sunny2
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Tackie Mackie won ton , male 44 years old from Shanghai comes to you with complaints of diminished energy and lack of enthusiasm for last three months. You noticed that Tackie was looking sad and moving slowly when he was approching you, he says that he is feelin terrible after his wife died in a car crash three months ago, he was driving the Nissan-Altima and is now feeling very guilty of what has happened because of him. Since then Tackie is suffering from disturbed sleep and is unable to concentrate on anythingh, he reports of having repeated flashbacks of the event, he stays aloof from his freinds and colleagues as he just don't feel like socializing with them anymore, he says that he has a poor appetite and has gained 8 Kg., he admits that he wants to commit suicide in order to forget the memories of that worst day of his life. What is the most appropriate next step :
1.Group psychotherapy with other people of similar history
2.Psychotherapy refrel for post traumatic stress disorder
3.prescribe Fluoxetine
4.Tri cyclic Anti depressant
5.benzodiazipine
6.order blood tests
7.CT scan
8.electroconvulsive therapy
9.Buspirone
10.MRI
Edited by sunny2 on 09/30/07 - 06:04 PM. Reason: misspelled
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| yash12
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3. Fluoxetine
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| Kamsi
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3 fluoxetine
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| Doc750
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7. CT ... b/c he gained 8 lbs with a poor appetite
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| DrVirgo
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Sounds like PTSD
3. Fluoxitine
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| kpmle2
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Major Depression
3.prescribe Fluoxetine
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| sunny2
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No.
Fluoxetine is the most common WRONG answer to this question 
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| neo235
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electroconvulsive therapy bcoz he has suicidal ideas
wats correct answer? sunny2
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| Ivonne
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6 Order blod tests specifically TSH............weigth gain and poor appetite hmmmmm
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| vallia
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2?
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fight possessed
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| elitoki
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8. electroconvulsive therapy
He is NOT on normal griefment and need treatment immediately.
SSRi takes 2~4 weeks to begin have effect on patient, it will not help now.
Order Blood Sample such as TSH will be good if there wasn't any specific reazon of depression.
Let me know if I'm wrong , but I think he should be hospitalized and receive immediate treatment such as electroconvulsive therapy.
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| aaroho
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Group Psychotherapy
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| Ivonne
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Of course this patient is having a major depression but the key is to think if there is any underlying disease that can be corrected before establishing a treatment plan...
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| Ivonne
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This patient reports weight gain in the presence of poor appetite. Atypical depression can be associate with weight gain but patients also have increased appetite. To order a TSH just take a few minutes and ECT is reserved for severe or refractory depression.
We need a TSH in this patient ASAP
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| sunny2
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Correct Answer - 6.Order Blood Test
Ivonne, well done, nice explanation !!
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