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

According to sleep specialists, 30 to 80% of insomnia cases have a psychiatric cause. The author distinguishes between acute insomnia induced by acute psychiatric disorders and chronic insomnia associated with more or less permanent personality disturbances. This article reviews neurotic, depressive and maniac insomnia, insomnia of the alcoholic and of the toxicomaniac, insomnia during schizophrenia and chronic delusion. Insomnia may be the first symptom reported by the patient, hiding a subjacent psychiatric disorder. At the contrary, a short and insufficient sleep can only be discovered through a thorough investigation of the patient and questioning of his familiars.
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PMID:[Where do we place insomnia within the framework of psychiatric nosography]. 714 83

1. The efficacy of butoctamide hydrogen succinate (BAHS) was compared with that of nitrazepam on the basis of the polysomnograms and the subjective assessments. 2. Twelve healthy male students were divided into three groups consisting of 4 subjects each with were administered BAHS 600 mg, nitrazepam 5 mg, and BAHS 600 mg + nitrazepam 5 mg, respectively. 3. Polygraphic recordings were made for 8 consecutive nights for each subject, and the polysomnograms were evaluated by computerized automatic analysis using the interval histogram method. 4. An inert placebo was administered on the first 3 nights and on the seventh and eighth nights, and the test article regimen was administered on the fourth, fifth and sixth nights. 5. The test articles and the placebo were administered orally at 22:30 hr, and the recording of polysomnograms was started at 23:00 hr and ended at 8:00 hr the next morning. 6. The subjects were requested to fill out the subjective assessment of sleep before falling asleep and after arising the next morning. 7. BAHS increased REM sleep and decreased stage 2 sleep significantly; however, it failed to affect stage 1, 3 or 4 sleep. 8. Nitrazepam increased significantly the total sleep time and stage 2 sleep but decreased significantly the stage 3 sleep and decreased slightly the stages 1, 4 and REM sleep. 9. The combined treatment with BAHS and nitrazepam did not alter the sleep parameters except for increasing the total sleep time. 10. No obvious changes were observed in the subjective assessments after administration of the drugs. 11. These findings suggest that BAHS results in a unique sleep pattern different from benzodiazepines, and that BAHS may be suitable for treating insomnia in elderly patients and those with drug abuse, manic-depressive illness or schizophrenia.
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PMID:Stimulatory effect of butoctamide hydrogen succinate on REM sleep in normal humans. 762 90

A double-blind, randomized study of parallel group design comparing remoxipride and thioridazine (dose range 150-600 mg/day of either drug) was undertaken at 11 Australian centres. A total of 144 patients (remoxipride = 73, thioridazine = 71) with DSM-III-R schizophrenia or schizophreniform disorder commenced the study, and 89 patients (remoxipride = 45, thioridazine = 44) completed the 6 weeks of the trial. The mean daily doses at last rating were 404 mg (remoxipride) and 378 mg (thioridazine). Initial Brief Psychiatric Rating Scale scores decreased by a mean 8.7 points in both remoxipride and thioridazine groups. Equivalent treatment responses were also confirmed by Clinical Global Impression. During the study, sedatives or hypnotics were needed by 68% of the remoxipride patients and 51% of the thioridazine patients. Thioridazine was associated with more postural hypotension, drowsiness, increased sleep, headache, dizziness on rising, dry mouth, sexual dysfunction and weight gain, while remoxipride patients reported more insomnia. There were no differences between remoxipride and thioridazine on dystonia, hypokinesia, dyskinesia, rigidity and akathisia. The results indicate that remoxipride has similar antipsychotic efficacy to thioridazine but causes fewer side effects.
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PMID:The Australian multicentre double-blind comparative study of remoxipride and thioridazine in schizophrenia. 787 41

Sleep variables and psychiatric symptoms were investigated in 6 male chronic schizophrenic outpatients. The patients were being treated with benzodiazepine (BZD) hypnotics for more than 8 weeks, and BZDs were replaced with zopiclone (ZPC) 15 mg/day. Polysomnographic examinations, subjective sleep assessments and BPRS scoring were performed during BZD therapy and at the end of 8 weeks of ZPC therapy. The doses of neuroleptics and anticholinergic agents remained fixed throughout the study. The amount of slow-wave sleep (SWS) was markedly small and that of stage 1 sleep was moderately large during BZD therapy. The amount of stage 1 was smaller and that of stage 2 was larger during treatment with ZPC than BZDs. There were no significant change in the amount of SWS between the treatment. Half of the patients exhibited a sleep-onset REM period (SOREMP) during ZPC therapy. Both total BPRS score and negative symptom score were lower during treatment with ZPC than BZDs. These results suggest that ZPC may be more beneficial in treating schizophrenic insomnia than BZD hypnotics and that reduced SWS and SOREMP may be partly involved in the pathophysiology of schizophrenia.
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PMID:Effects of zopiclone on sleep and symptoms in schizophrenia: comparison with benzodiazepine hypnotics. 791 46

The study was carried out in the Family Planning Center of Sir Salimullah Medical College, Mitford Hospital and Family Planning Center of Dhaka Medical College Hospital, Dhaka. 100 sterilized women were selected randomly within 6 months of sterilization during the period of July 1991 to December 1991. They were interviewed by a questionnaire collecting information on sociodemographic parameters, sterilization, and life events. Depressive disorder was assessed by applying the DSM III-R criteria for Major Depressive Episode (MDE). Then the Hamilton Rating Scale for Depression (HRSD) was applied. 19 were suffering from depressive disorder (MDE). Of these, 3 were severe, 8 were moderate, and 8 were mild. Their ages ranged from 21 to 38 years. 42.11% of the depressive cases were in the 26-30 age group. 84% of both groups were either illiterate or had primary education, and 86% were housewives. 78% were urban and 22% were rural residents, respectively. 52% were in the low and 41% were in the middle income category. 35.8% of the nondepressive group had 4 children at the time of operation, while 36.93% of the depressive group had 6 children (p 0.05). Abdominal pain occurred in 23 instances, while only 2% had pain, swelling, and fever. 46 (56.79%) of the nondepressive group had experienced no momentous life events 1 year prior to the interview. In contrast, only 2 (10.54%) of the depressive group had not experienced such life events. Relationship problems in both the nondepressive and depressive groups featured with 24 (29.63%) and 12 (63.16%) cases, respectively, (p 0.05). 3 (15.79%) of the depressive group had past history of anxiety disorder and 2 (10.5%) had previous history of depressive disorder. On the basis of DSM III-R, 18 (94.74%) of the depressive group had mood disorders as the main symptom. 16 each had insomnia and fatigability. 12 (63.16%) of the depressives were retarded and 10 subjects contemplated suicide. HRSD further revealed that all depressive patients had anxiety, and only 2 were receiving antidepressants. Among all patients there were 5 cases of family history of schizophrenia, 2 cases of depressive disorders, and 1 case of bipolar mood disorder in first degree relatives.
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PMID:Pattern of depressive disorder among the permanent sterilized women. 816 34

506 patients with schizophrenia, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria, were included in a long term treatment programme with remoxipride, a selective dopamine (D2)-receptor antagonist. This overview includes pooled data from all patients who have been treated long term with remoxipride in clinical trials, focusing on patients treated for more than 6 months (n = 283). Remoxipride was administered in daily doses of 75 to 600mg. The assessment tools were Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI), Simpson and Angus scale, Abnormal Involuntary Movements Scale (AIMS) for abnormal involuntary movements, adverse events/symptoms using a 26-item checklist, clinical chemistry, and haematology and cardiovascular investigations. The majority of patients had a long duration of illness (median 11 years). 67% of patients (340/506) withdrew from treatment before 12 months and 44% (223/506) stopped treatment before 6 months. The median BPRS total score decreased during the first 3 months from 23 to 12, and this level of improvement was maintained throughout the 12-month period. Treatment-emergent adverse events reported by more than 5% of the patients were insomnia, tiredness, drowsiness and tremor in the group treated for 6 to 12 months. No symptoms, including checklist extrapyramidal symptoms (EPS), were reported by more than 5% of patients treated for 12 months. Low frequencies of EPS according to the Simpson and Angus scale were seen in patients treated for more than 6 months (n = 147). A small but statistically significant reduction of the mean total AIMS score from baseline to last rating was observed. There were infrequent changes in heart rate, resting diastolic blood pressure and electrocardiogram (ECG). Clinical chemistry and haematology data showed no evidence of clinically significant changes over time during the 12 months of treatment. Among 506 patients, 7 suicides and 7 suicide attempts occurred during the study period. Other serious adverse events were abnormal liver function test (2 cases), gastrointestinal, urinary retention, status epilepticus (psychotic polydipsia), granulocytopenia (1 each) and myocardial infarction (5 cases). Remoxipride is of potential value as a drug which is both effective and well tolerated in the long term management of patients with schizophrenia.
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PMID:Tolerability of remoxipride in the long term treatment of schizophrenia. An overview. 832 49

The social and clinical characteristics of one hundred and thirty-one women who attended the psychiatric outpatient clinic for the first time at the Department of Psychiatry, University of Ghana Medical School, within five years (1988-1992) were studied. The data suggested that the peak age of depressed women at consultation was between twenty and forty; and that a significant proportion of them were in the married group. Moreover the majority have no or very little education and thus little opportunity for gainful employment hence the majority were self employed. This finding is markedly different from the findings in the Western Countries, where the depressed women were much older, between thirty-five and fifty-four years; single and were gainfully employed. The average number of children per woman were between five and eight and the women had no adequate financial support from their husbands. These social characteristics reflected in the life-style and the kind of social stresses imposed upon these women in coping with life. These stresses showed in the clinical symptoms they represented, which were mainly somatisation disorder and somatic symptoms, with headaches and insomnia being the most prominent. However, psychological symptoms such as morbid thoughts were found to be few at this first consultation. It was highlighted that the social stresses might possibly be the causes of the clinical presentation of the depressed Ghanaian women. It was suggested that the specificity of headaches as a symptom of other psychiatric disorders other than depressive illness, for example schizophrenia and other endogenous psychiatric disorder among Ghanaian women require further research.
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PMID:A study of the social and clinical characteristics of depressive illness among Ghanaian women--(1988-1992). 885 70

Pramipexole, a presynaptic dopamine D2/D3 autoreceptor agonist, has been given to haloperidol-treated patients with schizophrenia (n = 15) in an effort to ameliorate residual positive and negative symptoms that have not been satisfactorily influenced by haloperidol alone. Total scores of the positive and negative symptom scale (PANSS) decreased by more than 20% in 9 of 15 patients (reduction of total score: 22-62%). Serious adverse events did not occur. Three of the 15 patients dropped out due to worsening of schizophrenia. Insomnia, as the most frequent side effect, occurred in 4 patients. No clinically relevant electrocardiographic and laboratory changes were reported. This study supports the safety of the treatment of schizophrenia with pramipexole and haloperidol as a combination therapy. However, further clinical studies are required to support these preliminary findings.
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PMID:Pramipexole as adjunct to haloperidol in schizophrenia. Safety and efficacy. 908 87

Six of 13 outpatients with schizophrenia who participated in a ten-week open trial of risperidone had an initial good response to the medication followed by development of intolerable affect, including feelings of agitation and depression and periods of crying and insomnia. Patients who developed this syndrome did not differ from other patients in baseline ratings on the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Negative Symptoms, except that patients who developed the syndrome had a significantly higher mean baseline rating on the BPRS anxiety subscale. The authors suggest that risperidone may increase affect in patients with schizophrenia and that some patients, especially those with anxiety, may have difficulty managing the increase.
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PMID:A syndrome of increased affect in response to risperidone among patients with schizophrenia. 955 Feb 46

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


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