Other psychiatric disorders
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Other psychiatric disorders. Sleep disorder (Insomnia). Insomnia. Difficulty initiating or maintaining sleep or getting up early Daytime impairment. Sleep disorder and drug use. Sleep disturbance is extremely common among alcohol and other drug users

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Other psychiatric disorders

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Other psychiatric disorders

Other psychiatric disorders


Sleep disorder insomnia

Sleep disorder (Insomnia)


Insomnia

Insomnia

  • Difficulty initiating or maintaining sleep or getting up early

  • Daytime impairment


Sleep disorder and drug use

Sleep disorder and drug use

  • Sleep disturbance is extremely common among alcohol and other drug users

  • Sleep disturbance is prevalent during withdrawal states

  • Episodes of insomnia are extremely distressing and can trigger relapse following a period of abstinence


Non pharmacological treatments for insomnia

Non-pharmacological Treatments for Insomnia

Behavioral

Sleep RestrictionStimulus ControlRelaxation

Cognitive

Cognitive Therapy

Educational

SleepHygieneEducation

  • Reduce excessive time in bed

  • Correct irregularsleepschedules

  • Avoidsleepincompatible activities

  • Avoidhyperarousal

  • Unrealisticsleep expectations

  • Misconceptions about sleep

  • Sleepanticipatoryanxiety

  • Poorcopingskills

  • Inadequatesleephygiene


Sleep hygiene

Sleep hygiene

  • Arise at the same time each day

  • Limit daily time in bed to ‘normal’ amount (6–7 hours)

  • Discontinue use of drugs that act on the CNS such as caffeine, tobacco, alcohol, opioids and stimulants

  • Avoid daytime napping

  • Exercise in the morning and remain active throughout the day

  • Substitute watching television at night with light reading and listening to music


Sleep hygiene1

Sleep hygiene

  • Have a warm bath near bedtime

  • Eat on schedule; avoid large meals at night

  • Follow an evening relaxation routine

  • Ensure comfortable sleeping conditions

  • Spend no longer than 20 minutes awake in bed

  • Use the bed only for sleep and sex!


Stimulus control and sleep restriction

Stimulus control and sleep restriction

  • Go to bed only when sleepy

  • Get out of bed when unable to sleep

  • Increase sleep efficiency (time asleep as a percentage of time in bed)

  • Aim to restrict time in bed with average time actually asleep

  • Wake up at the same time irrespective of how much you slept

  • Alarm and help from family members


Pharmacological treatment of insomnia

Pharmacological treatment of Insomnia

  • Avoid using sleep inducing drugs such as benzodiazepines and other drugs such as Zolpidem in drug users (due to increased likelihood of dependence)

    When drug treatment is necessary to promote sleep, use drugs such asTrazadone

    Mirtazapine

    Amitryptaline

    Dotheipin

    Quetiapine


Other psychiatric disorders

Psychosexual dysfunction


Psychosexual dysfunction and drug use

Psychosexual dysfunction and drug use

  • Use of substances, in particular opioids is associated with:

    • Hypoactive sexual desire

    • Erectile dysfunction

    • Orgasmic dysfunction


Managing psychosexual dysfunction

Managing psychosexual dysfunction

  • Stopping or even reduction of dose of opioids may improve sexual function

  • Compared with methadone, buprenorphine is less likely to be associated with erectile dysfunction

  • Alcohol impairs sexual functioning: “Provokes the pleasure but takes away the performance”

  • Comorbid depression is often responsible for the psychosexual dysfunction and hence management of depression is important


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