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Clinical

Site Visit Summary OBGYN

Posted by Arianne Diaz (she) on

For my Women’s Health rotation, I had two site evaluations. Like my previous rotations, I had a mid site evaluation and a final site evaluation. Again, I was tasked with submitting three total H&Ps, ten drug cards, and one journal article with summary. Typically, I read my H&Ps off my laptop, occasionally glancing up to make eye contact with my site evaluator. This time, however, I was so excited to talk about my patients that I did not touch my laptop until it was time to discuss my drug cards. Both my mid-site and final site evaluations flowed like regular conversations, and I wound up talking in extensive detail about all three of my patients whereas in the past, I usually only had to present two. My preceptor provided me with valuable feedback on how to refine my differentials which I greatly appreciated. He also emphasized the importance of obtaining a comprehensive history for pregnant patients. He explained that it is essential to document what type of prenatal care these patients received to inquire about postpartum family planning options. It is important that future pregnancies are planned appropriately so providers always ask patients what their contraception plans are once they’ve given birth. I witnessed providers doing this during my time in the GYN clinic but I didn’t consider it for my own patient because I met her when she was already in the latent phase of labor. My preceptor also explained that patient education is imperative, especially for first-time mothers. Educating patients on proper latching techniques for breastfeeding as well as postpartum warning signs and symptoms can help mothers transition more seamlessly into this new role. Overall, this rotation truly helped me polish my clinical skills and I am grateful for the opportunity to have rotated at this location. 

Clinical

Site Visit Summary

Posted by Arianne Diaz (she) on

For my Women’s Health rotation, I had two site evaluations. Like my previous rotations, I had a mid site evaluation and a final site evaluation. Again, I was tasked with submitting three total H&Ps, ten drug cards, and one journal article with summary. Typically, I read my H&Ps off my laptop, occasionally glancing up to make eye contact with my site evaluator. This time, however, I was so excited to talk about my patients that I did not touch my laptop until it was time to discuss my drug cards. Both my mid-site and final site evaluations flowed like regular conversations, and I wound up talking in extensive detail about all three of my patients whereas in the past, I usually only had to present two. My preceptor provided me with valuable feedback on how to refine my differentials which I greatly appreciated. He also emphasized the importance of obtaining a comprehensive history for pregnant patients. He explained that it is essential to document what type of prenatal care these patients received to inquire about postpartum family planning options. It is important that future pregnancies are planned appropriately so providers always ask patients what their contraception plans are once they’ve given birth. I witnessed providers doing this during my time in the GYN clinic but I didn’t consider it for my own patient because I met her when she was already in the latent phase of labor. My preceptor also explained that patient education is imperative, especially for first-time mothers. Educating patients on proper latching techniques for breastfeeding as well as postpartum warning signs and symptoms can help mothers transition more seamlessly into this new role. Overall, this rotation truly helped me polish my clinical skills and I am grateful for the opportunity to have rotated at this location. 

Clinical

Reflection

Posted by Arianne Diaz (she) on

I recall the day I received my clinical year schedule. As I quickly glossed over the colorful rows, I made note of the rotations I was least looking forward to. At the time, Women’s Health was undoubtedly the top contender, it was the rotation I was dreading the most.

I still remember telling myself “Oh good! I won’t have to deal with this for another year” as I clicked off the Excel document detailing where I’d be rotating for the next 12 months.

I wanted to preface my reflection with this brief anecdote to demonstrate how foolish my thought process was. I didn’t feel very passionate about Women’s Heath and my opinions were based off the experiences of upperclassmen. These factors skewed my perception of the rotation, leading me to believe that I would not enjoy it. It was not until I was actually on my Women’s Health rotation that I realized how valuable, fascinating, and precious this specialty is. For my first two weeks I worked with PAs and attendings in the GYN clinic. I performed speculum examinations, bimanual examinations, collected cervical samples for pap smears and STI screening, assisted in family planning, measured fundal heights, listened to fetal heart sounds, and more. I was able to interact with patients of varying backgrounds, all with unique complaints. In particular, I remember one patient who came to the clinic with desires of becoming pregnant. The attending I worked with explained the most opportune time of each month to achieve pregnancy, and provided education on artificial methods for achieving pregnancy should she be unable to on her own. The patient expressed sincere gratitude and even asked for this attending to be assigned as her regular GYN provider moving forward. Working with providers like this inspires me to continue learning so that one day I can provide phenomenal patient centered care.

For my third week I was on GYN on-call. Each day, I worked closely with a different PA and, together, we examined consults. The majority of our consults were patients from the emergency room but I found myself scrubbing into two c-sections and assisting in a laparoscopic hysterectomy. During the lap hysterectomy, the PA I was paired with had to leave for an emergency consult. I was left in charge of the uterine manipulator which initially frightened me because I had never used one before. With the guidance of the attending and resident, however, I became more confident using this tool and the procedure was successful. By the end of this third week, I was considering GYN as a specialty but I wasn’t sure yet. This would change by the end of my 4th and 5th week.

During my last two weeks I was required to attend three overnight shifts and five day shifts on the labor and delivery unit. I assisted with two vaginal deliveries which I found absolutely life-changing. I will never forget the overwhelming happiness that came over me as I listened to the first cries of these babies. For the remainder of my time on labor and delivery, I was able to be more hands on with patients and perform postpartum examinations. The midwives, nurses, and other students on the unit were friendly, receptive, and eager to answer questions. It didn’t register until I was on my way home on my last day that I had more fun that I could have imagined. I loved my Women’s Health rotation, and I am proud to say this is now my top specialty. I learned to take the experiences of others with a grain of salt, and to go into every situation with my best foot forward. After all, “you get back what you put into these rotations!”

Clinical

Journal Article w/ Summary

Posted by Arianne Diaz (she) on

Article 1: Biophysical Effects, Safety, and Efficacy of Raspberry Leaf Use in Pregnancy: A Systematic Integrative Review

Abstract:

Background: Childbearing women have been using various herbs to assist with pregnancy, labor and birth for centuries. One of the most common is raspberry leaf. The evidence base for the use of raspberry leaf is however under-developed. It is incumbent on midwives and other maternity care providers to provide women with evidence-based information so they can make informed choices. The aim of this study was to review the research literature to identify the evidence base on the biophysical effects, safety and efficacy of raspberry leaf in pregnancy.

Methods: A systematic, integrative review was undertaken. Six databases were searched to identify empirical research papers published in peer reviewed journals including in vitro, in vivo, human and animal studies. The search included the databases CINAHL, MEDLINE, Cochrane Library, Scopus and Web of Science Core Collection and AMED. Identified studies were appraised independently by two reviewers using the MMAT appraisal instrument. An integrative approach was taken to analysis.

Results: Thirteen studies were included. Five were laboratory studies using animal and human tissue, two were experiments using animals, and six were human studies. Included studies were published between 1941 and 2016. Raspberry leaf has been shown to have biophysical effects on animal and human smooth muscle including the uterus. Toxicity was demonstrated when high doses were administered intravenously or intraperitoneally in animal studies. Human studies have not shown any harm or benefit though one study demonstrated a clinically meaningful (though non-statistically significant) reduction in length of second stage and augmentation of labor in women taking raspberry leaf.

Conclusions: Many women use raspberry leaf in pregnancy to facilitate labor and birth. The evidence base supporting the use of raspberry leaf in pregnancy is weak and further research is needed to address the question of raspberry leaf’s effectiveness.

Type of Study: Systematic Review

Summary:

                  This article focuses on the use of raspberry leaf in pregnancy as well as fetal outcomes. Raspberry leaf is associated with smooth muscle relaxation which, according to some studies, is particularly helpful during the active and latent phases of labor. One study conducted by Whitehouse demonstrated that raspberry leaves can relax the uterus without impacting blood pressure. While this is a significant finding, there are also unfavorable side effects associated with this product. For instance, in another study reported by Nguyen, women with gestational diabetes developed hypoglycemia after consuming 16 oz of raspberry tea leaf a day for 3 days. Care should be taken in women who are using insulin to manage their gestational diabetes as it may potentiate worsening hypoglycemia. Some women, however, may want to raspberry leaf to manage their gestational diabetes, though they must be monitored extremely closely.  Another study included in this article reported findings which demonstrated alterations of the CYP in offspring of mothers who used this herb during pregnancy. Other studies focused on the effect of raspberry leaf on pregnancy outcome. For one study, researchers documented increased incidence of c-section births in women using this herb. However, there were “no statistically significant differences” in between women who used raspberry leaf and women who didn’t where APGAR score, diastolic blood pressure, meconium-stained liquor, transfer to neonatal ICU, and postpartum hemorrhage were concerned. There were also no differences for other factors either such as labor augmentation, epidural, length of the stages of labor, etc. There is not enough evidence to indicate that use of this herb is beneficial in pregnancy and more research must be conducted before a definitive conclusion is established.

Clinical

History and Physical

Posted by Arianne Diaz (she) on

Chief Complaint: “I’ve been having heavy, painful menstrual bleeding every month for the past 4 years”

History of Present Illness: 46 y/o G10P4154 F presents today for heavy, painful menstrual bleeding x4 years. Patient states that symptoms began when she was diagnosed with fibroids four years ago. She states that her menses “have always been heavy”, lasting approximately five days. Her menses are now 26-28 days apart, lasting 7-8 days. She admits to using 12 medium sized sanitary napkins on the heaviest day of her menses. She endorses weakness during this time and admits to requiring two transfusions in the past as well as iron therapy due to her heavy menstrual bleeding. Patient states that she experiences severe, dull and achy, LT sided cramps which have been present for 6 years. As per patient, these cramps begin shortly before her menses and last throughout the entire cycle. She reports using heating packs and ibuprofen with minimal relief, and rates her pain a 10/10 in severity. LMP: current. Patient denies intermenstrual bleeding, postcoital bleeding, recent weight loss, dysuria, hematuria, urinary urgency, urinary frequency, abnormal vaginal discharge, excessively rough intercourse, or trauma.

Differential Diagnosis:

  1. Heavy menstrual bleeding secondary to uterine fibroids
  2. Adenomyoma
  3. Endometrial hyperplasia/malignancy
  4. Von Willebrand disease

Medications

Genvoya 150 mg daily with food

Aspirin 81 mg chewable tablet

Denies OTC or herbal supplement use

Past Medical History:

Asthma, not controlled

HIV positive, viral load undetectable

HPV positive on anal pap

Hx of CVA at age 30

Immunization History:  

Immunizations are up to date

Gardasil incomplete; last dose was due March 2023

Preventative Medicine Screening:

Mammography (contrast enhanced)  – (11/20/2023)  low suspicion for malignancy. LT breast densely enhanced, mass measuring 25×16 mm. RT breast mass measuring 13×10 mm, probably benign. Patient underwent LT breast lumpectomy on 11/22/2023. Patient was due for mammography early August 2024.

Pap Smear – (10/27/2023) negative for intraepithelial lesion or malignancy. No HPV cotesting performed at this time.

Bone Density/DEXA Scan – not due for screening

Colonoscopy – not due for screening

Dental – N/A

Ophthalmologic – N/A

Past Surgical History:

C-section x1 performed at Mount Sinai

Cholecystectomy performed at Mount Sinai

Hysteroscopy D&C performed at Woodhull Medical Center

Umbilical Hernia repair performed at Mount Sinai

Right inguinal hernia repair performed at Mount Sinai

LT eardrum surgery performed at Mount Sinai

RT foot surgery  performed at Woodhull Medical Center

Allergies:

Latex, reaction: hives

Peanuts, reaction: shortness of breath   

Pitocin, reaction: unknown

Family History:

Maternal cousin with breast cancer at 56, alive and in chemotherapy

Maternal uncle with colon/prostate cancer at unknown age, unknown if alive

Sister with ovarian cancer at unknown age, alive, unknown if in chemotherapy

Other family members with lymphoid cancers, unknown

Social History:

N.D. is a 46 y/o F living in Flushing Queens

Habits – denies smoking or alcohol use. Admits to marijuana use.

Travel – no recent travel

Diet – patient reports eating frequent meals during the day with limited vegetable intake

Exercise – patient reports minimal daily exercise

Sleep – reports some nights of interrupted sleep, some nights are uninterrupted

Safety measures – patient practices seatbelt safety

OB History:

  • G10P4154
    • Four children carried to term
    • One child born preterm
    • 5 abortions; 4 living children

GYN/Sexual History:

Menarche: age 12

Menstrual Cycle: regular and heavy; 26-28 days apart, lasting 7-8 days

LMP: current (09/04/2024)

Sexually active with 1 male partner

Contraception: none

STD History: HIV positive, no history of other STDs

Review of Systems:

General: Reports weakness during menses. Denies fever, chills, night sweats, fatigue, loss of appetite, recent weight gain or loss

Skin, hair, nails: Denies changes in texture, excessive dryness or sweating, discolorations, pigmentations, moles/rashes, pruritus, changes in hair distribution

HEENT: Denies headache, vertigo, head trauma, unconsciousness, coma, use of contacts, glasses, visual disturbances, fatigue, lacrimation, photophobia, deafness, pain, discharge, tinnitus, use of hearing aids, nasal discharge, epistaxis, bleeding gums, sore tongue, sore throat, mouth ulcers, voice changes, dentures

Neck: Denies localized swelling/lumps, stiffness/decreased range of motion

Breast: Denies lumps, nipple discharge, pain

Pulmonary system: Denies dyspnea, SOB, cough, wheezing, hemoptysis, cyanosis, orthopnea, PND

Cardiovascular system: Denies chest pain, HTN, palpitations, irregular heartbeat, edema/swelling of ankles or feet, syncope, known heart murmur

Genitourinary: Denies frequency, urgency, incontinence, dysuria, nocturia, oliguria, polyuria

Sexual history: as per GYN/Sexual History

Menstrual and Obstetrical: date of last normal period: 4 years ago, menarche: age 12, interval between periods 26-28 days, duration and amount of flow 7-8 days,  12 medium sized pads/24 hours. Admits dysmenorrhea, menorrhagia, premenstrual symptoms: abdominal pain. Denies postcoital bleeding, vaginal discharge, dyspareunia, menopause.

Musculoskeletal System: Denies muscle/joint pain, deformity or swelling, redness, arthritis

Peripheral Vascular System: Denies intermittent claudication, coldness of trophic changes, varicose veins, or peripheral edema, color change

Hematologic System: Denies easy bruising or lymph node enlargement

Endocrine System: Denies polyuria, polydipsia, polyphagia, heat or cold intolerance, goiter, hirsutism

Nervous System: Reports hx CVA at 30. Denies loss of consciousness, ataxia, loss of strength, change in cognition/mental status/memory, weakness (asymmetric)

Psychiatric: depression/sadness/anxiety

Vital Signs:       

Temperature: 97.8 degrees Fahrenheit

O2 Sat: 100% on room air

Height: 65 inches

Weight: 62.6 kg

BMI:  22.96 kg/m2

Respiratory Rate: 18

Heart Rate: 60 bears per minutes

Blood Pressure: 100/72 RT arm, seated

Physical:

General: Patient appears clean & well groomed, alert & oriented to time, place, and person. Has good posture and appears to be a reliable source of information. Appears stated age and appears to be mildly uncomfortable.

Skin/Hair/Nails: skin is warm and moist, and non-icteric, no lesions noted. Cannot visualize hair because patient is wearing a wig.

HEENT: Head is normocephalic, atraumatic, and non-tender to palpation. Face is symmetrical with no signs of drooping, swelling, or trauma. Eyes are symmetrical OU, conjunctiva is white. Bilateral ears are symmetrical and appropriate in size without lesions, masses, or trauma on external ears. The nose symmetrical without masses, deformities, trauma, or discharge. Good dentition, no obvious dental caries noted. No gingival hyperplasia or erythema noted. Pharynx is non-erythematous, uvula is midline.

Neck, Thyroid, and Lymph Nodes:

The trachea is midline without masses or scars. The thyroid is consistent in size and shape and non-tender to palpation. Evaluation of lymph nodes deferred.

Abdomen:

Abdomen is soft and non-tender to palpation. No guarding or rebounding noted. Pfannenstiel incision scar well-approximated and well-healed without any evidence of appreciable masses around or underneath it.

Breast Exam:

Deferred

Genitalia:

External genitalia without erythema or lesions. There is active, brisk vaginal bleeding noted. No clots or tissue are visible. Cervix appears closed and without lesions or trauma. No cervical motion tenderness noted. Uterus anterior, midline, smooth, non-tender and not enlarged. No adnexal tenderness or masses noted. No inguinal adenopathy.

Rectal:

Deferred

Peripheral Neurologic Exam

No atrophy, tics, tremors, or fasciculation. Gait steady with no ataxia. Strength and sensation intact.

Mental Status Exam

Patient is well appearing, good hygiene and neatly groomed. Patient is alert and oriented to name, date, time, and location. Speech and language ability intact, with normal quantity, fluency, and articulation. Patient denies changes to mood. Conversation progresses logically. Insight, judgement, cognition, memory, and attention intact.

Peripheral Vascular Exam

The extremities are normal in color, size and temperature. No clubbing, cyanosis or edema noted bilaterally. No stasis changes or ulcerations noted.

MSK Upper and Lower Extremity

No soft tissue swelling/erythema/ecchymosis/atrophy/or deformities in bilateral upper and lower extremities. FROM of all upper and lower extremities bilaterally.

Imaging:

Image not available  Pelvic U/S performed at Mt. Sinai on 07/08/2024

Indication: LLQ pain, concern for torsion

Technique: transabdominal and pelvic ultrasound

Comparison: pelvic ultrasound on 08/30/2016

Findings:

  • Uterus: 9.9 x 5.5 x 7.4 cm, anteverted in configuration. Numerous fibroids present. sample fibroids measuring 2.4×2.3×1.9 cm, second measuring 1.5×1.6×1.9 cm, and smaller fibroid measuring 0.7×0.8×0.8 cm.
  • Endometrium: 0.2 cm in double layer thickness 
  • Right Ovary: 3.0 x 1.5 x 1.4 cm. 3.2 mL. Normal. Adnexal cys measuring 1.2×1.0x0.5 cm. Doppler color flow and spectral analysis demonstrates normal arterial and venous waveforms.
  • Left Ovary: 2.7×1.6×1.7 cm. 4.0 mL. Normal. Doppler floor flow and spectral analysis demonstrates normal arterial and venous waveforms. 
  • Free Fluid: none

Assessment:

46 y/o G10P4154 F presents today for heavy, painful menstrual bleeding x4 years. Transabdominal and pelvic ultrasounds reveal the presence of multiple small fibroids. Patient has extensive family history cancers, including GYN cancers. Endometrial biopsy required before determining best course of management.

Plan:

Return after menses have ceased for endometrial biopsy

Follow up in clinic to discuss results & definitive management (patient would like to undergo hysterectomy but unsure if partial or total)  

BRCA testing

Tranexamic acid to temporarily improve heavy menstrual bleeding; patient says she has adverse effects associated with OCPs        

Clinical

Site Visit Summary

Posted by Arianne Diaz (she) on

My site visits for Family Medicine were similar to my previous site visits. Again, we were required to submit one H&P and 5 drug cards for our mid site evaluation, and two H&Ps, 5 drugs cards, and a summarized journal article for our second evaluation. Like previous site evaluators, our site evaluator gave us leeway when it came to picking our article, so long as it was of the highest level of evidence. Our site visits flowed more like a conversation than a presentation which made it easier for me to talk about my patient and explain my top differential. I appreciate being able to talk freely about the patient’s presentation without reading directly from the H&P. This is something that I found helpful for learning how to present to my preceptor without referencing my notes. I’ve been working on this skill since the beginning of clinical year but this site visit helped me feel more confident in how to report on a patient and focus on the pertinent information. It is definitely a skill I want to implement in my upcoming rotations. Our site evaluator also asked my classmate and I about our drug cards in random order. This was a great way, low-stakes way of reviewing our drugs. Moving forward I want to focus more on understanding the mechanism of action of commonly used classes/drugs so that I can explain how medications work for my patients should they ever ask me. All in all, both evaluations were concise and comprehensive!

Clinical

Reflection

Posted by Arianne Diaz (she) on

My Family Medicine Rotation was one of the rotations I was looking forward to the most. I wanted to be in an environment where I would be able to interact with adults and children, and not just one or the other exclusively. I was, however, absolutely unprepared by the large volume of patients I saw everyday. During this rotation, I saw anywhere from 45-50 patients a day within an 8 hour span. While many patients presented for annual comprehensive exams or to review results of labs/imaging, others had acute complaints which required further workup. At first I was worried about how I would incorporate study time with such a busy schedule, but I learned to distribute my time in a way that I was able to rest and study everyday. I would come home, nap for a couple of hours, wake up and study for a few hours, then go back to sleep. This was quite an adjustment for me since I haven’t needed to rest in the middle of the day for any rotation but I knew it was necessary to relax a little each day before sitting down to go over my flashcards and study guide. I also took advantage of my preceptor, asking her questions and seeking clarification on lab results, treatment options, and other things I was unsure of. I learned to be confident in my interactions with my patients, and I strengthened my ability to interpret labs (which was a goal of mine for my clinical year).

In some instances, I found it difficult to interact with patients because there was somewhat of a language barrier. During these instances, my preceptor would come into the room with me, but allow me to lead the encounter. Since she is fluent in both English and the language spoken by her patient population, she was able to seamlessly ask whatever questions I had before taking over and discussing the treatment plan with the patient. The patients were kind towards me and always agreeable to having me lead the encounter. This made me feel included in their care, which always felt lovely! These experiences were valuable to me and I know I will carry them into my career. Lastly, I realized during this rotation that I want to strengthen my knowledge on alternative medicine. A lot of the patients I encountered used herbal supplements and spices as adjunct therapies to manage their chronic conditions. I could tell that this practice was important to them and it encouraged me to do my own research during rotations. I want to continue doing research and teaching myself on how these natural remedies may be incorporated into contemporary medicine. Overall, I enjoyed my experience during my Family Medicine rotation and wouldn’t change anything about it!

Clinical

Journal Article w/ Summary

Posted by Arianne Diaz (she) on

Article

Idiopathic Hypersomnia and Hypersomnolence Disorder: A Systematic Review of the Literature.

Sowa NA.Psychosomatics. 2016 Mar-Apr;57(2):152-64. doi: 10.1016/j.psym.2015.12.006. Epub 2015 Dec 17.PMID: 26895727 Review.

https://www.sciencedirect.com/science/article/pii/S0033318215002315?via%3Dihub

Abstract

Background: Hypersomnia is a common complaint in medical offices. Often patients are given psychiatric diagnoses, but a primary sleep disorder may be present. The new diagnosis of “hypersomnolence disorder” (HD) in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition is a primary sleep disorder most similar to the diagnosis “idiopathic hypersomnia” (IH) in sleep literature and can be missed in psychiatric settings.

Methods: systematic review of the computerized databases PubMed, EMBASE, Web of Science, and Psychinfo using the search criteria “idiopathic AND (hypersomnolence OR hypersomnia),” as well as “hypersomnolence disorder was conducted.” Articles were included if they were in English and included information regarding the epidemiology, diagnosis, pathophysiology, or treatment of IH or HD. Where relevant, weighted means and 95% CI were calculated based on the number of subjects in each study.

Results: A total of 143 articles discussed IH, whereas no articles were found regarding HD. Most articles were review articles, prospective studies, or studies of pathophysiology. IH is found in approximately 0.02%–0.010% of the general population, has a mean age of onset of 21.8 years, and is associated with several somatic symptoms. Alterations in histaminergic or dopaminergic signaling may be involved in IH. Treatment with modafinil or other stimulants appears moderately effective. IH can be differentiated from psychiatric hypersomnolence by formal polysomnography.

Conclusions: IH and HD are relatively uncommon disorders, and little is known about them. However, they are distinct from psychiatric disorders and respond well to treatment once properly identified.

Type of Study: Systematic Review

Why I Selected This Article

            I chose this article because one of my patients is a 24 y/o F that presented to clinic complaining of feeling tired for three months. During my talk with her, she admitted to persistent fatigue unalleviated by rest. This articles goes into depth on one of the differentials I selected for her case, idiopathic hypersomnia. I selected this as one of my differentials for her because my preceptor brought it up as a potential diagnosis. I was not familiar with this condition and wanted to learn more about it.

Summary

            Idiopathic hypersomnia is a rare sleep disorder characterized by difficulty staying awake. Patients fall asleep unintentionally or at inappropriate times and may have trouble getting up in the morning. These symptoms are not relieved by adequate sleep and are usually accompanied by a family history of other sleep disorders such as narcolepsy. Hypersomnolence disorder and idiopathic hypersomnia are often used interchangeably but doing so is incorrect. Hypersomnolence disorder is a sleep-wake disorder in which there is  “excessive subjective sleepiness despite extended periods of sleep”. The sleep is non-restorative, and the patient has recurrent periods of sleep lapses in the day. There is also a phenomenon known as “sleep drunkenness” that is common amongst these patients. To meet criteria for hypersomnolence disorder, patients must experience symptoms for more than 3 months and have associated functional impairment because of it. Hypersomnolence disorder and idiopathic hypersomnia differ in mean sleep latency and number of sleep-onset REM periods during sleep. For diagnosis of idiopathic hypersomnia there must be a “mean sleep latency of ≤ 8 minutes and < 2 sleep-onset REM periods” during sleep. Authors conducted a systematic search using various databases and only included articles published in English containing information regarding the epidemiology, diagnosis, pathophysiology, treatment, or prognosis or idiopathic hypersomnia or hypersomnolence disorder.  145 articles met the inclusion criteria, and the findings were summarized in a table. According to this study, the mean age of onset for idiopathic hypersomnia is 21.8 years, and the mean sleep latency time was 5.86 minutes. About 30% of patients had a family history of some form of sleep disorder, and 16% experienced associated sleep paralysis. Approximately 80% of these patients experienced memory impairment, and 55% experienced difficulties with attention. Several studies suggest that neurotransmitter abnormalities may contribute to idiopathic hypersomnolence. Orexin is one of the neurotransmitters implicated in this condition as it is associated with wakefulness, arousal, and appetite. This neurotransmitter is found to be decreased in those with narcolepsy with cataplexy. There are other studies which suggest that decreased histamine and serotonin metabolites may be the cause of idiopathic hypersomnolence. It was found that patients had partial/complete improvement in symptoms when managed with modafinil and/or other stimulants such as caffeine, methylphenidate, or dextroamphetamine.  

Additional Sources: https://rarediseases.info.nih.gov/diseases/8737/idiopathic-hypersomnia

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