MRCP2-0878
A 35-year-old software developer visits his primary care physician complaining of symptoms indicative of a mixed anxiety and depression disorder. The doctor prescribes him fluoxetine 20 mg daily and alprazolam 0.25 mg per day. The next day, the patient arrives at the hospital with his wife, who reports that he has become excessively elated and hyperactive.
During the examination, the patient appears disoriented and experiences frequent sudden, brief muscle spasms in different parts of his body. When asked about his medication history, he admits to self-medicating with St. John’s wort in addition to his prescribed medications. He provides a urine sample at the hospital, which tests positive for blood.
What is the most probable diagnosis?