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)

Despite the vast literature on drug dependence, little has been written about patients who become addicted while taking medically prescribed drugs for organic pathology. Observations from a psychiatric consultation-liaison service reveal that these patients are frequently middle-aged with no history of drug abuse before the onset of a chronic medical condition. Associated with their medical condition is a dependence on narcotics and/or psychotropic medications for such complaints as pain, headache, insomnia, and anxiety. Thea addiction may persist for years without acknowledgement by a patient, doctor, or family, although there is usually a progressive constriction of social and occupational functioning. The primary physician is highly valued by the patient; this manifest appreciation trends to facilitate the primary physician's continued prescription of large doses of addicting drugs. Treatment involving detoxification typically goes through a series of stages, each of which has characteristic hazards and pitfalls that can lead to failure of treatment.
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PMID:Treatment of iatrogenic drug dependence in the general hospital. 746 45

We prospectively studied side effects about 54 patients with chronic hepatitis C treated with 3 to 10 MIU a day of interferon (IFN) alpha, which was administrated for 16 to 24 weeks. Every day, all of them wrote down every symptoms, by themselves, during its treatment. Any symptoms occurred in all patients and each incidence of symptoms such as fever, fatigue, headache, anorexia, arthalgia, myalgia, chill, itching, insomnia, nausea, numbness of hand and foot, irritability, diarrhea, eye ball pain, vomiting, were all higher than those which have been reported by some papers in Japan. So, it was considered that the symptom self-wrighting method by patient was useful to evaluate the entity of side effects. Furthermore, we studied 26 patients, who discontinued IFN treatment because of side effects and analyzed the background factors. Each incidence of symptoms of these patients were not always compatible to those incidences. But by observation of those symptoms, we could know severe side effects earlier.
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PMID:[Clinical analysis of patients with chronic hepatitis C who discontinued interferon treatment because of side effects--our experiences and recent reports]. 752 35

Respiratory patients require psychotropic drug administration to treat pain, cough and respiratory distress or to treat insomnia, anxiety, depression or psychosis. Terminal patients require thoughtful and compassionate use of these drugs, even when there is an expectation that such therapy may lead to an earlier death. Most psychotropic agents can be used safely in patients with respiratory disease, and careful use of selected drugs should always be employed if indicated for treating distressful conditions that may be benefitted. Guidelines to appropriate choices and doses are provided.
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PMID:Psychotropic drugs in terminal care. 753 7

A prospective study was carried out of 125 hospital inpatients with malignant disease, referred to the King's College Hospital advisory palliative care team. A palliative care assessment (PACA) tool was developed in order to assess the outcome of interventions made within two weeks of referral with regard to: symptom control, change in the patients' and their relatives' insight regarding diagnosis and prognosis, and facilitation of patient placement. Reliability was assessed by cross-observer analysis, and validity by comparison with data obtained using the McCorckle symptom distress scale in a separate group of hospice inpatients. At initial assessment, the commonest symptom was pain, as reported by 74% of patients. One-third of the patients were unsure of their diagnosis and placement had not been decided in 61%. In total, the team undertook 245 pharmacological interventions for symptom control, 165 interventions regarding insight and 114 interventions concerning placement. Analysis of the data showed statistically significant improvements in pain (p < 0.001), nausea (p < 0.009), insomnia (p < 0.004), anorexia (p < 0.001) and constipation (p < 0.02). Discussion regarding diagnosis significantly changed the insight of patients (p < 0.001) and relatives (p < 0.02). Appropriate placement was assisted by interventions undertaken by the team. This study shows that a hospital palliative care team is effective at improving symptom control, facilitates understanding of the diagnosis and prognosis, and contributes to the appropriate placement of patients.
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PMID:Assessing the effectiveness of a hospital palliative care team. 754 84

Levels of symptom distress are most often measured in a clinical trial context rather than in general ambulatory populations. The purpose of this paper is to report levels of symptom distress in such a population, and to describe the factors associated with this distress. Over a 6-month period, a consecutive sample of 434 newly diagnosed patients, including 82 patients with lung cancer, were tested with the symptom distress scale at two tertiary oncology clinics serving the population of one Canadian prairie province. While levels of symptom distress in this population were generally low, the most problematic symptoms for patients were fatigue and insomnia, with 40% and 30% having moderate or high scores on these symptoms, respectively. Patients with advanced disease reported more distress than those with early stage disease; women reported more distress than men; older patients had less distress than younger patients; distress was highest in lung cancer patients and lowest in men with genitourinary cancers. Consistent with the findings of four previous studies, the single measure of symptom distress was a significant predictor of survival in lung cancer patients, with the exception of three patients who had substantial post-thoracotomy symptoms.
J Pain Symptom Manage 1995 Aug
PMID:Symptom distress in newly diagnosed ambulatory cancer patients and as a predictor of survival in lung cancer. 756 Dec 24

To clarify the diverse published results of cranial electrostimulation (CES) efficacy, we conducted an extensive literature review that identified 18 of the most carefully conducted randomized controlled trials of CES versus sham treatment. For the 14 trials that had sufficient data, we used the techniques of meta-analysis to pool the published results of treating each of four conditions: anxiety (eight trials), brain dysfunction (two trials), headache (two trials), and insomnia (two trials). Because studies utilized different outcome measures, we used an effect size method to normalize measures which we then pooled across studies within each condition. The meta-analysis of anxiety showed CES to be significantly more effective than sham treatment (p < .05). Pooling did not affect results that were individually positive (headache and pain under anesthesia) or negative (brain dysfunction and insomnia). Most studies failed to report all data necessary for meta-analysis. Moreover, in all but two trials, the therapist was not blinded and knew which patients were receiving CES or sham treatment. We strongly recommend that future trials of CES report complete data and incorporate therapist blinding to avoid possible bias.
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PMID:Meta-analysis of randomized controlled trials of cranial electrostimulation. Efficacy in treating selected psychological and physiological conditions. 944 90

Fibromyalgia syndrome (FMS) affects predominantly females and is characterised by widespread musculoskeletal pain, fatigue, insomnia, nonrefreshing sleep, diffuse stiffness and other organic and psychic signs and symptoms. Diagnosis is essentially based on the 1990 American College of Rheumatology Classificative Criteria, but if, in some cases, they are not completely fulfilled, diagnosis is not excluded in a particular patient. The causes of the enhanced pain perception and of all the other clinical characteristics are unknown. Both the central hypothesis (sleep disturbance; psychological affection; hypothalamus-hypophysis-adrenal axis disorder; neuromediators disregulation; etc.) and the peripheral theory (anatomical and/or functional muscle disturbance) try to explain FMS etiopathogenesis. Tricycles antidepressants (i.e. amitriptilin) and some muscle relaxants (i.e. ciclobenzaprine) have demonstrated some beneficial effect contrary to the classic antirheumatic drugs (NSAID; corticosteroids; etc.). Physical exercise, multidisciplinary support (behavioural therapy, physical agents; etc.) and patient education are some of the other approaches which contribute to the correct management of FMS.
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PMID:[The diagnosis and treatment of fibromyalgia]. 762 18

A 32-year-old woman was bedridden for a year because of chronic pain and headaches. She had insomnia, depression, suicidal thoughts and a severe chemical allergy. She had been on steroid therapy for two years and became Cushingoid with striae in the arm pits, groins and abdomen. However, she had no hypertension, nor the buffalo fat and hirsutism. She was very edematous, with a weight gain from 112 to 180 lbs. The fluid retention did not conform to the syndrome of inappropriate antidiuretic hormone. Studies revealed abnormal scalp EEG discharges and high-voltage seizure discharges in the posterior thalamus. Electrothalamic stimulation suppressed the thalamic discharges and relieved the patient's pelvic pain and headaches. After one month of several thalamic stimulations per day, she was able to get out of bed and ambulate. In addition, the patient no longer was edematous and was tolerating perfumes and floor detergents. Steroids were progressively reduced without complications of withdrawal. She went from a completely steroid dependent state to independent during the first 1-1/2 yrs of thalamic stimulation. With continued thalamic stimulation she has done well for 8-1/2 yrs, weighs 112 lbs, keeps house and drives a car. It's speculated the illness is a chronic pain multiple syndrome predominantly due to mesothalamic discharges and body infirmities. The mesothalamic discharge implicated neural networks, which represent biologic systems, i.e. pain, sleep, fluid retention, etc. Therapeutic stimulation attenuates the discharges and the neural networks return to their normal set points of homeostasis.
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PMID:Mesothalamic discharge in a chronic pain, allergy and fluid retention syndrome (case report). 766 2

In a prospective study of 167 patients with head and neck cancer, we assessed the causes and mechanisms of pain, as well as the efficacy and side effects of analgesic treatment, along World Health Organization (WHO) guidelines. The majority of patients had pain caused by cancer (83%) and/or treatment (28%), 4% had pain due to debility, and 7% had pain unrelated to cancer. Palliative antineoplastic treatment was performed in 32% of patients. Systemic analgesics were administered on 97% of a total of 8,106 treatment days, and coanalgesics or adjuvant drugs on 100%. The treatment proved to be very successful, as severe pain was experienced only during 5% of the observation period. In the absence of serious side effects, the most frequent symptoms observed were insomnia, dysphagia, anorexia, constipation, and nausea. The use of analgesic and adjuvant drugs along WHO guidelines to treat pain in head and neck cancer is highly effective and relatively safe.
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PMID:Validation of World Health Organization guidelines for pain relief in head and neck cancer. A prospective study. 768 53

In order to assess the quality of sleep in surgical patients the amount of self-rated postoperative insomnia and its predisposing factors, we conducted a three-fold questionnaire * survey in 176 consecutive patients undergoing elective orthopaedic, vascular or abdominal surgery. The first questionnaire was completed the day preceding surgery, the second at the day of discharge and the third two weeks later. This survey concerned the patient's general status, his usual sleep profile and factors which could interfere with sleep (hypnotics, pain, environmental factors) throughout the study period. It allowed quantification of these parameters and the assessment of their time-course. Perioperative insomnia appeared to be a long-lasting phenomenon which persisted after discharge. Factor analysis and multiple regression models showed that postoperative, self-rated insomnia was multifactorial and mainly explained by the amount of postoperative pain (p = 0.035).
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PMID:[Survey of the quality of sleep during the perioperative period. Study of factors predisposing to insomnia]. 773 16


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