Psychiatric disorders insomnia

Primary insomnia, with underlying pathophysiology of sleep Insomnia secondary to a psychiatric disorder Insomnia secondary to a medication or drug of abuse... 

The short-acting clomethia2ole [533-45-9] (1), sometimes used as therapy for sleep disorders ia older patients, shares with barbiturates a risk of overdose and dependence. Antihistamines, such as hydroxy2iae [68-88-2] (2), are also sometimes used as mild sedatives (see HiSTAMlNES AND HISTAMINE antagonists). Antidepressants and antipsychotics which have sedative effects are used to treat insomnia when the sleep disorder is a symptom of some underlyiag psychiatric disorder. 

Address other medical conditions that frequently coexist with insomnia and can worsen a patient s symptoms (e.g., psychiatric disorders, benign prostatic hypertrophy). 

Transient (two to three nights) and short-term (less than 3 weeks) insomnia is common and is usually related to a precipitating factor. Chronic insomnia (greater than 1 month) may be related to medical or psychiatric disorders or medication, or it may be psychophysiologic. 

Eplivanserin (39) is a 5-HT2A antagonist initially developed for a broader spectrum of psychiatric disorders but that has been tested recently for insomnia. Within this latter indication, phase II studies showed benefits in sleep maintenance, but not in induction [9]. Compound 39 is currently in phase III, to assess the efficacy for the treatment of sleep maintenance insomnia, evaluating both sleep and daytime functioning [96]. 

Although we are focusing on the primary sleep disorders, sleep disturbance quite often occurs as a symptom of another illness. Depression, anxiety, and substance abuse can impair the quality of sleep, though in the setting of chronic insomnia, other psychiatric disorders account for less than 50% of cases. Nightmares are a frequent complication of post-traumatic stress disorder (PTSD), and pain, endocrine conditions, and a host of medical illnesses can produce sleep problems. Thus, when discussing insomnia or hypersomnia, we are well advised to remember that these can be either a symptom of a psychiatric syndrome, a medical illness, or a sleep disorder. 

Insomnia Due to Another Psychiatric Illness. Insomnia is often a symptom of mood and anxiety disorders. Depression is classically associated with early-morning awakening of the melancholic type, whereas so-called atypical depression leads to hypersomnia. Anxiety commonly leads to problems falling asleep. These patterns are not invariable. One should therefore always perform a thorough assessment for anxiety or depression in patients complaining of insomnia. 

Other medical conditions, drugs, or psychiatric disorders that may be causing the insomnia should also be identified. Once these conditions have been ruled out or treated, treatment for the remaining insomnia can be initiated. 

Psychiatric/Physical disorder Because sleep disturbances may be the presenting manifestation of a physical or psychiatric disorder, initiate symptomatic treatment of insomnia only after a careful evaluation of the patient. 

Duration of therapy Because sleep disturbances may be the presenting manifestation of a physical or psychiatric disorder, initiate symptomatic treatment of insomnia only after careful evaluation of the patient. The failure of insomnia to remit after 7 to 10 days of treatment may indicate the need for evaluation of a primary psychiatric or medical illness. Do not prescribe zaleplon in quantities exceeding a 1-month supply. 

Antihistamines have been used for several decades in the treatment of anxiety in children (Tader, 1988). Prescription data show that antihistamines are widely used in pediatric psychiatric practices (Zito et ah, 2000). Diphenhydramine and hydroxyzine have been reported to modify anxiety symptoms in children with various psychiatric disorders. They are mainly used as a sedative in patients with insomnia. Occasionally they are used for mild acute agitation (AACAP, 1997). 

Soldatos CR Computerized sleep EEG (CSEEG) in psychiatry and psychopharmacology, in Biological Psychiatry Today. Edited by Obiolo J, Ballus C, Monclus EG, et al. Amsterdam, Elsevier, 1979 Soldatos CR Insomnia in relation to depression and anxiety epidemiologic considerations. J Psychosom Res 38 [suppl l 3-8, 1994 Soldatos CR, Paparrigopoulos TJ Sleep patterns in depression, in WPA Teaching Bulletin on Depression. November [issue 11), 1995 Soldatos CR, Vela-Bueno A, Kales A Sleep in psychiatric disorders. Psychiatric Medicine 4[2) 119-132, 1987... 

It is indicated in treatment of transient, situational and chronic insomnia, insomnia secondary to psychiatric disorders. 

Insomnia is a complaint, not a disease. The causes of insomnia are classified both in the DSM-IV for psychiatrists and in the International Classification of Sleep Disorders for sleep experts (Table 8—3). Insomnia can be a primary problem, or it can be secondary to medical or psychiatric disorders or to medications. Insomnia can also be due psychophysiological factors such as stress or to circadian rhythm distur-... 

When these issues are taken into consideration, there is still a high frequency of primary insomnia, as well as secondary insomnia the primary cause of which cannot be satisfactorily treated. Many patients also have both a psychiatric disorder and a primary insomnia. Still others have a psychiatric disorder requiring a sleep-disrupting antidepressant. Here we will discuss the use of sedative-hypnotics for these patients. 

Insomnia may also be classified according to its duration as a symptom. Thus, transient insomnia occurs in normal sleepers who have traveled to another time zone (jet lag), who are sleeping in an unfamiliar surrounding, or who are under acute situational stress. Often treatment is not required, and insomnia is reversed with time alone. Short-term insomnia can be experienced by one who is generally a normal sleeper but is under a stress that does not resolve within a few days, such as divorce, bankruptcy, or a lawsuit. Such individuals may not meet the criteria for a psychiatric disorder other than an adjustment disorder and yet may require short-term symptomatic relief of their insomnia in order to function optimally. 

Finally, long-term insomnia is not only persistent but disabling. Studies suggest that almost all of these patients have either an associated psychiatric disorder, an associated drug use, abuse, or withdrawal problem, or an associated medical disorder. As mentioned above, treatment of these associated disorders may be sufficient to treat the insomnia as well. However, if the underlying disorder is not treatable or if there is a requirement to relieve the symptom of insomnia before the underlying condition can be relieved, it may be necessary to treat the insomnia symptomatically with a sedative-hypnotic agent. 

The manner and severity of withdrawal symptoms varies according to the type of drug and the extent of physical dependence.50 Withdrawal after short-term benzodiazepine use may be associated with problems such as sleep disturbances (i.e., so-called rebound insomnia).34 62 As discussed earlier, withdrawal effects seem to be milder with the newer nonbenzodiazepine agents (zolpidem and zaleplon).34,62 Newer agents, however, are not devoid of these problems and care should be taken with prolonged use, especially in people with psychiatric disorders or a history of substance abuse.26... 

Once recognized as a tonic, tranquilizer, and antispasmodic, skullcap was therefore used as an ingredient in many patent medicines for female weakness. It was also combined with other reputedly calming herbs, such as hops and valerian, and promoted as a sedative or anxiolytic. Other traditional uses include treatment of epilepsy, headache, insomnia, various other neurological and psychiatric disorders, hypertension, fever, rheumatism, and stress. 

Insomnia is a serious health problem. With an estimated 30 000 000 Americans experiencing chronic, clinically significant insomnia [1], this condition is the most prevalent sleep disorder and is among the most prevalent psychiatric disorders. The health burden of insomnia is felt in a number of ways. It has an estimated annual economic impact in the United States alone of about 14 billion as of 10 years ago [2], Not only is nighttime experience degraded, but quality of life, broadly conceived, is also compromised [3],... 

Progressive inactivity, dissatisfaction with social life, and presence of medical and psychiatric illness can be most predictive of insomnia in old age [6, 7], In modern societies higher rates of insomnia are present in women, people who are less educated or unemployed, separated or divorced, the medically ill, and those with depression, anxiety, or substance abuse [8], In a number of studies, insomnia has been found to be correlated with frequent use of medical facilities [9-13], chronic health problems [13-18], perceived poor health [17], increased use of drugs [10,14], and specific medical conditions including respiratory diseases [19-21], hypertension [21], musculoskeletal and other painful disorders [19-24], heart diseases [19, 23], and prostate problems [19], On the other hand, chronic insomnia predisposes to the development of psychiatric disorders [25-27], Therefore, it is important to clearly establish whether co-morbidities are causative for, or simply co-exist with insomnia, in order to recommend the most appropriate treatment. This is why it is better to categorize insomnia as a disease rather than as a symptom [28],... 

The effective management of insomnia begins with recognition and adequate assessment. Family doctors and other health care providers should routinely enquire about sleep habits as a component of overall health assessment. Identification and treatment of primary psychiatric disorders, medical conditions, circadian disorders, or specific physiological sleep disorders, such as sleep apnea and periodic limb movement disorder, are essential steps in the management of insomnia [8],... 

Weissman MM, Greenwald S, Nino-Murcia G, Dement WC (1997) The morbidity of insomnia uncomplicated by psychiatric disorders. Gen Hosp Psychiatry 19 245-250... 

Primary insomnia includes a number of insomnia diagnoses according to the International Classification of Sleep Disorders, including psychophysiological insomnia and idiopathic insomnia [11]. Psychophysiological insomnia most closely resembles primary insomnia. Individuals with idiopathic or childhood-onset insomnia show a lifelong inability to obtain adequate sleep there is no evidence of medical or psychiatric disorders that could account for the sleep disturbance. In sleep disor-... 

Hypnotics need to be prescribed appropriately, and guidance has been published (6). In particular, treatable causes for insomnia, such as psychiatric disorders and physical illnesses, need to be identified and treated before prescribing hypnotics. 

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