A 72-Year-Old Woman Is Admitted to the Hospital Because of Worsening

question 8

Multiple Choice

A 72-year-old woman is admitted to the hospital because of worsening suicidal ideation for the past month.  The patient has been refusing meals in order to "sacrifice" herself for "the greater good."  She has stopped communicating with her family and spends most of her days sleeping or staring at the television.  The patient has been treated with multiple antidepressants in the past for recurrent major depressive disorder.  Two weeks ago, she discontinued taking venlafaxine because she felt it "interfered" with her plan to kill herself.  The patient is 165 cm (5 ft 5 in) tall and weighs 48 kg (105 lb) .  BMI is 17.5 kg/m2.  Physical examination shows decreased skin turgor and dry mucous membranes.  Which of the following is the best next step in management?

• A)Clozapine
• B)Cognitive-behavioral therapy
• C)Electroconvulsive therapy
• D)Imipramine
• E)Olanzapine
• F)Phenelzine