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* psych 8
 #141085  
  cjay - 11/24/06 18:10
 
  A 28-year-old woman comes to establish care with you as her new provider. She carries with her two large manila envelopes that turn out to be her past medical records from multiple prior physicians. Today she complains of excessive belching, “bloating,” and diffuse abdominal pain that she has had for the last 2 years. A quick review of her most recent chart note shows complaints of chest pains, nausea, nonwitnessed syncopal episodes, headaches, dizziness, and joint pains. Past diagnoses have included chronic fatigue syndrome and fibromyalgia. She has clearly seen many physicians and has had numerous negative workups. She states that she has heard great things about you and is hopeful that you can cure her. She is angry that her previous physicians have believed her condition to be emotionally related. Currently she takes no prescribed medications, but lists several over-the-counter vitamin and mineral supplements that she takes regularly. She has multiple vague allergies to various foods and chemicals, and denies tobacco, alcohol, and drug use. Vital signs are within normal limits and physical examination is unremarkable, including abdominal examination. In addition to reviewing this patient’s medical records and previous workups, which of the following is a reasonable next step in the treatment of this patient?

A. Antidepressant trial
B. Empiric treatment of symptoms
C. Explanation of psychologic causes
D. Referral to psychiatry
E. Schedule return visit in 3 to 4 weeks

 
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* Re:psych 8
#570318
  malak - 11/24/06 18:12
 
  E. Schedule return visit in 3 to 4 weeks  
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* Re:psych 8
#570370
  zosima - 11/24/06 18:52
 
  E.  
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* Re:psych 8
#570372
  cjay - 11/24/06 18:52
 
  rt  
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