1/10. The kleine-levin syndrome. Report of a case and review of the literature.kleine-levin syndrome is a rare self-limited disorder which usually affects adolescent males and is characterized by episodic hypersomnia, increased appetite, and behavioral/psychiatric disturbances. Individuals are normal between the attacks. The case of an adolescent boy is presented who suffered from recurrent sleepiness, hyperphagia, and behavioral disturbances such as rocking, punching and pacing, and was originally misdiagnosed as suffering from encephalitis. Before the diagnosis of Kleine-Levin was given, the patient underwent unnecessary investigations and treatment which, in turn, complicated his clinical condition both physically as well as psychologically. In the course of five years he had four such episodes which appeared to have progressively milder manifestations. Between episodes he was normal. It is important that the diagnosis is suspected early, especially in adolescent males who present with recurrent episodes of somnolence, increased appetite, and abnormal behavior, since it most often represents a benign and self-limited entity and does not warrant extensive investigations or treatment. It is also important to distinguish this syndrome from more serious organic and psychiatric diseases with more serious prognoses. The differential diagnosis of this syndrome is discussed and a review of the literature is presented including evidence and hypotheses regarding its pathophysiology.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/10. Is the delayed sleep phase syndrome a physical or psychological disease? A case report of disappearance following a change of latitude.The delayed sleep phase syndrome is characterized by an abnormally late sleeping and arousal time. Among several available treatments, chronotherapy, light therapy and melatonin administration strongly suggest a frequently recurring disturbance of the brain's circadian clock. However, several studies show psychological disturbances, which are either potentially a consequence or a cause or only fortuitously associated. The first case of disappearance of the disturbance after a move to a tropical latitude does not determine the main responsible factor.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
3/10. Increased deep sleep in a medication-free, detoxified female offender with schizophrenia, alcoholism and a history of attempted homicide: case report.BACKGROUND: Psychiatric sleep research has attempted to identify diagnostically sensitive and specific sleep patterns associated with particular disorders. Both schizophrenia and alcoholism are typically characterized by a severe sleep disturbance associated with decreased amounts of slow wave sleep, the physiologically significant, refreshing part of the sleep. Antisocial behaviour with severe aggression, on the contrary, has been reported to associate with increased deep sleep reflecting either specific brain pathology or a delay in the normal development of sleep patterns. The authors are not aware of previous sleep studies in patients with both schizophrenia and antisocial personality disorder. CASE PRESENTATION: The aim of the present case-study was to characterize the sleep architecture of a violent, medication-free and detoxified female offender with schizophrenia, alcoholism and features of antisocial personality disorder using polysomnography. The controls consisted of three healthy, age-matched women with no history of physical violence. The offender's sleep architecture was otherwise very typical for patients with schizophrenia and/or alcoholism, but an extremely high amount of deep sleep was observed in her sleep recording. CONCLUSIONS: The finding strengthens the view that severe aggression is related to an abnormal sleep pattern with increased deep sleep. The authors were able to observe this phenomenon in an antisocially behaving, violent female offender with schizophrenia and alcohol dependence, the latter disorders previously reported to be associated with low levels of slow wave sleep. New studies are, however, needed to confirm and explain this preliminary finding.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/10. Managing sleep disturbances in children with learning disabilities.The view that children with special needs are more likely to experience sleep disturbances is well recognised. various physical and psychological factors associated with the child's condition, as well as the influence that the child's disability has on parents' attitude and management, combine to increase the likelihood of the child developing sleep disturbances. However, these factors should not act as a barrier to trying to find successful solutions.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/10. Hypnogenic paroxysmal dystonia: a new type of parasomnia?Four cases of hypnogenic paroxysmal dystonia are described. The patients (three males and one female), aged between 12 and 39 were subjected to neurological, physical and psychological examination, and routine lab tests and brain CT scan were carried out within normal limits. One of the patients suffered from diurnal epileptic seizures. Repeated EEG recordings during wakefulness were normal. During polysomnographic and TV recordings the patients showed different types of dystonic fits occurring several times a night, always brief, and starting during NREM sleep. carbamazepine therapy proved to be relatively effective in three subjects.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/10. Anaesthesia for Treacher Collins and Pierre Robin syndromes: a report of three cases.We present three patients with Treacher Collins or Pierre Robin syndromes who had historical and physical evidence of airway obstruction, difficulty feeding, and sleep disturbances. These preoperative findings correlated with difficult airway management intraoperatively. Based on this experience, we recommend that children with obstructive symptoms have laryngoscopy prior to anaesthetic induction. If the glottic opening is visualized, inhalational induction can proceed. If the glottic structures cannot be visualized, then the anaesthetist must choose between awake oral or nasal intubation, elective tracheostomy, or fiberoptic intubation. In all cases, a tracheostomy tray should be ready and a surgeon experienced in paediatric tracheostomy should be in attendance. After intubation, anaesthesia is best maintained with oxygen and a potent inhalational agent. Extubation should only be done with the patient fully awake and with emergency airway equipment immediately available. Postoperatively, these patients should be transferred to an intermediate care area or intensive care unit where they can be observed closely since delayed complications of airway obstruction are common in this group of patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/10. conversion disorder revisited: severe parasomnia discovered.In light of recently described and reviewed disorders of movement and behaviour during sleep, the long standing diagnosis of conversion disorder in a forty-nine year old vietnam veteran was reappraised. Polysomnographic studies showed that the nocturnal component of his "pseudoseizures" was due to physical disorder, a severe mixed parasomnia comprising the recently described REM behaviour disorder and a non-REM parasomnia. His sleep architecture was also deranged, featuring reduced REM latency and increased REM density. An association between these abnormalities and psychological trauma is recognised in the literature. Treatment with clonazepam has abolished the nocturnal behavioural disturbance. His daytime pseudoseizures occur less frequently and his general well being is improved. The case is a reminder that physical disorder may underlie and act as prototype to the psychologically-driven symptom. Before attributing behavioural disturbance at night to psychological causes alone, polysomnographic studies should be done to exclude a treatable parasomnia.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
8/10. Benign neonatal sleep myoclonus.Benign neonatal sleep myoclonus is a disorder characterised by abnormal episodic jerky movements, which occur exclusively during sleep. When the history is suggestive of the diagnosis, and physical examination and basic investigations are normal, a confident diagnosis can usually be reached, and other potentially more serious neonatal seizure disorders excluded. This allows the doctor to reassure the parents as to the prognosis--the condition resolves spontaneously within the first year, most often within the first three months, with no sequelae. We describe four patients who presented to one unit with this condition.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/10. Resolution of sleep paralysis by weak electromagnetic fields in a patient with multiple sclerosis.sleep paralysis refers to episodes of inability to move during the onset of sleep or more commonly upon awakening. patients often describe the sensation of struggling to move and may experience simultaneous frightening vivid hallucinations and dreams. sleep paralysis and other manifestations of dissociated states of wakefulness and sleep, which reflect deficient monoaminergic regulation of neural modulators of REM sleep, have been reported in patients with multiple sclerosis (MS). A 40 year old woman with remitting-progressive multiple sclerosis (MS) experienced episodes of sleep paralysis since the age of 16, four years prior to the onset of her neurological symptoms. Episodes of sleep paralysis, which manifested at a frequency of about once a week, occurred only upon awakening in the morning and were considered by the patient as a most terrifying experience. Periods of mental stress, sleep deprivation, physical fatigue and exacerbation of MS symptoms appeared to enhance the occurrence of sleep paralysis. In July of 1992 the patient began experimental treatment with AC pulsed applications of picotesla intensity electromagnetic fields (EMFs) of 5Hz frequency which were applied extracerebrally 1-2 times per week. During the course of treatment with EMFs the patient made a dramatic recovery of symptoms with improvement in vision, mobility, balance, bladder control, fatigue and short term memory. In addition, her baseline pattern reversal visual evoked potential studies, which showed abnormally prolonged latencies in both eyes, normalized 3 weeks after the initiation of magnetic therapy and remained normal more than 2.5 years later. Since the introduction of magnetic therapy episodes of sleep paralysis gradually diminished and abated completely over the past 3 years. This report suggests that MS may be associated with deficient REM sleep inhibitory neural mechanisms leading to sleep paralysis secondary to the intrusion of REM sleep atonia and dream imagery into the waking state. Pineal melatonin and monoaminergic neurons have been implicated in the induction and maintenance of REM sleep and the pathogenesis of sleep paralysis and it is suggested that resolution of sleep paralysis in this patient by AC pulsed applications of EMFs was related to enhancement of melatonin circadian rhythms and cerebral serotoninergic neurotransmission.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/10. Psychological features of acromegaly.acromegaly is a serious but often undiagnosed condition that is often unrecognized for many years. The delay from onset of symptoms until the time of diagnosis results in a unique constellation of physical and mental problems for patients and health care professionals. The purpose of this chapter is to identify the psychological consequences experienced by individuals affected with pituitary tumors which alter growth hormone release. As little research has been completed on the subject, very little is known, or has been applied, in the treatment of these patients. To identify the presence of psychological features, the research which exists and an in-depth qualitative analysis of the personal experience of one of the author (K.F.), having suffered a pituitary macroadenoma with accompanying acromegaly, is described. Our findings are compared with those from an earlier series and the few published reports.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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