Assignment 2: Assessing and Treating Patients With Sleep/Wake Disorders

1/16/22, 8:33 PM Psychopharmacologic Approaches to Treatment of Psychopathology

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Insomnia 31-year-old Male

Decision Point One

Trazodone 50 mg po at bedtime

RESULTS OF DECISION POINT ONE � Patient returns to clinic in 2 weeks

� Patient states medication works well but gives him an unpleasant side e�ect of an erection lasting approximately 15 minutes after waking

1/16/22, 8:33 PM Psychopharmacologic Approaches to Treatment of Psychopathology

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� Patient states this makes it di�cult to get ready for work or go downstairs and have co�ee with his girlfriend and daughter in the morning

� Patient denies auditory/visual hallucinations and is future oriented

Decision Point Two

Explain that an erection lasting 15 minutes is not considered a

priapism and should diminish over time, continue with current dose

RESULTS OF DECISION POINT TWO � Patient returns to clinic in 2 weeks

� Patient states priapism has diminished over time

� Patient denies auditory/visual hallucinations and is future oriented

� Patient states trazodone is e�ective at 50 mg dose but sometimes wakes up following day with next-day drowsiness

� Patient denies auditory/visual hallucinations and is future oriented

Decision Point Three

1/16/22, 8:33 PM Psychopharmacologic Approaches to Treatment of Psychopathology

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Continue dose. Explain to patient he may split the 50 mg tablet

in half. The decreased dose should minimize next-day drowsiness.

Follow up in 4 weeks

Guidance to Student

Trazodone is a selective serotonin reuptake inhibitor that has a low

side e�ect pro�le. It would not be prudent to prescribe sonata as it

carries with it the risk of complex sleep behaviors. Hydroxyzine is

an antihistamine with strong sedative properties. However, many

patients complain of anticholinergic adverse e�ects the following

morning, such as Xerostomia and Xerophthalmia.

The patient is presenting with excessive somnolence. It would be

prudent to reduce the dose of trazodone by 50% and reassess in 4

weeks.

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