Insomnia Flashcards
When should caffeine, EtOH, heavy, spicy, or sugary foods be avoided prior to bed?
4 to 6 hrs
When should you avoid exercise prior to bed?
2 hrs
What are good pre-bed snacks?
Warm mild or bananas (tryptophan)
What is the max time you should allow yourself to fall asleep?
30 minutes
How long should you lay in bed if you wake up?
20 minutes
Who is most likely to succeed at suicide?
White males
Who is most likely to attempt suicide?
What females
Characteristics of an elderly person who might commit suicide?
Widows/widower Live alone Poor health perception Poor sleep Lack a confidante Stressful life event
What percent of patients see a PCP before suicide?
75%
What are not risk factors for suicide?
Ethnic minority
Poverty
SIG E CAPs
Need 5+ for 2 weeks
Sleep Interest Guilt Energy Concentration Appetite Psychomotor retardation Suicide ideation
When does bereavement become MDD?
2+ months is typical Red flags - Guilt - Thoughts of death - Feeling worthless - Functional impairment - Hallucinations
Risk factors for late life depression?
Female Isolation Widowed, divorced, or separated Low SES Poor health Pain Insomnia Functional impairment Cognitive impairment
How bad is depression on the elderly?
Increases disabilities by 70% in about 6 years
SAD PERSONS
Sex: Male
Age: 45
Depression
Previous Attempt EtOH or other substance Rational thinking: Impaired Social support: Lacking Organized plan No significant other Sickness
When is SAD PERSONS treated outpatient?
4 to 6
7+ = inpatient treatment
Does the USPSTF recommend depression screening for all adults?
Yes, especially people who are sick
Which tool is faster and more sensitive when screening for dementia?
Minicog (99% & 93%)
Most common SE of SSRI or SNRI?
Headache
Sleep disturbances
GI upset
Other SE of SSRI of SNRI?
SIADH -> Low Na+
Serotonin syndrome
GI bleeds
Special risk of SSRI or SNRI in elderly?
Falls
Lower bone density
What two SSRIs may prolong QT?
Citalopram and Escitalopram
How might a hispanic patient present with depression?
Somatic complaints > mood symptoms
Who has the lower rate of depression US born or immigrant hispanics?
Immigrants
Risk factors for elder abuse?
Dementia Shared living Substance abuse or mental illness (care giver) Heavy dependence on care giver Isolation
Medical conditions associated with depression
Hypothyroidism
Parkinson’s
Dementia
What studies should be done when someone presents with fatigue or depression?
CBC: anemia and vitamin deficiencies
TSH
CMP: R/O renal, electrolytes, and liver problems
What two behavioral therapies are considered EB for insomnia?
Sleep restriction/compression
Multi-component CBT (Most effective)
What are the safest and most effective hypnotic drugs?
Zolpidem and melatonin-receptor agonists
How long should treatment last for one episode of depression?
9 to 12 months
How long should treatment last with recurrent episodes?
2 to 3 years
How long should treatment last with multiple recurrences?
Lifetime
What enzyme is most affected by SSRIs?
P450
Which SSRI is preg cat D?
Paxil
SSRI with longest half life?
Prozac/fluoxetine
- agitation
- restlessness
- poor libido (women)
- insomnia
Most common SSRI used in pregnancy and breast feeding?
Zoloft
- OCD, panic, and PTSD uses as well
- Has most GI side effects
SSRI with strong antianxiety?
Paxil/paroxetine
- Best studied in children
- Weight gain, impotence, sedation, and constipation
- Shortest half-life -> antidepressant discontinuation syndrome
Greater frequency of emesis?
Fluvoxamine
- Good use in OCD
Most common SE are dry mouth, nausea, and somnolence.
Citalopram
- Do not exceed 20 mg/day in pts > 60 (Long QT)
Approved specifically for GAD
Escitalopram
Adherence rate of deprssion treatment in adults
~50%
- Cost
- Side effects
- Stigma of dx
- Don’t understand how to take the medicine
