The woman who liked a late-night TV

Please follow this instruction

To prepare for this Discussion:

Case 1: Volume 2, Case #16: The woman who liked late-night TV

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.

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.

Learning Resources

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.

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

The case Study

PATIENT FILE

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

Pretest self-assessment question (answer at the end of the case)

Which of the following hypnotic agents is less likely to be addictive, impair

psychomotor function, or cause respiratory suppression?

A. Ramelteon (Rozerem)

B. Zolpidem (Ambien)

C. Doxepin (Silenor)

D. Temazepam (Restoril)

E. A and C

F. B and D

G. None of the above

Patient evaluation on intake

• 70-year-old female with a chief complaint of “being sad”