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 10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The postconcussion syndrome refers to a large number of symptoms and signs that may occur alone or in combination following usually mild head injury. The most common complaints are headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of consciousness and memory, and noise sensitivity. Mild head injury is a major public health concern because the annual incidence is about 150 per 100,000 population, accounting for 75% or more of all head injuries. The postconcussion syndrome has been recognized for at least the last few hundred years and has been the subject of intense controversy for more than 100 years. The Hollywood head injury myth has been an important contributor to persisting skepticism and might be countered by educational efforts and counter-examples from boxing. The organicity of the postconcussion syndrome has now become well documented. Abnormalities following mild head injury have been reported in neuropathologic, neurophysiologic, neuroimaging, and neuropsychologic studies. There are multiple sequelae of mild head injury, including headaches of multiple types, cranial nerve symptoms and signs, psychologic and somatic complaints, and cognitive impairment. Rare sequelae include hematomas, seizures, transient global amnesia, tremor, and dystonia. Neuroimaging and physiologic and psychologic testing should be used judiciously based on the problems of the particular patient rather than in a cookbook fashion. Prognostic studies clearly substantiate the existence of a postconcussion syndrome. Manifestations of the postconcussion syndrome are common, with resolution in most patients by 3 to 6 months after the injury. Persistent symptoms and cognitive deficits are present in a distinct minority of patients for additional months or years. Risk factors for persisting sequelae include age over 40 years; lower educational, intellectual, and socioeconomic level; female gender; alcohol abuse; prior head injury; and multiple trauma. Although a small minority are malingerers, frauds, or have compensation neurosis, most patients have genuine complaints. Contrary to a popular perception, most patients with litigation or compensation claims are not cured by a verdict. Treatment is individualized depending on the specific complaints of the patient. Although a variety of medication and psychologic treatments are currently available, ongoing basic and clinical research of all aspects of mild head injury are crucial to provide more efficacious treatment in the future.
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PMID:The postconcussion syndrome and the sequelae of mild head injury. 143 59

A case pertaining to legal psychiatric practice is described: the development of dusk clouding of consciousness in a patient with chronic alcoholism after the intake of indomethacin in high doses, foregoing insomnia and episodic alcohol abuse. Possible casuistry of the case forms no basis for ignoring the fact that in legal psychiatry, analogous episodes because of the intake of the high doses of certain drugs including indomethacin may be repeated.
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PMID:[Twilight consciousness disorder caused by overdose of indomethacin]. 165 20

The authors studied 954 psychiatric patients with major affective disorders and found that nine clinical features were associated with suicide. Six of these--panic attacks, severe psychic anxiety, diminished concentration, global insomnia, moderate alcohol abuse, and severe loss of interest or pleasure (anhedonia)--were associated with suicide within 1 year, and three others--severe hopelessness, suicidal ideation, and history of previous suicide attempts--were associated with suicide occurring after 1 year. These findings draw attention to the importance of 1) standardized prospective data for studies of suicide, 2) assessment of short-term suicide risk factors, and 3) anxiety symptoms as modifiable suicide risk factors within a clinically relevant period.
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PMID:Time-related predictors of suicide in major affective disorder. 185 69

Benzodiazepines are medications used to treat many of the most frequent and disturbing symptoms seen in medical practice, including anxiety, insomnia, muscle spasms, some forms of epilepsy, and other illnesses. The World Health Organization (WHO) has determined benzodiazepines to be "essential drugs" that should be available in all countries for medical purposes. As benzodiazepines were recognized as generally safe and effective drugs, their medical use increased but so did problems of abuse outside medical practice. This report focuses specifically on the nonmedical use, or abuse, of benzodiazepines for purposes, durations, or at dosage levels not intended by the prescribing physician or in ways outside medical guidelines. The principal contribution of this report to the resolution of the controversy about the use of benzodiazepines is to draw a sharp distinction between the medical use of these drugs and their nonmedical use, which this report labels "abuse." Problems which exist with the medical use of benzodiazepines, such as their use by patients who are better treated with other medications (or without medication) and the problems of withdrawal symptoms on discontinuation of medically prescribed benzodiazepines, are not addressed because these are problems of routine, legitimate medical practice. On the other hand, aspects of medical practice which affect nonmedical use of benzodiazepines are extensively dealt with in this report including the diversion of legitimately prescribed benzodiazepines into the illicit drug market and the prescribing of benzodiazepines for drug abusers. Extensive animal and human research has shown that benzodiazepines are "reinforcing" drugs in the sense that animals and humans will maintain behavior on which delivery of the drug is dependent. Animal studies of self-administration of potentially abused drugs show that benzodiazepines are less powerful reinforcers than intermediate half-life barbiturates (such as secobarbital) and psychomotor stimulants (such as amphetamine and cocaine). A substantial body of human research has shown that benzodiazepines are moderately "liked" for their reinforcing effects by drug abusers and alcoholic subjects but that both anxious people and normal (non-drug abusing, non-anxious) human subjects prefer placebo to benzodiazepines, demonstrating that these substances are usually not liked by people who are not drug abusers or alcoholics. Among drug abusers, benzodiazepines are preferred less than either intermediate half-life barbiturates or stimulants. This difference between the response of substance abusers and normal and anxious research subjects supports the fundamental distinction
Am J Drug Alcohol Abuse 1988
PMID:Abuse of benzodiazepines: the problems and the solutions. A report of a Committee of the Institute for Behavior and Health, Inc. 290 82

A cross-sectional study on patients with different abstinence time was performed to describe long-time biochemical and psychiatric changes due to withdrawal from heavy alcohol abuse. Physical, neurological, psychiatric and biochemical parameters were measured in 70 patients with a withdrawal period ranging from 2-90 days. The various parameters changed over time in different manners. Fatigability, reduced sleep, reduced sexual interest, apparent sadness, hostility and global ratings of abstinence improved significantly with the duration of the recovery period. Symptoms related to brain hyperexcitability such as fatigability, inner tension, insomnia and pains persisted for approximately 5 weeks. Of the biochemical parameters, the transaminases were normal in patients with more than 10 days of abstinence, while the levels of gamma-glutamyltransferase and HDL-cholesterol remained high for longer periods. The essential fatty acid status, measured by the fatty acid composition of serum lecithin, appeared to be normal only in patients with long recovery time. MAO in platelets was significantly lower than in the controls. The highest values were seen in the early recovery phase, which may indicate a temporary increase. Since polyunsaturated fatty acids are important constituents of synaptic membranes and since platelet MAO may reflect brain MAO, we consider these co-existing findings important in the interpretation of the psychiatric symptoms. The study demonstrated the existence of a subacute withdrawal syndrome lasting for 4-6 weeks.
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PMID:Studies on duration of a late recovery period after chronic abuse of ethanol. A cross-sectional study of biochemical and psychiatric indicators. 612 76

The capacity of the benzodiazepine drugs to produce dependence and addiction has been associated with what has recently been recognized as a benzodiazepine withdrawal syndrome. Abrupt discontinuation of benzodiazepine treatment may show a spectrum of symptoms similar to those observed from withdrawal of alcohol or barbiturates. Such reactions have been reported with and are reviewed for the following drugs: chlordiazepoxide, diazepam, oxazepam, lorazepam, nitrazepam, temazepam, and clobazam. Generally, the higher the dose and the longer the benzodiazepine is taken, the greater the risk of developing withdrawal symptoms. However, withdrawal symptoms may occur in patients receiving recommended doses and/or short-term therapy. Although most withdrawal reactions have been reported with the long-acting benzodiazepines having psychoactive metabolites, reactions may also occur with the short-acting agents. In contrast, rebound insomnia occurs with greater frequency and severity with the short-acting agents. Benzodiazepine therapy should be stopped as early as possible, with tapering after moderate dose and/or prolonged use therapy.
Am J Drug Alcohol Abuse 1982
PMID:Benzodiazepine withdrawal syndrome: a literature review and evaluation. 613 46

Sleep disorders can be intrinsic, as are insomnia or narcolepsy, or can be accounted for by external factors, such as noise, altitude, drug or alcohol abuse, or shift work. The arousal disorders, common in children, are usually benign and disappear by puberty. Sleep-wake transition disorders such as sleep starts are benign as well, and may occur at any age. The parasomnias comprise different entities such as nightmares, REM-sleep behavior disorder, sleep enuresis, and bruxism. Diagnosis and treatment often require a multidisciplinary approach. Virtually every psychiatric, neurologic, or medical disease, when of sufficient severity, leaves its specific fingerprint on sleep; some disorders, such as peptic ulcer disease, gastroesophageal reflux, or epilepsy, tend to be exacerbated during sleep. Fortunately, most sleep disorders are amenable to therapy, which can include counseling, sleep hygiene, withholding of an offending agent, behavioral therapy, light therapy, or cautious drug therapy.
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PMID:Dyssomnias, parasomnias, and sleep disorders associated with medical and psychiatric diseases. 802 26

The problems in association with agoraphobia and social phobia were examined in an 11-year prospective longitudinal study of a Swiss cohort of young adults. The weighted prevalence rates according to DSM-III were 2.9% for agoraphobia and 3.8% for social phobia. Although the problem of agoraphobia was greater in females, an equal sex ratio was observed for social phobia. There was a significant degree of comorbidity between the two subtypes of phobia, with females exhibiting a significantly greater frequency of co-occurrence of both disorders than males. The course of the two disorders was quite similar. In general, subjects with both disorders reported a more severe course. Assessment of comorbidity of phobias and other disorders revealed that agoraphobia was most significantly associated with extended neurasthenia, sexual problems, and the consumption of cannabis. On the other hand, social phobia was associated with other disorders than agoraphobia, with the strongest associations emerging for simple phobia, extended insomnia, and alcohol abuse. These findings support the validity of the distinction between different subtypes of phobia. The longitudinal analysis revealed that also phobia in general was not stable at the diagnostic level phobic symptoms were quite persistent across time.
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PMID:The Zurich study. XX. Social phobia and agoraphobia. 821 33

Clinical depression is associated with social, occupational and physical impairment and mortality. Furthermore, data are reviewed which have related the severity of depressive symptoms, such as anhedonia, psychic anxiety, panic attacks, alcohol abuse, insomnia and diminished concentration in depressed patients, to suicide within 1 year. By contrast, hopelessness, suicidal ideation, and prior suicide attempts were related to suicide within 2-10 years after examination, but did not correlate with suicide within the first year of follow-up. It is concluded that clinical depression continues to be associated with significant morbidity and mortality, despite progress which has been made in its treatment.
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PMID:The morbidity and mortality of clinical depression. 827 38

Patients meeting the social phobia criteria of the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) on the DSM-III-R Structured Clinical Interview (n = 101) entered a long-term moclobemide treatment study. These patients were treated for 2 years with moclobemide (phase I) followed by drug withdrawal, in most cases abruptly (phase II). Those who relapsed entered phase III for a further period of 2 years of treatment. During phase I 40 patients (39.6%) withdrew due to inefficacy or relapse. Two patients were removed from the study because of other diagnoses (borderline or schizophreniform). At the end of phase I the remaining patients (58.4%) were rated as not ill (45.5%) or minimally ill (11.9%). Effort was taken to achieve the maximum dose of moclobemide (750 mg/day) and the mean (+/-SD) dose was 723.3 +/- 67.7 mg/day (month 21). A marked decrease in symptoms in the patients who responded was recorded on the Liebowitz Scale for Social Phobia, Clinical Global Impressions. Hamilton Anxiety Scale and Hamilton Depression Scale. Non-response was mainly associated with co-morbidity, especially alcohol abuse, axis II disorders, and a history of major depression or secondary dysthymia. The drug was well tolerated; the more frequent side effects were mild and occurred mainly in the first 2 months of phase I, including nausea, headaches or insomnia. In phase II there was a relapse rate of 88% and 51 patients entered phase III; these patients are still being treated.
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PMID:The long-term treatment of social phobia with moclobemide. 892 15


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