Archer USMLE Blog

107)  A 24-years old man with history of Hepatitis C is brought to the ER with history of attempted suicide by cutting his veins with a knife. His family members spotted him while trying to cut his wrist and could save him. He was immediately admitted to psychiatric ward of the hospital. On examination, his vitals are stable. The patient appeared very depressed. The wrist was bandaged and there is no significant bleeding. The patient has a history of depression for the past three years which was adequately controlled on Fluoxetine. Laboratory investigations revealed  ALT: 95 IU/ml , AST: 65 IU/ml, , Hemoglobin: 15.2 gr/dl, Platelet count: 345000/ml, WBC count: 6500/ml. Approximately 4 weeks ago, the patient was diagnosed with HCV infection  after screening due to intravenous drug addiction history. At that time, HCV – RT PCR was positive, HIV ab  and Hepatitis B Surface antigen were negative. The patient was started on Interferon and ribavirin for Hepatitis – C infection. The patient denied any recent drug use. He has been compliant with his Fluoxetine. He reports  increased suicidal thoughts over the past few days. The most important next step in controlling this patient’s depression :

A) Electroconvulsive therapy

B) Discontinue Fluoxetine

C) Start Cyproheptadine

D) Discontinue Interferon

E) Start Clozapine to reduce suicidal tendency

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