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Presentation/PPT
27/08/2022
Respond to your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned.
NOTE: Positive comment (bellow is attached the sleep disorder assigned to me)
Main Post
Treatment of Sleep/Wake Disorders
Narcolepsy is a chronic sleep disorder categorized by overwhelming daytime drowsiness and sudden attacks of sleep. Individuals with narcolepsy often find it challenging to stay awake for long periods. At times narcolepsy can be accompanied by a hurried muscle tone (cataplexy) triggered by strong emotion. Narcolepsy that happens with cataplexy is known as type one narcolepsy, and without cataplexy is called type two. The average sleep process starts with a phase called non-rapid eye movement (NREM) sleep, where a person’s brain waves slow considerably. An hour or so of NREM sleep, an individual’s brain activity changes, and rapid eye movement sleep begins. In narcolepsy, a person can suddenly go into rapid eye movement without first experiencing non-rapid eye movement sleep. The cause of narcolepsy is unknown; however, individuals with type one narcolepsy have low levels of the chemical hypocretin, a neurochemical in the brain that helps regulate wakefulness and rapid eye movement sleep. Narcolepsy starts in an individual between 10and 30 years old and has no cure. However, a psychiatric mental health nurse practitioner can help the individual manage the symptoms (Sadock et al., 2014).
Diagnostic Criteria for Narcolepsy
Recurrent periods of uncontainable sleep lasting or napping happening within the same day at least three times per week over the last three months. The presence of at least one of the following: people with long-standing disease brief (seconds to minutes) episodes of sudden bilateral loss of muscle tone with sustained consciousness that are triggered by joking or laughter. Hypocretin deficiency, as measured by cerebrospinal fluid hypocretin -1 immunoreactivity values of less than or equal to 110 pg/ml, must not be due to brain injury, inflammation, or infection. Nocturnal sleep polysomnography revealing rapid eye movement sleep latency less than or equal to 15 minutes (American Psychiatric Association, 2013).
Psychotherapy Treatment
In combination with pharmacology treatments, various behavioral approaches are also frequently recommended by psychiatric mental health nurse practitioners for narcolepsy symptom management. Cognitive-behavioral therapy for narcolepsy has increasingly been identified as a crucial supplement for treatment. Cognitive-behavioral therapy focuses on managing clients’ behaviors with narcolepsy, such as sticking to medication regimens and engaging in acceptable nocturnal sleep hygiene practices. Providing relevant education is vital, especially when clients are first diagnosed with narcolepsy for effective symptom management and treatment. Establishing good sleep hygiene is a powerful approach that is key in successfully managing symptoms. Sleep hygiene includes reoccurring habits and behaviors that contribute to a high quality of sleep. Naps ranging from 15 to 20 minutes scheduled about two to three times a day are particularly useful in treating excessive daytime sleepiness and improving alertness. A sleep diary is another beneficial tool when treating and diagnosing narcolepsy (Bhattarai
& Sumerall, 2017).
Psychopharmacologic Treatment
Current medications have been developed to target symptoms, yet most individuals continue to experience the adverse effects of their symptoms despite receiving standard treatment. Stimulants, such as amphetamines/dextroamphetamine and methylphenidate, are the conventional medications prescribed for symptom indication, particularly excessive daytime sleepiness. Modafinil and armodafinil are not as addictive as older stimulants and do not produce the highs and lows often associated with older stimulants. Side effects are headache, nausea, or anxiety. Sodium oxybate is a more recent medication effective in treating narcolepsy. It is the only medication effective and recommended by the Food and Drug Administration (FDA) to treat cataplexy and excessive daytime sleepiness. The FDA does not approve antidepressants for narcolepsy treatment, and further testing is required to determine their efficacy in treating cataplexy. However, practitioners commonly prescribe antidepressants due to their clinical effectiveness. More specifically, an antidepressant that inhibits norepinephrine reuptake (SNRIs), such as venlafaxine, has been reported as effective in treating cataplexy (Bhattarai & Sumerall, 2017).
Additional Referral
After an initial diagnosis, the psychiatric mental health nurse practitioner refers the client to a sleep specialist for further evaluation. Formal diagnosis demands staying overnight at a sleep center for an in-depth sleep analysis by the sleep specialist. Polysomnography measures a variety of signals during sleep using electrodes placed on the scalp. For this test, a person must spend a night at a medical facility. The test measures the electrical activity of the individual’s brain and heart and his or her muscle’s movement. It also monitors breathing (Mayo Clinic, 2020).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC
Bhattarai, J., & Sumerall, S. (2017). Current and Future Treatment Options for Narcolepsy: A
Review. Sleep Science (Sao Paulo, Brazil), 10(1), 19–27. https://doi-org.ezp.waldenulibrary.org/10.5935/1984-0063.20170004
Mayo Clinic. (2020, November 6). Narcolepsy.
https://www.mayoclinic.org/diseases-conditions/narcolepsy/diagnosis-treatment/drc-20375503
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA
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