MRCP2-3768

MRCP2-3768

A 42-year-old woman is brought to the Emergency Department by her husband. She tells you that she is not real and is living in a dream, that she does not exist in this world.
Her husband tells you that she barely eats, sleeps for long periods in the day and wakes in the early hours of the morning. She says she became preoccupied and very low in mood after some problems at work. Most recently, she had tried to jump out of the car whilst they were driving to the hospital.
On examination, she stares continuously at the wall, mumbling only that she is in a dream, nothing is real and she’s not really here. She looks unkempt and as if she has not been taking good care of herself.
Investigations:
Haemoglobin (Hb) 142 g/l 135 – 175 g/l
White cell count (WCC) 5.2 × 109/l 4.0 – 11.0 × 109/l
Platelets (PLT) 189 × 109/l 150 – 400 × 109/l
Sodium (Na+) 137 mmol/l 135 – 145 mmol/l
Potassium (K+) 4.2 mmol/l 3.5 – 5.0 mmol/
Creatinine (Cr) 90 µmol/l 50 – 120 µmol/l
Thyroid-stimulating hormone (TSH) 2.8 mu/l 0.4 – 5.0 mu/l
Which of the following treatments is most likely to be effective in this case?