ABSTRACT
ABSTRACT Yawning is a stereotyped physiological behavior that can represent a sign or symptom of several conditions, such as stroke, parakinesia brachialis oscitans, parkinsonism, Parkinson's disease and epilepsy. More rarely, it can occur in patients with intracranial hypertension, brain tumor, multiple sclerosis, migraine, Chiari malformation type I, and amyotrophic lateral sclerosis. Drug-induced yawning is an uncommon clinical condition and yawning in patients with autism or schizophrenia is very rare. The aim of this review is to describe in detail the occurrence of the phenomenon in such conditions, and its' phenomenology and pathophysiology.
RESUMO Bocejo é um comportamento estereotipado fisiológico, o qual, contudo, pode representar um sinal ou sintoma de várias condições neurológicas, tais como, acidente vascular encefálico, incluindo a parakinesia brachial oscitans, parkinsonismo, doença de Parkinson, e epilepsia. Mais raramente, o bocejo pode ocorrer em pacientes com hipertensão intra-craniana, tumor cerebral, esclerose múltipla, migrânea, malformação de Chiari tipo I, e esclerose lateral amiotrófica. Bocejo-induzido por drogas representa outra condição clínica pouco comum. De outro modo, bocejo é muito raro em pacientes com autismo e esquizofrenia. O objetivo desta revisão foi descrever em detalhes a ocorrência deste fenômeno em tais condições, sua fenomenologia e fisiopatologia.
Subject(s)
Yawning , Nervous System Diseases/physiopathologyABSTRACT
Introduction Antidepressant induced excessive yawning has been described as a possible side effect of pharmacotherapy. A syndrome of indifference has also been described as another possible side effect. The frequency of those phenomena and their physiopathology are unknown. They are both considered benign and reversible after antidepressant discontinuation but severe cases with complications as temporomandibular lesions, have been described. Methods We report two unprecedented cases in which excessive yawning and indifference occurred simultaneously as side effects of antidepressant therapy, discussing possible physiopathological mechanisms for this co-occurrence. Case 1: A male patient presented excessive yawning (approximately 80/day) and apathy after venlafaxine XR treatment. Symptoms reduced after a switch to escitalopram, with a reduction to 50 yawns/day. Case 2: A female patient presented excessive yawning (approximately 25/day) and inability to react to environmental stressors with desvenlafaxine. Conclusion Induction of indifference and excessive yawning may be modulated by serotonergic and noradrenergic mechanisms. One proposal to unify these side effects would be enhancement of serotonin in midbrain, especially paraventricular and raphe nucleus. .
Introdução Alguns relatos de caso descrevem pacientes com bocejos excessivos induzidos por antidepressivos. Também é relatada a capacidade dos antidepressivos induzirem uma síndrome de indiferença. A frequência desses efeitos colaterais é desconhecida, assim como seus mecanismos fisiopatológicos. Ambos os efeitos são considerados benignos e costumam ser reversíveis após a suspensão dos antidepressivos, porém há relatos de casos graves com a ocorrência de luxação temporomandibular devida aos bocejos excessivos induzidos por antidepressivos. Métodos Relatamos dois casos inéditos de pacientes, apresentando esses efeitos colaterais de forma concomitante, discutindo os possíveis mecanismos fisiopatológicos e explicando essa coocorrência. Caso 1: O paciente apresentou bocejos excessivos e apatia com o uso de venlafaxina XR (cerca de 80 bocejos por dia) e, após a troca para escitalopram por conta desse efeito, teve redução para cerca de 50 bocejos por dia. Também relatava sentimento de lentidão e apatia com ambas as medicações. Caso 2: A paciente apresentou bocejos excessivos (cerca de 25 por dia) e declínio na responsividade emocional a estímulos ambientais, associado à incapacidade de chorar com o uso de desvenlafaxina. Conclusão A indução de indiferença e de bocejos excessivos parece ser modulada por mecanismos serotonérgicos e noradrenérgicos. Uma proposta que poderia unificar esses efeitos é pelo aumento serotoninérgico no mesencéfalo, especialmente nos núcleos paraventriculares hipotalâmicos e da rafe. .
ABSTRACT
OBJECTIVES: Dislocation of the temporomandibular joint may occur for various reasons. Although different invasive methods have been advocated for its treatment, this study highlights the value of non-invasive treatment options even in chronic cases in a resource-poor environment. MATERIALS AND METHODS: A seven-year retrospective analysis of all patients managed for temporomandibular joint dislocation in our department was undertaken. Patient demographics, risk factors associated with temporomandibular joint dislocation and treatment modalities were retrieved from patient records. RESULTS: In all, 26 patients were managed over a seven-year period. Males accounted for 62% of the patients, and yawning was the most frequent etiological factor. Conservative treatment methods were used successfully in 86.4% of the patients managed. Two (66.7%) of the three patients who needed surgical treatment developed complications, while only one (5.3%) patient who was managed conservatively developed complications. CONCLUSION: Temporomandibular joint dislocation appears to be associated with male sex, middle age, yawning, and low socio-economic status, although these observed relationships were not statistically significant. Non-invasive methods remain an effective treatment option in this environment in view of the low socio-economic status of the patients affected.
Subject(s)
Humans , Male , Middle Aged , Demography , Joint Dislocations , Nigeria , Retrospective Studies , Risk Factors , Temporomandibular Joint , YawningABSTRACT
Debido a la vida tan dinámica de hoy día, y a factores de índole ambiental, genético y social, la ansiedad ha pasado a ocupar uno de los lugares principales dentro de los trastornos psicológicos, no solo en Cuba, sino a nivel mundial. Actualmente el diagnóstico y su evaluación se basan en pruebas subjetivas fundamentalmente a través de test. Motivados por los elementos antes expuestos se decidió investigar con el objetivo de hacer una evaluación preliminar de un software encaminado a medir variables, mediante la prueba del tecleo (mouse finger tapping) e inducción del bostezo, que aporten elementos objetivos para la valoración de pacientes con trastornos de ansiedad. Se realizó un estudio descriptivo transversal sobre la observación de las pruebas realizadas en pacientes atendidos en el Centro Comunitario de Salud Mental La Lisa, Ciudad Habana, de enero de 2008 a septiembre de 2009. La población de estudio estuvo conformada por 90 sujetos, y fueron evaluados mediante la prueba de Scam. Se tomaron datos de la historia clínica individual, y posteriormente se procesaron y representaron en tablas arribando a resultados. Se concluyó que las pruebas de tecleo e inducción visual del bostezo, permiten diferenciar de manera eficiente los grupos de sujetos estudiados.
Due to the agitated dynamic of the current life and many other environmental, genetic and social factors, the anxiety has passed to occupy one of the main places among the psychological dysfunctions, not only in Cuba, but at the world level. Nowadays the diagnosis and evaluation of this illness are based fundamentally on subjective tests. Motivated by the previously exposed elements, we decided to carry out a research with the objective of preliminary evaluating a software made for measuring variables, by means of the tapping test (mouse finger tapping) and yawn induction that renders objective elements in the evaluation of patients with anxiety dysfunctions. We carried out a cross-sectional descriptive study on the observation of the tests made in patients attended at the Communitarian Center of Mental Health La Lisa, Ciudad de La Habana, from january 2007 to september 2008. The studied population was formed by 90 subjects that were evaluated by means of the Scam test. We collected data from the individual clinical history. They were processed and shown in tables and charts arriving to conclusions. We concluded that the tapping test and the test of yawning visual induction allow differentiating, in an efficient way, the groups of studied patients.
Subject(s)
Humans , Male , Adult , Female , Anxiety/diagnosis , Yawning/physiology , Computers , Exploratory Behavior , Epidemiology, Descriptive , Observational Studies as TopicABSTRACT
BACKGROUND: We can usually see the yawning at induction of anesthesia, however, it has not been studied as such an indicator of anesthesia. The yawning is one means of changing arousal level, and a sign or marker that such a change is occurring, although its functions are not well understood. The purpose of the present study was to evaluate the yawning whether it could be used as an indicator of induction of anesthesia, using its property as a marker of changed arousal level. METHODS: In 60 adult patients, group 1 was done propofol target controlled infusion (TCI) with Stelpump software, while group 2 was done thiopental TCI similarly. Clinical indicators of induction of anesthesia were measured as follows: loss of verbal control (LOV), loss of eyelash reflex (LOE), the yawning. In addition, the occurrence of apnea (OOA) were measured, too. We assessed the hypnosis levels of indicators of induction of anesthesia including the yawning and demonstrate their effect site concentrations and elapsed time. Furthermore, we compared the incidences of yawning and apnea between both groups. RESULTS: Clinical indicators of induction occurred in the order of LOV > LOE > the yawning >> OOA in both groups. With respect to BIS, the yawning showed the lowest BIS and the highest effect site concentrations except OOA in both groups. The incidence of the yawning in group 2 was higher than in group 1 (about 82 vs 63%). On the contrary, the incidence of apnea in group 1 was higher than in group 2 (about 79 vs 53%). CONCLUSIONS: As far as the yawning could be shown, we could observe, it approximated most closely to their clinical impression of the 'true' induction in terms of the hypnosis level and its effect site concentration.
Subject(s)
Adult , Humans , Anesthesia , Apnea , Arousal , Hypnosis , Incidence , Propofol , Reflex , Thiopental , YawningABSTRACT
The present experiments were performed to investigate effects of a Kampo (Japanese herbal) medicine, Kambaku-taiso-to (Gan-mai-da-zao-tang), on incidence of yawning in rats. Physostigmine, a cholinesterase inhibitor, 0.05-0.1mg/kg s. c., induced yawning responses with a marked effect at 0.05mg/kg. Pilocarpine, a muscarinic receptor agonist, 1-2mg/kg s. c., also induced yawning responses, the maximum effect being observed at a dose of 2mg/kg. Talipexole, a dopaminergic D-2 receptor agonist, 0.02mg/kg s. c., also induced yawning. Kambaku-taiso-to, 250-1, 000mg/kg, was orally administered 30min before injection of physostigmine, pilocarpine or talipexole. The yawning induced by both cholinergic and dopaminergic agents was reduced in a dose-dependent manner by Kambaku-taiso-to. All the yawning responses to cholinergic and dopaminergic agents were also reduced by rauwolscine 0.5mg/kg, yohimbine 2.5mg/kg, α-2 adrenoceptor antagonists, and by scopolamine 0.5mg/kg—muscarinic receptor antagonist. The present findings thus suggest that Kambaku-taiso-to exerts a suppressive effect on the incidence of yawning, and dopaminergic and cholinergic suppression and the indirect suppressive mechanism mediated by the central adrenergic nerve are associated with this suppression.
ABSTRACT
The present experiments were performed to investigate the potential role of Kambaku taiso-to (Gan mai da zao tang) in modifying the occurrence of yawning in rats. Subcutaneous injection of talipexole, a selective dopamine D-2 receptor agonist, at 5-100μg/kg, elicits yawning behavior for over one hour, the maximal effect being observed at a dose of 25μg/kg. Kambaku-taiso-to significantly suppressed the incidence of yawning induced by talipexole. These results suggest that Kambaku-taiso-to exerts a suppressive effect on the incidence of yawning.