A 23-Year-Old Man Comes to the Office with Symptoms of Daytime

question 250

Multiple Choice

A 23-year-old man comes to the office with symptoms of daytime sleepiness.  The patient initially attributed his sleepiness to the frequent travel required by his job, but he grew more concerned when he fell asleep in the middle of a business meeting last week.  At night, the patient initially falls asleep quickly, but then wakes up frequently throughout the night.  He couldn't move when he first woke up one morning this week, and he has recently begun to hear "demonic" voices at night as he lies in bed.  The patient has a history of remitted major depressive disorder.  The patient's brother has schizophrenia.
Vital signs and physical examination are within normal limits.
A daytime, multiple sleep latency test shows a short sleep latency of 4 minutes (normal >10 minutes) .
Which of the following is the most appropriate therapy?

• A)Continuous positive airway pressure
• B)Increased sleep time
• C)Melatonin
• D)Modafinil
• E)Quetiapine

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