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Psych II > Sleep, Sex, drugs > Flashcards

Sleep, Sex, drugs Flashcards

(58 cards)

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1
Q

What is insomnia?

A

Trouble with quality of sleep

Part of a psychiatric d/o or stand alone

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2
Q

Types of insomnia?

A

Can be trouble:

  • getting to sleep
  • staying asleep
  • early awakening
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3
Q

Severity levels for insomnia?

A

Episodic: 1-3 months
Persistent: 3+ months
Recurrent: 2+ episodes in 1 yr

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4
Q

Situational insomnia?

A

Insomnia for a few days/weeks

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5
Q

Treatment for insomnia?

A

Psych:
- sleep hygiene education

Pharm:

  • lorazepam, temazepam
  • non benzo hypnotics (zolpidem, zaleplon)
  • antihistamines
  • trazadone (low dose)
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6
Q

Problems with giving antihistamines to the elderly?

A

They may cause

  • confusion
  • urinary problems
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7
Q

How should nonbenzo hypnotics be given for sleep aid?

A

Short course 1-2 weeks only

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8
Q

What is hypersomnolence d/o?

A

Excessive daytime sleepiness despite getting >7hrs plus 1 of:

  • recurrent sleep lapses during day
  • sleeping > 9hrs (nonrestorative)
  • difficulty being fully awake after abrupt awakening (groggy)
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9
Q

Timeline for hypersomnolence?

A

Must be 3x per week x 3 months

  • acute - 1 month
  • subacute - 1-3 months
  • persistent >3 months
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10
Q

Severity for hypersomnolence?

A

Mild: 1-2 days/week
Moderate: 3-4 days/week
Severe: 5-7 days/week

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11
Q

Narcolepsy is?

A

Recurrent periods of:

  • an irrepressible need to sleep
  • lapsing into sleep
  • napping

Occurring w/in the same day 3x/week x 3 mohths

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12
Q

Tetrad of symptoms for narcolepsy?

A
  1. Sudden brief sleep attacks (during any type of activity)
  2. Cataplexy: sudden loss of muscle tone in specific or gen muscle groups
    (Slump to floor, cant move)
  3. Sleep paralysis: gen flacidity of muscles w full consciousness
  4. Hypnagogoc hallucinations: visual/auditory
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13
Q

Txt for narcolepsy?

A

Daily stimulant:

  • dextroamphetamine sulfate
  • modafinil
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14
Q

What is needed for a diagnosis of “breathing related sleep disorder”?

A

Either (by polysomnography)

  • min 5 OSA or hypopneas per hr w symptoms
  • 15+ OSA or hypopneas/hr w/o symptoms
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15
Q

Symptoms that are seen with OSA or hypopneas?

A

Nocturnal breathing disturbances

Daytime sleepiness, fatigue, or other un-refreshing sleep

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16
Q

MC breathing related sleep d/o?

A

OSA - obstructive sleep apnea hypopnea

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17
Q

Describe OSA

A

Can be:

  • Snoring
  • Gasping
  • Breathing pauses

And 5+ apnease or hypoapneas per hr

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18
Q

What is central sleep apnea?

A

Evidence of 5 or more sleep apneas cause by centrally (brain not airway)

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19
Q

What is sleep related hypoventilation?

A

Polysomnography shows episodes of decreased respiration and high Co2

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20
Q

What is a circadian rhythm sleep-wake d/o?

A

Sleep disruption due to alteration of circadian system or misalignment between endogenous circadian rhythm and sleep-wake schedule

Your job and your sleep cycle dont match

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21
Q

What are parasomnias?

A

Sleep terror
Nightmares
Sleepwalking
Enuresis

Common in kids not so much in adults

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22
Q

Payor nocturnus?

A

Sleep terror - abrupt terrifying arousal from sleep.

  • fear,
  • sweating,
  • tachy,
  • confusion

X several minutes with AMNESIA

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23
Q

When do nightmares occur?

A

During REM sleep

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24
Q

What is somnabulism?

Study These Flashcards
A

Sleep walking

  • ambulation
  • other intricate behaviors

With amnesia, while sleeping

25
Patient population for sleep walking?
Kids - normal | Elderly - dementia
26
What is enuresis
Wetting the bed | - confusion and amnesia are common
27
Sleep terror tx?
Benzo’s to suppress stage 3 and 4 of sleep
28
Somnambulism tx?
Benzo’s to suppress stage 3 and 4 of sleep
29
Enuresis tx?
Imipramine or desmopressin nasal spray Also sleep alarms
30
Stages of sexual stuff?
Excitement Orgasm Resolution
31
What are the 3 groups of sexual dysfunction?
- Paraphilia’s (excitement stage) - Gender dysphoria - Sexual dysfunctions
32
Name the paraphilias
``` Exhibitionism Transvestism Voyeurism Pedophilia Incest Sexual sadism Sexual masochism ```
33
Paraphilias txt?
Psych - generally responsive to psychotherapy Behavioral - modeling/role playing Social - self help groups Pharm - medroxyprogesterone (suppress sex drive) - SSRI (fluoxitine) may help
34
Gender dysphoria txt?
Psych - safe place to “explore” Social - peer groups Medical - hormone/sex change
35
Standard of care for persistent gender dysphoria?
Hormone therapy | Sex change
36
Sexual dysfunction med for women?
Finasterone
37
Sexual dysfunction meds for men?
Afils - Avanafil (Stendra) - Sildenafil (Viagra) - Tadalafil (Cialis) - Vardenafil (Levitra, Staxyn)
38
Psychologic dependence
Craving and behavior involved in procurement of the drug
39
Physiologic dependence
Withdrawal symptoms w/o the drug
40
Tolerance
The need to increase dose to obtain effects
41
At risk drinking red flags?
At risk drinking - men: 4 drinks/day and 14/week - women 3 drinks/day and 7/week
42
Alcohol use d/o test?
AUDIT
43
Alcohol doses
50mg/dL - wont cause motor symptoms 80mg/dL - legal limit in most states
44
Syptoms of ETOH withdrawal
``` Anxiety Decreased cognition Tremulousness Hyperactivity Full blown DT’s ```
45
Levels of ETOH withdrawal
``` Mild Moderate Severe withdrawal Withdrawal seizures DT’s ```
46
What are DT’s?
Organic psychosis 48-72hrs after last drink
47
S/s of DT’s?
- Visual hallucinations - Autonomic hyperactivity (tachy, HTN) - Dehydration - Electrolyte disturbances (hypoK, HypoMg) - Arrhythmias/seizures - Cardiovascular collapse - Death
48
Pt comes in with unexplained delirium you should suspect?
ETOH withdrawal
49
How long do ETOH withdrawal symptoms last?
3-12 months
50
S/s of persistent long term withdrawal symptoms?
- Sleep - Anxiety - Depression - Excitability - Fatigue - Emotional volatility
51
ETOH (organic) hallucinations s/s
- Paranoid psychosis w/o tremulousness - Confusion - Clouded sensorum
52
Types of alcohol use d/o?
Primary alcohol use d/o - no other maj psych stuff Secondary alcohol use d/o - self medicating for underlying psych d/o
53
Tx for etoh use d/o?
Psych - motivational interviewing (address pt’s ambivalence and motivational for change IOT reduce consumption) Social - AA Medical - hospitalization (only need for really bad ones) Meds - disulfam (toxic effects when drink) - naltrexone (takes fun out of drinking) - acamprosate (reduces cravings)
54
How are ETOH hallucinations treated?
Antipsychotics
55
How are withdrawal symptoms treated?
Mild - lorazepam, chlordiazeperoxide (PO) Moderate - lorazepam, chlordiazeperoxide (IV q 2hrs) Severe (ICU) - lorazepam or chlordiazeperoxide (IV q 15 min)
56
Caffeine intoxication and withdrawal
Headache? | WHO CARES
57
Opioid withdrawal grades?
Grade 0 - craving and anxiety Grade 1 - yawning, lacrimation, rhinorrhea and perspiration Grade 2 - grade 1 + mydriasis, piloerection, anorexia, tremors, hot/cold flashes, gen aching Grade 3 and 4 - grade 1 and 2 + increased temp, BP, pulse, respiratory rate/depth - most severe cases: vomiting, diarrhea, wt loss, hemoconcentration and spontaneous ejaculation/orgasm
58
Treatment for opioid withdrawal?
Initial - Methadone | 7-10 days later - naltrexone

Psych II (10 decks)

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