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A 42-Year-Old Man Comes to the Office Due to Insomnia

question 829

Multiple Choice

A 42-year-old man comes to the office due to insomnia for the past month. He often awakens in the middle of the night anxious about his job performance and is unable to go back to sleep. He says, "I think I'm getting only 5 hours of sleep. All I really need is something to knock me out." The patient is an accountant for a furniture store; he has been very tired at work and has difficulty concentrating from lack of sleep. He adds, "Last month I made several accounting errors. My boss was really understanding about it, but he isn't going to be understanding for long if I keep making mistakes." Further questioning indicates that the patient has not felt like himself for several months. He has been uncharacteristically irritable with his wife and children and has lost interest in going to the gym and socializing with his friends and coworkers. On weekends, he stays in bed until noon and then lies on the couch for the rest of the day. The patient believes it is inevitable that he will lose his job and feels very guilty that he is letting his family down. He has no medical or psychiatric history. There is a family history of Sjögren syndrome in his mother and obesity, hypertension, and heart disease in his father and paternal grandfather. He says, "If I can just get some sleep, maybe things will be better." Physical examination and laboratory test results are unremarkable. Which of the following is the most appropriate next step in management of this patient?

Definitions:

Read Back

A communication technique where the listener repeats the spoken message back to the sender to confirm accuracy, commonly used in healthcare settings.

Critical Pathway

A specific plan that details the course of treatment for patients with a similar diagnosis or procedure, aimed at improving outcomes by providing a standardized approach to care.

Specifics Of Care

Detailed and individualized considerations and actions tailored to meet the unique healthcare needs of a patient.

Incident Report

A detailed account of an unexpected event, usually in a healthcare or institutional setting, aimed at identifying how to prevent recurrence.