The patient described in the case study is a 31-year-old male whose presenting complaint is insomnia. The patient reports that the onset of the insomnia was 6 months before the current visitation and was attributable to the loss of his fiancée. The patient agrees to have altered sleep patterns, as evidenced by difficulty in falling asleep as well as in maintaining sleep. On the patient’s account, the insomnia is beginning to affect his daytime functionality with bouts of sleepiness and sleep during normal work time. Additionally, his workability as a forklift operator at a local company has been considerably affected by his disorder. Our assignment writing help is at affordable prices to students of all academic levels and academic disciplines.
The patient’s past medical history reveals previous abuse of opioids. This began upon being prescribed hydrocodone/acetaminophen for pain management when he broke his ankle in a skiing accident. He also reported using alcohol to help him with his sleep. On mental examination, the patient was found to be alert and exhibiting proper orientation to person, time, place, and event. He also makes good eye contact. He is also appropriately dressed for events and weather and denies any auditory or visual hallucinations. Additionally, he exhibits orientation to the future and denies any suicidal thoughts.
The patient described in the case study has a positive diagnosis of insomnia. Insomnia is a sleep disorder that is characterized by difficulty in falling asleep or staying asleep (Bjorvatn, Olufsen & Sørensen, 2019). Diagnosis is usually subjective, often depending on the individual’s account. People with insomnia often report multiple awakenings during their sleep and difficulty or considerable delays in falling asleep outside the usual. Insomnia also causes daytime fatigue, daytime loss of concentration, irritability, and anxiety in the short term(Hall, Kline & Nowakowski, 2016). In the long term, it may lead to multiple chronic pathologies. As evident in this patient, daytime fatigue and reduced workability are a consequence of his insomnia. Appropriate management of this patient will utilize pharmacological as well as non-pharmacological interventions. The goal is to alleviate insomnia to prevent other effects attributable to insomnia.
The first intervention in this patient will be to initiate trazodone 50mg once daily at bedtime. Trazodone is an antidepressant under selective serotonin reuptake inhibitors. It has off-label utility in the management of insomnia. Use in insomnia is, however, at lower doses compared to doses for antidepressant use. Trazodone uses, however, often present with several adverse events. These events include anticholinergic effects of constipation, headaches, dizziness, and xerostomia, among others. These events are considerably pronounced at higher doses. As evident in the patient, the prolonged erection 15 minutes after waking was considerably unpleasant and was a point of concern for him (Sateia, Buysse, Krystal, Neubauer & Heald, 2017). This is an effect of high doses of trazodone utilized in this therapy.
The higher efficacy of trazodone, coupled with its tolerable toxicity profile, informed my decision to select it over other medications. Zolpidem and hydroxyzine also exhibit near equal efficacy as zolpidem in the management of insomnia. However, zolpidem exhibits side effects that may be intolerable to some patients. Zolpidem is a non-benzodiazepine drug belonging to the Z class of drugs. It is an FDA-approved drug for the treatment of insomnia. This drug maintains high efficacy in the treatment of insomnia but may be associated with several side effects, such as headache, dizziness, and stuffy nose, among others(Satheesh et al., 2020). These effects limit its use.
Likewise, hydroxyzine has been used for its off-label efficacy in insomnia. The drug has been linked with anticholinergic side effects that may be intolerable to some patients. Such adverse effects include xerostomia, xeropthalmia, headache, dizziness, and urinary retention (Hassinger, Bletnisky, Dudekula & El-Solh, 2020). These side effects may be debilitating to the patient and may sometimes warrant withdrawal. In the case with the patient case study, the patient reported dryness of the eyes and mouth, evidence of the anticholinergic effects of the drugs on the patient. The adverse event profile of hydroxyzine and zolpidem grants trazodone superiority over them and makes it the drug of choice.
The treatment plan with trazodone is aimed at alleviating insomnia and improving the quality of life of the patients. The pat
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