Differential Diagnosis and Patient Treatment

Psychopharmacological Approaches to Treat Psychopathology

The first question is, how many meals do you have in a day and have lost your appetite? Considering that her BMI indicates she is underweight, we need to establish if she is getting enough food and nutrients for her body. The second question will be, how is your current sleep pattern? The question tries to uncover the patient’s sleep and wake schedule, bedtime routine, and daily functioning. Obtaining the patient’s sleep routine helps determine the diagnosis and identify the best treatment plan. The third question is, do you consume caffeine? If so, how many cups do you take in a day? Caffeine is a stimulant that has a negative effect on sleep at night. The lack of sleep can be due to caffeine if the patient consumes coffee before bedtime.

We can get further information from children and caregivers familiar with the patient. The question to ask the children will be if they have noticed any changes in their mother’s energy, mood, appetite, or interests. The question offers information on what others have seen and if it is similar to what has been reported by the patient. Another question to ask the children is how their mother has been coping with the loss of their father. Dealing with a loss of a loved one can be devastating, and we should understand the support system she has at home. Caregivers can offer insights into the patient’s functioning in daily activities, especially after the loss of her husband.

The test to administer to the patient would aid in determining her anxiety and depression. The Hamilton Anxiety Rating Scale (HAM-A) assesses the severity of the patient’s anxiety, assisting in determining the cause of insomnia for the patient (Zimmerman et al., 2020). The second test would be the Hamilton Depression Rating Scale (HDRS). HDRS is commonly used to assess symptoms of depression. The goal is to establish if the patient has a clinical diagnosis of depression.

The patient presents with a complaint of insomnia. The differential diagnosis for the patient would be depression. The patient reports they have had a depressed mood for ten months, and her depression has not been subsiding. The patient has been taking Sertraline 100mg daily, which is a drug used for the treatment of depression or anxiety.

Temazepam and Trazodone are the pharmacologic agents appropriate for the patient’s antidepressant therapy. Temazepam is a drug used to treat insomnia and will assist in treating the patient’s depressive mood (Lähteenmäki et al., 2019). The patient is an elderly woman who should be started on a dose of 7.5mg once a day at bedtime until the patient’s response is determined. Trazodone is used for the treatment of major depressive disorder and insomnia (Yi et al., 2018). The dosing for the patient will be 150mg per day at the start, which may be increased by 50mg per day every 3 to 4 days.

From a mechanism of action point, the best agent would be Trazodone because the drug has a lower addiction risk than Temazepam. Trazadone is metabolized by liver enzymes, inhibits serotonin reuptake, and causes adrenoreceptor subsensitivity. When Trazadone is used for the treatment of insomnia, lower dosages are recommended. The side effects of the drug for insomnia are morning grogginess, postural hypotension, cognitive and motor impairment, and daytime sleepiness. The patient would have to stop taking Sertraline because the drug is used to treat depression. Considering the patient’s depressive mood is due to her insomnia, we should stop her Sertraline medication because we can cure her depressive mood once she starts getting a good night’s sleep. Combining the two drugs would cause the patient to have hallucinations, increased heart rate, fever, seizure, excessive sweating, shivering, blurred vision, and muscle spasms.

The starting dose for Trazodone would be 25 to 150 mg daily for the patient (Yi et al., 2018). The low dosage is suitable for treating insomnia. However, higher doses can be prescribed if the low dosage is ineffective. The expected outcome is that the patient will have an increased sleep ability, and their depressive mood will reduce. The side effects of the drug, like daytime sleepiness, should not be a significant concern, considering the patient is an elderly woman and does not need to stay awake the whole day. We should evaluate the effects of the drug after four weeks to determine efficacy and if there is a need to change the dosage or stop the prescription.