HPI: 40 yo executive man comes to the office with chief complaint of headache. Later he gives history of financial problem and starts crying. First pay attention to history for alcohol or recent drug use.you should check HPI to see when these headaches started ,is it reoccurent?, is patient's energy level has change recently, etc..R/O medical cause.PE:complete
Labs:CBC- posssibly WNL Chem-7UA- WNL Alcohol and Urine Drug screening- need to rule out drug use.TSH- probably WNL- rule out thyroid problem.if all above normal. depression index- response to 20 question indicates depression.start antidepressant- if patient is obese use celexa otherwise any ssri would be fine.schd. psychotherapy (with psychiatrist) to augment medication.schd. patient for follow-up in 3 weeks.
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