Читать книгу Dynamic Consultations with Psychiatrists - Jason Maratos - Страница 16

Ms. A's mood improved quickly after admission. Mirtazapine was titrated to 30 mg nightly. Clonazepam 0.5 mg nightly was also given. Pregabalin was added for restless leg syndrome related to mirtazapine and clonazepam. Ms. A had a good response to mirtazapine and refused to switch to an alternative antidepressant. She enjoyed when her family visited her. Sleep improved from 3 to 5 hours per night with structured routine, good sleep hygiene, and medication.

Ms. A wanted to live in her hometown for a short while and wait there for a singleton public housing unit to become available. Ms. A felt that living separately would prevent any conflict developing with her daughter. She was encouraged to develop leisure activities and participate in social gatherings. During discussion on postdischarge life, she often claimed sleep was still suboptimal and requested further hospital stay.

After the first discharge from hospital, Ms. A had repeated admissions for suicidal thoughts when she was feeling that she was being abandoned by her family. She still had insomnia with poor sleep hygiene. She continued to lack any daytime engagement, and this was more so when grandchildren grew up and did not need much of her care.