Nightmare disorder

Nightmare disorder Sleep terror disorder Sleepwalking disorder Parasomnia not otherwise specified Sleep disorders related to another mental disorder Insomnia related to another mental disorder Hypersomnia related to another mental disorder Other sleep disorders... 

Parasomnias are adverse events that either occur during sleep or are exaggerated by sleep. Many of these disorders are considered to be disorders of partial arousal from various sleep stages. Examples of parasomnias are sleepwalking disorder, sleep terror disorder, and nightmare disorder. 

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. 

Although we are focusing on the primary sleep disorders, sleep disturbance quite often occurs as a symptom of another illness. Depression, anxiety, and substance abuse can impair the quality of sleep, though in the setting of chronic insomnia, other psychiatric disorders account for less than 50% of cases. Nightmares are a frequent complication of post-traumatic stress disorder (PTSD), and pain, endocrine conditions, and a host of medical illnesses can produce sleep problems. Thus, when discussing insomnia or hypersomnia, we are well advised to remember that these can be either a symptom of a psychiatric syndrome, a medical illness, or a sleep disorder. 

Adverse reactions include the following anorexia, apprehension, body/joint pain, chest pains, confusion, confusional states/memory impairment, congestion, constipation, coordination disorders, cramps/pain, depression, diarrhea, dreaming/nightmares, dry mouth, dysesthesia, euphoria, Gl pain, GU complaints, headache, heartburn, insomnia, irritability, lack of concentration, nausea, nervousness, palpitations, paresthesia, relaxed feeling, restlessness, tachycardia, taste alterations, tinnitus, tiredness, tremor, vomiting, weakness. 

Eor preventive treatments, the adverse effects of the beta blockers are classical for this class bradycardia, bronchospasm, hypotension, nightmares and depression. Indoramine induces neuropsychiatric effects (sedation, asthenia) and cardiovascular disorders (hypotension). Eluanarizine is strictly contraindicated in patients with Parkinsonism and depression. 

Narcolepsy is another medically recognized indication for the use of the psychomotor stimulants. This disorder is characterized by sleep attacks, particularly during the day, sudden loss of muscle tone cataplexy), sleep paralysis, and vivid visual and auditory nightmares that may persist into the waking state. Drugs that influence the central action of adrenomimetic amines re-... 

ADHD, attention-deficit hyperactivity disorder MAOI, monoamine oxidase inhibitor TCA, tricyclic antidepressants. Cluster B symptoms, reexperiencing, intrusive recollections, traumatic nightmares, flashbacks cluster C symptoms, avoidant behavior, numbing, dissociation cluster D symptoms, hyperarousal, insomnia, irritability, hypervigilance, hyperstartle. 

Brophy, M.H. (1991) Cyproheptadine for combat nightmares in posttraumatic stress disorder and dream anxiety disorder. Mil... 

Horrigan, J.P. (1996) Guanfacine for posttraumatic stress disorder nightmares [letterl]./ Am Acad Child Adolesc Psychiatry 3 5 975-976. 

Recent case reports have suggested that atypical antipsychotics may also benefit patients with PTSD. For example, low doses of risperidone in combination with an antidepressant or mood stabilizer were reported effective for nightmares and flashbacks in patients with treatment-refractory PTSD ( 292). Both clozapine and olanzapine have also been reported to reduce PTSD symptoms in patients with a co-morbid psychotic disorder ( 293, 294). Finally, olanzapine added to fluoxetine resulted in significant improvement of hyperarousal symptoms in a patient with treatment-refractory PTSD caused by severe childhood physical and sexual abuse (295). 

POST-TRAUMATIC STRESS DISORDER A mental dis order that can occur in those who have experienced a life threatening-situation. PTSD is characterized by nightmares and flashbacks, among other symptoms. 

Types of anxiety disorders Difficulty in initiation of sleep Difficulty in maintenance of sleep Early morning awakening Nightmares ... 

Germain A, Nielsen TA (2003) Sleep pathophysiology in posttrraumatic stress disorder and idiopathic nightmare sufferers. Biol Psychiatry 54 1092-1098... 

Taylor F, Raskind MA (2002) The alpha 1-adrenergic antagonist prazosin improves sleep and nightmares in civilian trauma posttraumatic stress disorder. J Clin Psychopharmacol 22 82-85... 

Krakow B, Hollifield M, Johnston L, Koss M, Schrader R, Warner TD, Tandberg D, Lauriello J, McBride L, Cutchen L et al. (2001) Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder. JAMA 286 537-545... 

September 2004 during a nightmare that unfolded in Washington State and Arizona. Local conditions — mold, pollen, daily controlled forest fire burnings, pesticides — brought on severe MCS, and along with it, post-traumatic stress disorder (PTSD). 

HT2 receptors might have played a causal role, because 5-HT2 receptor antagonists, such as nefazodone, can be helpful in the treatment of nightmares, for example in patients with post-traumatic stress disorder. 

In posttraumatic stress disorder (PTSD) (15), a characteristic set of symptoms develops following exposure to an event that induces extreme fear or terror (e.g., war, rape). These symptoms include a persistent and intrusive reexperiencing of the event through flashbacks or nightmares, and an intense distress at exposure to cues that are reminiscent of the event. The sufferer deliberately avoids such stimuli and may become detached, withdrawn, and emotionally numb. Additional symptoms include insomnia, impaired concentration, and unprovoked anger. Prevalence... 

Uses include major depressions, phobic and panic anxiety states, neuropathic pain, enuresis, and obsessive-compulsive disorder (OCD) (clomipramine now backup). Withdrawal syndrome follows discontinuance in depression—nausea, headache, vertigo, malaise, nightmares. 

Greater risk of future psychoses, personality disorders, and neuroses decrease in cognitive and intellectual performance mental retardation fatigue somnolence (postirradiation syndrome) Radiation necrosis decreased appetite, weakness, depression, nightmares, paranoia, psychosis, labile mood, personality changes, cognitive decline, dementia... 

Organophosphate pesticides do not cause a significant percentage of major mental illnesses, such as schizophrenia and bipolar disorder, but they do cause severe psychiatric symptoms of both acute and chronic duration. The most prominent psychiatric symptoms include early anxiety and emotional lability, followed by insomnia, excessive dreaming, nightmares, and reduced concentration. Other symptoms listed in Table 4-3 usually develop only after exposures severe enough to cause physical symptoms but may occur at lower doses in individuals with genetic vulnerability. The limited informa-... 

---