Anxiety and insomnia (spring) Flashcards
define personality
Complex pattern of characteristics, largely outside of the person’s awareness
Distinctive patterns of perceiving, feeling, thinking, coping and behaving
define personality disorder
Problematic ways of dealing with everyday life, dealing with self others or the world.
Leads to distress or impairment
Types of Personality Disorders
Cluster A - odd-eccentric
- Paranoid Personality Disorder
- Schizoid Personality Disorder
- Schizotypal Personality Disorder
Cluster B - dramatic and emotional (impulsivity)
- Antisocial Personality Disorder
- Borderline Personality Disorder
- Histrionic Personality Disorder
- Narcissistic Personality Disorder
Cluster C - anxious-fearfulness
- Avoidant Personality Disorder
- Dependent Personality Disorder
- Obsessive-compulsive Disorder
Possible causes of insomnia
stress and anxiety
a poor sleeping environment – such as an uncomfortable bed, or a bedroom that’s too light, noisy, hot or cold
lifestyle factors shift work, or drinking alcohol or caffeine before going to bed
mental health conditions – depression, psychosis, mania
physical health conditions – such as heart problems, other sleep disorders and long-term pain
certain medicines – steroids, antidepressants
Symptoms of Insomnia?
- Difficulty in falling asleep
- Frequent waking throughout the night
- Early morning wakening
- Feeling tired all the time
- A general feeling of loss of wellbeing
- Difficulty in concentrating
- Starting to feel depressed
Sleep Hygiene Advice?
- Increase daily exercise (not in the evening)
- Reduce daytime napping
- Reduce caffeine or alcohol intake, especially before bedtime
- Only use the bed for sleeping
- Use anxiety management or relaxation techniques
- Develop a regular routine of rising and retiring at the same time each day
- Avoid large meals within 2 hours of bedtime
- A warm bath and hot drink (not surgery)
examples of Hypnotics used in practice
Benzodiazepines
- Short acting…
- Temazepam (controlled drug) 10-20mg ON (max 40mg ON – adults, 20mg ON – elderly)
- Lormetazepam 0.5-1.5mg ON (elderly 0.5mg)*
- Loprazolam 1-2mg ON (elderly 0.5-1mg)*
- Long acting…
- Nitrazepam 5-10mg ON (elderly 2.5-5mg)*
- All licensed for short term use only 2-4 weeks
- non-formulary
Z- Drugs
- Zopiclone 3.75-7.5mg ON
- Zolpidem 10mg ON (elderly 5mg)
- Zaleplon 10mg ON (elderly 5mg ON)*
Other meds used as hypnotics
- Promethazine HCl 25-50mg ON included in SHFT RT guidelines
- Melatonin 2mg ON * only licensed in adults over 55 and children 1month- 18years
- Cloral hydrate/betaine ( v rarely used, mist trust it is non-formulary)
- Clomethiazole* - licensed in elderly only
adverse effects of Benzodiazepine
- drowsiness and light-headedness the next day
- confusion and ataxia (especially in the elderly)
- memory disturbance
- physical and psychological dependence
- withdrawal syndrome (anxiety, depression, nausea, vertigo and perceptual changes, ‘rebound insomnia’)
- depressed mood
- Impairment of driving performance
- Long acting – hangover effects
adverse effects of Z drugs
- nausea, vomiting, diarrhoea
- bitter or metallic taste (zopiclone)
- aggression, irritability
- drowsiness may persist the next day (hangover effect)
- dizziness, light-headedness, ataxia
- memory disturbances
- confusion
- perceptual disturbances and nightmares
- depressed mood
- skin reactions (hypersensitivity)
- dependence
- Impairment of driving performance
complete the table on antidepressant Discontinuation symptoms…
Non-medication options for Depression?
Psychological therapies
- Cognitive Behavioural Therapy
- Mindfulness
- Compassion Focused Therapy
- Family Therapy
Psychotherapy Art/Dance/Music therapy
Mindfulness
Physical/relaxing/social activities
Vitamins and supplements
Homeopathy and Herbal
Electroconvulsive therapy(ECT)
Seasonal Affective Disorder (SAD) light
Transcranial Magnetic Stimulation (TMS)
Spiritual support
Lifestyle advise for anxiety disorders?
Avoiding things that can make symptoms worse
- e.g. smoking cannabis or taking other illicit drugs.
Avoiding alcohol
Stress can make the symptoms worse
Drinking too much caffeine
- make the symptoms worse and more difficult to treat
Eating healthily (Omega-3 fatty acids)
Exercise (“exercise to energise”) or being active.
Stopping smoking (may effect medication) seek advice.
Getting a good nights sleep.
