phuluong2k
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29) A 34-year-old woman in her first trimester of pregnancy is evaluated by her psychiatrist. She complains of voices telling her to kill herself because she doesn't deserve to live, and she feels extremely depressed, guilty, and worthless. Which of the following is the most appropriate treatment?
A. Clonazepam
B. Electroconvulsive therapy (ECT)
C. Fluoxetine
D. Lithium
E. Psychotherapy
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| ARJ
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B. Electroconvulsive therapy (ECT)
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| satyaking
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WHY not A
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| Dot
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side effects 1) Seizure 2) lukocytopenia so monitor w.b.c
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have fun
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| Rasul
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Clonazepam doesn't have side-effects of agranulocytosis and seizures. The answer is ECT coz 1) she's pregnant, 2) ECT is very effective antidepressant treatment-to fight suicidal thoughts.
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| psysaji
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Why not E???
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| cirus
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ECT
psychotherapy is useful too but it will not treat the voices & so will not stabilize the pt, u don't treat a potentially suicidal pt with just psychotherapy,so ECT ( safest in preg) is the ttt of choice..
clonazepam is a benzo, don't mix it with clozapine (Antipsychotic) which causes Agranulocutosis
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| dr_arc
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this sounds like a schizoaffective disorder
hears voices = schizo
depressed guilty worthless= affect problem
ECT is the t/t of choice for a pregnant depressed lady
but what abt the schizo symptom , ECT wont help that
but then again of the other choices you cannot use lithium in pregnancy and clonazepam doesnt help here.
that leaves fluoxetine, so i guess it could be that too.
hmm does SSRI help in schizoaffective disorder?
is it safe in pregnancy?
anyboy know this?
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| dr_arc
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oh i forgot to mention the psycotherapy option. that i guess is not usually right for a person who has command hallucinations of sucide. so that one is out too.
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| elitoki
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B. nod:
SSRI take too much time. pt need treatment now~:
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| dr_arc
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yes elitoki ECT is def the fastest and the best for pregnancy. my query is does it also help in schizoaffective disrder, cos this one looks like it.
let me know what you think.
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| elitoki
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I found that ECT also helps patients with most forms of mania, some forms of schizophrenia, and a few other mental and neurological disorders such as bipolar disorder, schizoaffective disorder, catatonia, and Parkinson's disease. So, my answer is yes, you can use also in schizoaffective patients. For more info there is American Psychiatric Web for indications of ECT. http://www.psych.org/research/apire/training_fund...
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| dr_arc
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thanks a tom elitoki . this was exactly what i wanted to know. good luck 
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| gr8doc
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ECT . The way to go.
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| Dr.D
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ECT is the right answer.
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