Successful electroconvulsive therapy in major depression with fluvoxamine-induced bruxism.

SUMMARY: A 61-year-old patient with major depression and selective serotonin reuptake inhibitor-induced bruxism was successfully treated with a course of bilateral electroconvulsive therapy. Both the depressive symptoms and bruxism completely remitted after six treatments. Possible mechanisms of this effect are discussed.

Sleep disturbances and depression in the elderly in Japan.

UNLABELLED: The purpose of the present study was to evaluate the relationship between sleep disturbances and depression in the Japanese elderly. METHODS: These investigations in the Japanese elderly were carried out with the Geriatric Depression Scale, the Pittsburgh Sleep Quality Index, and questions on restless legs syndrome and nocturnal eating disorder. A total of 2023 people (male: 1008; female: 1015; average age: 74.2 +/- 6.3 years) were analyzed by chi2 test and simple and multiple logistic regression. The prevalence of sleep disturbance was 37.3% and that of depression was 31.3%. Female gender and/or older (> or =75 years) age were significantly associated with depression. Characteristics in depressive elderly were poor sleep efficiency, sleep disturbances due to difficulty of initiating sleep (DIS), breathing discomfort, coldness and pain, poor subjective sleep quality and lack of enthusiasm for activities. Sleep disturbances due to using the bathroom, breathing discomfort and coldness and long sleep latency were associated with depression in younger (65-74 years) men. Sleep disturbance due to DIS was associated with depression in older (> or =75 years) men. Sleep disturbance due to pain was associated with depression in younger and older women. Poor sleep efficiency was associated with depression in older women. Poor subjective sleep quality was associated with depression in younger and older men and younger women. Lack of enthusiasm was associated with depression in younger and older men and older women. Restless legs syndrome was statistically significantly associated with depression in younger men. It is concluded that sleep disturbance and depression among the Japanese elderly are closely related symptoms. The features of sleep disturbance with depression differed with sex and age.

Successful treatment of nocturnal eating/drinking syndrome with selective serotonin reuptake inhibitors.

Nocturnal eating/drinking disorder (NE/DS) is a rare syndrome that includes disorders of both eating and sleeping. It is characterized by awakening in the middle of the night, getting out of bed, and consuming large quantities of food quickly and uncontrollably, then returning to sleep. This may occur several times during the night. Some patients are fully conscious during their nocturnal eating, while some report total amnesia. The aetiology of NE/DS is still unclear, and there is no satisfactory treatment. Four patients with NE/DS are described. Treatment with a selective seroronin reuptake inhibitor (SSRI) was effective in controlling their episodes of nocturnal eating. To our knowledge, this is the first published case report of successful treatment with SSRIs in NE/DS.

Echocardiographic investigation of pericardial effusion in a case of anorexia nervosa.

OBJECTIVE: Pericardial effusion has recently been reported as a complication of anorexia nervosa. A distinct pathophysiological cause of it could not be revealed. In some reports, there was a probable correlation between weight gain and reduction of pericardial effusion in anorexia nervosa cases. We encountered a case in which pericardial effusion remitted completely along with body weight increase and normalization of low T3 syndrome. These findings suggest that the reduction of pericardial effusion may correlate with both weight gain and low T3 normalization. Plasma brain natriuretic peptide (BNP) levels were increased in this case despite heart failure, and plasma BNP decreased as pericardial effusion remitted. The measurement of serum BNP level may be a clinical parameter in such a case of pericardial effusion.

Late onset anorexia nervosa: two case reports.

OBJECTIVE: Some patients develop an eating disorder at a late age. It is worth investigating why this syndrome develops at such widely different ages. METHODS: Two Japanese cases of late onset anorexia nervosa are reported. RESULTS: In these late onset cases, anorexia developed out of sadness over a loss such as bereavement, divorce, and fear or anxiety for the future. In addition, these two patients didn't demonstrate a fear of aging or of losing their attractiveness and sexuality, nor did they develop a dissociative disturbance based on an early traumatic history of sexual abuse in PTSD. CONCLUSION: Although the clinical features are similar, there appear to be differences between late onset and adolescent cases in psychological mechanisms.

Change in the equilibrium of the levels of free and bound forms of alpha1-microglobulin and ulinastatin in patients with mood disorders.

We have previously found that the relationship between the urinary content of alpha1-microglobulin (alpha1M) and ulinastatin (UT) in patients with mood disorders (MD) differs from that in age-matched healthy subjects. Similar results were obtained for the relationship between the content of free forms of alpha1M and UT in serum, and that between the ratio of the content of free form to the total (free + bound forms) content (F/T ratio) of alpha1M and UT in serum. As for the content of alpha1M and UT in serum, statistical differences were not observed between MD patients and healthy subjects with regard to the respective total content of alpha1M and UT nor the F/T ratio of alpha1M, whereas the F/T ratio of UT was significantly (p < 0.05) lower in MD patients than in healthy subjects. Furthermore, the serum cortisol content was higher in MD patients than in healthy subjects, and a positive correlation between cortisol content and F/T ratios of UT was demonstrated in the present investigation. These results suggest that the equilibrium of free and bound forms of UT in serum, but not of alpha1M, tends to decrease the free-form level of UT in MD patients. The efficiency of cortisol, which might increase the free-form level of UT, markedly deteriorated in MD patients.