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8 results

  • Alternative treatment strategies for lithium in bipolar disorder

  • P.F. Bouvy
  • Journal:
    Acta Neuropsychiatrica / Volume 5 / Issue 3 / September 1993
    Published online by Cambridge University Press:
    18 September 2015, pp. 55-59

  • Indications for lithium in the treatment of bipolar disorders are acute mania, depression and preventive treatment. In the case of insufficient efficacy or adverse effects the first alternative for lithium in acute mania is carbamazepine. However, the role of carbamazepine in preventive treatment is still uncertain. Well designed prospective research is hardly done. Clearly positive reports on the efficacy of carbamazepine concern specific lithium-resistant groups such as the ‘rapid-cyclers’. Valproic acid has been found effective in a few studies in bipolar disorders, especially in acute mania. Clonazepam is sometimes mentioned as a possible alternative, however recent research seriously questions the efficacy of clonazepam in bipolar disorders. Calcium-antagonists, especially verapamil, may have some efficacy in the treatment of acute mania, their role is still very uncertain.

  • Case 29 - Sounds of choking at night

  • from Part V - Sleep-related epilepsy
  • Edited by Antonio Culebras
  • Book:
    Case Studies in Sleep Neurology
    Published online:
    10 November 2010
    Print publication:
    23 September 2010, pp 200-207

  • Summary

    This chapter discusses the case of a 38-year-oldwoman who had presented to the sleep center's outpatient clinic for evaluation of frequent sleepwalking episodes. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. A comprehensive evaluation including polysomnography (PSG), video-electroencephalography (EEG), psychological testing and necessary medical testing is important as it can have a major impact on the question of the patient's criminal responsibility. The EEG showed no epileptiform abnormalities interictally or during the events. The patient was referred for hypnotherapy and cognitive behavioral therapy (CBT) for her insomnia. Given these results, a diagnosis of sleepwalking, arousal disorder, was made. The daytime sleepiness was thought to be due to the intake of excess clonazepam. Medications (lithium, zolpidem, high doses of neuroleptic drugs and benzodiazepines) and recreational drugs may also induce sleepwalking.

  • Case 28 - Seizure, parasomnia or behavioral disorder?

  • from Part V - Sleep-related epilepsy
  • Edited by Antonio Culebras
  • Book:
    Case Studies in Sleep Neurology
    Published online:
    10 November 2010
    Print publication:
    23 September 2010, pp 193-199

  • Summary

    This chapter discusses the case of a 48-year-old woman who was having episodes of sitting upright in bed, letting out a blood curdling scream and patting the bed with both hands, and often going back to sleep without realizing what had happened. It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. The specialist ordered an MRI of the brainwith special thin cuts through the frontal and temporal lobes, and nocturnal polysomnography (PSG) with an additional all-night 16-channel EEG running concomitantly with the PSG. Based on the results of the studies, a diagnosis of sleep terrors or disorder of partial arousal was made. She was prescribed clonazepam 0.5mg and was urged to follow up with the behavior therapist. Six months later, her events were all well controlled by the behavioral therapy recommendations.

  • Case 39 - Snoring and leg cramps

  • from Part VIII - Neuromuscular disorders and sleep
  • Edited by Antonio Culebras
  • Book:
    Case Studies in Sleep Neurology
    Published online:
    10 November 2010
    Print publication:
    23 September 2010, pp 275-280

  • Summary

    This chapter presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on a man who presented with frequent episodes of sudden and unexplained arousals from nocturnal sleep. The sleep medicine specialist ordered a full-night video-polysomnography (PSG) recording including standard bipolar EEG, right and left electro-oculograms (EOGs), surface EMG of the mylohyoideus muscle, ECG, oro-nasal, thoracic and abdominal respirograms, and circulating oxyhemoglobin saturation. The specialist decided to withdraw clonazepam and advised the patient not to drive due to drowsiness until the results of the investigations became available and appropriate therapy was prescribed. The sleep medicine specialist established a diagnosis of nocturnal frontal lobe epilepsy (NFLE) based on historical features and video-PSG findings. Nocturnal frontal lobe epilepsy is a peculiar partial epilepsy whose clinical features comprise a spectrum of paroxysmal motor manifestations of variable duration and complexity, occurring mainly during sleep.

  • Chapter 17 - Sleep-related dissociative disorder

  • from Section 4 - Other parasomnias
  • Edited by Michael J. Thorpy, Giuseppe Plazzi, Università di Bologna
  • Book:
    The Parasomnias and Other Sleep-Related Movement Disorders
    Published online:
    10 November 2010
    Print publication:
    10 June 2010, pp 163-174

  • Summary

    Sexual arousal and sleep have never been at odds. Some of the well-known physiological phenomena associated with sleep were described centuries ago, most notably wet dreams, nocturnal emissions in males, and nocturnal orgasms in females. A significant number of case reports and first epidemiological and Meta studies suggest that sexual behavior in sleep primarily represents a distinctive variation of known types of NREM arousal parasomnias. Sexsomnia treatment has two objectives. First is to educate patients concerning their disorder. The second treatment objective is to provide pharmacological intervention when necessary, most often in the form of clonazepam, a common medication that is easily administered and titrated. Patients who suffer from sexsomnia are at higher risk of being charged for sexual offences. The legislatures across the world differ considerably when dealing with this issue, and those jurisprudent differences are present even at national levels.

  • 11 - Skin Picking: Clinical Aspects

  • from Section II - Pellicular Impulses
  • Edited by Elias Aboujaoude, Stanford University School of Medicine, California, Lorrin M. Koran, Stanford University School of Medicine, California
  • Book:
    Impulse Control Disorders
    Published online:
    06 July 2010
    Print publication:
    08 February 2010, pp 124-137

  • Summary

    Kleptomania is classified in the International Classification of Diseases of the World Health Organization (WHO) ICD-10 (Code F63.2) under the heading of habit and impulse disorders together with pathological gambling, pyromania, and trichotillomania. Individuals with kleptomania typically suffer from emotional distress and/or impaired functioning in social and occupational areas. Kleptomania has occasionally been reported to stem from neurological disorders. The emotional distress, stress, potential marital conflict, arrests, and jail time associated with kleptomania undoubtedly diminish patients' quality of life (QOL). Kleptomania patients are highly likely to suffer from comorbid psychiatric disorders, most notably mood disorders, anxiety disorders, eating disorders, other impulse control disorders, and alcohol and other psychoactive substance abuse/dependence disorders. Clonazepam and alprazolam have been reported to produce partial success in treating kleptomania. Over the past 50 years, the treatment approach toward kleptomania has shifted away from psychodynamic therapy. Cognitive-behavioral interventions have been reported to help in individual cases.

  • 34 - Use of benzodiazepines in the aging population: do the benefits outweigh the risks?

  • from Part 4 - Treatment of sleep disorders in the elderly
  • Edited by S. R. Pandi-Perumal, Jaime M. Monti, Universidad de la República, Uruguay, Andrew A. Monjan, National Institute on Aging, Bethesda, Maryland
  • Book:
    Principles and Practice of Geriatric Sleep Medicine
    Published online:
    04 August 2010
    Print publication:
    26 November 2009, pp 362-370

  • Summary

    This chapter describes the pathogenesis, neurovegetative and olfactory functions, EEG activity, neuropsychological assessment, and treatment of rapid eye movement (REM) sleep behavior disorder (RBD). In RBD patient's polysomnographic (PSG) recording reveals intermittent or complete loss of REM sleep muscle atonia and excessive phasic electromyographic (EMG) activity during REM sleep. Multiple neural substrates, mainly located in the brainstem, contribute to REM sleep atonia and may be involved in the pathogenesis of RBD. Recent studies have examined various neurophysiological and neuropsychological functions in idiopathic RBD, in order to detect early signs of central nervous system (CNS) dysfunction associated with the REM sleep motor dyscontrol. Lewy body pathology begins in the anterior olfactory nucleus and in the lower brainstem nuclei, affecting olfactory and autonomic functions initially, and progressing rostrally to ultimately affect the cerebral cortex. Clonazepam is currently regarded as the treatment of choice for RBD, and it is ineff ective in only 10% of patients.

  • Drug Treatment of REM Sleep Behavior Disorders in Dementia With Lewy Bodies

  • Gloria Massironi, Samantha Galluzzi, Giovanni B. Frisoni
  • Journal:
    International Psychogeriatrics / Volume 15 / Issue 4 / December 2003
    Published online by Cambridge University Press:
    10 January 2005, pp. 377-383

  • Background: Dementia with Lewy bodies (DLB) is often associated with REM sleep behavior disorders (RBD) characterized, in contrast to the usual paralysis of REM sleep, by violent motor and verbal activity. Patients and Methods: The pharmacological management of RBD was investigated in three DLB patients treated with clonazepam, a benzodiazepine used as an antiepileptic, or donepezil, a cholinesterase inhibitor. Results: All three patients had marked improvement. The pharmacodynamic mechanisms underlying the efficacy of the two drugs might be due to facilitator effect on the pedunculopontine nucleus, a key structure in the physiology of REM sleep.