It is not uncommon to experience a night or two of disrupted sleep when there is something major going on in your life. However, sleep/wake disorders are much more than an occasional night of disrupted sleep. A recent report from the Centers for Disease Control and Prevention estimated that between 50 and 70 million American have problems with sleep/wake disorders (CDC, 2015). Although the vast majority of Americans will visit their primary care provider for treatment of these disorders, many providers will refer patients for further evaluation. For this Discussion, you consider how you might assess and treat the individuals based on the provided client factors Sleep/Wake Disorders Research Paper.
To prepare for this Discussion:
Case 3: Volume 1, Case #5: The sleepy woman with anxiety
Examine the case study uploaded.
Take the pretest for the case study.
Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.
Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
Develop a differential diagnosis for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.
Review the posttest for the case study.
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PLEASE Addressed each of the following numbers with a subtopic, all the references used must have an in-text citation in each paragraph. All Articles used should come from USA and must be within last five years only that is from 2014 to 2018. Please do not begin a paragraph with author name(s) (PLEASE USE parenthetical/in-text citations)
Post a response to the following bullets
Provide the case number in the subject line of the Discussion.
List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s sleep/wake therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 11, “Disorders of Sleep and Wakefulness and Their Treatment”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication Sleep/Wake Disorders Research Paper.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Note: Retrieved from Walden Library databases.
Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: Going beyond the guidelines. British Journal of Psychiatry, 2(6), e16-e18. doi:10.1192/bjpo.bp.116.003707. Retrieved from http://bjpo.rcpsych.org/content/2/6/e16
This is an essay on the case study of a Forty-four-year-old woman who has anxiety. She has a psychiatric history of depression. Despite the treatment, she still disabled by the depression and also has anxiety issues. She is married, has no children, has a supportive husband, has little contact with her family and has few friends. She has a medical history of narcolepsy, rest legs syndrome, nighttime urinary incontinence. She has a family history of depression. She is currently on bupropion, ziprasidone, lamotrigine, gabapentin, pramipexole, methylphenidate, sodium oxybate and DDAVP (the peptide Desmopressin). The assignment will focus on the three questions to ask a patient if he came to the office and the rationale. Secondly, identify the persons in patient’s life that would give more information about the patient’s situation. Thirdly, explain the details of the diagnostic tests and physical exams that are appropriate to the patient. fourth, come up with three differential diagnoses and explain the one that best suites her. Fifth, list two pharmacological agents and their dosages for the sleep/wake disorder basing them on the pharmacodynamics and pharmacokinetics and the rationale. Lastly, conclude the assignment.
Questions for the patient.
The following are the questions to ask; does your mood affect your friendship or socializing? This question is important as it will assess the effects/impacts that the depressive symptoms has on the individuals socializing/relationship and working. Secondly, do you use any substance of abuse (alcohol, smoking, other drugs of abuse). This will elicit the patient’s substance use, the coping mechanisms. Thirdly, do you think/feel like there is smoothing wrong? This is important as it will assess the patient’s insight (Walter et al., 2015; American Psychiatric Association, 2017).
Questions for the patient’s relatives and friends.
To get further information on the patient, the spouse will be a good source in assessing the mood and the effect of the patient. Is there a change in your sexual life? Depression tends to cause loss of interest in pleasures, for example, sexual pleasures. Secondly, is she irritable and pessimistic? A question that will be appropriate to her friends and co-workers. Thirdly, a question for both the spouse and friends, is she having difficulties concentrating and remembering things? This will assess depression (Wysowski et al., 2016; American Psychiatric Association, 2017).
Physical exam and the diagnostic tests.
A systematic head to toe examination should be done on the patient although the main aim is to assess the risk of the patient hurting herself, being malnourished and immobility/disabilities. When depressed one feels hopeless and desperation. They tend to commit suicide by hurting themselves. secondly, they have reduced appetite and sleep which causes malnourishment. Lastly, they tend to be immobile as they are always fatigued and tired (Stahl, 2013; Pagel & Parnes 2016).
On the diagnostic tests performed, for diagnosis of depression, the patient needs to have at least one of these symptoms for the most days in two weeks; fatigue, loss of pleasures/interests or/and persistent low mood or sadness. In addition to this, the patient can have trouble sleeping, concentrating, appetite, has low confidence, is agitated and has suicidality thoughts (Stahl, 2013) Sleep/Wake Disorders Research Paper.
The patient presentation points to major depressive disorders, narcolepsy, and/or generalized anxiety disorder. It is most likely, a major depressive disorder as it encompasses the other two diagnoses. Depression can cause anxiety and hypersomnia (American Psychiatric Association, 2017).
Diazepam (benzodiazepam), for the anxiety 5mg for two to four times a day. It increases GABA in the brain. This reduces the anxiety level normalizing the sleeping patterns. Secondly, mirtazapine an antidepressant 15mg taken at bedtime. They increase serotonin levels reducing depression (Mindell, Owen & Carskadon 2015; Mitler, 2017).
American Psychiatric Association. (2017). Diagnostic and statistical manual of mental disorders; DSM-IV. Washington DC.
Mindell, J. A., Owens, J. A., & Carskadon, M. A. (2015). Developmental features of sleep. Child and adolescent psychiatric clinics of North America, 8(4), 695-725.
Mitler, M. M. (2017). Nonselective and selective benzodiazepine receptor agonists: Where are we today? Sleep, 23(1), S39.
Pagel, J. F., & Parnes, B. L. (2016). Medications for the treatment of sleep disorders: an overview. Primary care companion to the Journal of clinical psychiatry, 3(3), 118.
Stahl, S. M., & Stahl, S. M. (2013). Stahl’s essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press.
Walters, A. S., Aldrich, M. S., Allen, R., Ancoli‐Israel, S., Buchholz, D., Chokroverty, S., … & Hening, W. (2015). Toward a better definition of the restless legs syndrome. Movement disorders: official journal of the Movement Disorder Society, 10(5), 634-642.
Wysowski, D. K., & Baum, C. (2016). Outpatient use of prescription sedative-hypnotic drugs in the United States, 1970 through 1989. Archives of internal medicine, 151(9), 1779-1783 Sleep/Wake Disorders Research Paper.
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