The Therapy Approaches To Treat Insomnia Patient Discussion

The Therapy Approaches To Treat Insomnia Patient Discussion

Insomnia

Besides clinical questions, I would ask the patient open-ended lifestyle-related questions to get a broader perspective of her condition. For instance, I would ask her; what inspired you to visit the clinic today? Open-ended questions enhance the client’s willingness to open up to the healthcare provider. Secondly, I would ask her; do you take coffee or any other caffeine beverage? If so, how often do you take it? According to Farazdaq et al. (2018), consuming coffee, especially before bedtime, is a leading contributor to insomnia. The third question would be; have you ever suffered gastro-esophageal reflux disease (GERD)? Notably, GERD significantly contributes to insomnia among older adults (Farazdaq et al., 2018)The Therapy Approaches To Treat Insomnia Patient Discussion. These questions enable the clinician to assess the patient’s primary concerns through open-ended questions while ruling out environmental factors.

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Various individuals in the patient’s life could offer additional information, mainly her children or caregivers. Questions appropriate for these persons would explore recent changes in the patient’s life, such as reduced interests, moods, and appetite. Exploring these areas would enable the healthcare provider to access information the patient would be unaware of or withholding.

Healthcare providers usually utilize self-assessments when diagnosing insomnia. However, they can perform physical examinations or blood tests to rule out conditions affecting thyroids. Thyroid problems usually cause hyperthyroidism leading to increased anxiety and insomnia. Thus, a Hamilton Anxiety Rating Scale would be appropriate to examine the patient’s nervousness. Additionally, the Hamilton Depression Rating Scale would also enable the clinician to assess the patient’s feelings, insomnia levels, body weight, suicidal ideation, and guilt. These assessment tools will provide a comprehensive understanding of the patient’s condition The Therapy Approaches To Treat Insomnia Patient Discussion.

The patient’s medical history indicates a past depression diagnosis. Secondary to her husband’s demise, I would consider GERD her differential diagnosis. Possible life dynamics like loneliness, fear of the unknown, death, and financial constraints could cause insomnia. Thus, changes following her husband’s death could contribute to her insomnia.

I would prescribe Temazepam, an effective insomnia treatment agent, for this patient. Temazepam enhances GABA’s inhibitory activities and undergoes metabolism in the liver (Puzantian & Carlat, 2020). Another medication would be Trazodone, which effectively controls major depression, anxiety, and insomnia (Puzantian & Carlat, 2020). It enhances hormonal balance, mainly serotonin improving the patient’s moods. However, Trazodone causes dizziness which could cause other health risks for the patient considering her age.

Temazepam is the ideal and safer drug for elderly patients. It has a shorter lifespan, does not produce drug-drug interactions, and lacks active metabolites (Puzantian & Carlat, 2020)The Therapy Approaches To Treat Insomnia Patient Discussion. The patient is presently using Sertraline, HCTZ, Metformin, Losartan, and Januvia, treatments for depression, hypertension, and type 2 diabetes. Using Temazepam would not produce adverse reactions due to the absence of drug-drug interactions.

Older patients usually require a lower Temazepam dosage. Thus, I would prescribe Temazepam 7.5mg tab PO QHS for this patient and follow up after weeks. The expected results include sleeping ability and decreased anxiety during this period (Puzantian & Carlat, 2020). If the patient does not exhibit these improvements, I would increase the dosage to 15.0 mg and monitor the subsequent changes. Notably, Temazepam’s side effects include dizziness and general weakness; thus, caution and care are essential when altering the dosage (Puzantian & Carlat, 2020)The Therapy Approaches To Treat Insomnia Patient Discussion. The patient will return for assessment after another four weeks; she should have experienced improved sleeping patterns and lower anxiety levels.

References

Farazdaq, H., Andrades, M., & Nanji, K. (2018). Insomnia and its correlates among elderly patients presenting to family medicine clinics at an academic center. Malaysian family physician: the official journal of the Academy of Family Physicians of Malaysia, 13(3), 12.

Puzantian, T., & Carlat, D. J. (2020). Medication Fact Book: For Psychiatric Practice. Carlat Publishing, LLC.

For this Discussion, review the case below. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs. Please keep in mind this is a Pharmacology course and Pharmacology should be your main point of emphasis in the discussion The Therapy Approaches To Treat Insomnia Patient Discussion.

Case: An elderly widow who just lost her spouse.

Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:

Metformin 500mg BID
Januvia 100mg daily
Losartan 100mg daily
HCTZ 25mg daily
Sertraline 100mg daily
Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86

By Day 3 (Wednesday) of Week 7:
Post a response to each of the following:

List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?

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Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on the data provided.
Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations. The Therapy Approaches To Treat Insomnia Patient Discussion