慢性失眠及安眠藥物的使用ppt(編輯修改稿)
2025-03-23 10:45 本頁(yè)面
【文章內(nèi)容簡(jiǎn)介】 idents – Seven times higher rate of work accidents in insomniacs than in good sleepers Metlaine A, et al. Industrial Health. 2023。43:11–19. Therapeutic Goals in Treating Insomnia Sleep Onset Sleep Maintenance ? Number of awakenings ? Duration of awakenings ? Time to fall asleep Sleep Duration ? Total sleep time ? Alertness ? Functioning ? Vitality NextDay Functioning Initial Screening ? Nature of plaint ? Daytime consequences ? Frequency ? Duration ? Precipitating events ? Exacerbating factors ? Sleepwake schedule ? Other nocturnal symptoms ? Associated behaviors ? Cognitions ? Previous treatments ? Psychiatric disorders ? Substance abuse ? Conitant medications ? Medical/neurological illness ? Other sleep disorders Assessment of Insomnia Additional History for Persistent Insomnia Chronic Insomnia: Treatment Considerations TREATMENT Cognitive Behavioral Therapy (CBT) Benzodiazepine Receptor Agonist ? Benzodiazepines ?NonBenzodiazepines Antidepressants* Atypical Antipsychotics* OTC Alternative Meds: Melatonin and Herbal Remedies *Not FDA approved for treatment of insomnia NIH Statement. Sleep. 2023。28:10491057. Treat Insomnia with Drugs Before treating insomnia with drugs, consider: ? Is the underlying cause being treated ( depression, mania, breathing difficulties, urinary frequency, pain, etc.)? ? Are other drugs being given at appropriate times (. stimulating drugs in the morning, sedating drugs at night)? ? Are the patient’ s expectations of sleep realistic ( sleep requirements decrease with age)? ? Have all sleep hygiene approaches (see table below) been tried? Guidelines for Prescribing Hypnotics ? Use the lowest effective dose ? Use intermittent dosing (alternate nights or less) where possible ? Prescribe for shortterm use (no more than 4 weeks) in the majority of cases ? Discontinue slowly ? Be alert for rebound insomnia/withdrawal symptoms ? Advise patients of the interaction with alcohol and other sedating drugs ? Avoid the use of hypnotics in patients with respiratory disease or severe hepatic impairment and in addictionprone individuals Prescribing Guidelines, The Maudsley, 2023 The efficacy and safety of drug treatments for chronic insomnia in adults: a metaanalysis of RCTs J Gen Intern Med. 2023 Sep。22(9):133550. Epub 2023 Jul 10 ? BACKGROUND: Hypnotics have a role in the management of acute insomnia。 however, the efficacy and safety of pharmacological interventions in the management of chronic insomnia is unclear. ? OBJECTIVE: The objective of this paper is to conduct a systematic review of the efficacy and safety of drug treatments for chronic insomnia in adults. ? DATA SOURCES: Twentyone electronic databases were searched, up to July 2023. ? STUDY SELECTION: Randomized doubleblind, placebocontrolled trials were eligible. Quality was assessed using the Jadad scale. Data were pooled using the random effects model. ? DATA SYNTHESIS: One hundr
教學(xué)課件相關(guān)推薦
鄂ICP備17016276號(hào)-1