Psych Vivas · Specialty psychiatry — sleep medicine interface
Circadian rhythm sleep-wake disorders — structured clinical viva
Fellowship viva covering DSWPD vs SWD, PRC/melatonin timing, occupational safety, and landmark trial anchors.
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FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the psychiatry registrar. A 42-year-old night-shift nurse has insomnia when trying to sleep by day, microsleeps on the drive home, and residual depression. A 19-year-old university student in the same clinic falls asleep at 04:00 and skips morning labs but sleeps well in semester break until noon. Discuss CRSWD classification, mechanisms (SCN, two-process, PRC), discriminators from insomnia and mania, assessment tools, and evidence-based management for DSWPD and shift-work disorder including melatonin timing and modafinil evidence.
Interpretation
Reveal interpretationShowHide
References7ShowHide
- [1]Auger RR, Burgess HJ, Emens JS, et al. Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline J Clin Sleep Med, 2015.PMID 26414986
- [2]Sack RL, Auckley D, Auger RR, et al. Circadian rhythm sleep disorders: part I, basic principles, shift work and jet lag disorders. An American Academy of Sleep Medicine review Sleep, 2007.PMID 18041480
- [3]Sletten TL, Magee M, Murray JM, et al. Efficacy of melatonin with behavioural sleep-wake scheduling for delayed sleep-wake phase disorder: A double-blind, randomised clinical trial PLoS Med, 2018.PMID 29912983
- [4]Czeisler CA, Walsh JK, Roth T, et al. Modafinil for excessive sleepiness associated with shift-work sleep disorder N Engl J Med, 2005.PMID 16079371
- [5]Drake CL, Roehrs T, Richardson G, et al. Shift work sleep disorder: prevalence and consequences beyond that of symptomatic day workers Sleep, 2004.PMID 15683134
- [6]Wilson S, Anderson K, Baldwin D, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update J Psychopharmacol, 2019.PMID 31271339
- [7]Lockley SW, Dressman MA, Licamele L, et al. Tasimelteon for non-24-hour sleep-wake disorder in totally blind people (SET and RESET): two multicentre, randomised, double-masked, placebo-controlled phase 3 trials Lancet, 2015.PMID 26466871