Discussion: 7 Sleep/Wake Disorders 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. Learning Objectives Students will: Assess client factors and history to develop personalized therapy plans for clients with sleep/wake disorders Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for sleep/wake disorders Evaluate efficacy of treatment plans for clients presenting for sleep/wake therapy Apply knowledge of providing care to adult and geriatric clients presenting for sleep/wake disorders Learning Resources Note: To access this weeks required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Required Readings Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear. Stahl, S. M. (2013). Stahls 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 prescribers guide (5th ed.). New York, NY: Cambridge University Press. To access information on the following medications, click on The Prescribers Guide, 5th ed tab on the Stahl Online website and select the appropriate medication. Review the following medications: For insomnia alprazolam amitriptyline amoxapine clomipramine clonazepam desipramine diazepam doxepin flunitrazepam flurazepam hydroxyzine imipramine lorazepam nortriptyline ramelteon temazepam trazodone triazolam trimipramine zaleplon zolpidem 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 https://bjpo.rcpsych.org/content/2/6/e16 To prepare for this Discussion: Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number. Case 1: Volume 2, Case #16: The woman who liked late-night TV Case 2: Volume 2, Case #11: The figment of a man who looked upon the lady Case 3: Volume 1, Case #5: The sleepy woman with anxiety Review this week’s Learning Resources and reflect on the insights they provide. Go to the Stahl Online website and examine the case study you were assigned. 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 patients 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 diagnoses for the patient. Refer to the DSM-5 in this weeks Learning Resources for guidance. Review the patients past and current medications. Refer to Stahls Prescribers Guide and consider medications you might select for this patient. Review the posttest for the case study. Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! By Day 3 Post a response to the following: 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 patients life you would need to speak to or get feedback from to further assess the patients 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 patients 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.