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.

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 11, “Disorders of Sleep and Wakefulness and Their Treatment”

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.

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

To prepare for this Discussion:

Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following case studies to review for this
Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number.

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

Case 2: Volume 2, Case #11: The figment of a man who looked upon the lady

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

• 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