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PubMed2003

Generalized anxiety disorder.

Anxiety is a part of daily life. While mild levels of anxiety can be positive, moderate to severe levels can cause intense distress. When anxiety interferes with a person's ability to function, it warrants treatment. Generalized anxiety disorder (GAD) is a chronic disabling condition characterized by at least 6 months of frequent worries and three of the following symptoms: fatigue, restlessness, poor concentration, irritability, muscle tension, and unsatisfying sleep. The primary treatment for anxiety is pharmacotherapy. Medication prescribed for anxiety has shifted from exclusive benzodiazepine therapy to a combination of benzodiazepine and antidepressant drugs. The principal disadvantages of benzodiazepines are their long-term use with associated physical dependence, tolerance, and withdrawal symptoms. Several reports support the serotonin reuptake inhibitors and the serotonin norepinephrine reuptake inhibitors for the treatment of anxiety disorders.

Anxiety Disorders↗
PubMedDate not supplied

Astemizole-D causes less sleep impairment than loratadine-D.

This randomized, double-blind, double-dummy, parallel-group trial was initiated to evaluate and compare the tolerability of once-daily astemizole-D capsules (10 mg astemizole/240 mg pseudoephedrine) and twice-daily loratadine-D tablets (5 mg loratadine/120 mg pseudoephedrine), with particular reference to the impact of treatment on quality of sleep. A total of 240 healthy volunteers participated in this study with a treatment duration of 3 days. Astemizole-D consistently produced less sleep impairment than loratadine-D with statistically significant differences in favour of astemizole-D reported for night-time waking on days 4 and 5 (P = 0.004 and P = 0.006, respectively), as well as for night-time restlessness on day 4 and the total score for all sleep parameters on day 4 (P < 0.05). Global evaluations of overall sleep quality at the end of the trial also revealed some statistically significant differences in favour of astemizole-D. Both drugs were well tolerated and there were no differences in the incidence and type of adverse events reported in the two treatment groups. Slight changes in heart rate and blood-pressure were observed in both treatment groups, but these were small and were not considered to be of clinical significance. In conclusion, once-daily astemizole-D is well tolerated and appears to cause less sleep impairment than twice-daily loratadine-D.

Adolescent↗
PubMed1992

Sensory and motor components of the restless legs syndrome.

The restless legs syndrome (RLS) is characterized by two major manifestations: dysesthesias in the legs and irresistible leg movements. We developed a procedure to quantify these manifestations, and we studied their temporal interrelationships. We found that many dysesthesias may either closely precede or follow occurrences of EMG-defined leg activity, or both manifestations may occur independently. These results suggest that the sensory and motor components of RLS may represent two distinct manifestations of a common basic neurologic defect.

Adult↗
PubMed2000

[Antidepressive drug against nicotine. A method for smoking cessation].

Currently, two drugs are considered useful for those wishing to quit smoking in Germany--nicotine and bupropion. The mechanism of action appears to involve reuptake inhibition of the transmitters noradrenaline and/or dopamine by the brain. Treatment with a daily dose of 300 mg delayed release buproplon for 7 to 9 weeks resulted in smoking cessation in 30.3% (buproplon) and 35.5% (bupropion plus nicotine patch) of the smokers at 12 months (placebo: 15.6%, nicotine patch: 16.4%). A large number of the participants had had negative experience with nicotine preparations in previous attempts to stop smoking. Most side effects of bupropion involve the nervous system (disturbed sleep, trembling, loss of concentration, headache, dizziness, depression, restlessness, anxiety) and the gastrointestinal tract (dry mouth, nausea, vomiting, abdominal pain, constipation) and elevated temperature (> 1% of the treated subjects). It is suggested that, at present, bupropion should be used for this indication only in those smokers in whom treatment with nicotine has failed.

Administration, Cutaneous↗
PubMed1992

[Suicide in the Ravensburg/Oberschwaben area. Results of a study of 508 suicides based on criminal police records].

On the basis of criminal police files we studied 508 suicides which happened between 1970 up to 1981 in the Ravensburg area in southern Germany. The police files also included medical records about in- or outpatient psychiatric treatment and also data about former violent behaviour. Mental disease as follows were most frequent: Depression 66% (diagnoses were made according to IDC-0 by two doctors under supervision of two senior psychiatrists; ICD-9: 300.4, 309.0 and 309.1 22%, ICD-9 296.1, 296.3 7.1% of the entire suicide group); neuroses and personality disorders 19%, addition, especially alcoholism, 28%. No psychiatric diagnosis could be made retrospectively in 10.6% (54 suicides). Sign in the presuicidal development like depressive symptoms, hopelessness and feelings of having no future, sleeping disturbances, feelings of guilt and anxiety, inner restlessness, but also changes in the direction of serenity and relaxation, treats of suicidal behaviour and reactions of the family and environment were reported showing a broad span of reactions from lack of perception to wrong interpretation. 15% of the suicides had also criminal activities in their former history. From a psychiatric point of view, improved diagnostic and therapeutic procedures in the treatment of the mentally ill, especially in the field of outpatient medical care of depressive and addictive patients, and better information of the relatives is to be demanded in order to prevent suicides.

Adult↗
PubMed1968

[Results of studies on the use of psychotropic drugs in the treatment of encephalopathies following early childhood brain damage].

Results are reported of three years' experiments on the use of psychotropic drugs in the treatment of 240 encephalopathic children between the ages of 6 and 15 years, who received 322 treatments in the clinic or ambulatory. The authors consider psychotropic drugs a good symptomatic medicament, helping to remove, alleviate or correct symptoms like psychomotor disturbances, distractability of attention, restlessness, tension, anxiety, night enuresis, explosivity, irritability, disturbed sleep etc. Effects of treatment are much better owing to the fact that patients are made more accessible to psychotherapy and psychagogic measures. Chlorpromazine, glutaminic acid and vitamins of the B group were particularly effective in the treatment of motorically excited encephalopaths with a passive attitude towards their surroundings.

Adolescent↗
PubMed1995

[Sleep disorders in patients with dialysis-dependent renal failure].

A questionnaire was performed in order to classify the prevalence of sleep disorders in patients with end-stage renal disease treated with hemodialysis. 69 patients (41 male, 28 female) with a median age of 57 years completed the questionnaire. 67% of these patients complained of sleep disorders. 31 patients (45%) had evidence of periodic leg movement syndrome, 22 patients (32%) of restless legs syndrome. 29 patients (42%) had difficulties in falling asleep, 27 patients (39%) in maintaining sleep and 17 (25%) experienced both. Snoring was found in 25 patients (36%), 13 patients (19%) seemed to have sleep apnea. These data show an increased prevalence of sleep disorders in patients with end-stage renal disease on hemodialysis treatment. We conclude that these patients should consequently be asked for sleep disorders, as a specific diagnostic and therapeutic regime could improve quality of life and life expectancy. Especially sleep apnea is a disease that has a high prevalence in this patient group and which can be treated successfully.

Adult↗
PubMed1988

Psychological and social complaints reported by Dutch patients to their family doctors.

Ninety-three percent of all problems and complaints reported by patients aged 21 and older to their family physician dealt with somatic disorders, and only 7% with psychosocial problems. Psychological complaints were evenly distributed among major age groups, and between male and female patients. "Social problems" peaked in the middle-age range. The most frequently reported psychological problems were feeling anxious, nervous or tense; feeling irritable, angry, restless or agitated; experiencing feelings of depression; and disturbances of sleep. Marital problems, problems at work, and problems caring for an ill or disabled relative were the most frequently reported "social" reasons for encounter. More women than men reported feelings of depression and marital problems. Men more often felt irritable, angry, restless or agitated, and had more problems at work.

Adult↗
PubMedDate not supplied

Restless legs syndrome: a review for the renal care professionals.

Restless legs syndrome is a common neurological disorder with an estimated prevalence between 2 and 10%. It is characterised by an imperative desire to move the extremities associated with paraesthesias, motor restlessness, worsening of symptoms at rest with at least partial relief by activity, and worsening of symptoms in the evening or at night. As a consequence, patients suffer from severe sleep disturbances and, less frequently, from daytime sleepiness. The cause of restless legs syndrome remains unknown. It has been divided into idiopathic and symptomatic (secondary, e.g. uraemic restless legs syndrome) forms. Based on pharmacological, neurophysiological and imaging studies it is suggested that it is a disease of the subcortical central nervous system with involvement of the brainstem and spinal chord. Dopaminergic agents are regarded as the first choice of treatment; however, the development of augmentation of symptoms especially under levodopa therapy may be a major problem. Alternative medications are opioids and benzodiazepines. In secondary restless legs syndrome the underlying illness should be treated first, but dopaminergic drugs may also be helpful.

Dopamine Agents↗
PubMed1976

[Wallenberg's syndrome with sleep-induced dyspnea--a case study].

One case with Wallenberg's syndrome followed by the neck clipping of the posterior inferior cerebellar aneurysm was reported. The patient was 49 years old female with the subarachnoid hemorrhage, who had previously no history of the cardiovascular disease. The vertebral angiogram revealed a saccular aneurysm of the left vertebral artery at the origin of the posterior inferior cerebellar artery. The preoperative neurological examination were normal, except for the slight degree of the meningeal irritation. The surgical intervention was successfully performed on 39th day after the subarachnoid hemorrhage. Postoperative course was eventful, presenting the typical Wallenberg's syndrome, which was complicated the accompanying signs. The troublesome accompanying signs were chiefly automatic respiratory dysfunction (sleep-induced dyspnea), autonomic dysfunction (Horner's syndrome, perspiration, hypertension), and restless confusion. The postoperative vertebral angiogram showed the obliteration of the aneurysm and the sufficient circulation of the vertebrobasilar system, especially the posterior inferior cerebellar artery. The mechanism of "sleep-induced dyspnea" was discussed in detail from the literatures. In addition to the above mentioned, it should be stressed that the recognition of "sleep-induced dyspnea" and the other accompanying signs are important for the treatment of the patient with the brain stem lesion.

Cerebellar Diseases↗
PubMed2000

Epidemiology of restless legs symptoms in adults.

BACKGROUND: Restless legs syndrome (RLS) is a disorder characterized by sleep-disrupting unpleasant leg sensations, often accompanied by daytime behavioral problems. Treatment for this condition is available, but it is suspected that most instances of RLS remain undiagnosed. The goal of this investigation was to assess the prevalence and health status correlates of restless legs symptoms (hereinafter referred to as restless legs) in the general population. METHODS: A question reflecting the clinical features of RLS was added to the 1996 Kentucky Behavioral Risk Factor Surveillance Survey. Data on the frequency of experiencing restless legs, self-rated general and mental health status, demographics, and behavioral risk factors were collected by telephone interview from 1803 men and women, 18 years and older. RESULTS: Experiencing restless legs 5 or more nights per month was reported by 3% of participants aged 18 to 29 years, 10% of those aged 30 to 79 years, and 19% of those 80 years and older. The age-adjusted prevalence for Kentucky adults is 10.0%; prevalence did not vary significantly by sex. The adjusted odds ratios (95% confidence intervals) for restless legs and diminished general health and poor mental health status were 2.4 (1.4-4.0) and 3.1 (2.0-4.6), respectively. Restless legs were significantly associated with increased age and body mass index, lower income, smoking, lack of exercise, low alcohol consumption, and diabetes. CONCLUSIONS: The prevalence of restless legs in the general adult population is high. Restless legs may be associated with decreased well-being, emphasizing the need for further research and greater medical recognition of this condition.

Adolescent↗
PubMed1991

Aging, sleep disorders, and male sexual function.

The relation between age, sleep disorders, nocturnal penile tumescence, and sexual behavior was investigated in 70 healthy married men aged 45-75 years. They had an extensive psychosexual interview, a medical and psychiatric evaluation, and were studied in the sleep laboratory for four nights. Electroencephalogram (EEG), eye movements, muscle tone, and penile tumescence were monitored continuously, and respiratory airflow and bilateral anterior tibialis recordings were obtained during the first sleep session. There was a marked age-related increase in sleep-disordered breathing, but no significant changes in periodic leg movements with age. Respiratory distress and periodic leg movement (PLM) indices were mostly unrelated with nocturnal penile tumescence (NPT) measures as well as with all sexual behavior dimensions when age was taken into account in the analysis of results. Men with a respiratory distress disorder did not differ from a nondisordered group of similar age in NPT and behavioral parameters. Men with PLM disorder differed from their comparison group in only two variables: fewer number of maximum tumescent episodes and less frequent sexual thoughts. Men who met criteria for erectile impotence did not differ significantly in degree of respiratory or PLM disturbances or in the prevalence of sleep disorders when compared to an aged-matched sexually nondysfunctional group. The overall results did not support the notion that sleep disorders are involved in the increased prevalence of erectile impotence in healthy older individuals. Assessment of blood oxygenation and respiratory effort, in addition to airflow, need to be carried out before final conclusions can be drawn on the significance of sleep-disordered breathing in male sexuality.

Age Factors↗
PubMed2004

Parkinson's disease and RLS: the dopaminergic bridge.

Dopamine is a neurotransmitter that modulates diverse waking behaviors including movement, motivation, cognition, reward, and feeding. Interest in dopamine's additional contributions to normal and pathologic sleep-wake states has experienced a recent rebirth originating from two clinical disorders: Parkinson's disease and Restless Legs Syndrome. The former, the prototypical disorder of brain dopamine cell loss, is accompanied by marked sleep disruption and impairments in daytime alertness. The latter is exquisitively responsive to pharmacologic agents that act upon dopamine receptors. The potential neurobiological substrates underlying these observations are reviewed here. Converging lines of evidence suggest that mesocorticolimbic dopamine circuits are involved in promoting wakefulness, while a less studied diencephalospinal dopamine system might underly the sensorimotor dysfunction of Restless Legs Syndrome.

Brain↗
PubMed2003

Olfactory deficits and sleep disturbances in Parkinson's disease: a case-control survey.

BACKGROUND: Olfactory and sleep disturbances are common in Parkinson's disease, and may be early disease indicators. OBJECTIVE: To obtain information about olfactory and sleep deficits preceding the onset of motor symptoms in Parkinson's disease. SUBJECTS: 38 community dwelling patients with Parkinson's disease (73% response rate) and 32 age matched controls (60% response rate). METHODS: Using a questionnaire survey, the frequencies, timing, and relations between olfactory and sleep disturbances, drug treatment, mood, and motor deficits in Parkinson's disease were compared with those in age matched controls. Reliability of information was validated by informant interview in 9% of the sample. Interdependency of factors was assessed using Fisher's fourfold table test, and differences between populations were analysed using chi(2) and unpaired t tests. RESULTS: Microsmia was reported by 26 patients (68%) (and only one control), on average within a year of the diagnosis of Parkinson's disease. More patients than controls had excessive daytime somnolence (45% v 6%), restless legs (50% v 19%), and abnormal movements during sleep (34% v 0%), which generally occurred three to five years after diagnosis and were independent of mood disorders and drug treatment. CONCLUSIONS: Many patients with Parkinson's disease have microsmia at the onset of motor deficits, but some sleep disorders are a subsequent occurrence.

Aged↗
PubMed2005

Restless Legs Syndrome in patients after renal transplantation.

BACKGROUND: There is an almost complete lack of information on the epidemiology of sleep disorders in kidney-transplanted patients. In this report the authors assess the prevalence and clinical correlates of restless legs syndrome (RLS) in kidney-transplanted (Tx) patients. They also analyze the impact of declining renal function on this condition in the Tx population. Finally, the prevalence of RLS was compared between waitlisted dialysis patients (WL), and the Tx group. METHODS: In a cross-sectional study enrolling 992 patients (816 Tx and 176 WL), the presence of RLS was assessed using the Restless Legs Syndrome Questionnaire. Clinical and sociodemographic data were collected from the patients' medical records. RESULTS: In transplanted patients, the prevalence of RLS was 4.8%. RLS was associated strongly with declining renal function. In groups formed on the basis of estimated glomerular filtration rate (eGFR), the prevalence of RLS was 1.8%, 5.1%, 6.5%, and 23.5% in patients with eGFR greater than 60 mL/min/1.73 m 2 ; eGFR 30 to 59 mL/min/1.73 m 2 ; eGFR 15 to 29 mL/min/1.73 m 2 ; and eGFR less than 15 mL/min/1.73 m 2 , respectively (P < 0.001). There was also a significant association between RLS and lower serum hemoglobin, higher number of self-reported comorbid conditions, and higher prevalence of iron deficiency. RLS was significantly less frequent in patients taking steroids than in patients not taking this medication (4% versus 9%, P < 0.05). In multivariate analysis, not taking steroids, eGFR, self-reported comorbidity, and iron deficiency were significant and independent predictors of RLS. Dialysis treatment was associated with increased odds for RLS (odds ratio 2.2; 95% confidence interval 1.11 to 4.35; P < 0.05) even after adjusting for serum hemoglobin and comorbidity. CONCLUSION: The prevalence of RLS is significantly lower in Tx patients than in patients on maintenance dialysis. Declining renal function is associated with increasing prevalence of the condition.

Anemia↗
PubMed2002

EEG mapping in patients with restless legs syndrome as compared with normal controls.

Restless legs syndrome (RLS) is a sensorimotor movement and sleep disorder with a high prevalence. While the sleep disturbance due to RLS has been studied quite well polysomnographically, little is known about the electrophysiological function during daytime. The aim of the present study was to investigate the diurnal quantitative EEG and clinical symptomatology in 33 drug-free RLS patients as compared with age- and sex-matched normal controls. Investigations comprised brain mapping of the vigilance-controlled EEG as well as completion of the Zung Self-Rating Depression Scale, the Zung Self-Rating Anxiety Scale, the Quality of Life Index, the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale for evaluation of clinical symptomatology. Statistical analysis demonstrated an increase in absolute delta and absolute and relative alpha-2 power, a decrease in absolute and relative alpha-1 power, an acceleration of the dominant frequency and the alpha centroid, and a slowing of the delta/theta centroid, as well as a non-significant attenuation in total power. These findings are characteristic of dissociated vigilance changes described in depression. Indeed, RLS patients demonstrated significantly higher depression and anxiety scores, lower quality of life and deteriorated sleep quality. The score of the Epworth Sleepiness Scale was not elevated, in contrast to the increased daytime sleepiness observed in other highly prevalent organic sleep disorders (e.g. sleep apnea). In conclusion, daytime EEG mapping revealed neurophysiological correlates of depression in RLS, which was confirmed by self-ratings at the symptomatological level.

Adult↗
PubMedDate not supplied

Clinical relevance of cannabis tolerance and dependence.

Psychoactive drugs are often widely used before tolerance and dependence is fully appreciated. Tolerance to cannabis-induced cardiovascular and autonomic changes, decreased intraocular pressure, sleep and sleep EEG, mood and behavioral changes is acquired and, to a great degree, lost rapidly with optimal conditions. Mechanisms appear more functional than metabolic. Acquisition rate depends on dose and dose schedule. Dependence, manifested by withdrawal symptoms after as little as 7 days of THC administration, is characterized by irritability, restlessness, insomnia, anorexia, nausea, sweating, salivation, increased body temperature, altered sleep and waking EEG, tremor, and weight loss. Mild and transient in the 120 subjects studied, the syndrome was similar to sedative drug withdrawal. Tolerance to drug side effects can be useful. Tolerance to therapeutic effects or target symptoms poses problems. Clinical significance of dependence is difficult to assess since drug-seeking behavior has many determinants. Cannabis-induced super sensitivity should be considered wherever chronic drug administration is anticipated in conditions like epilepsy, glaucoma or chronic pain. Cannabis pharmacology suggests ways of minimizing tolerance and dependence problems.

Cannabinoids↗