GF is a forty-one-year-old woman who arrives for her first visit at the clinic.

Discussion Question 1

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GF is a forty-one-year-old woman who arrives for her first visit at the clinic. She reports that she has been feeling sad and depressed, with crying spells, trouble sleeping, increased appetite, impaired concentration, and fatigue. She has experienced depression in the past but was able to overcome the symptoms without medication. Upon physical exam, she appears to be poorly groomed and with minimal facial expression. She is slow to respond to questions. She admits to being very anxious and worried about “everything.” She denies any current suicidal ideation. However, she expresses concerns about the future and that it may not be an improvement. She has tried over-the-counter medications to help with sleep, but they have not been effective. Answer the following questions:

• What additional information would you like before making a decision about what to do with GF?
• What approach would you suggest for this patient? Which of her symptoms would concern you and require intervention?
• Does she need to be referred to another provider, or can she be managed in a primary care setting?
• Are there any nonpharmacological strategies that might be appropriate for her?

For medications, include dosages and schedules. Include highlights of patient teaching and/or lifestyle alterations. Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication.

Discussion Question 2

ST is a twenty-five-year-old male who presents to the clinic with a major complaint of insomnia. He has been experiencing problems sleeping for the past month. He has been “borrowing” medication from his mother and friends, such as diazepam and alprazolam, and he finds that these are helpful in allowing him to sleep. He was also diagnosed with asthma at the age of ten. He has been using an inhaler, as needed, but he cannot recall the name of the inhaler. He is currently working part-time through a temporary agency, and he has not been able to find any full-time work. Answer the following questions:

• What additional information would you like to obtain from ST?
• What are the possible reasons for his insomnia?
• What are the possible strategies you can use to help him with the insomnia?

For medications, include dosages and schedules. Include highlights of patient teaching and/or lifestyle alterations. Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication.