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Psych II > Sleep, Sex, drugs > Flashcards

Sleep, Sex, drugs Flashcards

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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?

A

Sleep walking

  • ambulation
  • other intricate behaviors

With amnesia, while sleeping

25
Q

Patient population for sleep walking?

A

Kids - normal

Elderly - dementia

26
Q

What is enuresis

A

Wetting the bed

- confusion and amnesia are common

27
Q

Sleep terror tx?

A

Benzo’s to suppress stage 3 and 4 of sleep

28
Q

Somnambulism tx?

A

Benzo’s to suppress stage 3 and 4 of sleep

29
Q

Enuresis tx?

A

Imipramine or desmopressin nasal spray

Also sleep alarms

30
Q

Stages of sexual stuff?

A

Excitement
Orgasm
Resolution

31
Q

What are the 3 groups of sexual dysfunction?

A
  • Paraphilia’s (excitement stage)
  • Gender dysphoria
  • Sexual dysfunctions
32
Q

Name the paraphilias

A 
Exhibitionism
Transvestism
Voyeurism
Pedophilia
Incest
Sexual sadism
Sexual masochism
33
Q

Paraphilias txt?

A

Psych - generally responsive to psychotherapy

Behavioral - modeling/role playing

Social - self help groups

Pharm

  • medroxyprogesterone (suppress sex drive)
  • SSRI (fluoxitine) may help
34
Q

Gender dysphoria txt?

A

Psych - safe place to “explore”

Social - peer groups

Medical - hormone/sex change

35
Q

Standard of care for persistent gender dysphoria?

A

Hormone therapy

Sex change

36
Q

Sexual dysfunction med for women?

A

Finasterone

37
Q

Sexual dysfunction meds for men?

A

Afils

  • Avanafil (Stendra)
  • Sildenafil (Viagra)
  • Tadalafil (Cialis)
  • Vardenafil (Levitra, Staxyn)
38
Q

Psychologic dependence

A

Craving and behavior involved in procurement of the drug

39
Q

Physiologic dependence

A

Withdrawal symptoms w/o the drug

40
Q

Tolerance

A

The need to increase dose to obtain effects

41
Q

At risk drinking red flags?

A

At risk drinking

  • men: 4 drinks/day and 14/week
  • women 3 drinks/day and 7/week
42
Q

Alcohol use d/o test?

A

AUDIT

43
Q

Alcohol doses

A

50mg/dL - wont cause motor symptoms

80mg/dL - legal limit in most states

44
Q

Syptoms of ETOH withdrawal

A 
Anxiety
Decreased cognition
Tremulousness
Hyperactivity
Full blown DT’s
45
Q

Levels of ETOH withdrawal

A 
Mild
Moderate
Severe withdrawal
Withdrawal seizures 
DT’s
46
Q

What are DT’s?

A

Organic psychosis 48-72hrs after last drink

47
Q

S/s of DT’s?

A
  • Visual hallucinations
  • Autonomic hyperactivity (tachy, HTN)
  • Dehydration
  • Electrolyte disturbances (hypoK, HypoMg)
  • Arrhythmias/seizures
  • Cardiovascular collapse
  • Death
48
Q

Pt comes in with unexplained delirium you should suspect?

A

ETOH withdrawal

49
Q

How long do ETOH withdrawal symptoms last?

A

3-12 months

50
Q

S/s of persistent long term withdrawal symptoms?

A
  • Sleep
  • Anxiety
  • Depression
  • Excitability
  • Fatigue
  • Emotional volatility
51
Q

ETOH (organic) hallucinations s/s

A
  • Paranoid psychosis w/o tremulousness
  • Confusion
  • Clouded sensorum
52
Q

Types of alcohol use d/o?

A

Primary alcohol use d/o
- no other maj psych stuff

Secondary alcohol use d/o
- self medicating for underlying psych d/o

53
Q

Tx for etoh use d/o?

A

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
Q

How are ETOH hallucinations treated?

A

Antipsychotics

55
Q

How are withdrawal symptoms treated?

A

Mild
- lorazepam, chlordiazeperoxide (PO)
Moderate
- lorazepam, chlordiazeperoxide (IV q 2hrs)
Severe (ICU)
- lorazepam or chlordiazeperoxide (IV q 15 min)

56
Q

Caffeine intoxication and withdrawal

A

Headache?

WHO CARES

57
Q

Opioid withdrawal grades?

A

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
Q

Treatment for opioid withdrawal?

A

Initial - Methadone

7-10 days later - naltrexone

Psych II (10 decks)

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