gc08-12 - Managing Insomnia and Anxiety In the Elderly...

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1 Managing Insomnia and Anxiety In the Elderly Francisco Fernandez, M.D. Professor and Chair USF Health Department of Psychiatry Insomnia - Objectives ± To review the new research findings of insomnia in the elderly ± To discuss the implications for improving clinical practice
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2 Barriers & Changes In Attitude Insomnia is associated with significant impairment in function and quality of life Chronic insomnia occurs in the context of med-psych disorders Other Treat insomnia as well as other disorder(s): improvements in insomnia may result in improvements in other disorder(s) Hypnotics should generally be used only for short-term treatment Chronic insomnia exists and merits treatment Treat the primary disorder Treatment Insomnia is a disorder, typically comorbid with other disorders Insomnia is a symptom, not a primary disorder Definition NIH – 2005 NIH – 1983 Myth 1: Insomnia is Sleep Deprivation ± Sleep deprivation – Adequate ability to sleep – Inadequate opportunity ± Insomnia patients – Inadequate ability to sleep – Adequate opportunity
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3 Myth 2: Insomnia Æ Symptom ± Unique set of physiologic changes ± Associated with impairment in function and quality of life Insomnia Is Associated With Decreased Cortical Activity Thomas M et al. J Sleep Res . 2000;9:335-352. 18 FDG PET Study of Healthy, Sleep-Deprived Adults, Showing Decreased Metabolism in the Thalamus, Prefrontal Cortex, and Inferior Parietal Cortex FDG, fluorodeoxyglucose; PET, positron emission tomography Prefrontal cortex Inferior parietal cortex Occipital cortex Thalamus
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4 Insomnia Definition (Research Diagnostic Criteria) A. The individual reports one or more of the following sleep-related complaints: 1. Difficulty initiating sleep 2. Difficulty maintaining sleep 3. Waking up too early, or 4. Sleep that is chronically nonrestorative or poor in quality B. The above sleep difficulty occurs despite adequate opportunity and circumstances for sleep Edinger JD et al. Sleep . 2004;27:1567-1596. C. At least one of the following forms of daytime impairment related to the nighttime sleep difficulty is reported by the individual: 1. Fatigue/malaise 2. Attention, concentration, or memory impairment 3. Social/vocational dysfunction or poor school performance 4. Mood disturbance/irritability 5. Daytime sleepiness 6. Motivation/energy/initiative reduction 7. Proneness for errors/accident at work or while driving 8. Tension headaches, and/or GI symptoms in response to sleep loss 9. Concerns or worries about sleep Edinger JD et al. Sleep . 2004;27:1567-1596. Insomnia Definition (Research Diagnostic Criteria)
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5 Foley DJ et al. Sleep . 1995;18:425-432. Insomnia Complaints Prevalence within Elderly (n=9,282) NIA Multicenter Study – Interview Data 0% 10% 20% 30% 40% Symptoms Suggesting Chronic Insomnia No Sleep Complaints 29 12 More prevalent among those with depressed mood, respiratory symptoms, fair to poor health, physical disability Functional Impairment and Health Services Cost for Elderly Patients with and without Insomnia Simon GE, VonKorff M. Am J Psychiatry. 1997;154:1417-1423.
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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gc08-12 - Managing Insomnia and Anxiety In the Elderly...

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