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)

Clonazepam is a potent, long-acting benzodiazepine approved for use in myoclonic and petit mal seizures. Initial reports have demonstrated encouraging results with clonazepam in the treatment of acute mania as well as a favorable side-effect profile. A trial of adjunctive clonazepam was initiated in a 41-year-old patient with chronic schizophrenia. Two weeks later, while on an 8-mg dosage, he became manic, developing pressured speech, euphoria, inflated esteem, agitation, and insomnia. Initiation of electroconvulsive therapy with gradual tapering and discontinuation of the clonazepam resulted in amelioration of the manic episode and a return to his previous clinical status. Clinicians should be alerted to the potential of clonazepam to cause manic-like behavior in susceptible patients.
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PMID:Mania associated with clonazepam. 194 70

Based on evidence available at present, it appears that heterogeneity does exist within bipolar disorder. Persons with mania differ in family history of affective illness, their age at the onset of illness, sex, and organic cause and course of the illness. The question of how these variables influence an individual's response to treatment has never been systematically studied. Multicenter trials of the various antimanic agents need to be conducted to determine whether the various subgroups of manic patients have different pharmacological response profiles. At present, the clinical management of mania is best approached using lithium carbonate in a dosage adequate to achieve a 12-hour serum lithium level to 1.0 to 1.2 mEq/L. The time to response is usually 2 to 3 weeks, and during this period an antipsychotic or benzodiazepine agent may be added to help control symptoms such as agitation or sleeplessness. Prophylactic maintenance with 12-hour serum lithium levels between 0.8 and 1.0 mEq/L should be used for at least 6 to 12 months after resolution of the manic episode. In patients with more than one episode, lithium maintenance therapy may need to be continued indefinitely. In patients who are not responsive to lithium, the most prominent alternative therapies include anticonvulsants and calcium-channel blocking agents. Anticonvulsants (e.g., carbamazepine, valproic acid, clonazepam) are generally first used as alternative therapy (either alone, or in combination with lithium), followed by a calcium-channel blocker (e.g., verapamil). Clinical practice would generally suggest first using the alternative agent alone, then adding lithium if response is inadequate.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Perspectives on bipolar illness. 198 97

The model of sleep deprivation in rats by the platform method has been extensively studied in our laboratory as a possible animal model of mania. At the end of the period of sleep deprivation, the rat does not fall asleep as soon as it is returned to its home cage, but shows a period of wakefulness of about 30 min, during which the animal presents a cohort of symptoms that appear to mimic those present in idiopathic mania. In particular, during this period the animal displays insomnia, a high degree of hyperactivity, irritability, aggressiveness, hypersexuality and stereotypy. Haloperidol (0.2 mg/kg) was effective in reducing latency to sleep, while L-sulpiride was much weaker (< 50 mg/kg). The dopamine D1 receptor antagonist SCH 23390 exhibited an extremely high potency and efficacy in reducing sleep latency, a significant effect being observed with 3 micrograms/kg. The administration of the specific D1 receptor agonist SKF 38393 markedly prolonged the period of insomnia with the correlated behavioral syndrome. When lithium was added to the diet and consumed during the sleep deprivation period in adequate amounts to produce serum lithium levels of 0.7-1.0 mEq/l, sleep latency and locomotor activity were significantly reduced. The administration of naloxone (1-10 mg/kg) reduced the latency to sleep in a dose-related manner. By contrast, morphine (1 and 5 mg/kg, i.p.), beta-endorphin and [D-Ala2,D-Leu5]enkephalin (i.c.v., 2 and 1 micrograms, respectively) markedly prolonged the insomnia. The model not only represents a confirmation in the rat that sleep loss often precedes and may trigger a manic episode in man, but suggests that an opioid-dopamine interaction may play a pathogenetic role in mania.
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PMID:Sleep deprivation in the rat: an animal model of mania. 877 65

The authors describe the clinical course of a 10-year-old boy with bipolar disorder diagnosed at age 5 years. Lithium, carbamazepine, and valproic acid were ineffective or caused intolerable side effects. A trial of melatonin led to rapid relief of insomnia and aborted a manic episode. He has continued to take melatonin and adjunctive alprazolam for 15 months without recurrence of insomnia or mania. Affective disorders involving circadian dysregulation may respond to interventions that restore a normal sleep-wake cycle. Literature supporting this hypothesis is cited.
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PMID:Case study: the use of melatonin in a boy with refractory bipolar disorder. 918 38

Sleep is highly altered during affective episodes in patients with bipolar disorder. There is accumulating evidence that sleep is also altered in euthymic states. A deficit in sleep regulation may be a vulnerability factor with aetiological relevance in the development of the disease. This study aims to explore the objective, subjective and lifetime sleep characteristics of patients with manifest bipolar disorder and persons with an elevated risk of developing the disease. Twenty-two patients with bipolar I and II disorder, nine persons with an elevated risk of developing the disorder and 28 healthy controls were evaluated with a structured interview to characterize subjective and lifetime sleeping habits. In addition, participants wore an actimeter for six nights. Patients with bipolar disorder had longer sleep latency and duration compared with healthy controls as determined by actigraphy. The subjective and lifetime sleep characteristics of bipolar patients differed significantly from healthy controls. The results of participants with an elevated risk of developing the disorder had subjective and lifetime characteristics that were largely analogous to those of patients with manifest bipolar disorder. In particular, both groups described recurring insomnia and hypersomnia, sensitivity to shifts in circadian rhythm, difficulties awakening and prolonged sleep latency. This study provides further evidence that sleep and circadian timing are profoundly altered in patients with bipolar disorder. It may also tentatively suggest that sleep may be altered prior to the first manic episode in subjects at high risk.
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PMID:The characteristics of sleep in patients with manifest bipolar disorder, subjects at high risk of developing the disease and healthy controls. 2290 11

Memantine, an N-methyl-d-aspartate receptor antagonist, is a well-established treatment option for moderate-to-severe cognitive impairment related to Alzheimer disease. Recently, growing evidence has indicated memantine might also be effective in treatment of affective disorders. The common drug-induced adverse events of memantine include confusion, dizziness, drowsiness, headache, insomnia, and agitation. Herein, we presented a case of a 73-year-old female patient with vascular neurocognitive disorder, who developed a manic episode after taking memantine.
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PMID:Memantine induces manic episode in a 73-year-old patient with vascular neurocognitive disorder: a case report. 2988 Dec 76