Psychiatrymiddle twist
A 74-year-old man has been in hospital for ten days with a severe depressive episode. He is convinced that his bowel has rotted away and that he is being punished for a debt he repaid forty years ago. He has taken sertraline 50 mg and olanzapine 5 mg daily since admission with no change. For the last three days he has refused all food and fluid, he has lost 9 kg since the illness began, and his serum urea is 16.4 mmol/L [3.0 to 8.0]. Which one of the following is the most appropriate treatment now?