Long-term management strategies US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Long-term management strategies. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Long-term management strategies US Medical PG Question 1: A 21-year-old female was brought to the emergency room after losing large amounts of blood from slicing her wrists longitudinally. A few days later, she was interviewed by the psychiatrist and discussed with him why she had tried to kill herself. "My evil boyfriend of 2 months left me because I never let him leave my side for fear that he would cheat on me and leave me...now I feel so empty without him." Which of the following personality disorders does this female most likely have?
- A. Avoidant
- B. Dependent
- C. Borderline (Correct Answer)
- D. Paranoid
- E. Histrionic
Long-term management strategies Explanation: ***Borderline***
- The patient exhibits core features of **borderline personality disorder (BPD)**, including **impulsivity** (suicide attempt via wrist-slicing), **unstable relationships** marked by fear of abandonment, and intense feelings of **emptiness**.
- Her statement about her boyfriend refusing to let him leave her side reflects classic BPD traits of **frantic efforts to avoid abandonment** and a **pattern of intense and unstable interpersonal relationships**.
*Avoidant*
- Individuals with **avoidant personality disorder** are characterized by **social inhibition**, feelings of inadequacy, and hypersensitivity to negative evaluation, which are not the primary features presented in this scenario.
- They tend to *avoid* social interactions due to fear of criticism, rather than engaging in intense, unstable relationships and dramatic self-harm as described.
*Dependent*
- While a **dependent personality disorder** involves a pervasive and excessive need to be cared for, leading to submissive and clinging behavior, it typically doesn't manifest with the same level of **impulsivity**, **self-harm**, or extreme relationship instability seen here.
- The "fear that he would cheat on me and leave me" relates more to the **frantic efforts to avoid abandonment** characteristic of borderline personality, rather than general clinginess and submission.
*Paranoid*
- **Paranoid personality disorder** is characterized by pervasive distrust and suspiciousness of others, often interpreting their motives as malevolent.
- The patient's behaviors (suicide attempt, fear of abandonment in a short-term relationship, feeling empty) do not align with the prominent **distrust and suspiciousness** of paranoid personality.
*Histrionic*
- **Histrionic personality disorder** involves excessive emotionality and attention-seeking behavior. While the suicide attempt might be seen as attention-seeking, the underlying **fear of abandonment**, **feelings of emptiness**, and extremely rapid relationship deterioration are more indicative of borderline personality.
- Histrionic individuals tend to be dramatic and theatrical, using physical appearance to draw attention, which is not emphasized in this clinical picture.
Long-term management strategies US Medical PG Question 2: A 24-year-old male comes into the psychiatric clinic complaining of consistent sadness. He endorses feelings of worthlessness, anxiety, and anhedonia for the past couple months but denies feeling suicidal. He further denies any past episodes of feeling overly energetic with racing thoughts. Confident of the diagnosis, you recommend frequent talk therapy along with a long-term prescription of a known first-line medication for this disorder. What is the drug and what are some of the most frequently encountered side effects?
- A. Selective serotonin reuptake inhibitor; hypomania, suicidal thoughts
- B. Tricyclic antidepressants; hypomania, suicidal thoughts
- C. Selective serotonin reuptake inhibitor; anorgasmia, insomnia (Correct Answer)
- D. Monoamine oxidase inhibitors; Orthostatic hypotension, weight gain
- E. Tricyclic antidepressants; Orthostatic hypotension, anticholinergic effects
Long-term management strategies Explanation: ***Selective serotonin reuptake inhibitor; anorgasmia, insomnia***
- The patient presents with classic symptoms of **major depressive disorder**, including persistent sadness, worthlessness, anxiety, and anhedonia, without any history of manic or hypomanic episodes. **SSRIs** are considered first-line pharmacotherapy for this condition.
- Common side effects of SSRIs include **sexual dysfunction** (e.g., anorgasmia, decreased libido) and **insomnia** or agitation, especially during the initial weeks of treatment.
*Selective serotonin reuptake inhibitor; hypomania, suicidal thoughts*
- While SSRIs are the correct drug class, **hypomania** is not a frequent side effect in patients without bipolar disorder. For patients with bipolar disorder, antidepressant monotherapy can induce hypomania or mania, but this patient denies such episodes.
- **Suicidal thoughts** can occur, particularly in young adults, during the initial phase of antidepressant treatment, but it is less common to frame it as a *frequently encountered side effect* in the general population compared to sexual dysfunction or sleep disturbances.
*Tricyclic antidepressants; hypomania, suicidal thoughts*
- **Tricyclic antidepressants (TCAs)** are generally not first-line due to their less favorable side effect profile compared to SSRIs, including significant anticholinergic effects and cardiovascular risks.
- As with SSRIs, **hypomania** is not a typical frequent side effect in unipolar depression, and while **suicidal thoughts** are a concern with antidepressants, TCAs carry a higher risk of lethality in overdose, making them less preferred initially.
*Monoamine oxidase inhibitors; Orthostatic hypotension, weight gain*
- **Monoamine oxidase inhibitors (MAOIs)** are effective but are typically reserved for **refractory depression** due to their significant drug and food interactions (e.g., tyramine-induced hypertensive crisis).
- While **orthostatic hypotension** and **weight gain** are known side effects of MAOIs, this class is not considered a first-line treatment for major depressive disorder.
*Tricyclic antidepressants; Orthostatic hypotension, anticholinergic effects*
- **TCAs** are indeed associated with side effects such as **orthostatic hypotension** and prominent **anticholinergic effects** (e.g., dry mouth, constipation, blurred vision, urinary retention).
- However, because of these more burdensome side effects and higher toxicity in overdose, TCAs are not generally considered the first-line medication choice, especially when SSRIs are available and safer.
Long-term management strategies US Medical PG Question 3: A 28-year-old woman is brought to a counselor by her father after he found out that she is being physically abused by her husband. The father reports that she refuses to end the relationship with her husband despite the physical abuse. She says that she feels uneasy when her husband is not around. She adds, “I'm worried that if I leave him, my life will only get worse.” She has never been employed since they got married because she is convinced that nobody would hire her. Her husband takes care of most household errands and pays all of the bills. Physical examination shows several bruises on the thighs and back. Which of the following is the most likely diagnosis?
- A. Schizoid personality disorder
- B. Separation anxiety disorder
- C. Avoidant personality disorder
- D. Dependent personality disorder (Correct Answer)
- E. Borderline personality disorder
Long-term management strategies Explanation: ***Dependent personality disorder***
- This patient exhibits a pervasive and excessive need to be taken care of, leading to **submissive and clinging behavior, and fears of separation**. Key features include difficulties making decisions, avoiding disagreement due to fear of loss of support, and preoccupation with fears of being left to care for herself.
- Her comments about her life getting worse if she leaves her husband, her inability to seek employment, and her husband managing all household affairs are consistent with her **reluctance to leave an abusive relationship** because of an exaggerated fear of being alone or unable to care for herself.
*Schizoid personality disorder*
- Characterized by a pervasive pattern of **detachment from social relationships** and a restricted range of emotional expression.
- Individuals with this disorder typically show **little interest in forming close relationships**, in contrast to the patient's clinging behavior.
*Separation anxiety disorder*
- Primarily marked by **excessive anxiety concerning separation from home or from those to whom the individual is attached**, often seen in childhood, but can occur in adults.
- While there is some anxiety about separation, the patient's broader pattern of submissive behavior, difficulty with independent functioning, and belief she cannot care for herself points more strongly to a **personality disorder** rather than an anxiety disorder focused solely on separation.
*Avoidant personality disorder*
- Involves extreme social inhibition, feelings of inadequacy, and **hypersensitivity to negative evaluation**.
- These individuals **desire social connection but avoid it due to fear of rejection**, which contrasts with the patient's clinging and submissive efforts to maintain a relationship.
*Borderline personality disorder*
- Characterized by significant **instability in moods, interpersonal relationships, self-image, and behaviors**.
- While there can be fear of abandonment, this disorder typically involves **impulsivity, intense anger, and frantic efforts to avoid abandonment**, which are not the primary features described in this patient.
Long-term management strategies US Medical PG Question 4: A 26-year-old man being treated for major depressive disorder returns to his psychiatrist complaining that he has grown weary of the sexual side effects. Which other medication used to treat major depressive disorder may be appropriate as a stand-alone or add-on therapy?
- A. Venlafaxine
- B. Cyproheptadine
- C. Aripiprazole
- D. Bupropion (Correct Answer)
- E. Paroxetine
Long-term management strategies Explanation: ***Bupropion***
- **Bupropion** is an antidepressant that works via **norepinephrine-dopamine reuptake inhibition**, and unlike most common antidepressants, it is **not associated with sexual dysfunction**.
- It can be used as a **stand-alone treatment** or as an **add-on therapy** to counteract sexual side effects from other antidepressants like SSRIs.
- This makes it the ideal choice for this patient.
*Venlafaxine*
- **Venlafaxine** is a **serotonin-norepinephrine reuptake inhibitor (SNRI)**, and like SSRIs, it can cause or worsen **sexual dysfunction**.
- It is unlikely to resolve the patient's complaint of sexual side effects.
*Cyproheptadine*
- **Cyproheptadine** is an **antihistamine** with **serotonin antagonist** properties that is sometimes used **off-label to treat SSRI-induced sexual dysfunction**.
- However, it is **not an antidepressant** itself and therefore would not be appropriate as a **stand-alone therapy** for major depressive disorder.
- The question specifically asks for "medication used to treat major depressive disorder," which excludes cyproheptadine despite its utility for sexual side effects.
*Aripiprazole*
- **Aripiprazole** is an **atypical antipsychotic** that is approved as an **adjunctive treatment** for major depressive disorder.
- While it can be an add-on, it is **not typically used to mitigate sexual side effects** and can sometimes have its own sexual side effects.
*Paroxetine*
- **Paroxetine** is an **SSRI** that is notoriously associated with a **high incidence of sexual side effects**, including decreased libido, delayed orgasm, and anorgasmia.
- Using paroxetine would likely **exacerbate** rather than alleviate the patient's complaint.
Long-term management strategies US Medical PG Question 5: A 35-year-old man comes to the Veterans Affairs hospital because of a 2-month history of anxiety. He recently returned from his third deployment to Iraq, where he served as a combat medic. He has had difficulty readjusting to civilian life. He works as a taxi driver but had to take a leave of absence because of difficulties with driving. Last week, he hit a stop sign because he swerved out of the way of a grocery bag that was in the street. He has difficulty sleeping because of nightmares about the deaths of some of the other soldiers in his unit and states, “it's my fault, I could have saved them. Please help me.” Mental status examination shows a depressed mood and a restricted affect. There is no evidence of suicidal ideation. Which of the following is the most appropriate initial step in treatment?
- A. Dialectical behavioral therapy
- B. Venlafaxine therapy
- C. Cognitive behavioral therapy (Correct Answer)
- D. Motivational interviewing
- E. Prazosin therapy
Long-term management strategies Explanation: ***Cognitive behavioral therapy***
- **Cognitive Behavioral Therapy (CBT)** is considered a first-line psychological treatment for **Post-Traumatic Stress Disorder (PTSD)**, which the patient's symptoms (deployments, intrusive thoughts, nightmares, avoidance, guilt) strongly suggest.
- CBT helps individuals identify and challenge **maladaptive thought patterns** and behaviors related to the trauma, fostering new coping mechanisms.
*Dialectical behavioral therapy*
- **Dialectical Behavioral Therapy (DBT)** is primarily used for individuals with **Borderline Personality Disorder** or severe emotional dysregulation.
- While it can help with emotional regulation, it is not the **first-line therapy** specifically targeting trauma-related cognitive distortions and avoidance behaviors seen in PTSD.
*Venlafaxine therapy*
- **Venlafaxine**, an SNRI, is an antidepressant that can be effective for PTSD symptoms. However, current guidelines recommend **psychotherapy (like CBT)** as the initial step, especially when feasible.
- While pharmacotherapy can be used, it's typically considered **adjunctive** or for cases where psychotherapy alone is insufficient or not preferred.
*Motivational interviewing*
- **Motivational interviewing** is a patient-centered counseling style used to address ambivalence and enhance a person's **intrinsic motivation** for change.
- It is often utilized in substance abuse treatment or when patients are resistant to treatment, but it is not a primary, standalone treatment for the core symptoms of PTSD.
*Prazosin therapy*
- **Prazosin** is an alpha-1 antagonist used off-label to treat **PTSD-related nightmares** and sleep disturbances.
- While it can be helpful for a specific symptom, it does not address the broader spectrum of PTSD symptoms, such as intrusive thoughts, avoidance, or negative cognitions.
Long-term management strategies US Medical PG Question 6: A 37-year-old African American man is brought to the emergency department by police. The patient refused to leave a petting zoo after closing. He states that he has unique ideas to revolutionize the petting zoo experience. The patient has a past medical history of multiple suicide attempts. His temperature is 99.5°F (37.5°C), blood pressure is 130/85 mmHg, pulse is 100/min, respirations are 16/min, and oxygen saturation is 99% on room air. The patient's cardiac and pulmonary exams are within normal limits. He denies any nausea, vomiting, shortness of breath, or systemic symptoms. The patient struggles to answer questions, as he is constantly changing the subject and speaking at a very rapid rate. The patient is kept in the emergency department overnight and is observed to not sleep and is very talkative with the nurses. Which of the following is the best long-term therapy for this patient?
- A. Haloperidol
- B. Lithium (Correct Answer)
- C. Diphenhydramine
- D. Valproic acid
- E. Risperidone
Long-term management strategies Explanation: ***Lithium***
- The patient exhibits classic symptoms of **mania**, including grandiosity, decreased need for sleep, pressured speech, and flight of ideas, suggesting **bipolar I disorder**.
- **Lithium** is considered a first-line agent and the best long-term maintenance therapy for **bipolar I disorder**, effective in reducing both manic and depressive episodes and decreasing suicide risk.
*Haloperidol*
- **Haloperidol** is a potent typical antipsychotic primarily used for acute management of severe agitation, psychosis, or manic episodes due to its rapid tranquilizing effects.
- While it could be used for immediate symptom control, it is not the **best long-term therapy** for mood stabilization in bipolar disorder and carries a high risk of **extrapyramidal side effects**.
*Diphenhydramine*
- **Diphenhydramine** is an antihistamine with sedative properties, sometimes used for mild insomnia or allergic reactions, but it has no role in the treatment of acute mania or the long-term management of bipolar disorder.
- It would not address the underlying mood dysregulation and behavioral symptoms seen in this patient's presentation.
*Valproic acid*
- **Valproic acid** (divalproex) is an effective mood stabilizer used for bipolar disorder, particularly in patients who cannot tolerate lithium or have rapid cycling.
- However, for long-term therapy and overall efficacy, especially considering lithium's proven benefits in reducing suicidality, **lithium** is generally considered the preferred first-line agent, although valproic acid is a strong alternative.
*Risperidone*
- **Risperidone** is an atypical antipsychotic, primarily used for acute mania or as an adjunct in bipolar depression, and in schizophrenia.
- While useful for acute symptom management of psychosis and agitation in bipolar disorder, it is not typically the sole **best long-term maintenance monotherapy** compared to mood stabilizers like lithium, which directly target the mood swings.
Long-term management strategies US Medical PG Question 7: A 25-year-old woman is brought to the emergency department by her boyfriend after she cut her forearms with a knife. She has had multiple visits to the emergency department in the past few months for self-inflicted wounds. She claims that her boyfriend is the worst person in the world. She and her boyfriend have broken up 20 times in the past 6 months. She says she cut herself not because she wants to kill herself; she feels alone and empty and wants her boyfriend to take care of her. Her boyfriend claims that she is prone to outbursts of physical aggression as well as mood swings. He says that these mood swings last a few hours and vary from states of exuberance and self-confidence to states of self-doubt and melancholy. On examination, the patient appears well-dressed and calm. She has normal speech, thought processes, and thought content. Which of the following is the most likely diagnosis?
- A. Dependent personality disorder
- B. Borderline personality disorder (Correct Answer)
- C. Bipolar II disorder
- D. Cyclothymic disorder
- E. Histrionic personality disorder
Long-term management strategies Explanation: ***Borderline personality disorder***
- This patient exhibits characteristic features of **borderline personality disorder**, including **impulsivity** (self-harm), **unstable relationships** (frequent breakups, idealization/devaluation of boyfriend), **affective instability** (rapid mood swings lasting hours), and feelings of **emptiness** and **abandonment**.
- **Self-harm** in BPD is often a coping mechanism for intense emotional pain or a way to elicit care, rather than a genuine suicide attempt, as stated by the patient.
*Dependent personality disorder*
- Characterized by an **excessive need to be cared for**, leading to submissive and clinging behavior and fears of separation, which is not the primary presentation here.
- While there is a desire for care, the prominent features of **impulsivity**, **affective instability**, and **unstable relationships** are not typical of dependent personality disorder.
*Bipolar II disorder*
- Involves episodes of **hypomania** and **major depression**, with mood swings typically lasting for at least **four days** (hypomania) or **two weeks** (major depression), much longer than the hours described here.
- The patient's presentation emphasizes **interpersonal instability** and **self-harm** more than episodic mood disturbances.
*Cyclothymic disorder*
- Involves **numerous periods of hypomanic symptoms** and numerous periods of **depressive symptoms** for at least two years, but these symptoms are less severe than full-blown hypomanic or major depressive episodes.
- The rapid mood shifts within hours and the intensity of **interpersonal dysfunction** and **self-harm** are more indicative of borderline personality disorder.
*Histrionic personality disorder*
- Characterized by **excessive emotionality** and **attention-seeking behavior**, often sexually provocative, and using physical appearance to draw attention.
- While emotionality is present, the **self-harm**, **emptiness**, and **rapid mood shifts** are not core features of histrionic personality disorder.
Long-term management strategies US Medical PG Question 8: A 19-year-old man presents to the emergency room after a suicidal gesture following a fight with his new girlfriend. He tearfully tells you that she is “definitely the one," unlike his numerous previous girlfriends, who were "all mean and selfish” and with whom he frequently fought. During this fight, his current girlfriend suggested that they spend time apart, so he opened a window and threatened to jump unless she promised to never leave him. You gather that his other relationships have ended in similar ways. He endorses impulsive behaviors and describes his moods as “intense” and rapidly changing in response to people around him. He often feels “depressed” for one day and then elated the next. You notice several superficial cuts and scars on the patient’s arms and wrists, and he admits to cutting his wrists in order to “feel something other than my emptiness.” Which of the following is the most likely diagnosis for this patient?
- A. Bipolar I disorder
- B. Major depressive disorder
- C. Borderline personality disorder (Correct Answer)
- D. Bipolar II disorder
- E. Histrionic personality disorder
Long-term management strategies Explanation: ***Borderline personality disorder***
- This patient exhibits characteristic features of **borderline personality disorder (BPD)**, including a pattern of **unstable relationships** marked by idealization ("definitely the one") and devaluation ("all mean and selfish").
- Other key features are **impulsivity** (suicidal gesture, cutting), **affective instability** ("intense" and rapidly changing moods), chronic feelings of **emptiness**, and a history of **self-harm** (superficial cuts and scars).
*Bipolar I disorder*
- While the patient describes rapidly changing and "intense" moods, the rapid shifts over days and reactivity to others are more characteristic of **mood lability** in BPD than distinct **manic or hypomanic episodes** lasting several days or longer, which define bipolar disorder.
- The suicidal gesture stemming from interpersonal conflict and fear of abandonment, combined with chronic self-harm, points strongly away from a primary mood disorder.
*Major depressive disorder*
- Although the patient reports feeling "depressed," the predominant features are not a persistent depressed mood or anhedonia but rather **unstable relationships**, **impulsivity**, and **affective dysregulation** beyond typical depressive symptoms.
- The "elated" periods described are also inconsistent with unipolar depression.
*Bipolar II disorder*
- This diagnosis requires a history of at least one **major depressive episode** and at least one **hypomanic episode**. While the patient describes mood shifts, they are described as "rapidly changing in response to people around him" and lasting for a day, which is more consistent with **affective instability** seen in BPD rather than sustained hypomanic episodes.
- The prominent features of self-harm and unstable relationships are not central to Bipolar II disorder.
*Histrionic personality disorder*
- Patients with **histrionic personality disorder** typically display excessive emotionality and attention-seeking behavior, often with a theatrical presentation.
- While there may be some overlap in attention-seeking aspects (suicidal gesture), the profound **instability of mood**, chronic **emptiness**, self-harm, and intense **fear of abandonment** are core to BPD and less characteristic of histrionic traits.
Long-term management strategies US Medical PG Question 9: A 25-year-old woman with a history of moderate persistent asthma presents to the emergency department with tachypnea, shortness of breath, and cough. She also mentions that she has recently started to notice red flecks in the sputum that she coughs up. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 26/min. Her physical examination is significant for moderate bilateral wheezes and poor air movement. The forced expiratory volume-1 (FEV-1) is less than 50% of the predicted value, and she is found to have a concurrent upper respiratory tract infection. She is given oxygen, albuterol, and corticosteroids for her exacerbation, and she starts to feel better after a few hours of monitoring in the emergency department. She is ultimately discharged home on a 14-day prednisone taper. Which of the following is a side effect she could experience on this short course of steroids?
- A. Impaired wound healing
- B. Amenorrhea
- C. Fat deposits in the face
- D. Emotional instability (Correct Answer)
- E. Cushing’s syndrome
Long-term management strategies Explanation: ***Emotional instability***
- A short course of corticosteroids can significantly impact **mood and cognition**, leading to symptoms like **anxiety**, **irritability**, **insomnia**, or even an acute psychotic episode.
- These psychiatric side effects are relatively common, even with short-term use, due to the direct effects of glucocorticoids on the **central nervous system**.
*Impaired wound healing*
- While chronic corticosteroid use can impair wound healing by inhibiting **collagen synthesis** and **fibroblast proliferation**, it is less likely to be a prominent side effect with a short, 14-day taper.
- Significant wound healing issues are typically seen with **prolonged high-dose therapy**.
*Amenorrhea*
- **Menstrual irregularities** and amenorrhea are usually associated with **long-term steroid use**, leading to suppression of the hypothalamic-pituitary-gonadal axis.
- A short, 14-day course is unlikely to cause a significant or lasting impact on the **menstrual cycle**.
*Fat deposits in the face*
- The development of **"moon face"** (fat deposits in the face) is a characteristic feature of **Cushing's syndrome** resulting from **chronic, high-dose corticosteroid use**.
- This symptom primarily develops over **weeks to months** of continuous exposure, not from a short-term taper.
*Cushing’s syndrome*
- **Cushing's syndrome** is a constellation of symptoms resulting from **prolonged exposure to high levels of cortisol**, endogenous or exogenous.
- A 14-day prednisone taper is **insufficient duration** to induce the full clinical picture of Cushing's syndrome.
Long-term management strategies US Medical PG Question 10: A 38-year-old woman presents to her primary care physician for complaints of insomnia. She states that for the last 8 months, she has had difficulty falling asleep. Additionally, she awakens in the middle of the night or early morning and cannot fall back to sleep. When further questioned, she reports decreased appetite with a 12-lb. weight loss in the last 6 months. She was recently demoted at her work as a baker due to trouble focusing and coordinating orders and excess fatigue. She feels she is to blame for her family's current financial status given her demotion. She is given a prescription for fluoxetine at this visit with follow-up 2 weeks later. At the follow-up visit, she reports no improvement in her symptoms despite taking her medication consistently. What is the most appropriate next step in management?
- A. Increase dose of current medication
- B. Switch to bupropion
- C. Add lithium
- D. Switch to paroxetine
- E. Continue current medication (Correct Answer)
Long-term management strategies Explanation: ***Continue current medication***
- It takes approximately **4-6 weeks** for an antidepressant, such as fluoxetine, to reach its full therapeutic effect and for patients to experience significant symptom improvement.
- Due to the **delayed onset of action**, continuing the medication for a longer period is necessary to assess its efficacy before making changes.
*Increase dose of current medication*
- Increasing the dose after only 2 weeks is premature as the medication has not had sufficient time to reach its **therapeutic plasma concentration** or demonstrate its full effect.
- Adjusting the dose too early could also increase the risk of **side effects** without a clear benefit.
*Switch to bupropion*
- Switching to a different antidepressant like bupropion after just 2 weeks is also premature, as the patient has not had an adequate trial of fluoxetine.
- Bupropion has a different mechanism of action and side effect profile but also requires a similar **onset period** for efficacy.
*Add lithium*
- Lithium is primarily used as a **mood stabilizer** in bipolar disorder or as an augmentation strategy for treatment-resistant depression.
- There is no indication of bipolar disorder, and it's too early to consider her depression as **treatment-resistant** given the short duration of fluoxetine use.
*Switch to paroxetine*
- Switching to another **SSRI** (selective serotonin reuptake inhibitor) like paroxetine after only 2 weeks is not appropriate because the initial SSRI has not been given sufficient time to work.
- The patient has not failed therapy with fluoxetine yet, and such a change would unnecessarily prolong the search for an effective treatment.
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