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Insomnia
Kinds of Insomnia Terms modified by Insomnia Selected AbstractsINSOMNIA AND COGNITIVE DECLINEJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2002Thomas E. Finucane MD No abstract is available for this article. [source] Review of systematic reviews about the efficacy of non-pharmacological interventions to improve sleep quality in insomniaINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2009Gerrit J De Niet MSc RN Abstract Background, Insomnia is a very common condition in various populations. Non-pharmacological interventions might offer (safe) alternatives for hypnotics. Aim, To evaluate the evidence for efficacy from systematic reviews about non-pharmacological interventions to improve sleep quality in insomnia by a systematic review of systematic reviews and meta-analyses. Search strategy, Search strategies were conducted in the Database of Abstracts of Reviews of Effects (2002,July 2008), The Cochrane Database of Systematic Reviews (2000,July 2008) and PubMed (1950,July 2008). Sleep quality was the outcome measure of interest. Selection criteria, Systematic reviews about the efficacy of one or more non-pharmacological interventions for insomnia, concerning both adult and elderly populations, were included. Reviews that included studies performed among populations suffering with severe neurological or cognitive impairments or with addictive disorders were excluded. Data analysis, Relevant data were extracted. The quality of the reviews found was appraised by using the Overview Quality Assessment Questionnaire. The evidence was appraised and divided into six classes. Results and conclusions, Sixteen reviews about 17 interventions were included. Six reviews were of adequate methodological quality. Of these, only one provided an effect size: a moderate effect was found for music-assisted relaxation. Weak evidence indicating a large effect was found for multicomponent cognitive behavioural therapy, progressive muscle relaxation, stimulus control and ,behavioural only'. Weak evidence indicating a moderate effect was found for paradoxical intention. Finally, weak evidence indicating a moderate to large effect was found for relaxation training. Because of the lack of sufficient methodological quality and the lack of calculated effect sizes, most of the included reviews were not suitable for drawing rigorous conclusions about the effect of non-pharmacological interventions on sleep quality in insomniacs. The non-pharmacological treatment of insomnia would benefit from renewed reviews based on a rigorous methodological approach. [source] Daily Variations in Objective Nighttime Sleep and Subjective Morning Pain in Older Adults with Insomnia: Evidence of Covariation over TimeJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2010Joseph M. Dzierzewski MS OBJECTIVES: To examine the relationship between objectively measured nocturnal sleep and subjective report of morning pain in older adults with insomnia; to examine not only the difference between persons in the association between sleep and pain (mean level over 14 days), but also the within-person, day-to-day association. DESIGN: Cross-sectional. SETTING: North-central Florida. PARTICIPANTS: Fifty community-dwelling older adults (mean age±standard deviation 69.1±7.0, range 60,90) with insomnia. MEASUREMENTS: Daily home-based assessment using nightly actigraphic measurement of sleep and daily self-report of pain over 14 consecutive days. RESULTS: Between persons, average sleep over 14 days was not associated with average levels of rated pain, but after a night in which an older adult with insomnia experienced above-average total sleep time he or she subsequently reported below-average pain ratings. The model explained approximately 24% of the within-person and 8% of the between-person variance in pain ratings. CONCLUSIONS: Sleep and pain show day-to-day associations (i.e., covary over time) in older adults with insomnia. Such associations may suggest that common physiological systems underlie the experience of insomnia and pain. Future research should examine the crossover effects of sleep treatment on pain and of pain treatment on sleep. [source] Evidence-Based Recommendations for the Assessment and Management of Sleep Disorders in Older PersonsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2009AGSF, Harrison G. Bloom MD Sleep-related disorders are most prevalent in the older adult population. A high prevalence of medical and psychosocial comorbidities and the frequent use of multiple medications, rather than aging per se, are major reasons for this. A major concern, often underappreciated and underaddressed by clinicians, is the strong bidirectional relationship between sleep disorders and serious medical problems in older adults. Hypertension, depression, cardiovascular disease, and cerebrovascular disease are examples of diseases that are more likely to develop in individuals with sleep disorders. Conversely, individuals with any of these diseases are at a higher risk of developing sleep disorders. The goals of this article are to help guide clinicians in their general understanding of sleep problems in older persons, examine specific sleep disorders that occur in older persons, and suggest evidence- and expert-based recommendations for the assessment and treatment of sleep disorders in older persons. No such recommendations are available to help clinicians in their daily patient care practices. The four sections in the beginning of the article are titled, Background and Significance, General Review of Sleep, Recommendations Development, and General Approach to Detecting Sleep Disorders in an Ambulatory Setting. These are followed by overviews of specific sleep disorders: Insomnia, Sleep Apnea, Restless Legs Syndrome, Circadian Rhythm Sleep Disorders, Parasomnias, Hypersomnias, and Sleep Disorders in Long-Term Care Settings. Evidence- and expert-based recommendations, developed by a group of sleep and clinical experts, are presented after each sleep disorder. [source] Prevalence and Comorbidity of Insomnia and Effect on Functioning in Elderly PopulationsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue S7 2005Sonia Ancoli-Israel PhD A good night's sleep is often more elusive as we age, because the prevalence of insomnia in older people is high. Insufficient sleep can have important effects on daytime function by increasing the need to nap, reducing cognitive ability including attention and memory, slowing response time, adversely affecting relationships with friends and family, and contributing to a general sense of being unwell. However, rather than aging per se, circadian rhythm shifts, primary sleep disorders, comorbid medical/psychiatric illnesses, and medication use cause sleep difficulties in older people, which psychosocial factors may also affect. Clinicians should ask elderly patients about satisfaction with sleep. Any sleep complaints warrant careful evaluation of contributing factors and appropriate treatment. [source] The Role of Benzodiazepines in the Treatment of InsomniaJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2001Meta-Analysis of Benzodiazepine Use in the Treatment of Insomnia PURPOSE: To obtain a precise estimate of the efficacy and common adverse effects of benzodiazepines for the treatment of insomnia compared with those of placebo and other treatments. BACKGROUND: Insomnia, also referred to as disorder of initiating or maintaining sleep, is a common problem and its prevalence among older people is estimated to be 23% to 34%.1 The total direct cost in the United States for insomnia in 1995 was estimated to be $13.9 billion.2 The complaint of insomnia in older people is associated with chronic medical conditions; psychiatric problems, mainly depression, chronic pain, and poor perceived general condition;1,3,4 and use of sleep medications.5 Thus in most cases, insomnia is due to some other underlying problem and is not just a consequence of aging.6 Accordingly, the management of insomnia should focus on addressing the primary problem and not just short-term treatment of the insomnia. Benzodiazepines belong to the drug class of choice for the symptomatic treatment of primary insomnia.7 This abstract will appraise a meta-analysis that compared the effect of benzodiazepines for short-term treatment of primary insomnia with placebo or other treatment. DATA SOURCES: Data sources included articles listed in Medline from 1966 to December 1998 and the Cochrane Controlled Trials Registry. The medical subject heading (MeSH) search terms used were "benzodiazepine" (exploded) or "benzodiazepine tranquillizers" (exploded) or "clonazepam,""drug therapy,""randomized controlled trial" or "random allocation" or "all random,""human," and "English language." In addition, bibliographies of retrieved articles were scanned for additional articles and manufacturers of brand-name benzodiazepines were asked for reports of early trials not published in the literature. STUDY SELECTION CRITERIA: Reports of randomized controlled trials of benzodiazepine therapy for primary insomnia were considered for the meta-analysis if they compared a benzodiazepine with a placebo or an alternative active drug. DATA EXTRACTION: Data were abstracted from 45 randomized controlled trials representing 2,672 patients, 47% of whom were women. Fifteen studies included patients age 65 and older and four studies involved exclusively older patients. Twenty-five studies were based in the community and nine involved inpatients. The duration of the studies ranged from 1 day to 6 weeks, with a mean of 12.2 days and median of 7.5 days. The primary outcome measures analyzed were sleep latency and total sleep duration after a sleep study, subjects' estimates of sleep latency and sleep duration, and subjects' report of adverse effects. Interrater reliability was checked through duplicate, independent abstraction of the first 21 articles. Overall agreement was between 95% and 98% (kappa value of 0.90 and 0.95 accordingly) for classification of the studies and validity of therapy, and 76% (kappa value of 0.51) for study of harmful effects. A scale of 0 to 5 was used to rate the individual reports, taking into account the quality of randomization, blinding, follow-up, and control for baseline differences between groups. Tests for homogeneity were applied across the individual studies and, when studies were found to be heterogeneous, subgroup analysis according to a predefined group was performed. MAIN RESULTS: The drugs used in the meta-analysis included triazolam in 16 studies; flurazepam in 14 studies; temazepam in 13 studies; midazolam in five studies; nitrazepam in four studies; and estazolam, lorazepam, and diazepam in two studies each. Alternative drug therapies included zopiclone in 13 studies and diphenhydramine, glutethimide, and promethazine in one study each. Only one article reported on a nonpharmacological treatment (behavioral therapy). The mean age of patients was reported in 33 of the 45 studies and ranged between 29 and 82. SLEEP LATENCY: In four studies involving 159 subjects, there was sleep-record latency (time to fall asleep) data for analysis. The pooled difference indicated that the latency to sleep for patients receiving a benzodiazepine was 4.2 minutes (95% CI = (,0.7) (,9.2)) shorter than for those receiving placebo. Patient's estimates of sleep latency examined in eight studies showed a difference of 14.3 minutes (95% CI = 10.6,18.0) in favor of benzodiazepines over placebo. TOTAL SLEEP DURATION: Analysis of two studies involving 35 patients in which total sleep duration using sleep-record results was compared indicated that patients in the benzodiazepine groups slept for an average of 61.8 minutes (95% CI = 37.4,86.2) longer than those in the placebo groups. Patient's estimates of sleep duration from eight studies (566 points) showed total sleep duration to be 48.4 minutes (95% CI = 39.6,57.1) longer for patients taking benzodiazepines than for those on placebo. ADVERSE EFFECTS: Analysis of eight studies (889 subjects) showed that those in the benzodiazepine groups were more likely than those in the placebo groups to complain of daytime drowsiness (odds ratio (OR) 2.4, 95% confidence interval (CI) = 1.8,3.4). Analysis of four studies (326 subjects) also showed that subjects in the benzodiazepine groups were more likely to complain of dizziness or lightheadedness than the placebo groups. (OR 2.6, 95% CI = 0.7,10.3). Despite the increased reported side effects in the benzodiazepine groups, drop-out rates were similar in the benzodiazepine and placebo groups. For patient reported outcome, there was no strong correlation found for sleep latency data, (r = 0.4, 95% CI = (,0.3) (,0.9)) or for sleep duration (r = 0.2, 95% CI = ,0.8,0.4) between benzodiazepine dose and outcome. COMPARISON WITH OTHER DRUGS AND TREATMENTS: In three trials with 96 subjects, meta-analysis of the results comparing benzodiazepines with zopiclone, did not show significant difference in sleep latency in the benzodiazepine and placebo groups, but the benzodiazepine groups had increased total sleep duration (23.1 min. 95% CI = 5.6,40.6). In four trials with 252 subjects, the side effect profile did not show a statistically significant difference (OR 1.5, CI 0.8,2.9). There was only one study comparing the effect of behavioral therapy with triazolam. The result showed that triazolam was more effective than behavioral therapy in decreasing sleep latency, but its efficacy declined by the second week of treatment. Behavioral therapy remained effective throughout the 9-week follow-up period. There were four small trials that involved older patients exclusively, with three of the studies having less than 2 weeks of follow-up. The results were mixed regarding benefits and adverse effects were poorly reported. CONCLUSION: The result of the meta-analysis shows that the use of benzodiazepines results in a decrease in sleep latency and a significant increase in total sleep time as compared with placebo. There was also a report of significantly increased side effects, but this did not result in increased discontinuation rate. There was no dose-response relationship for beneficial effect seen with the use of benzodiazepines, although the data are scant. Zopiclone was the only alternative pharmacological therapy that could be studied with any precision. There was no significant difference in the outcome when benzodiazepines were compared with zopiclone. There was only one study that compared the effect of benzodiazepines with nonpharmacological therapy; thus available data are insufficient to comment. [source] Systematic review on the effectiveness of caffeine abstinence on the quality of sleepJOURNAL OF CLINICAL NURSING, Issue 1 2009Celia WM Sin Aim., The aim of the present study is to review the effects of caffeine abstinence on the quality of sleep. Background., Insomnia is a common problem and abstinence from caffeine is the most popular component in sleep hygiene advice. However, there have been inconsistent results relating to the effectiveness of caffeine abstinence in improving sleep. Design., Systematic review. Methods., We browsed several electronic databases and reference lists of articles about the correlation of caffeine consumption and sleep deprivation. We selected the articles according to predefined inclusion and exclusion criteria. Two reviewers assessed the quality of trials, which were selected according to the Jadad quality assessment scale. We included the trials scoring three or above in the systematic review and extracted their data. We assessed the heterogeneity of the studies before we considered whether or not to combine the studies' results. Results., Three randomised control trials fulfilled the selection criteria among which two trials scored ,3 on the Jadad scale. We included these two trials in our systematic review. The designs and outcome measurements of these two trials were not homogeneous, therefore, we did not combine their results. Instead, we conducted a critical appraisal. In one trial, caffeine abstinence was associated with significant lengthening of sleep duration (p < 0·01) and better sleep quality (p < 0·05). In another trial, subjects had less difficulty falling asleep on days when they drank decaffeinated coffee (p < 0·05). Conclusions., The results showed that caffeine abstinence for a whole day could improve sleep quality. Thus, health practitioners were recommended to include caffeine abstinence in the instructions for sleep hygiene. Relevance to clinical practice., This study demonstrates the effectiveness of caffeine abstinence in improving sleep quality. It provides evidence for the practice of including caffeine abstinence in sleep hygiene advice. [source] Acute sleep-promoting action of the melatonin agonist, ramelteon, in the ratJOURNAL OF PINEAL RESEARCH, Issue 2 2008Simon P. Fisher Abstract:, Insomnia, which is severe enough to warrant treatment, occurs in ,10% of the general population. It is associated with a range of adverse consequences for human health, economic productivity and quality of life. In animal and human studies, administration of melatonin has been reported to promote sleep, although there has been controversy regarding its effectiveness. The present study used a chronically implanted radiotelemetry transmitter to record electroencephalogram (EEG) and electromyogram (EMG) to enable discrimination of wake (W), nonrapid eye movement (NREM) sleep and rapid eye movement (REM) sleep in un-restrained rats. The acute action of melatonin and ramelteon, a melatonin agonist recently approved for long-term treatment of insomnia in the USA, was examined. Radioligand binding assays on recombinant human MT1/MT2 receptors showed that both the melatonin and ramelteon were both high affinity, nonsubtype selective ligands. Both compounds acted as potent full agonists on a cellular model of melatonin action, the pigment aggregation response in Xenopus laevis melanophores. Both melatonin and ramelteon (10 mg/kg, i/p), administered close to the mid-point of the dark phase of the L:D cycle, significantly reduced NREM sleep latency (time from injection to the appearance of NREM sleep). Both the drugs also produced a short-lasting increase in NREM sleep duration, but the NREM power spectrum was unaltered. Neither drug altered REM latency, REM sleep duration nor power spectrum during REM sleep. In conclusion, ramelteon administration, like melatonin, exerted an acute, short-lasting sleep-promoting effect in the rat, the model most commonly used to evaluate the activity of novel hypnotic drugs. [source] Disruptions in Sleep Time and Sleep Architecture in a Mouse Model of Repeated Ethanol WithdrawalALCOHOLISM, Issue 7 2006Lynn M. Veatch Background: Insomnia and other sleep difficulties are perhaps the most common and enduring symptoms reported by alcoholics undergoing detoxification, especially those alcoholics with a history of multiple detoxifications. While some studies have reported sleep disruptions in animal models after chronic ethanol exposure, the reports are inconsistent and few address sleep architecture across repeated ethanol exposures and withdrawals. The present study evaluated sleep time and architecture in a well-characterized mouse model of repeated chronic ethanol exposure and withdrawal. Methods: C57BL6/J mice were fitted with electrodes in frontal cortex, hippocampus, and nuchal muscle for collection of continuous electroencephalogram (EEG)/electromyogram (EMG) data. Baseline data were collected, after which mice received 4 cycles of 16-hour exposure to alcohol (ethanol: EtOH) vapor separated by 8-hour periods of withdrawal or similar handling in the absence of EtOH vapor. Ethanol-exposed mice attained a blood ethanol concentration of 165 mg%. Upon completion of vapor exposure, EEG/EMG data were again collected across 4 days of acute withdrawal. Data were subjected to automated analyses classifying 10-second epochs into wake, non,rapid eye movement (REM) sleep, or REM sleep states. Results: Mice in withdrawal after chronic EtOH exposure showed profound disruptions in the total time asleep, across the acute withdrawal period. Sleep architecture, the composition of sleep, was also disrupted with a reduction in non-REM sleep concomitant with a profound increase in REM sleep. While altered sleep time and non-REM sleep loss resolved by the fourth day of withdrawal, the increase in REM sleep ("REM rebound") persisted. Conclusions: These results mirror those reported for the human alcoholic and demonstrate that EtOH withdrawal,induced sleep disruptions are evident in this mouse model of alcohol withdrawal,induced sensitization. This mouse model may provide mechanisms to investigate fully the high correlation between unremitting sleep problems and increased risk of relapse documented clinically. [source] Diagnosis and management of geriatric insomnia: A guide for nurse practitionersJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 12 2008MN (Nurse Practitioner), Preetha Krishnan RN Abstract Purpose: To discuss the assessment, diagnosis, and management of geriatric insomnia, a challenging clinical condition of older adults frequently seen by primary care providers. Data sources: Extensive literature review of the published research articles and textbooks. Conclusions: Complaints of insomnia among older adults are frequently ignored, considered a part of the normal aging process or viewed as a difficult to treat condition. Geriatric insomnia remains a challenge for primary care providers because of the lack of evidence-based clinical guidelines and limited treatment options available. Effective management of this condition is necessary for improved quality of life, which is a primary issue for the elderly and their families. Therefore, geriatric insomnia warrants thorough attention from the nurse practitioners (NPs) who provide care for older adults. Implications for practice: Undiagnosed or under treated insomnia can cause increased risk for falls, motor vehicle accidents, depression, and shorter survival. Insomniacs double their risk for cardiovascular disease, stroke, cancer, and suicide compared to their counterparts. Insomnia is also associated with increased healthcare utilization and institutionalization. NPs could play a central role in reducing the negative consequences of insomnia through a systematic approach for diagnosis, evaluation, and management. [source] Pharmacokinetics of valerenic acid after single and multiple doses of valerian in older womenPHYTOTHERAPY RESEARCH, Issue 10 2010Gail D. Anderson Abstract Insomnia is a commonly reported clinical problem with as many as 50% of older adults reporting difficulty in falling and/or remaining asleep. Valerian (Valeriana officinalis) is a commonly used herb that has been advocated for promoting sleep. Valerenic acid is used as a marker for quantitative analysis of valerian products with evidence of pharmacological activity relevant to the hypnotic effects of valerian. The objective of this study was to determine the pharmacokinetics of valerenic acid in a group of elderly women after receiving a single nightly valerian dose and after 2 weeks of valerian dosing. There was not a statistically significant difference in the average peak concentration (Cmax), time to maximum concentration (Tmax) area under the time curve (AUC), elimination half-life (T1/2) and oral clearance after a single dose compared with multiple dosing. There was considerable inter- and intra-subject variability in the pharmacokinetic parameters. Cmax and AUC deceased and T1/2 increased with increased body weight. The variability between the capsules was extremely low: 2.2%, 1.4% and 1.4%, for hydroxyvalerenic acid, acetoxyvalerenic acid and valerenic acid, respectively. In conclusion, large variability in the pharmacokinetics of valerenic acid may contribute to the inconsistencies in the effect of valerian as a sleep aid. Copyright © 2010 John Wiley & Sons, Ltd. [source] Insomnia: guide to diagnosis and choice of treatmentPRESCRIBER, Issue 8 2008Sue Wilson PhD The tiredness and poor performance associated with insomnia have a considerable impact on quality of life. Our Drug Review considers when drug treatments are justified and which are preferred, followed by sources of further information and a review of prescription data. Copyright © 2008 Wiley Interface Ltd [source] The relative importance of specific risk factors for insomnia in women treated for early-stage breast cancerPSYCHO-ONCOLOGY, Issue 1 2008Wayne A. Bardwell Abstract Background: Many individual risk factors for insomnia have been identified for women with a history of breast cancer. We assessed the relative importance of a wide range of risk factors for insomnia in this population. Methods: Two thousand six hundred and forty-five women ,4 years post-treatment for Stage I (,1 cm),IIIA breast cancer provided data on cancer-related variables, personal characteristics, health behaviors, physical health/symptoms, psychosocial variables, and the Women's Health Initiative-Insomnia Rating Scale (WHI-IRS; scores ,9 indicate clinically significant insomnia). Results: Thirty-nine per cent had elevated WHI-IRS scores. In binary logistic regression, the variance in high/low insomnia group status accounted for by each risk factor category was: cancer-specific variables, 0.4% (n.s.); personal characteristics, 0.9% (n.s.); health behaviors, 0.6% (n.s.); physical health/symptoms, 13.4% (p<0.001); and, psychosocial factors, 11.4% (p<0.001). Insomnia was associated with worse depressive (OR = 1.32) and vasomotor symptoms (particularly night sweats) (OR = 1.57). Conclusion: Various cancer-specific, demographic, health behavior, physical health, and psychosocial factors have been previously reported as risk factors for insomnia in breast cancer. In our study (which was powered for simultaneous examination of a variety of variables), cancer-specific, health behavior, and other patient variables were not significant risk factors when in the presence of physical health and psychosocial variables. Only worse depressive and vasomotor symptoms were meaningful predictors. Copyright © 2007 John Wiley & Sons, Ltd. [source] Insomnia in Dual Diagnosis PatientsTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 4 2010Mark J. Albanese MD No abstract is available for this article. [source] Benzodiazepine Treatment of Anxiety or Insomnia in Substance Abuse PatientsTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 4 2000Domenic A. Ciraulo M.D. First page of article [source] Sleep symptoms and their clinical correlates in Machado,Joseph diseaseACTA NEUROLOGICA SCANDINAVICA, Issue 4 2009A. D'Abreu Objective,,, To evaluate the presence of sleep symptoms in Machado,Joseph disease/spinocerebellar ataxia type 3 (MJD/SCA3). Subjects/methods,,, We used a sleep questionnaire and the Epworth Sleepiness Scale to compare 53 patients with MJD/SCA3 and 106 controls. Results,,, Patients with MJD/SCA3 reported more symptoms of insomnia, restless leg syndrome and REM sleep behavior disorder as well as nocturnal cramps, snoring and nocturnal apnea. Insomnia was the most frequently reported sleep-related complaint in the MJD/SCA3 group. Conclusions,,, Our results indicate that sleep disorders are common in patients with MJD/SCA3 and probably have a multifactorial etiology, with components of a primary sleep disorder in addition to sleep-disrupting symptoms such as nocturia and cramps. [source] Atomoxetine treatment in adults with attention-deficit/hyperactivity disorder and comorbid social anxiety disorderDEPRESSION AND ANXIETY, Issue 3 2009Lenard A. Adler M.D. Abstract Background: To evaluate the effect of atomoxetine (ATX) on attention-deficit/hyperactivity disorder (ADHD) and comorbid social anxiety disorder in adults. Methods: Randomized, double-blind, placebo-controlled, conducted in adults with ADHD and social anxiety disorder. Patients received 40,100,mg ATX (n=224) or placebo (n=218) for 14 weeks following a 2-week placebo lead-in period. Efficacy measures included the Conners' Adult ADHD Rating Scale: Investigator-Rated: Screening Version (CAARS:Inv:SV), Liebowitz Social Anxiety Scale (LSAS), Clinical Global Impression-Overall-Severity (CGI-O-S), State-Trait Anxiety Inventory (STAI), Social Adjustment Scale-Self Report (SAS), and Adult ADHD Quality of Life Scale-29 (AAQoL). Safety and tolerability were also assessed. Results: ATX mean change (,8.7±10.0) from baseline (29.6±10.4) on CAARS:Inv:SV Total ADHD Symptoms score was significantly greater than placebo mean change (,5.6±10.2) from baseline (31.2±9.4; P<.001). ATX mean change (,22.9±25.3) from baseline (85.3±23.6) on LSAS Total score was significant compared to placebo mean change (,14.4±20.3) from baseline (82.1±21.3; P<.001). The visit-wise analysis revealed greater improvement on the CAARS:Inv:SV Total ADHD Symptoms score and LSAS Total score for ATX at every time point throughout the study (P values ,.012). Mean changes in CGI-O-S, STAI-Trait Anxiety scores, and AAQoL Total score were significantly greater for ATX compared to placebo. Mean change for both groups on STAI-State Anxiety scores was comparable. Improvement on SAS for ATX compared to placebo was not significant. Rates of insomnia, nausea, dry mouth, and dizziness were higher with ATX than with placebo. Discontinuation rates due to treatment-emergent adverse events were similar between groups. Conclusions: ATX monotherapy effectively improved symptoms of ADHD and comorbid social anxiety disorder in adults and was well tolerated. Depression and Anxiety, 2009. Published 2009 Wiley-Liss, Inc. [source] Clarithromycin-induced hypomania in a child , a case reportACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2010W. J. Baranowski Baranowski WJ. Clarithromycin-induced hypomania in a child , a case report. Objective:, We report here a child developing hypomania while treated with clarithromycin. Method:, Case report. Results:, A 3-year-old boy was treated for pneumonia with oral clarithromycin in monotherapy. The boy became somewhat hyperactive and irritable after the second dose. After the third dose he presented with psychomotor agitation, pressured speech, irritability, aggressive behaviour and insomnia. The antibiotic was identified as the only possible cause of the described clinical picture and was discontinued immediately. The hypomanic symptoms subsided gradually over 36 h. Conclusion:, Commonly-used medications can produce uncommon adverse reactions. Clinicians, especially general practitioners, pediatricians, as well as child and adolescent psychiatrists ought to be aware of such a possibility when evaluating a child with suddenly changed behaviour. [source] Treatment of insomnia in patients with mood disordersDEPRESSION AND ANXIETY, Issue 1 2001Peter D. Nowell M.D. Abstract Mood disorders and chronic insomnia share complex theoretical and clinical relationships. This article reviews the subjective symptoms and polysomnographic findings of subjects with mood and insomnia syndromes. The polysomnographic findings reviewed include macro-architectural and micro-architectural data. Various treatments of patients with insomnia and mood disorders will be presented, including both behavioral and pharmacological interventions. Depression and Anxiety 14:7,18, 2001. © 2001 Wiley-Liss, Inc. [source] Review of bupropion for smoking cessationDRUG AND ALCOHOL REVIEW, Issue 2 2003ROBYN RICHMOND Abstract The advent of bupropion hydrochloride sustained release (Zyban) has heralded a major change in the options available for smoking cessation pharmacotherapy. Bupropion is a selective re-uptake inhibitor of dopamine and noradrenalin which prevents or reduces cravings and other features of nicotine withdrawal. Bupropion is a useful oral and non-nicotine form of pharmacotherapy for smoking cessation. For this review a total of 221 papers were reviewed plus poster presentations. This review examines in detail original clinical trials on efficacy, categorised according to whether they were acute treatment trials in healthy smokers; studies in specific populations such as people with depression, chronic obstructive pulmonary disease (COPD) or cardiovascular disease; or relapse prevention studies. Overall, these studies in varying populations comprising over four thousand subjects, showed bupropion consistently produces a positive effect on smoking cessation outcomes. The evidence highlights the major public health role that bupropion has in smoking cessation. The methodological issues of published clinical trials reporting one year outcomes were examined in detail including: completeness of follow-up; loss to follow-up; intention to treat analysis; blindness of assessment; and validation of smoking status. The review discusses contraindications, adverse effects, dose and overdose, addictive potential, and the role of bupropion in reducing cessation-related weight gain. Bupropion combined with or compared to other pharmacotherapies (nicotine patch; nortriptyline) is considered. Impressive evidence exists for the use of bupropion in smoking cessation among difficult patients who are hard-core smokers such as those with cardiovascular disease, chronic obstructive pulmonary disease (COPD) and depression. Bupropion reduces withdrawal symptoms as well as weight gain and is effective for smoking cessation for people with and without a history of depression or alcoholism. Serious side effects of bupropion use are rare. The major safety issue with bupropion is risk of seizures (estimated at approximately 0.1%) and it should not be prescribed to patients with a current seizure disorder or any history of seizures. In clinical trials of bupropion for smoking cessation no seizures were reported. Allergic reactions occur at a rate of approximately 3% and minor adverse effects are common including dry mouth and insomnia. [source] The relationship between melatonin and cortisol rhythms: clinical implications of melatonin therapyDRUG DEVELOPMENT RESEARCH, Issue 3 2005N. Zisapel Abstract Disturbances in circadian rhythm have been linked to chronic diseases such as insomnia, hypertension, diabetes, and depression. Here we review recent studies on the age-related changes in cortisol and melatonin rhythms and then present descriptive statistics on our preliminary findings on the rectification of the cortisol rhythms by melatonin therapy in elderly patients with insomnia. In adults, the melatonin onset typically occurs during low cortisol secretion. Administration of exogenous melatonin around dusk will shift the phase of the human circadian clock to earlier hours (advance phase shift) leading to phase advances in circadian rhythms (e.g., sleep, endogenous melatonin, cortisol). With aging, the production of melatonin declines and is shifted to later hours while the production of cortisol increases and its peak occurs earlier in the night. In a randomized placebo-controlled crossover study with 8 patients with insomnia aged 55 years and older, a group characterized by low and delayed melatonin production, administration of prolonged-release melatonin in the evening was able to rectify the early onset cortisol production. This delay in nocturnal cortisol onset may explain in part the improvement in sleep quality in elderly patients with insomnia, in schizophrenics, and in depressed patients. Support of circadian pacemaker function by melatonin may provide a new strategy in the treatment of disorders related to impairments in the internal temporal order. The clinical benefit from a decrease in cortisol during the early part of the night may lie beyond the improvement of sleep into a better control of blood pressure, metabolism, and mood. Drug Dev. Res. 65:119,125, 2005. © 2005 Wiley-Liss, Inc. [source] Mephentermine dependence without psychosis: a Brazilian case reportADDICTION, Issue 6 2010Henrique Faria De Sousa ABSTRACT Background Substance abuse is a serious health concern. This report presents the case of a 22-year-old Brazilian man with a history of mephentermine use who fulfils all the criteria for chemical dependence listed by ICD-10. Mephentermine is a sympathomimetic agent derived from methamphetamine which, in Brazil, is restricted to veterinary use. Case description The subject used the substance at a high dose (120 mg) to improve his physical performance while working out at a gym. His symptoms included anorexia and insomnia. After days of intense activity, he felt fatigue and soreness. A physical examination revealed scars on both forearms from the injections and a psychological examination revealed moderate speech and motor agitation. Conclusions Cases such as this may be common among the general public. They should have some bearing upon medical practice and public health policies involving drugs. [source] Effects of Qi therapy (external Qigong) on symptoms of advanced cancer: a single case studyEUROPEAN JOURNAL OF CANCER CARE, Issue 5 2005M.S. LEE phd The aim of this study was to examine the effectiveness of Qi therapy (external Qigong) in the management of symptoms of advanced cancer in a man. We used a single case study design to evaluate the effectiveness of Qi therapy (external Qigong) in a 35-year-old man with advanced cancer (Stage IV) involving metastases in the stomach, lung and bone (Karnofsky performance scale: KPS, 40: requires special care and assistance, disabled). Treatment involved six days of pre-assessment, eight treatment sessions on alternate days over 16 days, and a two-week follow-up phase. A visual analogue scale (VAS) was used to assess the patient's self-reported symptoms of cancer over the intervention and follow-up periods. Following treatment, VAS scores' analysis revealed beneficial effects on pain, vomiting, dyspnoea, fatigue, anorexia, insomnia, daily activity and psychological calmness. These improvements were maintained over the two-week follow-up phase. After the first Qi therapy session, the patient discontinued medication and could sit by himself; after the fourth session, the patient was able to walk and use the toilet without assistance (improvement in KPS: 70: care for self, unable to perform normal activity or to do active work). Although limited by the single case study approach, our results support previous studies on this topic and provide reasons to conduct controlled clinical trials. [source] Drug/substance reversal effects of a novel tri-substituted benzoflavone moiety (BZF) isolated from Passiflora incarnata Linn.,a brief perspectiveADDICTION BIOLOGY, Issue 4 2003Kamaldeep Dhawan The present work is a mini-review of the author's original work on the plant Passiflora incarnata Linn., which is used in several parts of the world as a traditional medicine for the management of anxiety, insomnia, epilepsy and morphine addiction. A tri-substituted benzoflavone moiety (BZF) has been isolated from the bioactive methanol extract of this plant, which has been proposed in the author's earlier work to be responsible for the biological activities of this plant. The BZF moiety has exhibited significantly encouraging results in the reversal of tolerance and dependence of several addiction-prone psychotropic drugs, including morphine, nicotine, ethanol, diazepam and delta-9-tetrahydrocannabinol, during earlier pharmacological studies conducted by the author. In addition to this, the BZF moiety has exhibited aphrodisiac, libido-enhancing and virility-enhancing properties in 2-year-old male rats. When administered concomitantly with nicotine, ethanol and delta-9-tetrahydrocannabinol for 30 days in male rats, the BZF also prevented the drug-induced decline in sexuality in male rats. Because the BZF moiety isolated from P. incarnata is a tri-substituted derivative of alpha-naphthoflavone (7,8-benzoflavone), a well-known aromatase-enzyme inhibitor, the mode of action of BZF has been postulated to be a neurosteroidal mechanism vide in which the BZF moiety prevents the metabolic degradation of testosterone and upregulates blood-testosterone levels in the body. As several flavonoids (e.g. chrysin, apigenin) and other phytoconstituents also possess aromatase-inhibiting properties, and the IC 50 value of such phytomoieties is the main factor determining their biochemical efficacy, by altering their chemical structures to attain a desirable IC 50 value new insights in medical therapeutics can be attained, keeping in view the menace of drug abuse worldwide. [source] Report of an EFNS task force on management of sleep disorders in neurologic disease (degenerative neurologic disorders and stroke)EUROPEAN JOURNAL OF NEUROLOGY, Issue 11 2007P. Jennum A task force to develop guidelines for diagnostic evaluation and treatment of sleep disorders in degenerative neurologic disorders and stroke was initiated by the European Federation of Neurological Societies (EFNS). The aims were to provide evidence-based recommendations in the management of sleep disorders associated with degenerative neurologic disorders and stroke. Neurological patients often have significant sleep disorders like sleep-related breathing disorders (SBD), insomnia, sleep-related motor and rapid eye movement behavioral disorders affecting nocturnal sleep and daytime function. A polysomnography (PSG) is usually a diagnostic minimum for the diagnoses of the most commonly reported sleep disorders in patients with neurologic diseases. A full video-PSG/video-EEG-PSG should be considered in patients with nocturnal motor and/behavior manifestations. Respiratory polygraphy has a moderate sensitivity and specificity in the diagnosis of SBD without neurologic diseases, but its value in patients with neurologic diseases has not been evaluated. Oximetry has a poor sensitivity-specificity for the identification of SDB. Continuous and bi-level positive airway pressure devices are the most effective treatment of SDB in patients with neurologic diseases. There is a need for further studies focusing on the diagnostic procedures and treatment modalities in patients with sleep disorders and degenerative neurologic diseases and stroke. [source] Clinical and genetic features of human prion diseases in Catalonia: 1993,2002EUROPEAN JOURNAL OF NEUROLOGY, Issue 10 2004R. Sanchez-Valle We describe the clinical and genetic characteristics of the 85 definite or probable human prion diseases cases died between January 1993 and December 2002 in Catalonia (an autonomous community of Spain, 6 million population). Seventy-three (86%) cases were sporadic Creutzfeld-Jakob diseases (sCJD) (49 definite, 24 probable), with a median age at onset of 66 years. The clinical presentation was dementia in 29 cases, ataxia in 14 and visual symptoms in five. The median survival was 3 months. The 14-3-3 assay was positive in 93% cases, 62% presented periodic sharp wave complexes (PSWC) in EEG but only 18% the typical signs on MRI. Forty-eight sCJD were studied for codon 129 PRNP polymorphism: 69% were methionine/methionine (M/M), 14.5% valine/valine (V/V) and 16.5% M/V. Six out of seven V/V cases did not present PSWC and in two survival was longer than 20 months. Eleven cases (13%) were genetic: five familial fatal insomnia and six familial CJD (fCJD). Up to four (67%) fCJD lacked family history of disease, two presented seizures early at onset and one neurosensorial deafness. The only iatrogenic case was related to a dura mater graft. No case of variant CJD was registered. The study confirms in our population the consistent pattern reported worldwide on human prion diseases. Atypical features were seen more frequently in sporadic 129 V/V CJD and fCJD cases. [source] Codon 129 polymorphism and the E200K mutation do not affect the cellular prion protein isoform composition in the cerebrospinal fluid from patients with Creutzfeldt,Jakob diseaseEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 11 2010Matthias Schmitz Abstract The cellular prion protein (PrPc) is a multifunctional, highly conserved and ubiquitously expressed protein. It undergoes a number of modifications during its post-translational processing, resulting in different PrPc glycoforms and truncated PrPc fragments. Limited data are available in humans on the expression and cleavage of PrPc. In this study we investigated the PrPc isoform composition in the cerebrospinal fluid from patients with different human prion diseases. The first group of patients was affected by sporadic Creutzfeldt,Jakob disease exhibiting different PrP codon 129 genotypes. The second group contained patients with a genetic form of Creutzfeldt,Jakob disease (E200K). The third group consisted of patients with fatal familial insomnia and the last group comprised cases with the Gerstmann,Sträussler,Scheinker syndrome. We examined whether the PrP codon 129 polymorphism in sporadic Creutzfeldt,Jakob disease as well as the type of prion disease in human patients has an impact on the glycosylation and processing of PrPc. Immunoblotting analyses using different monoclonal PrPc antibodies directed against various epitopes of PrPc revealed, for all examined groups of patients, a consistent predominance of the glycosylated PrPc isoforms as compared with the unglycosylated form. In addition, the antibody SAF70 recognized a variety of PrPc fragments with sizes of 21, 18, 13 and 12 kDa. Our findings indicate that the polymorphisms at PrP codon 129, the E200K mutation at codon 200 or the examined types of human transmissible spongiform encephalopathies do not exert a measurable effect on the glycosylation and processing of PrPc in human prion diseases. [source] Sensory gating in primary insomniaEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 11 2010Ilana S. Hairston Abstract Although previous research indicates that sleep architecture is largely intact in primary insomnia (PI), the spectral content of the sleeping electroencephalographic trace and measures of brain metabolism suggest that individuals with PI are physiologically more aroused than good sleepers. Such observations imply that individuals with PI may not experience the full deactivation of sensory and cognitive processing, resulting in reduced filtering of external sensory information during sleep. To test this hypothesis, gating of sensory information during sleep was tested in participants with primary insomnia (n = 18) and good sleepers (n = 20). Sensory gating was operationally defined as (i) the difference in magnitude of evoked response potentials elicited by pairs of clicks presented during Wake and Stage II sleep, and (ii) the number of K complexes evoked by the same auditory stimulus. During wake the groups did not differ in magnitude of sensory gating. During sleep, sensory gating of the N350 component was attenuated and completely diminished in participants with insomnia. P450, which occurred only during sleep, was strongly gated in good sleepers, and less so in participants with insomnia. Additionally, participants with insomnia showed no stimulus-related increase in K complexes. Thus, PI is potentially associated with impaired capacity to filter out external sensory information, especially during sleep. The potential of using stimulus-evoked K complexes as a biomarker for primary insomnia is discussed. [source] Psychological trauma exposure and trauma symptoms among individuals with high and low levels of dental anxietyEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 4 2006Ad De Jongh This questionnaire-based study investigated the traumatic background and trauma-related symptomatology among 141 treatment-seeking individuals with high levels of dental anxiety and among a low-anxious reference group consisting of 99 regular dental patients. The highly anxious individuals reported a significantly higher number of traumatic events, both within and outside the dental or medical setting, than those in the reference group (73% vs. 21%). Horrific experiences in the dental setting were the most common traumatic events reported. Of the highly anxious individuals, 46.1% indicated suffering from one or more of the post-traumatic stress disorder (PTSD) symptom clusters (re-experiencing, avoidance, loss of interest, and insomnia), while in the reference group this percentage was 6%. Severity of dental anxiety was significantly associated with number of screening criteria for specific phobia and the extent to which the anxious subjects displayed symptoms of post-traumatic stress. Two variables were uniquely predictive for positive diagnostic screens for dental phobia and PTSD: having experienced a horrific dental treatment and having been a victim of a violent crime. In conclusion, post-traumatic symptoms are common accompaniments of severe forms of dental anxiety and are experienced even when dental treatment is not imminent. [source] No effect of Piper methysticum (kava) and Valeriana officinalis (valerian) for relief of anxiety and insomniaFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 1 2006Article first published online: 14 JUN 2010 [source] | ||||||||||||||||||||||||||||||||||||||||