A 45-year-old man presents to his primary care physician accompanied by his wife. Three days ago, he was passed over for promotion at work, which he had anticipated receiving. Since that time, he has consumed alcohol daily, remained in bed most of the weekend, and has been tearful. He reports feeling hopeless about his career prospects but denies suicidal ideation. He states, "I need to pull myself together and get back to work tomorrow or I'll be fired." He has never had a psychiatric diagnosis, has no family history of mood disorders, and prior to this week drank alcohol only socially. Vital signs are within normal limits. Physical examination is unremarkable. Which of the following is the most appropriate next step in management?
- A)Supportive psychotherapy and psychoeducation about the expected course of his conditionGABARITO
- B)Start sertraline 50 mg daily and refer to psychiatry
- C)Prescribe lorazepam 1 mg TID and schedule follow-up in 1 week
- D)Refer for inpatient psychiatric hospitalization
- E)Refer to substance abuse treatment program immediately
Explicação
This patient presents with an adjustment disorder with depressed mood—emotional symptoms that developed within 3 days of an identifiable, discrete stressor (job promotion denial), without meeting full criteria for major depressive disorder (symptom duration on... Ver explicação completa e trilha adaptativa →