问题 单项选择题 A1/A2型题

患者男,23岁。兴奋话多与悲观消极念头交替发作3年,此次患者情绪低落1周,偶有自杀想法,诉脑子反应慢,记忆力下降,觉得自己拖累家人,是一个累赘,觉得周围的人都在用异样的眼神在看他,瞧不起他,要家人不要管他,不肯住院治疗,睡眠差。此时患者最合适的治疗措施是()

A.抗抑郁药

B.心境稳定剂

C.电抽搐治疗(ECT)

D.抗抑郁药和心境稳定剂

E.心境稳定剂和抗精神病药

答案

参考答案:E

解析:该患者的诊断应该比较明确,是一个双相情感障碍,目前为抑郁发作。该题主要是考查双相情感障碍抑郁相时如何治疗,因为出现了抑郁就牵涉到是否要用抗抑郁剂或者电休克治疗来改善抑郁情绪。但是应用抗抑郁剂可能诱发躁狂或者轻躁狂发作,或使循环频率增加,或促发快速循环发作,而使治疗更加困难。因此双相障碍抑郁发作时应慎用抗抑郁剂。如果抑郁症状十分严重、且持续时间超过4周以上,既往发作以抑郁为主要临床相,则可以在充分使用心境稳定剂的前提下合用抗抑郁剂,一般可首选无转躁作用的安非他酮,其次选用5-羟色胺再摄取抑制剂,而不宜选用转躁作用强的三环类抗抑郁剂。根据题干信息,该患者有情绪低落,偶有自杀观念,目前抑郁症状不十分严重,持续时间也不长,所以可以暂不使用抗抑郁剂或者电休克治疗,而可以考虑选用心境稳定剂加抗精神病药,加用抗精神病药有两个方面的原因,其一是患者有自责自罪和牵连观念需要使用抗精神病药,其二是抗精神病药主要是第二代抗精神病药可以作为心境稳定剂使用,如喹硫平既可以治疗双相躁狂也可以治疗双相抑郁,同时因为抗精神病药的镇静作用还可以改善患者的睡眠,因此最佳治疗方案为E。

完形填空
Having lived in the house for so long, we found our kitchen looked old. We decided it was time to   1   the kitchen, and my husband and I were discussing   2   colors. The children, sitting nearby, suddenly all spoke together: “Not the measuring stick.”
“No,” I   3   them. “Not the measuring stick..”
The measuring stick isn’t a (an)   4   stick but the kitchen side of the door between our kitchen and dining room. Along the edge we’ve   5    each child’s growth by making a mark showing his or her   6   on every birthday. Over the years so many colored pens, pencils and markers have been used, that now, this white door is somewhat like an abstract painting.
Names and dates show different    7  , and I can tell by the script(手迹) who measured whom. An eight-year-old measured her three-year-old sister, a grandchild measured her grandmother, my husband measured me. At the parties, when this door   8   back and forth frequently, friends stop to   9   the names and dates. When we ask if they would like to be always remembered, they usually smile   10   and go back right up into place,   11   to be measured.
Many of those listed on the door are still  12  ; some have stopped. Some remain with us only in   13 . When my mother came to see my eldest daughter graduate from university, we measured her too. It was her last visit to our home.
We haven’t  14   the new kitchen color plan yet, but one thing is certain: whatever color we choose, the back of the kitchen door will always remain   15  , with lots of names and dates in various colors.
小题1:
A.restore
B.rebuild
C.sell
D.repaint
小题2:
A.comfortable
B.possible
C.available
D.changeable
小题3:
A.promised
B.repeated
C.followed
D.responded
小题4:
A.false
B.wonderful
C.actual
D.obvious
小题5:
A.kept
B.witnessed
C.recorded
D.accompanied
小题6:
A.age
B.weight
C.name
D.height
小题7:
A.information
B.handwriting
C.style
D.characteristic
小题8:
A.adjusts
B.shuts
C.opens
D.swings
小题9:
A.copy
B.read
C.appreciate
D.remove
小题10:
A.proudly
B.automatically
C.shyly
D.calmly
小题11:
A.ready
B.voluntary
C.able
D.unwilling
小题12:
A.growing
B.contributing
C.studying
D.working
小题13:
A.sight
B.design
C.amazement
D.memory
小题14:
A.concerned about
B.approved of
C.decided on
D.relied on
小题15:
A.fresh
B.old
C.white
D.original
单项选择题