Module 6 - Association of Mental Health with Sleep Flashcards
(116 cards)
1
Q
What percentage of depressive episodes are associated with insomnia?
A
Approximately 80%.
2
Q
What is REM latency and how is it affected in depression?
A
REM latency is the time it takes to enter REM sleep; it is shortened in depression.
3
Q
Which mental health conditions show a bidirectional relationship with sleep?
A
Depression, schizophrenia, PTSD, and bipolar disorder.
4
Q
What sleep symptoms are commonly seen in PTSD?
A
Nightmares and insomnia.
5
Q
What therapy has been shown to improve sleep and reduce PTSD symptoms?
A
Cognitive behavioural therapy for insomnia and imagery rehearsal therapy.
6
Q
What is the typical sleep complaint during manic episodes?
A
Insomnia with the patient feeling refreshed after only a few hours.
7
Q
How does sleep disturbance affect the onset of psychotic symptoms?
A
Poor sleep can predict later occurrences of paranoia and hallucinations.
8
Q
Which neurotransmitter systems are hypothesised to link sleep disruption and depression?
A
Cholinergic and aminergic systems.
9
Q
What effect does acute sleep deprivation have on depression?
A
It can reduce depressive symptoms short-term in some patients.
10
Q
What is the minimum duration for a hypomanic episode?
A
4 days.
11
Q
What proportion of people with PTSD report nightmares?
A
Over 70%.
12
Q
What is the typical change in REM sleep in individuals with PTSD?
A
Increased REM density and fragmented REM sleep.
13
Q
Which condition is associated with increased sleep latency and reduced sleep efficiency?
A
Major depressive disorder.
14
Q
What is ‘REM density’?
A
The frequency of rapid eye movements during REM sleep; often increased in depression and PTSD.
15
Q
How does schizophrenia typically affect sleep architecture?
A
It is associated with decreased slow wave sleep and reduced sleep spindle density.
16
Q
What sleep disorder is commonly seen in people with bipolar disorder during euthymic periods?
A
Insomnia and sleep maintenance difficulties.
17
Q
What does CBT-I stand for?
A
Cognitive Behavioural Therapy for Insomnia.
18
Q
Which type of therapy targets maladaptive thoughts around sleep?
A
Cognitive therapy.
19
Q
What is imagery rehearsal therapy (IRT) used for?
A
Reducing nightmares, particularly in PTSD.
20
Q
How is actigraphy useful in sleep assessment?
A
It measures sleep-wake patterns using a wrist-worn device.
21
Q
What is the function of polysomnography?
A
A comprehensive recording of the biophysiological changes during sleep.
22
Q
What is the impact of sleep deprivation on bipolar disorder?
A
It can trigger manic or hypomanic episodes.
23
Q
What is the main characteristic of sleep in mania?
A
Reduced need for sleep without fatigue.
24
Q
How can insomnia influence the onset of depression?
A
It increases the risk of developing depression.
25
Which sleep disorder can mimic psychotic symptoms?
REM sleep behaviour disorder.
26
What is 'sleep misperception'?
A condition where individuals perceive their sleep as worse than it is objectively.
27
What is the gold-standard treatment for chronic insomnia?
CBT-I (Cognitive Behavioural Therapy for Insomnia).
28
How does PTSD affect sleep differently from depression?
PTSD typically presents with nightmares and hyperarousal, while depression shows early morning awakening and REM abnormalities.
29
What sleep disturbances are often seen in adolescents with depression?
Delayed sleep phase, hypersomnia, or insomnia.
30
Which mental health condition is uniquely associated with sleep-related hallucinations?
Schizophrenia.
31
What type of hallucinations are associated with narcolepsy?
Hypnagogic and hypnopompic hallucinations.
32
What does the hyperarousal model of insomnia propose?
That individuals with insomnia have heightened cognitive and physiological arousal.
33
How do sleep disturbances affect the severity of psychotic symptoms?
They exacerbate symptoms like paranoia, hallucinations, and cognitive dysfunction.
34
What are some behavioural techniques used in CBT-I?
Stimulus control, sleep restriction, relaxation training.
35
What are hypnagogic hallucinations?
Vivid sensory experiences occurring at sleep onset.
36
What are hypnopompic hallucinations?
Vivid sensory experiences occurring upon waking.
37
Which sleep stage is most commonly disrupted in PTSD?
REM sleep.
38
How can light therapy be beneficial in mood disorders?
It helps reset circadian rhythms and improve depressive symptoms.
39
Which neurotransmitter systems are involved in sleep-wake regulation and mood?
Serotonin, norepinephrine, dopamine, and acetylcholine.
40
What role does the HPA axis play in sleep disturbance?
Dysregulation contributes to hyperarousal and insomnia.
41
What is the recommended first-line treatment for chronic insomnia in comorbid psychiatric disorders?
CBT-I.
42
Which condition may present with sleep paralysis and hallucinations, sometimes mistaken for psychosis?
Narcolepsy.
43
How does social rhythm therapy help with bipolar disorder?
It stabilises daily routines and sleep-wake cycles.
44
What is a hallmark of REM sleep behaviour disorder (RBD)?
Acting out dreams due to loss of muscle atonia.
45
What symptom can act as a prodrome to manic episodes in bipolar disorder?
Decreased need for sleep.
46
What is paradoxical insomnia?
A form of insomnia where subjective sleep complaints are not reflected in objective measures.
47
What cognitive technique is used to challenge unhelpful beliefs about sleep?
Cognitive restructuring.
48
How does delayed sleep phase affect adolescents with depression?
It can worsen mood and school performance.
49
What are some common side effects of hypnotic medications?
Daytime drowsiness, tolerance, dependence, and cognitive impairment.
50
What is sleep hygiene?
A set of practices that promote healthy, consistent sleep patterns.
51
Which mental disorder is most frequently comorbid with insomnia?
Major depressive disorder.
52
What is the primary sleep complaint in schizophrenia?
Insomnia, including difficulty falling and staying asleep.
53
How does sleep deprivation affect emotional regulation?
It impairs the ability to manage emotional responses, increasing reactivity.
54
Why is sleep considered a transdiagnostic process in mental illness?
Because sleep disturbances are common across many psychiatric conditions and can influence their onset, maintenance, and treatment.
55
What is the recommended method for assessing sleep in psychiatric patients?
Clinical interview supplemented by sleep diaries or actigraphy.
56
Which condition features hyperarousal both during sleep and wakefulness?
Primary insomnia.
57
What does sleep restriction therapy involve?
Limiting time in bed to increase sleep drive and consolidate sleep.
58
What is a limitation of pharmacological treatments for insomnia in psychiatric populations?
They may cause dependence, tolerance, or interact with psychiatric medications.
59
How does REM sleep contribute to emotional memory processing?
REM sleep helps consolidate emotional memories and reduce emotional reactivity.
60
What are the two types of circadian rhythm sleep disorders commonly seen in psychiatric populations?
Delayed sleep-wake phase disorder and non-24-hour sleep-wake rhythm disorder.
61
What is one way that trauma can impact sleep architecture?
It can cause fragmented REM sleep and increased nocturnal awakenings.
62
Why is consistent sleep-wake timing important in mood disorders?
Irregular sleep timing can disrupt circadian rhythms and exacerbate mood symptoms.
63
Which population is most affected by the sleep phase delay during adolescence?
Teenagers, particularly those with mood disorders.
64
How does insomnia contribute to suicidal ideation?
It increases emotional dysregulation and hopelessness.
65
What is one proposed mechanism linking sleep disturbance to psychosis?
Sleep disruption impairs prefrontal cortex function and increases dopaminergic activity.
66
What sleep complaint is commonly seen during depressive episodes?
Early morning awakenings.
67
Which assessment tool measures perceived sleep quality over the past month?
The Pittsburgh Sleep Quality Index (PSQI).
68
What is the role of melatonin in sleep regulation?
It helps signal the body that it is time to sleep and regulate circadian rhythms.
69
Which two components are central to sleep onset?
Homeostatic sleep drive and circadian timing.
70
What intervention targets irregular social and sleep routines in bipolar disorder?
Interpersonal and social rhythm therapy.
71
What does it mean for sleep disturbance to be a 'transdiagnostic' feature in mental illness?
It means that disrupted sleep contributes to and is present across many mental health disorders, not just one specific condition.
72
How does network theory challenge traditional psychiatric classification?
It suggests that psychiatric symptoms are interlinked and can influence each other across diagnoses, rather than stemming from discrete, independent disorders.
73
Which RDoC domain includes sleep and circadian rhythms?
The arousal and regulatory systems domain.
74
Why might ramelteon be preferred over benzodiazepine receptor agonists in some psychiatric patients?
Because it has no abuse potential and is better suited for patients with substance use histories.
75
How does low-dose quetiapine help with sleep?
Its antihistaminergic properties promote sedation, although it carries risks like weight gain and QT prolongation.
76
Why must antidepressants be used cautiously in bipolar depression?
They may trigger mania or mood instability unless combined with a mood stabilizer.
77
What distinguishes cyclothymic disorder from bipolar disorder?
It involves chronic hypomanic and depressive symptoms that don’t meet full episode criteria, lasting at least 2 years.
78
What is the primary difference between bipolar I and bipolar II disorder?
Bipolar I includes full manic episodes; bipolar II involves hypomanic episodes without a history of mania or mixed episodes.
79
What are the main symptom clusters in PTSD diagnosis?
Re-experiencing, avoidance/numbing, increased arousal, and symptom duration over one month.
80
What PSG findings are typical in major depressive disorder?
Long sleep latency, short REM latency, reduced stage N3, increased REM density early in the night.
81
What are key functions of sleep in brain health?
Memory consolidation, emotional processing, brain restoration (e.g., glymphatic clearance).
82
What are some effects of sleep loss?
Impaired emotional regulation, increased anxiety, reduced working memory, increased pain sensitivity, immune and endocrine dysfunction.
83
Which neurotransmitters are involved in sleep-wake regulation and mental health?
Serotonin, norepinephrine, dopamine, acetylcholine.
84
Which antidepressants are known to improve sleep?
Trazodone and mirtazapine.
85
Which antidepressants may worsen sleep symptoms?
SSRIs and venlafaxine (due to insomnia, restless legs syndrome, or bruxism).
86
Which antipsychotics are associated with better sleep onset and continuity?
Clozapine and olanzapine.
87
How can some medications contribute to obstructive sleep apnoea?
By causing weight gain which increases apnoea risk.
88
What are standard tools for sleep assessment?
Polysomnography, actigraphy, MSLT, and subjective sleep questionnaires.
89
Which depression scales are commonly used in psychiatric sleep research?
PHQ-9, HAMD, and MADRS.
90
What is mediation analysis used for in sleep research?
To show that sleep disruption may causally contribute to psychiatric symptoms.
91
How does network theory relate to sleep and mental health?
It positions sleep as a central, interacting symptom node across disorders.
92
Which RDoC domain includes sleep and circadian rhythms?
The arousal and regulatory systems domain.
93
What did the OASIS trial show about treating insomnia?
That it reduced psychotic experiences even when not targeting psychosis directly.
94
What has sleep loss been shown to induce in healthy participants?
Paranoia, hallucinations, and cognitive disorganisation.
95
In veterans with PTSD, what was the impact of sleeping less than 4 hours?
It predicted persistence of PTSD symptoms.
96
What is wake therapy in depression?
Sleep deprivation therapy that may produce short-term mood elevation but often leads to rapid relapse.
97
How does CBT-I compare to antidepressants in treating insomnia with comorbid depression?
CBT-I is equally or more effective and may reduce depressive symptoms even when insomnia is targeted.
98
What is imagery rehearsal therapy (IRT) used for and how effective is it?
IRT is used for PTSD-related nightmares and has an effect size around 1.1 for reducing overall PTSD symptoms.
99
What is a key caution when using prazosin for nightmares in PTSD?
It can cause first-dose hypotension, requiring cautious titration.
100
What symptom often remains after remission from depression and predicts relapse?
Residual insomnia.
101
How does insomnia affect depression relapse risk?
Persistent insomnia increases recurrence risk by 1.8 to 3.5 times.
102
What proportion of patients with schizophrenia report sleep problems before delusions appear?
Approximately 75%.
103
What PSG findings are typical in major depressive disorder?
Increased sleep latency, decreased REM latency, increased REM density, reduced stage N3.
104
What diagnoses should be considered when hypersomnia is a prominent complaint?
Obstructive sleep apnoea or narcolepsy.
105
When insomnia is the main complaint, what differential diagnoses should be ruled out?
Psychophysiological insomnia or poor sleep hygiene.
106
What is a limitation of actigraphy in psychiatric populations?
It may be less accurate in sedentary individuals, such as those with psychosis.
107
What is a mnemonic to remember the PTSD symptom clusters?
'A RARE NIGHT' – Avoidance, Re-experiencing, Negative thoughts, Increased arousal, Time >1 month.
108
What is a mnemonic to recall symptoms of a manic episode?
'DIGFAST' – Distractibility, Indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep deficit, Talkativeness.
109
A 25-year-old reports chronic difficulty falling asleep, increased energy, pressured speech, and hasn't slept in 3 days but feels rested. What is the likely diagnosis?
Bipolar I disorder – current manic episode.
110
A 35-year-old veteran experiences vivid nightmares, avoids reminders of trauma, and startles easily. Symptoms have persisted for 3 months. What is the likely diagnosis?
Post-traumatic stress disorder (PTSD).
111
A teenager struggles with late sleep onset, excessive daytime sleepiness, and poor academic performance. What sleep-related diagnosis should be considered?
Delayed sleep-wake phase disorder.
112
A 50-year-old with schizophrenia reports increased hallucinations and disrupted sleep. What role might sleep be playing?
Sleep disruption is likely exacerbating positive psychotic symptoms.
113
Why is insomnia considered a risk factor for suicide?
It increases hopelessness and emotional dysregulation.
114
What symptom may act as a prodrome to relapse in bipolar disorder?
Reduced need for sleep.
115
Which treatment is most appropriate for persistent nightmares in PTSD?
Imagery rehearsal therapy (IRT).
116
What distinguishes sleep misperception from insomnia?
Objective sleep is normal in misperception, but patients report poor sleep quality.
