Flaccid
Behavioral Health
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/Y6_F1.jpg"}},{"insert":"\n\n"},{"insert":"It has been a busy day in the psychiatry clinic.\r\n\r\nYour current patient is 28-year-old computer scientist, Zacchary, whom you have been treating for depression for about 4 months.\r\n\r\nWhen you first saw him, Zachary had broken up with his fianc\u00e9e and was feeling hopeless. He has responded well to sertraline therapy, with his energy levels and mood returning to normal.\n\nZachary is here today to discuss a newly discovered symptom: erectile dysfunction. He just started dating again and met a girl whom he became intimate with.\r\n\r\n\u0022We tried to have sex a couple of times, and even though I wanted to, I couldn\u0027t,\u0022 he says.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/Y6_F2.jpg"}},{"insert":"\n\n"},{"insert":"His medical history is significant for mild intermittent asthma during childhood, which was completely cured after a course of inhaled corticosteroids. He is currently on sertraline 100 mg OD, and is not using any other drugs, over-the-counter medications, or herbal supplements.\r\n\r\nBoth parents are alive and well, as is a younger brother aged 17. All of them appear to be completely healthy. He does not smoke, rarely drinks, and doesn\u0027t use recreational drugs.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/Y6_F1.jpg"}},{"insert":"\n\n"},{"insert":"You proceed to the mental state examination.\r\n\r\nZachary is well-dressed and groomed, but hardly makes eye contact with you. His speech, thought and behaviour are normal. There is no psychomotor retardation, agitation or cognitive impairment. He describes his mood as \u0022great, maybe in love\u0022 but he is petrified about his erectile dysfunction. There is no suicidal ideation.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/Y6_F4.jpg"}},{"insert":"\n\n"},{"insert":"Proceeding to the physical examination, you note the following:\r\n\r\nHeight: 180 cm; weight: 75 kg; BMI: 23 kg\/m2. Pulse: 67 bpm, regular; BP: 115\/80 mmHg; respiratory rate: 15 per min.\n\nThe general examination is unremarkable, as is examination of the heart, lungs, abdomen, and nervous system. In particular, the digital rectal exam and cremasteric reflex are both normal, as is vascular and neurologic examination of both lower limbs.\n\nRandom capillary glucose and urine dipstick testing are also normal.\n"}]}
4
{"ops":[{"insert":"What will you recommend?\n"}]}
1. Sildenafil 50 mg, 1 hour before sexual activity
2. Omit sertraline; start fluvoxamine 100 mg OD
3. Reduce the sertraline dose to 50 mg OD
8
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6
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7
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5
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