You have decided that in addition to the counseling she has been receiving for depression, a 12-year-old female in your practice might benefit from an antidepressant medication.
Which one of the following has shown the most favorable risk-to-benefit ratio in children and adolescents?
Correct Answer A:
SSRIs have been shown to benefit children and adolescents with depression, but there are concerns regarding their association with suicidal behavior. Fluoxetine seems to be the most favorable SSRI, and is the only one recommended by the FDA for treatment of depression in children 8-17 years old. There is limited or no evidence to support the use of lithium, venlafaxine, or St. John’s wort in children and adolescents. Amitriptyline and other tricyclic antidepressants are ineffective in children and have limited effectiveness in adolescents, and safety is an issue in both of these groups.
A severely depressed 77-year-old male is hospitalized after an intentional drug overdose. He was found by chance when his housekeeper returned to retrieve something she had left behind. The patient has been severely depressed since he suffered a myocardial infarction 1 year ago, and the recent death of his wife has increased his despondency. He had left a note apologizing to his family and his physician, who has treated him with multiple medications for depression over the past year. He has been treated with SSRIs, SNRIs, and atypical antipsychotics in high doses and in various combinations without significant improvement.
Which one of the following would be most likely to improve this patient’s depression at this point?
Correct Answer C:
Electroconvulsive therapy has been shown to be more effective than psychiatric therapy, pharmacologic therapy, and other interventions in depressed older patients. It would be particularly appropriate in this case given the patient’s age, his failure to respond to medications, and the need for rapid improvement to decrease the risk of further suicide attempts.
A 19-year-old man comes home late at night from a party. When he started hallucinating and showing violent behaviour he was taken to the ED. On exam, nystagmus, hypertension, and tachycardia were found.
What was the substance he likely was abusing that night?
Nystagmus can be found with the abuse of the following illicit drugs: Lysergic acid diethylamide (LSD) and Phencyclidine (PCP).
Common physical examination findings in PCP intoxication include the following:
→ Marijuana usually causes relaxation, sleepiness, mild euphoria, decreased short-term memory, dry mouth, impaired perception and motor skills, and red eyes.
→ Cocaine causes hypertension, anxiety, nasal damage, loss of appetite and sleeplessness.
→ Inhalants such as fingernail polish remover, insecticides and paint thinner can cause nausea, nosebleeds, headache and lightheadedness.
Which of the following drugs would be the best to use in a patient with obsessive compulsive disorder?
Obsessive-compulsive disorder is characterized by recurring, unwanted, anxiety-provoking, intrusive ideas, images, or impulses (obsessions) that may even seem silly, weird, nasty, or horrible to the person experiencing them. The person also has urges (compulsions) to do something that will relieve the discomfort caused by the obsessions.
Rituals used to control an obsession include the following:
Mainstay of treatment for OCD is with a Selective serotonin reuptake inhibitors such as fluoxetine and fluvoxamine, and with clomipramine which is a tricyclic antidepressant. Many experts believe that a combination of exposure therapy and drug therapy is the best treatment.
A 41-year-old man reports that he washes his hands 50 times a day. In the evening, he will check the doors, windows, and stove at least a dozen times before retiring for the night.
Which one of the following is the most likely diagnosis?
Correct Answer D:
Obsessive-compulsive disorder (OCD) is characterized by anxiety-provoking ideas, images, or impulses (obsessions) and by urges (compulsions) to do something that will lessen that anxiety. The cause is unknown.
Typically, affected people feel compelled to perform repetitive, purposeful rituals to balance their obsessions, as in the following:
Most rituals, such as hand washing or checking locks, are observable, but some rituals, such as repetitive counting or statements muttered under the breath, are not.
Diagnosis is based on history. Treatment consists of psychotherapy, drug therapy, or, especially in severe cases, both.
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