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)

Side effects play a significant role in the selection of drugs to be used in panic disorder/agoraphobia whose polyphobic symptomatology often includes a suspiciousness about taking drugs and a fear of undesired side effects which may lead to the refusal of treatment. The safety, side effects and patients' acceptance of alprazolam and imipramine versus placebo were evaluated in 1168 subjects with panic disorder/agoraphobia who had been enrolled in the second phase of the Upjohn World Wide Panic Study. Side effects that worsened over baseline to a greater extent with alprazolam than with imipramine and placebo were sedation, fatigue/weakness, memory problems, ataxia and slurred speech. In the imipramine group blurred vision, tachycardia/palpitations, insomnia, sleep disturbance, excitement/nervousness, malaise, dizziness/faintness, headache, nausea/vomiting and decrease in appetite were worse than in the other groups. In the placebo group the anxious symptoms were most prominent. The highest level of compliance was shown in the alprazolam-treated group and the lowest in the placebo-treated group. Strong predictors of side effects were not observed. If a side effect profile is known, it will be easier for a clinician to choose the right drug and the appropriate management by taking into account compliance, safety and efficacy in each patient under treatment. Further information about side effects in long-term maintenance treatment would be of great clinical pertinence in ensuring safety and enhancing patients' quality of life.
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PMID:Adverse effects associated with the short-term treatment of panic disorder with imipramine, alprazolam or placebo. 820 96

Workers exposed to carbon monoxide (CO) at a concentration of 26.8mg/m3 at an altitude of 2,300 metres above sea level were compared with a control group of local inhabitants. There were significant differences in symptoms of headache, vertige fatigue and weakness memory impairment, insomnia, palpitation and neurobehavioral functions. CO concentration in respiratory air and HbCO in blood was higher but partial pressure of oxygen (PO2) and saturation of oxygen (SaO2) in blood was lower in the exposed group than the control group. Self-comparison of CO in respiratory air and HbCO in blood was higher after work than before work. Neurasthenia rate was significantly higher but PO2 and SaO2 significantly lower at high altitude than in the plain. The results indicated that under same CO concentrations the hazards to workers at high altitude were greater than to those working in the plain. The author recommends that at high altitude the CO permissible level should be appropriately lowered.
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PMID:[Health effects on workers exposed to low concentration carbon monoxide at high altitude]. 835 10

A middle aged man who inhaled sarin in a train in a subway station in Tokyo in 1995 and showed a variety of symptoms including psychiatric symptoms was reported. He experienced muscle weakness, dyspnea and unconsciousness of sudden onset immediately after exposure to sarin. Marked miosis was observed on admission. Plasma cholinesterase activity was remarkably decreased at that time. He also experienced delirium consisting of visual hallucination, insomnia and irritability at mid-night for more than seven days. These psychiatric symptoms gradually improved without any medication. To date there is no detailed description of such psychiatric symptoms in sarin poisoning.
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PMID:[Psychiatric symptoms following accidental exposure to sarin--a case report]. 852 73

Acute mountain sickness (AMS) affects, to varying degrees, all travelers to high altitudes (elevations greater than 5280 feet). In a small percentage of patients, AMS can lead to high-altitude pulmonary edema (HAPE) or high-altitude cerebral edema (HACE). Symptoms of AMS range from a combination of headache, insomnia, anorexia, nausea, and dizziness, to more serious manifestations, such as vomiting, dyspnea, muscle weakness, oliguria, peripheral edema, and retinal hemorrhage. Although the primary cause of these symptoms is related to the reduced oxygen content and humidity of the ambient air at high altitudes, the physiologic pathway relating hypoxemia to AMS and its sequelae remains unclear. Tips on self-diagnosis and symptom recognition are critical elements to be included in educating patients who are contemplating a trip to high altitudes. Preventive strategies include allowing 2 days of acclimatization before engaging in strenuous exercise at high altitudes, avoiding alcohol, and increasing fluid intake. Conditioning exercise for patients older than 35 years is also recommended before departure. A high-carbohydrate, low-fat, low-salt diet can also aid in preventing the onset of AMS. Acetazolamide (125 mg two or three times daily, or once at bedtime) has also been shown to reduce susceptibility to AMS and the incidence of HAPE and HACE. Although effective in treating cerebral symptoms of AMS, dexamethasone is not routinely recommended as a prophylactic agent for AMS.
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PMID:A trek to the top: a review of acute mountain sickness. 855 56

Aging is a physiological process that shares many behavioral, biochemical and neuroendocrine phenomena with the pathophysiological situation of unresolved stress, as well as with a pharmacologically induced syndrome resulting from chronic benzodiazepine (BZ) consumption. Behavioral findings include symptoms such as drowsiness, ataxia, fatigue, confusion, weakness, dizziness, vertigo, syncope, reversible dementia, depression, impairment of intellectual, psychomotor and sexual function, agitation, auditory and visual hallucinations, paranoid ideation, panic, delirium, depersonalization, sleepwalking, aggressivity, orthostatic hypotension, and insomnia. Neuroendocrine findings include: central depletion of noradrenaline (NA), dopamine, adrenaline (AD), and serotonin (5-HT); reduction in the ratio of circulating NA/AD as well as platelet 5-HT and increase of AD, plasma free 5-HT and cortisol. These disturbances together with the increased platelet aggregability observed in the three groups are typical of unresolved-stress situations. Immunological findings include significant reduction of peripheral T lymphocytes (CD3, CD4, CD8) and the CD4/CD8 ratio, CD16 and gamma-delta cells. On the other hand, the three groups (elderly subjects, subjects faced with unresolved stress, and BZ consumers) show increase of the CD57 lymphocyte subset as well as natural killer cytotoxicity. Alterations of several biological markers have also been found, specifically in the oral glucose tolerance test, the intramuscular clonidine test, and the supine/orthostasis/exercise test. From a clinical point of view, the three groups appear to be more susceptible to the appearance and progression of many acute and chronic diseases (infectious and malignant diseases). As a result, chronic consumption of BZs should be avoided in both the elderly and subjects in unresolved-stress situations.
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PMID:Benzodiazepines: tolerability in elderly patients. 884 97

Thirty five patients with imported malaria were hospitalised in a period of 1980-93 in Department of Infectious Diseases of Pomeranian Medical School, Szczecin, Poland. The diagnosis of malaria was established on a base of clinical feature, the presence of Plasmodium in peripharal blood smears and, in some cases, on positive serological tests. Thirty two patients were Polish citizens, and three persons were foreigners. Malaria was caused mostly by invasion of Plasmodium falciparum (62.8), then P. vivax (31, 4), in 1 case--P. ovale and 1 case--mixed invasion occurred (P. falciparum and P. vivax). The majority of cases caused by P. falciparum were imported from Central Africa. Invasions of P. vivax were brought from North Africa, India and Middle East. Malaria in Polish patients was connected with occupational exposure and lack of proper antimalarial prophylaxis was obvious. A clinical course of disease was serious, with one mortal case. Fever, headache, abdominal pain, weakness, jaundice, insomnia were main complaints. Anemia, leucopenia, thrombocytopenia, hyperbilirubinemia, hypertransaminasemia and high serum concentration of urea were observed. A level of parasitemia in peripheral blood varied from minimal to very high (22.5%) in cases of P. falciparum invasions. In treatment chloroquine, fansidar, quinine, primaquine, halfan were used.
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PMID:[Observation of patients with malaria hospitalized during the years 1980-1993 in the Clinic of Infectious Diseases in Szczecin]. 886 94

The aim of this study was to evaluate age-related changes in the circadian rhythm of subjective alertness and to explore the circadian mechanisms underlying such changes. Using a visual analogue scale (VAS) instrument, 25 older men and women (71 y and older; 15 female, 10 male) rated their subjective alertness about 7 times per day during 5 baseline days of temporal isolation during which habitual bedtimes and waketimes were enforced. Comparisons were made with 13 middle-aged men (37-52 y) experiencing the same protocol. Advancing age (particularly in the men) resulted in less rhythmic alertness patterns, as indicated by lower amplitudes and less reliability of fitted 24-h sinusoids. This appeared in spite of the absence of any reliable age-related diminution in circadian temperature rhythm amplitude, thus suggesting the effect was not due to SCN weakness per se, but to weakened transduction of SCN output. In a further experiment, involving 36 h of constant wakeful bedrest, differences in the amplitude of the alertness rhythm were observed between 9 older men (79 y+), 7 older women (79 y+), and 17 young controls (9 males, 8 females, 19-28 y) suggesting that with advancing age (particularly in men) there is less rhythmic input into subjective alertness from the endogenous circadian pacemaker. These results may explain some of the nocturnal insomnia and daytime hypersomnia that afflict many elderly people.
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PMID:Subjective alertness rhythms in elderly people. 887 98

The aging population in western countries and the increase in longevity make the problem of recognition and treatment of sleep disorders more acute in the elderly population. The risk of evolution of sleep disorders in the elderly leads to a greater weakness of their physical health, a greater dependence on their environment, and finally to more frequent recourse to institutionalization. We investigated sleep habits, sleep disorders and psychiatric diagnoses, physical illnesses and psychotropic drug consumption in a representative sample of the general population of France. Interviews were performed over the telephone by lay interviews using the Eval Knowledge Based System, a computerized system that guides the interviewer through the interview process, 6966 subjects were contacted, and 5622 interviews (80.8% of the potential sample) were completed. The sample was divided into four age groups: 15 to 44 years old (56.4%); 45 to 64 years old (25.6%); 65 to 74 years old (10.8%) and 75 years old or more (7.2%). Earlier bedtime, long sleep latency, spending more time in bed with a reduction of nocturnal sleep time, nocturnal awakenings and daytime naps were found more frequently in "young old" (65 to 75 years old) and "old old" subjects (75 years old or more). Daytime naps and spending more time in bed with a reduction of nocturnal sleep time also distinguished "old old" subjects from "young old" subjects. About half of "old old" subjects who complained about their sleep did not get a diagnosis of sleep disorder, nor psychiatric disorder (52.4%). An insomnia diagnosis was given in 14% of cases (mostly primary insomnia-6.7%) and a psychiatric diagnosis in 33.4% of cases (mostly anxiety diagnoses-28.2%). The rate of psychotropic drug consumption was 11.7% (95% Cl: 10.9% to 12.5%) for the entire sample. This consumption dramatically increased with age: 4.8% between 15 to 44 years old; 15.6% between 45 to 64 years old; 24.3% in "young old" subjects and 32.8% in "old old" subjects. Psychotropic drug consumption was distributed as follows: 6.4% of the sample used anxiolytic, 2.7% hypnotic, 1.5% antidepressant and 0.9% hypnotic and anxiolytic together. The chronic use (at least one year) of hypnotic or anxiolytic drugs was frequent in "old old" subjects (92.6% and 80.2%, respectively) and "young old" subjects (74% and 78% respectively). The assessment of sleep by the physician should be made part of the routine clinical examination of older subjects. Review of the etiology of insomnia complaints is crucial in the choice of treatment. The reflex of psychotropic prescription in case of poor sleep is neither sufficient nor desirable, especially because of the risk of chronic use of the prescription. These data underline the importance of educating physicians about consequences of long-term utilization of these drugs and on the need for sleep hygiene measures as alternative solutions for treating insomnia complaints.
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PMID:[The elderly, sleep habits and use of psychotropic drugs by the French population]. 903 90

Reduced brain function represents the diagnosis, which is found most often in psychiatry and can be defined most exactly. These impairments of the perception, memory and the intellectual performance may be assigned to several diagnostic fields of the ICD-10-code: mild cognitive disorders, organic amnestic impairments, and dementia. In dementias emotional performance, affectivity, motivation and instinct are disturbed too. Other relevant diseases should be excluded in a differential diagnosis: especially depressive syndromes and delirious states are important: relevant hints for the correct diagnosis "depression" are the classic symptoms: retardation, reduced general performance and irritability, which results in sleeplessness, feelings of weakness and inability to work, reduced vital functions, delusions and suicidal ideas in depressive patients, disturbances of orientation and impairment of higher cortical functions in demented people. Objectivation by psychological tests (ergopsychometry) are shortly described. Differential diagnostic doubts and problems may occur in patients with dementive cerebral processes and are caused by less experienced medical doctors especially because of the difficulty, to clarify possible cognitive disorders in depressive persons and last but not least because of the intention of some patients to dissimulate. Additional clinical tests e.g. EEG, cerebral computer-tomography and magnetic resonance imaging findings, etc. are necessary for further differentiation.
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PMID:[Diagnosis of cerebral cognitive deficits]. 909 13

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


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