Sadness, Guilt, and Maybe Suicidal! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 05-09-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Psyche Sadness, Guilt, and Maybe Suicidal!

A 72-year-old man presents for a follow-up visit regarding his depressed mood after his wife's death seven months ago. The patient complains of lethargy and episodes of tearfulness. He has attended three sessions of supportive sychotherapy so far and expresses appreciation for the referral because he likes the therapist.
However he continues to feel depressed and is now experiencing insomnia. He is also feeling very guilty about his wife's death and feels that he should have somehow done more for her in her final months. He admits that during a particularly dark moment last month he briefly contemplated committing suicide so that he could "join her," although he is adamant that he does not feel suicidal at this time and will readily contract for safety. Physical examination reveals the patient has lost 13 lbs (5.9 kg) since his wife's death.
What is the most appropriate next step?

A. Prescribe amitriptyline and alprazolam
B. Prescribe sertraline
C. Increase psychotherapy sessions to twice weekly
D. Recommend electroconvulsive therapy
E. Provide reassurance and continue psychotherapy regimen
Reply With Quote Quick reply to this message



  #2  
Old 05-09-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 762 Times in 256 Posts
Reputation: 773
Default

7 months + substantial weight loss + past suicidal attempt +/- feelings of guilt.... suggest u more towards depression than normal grief.


but it is a little confusing.

the only thing going for normal grief is that its less than a year.

anyways.. id pick a treatment...
and start with an SSRI. so choice B


Choice A has a TCA which is usually contra indicated in the elderly due to its anticholinergic effects hence precipitates dementia in the elderly.(step 1 concept)
Reply With Quote Quick reply to this message
The above post was thanked by:
tyagee (05-10-2012)
  #3  
Old 05-09-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 137
Threads: 2
Thanked 65 Times in 40 Posts
Reputation: 75
Default

Quote:
Originally Posted by tyagee View Post
A 72-year-old man presents for a follow-up visit regarding his depressed mood after his wife's death seven months ago. The patient complains of lethargy and episodes of tearfulness. He has attended three sessions of supportive sychotherapy so far and expresses appreciation for the referral because he likes the therapist.
However he continues to feel depressed and is now experiencing insomnia. He is also feeling very guilty about his wife's death and feels that he should have somehow done more for her in her final months. He admits that during a particularly dark moment last month he briefly contemplated committing suicide so that he could "join her," although he is adamant that he does not feel suicidal at this time and will readily contract for safety. Physical examination reveals the patient has lost 13 lbs (5.9 kg) since his wife's death.
What is the most appropriate next step?

A. Prescribe amitriptyline and alprazolam
C. Increase psychotherapy sessions to twice weekly
D. Recommend electroconvulsive therapy
E. Provide reassurance and continue psychotherapy regimen

-B. Prescribe sertraline
Reply With Quote Quick reply to this message



Reply

Tags
Psychiatry-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
What is the best management of this suicidal 16 year old girl? tyagee USMLE Step 2 CK Forum 1 05-09-2012 02:39 PM
Suicidal Risk Assessment? Yallah USMLE Step 1 Forum 10 04-21-2012 09:20 PM
Suicidal Patient wants to go home! bunny USMLE Step 1 Forum 15 03-21-2012 08:33 PM
Suicidal patients are incompetent! doxorubicin USMLE Step 1 Forum 0 12-19-2011 11:48 AM
Suicidal Risk drgsarunprasath USMLE Step 1 Forum 7 08-15-2011 02:30 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)