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)

The efficacy, safety, and performance of triazolam was compared with those of other shorter-acting hypnotics acting on the gamma-aminobutyric acid (GABA) receptor--zopiclone, zolpidem, midazolam, brotizolam, temazepam, lormetazepam, and loprazolam. In all, 5506 patients participated in 38 clinical and epidemiologic studies, of whom 2462 were treated with triazolam in parallel-design and crossover studies. To provide clinically relevant comparisons, only studies using comparator agents in doses equipotent to the triazolam doses were included. Two general findings emerged. First, "serious" central nervous system side effects, such as excitement and violence, were not demonstrated for any of the hypnotic agents, including triazolam. Other central nervous system side effects, such as depression and irritability, were reported with equal frequencies for all the hypnotics reviewed. Rebound insomnia, reported intermittently with most of these agents, was short-lived and not clinically significant. So-called early morning insomnia was noted only once and does not appear to be a valid clinical entity. Daytime anxiety was not observed in large numbers of triazolam-treated subjects studied, which is contrary to claims that the drug is anxiogenic. Second, a remarkable similarity was found among all of these shorter-acting agents in terms of efficacy, side effects, and performance-related effects. This was particularly of note for zopiclone and zolpidem. Although claims have been made suggesting differences, evaluation of the studies herein showed that these nonbenzodiazepine hypnotics were indistinguishable from triazolam and other benzodiazepine hypnotics in their clinical and pharmacologic activity. Thus, different chemical structures did not a priori predict different clinical profiles when drugs share a similar mechanism of action.
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PMID:Comparative clinical profiles of triazolam versus other shorter-acting hypnotics. 133 76

Secondary mania is increasingly recognized clinically, and consists of acute exhibition of manic symptoms without past or family history of affective disorder. It has been reported with toxic and metabolic disturbances, primary and metastatic brain tumors, epilepsy, and cerebrovascular events. A multifactorial etiology has been suggested. We report two men, 52 and 56 years old, who developed grandiosity, sleeplessness, irritable mood, hyperactivity, and paranoid and religious delusions, with attempted violence in one case. Both had no premorbid psychiatric history and were healthy except for hypertension. One patient had a normal neurologic examination, and the other had mild left hemiparesis and hyperreflexia. EEGs, brainstem auditory-evoked responses, and median nerve somatosensory-evoked potentials were normal. Magnetic resonance studies demonstrated infarction of the ventral pons (on the right in the patient with left-sided signs and on the left in the patient with normal neurologic examination). The two patients responded to lithium carbonate and neuroleptics and have not had further psychiatric symptoms in 18 months of follow-up. These cases emphasize the relationship of late-onset mania with predisposing brain disease, and they suggest that brainstem disturbances can influence mood, sleep, libido, and thought.
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PMID:Secondary mania after ventral pontine infarction. 213 93

A total of 1600 adolescents between the ages of 13 and 16 living in a county bordering on Paris were interviewed concerning their health, their use of drugs, both legal and illegal, their behavior, and their seeking of health care. Fourteen percent of the boys and 23% of the girls had already thought about suicide and 5% and 10% (respectively) proclaimed having thought about it frequently. Young adolescents who thought about suicide, the girls as well as the boys, had more health problems (fatigue, nightmares, insomnia), used more drugs (including tobacco, alcohol, illegal drugs, psychotropic medicine) and had more delinquent behavior (robbery, running away from home, racketeering). Furthermore, the girls had problems in school (absenteeism and being left back). In general, youngsters with suicidal thoughts resorted to violence in a variety of ways. Although these youngsters spoke less readily about their personal problems, they more frequently sought physical health care (doctors, nurses, social workers). This discrepancy between their difficulty in communication and their readiness to ask for physical care is a clear indication of their need to be helped.
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PMID:Suicidal thoughts during early adolescence: prevalence, associated troubles and help-seeking behavior. 232 80

This clinical presentation deals with the aftereffects, in a male patient, of a severely disturbed rapprochement phase, marked by many separations and a molestation before the age of three. The patient dreamed repeatedly of violence, often directed against himself, but the actual molestation was sealed off by formidable repression. A first analysis, with a male analyst, produced no relief from the patient's depression, crippling insomnia, and inability to form an intimate relationship. The second analysis progressed only when the repetitive dreams were understood to be repressed experiences of seduction and molestation.
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PMID:Reconstruction of an early seduction and its aftereffects. 358 15

As the end of this century approaches, the pressure of migration is increasing. It is difficult to limit with restrictive measures the number of refugees and persons seeking asylum in Europe in each country, medical screening programs are organised for arriving refugees and asylum seekers. In Switzerland, they are screened for tuberculosis and hepatitis B. They are offered standard vaccinations and immunized for hepatitis B according to screening results. The prevalence of tuberculosis in asylum seekers is 414 per 100,000, 227 per 100,000 of bacteriologically active tuberculosis. Anti-HBc antibody is present in 22% of women and 39% of men. The frequency increases with age and varies greatly according to origin. Initially, refugees were screened for intestinal parasites. Over a quarter were carriers, a large majority asymptomatic. Increasing numbers of asylum seekers come from countries affected by war and insecurity. Systematic screening carried out in Geneva for previous exposure to violence revealed that 61% reported major trauma, 18% reported torture and 37% complained of symptoms such as nightmares, insomnia, flashbacks, etc. The authors discuss issues related to medical screening programs, and their relative usefulness in an increasingly mobile world where the distinction between travellers and migrants is not always clear.
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PMID:[The health of asylum seekers: from communicable disease screening to post-traumatic disorders]. 947 57

Recently, with the increase in elderly population, we have had more opportunities to administer neuroleptics to elderly patients for hallucinatory delusional state, delirium, psychomotor excitement, wandering etc. However, little is known about the characteristics of the neuroleptic malignant syndrome (NMS) in elderly patients, which is the most serious side effect of neuroleptics. In this paper, we present the clinical course of five NMS patients in the presenium and senium. Case 1 was 72-year-old male who was diagnosed as having dementia of Alzheimer's type (with late onset). He showed nocturnal wandering, insomnia, and irritability. Tiapride 60 mg per day had been administered previously. Just after the addition of oxypertine 10 mg per day, NMS occurred, and he died of pneumonia a week later. Case 2 was 75-year-old male who was diagnosed as having vascular dementia. He showed insomnia, hyperactivity and wandering. He had been given levomepromazine (LPZ) 10 mg per day over a long period of time. At first, he had daily episodic fever, however, serum CPK levels did not increase at that time. A month later, all the symptoms of NMS appeared and then the patient's condition suddenly deteriorated and he died three days later. Case 3 was a 64-year-old male who was diagnosed as having dementia of Alzheimer's type (with early onset). He showed insomnia, irritability and violence. Tiapride 50-125 mg per day was administered along with oxypertine 50-115 mg per day. Almost two months later, NMS occurred. He had daily episodic fever at first, extrapyramidal symptoms and autonomic instabilities gradually increased. Soon after symptoms of NMS were completed. In this case, NMS seemed to be induced by bacterial pneumonia after long term administration of LPZ 5 mg per day. Case 4 was a 75-year-old female who was diagnosed as having dementia of Alzheimer's type (with late onset). She showed hallucinatory delusional state. Although she had autonomic instabilities just after adminstration of haloperidol 1-2 mg per day, NMS itself occurred after discontinuing the neuroleptic. Case 5 was a 61-year-old female who was diagnosed as having schizophrenia at the age of forty. She was given various neuroleptics over a period of time. The neuroimaging in SPECT showed her cerebral cortex was generally hypoactive. She had a tendency to have autonomic instabilities after the administration of relatively high potential neuroleptics. Risperidone 3-6 mg per day was administered, and almost a month later, autonomic instabilities increased and she was diagnosed as having NMS. All the patients would be able to have brain dysfunction, which suggested that such patients may be liable to NMS. In our patients, NMS occurred after the additional administration of oxypertine 10 mg per day or after long time administration of LPZ 5 mg per day. It was suggested that NMS could occur after the administration of low dose and relatively low potential neuroleptics in elderly patients. Our 3 of 5 patients showed the delayed type of NMS, which might be relatively more frequent in senior and presenior patients than in younger patients. In case 3, NMS was induced by the somatic disease (bacterial pneumonia), however in other cases, NMS was not always induced by somatic disease. Our 4 of 5 patients experienced some of the symptoms of NMS--episodic fever, extrapyramidal symptoms and autonomic instabilities--before the onset of NMS. Such symptoms may be "pre-steps" to NMS. Once NMS occurred, the patient's systemic condition tended to deteriorate acutely. Due to the fact that our 2 of 5 patients died, it was suggested that the prognosis of the NMS patients in presenium and senium tends to be much worse. It is important to find the "pre-steps" to NMS and treat them as soon as possible for better prognosis.
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PMID:[A study of neuroleptic malignant syndrome in the presenium and senium]. 974 53

There is abundant evidence to suggest that doctors are increasingly being exposed to violent incidents at their workplace. The possible effects of aggression on an individual are varied and likely to depend on the severity and frequency of episodes and the perceived vulnerability to further episodes. The reported sequaelae of violent incidents towards doctors include varied psychological disturbances, and changes in behaviour, such as increasing prescribing, ongoing fear of violence at work, and poor staff morale. We investigated the effects of violence against doctors in the accident and emergency departments in Kuwait. Seventy-five (86%) out of 87 doctors exposed to violent incidents reported one or more of the symptoms consisting of: depression, reliving experience (flashbacks), insomnia, and taking 'time off'. The effects lasted for more than 4 weeks in 25, for 3-4 weeks in 17, and for 2-3 weeks in 21. The duration of symptoms was longer in doctors exposed to verbal insults or threats of imminent violence coupled with incidents involving single acts of violence. Out of a total of 101 doctors; 90 (89%) remained worried about violence at work and 72 (71%) thought training to deal with potentially violent situations would be useful.
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PMID:Violence against doctors: 2. Effects of violence on doctors working in accident and emergency departments. 1064 18

Doping consists in the use of artificial means or substances with the unique aim of improving performance despite adverse effects on health. Amphetamines stimulate the central nervous system by increasing motivation and vigilance. Often consumed in association with analgesics, they increase the fatigue threshold during prolonged or repeated exercise. Addiction and dependency to these substances are extremely rapid. Side-effects include insomnia, exhaustion, violence and can lead to serious heart diseases. By enhancing capacity for intensive training, anabolic steroids improve strength, alertness and speed. This action is often further strengthened by the use of growth hormones DHEA and IGF-1. Extremely high dosage is used and is in no way comparable with natural secretions or those necessary to re-balance an exhausted glandular system. During prolonged endurance exercise, doping aims at improving the circulation of oxygen in the blood and thus its availability to the muscles. Firstly, the blood haemoglobin concentration was increased by blood transfusions. At present the production of red blood cells is stimulated by repeated injections of exogenous erythropoietin. The extreme viscosity of the blood leads to a risk of vascular thromboses and high blood pressure and accentuates greatly and sometimes even fatally the possibility of brachycardia which is common with sportsmen.
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PMID:[Doping in sports]. 1142 Nov 66

An overview is provided of the gravity of the problems of trauma from conflicts and effects on the health and survival of children and the relevance for India. Article 39 of the convention of the Rights of the Child adopted by the UN General Assembly is an agreement "to promote physical and psychological recovery and social reintegration of a child victim of any form of neglect, exploitation, abuse, inhuman treatment, or armed conflicts." The World Summit expanded the provision to include protecting women and children from the effects of war and to work toward preventing future conflicts. Safe corridors must be secured in order to protect children and families from surrounding war or violence. Concern for children was first indicated in the formation of UNICEF in the aftermath of World War II. Since that time, civilians, mostly women and children, have been the dominant population suffering from the effects of war. By 1991, 80% of the 20 million killed and the 80 million wounded were women and children involved in 150 conflicts. In the recent past, the Gulf War had a disastrous impact on children. Infant mortality increased from 39/1000 to 111/1000 and low birth weight rose from 5% to 12%. Child mortality of these under 5 years increased from 48/1000 to 143/1000. Another impact of armed conflicts on children is psychological trauma and detachment from emotional ties and enjoyment, and sleeplessness. Other symptoms are described. Recent action to counteract children's trauma has been taken in Kuwait, Mozambique, and Sri Lanka. Community-based programs help to identify needy children through parent and teacher education and to offer counseling. Several manuals are available on how to help children affected by war. One strategy is the establishment of a trauma center. In the Philippines, programs have been developed to involve children in therapy through drama, painting, and dance. India has experienced severe rioting, which has left many women and children orphaned. Programs need to be developed to deal with the effects on women and children.
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PMID:Conflicts and child survival. 1231 61

There is abundant evidence to suggest that violence in healthcare settings, especially in emergency departments (EDs) and psychiatry, is escalating and that nurses are particularly vulnerable. The authors, therefore, investigated the prevalence and effects of violence against nurses in an ED in a general hospital setting in Kuwait. A 12-item frequency-weighted questionnaire was used to measure rates, frequency and severity of violence. The questions related to the experience of violent incidents during the past year. Seventy out of 81 nurses experienced verbal insults or threats of imminent violence and 13 were also physically attacked during the 1-year period. Sixty-seven out of 70 nurses suffered from one or more after-effects, including flashbacks, sleeplessness, fearfulness, depression or taking time off work. Violence in healthcare services often reflects the community in which service is provided. Our findings suggest that doctors experience more violence but nurses suffer from more after-effects of violence at work.
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PMID:Violence against nurses in hospitals: prevalence and effects. 1257 14


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