A patient being treated for insomnia is prescribed ramelteon (Rozerem). Which comorbid mental health condition would make this medication the hypnotic of choice for this particular patient?

Correct Answer: D

Rationale: The correct answer is D: Substance use disorder. Ramelteon is the preferred hypnotic for patients with substance use disorder as it lacks abuse potential and does not affect the GABA system, reducing the risk of dependence. Patients with substance use disorder are at higher risk of developing addiction to traditional hypnotics like benzodiazepines. Ramelteon's unique mechanism of action targeting melatonin receptors makes it a safer option for this patient population. Incorrect Choices: A: Obsessive-compulsive disorder - Ramelteon is not specifically indicated for OCD. B: Generalized anxiety disorder - While ramelteon may help with sleep in patients with anxiety, it is not the preferred choice for this condition. C: Persistent depressive disorder - Ramelteon is not typically used as a first-line treatment for depression-related insomnia.

Correct Answer: B

Rationale: Step 1: Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for anxiety disorders due to their efficacy and tolerability. Step 2: SSRIs are also effective in treating somatic symptom disorders by addressing the underlying anxiety symptoms. Step 3: MAOIs are not commonly used for anxiety due to their dietary restrictions and potential for drug interactions. Step 4: Tricyclic antidepressants (TCAs) are less preferred due to their side effect profile and risk of toxicity. Step 5: Atypical antipsychotics are not typically prescribed for anxiety unless there is a specific indication for their use. Summary: B, SSRI is the correct choice for treating both anxiety and somatic symptom disorder, while the other options have limitations or are not commonly used for these conditions.

Correct Answer: D

Rationale: The correct answer is D: Exhaustion. In the general adaptation syndrome model, developed by Hans Selye, the final stage is exhaustion. This stage occurs when the body can no longer cope with the stressors and resources are depleted. This leads to a breakdown in physical and emotional functioning. The other choices are incorrect because: A: Perception of a threat is the first stage (alarm reaction); B: Use of coping mechanisms occurs in the second stage (resistance); C: Physiologic response is a general term encompassing all stages, not specific to the final stage.

Correct Answer: D

Rationale: The correct answer is D: Substance use disorder. Ramelteon is the preferred hypnotic for patients with substance use disorder as it lacks abuse potential and does not affect the GABA system, reducing the risk of dependence. Patients with substance use disorder are at higher risk of developing addiction to traditional hypnotics like benzodiazepines. Ramelteon's unique mechanism of action targeting melatonin receptors makes it a safer option for this patient population. Incorrect Choices: A: Obsessive-compulsive disorder - Ramelteon is not specifically indicated for OCD. B: Generalized anxiety disorder - While ramelteon may help with sleep in patients with anxiety, it is not the preferred choice for this condition. C: Persistent depressive disorder - Ramelteon is not typically used as a first-line treatment for depression-related insomnia.

Correct Answer: B

Rationale: The correct answer is B: Catharsis. Catharsis refers to the process of emotional release and purification through expressing feelings and emotions. In this scenario, the patient is engaging in bibliotherapy and expressing his feelings, indicating a release of pent-up emotions. This is a therapeutic process that allows the patient to process and cope with their emotions in a healthy way. Choice A: Insight is incorrect as it refers to gaining a deeper understanding or awareness, which is not explicitly mentioned in the scenario. Choice C: Anxiety reduction is incorrect as the scenario does not specify that the patient's goal is to reduce anxiety, but rather to express feelings associated with the reading material. Choice D: Problem solving is incorrect as the scenario does not involve the patient actively working through a specific problem, but rather expressing emotions related to the reading material.