Childhood insomnia

Increasing dopaminergic neurotransmission can cause several side effects including insomnia, irritability, decreased appetite, and nausea. On rare occasions, increasing dopamine tone can trigger paranoia, hallucinations, or involuntary movements known as tics. There has also been some concern that prolonged use of stimulants to treat childhood ADHD can retard growth. 

Overall, the clinical picture of childhood MDD parallels the symptoms of adult MDD (Birmaher et ak, 1996b). There are some developmental differences, however. Symptoms of melancholia (e.g., lack of appetite, insomnia, lack of interest in anything), delusions, suicide attempts, especially high-lethality ones, are all less prevalent in young children and increase with age. In contrast, symptoms of anxiety, behavioral problems, and perhaps auditory and visual hallucinations seem to occur more frequently in children (AA-CAP, 1998 Birmaher et ah, 1996a). Also, it appears that the rate of onset of bipolar disorder is higher in... 

Buspirone is a nonbenzodiazepine anxiolytic serotonin 5-HTia partial agonist that may have a role in reducing anxiety, flashbacks, and insomnia (Wells et al., 1991), although no controlled studies of this agent have been published in childhood populations. 

There have been three randomized clinical trials and multiple case reports and open-label trials with the tricyclic antidepressants (TCAs) in PTSD, although only one study of childhood PTSD (Southwick et al., 1994) has been reported. Robert et al. (1999) reported the use of low-dose imipramine (1 mg/kg) to treat symptoms of ASD in children with burn injuries. In this study, 25 children ages 2 to 19 years were randomized to receive either chloral hydrate or imipramine for 7 days. Ten of 12 subjects receiving imipramine experienced from half to full remission of ASD symptoms, whereas 5 of 13 subjects responded to chloral hydrate. Sleep-related flashbacks and insomnia appeared to be particularly responsive to treatment. 

Primary insomnia includes a number of insomnia diagnoses according to the International Classification of Sleep Disorders, including psychophysiological insomnia and idiopathic insomnia [11]. Psychophysiological insomnia most closely resembles primary insomnia. Individuals with idiopathic or childhood-onset insomnia show a lifelong inability to obtain adequate sleep there is no evidence of medical or psychiatric disorders that could account for the sleep disturbance. In sleep disor-... 

The efficacy of olanzapine in treatment-refractory childhood-onset schizophrenia has been examined in eight patients (mean age 15 years) over 8 weeks (22). There was a 17% improvement in the BPRS total score. Olanzapine was moderately well tolerated. The most common adverse events were increased appetite (n = 6), constipation (n = 5), nausea/vomiting (n = 6), headache (n = 6), somnolence (n = 6), insomnia (n = 7), difficulty in concentrating (n = 5), sustained tachycardia (n = 6), transient rises in liver transaminases (n = 7), and increased agitation (n = 6). 

An open trial with 3-year follow up has been conducted in 36 patients with catastrophic childhood onset epilepsy (2). The overall responder rate (more than a 50% reduction in seizure frequency) fell with time 69% at 3 months, 66% at 6 months, 47% at 1 year, and 41% at the end of the study. The most frequent adverse effects were anorexia, weight loss, urinary retention, somnolence, nervousness, and insomnia. Other reported adverse effects include skin reactions (including Stevens-Johnson syndrome), various blood dyscrasias, hepatotoxicity, and systemic lupus erythematosus (3). 

Clomipramine, fluvoxamine, sertraline, and fluoxetine are approved by the FDA for treatment of OCD in children and adolescents. Childhood and adult OCD appear to respond similarly to drug therapy. The SSRIs appear to be effective and well tolerated in treatment of OCD in children and are generally considered first-line agents. Treatment with an SSRI produces a favorable response in 75% of children and adolescents with OCD. A combination of SSRIs and CBT is preferred in most cases. In children, the most commonly described side effects of SSRI therapy include nausea, headache, tremor, gastrointestinal complaints, drowsiness, akathisia, insomnia, disinhibition, and agitation. Clomipramine was significantly better than placebo in the treatment of OCD in children and adolescents, with 75% of patients having a moderate to marked improvement. Clomipramine was also more effective than desipramine in children and adolescents. ... 

Insomnia is the most common complaint in general medical practice settings. Primary insomnia usually begins in young adulthood or middle age, and is rare in childhood or adolescence. More than 50% of the population complains of insomnia in their lifetime. A 1-year prevalence study of insomnia in the United States reports that one-third of the individuals surveyed complained of insomnia, and 17% reported that the symptoms were serious. Conservative estimates of chronic insomnia range from 9% to 12% in adulthood and up to 20% in the elderly. Women complain of insomnia twice as frequently as men. Individuals who are elderly, unemployed, separated or widowed, or those with a lower socioeconomic status reported a significantly higher incidence of insomnia. Forty percent with insomnia also had a concurrent psychiatric disorder (anxiety, depression, or substance abuse). ... 

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