CASE:A 38-year-old woman presents to the office with complaints of weight loss, fatigue, and insomnia of 3-mont

CASE:

A 38-year-old woman presents to the office with complaints of weight loss, fatigue, and insomnia of 3-month duration. She feels tired most of the time and frequently does not want to get out of bed. Despite feeling so tired, she has been staying up late at night because she cannot fall to sleep. She does not feel that she is doing well in her occupation as a secretary and states that she has trouble remembering things. She does not go outdoors as much as she used to and cannot recall the last time she went out with friends or enjoyed a social gathering. She denies any recent medication, illicit drug, or alcohol use. She feels intense guilt regarding past relationships because she feels that it was her fault they failed. She states she has never thought of suicide, but has begun to feel increasingly worthless. Her vital signs and general physical examination are normal, although she becomes tearful while discussing her symptoms. Her mental status examination is significant for depressed mood, psychomotor retardation, and difficulty attending to questions. Laboratory studies reveal a normal metabolic panel, normal complete blood count (CBC), and normal thyroid functions.

Note : see attachment for sample and procedure.