Question of the Week # 107

107)  A 24-years old man with history of Hepatitis C is brought to the ER with history of attempted suicide by cutting his veins with a knife. His family members spotted him while trying to cut his wrist and could save him. He was immediately admitted to psychiatric ward of the hospital. On examination, his vitals are stable. The patient appeared very depressed. The wrist was bandaged and there is no significant bleeding.  The patient has a history of depression for the past three years which was adequately controlled on Fluoxetine. Laboratory investigations revealed  ALT: 95 IU/ml , AST: 65 IU/ml, , Hemoglobin: 15.2 gr/dl, Platelet count: 345000/ml, WBC count: 6500/ml. Approximately 4 weeks ago, the patient was diagnosed with HCV infection  after screening due to intravenous drug addiction history. At that time, HCV – RT PCR was positive, HIV ab  and Hepatitis B Surface antigen were negative. The patient was started on Interferon and ribavirin for Hepatitis – C infection. The patient denied any recent drug use. He has been compliant with his Fluoxetine. He reports  increased suicidal thoughts over the past few days. The most important next step in controlling this patient’s depression :

A) Electroconvulsive therapy

B) Discontinue Fluoxetine

C) Start Cyproheptadine

D) Discontinue Interferon

E) Start Clozapine to reduce suicidal tendency

 

14 Responses

  1. B
    Anti deppressants are notorious for increasing suicidal ideations in young adults.

  2. D

    Interferon can induce depression

  3. D

  4. d- more likely

  5. ddd

  6. The pt. has suicidal ideation, shouldn’t he be treated with ECT ,answer A

  7. Discontinue interferon as it can induce or add on to depression that is why before starting interferon the pt is asked about depression and also sometimes psychiatric consultation is recommended

    • agree answer in exam or even CCS case discontinue interferon and psychiatry consult, as patient has severe depression with suicidal ideation, medications should also be reviewed by psychiatrist

  8. ECT is the most effective and rapid acting treatment for unipolar depression; therefore for depressed persons at high risk for suicide, it can be the treatment of choice.

  9. @ archer:please give the right answers

    101-200

    qts are good.thanks

  10. ECT is a good option in patient with suicide ideation due to the rapid and effective response.other indications include resistent depression,sever depression and possible in pregnancy,elderly or non compliant

  11. Alfa interferons cause or aggravate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, and infectious disorders

    Monitor closely with periodic clinical and laboratory evaluations

    Discontinue drug if persistently severe or worsening signs or symptoms of the above conditions are present; disorders typically resolve after stopping therap the medscape website

  12. A. ECT Indicated when major depressive episodes have not responded to antidepressants , or high risk for immediate suicide.

  13. Patient’s depression had been adequately controlled for 3 years. The only recent change was the diagnosis of HCV for which treatment was initiated.

    Therefore, manage by stopping interferon. He can be monitored closely as an inpatient and if necessary, other interventions (eg ECT) can then be started on if he continues to deteriorate.

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