Dear Sir/Madam, I am writing to you about a 51

Patient : Dear Sir/Madam, I am writing to you about a 51 years old female who is a known case of irritable bowl syndrome and migraine headache [ on omeprazole(20mg OD) and amitryptiline(50mg OD) for more than eight years]. She complains of insomnia, mood swinging, tiredness and occasional episodes of diarrhea since about 4 weeks. She was at her usual state of health till 10 months ago when she started to complain of insomnia, mood changes, hot flushes and diarrhea. The patient was unable to sleep for more than an hour a day for most of the week days. She also complained of excessive irritability and mood swingings. In order to manage her symptoms, a GI consultant discontinued her amitryptiline dosage and started her on romeron. Unfortunately, her medical condition deteriorated for the next 2 months more and more. Afterthat, she was restarted on amitryptiline 50 mg OD which started to alleviate her symptoms few weeks later. She was taking alprazolam also and the dosage was 1.5 mg for 6 weeks then it was reduced over a 3 months period to 0.25 mg OD. The patient was at a perfect mental and physical state of health for about 6 months till 4 weeks ago when she started complaining of the same symptoms which she suffered from 10 months earlier. The patient clinical condition is relapsing nowadays while is currently taking: - 50 mg amitryptiline OD - 0.5 mg alprazolam TID - 20 mg omeprazole BD She was started on Spasmomen for 5 days by a GI consultant but with no improvement at all. The alprazolam dosage improved her sleep but no improvement was noticed in the other symptoms : the agitation, restlessness, tiredness and diarrhea, nausea and loss of appetite. Please suggest if you have any alternative treatment plans for her. Yours faithfully, Husain Mohd
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