Therapy for Clients with Pain and Sleep/Wake Disorders Paper
This paper delves into the assessment, diagnosis, and treatment of major depressive disorder with a comorbid sleep disorder using the woman who liked late-night TV as the basis of discussion (Case 1: Volume 2, Case #16).
Questions
- Have you ever experienced a traumatic event or an accident?
- Does any of your family members suffer from any other psychotic disorder?
- Do you stick to all medications presently prescribed?
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Other Interviewees
I would speak to one of the client’s parents, as well as his son. I would ask them to provide information about the nature of the disorder, social history, adherence matters, and family psychiatric and medical history Therapy for Clients with Pain and Sleep/Wake Disorders Paper.
Physical Examination and Diagnostic Tests
Along with the usual head-to-toe assessment and mental health status examination, I would also include other objective assessments. Among the most vital tests consists of the Geriatric Depression Scale (GDS), a useful technique for evaluating depression symptoms in older persons (Greenberg, 2017). The method is often used to ascertain the degree of distress in the aged, and its outcomes can, therefore, be used as a benchmark for evaluating the treatment routine’s efficacy (Greenberg, 2017). Another test I would suggest is polysomnogram (PSG), which allows me to assess the essence of the patient’s insomnia. The procedure can be used to exclude potential sleep-related indications, which can conflict with the client’s sleep patterns Therapy for Clients with Pain and Sleep/Wake Disorders Paper.
Differential Diagnosis
As per DMS-5, signs and symptoms of the client are typical of Major Depressive Disorder (MDD). The manifestations include energy loss, weight gain, reduced attention level, insomnia, lack of involvement in past exciting practice, and depressed disposition nearly every day (APA, 2013). Another potentially distinct condition is the traumatic stress condition that exhibits the same symptoms with MDD but varies in traumatic experience history and often odd actions.
Review of Medications
I would select Doxepin or Ramelteon because they are not addictive, are generally accepted, and do not trigger psychomotor impairment (Stahl, 2013). Nonetheless, because the medication is considered to respond adversely when used with SSRIs, the fact that the person is also on SSRIs and is a first-line antidepressant, usage of Doxepin is not appropriate (Davidson, 2016). Thus, my preferred treatment of insomnia, in this case, is Ramelteon’s usage given the client’s safety (NOCTE) (Stahl, 2013) Therapy for Clients with Pain and Sleep/Wake Disorders Paper.
Check Points
The patient has polypharmacy and can be extremely difficult to handle as an older person and a subject to mental disorder. My main concern is about reducing the number of medications. Some considerations impede the lowering of medications in the care process because the patient struggled with several complications that had to be handled differently. Critical situations where I would have handled it differently involve scheduling electrophysiology after the drug continually failed to resolve insomnia. This would assist me in ruling out or identifying OSA and RLS that might be a cause of lack of responsiveness. Additionally, I would use bupropion-XL (300mg/d) to reduce exhaustion and enhance other antidepressants’ effectiveness.
Lesson Learnt
The case study has provided me with a wide variety of information relevant to assessing, diagnosing, and managing sleeping disorders resulting from other conditions such as MDD in this case. Furthermore, the case has introduced me to numerous factors that should be addressed when selecting therapeutic evaluations like side effects, medication interactions, and age. I established polypharmacy as a big problem of aged persons and those experiencing mental issues. Knowledge learned here-in will benefit me in making future healthcare choices Therapy for Clients with Pain and Sleep/Wake Disorders Paper
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, DC.
Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: going beyond the guidelines. BJPsych open, 2(6), e16-e18.
Greenberg, S. A. (2017). The geriatric depression scale (GDS). 2012.
Pujol, M., Pujol, J., Alonso, T., Fuentes, A., Pallerola, M., Freixenet, J., … &Iranzo, A. (2017). Idiopathic REM sleep behavior disorder in the elderly Spanish community: a primary care center study with a two-stage design using video-polysomnography. Sleep medicine, 40, 116-121.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press Therapy for Clients with Pain and Sleep/Wake Disorders Paper
Discussion: Therapy for Clients With Pain and Sleep/Wake Disorders This week, as you study therapies for individuals with pain and sleep/wake disorders, you examine the assessment and treatment of clients with these disorders. You also explore ethical and legal implications of these therapies. Case 16 (SEE ATTACHMENT FULL CASE STUDY- PDF) The Case: The woman who liked late-night TV The Question: What to do when comorbid depression and sleep disorders are resistant to treatment The Dilemma: Continuous positive airway pressure (CPAP) may not be a reasonable option for treating apnea; polypharmacy is needed but complicated by adverse effects • 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.
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• 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. References: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Washington, DC: Author. Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: Going beyond the guidelines. BJPsych Open, 2(6), E16-E18. doi:10.1192/bjpo.bp.116.003707 Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press Therapy for Clients with Pain and Sleep/Wake Disorders Paper