08-28-2009, 04:05 AM
A 25-year-old woman comes to the emergency department because of nausea, diarrhea, and anxiety for 2 days. She also has noticed dizziness and tingling sensations shooting down her forearms. Her sleep and appetite have been normal. She has a 3-year history of social phobia well controlled for the past year with paroxetine. She is attending an out-of-town conference and forgot to pack her medication; her last dose was 3 days ago. She does not drink alcohol or use illicit drugs. She is 163 cm (5 ft 4 in) tall and weighs 80 kg (176 lb); BMI is 30 kg/m2. Her temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 110/75 mm Hg. Physical examination shows no other abnormalities. Mental status examination shows an irritable mood with a full range of affect. Her speech is of normal rate and rhythm. There is no evidence of suicidal ideation or hallucinations. She can recall three of three objects after 5 minutes. Long-term memory is intact. Serum studies show no traces of paroxetine. Which of the following is the most appropriate next step in management?
a) Begin behavioral therapy
b) Begin bupropion therapy
c) Begin clomipramine therapy
d) Begin gabapentin therapy
e) Resume paroxetine therapy
a) Begin behavioral therapy
b) Begin bupropion therapy
c) Begin clomipramine therapy
d) Begin gabapentin therapy
e) Resume paroxetine therapy