Introduction
Hi Sara, as you have promptly identified, the patient is experiencing insomnia, which is the inability to obtain sufficient or good quality sleep. Often, insomnia is characterized by patient’s inability to sustain sleep, difficulty falling asleep, getting up too early and feeling fatigued, inability to concentrate, and irritability over the day. The causes of insomnia vary but are largely attributable to psychiatric conditions such as mood and anxiety disorders (Patel, Steinberg & Patel, 2018).
Your idea of using questions to develop the best treatment plan for the patient, through time evaluation of the period that insomnia has been experienced, we can be able to categorize insomnia as acute or chronic. It also promotes understating of the aggravating factors. One needs to evaluate the patient’s sleep habits and for how long the patient has been taking sertraline, an antidepressant that may have the side effect of insomnia.
I have also found your idea that a support system to the patient is of great importance as many people of this age depend on their children and caretakers to meet their needs. The support system provides answers to the patient’s change in mood and behavior or whether she is still recovering from the bereavement, as well as the likely continued abuse of illegal substances. She will need support if she is depressed since it is associated with an increased likelihood of comorbidity, physical illness, and suicide leading to premature death.
Further, your differential diagnoses that include complicated grief due to prolonged emotional responses to the loss of a husband is plausible. However, it is also important to assess for drug-induced insomnia such as sertraline and antidepressants as they “cause activation of serotonergic 5-HT2 receptors and increased noradrenergic and dopaminergic neurotransmission,” (Riemann et al., 2017). Diagnosis should be carried out using Hamilton Rating Scale for Depression, Beck Depression Inventory (BDI), and Geriatric Depression Scale (Riemann et al., 2017)
In my opinion use of Mirtazapine has great advantages to the patient in the improvement of patient insomnia episodes as it does not have anticholinergic or cardiovascular system side effects. The use of Trazadone in place of sertraline has also been effective since it reduces insomnia episodes. Provide the patient with a follow up 1-2 weeks to ensure compliance by the patient (Gandotra et al., 2018).
References
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