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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Seasonal Affective Disorder (SAD) has received formal research attention only within the last eight years. Diagnostic criteria for SAD include many characteristics typical of depression: sadness, low self-esteem, lack of energy, social withdrawal, and suicide ideation, and features of atypical depression: carbohydrate craving, overeating, weight gain, and hypersomnia. Differential diagnosis of the disorder depends on an onset in fall/winter and remission in spring/summer. It was hypothesized that spinal cord injury (SCI) patients would have a higher incidence of the disorder in the northern latitudes because of decreased outdoor activities in winter and because of such light-depriving winter survival tactics as installing opaque plastic for storm windows. SCI patient responded to a postal survey which included Rosenthal's Seasonal Pattern Assessment Questionnaire (SPAQ) and the Beck Depression Inventory (BDI). Results showed a substantially higher rate of SAD among SCI patients than in the normative sample.
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PMID:Seasonal affective disorder in a spinal cord injury population. 158 5

Modafinil, a novel stimulant which has several remarkable features that distinguish it from other stimulants, has been developed by Lafon, a French pharmaceutical company. Unlike the amphetamines, for example, modafinil is reported to have minimal peripheral side effects at therapeutic doses. It also appears to have a low abuse potential, does not interfere with normal sleep, and does not seem to produce tolerance. It improves vigilance especially in sleep-deprived subjects. It has been used clinically for up to 3 years in the treatment of narcolepsy and idiopathic hypersomnia. It could be an ideal replacement for amphetamine in short-term operations in which fatigue might threaten the successful completion of a mission. We recommend that military laboratories experienced in studying sustained performance include modafinil or perhaps a more selective alpha 1 receptor agonist in their investigations.
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PMID:Modafinil: the unique properties of a new stimulant. 167 50

Bromazepam was compared with placebo and with chlorprothixene in a randomized, double-blind group-comparative multicenter trial in general practice. Two hundred and forty-five patients with generalized anxiety disorder (DSM-III 1980) were treated for 2 weeks with two daily doses of bromazepam, 3 mg or chlorprothixene, 15 mg or placebo. Median reductions in Hamilton Anxiety rating were 12 (bromazepam), 10.3 (chlorprothixene) and 7.3 (placebo). The study revealed significant superiority of bromazepam over placebo (median differences 3.3, 95% confidence limits: 0.3 and 6.1) but not over chlorprothixene (median difference 1.4, 95% confidence limits -0.8 and +3.5). Significantly higher rates of tiredness, sedation and hypersomnia were found on bromazepam and chlorprothixene compared to placebo. Tolerance was rated as "at least good" in 85.6% on bromazepam, in 86% on chlorprothixene and in 87.8% on placebo. Neither previous psychopharmacological treatment nor presence of psychosocial stress were of perceptible influence. Bromazepam and chlorprothixene are both superior to placebo in generalized anxiety states treated in general practice, but spontaneous improvements/placebo effects are substantial.
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PMID:Bromazepam in generalized anxiety. Randomized, multi-practice comparisons with both chlorprothixene and placebo. 196 72

Bright white light (500lx) for 4 h/day was applied to seven narcoleptic patients (age 47-65 years, mean 55 years). The effects of the light on the disturbed sleep-wake cycle in narcoleptics were investigated by the measurement of the following parameters: (1) excessive daytime sleepiness and sustained attention (multiple sleep latency test); (2) rest-activity cycles; (3) self-ratings (mood, anxiety, tiredness); (4) urinary cycles of 6-OH melatonin sulphate and cortisol; (5) sleep EEG. Treatment with bright light showed neither objective nor subjective changes in the clinical symptoms of narcolepsy. While similar "dosage" light applications can phase shift human circadian rhythms and improve depression and hypersomnia in winter depression, it is not an appropriate treatment for narcolepsy.
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PMID:Bright white light does not improve narcoleptic symptoms. 275 54

In this study we estimate the power of DSM-III Major Depression (MDD) symptoms to discriminate MDD from (1) Generalized Anxiety Disorder (GAD) and (2) no disorder. The NIMH-DIS was administered to 319 women exposed to chronic stress (all were mothers of disabled children). Two methods were used: (1) conditional probabilities, and (2) multiple regression analysis. Symptoms had greater utility in discriminating MDD from no disorder than from GAD. 'Gained weight' and 'thinking about death' had the least efficacy in either discrimination. 'Hypersomnia' and 'insomnia' contributed to the discrimination from no disorder, whereas 'fatigue' and 'sex disinterest' discriminated MDD from GAD. 'Guilt', 'trouble concentrating', 'lost appetite' and 'wanted to die' were important in both comparisons. Despite recent emphasis on observable behaviors and physiologic measures, guilt, a subjectively experienced inner state, was the most important symptom in MDD.
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PMID:Refining DSM-III criteria in Major Depression. An assessment of the descriptive validity of criterion symptoms. 293 53

Most people attribute a restorative function to sleep. This is because experimental or clinical sleep disturbance is usually followed by annoying symptoms of fatigue and sleepiness the following day. Can these daytime changes be documented objectively? In the past several years, the Multiple Sleep Latency Test (MSLT) has been developed and validated as an objective quantitative measure of sleepiness. Multiple assessments of sleep latency yield a profile of sleepiness across the day. This profile changes in the predicted direction with acute total and partial sleep deprivation, chronic sleep deprivation, sleep satiation, and in comparisons between hypersomnia patients and controls. Sleep and wakefulness are complementary phases in the daily cycle of human existence. Adequacy of sleep and energetic wakefulness next day are interacting phases in this cycle. Insomnia can be seen as a perception of disturbed sleep with daytime consequences, but is essentially also a symptom. This paper reviews a number of issues in the diagnosis and treatment of insomnia. The dimensions, daytime consequences and longitudinal aspects of insomnia are considered. Most investigations to date have been geared towards the problem of chronic insomnia and yet we are all likely to suffer from transient insomnia at some point. Psychiatric and psychophysiological disorders have been shown to be the most frequent causes of disorders of initiating and maintaining sleep. Moreover, there is an apparent disparity between subjective and objective sleep parameters with, for example, objectively disturbed sleep in noncomplaining subjects. The criteria of hypnotic efficacy and the effects of triazolam and flurazepam on sleep and daytime alertness have been investigated in normals, chronic insomniacs and the elderly. In general, chronic insomniacs showed all degrees of daytime alertness regardless of nocturnal sleep parameters. About one-third could be classified as fully alert all day long in spite of their complaints. The effect of flurazepam and triazolam on sleep (improvement) was essentially the same. Daytime effects were most closely related to half-life. The long-acting benzodiazepine, flurazepam, impaired daytime alertness although nocturnal sleep was improved. Triazolam improved not only nighttime sleep but also daytime alertness.
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PMID:Issues in the diagnosis and treatment of insomnia. 638 52

The chronic fatigue syndrome (CFS) was formally defined in 1988 to describe a syndrome of severe and disabling fatigue of uncertain aetiology associated with a variable number of somatic and/or psychological symptoms. CFS has been reported in most industrialised countries and is most prevalent in women aged between 20 and 50 years. Despite occasional claims to the contrary, the aetiology of CFS remains elusive. Although abnormalities in tests of immune function and cerebral imaging have been described in variable numbers of CFS patients, such findings have been inconsistent and cannot be relied upon, either to establish or exclude the diagnosis. Thus, diagnosis rests on fulfillment of the Centers for Disease Control case definition which was revised in 1992. This case definition remains somewhat controversial, largely due to its subjectiveness. The mainstay of treatment is establishing the diagnosis and educating the patient about the illness. An empathetic clinician can stop further consultations elsewhere ('doctor shopping') and subsequent excessive investigations, which frequently occur in such patients. Most patients should undertake a trial of antidepressant therapy, even if major depression is not present. The choice of antidepressant drug should tailor the tolerability profile to relief of particular CFS symptoms, such as insomnia or hypersomnia. Failure to improve within 12 weeks warrants an alternative antidepressant agent of another class. Many other drugs have been reported anecdotally to be beneficial, but no therapy has been demonstrated to be reproducibly useful in double-blind, placebo-controlled clinical trials with an adequate duration of follow-up.
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PMID:Treatment of the chronic fatigue syndrome. A review and practical guide. 750 50

Seasonal changes in human behavior have been recognized since ancient times. Starting in 1980 systematic research has been carried out by Rosenthal et al. (1984), who described and characterized a psychopathological and clinical syndrome which is linked to fall/winter and shows remission in spring/summer and which was termed seasonal affective disorder (SAD). The symptomatology includes depressed mood, decreased energy, hypersomnia, increased appetite and subsequently weight gain and frequently carbohydrate craving. The efficacy of light therapy with bright, fluorescent, full-spectrum light has been widely demonstrated for treatment of fall/winter SAD. In addition, treatment with selective serotonin reuptake inhibitors appears to be successful in this condition.
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PMID:[Fall/winter depression and its therapy]. 781 Jan 51

The prevalence of sleep disorders manifest as insomnia and fatigue of excessive daytime sleepiness in the general population; office practice is high. Poor quality sleep may pose a significant health risk for not only the patient but society in general. Sensitivity for potentially serious sleep disorders should be coupled with an organized approach to diagnosis and therapy. Differentiation of the principal complaint into insomnia versus hypersomnia and determination of duration are the key elements. Office-based management of the most common sleep-wake disorders and current diagnostic testing standards are discussed.
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PMID:Office management of common sleep-wake disorders. 787 98

Numerous investigators have shown a strong association between the seasons and the incidence of depression, mania and suicides. However, little has been known about patients who reveal affective episodes in association with the changing seasons year after year. Lewy and Rosenthal established the concept of Seasonal Affective Disorder (SAD). SAD is characterized by recurring cycles of fall-winter depression and spring-summer hypomania (or euthymia). Depressive symptoms often include hypersomnia, anergia, fatigue, carbohydrate craving and weight gain. The syndrome occurs predominantly in women and begins in late twenties. Lewy, Rosenthal and other investigators found that exposure of the SAD patients to bright artificial light improved depressive symptoms. Some hypotheses of light therapy are proposed, however, each of them has not well explained the mechanisms.
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PMID:[Light therapy of patients with seasonal affective disorder]. 800 95


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