Chapter 13 Anxiolytics Hypnotics 抗焦虑药和催眠药 2015年5月
Chapter 13 Anxiolytics & Hypnotics 抗焦虑药和催眠药 2015年5月
§1 Introduction 失眠(insomnia)◆属于症状而非独立疾病；◆睡眠质量下降 失眠分类：按病程长短=①暂时性失眠；②短期失眠；③慢性失眠 Mr.Insomnia 按病因=①原发性失眠症；②继发性失眠症 睡眠呼吸暂停综合征 环境因素强光、噪声 年龄因素 生活习惯因素睡前饮咖啡 药物咖啡因、阿托品 躯体因素咳嗽、疼痛 精神疾病焦虑症、抑郁症 精神心理因素焦虑、紧张
失眠 (insomnia) 属于症状而非独立疾病;睡眠质量下降 失眠分类: 按病程长短= ①暂时性失眠; ②短期失眠; ③慢性失眠 按病因= ① 原发性失眠症; ② 继发性失眠症 §1 Introduction 睡眠呼吸暂停综合征 环境因素 强光、噪声 生活习惯因素 睡前饮咖啡 躯体因素 咳嗽、疼痛 精神心理因素 焦虑、紧张 精神疾病 焦虑症 、抑郁症 药物 咖啡因、阿托品 年龄因素
Mr.Anxiety Anxiety is the sense of threat that danger and bad events is coming Anxiety can be thought of as consisting of anxious thinking plus nervous tension Anxious moods may begin with a worry or panicky feeling and last for hours or even days anxiety disorders Causes of Anxiety 广泛性焦虑障碍(GAD)》 1)Medical 杜交焦虑障碍(SP) a) Respiratory 惊恐障碍(PD)】 b) Endocrine c) Cardiovascular 强迫障得(OCD) d) Metabolic 创伤后应激障得(PTSD) e)Neurologic 2)Drug-Induced Cocaine,Ephedrine,L-Dopa
Mr. Anxiety Anxiety is the sense of threat that danger and bad events is coming Anxiety can be thought of as consisting of anxious thinking plus nervous tension Anxious moods may begin with a worry or panicky feeling and last for hours or even days anxiety disorders 广泛性焦虑障碍（GAD） Causes of Anxiety 社交焦虑障碍（SP） 惊恐障碍（PD） 强迫障碍（OCD） 创伤后应激障碍（PTSD） …… 1) Medical a) Respiratory b) Endocrine c) Cardiovascular d) Metabolic e) Neurologic 2) Drug-Induced Cocaine, Ephedrine, L-Dopa……
Anxiolytics(抗焦虑药)：the medicine for relief anxiety,tense and dread Sedatives(镇静药)：the medicine for reducing activity or excitement and making some degree of drowsiness ypnotics(催眠药)the drugs used to induce drowsiness or sleep or to reduce psychological excitement or anxiety
Anxiolytics (抗焦虑药）：the medicine for relief anxiety, tense and dread Sedatives（镇静药）：the medicine for reducing activity or excitement and making some degree of drowsiness Hypnotics （催眠药) the drugs used to induce drowsiness or sleep or to reduce psychological excitement or anxiety
Normal y Relief from Anxiety Therapeutic dose SEDATION (Drowsiness/decrease reaction time) 多 HYPNOSIS 轴 Confusion,Delirium(谵妄)，Ataxia(共济失调) 业 Surgical Anesthesia Depression of respiratory and vasomotor center in the brainstem COMA DEATH
Normal Relief from Anxiety _________ _________________ SEDATION (Drowsiness/decrease reaction time) HYPNOSIS Therapeutic dose Confusion, Delirium (谵妄), Ataxia (共济失调) Surgical Anesthesia Depression of respiratory and vasomotor center in the brainstem COMA DEATH
Respiratory Depression BARBS Coma BDZs Ataxia Hypnosis ETOH Sedation Anxiolytic DOSE
Respiratory Depression Coma Ataxia BARBS BDZs Sedation Anxiolytic DOSE Hypnosis ETOH
Respiratory Depression BARBS Coma BDZs Ataxia Hypnosis Sedation 0 Anxiolytic DOSE
Respiratory Depression Coma Ataxia BARBS BDZs Hypnosis Sedation Anxiolytic DOSE
Physiological sleep pharmacological sleep 1.non rapid eye movement,NREM 2.rapid eye movement sleep,REM Sleep cycle NREM眼球不作转动，呼吸平稳，心率↓， BP↓，代谢↓，全身肌肉松弛 —与肌肉组织休整，恢复体力疲劳有关 REM眼动活跃、多梦、呼吸快、心率快、 血压高、骨骼肌极度松弛 与神经系统发育、记忆、恢复脑力疲劳有关
1. non rapid eye movement, NREM 2. rapid eye movement sleep, REM Sleep cycle NREM：眼球不作转动, 呼吸平稳，心率↓， BP↓，代谢↓，全身肌肉松弛 Physiological sleep & pharmacological sleep BP↓，代谢↓，全身肌肉松弛 ——与肌肉组织休整，恢复体力疲劳有关 REM 眼动活跃、多梦、呼吸快、心率快、 血压高、骨骼肌极度松弛 ——与神经系统发育、记忆、恢复脑力疲劳有关
Blue Bars: 0 2hr图hrs4r85hr图6hrs7rs Time after falling aslee吧 REM Pharmacological sleep 一般镇静催眠药缩短REM,使NREM/REM交替数增 多，总睡眠时延长 长期用药停药后出现“反跳”(bounce)现象，REM 频率增加，时间延长，患者主诉多梦、恶梦，无法停 药，药物滥用(abuse),产生依赖和成瘾(addiction)
Pharmacological sleep Blue Bars: REM 一般镇静催眠药缩短REM，使 NREM/REM交替数增 多，总睡眠时延长 长期用药停药后出现“反跳” (bounce)现象，REM 频率增加，时间延长，患者主诉多梦、恶梦，无法停 药，药物滥用(abuse)，产生依赖和成瘾 (addiction)
Develop tolerance to higher doses The Increase vicious circle of dose and dependence on Increase dependence sleeping pills. dose Start taking on drug Because of the body's ability to sleeping develop tolerance to pills drugs,using Develop Suffer from sedatives routinely to“cure"insomnia tolerance to insomnia can lead to a vicious drug:pills Begin to circle of escalating begin to feel dependency as lose their dependent larger and larger doses of the effective on sedatives sedative are needed ness to fall to produce the same asleep effect. Use sleep medication regularly