Case Study: Chapter 12-Drugs Affecting the Central Nervous System
Complaint
Annual examination; fatigue
History
Angela is a 54-year-old married woman with three adult children. She has been the office manager of a small law firm for 20 years and has enjoyed her work until this past year. She has rheumatoid arthritis with minimal impairment that has been managed well with NSAIDs. She has been taking conjugated estrogens for 8 years and decided to stop taking them because of her concern of their risks without sufficient medical benefit. She has tolerated the discontinuation without difficulty.
Assessment
At her annual medical checkup appointment, she told her primary care provider that she seemed to be tired all of the time, and she was gaining weight because she had no interest in her usual exercise activities and had been overeating, not from appetite but out of boredom. She denied that she and her husband have had marital difficulties beyond the ordinary and she was pleased with the achievements of her children. She noticed that she has difficulty falling asleep at night and awakens around 4 a.m. most mornings without her alarm and cannot go back to sleep even though she still feels tired. She finds little joy in her life but cannot pinpoint any particular concern. Although she denies suicidal feelings, she does not feel that there is meaning to her life: "My husband and kids would go on fine if I died and probably would not miss me that much."
The primary care provider asks Angela to fill out a Beck's Depression Scale, which indicates that she has moderate depression.
What would be the initial management plan? Need Assignment Help?
At the follow-up visit the patient reports no improvement in symptoms and states she stopped taking the SSRI antidepressant because it wasn't working.
The patient was prescribed citalopram for her depression and has been complaining of morning nausea and vertigo. What would be a treatment option?
After taking 2 weeks of escitalopram, Angela returns to the clinic for a follow-up visit. She states that she does not feel much different but may be less tired. She reports that the nausea and vertigo she experienced with citalopram has not occurred with escitalopram. What would be the next step in treatment?
Ongoing Care: when should he patient be scheduled for a follow-up visit after starting therapy?
Ongoing Management: What should the PCP do after a year of therapy?
What principles are demonstrated?