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as the proportion of women with hot flushes, paresthesia, insomnia, nervousness, vertigo and formication. The symptom score of hot flushes and insomnia declined significantly (p less than 0.01). In the 24 women with hot flushes and in the 19 without, e/g caused similar reduction in the mean score of the other 10 symptoms. No placebo effect was seen. E/g caused a significant (p less than 0.01) fall in the elevated plasma concentrations of FSH and LH. Vaginal bleeding was regular in 38/43 and irregular in 4/43 (...) women during hormone treatment. No serious side effects were attributed to e/g therapy. It is concluded that e/g treatment, in addition to its beneficial effects on hot flushes and insomnia, also alleviates several other climacteric symptoms.
significantly from placebo. Motor activity tended to be increased in the drug nights. Diphenhydramine caused neither an impairment of psychomotor performance in the morning, nor a rebound insomnia in the following night.
Mirtazapine for treatment of depression and comorbidities in Alzheimer disease. Depression in patients with Alzheimer disease is a treatable cause of functional decline, caregiver burden, and mortality. It is often associated with severe weight loss, insomnia, and anxiety. These symptoms independently and collaboratively further worsen the prognosis of these vulnerable patients. An antidepressant medication with good adverse effect profile and salutary effects on these comorbid symptoms may (...) be of significant therapeutic value in these patients.To describe the role of mirtazapine in the treatment of depressed Alzheimer patients with comorbid weight loss, insomnia, and anxiety.Three patients with dementia and depression complicated by weight loss, insomnia, and anxiety were treated with mirtazapine at an outpatient memory loss clinic of a university hospital.Despite the persistence of memory loss, the patients experienced a prompt and sustained response to mirtazapine. There was a complete remission
[Psychosexual problems in menopause]. A case-control study about the evaluation of sexual disturbances during menopause considering the ways in which these are caused by neuro-endocrine disequilibrium, or by a psycho-social crisis during menopause. In addition, there is an evaluation of the efficacy of hormonal replacement therapy on sexual disturbances.Two groups of 44 menopausal women. The first group was transdermically treated with 50 micrograms/day of estradiol for three weeks in a one (...) and intensity of sexual desire. The same questions were consecutively asked to the subjects at three month intervals.The presence of crucial symptoms was distributed as follows: hot flashes and perspiration in 65%, anxiety in 60%, symptoms of depression in 50%, paraesthesia and asthenia in 40%, insomnia in 35%, varying degrees of memory loss in 30%, vaginal dryness and dyspareunia in 15% of the subjects in both groups (control and sperimental). Sexual desire was diminished or very diminished in 48
Efficacy and safety of midazolam and vesparax in treatment of sleep disorders. In a double-blind parallel study in which a placebo phase preceded and followed the double-blind verum phase, midazolam 15 mg and Vesparax (150 mg secobarbital, 50 mg brallobarbital, 50 mg hydroxyzine) were administered to 30 female patients aged 20-76 years, suffering from insomnia secondary to neuromuscular disease. Both products were shown to be efficient hypnotics maintaining a constant level of effect. Midazolam (...) proved to be better tolerated and, in contrast to Vesparax, did not cause hangover, nor did rebound phenomena ensue after its withdrawal.
displayed negative side effects such as tension, agitation, insomnia, and sweating during the 16-week period they received fenfluramine. The results demonstrated that fenfluramine caused no significant reductions in maladaptive behaviors. The lack of any significant positive results from this medication and the side effects observed strongly indicate the need for caution in the use of fenfluramine with autistic persons.
Efficacy of a reduced triazolam dose in elderly insomniacs. Elderly persons with insomnia are unique because the cause of their insomnia differs from that of younger people and their metabolism of benzodiazepine hypnotics differs as well. This study used nocturnal polysomnography and daytime sleep/wake tendency measures (Multiple Sleep Latency Test, MSLT) to assess the efficacy and safety of a reduced triazolam dosage (0.125 mg) in elderly subjects with insomnia. After 2 nights
group. There were no other statistically significant differences in symptoms or side effects.Phytoestrogens did not cause stimulation of the endometrium. Insomnia was more frequent over the 6-month study in the soy group, whereas hot flushes, night sweats, and vaginal dryness improved from baseline in the placebo group but not in the soy group. (...) June 2000. Twenty-seven subjects were randomized, and 19 completed the study. One (3.7%) baseline endometrial sample was weakly proliferative. All other baseline and final biopsies were consistent with atrophic, inactive endometrium. The maximum risk of endometrial stimulation with phytoestrogens is 35%. Hot flushes, night sweats, and vaginal dryness were significantly less severe at the final week of the study compared with baseline in the placebo group. Insomnia was more common in the treated
. Three patients receiving midazolam complained of headache. Headache was observed also in one patient given placebo and another experienced tachycardia. Midazolam administered the night before surgery is a preferable hypnotic for transient insomniacaused by preoperative anxiety.
, and returned on the 1st, 2nd, and 4th evenings of abstinence for further measurement. Nicotine reduced the increase in irritability, anxiety, difficulty concentrating, restlessness, impatience, and somatic complaints that subjects reported after cessation. Reductions in these withdrawal symptoms by nicotine were confirmed by ratings of significant others and by subjects' scores on the Profile of Mood States. Nicotine did not reduce the increases in cigarette craving, hunger, eating, insomnia, tremulousness (...) , or supine heart rate after cessation. The effects of nicotine occurred immediately and persisted throughout the study. Although many subjects correctly identified their drug group, the efficacy of the gum was independent of subjects' identifications of drug. The relief of tobacco withdrawal by nicotine gum suggests that the tobacco withdrawal syndrome is caused, in part, by nicotine deprivation.
Treatment of sleep disturbance in arthritis with chlormezanone. A double-blind, crossover study was carried out in 31 patients with rheumatoid arthritis or osteoarthritis who suffered from insomnia which was considered to be caused primarily by their disease. Patients received 7-day courses of 400 mg chlormezanone, 200 mg chlormezanone and placebo in a pre-determined random order. Patients rated chlormezanone significantly (p less than 0.025) more effective than placebo in overcoming sleep (...) disturbance and preferred the 400 mg dose. There was also a trend towards better quality of sleep with chlormezanone, although this did not attain statistical significance in this relatively small study. Daytime alertness was similar for both active and placebo treatment periods. Chlormezanone, therefore, would seem to be a useful addition to antirheumatic therapy when there is related insomnia.
of temazepam reduced night-time motor activity, an effect that was significant only for the first half of the night. After temazepam subjects rated their sleep as deeper and more quiet. A dose of 30 mg caused increased ratings of "grogginess" in the morning and at noon. There was no evidence for rebound insomnia in the 3 nights following drug intake. The results indicate that temazepam 20 mg in young adults has a reliable hypnotic effect without significant residual sequelae.
(P = 0.09 and 0.24, respectively). Lack of significant difference between the two regimens was demonstrated irrespective of the administered cytotoxic drugs. The DMD protocol caused more adverse reactions than D. While 27 patients (45%) experienced no side effects from D, only 14 (24%) remained free of complications due to DMD (P = 0.001). Furthermore, DMD produced more sedation, insomnia, headache, diaphoresis, dizziness and diarrhoea than the D regimen. In addition it gave rise to more adverse
Cognitive deterioration from long-term abuse of dextromethorphan: a case report. Dextromethorphan (DM), the dextrorotatory isomer of 3-hydroxy-N-methylmorphinan, is the main ingredient in a number of widely available, over-the-counter antitussives. Initial studies (Bornstein 1968) showed that it possessed no respiratory suppressant effects and no addiction liability. Subsequently, however, several articles reporting abuse of this drug have appeared in the literature. The drug is known to cause (...) a variety of acute toxic effects, ranging from nausea, restlessness, insomnia, ataxia, slurred speech and nystagmus to mood changes, perceptual alterations, inattention, disorientation and aggressive behavior (Rammer et al 1988; Katona and Watson 1986; Isbell and Fraser 1953; Devlin et al 1985; McCarthy 1971; Dodds and Revai 1967; Degkwitz 1964; Hildebrand et al 1989). There have also been two reported fatalities from DM overdoses (Fleming 1986). However, there are no reports describing the effects
, skin penetration, or both, often affects children's performance in school because it can stunt growth, decrease physical activity, and cause poor physical and mental development. The most common symptoms of worm infestation are pain, enlargement of the abdomen, loss of appetite and weight, vomiting, insomnia, and irregular respiration. Worms thrive in tropical climates and are endemic to many developing countries. Infestation, however, is easily dealt with; 1 dose of albendazole given once per year
discontinuation syndrome. These criteria are 2 or more of the following symptoms developing within 1 to 7 days of discontinuation or reduction in dosage of an SSRI after at least 1 month's use, when these symptoms cause clinically significant distress or impairment and are not due to a general medical condition or recurrence of a mental disorder: dizziness, light-headedness, vertigo or feeling faint; shock-like sensations or paresthesia; anxiety; diarrhea; fatigue; gait instability; headache; insomnia (...) common. Other common symptoms were nausea or emesis, fatigue, headache, gait instability and insomnia. Shock-like sensations, paresthesia and visual disturbances were the most rare. Without intervention, symptoms persisted for more than a week in half of the cases. In cases in which the SSRI was restarted, symptoms resolved within 72 hours. In some cases, withdrawal symptoms recurred when the same SSRI was again discontinued.Findings were used to construct diagnostic criteria for the SSRI
Medications for the Treatment of Sleep Disorders: An Overview Sleep disorders can be divided into those producing insomnia, those causing daytime sleepiness, and those disrupting sleep. Transient insomnia is extremely common, afflicting up to 80% of the population. Chronic insomnia affects 15% of the population. Benzodiazepines are frequently used to treat insomnia; however, there may be a withdrawal syndrome with rapid eye movement (REM) rebound. Two newer benzodiazepine-like agents, zolpidem (...) and zaleplon, have fewer side effects, yet good efficacy. Other agents for insomnia include sedating antidepressants and over-the-counter sleep products (sedating antihistamines). Nonpharmacologic behavioral methods may also have therapeutic benefit. An understanding of the electrophysiologic and neurochemical correlates of the stages of sleep is useful in defining and understanding sleep disorders. Excessive daytime sleepiness is often associated with obstructive sleep apnea or depression. Medications
Multiple Sleep Pathologies Presenting as Depression Successful management of patients with sleep disorders requires attention to the clinical history, particularly the sleep history, knowledge of the causes of insomnia and hypersomnia, and familiarity with a variety of therapeutic interventions. To illustrate these principles, the authors describe a 68-year-old woman who had a history of clinical depression but who, on further investigation, was found to suffer from three sleep disorders (...) : narcolepsy, periodic leg movements during sleep, and rapid eye movement sleep behaviour disorder. Treatment of these sleep disorders caused a complete amelioration of the mood symptoms and a significant improvement in psychosocial functioning and well-being.
Health Consequences of Selected Lifestyle Factors: A Review of the Evidence, Part 2 Generalized resistance to disease and reduced tendency to depression have been related to the extent of social relationships, with a greater association for females than males. Cigaret smoking is the largest cause of preventable death: smokers' mortality rates are almost double those for non-smokers. Coronary heart disease and lung cancer are the main causes of death. Morbidity is also higher among smokers, who (...) are more prone to bronchitis, emphysema, sinusitis, peptic ulcers, and influenza. Abuse of drugs, both prescribed and unprescribed, is linked directly to drug dependency and death, often suicide. Misuse of prescribed drugs is a major concern in the elderly. High caffeine consumption has been related to chronic insomnia, persistent anxiety and depression, and stomach upset. Use of properly adjusted seatbelts halves the number of deaths and the severity of injury in motor vehicle accidents. Type
women, 57 men) had a mean age 63.9 years. The median length of admission was 61.5 days (range 1 to 2147). 84 patients (68%) were aware of their diagnosis and its implications when first seen by a hospice doctor. Functionally, the patients were very dependent. Symptoms such as pain, dyspnoea, and insomnia were major problems that responded well to opioids. Many patients were noted to deteriorate "suddenly," and in 58% of cases death occurred within 24 hours of this deterioration. When dying, 106 (...) patients (94%) were peaceful and settled. 101 patients (89%) received opioids during this dying period. No patient chocked to death.Although motor neurone disease is an uncommon disorder, many of its symptoms occur commonly in medical practice and must be actively treated. Opioids are both safe and effective for such treatment. The term chocking is both inaccurate and inappropriate in describing the cause of death in motor neurone disease and its use should be abandoned.