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At least 145 records · Page 8Linked to original sources

PubMed2004

Neurological aspects of some sleep disorders.

My aim is to examine the relation between some sleep disorders and neurological diseases; to analyse their mutual interactions in order to achieve new practical data for clinical use. In the theoretical part I summarise some main points of sleep physiology concentrating on the associations of sleep regulation and neurological diseases. In my examinations, besides clinical methods, the most important tools used are sleep analyses performed by polysomnography and MESAM IV as well as brain imaging methods. To assess clinical state of my stroke patients I utilised NIH Stroke Scale. I found pathological sleep apnoea frequency in more than half of the patients in any type (bleeding/infarction) of acute stroke. In a prospective study, sleep apnoea parameters remain permanent during 3 months in the ischaemic group; on the other hand, sleep apnoea improves during follow up after brain haemorrhages. I showed pathological sleep apnoea frequency in myasthenia gravis among male patients without daytime respiration complaint. I looked for the link between the mechanism of the sleep disorder and the underlying organic lesion in two cases. In this analyses I took into account the function of the affected structure in sleep regulation. I found a basal forebrain tumour, affecting sleep regulating centres underlying severe insomnia and I suggest a neuro-vascular compression of the lateral preoptic area of the hypothalamus being the reason of sleep related painful erection, a parasomnia of unknown origin.

Brain Neoplasms↗

PubMed2006

[Depressive symptoms as differential-diagnostic problem].

The 59 year-old, high-qualified male patient had been treated for psychiatric illness due to depressive symptoms, "pathological crying", amplified somatic style and severe insomnia. Earlier he had one depressive episode. There was no psychotrauma detected to cause these symptoms and no neurological symptoms, either. The clinical appearance was psychotic depression, so combined antidepressant, anxiolytic, hypnotic, and antipsychotic therapy was started. The MAWI examination showed mild intellectual deficit, so cerebral MRI was done, also. This examination helped to verify the correct diagnosis: post-stroke depression.

Depression↗

PubMed1977

[Experimental studies of the effects of Seda-Kneipp on the sleep of sleep disturbed subjects; implications for the treatment of different sleep disturbances (author's transl)].

Seda-Kneipp a compound preparation of valerian and hops was given to sleep disturbed subjects during the second or third of three consecutive nights disturbed by heavy traffic noise. Prior drug administration reduced the noise induced disturbance of sleep stage patterns: slow-wave sleep and stage REM increased. It is recommended that the initial treatment of severe insomnia by "strong" sleeping pills should be followed by a period during which "weak" sleeping pills are given before the drug administration finally is discontinued.

Adult↗

PubMedDate not supplied

[Detection of the anxio-depressive disorders in liaison psychiatry. Contribution of the General Health Questionnaire].

Among self-report inventories of psychopathology for adults, the General Health Questionnaire (GHQ) is one of the prominent instruments developed for the screening of minor psychiatric morbidity. Four versions of the GHQ were provided from the original 60 items (GHQ-30, 28, 20, 12) and three different scorings have been suggested. A large number of validity studies, mostly favourable, have been performed and are reviewed in this paper. Recent work has suggested that the sensitivity of the GHQ to clinical change was fair, compared to the Present State Examination. The most recent version, the GHQ-28, was built from factor analyses of the 60-item version and covered four dimensions, with seven items each: anxiety and insomnia, severe depression, social impairment, somatic complaints, but their subscores were not independent. Several international extensive studies have confirmed that the GHQ was an interesting tool in Community as well as in General Practice. But, as it falls short from detecting all the chronic cases, research aimed at improving its quality in this direction is still in progress. The use of the French version of the GHQ-28 is expected to be encouraged.

Anxiety Disorders↗

PubMed1990

Assessing suicide risk in stroke patients: review of two cases.

Poststroke depression can be accompanied by suicidal ideation, yet reports of suicide among stroke patients are rare. When untreated, depression can become prolonged and severe. Risk factors for suicide include depression, severe insomnia, chronic illness, and organic brain syndrome. Early clinical assessment of suicide risk factors is essential in the rehabilitation setting. Two patients who developed mood disturbances in the acute poststroke period and eventually committed suicide are presented. Neither patient openly expressed suicidal thoughts to staff or family members. Retrospective analysis of medical records was compared to established suicide risk factors reported in the medical literature. Indirect verbal cues and nonverbal behavior patterns indicating potential suicide risk may have been present. Strategies for evaluation and management of suicidal behavior are discussed. These cases emphasize the need for early assessment of suicide risk by the entire rehabilitation team.

Aged↗

PubMed1988

Comparison of midazolam and oxazepam as hypnotics in elderly hospitalized patients. A double-blind clinical trial.

The efficacy and safety of 15 mg midazolam versus 15 mg oxazepam were compared in a double-blind clinical trial in 61 aged hospitalized patients (mean age 82.5, range 69 to 96), suffering from moderate to severe insomnia. The study covered 8 nights, i.e., 1 placebo night followed by 5 treatment nights and 2 further placebo nights. Both drugs were equally effective with respect to total sleep time, number of nocturnal awakenings, quality of sleep, condition on awakening, patients' assessment and dreams. However, sleep latency was significantly shorter in the midazolam group, which was also rated significantly more favorably by the medical staff. Side effects were mild and similar in both groups. No rebound or carry-over effects were noted. Midazolam can be considered an effective and safe sleep inducer in aged patients.

Aged↗

PubMed1986

Restless legs syndrome.

Patients with restless legs syndrome often have difficulty describing their symptoms. Three features characterize the classic syndrome: an unusual, almost indescribable sensation in the lower extremities; an irresistible urge to move the legs, and the exclusive occurrence of the symptoms at rest, with their relief by movement. Restless legs syndrome may cause severe insomnia. Variants of the syndrome, as well as numerous associated conditions, have been described. The etiology is unknown. Clonazepam and carbamazepine are reported to be effective in treating this syndrome.

Adolescent↗

PubMed1982

Psychological symptoms and intermittent hypertension following acute microwave exposure.

Two men who were accidentally, acutely irradiated with X-band microwave radiation have been followed up clinically for 12 months. Both men developed similar psychological symptoms, which included emotional lability, irritability, headaches, and insomnia. Several months after the incidents, hypertension was diagnosed in both patients. No organic basis for the psychological problems could be found nor could any secondary cause for the hypertension. A similar syndrome following microwave exposure has been described by the East Europeans. The two cases we report, with comparable subjective symptoms and hypertension following a common exposure, provide further strong, circumstantial evidence of cause and effect. A greater knowledge of the mechanisms involved in bioeffects which may be induced by radiofrequency and microwave radiation is definitely needed.

Adult↗

PubMed1993

[A case of life-threatening ventricular arrhythmias probably due to psychotropic drugs].

We present a case provoked life-threatening ventricular arrhythmias probably due to psychotropic drugs. The patient was a 55-year-old man who had previously twice operations of aortic valve replacement (AVR). The signs of cardiac failure were recurrently appeared from the end of 1991, and he had received promethazine and sulpiride for his depressive state. From cardiac catheterization, we planned his third AVR. The electrocardiographic (ECG) QTc interval was prolonged to 0.48 seconds on this admission. In March 1992 syncopal attack appeared suddenly, and his monitor ECG revealed frequent polymorphous ventricular tachycardia (VT) and Torsade de Pointes (Tdp). These arrhythmias stopped by emergent cardiac pacing. After discontinuing these psychotropic drugs, no ventricular arrhythmias appeared. Since the patient complained severe insomnia one month before operation, the diminished dose of psychotropic drugs (promethazine and levomepromazine) was readministered. Ten days after the operation, syncopal attack reappeared and his ECG recorded frequent VT and Tdp. During both syncopal attacks his serum potassium and magnesium were within normal limits. Two days later, he died from multi-organ failure. We concluded that life-threatening arrhythmias such as VT and Tdp might develop under the administration of mild psychotropic drugs (promethazine or levomepromazine), therefore, must better take a care of ECG changes in cases of using any psychotropic drugs.

Electrocardiography, Ambulatory↗

PubMed1996

Overview of generalized anxiety disorder in the elderly.

Both situational anxiety and pathologic anxiety are common in the elderly. Pathologic anxiety, however, may significantly disable a previously functioning older adult. Moderate-to-severe anxiety is important to accurately diagnose and treat in older persons in order to improve daily functioning and because individual symptoms of anxiety can be easily confused with even more severe geropsychiatric disorders such as dementia, delirium, depression, and psychosis. These particular symptoms include impaired concentration and attention, impaired memory, dizziness, disabling fear, severe insomnia, and hypervigilance, among others. This article will review epidemiology, characteristics of anxiety in late-life, patterns of medication use, and treatment.

Adolescent↗

PubMed1998

[Periodic limb movement disorder].

The periodic limb movements (PLM) are defined as stereotyped, periodic movements of the legs and/or upper limbs during sleep. The patient exhibits dorsifilexion of the ankle and extension of the big toe with occasional flexion of the knee and hip. PLM originally was described as "nocturnal myoclonus" by Symonds in 1953. Recently, the term "nocturnal myoclonus" has been replaced with PLM, because the movements are slower than true myoclonic movement. The appearance of PLM was reported in sleep apnea syndrome, delayed sleep phase syndrome, narcolepsy, spinal cord tumor, diabetes mellitus and uremia. The prevalence of PLM statistically increase with age. Patients with PLM show excessive daytime sleepiness or insomnia. Several reports show the difficulty recognizing periodic limb movement disorder (PLMD) without polysomnography (PSG). The diagnosis of PLMD is established only by PSG.

Anticonvulsants↗

PubMed2005

Family studies in insomnia.

OBJECTIVE: Several predisposing factors to insomnia have been hypothesized, including a familial component; however, few studies have focused on this topic. The aim of this study is to evaluate the prevalence of insomnia among first-degree relatives of chronic insomniacs and to compare the symptoms between sporadic and familial insomnia. METHODS: Two hundred fifty-six consecutive chronic insomniacs completed a clinical interview, psychometric questionnaires, a questionnaire on the family history of insomnia and, when indicated, a polysomnography. A control group was performed to estimate a base-rate incidence of insomnia in their families. RESULTS: Patients with primary (n=77) and psychiatric (n=104) insomnia were definitely included. Of those with primary insomnia, 72.7% reported familial insomnia compared with 24.1% in the noninsomnia control group. Among the psychiatric insomniacs, 43.3% reported familial insomnia. The mother was the relative most frequently affected. Comparisons between the family prevalence rates of insomnia assessed by the probands and by first-degree relatives show high concordance. A tendency to a younger age at onset was observed in familial and primary insomnia. CONCLUSION: This study reports a significant increase of familial aggregation of insomnia, warranting further genetic studies in primary insomnia with early age at onset.

Adolescent↗

PubMed2002

Interactions between evening and nocturnal cortisol secretion and sleep parameters in patients with severe chronic primary insomnia.

Recent research provides evidence for an interaction between sleep and the activation of the hypothalamic-pituitary-adrenal (HPA)-axis, but detailed studies in patients are still missing. We investigated hourly evening and nocturnal plasma cortisol secretion and sleep in seven male patients with severe chronic primary insomnia and age- and gender-matched controls. Evening and nocturnal cortisol levels were significantly increased in patients. Evening cortisol correlated with the number of nocturnal awakenings in patients and controls. Additionally, patients showed significant correlations between sleep parameters and the first 4 h of nocturnal cortisol secretion. These results are indicative of changes in the HPA system in insomnia and may reflect a pathophysiological mechanism of chronic insomnia resulting in a vicious cycle of both disturbed HPA functions and chronic insomnia according to the arousal hypothesis of insomnia.

Adult↗

PubMed2002

The relationship between insomnia and health-related quality of life in patients with chronic illness.

OBJECTIVES: To determine the association between insomnia and health-related quality of life (HRQOL) in patients with chronic illness after accounting for the effects of depression, anxiety, and medical comorbidities. STUDY DESIGN: We used a cross-sectional analysis of Medical Outcomes Study (MOS) data. POPULATION: The sample consisted of 3445 patients who completed a self-administered questionnaire and who were given a diagnosis of 1 or more of 5 chronic medical and psychiatric conditions by an MOS clinician. Patients were recruited from the offices of clinicians practicing family medicine, internal medicine, endocrinology, cardiology, and psychiatry in 3 US cities. OUTCOMES MEASURED: Outcomes were sleep items, health-related quality of life as measured by the Medical Outcomes Study Short Form Health Survey (SF-36), chronic medical comorbidity, depression, and anxiety. Insomnia was defined as the complaint of difficulty initiating or maintaining sleep. RESULTS: Insomnia was severe in 16% and mild in 34% of study patients. Patients with insomnia demonstrated significant global decrements in HRQOL. Differences between patients with mild insomnia versus no insomnia showed small to medium decrements across SF-36 subscales ranging from 4.1 to 9.3 points (on a scale of 0 to 100); the corresponding decrements for severe insomnia (versus no insomnia) ranged from 12.0 to 23.9 points. CONCLUSIONS: Insomnia is independently associated with worsened HRQOL to almost the same extent as chronic conditions such as congestive heart failure and clinical depression.

Adult↗

PubMed2005

Relationship between chronic painful physical condition and insomnia.

BACKGROUND: A chronic painful physical condition (CPPC) can be a major cause of sleep disturbances. Few community-based surveys examined the specific relationship between these two conditions. METHODS: Eighteen thousand, nine hundred and eighty participants aged 15 years or older from five European countries (the United Kingdom, Germany, Italy, Portugal and Spain) and representative of approximately 206 millions Europeans were interviewed by telephone. The interview included questions about sleeping habits, health, sleep and mental disorders. Painful physical conditions were ascertained through questions about medical treatment, consultations and/or hospitalizations for medical reasons and a list of 42 diseases. A painful physical condition was considered chronic when it lasted at least six months. Insomnia symptoms were defined as difficulty initiating or maintaining sleep or non-restorative sleep, present at least three nights per week, lasting at least one month, and accompanied by daytime consequences. RESULTS: (1) The point prevalence of at least one CPPC was set at 17.1% (95% CI: 16.5-17.6%) in the sample. (2) Difficulty initiating sleep was found in 5.1% (95% CI: 4.8-5.4%) of the sample, disrupted sleep in 7.5% (95% CI: 7.2-7.9%); early morning awakenings in 4.8% (95% CI: 7.2-7.9%) and non-restorative sleep in 4.5% (95% CI: 4.2-4.8%). (3) More than 40% of individuals with insomnia symptoms reported at least one CPPC. (4) CPPC was associated with more frequent difficulty or inability to resume sleep once awake and a shorter sleep duration. (5) In middle-aged subjects (45-64 years of age), CPPC was associated with longer insomnia duration. At any age, insomnia with CPPC was associated with a greater number of daytime consequences (average of four consequences) than in insomnia without CPPC (average of 2.3 consequences). (6) In multivariate models, CPPC, especially backaches and joint/articular diseases, were at least as importantly associated with insomnia than were mood disorders with odds ratios ranging from 4.1 to 5.0 for backaches and from 3.0 to 4.8 for joint/articular diseases. CONCLUSIONS: CPPC is associated with a worsening of insomnia on several aspects: a greater number of insomnia symptoms, more severe daytime consequences and more chronic insomnia situation. CPPC plays a major role on insomnia. Its place as major contributive factor for insomnia is as much important as mood disorders.

Adolescent↗

PubMed2005

Sleep disturbances before and after parathyroidectomy for secondary hyperparathyroidism.

BACKGROUND: The prevalence of insomnia in patients with symptomatic secondary hyperparathyroidism and the improvements of sleep disturbances after parathyroidectomy have not been previously reported. METHODS: Thirty-one patients who had undergone successful total parathyroidectomy and autotransplantation for symptomatic secondary hyperparathyroidism were enrolled in the study. The symptoms of skin itching, bone pain, and general weakness were recorded. Preoperatively, serum levels of calcium, phosphorus, alkaline phosphatase (Alk-ptase), intact parathyroid hormone (iPTH), am melatonin (noon), and pm melatonin (midnight) were measured in association with a simple yes/no questionnaire of 5 items about sleep disturbances as described previously. The severity of insomnia was the sum of positive items of sleeping disturbances. The sleep hours per night and the habit of taking sleeping pills were also recorded. One week after surgery, serum levels of calcium, phosphorus, Alk-ptase, iPTH, am melatonin, and pm melatonin were measured again. Three months after surgery, symptoms of skin itching, bone pain, and general weakness were recorded, and serum levels of calcium, phosphorus, Alk-ptase and iPTH were measured in association with a yes/no questionnaire of sleep disturbances. The severity of insomnia, sleep hours per night, and the habit of taking sleeping pills were recorded again. RESULTS: One week after parathyroidectomy, serum levels of calcium, phosphorus, and iPTH decreased significantly; serum levels of Alk-ptase and am melatonin increased significantly; serum levels of pm melatonin did not change significantly. Three months after parathyroidectomy, symptoms of skin itching, bone pain, and general weakness decreased significantly; serum levels of calcium, phosphorus, Alk-ptase, and iPTH decreased significantly; sleeping disturbances and severity of insomnia improved significantly in association with longer sleep hours per night. A significant reduction of the habit of taking sleeping pills was also noted. Preoperatively, the severity of insomnia was correlated with skin itching, general weakness, and levels of iPTH. Postoperatively, the severity of insomnia was correlated with skin itching, general weakness, and bone pain. CONCLUSIONS: Preoperatively, a high prevalence of sleep disturbances (97%) was found in patients with symptomatic secondary hyperparathyroidism. We conclude that nocturnal melatonin levels do not change after parathyroidectomy; the improvements in sleep disturbance and the decreases in severity of insomnia are found 3 months after surgery in association with longer sleep hours per night. Decreases of symptoms such as skin itching, bone pain, and general weakness may be the reasons for the improvement in sleep and the decrease in insomnia.

Adult↗

PubMed2005

Self-help treatment for insomnia: a randomized controlled trial.

STUDY OBJECTIVES: Insomnia is a prevalent health complaint that often remains untreated. Several interventions are efficacious but they are not widely available. This study evaluated the efficacy of a self-help behavioral intervention for insomnia. DESIGN: The study used a 2 (conditions; self-help treatment, no treatment control) x 3 (assessments; pretreatment, posttreatment, 6-month follow-up) mixed factorial design. SETTING: This study was part of a larger epidemiologic study conducted with a randomly selected sample of 2001 adults of the province of Quebec in Canada. PARTICIPANTS: One-hundred ninety-two adults (n = 127 women, 65 men; mean age, 46 years) with insomnia, selected from a larger community-based epidemiologic sample, were randomly assigned to self-help treatment (n = 96) or no-treatment control (n = 96). INTERVENTIONS: The self-help intervention included 6 educational booklets mailed weekly to participants and providing information about insomnia, healthy sleep practices, and behavioral sleep scheduling and cognitive strategies. MEASUREMENTS AND RESULTS: Participants completed sleep diaries and questionnaires at pretreatment, posttreatment, and 6-month follow-up. Significant but modest improvements were obtained on subjective sleep parameters for treatment but not control participants. Treated participants averaged nightly gains of 21 minutes of sleep and a reduction of 20 minutes of wakefulness, with a corresponding increase of 4% in sleep efficiency. Improvements were also obtained on measures of insomnia severity (Insomnia Severity Index) and of sleep quality (Pittsburgh Sleep Quality Index), and those changes were maintained at follow-up. CONCLUSIONS: A self-help behavioral intervention was effective in alleviating a broad range of insomnia symptomatology in a community sample. Self-help may be a promising approach to make effective intervention more widely available.

Adult↗

PubMed2004

Frequency of insomnia report in patients with obstructive sleep apnoea hypopnea syndrome (OSAHS).

BACKGROUND AND PURPOSE: Insomnia and Obstructive Sleep Apnoea Hypopnea Syndrome (OSAHS) are the two most common sleep disorders, and both have significant associated health costs. Despite this, relatively little is known about the prevalence or impact of insomnia in those with OSAHS, although a recent study suggested there may be substantial comorbidity between these disorders [Chest 120 (2001) 1923-9]. The primary aim of this study was to further explore the prevalence of insomnia in OSAHS. A secondary aim was to assess the effect of factors that may impact on both conditions, including mood and sleep-beliefs. PATIENTS AND METHODS: Consecutive patients referred to an accredited Sleep Investigations Unit [n = 105] completed a brief standardized battery of validated questionnaires assessing sleep-related variables and mood. RESULTS: Results showed a high rate of prevalence of clinical insomnia in this OSAHS population, and a strong positive correlation between OSAHS and insomnia symptom severity. Further, OSAHS patients with comorbid insomnia had increased levels of depression, anxiety and stress compared to patients with OSAHS-only, and both patient groups reported similar and significant levels of dysfunctional beliefs about sleep. Findings in relation to habitual sleep, assessed using subjective (diary) and objective criteria (polysomnogram), were mixed but generally showed greater sleep disturbance among those with OSAHS-insomnia compared to those with OSAHS-only. CONCLUSIONS: Overall these findings suggest that comorbidity of insomnia in OSAHS patients may lead to increased OSAHS severity and that patients with both conditions may experience more symptoms relating to depression, anxiety and stress. These findings underscore the need for insomnia assessment and management services, even in clinics that primarily service patients with OSAHS.

Adolescent↗