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umpalumpa
Actually, weight loss and exercise are the only measures to decrease mortality (other than statins) in pt with impaired lipid lab values. I'm not able to explain why a low-calorie diet is wrong (it should decrease weight-->decrease mortality); maybe there is no direct correlation in clinical studies beween low-calorie diet and mortality.
+1
fhegedus
even though i got this wrong, i believe i have figured out why low-calorie diet is wrong. In the first sentence of the question, it states he has low appetite. So we can pretty much ignore diet and calories from the equation.
+1
drbravojose
I think maybe 2 years next is the key to choose antidep instead of low-calorie which takes a long term to make its effect.
+1
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sohaib111
Won't having an MI be a very big risk factor for another one ?
And also if they wanted this answer (the anti-depressant), why would they just add that his LDL is inreasing in the last sentence...
+14
dbg
bc they're SOBs and DOBs
+33
doodimoodi
Yeah, recommended LDL in people with previous heart problem is < 100 jeez
+1
asingh
It is because of the timeframe of mortality is 2 yrs, everything else will affect later
+6
benny
Type 2 diabetes and major depressive disorder (MDD) are independent contributors to cardiovascular disease and to an increased risk of myocardial infarction (MI).
+
drzed
None of the cardiovascular options would improve mortality (statins, ACEi, BB, spironolactone are the ones that have proven mortality benefit). So if they had put one of those, I think I would have chosen that, but given that the rest don't change mortality at all, I went with the antidepressants.
+2
ihatetesting
My thinking was that since he had an MI, a beta blocker would improve mortality, and propranolol is also used as an anxiolytic.
+2
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bharatpillai
why antidepressant therapy though? there are not enough features given to suggest MDD.
He's 56 years old, not an elderly single male so not at the highest "classical" population at risk of suicide? the question is so ambiguous...
Given MI, wouldn't chronic alcoholic intake predispose him to dilated cardiomyopathy?
+1
neovanilla
I don't believe it's that he has MDD by the clinical definition. It's more that his QoL has probably changed drastically since the MI and MIs are strongly associated with decreased outlook on life, especially considering how common it is to get a second MI soon after the first. I don't know the stats on suicide post-MI, but helping the patient's depression to make him more pro-active to help himself prevent another MI would be better than "a diet high in omega 3 FAs" (at least, this was my justification, as mbourne was saying)
+2
drzed
First sentence of the stem: he has a 6-week history (e.g. >2 weeks) of depression (1), difficulty sleeping (2), fatigue (3), decreased appetite (4), and poor memory/concentration (5)
For a diagnosis of MDD, you need a 2 week history of 5 of the SIGECAPS symptoms which he meets (he is only missing suicidal ideation and interest in activities). Thus he meets the diagnostic criteria for a major depressive episode, which means that treatment is indicated with an SSRI.
+3
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underd0g
An SSRI would cover both depression and anxiety.
+2
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submitted by โdrzed(333)
First sentence of the stem: he has a 6-week history (e.g. >2 weeks) of depression (1), difficulty sleeping (2), fatigue (3), decreased appetite (4), and poor memory/concentration (5)
For a diagnosis of MDD, you need a 2 week history of 5 of the SIGECAPS symptoms which he meets (he is only missing suicidal ideation and interest in activities). Thus he meets the diagnostic criteria for a major depressive episode, which means that treatment is indicated with an SSRI.
For the other cardiovascular factors, the only ones proven to improve mortality are statins, ACEi, BB (esp. carvedilol in heart failure), and spironolactone. None of those were answer choices, so MDD treatment was the best choice.