Question

A 66-year-old man is brought to the clinic by his wife. He is weepy, responds slowly to queries, has poor hygiene, and has urine stains on his pants. He is oriented x 3 but does not respond to other cognitive screening questions. His spouse reports he's never had a depressive episode earlier in his life. What is your next clinical step?

A. Complete full medical workup
B. Start fluoxetine
C. Start citalopram with low dose risperidone
D. Schedule a follow-up visit without starting medication
E. Refer for ECT evaluation

Answer 1

The next clinical step is to schedule a follow-up visit without starting medication.

Step-by-step explanation:

The next clinical step for the 66-year-old man with symptoms of depression, poor hygiene, and urine stains on his pants would be to:

• Schedule a follow-up visit without starting medication

Since the patient is experiencing new-onset depressive symptoms and cognitive impairment, it is important to conduct a full medical workup to identify any potential underlying medical conditions that may be causing his symptoms. This may include performing laboratory tests, imaging studies, and consultations with other specialists, as needed. Only after a comprehensive assessment can an appropriate treatment plan be developed.