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)

Clonazepam is a potent, long-acting benzodiazepine approved for use in myoclonic and petit mal seizures. Initial reports have demonstrated encouraging results with clonazepam in the treatment of acute mania as well as a favorable side-effect profile. A trial of adjunctive clonazepam was initiated in a 41-year-old patient with chronic schizophrenia. Two weeks later, while on an 8-mg dosage, he became manic, developing pressured speech, euphoria, inflated esteem, agitation, and insomnia. Initiation of electroconvulsive therapy with gradual tapering and discontinuation of the clonazepam resulted in amelioration of the manic episode and a return to his previous clinical status. Clinicians should be alerted to the potential of clonazepam to cause manic-like behavior in susceptible patients.
DICP 1991 Sep
PMID:Mania associated with clonazepam. 194 70

Because of their influence on psychological adaptation, biological rhythms associated with sleep have received growing attention during the last two decades. We are presenting an outline of (1) the ultradian rhythms of rapid-eye-movement (REM) sleep and of slow wave sleep (SWS), (2) the circadian rhythms of sleep/wake, body temperature and melatonine secretion, and (3) the infradian rhythms of the menstrual cycle and seasonal affective disorders emphasizing their importance in psychological adaptation. Particular attention is given to the consequences of the desynchronization of the circadian phase of sleeping and waking with that of core body temperature observed in the cases of abrupt time zone changes, shift work and some forms of insomnia and depression. New methods of intervention, such as the use of exposure to bright lights are discussed. A case is made for increased attention to a new form of hygiene, that of the biological rhythms associated with sleeping and waking.
J Psychiatry Neurosci 1991 Sep
PMID:[Biological rhythms associated with sleep and psychological adjustment]. 195 44

In summary, it is proposed that the more frequent or severe side effects associated with the newer triazolo-benzodiazepines are related to an interaction of several factors, including rapid elimination, high receptor-binding affinity, and unique chemical properties. Among benzodiazepine hypnotics, triazolam has a unique side effect profile for CNS adverse reactions in regard to type, frequency, and severity. All of the three factors mentioned contribute to this side effect profile: rapid elimination (the shortest half-life among benzodiazepine anxiolytics and hypnotics); high receptor-binding affinity (the highest among benzodiazepine anxiolytics and hypnotics); and unique chemical properties as a triazolo-benzodiazepine. Given these three factors, the drug's side effects can be understood as follows: Hyperexcitability states (daytime anxiety during drug administration and rebound insomnia following withdrawal) are related primarily to its rapid elimination and secondarily to the other two factors, whereas cognitive impairments (amnesia, confusion, and psychiatric symptoms) are related to the high binding affinity and unique chemical properties as well as to its rapid elimination. In contrast, benzodiazepines that are slowly eliminated and have only relatively moderate receptor-binding affinity (flurazepam) are unlikely to produce daytime anxiety and rebound insomnia and CNS adverse reactions such as cognitive impairment. The most common side effect, daytime sedation, is easily recognized and can be managed by dose reduction and/or intermittent use. This safety profile combined with the drug's high degree of efficacy both initially and with continued use provides a high benefit-risk ratio in using the drug in the adjunctive pharmacologic treatment of insomnia. Similarly, temazepam, which has relatively weak receptor-binding affinity produces very few CNS adverse reactions. Furthermore, temazepam (15 mg) is more efficacious than triazolam (0.25 mg). However, temazepam is not as effective as flurazepam, because it is slowly absorbed and therefore has limited efficacy for sleep induction. On the other hand, triazolam's safety profile of frequent and severe adverse reactions combined with the lack of efficacy for the current dose of 0.25 mg limits the drug's usefulness. In fact, the 0.25-mg dose has such a poor benefit-to-risk ratio that there is a real question as to whether the drug should remain on the market.(ABSTRACT TRUNCATED AT 400 WORDS)
Hosp Pract (Off Ed) 1990 Sep
PMID:Benzodiazepine hypnotics and insomnia. 197 24

The authors studied 954 psychiatric patients with major affective disorders and found that nine clinical features were associated with suicide. Six of these--panic attacks, severe psychic anxiety, diminished concentration, global insomnia, moderate alcohol abuse, and severe loss of interest or pleasure (anhedonia)--were associated with suicide within 1 year, and three others--severe hopelessness, suicidal ideation, and history of previous suicide attempts--were associated with suicide occurring after 1 year. These findings draw attention to the importance of 1) standardized prospective data for studies of suicide, 2) assessment of short-term suicide risk factors, and 3) anxiety symptoms as modifiable suicide risk factors within a clinically relevant period.
Am J Psychiatry 1990 Sep
PMID:Time-related predictors of suicide in major affective disorder. 185 69

Sleep deprivation induced by the platform technique is considered to be a heavy stressful situation in rats. At the end of the sleep deprivation period (72 h) the rats displayed particular behaviour characterized by wakefulness, a high degree of motor and exploratory activity, increased alertness and reactivity to environmental stimuli. Our previous results indicated that this behaviour was potently antagonized by the administration of the D1-selective antagonist SCH 23390. In this paper we show that concomitantly to this behaviour, an increased number of D1 receptors associated with an increased dopamine-stimulated adenylate cyclase activity is present in the limbic system but not in the striatum of these animals. These data suggest an active role of limbic D1 receptors in the generation of arousal and insomnia related to sleep deprivation induced stress.
Neurosci Lett 1990 Sep 04
PMID:Sleep deprivation increases dopamine D1 receptor antagonist [3H]SCH 23390 binding and dopamine-stimulated adenylate cyclase in the rat limbic system. 214 48

The prescriptions of all patients who attended an urban general practice from September 1987 to December 1987 were studied. Of the 111 patients (60 females and 51 males) who received a psychotropic prescription the commonest presenting complaint was insomnia (56 patients or 50.5%). This was followed by tension, headache and unexplained aches and pains (19 patients or 17.1%), and anxiety (nine patients or 8.1%). Consistent with these presentations a vast majority (92.8%) received a benzodiazepine. The commonest drugs prescribed were Lorazepam and Bromazepam whereas the longer acting benzodiazepines were rarely used. Polypharmacy was rare.
Med J Malaysia 1990 Sep
PMID:The prescription of psychotropic medication in general practice--a descriptive study. 215 83

Trazodone (150 mg to 400 mg) was administered to six depressed patients with significant sleep disturbances in an 8-week single-blind study design. Patients were evaluated psychologically by means of the Hamilton Rating Scales for Anxiety and Depression. Polysomnographic monitoring in the sleep laboratory was conducted at each of the time points corresponding to the psychiatric evaluations. Five of the six subjects completed treatment. Patients showed a significant improvement in symptoms of depression and in their polysomnographic-determined sleep architecture. There was a 44% improvement in persistent sleep latency, decreasing from a mean +/- SD of 51.0 +/- 59.3 minutes at baseline to 28.5 +/- 24.2 minutes after 5 weeks of active treatment. Total sleep time improved 14% from 387.1 +/- 59.2 minutes at baseline to 441.3 +/- 23.7 minutes after 5 weeks. Stage IV sleep more than doubled with an increase of 153% from 1.9 +/- 3.0% at baseline to a more normal 4.8 +/- 5.5%. There was no change in percentage of rapid eye movement (REM); however, REM latency increased 28% from a mean of 74.6 +/- 35.9 minutes at baseline to a mean of 95.6 +/- 28.8 minutes. Sleep efficiency improved from 80.6 +/- 12.3%, considered clinically significant insomnia, to 91.9 +/- 4.9%, which is well within normal sleep patterns.
J Clin Psychiatry 1990 Sep
PMID:Sleep laboratory evaluation of the effects and efficacy of trazodone in depressed insomniac patients. 221 59

In a prospective longitudinal study, 202 primigravidas were assessed for depression using the National Institute of Mental Health's (NIMH) standardized clinical interview, the Schedule for Affective Disorders and Schizophrenia (SADS), and Research Diagnostic Criteria (RDC) at four periods: 10 to 14 weeks of pregnancy, 30 to 32 weeks of pregnancy, 1 to 2 weeks postpartum, and 14 weeks postpartum. Women's responses did not fit the SADS standardized questions and prescribed ratings because pregnancy and postpartum symptoms often mimicked depression symptoms. This was addressed by adding questions and scoring criteria to separate out pregnancy and postpartum symptoms from depression symptoms. Results showed that, after accounting for pregnancy-postpartum symptoms, women consistently claimed eight symptoms with high frequency and higher mean ratings: dysphoric mood, worrying, somatic and psychic anxiety, insomnia, fatigue, anger, and irritability. The findings suggest that 1) depression in pregnant and newly delivered women may be underdiagnosed if caregivers attribute their complaints or symptoms to time-limited somatic conditions; 2) depression may be overdiagnosed if clinicians use self-report measures solely, or without carefully interviewing women to separate the symptoms of depression from symptoms of pregnancy and postpartum; and 3) women's reactions to perinatal symptoms may have some bearing on the development of depression then or later. Simple clinical and social amelioration of the symptoms of distress might reduce their effect and diminish the rate of mistaken diagnoses of depression.
Birth 1990 Sep
PMID:A standardized interview that differentiates pregnancy and postpartum symptoms from perinatal clinical depression. 222 37

A mentally-retarded 21-year-old female with narrowing of the visual field was admitted to our hospital because of dystonia in the body and extremities which appeared 6 months before and was gradually exacerbating. On admission, torsion dystonia, pyramidal tract sign, and retinitis pigmentosa with optic atrophy, urinary incontinence, hyperhidrosis and insomnia were noted. On the Wechsler Adult Intelligence Scale, she achieved less than 60 for verbal-IQ. Laboratory tests including serum copper and ceruloplasmin, were all normal. A computed tomography of the brain showed small hyperdense spot in the globus pallidus on the both sides. There was neither cortical atropy nor ventricular dilatation. A Magnetic Resonance Imaging was obtained using both moderate-field (0.5 Tesla) and high-field (1.5 Tesla) superconducting MR systems. T2-weighted spin echo images demonstrated markedly decreased signal intensity area restricted in the globus pallidus and substantia nigra on both system. Moreover, in the center of the globus pallidus, a small high signal spot was seen ("eye-of the-tiger" sign coined by Sethi et al). There was no abnormal signal in the putamen, caudate nucleus, red nucleus, and dentate nucleus. On the other hand, T1-weighted inversion recovery images were not remarkable. These striking low attenuation on T2-weighted findings suggests an increased iron deposition limited to the globus pallidus and substantia nigra which is characteristic of Hallervorden-Spatz disease/syndrome (H-S). Moreover, "eye-of-the-tiger" sign on T2-weighted MR images in the globus pallidus is previously described in H-S.(ABSTRACT TRUNCATED AT 250 WORDS)
Rinsho Shinkeigaku 1990 Sep
PMID:[The role of magnetic resonance imaging in the diagnosis of Hallervorden-Spatz disease]. 226 8

It is evident that couvade syndrome exists in the industrialized culture. However, there are questions about the occurrence of couvade given the large range of reported incidence. Clinton found no difference in the occurrence of symptoms between expectant fathers and nonexpectant men throughout the three trimesters of pregnancy. Differences were noted, however, in the types and perceived seriousness of symptoms between these men, with expectant fathers reporting more colds, unintentional weight gain, insomnia, and restlessness. Significant differences in health deviation were reported by the new fathers during the immediate postpartum period. These new fathers experienced fatigue, emotional and cognitive disturbances, and headaches. Strickland's work did not provide comparative estimates of the incidence of couvade syndrome. The focus of this study was to explore the nature of pregnancy-related symptoms among expectant fathers. These expectant fathers reported key symptoms during the second trimester of pregnancy with increasing occurrence during the last trimester of pregnancy. Expectant fathers most likely to experience couvade were anxious, black, working class men experiencing an unplanned pregnancy. Anxiety, suppression of hostility, and identification with the pregnant partner were explored as predictors of the occurrence of couvade syndrome. Anxiety is likely to occur in expectant fathers because of financial concerns and changes in relationships and roles. Feelings of protectiveness toward the partner and fetus/infant also can be anxiety producing for the expectant father. The developmental tasks described by Duvall and Penticuff were predicated on the transitional nature of becoming a parent. Each task depicts the inherent change in both structure and function of the male's family role which is influenced by society and the family unit. May proposed that expectant fathers have unique styles that predict the degree of involvement with the partner and the pregnancy. Phases of father involvement, described by May, and the father's laboring for relevance, described by Jordan, are conceptually consistent with the developmental tasks identified by Duvall. Each phase or subprocess is sequential, marked by intrapersonal and interpersonal characteristics. Movement through these tasks, phases, or subprocesses is dependent upon accepting the reality of the pregnancy, cultural norms, and society's expectations of fathers. Herzog identified degrees of involvement among fathers whose partners delivered prematurely. In this retrospective inquiry, fathers with a high degree of involvement were more likely to experience symptoms of couvade syndrome than were fathers who were less involved. All fathers in the study, regardless of the involvement, reported being fearful of the unknown outcome and experiencing grief over the preterm delivery.(ABSTRACT TRUNCATED AT 400 WORDS)
J Perinat Neonatal Nurs 1990 Sep
PMID:Expectant fathers' response to pregnancy: review of literature and implications for research in high-risk pregnancy. 239 46


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