A 34 years old female has 3 months history of disturbed sleep with early morning awakening, decreased appetite, lethargy, multiple body pains, feelings low, & worthlessness. Most appropriate treatment in this case will be:

1. A

   Anxiolytics

2. B

   Hypnosedatives

3. C

   Antipsychotics

4. D

   Antidepressants

Appeared in: BHU NO-2019

Explanation

• The patient's cluster of symptoms—including low mood, worthlessness, lethargy, sleep disturbance (early morning awakening), and decreased appetite—over a 3-month period is characteristic of a Major Depressive Episode.
• Antidepressants are the first-line pharmacological treatment for moderate to severe MDD.
• These medications work by modulating neurotransmitters like serotonin and norepinephrine to alleviate the full spectrum of depressive symptoms, including mood, energy, sleep, and appetite.

Why Other Options Were Wrong

• Option A: Anxiolytics primarily target symptoms of anxiety, such as excessive worry, tension, and panic. They do not address the core depressive symptoms of anhedonia (loss of interest) and feelings of worthlessness.
• Option B: Hypnosedatives are sleep-inducing agents. Using them would only provide symptomatic relief for the patient's insomnia without treating the underlying depression, which is the root cause of the sleep disturbance.
• Option C: Antipsychotics are used to manage psychosis, which involves symptoms like hallucinations, delusions, and disorganized thought. The patient in this scenario does not exhibit any psychotic features.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Pharmacological management of Major Depressive Disorder (MDD) to guide bedside assessment, documentation, and the next nursing action.
• A key nursing responsibility is to educate patients that antidepressants can take 4-6 weeks to reach their full therapeutic effect. This manages expectations and encourages adherence.
• Nurses must closely monitor patients starting antidepressants for side effects and, most critically, for any increase in suicidal thoughts or behaviors, as energy may return before mood improves, creating a high-risk period.
• What if the patient also reported periods of elevated mood, high energy, and decreased need for sleep? The diagnosis might shift to Bipolar Disorder. In that case, prescribing an antidepressant alone could trigger a manic episode, and a mood stabilizer would be the more appropriate primary treatment.

How to Approach the Question

• First, analyze the clinical vignette to identify all the presenting symptoms (e.g., disturbed sleep, low mood, lethargy, worthlessness) and their duration (3 months).
• Next, cluster these signs and symptoms to recognize a specific clinical pattern or syndrome. In this case, the symptoms strongly align with the diagnostic criteria for Major Depressive Disorder (MDD).
• Recall the first-line pharmacological treatment for the identified disorder (MDD).
• Evaluate the given options and select the drug class that matches the standard treatment for MDD.
• Differentiate the correct option from the distractors by understanding the primary indications for each drug class (Anxiolytics for anxiety, Hypnosedatives for insomnia, Antipsychotics for psychosis).

Concept Tested & Keywords

• Concept Tested: Pharmacological management of Major Depressive Disorder (MDD).
• Stem keywords: disturbed sleep, early morning awakening, decreased appetite, lethargy, body pains, feeling low, worthlessness, 3 months history
• Lead-in keywords: Most appropriate treatment
• Clinical cues: The 3-month duration points to a persistent disorder, not a temporary mood swing.
• Clinical cues: Early morning awakening is a classic biological symptom of major depression.

Question ID

QKVrG3BRiFE4WVbnLAvNwG

Copy ID

Reference Book

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 1620-1622

E6 Pharmacology Nursing Lilley 11e Part 1 p. 291-293