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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

128 case reports of drug-induced mania were reviewed. Steroids, levodopa and other dopaminergic agents, iproniazid, sympathomimetic amines, triazolobenzodiazepines and hallucinogens were the agents that most commonly induced manic syndromes. The most common characteristics of drug-induced manic episodes were increased activity, rapid speech, elevated mood, and insomnia. Patients who developed mania often had a prior history, family history, or current symptoms of mood disturbance. The episodes were most commonly treated by discontinuing or reducing the dose of causative agent. Discontinuation of the inciting drug and treatment with neuroleptic agents were equally efficacious: lithium treatment was less effective. The majority of agents that induce mania have an effect on monoaminergic systems.
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PMID:Drug-induced mania--causative agents, clinical characteristics and management. A retrospective analysis of the literature. 265 43

There is relatively little documentation on the common side effects associated with monoamine oxidase inhibitors (MAOI) and their frequency of occurrence. A retrospective chart review of patient records in a Mood Disorders Service was completed. Side effects of patients receiving phenelzine (N = 42) and tranylcypromine (N = 19) were rated as mild (resulting in no change in treatment), moderate (some modification in treatment plan necessary), and severe (definite change in treatment plan or drug discontinuation due to MAOI side effect). A total of 35 reports of side effects were noted in 15 of 19 tranylcypromine patients (1.84 per patients) and a total of 125 side effect reports were noted in 39 of 42 phenelzine patients (2.98 per patient). Only two severe tranylcypromine side effects occurred (resulting in drug cessation for one of these patients - hypotension), while 9 severe reactions occurred with phenelzine, resulting in drug discontinuation in 6 of these patients. The side effects for tranylcypromine and the number of reports were insomnia (N = 10), sedation (N = 8), hypotension (N = 5), sexual dysfunction (N = 3), hypomania (N = 3), weight gain/edema (N = 2), hypertensive episode (N = 2), and myoclonic jerking (N = 2). The number of reports of phenelzine side effects were insomnia (N = 26), hypomania/mania (N = 27; most common reason for drug cessation - 4), hypotension (N = 16; three cases considered severe), weight gain/edema (N = 15), sedation (N = 15), sexual dysfunction (N = 13), hypertensive episode (N = 6), and myoclonic jerking (N = 7).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Common side effects associated with monoamine oxidase inhibitors. 274 73

The astute family physician recognizes that such complaints as fatigue, pain, weight change and insomnia may be manifestations of depression rather than of physical illness. This diagnostic challenge is simplified by a working knowledge of the criteria for depression and mania. In addition to diagnosing depression, family physicians can successfully treat this condition with antidepressant medications.
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PMID:Recognition and treatment of depression. 381 72

Diverse psychological, interpersonal, environmental, and pharmacological factors that appear to trigger the onset of mania could act via their capacity to cause sleep deprivation, a mechanism that has been shown in experiments with bipolar patients to induce transient or sustained switches into mania. Since mania in turn causes insomnia, the development of mania is potentially self-reinforcing and could become autonomous after being initiated by precipitating factors. The sleep reduction model is based on experimental evidence and is a parsimonious explanation for the precipitation of manic episodes by a wide variety of factors. Furthermore, this model has clear implications for the prevention and treatment of mania and provides a conceptual focus and an experimental paradigm for psychological investigations of the causes of mania.
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PMID:Sleep reduction as a final common pathway in the genesis of mania. 381 88

The authors review the antidepressant withdrawal literature. Withdrawal of tricyclic antidepressants may precipitate the development of discrete syndromes. The most common of these are general somatic or gastrointestinal distress with or without anxiety and agitation, sleep disturbance characterized by excessive and vivid dreaming and initial and middle insomnia, movement disorder, and psychic and behavioral activation extending on a continuum to frank mania. The etiology of these syndromes is discussed. The "cholinergic overdrive hypothesis" explains most antidepressant withdrawal phenomena, including infrequent manifestations. Some antidepressant withdrawal symptomatology may be due to an interaction between cholinergic overdrive and monoaminergic systems. A treatment program useful in ameliorating the distress of patients who develop antidepressant withdrawal symptoms and who cannot continue to take antidepressants is outlined. The theoretical significance of tricyclic withdrawal phenomena and the heuristic value of current hypotheses as to their pathophysiology are discussed.
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PMID:Antidepressant withdrawal phenomena. 632 97

This interview study investigated nonspecific psychological distress in the general population. A probability sample of 200 adults was drawn from heterogenous sex, class, and ethnic groups in New York City. Twenty-five scales were developed. Eight reflect a single dimension of nonspecific distress (eg, Poor Self-esteem, Sadness, and Perceived Physical Health) and 17 are distinct from these and from each other (eg, False Beliefs and Perceptions, Manic Characteristics, Insomnia, Antisocial History, and illness-linked Somatic Problems). Both sets of scales have become part of a new interview instrument, the Psychiatric Epidemiology Research Interview (PERI). Questions are raised about the nature of nonspecific distress in relation to Frank's construct of "demoralization," the value of the measured dimensions of psychopathology that contrast with it, and the relation of PERI, which uses a self-report format, to diagnostic interviews developed here and abroad.
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PMID:Nonspecific psychological distress and other dimensions of psychopathology. Measures for use in the general population. 743 85

Ninety-six patients with bipolar disorder who attended a lithium clinic were reviewed in a retrospective study. Sleep disorders were studied in 85 depressive episodes. Eighty-one percent of the subjects presented with insomnia; the mixed type being the most frequent (49%) followed by early awakening (25%). The evolution of depression in the patients was compared according to the treatment received for insomnia: sedative antidepressants vs other anxiolytic or hypnotic drugs. Fifteen percent of patients shifted to mania, this group more frequently receiving sedative antidepressants (p < 0.05). Moreover, the patients who had received sedative antidepressants as therapy for insomnia (N = 61) showed a tendency to have a shorter asymptomatic interval before the following relapse (13 months vs 19 months; p = 0.06). In view of these results, we consider that the use of sedative antidepressants as a treatment for insomnia during depressive episodes in bipolar patients could be a factor contributing to worse prognoses; in these cases it appears that the use of other hypnotic drugs would be more advisable.
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PMID:Sleep disorders in bipolar depression: hypnotics vs sedative antidepressants. 779 52

Side effects often complicate the use of antidepressants for treatment of patients with major depression. Aggressive minimization and management of antidepressant side effects may relieve discomfort and distress, improve quality of life, enable clinicians to use appropriate medications at therapeutic doses, improve compliance, and thus enhance overall outcome. In this article we present recommendations for the management of side effects associated with antidepressant medications. Specifically, strategies are provided for the management of anticholinergic, cardiovascular, sedative, and activating side effects. Strategies for the management of antidepressant-associated insomnia, hypomania and mania, sexual dysfunction, appetite stimulation and weight gain, cognitive impairment, and parathesias are also discussed.
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PMID:Minimizing and managing antidepressant side effects. 862 55

An 81-year-old woman had the sudden onset of left-sided ballismus and an accompanying behavioral change characterized by elation, distractibility, inflated self-esteem, and insomnia, suggesting secondary mania. An MRI revealed a small ischemic infarction of the right thalamus.
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PMID:Hemiballismus and secondary mania following a right thalamic infarction. 814 41


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