1/10. Acute abstinence syndrome following abrupt cessation of long-term use of tramadol (Ultram): a case study.We report on a patient who had taken the centrally acting analgesic tramadol for over 1 year. The compound had proven to be sufficient to treat her painful episodes related to fibromyalgia. Due to lack of supply while being on a trip, intake of the drug was stopped abruptly, resulting in the development of classical abstinence-like symptoms within 1 week. Abstinence-like symptoms consisted of restlessness and insomnia for which the benzodiazepine lorazepam was given. Diarrhoea and abdominal cramps were treated with the peripherally active opioid loperamide, while bouts of cephalgia were treated with sumatriptan. Diffuse musculoskeletal-related pain and restless leg syndrome (RLS) were treated with dextromethorphan. All these different medications proved to be efficacious as they resulted in the cessation of symptoms. Within 1 week symptoms ceased and the patient regained her normal activities without any sequelae. Although tramadol is considered a non-habit- and non-dependence-forming analgesic, abstinence symptoms are likely to develop following abrupt cessation of intake, especially when the compound had been taken over 1 year. Therefore patients should be advised of such an effect whenever they decide to stop intake or their physician is planning to switch to another medication. To avoid abstinence-like symptoms doses should be slowly tapered down.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/10. Detection of insomnia in primary care.Insomnia is a widespread condition with diverse presentations. Detection and diagnosis of insomnia present a particular challenge to the primary care physician. patients seldom identify their sleep habits as the source of the complaints for which they are seeking treatment. Insomnia may be the result of many different medical or psychiatric illnesses or the side effects of medications or legal or illegal recreational drugs. Insomnia has a serious impact on daily activities and can cause serious or fatal injuries. With ever-increasing competition with sleep from 24-hour television broadcasts from hundreds of channels and the internet, as well as more traditional distractions of late-night movies, clubs, and bars, we have become a society that sleeps 25% less than our ancestors did a century ago. We have no evidence, however, that we require less sleep than they did. This article presents strategies for detecting and diagnosing insomnia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/10. Zolpidem dependence case series: possible neurobiological mechanisms and clinical management.Zolpidem is a short-acting imidazopyridine hypnotic that is an agonist at the gamma-aminobutyric acid A type (GABAA) receptor. It has been suggested that it acts selectively on alpha1 subunit-containing GABAA benzodiazepine (BZ1) receptors presenting (contrary to classic benzodiazepines) low or no affinity for other subtypes. Therefore, it has been proposed that it lacks the benzodiazepines-like side-effects, having minimal abuse and dependence potential. Nevertheless, there is a considerable number of zolpidem dependence case reports in the literature. We present eight cases of zolpidem abuse and dependence without criminal record, without history of substance abuse (except for one alcohol abuser), with minor psychiatric disorders, who took zolpidem after physicians prescription in order to deal with their insomnia. However, they became zolpidem abusers not craving its sedative, but its anxiolytic and stimulating action, which helped them to cope with everyday activities. It is possible that, in the high doses that our patients used, zolpidem abandons its selectivity for BZ1 receptors and demonstrates all the actions of classic benzodiazepines. molecular biology, via possible mutations on GABA receptors, may provide some answers as to why our eight patients (who did not differ much from the thousands of insomniacs who use zolpidem) and other zolpidem abusers, raised the dose progressively, and sought something from the drug other than hypnotic action.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/10. sleep disorders.humans spend approximately one third of their lives asleep. Although the same medical disorders that occur during wakefulness persist into sleep, there are many disorders that occur exclusively during sleep or are manifestations of a disturbance of normal sleep-wake physiology. The most common reason for referral to a sleep laboratory is OSA, whereas the most common sleep disorder is insomnia. Effective treatments now exist for many sleep disorders, such as OSA and RLS, and a major breakthrough in the treatment of narcolepsy seems imminent. Because all disease processes are adversely affected by insufficient sleep, it is essential that the practicing physician understand the causes and treatments of the common sleep disorders.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/10. A problem-solving approach to the treatment of insomnia: selected case histories.The author presents case histories that demonstrate an approach to a spectrum of clinical scenarios that have common to them the complaint of insomnia. In the first, the physician is faced with an acute problem with an easily apparent, but superficial, etiology. The use of a benzodiazepine in this instance would be relatively noncontroversial. Its usage, without an exploration of the patient's perceptual frame, including psychosocial factors, would miss potentially important underlying problems. In the second case, the physician's concern about the habituating effects of benzodiazepines could have resulted in the underutilization of their benefits. The third case represents a scenario in which overutilization with resultant habituation was potentially a problem. It becomes apparent that an "either/or" generalization might hinder good patient outcome. Questioning around the symptom for purposes of gathering information regarding the patient's perceptual frame and the consequences of change may be useful in developing treatment strategies.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
6/10. New solutions for treating chronic insomnia: an introduction to behavioral sleep medicine.Insomnia is one of the most frequent complaints brought to primary care physicians and research suggests insomnia's prevalence is on the rise. Insomnia evaluation and treatment can be a time-intensive process that puts significant demands on a busy medical practice. To date, hypnotic medications are the most frequently prescribed treatment for insomnia and have been demonstrated to be efficacious for the treatment of acute insomnia. Cognitive-behavioral treatment (CBT) has been found to be just as effective as hypnotics for the treatment of acute insomnia and more effective for the treatment of chronic insomnia. CBT is now recognized as a first-line intervention for chronic insomnia, yet is underutilized. Many patients and healthcare providers are unaware of the efficacy of CBT for insomnia and currently there are few qualified providers. To address this need, the American Academy of Sleep medicine (AASM) has developed a new subspeciality to train providers in the provision of CBT for insomnia as well as other sleep disorders.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/10. Anterograde amnesia following triazolam use in two emergency physicians.Anterograde amnesia following triazolam ingestion lasting beyond the sedative-hypnotic effect of the drug has recently been reported. Two additional cases are presented involving emergency physicians.- - - - - - - - - - ranking = 5keywords = physician (Clic here for more details about this article) |
8/10. Agitation observed during treatment with newer hypnotic drugs.Side effects involving agitation, e.g., sleepwalking, anger, and panic, were observed in 10 insomniac patients treated with temazepam or triazolam but not other benzodiazepines. Each patient described these side effects as uncharacteristic. Milder agitation was observed in 2 cases. In 4 cases, these effects were doubted by the prescribing physician. This type of side effect has been only slowly recognized for other benzodiazepines and has not been much reported for these newer agents. Agitation observed during treatment with these agents may be related to their short elimination half-lives.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/10. Acute psychosis after mefloquine: a case report.A self-limiting psychosis characterized by visual and auditory hallucinations and isomnia occurred in a 17-year old male after mefloquine administration for presumed chloroquine resistant falciparum malaria. The attending physician failed to recognise the association between mefloquine and psychosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/10. Outbreak of obstructive ventilatory impairment associated with consumption of Sauropus androgynus vegetable.BACKGROUND: Forty four individuals, suffering from temporary insomnia and poor appetite followed by progressive difficulty breathing after four weeks or more ingestion of the Sauropus androgynus or Sabah vegetable, were reported to the National Poison Center of taiwan by physicians between August 23, 1994 and August 25, 1995. OBJECTIVE: A telephone questionnaire survey was designed and conducted to collect demographic data, information about use of the vegetable, past medical history and clinical presentation. Laboratory data were obtained from their physicians as available. RESULTS: Forty one patients, predominantly women, 43 /- 11 years old, were identified in our survey. They reported a variety of sources and preparation methods for the vegetable. Difficulty breathing, identified in 36 cases, was the clinical hallmark. Twenty people gave a history of dyspnea delayed until 44 /- 40 days after discontinuing vegetable consumption. Laboratory evidence of obstructive ventilatory impairment (FEV1/FVC 56 /- 12%, FEV1 31 /- 6%, PaO2 71 /- 15%) was observed in 12 cases tested. An open lung biopsy performed in a demonstration case disclosed bronchiolitis obliterans organizing pneumonia. CONCLUSION: In this case series of 41 victims, we have identified a severe pulmonary effect and hypothesize that it is related to consumption of sauropus androgynus vegetable. papaverine has been previously identified in this vegetable but is unlikely to be responsible for the full range of toxicity seen.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
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