Examkin

Soru

Zorluk: ZorDepressive Disorders

For each of the following patients presenting with depressed mood, select the most appropriate initial or next-step intervention based on their specific clinical diagnosis.

  • A 24-year-old woman presenting with a 6-week history of severe depressed mood and hypersomnia. Review of systems reveals a distinct 5-day period last year involving decreased sleep and impulsive spending. She currently takes no medications.Initiate quetiapine monotherapy
  • A 71-year-old man with major depressive disorder who expresses a fixed delusion that his organs are decaying. He has refused all oral intake for four days, resulting in acute kidney injury and hemodynamic instability.Prepare for urgent electroconvulsive therapy
  • A 45-year-old woman presenting with a 6-week history of tearfulness and difficulty concentrating that began days after an unexpected divorce. She experiences reactivity of mood and does not meet full criteria for a major depressive episode.Refer for cognitive behavioral psychotherapy
  • A 60-year-old man presenting with new-onset pervasive sadness, anhedonia, and insomnia. These symptoms began two weeks after starting high-dose prednisone for giant cell arteritis. He has no prior psychiatric history.Taper the corticosteroid dose if clinically feasible

Cevap

The correct matches pair bipolar II depression with quetiapine, life-threatening psychotic depression with urgent ECT, adjustment disorder with psychotherapy, and medication-induced depression with tapering the offending corticosteroid.
Each depressive syndrome requires precise identification to select the optimal intervention. Bipolar depression requires mood stabilization, severe psychotic depression with medical compromise requires ECT, adjustment disorder is treated with psychotherapy, and medication-induced depression is managed by modifying the offending agent.

Adım Adım Çözüm

1
Analyze each patient's clinical history to differentiate the specific etiology of their depressed mood.
Patient 1 has bipolar II depression; Patient 2 has unipolar psychotic depression with medical emergency; Patient 3 has an adjustment disorder; Patient 4 has substance/medication-induced depressive disorder.
Accurate diagnosis among the differential for depressed mood is required before selecting an intervention.
2
Match the specific psychiatric diagnosis to its optimal evidence-based management strategy.
Bipolar depression warrants an atypical antipsychotic (quetiapine). Medically compromised psychotic depression requires rapid somatic therapy (ECT). Adjustment disorder is primarily treated with psychotherapy. Medication-induced mood changes are managed by dose reduction.
To ensure the intervention directly targets the underlying pathophysiology while minimizing the risk of adverse outcomes (e.g., manic switch, worsening renal failure).

Anahtar Kavram

The management of depressed mood requires differentiating unipolar major depressive disorder from bipolar depression, adjustment disorder, and substance-induced mood disorders, as each has distinct treatment pathways.
Tahmini Süre:1m 30s
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Depressive Disorders

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