JAWAL-3LMNY

50y W is taken 2 the hospital after neighbors find her wandering the streets mumbling 2 herself & gesturing When approached she begins 2 cry & expresses thoughts about hurting herself Examination reveals scratch marks & lacerations on her throat She reported feeling depressed since her husband died 5m ago also reports decrease in concentration & feelings of helplessness,hopelessness,& anhedonia which resulted in quitting her job & staying home she begun 2 hear her husbands voice asking her to join him NEXT STEP IN MANAGING THIS PATIENT IS?

1.BEGIN ANTIDEPRESSANT
2.REFER 2 PSYCHIATRY
3.REFER 2 ECT
4.ASSESS 4 SUICIDEL THOUGHTS
5.REFER 2 OUTPATIENT FOLLOW UP

Assuming U decide 2 begin treatment, which of these is the initial treatment?
1.Individual psychotherapy
2.Behavioral therapy
3.Fluoxetine
4.Risperidone
5.Phenelzine

1. Answer:D. The most important thing to assess in patients suffering from depression is their suicidal status, which of course determines her prognosis and wether or not you will admit her to the hospital for treatment. You will probably begin a course of pharm-acotherapy, but you need to assess suicidal status first. "Refer to psychiatry"will always be wrong on a test, given that you need to know what to do in these situations. Elctroconvulsive therapy might be indicated in her condition but usually not the first line of treatment.

2.Answer:D. Patients with both mood and psychotic symptoms respond to both antideressants as well as to antipsychotic medication. However, you must treat the worst symptom first. In this case, the antipsychotic would be most indicated to reduce her psychotic symptoms. Choice D is an atypical antipsychotic medication with minimal side effects.