Lethargy in a 65-yr-old Man

Review of Systems

  • General: No fevers, chills, weight loss, or fatigue.

  • Skin: No rash or skin lesions; no excessive sweating.

  • HEENT: No vision changes; no excessive salivation or lacrimation.

  • Pulmonary: No cough, shortness of breath, or wheezing.

  • Cardiovascular: No chest pain or pressure; no palpitations or lower-extremity edema.

  • Gastrointestinal: No nausea or vomiting; no constipation; no diarrhea; no abdominal pain.

  • Genitourinary: No hematuria, dysuria, or change in urine output.

  • Musculoskeletal: Chronic low back pain since a motor vehicle accident 7 yr ago; no recent falls or injuries.

  • Neurologic: No numbness or weakness of extremities; no headache.

  • Psychiatric: Describes depressed mood and suicidal ideation; admits he attempted to end his life today by ingesting his medications.