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  #1  
Old 11-16-2012
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ObGyn Feeling Depressed 6 Weeks Postpartum

A 21 year- old women G2P2 comes to physician for a 6 week postpartum visit. Her prenatal course was uncomplicated and resulted in a normal spontaneous vaginal delivery at 39 week’s gestation. She states that she has not been feeling so well emotionally since the birth of the baby. She feels depressed most of the time and cries easily. She is having trouble sleeping and has little appetite. She has no suicidal or homicidal ideation and no strange thoughts or hallucinations. She did not experience these emotions after her first delivery. She has no medical problems and takes no medications. Her physical examination is within normal limits for a woman who is 6 weeks postpartum. Which of the following is the most appropriate next step in management?
A- Admit the patient to the psychiatric word
B- Reassure the patient that these feelings are normal
C- Refer the patient to a psychiatrist
D- Start antipsychotic therapy
E- Start ECT
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accrdng to me...its B........
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E- Start ECT

Postpartum depression
--Typically happens after second delivery.
ECT is the treatment of choice in women who are breastfeeding.
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Quote:
Originally Posted by Novobiocin View Post
E- Start ECT

Postpartum depression
--Typically happens after second delivery.
ECT is the treatment of choice in women who are breastfeeding.
Yup z diagnosis is PP depression but i think ECT is not suitable choice cuz no risk of suicide and antidepressant is not absolutely contraindicated in this case
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Yup z diagnosis is PP depression but i think ECT is not suitable choice cuz no risk of suicide and antidepressant is not absolutely contraindicated in this case
You have to choose from the choices given.
Antidepressants are not among the choices given so the only answer could be ECT which works very well and has the minimal side effects.
This question could have been made more difficult by mentioning in the stem that she is breastfeeding and given an antidepressant among the choices. Some people would have fallen for the trap by choosing antidepressant as the answer.
Don't think of ECT as the treatment of last resort. It has it's own indications.
Moreover, these kind of questions remind you that in the real test they might not give the "best" test or treatment among the choices but you have to know the next best and more on that topic.
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Quote:
Originally Posted by Novobiocin View Post
Antidepressants are not among the choices given so the only answer could be ECT which works very well and has the minimal side effects.
Damn man... I mean... wow.... I swear I was thinking the exact same thing... And by that I mean... the exact same words.
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Damn man... I mean... wow.... I swear I was thinking the exact same thing... And by that I mean... the exact same words.
Looks like I finally found my long lost twin...........
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Your thinking is logical Novo
By the way the correct ans in the Bank is C- Refer the patient to a psychiatrist. they explain that:
Quote:
The correct management include psychotherapy and antidepressant, which are usually best managed by a psychiatrist or someone who has a strong mental health background and who is comfortable dealing with postpartum depression
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ECT should be given when there is PP psychosis. There is no evidence of psychosis here.
pp depression willbe antidep or psychotherapy.
try the least invasive.
thus psychotherapy.
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and ofcourse breast feeding so no antidepressants.
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Quote:
Originally Posted by heartbeat View Post
Your thinking is logical Novo
By the way the correct ans in the Bank is C- Refer the patient to a psychiatrist. they explain that:
according to Conrad Fischer "you only choose referral to a specialist" when the obvious choice is not among the choices given and the referral satisfies that choice. I guess, I missed that . Moreover, they have not given the key fact in history about breastfeeding (if breastfeeding and severe depression --would go in favor of ECT). Also, there is no "feeling of hurting the baby" which would go in favor of ECT.
I was having this nagging feeling that something is not right--but you are always wiser in hindsight.
This is a very good example and the reason why we should discuss these kind of questions since they clear our concepts which cannot be done by simply reading or even doing questions alone.

Bottomline:

For ECT you need some emergent reason like "hurting the baby" or severe depression and the patient is breastfeeding.

Antidepressants are the treatment of choice here but if not given among answer choices then "refer to the Psychiatrist" serves the same purpose.
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Quote:
Originally Posted by heartbeat View Post
Your thinking is logical Novo
By the way the correct ans in the Bank is C- Refer the patient to a psychiatrist. they explain that:
Which QBank is this? Thank you for sharing
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Old 11-18-2012
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even i found a question in uworld where i had to choose an option referring the patient to orthopedician for giant cell tumor of bone.....



i think we should not always avoid the "referral" answer choices(which has been the norm in step 1---never refer) and use our wisdom to answer accordingly to what the question demands......
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Default wwaaw

I chose CC But I never knew about the antidepressant contraindication in lactating women amazing so we just shock here after psychotherapt do not work

Look what UW says about ECT indication for recapping:
1. Sever depression
2. Depression in pregnancy
3. Refractory Mania
4. Catatonic schizophrenia
5. Neuroleptic Malignant syndrome

Last edited by hamzarayes; 11-18-2012 at 04:38 AM. Reason: Extra info..
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I had a doubt.. do 'you' start ECT or refer to a psychiatrist for ECT?
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Old 11-19-2012
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Quote:
Originally Posted by docwedsengr27 View Post
I had a doubt.. do 'you' start ECT or refer to a psychiatrist for ECT?
Good Q
I am not sure but i think should refer to a psychiatrist cuz it's difficult procedure and need experience
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Quote:
Originally Posted by Dr. Mexito View Post
Which QBank is this? Thank you for sharing
Definitely not UW or NBME
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