Master the board step 3

Psychiatry
A school bus is involved in a major collision. Two children are killed, and 7 others
are injured. What is the most important therapy to prevent PTSD?
a. Diazepam
b. Fluoxetine
c. Group counseling
d. Haloperidol
e. Individual psychotherapy
Answer: C. Group counseling is the most effective therapy to prevent PTSD following
a traumatic event.
Mood Disorders
Major Depressive Disorder
This disorder is characterized by depressed mood or anhedonia and depressive
symptoms lasting at least 2 weeks.
Look for other causes of depression where the first step in management is different,
such as the following:
··
Hypothyroidism:
--
Check TSH
--
First step in management is thyroxine
··
Parkinson’s disease:
--
Treat with anti-Parkinson medications
··
Medications:
--
Corticosteroids, β-blockers, antipsychotics (especially in the elderly), and
reserpine
--
Treat by discontinuing medication and switching to an alternative
··
Substance disorders:
--
Alcohol (ask CAGE questionnaire), amphetamines
--
Treat with detoxification and antidepressants
Treatment
··
Admit the patient if there is suicidal/homicidal ideation or paranoia.
··
Begin antidepressant medications (SSRI is first drug of choice).
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Give benzodiazepines if agitated.
··
Electroconvulsive therapy (ECT) is the best choice if the patient is acutely
suicidal (works quicker than antidepressants) or for patients worried about
side effects from medications.
SIGECAPS: Major depressive
disorder = depressed mood +
S: changes in sleep
I: loss of interests/pleasure
G: thoughts of
worthlessness or guilt
E: loss of energy
C: trouble concentrating
A: changes in appetite or
weight
P: changes in psychomotor
activity
S: thoughts about death or
suicide
In patients with unipolar
psychotic depression,
the combination of an
antidepressant and an
antipsychotic is more
effective than monotherapy
with either drug.
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