@psycheureka Nice thread. Many practitioners struggle to treat psychophysiological insomnia. CBT-I doesn’t work properly, nor do sleep hygiene/SC. I’ve seen cases with good PSG who do everything and not work and become dependent on benzos or Z-drugs. Any recommendation? Also threads is nice.

𝐈𝐧 𝐣𝐮𝐬𝐭 𝐭𝐰𝐨 𝐝𝐚𝐲𝐬, 𝐓𝐡𝐞 𝐀𝐜𝐚𝐝𝐞𝐦𝐲 𝐀𝐃𝐇𝐃 𝐌𝐚𝐬𝐭𝐞𝐫𝐜𝐥𝐚𝐬𝐬 𝐠𝐨𝐞𝐬 𝐥𝐢𝐯𝐞 𝐢𝐧 𝐌𝐞𝐥𝐛𝐨𝐮𝐫𝐧𝐞.🚀 We’ll be at the Langham Hotel with colleagues joining both in-person and online. I’ll be sharing what I’ve learned across more than a decade of

Want to refine your understanding of PTSD management? Join The Academy for clinician-focused courses covering PTSD symptoms, neurobiology and management strategies: Earn CPD points and translate evidence into practice 🎓 https://t.co/YRvxNiWH01

PTSD recovery isn’t just symptom reduction—it’s restoring adaptive functioning. By improving the balance and coordination among the salience, default-mode and executive networks, patients regain emotional regulation, cognitive control and the ability to re-engage with life.

Pharmacological Approaches • SSRIs/SNRI: (e.g., sertraline, paroxetine; venlafaxine used per guidelines) help at the symptom level; network effects are an area of research. • Prazosin: May reduce trauma-related nightmares for some; evidence is mixed for overall PTSD symptoms.

How Therapies Work • Trauma-Focused CBT: First-line. Reduces symptoms by modifying appraisals and avoidance; imaging suggests normalisation of abnormal network interactions. • EMDR: First-line. Mechanism not settled; a leading account is working-memory taxation during

Why do some recover while others develop chronic symptoms? Resilience and vulnerability factors matter—e.g., social support, prior mental health, and stress biology. Evidence-based early assessment and treatment improve outcomes. Routine single-session psychological debriefing

The Role of the Anterior Insula The anterior insula helps switch between the DMN (internal focus) and CEN (goal-directed control). In PTSD, switching can be impaired—leaving patients “stuck” in reactive states with limited top-down regulation. A promising mechanistic account,

How network disruptions show up clinically • Intrusions: flashbacks, distressing memories • Avoidance: of trauma-related cues • Hyperarousal: sleep disturbance, exaggerated startle Each arises from interacting neurocognitive changes rather than a single circuit failure.

Central Executive Network (CEN/FPN) The DLPFC and frontoparietal control systems support regulation of attention and emotion. In PTSD, altered engagement/connectivity is linked with: • Difficulty managing intrusive memories • Reduced cognitive flexibility

In PTSD, altered connectivity in hubs such as the mPFC and PCC relates to difficulties with self-referential processing and autobiographical memory—contributing to: • Flashbacks • Intrusive thoughts These experiences reflect dysregulated memory processing rather than a

The Salience Network Heightened signalling in the anterior insula and dorsal ACC can bias threat appraisal, making neutral cues feel unsafe. This helps explain: • Hypervigilance • Heightened arousal Competitive dynamics with other networks may occur, but direct “resource

The Integrated Model of PTSD highlights these networks: • Salience Network: Detects and prioritises salient/interoceptive and potential threat cues. • Default Mode Network (DMN): Supports autobiographical memory and self-referential processing. • Central Executive Network

Why do some individuals recover from trauma while others develop PTSD? A useful lens is how three large-scale brain networks interact: • The Salience Network (SN) • The Default Mode Network (DMN) • The Central Executive/Frontoparietal Network (CEN/FPN) Understanding their

Learn more about the neurobiology and pathophysiology of insomnia on the Psych Scene Hub:  https://t.co/iwkU15nUJf

Insomnia is best conceptualised as a 24-hour hyperarousal disorder involving cognitive, cortical and autonomic systems; precise causal pathways remain under investigation. Understanding diagnostic criteria, circadian factors, and common psychiatric/medical links helps identify

7. Assessment Tools A sleep diary tracks bedtimes, awakenings, sleep quality, and routines. Actigraphy offers movement-based estimates of sleep but may be inaccurate in insomnia. Polysomnography remains the gold standard when other sleep disorders are suspected.

6. Validated Scales Use standardised tools to support assessment and monitoring: • Insomnia Severity Index (ISI) or Sleep Condition Indicator (SCI) to quantify insomnia severity and change over time.  • Pittsburgh Sleep Quality Index (PSQI) for global sleep quality. •

5. Risk Assessment Evaluate daytime sleepiness and safety-critical activities. Ask specifically about driving and operating machinery; follow DVLA fitness-to-drive guidance when excessive sleepiness is present.

4. Psychosocial Factors Assess perfectionism, evening cognitive/emotional arousal, and limited wind-down time. Consider caregiving duties, stressful events, or bedtime disruptions. Note sleep disturbance from pets or household demands.