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London Review > Jour 3 > Flashcards

Jour 3 Flashcards

1
Q

Flow sanguin en REM

A

Increased brain temperature, cerebral glucose metabolism, and cerebral blood flow

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2
Q

Où est le noyau suprachiasmatique?

A

Hypothalamus antérieur

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3
Q

Quel neurotransmetteur promouvoit le REM?

A

Acetylcholine

À noter que ça promeut l’éveil, pas le sommeil

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4
Q

Prévalence insomnie

A

6-10% in general population
Up to 25% in elderly

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5
Q

Agents avec indication pour insomnie

A

-Benzo: temazepam, triazolam
-Agoniste récepteur benzo: zopiclone, zolpidem, eszopiclone
-Antidépresseur sédatif: doxépine
-Antagoniste d’orexine: lemborexant
-Agoniste récepteur mélatonine: ramelton (pas dispo Canada)

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6
Q

Pourquoi donner ISRS en narcolepsie (off-label)?

A

Parce qu’ils suppriment le REM, et qu’en narcolepsie il y a trop de REM (sleep attacks sont intrusions de REM dans l’éveil)

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7
Q

Effet benzo sur sommeil

A

Suppression N3

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8
Q

Impact alcool sur sommeil

A

Acute
-Decreased sleep latency
-Increased SWS initially, but then decreases in second half of sleep period
-Decreases REM in first 2-4 hours of sleep period
-REM sleep rebounds in second half of sleep period
-Intense dreaming/nightmares and sleep fragmentation
Chronic
-Increased SL
-Decreased sleep efficacy, slow wave sleep, REM, TST
Withdrawal
-Disrupted sleep continuity, increased REM associated with vivid dreaming
After acute w/drawal, chronic alcohol users may experience light fragmented sleep for weeks to years associated with persistent decrease in SWS
In general
Exacerbates OSA, PLMD, RLS, SWS Parasomnias, RBD

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9
Q

Seul antidépresseur qui n’empire pas restless leg?

A

Bupropion

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10
Q

Groupe d’âge avec le plus haut taux de TDAH

A

10-14 ans

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11
Q

Augmentation du risque chez l’adulte qui a TDAH

A

Adults with ADHD:
▪ 2x more likely to have been arrested, divorced
▪ 3x more likely to be currently unemployed
▪ 4x more likely to have contracted an STI

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12
Q

Conséquences TDAH chez l’ado

A

Adolescents:
▪ Increased risk of suspensions from school
▪ Difficulty with note-taking, planning assignments, writing, efficiency, self-motivated study
▪ Begin sexual activity earlier, have more partners, less likely to use contraception, increase pregnancy risk, increased STI risk (from Milwaukee Young Adult Outcome Study)
▪ Increased risk of smoking, which is risk factor for later substance use

Mon truc pour m’en rappeler: 3S - school, sex, smoking

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13
Q

Lequel est le plus efficace (mais a plus d’effets secondaires): amphétamines ou methylphenidate?

A

Amphétamines

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14
Q

Thérapies avec meilleur effect size en TPL

A

 Psychodynamic method (MBT/TFP) effective 0.41
Comparé à
 DBT effect size of 0.34

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15
Q

4 stades de DBT

A
  1. Behaviour control
  2. Emotional experiencing
  3. Define and attain life goals
  4. Finding a “deeper meaning”
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16
Q

DBT assumptions about the patient

A

▪ patients are doing the best they can
▪ patients want to improve
▪ patients cannot fail in DBT
▪ patients need to do better, try harder
▪ patients may not have caused all their own problems,
but they have to solve them anyway
▪ the lives of suicidal, borderline individuals are
unbearable as they are currently being lived

17
Q

DBT assumptions about the therapy

A

▪ clarity, precision and compassion are of the utmost
importance in the conduct of DBT
▪ the therapeutic relationship is a real relationship
between equals
▪ therapists treating BPD patients need support
▪DBT therapists can fail
▪ therapy can fail even when therapists do not

18
Q

Qui a inventé le thérapie basée sur la mentalisation?

A

Bateman, Fonagy

19
Q

Outre que disulfiram fait vomir, qu’est-ce qu’on peut craindre avec?

A

Métabolisme de dopamine inhibé, menant à sx psychiatrique

20
Q

Acronyme SBIRT

A

Screen
Brief intervention
Refer to treatment

21
Q

The four Cs des TUS

A

loss of Control over subtance
use in a Compulsive manner
Craving
use despite Consequences

22
Q

% des patients avec un TUS qui reçoivent un traitement

A

10%
Seulement 1% reçoit traitement evidence-based

23
Q

Est-ce que traitement pour TUS peut être efficace si n’est pas volontaire

A

Oui!

24
Q

Effet de naltrexone

A

Diminution du nb de jour où pt consomme/mois
Diminution du nb de consommation/jour de consommation

25
Q

Mécanisme d’action acamprosate

A

Agoniste GABA, antagoniste glutamate

26
Q

Pt sous Suboxone qui tombe enceinte. On fait quoi?

A

Ne donner que buprénorphine (pas naltrexone)

27
Q

Conseils pour limiter risque THC

A

-Health risks best avoided by abstaining
-If you smoke, avoid harmful smoking practices (deeply inhaling, holding your breath)
-Delay taking up cannabis use until later in life
-Limit and reduce how often you use cannabis
-Choose lower-risk cannabis products
-Don’t use and drive or operate other machinery
-Don’t use synthetic cannabinoids
-Avoid cannabis use altogether if you are at risk for mental health problems or are pregnant
-Avoid smoking burnt cannabis
-Avoid combining these risks

28
Q

Combien de sessions en IPT

A

12-16

29
Q

Où est l’IPT dans des lignes directrices de dépression unipolaire?

A

1ere ligne en dépression aigue, 2eme ligne en maintien
Téléphone: 2eme ligne aigue, pas d’évidence en maintien

30
Q

Tâches dans la phase initiale d’IPT

A

Diagnostic evaluation with psychiatric history
Assess need for medication
Set framework for treatment
Give patient the sick role
Do interpersonal inventory
Offer interpersonal formulation and link situation with one of four focal areas
Introduce IPT and plan for therapy

31
Q

Tâches dans la phase du milieu d’IPT

A

Help patient to discuss topics pertinent to problem area
Attend to patient’s affective state and the therapeutic relationship to foster patient’s self-disclosure
Prevent sabotaging of treatment
Track mood with validated scales
Recruiting Social Supports
Brainstorming
Role plays
Decisional Analysis
Communication Analysis
Incorporate empathy and mentalizing

32
Q

Tâches dans la terminaison d’IPT

A

Consolidate skills gained
Anticipate future difficulties
Identify signs of relapse
Strategies to manage signs and symptoms of relapse
Foster independence
Re-contract for continuation and maintenance prn
Address guilt and blame therapy if non-responder

London Review (5 decks)

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