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A 34-Year-Old Woman with a History of Migraine Headaches Comes

question 485

Multiple Choice

A 34-year-old woman with a history of migraine headaches comes to the office due to insomnia. She has difficulties with sleep initiation/maintenance that started 5 years ago when she became the caretaker for her mother, who had Alzheimer dementia. She slept poorly as she had to be alert in case her mother called for her during the night. Although her mother passed away 3 years ago, the patient still has insomnia.
The patient takes >1 hour to fall asleep. She wakes up twice in the middle of the night and may take up to 45 minutes to fall back asleep. When she can't sleep, she stays in bed thinking about her career, lack of social life, and "ticking biological clock." She is exhausted the next day. The patient has no snoring or awakenings with gasping. She does not feel depressed. There is no history of tobacco, alcohol, or illegal drug use.
Vital signs are within normal limits. The patient is thin and in no acute distress. Physical examination is unremarkable.
Which of the following is the most appropriate treatment for this patient's insomnia?

Definitions:

Catatonic Stupor

A state of psychic and motor immobility and behavioral abnormality marked by periods of rigidity and excitement.

Heritability

A measure of how much of the variation in a trait within a population is due to genetic differences.

Schizophrenia

A psychiatric disorder marked by significant disruptions in thought processes, perceptions, emotional responsiveness, and social interactions.

Genetic Vulnerability

A predisposition to develop certain conditions or diseases based on one’s genetic makeup.