The Psychiatric Dimensions of Sleep Medicine, An Issue of by Karl Doghramji MD
By Karl Doghramji MD
This factor is the definitive guide at the most crucial psychiatric features of sleep medication. themes comprise a ancient viewpoint of sleep and psychiatry; the psychology of sleep and dreaming; the superiority, effect, pathogenesis, differential analysis, and assessment of insomnia; pharmacological administration of, in addition to nonpharmacological options for, insomnia; over the top daylight hours somnolence and fatigue within the psychiatric sufferer; parasomnias; sleep in temper issues, schizophrenia, and anixiety issues; behavioral sleep problems in youngsters and young people; sleep issues in particular in seniors and in ladies; and seasonal affective affliction and phototherapy.
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Additional resources for The Psychiatric Dimensions of Sleep Medicine, An Issue of Sleep Medicine Clinics, 1e
Sleep Med Rev 1997;1:97–108. Stepanski E, Zorick F, Roehrs T, et al. Daytime alertness in patients with chronic insomnia compared with asymptomatic control subjects. Sleep 1988;11:54–60. Bonnet MH, Arand DL. 24-hour metabolic rate in insomniacs and matched normal sleepers. Sleep 1995;18:581–8. Pavlova M, Berg O, Gleason R, et al. Selfreported hyperarousal traits among insomnia patients. J Psychosom Res 2001;51:435–41. Nofzinger EA, Buysse DJ, Germain A, et al. Functional neuroimaging evidence for hyperarousal in insomnia.
Off-label use Sedating antidepressants The most frequently prescribed medications for the treatment of primary insomnia are sedating antidepressants, trazodone, amitriptyline, and mirtazepine being the leading three . Unfortunately, little is known about their mechanism of action for hypnotic effects or their efficacy and safety as hypnotics. The transmitter systems altered by the three leading sedating antidepressants differ. Trazodone antagonizes serotonin 2a (5HT2a), 5HT2c, and alpha1-adrenergic receptors and also inhibits 5HT reuptake [58,59].
Zolpidem was reported to exacerbate sleep-related eating disorder and in several cases to induce it de novo . In some of these cases doses of zolpidem greater than 10 mg were being used, and in other cases there was use of sedating antidepressants. Sleep-related eating disorder also has been reported with triazolam [47,49]. A common thread links much of this case-report information: excessive hypnotic activity or sleep drive. The excessive hypnotic activity can occur as a result of high doses, clinical doses in vulnerable individuals (ie, those who have a past history of sleep disorders or brain injury), the combination of clinical or high doses with prior sleep deprivation caused by stress or illness, or the combination of clinical or high doses with the prior consumption of alcohol.