Published on 03/03/2015 by admin
Filed under Neurology
Last modified 03/03/2015
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28 Dysthymia
Kenneth Lakritz
A 47-year-old woman was referred to psychiatry by her internist who was caring for her chronic fatigue and diffuse achiness. He was uncertain of her diagnosis and wondered if the patient was depressed. Although the patient resented this referral, she agreed to a single consultation. This lady was experiencing inadequate and poor-quality sleep, impaired concentration, migratory chest pain, and migraine headaches. Utilizing the web, she had sought out a “Lyme specialist” and subsequently received antibiotic treatment for “chronic Lyme disease.” However, her symptoms continued unabated despite this treatment.
Although she had been clearly depressed on two occasions, at age 19 years after her father’s death and at age 26 years after the birth of her first child, she denied current feelings of sadness, guilt, or hopelessness. She described herself as overworked, justifiably pessimistic, socially isolated, and burdened with an unappreciative and unsympathetic husband. She wondered whether she had chronic fatigue syndrome, fibromyalgia, or multiple chemical sensitivities, but she had no obvious delusions about her health. An extensive medical workup had revealed an iron deficiency anemia and hypothyroidism; however, their treatment was not helpful in resolving her many symptoms. An overnight sleep study was unremarkable, excluding sleep apnea as a potential mechanism. As this woman was generally sedentary, her physician recommended aerobic exercise, but she felt too tired to try it.
She reluctantly acknowledged that her pessimism and low mood might be contributing to her problems. She agreed to a trial of cognitive–behavioral therapy, which she found helpful especially as it induced her to exercise more and change jobs. She also convinced her husband to start marriage counseling.
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