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)

Secondary side-effects often occur in women undergoing hormonal stimulation treatment with clomiphene citrate. In general 10.4% of women experience hot flushing, 5.5% have complaints caused by enlargement of the ovaries and 3.5% experience central nervous symptoms (nervousness, sleeplessness, headaches, visual disturbances, vertigo). During ovarian stimulation with clomiphene citrate for in-vitro fertilization, a 32 year old patient developed psychotic symptoms, commencing 3 days after initiation of treatment. Hospitalization in the psychiatric ward became necessary when severe formal and rational thought disturbances arose together with perceptory and sensory delusions. Under neuroleptic treatment the symptoms improved. Nevertheless, follow-up psychiatric care on an outpatient basis was deemed necessary. The infertility treatment was continued with human menopausal gonadotrophin stimulation. Psychiatric instability occurred neither at this point nor during the 2 year follow-up observation period. Both an exogenous psychosis (ICD F23.9) as well as the exacerbation of an endogenous psychosis (ICD F29) may be considered for the differential diagnosis. The stimulation with clomiphene citrate in connection with the physical and psychic stress of the infertility therapy can be regarded as the trigger factor. For patients with evidence of psychiatric illness in their case history, ovulation-inducing substances such as clomiphene citrate should be implemented with particular care.
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PMID:Clomiphene citrate as a possible cause of a psychotic reaction during infertility treatment. 915 29

The pharmacology, pharmacokinetics, clinical efficacy, adverse effects, drug interactions, dosage and administration, and cost of olanzapine are reviewed. Olanzapine is a serotonin-dopamine-receptor antagonist indicated for use in the treatment of schizophrenia and other psychotic disorders. The affinity of olanzapine for neuroreceptors is similar to that of clozapine. The drug is well absorbed from the GI tract; food has no effect. Olanzapine is more effective than placebo and equal to haloperidol in reducing psychotic symptoms on two rating scales. However, unlike typical dopamine-receptor antagonists used for antipsychotic therapy, olanzapine is more effective in reducing the negative symptoms of schizophrenia. The most frequent adverse drug reactions (ADRs) associated with olanzapine are somnolence, agitation, insomnia, and headache. Constipation and dry mouth occur as dose-dependent ADRs. Unlike clozapine, olanzapine does not cause agranulocytosis. No cases of tardive dyskinesia or neuroleptic malignant syndrome have been reported. Olanzapine has been associated with slight increases in hepatic transaminases. More study is needed to determine whether olanzapine interacts significantly with other drugs. The recommended starting dosage is 5-10 mg orally once daily. Efficacy beyond six weeks has not been evaluated; patients treated for longer than six weeks should be periodically reassessed. Olanzapine costs about 10 times more than typical antipsychotics because a generic version is not available; however, olanzapine costs less than clozapine therapy and may cost less than haloperidol in terms of total health care costs. Olanzapine offers an effective alternative for treating schizophrenia and has a favorable adverse-effect profile.
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PMID:Olanzapine: a serotonin-dopamine-receptor antagonist for antipsychotic therapy. 1047 99

Risperidone is a novel serotonin-dopamine antagonist antipsychotic in a class of benzisoxazole derivative which has been shown to be effective in reducing psychotic symptoms in schizophrenia. The study was designed as perspective, 8-week, multicenter, open label study in schizophrenic patients from 6 psychiatric hospitals. One hundred and twenty cases were recruited and 105 patients completed the study. The average total PANSS score at the baseline was 90.6 (range 60-133). Patients were evaluated with quantitative rating scales for the efficacy (PANSS score) and extrapyramidal rating scale at week 4 and 8 after starting risperidone treatment. The titrated dose of risperidone was given to the patients with the final dose of 6 mg risperidone throughout the study period. At week 4, the average PANSS score was significantly reduced to 73.4 (p < 0.05). The average PANSS score at week 8 was further declined to 61.9 which was significantly different (P < 0.05) from the baseline. Seventy-eight cases (74.3%) were classified as responders (those patients showing more than 20 per cent decrease in PANSS score). Extrapyramidal side effect was occurred in some patients, but usually mild and tolerable. However twenty-four patients (22.9%) required medications for this side effect. Other adverse reactions were insomnia found 15 cases (14.3%), elevated hepatic enzyme 5 cases (4.8%) and weight gained 2 cases (1.9%). Our data suggested that risperidone is effective and well-tolerated in chronic schizophrenic Thai patients.
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PMID:Efficacy and tolerability of risperidone in chronic schizophrenic Thai patients. 962 31

Severe disturbances of sleep architecture and circadian rhythms are common in traumatic brain injured patients; however, complete absence of the rapid eye movement sleep stage is very rare. We describe a brain injured patient with cognitive disturbances who developed severe alterations of sleep architecture, accompanied by paranoid and jealousy delusions. Following several trials with conventional antipsychotics his psychotic state stabilized but he continued to complain of insomnia and daytime fatigue. When treated with risperidone 2 mg/day, both his sleep and the delusional thoughts improved markedly and his daytime alertness increased. Severe deterioration of his support system brought about discontinuation of treatment with re-emergence of all symptoms.
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PMID:Beneficial effect of risperidone on sleep disturbance and psychosis following traumatic brain injury. 986 78

Barbiturates can produce psychological and physical dependence and produce a withdrawal syndrome on the second to fourth day after the drug is suspended. Symptoms include anxiety, restlessness, insomnia, rhythmic intention tremor, dizziness, seizures, and psychosis. If the syndrome is not recognized and correctly treated, hyperthermia, circulatory failure, and death may ensue. Although barbiturates are less frequently used nowadays, they are employed in combination with other drugs in many medications used for the treatment of headache. We report the case of a 54-year-old woman who developed a barbiturate abstinence syndrome when she suspended self-administration of a drug containing butalbital. The patient had been using barbiturates, 900 mg/die, for 2+ years for persistent headache. She was admitted to the hospital because of seizures, hallucinations and delirium not controlled by benzodiazepine and phenothiazine administration. Her symptoms resolved after parenteral phenobarbital administration.
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PMID:[Barbiturate withdrawal syndrome: a case associated with the abuse of a headache medication]. 1034 6

This is the first reported use of electroconvulsive treatment (ECT) in an adolescent with bipolar mania who had been treated with craniectomy for an intracranial neoplasm. The reported case is of a 16-year-old girl with a history of brain stem glioma (pontomesencephalic astrocytoma) diagnosed at 13 years of age. She presented in a psychiatric emergency room with suicidal ideation, depressed mood, irritability, olfactory hallucinations, early insomnia, grandiosity, and guilt. Her symptoms failed to respond to a trial of an antidepressant, mood stabilizer alone, and mood stabilizer in conjunction with a neuroleptic. The decision to use ECT was based on suicidal ideation, extreme disinhibition, and danger to self and others. Significant improvement in mood and remission in psychosis were noted after the eighth treatment. Comparison of 2-week pre-ECT and 3-month post-ECT cognitive testing revealed no change in IQ. This report highlights rapid response and the ability to tolerate ECT in an adolescent diagnosed with bipolar disorder, who had also been treated with radiation and craniotomy.
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PMID:Electroconvulsive treatment of a bipolar adolescent postcraniotomy for brain stem astrocytoma. 1035 19

It is well known that mood disorder such as depression occasionally develops during interferon (IFN) therapy for chronic viral hepatitis. So far, however, IFN-induced manic disorder has been rarely reported. We present a case of manic psychosis which developed during IFN treatment for chronic hepatitis C. A 35-year-old man with chronic hepatitis positive for hepatitis C virus RNA in serum was treated with natural IFN alpha with a daily dosage of 5 million units. Six weeks later he complained of insomnia, and then became exhilarated, talkative, restless and aggressive. Since the mental state was compatible with manic disorder, IFN therapy was immediately ceased. Simultaneously, psychotropic drugs were administered. One week later, the psychiatric disturbances disappeared. He has been keeping his usual social interactions without the psychotropic drugs after that. It is suggested that manic psychosis happened secondary to IFN alpha treatment.
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PMID:A case of interferon alpha-induced manic psychosis in chronic hepatitis C. 1045 96

The extensive use of antidepressant drugs in the treatment of all forms of depression makes the question of the real nature of agitated depression a crucial issue because many patients have adverse outcomes, including increased agitation, increased insomnia, increased risk of suicide, and sometimes the onset of psychotic symptoms. Agitated depression is no longer considered a mixed state in the DSM system. After a review of the literature on melancholia agitata as a mixed state and on the introduction of the concept of mixed states, this article has examined the psychopathology of agitated depression. The main symptoms are depressive mood with marked anxiety, restlessness, and often delusions. In other cases, psychic agitation and racing or crowded thoughts prevail alongside anxiety and depressed mood. The mixed nature of these symptoms has been discussed and new diagnostic criteria proposed, including those syndromes without marked restlessness but with evident psychic agitation and racing or crowded thoughts. It is suggested that all the varieties of agitated depression be called mixed depression, with the following diagnostic criteria: A. Major depressive episode B. At least two of the following symptoms: 1. Motor agitation 2. Psychic agitation or intense inner tension 3. Racing or crowded thoughts.
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PMID:Agitated depression as a mixed state and the problem of melancholia. 1055 Aug 55

The most effective method to maintain clinical improvement in the course of schizophrenia is the continuation of neuroleptic therapy. Sometimes we face the dilemma whether neuroleptic administration could be discontinued. There are some unconditional indications for treatment cessation (signs of intolerance, complications, general medical conditions); all other situations can be considered as relative indications. The risk and benefit of treatment discontinuation should be carefully evaluated. Neuroleptic withdrawal seems to be safer among older patients, with single episode of the psychosis of mild severity, with no family history of schizophrenia. It is necessary to achieve a stable clinical improvement before neuroleptic withdrawal. Worsening of the clinical status creates the most important risk of treatment discontinuation. Other risk factors include unacceptable threatening behavior, increase of family burden. The appearance of withdrawal symptoms such as nausea, vomiting, dyskinesia, insomnia, anxiety, etc. are to be considered. These symptoms are rare, and the risk of relapse is smaller when patients were treated with depot neuroleptics before treatment discontinuation than in the case of treatment with oral neuroleptics. Neuroleptic discontinuation and introduction of placebo cause more risk of relapse than continuation of active treatment.
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PMID:[The risk of neuroleptic discontinuation in schizophrenia]. 1078 16

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


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