Insomnia Flashcards

1
Q

When should caffeine, EtOH, heavy, spicy, or sugary foods be avoided prior to bed?

A

4 to 6 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When should you avoid exercise prior to bed?

A

2 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are good pre-bed snacks?

A

Warm mild or bananas (tryptophan)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the max time you should allow yourself to fall asleep?

A

30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How long should you lay in bed if you wake up?

A

20 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Who is most likely to succeed at suicide?

A

White males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Who is most likely to attempt suicide?

A

What females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Characteristics of an elderly person who might commit suicide?

A
Widows/widower
Live alone
Poor health perception
Poor sleep
Lack a confidante
Stressful life event
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What percent of patients see a PCP before suicide?

A

75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are not risk factors for suicide?

A

Ethnic minority

Poverty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

SIG E CAPs

Need 5+ for 2 weeks

A
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor retardation
Suicide ideation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When does bereavement become MDD?

A
2+ months is typical
Red flags
- Guilt
- Thoughts of death
- Feeling worthless
- Functional impairment
- Hallucinations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Risk factors for late life depression?

A
Female
Isolation
Widowed, divorced, or separated
Low SES
Poor health
Pain
Insomnia
Functional impairment
Cognitive impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How bad is depression on the elderly?

A

Increases disabilities by 70% in about 6 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SAD PERSONS

A

Sex: Male
Age: 45
Depression

Previous Attempt
EtOH or other substance
Rational thinking: Impaired
Social support: Lacking
Organized plan
No significant other
Sickness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When is SAD PERSONS treated outpatient?

A

4 to 6

7+ = inpatient treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Does the USPSTF recommend depression screening for all adults?

A

Yes, especially people who are sick

18
Q

Which tool is faster and more sensitive when screening for dementia?

A

Minicog (99% & 93%)

19
Q

Most common SE of SSRI or SNRI?

A

Headache
Sleep disturbances
GI upset

20
Q

Other SE of SSRI of SNRI?

A

SIADH -> Low Na+
Serotonin syndrome
GI bleeds

21
Q

Special risk of SSRI or SNRI in elderly?

A

Falls

Lower bone density

22
Q

What two SSRIs may prolong QT?

A

Citalopram and Escitalopram

23
Q

How might a hispanic patient present with depression?

A

Somatic complaints > mood symptoms

24
Q

Who has the lower rate of depression US born or immigrant hispanics?

A

Immigrants

25
Q

Risk factors for elder abuse?

A
Dementia
Shared living
Substance abuse or mental illness (care giver)
Heavy dependence on care giver
Isolation
26
Q

Medical conditions associated with depression

A

Hypothyroidism
Parkinson’s
Dementia

27
Q

What studies should be done when someone presents with fatigue or depression?

A

CBC: anemia and vitamin deficiencies
TSH
CMP: R/O renal, electrolytes, and liver problems

28
Q

What two behavioral therapies are considered EB for insomnia?

A

Sleep restriction/compression

Multi-component CBT (Most effective)

29
Q

What are the safest and most effective hypnotic drugs?

A

Zolpidem and melatonin-receptor agonists

30
Q

How long should treatment last for one episode of depression?

A

9 to 12 months

31
Q

How long should treatment last with recurrent episodes?

A

2 to 3 years

32
Q

How long should treatment last with multiple recurrences?

A

Lifetime

33
Q

What enzyme is most affected by SSRIs?

A

P450

34
Q

Which SSRI is preg cat D?

A

Paxil

35
Q

SSRI with longest half life?

A

Prozac/fluoxetine

  • agitation
  • restlessness
  • poor libido (women)
  • insomnia
36
Q

Most common SSRI used in pregnancy and breast feeding?

A

Zoloft

  • OCD, panic, and PTSD uses as well
  • Has most GI side effects
37
Q

SSRI with strong antianxiety?

A

Paxil/paroxetine

  • Best studied in children
  • Weight gain, impotence, sedation, and constipation
  • Shortest half-life -> antidepressant discontinuation syndrome
38
Q

Greater frequency of emesis?

A

Fluvoxamine

- Good use in OCD

39
Q

Most common SE are dry mouth, nausea, and somnolence.

A

Citalopram

- Do not exceed 20 mg/day in pts > 60 (Long QT)

40
Q

Approved specifically for GAD

A

Escitalopram

41
Q

Adherence rate of deprssion treatment in adults

A

~50%

  • Cost
  • Side effects
  • Stigma of dx
  • Don’t understand how to take the medicine