| |
Problem
18.1
A
68-year-old man with metastatic prostate cancer reports increasing
back pain which is poorly controlled on his current regimen of
narcotic analgesics. Additionally, he complains of constipation
and diminished appetite. His responses on the PHQ-15 are shown
in Figure 18.1 below.
| Figure
18.1: Patient's Responses on the PHQ-15
|
|---|
| During
the past 4 weeks, how much have you been bothered by
any of the following problems?
|
|---|
| Symptom
| Not
bothered at all (0)
| Bothered
a little (1)
| Bothered
a lot (2)
|
|---|
| a.
Stomach Pain |
|
X
|
|
| b.
Back Pain |
|
|
X
|
| c.
Pain in your arms, legs, or joints (knees, hips, etc.) |
|
|
X
|
| d.
Menstrual cramps or other problems with your periods
[women only] |
X
|
|
|
| e.Headaches |
|
X
|
|
| f.
Chest pain |
X
|
|
|
| g.
Dizziness |
|
|
X
|
| h.
Fainting spells |
X
|
|
|
| i.
Feeling your heart pound or race |
X
|
|
|
| j.
Shortness of breath |
|
X
|
|
| k.
Pain or problems during sexual intercourse |
X
|
|
|
| l.
Constipation, loose bowels, or diarrhea |
|
|
X
|
| m.
Nausea, gas, or indigestion |
|
|
X
|
| n.
Feeling tired or having low energy |
|
|
X
|
| o.
Trouble sleeping |
|
|
X
|
|
(For
office coding: Total score 17 = 3 + 14)
|
|
Question
18.1
| His
high PHQ-15 score suggests that in addition to his chief complaints
of pain and constipation, this patient is likely to be suffering
from somatization due to coexisting depression or other psychosocial
factors associated with his terminal illness. |
 | True |
 | False |
|