Sleep patterns of urban school-going adolescents.

OBJECTIVE: To analyze the variance in sleep habits of adolescents of different high school Grades in urban India. DESIGN: Cross-sectional questionnaire-based study. SETTING: Community based school survey in an urban setting. SUBJECTS: School going adolescents from 9th to 12th Grades. METHODS: A total of 1,920 adolescents aged 12-18 years were included. The questionnaire contained questions related to sleep habits. Each question was explained to the participants and their responses were noted. Outcome parameters were total sleep time in a day, time to go to bed and wake up-time, sleep latency, nocturnal awakenings (duration, frequency per night and nights per week), wake-time after sleep onset, wake time after sleep offset, sleep efficiency, quality of sleep, daytime napping (duration and frequency), and sleepiness during the day. RESULTS: Mean age of the adolescents included in this study was 15.1 years and mean total sleep time was 7.8 hr/day. Adolescents of higher Grades had lesser total sleep time (9th=8 hours; 10th=7.7 hours; 11th=7.9 hours; 12th=7.6 hours; P=0.001), and more frequent nocturnal awakenings (9th=35.9%; 10th=44.7%; 11th=40.3%; 12th=28.3%; P=0.001). Daytime leg pain ( 9th=14.4%; 10th=18.4%; 11th=6.1%; 12th= 21.8%; P=0.01), daytime napping (9th=47.6%; 10th=50.4%; 11th=61.8%; 12th=69.8%; P=0.001), and daytime sleepiness (9th=37.2%; 10th=39.1%; 11th=39.7%; 12th=54.2%; P=0.001) increased progressively among higher Grades. Adolescents in higher Grades were more prone to not follow their weekly schedule on week-ends (P= 0.001). Sleep debt of approximately one hour per day was seen in all adolescents, and progressed with higher Grades. CONCLUSION: Adolescents of higher Grades had lesser sleep time, and frequent awakenings; suffered daytime leg pain, and felt sleepy during the day. These factors suggest increasing sleep deprivation among higher Graders.

Amisulpride: a Brief Review.

Amisulpride, belonging to second generation antipsychotics, is a substituted benzamide derivative indicated for the treatment of acute and chronic schizophrenia with prominent positive and/or negative symptoms. Amisulpride has high affinity for the dopamine D2/D3 receptors. It inhibits dopamine transmission by blocking postsynaptic D2/D3 receptors in the limbic system, which is predicative of potent antipsychotic activity. The elimination half-life is 12 hours. Metabolism is limited with most of the drug excreted unchanged in the feces (64%). Clinical studies have supported that Amisulpride (400-1200mg/day) is at least as effective as Haloperidol and Risperidone and more effective than flupenthixol in acute exacerbation. In the treatment of patients with predominantly negative symptoms, Amisulpride was more effective than placebo. Recently some studies have shown it to be having efficacy in dysthymia also. Its favorable characteristics also include low incidence of EPSE and weight gain, however, it has a high incidence of prolactin elevation.

Chronic daily headache: medications overuse and psychiatric morbidity

The objectives of the study were: [i] To assess the frequency of different chronic daily headaches in patients using ICHD-2 criteria [ii] To find out the frequency and type of medication overuse and psychiatric morbidity in chronic daily headache subjects. Cross sectional observational study. The study was conducted in the psychiatry outpatient department of a teaching medical institution during January to September 2005. Subjects suffering from chronic daily headache were recruited from a specialized headache clinic in a tertiary care hospital's Psychiatry department. The diagnoses were made according to ICHD-2. Medication overuse was defined according to ICHD-2 criteria and psychiatric illness was diagnosed following ICD-10 criteria in CDH patients. In subjects fulfilling the criteria for 'medication overuse', the culprit drug was stopped immediately and prophylactic therapy was started. Frequency of chronic daily headache was 37% in this sample. Females outnumbered males [1:1.52] and formed higher number of migraine cases [p=0.02]. Tension Type Headache [TTH] was most frequent headache [48.5%]. According to ICHD-2 criteria, probable medication overuse headache could be diagnosed in all patients, which precluded the diagnosis of chronic migraine and chronic TTH. Psychiatric morbidity was seen in 70.3% subjects and mild to moderate depression was the most common illness [53%]. TTH subjects showed predisposition for anxiety disorders [OR= 6.41; p= 0.004]. TTH is the most common subtype of CDH when ICHD-2 is followed. Medication overuse is common in this group of patients and these probably should be discontinued according to substance dependence de-addiction model for better compliance, and even more slowly in subjects with chronic migraine headache. Psychiatric morbidity is prevalent in CDH patients and requires special attention