Question

Mildred is a 45-y.o. married female with three children. She presents to you with complaints of fatigue and difficulties sleeping. She states she wants to get a good night’s sleep and is requesting a prescription to help her sleep. Mildred tells you she is awake off and on during the night, frequently thinking about her husband’s recent layoff from construction work and the effect this is having on the family. She lies down often during the day and has been so fatigued that she took some time off from work during the last 2 weeks. She is tearful at times during the visit and looks sad and anxious. On further discussion, she says she feels overwhelmed, helpless, and anxious. She tells you about an episode where she felt her heart beating rapidly, had difficulty catching her breath, felt she was going to have a heart attack, and became frightened until her husband was able to help calm her down. She is not eating as much as usual, and when she reads the newspaper, she doesn’t remember what she has read.

As a healthcare provider...

1. What would your focused clinical assessment include?

2. What major psychological question needs to be addressed?

3. What are the mainstays of treatment?

4. What will you educate the patient about?

Answer 1

1.My focussed clinical assessment will include her history (past and present medical history ,her family social environmental history,about presence of psychological disturbances in past,mental status and emotional expressions) and physical examination ( her vital signs ,ECG, grooming and hygiene level,speech and motor activity,include systems like respiratory,gastrointestinal and cardiac ).A mental status examination and her menstrual history is very important to rule out the condition of Mildred.She is at the menopausal age.

2.Major psychological question needs to be addressed are the connection between menopause and mental status

3. Depression, cognitive impairment always accompany the aging female at menopause along with cardiovascular diseases and psychiatric issues .So treatment involves counselling, guidance ,cognitive behaviour therapy ,menopausal hormone therapy and psychotherapy.

4.Educate her to exercise daily,eat a well balanced nutritious diet, with adequate fruits, vegetables, and fish, engage in regular social activities, participate in cognitive exercise (reading, crossword puzzles, etc.) Patients should also be encouraged to maintain good cardiovascular and bone health , with treatment of hyperlipidemia, hypertension, and diabetes mellitus if present.