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+--- Thread: Sleep DISORDERS - spartans1 (/showthread.php?tid=536281)
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Sleep DISORDERS - spartans1 - ArchivalUser - 09-26-2010
USMLE CK : Sleep Disorders
Sleep Disorders
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Characteristics:
Narcolepsy
Excessive daytime sleepiness and abnormalities of REM sleep for a period of greater than 3 months
REM sleep occurs in less than 10 minutes. Patients will feel refreshed upon awakening
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Clinical Features:
Narcolepsy
Sleep attacks
Cataplexy
Hypnagogic and hypnopompic hallucinations
Sleep paralysis
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Management:
Narcolepsy FORCED NAP AT REGULAR TIME OF DAY
Pharmacotherapy (psychostimulants for sleep attacks and imipramine for cataplexy)
ANTIDEPRESSANTS FOR CATAPLEXY
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Characteristics:
Sleep Apnea
Cessation of air flow at the nose or mouth during sleep
Apneic episodes usually last greater than 10 seconds each
Loud snore followed by a heavy pause Usually seen in obese, middle aged males, who complain of being tired during the day
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Clinical Features:
Sleep Apnea
Types
o obstructive MS ATONY IN OROPHARYNX
o central LACK RSP EFFORT
o mixed
Complications
oArrhythmias
o pulmonary hypertension
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Management:
Sleep Apnea
Nasal continuous positive airway pressure
Weight loss
Surgery
Treat the underlying condition
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Case Study
Case #1 A 45-year-old housewife is being seen at a sleep clinic for the first time. She claims that she has been unable to sleep for the last few years. According to the patient, her obese, middle-aged husband™s œsnoring keeps her up all night and interferes with her sleep.
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Case Study
Case #2 A 50-year-old businessman is seeking help to overcome his being œtired during the day. He has taken vitamins during the last few months since he thought theymight help. He is 54 and weighs 200 pounds.
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INSOMNIA
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Characteristics:
Difficulty in initiating or maintaining sleep
Underlying pschiatric disosrder : Depression [ more often in women] PTSD, OCD and eating disorder
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Clinical Features:
Difficulty initiating and maintaining sleep
level of functionning is affected
yawning and tiredness during daytime
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Management:
Good sleep hygiene techniques
Avoid evening stimulation
if med , Benzodiazepines for a short period of time
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Diff Diag:
Medical : Pain CNS lesions, Endocrine , Environmental changes Etoh diet medications
Psychiatric: Anxiety Depression
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PARASOMNIAS
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NIGHTMARES
SLEEP STAGE: REM
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Characteristics
memory of event at awakening & increased during time of stress
he denies any suicidal ideation or plan.
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Management
REM SUPPRESSant: TCAs
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SLEEP WAKING
SLEEP STAGE STAGE 3 & 4
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Sequence of behaviors of perversive behavior WITHOUT FULL CONCIOUSNESS .. TERMINATING wthout ANY MEMORY OF THE EVENT.. Exacerbate by SLEEP DEPRIVATION
------------------------------------------------------------------------------------------MANAGEMENT
assure patient safety
stages 3 7 4 suppressant ; BENZODIAZEPINES
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NIGHT TERROR
Awakening by scream or intense anxity
No memory of the following event
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no treatment if needed consider BENZODIAZEPINES
......................................................................................................................
SLEEP TALKING
0 - ArchivalUser - 09-26-2010
kfghjk
0 - ArchivalUser - 09-27-2010
thanks ..really helpful to revise....
0 - ArchivalUser - 09-27-2010
dear spartan please help me differentiate between adjustment disorder and bereavement ....thanks
0 - ArchivalUser - 09-27-2010
Adjustment Disorder
• Disorder characterized by the development of symptoms in response to an identifiable stressor occurring within 3 months of the onset of the stressor
• Treatment: usually require supportive psychotherapy
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Differences:
Grief/Bereavement
• Normal identification with deceased
• Crying, decreased libido, weight changes
• Self-limited, lasts 6 months - 1 year
• Antidepressants not helpful
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Differences:
Depression
• Abnormal identification with deceased
• Sleep disturbance, depressed mood, appetite disturbance
• Suicidal ideation rare
• Suicidal ideation common
• Symptoms persist greater than 1 year
• Antidepressants helpful
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Case Study
Case #1
A 30-year-old female was fired from her job about 1 month ago. Since then, she has complained of depressed mood and sleep problems. She denies any appetite or weight problems. She denies any suicidal ideation or plan. Her concentration is good and her memory is intact.
0 - ArchivalUser - 09-27-2010
ok...so if it happens after a death its bereavement and if ti occurs after any other stressor its called adjustment disorder ?
0 - ArchivalUser - 09-27-2010
Grieving after a loved one's death is known as bereavement.
@chocalat You might be French speaking
0 - ArchivalUser - 09-27-2010
Grieving after a loved one's death is known as bereavement.
@chocolat You might be French speaking
0 - ArchivalUser - 09-27-2010
no im not ...
thanks for the answer...
0 - ArchivalUser - 09-27-2010
let's have some
Somatoform Disorders
A group of disorders characterized by the presentation of physical symptoms without any medical explanation. The symptoms will be severe enough to interfere with the patient’s ability to function in social or occupational activities. Typically, patients are females of low socioeconomic status.
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Clinical Features:
Somatization Disorder
Presentation of many physical symptoms affecting many organ systems without any medical explanation
Need at least 8+ symptoms in order to make a diagnosis:
o 2 gastrointestinal symptoms
o 1 sexual symptom
o 1 pseudo-neurological symptom
o 4 pain symptoms
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Management:
Somatization Disorder
Must have a single identified physician as the primary caretaker
Regularly scheduled brief monthly visits
Increase the patient’s awareness of the possibility that the symptoms are psychological in nature
Psychotherapy
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Characteristics:
Conversion Disorder
One or two neurological symptoms affecting voluntary or sensory function that cannot be explained by any known neurological disorder
Must have psychological factors associated with the onset or exacerbation of the symptoms
Mutism-blindness and paralysis are mc symptoms
Sensory system> Motor system> seizures
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Clinical Features:
Conversion Disorder
Primary gain
Secondary gain
La belle indifference
Identification
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Management
Conversion Disorder
Psychotherapy
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Hypochondriasis
Patient believes that he or she has some specific disease
Despite constant reassurance, the patient’s belief remains the same
Treatment
o Psychotherapy
o Frequent, regular visits to their MDs
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Body Dysmorphic Disorder
Patients believes a body part is abnormal, defective, or misshapen
May involve serotonergic systems
Treatment:
o Psychotherapy
o Pharmacotherapy (SSRIs, TCAs, MAOIs)
Pain disorder
Disorder where presence of pain is the main complaint.
- in 1 or more anatomic sites
- Causes distress to pt
- Psychologic factors are found
- symptoms are real
- Hx of surgeries and medical cares
- ½ pts with depression
-
- Management
- Psychotherapy
- Biofeedback hypnosis and nerve blocking
- SSRIs
-
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Factitious Disorder
Conscious production of signs and symptoms of both medical and mental disorders
Assume sick role and hospitalization
Usually diagnosed with physical or psychological symptoms or both
Men > women
Hospital and health care workers
Treatment: usually involves management rather than cure
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Malingering
Conscious production of signs and symptoms for an obvious gain (money, avoid work, free bed and board, etc.). It is not a mental disorder.
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Case Study
A 50-year-old woman was referred by her husband™s psychiatrist because of œattacks of dizziness that have been occurring for more than 10 years. Every day, at about 3pm, the attacks occur. They leave her helpless and, when her husband arrives, she is unable to attend to him. She remains in bed until 8pm when the attacks subsided, and she would watch TV and fall asleep.
When questioned, she described her husband as abusive and not caring about her well-being. He has repeatedly abused her and their children, which resulted in their leaving home at an early age, and moving in with their grandmother. She stated that she hated when he came home and would make comments about the house, dinner, etc. Many times, these verbal comments were followed by actual episodes of violence, several of which have resulted in her hospitalization.
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