Response to Armandine L’s Post – Narcolepsy

Please respond to my colleagues post below. Be positive(do not critique), maybe you can add some additional information.

The initial instructions to my colleague are similar to 217414 instructions which you did, this is now day 6 part of the instructions.

Narcolepsy
Narcolepsy is a sleep disorder characterized by excessive sleepiness, sleep paralysis, hallucinations, and in some cases episodes of cataplexy (partial or total loss of muscle control, often triggered by a strong emotion such as laughter). Narcolepsy occurs equally in men and women and is thought to affect roughly 1 in 2,000 people. The symptoms appear in childhood or adolescence, but many people have symptoms of narcolepsy for years before getting a proper diagnosis (National Sleep Foundation, 2019) The purpose of this discussion is explain the diagnostic criteria of narcolepsy, as well as the evidence-based psychotherapy and psychopharmacologic treatment, and describe at what point a person needs referral to a specialist.
Diagnostic criteria
People with narcolepsy feel very sleepy during the day and may involuntarily fall asleep during normal activities. In narcolepsy, the normal boundary between awake and asleep is blurred, so characteristics of sleeping can occur while a person is awake. As PMHNPs, we have to refer to DSM-5 criteria to make a diagnosis of mental illness. According to DSM- 5, a person is diagnosed with Narcolepsy if he or she meets criteria A and criteria B. In criteria A, a person has recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring within the same day, at least three times a week over the past three months. Besides, the client must meet at least one criteria B, including an episode of cataplexy that occurs at least a few times per month; hypocretin deficiency, and nocturnal sleep polysomnography showing rapid eye movement sleep latency of 15 minutes or less, or a multiple sleep latency tests showing a mean sleep latency of 8 minutes or less or more than 2 sleep onset eyes movement periods (American Psychiatric Association, 2013).
Evidenced-based psychotherapy and psychopharmacologic treatment
There is currently no cure for narcolepsy. However, the goal of the treatment is symptoms management. The most evidenced-based pharmacological treatment for narcolepsy is stimulant drugs. Stimulants work by stimulating the central nervous system to help these patients stay awake. They have been shown in several studies to reduce excessive daytime sleepiness and improve alertness (Gabbard, 2014). The most commonly used stimulants for narcolepsy are Modafinil or Armodafinil. These medications are less addictive than older stimulants and do not produce the highs and lows often associated with older stimulants (Mayo Clinic Staff, 2019). Other medications used in narcolepsy include Selective serotonin reuptake inhibitors (SSRI’s), and Sodium Oxybate. SSRIs are used to suppress REM sleep, alleviate cataplexy, sleep paralysis and hypnagogic hallucinations. Sodium oxybate helps to improve nighttime sleep and is highly effective for cataplexy. However, this medication comes with serious safety concern and distribution is heavily restricted (Mayo Clinic Staff, 2019). In addition to pharmacologic treatment, behavioral change is important. This includes being flexible about social engagement and plan, taking a short nap during the day, knowing the triggers for intense sleepiness and cataplexy, paying attention to how the medication affects the symptoms, practicing good sleep habits, and finding a support group to learn from others with the same condition. In addition, Psychological counseling may be important for difficulties associated with self-esteem and for emotional support, especially since people with narcolepsy have difficulty doing tasks that require concentration and may be regarded as unmotivated by family and peers.
When to refer the client to a specialist
Symptoms of narcolepsy are usually lifelong but may be improved with treatment or after retirement. Cataplexy may sometimes disappear over time, either spontaneously or with treatment or after retirement. A condition known as secondary narcolepsy can result from an injury to the hypothalamus that helps regulate sleep. In addition to experiencing the typical symptoms of narcolepsy, individuals may also have neurological problems and sleep for long periods (more than 10 hours) each night (Hollingshaus,2007). This may require a referral to a neurologist. Narcolepsy can sometimes be difficult to diagnose because the symptoms may be attributed to other conditions, such as sleep apnea, epilepsy, depression, and underactive thyroid gland, or previous head injury. The client may be referred to a specialist in sleep disorders who will analyze the client’s sleep patterns.

References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Washington, DC: Author.
Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.
Hollingshaus, S. (2007). Secondary Narcolepsy: An Exploration of Case and Pathophysiology
Retrieved from https://intermountainphysician.org/intermountaincme/Documents/06_Hollingshaus_Secondary%20Narcolepsy%20Presentation.pdf
Mayo Clinic Staff (2018). Narcolepsy
Retrieved from https://www.mayoclinic.org/diseases-conditions/narcolepsy/diagnosis-
treatment/drc-20375503
National Sleep Foundation (2019). Narcolepsy
Retrieved from https://www.sleepfoundation.org/sleep-disorders-problems/narcolepsy-and-sleep

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