Nagging

A 40 year old man complains of feeling nervous and sad for 2 weeks. He also experienced constipation and difficulty sleeping during the same time.

His wife, who accompanied him, says that he has been unusually short-tempered, and constantly complaining of "decreased energy".

His medical and surgical histories are unremarkable. His family history is significant for a sister with schizophrenia; he himself has never had a psychiatric evaluation.

He had been using alcohol and marijuana daily since the age of 16, the latter up to 5 times a day. However, he gave up drinking 5 years ago, and has been cutting down on marijuana for the past few weeks. He strongly denies using any other recreational drugs.

Upon further questioning, he reveals that during the past 2 to 3 months, he has been hearing voices telling him that his wife would leave him unless he quits using marijuana.

Select Relevant Investigations
Beck Depression Inventory

Performed

Beck Depression Inventory (BDI) score: 15/63
Urine EMIT Test for THC

Performed

The Urine Enzyme Multiplied Immunoassay Technique (EMIT) test is negative for Tetrahydrocannabinol (THC).
Electroencephalogram

Performed

You realize that an electroencephalogram (EEG) is probably not indicated here.
Mini Mental State Examination

Performed

Mini Mental State Examination (MMSE) score: 26/30

Select Relevant Management
Motivational Enhancement Therapy
Dronabinol
Electroconvulsive Therapy
Cognitive Behavior Therapy