NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology | Week 7

From negative changes in mood to problems concentrating, pain and sleep/wake disorders can have a tremendous impact on clients’ lives. When clients suffer from these disorders, they often seek medical care with the intent of receiving medications to manage symptoms. However, many of the medications used to treat pain and sleep/wake disorders may be addictive, making thorough client assessments and close follow-up care essential. To prescribe appropriate therapies with client safety in mind, you must understand not only the pathophysiology of these disorders, but also the pharmacologic agents used to treat them. NURS 6630:Week 7: 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.

Discussion: 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 week’s 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). 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.

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.

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

To prepare for this Discussion: Sleep/Wake Disorders Paper

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 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 diagnoses 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.

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 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.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues who were assigned to a different case than you. For example, if you were assigned to Case Study 1, respond to one colleague assigned to Case Study 2 and one colleague assigned to Case Study 3. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings. Discussion: Sleep/Wake Disorders Paper

ADDITIONAL INFORMATION;

Discuss sleep and wake disorders

Introduction

Sleep disorders are a common condition that affects millions of Americans. The most common types of sleep disorders include insomnia, narcolepsy, and restless leg syndrome (RLS). In addition to these primary diagnoses, there are several other conditions that can cause sleep problems or affect your ability to fall asleep or stay asleep at night: obstructive sleep apnea (OSA) and periodic limb movement disorder (PLMD). Learn about each type here!

What is sleep?

Sleep is a natural state of rest, during which your body repairs itself and regenerates. It’s important for physical and mental health, growth and development, memory and learning, mood regulation, energy levels and weight control.

You spend about one-third (or more) of your life asleep but how much exactly? The average adult spends about 25% of their waking hours sleeping. That adds up to over a full decade!

As a general rule, the more you sleep, the better your health. The National Sleep Foundation recommends that adults should get seven to nine hours of sleep per night.

What is a sleep disorder?

Sleep disorders are conditions that affect the amount and quality of sleep.

• They may include:

• Insomnia (difficulty falling asleep or staying asleep)

• Narcolepsy (extreme daytime drowsiness)

• Sleep disorders can be caused by medical conditions, medications, or mental health issues. These types of sleep problems are diagnosed by a doctor who specializes in this area of medicine called a sleep specialist. If you have one of these disorders but don’t think it’s serious enough to seek treatment from your primary care physician or another doctor for help with it, then you should discuss it with them first before going to see a specialist.

What are the causes of sleep and wake disorders?

Sleep disorders are caused by many factors, including:

• Medical conditions like diabetes or high blood pressure

• Medications, such as antidepressants and anti-epileptic drugs

• Mental health issues that affect your ability to relax and fall asleep at night (sleepwalking disorder)

Physical and mental health conditions that interfere with your ability to get a good night’s sleep, including: Sleep apnea Chronic pain Stress Sleep deprivation

How are sleep and wake disorders diagnosed?

The diagnosis of a sleep or wake disorder is based on a medical history, physical exam, lab tests, sleep diary and questionnaires. A sleep study can also be used to help determine if you have an underlying condition that causes your symptoms (such as narcolepsy).

If your doctor suspects that you may have one of these disorders but cannot determine its cause through the above methods, he or she may refer you for further evaluation at specialty clinics. These facilities provide more specialized care than general hospitals do but are not designed specifically for this purpose; they may also require longer stays away from home so make sure to discuss any issues with your insurance company before agreeing to this type of care plan!

How are sleep and wake disorders treated?

There are many treatment options for sleep and wake disorders. Some of these include:

• Medications, such as antidepressants and sedatives

• Psychotherapy, which can help you understand your thoughts and feelings about sleep issues

• Behavioral therapy, which helps you change behaviors that contribute to or cause insomnia.

What research is being done on sleep and wake disorders?

Sleep and wake disorders are important to research because they are a common cause of injury and disease. Many sleep disorders result from a combination of factors, including genetics, environmental factors (such as stress or lack of sleep) and lifestyle choices (e.g., sleeping at night). Research is also being done on the causes of these disorders for example, scientists have found that poor quality sleep can lead to obesity in both children and adults and how treatments for them might work best for people who suffer from them.

Sleep disorders may be caused by medical conditions, medications, or mental health issues.

Sleep disorders are common, and they can be caused by medical conditions, medications, or mental health issues. Sleep disorders are also treated with medication and therapy.

For example:

• Insomnia (difficulty falling asleep or staying asleep)

• Restless legs syndrome (RLS) – an uncomfortable sensation in the legs that occurs upon waking up during the night; also called “periodic limb movement disorder” or “parasomnia”. This type of sleep problem may lead to daytime drowsiness as well as impaired short-term memory and concentration due to excessive daytime napping on RLS symptoms alone; however this symptom can be managed through behavioral techniques such as pacing yourself while at work so that you don’t fall asleep during work hours!

Conclusion

The sleep and wake disorders mentioned in this post are not the only medical conditions that can cause sleep disruption. Additional causes of disrupted sleep include heart disease, pain from arthritis or other conditions, and certain types of cancer. The best way to identify any medical problems that might be causing you sleepless nights is to talk with a health care professional.