Anne Morrison, Perimenopause

Anne Morrison (she, her, hers), age 51, presents with complaints of depressed mood and low libido. She says she has become irritable and snaps easily at her four children and her wife. She has no interest in sex, no urge to masturbate, and has had no sexual intercourse for six months. She also complains of fatigue, dry hair and skin, warm flushes, and painful joints. She has no personal or family history of depression. She is not suicidal but she “really doesn’t want to live anymore if this is it.”

Anne says her wife is angry about the lack of sexual intercourse and she feels the stress in their marriage. She also is worrying about her oldest children leaving for college and about her mother’s ill health.

She scores 20 on the Beck Depression Inventory, which indicates that she has mild to moderate depression. Her menstrual periods remain regular, but her cycle has shortened from 29 to 24 days. She reports that some hot flashes wake her at night and that she hasn’t had a good night’s sleep in months.

Laboratory tests show follicle-stimulating hormone of 25 mIU/mL and inhibin B below 45 pg/mL. Her estradiol is 80 pg/mL¯t yet in the menopausal range. Her thyroid-stimulating hormone is normal. Her shortened menstrual cycles suggest a diagnosis of perimenopause.

Questions

1. What are at least three questions would you ask to further evaluate Anneàcomplaints? Provide your rationale for your questions.
2. Are there any non-pharmacological recommendations that would help her situation?
3. What medication(s) would you recommend for her? Are there any psychiatric medications that do not interfere with the sex drive

Bobby Andres, Erectile Dysfunction

Bobby Andres (he, him, his), a 48-year-old man, presents to your office with complaints of erectile dysfunction for about one year. He reports that sexual desire is present but that he has a lack of ability to achieve and maintain erection. Bobby notes that he has avoided physical affection with his wife to avoid the embarrassment of “not being able to perform.” He often falls asleep early so that he may avoid initiation of sexual contact. Bobby also states that he had a history of depression and anxiety, but his primary care doctor put him on sertraline and buspirone and that has taken care of those symptoms. He reports that he has been on those medications for two to three years.

Questions

1. What lab(s) should be ordered for Bobby? Explain the rationale for each lab.
2. What screening tool(s) could be used with Bobby to assess his complaints of sexual dysfunction?
3. What referrals would you make for Bobby? Explain your rationale.