Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
To the Editor: In his Clinical Crossroads article, Dr Busse1 provides a scholarly discussion of problems in the diagnosis and treatment of a patient with severe shortness of breath, nocturnal awakening, and increasing dosage of many medications. However, Busse believes that emotions are only adjuvant to the process and that people with asthma are understandably anxious. The patient in this case had a history of depression and schizoaffective disorder, which may indicate severe psychiatric illness. Current medications included fluoxetine hydrochloride, 20 mg/d, and nortriptyline hydrochloride, 25 mg at bedtime. Although these drugs may be useful for depression (but usually at higher dosages), this regimen is not adequate treatment for schizoaffective disease.
Klein DF. Asthma and Psychiatric Illness. JAMA. 2001;285(7):881–882. doi:10.1001/jama.285.7.879
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