The Treatment of Insomnia Secondary to Generalized Anxiety Disorder: Evaluating Escitalopram Use With Concomitant High-Resolution, Relational, Resonance-Based, Electroencephalic Mirroring (HIRREM).

Patient autonomy is important. However, what if a patient seeks out poorly studied treatment options? In this case report, we describe a patient with insomnia secondary to generalized anxiety disorder (GAD) who was prescribed escitalopram but additionally used High-Resolution, Relational, Resonance-Based, Electroencephalic Mirroring (HIRREM) therapy. HIRREM is an electroencephalogram (EEG)-based therapy that has been evaluated for use in the treatment of various conditions including insomnia.

Valproate-Induced Encephalopathy Presenting at Therapeutic Blood Concentrations: A Case Report and Literature Review.

Patients presenting with hyperammonemic encephalopathy are likely to have hepatic encephalopathy. However, valproate (an anticonvulsant and mood stabilizer) can also cause hyperammonemic encephalopathy and belongs on the differential for patients taking it, especially if there are recent contributory medication changes. We present a case report of a 61-year-old woman with valproate-induced hyperammonemic encephalopathy but with an initial valproate level within the therapeutic range (50-100 mcg/dL).