A 37-Year-Old Man Comes to the Office for Evaluation of Insomnia

question 548

Essay

A 37-year-old man comes to the office for evaluation of insomnia and daytime fatigue for the past 6 months.  The patient describes frequent nighttime awakenings.  He has no snoring or gasping for air, but he awakens suddenly with a feeling of panic.  During the day, he feels tired at work and has made several errors in his paperwork due to poor concentration.  The patient does not feel sad or depressed but admits that he has been more irritable and uncharacteristically loses his temper with his wife and 2 young children.  He has a history of hypertension.  Two years ago, he required extensive orthopedic surgery following an injury sustained when he was deployed to a combat zone.  He has one alcoholic drink daily and recently has started having a second drink at bedtime to help him relax and fall asleep.
Blood pressure is 130/80 mm Hg, pulse is 72/min, and respirations are 14/min.  BMI is 27 kg/m².  Physical examination is unremarkable apart from well-healed surgical scars.
Which of the following is the most appropriate next step in management of this patient?
A)Obtain a polysomnogram
B)Perform a brief intervention for unhealthy alcohol use
C)Prescribe a selective serotonin reuptake inhibitor
D)Prescribe short-term zolpidem and follow up in 2 weeks
E)Screen the patient for post-traumatic stress disorder

• A)Obtain a polysomnogram
• B)Perform a brief intervention for unhealthy alcohol use
• C)Prescribe a selective serotonin reuptake inhibitor
• D)Prescribe short-term zolpidem and follow up in 2 weeks
• E)Screen the patient for post-traumatic stress disorder

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Definitions:

Psychosexual Stage

In Freudian psychology, sequential developmental stages in childhood during which personality formation occurs, focusing on how children manage erotic and sexual impulses.

Physical Maturation

A process of growth and development in which a person's body becomes capable of reproduction, synonymous with puberty.

Electra Conflict

A psychoanalytic theory describing a girl’s psychosexual competition with her mother for possession of her father.

Latency Period

A phase in Freudian psychology referring to an intermediate stage of psychosexual development in children, during which sexual instincts are temporarily inactive.