Page 1 of 1: worsening anxiety and depression

bebica · Credits: 25995 My Scrapbook

You are a general practician and a 24 year old woman presented to ur office with worsening anxiety and depression for the past week. She asks u to renew her prescription for chlorpromazine (25 mg BID) and diazepam (5mg bid) because her regular GP is away on holiday. Her sleep has been fitful this past week, her appetite stable (she hasn’t binged or purged for 2 years) and her energy is low. She uses marijuana daily and IV cocaine every 2 weeks. Although she has been depressed for years and often has daily mood swings, last week she had an argument with her new boyfriend, making her feel sad and hopeless.
She presented as an overly made up woman who related in an overly familiar manner. She states that she has complete confidence in your abilities and that you are the most understanding doctor she has met. She smiles as she says she might just hurt herself out of frustration if you don’t renew the prescription.
Q1
What is the differential diagnosis? list upto four

q2
What steps would u include in the management of this patient? select upto four
1. check with her GPs office that GP is indeed away (with patient's permission)
2 hospitalize for acute suicidal ideation
3 hospitalize to gradually wean her off the diazepam
4 order HIV test
5 order urinary MHPG (3 methoxy-4- hydroxyphenylglycol) to help quantify depression
6 order VRDL
7 prescribe antidepressants such as Prozac (fluoxetine) and fluvoxamine (luvox)
8 refer her to a drug rehab centre
9 refer to psychiatrist for insight oriented psychotherapy to help her understand her sadness over the breakup with her boyfriend
10 refer to psychiatrist for personality testing
11 reorder chlorpromazine and diazepam for one week
12 reorder chlorpromazine but not diazepam for one week
13 reorder diazepam but not chlorpromazine for one week and caution her about tardive dyskinesia
14 see her together with her boyfriend for couple counseling
15 send her back to her GP for follow up and psychotherapy

vioxx · Credits: 1620 My Scrapbook

You are a general practician and a 24 year old woman presented to ur office with worsening anxiety and depression for the past week. She asks u to renew her prescription for chlorpromazine (25 mg BID) and diazepam (5mg bid) because her regular GP is away on holiday. Her sleep has been fitful this past week, her appetite stable (she hasn’t binged or purged for 2 years) and her energy is low. She uses marijuana daily and IV cocaine every 2 weeks. Although she has been depressed for years and often has daily mood swings, last week she had an argument with her new boyfriend, making her feel sad and hopeless.
She presented as an overly made up woman who related in an overly familiar manner. She states that she has complete confidence in your abilities and that you are the most understanding doctor she has met. She smiles as she says she might just hurt herself out of frustration if you don’t renew the prescription.
Q1
What is the differential diagnosis? list upto four
GAD
DRUG ABUSE
MAJOR DEPRESSION

q2
What steps would u include in the management of this patient? select upto four
1. check with her GPs office that GP is indeed away (with patient's permission)
2 hospitalize for acute suicidal ideation
3 hospitalize to gradually wean her off the diazepam
4 order HIV test
5 order urinary MHPG (3 methoxy-4- hydroxyphenylglycol) to help quantify depression
6 order VRDL
7 prescribe antidepressants such as Prozac (fluoxetine) and fluvoxamine (luvox) 8 refer her to a drug rehab centre
9 refer to psychiatrist for insight oriented psychotherapy to help her understand her sadness over the breakup with her boyfriend
10 refer to psychiatrist for personality testing
11 reorder chlorpromazine and diazepam for one week
12 reorder chlorpromazine but not diazepam for one week
13 reorder diazepam but not chlorpromazine for one week and caution her about tardive dyskinesia
14 see her together with her boyfriend for couple counseling
15 send her back to her GP for follow up and psychotherapy

Mixi · Credits: 234 My Scrapbook

1)dystymia
MDD
GAD
DRUG abuse

bebica · Credits: 25995 My Scrapbook

You are a general practician and a 24 year old woman presented to ur office with worsening anxiety and depression for the past week. She asks u to renew her prescription for chlorpromazine (25 mg BID) and diazepam (5mg bid) because her regular GP is away on holiday. Her sleep has been fitful this past week, her appetite stable (she hasn’t binged or purged for 2 years) and her energy is low. She uses marijuana daily and IV cocaine every 2 weeks. Although she has been depressed for years and often has daily mood swings, last week she had an argument with her new boyfriend, making her feel sad and hopeless.
She presented as an overly made up woman who related in an overly familiar manner. She states that she has complete confidence in your abilities and that you are the most understanding doctor she has met. She smiles as she says she might just hurt herself out of frustration if you don’t renew the prescription.
Q1
What is the differential diagnosis? list upto four
drug abuse/drug addiction
borderline personality disorder
dysthimia
malingering

q2
What steps would u include in the management of this patient? select upto four
1. check with her GPs office that GP is indeed away (with patient's permission)
2 hospitalize for acute suicidal ideation
3 hospitalize to gradually wean her off the diazepam
4 order HIV test
5 order urinary MHPG (3 methoxy-4- hydroxyphenylglycol) to help quantify depression
6 order VRDL
7 prescribe antidepressants such as Prozac (fluoxetine) and fluvoxamine (luvox)
8 refer her to a drug rehab centre
9 refer to psychiatrist for insight oriented psychotherapy to help her understand her sadness over the breakup with her boyfriend
10 refer to psychiatrist for personality testing
11 reorder chlorpromazine and diazepam for one week
12 reorder chlorpromazine but not diazepam for one week
13 reorder diazepam but not chlorpromazine for one week and caution her about tardive dyskinesia
14 see her together with her boyfriend for couple counseling
15 send her back to her GP for follow up and psychotherapy

ieva · Credits: 3579 My Scrapbook

Q1
What is the differential diagnosis? list upto four
1)substance abuse
2) substance dependence
3)malingering
4)bipolar disorder (?)

q2
What steps would u include in the management of this patient? select upto four
1. check with her GPs office that GP is indeed away (with patient's permission)*****
2 hospitalize for acute suicidal ideation
3 hospitalize to gradually wean her off the diazepam
4 order HIV test
5 order urinary MHPG (3 methoxy-4- hydroxyphenylglycol) to help quantify depression
6 order VRDL
7 prescribe antidepressants such as Prozac (fluoxetine) and fluvoxamine (luvox)
8 refer her to a drug rehab centre****
9 refer to psychiatrist for insight oriented psychotherapy to help her understand her sadness over the breakup with her boyfriend
10 refer to psychiatrist for personality testing
11 reorder chlorpromazine and diazepam for one week**** (although in don`t know)
12 reorder chlorpromazine but not diazepam for one week
13 reorder diazepam but not chlorpromazine for one week and caution her about tardive dyskinesia
14 see her together with her boyfriend for couple counseling
15 send her back to her GP for follow up and psychotherapy*****

mikejonathan20055 · Credits: 3355 My Scrapbook

You are a general practician and a 24 year old woman presented to ur office with worsening anxiety and depression for the past week. She asks u to renew her prescription for chlorpromazine (25 mg BID) and diazepam (5mg bid) because her regular GP is away on holiday. Her sleep has been fitful this past week, her appetite stable (she hasn’t binged or purged for 2 years) and her energy is low. She uses marijuana daily and IV cocaine every 2 weeks. Although she has been depressed for years and often has daily mood swings, last week she had an argument with her new boyfriend, making her feel sad and hopeless.
She presented as an overly made up woman who related in an overly familiar manner. She states that she has complete confidence in your abilities and that you are the most understanding doctor she has met. She smiles as she says she might just hurt herself out of frustration if you don’t renew the prescription.
Q1
What is the differential diagnosis? list upto four
Dysthmia
Personality disorder
Drug abuse
Malingering

q2
What steps would u include in the management of this patient? select upto four
1. check with her GPs office that GP is indeed away (with patient's permission)
2 hospitalize for acute suicidal ideation---------------
3 hospitalize to gradually wean her off the diazepam
4 order HIV test
5 order urinary MHPG (3 methoxy-4- hydroxyphenylglycol) to help quantify depression
6 order VRDL
7 prescribe antidepressants such as Prozac (fluoxetine) and fluvoxamine (luvox)
8 refer her to a drug rehab centre------------------
9 refer to psychiatrist for insight oriented psychotherapy to help her understand her sadness over the breakup with her boyfriend
10 refer to psychiatrist for personality testing
11 reorder chlorpromazine and diazepam for one week
12 reorder chlorpromazine but not diazepam for one week----------------
13 reorder diazepam but not chlorpromazine for one week and caution her about tardive dyskinesia
14 see her together with her boyfriend for couple counseling
15 send her back to her GP for follow up and psychotherapy---------------

maryana · Credits: 15476 My Scrapbook

You are a general practician and a 24 year old woman presented to ur office with worsening anxiety and depression for the past week. She asks u to renew her prescription for chlorpromazine (25 mg BID) and diazepam (5mg bid) because her regular GP is away on holiday. Her sleep has been fitful this past week, her appetite stable (she hasn’t binged or purged for 2 years) and her energy is low. She uses marijuana daily and IV cocaine every 2 weeks. Although she has been depressed for years and often has daily mood swings, last week she had an argument with her new boyfriend, making her feel sad and hopeless.
She presented as an overly made up woman who related in an overly familiar manner. She states that she has complete confidence in your abilities and that you are the most understanding doctor she has met. She smiles as she says she might just hurt herself out of frustration if you don’t renew the prescription.
Q1
What is the differential diagnosis? list upto four
Borderline personality disorder
Bipolar disorder
Drug addiction
Malingering

q2
What steps would u include in the management of this patient? select upto four
1. check with her GPs office that GP is indeed away (with patient's permission) //////////
2 hospitalize for acute suicidal ideation (can someone explaine me why does she have suicidal ideation?????)
3 hospitalize to gradually wean her off the diazepam
4 order HIV test
5 order urinary MHPG (3 methoxy-4- hydroxyphenylglycol) to help quantify depression
6 order VRDL
7 prescribe antidepressants such as Prozac (fluoxetine) and fluvoxamine (luvox)
8 refer her to a drug rehab centre /////////////
9 refer to psychiatrist for insight oriented psychotherapy to help her understand her sadness over the breakup with her boyfriend
10 refer to psychiatrist for personality testing
11 reorder chlorpromazine and diazepam for one week///////////////////
12 reorder chlorpromazine but not diazepam for one week
13 reorder diazepam but not chlorpromazine for one week and caution her about tardive dyskinesia
14 see her together with her boyfriend for couple counseling
15 send her back to her GP for follow up and psychotherapy/////////////

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