Julie, age 35, was a computer programmer, but beginning last year, she started taking more and more days off work, as she couldnâ€™t seem to get out of bed. Her software company let her go, and she has been depressed lately. Julieâ€™s husband, Jim, keeps telling her to â€œsnap out of itâ€ and reminds her that they really need two paychecks. They have two young teenagers who are pretty much on their own, as Julie can barely manage to put dinner on the table, let alone do the cleaning and laundry. She has seen a number of physicians about her vague complaints, and other than ordering a selective serotonin uptake inhibitor (SSRI) and recommending counseling, they have been no help.
o CC: â€œI feel like Iâ€™m going crazy, because no one thinks Iâ€™m sick. Iâ€™m tired of feeling this way. Can you help? Iâ€™m always tired; I canâ€™t sleep; I ache all over; and Iâ€™m losing my memory.â€
o Physical Examination:
â€¢ Tired looking woman looking older than her stated age
â€¢ Pale skin, shoddy, tender cervical lymph nodes
â€¢ MMSE WNL
â€¢ Otherwise, normal examination except for vague muscle pain
Do you need to do any diagnostic examinations to rule out your initial diagnosis? (support your work)
What differentials are you considering and why? (Please support your differentials with references)
What nonpharmacological interventions will you suggest Julie try?
What pharmacological prescriptions will you order?