Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0917801 (insomnia)
 10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Behavioral disturbances in Parkinson's disease (PD) are a common source of disability to both patients and their families, but there is a considerable controversy regarding their frequency and their neuropathological and neurochemical bases. Since they are so common, the disorders associated with PD should be well recognized, and proper management by neurologists is required. The most frequent behavioral disturbances encountered in patients with PD are depression, anxiety, cognitive impairment and dementia. Also frequent are sleep disorders such as sleep fragmentation, REM sleep behavior disorder, insomnia and altered dreaming. The most troublesome situations come from drug-induced psychiatric states, such as delusional states, hallucinations, paranoid ideation, delirium, and confusion. The treatment of these behaviors is reviewed here.
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PMID:Therapy of behavioral disorders in Parkinson's disease. 1034 4

A case of Creutzfeldt-Jakob disease (CJD) with presenting Wernicke encephalopathy (WE)-like symptoms and severe insomnia is presented. An 80-year-old alcoholic man with a 6 month history of tremors, ataxia, memory loss and confabulation, developed profound insomnia, confusion, and delirium with vivid hallucinations. Polysomnography revealed a marked reduction of sleep time, with central-type sleep apnea. Neither myoclonus nor periodic synchronous discharge (PSD) was observed. An autopsy revealed diffuse spongiform changes and astrocytosis throughout the cerebral gray matter, with severe involvement of the mammillary bodies and thalamus. Prion protein (PrP) immunostaining was positive in kuru plaques in the cerebellum, PrP polymorphism at codon 129 was heterozygous Met/Val, and proteinase K resistant PrP (PrP(res)) was demonstrated by Western blotting. The lack of necrotizing lesions in the mammillary bodies, thalamus, and periaqueductal gray matter could rule out WE. The data suggest that the present case of CJD is consistent with PrP(res) type 2 (CJD M/V 2), but was unique in the lack of some typical CJD signs and the presence of signs of WE and sleep abnormalities.
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PMID:Wernicke encephalopathy-like symptoms as an early manifestation of Creutzfeldt-Jakob disease in a chronic alcoholic. 1037 Oct 84

Brain circuits for infrequently employed memories are reinforced largely during sleep by self-induced, electrical slow-waves, a process referred to as "dynamic stabilization" (DS). The essence of waking brain function in the absence of volitional activity is sensory input processing, an enormous amount of which is visual. These two functions: circuit reinforcement by DS and sensory information processing come into conflict when both occur at a high level, a conflict that may have been the selective pressure for sleep's origin. As brain waves are absent at the low temperatures of deep torpor, essential circuitry of hibernating small mammals would lose its competence if the animals did not warm up periodically to temperatures allowing sleep and circuit reinforcement. Blind, cave-dwelling vertebrates require no sleep because their sensory processing does not interfere with DS. Nor does such interference arise in continuously-swimming fishes, whose need to process visual information is reduced greatly by life in visually relatively featureless, pelagic habitats, and by schooling. Dreams are believed to have their origin in DS of memory circuits. They are thought to have illusory content when the circuits are partially degraded (incompetent), with synaptic efficacies weakened through infrequent use. Partially degraded circuits arise normally in the course of synaptic efficacy decay, or pathologically through abnormal regimens of DS. Organic delirium may result from breakdown of normal regimens of DS of circuitry during sleep, leaving many circuits incompetent. Activation of incompetent circuits during wakefulness apparently produces delirium and hallucinations. Some epileptic seizures may be induced by abnormal regimens of DS of motor circuitry. Regimens of remedial DS during seizures induced by electroconvulsive therapy (ECT) apparently produce temporary remission of delirium by restoring functional or 'dedicated' synaptic efficacies in incompetent circuitry. Sparing of sensory circuitry in fatal familial insomnia seemingly owes to supernormal circuit use in the virtual absence of sleep. ECT shocks and cardioverter defibrillation may have analogous remedial influences.
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PMID:Adaptations and pathologies linked to dynamic stabilization of neural circuitry. 1039 56

Zolpidem is one of the newer medications developed for the treatment of insomnia. It is an imidazopyridine agent that is an alternative to the typical sedative-hypnotic agents. Zolpidem use is gaining favor because of its efficacy and its side effect profile, which is milder and less problematic than that of the benzodiazepines and barbiturates used to treat insomnia. Still, side effects are not uncommon with zolpidem use. We report a series of cases in which the patients developed delirium, nightmares and hallucinations during treatment with zolpidem. We will review its pharmacology, discuss previous reports of central nervous system side effects, examine the impact of drug interactions with concurrent use of antidepressants, examine gender differences in susceptibility to side effects, and explore the significance of protein binding in producing side effects.
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PMID:Central nervous system side effects associated with zolpidem treatment. 1068 33

Dreams appear to be generated in the process of reinforcing memory circuits of the brain, as circuits are activated by self-generated electrical slow waves, with dream contents reflecting information stored in activated circuits. Illusory dreams and other healthy delirious states appear to occur when activated memory circuits are incompetent, containing synapses whose efficacies deviate from their 'dedicated' values. Organic delirium and some other mental disorders may have their basis in brain pathologies that alter reinforcing slow waves, causing synaptic efficacies to depart from dedicated values. Activation of these incompetent circuits leads to recall of faulty memories--a substrate for delirium. In treatment of organic delirium by electroconvulsive therapy (ECT), the electric shock temporarily suppresses abnormal slow-wave regimes, allowing remedial reinforcement regimes to resume. These restore dedicated synaptic efficacies, temporarily alleviating the delirium. The action of ECT shocks appears to parallel closely that of cardiac defibrillating shocks. Greater than normal amounts of circuit reinforcement protect sensory circuitry in fatal familial insomnia, and cognitive circuitry in encephalitis lethargica.
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PMID:Mental malfunction and memory maintenance mechanisms. 1085 64

The adequate primary care of patients with renal failure, from the choice of the modality of treatment down to the everyday answering of questions of patients, relatives, and staff, requires a knowledge of the major psychological stresses of the illness and the psychiatric complications resulting from these stresses and their treatment. Among the major stresses of dialysis are the procedure itself, the overall medical treatment which includes medications and diet, and dependency-independence issues arising from the unique and almost abject dependency of patients on a machine, a procedure, and a group of medical professionals. As a result of these physical and psychological stresses, the disorders seen include delirium, depression, anxiety, suicide, uncooperative behavior, sexual dysfunctions, and psychosis. In their treatment, one should first consider what prophylactic steps should be taken to avoid their occurrence. It is best that a behaviorally trained professional be involved in the initial evaluation of all prospective patients. Ideally this should be a consultation-liaison psychiatrist. Such involvement may help in the selection of a modality of treatment best suited for the psychosocial background of the patient and help identify those most susceptible to psychiatric symptoms and disorders. Patients should be told of the possibility of complications such as sexual dysfunctions and, in the case of dialysis patients, that they may at some point in the course of their treatment consider voluntary withdrawal from it. Medications have an important role in the treatment of anxiety, insomnia, depression, psychosis, and sexual dysfunctions. Concerning the latter, behavioral techniques of Masters and Johnson have been found to be useful. Talking therapies seem to be of value for only to a limited number of motivated patients.
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PMID:Psychiatric considerations in the primary medical care of the patient with renal failure. 1092 11

Psychiatric symptoms during interferon (IFN) therapy for viral hepatitis have been a crucial problem in consultation-liaison psychiatry. However, there have been few studies on psychiatric management for these symptoms and their prognosis. Among 943 patients who were treated with IFN for chronic hepatitis C between 1991 and 1995, 43 patients (4.6%) developed psychiatric symptoms during IFN treatment. Three patients (0.3%), with pre-existing psychiatric disorders showed aggravated symptoms and were excluded from the study. All three patients were able to finish the IFN therapy with psychiatric management. Forty patients (4.2%) manifested psychiatric symptoms induced by IFN. Thirteen patients (1.4%) were diagnosed as anxiety disorder and 21 patients (2.2%) revealed mood disorder with depressive features. There were other psychiatric disorders in six patients (0.6%), including psychotic disorder with delusions/hallucinations in four patients (0.4%), mood disorder with manic features in one patient (0.1%) and delirium in one patient (0.1%). Women developed psychiatric symptoms significantly more than men. Ten of 40 patients (25%) stopped IFN treatment because of manifesting psychiatric symptoms induced by IFN. Twelve patients (30%) required psychiatric treatment for more than 24weeks after ceasing IFN, and seven patients still had anxiety, insomnia and mild hypothymia at the end of the present study. Statistical analysis revealed that IFN-beta therapy and psychiatric manifestations including psychotic symptoms, delirium and manic symptoms were significantly related to long-term psychiatric problems. There are considerable numbers of patients who have required long-term psychiatric management even after cessation of IFN treatment.
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PMID:Psychiatric symptoms related to interferon therapy for chronic hepatitis C: clinical features and prognosis. 1104 7

This study assessed sedation in terminal cancer patients in terms of three characteristics: frequency; relationship to intractable symptoms; and the extent to which medical staff, family, and patients found sedation to be ethically acceptable and efficacious. Two hundred seventy-six consecutive patients, who were admitted to the palliative care unit of National Taiwan University Hospital in Taiwan between August 1998 and the end of May 1999, were enrolled. A recording form was completed every day. This included demographic data, pain and common symptom scores, and the use of sedation in the terminal phase. Seventy (27.9%) of 251 patients who died received sedation. Sedation was administered to relieve agitated delirium in 40 (57.1%), dyspnea in 16 (22.8%), severe pain in 7 (10%) and insomnia in 5 (7.2%). The drugs used for sedation were haloperidol in 35 (50%), midazolam in 17 (24.3%), and rapidly increasing dosage of morphine in 9 (12.9%). In fewer than half (42.9%) of the patients, sedation was with the consent of both patient and family, and half (50%) had the consent of family alone. The overwhelming majority of medical staff and family felt the decision to use terminal sedation was ethically acceptable. There was no significant difference in survival time between sedated and non-sedated patients (28.49 vs. 24.71 days, t = -0.791, P = 0.430). Positive ethical acceptability and higher satisfaction with symptom control with terminal sedation were found in both medical staff and family in this study. Further work is needed to find the most appropriate time of intervention and to improve management of refractory symptoms in dying patients.
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PMID:Sedation for refractory symptoms of terminal cancer patients in Taiwan. 1139 4

Postoperative delirium occurs frequently following major surgery, especially after hepatectomy. We hypothesized that better methods of postoperative pain control would decrease postoperative delirium. To clarify the magnitude of postoperative pain and incidence of postoperative delirium in hepatectomy patients, subjects received patient-controlled epidural analgesia (PCEA) using bupivacaine and fentanyl (Group P), or continuous epidural mepivacaine (Group E) following intraoperative epidural administration of morphine. The magnitude of postoperative pain was estimated by use of an analgesic adjuvant and delirium was classified as mild (insomnia, disturbance of sleepwake cycle), moderate (disorientation, hallucination), or severe (restlessness, confusion, agitation), based on the medical records. Analgesic adjuvant usage was less in Group P than in Group E, while the incidences of moderate and severe delirium were significantly less frequent in Group P than in Group E (35.7% versus 75.0%, and 14.3% versus 50.0% respectively). Moreover, less amount of antipsychotic drugs was given in Group P than in Group E. These results suggest that the better pain relief and patient satisfaction provided by PCEA contributed to a decrease in the incidence of delirium, because of continuous opioid administration and patient-control analgesia. We concluded that PCEA with bupivacaine and fentanyl can limit postoperative delirium following hepatectomy.
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PMID:[Patient-controlled epidural analgesia with bupivacaine and fentanyl suppresses postoperative delirium following hepatectomy]. 1151 63

This is a review on current knowledge of chronic occupational mercurialism syndrome. Major scientific studies and reviews on clinical manifestation and physiopathology of mercury poisoning were evaluated. The search was complemented using Medline and Lilacs data. Erethism or neuropsychological syndrome, characterized by irritability, personality change, loss of self-confidence, depression, delirium, insomnia, apathy, loss of memory, headaches, general pain, and tremors, is seen after exposure to metallic mercury. Hypertension, renal disturbances, allergies and immunological conditions are also common. Mercury is found in many different work processes: industries, gold mining, and dentistry. As prevention measures are not often adopted there is an increasing risk of mercury poisoning. The disease has been under diagnosed even though 16 clinical forms of mercury poisoning are described by Brazilian regulations. Clinical diagnosis is important, especially because abnormalities in the central nervous, renal and immunological systems can be detected using current medical technology, helping to develop the knowledge and control measures for mercurialism.
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PMID:[Chronic occupational metallic mercurialism]. 1248 28


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