A 34 year-old female comes to your office for the evaluation of her ongoing medical problems. For the last 6 months, she reports that she is feeling lack of energy, loss of appetite, difficulty concentrating, difficulty remembering, thoughts os suicide, loss of interest in activities which used to give her lots of pleasure and feeling empty and hopeless most of the time. These symptoms only made her pre-existing sleeping difficulties worse. For the last 4 years, she has had a hard time falling asleep at night, waking up during the night, and waking up too early. Of the following, which is the best medication to treat her symptoms?

A 68 year-old male comes to your office to discuss a ‘sensitive issue’. He has been having difficulty to become aroused, sustain arousal and reach an orgasm. His penis feels numbed up soon after he gets an erection. He has been taking fluoxetine for depression for the last three months and his sexual dysfunction has only got worse. He has seizure disorder and takes levetiracetam for it. He would like to get on a different medication for his depression. Of the following, which is a good choice for this individual?

A 76 year-old male comes to your office to discuss his ongoing medical problems. He reports feelings of sadness and hopelessness. He was fired from his job due to his angry outbursts and for showing frustration even over small matters. He has lost interest in watching football, which he used to enjoy a lot. He has difficulty sleeping. He feels a lack of energy even to do small tasks like waking up from his bed. His appetite has never been this low in ‘his entire life’. He was diagnosed with HIV over a decade ago. He can’t stop blaming himself because his life was lost over a one-night stand sexual encounter and he was diagnosed with a deadly disease. Sometimes he entertains thoughts of suicide but they are mostly under control now. He had taken sertraline 50 mg daily for a few months but in his words, ‘it didn’t do a thing for me’. His vital signs are normal. Physical examination is significant for a tearful patient, who looks sad and emaciated. Which of the following medications is the best choice to treat his symptoms?

A 72 year-old man is brought to your office by his daughter for evaluation. For the last 3 months, he has been suffering from difficulty falling and staying asleep, severe fatigue, poor appetite, and fatigue. He lost interest in the activities he used to enjoy such as fishing and spending time in the local library. He forces himself to go to the library a few times a week but he lost interest in reading the newspaper and watching television which he used to enjoy until recently. He feels like he has little energy and thinks he is a burden to his daughter’s family. His last hospitalization was four months ago for myocardial infarction. He denies any chest pain, palpitations or shortness of breath. He takes metoprolol 25 mg once daily and hydrochlorothiazide 25 mg once daily. He lost his beloved wife to cancer three years ago. His daughter says, ‘his grandkids love him. There is no reason for him to feel lonely’. Recently, he is having problems remembering details. His vital signs are normal. His physical examination is unremarkable. What is the next best step in the management of this patient?

A 27 year-old male comes to your urgent care center and reports that he has been feeling intense fear that something terrible is about to happen, worrying about losing control of his life, spending sleepless nights fearing he might go crazy, feeling as if he is choking and feeling a sense of impending doom. He insists that his symptoms are not ‘just mental’. He reports he has a pounding heart, upset stomach, diarrhea, shaking, sweating, numbness and tingling in his arms and legs.He has had 5 or 6 episodes of fear attacks in the last two months. He denies any alcohol or substance use. His medical history is unremarkable for medical and mental health histories. Suspecting drug abuse, you ordered a random urine drug screen, which came negative on a 12 panel test. When you ask him to stand during a physical examination, he reports feeling dizzy and lighthearted. When you are planning to order some laboratory tests, he reports that his family doctor checked him for a lot of things to rule out heart disease, gastrointestinal disease and neurological disease and ‘all those tests showed nothing abnormal’. To diagnose this individual with panic disorder, symptoms should be present for how long?

A 26 year-old male comes to your urgent care center and reports that he has been feeling intense fear that something terrible is about to happen, worrying about losing control of his life, spending sleepless nights fearing he might go crazy, feeling as if he is choking and feeling a sense of impending doom. He insists that his symptoms are not ‘just mental’. He reports he has a pounding heart, upset stomach, diarrhea, shaking, sweating, numbness and tingling in his arms and legs.He has had 5 or 6 episodes of fear attacks in the last two months. He denies any alcohol or substance use. His medical history is unremarkable for medical and mental health histories. Suspecting drug abuse, you ordered a random urine drug screen, which came negative on a 12 panel test. When you ask him to stand during a physical examination, he reports feeling dizzy and lighthearted. When you are planning to order some laboratory tests, he reports that his family doctor checked him for a lot of things to rule out heart disease, gastrointestinal disease and neurological disease and ‘all those tests showed nothing abnormal’. Which of the following is the cornerstone of drug therapy for the long term management of this disorder?

A 25 year-old male comes to your urgent care center and reports that he has been feeling intense fear that something terrible is about to happen, worrying about losing control of his life, spending sleepless nights fearing he might go crazy, feeling as if he is choking and feeling a sense of impending doom. He insists that his symptoms are not ‘just mental’. He reports he has a pounding heart, upset stomach, diarrhea, shaking, sweating, numbness and tingling in his arms and legs.He has had 5 or 6 episodes of fear attacks in the last two months. He denies any alcohol or substance use. His medical history is unremarkable for medical and mental health histories. Suspecting drug abuse, you ordered a random urine drug screen, which came negative on a 12 panel test. When you ask him to stand during a physical examination, he reports feeling dizzy and lighthearted. When you are planning to order some laboratory tests, he reports that his family doctor checked him for a lot of things to rule out heart disease, gastrointestinal disease and neurological disease and ‘all those tests showed nothing abnormal’. Which of the following medications indicated in this patient for immediate relief of panic symptoms?

A 34 year-old female comes to your office for the evaluation of her fears. For a little over a month, she has been feeling intense fear that something terrible is about to happen, worrying about losing control, worrying about dying, going crazy, and having a heart attack. She is also having an upset stomach, diarrhea, shaking, sweating, pounding heart after she experiences these fears. It feels as if she is choking and can’t breathe. As the fears overwhelm her, she feels dizzy, faint, and lightheaded. Her arms and legs go numb with tingling feet. The feelings start suddenly and get very strong, usually within 10 minutes. Then the symptoms usually last from 20 to 30 minutes. The attacks happen when she thinks about being lonely by herself in a dark room. But sometimes they come unexpectedly without a warning. She went to her primary care doctor, who according to the patient, ‘did every test in the world on me and found nothing wrong with me’. She also denies alcohol or drug use. Of the following, which medications are considered first-line in her treatment?

A 17 year-old female is brought to your office by her family members because she has been imagining things that are not grounded in reality. The symptoms started rapidly after the spring break holidays. For 5 months she can see the aliens coming on a mission to colonize this planet; she hears ‘satellite signals’ sent from an alien group who are stationed on a UFO; she smells the fumes coming out of the UFO engines. She believes that she and her family would be the first victims of the alien invasion. Her family reports that most of the time, she speaks in a flat voice, she stops in the middle of a sentence, uses words that have no meaning, and even when she expresses very dangerous scenarios, she expresses no emotions on her face. She dresses up oddly, like wearing winter gloves in summer. She takes a shower only once a week when the family members insist. She does not clean up after things get messy. She does not pay attention to the professors in the class and ‘stays in her own world’. Which of the following is the most likely diagnosis in this patient?