Case 1: A 37-Year-Old, Female 911 Operator Who Works the Night Shift and Complains of Insomnia and Depression

Program Description:

Shift work disorder has a significant impact on relationships, mood, and performance as well as on the hallmark symptoms of insomnia and daytime sleepiness. Symptoms of shift work disorder and depression may appear to be similar but may have subtle differences. This case illustrates how the use of appropriate assessment tools upon presentation can facilitate prompt diagnosis and effective management and improve patient quality of life.

Click here to see related material in this series.

Click here for the Sleep/Wake Disorders Video Q&A.

INTENDED AUDIENCE:

This activity is targeted to any primary care provider who treats patients with sleep/wake disorders.

Learning Objectives:

After taking part in this educational activity, participants should be better able to:

• Improve the identification and diagnosis of shift work disorder, using screening questions and diagnostic tools


• Outline management strategies for patients with shift work disorder that optimize sleep, alertness, and circadian rhythm alignment

Credits	Type	Accreditation Statement	Designation Statement
0.50	AMA PRA Category 1 Credit(s)TM	Primary Care Network is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.	Physicians: Primary Care Network designates this enduring material for a maximum of .50 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nonphysicians: All other healthcare professionals will be issued a certificate of participation.

Faculty:

Thomas Roth, PhD
Planning Committee/Author
Clinical Professor of Psychiatry
University of Michigan School of Medicine
Director, Sleep Disorders and Research Center
Henry Ford Health System
Detroit, MI

Disclosures:

Statement of Disclosure and Independence
It is the policy of Primary Care Network (PCN) to ensure all its sponsored educational activities are planned, developed, and conducted in accordance with the ACCME’s Essential Areas and Policies. In accordance with ACCME requirements, PCN has Conflict of Interest and Disclosure Policies that are designed to ensure that PCN-sponsored educational activities are fair balanced, independent, evidence-based and based on scientific rigor.

Primary Care Network’s Resolution of Personal Conflicts of Interest (COI) Policy aims to ensure that all conflicts are resolved prior to the activity, content is developed and presented free of commercial bias, and is in the interest of promoting improvements or quality in healthcare. All individuals who are in a position to influence and/or control content of a PCN-sponsored activity are required to disclose to the participants any real or apparent conflict of interest related to the activity. The educational content is also reviewed for independence and content validation by an independent external reviewer and internal clinical reviewer. Independence is also monitored through the activity and overall program evaluation process.

Faculty Disclosure
Thomas Roth, PhD, receives grant/research support from Merck & Co., Inc.; serves as a consultant for Abbott Laboratories, Cephalon, Inc., Eisai Co., Ltd., Eli Lilly, Intec Pharma, Merck & Co., Inc., Ocera Therapeutics, Inc., Pfizer Inc., Sanofi, Sepracor, Shire, Somaxon Pharmaceuticals, Somnus Therapeutics, Steady Sleep Rx, Takeda Pharmaceuticals North America, and Transcept Pharmaceuticals, Inc.; and is on the speakers’ bureau for Cephalon, Inc.

Planning Committee and Disclosures
Mary Jo Krey, Eileen McCaffrey, and Sharon Hill-Ingram, all of Haymarket Medical Education, have no relevant financial relationships to disclose.

Review Committee Disclosure
In accordance with PCN policy, all content is reviewed by external independent peer reviewers for balance, objectivity, and commercial bias. The peer reviewers, staff, and other individuals who control content have no relevant financial relationships to disclose.

Disclosure of Unlabeled Use
During this activity, author(s) may discuss an unlabeled use or an investigational use not approved for a commercial product. Each author is required to disclose this information to the participants when referring to an unlabeled or investigational use.

Medium: Online CME

Disclaimer
It is hoped that information in this activity will be useful in the management of your patients. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients' conditions, review of any applicable manufacturers' product information, and comparison with recommendations of recognized authorities.

The information in this activity is provided to medical professionals for information purposes only. It is NOT to be disseminated to patients or for any other purpose. In particular, no information contained within this program is intended to be used for medical diagnosis or treatment.

The authors are exclusively responsible for the respective content. Accordingly, no responsibility is assumed by the contributing faculty, educational grant providers, and Primary Care Network and its affiliates associated with this activity for any injury and/or damage to persons or property as a matter of product liability, negligence or otherwise; or from any use or operation of any methods, products, instructions or ideas contained in the material herein. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without medically appropriate (1) evaluation of (a) their patients' conditions and (b) indications and possible contraindications, warnings, and adverse effects or dangers in use; (2) review of any applicable manufacturers' prescribing and other product information; (3) comparison with recommendations of recognized authorities; and (4) independent verification of diagnostic methods, therapeutic methods, results of research, and measurement of medical doses.

Commercial Support Statement:

This activity is supported through an educational grant from Cephalon, Inc.



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Method of Participation
To receive credit for this activity, the participant must read the CME information (including learning objectives and disclosures) and the article. Upon finishing the article, participant must complete the session post-test, evaluation, and all required personal information. To receive CME certificate, participant will need to pass the post-test with 70% accuracy or better. If participant receives less than 70%, participant should review the article and take the test again.

Post-test and Evaluation
After completing the CME article, participant must click on the Post-test button at the end of the article. After successful completion of the post-test, participant will be asked to fill out a program evaluation form and prompted to print the CME certificate. Participant should please be ready to print certificate at this time. Your online certificate will be saved on myCME.com within your Profile/Exam History, which you can then access at any time.

SYSTEM REQUIREMENTS:

WINDOWS PC SYSTEM REQUIREMENTS:
266-MHz Pentium II; Windows 98 or higher; 64 MB RAM; 800 x 600 screen resolution set for “High Color (16-Bit)”; Macromedia Flash Player 6 or higher.

MACINTOSH^® SYSTEM REQUIREMENTS:
Power Mac g3 at 300 MHz; System 8.5 or higher (excluding Mac OSX); 96 MB RAM; 20 MB minimum hard disk space available; 800 x 600 screen resolution set to “Thousands of Colors”; Macromedia Flash Player 6 or higher.