An elderly house wife lost her husband who died suddenly of Myocardial infarction couple of years ago. They had been staying alone for almost a decade with infrequent visits from her son and grandchildren. About a week after the death she heard his voice clearly talking to her as he would in a routine manner from the next room. She went to check but saw nothing. Subsequently she often heard his voice conversing with her and she would also discuss her daily matters with him. This however, provoked anxiety and sadness of mood when she was preoccupied with his thought. She should be treated with –
Correct Answer: Clomipramine
Description: Once again, most of the guides have given option `d' haloperidol as the answer by saying that there are psychotic symptoms (auditory hallucination) therefore antipsychotic should be given. However, they are wrong. Read below :-
The information in this question -
Death of loved one
Seeing the deceased person
Hearing the voice of deceased
Preoccupation with thoughts of deceased which is producing anxiety and depression (sadness of mood)
Symptoms for > 1 year (couple of years)
So, here the diagnosis is pathological grief reaction. The characteristic symptoms of pathological grief is preoccupation with thoughts of deceased person which may produce anxiety or depressive symptoms. Patient may also see or hear the voice of deceased (these are not psychotic features).
Treatment of pathological grief reaction mainly involve the treatment of depressive symptoms and anxiety.
Antidepressants are the most commonly used drugs. Amongst the given option only clomipramine is the antidepressant.
So, the answer of this question is antidepressant (clomipramine), not antipsychotic (haloperidol) as the symptoms of the patients are classical symptoms of pathological grief (not psychotic features).
You, should also keep in mind that if the symptoms would have been for less than 1 year, the diagnosis will be normal grief and the answer will be option b i.e. alprazolam as normal grief usually does not require any treatment although benzodiazepine may be used for short term.
Category:
Psychiatry
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