p53
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An older spouse brings her 75-year-old husband to the primary care physician because he no longer has been working in his basement wood shop. He recently underwent radiation therapy for localized prostate cancer. The patient complains of a prolonged history of inability to fall asleep and arising early in the morning. He has not been eating well lately, and his energy level has really fallen off. He has not been doing his daily crossword; in fact, he is not interested in much of anything anymore. His general physical examination, including tests for cognitive function, is normal. Laboratory studies are also unhelpful at establishing the diagnosis. Which of the following would be the most useful systemic therapy?
A.Haloperidol
B.Amitriptyline
C.Methylphenidate
D.L-Thyroxine
E.Electroconvulsive therapy
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| babli
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E
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| srf
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B
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| drk1980
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Drugs first(B)...if refractory, then on to ECT right?
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| Rasul
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Amitriptilin on 75 yo?
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| Rasul
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E
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| p53
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Amitryptyline should be avoided due to the problems of anticholinergic and orthostatic side effects. Electroconvulsive therapy is only indicated if a reasonable attempt at drug therapy fails.
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| babli
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methylphenidate.
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| p53
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yes.
Methylphenidate in the morning and at noon can often be associated with a rapid response with a cost of few side effects. Sertaline and desipramine are effective for those with primarily psychomotor retardation, whereas nortriptyline or nefazodone are more useful for those who display agitation.
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| srf
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very good q
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