Savanna Samson Two Men

One of the reasons used to defend the health-visitor interaction is the fact that RESTATEMENT provides professional information about their discipline and on different and new pharmaceutical options. Is a valid argument if one does not have realized that we already installed a few years old in the XXI century ... Today, the possibilities offered by the Internet for information (and help to spread it) are so tremendous that represent a revolution about the state of scientific publication ten years ago. As an example, the network offers twitter, if one follows the right people (we, as in life itself) abundant medical information and specifically therapeutic. And again, not necessarily biased information as you provide our beautiful relationship with pharmaceutical industry. We strongly recommend monitoring, for example, Carlos Oropesa or Vicente Baños. High quality information.

And it was precisely because of information found on twitter as we learned of more severe adjustment plan (the etymology of adjustment supposed to come over oh, what a fright that justice is not ) that the Catalan government has designed for the public health community. The journal Public stated in a recent news some of the consequences of such adjustment: various hospitals of Catalonia in summer care of your plants and significantly reduced their surgical activity. A general reduction of salaries and increased workload due to the lack of substitutions, adding the non-recruitment of many specialists now completing their training. But these measures, burdensome to us as professionals, will be on anecdotes if you start to fire workers or the lowering of salaries continues, or if our residents year after year begin to systematically go to the street ... And do not say what has already announced to close hospital wards, with the consequent collapse of emergency and operating rooms, with which you can imagine what will happen with the famous waiting lists ... What do you tell the patient will have to wait days in ER in a corridor because there are fewer beds to enter, or does that, instead of six months, will take a year in operation? ... As I said once, we can be accused of being alarmist. And really, I wish I be.

But we will radically change of pace. No more talk of health spending and public deficit. No more prophesying the end of the welfare state and public health equality for all. No more bad feeling. Let's talk now, as the title of our input, sweet dreams. And sweet remedies to get them.

In current psychiatric care is very, very common prescription insomnia and hypnotic medication immediately. Not just talking about patients admitted psychotic episode or severe depressive and manic phases. We talked of many patients with varying degrees of discomfort or anxiety of mind more or less diffuse or paroxysmal and even people is difficult to define as a patient but has trouble falling or staying asleep. Although our current ratings and those to come, the true challenge is not listed as patient a wide variety of categories and / or dimensions ... Wonders of comorbidity ....

And the question arises: what is the proper hypnotic? There is a whole range of possibilities, depending on the type of insomnia severity, patient clinical characteristics, etc. This entry is not intended as a lecture on the treatment of insomnia (because that is in any book and it's a very very interesting), but noted some general options based on our clinical practice:

• Insomnia mild settlement lorazepam or lormetazepam perhaps zolpidem.

Insomnia
• conciliation and / or maintenance: flurazepam.

• mnatenimiento Insomnia conciliation or more severe: levomepromazine, clotiapine.

Of course, all this as indicative only and without any desire to create school. Although we are seeing more on our various partners around the prescribed as hypnotic quetiapine, either as immediate-release or extended-release form (although we still do not understand how a drug with a half life allows once-daily, it lasts 24 hours, can be used as a hypnotic ...).

And now, for as our loyal readers and would imply, a relationship should have the first part of the entrance to the second, let's make a list of hypnotics with their prices (as vademecum, 2008 except seroquel prolong, which is data, 2009). You'll see what education:

• Lorazepam (orfidal) 1 mg (50 comp.): 1.72 €.

• Lormetazepam (Noctamid, loramet) 2 mg (20 comp.): 2.36 €.

• Zolpidem (Stilnox) 10 mg (30 comp.): 3.11 €.

• Flurazepam (dormodor) 30 mg (30 comp.): 3.75 €.

• levomepromazine (Sinogan) 25 mg (20 comp.): 1.64.

• Clotiapine (etumina) 40 mg (30 comp.): 2.17 €.

And the winner is ...

• Quetiapine (Seroquel) 25 mg ( 6 comp.): 3.2 €.

• Quetiapine (Seroquel) 100 mg (60 comp.): € 88.06.

• Quetiapine (Seroquel) 200 mg (60 comp.): € 133.88.

• Quetiapine (Seroquel) 300 mg (60 comp.): € 187.29.

• of Quetiapine Prolonged Liberación (seroquel prolong) 50 mg (60 comp.): € 91.79.

• of Quetiapine Prolonged Liberación (seroquel prolong) 200 mg (60 comp.): € 165.06.

• of Quetiapine Prolonged Liberación (seroquel prolong) 300 mg (60 comp.) 195.63.

• of Quetiapine Prolonged Liberación (seroquel prolong) 400 mg (60 comp.) 226.21.

Obviously, one would think that quetiapine is much better than all other hypnotic. Because if it were not so, what is the justification for prescribing under the public health system that, in turn, is lowering wages to their workers, not hiring specialists and threatening form of plant closures and operating rooms, not to mention various copayments ...?

So we set out in search of data and studies to justify the use of quetiapine in insomnia, so rest assured that our money (and yours) was was well spent. And we have a comprehensive document published by the Canadian State University of British Columbia (Vancouver capital, for details) in 2010, which summarized a few paragraphs especially clarifiers below

have been published only two randomized clinical trials to study the hypnotic effect of quetiapine. One in healthy subjects, with a sample size of 14 ( uauh ... ), 2 of whom left for orthostatic hypotension. The others were distributed randomly and double blind between placebo and doses of quetiapine of 25 g and 100 mg. Both doses of quetiapine resulted in increased sleep time. The other study was conducted with 25 patients with primary insomnia, distribute them randomly between placebo and quetiapine. There was no statistically significant differences in any sleep variables studied.

Regarding the possibility of side effects have been associated with the use of quetiapine at both high and low doses, other extrapyramidal symptoms such as dystonia, akathisia or tardive dyskinesia. Frequently Secundary effects at high doses (considered these as 150 to 800 mg / day) are: weight gain, drowsiness, increased cholesterol and triglycerides, insulin resistance, dry mouth and orthostatic hypotension. In rare cases you may receive neuroleptic malignant syndrome or neutropenia. A small double-blind trial found that Quetiapine worsens cognitive decline in dementia.

The findings from the report reproduced in full:

• Quetiapine is not approved or recommended for primary insomnia.

• Quetiapine is commonly prescribed off-sheet as a hypnotic, but only A clinical trial examined its use in patients with insomnia. Found no benefit.

• No published clinical trials comparing quetiapine with other drugs for insomnia.

• The management of primary insomnia should focus on education and promoting healthy sleep habits.

• drugs should be limited to short-term, intermittent or daily use only in exceptional cases.

summary, quetiapine prescribed (Seroquel) or, even more surreal, quetiapine extended release (Seroquel XR) as a hypnotic, although there is no evidence of efficacy for such use and although there are other much cheaper options ... We can be proud.

Finally, to conclude with the post title, we sweet dreams to all our dear readers ... We also try to sleep without too many turns to some of the money that the state has failed to pay us or to be saved by not hiring residents coming years, or do not say which will be trimmed at the expense of delaying operations and income of patients, will be used to pay for AstraZeneca boxes and boxes of seroquel seroquel and prolong hypnotic prescription and ...

prefer what he said Estopa :

Do not have pasta, then sleep for a while,

not spend it sleeping, is much cheaper ...