Medical MCQ - A 32-year-old man comes to physician complaining of excessive sleepiness for the past several months. He repos falling asleep while dealing with customers, had an almost accident when he fell asleep while driving The patient repos that he occasionally hears voices while falling asleep and finds himself "temporarily frozen" and unable to move on awakening.Which of the following is the most appropriate treatment for this patient?

A 32-year-old man comes to physician complaining of excessive sleepiness for the past several months. He repos falling asleep while dealing with customers, had an almost accident when he fell asleep while driving The patient repos that he occasionally hears voices while falling asleep and finds himself “temporarily frozen” and unable to move on awakening.Which of the following is the most appropriate treatment for this patient?

Clonazepam

Continuous positive airway pressure

Melatonin

Modafinil

Question Category:

Psychiatry

Correct Answer:

Modafinil

Description:

The above history is suggestive of narcolepsy as patient complains of: -Excessive daytime sleepiness -Hypnagogic hallucinations(on falling asleep) -Sleep paralysis * Hypocretin, also known as orexin, is released from the hypothalamus and regulates wakefulness and arousal. * Hypocretin-1 deficiency, measured cerebrospinal fluid (CSF), is now a pa of DSM-5 diagnostic criteria for narcolepsy. * Hypocretin deficiency is considered to be less than 110 pg/ml in CSF. Treatment- Modafinil(DOC) Advise patient not to do any dangerous activity like driving and swimming as he might sleep in between and can harm him

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