Sleep Disorders Medicine In Psychiatry：在精神病学睡眠障碍的药物.ppt

Treatment Plan for Insomnia Is it ACUTE? Y N Does reassurance support help? Y N end Rx benzos short-term Identify treat medical, surgical, or environmental causes No better? Go to next page Is the insomnia acute? Ask psychiatric questions: substance abuse, depression, anxiety + Treat psychiatric illness or refer to psychiatrist. - Ask: sleep hygiene, naps, caffeine, shifts Counsel pt. yourself Refer to sleep psychologist, esp. if “primary insomnia” - + Physical sleep disorders? Refer to sleep lab if (+). + When to refer to sleep clinic Symptoms of sleep apnea (obese, snores, HTN, weight gain, awakens choking, morning headache). Symptoms of RLS / PLMD – legs squirm, cramp, tingle after supper and especially at night If nocturnal injuries – could be sleepwalking, REM Behaviour Disorder, or nocturnal epilepsy. Any chronic insomnia that does not have an obvious cause after reasonable investigations are negative. * Questions ? Instructions on applying the footer to all slides at once can be found here:http://www.medicine.uottawa.ca/medtech/eng/documentation_ppt_footer.html * Narcolepsy Treatments: SLEEPINESS: Stimulants (noradrenalin receptor agonists): amphetamine, methylphenidate, modafinil. CATPLEXY: Antidepressants that increase serotonin and or noradrenaline and block ACh, i.e. clomipramine, venlafaxine. * Narcolepsy versus Schizophrenia Narcolepsy Actually Daytime REM sleep intrusion Apparent “Schizophrenic” Hallucinations 90% aassociation of narcolepsy with an HLA antigen DNA fragment (DQB1*0602) allows “inverse” screening of schizophrenics for narcolepsy Narcolepsy is detectable in sleep lab (MSLT) but pt. must be medication-free for at least 3 weeks. Worm in lateral hypothalamus causing narcolepsy.(neurocysticercosis)J. Clin. Sleep Med. 1(1) 2005, p. 41. * Obstructive Sleep Apnea Normal Sleep Apnea * OSA Clinical Symptoms * Clinical Applicability – Apnea Sleep apnea and depression shar