NURS 6630 WEEK 8 ASSIGNMENT

NURS 6630 WEEK 8 ASSIGNMENT (Psychopharmacological Approaches to Treat Psychopathology) Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult Insomnia is classified by difficulty initiating sleep, difficulty maintaining sleep, sleep disturbances that cause significant distress (social, occupational, educational, academic, or behavioral), and symptoms present for three months or more (American Psychiatric Association, 2013). According to the DSM-IV, insomnia is only diagnosed when the patient’s sleep disturbances cannot be better explained by a medical condition such as narcolepsy, sleep apnea, substance abuse, or be caused by a medication (American Psychiatric Association, 2013). Research indicates that 10-15 % of the population suffers from insomnia. The difficulty in diagnosing and treating insomnia is that it is often associated with depression and anxiety (American Psychiatric Association, 2013 & Baglioni et al., 2011). Drug therapy often must address both issues for the patient to be successful and achieve remission. The following paper aims to discuss the decision process used to formulate a treatment plan for a 31-year-old male patient experiencing difficulty falling asleep and staying asleep. The patient’s history indicates that he has always had trouble with sleep but has seen an increase in sleep disturbances since the loss of his fiancé six months ago. The patient has even fallen asleep on his job as a forklift operator. The patient’s medical history also includes opiate abuse as well as his current admission to using alcohol nightly. The patient has tried over the counter sleep aids and has experienced unpleasant side effects. Some ethical considerations that will be discussed for this patient are his drug and alcohol abuse history and his job as a forklift driver. Both will impact what drug therapy is being prescribed. This paper will discuss several different pharmacological options for treating the patient and how each one is either appropriate or not. 3 Decision # 1 The first decision was to start the patient on Trazodone 50 mg at bedtime. Trazodone was chosen due to its effectiveness in treating both insomnia and depression, as well as its low potential for abuse (IBM Corporation, 2021). According to the DSM-IV, if insomnia is accompanied by a comorbid disorder such as depression, treatment needs to target both conditions (American Psychiatric Association, 2013). While the patient does not have an official diagnosis of depression, he has had a significant adverse life event (loss of his fiancé) that puts him at risk of developing depression and is displaying signs of depression (e.g., sleep disturbances following a death of a loved one) (Ancelin et al., 2015). Studies show that Trazodone is effective in inducing and maintaining sleep in patients with depressive symptoms as well as insomnia (Gözükırmızı et al., 2004). According to Abdelmesseh et al. (2017), Trazodone’s use for insomnia has surpassed its usage as an antidepressant and is one of the most common medications chosen off-label for insomnia. The expected outcome of starting the patient on Trazodone was that he would show a decrease in difficulty initiating sleep and sleep disturbances and would be more likely to stay asleep all night (Gada & Generali, 2015). It was also hoped that the patient would no longer have issues staying awake at work and be able to perform his job as a forklift operator safely. One ethical consideration at this point is the patient’s opiate abuse history and current alcohol use. It is pertinent that the patient is counseled on the dangers of mixing alcohol with Trazodone and being informed on possible adverse effects. Another consideration would be that Trazodone is sedating, and the patient operates a forklift. According to IBM Corporation (2021), patients should be advised against driving or any activity that requires alertness and coordination until they know how Trazodone will affect them.