doyoudig
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A 30-year-old woman has had progressive fatigue and muscle stiffness over the past 6 months. She is the primary caretaker for her three children and her elderly disabled parents and has had difficulty sleeping because of the needs of her children. She says that she has to stay motivated because of her responsibilities and has had no difficulty concentrating. She has not had suicidal ideation. She has had an increased appetite and has had a 14-kg (30-lb) weight gain over the past year. She has a previous history of binge-eating and purging by vomiting. She has no history of psychoactive substance abuse or dependence, cold or heat intolerance, or changes in bowel or urinary function. Range of motion of the upper extremities is limited by pain. There is no evidence of muscle atrophy. She has good eye contact. She describes her mood as down and stressed. Her affect is dysphoric and intermittently tearful. Which of the following is the most appropriate pharmacotherapy? A ) Bupropion
B ) Diazepam
C ) Fluoxetine
D ) Imipramine
E ) Phenelzine
what ur Dx and Rx Choice
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| liliaeliz
Forum Elite
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generalized anxiety disorder-C
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| Justice
Forum Fanatic
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C ) Fluoxetine
will also help to control the body weight
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| dr in trouble
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Fluoxetine as SSRIs are indicated for atypical depression , Phenelzine is better agent but not used routinely bcoz of its side effects.
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| doyoudig
Forum Guru
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has anybody considered Fibromyalgia as a Dx here? and if so will u treat w/ Tca or SSRI intially (like imipramine??)
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| bens18
Forum Newbie
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my Dx is Depression with Atypical features.
Remember this triad: Insomnia+ increased appetite+Weight gain.
Rx: SSRI: fluoxetine
This case doesnt really fit Fibromyalgia.What about the ESR,Physical examination, Trigger Areas...
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| doyoudig
Forum Guru
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bens18 good observation n thx
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| dreamer
Forum Elite
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but how to explain" muscle stiffness " and " Range of motion of the upper extremities is limited by pain " by atypical depression? also the insomnia seems caused by the need of the children , plus she has no problem in concentratiing.
please help to clear my confusion.thanks
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| tamerbashir
Forum Elite
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it is not bulemia associated with depression symptoms
treated with SSRIS?
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| dr.wad
Forum Senior
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fibromyalgia >>>>usually associated with psychiatric symptoms >>>tx by TCA
u r right doyoudig............. i am impressed..
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| tamerbashir
Forum Elite
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still need the true answer with explanation
now there is 3 answers SSRI , TCA , PHENELZINE
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