01-23-2009, 05:20 AM
A 43-year-old man with a history of alcohol abuse comes to the clinic seeking a refill of amitriptyline, 150 mg, which has helped him with his neck pain. He claims that he was prescribed this medication by a physician after being discharged from the psychiatric hospital. He needs this specific medication because, aside from reducing the neck pain, it helps with his depression and therefore helps to decrease the amount of alcohol he consumes. He is otherwise very vague about the previous psychiatric history, even though he admits that he was hospitalized several times, mostly because of his drinking. He was treated with haloperidol and some other medications such as lithium and carbamazepine. He claims not to remember what his diagnosis was. He has a remote history of trouble with erection and ejaculation. During the interview, he denies being euphoric but admits to having racing thoughts. His speech is a little pressured. He becomes quite irritable and loud when the physician asks more questions. Which of the following factors in this patient™s history would preclude prescribing amitriptyline at this time?
A. Alcohol abuse history
B. Neck-pain history
C. Racing thoughts and pressured speech
D. Possible liver damage secondary to alcohol
E. Sexual side effects
A. Alcohol abuse history
B. Neck-pain history
C. Racing thoughts and pressured speech
D. Possible liver damage secondary to alcohol
E. Sexual side effects
