DSM criteria for Insomnia 

At least 1 month causes impairment

Sleep is unrefreshing and nonrestorative; inability to fall asleep a/o stay asleep

Acute Insomnia

Last a few days, transient, only a few nights a week, 1-2 wks in duration 

Chronic Insomnia

Insomnia lasts longer than 3 weeks 

Hypnogogic

During narcolepsy, hallucination while falling asleep, Going into sleep

BSz for long term or short term

Short term

*only a week or two

EtOH effect on sleep 

Hypersomnolence (too much sleep)/insomnia (inability to sleep)

Cause hypersomnolence

alcohol, anti-HTN, sedative-hypnotics, anxiolytics, antipsychotics, TCAs, opioids, analgesics, cannabis

Cause Insomnia 

Sleep Terror

pt demographics

3-6 yrs old

M > F

usually resolves by adolescence 

no part of major psych problem

Child characteristic during sleep terror episode 

Scared, screams, stares, dilated pupils, sweating, rapid pulse, hyperventilation

Tx for Sleep Terror 

• education and reassurance to parents
• waking person b/f incidence NOT during
• Pharm meds if frequent or poss. danger --> diazepam (dec's delta sleep) 

Assoc. psych D/Os of Obstructive Sleep Apnea

1. MDD
2. Dysthymic DO
3. Panic DO
4. Dementia 

Cataplexy 

Sudden Loss of Postural tone w/o LOC. Typically triggered by some emotional stimulus 

Narcolepsy 

Irresistible attacks of refreshing sleep daily over 3 mo; includes cataplexy and recurrent intrusion of REM 

Somnambulism 

Repeated Episodes of arising and engaging in motor activities while asleep 

Somnambulism 

Last up to 30 min, occur 1-3 hrs after onset of sleep, occur during stage 3 & 4 delta (non-rem) sleep

Somnambulism 

Pt characteristic 

Onset btw 4-8 yo

Peaks @ 12 yo

Most remit by age 15

MDD, Dx'd using a sleep study 

EEG changes

Prolonged sleep latency 

Increased wakefulness

Early morning awakening

Shortened REM latency 

Reduced Stages 3 and 4

Redistribution of REM to the first 1/2 of the night 

Psych state most highest at risk for SUICIDE

Hopelessness

Hopelessness

Degree to which a person holds negative expectations about the future 

Best predictor of future attempts 

Hx of past attempts 

Annual Suicide rate 

10.4/100, 000 ppl

Psych dx of a person most likely to complete suicide 

Mood D/O; most commong: Bipolar 

Clues to physician suicide risk 

Mood d/o, substance dependence, Self-prescription

How is a physician most likely to commit suicide?

Overdose

Medical specialties most at risk for suicide 

1) Psych, 2) Opthalmology, 3) Anesthesiology

What is the prototype of a person who commits suicide

Elderly, anglo male w/ substance dependence, owns a gun and have experienced a recent loss

What are the 3 "I"s of suicidal behavior

Intolerable, Inescapable, Interminable

Somatization Disorder 

polysymptomatic, recurrent, begins early in life (must begin before age 30), fluctuating, and rarely remits 

In somatization D/O what are the four areas pt must have sx of: 

1. GI
2. Sexual
3. Pseudoneurological
4. Pain 

Somatization D/O

Tx? 

Management, not a cure, schedule re appts, cautious use of med WUs

Undifferentiated Somatoform Disorder 

One or more unexplained physical complaints that persist for at least 6 months 

Conversion Disorder 

Sx or deficits affecting voluntary motor or sensory fxn suggest a neurological or other medical condition

Conversion D/O course 

btw ages 10 and 35 

Acute Onset

Self-limited and does not lead to physiological changes: such as atrophy 

Conversion D/O

Good px factors 

acute onset, identifiable stressors, promptness of treatment, and above average intelligence

paralysis, aphonia, and blindness 

Conversion D/O 

Bad px factors 

Tremor and Seizures

Conversion D/O tx

Avoid direct confrontation, reassure, and relax them, make suggestions, be supportive

Pain D/O

distressing/incapacitaing pain in which psych factors play a big role 

Pain D/O assoc features 

unemployment, diability, discouragement, opoid, sedative/hypnotic use, dependence/alcohol, 

Pain + Depression or CA =↑risk of suicide

Hypochondriasis durations 

At least 6 mos 

Hypochondriasis Assoc. Feats 

hx @ great length and in detail, 'doctor shopping', deterioration of DP relationship, serious illness esp. in childhood, experience w/ disease/death in family 

Hypochondriasis Tx 

Management is the goal, consolidate care under single Dr, SSRIs can help 

BDD

Assoc. Features 

freq. checking in mirror, pts use special lighting, repeated requests for reassurance, avoid social activities that lead to social isolation

Tx for BDD 

SSRIs and Cognitive Behavioral Therapy 

Onset of BDD 

Adolescence 

* can be dx late d/t reluctance of pt to disclose

On what Axis does somatization D/O go? 

Axis I

On what axis do physical sx of Somatization D/O go? 

Axis III

On what axis do Psychosocial stressors go? 

Axis IV

How do you manage somatization? 

As an expression of emotional discomfort & psychosocial stress in the physical language of bodily sx

Somatoform, what kind of gain? 

Unconscious primary gain

Facticious, what kind of gain? 

Conscious primary gain

Malingering, what kind of gain? 

Conscious Secondary gain

Duration and Onset of Voyeurism? 

for at least 6 mos, onset before age 15

Onset and duration of Fetishism? 

begins in adolescence and tends to be chronic

Frotterism

what ages? 

15-25 yo

Exhibitionism

onset and duration? 

Usually before 18, diminishes after 40

Pedophiles

*person demographics

Person is at least 16 and 5 years older than the child

What are the four stages of the Sexual Cycle? 

1. desire
2. excitement/arousal
3. orgasm
4. resolution

Male Orgasmic D/O

Delay in, or absence of orgasm following nl sexual excitement phase based on what is reasonable to expect for age and stimulation

Tx for Male Orgasmic D/O

Sensate focusing for deconditioning, start w/ self stimulation and progress to partner

Premature Ejaculation

*Most common male sexual dysfxn

Orgasm and ejaculation w/ minimal stimulation before, during, or shortly after penetration and before partner wishes it

Tx for Male Sexual Dysfxn

Squeeze technique, stop-start method, meds (SSRI)

Real Life Test

12 mos living in desired gender role in gender identity disorder