A 67-year-old woman with a medical history of state III brea…
A 67-year-old woman with a medical history of state III breast carcinoma is receiving palliative care. The patient has been bedridden for the past three months and has been taking increased amounts of morphine for pain relief over the last two weeks. The patient mentions that she is feeling miserable and requests medication that could accelerate her death. On further questioning, the PHQ-2 questionnaire score is 4, and the PHQ-9 questionnaire score is 10. Which of the following is the best next step in managing this patient?
Read DetailsA 40-year-old man presents to his clinician for a follow-up…
A 40-year-old man presents to his clinician for a follow-up appointment. For the last 2 months, he has had trouble concentrating, decreased appetite, loss of motivation, decreased energy, and difficulty waking up in the morning. He admits to having suicidal thoughts but states that he “does not intend to act on them.” He has been taking the first-line medication with long half-life for this illness for 6 weeks without any improvement. His clinician stops the first medication and prescribes a different medication for this illness that has been available for many years, and the patient immediately begins taking it. What serious adverse event is the patient at risk of developing?
Read DetailsA 37-year-old man presents with a two-week history of sleepi…
A 37-year-old man presents with a two-week history of sleeping only two hours per night and “feeling on top of the world.” His only medication is hydrochlorothiazide, which he takes for hypertension. Clinical evaluation is remarkable for pressured speech, racing thoughts, and frequent topic switching. Given the likely diagnosis, what is the most appropriate treatment?
Read DetailsAn adult client expresses ambivalence about continuing thera…
An adult client expresses ambivalence about continuing therapy due to external stressors, but the counselor believes that stopping treatment at this stage could result in relapse. What is the most ethically appropriate action for the counselor to take in this situation?
Read DetailsA 44-year-old woman has been prescribed medication for treat…
A 44-year-old woman has been prescribed medication for treatment-resistant depression. She is told to discontinue her sertraline 14 days before starting this medication. At lower doses, this medication works selectively on an enzyme that metabolizes phenylethylamine. Which of the following medications was she most likely prescribed?
Read DetailsA 30-year-old woman presents for treatment of a major depres…
A 30-year-old woman presents for treatment of a major depressive episode. She reports sustaining a similar episode about 10 years earlier. The clinician discusses treatment options with her and wants to initiate therapy with a selective serotonin reuptake inhibitor. The patient expresses concern because she was treated with paroxetine and experienced significant adverse effects when it was discontinued, including insomnia, anxiety, moodiness, and headaches. She is adamant that she does not want to remain on antidepressant medication permanently and asks for a drug that can be discontinued without causing excessive withdrawal symptoms. Which of the following agents would be the best option?
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