1/44. circadian rhythm sleep disorders in adolescents: clinical trials of combined treatments based on chronobiology.Delayed sleep phase syndrome (DSPS) and non-24-h sleep-wake rhythm are circadian rhythm sleep disorders that are common in adolescents. Most patients have difficulty adjusting to school life, poor class attendance or refuse to go to school. Since a treatment has not been established, the present paper is presented to propose a strategy for treating circadian rhythm sleep disorders in adolescents, based on our clinical studies. Twenty subjects (12 males and eight females, mean age 16.2 /-1.7 years) participated in the study. The onset of sleep disorder occurred between the ages of 11 and 17. The most common factors affecting the onset of disorders were changes in social environment. The subjects kept a sleep-log for the periods before and during treatments. The treatments were based on chronobiology: resetting the daily life schedule, chronotherapy, regulation of the lighting environment, methylcobalamin, and/or melatonin. Bright light exposure was successful in 10 patients, of whom four were treated with methylcobalamin. melatonin treatment was successful in two patients (one with and one without chronotherapy). Thirteen of the 20 patients were successfully, treated with therapies based on chronobiology. After consideration of these results, a step-by-step procedure of combined treatments for the circadian rhythm sleep disorders is proposed.- - - - - - - - - - ranking = 1keywords = affect (Clic here for more details about this article) |
2/44. A case of neuroleptic-induced unilateral akathisia with periodic limb movements in the opposite side during sleep.We report on a patient with schizoaffective disorder who developed unilateral akathisia. This is the first case report of a patient with neuroleptic-induced unilateral akathisia on whom an all-night polysomnogram was recorded. On the polysomnogram we observed right side periodic limb movements (PLM) with left side unilateral akathisia, and after her akathisia disappeared, the PLM also disappeared. brain MRI findings and neurological findings were within normal limits. The pathogenetic lesion causing akathisia could not be elucidated.- - - - - - - - - - ranking = 1keywords = affect (Clic here for more details about this article) |
3/44. Impact of recurrent and chronic pain on child and family daily functioning: a critical review of the literature.The author reviewed the current status of research on the impact of recurrent and chronic pain on everyday functioning of children and families and organized the research findings around the specific life contexts (e.g., school, peers) that may be affected by pain. Although findings demonstrate that many different aspects of child and family life are affected by pain, the prevalence and severity of children's functional limitations associated with pain remain unknown. Few treatment studies for pediatric recurrent and chronic pain have focused on enhancing children's functioning. It has been shown, however, that functional outcomes can be improved by cognitive-behavioral interventions. Recommendations for research on functional outcomes and implications for clinical practice are discussed.- - - - - - - - - - ranking = 2keywords = affect (Clic here for more details about this article) |
4/44. The kleine-levin syndrome. Report of a case and review of the literature.kleine-levin syndrome is a rare self-limited disorder which usually affects adolescent males and is characterized by episodic hypersomnia, increased appetite, and behavioral/psychiatric disturbances. Individuals are normal between the attacks. The case of an adolescent boy is presented who suffered from recurrent sleepiness, hyperphagia, and behavioral disturbances such as rocking, punching and pacing, and was originally misdiagnosed as suffering from encephalitis. Before the diagnosis of Kleine-Levin was given, the patient underwent unnecessary investigations and treatment which, in turn, complicated his clinical condition both physically as well as psychologically. In the course of five years he had four such episodes which appeared to have progressively milder manifestations. Between episodes he was normal. It is important that the diagnosis is suspected early, especially in adolescent males who present with recurrent episodes of somnolence, increased appetite, and abnormal behavior, since it most often represents a benign and self-limited entity and does not warrant extensive investigations or treatment. It is also important to distinguish this syndrome from more serious organic and psychiatric diseases with more serious prognoses. The differential diagnosis of this syndrome is discussed and a review of the literature is presented including evidence and hypotheses regarding its pathophysiology.- - - - - - - - - - ranking = 1keywords = affect (Clic here for more details about this article) |
5/44. Three children with a syndrome of obesity and overgrowth, atypical psychosis, and seizures: a problem in neuropsychopharmacology.Three children presented with a complex syndrome of atypical psychotic and extremely immature behavior, obesity and overgrowth, borderline retardation, and seizures (prominent in two). Weight overgrowth exceeded height overgrowth and was stratospheric (up to 8 SD above mean). obesity seemed related to lack of satiety. The cases fit no known condition: hypothalamic damage, Sotos' syndrome, and prader-willi syndrome were excluded. Empirical treatment with anticonvulsants (carbamazepine and acetazolamide) together with psychotropic agents (selective serotonin reuptake inhibitors and risperidone) controlled seizures, improved behavior, and stopped weight gain in each patient. We have not found this syndrome previously described. The etiology is unknown: perinatal encephalopathy could be a factor in the two patients with prominent seizures; in the third, familial major affective disorder is implicated. Medication responses suggest a low-serotonin state underlying the lack of satiety, an imbalance of serotonin and noradrenergic modulation in the hypothalamus, and epileptogenic disorders (or affective disorder responsive to anticonvulsants in one case) involving these same systems.- - - - - - - - - - ranking = 2keywords = affect (Clic here for more details about this article) |
6/44. Relationship disturbances and parent-child therapy. Sleep problems.This article has attempted to establish the importance of considering behavioral disturbances in infancy and early childhood as disturbances of the parent-child relationship. When the psychologic and mental mechanisms of the individual infant are too immature to sustain disturbed behavior across several settings and when the behavioral disturbance seems to be specific to a particular relationship, it is more appropriate to diagnose the pathology as being in the relationship. The article has offered a diagnostic framework of relationship pathology that spans the spectrum from normal variation (relationship perturbation) to relationship behaviors that are at risk of becoming a disorder (relationship disturbance) to significant relationship disorders that most likely require a professional intervention. A multiaxial assessment protocol is recommended that evaluates primary relationships (axis I), parent-infant interaction styles (axis II), the parent and infant as individuals (axis III), and more distal contextual factors that affect the relationship (axis IV). Sleep disturbances in infancy have been used as an example to demonstrate the spectrum of relationship pathology. Additional research is needed to develop more precise, age-relevant cut points for the spectrum of relationship pathology for sleep problems and for other parent-infant relationship disturbances in the areas of feeding, excessive crying, and limit setting or tantrums. More research is also needed to define better when and how relationship pathology becomes transformed into individual pathology and how early intervention may alter the course of this trajectory.- - - - - - - - - - ranking = 1keywords = affect (Clic here for more details about this article) |
7/44. sleep disorders in Sanfilippo syndrome: a polygraphic study.OBJECTIVE: A high prevalence of sleep disorders is reported in patients affected by mucopolysaccharidosis iii (Sanfilippo syndrome). These disorders have never been investigated by prolonged, objective, and instrumental evaluations. The present work is based on sleep duration and structure in Sanfilippo patients. STUDY DESIGN: The features of sleep/wake cycle in 6 Sanfilippo patients and 6 healthy controls were evaluated by means of sleep diaries and 48 hour ambulatory EEG and polygraphic recordings. Statistical analysis was performed by means of the U-test (Mann-Whitney). RESULTS: Four out of six Sanfilippo patients, the oldest patients in our sample, showed an extremely irregular sleep pattern, with several sleep episodes of inconstant duration, irregularly distributed along 24 hours. The two younger patients showed sleep maintenance insomnia with several nocturnal awakenings. CONCLUSIONS: These results suggest that sleep disruption in Sanfilippo syndrome consists of an irregular sleep/wake pattern, which at its onset might appear as a disorder of initiating or maintaining sleep. This could explain why same patients do not respond to conventional hypnotics. The present observation might suggest attempting therapies aimed at resynchronization, such as behavioral treatment, light therapy or melatonin.- - - - - - - - - - ranking = 1keywords = affect (Clic here for more details about this article) |
8/44. Sleep-related headache syndromes.The relationship between sleep and sleep disorders and headache remains unclear. Clinical experience and numerous studies document some sort of relationship, but the exact nature remains understudied and complex. Changes in sleep duration and sleep quality appear to be capable of affecting headaches of different types. Obstructive sleep apnea can cause or exacerbate headaches in a susceptible person. Obstructive sleep apnea also may cause a specific headache when awakening, which is different from migraine or tension headache and disappears after treatment of the sleep and breathing disturbance. Hypnic headache is another type of sleep-exclusive headache that has been proposed. Hypnic headaches are brief, moderately severe, and affect the elderly primarily.- - - - - - - - - - ranking = 2keywords = affect (Clic here for more details about this article) |
9/44. sleep disorders.humans spend approximately one third of their lives asleep. Although the same medical disorders that occur during wakefulness persist into sleep, there are many disorders that occur exclusively during sleep or are manifestations of a disturbance of normal sleep-wake physiology. The most common reason for referral to a sleep laboratory is OSA, whereas the most common sleep disorder is insomnia. Effective treatments now exist for many sleep disorders, such as OSA and RLS, and a major breakthrough in the treatment of narcolepsy seems imminent. Because all disease processes are adversely affected by insufficient sleep, it is essential that the practicing physician understand the causes and treatments of the common sleep disorders.- - - - - - - - - - ranking = 1keywords = affect (Clic here for more details about this article) |
10/44. Evidence for S284L mutation of the CHRNA4 in a white family with autosomal dominant nocturnal frontal lobe epilepsy.PURPOSE: To identify mutations of the neuronal nicotinic acetylcholine receptor alpha4 subunit gene (CHRNA4) responsible for autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) in a group of white patients. methods: A group of 47 patients from 21 unrelated families with ADNFLE were screened for mutations in CHRNA4. Clinical features and EEG findings in the patients were consistent with those reported in the literature for other affected families. The entire gene was amplified from genomic dna by polymerase chain reaction (PCR) followed by multitemperature single-strand conformation polymorphism analysis (MSSCP) and sequencing. RESULTS: A c.851C>T transition in exon 5 of CHRNA4 was identified in three affected individuals from two generations of the same family, but not in the remaining patients or in 100 healthy volunteers. This mutation caused an S284L substitution in the transmembrane domain M2 segment of the alpha4 subunit of the neuronal nicotinic acetylcholine receptor. The same mutation had previously been detected in a single Japanese family with ADNFLE, and in an Australian woman with a sporadic form of NFLE. CONCLUSIONS: This is the first report of an occurrence of c.851C>T transition in a white family with ADNFLE.- - - - - - - - - - ranking = 2keywords = affect (Clic here for more details about this article) |
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