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Click here to open your browser's e-mail system. This is where you
will record your answers to questions plus any comments you want to
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check your response by clicking "Faculty Comments". In the
subject line of the e-mail form, enter your name and the name of the
case being submitted, i.e., Case #17B." When you finish your session
with Family Medicine On-line, click the Send button in the e-mail
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To complete the case during another session, go to the first page of the case and click the link above and then advance to the page where you left off. When finished with this session, click the Send button in the e-mail window. All materials copyrighted 2006 by Penn State University.
If you have completed case Y, this is a review. Completion of this case will not be counted toward your assignment.
"Completion of Depression #1 (Case #17 A) is recommended before completing this case"
It is two weeks later, and Mr. Bender returns to your office for his follow-up appointment. You recall he was started on Prozac, a Selective Serotonin Reuptake Inhibitor (SSRI) at his last visit. He has his initial session with a master-level counselor in three days. His TSH and T4 are both normal. His chest x-ray is unremarkable.
Mr. Bender is not accompanied by his wife today, stating she is "home with our 6-year old -- he is sick again." You ask him how he has been tolerating his medication. He hesitates and says, "I only started it seven days ago. I wasn't going to take that stuff, but my wife kept bugging me to get the prescription filled. Actually, she's the one who finally got it filled."
When asked how he is feeling since starting the medication seven days ago, Mr. Bender describes intermittent mild nausea. He reports no other perceived side effects at this time.
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Mr. Bender states that he has been sleeping "a little better,"
but he still feels as though he has no energy. His depressive
symptoms remain "about the same" and he continues to deny
suicidal ideation. In the Review of Systems, Mr. Bender's only
new complaint is the intermittent mild nausea. He continues to
have a poor appetite, but according to the office scale has
gained 1 pound since his last visit. He then asks, "When will I start to see some benefit from this medicine?" |
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Two weeks later, Mr.
Bender's name appears on your schedule. You enter the
examination room to find both Mr. and Mrs. Bender. Mr. Bender is concerned that he still feels "blue most of the time" and that his situation is "hopeless." He tells you that his counseling session went well, but he wonders how "talking about things" will make him happier. Mr. Bender also complains of nausea to the point that he can hardly eat -- his weight is down two pounds from his last visit. He continues to deny suicidal ideation. |
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It is now nine months later. Mr. Bender has been compliant with his medication, and has been free of depressive symptoms for the past six months. His interest in sports has returned and he is playing basketball once a week with friends. He says that his counseling has helped him to learn how to communicate more effectively with his wife. Mr. Bender states he plans to continue this individual therapy once every two weeks. Incidentally, he continues to smoke, but is "thinking about quitting" so I can "play hoops better." |
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