Prompt

You are the psychiatry registrar in clinic. A 62-year-old man with late-life depression and anxiety has taken temazepam nightly for 6 years. He falls twice in 3 months, scores high on an insomnia severity measure, and his daughter wants 'a stronger sleeping tablet.' BMI 36, loud snoring, ESS elevated. Discuss diagnosis hierarchy, why long-term benzodiazepines are problematic, CBT-I components, OSA work-up, and a safe deprescribing and safety plan.

Interpretation

Reveal interpretation

This is chronic insomnia disorder comorbid with late-life depression/anxiety, long-term benzodiazepine use with falls, and high pretest probability of OSA. The daughter’s request for a stronger hypnotic is the wrong vector — deprescribe, start CBT-I-adapted care, and evaluate OSA.[1][2][4]

Psychiatry Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.

References6Show ledger

[1]Glass J, Lanctot KL, Herrmann N, et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits BMJ, 2005.PMID 16284208
[2]Qaseem A, Kansagara D, Forciea MA, et al. Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians Ann Intern Med, 2016.PMID 27136449
[3]Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline J Clin Sleep Med, 2021.PMID 33164742
[4]Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults Am J Epidemiol, 2013.PMID 23589584
[5]Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults J Clin Sleep Med, 2017.PMID 27998379
[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

Interpretation

Reveal interpretation

Psychiatry Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.

References6Show ledger

[1]Glass J, Lanctot KL, Herrmann N, et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits BMJ, 2005.PMID 16284208
[2]Qaseem A, Kansagara D, Forciea MA, et al. Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians Ann Intern Med, 2016.PMID 27136449
[3]Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline J Clin Sleep Med, 2021.PMID 33164742
[4]Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults Am J Epidemiol, 2013.PMID 23589584
[5]Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults J Clin Sleep Med, 2017.PMID 27998379
[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

Sleep disorders in psychiatry — structured clinical viva

Interpretation

Sleep disorders in psychiatry — structured clinical viva

Interpretation