Seven Mechanistically Different Classes of Medications Can Be Used to Treat Insomnia and Related Sleep Disorders.

IF 1.3 4区 医学 Q3 PSYCHIATRY
Sheldon H Preskorn
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Abstract

This column reviews the neurobiology of the sleep-wake cycle as it is currently known, the 7 classes of currently available sleep-enhancing medications, and how their mechanisms of action relate to the neurobiology of sleep. Clinicians can use this information to select medications for their patients, which is particularly important because some patients respond to some of these medications but not others, or tolerate some but not others. This knowledge can also help the clinician switch among classes when a medication that was initially efficacious begins to fail a patient. It can also prevent the clinician from cycling through all of the members of a single medication class. Such a strategy is unlikely to be helpful for a patient except in the situation in which pharmacokinetic differences among members of the medication class result in some agents in that class being helpful for a patient who has either a delayed onset of action or undesirable carry-over effects with other agents in that class. An understanding of the classes of sleep-enhancing medications highlights the importance of knowing the neurobiology that underlies a psychiatric illness. The activity of a number of neurobiological circuits, such as the one reviewed in this column, has now been well established, while work to understand others is still at a much earlier stage. Psychiatrists who gain an understanding of such circuits will be better able to provide effective care for their patients.

七种机制不同的药物可以用来治疗失眠和相关的睡眠障碍。
本专栏回顾了目前已知的睡眠-觉醒周期的神经生物学,目前可用的7类睡眠增强药物,以及它们的作用机制与睡眠神经生物学的关系。临床医生可以利用这些信息为他们的病人选择药物,这一点尤其重要,因为有些病人对某些药物有反应,但对另一些药物没有反应,或者对某些药物耐受,但对其他药物不耐受。当一种最初有效的药物开始对病人无效时,这些知识也可以帮助临床医生在不同的班级之间切换。它还可以防止临床医生循环使用单一药物类别的所有成员。这种策略不太可能对患者有帮助,除非在药物类别成员之间的药代动力学差异导致该类药物中的某些药物对具有延迟起效或与该类其他药物产生不良遗留效应的患者有帮助。对增强睡眠药物种类的了解凸显了了解精神疾病背后的神经生物学的重要性。许多神经生物学回路的活动,如本专栏所回顾的,现在已经很好地建立起来,而了解其他回路的工作仍处于早期阶段。了解这种回路的精神病学家将能够更好地为他们的病人提供有效的治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.30
自引率
10.50%
发文量
159
审稿时长
>12 weeks
期刊介绍: Journal of Psychiatric Practice® seizes the day with its emphasis on the three Rs — readability, reliability, and relevance. Featuring an eye-catching style, the journal combines clinically applicable reviews, case studies, and articles on treatment advances with practical and informative tips for treating patients. Mental health professionals will want access to this review journal — for sharpening their clinical skills, discovering the best in treatment, and navigating this rapidly changing field. Journal of Psychiatric Practice combines clinically applicable reviews, case studies, and articles on treatment advances with informative "how to" tips for surviving in a managed care environment.
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