Psychoanalytic therapy for a child with somnambulism: a case report / 南方医科大学学报

Somnambulism is defined as a state of dissociated consciousness triggered by impaired arousal, which results in partial wakefulness and partial sleep. No effective therapy or medication has been available for treating children with somnambulism. Herein we present a case in a 4.5-year-old girl, who presented with somnambulism associated with separation anxiety disorder every night in a week. The girl received formal assessment and appropriate interventions, and the symptoms disappeared within a week. The treatment was carried out in 5 stages: diagnosis of the disease, establishment of trust, information collection, supervision, and individualized psychotherapy. Although dreams in childhood can be difficult to interpret, close observation of the behaviors in sleepwalking, as a special form of dream, in addition to the more precise description by the guardians, still provides useful clues to understand those dreams. For children with somnambulism, early intervention with psychotherapy can significantly decrease the false revival of the unconscious desires, and thus may serve as a treatment option other than medications.

As investigações dos fenômenos psíquicos/espirituais no século XIX: sonambulismo e espiritualismo, 1811-1860 / Investigations of psychic/spiritual phenomena in the nineteenth century: somnambulism and spiritualism, 1811-1860

Resumo No início do século XIX, investigações sobre a natureza de fenômenos psíquicos/espirituais como transes e supostas aquisições de informações indisponíveis aos canais sensoriais normais geraram grande debate no meio científico. Este artigo discute as principais explicações oferecidas pelos pesquisadores dos fenômenos psíquicos entre 1811 e 1860, concentrando-se nos dois movimentos principais no período: sonambulismo magnético e espiritualismo moderno. As investigações desses fenômenos geraram diversas teorias, sem que se chegasse a consenso, mas trouxeram implicações para a compreensão da mente e de seus transtornos, notadamente na área do inconsciente e da dissociação, constituindo-se como parte importante da história da psicologia e da psiquiatria.

Abstract In the early nineteenth century, investigations into the nature of psychic/spiritual phenomena, like trances and the supposed acquisition of information unattainable using normal sensory channels, prompted much debate in the scientific arena. This article discusses the main explanations offered by the researchers of psychic phenomena reported between 1811 and 1860, concentrating on the two main movements in the period: magnetic somnambulism and modern spiritualism. While the investigations of these phenomena gave rise to multiple theories, they did not yield any consensus. However, they did have implications for the understanding of the mind and its disorders, especially in the areas of the unconscious and dissociation, constituting an important part of the history of psychology and psychiatry.

<b>A Case of Somnambulism Successfully Treated with Sansoninto</b> / 日本東洋医学雑誌

We report a case of somnambulism successfully treated with sansoninto. A 55-year-old woman had an initial episode of somnambulism in childhood, which recurred in her early 20s along with development of psychotic manifestations. The patient was hospitalized in a psychiatric hospital with a diagnosis of schizoaffective disorder and coexisting Crohn's disease. At the age of 55, she began to show nocturnal wandering tendencies and we prescribed yokukansan at 2.5 g/day, though the symptoms only temporarily improved. Following a switch to sansoninto at 7.5 g/day, the symptoms disappeared. Based on our experience with this case, we speculate that the Heart component of the five viscera theory in traditional Chinese medicine plays a key role in somnambulism.

Sleepwalking Triggered by Hypoglycemia

Sleepwalking is a rare parasomnia in the elderly. We report two cases of the patients who presented complex motor behaviors during sleep triggered by hypoglycemia. A 76-year-old male patient with diabetes mellitus presented to the sleep clinic for recurrent sleepwalking with amnesia. Night polysomnogram showed REM sleep without atonia with sleep talking and distal arm movements. While taking clonazepam, he had a few more episodes of sleepwalking. The last episode finally revealed severe hypoglycemia when he was found very far from his house. The second patient, a 67-year-old male showed four episodes of nocturnal confusion and sleepwalking lasting 20 minutes during sleep. His blood glucose and HbA1c were low. After decrease of the dose of oral hypoglycemic agent, no more recurrent sleepwalking occurred. Our cases showed hypoglycemia can induce sleepwalking in the older adults, rather than decreased mentality. Metabolic workup should perform for evaluation of sleepwalking, especially in the elderly.

An unexpected increase of entropy in a sleepwalking disorder patient during propofol and remifentanil anesthesia: a case report / 대한마취과학회지

We report a case of increased values of entropy parameters Response Entropy (RE) and State Entropy (SE) during intravenous general anesthesia in a sleepwalking patient. An ASA class II, 64-year-old woman with stress incontinence underwent mid-urethral sling surgery. Prior to surgery, the patient had been administered paroxetine, valproic acid and clonazepam for the treatment of sleepwalking disorder. After 10 min of target-controlled infusion of propofol and remifentanil, entropy values increased up to 94 (RE) and 88 (SE) for 10 min. The target effect-site concentrations of anesthetics increased from 4 to 7 microg/ml propofol and 4 ng/ml remifentanil, at which point values fell back to adequate anesthesia levels. Episodes of recall or of explicit memories did not occur during the anesthesia. In conclusion, sleepwalking patients with long-term use medications may need increment of anesthetic dose caused by the anesthetic drug metabolism activation or impairment or immaturity of inhibitory circuits in brain.

An unexpected increase of entropy in a sleepwalking disorder patient during propofol and remifentanil anesthesia: a case report / 대한마취과학회지

We report a case of increased values of entropy parameters Response Entropy (RE) and State Entropy (SE) during intravenous general anesthesia in a sleepwalking patient. An ASA class II, 64-year-old woman with stress incontinence underwent mid-urethral sling surgery. Prior to surgery, the patient had been administered paroxetine, valproic acid and clonazepam for the treatment of sleepwalking disorder. After 10 min of target-controlled infusion of propofol and remifentanil, entropy values increased up to 94 (RE) and 88 (SE) for 10 min. The target effect-site concentrations of anesthetics increased from 4 to 7 microg/ml propofol and 4 ng/ml remifentanil, at which point values fell back to adequate anesthesia levels. Episodes of recall or of explicit memories did not occur during the anesthesia. In conclusion, sleepwalking patients with long-term use medications may need increment of anesthetic dose caused by the anesthetic drug metabolism activation or impairment or immaturity of inhibitory circuits in brain.

Síndrome de ingesta nocturna como efecto colateral del zolpidem / Sleep related eating disorders as a side effect of zolpidem

El zolpidem es una droga hipnótica utilizada para el tratamiento del insomnio. Disminuye la latencia del sueño, el número total de despertares y aumenta el tiempo total del sueño respetando en general su arquitectura. Se cree que aumenta la fase 3 del sueño lento profundo. Nuestro objetivo es comunicar 8 casos de síndrome de ingesta nocturna relacionado al sueño y conductas automáticas complejas asociadas a sonambulismo como efecto colateral del zolpidem. Se analizaron las historias clínicas de 8 pacientes tratados con zolpidem que referían ingesta nocturna de alimentos con amnesia total o parcial del episodio. Se presentan 6 mujeres y 2 hombres, entre 32 y 72 años (media: 58 años), 7 tratados con zolpidem 10 mg/noche y 1 con zolpidem 12.5 mg/noche de liberación prolongada. El tiempo de exposición previo al desarrollo de eventos fue de 1 a 180 días (media de 39.8). El número de episodios relatados era de 1 a 8/noche (media 2.5) asociado con amnesia. Los episodios desaparecieron por completo en el 100% de los casos al suspender la medicación. El síndrome de ingesta nocturna relacionado al sueño es una parasomnia de sueño lento profundo que consiste en episodios de ingesta de alimento o bebida durante la noche, con amnesia parcial o completa del episodio. El zolpidem podría inducir el síndrome de ingesta nocturna relacionado al sueño en aproximadamente el 1% de pacientes, aunque creemos que es un efecto adverso que está subdiagnosticado. Se resuelve simplemente suspendiendo la medicación.

Zolpidem is a hypnotic drug used in sleep disorders. It binds selectively to alpha 1 subunit of the GABA A benzodiazepine receptor. Zolpidem reduces sleep latency, number of arousals and increases the total time of sleep. However, it is considered that it may increase phase 3 of non rapid eye movement sleep, where somnambulism can take place. Our aim is to report 8 cases of sleep related eating disorders associated with the use of this drug. We have evaluated the medical history of 8 patients who had received zolpidem for sleeping disorders and who have presented sleep related eating disorders. Eight patients (6 women, 2 men) aged between 32 to 72 years old, which received 10 mg of zolpidem/night except 1 that received 12.5 mg, were presented. They have referred strange eating behavior compatible to sleep related eating disorder. Symptoms appeared at a mean of 39.8 days after starting the medication. The numbers of nocturnal episodes recorded by the family or by the patient were 1 to 8 episodes of nocturnal eating per night. The morning after, patients found leftovers from the night before which they did not recall to have eaten. The remission was complete after discontinuing zolpidem. Zolpidem may induce sleep related eating disorder in about 1% of patients, although we consider there may be a subdiagnosis of this phenomenon. It will be important to bear in mind and look for this side effect because all the episodes could easily be controlled by withdrawing the drug.

Prevalence of Sleepwalking in an Adult Population

Background: Sleepwalking consists of a series of behavioral activities that occur during sleep. These activities may be simple; complex or aggressive in nature. They include motor activities; confusion; and amnesia for the events. Sleepwalking is a disorder of arousal from non-rapid eye movement (NREM) sleep. In children; episodes of sleepwalking are rarely violent; in adults; however; sleepwalking might include violence; which could endanger the patient or others and might precipitate legal issues. There is inadequate information on the prevalence and demographic correlates of sleepwalking in Nigeria. Objectives: One objective of this study was to determine the lifetime prevalence rate of sleepwalking in an adult population in Ile-Ife; in Southwestern Nigeria. Another objective was to determine the age and sex distribution of sleepwalking among those who have experienced it at least once in their lifetime. Materials and Methods: A random sample of 228 healthy individuals aged 18-60 years was obtained and the members were asked to fill out a survey form about lifetime prevalence rate of sleepwalking. Results: The overall lifetime prevalence rate of sleepwalking was 7(16 of 228 participants). It was 10.4in males and 3.5in females; but the difference was not statistically significant (p=0.07). Conclusion: This study has shown that sleepwalking is common in the population. In view of the psychological effects of sleepwalking and the potential physical and legal problems associated with it; adequate efforts should be made for early detection and prompt management of the condition