Sleep/Wake Disorders
Sleep/Wake Disorders
Case 2 : Volume 2, Case #11: The figment of a man who looked upon the lady
To prepare
· 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( Case # 11 )
· 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.
The Assignment
· 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.
Resources ( Need 3 + references)
Required Readings
Note: All Stahl resources can be accessed through this link provided.
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 10, “Chronic Pain and Its Treatment”
Stahl, S. M., & Ball, S. (2009a). Stahl’s illustrated chronic pain and fibromyalgia. New York, NY: Cambridge University Press.
To access the following chapter, click on the Illustrated Guides tab and then the Chronic Pain and Fibromyalgia tab.
Chapter 5, “Pain Drugs”
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.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Case Number 7
Student’s Name
Institution Affiliation
Case Number 7. The case of physician do not heal thyself
Questions
1. Have you recently engaged in risky behaviors such as binge eating, unsafe sex, gambling, drug and substance abuse, or risky driving?
1. How would you describe your relationships with people such as your spouse, friends, neighbors, colleagues, and strangers while considering aspects of anger, irritability, and violence?
1. Do you have a recurring problem of variant moods that result to interpersonal stress, feeling of emptiness, and other challenges that are stress-related and they push you towards suicidal thoughts?
People to speak to
It is crucial to identify the right people to provide essential details for the assessment of the patient. Some of the most important people include the spouses, siblings, family friends, personal friends, and neighbors. Furthermore, the patient’s colleagues can provide important information regarding the behaviors of the patient and help in identifying issues that the patient could be hiding. Speaking to the people to whom the patient exercises authority is important in attaining the true image of the person.
Physical exam and diagnostic test
The disorder is mental, but it can be assessed through physical exams that indicate how the brain is working in relation to actions ( Stahl 2013). Fixing a puzzle would be an effective way of testing the patient and how stable they can be. The other approach is engaging the patient in a physical exercise and observing their participation. Physical exams provide a diagnostic insight to test how the patient relates with others.
Diagnoses
Personality Disorder
Mood Disorder
Depression with psychotic features
Pharmacological agents
Application of antidepressants
Use of antipsychotics
Administering mood-stabilizing drugs
Contradictions or Alterations
It is a complex situation to treat a complex and long-term unstable disorder of mood because the patients experience different emotions even during therapy (Yasuda & Huang 2008). It becomes difficult to separate mood disorder from personality disorder especially for difficult patient like in this case. Furthermore, there are no specific drugs that can be used for treatment without additional therapy since this patient is able to adjust or play with their own treatment as a physician. The mental condition observed in the patient requires a careful approach due to the delicate situations involving suicidal thoughts and aggression.
Lessons Learned
In the case study “The case of physician do not heal thyself,” the lessons include the importance of conducting a complete assessment of the patient and including other people who interact with the patient. It would be more effective to treat such conditions if the patients had stable emotions, but strategic approaches can help to streamline the treatment process ( Stahl 2014b).
References
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Yasuda, S.U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84( 3), 417–423. Retrieved from https://web.archive.org/web/20170809004704/https://www.fda.gov/downloads/Drugs/ScienceRe search/…/UCM085502.pdf
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