Cases reported "Sleep Disorders"

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1/25. 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.
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ranking = 1
keywords = affective
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2/25. 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.
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ranking = 9.9011453928962
keywords = psychosis, affective
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3/25. Delta sleep EEG in depressed adolescent females and healthy controls.

    BACKGROUND: Quantitative EEG studies have identified a number of sleep abnormalities in adults with major depressive disorders (MDD), including a reduction in the amplitude of delta activity during NREM sleep. To date, these methodologies have not been used in early onset MDD. methods: Delta activity during NREM sleep was compared in eight symptomatic but unmedicated adolescent females with MDD and eight age- and gender-matched healthy controls. RESULTS: The depressed group showed significantly lower delta amplitude and power in the first NREM sleep period. By contrast, standard sleep architecture did not differentiate between groups. LIMITATIONS: Given the sample size, this study is best viewed as tentative. In addition, it has yet to be determined whether adolescent males with MDD also show delta sleep abnormalities. Further, failure to find between-group differences in REM latency or other macroarchitectural measures may be due to the small sample size. CONCLUSIONS: The findings of this study underscore the utility of quantitative sleep EEG techniques in early onset MDD. The results of the present study do, however, diverge from reports in adults with MDD, where delta abnormalities are more prevalent in men. Such findings suggest that the maturational time course of sleep EEG disturbances may differ for males and females with depression. Early emergence of delta abnormalities in depression may be of relevance to clinical course of illness.
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ranking = 2.3734702013658
keywords = depression
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4/25. Alleviation of sleep disturbance and repetitive behavior by a selective serotonin re-uptake inhibitor in a boy with Asperger's syndrome.

    An 8 year-old boy with Asperger's syndrome had difficulties in communicating with his teachers and classmates. He occasionally stole out of the classroom. He could not sleep at night recalling his awful experience and kept crying every night and refused to go to school. The treatment with fluvoxamine was started at the dose of 25 mg daily. Four weeks after the treatment, his repetitive behavior and hyperactivity decreased and night crying diminished. Although he still has difficulties in communicating with others, he is now able to attend extra-curricular classes in a private school. fluvoxamine, a selective serotonin re-uptake inhibitor that has been mainly used for patients with depression and obsessive-compulsive disorder, might be effective for compulsive symptoms and sleep disturbance of patients with pervasive developmental disorders.
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ranking = 1.1867351006829
keywords = depression
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5/25. Persistent neuropsychological problems after 7 years of abstinence from recreational Ecstasy (MDMA): a case study.

    This case study concerns a 26-yr.-old male who had consumed large amounts of Ecstasy seven years previously. He stated that his increasingly intensive use of ecstasy over a 4-yr. period had led to the emergence of multiple psychiatric and psychological problems. Given these problems, he stopped using Ecstasy, but the problems had not resolved despite seven years of abstinence. The neurocognitive profile was very similar to that shown by current heavy Ecstasy users, with deficits in immediate and delayed verbal recall, moderately impaired memory function, but normal expressive language ability and perceptual functioning. Extremely high pathology was evident, including depression and phobic anxiety. Severe problems with sleep and sex were also reported. Further studies involving larger groups of abstinent former users are needed; adverse sequelae associated with intensive Ecstasy use may sometimes be enduring.
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ranking = 1.1867351006829
keywords = depression
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6/25. Case series utilizing exposure, relaxation, and rescripting therapy: impact on nightmares, sleep quality, and psychological distress.

    Experiencing a traumatic event may initiate or exacerbate the occurrence of nightmares. Nightmares may impact sleep quality and quantity, posttraumatic stress symptoms, and depression. Recently, imagery rehearsal has gained attention in the treatment of trauma-related nightmares and is reported to be promising in the reduction of nightmares. On the basis of the vast literature describing the therapeutic benefits of exposure techniques for anxiety-related problems, the treatment was modified to enhance the exposure component. This article presents a case series using this modified version of imagery rehearsal, Exposure, relaxation, and Rescripting Therapy, with 1 male and 3 female participants. overall, the participants treated reported a reduction in nightmare frequency and severity; 3 out of 4 participants also reported a reduction in posttraumatic stress and depression symptomotology and an increase in sleep quality and quantity. Clinical implications and future research directions are discussed.
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ranking = 2.3734702013658
keywords = depression
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7/25. Prominent eye movements during NREM sleep and rem sleep behavior disorder associated with fluoxetine treatment of depression and obsessive-compulsive disorder.

    The clinical polysomnographic (PSG) reports of 2,650 consecutive adults studied during 41 months were reviewed retrospectively to identify all patients treated with fluoxetine or tricyclic antidepressants. The PSG reports of four other adult groups were also reviewed: periodic limb movement (PLM) disorder (n = 28); sleep terror/sleepwalking (ST/SW) (n = 54); rapid eye movement (REM) sleep behavior disorder (RBD) (n = 70); patients with clinically unremarkable sleep during two consecutive PSG studies (n = 30). Standard PSG recording and scoring methods were employed. A total of 1.5% (n = 41) and 2.0% (n = 52) of patients were receiving fluoxetine or tricyclics (amitriptyline or nortriptyline, n = 31; imipramine or desipramine, n = 16; protriptyline or trimipramine, n = 5). A selective association between fluoxetine and extensive, prominent eye movements in nonrapid eye movement (NREM) sleep was detected, utilizing Fisher's exact one-tailed statistic (p less than 0.00001 for each comparison). The detection rates were fluoxetine, 48.8% (20/41); tricyclics, 5.8% (3/52); RBD, 4.3% (3/70); objectively normal sleepers, 3.3% (1/30); PLM, ST/SW, 0% (0/82). These groups had similar mean ages (31.5-45.4 years) and gender distributions (50.0-60.7% male), apart from RBD. The effect of fluoxetine, a potent and specific serotonin reuptake inhibitor, on NREM eye movements is postulated to derive from potentiation of serotonergic neurons that inhibit brainstem "omnipause neurons", which, in turn, inhibit saccadic eye movements, thus resulting in disinhibited release of saccades. In addition, a 31-year-old man with obsessive-compulsive disorder developed RBD soon after starting fluoxetine therapy, which persisted at PSG study 19 months after fluoxetine discontinuation.
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ranking = 4.7469404027317
keywords = depression
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8/25. The many faces of postpartum depression.

    OBJECTIVE: To provide a profile of women suffering from major postpartum depression as assessed by the Postpartum depression Screening Scale (PDSS). DESIGN: A secondary analysis conducted on a portion of the data collected from an earlier psychometric testing of the PDSS. SETTING: private practice in the san francisco Bay Area of a marriage and family therapist specializing in perinatal mood disorders. PARTICIPANTS: One hundred thirty-three women who were diagnosed with major postpartum depression. INTERVENTION: Each mother completed the PDSS followed by a diagnostic and statistical manual of mental disorders (4th ed.) diagnostic interview. MAIN OUTCOME MEASURE: Seven dimensions of postpartum depression: sleeping/eating disturbances, anxiety/insecurity, emotional lability, mental confusion, loss of self, guilt/shame, and suicidal thoughts as measured by the PDSS. RESULTS: Scores on all seven dimensions of the PDSS were elevated. The three top dimensions were emotional lability, mental confusion, and anxiety/insecurity. The mean total PDSS score of 120 was well beyond the recommended cutoff score of 80 for a positive screen for major postpartum depression. CONCLUSION: Clinicians who come in contact with new mothers need to be alert to the range of possible symptoms that postpartum depressed mothers may experience so that these women are not left to suffer in silence.
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ranking = 9.4938808054633
keywords = depression
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9/25. Sleep-related eating disorders: polysomnographic correlates of a heterogeneous syndrome distinct from daytime eating disorders.

    Over a 5-yr period, 19 adults presented to our sleep disorders center with histories of involuntary, nocturnal, sleep-related eating that usually occurred with other problematic nocturnal behaviors. Mean age ( /- SD) at presentation was 37.4 ( /- 9.1) yr (range 18-54); 73.7% of the patients (n = 14) were female. Mean age of sleep-related eating onset was 24.7 ( /- 12.9) yr (range 5-44). Eating occurred from sleep nightly in 57.9% (n = 11) of patients. Chief complaints included excessive weight gain, concerns about choking while eating or about starting fires from cooking and sleep disruption. Extensive polysomnographic studies, clinical evaluations and treatment outcome data identified three etiologic categories for the sleep-related eating: (a) sleepwalking (SW), 84.2% (n = 16); (b) periodic movements of sleep (PMS), 10.5% (n = 2) and (c) triazolam abuse (0.75 mg hs), 5.3% (n = 1). DSM-III axis 1 psychiatric disorders (affective, anxiety) were present in 47.4% (n = 9) of the patients, and only two patients had a daytime eating disorder (anorexia nervosa), each in remission for 3-7 yr. Nearly half of all patients fulfilled established criteria for being overweight, based on the body mass index. Onset of sleep-related eating was linked directly to the onset of SW, PMS, triazolam abuse, nicotine abstinence, chronic autoimmune hepatitis, narcolepsy, encephalitis or acute stress. In the SW group, 72.7% (8/11) of patients had nocturnal eating and other SW behavior suppressed by clonazepam (n = 7) and/or bromocriptine (n = 2) treatment. Both patients with PMS likewise responded to treatment with combinations of carbidopa/L-dopa, codeine and clonazepam. Thus, sleep-related eating disorders can generally be controlled with treatment of the underlying sleep disorder.
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ranking = 1
keywords = affective
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10/25. Behavioral treatment of multiple childhood sleep disorders. Effects on child and family.

    sleep disorders are highly prevalent among otherwise healthy young children and can be extremely disruptive to family life. Treatment was initiated in a multiple baseline fashion for the chronic night waking and nighttime disturbance exhibited by a 14-month-old girl. We found that "graduated extinction" (gradually increasing the time before attending to the child's crying) resulted in rapid reductions in these sleep disorders. Additionally, data on parental depression and marital satisfaction showed general improvement as a function of improved child sleep patterns. These results are discussed as they relate to the treatment of common childhood behavior disorders and their role in family satisfaction.
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ranking = 1.1867351006829
keywords = depression
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