A Medical Resident with a History of Alcohol Abuse and Suicidal Ideation: A Challenge for Both Psychiatry and Occupational Medicine in the Context of the First Wave of the COVID-19 Pandemic

Table 1

Psychiatric treatment rationale.

Service for pathological addictions: serD	Occupational psychiatrist	Addictology psychiatrist
(i) Confirmed low dose of buprenorphine: a partial mu-opioid receptor agonist and an antagonist of the kappa opioid receptor used to treat opioid dependence in order to reduce cravings and drug-seeking behaviours. Further, several pieces of evidence demonstrate that it is an efficacious, well-tolerated, and safe option in reducing depressive symptoms and serious suicidal ideation in treatment-resistant depression	(i) Added lithium: a drug with intrinsic antisuicidal property in order to prevent suicide attempts; (ii) Stopped trazodone: no beneficial effects on sleep pattern; (iii) Confirmed delorazepam: it could not be removed in this phase because the patient had been doing it for a long time for anxiety and alcohol addiction: further, the patient already tried acamprosate and sodium oxibate without a benefit on craving; (iv) CBT: to increase patient insight and to ensure continuity of the therapeutic project	(i) Stopped amitriptyline: no beneficial effects even at high doses. Already used many classes of antidepressants; (ii) Added a low dose of methylphenidate: stimulants which promote alertness and wakefulness and potentially enhance cognitive function appear to be potential treatment options in bipolar-depressed subjects not responding to first-line treatment