I'm studying for Step III using USMLE world and I get the following question:
22 year old pregnant female in her second trimester is brought to the emergency room by her boyfriend because she's threatening to commit suicide. On initial evaluation, she exhibits clear, unmistakable signs of a manic episode and a clear intent to kill herself. What is the appropriate management? (I'm paraphrasing to respect USMLE World copywright)
A. hospitalize and give prozac
B. ask to speak to the boyfriend privately and find out what he did to make her so crazy
C. grab her by the shoulders, shake vigorously and tell her to calm down already
D. hospitalize and give ECT (electroconvulsive therapy)
E. reassurance and discharge home
In real life, when this lady shows up to OB triage, the correct answer is: consult and let them deal with it - she has no OB issue. Unfortunately, the USMLE examiners operate under the assumption that the only doctor available is YOU. The scary thing about this question, however, is that one of the above answers is not made up. Think you know which one?
The the not-made-up, and apparently correct, answer is D - electroconvulsive (shock) therapy. Yeah, I have some misgivings about that answer. As an OB resident, we used to work very hard and even give potentially toxic medications to pregnant women in order to prevent seizures. It seems pretty counterintuitive to me that you'd want to induce a seizure in a pregnant woman. I understand that there's lots of literature on ECT. Proponents will cite its superb effectiveness. And, I have no argument there. ECT is very effective treatment. But, I always thought that "effective" kind of misses the point when your talking about ECT. I mean, a foot amputation is a pretty "effective" treatment for toenail fungus but, Jesus Christ, man - you're causing a seizure! I mean seizure - like on those medical shows when the camera starts moving around all fast, and the patient is foaming at the mouth and monitors are going off and everyone's yelling at each other; you're creating this situation intentionally.
Anyway, study time is over. I'm going to bed.
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