolar depression must be treated with mood stabilizers or specific atypical antipsychotics (lurasidone) to avoid manic switching. Chronic low-grade depression is classified as persistent depressive disorder. Postpartum depression with infanticidal thoughts is an absolute indication for emergency psychiatric hospitalization.
Adım Adım Çözüm
Anahtar Kavram
Management of Depressive Disorders across special populations requires tailoring therapy based on medical comorbidities, risk of self-harm or harm to others, and accurate differentiation from bipolar spectrum disorders.
Tahmini Süre:2m 0s