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)

Because anxiety is the third most common problem encountered in this Model Family Practice unit, the presentation and management of 36 randomly selected cases were reviewed. The incidence was not greater in one race, but was increased in all married females (age 25 to 35) who, despite wife or husband working, had a very low income. The foremost complaints were insomnia, headaches, and chest pain with 80% of the patients maintaing the same symptoms. The resident identified a conflict (the most frequent being marital problems) in 47% of the cases. Drug therapy was used in 86.1% with ten percent selected for symptom relief. Because there are times when an alternate to drug therapy is needed, an overview teaching series on brief psychotherapy is suggested as an appropriate part of the behavioral science curriculum in a residency program.
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PMID:Identification and management of the anxious patient within a model family practice unit. 63 66

This preliminary study represents 10% of the workers in this occupation in Bangalore. The industry is highly commercial in nature and the city of Bangalore; has the largest number of units in Karnataka State. The study provides base line data relating to some morbidity conditions for future comparisons. Low back ache, tiredness, head ache, irritation in the eyes, sleeplessness, joint pains, chest pain, postural giddiness, persistent running nose, abdominal pain, cough and tremors of hands, were some of the common conditions elicited among the workers. Some of the conditions were identified to be possibly related to various processes within the industry. Particularly low back ache and irritation in the eyes (rolling and dipping), tremors of hands (packing). It is very likely that in the final stages when certain chemical ingredients are added which finally give the scent, the chances of pollutants entering either through skin or inhalation is possible. Environmental monitoring has not shown any appreciable dust hazard. The study has helped in identifying some of the areas in the work environment which required improvement. There is a need for social workers, medical personnel and industrial hygienists to explore the possibilities of minimizing possible hazards. A national sampling survey in other parts of the country might also be beneficial.
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PMID:An enquiry into work environmental status and health of workers involved in production of incense sticks in city of Bangalore. 130 84

It is important to understand both the kinetic and the dynamic implications of dosing TCAs and BZs in the elderly, for whom these drugs are frequently prescribed. The TCAs are used to treat responsive signs and symptoms including such somatic complaints as chest pain, dizziness, and arthralgias, as well as the endogenous signs such as loss of appetite with associated weight loss, psychomotor retardation, loss of libido, and insomnia. The pharmacokinetic studies of TCAs such as desipramine and nortriptyline have shown few, if any, age-related changes. The dose required for responsivity is significantly reduced for both TCAs (desipramine and nortriptyline) in the elderly, which may suggest increased end-organ responsiveness. The major recommendations for treatment of depression with nortriptyline in the elderly are (1) to administer small doses in order to avoid side effects, and (2) to expect a longer response time for the antidepressant effect than in young and middle-aged depressed patients. Although the BZs are extensively prescribed in the elderly, primarily for insomnia and anxiety, the physiologic and biochemical changes of aging alter the kinetics and dynamics of these extensively metabolized and slowly eliminated drugs. Based on the kinetic data and information in Tables 1 and 2, the relatively sensitive elderly population should receive a reduced dosage. Careful evaluation of the patient and the kinetic profile of the agent employed will ensure safe use of these drugs. A clear understanding of anxiety and respect for the alterations in the pharmacokinetics and pharmacodynamics of these agents in the elderly will allow the physician to prescribe the BZs wisely. As with the TCAs, remember to administer doses of BZs that are reduced by 50 to 75 per cent of the usual recommended doses for young and middle-aged individuals and to increase dosage in small increments. Ultimately, sound, scientifically based, clinical judgment that considers the needs of the patient is the best guide for the selection of an appropriate BZ.
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PMID:Implications of dosing tricyclic antidepressants and benzodiazepines in geriatrics. 644 Nov 58

Charts of 28 hyperthyroid patients over 60 years old were retrospectively analyzed and compared with charts of 14 patients under 30 years old. The mean duration of symptoms prior to diagnosis was 16 months in the elderly and five months in the younger group. Heart rate was substantially lower in the older (107 beats/min) vs younger (117 beats/min) study group. The symptom of weakness or fatigue was more prevalent in the elderly group (94 percent) than in the younger group (57 percent). Cardiac palpitation was more prevalent in the elderly patients whereas insomnia, irritability, dysphagia, hyperphagia, and heat intolerance were more prevalent in the younger patients. Fifty percent of the elderly patients complained of chest pain. Cachexia (62 percent), thin, fine hair (50 percent), and weakness (58 percent) were prominent physical findings in the elderly group. Twenty-six percent of the elderly patients had atrial fibrillation. These findings confirm previous studies that show some differences in presentation of hyperthyroidism in elderly patients when compared with younger patients. The authors recommend that thyroid function tests be obtained for broad indications in the elderly.
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PMID:Thyrotoxicosis in the elderly. 664 37

Panic disorder is a chronic illness that affects at least 3 percent of the population. Panic disorder is associated with significant morbidity and an increased risk of suicide. Patients generally present with multiple somatic and psychologic complaints, including heart palpitations, chest pain, tremor, shortness of breath, choking, nausea or abdominal distress, dizziness, derealization, fear of losing control or going crazy, fear of dying, paresthesias, chills or hot flushes, headache, diarrhea, insomnia, chronic fatigue, anxiety and depression. To make the correct diagnosis, these symptoms must be evaluated carefully since they also occur with serious cardiovascular, pulmonary, endocrinologic and neurologic disorders. Many effective treatments are available, including tricyclic antidepressants, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, benzodiazepines such as alprazolam and clonazepam, and psychotherapy.
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PMID:Panic disorder. 748 99

During December 1993-September 1995, the Bureau of Food and Drug Safety, Texas Department of Health (TDH), received approximately 500 reports of adverse events in persons who consumed dietary supplement products containing ephedrine and associated alkaloids (pseudoephedrine, norephedrine, and N-methyl ephedrine). This total included reports by individuals and reports identified by the Bureau of Epidemiology, TDH, in a review of records from the six centers of the Texas Poison Center Network. Reported adverse events ranged in severity from tremor and headache to death in eight ephedrine users and included reports of stroke, myocardial infarction, chest pain, seizures, insomnia, nausea and vomiting, fatigue, and dizziness. Seven of the eight reported fatalities were attributed to myocardial infarction or cerebrovascular accident. This report describes three patients in which the recommended dosage for the dietary supplements reportedly was not exceeded, summarizes results from ongoing investigations, and underscores the potential health risks associated with the use of products containing ephedrine.
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PMID:Adverse events associated with ephedrine-containing products--Texas, December 1993-September 1995. 877 3

Fifty-eight outpatients with panic disorder (PD) were examined to determine their clinical features in comparison with a cohort of 52 patients with generalised anxiety disorder (GAD). Both groups were of comparable age, sex, educational level, marital status and ethnicity. PD patients were more likely to complain of palpitations, breathlessness, chest pain, numbness, choking sensations and especially fear of dying. GAD patients tended to complain of feeling tense, insomnia, headaches, weakness, restlessness and muscle aches. PD patients had greater comorbidity especially with agoraphobia and depression. Contrary to other reports, there were more males than females in both groups but alcohol dependence and suicide attempts were relatively rare. PD symptoms seemed more distressing, caused more social and occupational disruption, led to more requests for medical investigations and earlier psychiatric consultations. These factors seemed to suggest that panic disorder is a more severe illness than generalised anxiety disorder.
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PMID:Panic disorder in Singapore: clinical features and comparisons with generalised anxiety disorder. 920 72

This study aims to examine the situation for patients on the waiting list for possible coronary revascularization in terms of waiting time, treatment and various aspects of well-being in relation to gender. Patients on the waiting list for coronary angiography, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting in September 1990 were approached with a questionnaire dealing with various aspects as described above. Of the 831 patients who participated in the evaluation, 174 (21%) were women. Although age was similar for men and women, men had a higher prevalence of previous myocardial infarction and a lower prevalence of previous hypertension. In terms of medication, women were more frequently treated with diuretics and sedatives than men. Women reported a higher frequency than men with regard to the following symptoms: chest pain at rest and at night, dyspnoea when walking, tachycardia, tiredness, headache, dizziness and sweating. Women also suffered more frequently from difficulty going to sleep, difficulty waking up, repeated awakening and insomnia. Men, on the other hand, suffered more frequently from restlessness, inability to act and irritability. Among patients on the waiting list for possible coronary revascularization, women differed from men by being more frequently treated with diuretics, reporting a higher frequency of various cardiovascular symptoms including chest pain and dyspnoea and, furthermore, reporting more sleeping disorders. Gender differences were found but they were not consistent.
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PMID:Differences between men and women on the waiting list for coronary revascularization. 1084 47

HIV-positive individuals are at high risk of developing an anxiety disorder, with a prevalence rate as high as 38 percent. The symptoms may occur anytime during the course of the infection, and can become excessive in some patients, impairing the person's ability to cope with their circumstances. Signs and symptoms include chest pain, headache, numbness, and insomnia. HIV treatments that may cause anxiety symptoms include ddI, d4T, AZT, fluconazole, foscarnet, and isoniazid. Health care providers need to thoroughly evaluate anxiety symptoms during an initial evaluation to rule out substance abuse and pre-existing anxiety. Treatment of anxiety in HIV/AIDS ranges from benzodiazepines to alternative therapies such as massage and acupuncture. A chart lists potential drug interactions between common antidepressive and HIV antiretroviral drugs.
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PMID:Anxiety and HIV infection. 1136 9

Treatment of healthy donors with recombinant human granulocyte colony-stimulating factor (rhG-CSF) allows the mobilization and peripheralization into circulating blood of an adequate number of CD34+ cells that can then be collected by leukapheresis (PBSC). This procedure avoids the invasiveness of bone marrow harvest and the risks related to general anesthesia. The main adverse effects of rhG-CSF are: bone pain, 84%, headache, 54%, fatigue, 31%, and nausea, 13%, which are usually scored by the donors as moderate to severe, resolving within 2-3 days after discontinuation of the cytokine. Analgesics, mainly acetaminophen, are sufficient to control the pain. Less than 5% of the donors experience non-cardiac chest pain, a local reaction at the injection site, insomnia, dizziness or a low-grade fever. Discontinuation of the PBSC procedure because of adverse effects of rhG-CSF or leukapheresis is rarely necessary (0.5%) but this good tolerability can be hampered by the need, in 5-20% of cases, for an adequate venous access that requires insertion of a central or venous catheter. There are no absolute contraindications to the stimulation of healthy donors with rhG-CSF but the description of cases of non-traumatic splenic rupture, iritis, cardiac ischemia, and gouty arthritis suggests that further precautionary restrictions are advisable when deciding eligibility for PBSC collection. The main advantages for patients receiving an allogeneic PBSC transplant are the faster hematologic and immunologic recovery and the potential for a greater efficacy in advanced disease by lowering the transplant-related mortality. One of the major concerns regarding the use of rhG-CSF in unrelated healthy donors is the uncertainty about its possible role in triggering malignancy, in particular myelodysplastic syndrome and acute myeloid leukemia. There are no studies with an adequate sample size and follow-up that can answer this question but two recent retrospective studies reported that in the medium term rhG-CSF is not associated with an excess of lymphoproliferative disorders. Currently, caution on the long-term safety of the use of rhG-CSF in healthy donor is still warranted but the data so far accumulated on allogeneic PBSC transplants are encouraging both as far as concerns the good short-medium tolerability profile of G-CSF-stimulation of the donor and the potential major efficacy in leukemia patients.
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PMID:The use of cytokine-stimulated healthy donors in allogeneic stem cell transplantation. 1241 88


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