Jour 3 Flashcards
(32 cards)
Flow sanguin en REM
Increased brain temperature, cerebral glucose metabolism, and cerebral blood flow
Où est le noyau suprachiasmatique?
Hypothalamus antérieur
Quel neurotransmetteur promouvoit le REM?
Acetylcholine
À noter que ça promeut l’éveil, pas le sommeil
Prévalence insomnie
6-10% in general population
Up to 25% in elderly
Agents avec indication pour insomnie
-Benzo: temazepam, triazolam
-Agoniste récepteur benzo: zopiclone, zolpidem, eszopiclone
-Antidépresseur sédatif: doxépine
-Antagoniste d’orexine: lemborexant
-Agoniste récepteur mélatonine: ramelton (pas dispo Canada)
Pourquoi donner ISRS en narcolepsie (off-label)?
Parce qu’ils suppriment le REM, et qu’en narcolepsie il y a trop de REM (sleep attacks sont intrusions de REM dans l’éveil)
Effet benzo sur sommeil
Suppression N3
Impact alcool sur sommeil
Acute
-Decreased sleep latency
-Increased SWS initially, but then decreases in second half of sleep period
-Decreases REM in first 2-4 hours of sleep period
-REM sleep rebounds in second half of sleep period
-Intense dreaming/nightmares and sleep fragmentation
Chronic
-Increased SL
-Decreased sleep efficacy, slow wave sleep, REM, TST
Withdrawal
-Disrupted sleep continuity, increased REM associated with vivid dreaming
After acute w/drawal, chronic alcohol users may experience light fragmented sleep for weeks to years associated with persistent decrease in SWS
In general
Exacerbates OSA, PLMD, RLS, SWS Parasomnias, RBD
Seul antidépresseur qui n’empire pas restless leg?
Bupropion
Groupe d’âge avec le plus haut taux de TDAH
10-14 ans
Augmentation du risque chez l’adulte qui a TDAH
Adults with ADHD:
▪ 2x more likely to have been arrested, divorced
▪ 3x more likely to be currently unemployed
▪ 4x more likely to have contracted an STI
Conséquences TDAH chez l’ado
Adolescents:
▪ Increased risk of suspensions from school
▪ Difficulty with note-taking, planning assignments, writing, efficiency, self-motivated study
▪ Begin sexual activity earlier, have more partners, less likely to use contraception, increase pregnancy risk, increased STI risk (from Milwaukee Young Adult Outcome Study)
▪ Increased risk of smoking, which is risk factor for later substance use
Mon truc pour m’en rappeler: 3S - school, sex, smoking
Lequel est le plus efficace (mais a plus d’effets secondaires): amphétamines ou methylphenidate?
Amphétamines
Thérapies avec meilleur effect size en TPL
Psychodynamic method (MBT/TFP) effective 0.41
Comparé à
DBT effect size of 0.34
4 stades de DBT
- Behaviour control
- Emotional experiencing
- Define and attain life goals
- Finding a “deeper meaning”
DBT assumptions about the patient
▪ patients are doing the best they can
▪ patients want to improve
▪ patients cannot fail in DBT
▪ patients need to do better, try harder
▪ patients may not have caused all their own problems,
but they have to solve them anyway
▪ the lives of suicidal, borderline individuals are
unbearable as they are currently being lived
DBT assumptions about the therapy
▪ clarity, precision and compassion are of the utmost
importance in the conduct of DBT
▪ the therapeutic relationship is a real relationship
between equals
▪ therapists treating BPD patients need support
▪DBT therapists can fail
▪ therapy can fail even when therapists do not
Qui a inventé le thérapie basée sur la mentalisation?
Bateman, Fonagy
Outre que disulfiram fait vomir, qu’est-ce qu’on peut craindre avec?
Métabolisme de dopamine inhibé, menant à sx psychiatrique
Acronyme SBIRT
Screen
Brief intervention
Refer to treatment
The four Cs des TUS
loss of Control over subtance
use in a Compulsive manner
Craving
use despite Consequences
% des patients avec un TUS qui reçoivent un traitement
10%
Seulement 1% reçoit traitement evidence-based
Est-ce que traitement pour TUS peut être efficace si n’est pas volontaire
Oui!
Effet de naltrexone
Diminution du nb de jour où pt consomme/mois
Diminution du nb de consommation/jour de consommation
