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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sleep is a vital human physiologic process. Insomnia can be caused by obsession and depression states, pain, or worry over everyday problems. Because of their pharmacologic action, alcohol and high doses of soporifics used as remedies may produce REM-deficit sleep and actually prolong insomnia. If the true cause of sleeplessness is not recognized and properly treated, insomnia may develop into a severe sleep problem. Since benzodiazepines and chloral hydrate do not suppress REM sleep, they are the medications of choice in the therapy for insomnia.
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PMID:Insomnia and the physiology of sleep. 20 31

Animal data indicate that serotonin (5-HT) is a major neurotransmitter involved in the control of numerous central nervous system functions including mood, aggression, pain, anxiety, sleep, memory, eating behavior, addictive behavior, temperature control, endocrine regulation, and motor behavior. Moreover, there is evidence that abnormalities of 5-HT functions are related to the pathophysiology of diverse neurological conditions including Parkinson's disease, tardive dyskinesia, akathisia, dystonia, Huntington's disease, familial tremor, restless legs syndrome, myoclonus, Gilles de la Tourette's syndrome, multiple sclerosis, sleep disorders, and dementia. The psychiatric disorders of schizophrenia, mania, depression, aggressive and self-injurious behavior, obsessive compulsive disorder, seasonal affective disorder, substance abuse, hypersexuality, anxiety disorders, bulimia, childhood hyperactivity, and behavioral disorders in geriatric patients have been linked to impaired central 5-HT functions. Tryptophan, the natural amino acid precursor in 5-HT biosynthesis, increases 5-HT synthesis in the brain and, therefore, may stimulate 5-HT release and function. Since it is a natural constituent of the diet, tryptophan should have low toxicity and produce few side effects. Based on these advantages, dietary tryptophan supplementation has been used in the management of neuropsychiatric disorders with variable success. This review summarizes current clinical use of tryptophan supplementation in neuropsychiatric disorders.
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PMID:L-tryptophan in neuropsychiatric disorders: a review. 130 30

A workshop was held 18 to 19 March 1991 at the National Institutes of Health to address critical issues in research concerning the chronic fatigue syndrome (CFS). Case definition, confounding diagnoses, and medical outcome assessment by laboratory and other means were considered from the perspectives of key medical specialties involved in CFS research. It was recommended that published Centers for Disease Control (CDC) case-definition criteria be modified to exclude fewer patients from analysis because of a history of psychiatric disorder. Specific recommendations were made concerning the inclusion or exclusion of other major confounding diagnoses, and a standard panel of laboratory tests was specified for initial patient evaluation. The workshop emphasized the importance of recognizing other conditions that could explain the patient's symptoms and that may be treatable. It was viewed as essential for the investigator to screen for psychiatric disorder using a combination of self-report instruments followed by at least one structured interview to identify patients who should be excluded from studies or considered as a separate subgroup in data analysis. Because CFS is not a homogeneous abnormality and because there is no single pathogenic mechanism, research progress may depend upon delineation of these and other patient subgroups for separate data analysis. Despite preliminary data, no physical finding or laboratory test was deemed confirmatory of the diagnosis of CFS. For assessment of clinical status, investigators must rely on the use of standardized instruments for patient self-reporting of fatigue, mood disturbance, functional status, sleep disorder, global well-being, and pain. Further research is needed to develop better instruments for quantifying these domains in patients with CFS.
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PMID:NIH conference. Chronic fatigue syndrome research. Definition and medical outcome assessment. 132 76

To determine the risk factors of the subjective symptoms experienced by chain saw workers, we surveyed 206 forestry workers using this device in their work. The strength of the relationship between their symptoms and such potential risk factors as occupational, behavioral, and physical factors was evaluated by a multiple logistic regression model. It was found that many years of chain saw operation, and numerous hours of chain saw operation per day, increased the risk of white finger, numbness of hands and arms, chillness of hands and arms and difficulty in joint movement, indicating that these symptoms were closely related to vibration exposure. Many years of forestry work before chain saw work also increased the risk of joint pain, suggesting that bone and joint disorders are related to heavy manual work not using a chain saw. A second job involving manual labor increased the risk of weakness in the arms, stiffness of the shoulders, and lumbago. Infrequent bathing was associated with increased risk of pain in hands and arms and lumbago. Older workers had a higher prevalence of stomach discomfort. No risk factor was found to significantly increase the risk of easy fatigability, forgetfulness and sleep disorder. It was found that not only exposure to vibration but also other factors contributed to the prevalence of pain in hands and arms, joint pain, weakness in arms, stiffness of shoulder, and lumbago. Second job and infrequent bathing appeared to be related to the occurrence of certain subjective symptoms. These contributory factors should be taken into account when evaluating subjective symptoms encountered in field studies of forestry workers.
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PMID:[Multivariate analysis on the relationship between subjective symptoms and risk factors for the development of symptoms including working conditions, life habits and physical status in forestry workers using chain saw]. 133 68

Various aspects of the critically ill patient sharing pain, physical distress, anxiety, environmental components, predispose him to develop some sleep disorders (SD). We studied 20 conscious patients, age 16-80 (mean 48.15 SD of mean +/- 25), undergoing ICU mean 14.3 days (SD of mean +/- 7.5), to evaluate SD rate and their possible leading causes. Through Spearman Rank test SD was related to Apache II score, admission state anxiety, satisfactory sedation, days of ICU stay and age respectively. Conclusive results showed SD rate in all our patients. Excepted a statistical trend to significativity of SD versus satisfactory sedation: RS 0.311 (threshold value for 20 patients: 0.377), no relation was found between SD and data recorded. These preliminary results emphasize the importance of looking for SD in ICU patients though many factors may play a role to develop them.
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PMID:[Sleep disorders in patients in recovery. Preliminary results in 20 patients]. 143 60

Assessment of cases of chronic pelvic pain presents a challenging problem, and many physicians overlook the association of sleep disorders and depression with such pain. We examined these linkages in our chronic pelvic pain clinic, using a questionnaire that assists in diagnosis and management of these cases. To date, the cases of 72 patients (both physician- and self-referred) with pelvic pain have been evaluated. Of these patients, 51 of 71 (72%) reported sleep disorders, and 37 of 72 (51%) had clinical depression, as determined by the Beck Depression Inventory. After adjustment for a sleep-related item on the Beck scale, these two measures showed a positive correlation of .355 (P < .01). The scores of pain patients differed significantly from those of a control group of asymptomatic patients on the depression and sleep disorder measures. By being aware and using a simple questionnaire, the clinician may readily identify overlooked factors, such as sleep disorders and depression, when assessing cases of chronic pelvic pain.
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PMID:Unrecognized association of sleep disorders and depression with chronic pelvic pain. 147 Sep 59

Primary fibromyalgia may involve an anomaly in the metabolism of serotonin responsible for the sleep disorders and diffuse pain. Effectiveness of an agent with pure serotonin-agonist properties (fluoxetin hydrochloride) was evaluated in 23 patients during a three-month open study. Treatment had no effect on pain severity, number of tender sites, or pain score. Sleep disorders improved and 57% of patients believed the treatment was effective. Adverse events were recorded in 43.4% of patients, with the most common being nausea (21.7%). Effectiveness and tolerance of fluoxetin hydrochloride in fibromyalgia are mediocre. A double-blind placebo-controlled trail versus a placebo is needed to clarify these preliminary findings.
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PMID:[Evaluation of the effectiveness of serotonin (fluoxetine hydrochloride) treatment. Open study in fibromyalgia]. 148 40

Generalised tendomyopathy (fibromyalgia) is characterised by diffuse localized pain involving the locomotory system, tenderness in the regions of the tendon insertions and muscles, loss of muscular power, sleep disorders and other vegetative functional and psychological disorders. In many cases, the diagnosis is delayed, often being made only after comprehensive superfluous diagnostic procedures, sometimes invasive, and inappropriate treatment. Age at disease onset is about 35 years, and initially involves, usually localized, the cervical or lumbar region of the spine. The condition is usually progressive over years. Pathogenesis is multifactorial; for generalization and persistence of the disease, psychosocial factors and civilization-related phenomena appear to play a decisive role. Treatment of generalized tendomyopathy is, for the most part, symptomatic and, overall, unsatisfactory. By way of medical treatment, only antidepressants seem to have a certain positive effect in some of the patients. Of importance is a good doctor--patient relationship and successful motivation of the patient to undergo active physiotherapeutic--in some cases also psychotherapeutic--treatment. With an eye to instituting more successful therapeutic measures and avoiding unnecessary diagnostic and therapeutic procedures, and, last but not least, for socioeconomic reasons, early diagnosis is of great importance.
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PMID:[Generalized tendomyopathy]. 160 71

Vertebral compression fractures (VCFs) may be defined radiographically or as a clinical event. The prevalence of these fractures in women aged 50 and over has been estimated at 26% when defined as a reduction in vertebral height greater than 15%. Retrospective reviews of case records have shown a clinical detection rate of VCF in white women of 153/100,000 person years. Of these clinically detected VCFs, 84% were associated with pain. VCF may be defined as a clinical event characterised by loss of height and acute pain. The pain of acute fracture usually lasts 4 to 6 weeks with intense pain at the site of fracture. Chronic pain may also occur in patients with multiple compression fractures, height loss and low bone density but is probably due to structural changes or osteoarthritis. Radiographic VCF may not be symptomatic. The greater the deformity, the greater the likelihood of pain and disability. As height is lost, patients experience discomfort from the rib cage pressing downward on the pelvis. Patients develop a thoracic kyphosis, a lumbar lordosis, and a protuberant abdomen with prominent horizontal skinfold creases. The reduced thoracic space may result in decreased exercise tolerance and reduced abdominal space may give rise to early satiety and weight loss. Sleep disorders may also occur. Patients lose self esteem. Self care may become difficult. They are often depressed. They become fearful of further fracture. They have distorted body image and poor health perception. Patients with one vertebral fracture are at increased risk of peripheral fracture and further vertebral fracture. The aims of acute management are to reduce symptoms and mobilise the patient as quickly as possible.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The clinical consequences of vertebral compression fracture. 162 11

A consecutive series of patients with Parkinson's disease (PD) were examined for the presence of sleep disturbances, pain, and depression. We found that patients with PD and major depression had significantly more sleep disturbances and severe pain than non-depressed patients with PD. Moreover, depression scores accounted for most of the variance in a stepwise regression analysis of the effect of numerous clinical variables on either sleep disorders or pain severity. These findings suggest that depression is the most important factor associated with the common problems of sleep disorder and pain among patients with PD.
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PMID:Sleep disorders, pain, and depression in Parkinson's disease. 175 57


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