A Case Study On Narcolepcy And Anxiety

Sleep disorders are medical conditions that interfere with normal physical, as well as mental and emotional functioning. The lack of sleep may result in poor concentration, loss of energy, and disruption of overall health. Understanding the patient’s psychiatric history, medication history, and family history, in addition to undertaking physical examination and diagnostic testing can assist in developing the most appropriate treatment option for sleeping disorders. The case study for this assignment is for the sleepy woman with anxiety, where the main question is how an individual can be anxious and narcoleptic at the same time.

Narcolepsy is termed as a disabling neurodegenerative condition, which is characterized by excessive daytime sleepiness, sleep-related hallucinations, sleep fragmentation, as well as loss of tone that is caused by strong emotions. Being familiar with psychiatric illnesses that affect individuals with narcolepsy can assist in enhancing therapeutic outcomes. Individuals with sleeping disorders should evaluated through asking them questions that concern their personal lives. Understanding individual’s sleeping habits is essential for developing an appropriate medical intervention (Chaput & Dutil, 2016). As an APN, some of the questions that I would ask the patient when she comes to the office include:

1. How do you manage to survive in a constant situation of being either directly stimulated or being sleepy?
2. How have the family members helped in dealing with your condition?
3. Which types of over-the-counter medications have you been using to manage sleep/wake disorders?

Patients with sleeping disorders may require assistance from other people, who can offer feedback or assess their progress. Such people include family members, psychiatrist, nutritionist, and physical therapist.

Physical examination for MDD include vision, hearing problems, and allergies. However, evaluating the patient with a history of narcolepsy is a challenge due to the kind of medications she is taking, which could lead to excessive daytime sleepiness. According to American Psychiatric Association (2013), the three differential diagnoses, based on the patient’s history and physical examinations, include:

1. Obstructive sleep apnea
2. Major depressive disorder (MDD)
3. Hypersomnolence

The most probable diagnostic for this case scenario is MDD, which could be accompanied by recurrent unipolar disorder. Sleep disturbance is one of main problems of MDD, which is normally found in depressed patients. Narcolepsy is usually linked with depression, although the (MSLT) results do not portray any abnormality (American Psychiatric Association, 2013).

MDD may lead to morbidity and mortality; hence, it should be managed with the first-line antidepressants. Two pharmacologic agents that would be appropriate for the patient’s sleep/wake therapy, with respect to pharmacokinetics and pharmacodynamics, are:

• Quetiapine (Seroquel) Initial 25 mg/day BID, can be increased to 25-50 mg BID until the desired effect is achieved
• Anafranil (Clomipramine) 25mg orally, to be taken once a day during bedtime, can be increased after 2 weeks to 100 mg per day

My choice of pharmacological agent is Clomipramine, a tricyclic antidepressant (TCA), which is utilized to treat depression, anxiety, insomnia, as well as severe and treatment-resistant depression (Stahl, 2014). Clomipramine has an immediate effect when treating insomnia or anxiety, as it is capable of blocking serotonin reuptake pump, thus, increasing serotonergic neurotransmission. If the initial dosage is not working after 6 to 8 weeks, it should be increased, but should not exceed the maximum required level. The case study can assist APNs in assessing patients with sleeping disorders, as well as other disorders that increase the risk of having sleeping disorders.