A 70-year-old man has a 3-week history of low mood, early morning waking, weight loss and believes his bowels have rotted away. He refuses food. What is the most appropriate management?
Answer and explanation
Correct answer: A. Urgent psychiatric assessment for severe depression with psychotic features, with consideration of admission
- Step 1: A nihilistic delusion with biological features suggests psychotic depression.
- Step 2: Risk of starvation and suicide is high, so urgent specialist assessment is needed, and ECT is an option in severe cases.
Answer
Urgent psychiatric assessment for severe depression with psychotic features, with consideration of admission.
Why not the others: Reassurance and a routine review in the surgery in four weeks: Waiting four weeks leaves a high-risk patient untreated. Referral to a dietician for advice on weight and nutrition: A dietician does not address the underlying illness. A trial of St John's wort and a food diary, with review in a month: St John's wort is not recommended and interacts with other drugs.
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