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Query: UMLS:C0917801 (insomnia)
 10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The question of which psychotropic medications are safe during pregnancy is likely to remain unanswered for many years to come. There are ethical limitations to performing the type of prospective controlled studies required to answer a scientific question of this type definitively. At the present time, in all patients with worsening psychiatric illness during pregnancy, be it in the schizophrenic, affective, anxiety disorder, or personality disorder spectrum, outpatient psychotherapy, hospitalization, and milieu therapy should be attempted prior to the routine use of psychotropic medication. Prior to pregnancy, withdrawal of psychotropic medications should be attempted under close supervision. Situations will arise in which hospitalization is not sufficient to avert psychotic decompensation. In both schizophrenic illnesses and acute mania, neuroleptics should be used, especially in the first trimester in preference to lithium. The use of high-potency neuroleptics appears preferable to low-potency agents as the first line of therapy, although subsequent management decisions will depend on ability to control side effects. In depression, TCAs should be used in cases of suicidality or incapacitating vegetative signs after the first trimester if supportive measures fail. There appears to be no rationale for withdrawal of TCAs prior to labor. In the third trimester, use of TCAs, low-potency neuroleptics, or lithium should be accompanied by obstetrical surveillance. In severe anxiety or insomnia following the first trimester, the occasional use of benzodiazepines may be warranted except during labor and the first week postpartum. The chronic use of benzodiazepines during any phase of pregnancy and in breastfeeding women is contraindicated. The importance of close rapport between the treating physician and the pregnant or breastfeeding patient cannot be overstated and will obviate or decrease reliance on psychotropic medication in many cases.
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PMID:The use of psychotropic agents in pregnancy and lactation. 265 14

The author reviews the literature reporting the untoward effects of withdrawing monoamine oxidase inhibitors (MAOIs). The withdrawal of these agents can result in severe anxiety, agitation, pressured speech, sleeplessness or drowsiness, hallucinations, delirium and paranoid psychosis. MAOI withdrawal phenomena resemble the symptoms produced by the discontinuation of chronically administered psychostimulants. The capacity of MAOI to exert amphetamine-like effects presynaptically, and the propensity of somatic treatments for depression to subsensitize presynaptic receptors regulating the release of catecholamines, can provide a basis for the development of psychotic syndromes upon the withdrawal of MAOIs. Evidence for this hypothesis is reviewed.
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PMID:Monoamine oxidase inhibitor withdrawal phenomena: symptoms and pathophysiology. 284 11

The authors review the literature discribing non-dyskinetic antipsychotic withdrawal phenomena. Withdrawal of these agents can cause nausea, emesis, anorexia, diarrhea, rhinorrhea, diaphoresis, myalgia, paresthesia, anxiety, agitation, restlessness, and insomnia. Psychotic relapse is often presaged by increased anxiety, agitation, restlessness and insomnia, but the temporal relationship of these prodromal symptoms to reduction in the dosage or discontinuation of neuroleptics distinguishes them from the effects of abrupt withdrawal.
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PMID:Antipsychotic withdrawal symptoms: phenomenology and pathophysiology. 289 77

Psychiatric disorders in the elderly are common and often overlap with multiple medical problems. If used inappropriately, psychotropic drugs can further compromise a difficult clinical situation. Management of elderly patients with agitation, psychosis, anxiety, and insomnia are reviewed with a discussion of the optimal use of antipsychotic, anxiolytic, and sedating drugs. Initial attempts to control symptoms should involve nonpharmacologic techniques, but, when absolutely required, psychotropic drugs will often relieve symptoms with a minimum of side effects. Dangers in the chronic use of neuroleptics are stressed.
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PMID:Psychoactive drugs in the elderly: antipsychotics and anxiolytics. 290 Jul 97

We report two cases of severe withdrawal symptoms after abrupt discontinuation of a long-term normal-dose benzodiazepines (BZD) administration. Case 1, a 61-year-old man, suffered from delirium on the 7th day after abrupt discontinuation of nitrazepam, 10 mg/day. Case 2, a 49-year-old woman, suffered from auditory hallucination on the 4th day and visual cognitive disorder on the 5th day after abrupt discontinuation of nitrazepam, 5 mg/day, and triazolam, 0.5 mg/day. A withdrawal syndrome after discontinuation of normal-dose BZD is uncommon, and a psychotic withdrawal reaction is even more uncommon. We show how a continuous administration of BZD for a period of longer than 6 months and the presence of severe insomnia are risk factors predictive of a psychotic reaction. We also explain the predictive method used to determine the onset time of such a severe state. In the case of a psychotic state, we recommend intravenous diazepam injection. To prevent withdrawal reaction, we also recommend a gradual reduction after administration of normal-dose BZD.
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PMID:[Two cases of psychotic state following normal-dose benzodiazepine withdrawal]. 290 78

The literature describing nondyskinetic antipsychotic withdrawal symptoms is reviewed. The withdrawal of antipsychotic agents can result in nausea, emesis, anorexia, diarrhea, rhinorrhea, diaphoresis, myalgias, paresthesias, anxiety, agitation, restlessness, and insomnia. Psychotic relapse is often presaged by increased anxiety, agitation, restlessness, and insomnia. However, the temporal relationship of these prodromal symptoms to reduction in the dosage or discontinuation of neuroleptics distinguishes them from the effects of abrupt withdrawal.
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PMID:Antipsychotic withdrawal phenomena in the medical-surgical setting. 290 18

This article discusses the diagnostic and therapeutic problems that are unique to psychogeriatric patients in a primary care setting. Practical guidelines for the evaluation and treatment of dementia and depression, psychosis and agitation, and insomnia are presented.
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PMID:Geriatric psychiatry. 332 33

Within the context of the comprehensive treatment of sleep disorders, which includes medical, neurologic, psychiatric, and social interventions, use of medication is often indicated. Among the three benzodiazepine hypnotics that are available in the United States for the treatment of insomnia, flurazepam is effective for both sleep induction and maintenance, and it retains most of its efficacy over a 4-week period of nightly administration; temazepam is effective only for sleep maintenance, and triazolam improves both sleep induction and maintenance with initial but not with continued administration. Rebound phenomena are more frequent and intense with the more rapidly eliminated drug, triazolam, and to a lesser degree with temazepam. Also, with triazolam, certain behavioral side effects, such as amnesia and psychotic-like symptoms, have been reported. With flurazepam, which is a slowly eliminated benzodiazepine, daytime sedation is more frequent than with the other two drugs. When insomnia is secondary to major depression, antidepressant medication should be administered. Methylphenidate, amphetamines, or other stimulant medications are used for the symptomatic treatment of the sleepiness and sleep attacks of narcolepsy and hypersomnia. For cataplexy and the other two auxiliary symptoms of narcolepsy, imipramine or other tricyclics are the drugs of choice. Protriptyline and medroxyprogesterone have been used in treating mild cases of obstructive sleep apnea, but their efficacy is limited. Similarly, for the treatment of central sleep apnea, medroxyprogesterone and acetazolamide have shown only limited effects. Medication for patients with sleepwalking, night terrors, or nightmares should be prescribed judiciously, and primarily when treatment of an underlying psychiatric condition is desired. The neuropharmacology of sleep should also consider drugs that may cause sleep disorders. Medications with sleep disturbing effects include various antihypertensives, bronchodilators, and the energizing antidepressants. Withdrawal of REM-suppressant drugs, such as the barbiturates, may cause nightmares in association with a REM rebound. Occasionally, a drug or a combination of drugs may produce somnambulistic-like activity in some patients.
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PMID:Clinical neuropharmacology of sleep disorders. 333 64

The Zung Self-Rating Depression Scale (SDS) was presented to 99 depressed inpatients. The patients were categorized according to DSM-III as suffering from minor depression, major depression without melancholia and major depression with melancholia and/or with psychotic features. Differences in self-reported symptoms between these categories were studied with multivariate statistical techniques including linear discriminant analysis (LDA) and statistical isolinear multiple components analysis (SIMCA). Patients with minor depression rate themselves significantly less depressed than those with major depression. Patients with major depression without melancholia are less depressed than those with melancholia and/or psychotic features. The three DSM-III depressive categories can be regarded as belonging to a clinical continuum in which they form relevant levels with quantitative differences in self-reported symptoms. These differences are not only defined by gradual shiftings in the overall severity of illness, but also by quantitative differences in the severity of some target symptoms, i.e. agitation, retardation, diurnal variation, loss of libido, fatiguability, insomnia, anorexia, sadness and anhedonia.
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PMID:Self rated depression in relation to DSM-III classification: a statistical isolinear multiple components analysis. 334 93

In this sample of eighty consecutive admissions to the Centre-Neuro-Psycho-Pathologique (CNPP) of Kinshasa, 81% were given a DSM-III diagnosis. This demonstrates that the DSM-III is a useful tool for psychiatric research in developing sub-saharan Africa. Schizophrenia, schizophreniform psychoses, and affective disorders appeared in their familiar forms. Zairois patients tended to present with complaints of insomnia, agitation and pressured speech. The most striking observations were the relative paucity of depressed mood, self-reproach, and suicidal ideation in patients with major depression. Four cases of acute transient psychosis were noted.
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PMID:Tertiary care psychiatry in Zaire: DSM-III in the developing world. 338


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