Sleep disturbances and

Depression is one of the most common psychiatric disorders. It is characterized by feeling of intense sadness, helplessness, worthlessness, and impaired functioning. Those experiencing a major depressive episode exhibit physical and psychological symptoms, such as appetite disturbances, sleep disturbances, and loss of interest in job, family, and other activities usually enjoyed. A major depressive episode is a depressed or dysphoric (extreme or exaggerated sadness, anxiety, or unhappiness) mood that interferes with daily functioning and includes five or more of the symptoms listed in Display 31-1. 

The two plots can be superimposed into a biplot as shown in Fig. 32.7. Such a biplot reveals the correspondences between the rows and columns of the contingency table. The compound Triazolam is specific for the treatment of sleep disturbances. Anxiety is treated preferentially by both Lorazepam and Diazepam. The latter is also used for treating epilepsy. Clonazepam is specifically used with epilepsy. Note that distances between compounds and disorders are not to be considered. This would be a serious error of interpretation. A positive correspondence between a compound and a disorder is evidenced by relatively large distances from the origin and a common orientation (e.g. sleep disturbance and Triazolam). A negative correspondence is manifest in the case of relatively large distances from the origin and opposite orientations (e.g. sleep disturbance and Diazepam). 

Androgens are important for general sexual function and libido, but testosterone supplementation is only effective in patients with documented low serum testosterone levels. In patients with hypogonadism, testosterone replacement is the initial treatment of choice, as it corrects decreased libido, fatigue, muscle loss, sleep disturbances, and depressed mood. Improvements in ED may occur, but they should not be expected to occur in all patients.23 The initial trial should be for 3 months. At that time, re-evaluation and the addition of another ED therapy is warranted. Routes of administration include oral, intramuscular, topical patches or gel, and a buccal tablet. 

Finally, all of the trials in the FDA data set included the same measure of depression, a physician-rated scale called the Hamilton Rating Scale for Depression (HRSD). The Hamilton scale is completed by doctors based on interviews and observations of patients. The doctor rates the patient s mood, thoughts about suicide, sleep disturbances and other symptoms of depression. For example, one point is given if the patient feels that life is not worth living, and four points are scored if the person has made a serious suicide attempt. The result is a numerical score that can range from o to 51. 

Common side-effects associated with beta-adrenoceptor blockers, such as atenolol, include fatigue, bradycardia, sleep disturbances, and peripheral vasoconstriction leading to coldness of extremities. Water-soluble beta-blockers, such as atenolol, are less likely to cause sleep disturbances and nightmares than lipid-soluble beta-blockers, such as propranolol. 

Fig. 4.5 Central receptor occupancy after oral administration of p-adrenoceptor antagonists A, atenolol B, metoprolol C, pindolol D, propranolol. The high occupancy of pi receptors does not correlate with physicochemical properties (lipophilicity). The occupation of p2 receptors correlates with sleep disturbances and the intrinsic selectivity of the compounds.

Neurasthenia (i.e., fatigue, depressed mood, lack of initiative, dizziness, sleep disturbances) and impairment of attention and sensorimotor speed were associated with chronic inhalation, oral, and/or dermal exposures to jet fuel by factory workers (Knave et al. 1978). Nevertheless, it is not known to which jet fuels the workers were exposed, and confounding by exposure to other chemicals may have occurred. 

A number of effects have been associated with chronic exposure to jet fuel in factory workers (Knave et al. 1978). These effects included increases in the occurrence of neurasthenia (anxiety and/or mental depression, fatigue, depressed mood, lack of initiative, dizziness, palpitations, thoracic oppression, sleep disturbances) and eye irritation. Psychological tests found that attention and sensorimotor speed were impaired in exposed workers, but there were no effects on memory functions or manual dexterity. EEG tests suggested that there may have been instability in the thalamocortical system in the exposed group. However, the type of jet fuels were not noted nor was there a control for exposure to other compounds. Inhalation exposure is likely since jet fuel vapor was detected by the study authors however, dermal and oral (i.e., eating with contaminated hands) exposures may also be possible. 

The three main types of altitude illness, characterised initially by nausea, headache, sleep disturbance and stomach upset, are acute mountain sickness (AMS) high altitude pulmonary oedema (HAPE) and high altitude cerebral oedema (HACK). They occur after rapid ascent to altitudes greater than 2,500 m (about 8,000 feet) in unacclimatised people. In unacclimatised mountaineers, the prevalence of AMS at 4,559 metres (15,000 feet) is approximately 50% and HAPE 4%. Risk depends on individual susceptibility, rate of ascent and pre-exposure to high altitude. AMS is not a pre-requisite for HAPE. 

Other serious effects may include involuntary movements, impaired motor coordination, loss of balance, blepharospasm, facial grimaces, feeling of heaviness in the lower extremities, depression, nightmares, delusions, overstimulation, sleep disturbance, and anger. 

Daily fluoxetine (Prozac) Long half-life of drug and risk of producing excessive CNS stimulation, sleep disturbances, and increasing agitation. Safer alternatives exist. High... 

Anorectic patients are usually brought to professional attention by family members after the patients have lost a large amount of weight. If they seek help on their own it is usually because of their subjective distress over the somatic and psychological consequences of starvation. These include weakness, fatigue, difficulty concentrating, sleep disturbances, and depression. Because individuals with AN have considerable denial of the seriousness of their problem, they are often unreliable historians. Thus it is necessary to ob-... 

Hoder et al. (1984) studied clonidine in seven newborn infants with neonatal narcotic abstinence syndrome and found no significant changes in blood pressure, pulse, or electrocardiograms (EKG) in any of the seven infants. One infant had a transient abnormal eye exam and two infants developed a transient mild metabolic acidosis. On follow up 4-9 months later, four infants were found to be developmentally age appropriate. However, Huisjes et al. (1986) reported that 22 children exposed in utero to clonidine as result of treatment for maternal hypertension had increased sleep disturbances and hyperactivity, compared to a control group at a mean age of 6 years. It is unclear whether these differences were a direct effect of clonidine on prenatal development. More sophisticated preclinical studies need to be done in this area. At best the level of short-term and long-term safety regarding clonidine is level C. 

Yeung, C.K., Chiu, H.N., and Sit, F.K. (1999) Sleep disturbance and bladder dysfunction in enuretic children with treatment failure fact or fiction Scand J Urol Nephrol Suppl 202 20-23. 

Foote SL, Freedman R, Oliver AP Effects of putative neurotransmitters on neuronal activity in monkey auditory cortex. Brain Res 86 229-242, 1975 Ford DE, Kamerow DB Epidemiologic study of sleep disturbances and psychiatric disorders an opportunity for prevention JAMA 262 1479-1484, 1985 Foreman MM, Gehlert DR, Schaus JM Quinelorane, a potent and selective dopamine agonist for the D2-like receptor family. Neurotransmissions 11 1 -5, 1995 Forn J, Valdecasas FG Effects of lithium on brain adenyl cyclase activity. Biochem Pharmacol 20 2773-2779, 1971... 

Sleep disturbances and oppressive dreams become rarer. Daily mood swings with morning lows, lack of appetite and constipation cease. 

Adverse effects of the COMT inhibitors relate in part to increased levodopa exposure and include dyskinesias, nausea, and confusion. It is often necessary to lower the daily dose of levodopa by about 30% in the first 48 hours to avoid or reverse such complications. Other adverse effects include diarrhea, abdominal pain, orthostatic hypotension, sleep disturbances, and an orange discoloration of the urine. Tolcapone may cause an increase in liver enzyme levels and has been associated... 

The acute toxicity of dichloromethane is expressed mainly as disturbances of the central nervous system, involving sleep disturbance and reductions in spontaneous activity (Heppel Neal, 1944 Schumacher Grandjean, 1960 Fodor Winneke, 1971 United States National Institute for Occupational Safety and Health, 1976). 

Disruption of diurnal cortisol rhythm has been detected and could explain some of the sleep disturbances and psychic adverse effects that levodopa can have (SEDA-8, 143). 

Medical conditions based in nearly all physiological systems can produce coincident sleep disturbances and sleep deprivation. This includes disorders of the cardiovascular (chronic heart failure), pulmonary (asthma), gastrointestinal (hepatic failure), renal (urinary tract infections, polyuria), endocrine (diabetes, hypothyroidism, hyperthyroidism), and neurological (Parkinson s disease,... 

Drewes AM, Jennum P, Andersen A, Siol A, Nielsen KD. Self-reported sleep disturbances and daytime complaints in women with fibromylagia and rheumatoid arthritis. J Musculoskel Pain 1994 2 15-31. 

Schaefer KM. Sleep disturbances and fatigue in women with fibromyalgia and chronic fatigue syndrome. J Obstetric, Gynecologic, Neonat Nursi 1995 24 229-233. 

Sadeh A, Lavie P, Scher A, Tirosh E, Epstein R. Actigraphic home-monitoring sleep-disturbed and control infants and young children a new method for pediatric assessment of sleep-wake patterns. Pediatrics 1991 87 494-9. 

Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders an opportunity for prevention JAMA 1989 262(11) 1479-1484. 

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