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Insomnia Insomnia
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General Characteristics of Treatment for an Insomnia Complaint General Characteristics of Treatment for an Insomnia Complaint
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Behavioral and Psychological Treatments for Insomnia Behavioral and Psychological Treatments for Insomnia
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General Rationale General Rationale
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Evidence for Efficacy and Effectiveness Evidence for Efficacy and Effectiveness
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Expectations and Risks Expectations and Risks
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Pharmacological Treatments for Insomnia Pharmacological Treatments for Insomnia
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The Ideal Hypnotic, Alcohol, and the Not-So-Ideal Historical Context The Ideal Hypnotic, Alcohol, and the Not-So-Ideal Historical Context
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Evidence of Efficacy and Effectiveness Evidence of Efficacy and Effectiveness
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Expectations and Risks Expectations and Risks
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Restless Legs Syndrome: a Neurophysiological Disturbance Resembling Insomnia Restless Legs Syndrome: a Neurophysiological Disturbance Resembling Insomnia
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Description and Differential Diagnosis Description and Differential Diagnosis
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Evidence for Efficacy and Effectiveness Evidence for Efficacy and Effectiveness
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Expectations and Risks Expectations and Risks
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Case Presentation Case Presentation
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Comments About Case Comments About Case
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Conclusion Conclusion
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References References
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22 Treatments for Insomnia and Restless Legs Syndrome
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Published:February 2007
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Abstract
Treating a chief complaint of inability to sleep is a core problem in psychiatric practice, together with treating other comorbid physical or mental disorders. The treatments for insomnia and restless legs syndrome (RLS) are well within the scope of psychiatric practice. Treatments for insomnia have been controversial over the past several decades, with practice patterns being driven partly by nonmedical influences operating in the setting of limited data. In recent years, the need to consider both cognitive-behavioral and pharmacological approaches together has become more apparent, with less insistence on strict either-or approaches. Clinical trial data clearly point to the efficacy of cognitive-behavioral approaches such as stimulus control, bed restriction, and related approaches. The literature on the short-term efficacy of benzodiazepine receptor agonists (BZRAs) as hypnotics has strengthened. There is a great amount of use of non-BZRAs as hypnotics, even though there are limited studies supporting their use. For RLS, the use of low-dose dopamine agonists has been substantially supported in Type 1 clinical trials. For iron-deficiency-induced RLS, iron replacement is strongly encouraged. Approaches such as using benzodiazepines are second-line treatments. Limited support for the use of gabapentin and carbamazepine is available, but the centuries-old approach of using opiates for the treatment of RLS remains a third-line approach.
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