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

Despite many suicidal cases in patients with systemic lupus erythematosus (SLE), literature on this subject is lacking. To elucidate and prevent this phenomenon, we re-evaluated the clinical records of seven suicidal patients with SLE. Six patients had photosensitivity and insomnia. At the time of the suicide attempt, hypocomplementemia was observed in five of six patients. Diffuse slowing on electroencephalograms were observed in four of five patients. One patient successfully committed suicide while on no therapy while five patients made their attempts under the tapering courses of steroids. Five patients manifested psychoses whereas two patients displayed no psychotic findings. All patients attempted suicide shortly after admission (mean time 20 days). The subsequent courses of the survivors who received more medication were favorable. Therefore, it appears that disease activity was not fully controlled in these patients. Furthermore, signs of an imminent suicide attempt were missed in some cases. Psychosis, insomnia, history of photosensitivity, an incompletely controlled disease state, receiving tapering steroid dose, diffuse slowings on electroencephalograms and the presence of hypocomplementemia appeared to be risks for attempting suicide in SLE. We would recommend that such patients be under psychiatric care for at least 2 months to prevent suicide. When the patient is still psychotic or unstable, further medical care will be required.
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PMID:Suicide in patients with systemic lupus erythematosus: a clinical analysis of seven suicidal patients. 802 83

Among Harvard alumni aged 35-74 in 1962 or 1966, incidence rates of physician-diagnosed depression, together with suicide rates, were examined during a 23-27-year follow-up period, by antecedent physical activity habits and other personal characteristics. A total of 387 first attacks of depression developed among 10,201 alumni who survived through 1988; 129 suicides occurred among 21,569 alumni during follow-up through 1988. Depression rates were lower among the physically active and sports players, higher among cigarette smokers, unrelated to alcohol consumption, and higher among alumni reporting such personality traits as insomnia, exhaustion, cyclothymia, and self-consciousness. Suicide rates were largely unrelated to antecedent physical activity and alcohol consumption, higher among smokers, and substantially higher among men reporting the personality traits that predicted increased rates of depression.
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PMID:Physical activity and personal characteristics associated with depression and suicide in American college men. 805 61

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

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

Although antidepressant medications represent the cornerstone of treatment for patients with moderate to severe clinical depression, they also carry serious risks. There is evidence which suggests that antidepressants can, in rare instances, induce or exacerbate suicidal tendencies. Nine clinical mechanisms have been proposed through which this may occur. These are: (a) energizing depressed patients to act on pre-existing suicidal ideation; (b) paradoxically worsening depression; (c) inducing akathisia with associated self-destructive or aggressive impulses; (d) inducing panic attacks; (e) switching patients into manic or mixed states; (f) producing severe insomnia or interfering with sleep architecture; (g) inducing an organic obsessional state; (h) producing an organic personality disorder with borderline features; and (i) exacerbating or inducing electroencephalogram (EEG) or other neurological disturbances. Epidemiological and controlled studies also provide data on the association between antidepressant drugs and suicidal ideation, attempts and fatalities. These include studies which: (a) suggest that electroconvulsive therapy may be more effective than antidepressant drugs in reducing the frequency of suicide attempts; (b) indicate that antidepressants may differ in their capacity to reduce the frequency of suicide attempts; (c) find that more overdose attempts were made by patients receiving maprotiline than placebo; and (d) suggest that fluoxetine may be associated with a greater risk of inducing de novo suicidal ideation. Evidence suggests that antidepressants may vary by at least 15-fold in the number of fatal overdoses per million prescriptions. Estimated overdose proclivity rates were derived after adjusting the fatal toxicity data by the therapeutic index of the drug. These rates were very consistent between agents with the same pharmacological properties, and correlated well with known overdose risk rates for amitriptyline, mianserin and maprotiline. Estimated overdose proclivity rates suggest that the highly selective noradrenaline (norepinephrine) uptake inhibitors (desipramine, nortriptyline, maprotiline) may be associated with a greater risk for overdose than more mixed uptake inhibitors and monoamine oxidase inhibitors (MAOIs). Antidepressants are not uniformly neutral in regard to suicidal ideation and attempts. Data clearly demonstrate that antidepressants ameliorate suicidal ideation more effectively than placebo in patients with depression. Although antidepressants diminish suicidal ideation in many recipients, about as many patients experience worsening suicidal ideation on active medication as they do on placebo. Furthermore, at least as many patients attempted suicide on fluoxetine and tricyclic antidepressants as on placebo, and more patients attempted to overdose on maprotiline than placebo. These observations suggest that antidepressants may redistribute suicide risk, attenuating risk in some patients who respond well, while possible enhancing risk in others who respond more poorly.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Antidepressant drugs and the emergence of suicidal tendencies. 845 61

The purpose of this study was to examine the association between recurrent sleep, panic, and suicidal behavior in panic disorder. We compared the recurrent sleep panickers (N = 33) with other panickers (N = 34). The Schedule for Affective Disorders and Schizophrenia (SADS) suicide subscale was used to rate the severity of active suicidality. We found that recurrent sleep panickers also had a higher percentage of insomnia and comorbid major depression than the others. A multivariate analysis demonstrated an association between recurrent sleep panic and suicidal tendencies in patients with panic disorder. Although recurrent sleep panic alone is not an independent risk factor for suicidal behavior, it may modify the severity of illness in patients with panic disorder.
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PMID:Recurrent sleep panic, insomnia, and suicidal behavior in patients with panic disorder. 960 81

The composition of the depressive syndrome was examined at both the acute and chronic phases of schizophrenic illness in 86 newly admitted patients. A subgroup with pronounced depression was defined, and a discriminant analysis was performed using symptoms from the Hamilton Rating Scale for Depression (HRSD) as discriminant variables. At the acute phase, the following nine symptoms from the HRSD were significant: depressed mood, guilt, suicide, retardation, three types of insomnia, and two somatic symptoms. At the chronic stable phase, only four symptoms were significant: depressed mood, suicide, general somatic symptoms, and loss of weight. Initial insomnia, middle insomnia, genital symptoms, and loss of insight were poorly correlated. The positive and negative symptoms and extrapyramidal side-effects were not discriminators at either phase. These findings suggest that only certain items from the HRSD may be crucial when assessing depression in schizophrenia.
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PMID:The composition of the depressive syndrome in acute schizophrenia. 985 Sep 81

A study of 100 patients who made a severe suicide attempt suggested that the managed care criteria often applied for approving admission to hospitals for potentially suicidal patients were not, in fact, predictive of features seen in patients who actually made such attempts. Severe anxiety, panic attacks, a depressed mood, a diagnosis of major affective disorder, recent loss of an interpersonal relationship, recent abuse of alcohol or illicit substances coupled with feelings of hopelessness, helplessness, worthlessness, global or partial insomnia, anhedonia, inability to maintain a job, and the recent onset of impulsive behavior were excellent predictors of suicidal behavior. The presence of a specific suicide plan or suicide note were not. Patients with managed care were overrepresented by 245% in the study.
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PMID:Suicide risk assessment: a review of risk factors for suicide in 100 patients who made severe suicide attempts. Evaluation of suicide risk in a time of managed care. 998 17

Patients with major affective disorders are more likely to complete suicide than patients in any other medical group. Established risk factors for completed suicide in affective disorders include acute depression (with turmoil, hopelessness, global insomnia, anhedonia, anxiety and/or panic), mixed episodes, rapid cycling, substance abuse, aggression and/or impulsivity, low serotonergic activity, and hypothalamic-pituitary-adrenal axis activation. Although anticonvulsants have mood-stabilizing and antidepressant properties, few data are available on the antisuicide effects of anticonvulsant treatment in manic-depressive patients. On the other hand, as reviewed elsewhere in this issue, massive data have been accumulated on the antisuicide effect of lithium. This article discusses lithium versus anticonvulsants in the prevention of suicide associated with affective disorders and future treatment strategies to reduce this most serious complication of manic-depressive illness.
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PMID:Anticonvulsant therapy and suicide risk in affective disorders. 1007 94

Tinnitus is an extremely prevalent condition that impinges on the lives of sufferers to varying degrees. In some people, it is a fairly minor irritation but, for many, the tinnitus intrudes to such a degree that it affects their ability to lead a normal life, and in some very extreme cases has resulted in suicide. Insomnia, inability to concentrate and depression are commonly reported to accompany the condition. Relief can be reliably obtained using intravenous lignocaine, which indicates that pharmacology can provide a route for effective alleviation of the condition. In this article, Julie Simpson and Ewart Davies review the potential pharmacological therapies, and emphasize that clinical research has been hampered by the absence of a reliable objective assessment of the tinnitus and by the variable nature of the complaint.
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PMID:Recent advances in the pharmacological treatment of tinnitus. 1010 57


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