References chittawar s dutta d kalra s khandelwal d

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References Chittawar, S., Dutta, D., Kalra, S., & Khandelwal, D. (2017). Sleep Disorders in Type 2 Diabetes. Indian Journal of Endocrinology and Metabolism, 21 (5), 758–761. Fava, M., Rosenbaum, J. F., Stern, T. A., & Wilens, T. E. (2015). Massachusetts General hospital comprehensive clinical psychiatr y (1st ed.). Elsevier Health Sciences. Gözükırmızı, E., Guilleminault, C., Kaynak, D., & Kaynak, H. (2004). The effects of Trazodone on sleep in patients treated with stimulant antidepressants. Sleep Medicine, 5 (1), 15–20. IBM Corporation. (2021). IBM Micromedex. urce=deepLink&institution=SZMC%5ESZMC%5ET43537 Kitada M. (2003) Genetic polymorphism of cytochrome P450 enzymes in Asian populations: Focus on CYP2D6. International Journal of Clinical Pharmacological Research.23 (1),31-5. Monk, T. H., Germain, A., & Reynolds, C. F. (2008). Sleep disturbance in bereavement. Psychiatric Annals, 38 (10), 671–675. Pies R. W. (2014). The Bereavement Exclusion and DSM-5: An Update and Commentary. Innovations in Clinical Neuroscience, 11 (7-8), 19–22. Saddichha, S. (2010). Diagnosis and treatment of chronic insomnia. Annals of Indian Academy of Neurology, 13 (2), 94–102.
7 1 st response to Sally Herman Sally, Thank you for your post. The questions you suggested asking the patient were very similar to mine, although I feel it would be important to also spend some time assessing her grief and depression in more depth. In an article on bereavement in the elderly, Eng et al. (2013) stated that it can lead to depression. In my opinion, the patient has multiple things going on, so gathering the correct information to sort through it all is essential. Some additional questions I suggest asking the patient would revolve around her sleep habits. When did she start having trouble with her sleep? Knowing her sleep habits can help determine if actual insomnia or just her depression/grief are causing the sleep disturbances. You suggested asking when she started the Sertraline, and I would agree that it is essential as well. The onset of insomnia symptoms, how she is dealing with her husband's passing, and when she started the Sertraline would help give a comprehensive picture of what is going on. When addressing the medications changes, you would make you stated that you would increase her Sertraline and augment with Trazadone. I choose a little different route. I decided to stop the Sertraline and switch to Trazodone. Trazodone is indicated for use in both insomnia and MDD (IBM Corporation, 2021). Since the patient is 75 and does have multiple comorbidities, I was concerned about polypharmacy. I wanted to treat both her depression and insomnia with the least amount of pharmacology possible. While I agree with Trazadone as a choice, I feel it should be the only choice. By combining the Sertraline and Trazadone, the patient will be at a higher risk of serotonin syndrome. Trazadone and Sertraline both increase "levels of serotonin in the brain" (Fava et al., 2015, p. 102). Therefore, combining two drugs with the same effect (increase

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