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PAST PSYCHIATRIC HISTORY Kathryn has been seen in the outpatient clinic since July of 2017. Prior to this she had not been in psychiatric treatment. She had never been hospitalized . Her initial complaints were depression and anxiety and she was placed on an MAOI and responded well. Her depression was initially thought to be secondary to amphetamine withdrawal, since she had been using diet pills for 10 years. She stated that at first she took them to lose weight, but continued for so long because people at work had noted that she concentrated better and that her job performance had improved. In addition, her past doctors had all commented on her limited ability to change and her neediness, insecurity, low self-esteem, and poor boundaries. In addition, her past doctors had noted her promiscuity. All noted her poor attention span and limited capacity for insight.
Neurological testing during her initial evaluation had shown the possibility of non-dominant parietal lobe deficits. Testing was repeated in 2019 and showed ” problems in attention, recent visual and verbal memory (with a greater deficit in visual memory), abstract thought, cognitive flexibility, use of mathematical operations, and visual analysis. A possibility of right temporal dysfunction is suggested.” IQ testing showed a combined score of 77 on the Adult Weschler IQ test, which indicated borderline mental capacity. Over the years the patient has been maintained on various antidepressants and antianxiety agents. These included phenelzine (Nardil), trazadone, alprazolam, clonazepam, and hydroxyzine. Currently she is on fluoxetine 20 mg daily and clonazepam 0.5 mg twice a day and 1.0 mg at bedtime. The antidepressants have been effective over the years in treating her depression . She has never used more clonazepam than prescribed and there has been no history of abuse of alcohol or street drugs. Also, there was no history of discreet manic episodes and she was never treated with neuroleptics.
Answer the following questions and cite your references in the blank below:
What are the most critical pieces of the patient’s history and why?
2. Do you think that her current medication regimen is effective? Why or why not?
3. Considering your working diagnosis, what changes, if any, would you suggest to Kathryn’s medication regimen? Provide your rationale.

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