Assignment 1: Short Answer Assessment AND Assignment 2: Assessing and Treating Patients With Sleep/Wake Disorders
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Assignment 2: Assessing and Treating Sleep/Wake Disorders Patients
Sleep disorders present health as well as mental disorders to those diagnosed with the conditions. Such bring significant change to the sleep-wake cycle, which
impacts the general mental health of the clients. Mostly, the clients are seriously affected by the pathology leading to the life quality, leading to progression to further psycho-alterations and lack of self-reliance. As a result of such development, it is imperative to ensure that treatment is given to the client for healthy mental status. Consequently, this statement entails the basis of this work to look into a case study having a client presenting sleep disorders through appropriate formulation. Intro- duction
The case scenario entails a male client aged 31 years primarily having insomnia. The patient claims that lack of sleep has worsened in the recent six months, decreas- ing functionality. The client states that he has in the past had difficulty sleeping on the client's submission but not to the degree it is of late. Insomnia, in the recent past, has resulted in a decrease in the falling asleep capability as well as upholding a sleep status. According to the patient, the situation has worsened, compel-
ling him to go for medical care. He ascribes the lack of sleep condition to the untimely fiancé loss about six months ago. About the impacts of the disorder on pro- ductivity, he claims a reduction in his forklift work at a particular chemical company. The high-risk nature of the client's occupation makes him vulnerable to in-
jury to himself and others ascribed to high power machinery. In one case, he fell asleep as a result of the last night's lack of sleep. Furthermore, the client claims that he has used diphenhydramine to sleep previously, which led to undesirable side effects. The medical records indicate opiate abuse resulting from a broken due
to an incident of skiing. The accident led to a hydrocodone prescription for acute pain. Furthermore, the client states that he has not had the medicine opiate an-
algesic for the past four years. As a result, the patient says that he has been taking alcohol to help him get asleep. As per a mental status exam, the client is ap-
propriately oriented and has an excellent physical outlook. According to the patient, he has no suicide intentions and is future-oriented, having real insight and judg- ment intact. Decision 1
The first selected option is trazodone 50-100 mg daily taken during the night. The decision is based on the idea that trazodone is a selective receptor antagonist
and a reuptake inhibitor. The classification of the drug informed the choice of the medication that is an off-label one for insomnia. Despite the classification of
trazodone as a prescription for depression, the drug is regarded as the best treatment option for insomnia (Jaffer et al., 2017). The outlined case scenario presents the
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client developing insomnia due to a fiancé's death, which illuminates depression. As a result of the decision, the zolpidem 10 mg by mouth at bedtime was inappropri- ate because of the common side effects. The drug has immense side effects and is likely to result in several significant consequences, including hallucination, drowsi- ness, as well as night activity (Sharma et al., 2017). As a result, the other option not selected in the pharmaco-intervention was certainly hydroxyzine 50 mg at
bedtime. This was informed by the fact that it has undesirable anticholinergic effects, including xerophthalmia and xerostomia. As a result of the intake of trazodone 50mg daily at bedtime, it was expected that the sleeplessness would be reduced. Furthermore, a mentally stable client having enhanced mood levels was the
main goal (Khouzam, 2017). Unfortunately, the client reported back after two weeks having priapism and a problem getting to work. About ethical considera-
tions, this scenario would be influenced by human autonomy because the client is an alcoholic, hence, may experience drug interactions with the treatments. De- cision 2
The second selected option was to reduce trazodone to 25mg daily at bedtime. This was based on the remarkable enhancement in the client's condition after the 50 mg dosage. Remarkably, the client had stated enhanced sleep, but with slight effects like priapism problem in waking up. Therefore, continuous trazodone p tapering off is appropriate against lessening the overall prescription side effects besides eluding undesirable effects (Lipone et al. 2020). As a result, the gradual de-escal-
ation of the drug will lead to a healthier mental status. Two other options were there in the case at hand, which explained to the client that priapism is typically a trazodone side effect that ought to reduce over time. Unfortunately, this option is unfounded because priapism condition is a moderate trazodone effect that
affects blood circulation. Therefore, the left-out decision includes the trazodone discontinuation and the start of suvorexant 10mg at bedtime. Unfortunately,
this option is inappropriate because suvorexant has serious side effects like awful feelings (Keks, Hope, & Keogh, 2017).
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As a result, the second option could not be opted for. Courtesy of the trazodone tapering off decision from 50 mg down to 25mg, an enhanced sleep-wake cycle that evades depression manifestation was expected. Furthermore, it was anticipated that the patient would have a normal life function by appropriately completing his functionalities. As a result, the patient was expected to experience improved sleep plus slight interference from stimuli. Concerning the ethical consideration, indeed, the beneficence's moral principle will affect my therapy decision. Therefore, there is a necessity to carry out interventions that are of the most significant benefit to the patient.
Decision 3
Due to the second decision implementation, the patient claims that the dosage of 50 mg is appropriate but indicates a reduction in priapism. But, unfortunately,
he states that the dosage is insufficient to maintain sleep throughout the night. This brought about the third decision, claiming the dosage as well as ensure the hy- giene of sleep. Typically, sleep hygiene entails a behavioral and environmental intervention that intends to enhance the patient's psychological awareness and
define the appropriateness of an environment clean (Chung et al., 2018). Consequently, the environment contributes, to a great extent, to better sleep. Besides the decision opted for, two other options included V trazodone discontinuation and the start of treatment by ramelton.8mg. However, this decision was not good
because ramelteon has dire side effects, including irritability, drowsiness, and lethargy. Furthermore, ramelteon is associated with worsened sleep difficulties leading to poor sleep-wake patterns (Mishra et al. 2020). The other option not selected in the case at hand included trazodone discontinuation as well as hydroxyzine 8
mg medication at bedtime. Unfortunately, the vote did not go by the prescription decision because it caused the client severe side effects. Concerning the anti-
cipated developments after the decision, I hoped that appropriate sleep hygiene would enhance sleep activity and ensure a regular pattern of sleep-wake that would allow functionality. Furthermore, there was an anticipation that continuing with the dosage would mitigate the widespread impact on depression leading to a de-es- calation. Concerning the ethical considerations, it is apparent that confidentiality will ascertain whether sleep hygiene intervention happens for a better and
healthier outlook.
Conclusion
The case at hand comprised a 31-year-old male with classical insomnia signs associated with depression and common functionality signs. Therefore, the decision
opted for was trazodone 50 mg by mouth daily every bedtime. The therapy is particularly appropriate in managing insomnia despite being regarded as an antide- pressant. Consequently, the choice formulated in the first case would be relevant to the patient. Unfortunately, the patient got some effects, like priapism and
waking up difficulty after the dosage, prompting a reassessment. The proceeding option entailed tapering the drug to 25 mg by mouth daily during bedtime to stop the side effects. This decision allowed an enhancement of the condition for the better with slight side effects. Unfortunately, the patient still claimed inability to keep a sleep status. For that matter, a third decision came to reassess the patient's sleep hygiene, indicating the pertinence of behavioral and psychological intervention.
These two parameters would aid realize a positive mental attitude, which is crucial in reaching a healthy status. Thus, trazodone medication and sleep hygiene
are going to be beneficial in arriving at function ability status.
References
Chung, K. F., Lee, C. T., Yeung, W. F., Chan, M. S., Chung, E. W. Y., & Lin, W. L. (2018). Sleep hygiene education as a treatment of insomnia: a sys-
tematic review and meta-analysis. Family practice, 35(4), 365-375. Jaffer, K. Y., Chang, T., Vale, B., Dang, J., Steiner, A. J., Loera, N.,... & Ishak, W. W.
(2017). Trazodone for insomnia: a systematic review. Innovations in clinical neuroscience, 14(78), 24. Keks, N. A., Hope, J., & Keogh, S. (2017). Suvorex-
ant: scientifically interesting, utility uncertain. Australasian Psychiatry, 25(6), 622-624. Khouzam, H. R. (2017). A review of trazodone use in psychiatric and
medical conditions. Postgraduate medicine, 129(1), 140-148. Iovieno, N., Tedeschini, E., Bentley, K. H., Evins, A. E., & Papakostas, G. I. (2011). Anti-
depressants for major depressive disorder and dysthymic disorder in patients with comorbid alcohol use disorders: a meta-analysis of placebo-controlled ran-
domized trials. The Journal of clinical psychiatry, 72(8), 0-0. Mishra, A., Maiti, R., Mishra, B. R., Jena, M., Nath, S., & Sahu, P. (2020). Effect of add-on
ramelteon therapy on sleep and circadian rhythm disruption in patients with schizophrenia: A randomized controlled trial. European Neuropsychopharmacology, 31, 109-118. Sharma, M. K., Kainth, S., Kumar, S., Bhardwaj, A., Agarwal, H. K., Maiwall, R.,... & Sarin, S. K. (2019). Effects of zolpidem on sleep parameters in pa-
tients with cirrhosis and sleep disturbances:
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A randomized, placebo-controlled trial. Clinical and molecular hepatology, 25(2), 199. Welsh, C. H., & Fugit, R. V. (2005). Medications that can cause in-
somnia. Sleep: A Comprehensive Handbook. New York, NY: Wiley-Liss, 103-109.
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Student paper
Assessing and Treating Sleep/Wake Disorders Patients
Original source
Assessing and Treating Patients with Sleep/Wake Disorders
1
Student paper
Such bring significant change to the sleep-wake cycle, which impacts the general mental health of the clients. Mostly, the clients are seriously affected by the pathology leading to the life quality, leading to progression to further psycho-alterations and lack of self- reliance.
Original source
The conditions bring significant alterations to the sleep-wake cycle that impacts the over- all mental health of the patients In most cases, the patients are severely affected by the pathology resulting in depreciation of the quality of life, resulting in progression into other psycho-alterations, and lack of self-reliance
1
Student paper
According to the patient, the situation has worsened, compelling him to go for medical care. He ascribes the lack of sleep condition to the untimely fiancé loss about six months ago.
Original source
The status, according to the patient, has worsened, prompting him to seek medical care He attributes the lack of sleep to the sudden loss of his fiancé around six months ago
1
Student paper
The high-risk nature of the client's occupation makes him vulnerable to injury to himself and others ascribed to high power machinery.
Original source
The patient's occupation's high-risk nature makes him susceptible to injury to self and others attributed to high power machinery
1
Student paper
The medical records indicate opiate abuse resulting from a broken due to an incident of skiing. The accident led to a hydrocodone prescription for acute pain.
Original source
The previous medical records outline history of opiate abuse transcending from a broken ankle following a skiing incident The accident brought about a prescription of hydro- codone to manage acute pain
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Student paper
Furthermore, the client states that he has not had the medicine opiate analgesic for the past four years.
Original source
He has not received opiate analgesic for four years
1
Student paper
As per a mental status exam, the client is appropriately oriented and has an excellent physical outlook. According to the patient, he has no suicide intentions and is future-ori- ented, having real insight and judgment intact.
Original source
Following a mental status exam, the patient is well oriented and has an excellent physical outlook He denies any suicide intentions and is future-oriented with real insight and judg- ment intact
3
Student paper
The first selected option is trazodone 50-100 mg daily taken during the night. The de- cision is based on the idea that trazodone is a selective receptor antagonist and a reup- take inhibitor.
Original source
The first decision is trazodone 50-100 mg daily taken at bed time The decision is based on the fact that trazodone is a selective receptor antagonist and reuptake inhibitor
7/23/2021 Originality Report
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Student paper 70%
Student paper 68%
Student paper 63%
Student paper 64%
Student paper 66%
Student paper 64%
Student paper 65%
Student paper 64%
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Student paper
The classification of the drug informed the choice of the medication that is an off-label one for insomnia. Despite the classification of trazodone as a prescription for depression, the drug is regarded as the best treatment option for insomnia (Jaffer et al., 2017). The outlined case scenario presents the client developing insomnia due to a fiancé's death, which illuminates depression.
Original source
The drug classification informed the decision to choose the medication, which is an off- label treatment for insomnia 2017), despite the trazodone classification as a depression prescription, the drug is considered the right treatment choice for insomnia The case scenario outlined above depicts the patient developing insomnia following his fiancé's death, which illustrates depression
1
Student paper
As a result, the other option not selected in the pharmaco-intervention was certainly hy- droxyzine 50 mg at bedtime.
Original source
Consequently, the other decision left out in the pharmaco-intervention was hydroxyzine 50 mg at bedtime
1
Student paper
Furthermore, a mentally stable client having enhanced mood levels was the main goal (Khouzam, 2017).
Original source
Moreover, a mentally stable patient with improved mood levels was my primary goal (Khouzam, 2017)
1
Student paper
About ethical considerations, this scenario would be influenced by human autonomy be- cause the client is an alcoholic, hence, may experience drug interactions with the treatments.
Original source
Concerning ethical considerations, human autonomy would influence this scenario since the patient is a known alcoholic and may have drug interactions with the medications
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Student paper
As a result, the gradual de-escalation of the drug will lead to a healthier mental status.
Original source
Consequently, the slow de-escalation of the medication will result in a healthier mental status
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Student paper
Unfortunately, this option is unfounded because priapism condition is a moderate trazodone effect that affects blood circulation.
Original source
Priapism is a moderate disorder of trazodone, and it affects blood circulation
1
Student paper
Unfortunately, this option is inappropriate because suvorexant has serious side effects like awful feelings (Keks, Hope, & Keogh, 2017).
Original source
Moreover, Suvorexant possesses severe side effects, including awful feelings (Keks, Hope, & Keogh, 2017)
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Student paper
Due to the second decision implementation, the patient claims that the dosage of 50 mg is appropriate but indicates a reduction in priapism.
Original source
Following the implementation of the second decision, the client outlines that the 50 mg dosage is suitable but reports a decline in priapism
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Student paper 73%
Student paper 69%
Student paper 63%
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Student paper
Typically, sleep hygiene entails a behavioral and environmental intervention that intends to enhance the patient's psychological awareness and define the appropriateness of an environment clean (Chung et al., 2018).
Original source
Sleep hygiene involves a behaviour and environmental intervention that intends to raise the individual's psychological awareness and define the effectiveness of a clean environ- ment (Chung et al., 2018)
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Student paper
However, this decision was not good because ramelteon has dire side effects, including irritability, drowsiness, and lethargy. Furthermore, ramelteon is associated with worsened sleep difficulties leading to poor sleep-wake patterns (Mishra et al.
Original source
The decision did not suffice in this situation since ramelteon possesses severe side ef- fects, including drowsiness, lethargy, and irritability Moreover, ramelteon is linked to worsened sleep problems resulting in poor sleep-wake patterns (Mishra et al
3
Student paper
The other option not selected in the case at hand included trazodone discontinuation as well as hydroxyzine 8 mg medication at bedtime.
Original source
The other decision not chosen in the scenario included discontinuation of trazodone and hydroxyzine medication at 8mg at bedtime
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Student paper
Concerning the anticipated developments after the decision, I hoped that appropriate sleep hygiene would enhance sleep activity and ensure a regular pattern of sleep-wake that would allow functionality.
Original source
Regarding the expected developments following the decision, I expected that enabling sleep hygiene would increase sleep activity and maintain a regular sleep/wake pattern that would enable functionality
1
Student paper
Concerning the ethical considerations, it is apparent that confidentiality will ascertain whether sleep hygiene intervention happens for a better and healthier outlook.
Original source
Regarding the ethical considerations that would affect the client's treatment, it is clear that confidentiality will determine whether sleep hygiene intervention occurs to bring about a better and healthier outlook in the case scenario
1
Student paper
The case at hand comprised a 31-year-old male with classical insomnia signs associated with depression and common functionality signs. Therefore, the decision opted for was trazodone 50 mg by mouth daily every bedtime.
Original source
Conclusion The case study involved a 31-year-old male presenting with classical signs of insomnia linked with depression and exhibiting signs of low functionality Therefore, the primary decision arrived at was trazodone 50 mg orally daily every bedtime
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Unfortunately, the patient got some effects, like priapism and waking up difficulty after the dosage, prompting a reassessment.
Original source
The patient experienced some side effects such as difficulty waking up and priapism after the first dosage
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Student paper
These two parameters would aid realize a positive mental attitude, which is crucial in reaching a healthy status. Thus, trazodone medication and sleep hygiene are going to be beneficial in arriving at function ability status.
Original source
The two factors would help realize a positive mental attitude, which is vital in achieving a healthy status Therefore, trazodone medication and sleep hygiene would be useful in achieving function ability status
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F., Lee, C. T., Yeung, W. F., Chan, M. S., Chung, E.
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F., Lee, C T., Yeung, W F., Chan, M S., Chung, E
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Y., & Lin, W.
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Y., & Lin, W
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Sleep hygiene education as a treatment of insomnia:
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hygiene education as a treatment of insomnia
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a systematic review and meta-analysis.
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a systematic review and meta-analysis
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Family practice, 35(4), 365-375.
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Family practice, 35(4), 365-375
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Y., Chang, T., Vale, B., Dang, J., Steiner, A.
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Y., Chang, T., Vale, B., Dang, J., Steiner, A
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J., Loera, N.,...
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J., Loera, N.,
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Trazodone for insomnia: a systematic review.
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trazodone for insomnia A Systematic Review
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Innovations in clinical neuroscience, 14(78), 24.
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Innovations in clinical neuroscience, 14(7- 8), 24
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A., Hope, J., & Keogh, S.
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A., Hope, J., & Keogh, S
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scientifically interesting, utility uncertain. Australasian Psychiatry, 25(6), 622-624.
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scientifically interesting, utility uncertain Australasian Psychiatry, 25(6), 622-624
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A review of trazodone use in psychiatric and medical conditions.
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A review of trazodone use in psychiatric and medical conditions
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Postgraduate medicine, 129(1), 140-148.
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Postgraduate Medicine, 129(1), 140-148
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Iovieno, N., Tedeschini, E., Bentley, K.
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Iovieno, N, Tedeschini E, Bentley, K
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H., Evins, A. E., & Papakostas, G.
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H., Evins, A E., & Papakostas, G
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Antidepressants for major depressive disorder and dysthymic disorder in patients with comorbid alcohol use disorders:
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Antidepressants for major depressive disorder and dysthymic disorder in patients with comorbid alcohol use disorders
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a meta-analysis of placebo-controlled randomized trials.
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a meta-analysis of randomized placebo-controlled trials
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The Journal of clinical psychiatry, 72(8), 0-0.
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The Journal of clinical psychiatry, 72(8), 1144-1151
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Mishra, A., Maiti, R., Mishra, B. R., Jena, M., Nath, S., & Sahu, P.
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Mishra, A., Maiti, R., Mishra, B R., Jena, M., Nath, S., & Sahu, P
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Effect of add-on ramelteon therapy on sleep and circadian rhythm disruption in patients with schizophrenia: A randomized controlled trial. European Neuropsychopharmacology, 31, 109-118.
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Effect of add-on ramelteon therapy on sleep and circadian rhythm disruption in patients with schizophrenia a randomized controlled trial European Neuropsychopharmacology, 31, 109-118
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K., Kainth, S., Kumar, S., Bhardwaj, A., Agarwal, H. K., Maiwall, R.,...
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K., Kainth, S., Kumar, S., Bhardwaj, A., Agarwal, H K., Maiwall, R.,
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Effects of zolpidem on sleep parameters in patients with cirrhosis and sleep disturbances: A randomized, placebo-controlled trial. Clinical and molecular hepatology, 25(2), 199.
Original source
Effects of zolpidem on sleep parameters in patients with cirrhosis and sleep disturbances A randomized, placebo-controlled trial Clinical and molecular hepatology, 25(2), 199
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H., & Fugit, R.
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H., & Fugit, R
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Medications that can cause insomnia.
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Medications that can cause insomnia
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New York, NY:
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New York, NY
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Wiley-Liss, 103-109.
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Wiley-Liss, 103-109
