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Psychiatry > Sleep difficulties and conversion and dissociation disorders > Flashcards

Sleep difficulties and conversion and dissociation disorders Flashcards

1
Q

What is insomnia?

A

Difficulty sleeping

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2
Q

What are primary sleep disorders?

A

Sleep apnoea, narcolepsy, restless leg syndrome, periodic leg movement disorder

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3
Q

What are delayed sleep phase syndromes?

A

Circadian pattern of sleep is delayed so patient sleeps from early hours until midday or later

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4
Q

What are parasomnias?

A

Night terrors, sleep walking and talking

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5
Q

What is psychophysiological insomnia?

A

Secondary to functional, mood and substance misuse disorders and frequently present in individuals under stress
Can be triggered by one of these factors but then becomes a habit of its own driven by anticipation of insomnia and daytime naps

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6
Q

What is hypersomnia?

A

Not uncommon in adolescents with depressive illness
Occurs in narcolepsy and may temporarily follow infections such as infectious mononucleosis
Sleeping too much

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7
Q

What are secondary sleep disorders?

A

Secondary to other conditions

  • Psychiatric disorders
  • Drug use or misuse
  • Physical conditions - pain, nocturia, malnutrition
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8
Q

What should you ask in a sleeping disorder history?

A

Mood
Life difficulties
Drug intake - nicotine, alcohol, caffeine
Timing of insomnia
- Initial - trouble getting to sleep common in mania, anxiety, depressive disorders, substance misuse
- Middle - waking up in the middle of the night, apnoea, prostatism
- Late - early morning, waking, depressive illness, malnutrition

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9
Q

What are the risk factors for insomnia?

A 
Female
Over 60
Depression or anxiety
Frequently travelling long distances
Being under stress
Working night shifts
Pregnant or menopausal
Family history of insomnia
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10
Q

What are the risk factors for restless leg syndrome?

A 
Female
Middle-age or older
Family history
Northern European descent
Pregnancy
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11
Q

What are the risk factors for narcolepsy?

A

First degree relative with condition
Certain thyroid disorders
Diabetes
Autoimmune disorder

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12
Q

How common is insomnia?

A

1/3 adults complain of insomnia

In 1/3 it is severe

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13
Q

How common is delayed sleep phase syndrome?

A

More common in adolescents

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14
Q

How common are parasomnias?

A

Most commonly found in children

Recur in adults when under stress or suffering from mood disorders

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15
Q

How do sleep disorders present?

A

Daytime sleepiness and fatigue with consequences such as road traffic accidents

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16
Q

What is the pathology of sleep disorders?

A

Divided in REM and non-REM
As drowsiness being, alpha rhythm on EEG disappears and replaced by deepening slow wave activity (non-REM)
After 60-90 mins, slow wave pattern is replaced by low-amplitude waves on which are superimposed REM lasting a few minutes
Cycle repeated during the duration of sleep with REM periods becoming longer and slow-wave periods shorter and less deep
REM sleep accompanied by dreaming and physiological arousal
Slow-wave sleep associated with release of anabolic hormones and cytokines with increased cellular mitotic rate, helps maintain host defences, metabolism, and repair of cells
Slow-wave sleep increased in those conditions where growth or conservation is required eg adolescence, pregnancy, thyrotoxicosis

17
Q

What is the management of sleep disorders?

A 
Determined by diagnosis
Simple
- Decrease alcohol intake
- Eating dinner earlier
- Exercising daily
- Hot bath prior to going to bed
- Establishing a routine of going to bed at the same time
Relaxation techniques and CBT
Short half-life benzodiazepines
Non-benzodiazepine hypnotics
Certain antihistamines and antidepressants
18
Q

What are dissociation disorders?

A

Profound loss of awareness or cognitive ability without medical explaination

19
Q

What is dissociation?

A

Disintegration of different mental activities and convers phenomena such as amnesia, fugues, and pseudoseizures

20
Q

What are conversion disorders?

A

Occurs when unresolved conflict converted into physical symptoms as a defence against it such as paralysis, abnormal movements, sensory loss, aphonia, disorders of gait and pseudocyesis (false pregnancy)

21
Q

How common are conversion disorders?

A

Lifetime prevalence at 3-6 per 1000 in women
Lower prevalence in men
Most cases begin before age of 35
Unusual in the elderly

22
Q

What is a differential diagnosis of dissociation disorders?

A

Often just co-morbid with mood and personality disorders

Fugue - post-epileptic automatism, depressive illness, alcohol misuse

23
Q

What is a differential diagnosis of conversion disorders?

A

Changes in personality - personality disorder, rapid cycling manic-depressive disorders

24
Q

How do dissociation disorders present?

A

Mental presentation
Amnesia - sudden, unable to recall long periods of their lives, may deny knowledge of previous life or personal identity
Fugue - loss of memory and wander away from usual surroundings
Pseudodementia
Dissociative identity disorder
3 characteristics necessary to make diagnosis
- Occur in absence of physical pathology that would fully explain symptoms
- Produced unconsciously
- Not caused by overactivity of sympathetic nervous system

25
Q

How do conversion disorders present?

A 
Physical symptoms
Paralysis
Disorders of gait
Tremor
Aphonia
Mutism
Sensory symptoms
Globus
Pseudoseizures
Blindness
26
Q

What is the pathology of dissociation disorders?

A

Involves different areas of the brain than stimulation

27
Q

What is the pathology of conversion disorders?

A

Recalling past trauma activated emotional areas (amygdala) and reduced motor cortex activity

28
Q

What is the management of conversion and dissociation disorders?

A 
Graded and mutually agreed plan for a return to normal functioning - lead by appropriate therapist
Psychotherapeutic assessment
Hypnotherapy
Stop drugs
Treat underlying condition
29
Q

What is the prognosis of conversion and dissociation disorders?

A

Those of recent onset recover quickly with treatment
If lasts long than a year then likely to persist with entrenched abnormal illness behaviour patterns
83% still unwell at 12 years follow-up

Psychiatry (15 decks)

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