Case Discussion: Sleepy woman with Anxiety

Case Discussion: Sleepy woman with Anxiety
ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Case Discussion: Sleepy woman with Anxiety

Case Discussion: Sleepy woman with Anxiety

3 hours ago

Idalmis Espinosa

Case 3: Volume 1, Case #5: The sleepy woman with anxiety

COLLAPSE

Top of Form

NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology

Initial Post

Case 3: Volume 1, Case#5: The Sleepy Woman with Anxiety

Helpful Questions to Ask

1. What time do you generally go to bed and what time do you wake up?

Asking this is important as it helps to rule out night-time insomnia as the cause of the patient’s day time sleepiness. In order to diagnose her with a sleep/wake disorder, it has to be clear that her condition is being caused by an underlying issue that has nothing to do with the sleep itself.

1. What happens when you fall asleep?

Asking this allows the patient to explain in detail all the symptoms that she has been experiencing, with regard to her disorder. This information is crucial in helping to correctly diagnose a particular sleep/wake disorder.

1. Are you taking any medications? If so, which ones?

A number of health issues, including some sleep/wake disorders are have a lot to do with pharmacodynamics. The patients day time sleepiness may be caused by certain drug actions or interactions and as such would require a restructuring of their medication or dosages.

The person that would be most helpful in evaluating the patient’s sleep patterns in this case would be the husband. Given that she has no children and keep little contact with her family or friends, the husband is the only person who has stayed with the patient long enough to properly observe the quantity and quality of her sleep. In sleep evaluation cases, getting a second person’s assessment is important as the patient may not be able to correctly or exhaustively explain what happens when they fall asleep. In this case, specific questions to the patient’s husband would include the following:

1. What happens when your wife falls asleep? (This allows the husband to explain in his own words what he has observed in his wife’s sleep pattern.

2. What do you think causes her sleep to be this way? (This may help bring new information which the patient may have deliberately or unintentionally left out.)

In order to diagnose narcolepsy, a number of physical and diagnostic tests can be done. Physical tests generally involve learning the patient’s medical history, analyzing the patient’s symptom self-assessment, checking the patient’s vitals and observing their general appearance. A physical test reveals symptoms and patterns which may help the health practitioner diagnose the patient with a particular sleep/wake disorder. For instance, a narcoleptic patient’s physical exams would entail such symptoms as excessive daytime sleepiness, hallucinations, sleep paralysis and cataplexy. The physical test can also include an Epworth Sleepiness Scale (ESS) questionnaire, which is employed in many sleep clinics to evaluate patients’ sleep quantity and quality. In an ESS, patients are asked to rate a range of activities in which they are likely to fall asleep, with the scale generally being from 0-24. Patients who score 0-10 are generally considered non-narcoleptic while those with score of above 11 are considered possible cases for narcolepsy. Diagnostic tests may include the polysomnogram (PSG) test and the multiple sleep latency test (MSLT) (Abad & Guilleminault, 2017; Bhattarai & Sumerall, 2017). The PSG test electronically evaluates a patient’s quality of sleep at night while the MSLT test measures a patient’s sleep latency during the day. Narcolepsy can also be diagnosed by conducting a hypocretin level test. Most narcoleptic patients are deficient in the chemical hypocretin, produced in the brain (Abad & Guilleminault, 2017; Bhattarai & Sumerall, 2017).

Differential Diagnoses

1. Narcolepsy (Most likely)

2. Hypersomnia /Excessive Sleepiness

3. Insomnia

Narcolepsy is the most likely diagnosis in this case owing to the patient’s excessive daytime sleepiness, which points to a deficient daytime arousal (Stahl, 2013). In addition to that, the patient has also been taking a range of medications including bupropion for depression, gabapentin for anxiety and lamotrigine for stabilizing her mood. These medications cause her heavy sedation which may bring about narcolepsy as a side effect (Stahl, 2013).

Two pharmacological agents to prescribe in this case would be methylphenidate (54mg/day) and sodium oxybate (9mg/day. Of the two, methylphenidate is more suitable as sodium oxybate has been seen to cause sleep walking, exacerbate nervousness in patients with anxiety and cause urinary incontinence (bedwetting) (Bhattarai & Sumerall, 2017)

From this case, we learn that it is important to establish whether a patient’s daytime sleepiness is a symptom of narcolepsy or simply hypersomnia, which is an underlying symptom of depression. It is also highly important to evaluate a patient’s medication, as it could be the main reason why they are experiencing sleep disturbances. A patient with anxiety and depression is most likely to develop sleep/wake disorders owing to their normal symptoms and the effect of the drugs they are taking (Abad & Guilleminault, 2017; Bhattarai & Sumerall, 2017).

References

Abad, V. C., & Guilleminault, C. (2017). New developments in the management of narcolepsy. Nature and science of sleep, 9, 39.

Bhattarai, J., & Sumerall, S. (2017). Current and future treatment options for narcolepsy: a review. Sleep Science, 10(1), 19.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: neuroscientific basis and practical applications. Cambridge University Press.

Bottom of Form

Case Discussion: Sleepy woman with Anxiety

Case Discussion: Sleepy woman with Anxiety

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.