1/6. Is there a dissociative process in sleepwalking and night terrors?The enduring and contentious hypothesis that sleepwalking and night terrors are symptomatic of a protective dissociative mechanism is examined. This is mobilised when intolerable impulses, feelings and memories escape, within sleep, the diminished control of mental defence mechanisms. They then erupt but in a limited motoric or affective form with restricted awareness and subsequent amnesia for the event. It has also been suggested that such processes are more likely when the patient has a history of major psychological trauma. In a group of 22 adult patients, referred to a tertiary sleep disorders service with possible sleepwalking/night terrors, diagnosis was confirmed both clinically and polysomnographically, and only six patients had a history of such trauma. More commonly these described sleepwalking/night terrors are associated with vivid dream-like experiences or behaviour related to flight from attack. Two such cases, suggestive of a dissociative process, are described in more detail. The results of this study are presented largely on account of the negative findings. Scores on the dissociation questionnaire (DIS-Q) were normal, although generally higher in the small "trauma" subgroup. These were similar to scores characterising individuals with post-traumatic stress disorder. This "trauma" group also scored particularly highly on the anxiety, phobic, and depression scales of the Crown-Crisp experiential index. In contrast the "no trauma" group scored more specifically highly on the anxiety scale, along with major trends to high depression and hysteria scale scores. Two cases are presented which illustrate exceptional occurrence of later onset of sleepwalking/night terrors with accompanying post-traumatic symptoms during wakefulness. It is concluded that a history of major psychological trauma exists in only a minority of adult patients presenting with sleepwalking/night terror syndrome. In this subgroup trauma appears to dictate the subsequent content of the attacks. However, the symptoms express themselves within the form of the sleepwalking/night terror syndrome rather than as rapid eye movement sleep related nightmares. The main group of subjects with the syndrome and with no history of major psychological trauma show no clinical or DIS-Q evidence of dissociation during wakefulness. The proposition that, within the character structure of this group, the mechanism still operates but exclusively within sleep remains a possibility.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/6. Sexsomnia--a new parasomnia?OBJECTIVE: To describe a distinct parasomnia involving sexual behaviour, which we have named sexsomnia. METHOD: We have used a case series as a basis for the description of sexsomina. RESULTS: Eleven patients with distinct behaviours of the sexual nature during sleep are described. The features in common with other nonrapid eye movement arousal parasomnias, such as sleepwalking are documented. Some patients had simply been referred to a tertiary sleep clinic for investigation of unrelated sleep problems. A small number had been involved in medicolegal issues. Sexsomnia has some distinct features that separate it from sleepwalking. The automatic arousal is more prominent, motor activities are relatively restricted and specific, and some form of dream mentation is often present. CONCLUSIONS: A significant number of patients with this unusual parasomnia behaviour were identified only after specific questions were asked, suggesting that the behaviour is more common than previously thought.- - - - - - - - - - ranking = 4keywords = behaviour (Clic here for more details about this article) |
3/6. bupropion-induced somnambulism.Whereas there are some case reports of bupropion-induced vivid dreaming and nightmares, until now it has not been associated with somnambulism. A case is reported of a patient treated with bupropion as a smoking cessation medication, who developed somnambulism during nicotine withdrawal. Furthermore, the sleepwalking episodes were associated with eating behaviour. amnesia was reported for all episodes. As, on one hand,bupropion is a noradrenergic and dopaminergic drug and nicotine withdrawal, on the other hand, is associated with alterations in monoaminergic functions, an interaction at the level of these neurotransmitters is suggested as the underlying mechanism.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
4/6. Somnambulistic sexual behaviour (sexsomnia).somnambulism or sleepwalking is a viable defence on the basis of automatism. The behaviours that occur during sleepwalking can be highly complex and include sexual behaviour of all types. Somnambulistic sexual behaviour (also called sexsomnia, sleep sex) is considered a variant of sleepwalking disorder as the overwhelming majority of people with Sexsomnia have a history of parasomnia and a family history of sleepwalking. Sexual behaviour during a sleep automatism can vary from explicit sexual vocalisations, to violent masturbation, to complex sexual acts including anal, oral and vaginal penetration. A recent case in england is reported where the defendant was acquitted on 3 charges of rape on the basis of automatism due to somnambulistic sexual behaviour.- - - - - - - - - - ranking = 9keywords = behaviour (Clic here for more details about this article) |
5/6. Somnambulistic-like episodes secondary to combined lithium-neuroleptic treatment.Ten of 114 psychiatric patients undergoing combined lithium-neuroleptic treatment exhibited somnambulistic-like episodes. These episodes are differentiated from nocturnal wanderings and epileptic attacks during sleep; they occurred within two to three hours after sleep onset and were characterized by the patients appearing confused and walking about in a quiet, detached and clumsy manner. Generally, there was amnesia for the event. Since sleepwalking occurs out of slow wave sleep, the increase in slow wave sleep induced by lithium and certain neuroleptics may represent a neurophysiological mechanism responsible for these patients' somnambulistic behaviour. The occurrence of grand mal seizures in two patients was probably unrelated to the somnambulistic-like episodes. However, persistence of the latter appears to be associated with drug-induced EEG irregularity.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
6/6. Episodic nocturnal wandering and complex visual hallucination. A case with long-term follow-up.Episodic nocturnal wandering is rare and thought to be an atypical form of nocturnal epilepsy which is responsive to anticonvulsant therapy. We report a case of adult-onset episodic sleep-walking and daytime complex visual hallucination. Ambulatory EEG recordings suggested that both events were ictal phenomenon. Interictal sphenoidal EEG and SPECT studies revealed an epileptogenic focus in the left anterior temporal lobe. During the nocturnal wanderings, the patient had bizarre but non-violent behaviour, and was at risk of minor or severe injury to himself. Both events were completely controlled by carbamazepine for a follow-up period of 8 years. The present case further supports the notion that episodic nocturnal wandering represents an unusual type of nocturnal complex partial seizures.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |