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

This is a study of the prevalence of depressive disorder among elderly Chinese people living in the community in Singapore. A total of 612 subjects were assessed using the Geriatric Mental State Schedule. The prevalence of depressive disorder was found to be 4.6%. The rate was higher among Chinese people between 65-74 years than among those 75 years and above, and also higher for females than males. The majority of cases were mild and the common symptoms were feelings of sadness, insomnia, headache, pessimism and tension. There was no depressive psychosis or mania.
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PMID:Depressive disorder in elderly Chinese people. 234 65

Fluoxetine is a new antidepressant which enhances serotoninergic neurotransmission through potent and selective inhibition of neuronal reuptake of serotonin. Metabolism by N-desmethylation occurs in man yielding desmethylfluoxetine, which also inhibits serotonin reuptake. Both the parent compound and metabolite possess elimination half-lives of several days facilitating the maintenance of steady-state plasma concentrations during long term treatment. Fluoxetine has overall therapeutic efficacy comparable with imipramine, amitriptyline and doxepin in patients with unipolar depression treated for 5 to 6 weeks, although it may be less effective than tricyclic antidepressants in relieving sleep disorders in depressed patients. Geriatric patients also responded as well to fluoxetine as to doxepin. The symptomatic improvement in patients with unipolar depression during short term fluoxetine treatment has been satisfactorily maintained when therapy was extended for at least 6 months: the relapse rate was low and similar to that of imipramine. Preliminary data have shown that patients with bipolar depression gained similar therapeutic benefit from fluoxetine or imipramine. Other preliminary trials have indicated that fluoxetine may be useful in obsessive-compulsive disorders. Usual doses of fluoxetine cause significantly fewer anticholinergic-type side effects than tricyclic antidepressants. Nausea, nervousness and insomnia are the most frequently reported fluoxetine-related adverse effects, but these have usually not been severe. Therapeutic doses of fluoxetine do not affect cardiac conduction intervals in patients without pre-existing cardiovascular disease and fluoxetine has been relatively safe in the small number of patients who have taken overdoses. It has not been clearly established whether some types of depression may respond more readily to fluoxetine than other antidepressants, and its overall therapeutic efficacy has not been compared with other second generation antidepressants. Thus, with its different and perhaps improved side effect profile compared with older tricyclic antidepressants, fluoxetine offers properties that could be used to advantage in many patients with depression.
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PMID:Fluoxetine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in depressive illness. 287 98

Sleep rhythm can be influenced by narcotics and exogenous disturbances causing persistent insomnia, exhaustion and moodiness. In this study the influence of anesthesia on the patients' sleep during the first postoperative night was investigated. It was attempted to differentiate between the influences due to anesthesia, namely to surgery, and due to intensive care. In 10 patients with halothane narcosis, 12 patients with neuroleptanalgesia, 12 young patients and 12 patients more than 70 years of age with halothane/fentanyl anesthesia a sleep study was performed during the first postoperative night. Electrodes were placed according to the criteria of Rechtschaffen and Kales [US Department of Health, Education and Welfare, Public Health Service, Bethesda 1968]. The group of controls consisted of 10 healthy female volunteers, who had to sleep under identical conditions. The sleep stages were visually evaluated by criteria of Rechtschaffen and Kales [US Department of Health, Education and Welfare Public Health Service, Bethesda 1968]. The disturbances by nurses did not, on the whole, interfere with the sleep rhythms of the 10 healthy volunteers: 4-5 REM phases and stage IV sleep were seen regularly. The patients had a maximum of 1 REM phase. Stage II sleep was reached after falling asleep and maintained for several hours. Stage III and IV were hardly seen in all patient groups. Geriatric patients showed the most obvious changes in their sleep. They were sleepless during 41.1% of the monitored period. Stage II was slightly reduced. Night sleep of patients after anesthesia is disturbed not only by intensive care unit conditions, but also by direct effects of narcotics and surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:General anesthesia and postnarcotic sleep disorders. 344 24

An increasing life expectancy leads to a higher number of persons aged 70-84 years and persons aged 85 years and older. Information concerning changes in the spectrum of psychiatric morbidity is rare. The Berlin Aging Study was based on a representative age- and gender-stratified sample (n = 516) of Berlin citizens aged 70-100 years and older. In this inter-disciplinary study, an intensive investigation was carried out by psychologists, sociologists, internists and psychiatrists. This report focuses on subjectively reported complaints (Beschwerdeliste, BL), observed psychopathological symptomatology (Brief Psychiatric Rating Scale, BPRS) and psychiatric diagnoses following the criteria of DSM-III-R (based on the Geriatric Mental State Examination, GMSA). On the self-rating scale (BL) 10% of all persons reported severe subjective complaints, 32% moderate complaints. On the BPRS, 17% showed severe psychopathological symptomatology, 75% at least mild symptoms. Following the criteria of DSM-III-R, 23.5% of all persons had a psychiatric disease, 4.2% a disease of severe intensity. When the DSM-III-R diagnoses "Not Otherwise Specified" (NOS) were included 40.4% of all subjects were diagnosed by the clinical judgement of the psychiatrists to have a psychiatric disease. The most frequent psychiatric diseases were insomnia (18.8%), depression NOS (17.8%) and dementia (13.8%). Dementia showed the well-known age-related increase, whereas no other incidences of psychiatric morbidity were age-related. Persons aged 70-84 years did not differ in the investigated psychiatric variables from persons aged 85 years and older, the only exception being the prevalence of dementia.
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PMID:[Psychiatric morbidity in the oldest old. Results of the Berlin Aging Study]. 899 71

The Geriatric Depression Scale (GDS) is intended for easy measurement of symptoms of depression in elderly patients. The scale initially had 30 items but was reduced to a 15-item scale (GDS-15). This scale was translated into Swedish. However, five items were added: insomnia, anxiety, panic, aches and pain, and hypochondria. A total of 1002 elderly patients were rated by a research nurse using this scale. The results showed that 13.3% of the patients were considered to have affective disorders. The introduction of selective serotonin reuptake inhibitors has been of great importance for elderly patients, as these patients have difficulty in tolerating traditional tricyclic antidepressants. In a study of 133 elderly depressed patients, including those with somatic disorders and dementia, citalopram was tested. This drug provided significantly greater improvement than placebo. In another, inter-Nordic study, including 98 patients, citalopram was tested in patients with Alzheimer-type dementia. Depressed mood, and also other emotional disturbances, improved in these patients. Ratings have shown that in victims of Alzheimer-type dementia and vascular dementia, about 80% suffer from emotional disturbances. Drugs that influence both serotonin and noradrenaline metabolism have been introduced recently; these are of great interest in the treatment of elderly people.
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PMID:Recognition and management of depression in the elderly. 947 38

Geriatric patients with major depression present clinical challenges not encountered in younger individuals, including a greater incidence of medical comorbidity, higher rates of multiple medication use, changes in drug metabolism due to age or physical illness, and increased sensitivity to antidepressant side effects. Nevertheless, successful treatment of depressive disorders in the elderly improves mental and physical functioning, decreases morbidity and perhaps mortality, and enhances quality of life. Recent research indicates that newer antidepressants are effective for late life depression and safer for older individuals. Among newer antidepressants, venlafaxine has a pharmacological profile that makes it an attractive choice for geriatric patients. It has limited potential to interact with other medications because it only weakly inhibits the cytochrome P450 system and binds to plasma proteins at a low level. Dosing may have to be adjusted for patients with renal failure, but typically not for those with liver disease or other medical conditions. Data from three double-blind and four open clinical trials support the safety and efficacy of venlafaxine for geriatric depression. Patients may experience transient, generally tolerable side effects such as insomnia, nausea, agitation, or dry mouth early in treatment, but more serious problems such as falls or cardiac rhythm disturbances seem to be rare. Treatment emergent hypertension occurs in a small percentage of older patients, generally at doses above 150 mg/day. Finally, emerging data suggest that venlafaxine may be effective for conditions such as stroke, anxiety, and neuropathic pain that frequently accompany depressive disorders in the elderly.
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PMID:Efficacy of venlafaxine in geriatric depression. 1109 16

Memantine, an uncompetitive antagonist with moderate affinity for NMDA receptors, demonstrates voltage-dependency and relatively fast on/off receptor kinetics. Memantine 20 mg/day significantly slowed the rate of deterioration in outpatients with moderate to severe Alzheimer's disease in a 28-week US randomised, double-blind, placebo-controlled, multicentre study. Memantine 10 mg/day improved measures of dementia in care-dependent inpatients with Alzheimer's disease or vascular dementia in a 12-week randomised, double-blind study. Significantly more memantine than placebo recipients were responders according to Clinical Global Impression of Change scores and the Behavioural Rating Scale for Geriatric Patients Care Dependence subscale. Memantine 20 mg/day significantly improved cognition-related outcomes (cognitive subscale of the Alzheimer's Disease Assessment Scale) in patients with vascular dementia in two 28-week randomised, double-blind, placebo-controlled, multicentre trials. No statistically significant between-group difference was seen in other primary endpoints. Adverse events (incidence in memantine recipients greater than in placebo recipients) occurring in patients with moderately severe to severe dementia included diarrhoea, insomnia, dizziness, headache and hallucination.
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PMID:Memantine. 1271 Aug 65

To investigate subjective and objective changes in function in subjects with Parkinson's disease (PD) home visits with interviews were performed with a 1-year interval. Depressive symptoms were rated with the Geriatric Depression Scale, subjective health with the generic SF-36 scale and the disease-specific PDQ-8 scale; objective changes were assessed according to the Hoehn and Yahr scale; insomnia was rated with an eight-item questionnaire and the sense of coherence (SOC) was determined with the short version of that scale. A total of 91 subjects (39 women and 52 men with a mean age of 70 years) living at home, most of them moderately to severely disabled, were interviewed. Time since diagnosis was <2 years for 13%, 2-10 years for 55%, and >10 years for 32%. During the studied year the subjects' status declined significantly as shown by changes in both the PDQ-8 and the Hoehn and Yahr scales. The most striking finding was a pronounced decrease in the SOC scale (p < 0.0001). This indicates that the subjects' ability to handle stress-related problems secondary to the progress of disease might have decreased. In order to optimize nursing care for subjects with PD, in addition to medical treatment, an assessment of the SOC could aid nursing staff in evaluating subjects' ability to handle their life situation.
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PMID:Sense of coherence is a sensitive measure for changes in subjects with Parkinson's disease during 1 year. 1514 78

Geriatric patients often complain about sleep disorders, but many of the typical sleep disturbances in the elderly are thought to be normal consequences of old age and go underdiagnosed and undertreated. Sleep disorders are estimated to affect nearly 50% of older persons. Most frequently the elderly suffer from Sleep Disordered Breathing (SDB), Periodic Limb Movements in Sleep (PLMS), Restless Legs Syndrome (RLS), morning headaches, circadian rhythm disorders, excessive daytime sleepiness, Obstructive Sleep Apnea Syndrome (OSAS), and insomnia. This review describes all these common sleep problems in the older population and their possible treatment.
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PMID:Sleep disorders in the elderly. 1570 Jun 32

Depression is common in Parkinson's disease (PD) and associated with considerable morbidity, including a worsening of motor symptoms and measures of quality of life. Therefore, patients with PD should be routinely screened for depressive symptoms with rating scales such as the Geriatric Depression Scale. Patients meeting criteria should be treated using established algorithms for the management of depression and associated symptoms such as insomnia, anxiety, psychosis, and mania. The algorithm outlined in this paper describes the importance of maintaining an adequate dose of medication over a medication trial that can last up to 12 weeks. To optimally monitor patients' progress, clinicians should also consider using rating scales that measure depression severity, such as the Montgomery-Asberg Depression Rating Scale and Beck Depression Inventory.
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PMID:The diagnosis and treatment of depression in Parkinson's disease. 1656 83


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