Expert Opinions and Consensus Recommendations for the Evaluation and Management of Insomnia in Clinical Practice: Joint Statements of Five Italian Scientific Societies

Frontiers in Psychiatry

卷:11

Giuseppe Plazzi¹  Antonino Minervino²  Lino Nobili⁴  Giovanni Biggio⁵  Luigi Grassi⁷  Eugenio Aguglia⁸  Claudio Mencacci⁹  Paolo Girardi¹⁰  Roberto Brugnoli¹⁰  Mario Amore¹¹  Laura Palagini¹²  Raffaele Manni¹⁴ 

[1] 0IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy;

[2] 1Department of Psychiatry, UOP 25 ASST-Parma, Parma, Italy;

[3] 2Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy;

[4] 3Child Neuropsychiatry, IRCCS Istituto G. Gaslini, Genoa, Italy;

[5] 4Department of Life and Environmental Sciences, University of Cagliari, Cagliari, Italy;

[6] Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy;

[7] Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy;

[8] Department of Experimental and Clinical Medicine, Psychiatric Clinic University Hospital “Gaspare Rodolico”, University of Catania, Catania, Italy;

[9] Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy;

[10] Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Sapienza University, Rome, Italy;

[11] IRCCS Ospedale Policlinico San Martino, Genoa, Italy;

[12] Psychiatry Division, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy;

[13] Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy;

[14] Unit of Sleep Medicine and Epilepsy, IRCCS Mondino Foundation Pavia, Pavia, Italy;

关键词: insomnia;    evaluation;    treatment;    consensus recommendations;    expert opinions;    clinical practice;   

DOI  :  10.3389/fpsyt.2020.00558

来源: DOAJ

【 摘 要 】

BackgroundInsomnia is the most commonly reported sleep problem in industrialized countries worldwide being present in about 36.8% of the general population. In Italy, such a percentage seems to be even higher. Although insomnia can be an independent disorder, it is most frequently observed as a comorbid condition and may precipitate, exacerbate, or prolong a broad range of comorbid conditions including physical and mental illnesses. Evaluating and targeting insomnia in the Italian clinical practice should be a priority.MethodsThe present expert options and recommendations development process was based on the RAND/UCLA Appropriateness Method for conceptualizing, designing, and carrying out the appropriateness of procedures for the diagnosis and treatment. Only available options in Italy were taken into considerations.ResultsWe evaluated 12 international guidelines and 12 most recent systematic reviews for insomnia evaluation and treatment produced in the last 10 years.ConclusionsOur findings suggested that symptoms of insomnia must always be assessed in the Italian clinical practice by evaluating nocturnal and daytime symptoms, comorbid conditions and lifestyle. In a patient with chronic insomnia with and without comorbidity, insomnia treatment should be always initiated. CBT-Insomnia therapy should be the first option accordingly to availability. The choice of the drug should be based on different factors such as type of insomnia, age, comorbidities, and potential side effects. Melatonin 2 mg prolonged release should be the first choice in subjects >55 years. If the choice would be a Z-drug or a short-acting benzodiazepine (in subjects <65 years old) or a sedating antidepressant, the use should be in the short term (≤4 weeks) and then proceeds to tapering under clinical monitoring

【 授权许可】

Unknown