RESUMEN
None: We report the case of a 3-year-old boy with a history of frequent and injurious sleep-related rhythmic movements and sleep terrors. We documented six episodes of body rocking and head banging via video polysomnography. No epileptic seizures were observed. In addition to the association between a sleep movement disorder and a disorder of arousal, our case shows that sleep-related rhythmic movements can arise not only during relaxed wakefulness or during a stable sleep stage, but also during a less clearly defined sleep stage during which it is difficult to further subtype non-rapid eye movement sleep. On the contrary, the portion of sleep without rhythmic movement episodes were clearly depicted with their physiological features. These findings might be of relevance for understanding the pathophysiology of both sleep-related rhythmic movements and sleep terrors and emphasize the importance to assess sleep using polysomnography, especially when episodes are frequent and injurious. The neurophysiological information obtained from this assessment might be helpful and guide an eventual treatment option.
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Terrores Nocturnos/complicaciones , Terrores Nocturnos/fisiopatología , Trastornos de la Transición Sueño-Vigilia/complicaciones , Trastornos de la Transición Sueño-Vigilia/fisiopatología , Preescolar , Electroencefalografía/métodos , Estudios de Seguimiento , Humanos , Masculino , Niacinamida/análogos & derivados , Niacinamida/uso terapéutico , Terrores Nocturnos/tratamiento farmacológico , Polisomnografía/métodos , Trastornos de la Transición Sueño-Vigilia/tratamiento farmacológico , Grabación de Cinta de VideoAsunto(s)
Doxazosina/uso terapéutico , Terrores Nocturnos/tratamiento farmacológico , Trastornos por Estrés Postraumático/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Terrores Nocturnos/etiología , Trastornos por Estrés Postraumático/complicaciones , Resultado del TratamientoAsunto(s)
Humanos , Masculino , Trastornos por Estrés Postraumático/tratamiento farmacológico , Doxazosina/uso terapéutico , Terrores Nocturnos/tratamiento farmacológico , Trastornos por Estrés Postraumático/complicaciones , Resultado del Tratamiento , Terrores Nocturnos/etiología , Persona de Mediana EdadRESUMEN
Interest in the treatment of nightmares has greatly increased over the last several years as research has demonstrated the clinical significance of nightmare disorder. This paper provides an overview of nightmare disorder, its clinical relevance, and the leading treatments that are available. In particular, the paper defines nightmare disorder and then summarize the recent literature examining the clinical relevance of nightmare disorder, including its relation to post-traumatic stress disorder and other psychiatric conditions. The relation between nightmares and suicidality is also discussed. Recent findings on the treatment of nightmare with imagery rehearsal therapy and prazosin are then summarized. Lastly, the paper comments on potential future uses of nightmare treatment including using imagery rehearsal therapy or prazosin as a first-line intervention for post-traumatic stress disorder and using these treatments as an adjunctive therapy to reduce suicide risk in those at risk of suicide with nightmares.
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Terrores Nocturnos/terapia , Sueños , Humanos , Imágenes en Psicoterapia , Terapia Implosiva , Trastornos Mentales/complicaciones , Terrores Nocturnos/diagnóstico , Terrores Nocturnos/tratamiento farmacológico , Prazosina/uso terapéutico , Terapia por Relajación , Trastornos por Estrés Postraumático/complicacionesRESUMEN
INTRODUCTION: Victims of child sexual abuse (CSA) often experience symptoms such as recurrent nightmares, which affect their adult life. AIM: This study aimed to evaluate the effect of psychotherapy on the quality of life and sleep in a female patient with a previous history of CSA. METHODS: The patient was climacteric (menopausal transition) and treated in an outpatient clinic. She underwent 40 sessions of psychotherapy and was evaluated before and after the sessions using questionnaires and polysomnography (PSG). MAIN OUTCOME MEASURES: Measurements were taken using the following: Kupperman Index (KI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Prospective and Retrospective Memory Questionnaire, and PSG. Reports of dream content were also evaluated during the study. RESULTS: After psychotherapeutic intervention, the frequency of nightmares and their attendant suffering decreased. Additionally, the context of the nightmares changed, and a decrease was noted in the KI, BAI, and BDI parameters. The PSG indicated an increase in rapid eye movement sleep. CONCLUSION: Psychotherapeutic intervention combined with zolpidem and fluoxetine treatment contributed to a resignification of the dreams of a patient with a history of CSA. The treatment also improved the quality of her dreams and her quality of life.
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Abuso Sexual Infantil/psicología , Víctimas de Crimen/psicología , Terrores Nocturnos/terapia , Psicoterapia , Antidepresivos de Segunda Generación/uso terapéutico , Niño , Femenino , Fluoxetina/uso terapéutico , Humanos , Hipnóticos y Sedantes/uso terapéutico , Menopausia , Persona de Mediana Edad , Terrores Nocturnos/tratamiento farmacológico , Polisomnografía , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Piridinas/uso terapéutico , Estudios Retrospectivos , Sueño REM/efectos de los fármacos , Sueño REM/fisiología , Encuestas y Cuestionarios , ZolpidemRESUMEN
OBJECTIVE: Many patients with panic disorder (PD) experience nocturnal panic attacks. We investigated the differences in demographic variables and symptom characteristics as well as response to treatment among patients with primary day panic (DP), primary nocturnal panic (NP), and the coexistence of DP and NP (DP/NP), and discuss whether NP is a distinct disease category. METHOD: One hundred one consecutive untreated patients with PD were enrolled and subsequently divided into the NP, DP, and DP/NP groups. The presence of 13 panic attack symptom items as well as scores on the Panic Disorder Severity Scale (PDSS) and the Pittsburgh Sleep Quality Index (PSQI) were compared among the groups. After 3 months of regular treatment, PDSS scores were assessed again to evaluate treatment response. RESULTS: Nocturnal panic attacks of the participants were mostly reported to occur in the first tertile of nocturnal sleep. The number of males, onset age, and presence of choking sensation were significantly higher, and the PDSS score was significantly lower in the NP group compared with the other groups. The DP/NP group showed the highest PDSS score, and participants in this group were prescribed the highest doses of medication among all groups. Only diagnostic sub-category was significantly associated with treatment response. The total score for PDSS and PSQI correlated significantly only in the NP group. CONCLUSIONS: DP/NP could be a severe form of PD, while primary NP could be a relatively mild subcategory that may partially share common pathophysiology with adult type night terror.
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Terrores Nocturnos/diagnóstico , Terrores Nocturnos/epidemiología , Trastorno de Pánico/diagnóstico , Trastorno de Pánico/epidemiología , Adulto , Edad de Inicio , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/tratamiento farmacológico , Obstrucción de las Vías Aéreas/epidemiología , Análisis de Varianza , Antidepresivos Tricíclicos/uso terapéutico , Comorbilidad , Femenino , Humanos , Hipnóticos y Sedantes/uso terapéutico , Masculino , Terrores Nocturnos/tratamiento farmacológico , Trastorno de Pánico/tratamiento farmacológico , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Estudios Retrospectivos , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Índice de Severidad de la Enfermedad , Distribución por SexoRESUMEN
A meta-analysis of treatments for nightmares is reported. The studies were identified by database searches and by an inspection of relevant reference lists. The inclusion criteria were: nightmares as a target problem, studies published in English, use of a randomized controlled trials and reporting of nightmare-relevant outcomes. A total of 19 studies, published between 1978 and 2012 were identified, which included 1285 participants. Effect sizes were calculated as Cohen's d. A statistically significant improvement for all studies combined (d = 0.47, 95% CI = 0.33-0.60, fixed effects model; d = 0.49, 95% CI = 0.32-0.66, random effects model) and for psychological treatments alone (d = 0.48, 95% CI = 0.36-0.60, random) and for prazosin alone (d = 0.50, 95% CI = 0.03-0.96, random) was found. Individual therapy format yielded a higher effect size than a self-help format (p = 0.03). Minimal interventions (relaxation, recording) yielded lower overall effect size than studies offering more extensive interventions (p = 0.02). It is concluded that there are both psychological and pharmacological interventions which have documented effects for the treatment of nightmares.
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Sueños/efectos de los fármacos , Terrores Nocturnos/terapia , Terapia Combinada , Sueños/psicología , Humanos , Terrores Nocturnos/tratamiento farmacológico , Prazosina/uso terapéutico , Psicoterapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
OBJECTIVE: Nocturnal sleep disturbances, including insomnia and recurrent nightmares, represent common distressing sleep complaints that might have important prognostic and therapeutic implications in psychiatric patients. The present study aimed at investigating nocturnal sleep disturbances in relation to the risk of suicide attempts in a consecutive cohort of psychiatric outpatients. METHOD: Participants attending a psychiatric outpatient clinic in Hong Kong were recruited into the study with a detailed sleep questionnaire assessment. The questionnaire was distributed between May and June 2006. Relevant clinical information, with a comprehensive clinical history of patients since their attendance at psychiatric services and 1 year after completion of their questionnaires, was reviewed. RESULTS: The final study population consisted of 1,231 psychiatric outpatients with a mean age of 42.5 years (SD = 11.3; range, 18-65). Both frequent insomnia and recurrent nightmares were significantly and independently associated with an increased incidence of suicide attempts 1 year after questionnaire assessment (insomnia: OR = 6.96; 95% CI, 1.21-39.97; recurrent nightmares: OR = 8.17; 95% CI, 1.06-63.13) and an increase in lifetime prevalence of suicide attempts (insomnia: OR = 1.55; 95% CI, 1.06-2.25; recurrent nightmares: OR = 2.43; 95% CI, 1.51-3.91). Comorbid insomnia and nightmares had increased odds of lifetime prevalence (OR = 2.43; 95% CI, 1.53-3.85) and 1-year incidence of suicidal risk (OR = 17.08; 95% CI, 2.64-110.40). Antidepressants, particularly selective serotonin reuptake inhibitors (OR = 1.52; 95% CI, 1.02-2.25), serotonin-norepinephrine reuptake inhibitors (OR = 2.10; 95% CI, 1.15-3.83), heterocyclics (OR = 2.78; 95% CI, 1.21-6.42), and non-benzodiazepine hypnotics (OR = 1.54; 95% CI, 1.02-2.33) were independently associated with recurrent nightmares after adjustment for confounding variables. CONCLUSIONS: Nocturnal sleep disturbances, particularly frequent insomnia and recurrent nightmares, were independently associated with enhanced suicidal risk among psychiatric patients. Future studies are warranted to investigate the underlying pathophysiologic mechanism and interventional responses.
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Trastornos del Sueño-Vigilia/psicología , Intento de Suicidio/psicología , Adolescente , Adulto , Anciano , Antidepresivos/efectos adversos , Antidepresivos/uso terapéutico , Distribución de Chi-Cuadrado , Femenino , Humanos , Hipnóticos y Sedantes/efectos adversos , Hipnóticos y Sedantes/uso terapéutico , Modelos Logísticos , Masculino , Trastornos Mentales/complicaciones , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/psicología , Persona de Mediana Edad , Terrores Nocturnos/complicaciones , Terrores Nocturnos/tratamiento farmacológico , Terrores Nocturnos/psicología , Estudios Prospectivos , Factores de Riesgo , Trastornos del Inicio y del Mantenimiento del Sueño/complicaciones , Trastornos del Inicio y del Mantenimiento del Sueño/tratamiento farmacológico , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Trastornos del Sueño-Vigilia/complicaciones , Intento de Suicidio/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Clonidine is frequently prescribed to children. Clonidine overdose in children has resulted in major clinical effects and deaths. CASE REPORT: A 3.5-year-old male with a history of a seizure disorder and night terrors presented following difficulty walking, excessive sleeping, agitation when awake, and possible seizure activity. Chronic medications were valproic acid (VPA) and clonidine. On presentation, he alternated between poor responsiveness and agitation, with initial vitals: blood pressure, BP 144/76 mmHg; heart rate, 65 bpm; respiratory rate, 18 bpm; temperature 99.5 degrees F; and pulse oximetry 96% on room air. VPA level was 35 microg/mL. A toxicology consult the next day noted a dry mouth, 2-mm pupils, intermittent gasping, and central nervous system (CNS) depression, with a diagnostic impression of clonidine overdose. The caregiver had been giving 1 mL (0.1 mg) qd of a pharmacy-compounded clonidine suspension by a provided syringe. The pharmacy procedure record agreed with the physicians order. The amount dispensed was a 30-day supply but the bottle was empty on day 19, leading us to suspect a possible accelerated dosing error. The concentration in the bottle thus could not be confirmed. The child slowly returned to his baseline state over 48 hours. A serum clonidine level drawn approximately 18 hours after his last dose later returned at 300 ng/mL (reference range = 0.5-4.5 ng/mL). CASE DISCUSSION: Compounding and liquid dosing errors are common in children and may result in massive overdoses. There was an accelerated dosing error, but whether a compounding or suspension error or even an acute overdose occurred as well is unknown. CONCLUSION: Particular care should be taken with medications that have low therapeutic indices, that are extemporaneously compounded, and are prepared as liquids, where medication errors are more likely.
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Agonistas alfa-Adrenérgicos/envenenamiento , Clonidina/envenenamiento , Terrores Nocturnos/tratamiento farmacológico , Agonistas alfa-Adrenérgicos/sangre , Preescolar , Clonidina/sangre , Composición de Medicamentos , Sobredosis de Droga , Humanos , Masculino , Errores de Medicación , SuspensionesAsunto(s)
Terrores Nocturnos/psicología , Sonambulismo/psicología , Preescolar , Fluoxetina/uso terapéutico , Humanos , Masculino , Terrores Nocturnos/tratamiento farmacológico , Remisión Espontánea , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Sonambulismo/tratamiento farmacológicoAsunto(s)
Preescolar , Humanos , Masculino , Terrores Nocturnos/psicología , Sonambulismo/psicología , Fluoxetina/uso terapéutico , Terrores Nocturnos/tratamiento farmacológico , Remisión Espontánea , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Sonambulismo/tratamiento farmacológicoAsunto(s)
Antioxidantes/uso terapéutico , Melatonina/uso terapéutico , Terrores Nocturnos/complicaciones , Terrores Nocturnos/tratamiento farmacológico , Sonambulismo/complicaciones , Sonambulismo/tratamiento farmacológico , Síndrome de Asperger/complicaciones , Preescolar , Humanos , Masculino , Terrores Nocturnos/diagnóstico , Índice de Severidad de la EnfermedadRESUMEN
UNLABELLED: To test the hypothesis that the administration of L -5-hydroxytryptophan (L -5-HTP) might exert beneficial effects on sleep terrors, we carried out an open pharmacological trial in a group of children with sleep terrors compared to a group of children with the same disorder but without L -5-HTP treatment. Participants in the trial were 45 children (34 males and 11 females; age range 3.2-10.6 years), referred to the Sleep Centre of the Department of Developmental Neurology and Psychiatry of the University of Rome "La Sapienza", affected by sleep terrors. All subjects underwent: (1) complete medical and sleep history; (2) complete neurological examination and EEG recording whilst awake and sleeping, (3) a structured sleep diary for 2 months, (4) after 1 month, all subjects were examined again from the clinical and EEG points of view and (5) after 6 months, a structured interview in order to evaluate the clinical outcome. After the first visit, L -5-HTP was administered (2 mg/kg per day) at bedtime to 31 randomly selected patients for a single period of 20 consecutive days. After 1 month of treatment, 29/31 (93.5%) of patients showed a positive response. In the comparison group without drug therapy, after 1 month, the episodes disappeared only in four children (28.6%) while ten children (71.4%) showed the persistence of episodes with the same frequency as before. After 6 months, 26/31 (83.9%) of children treated with L -5HTP were sleep terror-free, while in five children (16.1%) sleep terror episodes persisted. Of the children in the comparison group, ten (71.4%) continued to show sleep terrors at 6-month follow-up. CONCLUSION: to our knowledge, this is the first study demonstrating the efficacy of a new drug treatment for sleep terrors. These results confirm our initial hypothesis and represent evidence that treatment with L -5-hydroxytryptophan is able to modulate the arousal level in children and to induce a long-term improvement of sleep terrors.