A 24-Year-Old Man Comes to the Emergency Department After Injuring

question 217

Multiple Choice

A 24-year-old man comes to the emergency department after injuring his arm.  Following an argument with his girlfriend, the patient broke a vase and used a shard of glass to cut his wrist.  He says, "I wasn't trying to kill myself.  I just don't know how to deal with my anger."  The patient says he has struggled with depression and anger problems since he was a teenager; this has led to difficulties with romantic relationships and has caused him to get fired from jobs.  He was hospitalized at age 17 for a suicide attempt.  The patient's bouts of depression are "too numerous to count," and he explains that his moods shift unpredictably from one minute to the next.  Previous medication trials of fluoxetine and sertraline were ineffective and caused sexual side effects; he does not currently take any medications.  The patient has a 2-cm, superficial laceration on his left forearm; physical examination is otherwise normal.  He has no suicidal ideation, hallucinations, or delusions.  Which of the following is the most appropriate treatment for this patient's condition?

• A)Bupropion
• B)Couples counseling
• C)Dialectical behavior therapy
• D)Lithium
• E)Occupational therapy
• F)Valproate
• G)Venlafaxine

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