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Psychiatry > Sleep Disorders + Sexual Disorders > Flashcards

Sleep Disorders + Sexual Disorders Flashcards

0
Q

Most common of hypersomnias

A

Breathing related disorders

Eg: OSA, central sleep apnea

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1
Q

REM sleep

A

Characterized by

Increased BP, HR, RR

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2
Q

Sleep disorder classifications

A

Dyssomnias - insufficient, excessive or altered timing of sleep (primary insomnia, OSA, narcolepsy, idiopathic hypersomnia, Klein-levin syndrome, circadian rhythm sleep DO)

Parasomnias - unusual sleep related behaviors (sleepwalking, sleep terrors, REM sleep behavior DO, nightmare DO)

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3
Q

Acute insomnia

A

1-4 weeks

Assoc with stress or changes in sleep schedule and usually resolves spontaneously

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4
Q

Primary insomnia

  • Definition
  • symptoms
A

Difficulty initiating or maintaining sleep or nonrestorative sleep for at least 1 month

Significant distress or impairment in functioning

Does not occur exclusively in course of another sleep DO or mental DO

Not 2/2 substance or GMC

Types:
Sleep onset insomnia
Sleep maintenance insomnia
Sleep offset insomnia (early AM awakenings)
Nonrestorative sleep (wake up feeling fatigued)

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5
Q

Prevalence primary insomnia

A

5-10%

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6
Q

Chronic insomnia

A

> = 1 month - years

Assoc with reduced quality of life
And inc risk of psych illness

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7
Q

Non pharm tx primary insomnia

A

Sleep hygiene

CBT (first line for chronic insomnia)

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8
Q

Causes primary insomnia

A

Sub clinical mood or anxiety DO

Preoccupation with perceived inability to sleep

Poor sleep hygiene

Idiopathic

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9
Q

Pharm tx primary insomnia

A

Benzodiazepines

  • most common approved reason to put pt on long term benzodiazepines
  • reduce sleep latency and nocturnal awakening
  • as effective as CBT in short term
  • SE: tolerance, addiction, daytime sleepiness, rebound insomnia; falls, confusion, dizziness in elderly

Zolpidem, zaleplon

  • good short term
  • assoc with low incidence daytime sleepiness and orthostatic hypotension
  • inc risk falls and cognitive impairment in elderly

Antidepressants

  • trazadone, amitryptyline, doxepin
  • SE: sedation, dizzy, psychomotor impairment
  • trazadone esp for pts with insomnia and depression
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10
Q

OSA

A

Grin if breathing related DO 2/2 collapse of upper airway assoc with reduction in mood O2 saturation

Lots of daytime sleeping a
Apneic epi with cessation breathing 
Sleep fragmentation
Snoring
AM headaches
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11
Q

OSA risk factors and prevalence

A

Obesity
Inc neck circ
Airway narrowing

4% men
2% women

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12
Q

Tx OSA

A

CPAP
BiPAP

Wt loss

Surgery

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13
Q

Hypnagogic vs hypnopompic hallucination

A

HypnaGOgic = when GOIng to sleep

HypnoPOMPic = when coming from sleep (POMP and circumstance with awakening)

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14
Q

Narcolepsy

A

Excessive daytime sleepiness
Falling asleep at inappropriate times

Irresistible attacks of refreshing sleep occurring daily for at least 3 mo

Cataplexy

Hallucinations and/or sleep paralysis at beginning or end of sleep episodes

No REM latency

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16
Q

Narcolepsy

  • epi
  • prevalence
  • pathophys
A

.02-.16% US pop

Males = females

Linked to loss of hypothalamic neurons that contain hypocretin

Autoimmune component?

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17
Q

Cataplexy vs catalepsy

A

Catapexy = brief episodes of sudden bilateral LOSS of muscle tone

Catalepsy = unprovoked muscular rigidity (like in epiLEPSY)

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18
Q

Tx narcolepsy

A

sleep hygiene
schedule daytime naps
avoidance of shift work

For daytime sleepiness:

  • amphetamines
  • methylphenidate
  • modafinil (#1)
  • Na oxybate

Cataplexy:

  • Sodium oxybate (#1)
  • TCAs - imipramine, protriptyline, clomipramine
  • SSRIs - fluoxetine, fluvoxamine, venlafaxine
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19
Q

Idiopathic hypersomnia

A

Excessive daytime sleepiness
Prolonged nocturnal sleep episodes
Freq irresistible urges to nap

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20
Q

Kleine Levin syndrome

A 
Recurrent hypersomnia
\+
Episodes of daytime sleepiness w/ 
- hyperphagia
- hypersexuality
- aggression
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21
Q

Circadian rhythm sleep disorders

A

Intrinsic defects in circadian pacemeker or impaired entrainment (absence of light or other time-signaling stimuli)

Ex:
Delayed sleep phase disorder
Advanced sleep phase disorder
Shift work disorder
Jet lag disorder
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22
Q

Delayed sleep phase disorder

A

Chronic or recurrent delay in sleep onset and awakening times
preserved quality and duration of sleep

Risk factors:
Puberty
Caffeine + nicotine
Irregular sleep schedules

Tx:
Timed bright light in AM
+ melatonin in PM
Chronotherapy = delaying bedtime by few hrs each night

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23
Q

Advanced sleep phase disorder

A

Normal duration + quality of sleep
Sleep onset and awakening times earlier than desired

Risk factors:
Older age

Tx:
Timed bright light in AM
Early AM melatonin NOT recommended

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24
Q

Shift work disorder

A

Sleep deprivation + misalignment of circadian rhythm 2/2 nontraditional work hrs

Risk factors:
Night shift work

Tx:
Avoid risk factors
Bright light phototherapy
Modafinil if severe

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25
Jet lag disorder
Sleep distrubances (insomnia, hypersomnia) assoc w/ travel across multiple time zones Risk factors: Recent sleep deprivation Tx: DO self limiting Sleep disturbances resolve 2-3 days after travel
26
Suprachiasmic nucleus
In hypothalamus Coordinates 24 hr or circadian rhythmicity
27
Sleepwalking
Behaviors initiated during slow wave sleep --> walking during sleep Eyes usually open with glassy look Difficult to wake up Confusion w/ waking; amnesia for episode Rare for violence to occur
28
Sleepwalking - epidemiology - risk factors - pathophys
1-4% adults 10-20% kids More often in kids w/ OSA Risk factors: - sleep deprivation - stress - hyperthydoism - seizures - Mg deficiency - sedatives/hypnotics, lithium, anticholinergics Familial basis in 1/3 cases
29
Tx sleepwalking
Addressing precip factors (make sure safe environment, proper sleep hygiene) Refractory cases: - clonazepam - TCA
30
Sleep terrors
Episodes sudden arousal w/ screaming from slow wave sleep Sympathetic hyperactivation (tachy, tachypnea, diaphoresis) Usually go back to sleep w/o waking Confused + disoriented w/ forced awakening
31
Sleep terrors - epi - risk factors
1-6% kids 1-2% adults Prevalence more in 1st degree relatives of affected High comorbidity w/ sleepwalking Risk factors: - fever - nocturnal asthma - GERD - sleep deprivation - CNS stimulating meds
32
Tx sleep terrors
reassure condition benign and self limited Low dose short acting benzos (clonazepam, diazepam) in refractory Sleep hygiene Psychotherapy
33
Nightmare disorder - features - epi
Recurrent frightening dreams Stop w/ awaking - vivid recall No confusion or disorientation w/ waking Can cause lots of distress + anxiety 5% adults, women > men Nightmares in at least 50% PTSD pts
34
Tx nightmare disorder
Imagery rehearsal therapy (IRT) - very good for recurrent nightmares in PTSD - use of mental imagery to modify outcome of recurrent nightmare Prazosin
35
REM sleep behavior disorder
Muscle atonia during REM sleep Complex motor activity assoc w/ dream mentation (dream enactment) Dream enactment behaviors: - sleep talking - limb jerking - violence - walking/ running Presents w/ violent behaviors during sleep usually causing injury to bed partner or pt
36
REM sleep behavior disorder - epi - risk factors
0.5% Males > women Risks: - elderly - TCAs, SSRIs, MAOIs - narcolepsy - brain stem lesions - dementia
37
Tx REM sleep behavior disorder
Clonazepam 90% efficacious Imipramine Carbamazepine Pramipexole Levodopa
38
Drugs - increasing libido - decreasing libido
Increasing: - EtOH and Marijuana by suppressing inhibitions - cocaine, meth Decreasing: - long term EtOH use - narcotics
39
Pharm causes of sexual side effects
Anti HTN Anti cholinergic Antidepressants Antipsychotics
40
Hormone causing sexual dysfunction
Decreased estrogen (vaginal dryness) Decreased testosterone Increased progesterone (blocks androgen receptors)
41
Which neurotransmitters inhibit and enhance libido?
Inhibit - serotonin enhance - dopamine
42
Disorders of desire
Hypoactive sexual desire disorder - dec desire or fantasies Sexual aversion disorder - avoid genital contact w/ sex partner
43
Disorders of arousal
Male erectile disorder - inability to maintain erection Female sexual arousal disorder - inability to maintain lubrication until completion of sex act (common)
44
Disorders of orgasm
Primary - never achieved orgasm Secondary - acquired Female orgasmic DO - inability to have orasm after nl excitement phase Male orgasmic DO - achieves orgasm with great difficulty Premature ejaculation - ejaculate eralier than desired; high prevalence
45
Sexual pain disorders
Dyspareunia - genital pain peri-sexual act - women > men - often assoc with vaginismus Vaginismus - involuntary muscle contraction of outer 1/3 of vagina during insertion of penis or object
46
Most common sexual DO in women
SExual desire disorder Orgasmic disorders
47
Most common sexual DO in men
Secondary ED Premature ejaculation
48
Dual sex therapy
uses concept of marital unit for therapy meet as couple with a male and fem therapist Tx is short term Therapy most useful when no other psychopath is involved
49
Behavior therapy
Approaches sex dysfunction as learned maladaptive behavior Use systemic desensitization
50
Other sex therapies
Hypnosis (best as adjuvant) Group therapy Analytically oriented psychotherapy
51
Pharm tx sexual dysfunciton
Erectile dysfunction - PDE5 inhibitors (sildenafil orally or alprostadil injection) Premature ejaculation - SSRI - TCA Hypoactive sexual desire disorder - Testosterone replacement men + women - estrogen replacement in women
52
Paraphilias
Sexual disorders characterized by engagement in unusual sexual activities and/or preoccupation wiht unusual sexual urges for at least 6 mo that cause impairment in daily function
53
3 most common paraphilia
Pedophilia Voyeruism Exhbitionism
54
Pedophilia
Like children < 13 yo
55
Frotteurism
Like touching or rubbing nonconsenting person
56
Voyeurism
Waching unsuspecting nude ppl
57
Exhibitionism
Expose genitals to strangers
58
Sadism
Like hurting others
59
Fetishism
Sex preference for inanimate objects
60
Transvestic fetishism
Sex gratifiction in men from wearing women's clothing
61
Masochism
sex excitement from being beaten
62
Necrophilia
Like sex w/ dead ppl
63
Telephone scatologia
Like calling unsuspecting women and engaging in sexual convo with them
64
Tx paraphilias
INsight oriented psychotherapy Aversion therapy Pharm therapy - antiandrogens to reduce sexual desire
65
Gender identity disorder
Feeling born in wrong sex Start before age 3 yo
66
If someone has severe distress and depressive sx because of conflict between homosexuality and values of society, may have...
Adjustment disorder or MDD
67
decreased latency of REM sleep seen in...
depression

Psychiatry (9 decks)

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