Treating Insomnia in Patients With Psychiatric Comorbidities

Treating Insomnia in Patients With Psychiatric Comorbidities: A Case Study Ruth M. Benca, MD, PhD Presentation The patient is a 21-year-old woman who comes to your office to establish medical care and reports a 3-year history of worsening insomnia. She has a history of hypothyroidism, depression and obsessive-compulsive disorder (OCD). She reports that she has particular difficulty falling asleep at night, sometimes lying awake until as late as 5:00 AM. She also complains of fragmented sleep, with frequent arousals and difficulty returning to sleep at times. Some nights, she claims she is not able to sleep at all. On further questioning, however, she admits that she can also have days where she may sleep up to as many as 16 hours, usually after extended periods of severe insomnia that last several days. Regardless of how much she sleeps, however, she finds her sleep to be nonrestorative and feels fatigued during the day. What is most troubling to her right now is that she has been unable to finish college or get a job because of her insomnia and erratic sleep pattern. Current medications include levothyroxine 50 micrograms (mcg) daily, aripiprazole 10 mg at bedtime and clomipramine 100 mg twice daily. She is noted to be morbidly obese (weight 284 pounds, height 62.5 inches, body mass index 51.1), but her physical examination is otherwise normal. Her mental status examination shows her to be alert, with no significant mood disturbance. She is somewhat anxious and concerned about her sleep problem, but otherwise not severely anxious. The mental status examination is otherwise normal. Articolul se gaseste la adresa : http://www.medscape.com/viewprogram/14875?src=nlcmealert&spon=12&uac=94998SN