Scenarios wanted! Please add your favorites! [Click on "Easy Edit", above]

Information about each scenario can include, but need not be limited to:

• the case
  
• the PICO'd question
  
• type of question/preferred study design
• suggested search strategies
• teaching tips

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Case: The patient, BF, is a 35 year old woman who recently gave birth to her first child. She comes to the clinic because for the last six weeks she has been experiencing feelings of panic and immense sadness. She is not sleeping well and has little interest in the new baby. Recently she has had thoughts about suicide. She has no history of depression or other mental health problems. She wants to know if there is a medication, like Prozac, that she can take to help her return to normal. She goes on to say that her so-called friend, Tom, told her to take vitamins for this problem. She's confused and wants to know if there is any proof that either vitamins or drugs could help her feel better.

P post partum depression
I prozac, antidepressives
C
O resolve depression
T therapy
T RCT, sys. review

SEARCH Strategy: post partum depression AND (prozac OR serotonin uptake inhibitors)
therapy narrow clinical query

TEACHING Tips: go to MeSH database and look up prozac to find classification of drug (if class doesn't know), under scope note see serotonin uptake inhibitor mentioned. search this additionally

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Case: The patient is an elderly woman who is being treated for unipolar major depression. At this time she appears to be in remission from a depressive episode. However, she is planning to spend the next year abroad, taking care of her grandchildren, and she is worried that she might suffer a relapse. She wants to know if she continued taking her antidepressant (citalopram) medicine, would it help her to prevent another episode.

P unipolar major depression
I citalopram
C
O prevent episode
T therapy
T RCT

SEARCH Strategy: Major depressive disorder AND citalopram AND (recurrence OR relapse OR prevent*)
TEACHING Tips: unipolar major depression is too specific and doesn't map to MeSH, use Major depressive disorder, use clinical queries and age limits

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A 26 year old woman with schizophrenia has been successfully treated with olanzapine for the past 4 years. She is concerned about her 20-lb. weight gain and wants to discontinue the drug – or switch to another that will not cause weight gain. What do you recommend?
P – young woman with schizophrenia
I – antipsychotics
C – olanzapine
O – Control psychotic symptoms and stabilize or reduce weight gain
OR
P – young woman with schizophrenia
I – olanzapine discontinued or reduced dosage
C – olanzapine – regular dosage
O – Control psychotic symptoms and stabilize or reduce weight gain
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A 40 year old woman is hospitalized with severe depression. Might the addition of group psychotherapy improve her outcomes?
P – middle-aged woman hospitalized with severe depression
I – Group psychotherapy
C – Usual care (pharmacotherapy)
O – improve symptoms and shorten hospital stay
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A 30 year old man has been taking Zoloft for mild depression for 6 months with good results. He’s concerned, however about the sexual side effects of the drug. Are phosphodiesterase inhibitors (e.g. sildenafil=Viagra) effective in treating sexual dysfunction associated with SSRIs?
P - 30 year old man with sexual side effects from ssri
I - Phosphodiesterase inhibitors in addition to SSRIs
C – Placebo + SSRIs
O – Improved sexual function
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A 32 year old man with general anxiety disorder has been referred for treatment of alcoholism with naltrexone. Is there any evidence that naltrexone is effective with this dual diagnosis?
P - 32 year old man with general anxiety disorder and alcoholism
I – addition of Naltrexone
C – Placebo or usual care
O - Effective treatment of alcoholism
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A 14 year old girl presents with new onset of significant depression. Her mother is concerned about her taking Prozac or other SSRIs; she’s heard about how they can increase the risk of suicide. Do SSRIs increase or decrease the risk of suicide in adolescents with major depressive disorder?
P – adolescent with major depressive disorder
I – SSRIs
C – placebo or no treatment
O – incidence of suicide attempt and/or ideation
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A 32 year old woman with schizophrenia wants to go off her medications completely. Is cognitive-behavior therapy a viable alternative?
P – woman with schizophrenia
I – cognitive-behavior therapy
C – antipsychotics
O – reduce psychotic symptoms (can specify)
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A 40 year old man with bipolar disorder wants to work at a “real job” in the community. You’ve heard of Supported Employment but don’t know if it would be appropriate.
P – middle aged man with bipolar disorder
I – supported employment
C – vocational rehab programs
O – increase hours worked at competitive employment
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A 9 year old boy is referred by his school for symptoms of hyperactivity and inattention. You confirm a diagnosis of ADHD without co-morbid conditions. Would treatment with stimulants alone be as effective as combined medication and psychosocial intervention?
P – child diagnosed with ADHD
I – stimulants
C – stimulants and psychotherapy
O – control symptomatic behavior
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A 12 year old girl is being treated with sertraline for severe PTSD secondary to early childhood sexual abuse. While some of her symptoms have improved, she continues to have re-experiencing symptoms at a level that interferes with daily functioning. Is there a psychosocial intervention which is likely to result in further symptom improvement?
P – child with ptsd secondary to early sexual abuse
I – psychotherapy and sertraline
C – sertraline alone
O – decreased re-experiencing symptoms and improved daily functioning
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You are providing psychiatric consultation to a long standing patient of yours with generalized anxiety disorder who is now having falls in a nursing home. You recommend continued use of lorazepam which has been effective at a constant dose. Because of concern about the falls and violating OBRA regulations, the medical director of the nursing home asks you to consider using something else for anxiety, like an SSRI. What is the evidence for risk of falls from these two class of drugs?
P – elderly nursing home residents with general anxiety disorder
I – ssri
C – lorazepam
O – decreased risk of falls and continued control of anxiety
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An administrator from a local nursing home is considering banning the use of atypical antipsychotics as she has heard that atypical antipsychotics are associated with a significant rate of cerebrovascular accidents and that they are no more effective than behavioral interventions. Is this true?
P – nursing home patients with schizophrenia
I – atypical antipsychotics [OR cognitive behavior therapy]
C – cognitive behavior therapy [OR atypical antipsychotics]
O – increased risk of CVAs [OR decreased risk of CVAs]
OR
P – nursing home patients with schizophrenia
I – cognitive behavior therapy
C – atypical antipsychotics
O – symptom improvement
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A 75 year old man with recurrent major depression has been maintained on an SSRI antidepressant for 6 months without any recurrence of symptoms. He wants to stop the antidepressant, but is willing to engage in psychotherapy. Will psychotherapy reduce his risk of relapse?
P – elderly male with recurrent major depressive disorder on ssri
I – psychotherapy alone
C – continuing ssri
O – prevent relapse of depressive symptoms
OR
P - elderly male with recurrent major depressive disorder on ssri
I – psychotherapy
C – no treatment
O – prevent relapse of depressive symptoms