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

This article discusses the causes of sleeplessness and its long-term management. Sleep may be repeatedly disturbed by pain, dyspnoea, micturition, or restlessness. The sleep patterns of the diseases which produce these symptoms are given, with an explanation in physiological terms of why they disturb sleep. A knowledge of these sleep patterns provides a valuable aid to diagnosis. It is concluded that there is only one condition, senility leading to senile dementia, for which long-term night sedation is justified.
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PMID:The clinical significance of disturbed sleep and the use of hypnotics. 437 78

A severe rebound rise in blood pressure with agitation and insomnia had been noted in five patients when they had previously ceased clonidine (Catapres) This has been shown to be reproducible in these patients and to be associated with a significant increase in urinary catecholamine excretion. The blood pressure can be controlled and the symptoms alleviated promptly by alpha and beta adrenergic receptor blockade using intravenous phentolamine and propranolol.
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PMID:Effects of clonidine withdrawal: possible mechanisms and suggestions for management. 470 9

To assess sex-related differences, 53 inpatients with major depression were evaluated with the Zung, Dempsey , and Hamilton depression scales, and part of the Beck scale. Women had more fitful sleep, easy crying, social withdrawal, agitation, somatic anxiety, gastrointestinal symptoms, genital symptoms, crying spells, constipation, and fast heartbeat. Men had more self-dislike and lack of clear mind. Differences in manifestations of major depression may account for misdiagnosis of female depressives as suffering from anxiety or functional insomnia and lead to treatment with anxiolytics rather than antidepressants. Self-dislike and mental clouding may lead male depressives to serious suicide attempts and work failures.
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PMID:Sex differences in inpatients with major depression. 614 72

In a randomized parallel-group trial the blood-pressure lowering effect of a new beta-adrenoceptor blocker bopindolol (LT 31-200) in a dose of 1-4 mg once daily (eight patients) was compared with that of propranolol in a dose of 40-120 mg t.i.d. (nine patients). The average blood pressure fell in the bopindolol group from 185/113 mmHg to 135/90 mmHg and in the propranolol group from 183/120 mmHg to 147/102 mmHg. Both changes were statistically significant. This was achieved during a nine week treatment period at the end of which the average dose of bopindolol was 3 mg per day and of propranolol 330 mg per day. One patient receiving bopindolol interrupted the trial because of restlessness and insomnia, and one receiving propranolol because of bronchospasm. Side-effects were, otherwise, mild in both groups. During a one-year treatment period following the comparative trial, the seven patients who had received bopindolol showed no evidence of tachyphylaxia, the blood-pressure remaining well controlled while the dosage was slightly reduced. No new side-effects were reported and the ANA and AMA tests remained negative in all patients.
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PMID:Bopindolol, a new long-acting beta-adrenoceptor antagonist--a randomized comparison against propranolol in hypertensive patients. 614 12

Twenty-six chronic schizophrenic outpatients receiving low-potency anticholinergic neuroleptics were switched over periods of up to 2 years to an equivalent dose of high-potency neuroleptics. Of these patients, 85% experienced withdrawal symptoms, mainly insomnia, anxiety, and tensional restlessness. Complete withdrawal of low-potency medication was achieved during the study period in 9 patients only. The mean duration of treatment with low-potency neuroleptics was 15 years and the mean dose was 147 mg chlorpromazine equivalents/day. It is suggested that new symptoms associated with withdrawal of low-potency neuroleptics may lead to overcompliance by patients and difficulty in achieving the minimum therapeutic dosage. Thus, low-potency neuroleptics would not appear suitable for the long-term treatment of most schizophrenic patients.
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PMID:Withdrawal symptoms after long-term treatment with low-potency neuroleptics. 615 30

Eighty-six patients suffering from nonpsychotic unipolar major depressive disorder, according to Research Diagnostic Criteria, were rated on a modified Hamilton Rating Scale for Depression (HRS). All completed the self-rating Beck Depression Inventory (BDI). Distal colon motility (dcm) studies, performed in all the patients, differentiated two types: low intestinal tone (low-IT) = 40 subjects, and high intestinal tone (high-IT) = 46 subjects. Low-IT depressed patients showed a statistically significant preponderance in the HRS items 'retardation', 'somatization', 'fatigability', 'hypochondriasis' and 'obsessional symptoms'. The high-IT depressed patients, on the other hand, showed preponderance in the items 'guilt', 'suicide', 'insomnia', 'agitation', 'anxiety psychic', 'loss of insight', 'depersonalization' and 'paranoid symptoms'. A positive correlation (r) was found between HRS- and BDI-mean total scores. In addition, a positive correlation (r) was found between HRS scores and distal colon tone in high-IT patients, although the same was not true for low-IT patients. Our results suggest the existence of two subtypes of depressive syndromes, distinguishable on the basis of distal colon motility profiles.
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PMID:Distal colon motility and clinical parameters in depression. 622 40

Psychoactive drugs are often widely used before tolerance and dependence is fully appreciated. Tolerance to cannabis-induced cardiovascular and autonomic changes, decreased intraocular pressure, sleep and sleep EEG, mood and behavioral changes is acquired and, to a great degree, lost rapidly with optimal conditions. Mechanisms appear more functional than metabolic. Acquisition rate depends on dose and dose schedule. Dependence, manifested by withdrawal symptoms after as little as 7 days of THC administration, is characterized by irritability, restlessness, insomnia, anorexia, nausea, sweating, salivation, increased body temperature, altered sleep and waking EEG, tremor, and weight loss. Mild and transient in the 120 subjects studied, the syndrome was similar to sedative drug withdrawal. Tolerance to drug side effects can be useful. Tolerance to therapeutic effects or target symptoms poses problems. Clinical significance of dependence is difficult to assess since drug-seeking behavior has many determinants. Cannabis-induced super sensitivity should be considered wherever chronic drug administration is anticipated in conditions like epilepsy, glaucoma or chronic pain. Cannabis pharmacology suggests ways of minimizing tolerance and dependence problems.
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PMID:Clinical relevance of cannabis tolerance and dependence. 627 20

Tiapride was used in 55 chronic alcoholics. It has a sedative effect on the anxiety, aggressiveness and agitation observed during the alcohol withdrawal syndrome. It is also effective against tremor, insomnia and fatigue. Fatigue or depression do not occur as side-effects. Tiapride induces a psychological feeling of wellbeing which is heightened by continuation of detoxication and general management.
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PMID:[Tiapride in detoxication of chronic alcoholics (author's transl)]. 627 32

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 study tested the ability of nicotine to alleviate the tobacco withdrawal syndrome. Signs and symptoms of tobacco withdrawal were measured in 100 smokers who fulfilled DSM-III criteria for tobacco dependence and a past history of tobacco withdrawal. After 2 evenings of baseline measurement, subjects were randomly assigned to receive either nicotine or placebo gum in a double blind manner. Subjects then stopped smoking, chewed gum freely, and returned on the 1st, 2nd, and 4th evenings of abstinence for further measurement. Nicotine reduced the increase in irritability, anxiety, difficulty concentrating, restlessness, impatience, and somatic complaints that subjects reported after cessation. Reductions in these withdrawal symptoms by nicotine were confirmed by ratings of significant others and by subjects' scores on the Profile of Mood States. Nicotine did not reduce the increases in cigarette craving, hunger, eating, insomnia, tremulousness , or supine heart rate after cessation. The effects of nicotine occurred immediately and persisted throughout the study. Although many subjects correctly identified their drug group, the efficacy of the gum was independent of subjects' identifications of drug. The relief of tobacco withdrawal by nicotine gum suggests that the tobacco withdrawal syndrome is caused, in part, by nicotine deprivation.
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PMID:Effect of nicotine on the tobacco withdrawal syndrome. 642 5


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