Problem
Valentina Guzman (she, her, hers) 39-year-old Latina woman presents.
CC: "If I had a better handle on my night-time eating, I could lose enough weight to have this bariatric surgery."
HPI: Patient complains of unconscious nocturnal eating behaviors that started 10 years ago. Initially, she was able to partially recall the nocturnal binges (reportedly would eat peanut butter and uncooked spaghetti), but over the past year she has no recollection of these episodes the following morning.
Has had chronic insomnia for 5 years and has been taking Ambien for 5 years, which has been helpful.
Denies binge episodes during the day. Denies compensatory behaviors such as purging, laxatives, or excessive exercise.
History
1) Medical hx: GERD, PCOS
2) Surgical hx: Gall bladder removal
3) Psych hx: Was treated for a single major depressive episode in the past. Took Seroquel for sleep, which worked well, but weight loss doctor advised against it so stopped.
4) Family psych hx: Mother: bulimia
5) Social: Divorced 10 years ago, no children, works full-time; no current or previous alcohol use, illicit substance use, or tobacco use
6) Reproductive: Has Nexplanon implant, no period in over a year
Current Medications
1) Ambien (zolpidem) 10 mg at bedtime
2) Prilosec (omeprazole) 40 mg daily
Tests
1) Overnight polysomnography: Recurrent confusional arousals arising from non-REM sleep and eating binges while asleep with no subsequent recall
2) Thyroid panel: WNL
Task
a) What is the likely diagnosis for Valentina?
b) What is a differential diagnosis for Valentina?
c) How do you distinguish your primary diagnosis from your differential diagnosis?
d) What psychiatric medication(s) would you use to treat her?