ChoiceHub
Sign in
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?
Shared by Mornienmiddle twist

Keep going — a set of ten like this one, one at a time.

Practise more

More from Psychiatry

See all

A 34-year-old man who came to Australia from Somalia six years ago is reviewed by his general practitioner for a depressive episode. After eight weeks of sertra…

Pre-internship · niche

A 40-year-old man who came to Australia from Iraq as a refugee eight years ago attends a general practice with six months of broken sleep, nightmares and daily…

Clinical rotations · middle twist

A 71-year-old woman who migrated from Hong Kong 40 years ago is admitted to a psychiatric ward with a severe depressive episode. She speaks Cantonese and almost…

Pre-internship · middle twist

A metropolitan mental health service is examining why Aboriginal and Torres Strait Islander inpatients leave the ward against medical advice far more often than…

Clinical rotations · middle twist

A 52-year-old man born in Vietnam, who has had schizophrenia for 25 years, comes to an emergency department with six hours of epigastric pain. He speaks limited…

Pre-internship · niche