Non-pharmacological management of chronic insomnia in primary care.
Non-pharmacological management of chronic insomnia in primary care.
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初级保健中慢性失眠的非药物治疗。
DOI：
10.3399/bjgp08x264018
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
C. Espie
中科院分区：
文献类型：
--
作者：
B. McKinstry;P. Wilson;C. Espie
在初级保健咨询中，五分之一的患者有失眠症1，失眠在老年人中的患病率从10%-12%到20%以上。2失眠是精神疾病最常见的症状，无论年龄、性别或种族。3失眠比担忧更常见，是焦虑或抑郁症状的两倍。失眠通常与白天警觉性和工作效率降低、生活质量下降、人际关系受损和健康不良增加有关。4失眠是抑郁症最大的、有可能治愈的风险因素，也是事故的主要原因。
持续性失眠对大多数全科医生来说是一个挑战。这个问题往往没有被认识到，管理通常也不令人满意。7许多医生通过开“标签外”的催眠药或镇静抗抑郁药来管理这种情况，这两种药物都没有表现出超过边际的效果。8几乎没有证据表明新一代催眠药改善了持续性失眠的管理。9催眠药的不良反应很常见10，一项对老年患者与药物有关的住院调查表明，高达10%的可能是由于苯二氮类药物。11尽管许多人倾向于非药物方法，如果有有效的方法，患者仍然经常要求使用催眠药，停药往往给医生和患者带来…困难。
One-fifth of patients consulting in primary care have insomnia1 and prevalence in the population ranges from 10–12% to over 20% in older adults.2 It is the most common symptom of mental illness, regardless of age, sex, or ethnic group.3 Insomnia is more common than worry, and twice as common as anxiety or depressive symptoms. Typically, insomnia is associated with reduced daytime alertness and productivity, poorer quality of life, impaired relationships, and increased ill health.4 It is the largest, potentially treatable, risk factor for depression5 and is a major cause of accidents.6
Persistent insomnia presents a challenge for most GPs. The problem is often unrecognised and management is generally unsatisfactory.7 Many doctors manage the condition with ‘off-label’ prescribing of hypnotic or sedative antidepressant drugs, neither of which have demonstrated more than marginal efficacy.8 There is little evidence that the new generation of hypnotics has improved the management of persistent insomnia.9 Adverse effects of hypnotics are common10 and an investigation of drug-associated hospital admissions among older patients has shown that up to 10% may be due to benzodiazepines.11 Despite the fact that many would prefer a non-pharmaceutical approach if an effective one were available, hypnotics are nevertheless often requested by patients and withdrawal often poses difficulties for doctors and patients as a …
影响因子：
5.6
作者：
T. Roth;S. Ancoli-Israel
通讯作者：
T. Roth;S. Ancoli-Israel
初级保健患者的失眠。
影响因子：
5.6
作者：
Shochat,T;Umphress,J;Israel,AG;Ancoli-Israel,S
通讯作者：
Ancoli-Israel,S