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Biomedical subjects

Carlos H Schenck

Publications and source records attributed to Carlos H Schenck.

18 recordsLinked to original sources
PubMed2006

Parasomnias: clinical features and forensic implications.

Parasomnias are undesirable behavioral or experiential phenomena arising from the sleep period. Once felt to be a unitary phenomenon, it is now clear that a wide variety of sleep disorders are capable of resulting in complex behaviors arising during sleep. The most common are disorders of arousal and rapid eye movement sleep disorder. Less common conditions include nocturnal seizures and psychogenic dissociative states. Malingering and Munchausen syndrome by proxy, while they are not actually parasomnias, may masquerade as parasomnias. Careful clinical and sleep laboratory evaluation can usually provide an accurate diagnosis with effective therapeutic implications. Due to the potential forensic implications, sleep medicine specialists may be asked to participate in legal proceedings resulting from sleep-related violence. An awareness of the spectrum of such behaviors, and their clinical and legal evaluation, is becoming more important in the practice of sleep medicine.

Arousal↗
PubMed2005

Insights from studying human sleep disorders.

Problems with sleep are one of the commonest reasons for seeking medical attention. Knowledge gained from basic research into sleep in animals has led to marked advances in the understanding of human sleep, with important diagnostic and therapeutic implications. At the same time, research guided by human sleep disorders is leading to important basic sleep concepts. For example, sleep may not be a global, but rather a local, brain phenomenon. Furthermore, contrary to common assumptions, wakefulness, rapid eye movement (REM) and non-REM sleep are not mutually exclusive states. This striking realization explains a fascinating range of clinical phenomena.

Circadian Rhythm↗
PubMed2005

Sleep-related violence.

Most violent behaviors arise from wakefulness. It is important to realize that violent behaviors that may have forensic science implications can arise from the sleep period. By virtue of the fact that these behaviors arise from sleep, they are executed without conscious awareness, and, therefore, without culpability. The most common underlying conditions arising from sleep are disorders of arousal (sleepwalking and sleep terrors), the rapid eye movement sleep behavior disorder, and nocturnal seizures. In addition, there are a number of psychiatric conditions (dissociative disorders, malingering, and Munchausen syndrome by proxy) that actually arise from periods of wakefulness occurring during the sleep period. The clinical and medico-legal evaluation of such cases is outlined, and should be performed by a multidisciplinary team of experienced sleep medicine practitioners.

Humans↗
PubMed2005

Non-rapid eye movement sleep parasomnias.

Parasomnias are unpleasant or undesirable behavioral or experiential phenomena that occur during sleep. Once believed unitary phenomena related to psychiatric disorders, it is now clear that parasomnias result from several different phenomena and usually are not related to psychiatric conditions. Parasomnias are categorized as primary (disorders of the sleep states) and secondary (disorders of other organ systems that manifest themselves during sleep). Primary sleep parasomnias can be classified according to the sleep state of origin: rapid eye movement sleep, non-rapid eye movement sleep, and miscellaneous (those not respecting sleep state). Secondary sleep parasomnias are classified by the organ system involved.

Arousal↗
PubMed2005

Rapid eye movement sleep parasomnias.

The recognition of RBD has shed additional scientific light on the "bumps in the night"; expanded knowledge of states of being and state dissociation; opened up new areas of research on brain and mind dysfunction during sleep; expanded knowledge of various neurologic disorders, particularly narcolepsy and parkinsonism; and reaffirmed the vital link between basic research and clinical medicine. Moreover, the safe and effective treatment of RBD with clonazepam is especially gratifying.

Aged↗
PubMed2004

A case of marital discord and secondary depression with attempted suicide resulting from REM sleep behavior disorder in a 35-year-old woman.

A 35-year-old woman with childhood-onset parasomnia, marked by arm waving with talking and shouting, developed marital discord solely because her parasomnia disrupted her husband's sleep. She became progressively depressed after her husband began to sleep in a separate bedroom, eventually becoming acutely suicidal. There had been no psychiatric history prior to her marriage. An evaluation with a sleep specialist-neurologist and polysomnographic monitoring confirmed the diagnosis of idiopathic REM sleep behavior disorder (RBD). Treatment with clonazepam, 1.0-1.5 mg at bedtime controlled her RBD and she again slept with her husband, which fully resolved their marital discord and her secondary depression.

Adult↗
PubMed2004

Parasomnias.

Parasomnias are defined as unpleasant or undesirable behavioral or experiential phenomena that occur predominately or exclusively during the sleep period. Initially thought to represent a unitary phenomenon, often attributed to psychiatric disease, it is now clear that parasomnias are not a unitary phenomenon but rather are the manifestation of a wide variety of completely different conditions, most of which are diagnosable and treatable. The parasomnias may be conveniently categorized as "primary sleep parasomnias" (disorders of the sleep states per se) and "secondary sleep parasomnias" (disorders of other organ systems, which manifest themselves during sleep). The primary sleep parasomnias can be classified according to the sleep state of origin: rapid eye movement (REM) sleep, non-REM (NREM) sleep, or miscellaneous (i.e., those not respecting sleep state). The secondary sleep parasomnias can be further classified by the organ system involved. The underlying pathophysiology of many parasomnias is state dissociation-the brain is partially awake and partially asleep. The result of this mixed state of being is that the brain is awake enough to perform very complex and often protracted motor and/or verbal behaviors but asleep enough not to have conscious awareness of, or responsibility for, these behaviors.

Humans↗
PubMed2003

Parasomnia pseudo-suicide.

Complex behaviors arising from the sleep period may result in violent or injurious consequences, even death. Those resulting in death may be erroneously deemed suicides. A series of case examples and review of the pertinent literature are provided to increase awareness of the possibility that some apparent "suicides" are the unfortunate, but unintentional, consequence of sleep-related complex behaviors and therefore are without premeditation, conscious awareness, or personal responsibility. The correct cause-of-death determination in such cases may have profound social, religious, and insurance implications for surviving friends and family members.

Adult↗