A 74-year-old woman is referred with six months of worry, restlessness and broken sleep. She has never been an…

Question

A 74-year-old woman is referred with six months of worry, restlessness and broken sleep. She has never been anxious before and can point to no trigger. She has lost 5 kg, wakes at four each morning unable to get back to sleep, has stopped visiting her friends, and tells you her family would manage better without her. Her Mini-Mental State Examination score is 27/30. Physical examination, thyroid function and full blood count are normal. Which one of the following should you do first?

Accepted Answer

Ask directly about thoughts of suicide

Answer

Arrange computed tomography of the brain

Answer

Prescribe sertraline 25 mg daily

Answer

Refer for cognitive behavioural therapy

Answer

Request formal neuropsychological testing

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