Behavior Disorders

S = Sleep disturbances (insomnia, rapid eye movement sleep behavioral disorder, restless legs syndrome)... 

Non-REM parasomnias have variable prevalence rates depending on patient age and different diagnoses. Sleep talking, brux-ism, sleepwalking, sleep terrors, and enuresis occur more frequently in childhood than in adulthood. Nightmares appear to occur with similar frequency in adults and children. REM behavior disorder (RBD), an REM-sleep parasomnia, has a reported prevalence of 0.5% and frequently is associated with concomitant neurologic conditions.16 Chronic RBD is more common in elderly men and may have a familial disposition. 

RBD REM-sleep behavior disorder Academy of Sleep Medicine. An update on the dopaminergic... 

Parasomnia Undesirable physical or behavioral phenomena that occur predominantly during sleep (e.g., sleep walking, brux-ism, enuresis, sleep talking, and rapid eye movement behavior disorder). 

K. E. Appel and E. A. Strecker. Practical Examination of Personality and Behavior Disorders. New York Macmillan, 1936. 

Use of succimer in the prevention of developmental delay, slowed growth, and behavior disorders in toddlers... 

Sleep-wake state alterations in PD can be broadly classified into disturbances of (1) thalamocortical arousal state and (2) excessive nocturnal movement (Rye and Bliwise 2004 Rye and Iranzo 2005). The former includes the loss of sleep spindles and SWS, daytime sleepiness, and intrusion of REM sleep into daytime naps (i.e. sleep onset REM periods, or SOREMs), and the latter encompass periodic leg movements of sleep (PLMs) and REM sleep behavior disorder (RBD). The pathophysiological basis of sleepiness and SOREMs appears to be dopaminergic cell loss in PD, though excessive nocturnal movements are not as clearly related to dopaminergic deficits. 

Albin R., Koeppe R., Chervin R. et al. (2000). Decreased striatal dopaminergic innervation in REM sleep behavior disorder. Neurology. 55, 1410-12. 

Boeve B., Silber M., Pirisi J. et al. (2003). Synucleinopathy pathology and REM sleep behavior disorder plus dementia or parkinsonism. Neurology 61, 40-5. 

Gagnon J., Bedard M-A., Fantini M. et al. (2002). REM sleep behavior disorder and REM sleep without atonia in Parkinson s disease. Neurology 59, 585-9. 

Lavia Fantini M., Gagnon J., Petit D. et al. (2003). Slowing of electroencephalogram in rapid eye movement sleep behavior disorder. Ann. Neurol. 53, 774-80. 

Rye D., Johnston L., Watts R., Bliwise D. (1999). Juvenile Parkinson s disease with REM behavior disorder, sleepiness and daytime REM-onsets. Neurology 53, 1868-70. 

Schenck C., Bundlie S., Mahowald M. (2003). REM behavior disorder (RBD) delayed emergence of parkinsonism or dementia in 65% of older men initially diagnosed with idiopathic RBD, and an analysis of the minimum and maximum tonic and/or phasic electromyographic abnormalities found during REM sleep. Sleep 26(Suppl.), A316. 

Turner R., DAmato C., Chervin R., (2000). Blaivas M. The pathology of REM-sleep behavior disorder with comorbid Lewy body dementia. Neurology 55, 1730-2. 

Comings, D.E. and Blum, K., Reward deficiency syndrome genetic aspects of behavioral disorders, Prog. Brain Res., 126, 325, 2000. 

I CD-10 Classification of Mental and Behavioral Disorders Clinical Descriptions and Diagnostic Guidelines. Geneva the Organization, 1992. 

Onoder, K., Yamatodani, A., Watanabe, T. and Wada, H. Neuropharmacology of the histaminergic neuron system in the brain and its relationship with behavioral disorders. Prog. Neurobiol. 42 685-702,1994. 

TABLE 45-1 a-Synuclein diseases Idiopathic Parkinson s disease Dementia with Lewy bodies Pure autonomic failure REM sleep behavior disorder Lewy body dysphagia Incidental Lewy body disease Inherited Lewy body diseases Multiple system atrophy... 

The patient experiences anxiety, apathy, bradyphrenia (slowness of thought processes), confusional state, dementia, depression, hallucinosis/psychosis (typically drug-induced), and sleep disorders (excessive daytime sleepiness, insomnia, obstructive sleep apnea, and rapid eye movement sleep behavior disorder). 

Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., Strosahl, K. (1996). Experiential avoidance and behavioral disorders A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152-1168. 

A fourth way to conceive of a drug problem is to consider it as a behavioral disorder. Many psychologists and other mental health professionals operate within this model. The typical treatment within this model involves individualized therapy with a psychotherapist. Three common avenues for treating a drug problem as a behavior disorder include behavior modification, cognitive modification, and skills training these techniques have been described previously, so I will not describe them again here. 

Klotz U, Avant GR, Hoyumpa Aet al. (1975) The effects of age and liver disease on the disposition and elimination of diazepam in adult man. J Clin Invest 55(2) 347-359 Kompoliti K and Goetz CG (1998) Neuropharmacology in the elderly. Neurol Clin 16(3) 599-610 Lanctot KL, Best TS, Mittmann N et al. (1998) Efficacy and safety of antipsychotics in behavioral disorders associated with dementia. J Clin Psychiatry 59(10) 550-561 Landi F, Onder G, Cesari M et al. (2005) Psychotropic medications and risk for falls among community-dwelling frail older people an observational study. J Gerontol A Biol Sci Med Sci 60(5) 622-626... 

Conners Parent Questionnaire. Conners Parent Questionnaire (PQ) is a 94-item checklist of symptoms that evaluates common behavior disorders using a four-point scale in children up to 15 years of age and takes 15 to 20 minutes to complete. It is used once pretreatment and may be repeated but is often replaced after the first use by the 11-item Conners Parent-Teacher Questionnaire (PTQ). There are eight subscales conduct problem, anxiety, impulsive-hyperactive, learning problem, psychosomatic, perfectionism, antisocial, and muscular tension. 

The MRL is based on a NOAEL of 0.5 mg/m3 for decreased acetylcholinesterase activity in rats exposed to disulfoton 4 hours/day for 5 days in a study by Thyssen (1978). The NOAEL was adjusted for intermittent exposure, converted to a human equivalent concentration, and divided by an uncertainty factor of 30 (3 for extrapolation from animals to humans and 10 for human variability). Inhibition of erythrocyte cholinesterase activity and unspecified behavioral disorders were observed at 1.8 mg/m, and unspecified signs of cholinergic toxicity were observed at 9.8 mg/m. Similar effects were observed in rats or mice exposed to higher concentrations for shorter duMtions (Doull 1957 Thyssen 1978). The NOAEL value of 0.5 mg/m is supported by another study, in which no significant decrease in the activity of brain, serum, or submaxillary gland cholinesterase was found in rats exposed to 0.14-0.7 mg/m for 1 hour/day for 5-10 days (DuBois and Kinoshita 1971). Mild depression of erythrocyte cholinesterase activity was reported in workers exposed by the inhalation and dermal routes (Wolfe et al. 1978). 

Another problem in validating targets for behavioral disorders related to neurotransmitter abnormalities is the interplay between several neurotransmitter systems in specific brain regions. For example, in the hippocampus, limbic, and nigral-striatal areas, functions connected by serotonin, norepinephrine, and dopamine are interconnected so that blocking selected receptor subtypes or changing synaptic levels of certain neurotransmitters may... 

Other Childhood Disruptive Disorders. The child with ADHD typically avoids schoolwork that taxes his/her attention. Difficulty completing work can quickly become a frustrating experience independent of one s age. A child with ADHD who complains about an assignment in many respects resembles the defiant refusal of a child with oppositional defiant disorder or conduct disorder. These disorders must be carefully distinguished from ADHD, but it is entirely possible that a child with ADHD may also have a comorbid disruptive behavior disorder. 

Mood Stabilizers. Lithium (Eskalith, Lithobid), valproic acid (Depakene), sodium valproate (Depakote), and carbamazepine (Tegretol) are most often used by psychiatrists to treat the bipolar disorders. These so-called mood stabilizers are also used to treat impulsivity and agitation in a variety of psychiatric disorders including dementia, certain personality disorders, and the disruptive behavior disorders of childhood. 

Starting Treatment in Children. The importance of an accurate diagnosis confirmed by obtaining information from multiple sources cannot be overstated. The mainstay of treatment for ADHD, psychostimulants, are less helpful for the other disruptive behavior disorders of childhood and may worsen the course of bipolar disorder in patients misdiagnosed with ADHD. 

When these measures have failed and impulsivity and aggression remain a problem, additional strategies are available. First, reconsider the diagnosis. Does the patient have bipolar disorder rather than ADHD Is there another disruptive behavior disorder in addition to or instead of ADHD Does (s)he have an impulse control disorder In these more severe cases, other medications such as atypical antipsychot-ics or mood stabilizers are often helpful. 

Feelings of isolation were common among interviewees at both historically black colleges and universities and historically white colleges and universities. In instances where the chemists were the only persons of color in the department or perhaps the first ones ever appointed to a faculty position in chemistry, many became discouraged and sometimes very depressed. Benjamin (1991) posits that the social isolation faced by many upwardly mobile African Americans often leads to stress, which can manifest itself in physiological disorders, such as hypertension, behavioral disorders, and even suicide. One Cohort V interviewee offered the following comments ... 

Behavioral disorders/Hyperactivity-Generally, do not use chlorpromazine in children younger than 6 months of age except where potentially lifesaving. It should not be used in conditions for which specific children s dosages have not been established. 

Oral- Start with low doses and increase gradually. In severe behavior disorders, 50 to 100 mg/day, or in older children, 200 mg/day or more may be necessary. There is little evidence that improvement in severely disturbed mentally retarded patients is enhanced by doses beyond 500... 

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