Intro to Psych & Sleep Disorders (Zboyovski)

Thought Blocking

Stops speaking suddenly without explanation

• When hallucinations or delusions intrude into the person’s thinking

• When upsetting issues are discussed

Affect

• Current emotional tone observed by the clinician

• Facial expression, body posture, tone of voice

• Objective from clinician

Circumstantial Speech

Takes a long time to get to the point, and includes excessive, unrelated information

Delusions

• Fixed false beliefs that are not based in reality or consistent with the patient’s religion or culture

• Delusions often accompanied by anosognosia (lack of awareness of a mental disorder)

Illusions

• Visual mispreceptions involving a misinterpretation of a real sensory stimulus

• Does not always indicate a mental disorder

Perseveration

• Repetition of an original answer to subsequent questions

• Repeating words or phrases or movements

Diagnostic and Statistical Manual of Mental Disorders (DSM)

• Provides a common language for practitioners to describe, assess, and diagnose mental health conditions

  • Describes mental “disorders” vs “illness” or “disease”

  • A psych diagnostic “cookbook”

  • Defines and differentiates characteristics

  • Helps develop understanding of mental illness

• 20 chapters for 20 disorders

  • Descriptive approach includes: Diagnostic features, Development, Course, Risk, Prognosis, Comorbidity Functional Consequences, Differential Diagnosis, Culture and Gender Considerations

International Classification of Disease and Related Health Problems (ICD)

• By WHO for billing purposes

• Organizes diagnostic categories using a developmental lifespan approach

  • Allows clinicians to clarify diagnoses, terms to desribe severity, course, patten of presentation, and resources

DSM-5 and ICD-11

• Exist as companions in the diagnostic coding classification of mental health disorders

  • In US, ICD mandated by insurance companies to secure payments

  • Globally used to secure info regarding the epidemiology of the disorders

• Provides clinicians with a systemic approach to evaluating patients

  • Allowing for better treatment plans and a consistent way to evaluate treatment outcomes

List the essential components of the Psych interview

• Open ended questions

  • Ensure patient does majority of talking; avoids leading the patient

• Affirmations

  • Build rapport, helps patient feel that they are being heard

• Reflective listening

  • Helps patient identify discrepancies in their thinking

• Summary

  • Reinforces commitment of the patient to making a change

Mental Status Examination (MSE) components

• Appearance

• Attitude

• Activity

• Speech and Language

  • Thought blocking, pressured speech, flight of ideas, tangenital, perseveration, mutism

• Mood and Affect

  • Flat, excited, blunted

• Thought and Perceptual Disturbances

  • Delusions and Illusions

• Cognition

• Insight and Judgement

Various scales for assessing and identifying different psych disorders

• Mental Staus Exam (MSE)

  • Multiple components

• Abnormal Involuntary Movement Scale (AIMS)

  • Tardive Dyskinesias (TD) secondary to antipsychs

• Hamilton Depression Rating Scale (HDRS)

  • Screen pts for drug studies- determine severity of sx

• Patient Health Questionnaire (PHQ-9)

  • Used in primary care to diagnose and assess severity

• Hamilton Anxiety Scale (HAM)

  • Subscale measure somatic and psych anxiety

Basic principles of sleep

1. Non-Rapid Eye Movement (NREM) Sleep

2. Rapid Eye Movement (REM) Sleep

Basic Principles of Circadian Rhythm

• Infants

  • spend ~20h a day sleeping

  • no differentiation between REM and NREM until 3-6 months

• 3yo

  • sleep-wake rhythm changes to a circadian pattern

• Adults

  • gradual decline in sleep efficiency and sleep time

• Older Adults

  • lighter and more fragmented sleep with intermittent arousals

List the causes of sleep disorders

• Insomnia Disorder

• Restless Leg Syndrome (RLS)

• Narcolepsy

Non-pharm therapies for sleep disorders

• Discontinue meds that can worsen insomnia

  • Diuretics, Fluoxetine, Steroids (bolded in lecture)

• Sleep Hygiene

  • Exercise routinely (3-4x weekly) but not close to bedtime

  • comfy sleep environment

  • Reduce alcohol, caffeine and nicotine

  • Dont drink a lot of liquid before bed

  • Relax before bedtime

Insomnia Pharm Therapy

• Temazepam preferred Benzo in older adults

• Zaleplon (Sonata) and Zolpidem (Ambien) for non benzo (5-10mg PO HS)

  • Warning: Complex sleep behavior- sleep walking/driving and engaging in other activities while not fully awake

  • Ambien helps with falling and staying asleep

• Ramelteon (Rozerem) is approved for sleep onset insomnia

  • Selective for melatonin receptors

  • Regulate ciradian rhythm and sleep onset

• Doxepin (Silenor) is sedating antidepressant

  • 14 day washout period with other MAOIs

RLS Pharm Therapy

• Dopamine Agonists 1st line FDA approved

  • Ropinirole (Requip)

  • Pramipexole (Mirapex)

  • Rotigotine (Neupro)

Narcolepsy Pharm Therapy

• CNS Stimulant 1st line for Excessive Daytime Somnolence (EDS)

  • Modafinil (Provigil) is C-IV

  • Lacks efficacy for the treatment of cataplectic symptoms