ABSTRACT
Nightmares are common in patients with advanced cancer. However, there are no standard treatment of nightmare in patients with cancer. We experienced a case with nightmares improved by Saikokaryukotsuboreito (SRBT). An 82-year-old man with malignant lymphoma experienced insomnia and nightmares. Antidepressants, orexin receptor antagonists, and atypical antipsychotics failed to improve the symptoms, but SRBT immediately eliminated his insomnia and nightmares. SRBT, an herbal medicine, has been used in a variety of clinical situations for treatment of stress-induced psychiatric symptoms, i.e., anxiety, depression, and insomnia, without serious adverse events. Several reports suggest that SRBT improves depression and anxiety with the effects on chronic stress-induced disruption of hypothalamo-pituitary-adrenal axis. The effects of SRBT might have improved nightmares in this case. SRBT may be a drug of choice in the treatment of nightmares in patients with cancer.
ABSTRACT
Reactions to severe stress and adjustment disorders may go unnoticed if their symptoms are not related to the original traumatic situation; they may be masked by different psychosomatic complaints or mistaken for other mental disorders. If the disorder goes undiagnosed, the treatment and the psychotherapeutic approach will not be effective, resulting in chronicity and treatment resistance. Therefore, in order to achieve the desired diagnosis, besides the comprehensive assessment of disturbances, it was of great help to explore a symptom which, although frequently reported by patients, can go unnoticed in the psychopathology of these disorders: distressing dreams or nightmares. We consistently noticed that distressing dreams or nightmares in women with various affective and behavioral disorders would appear to be a premonitory symptom of the post-abortion traumatic origins of the condition and a call to consider such hypothesis. The conclusion is that nightmares are very sensitive and specific indicators of the presence of post-traumatic disorders. Therefore, in order to reach the desired efficiency in the diagnosis and treatment of post-abortion psychopathology, we postulate that, in all affective or adjustment disorders, in addition to a comprehensive assessment of their disturbances, the presence of abortion-related persistent nightmares should be taken into account or investigated, since they are often the key symptom in identifying post-abortive reactivity within the disorde
Las reacciones al estrés grave y los trastornos de adaptación pueden pasar inadvertidos, enmascarados por diferentes quejas psicosomáticas o confundidos con otras alteraciones mentales, si sus síntomas no se relacionan con el trauma que los originó. Si el trastorno queda sin diagnosticar, su tratamiento y abordaje psicoterapéutico no serán efectivos, dando lugar a la cronicidad y resistencia de la afección. Pero para llegar a dicho diagnóstico, además de la evaluación integral de las alteraciones, nos fue de gran ayuda la exploración de un síntoma que, aunque referido frecuentemente por las pacientes, puede pasar desapercibido en el conjunto psicopatológico de estos trastornos: los sueños angustiosos o pesadillas. De forma repetida fuimos comprobando que los ensueños angustiosos o pesadillas, en mujeres con diversos trastornos afectivos y conductuales, parecían ser un síntoma premonitorio del origen traumático posabortivo de la sintomatología y una llamada de alerta que obligaba a tener en cuenta dicha hipótesis, llegando finalmente a la conclusión de que las pesadillas son indicadores muy sensibles y específicos de la presencia de alteraciones postraumáticas. Por ello, para lograr la deseada eficiencia en el diagnóstico y tratamiento de la psicopatología posabortiva, postulamos que, ante todo trastorno afectivo o conductual-desadaptativo, aparte de una evaluación integral de sus alteraciones, se tenga muy en cuenta -o se investigue en su caso- la presencia de pesadillas persistentes sobre temas abortivos, por ser éstas muchas veces el síntoma clave en la identificación de la reactividad posabortiva de los trastornos
Subject(s)
Psychopathology , Abortion, Induced , Abortion, Induced/adverse effects , DreamsABSTRACT
OBJECTIVES: The current study aimed to explore the difference of dream themes, emotional intensity, and sleep parameters between nightmares and bad dreams in nightmare sufferers. METHODS: Twenty-four nightmare sufferers who endorsed clinical levels of nightmares (Disturbing Dream and Nightmare Severity Index Scores ≥10) recorded daily information about their dream themes using a modified version of the Typical Dreams Questionnaire, emotional intensity about their nightmares and bad dreams, and sleep for two weeks on a mobile device. RESULTS: Evil presence (35%) was reported with higher frequency in nightmares, whereas interpersonal conflicts (31%) were predominantly reported in bad dreams. Nightmares were rated substantially more emotionally intense than bad dreams. Especially, fear (Z=-2.118, p=0.034) was rated as being significantly higher in nightmares than bad dreams. There were differences on time in bed, wake after sleep onset, sleep efficiency on the days with nightmares or bad dreams compared to other days; however, there were no differences in sleep parameters between nightmares and bad dreams. CONCLUSIONS: The results suggest that nightmares may be qualitatively and quantitatively different from bad dreams in nightmare sufferers.
Subject(s)
DreamsABSTRACT
Se realizó un estudio descriptivo de 110 estudiantes de primer año de la carrera de medicina en la Facultad de Ciencias Médicas No. 2 de Santiago de Cuba, desde enero hasta julio del 2014, con el objetivo de determinar algunas variables biológicas que pudieran estar relacionadas con los principales trastornos del sueño. La información fue procesada estadísticamente, con el empleo del porcentaje como medida de resumen y la aplicación de la prueba de la Χ² para valorar la posible asociación entre variables. En la serie se obtuvo que los trastornos del sueño más frecuentes fueran el insomnio, los ronquidos y las pesadillas, con predominio en las féminas; no obstante, en la mayoría de los alumnos el electroencefalograma resultó normal.
A descriptive study of 110 first year students of the medicine career was carried out in the Medical Sciences faculty No. 2 in Santiago de Cuba, from January to July, 2014, with the objective of determining some biological variables that could be related to the main sleep dysfunctions. The information was statistically processed, with the use of the percentage as summary measure and the chi squared test to evaluate the possible association between variables. In the series it was obtained that the most frequent sleep dysfunctions were insomnia, the snoring and nightmares, with prevalence in the females; nevertheless, in most of the students the electroencephalogram was normal.
Subject(s)
Sleep Wake Disorders , Sleep Initiation and Maintenance Disorders , Students, Medical , Respiratory Sounds , DreamsABSTRACT
Parasomnias are abnormal experiences or behaviours that occur during sleep and can be subdivided into disorders of arousal, disorders of rapid eye movement (REM) sleep or other parasomnias. Diagnosis rests on a thorough clinical evaluation with supporting data from a full polysomnography with time synchronized video. While the prognosis for arousal disorders is generally excellent, the diagnosis of REM behaviour disorder (RBD) is more ominous and associated with neurodegenerative disorders, and as such, requires routine neurological surveillance. The cornerstone of treatment for all parasomnias is adequate patient and bed partner education. Data supporting pharmacologic therapy are limited but clonazapam for RBD has been reported to be effective in up to 89 per cent of patients.
Subject(s)
Adolescent , Adult , Age of Onset , Aged , Clonazepam/therapeutic use , Female , Humans , Male , Mental Disorders/diagnosis , Mental Disorders/etiology , Middle Aged , Neurodegenerative Diseases/diagnosis , Neurodegenerative Diseases/etiology , Parasomnias/diagnosis , Parasomnias/epidemiology , Parasomnias/therapy , Polysomnography/methods , Treatment Outcome , Young AdultABSTRACT
Introducción: Las pesadillas son síntomas usuales y característicos del trastorno por estrés postraumático (TEPT). Su presencia se relaciona directamente con la gravedad del trastorno, suelen tener un impacto negativo en la calidad de vida de los pacientes y, como frecuentemente se convierten en un síntoma residual y refractario, requieren especial atención y tratamiento específico. Objetivo: Revisar y actualizar los conocimientos acerca del tratamiento farmacológico de las pesadillas en el TEPT. Método: Este artículo revisa y actualiza los tratamientos disponibles para el manejo de las pesadillas en el TEPT. Conclusión: Se han realizado muy pocos estudios acerca del tratamiento farmacológico específico para las pesadillas en el TEPT. La mayoría han sido de diseño abierto o reportes de casos, las muestras han sido pequeñas, con grupos heterogéneos y algunos de los resultados han sido contradictorios. La psicoterapia adquiere entonces gran relevancia en el tratamiento de las pesadillas, pues aunque aún no hay estudios que muestren la superioridad de una modalidad sobre la otra (farmacoterapia versus psicoterapia), la experiencia clínica muestra que la combinación es importante y benéfica para los pacientes...
Introduction: Nightmares are common and characteristic symptoms of Posttraumatic Stress Disorder (PTST). Their presence is directly related with the severity of the disorder, usually having a negative impact on the patients quality of life. They frequently become a refractory and residual symptom, and require special attention and specific treatment. Objective: To review and update current knowledge on the pharmacological treatment available for PTSD nightmares. Conclusion: Very few studies have been done addressing the pharmacological treatment for PTSD nightmares. Most have an open design or are case reports, the samples have been small with heterogeneous groups, and some of the results have been contradictory. Psychotherapy, then, acquires great relevance in the treatment of nightmares, since although no studies exist that show the superiority of one modality over another (pharmacotherapy versus psychotherapy), clinical experience shows that the combination is beneficial for patients...