Chief complaint
“Debilitating” fatigue, weight loss, trouble concentrating
History of present illness
Tessa is a 35 year-old married female. She has a full-time managerial job and is a mother to 3 young children. Balancing work and family life has been challenging, but until recently, she thought she was handling it. Her husband, who works full-time as well, is involved at home and is proactive in sharing the workload. For the past few months, however, she has felt “debilitatingly” fatigued but ironically she is having trouble sleeping at night (insomnia). She has called in sick to work three times in the past three weeks. Tessa is having trouble concentrating and is finding that work is piling up at at her job and at home, which is uncharacteristic and has led to feelings of shame and worthlessness. In addition, Tessa’s appetite is diminished, and she has lost 5 pounds in the last two weeks. She is feeling overwhelmed and thinks something must be wrong with her.
Past medical history
- Three healthy pregnancies and successful deliveries
- Feelings of sadness and withdrawal after first pregnancy
Family history
- Maternal grandmother had bouts with “the blues.”
Focused physical
(Using PHQ-9 Depression Inventory)
Patient health questionnaire (PHQ-9) filled out by Tessa.
- Insomnia
- Fatigue
- Difficulty concentrating
- Weight loss
- Feelings of worthlessness