Psychiatry & Insomnia Flashcards
What is Psychiatry?
The study and treatment of metal illness, emotional disturbances and abnormal behaviour
What can effect your mental health?
- Family
- Finance
- Personal care/ physical well being
- Accomidation
What is mental health symptoms?
- Inner battle with self
- confusion
- disorded thinking
How is mental health diagnosed?
Specialist mental health professional will take a family history and talk about it. Will talk about things such as suicide
What is isomnia?
- A sleep disorder
- Inability to fall asleep, stay asleep, poor quailty of sleep, early morning waking (3/4am)
- Can come with depression
Disturbance of arousal/ sleep system
What do the following terms mean:
- Diurnal
- Nocturnal
- Circadian
- Cathemeral
- Crepuscular
Diurnal: active during the day
Nocturnal: active during the night
Circadian: biological process recurring naturally on a twenty-four-hour cycle, even in the absence of light fluctuations.
Cathemeral: irregularly active at any time of night or day, according normal pattern.
Crepuscular: active primarily during twilight
What are differnet sleeping patterns driven by?
Changes in signalling of brain markersbody temperature
- hypothalamic serotonin levels
- melatonin levels
- Changes in signalling of brain markers
When is melatonin and orexin secreted?
Describe how circadian rhythms are produced
Melatonin - secreted in dark phases
orexin: secreted during active walking (light phases)
Circadian rhythms produced by a centeral biological clock in the suprachiasmatic nucleus (SCN) according to light/ dark cycles. Circadian signals sned to pineal gland (PG) through paraventricular hypothalamic nucleus (PVN), the inner mediolateral nucleus (IML) in the spnial cord and superior cervical ganglia
What are effects of sleep deprivation and increased risks?
- Mental ability e.g. concentration effected
- Effects coordination
increased risk of:
- breast cancer
- diabetes
- MI
What causes insomnia?
- Self limiting: travel, jet lag, stress, shift work, hospitlisation (new enviroment/ people)
- Pyschological: drepression, anxiety, Obsessive CD, grief
- physical/ organic: Drugs, alchohol, pain, ashtma
What is the arousal and sleep systems responsible for?
Arousal: determines degree and type of alertness
Sleep: determines depth and quality of sleep
What are the main goals of therpy for insomnia?
- Avoid chronic drug use
- Identify cause
- eliminate agents contributing to the problem
- Ensure appropriate course of therpy
- Place emphasis on views of pateints
- course of managment to achieve goals
What therapies are available for people with insomnia?
- Cognitive behaviour therpy (CBT)
- Sleep hygiene
- Hypnotics
What does sleep hygiene involve?
- Don’t go to bed if not sleepy
- Avoid day time naps
- Establish a routine
- Reserve a room for sleep - no eating/ watching TV
- avoid caffeine, nicotine, alcohol
- Avoid late evening hard exercise
Desribe the stages involved in determing treatment for insomnia
What is CBT and what does it involve?
Challenging behaviour and/ or thoughts
- Challenge assumption/ thoughts - how many hours of sleep do you need. Sleep diary
- Challenge behaviour - if can’t sleep go do something
Considerations before using hypnotics
- Cause must first be identified
- Short term use of hypnotics in acute distress
- In chronic insomnia CBT is preferref. Although can use antidepresdants, hypnotics, melatonin and sedating
What class of drugs can be used for the treatment of insomnia?
- Benzodiazepines
- Z-drugs
- Antidepressants
- melatonin
How do benzodiazepines effect patients with insomnia?
- Sedative and induction of sleep
- Help reduce time to sleep and increase total sleeping duration
Apart from effects on sleeping, what other effects do benzodiazepines have?
- Reduce Anxiety
- Reduce muscle tone (diazepam)
- Anticoagulant activity
What are side effects of benzodiazepines?
- Drowsiness, confusion, impaired- coordination
- Hangover effect
- Effects of alchohol and othe CNS depressants : respiratory depression
- Elderly: problems of ataxia and confusion leading to falls
What are the pharmacokinetics associated with benzodiazepines?
Absorbed well from GI tract, metabolised by liver (several active metabolites), high lipid solubility, range in duration of action
Give examples of drugs which are benzodiazepines
- Diazepam
- Clonazepam
- Lorazepam
- Temazepam
- Flurazepam
- Nitrazepam
- Lormetazepam
What is the active metabolite of Temazepam?
What benzodiazepine has the longest 1/2 life?
Oxazepam
Nitrazepam
Disuss the use of benzodiazepines in terms of tolerance and dependance
Tolerance: pharmacological effect reduces on repeated administration
Dependance: drug takig becomes complusive
GIve examples of Z-drugs
Zolpidem, Zopiclone, Zaleplon, Eszopiclone
What is the mechanism of action for Z-drugs?
Act at GABAA Receptor benzodiazepine site
Discuss half life in terms of Z-drugs and BZs
What Z-drug is better for inducing sleep and which on better for maintaining?
Which drug has little motor impariment and which has little hang over effect?
- Z-drugs shorter half life
- Zolpidem. Zopiclone
- Zolpidem. Zaleplon
How does melatonin treatment work?
M1and M2 receptors in hypothalamus-feedback to increase melatonin release from pineal gland- effect on circadian signals.
Binds to M1/ M2 receptors - Gai and Gaq PCR. Leads to inhibition to AC and PLC therefore downregulation of PKA and PKC singalling. ALters ion channel function and circadain related transcription. Also binds to NQO2
If CBT isn’t working for chronic insomnia what should be used?
hypnotics
