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Go to the Stahl Online website and examine the case study you were assigned

Go to the Stahl Online website and examine the case study you were assigned

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 post test for the case study.

  • 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 the ethical and legal implications of these therapies.

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

Week 7: Therapy for Clients With Pain and Sleep/Wake Disorders

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.

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 this link provided.

https://stahlonline.cambridge.org/essential_4th.jsf

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.

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.

https://stahlonline.cambridge.org/prescribers_guide.jsf

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.

https://dsm-psychiatryonline-org.ezp.waldenulibrary.org/doi/book/10.1176/appi.books.9780890425596

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

Sleeping woman with anxiety case (1)

Sample Answer

Therapy for Clients with Pain and Sleep/Wake Disorders

This discussion’s purpose is to analyze Case 3: Volume 1, Case #5: The sleepy woman with anxiety to determine whether she was offered the right diagnosis and treatment.

Questions for the Client

Question 1: Have you ever suffered any traumatic event at your young age? Rationale: The question would help me understand what triggered the patient’s episodes of depression and anxiety she suffered when she was 15 years old.

Question 2: Did you find yourself worried when you developed a panic attack? Rationale: This question would help me assess whether the patient had developed a panic attack due to generalized anxiety. Zhang and Walton (2018) note that constant worry is a sign of anxiety condition.

Question 3: Have you ever had any suicidal thoughts? Rationale: Anxiety or depressed patients often have suicidal thoughts (Votaw et al., 2019). This question would help me understand the level of anxiety or depression the patient suffers.

The question to the Support System

I would speak to the patient’s husband because he is the most supportive person to the patient. The question to the husband is, when did you observe the patient behaving weird. Rationale: This question would help me understand the onset of the disorder.

Physical Exams and Diagnostic Tests

A physical exam may focus on the patient’s general appearance. The PMHNP should examine how the patient is dressed, her orientation, and her thoughts. Zhang and Walton (2018) note that there are no laboratory tests for anxiety disorder. However, the PMHNP may use DSM-5 to diagnose the patient.

Differential Diagnosis

  1. Generalized Anxiety Disorder- Generalized anxiety is the primary diagnosis for this case. This condition has been selected as the primary diagnosis because the patient has complained of a panic attack and worry. The patient also notes that she experiences a great deal of anxiety, a condition that is disturbing her more than her depression.
  2. Major Depressive Disorder
  3. Geriatric Sleep Disorder

Pharmacological Agents and their Dosing

Based on the diagnosis, the patient may be prescribed Zoloft 50 mg orally daily. Another drug that might be prescribed is Buspirone 10 mg orally twice a day. From the two listed medications, I would prefer Zoloft to Buspirone due to the following reasons. First, the medication can easily reduce anxiety symptoms, such as chest pain, worry, and any other discomfort. Second, Lewis et al. (2019) conducted a study and found that anxiety patients who took Zoloft experienced symptoms reduction of about 46% after four weeks of usage.

Changes During Follow-up Session

According to Lewis et al. (2019), Zoloft 50 mg orally daily can reduce anxiety symptoms by up to 46% within four weeks of use. Hence, when the client returns for her check-up, the PMHNP can increase the dosage to 75 mg orally daily to improve the medication’s effectiveness (Lewis et al., 2019).

Ethical and Legal Implications for the Therapies

Several ethical and legal implications should be considered when prescribing the medications. The first implication is nonmaleficence. This implication states that the PMHNP should not harm the patient while improving the health of the patient. The second implication is beneficence. This ethical consideration states that the PMHNP should weigh the benefits and negative effects of medications before administering them to patients.

Lessons Learned

I have learned a lot of lessons from this case. I have gained knowledge on how to conduct proper patient analysis before prescribing medications. I have also gained an understanding of ethical and legal implications to be considered when prescribing medications.

Conclusion

The patient in the case has been diagnosed with a generalized anxiety disorder. She should be prescribed Zoloft 50 mg orally daily to improve her health.

References

Lewis, G., Duffy, L., Ades, A., Amos, R., Araya, R., Brabyn, S., … & Gilbody, S. (2019). The clinical effectiveness of sertraline in primary care and the role of depression severity and duration (PANDA): a pragmatic, double-blind, placebo-controlled randomised trial. The Lancet Psychiatry, 6(11), 903-914. https://doi.org/10.1016/S2215-0366(19)30366-9

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Votaw, V. R., Geyer, R., Rieselbach, M. M., & McHugh, R. K. (2019). The epidemiology of benzodiazepine misuse: a systematic review. Drug and alcohol dependence, 200, 95-114. https://doi.org/10.1016/j.drugalcdep.2019.02.033

Zhang, N., & Walton, D. M. (2018). Why so stressed? A descriptive thematic analysis of physical therapy students’ descriptions of causes of anxiety during objective structured clinical exams. Physiotherapy Canada, 70(4), 356-362. https://doi.org/10.3138/ptc.2016-102.e

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