Differential Diagnosis and Therapy

¶ … Night TV Watcher Questions to Ask the Patient Would you be interested in recording your late night TV shows and watching them in the day if it means you can get to sleep earlier and be more wakeful during the daytime? If not Would you be interested in asking your morning nurse to arrive later and if she is unable to do so would you be interested in making other arrangements for a nurse who can better accommodate your schedule? If not Would you be interested in conducting a type of therapy that utilizes your enjoyment of receiving faxes during the day -- something like dignity therapy or spirituality therapy, which can have positive impacts on mood and outlook (Azizi, Azizi, Abedi et al., 2016)? People to speak with for feedback to further assess the patient's situation would be her son who is devoted to her as well as her morning health assistant who visits her.

Identifying and seeking feedback from her friends might also be helpful for determining the state of her social wellbeing.

Questions to ask would include: 1) Does the patient signify any desire to talk to others? 2) Does the patient question her existence or why she is alive? 3) Does the patient have a desire to contact or communicate with others? Physical exams and diagnostic tests that would be appropriate for the patient would include: blood test to rule out anemia, as well as hormone, calcium, vitamin D level depletions; endocrine tests for thyroid; CT scan or MRI to test for brain tumor.

Differential diagnoses would include: central nervous system diseases such as Parkinson's, MS, dementia, or endocrine disorders such as hyper- or hypothyroidism. I would also test for OSA by sleep electrophysiology, as this could be linked to depression caused by opioids (Wang, Rowsell, Wong et al., 2016). The most likely differential diagnosis is OSA.

Two pharmacological agents that would be appropriate for the patient's sleep/wake therapy based on pharmacokinetics and pharmacodynamics would be: modafinil and armodafinil as both are non-amphetamine drugs that could be used for the patient during the day to help her feel less tired. I would recommend modafinil as it uses both R. and S. enantiomers (Loland, Mereu, Okunola, 2012). Dosage would be 200mg once a day in the morning.

Therapeutic changes that might I might make based on the data would be based on cardiovascular test results to see if the modafinil is impacting the heart rate or blood pressure as well as the extent that it is helping the sleep wake cycle. Monitoring would also include any emergence of exacerbating psychiatric disorders, which could be impacted by dosage strength.

Lessons learned from this study include the need to discuss the patient's mental health with loved ones (family and friends) with the patient's consent in order to identify any underlying issues that might be resolved by way of psychiatric therapy. Attempts to modify or positively impact health symptoms through.