1/27. Insomnia related to biperiden withdrawal in two schizophrenic patients.It is not uncommon for patients who are receiving antipsychotic medication to be given anticholinergic agents, such as biperiden, despite the relative absence of neurological side-effects. Two cases of schizophrenia are reported in which insomnia developed after biperiden withdrawal or reduction. The insomnia continued until biperiden treatment was reinstated, despite the fact that the patients did not exhibit signs or report symptoms indicative of antipsychotic drug-induced neurological side-effects. The occurrence of insomnia following the withdrawal of biperiden or reduction in the dose has not been previously reported. One potential explanation for the insomnia is cholinergic rebound following the withdrawal of biperiden.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
2/27. Insomnia in children: when are hypnotics indicated?Insomnia in children is a nonspecific impairing symptom that may be the result of normal developmental changes, psychosocial duress, a sleep disorder, a psychiatric disorder, other medical disorders, substance misuse, or an adverse effect of medication. Careful clinical assessment of insomnia in children may include the use of symptom rating scales, laboratory testing, or other medical assessment. Short- and long-term treatment of insomnia in children involves management of etiological factors and associated syndromes. Controlled treatment studies of pediatric insomnia are limited to <10 published studies of psychosocial and/or psychopharmacological treatment in young children. Directive parent education and behavior modification techniques have been effective in short-term treatment of insomnia in young children, and may be the preferred treatment of extrinsic insomnia, as well as an important adjunctive treatment of any insomnia symptoms. Two benzodiazepines [flurazepam and delorazepam (chlordesmethyldiazepam)], one antihistamine (niaprazine) and one phenothiazine [alimemazine (trimeprazine)] have been shown to be effective in the short-term treatment of insomnia in young children, although none of these agents have US food and Drug Administration approval for pediatric insomnia. Short-acting benzodiazepines may have a role in the brief treatment of pediatric insomnia associated with an anxiety or mood disorder, psychosis, aggression, medication- induced activation, or anticipatory anxiety associated with a medical procedure. However, tachyphylaxis and risk of misuse preclude the long-term use of benzodiazepines for the treatment of insomnia in children. Newer hypnotics, which appear better tolerated than the benzodiazepines in studies of adults, may have a role when combined with psychosocial treatments of pediatric insomnia. Treatment of intrinsic pediatric insomnia may additionally involve chronotherapy or medical management.- - - - - - - - - - ranking = 9110.9583093243keywords = anxiety (Clic here for more details about this article) |
3/27. Cases from the aerospace medicine Resident's teaching File. Low G-tolerance presenting as insomnia.An aviator presenting with anxiety and insomnia is determined to have low G tolerance. Presentation, diagnosis, and treatment are discussed.- - - - - - - - - - ranking = 4555.4791546621keywords = anxiety (Clic here for more details about this article) |
4/27. Abnormal serotonin reuptake in an overtrained, insomnic and depressed team athlete.The purpose of this report is to study serotonin reuptake of the brain in a severely overtrained athlete by using single-photon emission computed tomography (SPECT). A 26-year-old team athlete increased his training volume (by 200 %) and intensity markedly in a new high-level team. After two months, he started to feel continuous fatigue. He had tinnitus in his left ear, he felt disturbing palpitation and had pollacisuria. After four months, he started to suffer from insomnia. He still continued to play for another three months, after which he was unable to play. He could only sleep for 3 to 4 hours per night. Only minor abnormalities could be found in extensive physical and laboratory examinations. The athlete had a severe overtraining state. In the brain SPECT scans, using the specific radioligand for serotonin transporter imaging ( (123)I labelled 2beta-carbomethoxy-3beta-[4-iodophenyl]-nortropane), low activity areas were detected in the midbrain, anterior gingulus, and left frontal and temporo-occipital lobes. In a psychiatric examination, the patient was found to have signs of major depression, which he hardly recognized himself. We conclude, that that the severe overtraining state could have been related to decreased serotonin reuptake in the brain and signs of major depression.- - - - - - - - - - ranking = 2keywords = state (Clic here for more details about this article) |
5/27. Reverse sleep state misperception.A 71-year-old woman with a 3-year history of excessive daytime sleepiness and an increased need for sleep did not feel restored upon awakening and had daytime fatigue despite a full night's sleep. She was evaluated with polysomnography (PSG). She significantly underestimated her sleep latency and awake time after sleep onset. The following morning, she stated that she had slept all night, when in fact she had extremely poor sleep efficiency and prolonged sleep latency. Another PSG and a two-week long actigraphy confirmed her misperception. Therefore, she perceived physiologic wakefulness, by PSG and actiraphy criteria, as subjective sleep, in direct contrast to 'conventional' sleep state misperception, in which patients usually present with a complaint of insomnia but have normal sleep quality and duration by PSG criteria. This patient may have a previously undescribed variation of sleep state misperception that the authors have tentatively named 'reverse' sleep state misperception.- - - - - - - - - - ranking = 8keywords = state (Clic here for more details about this article) |
6/27. Subjective total insomnia: an example of sleep state misperception.Sleep state misperception (SSM) is the diagnostic term proposed in the International classification of sleep disorders to describe those insomniacs who mislabel their sleep as wakefulness. Although sleep misperception has long been recognized among insomnia patients, it is debatable whether this clinical finding warrants a distinctive diagnosis or simply represents an extreme variation of other, more common forms of insomnia. We present two cases to explore the clinical meaningfulness of SSM. It is concluded that SSM represents a distinctive, albeit rare, sleep disorder. However, refinements in existing diagnostic criteria may be needed to improve the meaningfulness of the SSM diagnosis.- - - - - - - - - - ranking = 5keywords = state (Clic here for more details about this article) |
7/27. Benzodiazepine dependence.BACKGROUND: Benzodiazepine dependency can occur as a result of treatment for anxiety disorders or sleep disturbance. While benzodiazepine withdrawal can be challenging, cessation of use can be even more difficult if there are other comorbidities such as oestrogen deficiency with vasomotor symptoms and anxiety disorders. OBJECTIVE: This article provides practical information for general practitioners in the management of patients with benzodiazepine dependence. DISCUSSION: Some patients may have common medical presentations and coexisting drug dependence. It is often difficult to separate these two issues. In the case of benzodiazepine dependence, gradual withdrawal over time and nonpharmacological treatment of the symptoms of withdrawal such as anxiety or insomnia is effective. Better outcomes are achieved where the GP discusses and plans strategies well in advance with the patient. Treatment often involves multiple interventions from various health professionals. general practitioners are ideally placed to coordinate such treatment.- - - - - - - - - - ranking = 15464.125572969keywords = anxiety, anxiety disorder (Clic here for more details about this article) |
8/27. Persistent tardive rebound panic disorder, rebound anxiety and insomnia following paroxetine withdrawal: a review of rebound-withdrawal phenomena.OBJECTIVE: To describe tardive rebound anxiety phenomena (panic, anxiety and insomnia) following abrupt paroxetine discontinuation. METHOD: Case report, with comprehensive literature review on rebound and withdrawal phenomena associated with psychotropic medications. RESULTS: Three different discontinuation syndromes with psychotropics are described: (1) new-onset CNS-depressant type withdrawal symptoms (minor and major); (2) rebound syndromes; and (3) supersensitivity symptoms. Abrupt paroxetine discontinuation has been well described and fits the first category. Tardive rebound panic disorder-phenomena with paroxetine has some features of the supersensitivity category. CONCLUSION: Chronic paroxetine treatment may lead to 5-HT2-receptor down regulation, with desensitization of 5-HT1A and 5-HT2 receptors, which may contribute to tardive rebound symptoms upon abrupt withdrawal. Early reports suggest that genetic factors may also contribute to withdrawal symptoms in susceptible individuals. Cholinergic rebound may also occur and could explain tardive insomnia and anxiety in paroxetine withdrawal.- - - - - - - - - - ranking = 31888.354082635keywords = anxiety (Clic here for more details about this article) |
9/27. Nocturnal wandering caused by restless legs and short-acting benzodiazepines.A patient with incapacitating restless-leg syndrome had suffered from repetitive confusional states exclusively after use of short-acting benzodiazepines. Complete removal of symptoms was achieved using levodopa. An association between many reported adverse reactions to triazolam and the common syndrome of restless legs or nocturnal myoclonus is suggested.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
10/27. Cardiovascular dysautonomia in fatal familial insomnia.Autonomic control of the cardiovascular system was assessed in two patients with Fatal Familial Insomnia. The diagnosis was confirmed at autopsy in patient 1. In the resting state blood pressure and heart rate were higher than controls in patient 1; plasma noradrenaline levels were elevated in both patients. Evaluation of cardiovascular reflexes indicated intact baroreflex pathways but with exaggerated blood pressure and biochemical responses to certain stimuli (postural change, Valsalva manoeuvre, isometric handgrip). There was no pressor response to intravenously infused noradrenaline, an increased response to atropine and diminished depressor and sedative effects to clonidine. overall these results are indicative of an unbalanced autonomic control with preserved parasympathetic and higher background and stimulated sympathetic activity. These physiological, biochemical and pharmacological data, together with known neuro-pathological findings in this disorder, emphasize the possible role played by the thalamus in regulating autonomic control of cardiovascular function in man.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
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