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Insomnia
What causes insomnia, and what to do to fix it. Read more...
Sleep and Anxiety Disorders in the Elderly
Sleep, depression, and fatigue
It is not an accident that sleep problems and depression are closely linked. This article presents the theory that too much REM sleep can cause depression, and the hypothesis that in certain circumstances, depressive symptoms are essential for survival. Read more...
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Dreams and Nightmares
All of us have dreams, some of which may be disturbing or frightening. If our fear, horror, or distress is intense, these dreams qualify as nightmares.
Many of us, however, rarely remember our dreams. What seems to be important in recalling a dream or nightmare is waking during that dream or shortly afterwards. Therefore, to minimize the impact of nightmares, one approach would be to ensure a more sound sleep so that the likelihood of waking during sleep is minimized.
Although medication can lead to a deeper, more sound sleep, this effect tends to wear off with repeated usage. Longer-lasting approaches to improving sleep quality involve changing behavior. Probably the most effective is spending less time in bed (variously called sleep restriction or sleep compression). If one induces mild sleep deprivation, sleep will be deeper, the likelihood of waking during a nightmare will be less, and thus nightmares will be less disruptive and disturbing.
Most dreams are believed to occur during REM sleep. Thus, it would seem reasonable that medications that suppressed REM sleep would also suppress dreaming. Many antidepressant medications, as well as other effective antidepressant treatments including exercise, electroconvulsive therapy, light, and sleep deprivation, suppress REM sleep quite powerfully, and some researchers believe that REM sleep suppression is what causes the improvement in depression. That being said, antidepressant medication seems to have a variable effect on dreams: while it may suppress the number of dreams, the intensity of the dream recall may be increased. Perhaps this might be due to the arousing effects of some antidepressants which tends to worsen sleep quality.
Prazosin is an adrenergic agent that seems to inhibit the arousing effects of norepinephrine; there are several studies showing that this medication reduces nightmares in combat veterans with PTSD.
Vitamin B12 (Cobalamin)
Management of Manic States
Here are some guidelines and suggestions for managing manic states in patients. Remember that 5% of the population is believed to have bipolar spectrum disorder, so manic states are frequently found in medical patients. Common triggers are sleep deprivation and corticosteroids. Read more...
Omega-3 Fatty Acids
Here is a link to a presentation on omega-3 fatty acids and their importance in psychiatry as well as in other aspects of our health. Presentation for Internet Explorer and Presentation for other browsers (eg, FireFox, NetScape, Safari)
Documentation of Symptoms, Signs, and Behaviours in Psychiatry
In dealing with acutely ill psychiatric inpatients, we are concerned primarily with behaviours (ie what the patient says and does) as well as with what the patient complains of (symptoms) and what we can observe (signs). Here's a guide to what to write down in the patient chart, organized either by syndrome or by type of treatment.
Low-carb diets
My wife Helen and I have been following an Atkins low-carb diet since 1995, in order to prevent weight gain and to avoid type II diabetes which runs in both our families. The decision to follow this diet is based on an ongoing perusal of the medical literature in this area.
Type II diabetes and reduced-carbohydrate dieting
The Paradoxical Approach in Psychotherapy
These are course notes from my psychotherapy training at the Jewish General Hospital, 1981-1982
Personality Disorders
How I explain this diagnosis to a patient.
Hypotheses and Ideas
A collection of ideas and hypotheses that need further work and development. Your comments and input are welcome!
