scholarly journals My Husband Tells Me I’m Lazy

2019 ◽  
pp. 501-513
Author(s):  
Erin Bremer ◽  
Lynn Marie Trotti
Keyword(s):  
Treatment Options ◽  
Sleep Inertia ◽  
Excessive Sleepiness ◽  
Chronic Disorder ◽  
Unrefreshing Sleep ◽  
Long Sleep ◽  
Idiopathic Hypersomnia ◽  
New Treatments ◽  
Multiple Sleep Latency ◽  
Sleep Propensity

Idiopathic hypersomnia is a chronic disorder of excessive daytime sleepiness that is characterized by unrefreshing sleep despite normal or long sleep times and sleep inertia. Both symptoms can interfere with normal functioning. The diagnosis requires confirmation of sleepiness or increased sleep propensity via actigraphy, polysomnography, and/or multiple sleep latency test. Clinical evaluation, sleep diagnostics, and laboratory testing must exclude other disorders of excessive sleepiness. Treatment options are limited by the lack of approval by the U.S. Food and Drug Administration of any medications for this indication, as well as the relatively small number of clinical trials including patients with this disorder. Off-label treatments may be used and new treatments are being researched.

511 Pathological sleep prolongation and sleep onset REM period

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A201-A201
Author(s):  
Makoto Honda ◽  
Shinya Kimura ◽  
Kaori Sasaki ◽  
Masataka Wada ◽  
Wakako Ito
Keyword(s):  
Clinical Symptoms ◽  
Sleep Latency ◽  
Total Sleep Time ◽  
Sleep Onset ◽  
Sleep Time ◽  
Sleep Studies ◽  
Long Sleep ◽  
The Status ◽  
Idiopathic Hypersomnia ◽  
Sleep Propensity

Abstract Introduction ICSD-3 employs two definitions of pathological sleepiness: sleep prolongation with 24-hour total sleep time (24hrPSG TST) ≥660 and high sleep propensity with mean sleep latency(mSL) ≤8 min on MSLT. Multiple SOREMPs on MSLT reflects the pathophysiology (sleep instability) of narcolepsy, but it is not clear whether the lack of SOREMPs is associated with the pathophysiology of idiopathic hypersomnia. We performed 24hr PSG and PSG-MSLT sequentially to understand the meaning of SOREMP in those with pathological sleep prolongation. Methods Fifty-six consecutive patients visiting Seiwa Hospital or Koishikawa Tokyo Hospital affiliated to Institute of Neuropsychiatry with suspected idiopathic hypersomnia with habitually long sleep time were evaluated by 3-day sleep studies: unattended 24hr PSG followed by PSG and MSLT from January 2017 to November 2020. After excluding inadequate recordings or other sleep pathologies, we analyzed 52 data and found that 39 patients (23 females, 21.8 ± 7.9 years old, BMI 20.4 ± 2.5 kg/m2) exhibited pathological sleep prolongation. Results We divided 39 patients with pathological sleep prolongation into those with at least one SOREMP(n=9) and those without SOREMP(n=30) and explored differences in clinical symptoms and PSG variables. There were no differences in conventional sleep variables except for PSG sleep latency, shorter in those with SOREMP (20.8min vs 43.8min, p=0.032). Also 24hr PSG sleep variables showed no differences except for the number of NREM-REM cycles, more in those with SOREMP (10.4 vs 8.1, p=0.037). Frequency of clinical symptoms such as REM related phenomena and various symptoms characteristic for idiopathic hypersomnia did not differ between groups except for less frequency of general malaise p=0.003 and orthostatic hypotension p=0.049 in those with SOREMP. We had similar results when we compared 5 patients with multiple SOREMPs and 30 patients without SOREMP. Conclusion Our results indicated that sleep variables and clinical characteristics of idiopathic hypersomnia in those with pathological sleep prolongation were mostly the same regardless of the status of SOREMP on MSLT, suggesting that the absence of SOREMPs on MSLT were not fundamentally related to the pathophysiology of those with pathological sleep prolongation (idiopathic hypersomnia with long sleep time). Support (if any):

scholarly journals Challenges in Treating Tardive Dyskinesia: Assessing the Impact of Virtual Medical Education

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 165-165
Author(s):  
Amanda Glazar ◽  
Cecilia Peterson ◽  
Michael Lemon ◽  
Chirag Shah ◽  
Prakash Masand
Keyword(s):  
Medical Education ◽  
Tardive Dyskinesia ◽  
Treatment Options ◽  
Respiratory Muscles ◽  
Educational Activity ◽  
Activity Participation ◽  
Chi Square ◽  
Practice Performance ◽  
New Treatments ◽  
The Impact

AbstractIntroductionTardive Dyskinesia (TD) refers to abnormal, involuntary, choreoathetoid movements of the tongue, lips, face, trunk, and extremities and is associated with long-term exposure to dopamine-blocking agents, such as antipsychotic medications. Once established, these movements usually persist. The movements are disfiguring and can bring unwanted attention to affected individuals. When severe, especially if the respiratory muscles are affected, the movements can be disabling, limit activity, and reduce quality of life. The prevalence is 7.2% in individuals on newer antipsychotics who have never been exposed to older neuroleptics. Until recently, there were no effective treatments for TD. In recent years, many new treatments have been investigated for the treatment of TD, including valbenazine, deutetrabenazine, and branched chain amino acids. Valbenazine first, followed by deutetrabenazine are FDA approved to treat TD. A virtual broadcast was developed to assess the ability of continuing medical education (CME) to improve awareness of the recognition and treatment of TD among psychiatrists.MethodsThe virtual broadcast (May 9, 2020) consisted of a two-hour, live-streamed discussion between two expert faculty. Impact of the educational activity was assessed by comparing psychiatrists’ responses to four identical questions presented before and directly after activity participation. A follow-up survey was sent to all participants six-weeks post-activity to measure performance in practice changes. A chi-square test was used to identify significant differences between pre- and post-assessment responses. Cohen’s d was used to calculate the effect size of the virtual broadcast.ResultsActivity participation resulted in a noticeable educational effect among psychiatrists (n=621; d=6.12, P<.001). The following areas showed significant (P<0.05) pre- vs post-educational improvements: recognition of movements in patients with TD, rate of TD in SGA exposed patients, treatment options for TD (on and off-label), and treatment of TD using VMAT inhibitors. Additionally, 54% of psychiatrists reported a change in practice performance as a result of the education received in the activity, including utilization of a standard scale to evaluate movement disorders and educate patients and family members about potential for TD, how to recognize symptoms, and when to treat.ConclusionsThe results indicated that a CME-certified two-hour virtual broadcast was effective at improving knowledge among psychiatrists for the recognition and treatment of TD. This knowledge also resulted in positive changes in practice performance post-activity. Future education should continue to address best practices in the diagnosis, treatment and management of patients with TD, as there remains an increased need for tailored CME among psychiatrists.FundingNeurocrine Biosciences, Inc.

scholarly journals Cerebrospinal fluid monoamine levels in central hypersomnolence disorders

SLEEP ◽  
2021 ◽  
Author(s):  
Lucie Barateau ◽  
Isabelle Jaussent ◽  
Julien Roeser ◽  
Claudio Ciardiello ◽  
Thomas S Kilduff ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Daytime Sleepiness ◽  
Direct Consequence ◽  
Trace Amines ◽  
Idiopathic Hypersomnia ◽  
National Reference Center ◽  
Drug Free ◽  
Sleep Propensity

Abstract Study objectives Whether the cause of daytime sleepiness in narcolepsy type 1 (NT1) is a direct consequence of the loss of orexin neurons or whether low orexin reduces the efficacy of the monoaminergic systems to promote wakefulness is unclear. The neurobiology underlying sleepiness in other central hypersomnolence disorders, narcolepsy type 2 (NT2) and idiopathic hypersomnia (IH), is currently unknown. Methods Eleven biogenic amines including the monoaminergic neurotransmitters and their metabolites and five trace amines were measured in the cerebrospinal fluid (CSF) of 94 drug-free subjects evaluated at the French National Reference Center for Narcolepsy: 39 NT1(orexin-deficient) patients, 31 patients with objective sleepiness non-orexin deficient (NT2 and IH), and 24 patients without objective sleepiness. Results Three trace amines were undetectable in the sample: Tryptamine, Octopamine, and 3-iodothyronamine. No significant differences were found among the three groups for quantified monoamines and their metabolites in crude and adjusted models; however, CSF 5-HIAA levels tended to increase in NT1 compared to other patients after adjustment. Most of biomarkers were not associated with ORX-A levels, clinical or neurophysiological parameters, but a few biomarkers (e.g., MHPG and norepinephrine) correlated with daytime sleepiness and high REM sleep propensity. Conclusion We found no striking differences among CSF monoamines, their metabolites and trace amine levels, and few associations between them and key clinical or neurophysiological parameters in NT1,NT2/IH and patients without objective sleepiness. Although mostly negative, these findings are a significant contribution to our understanding of the neurobiology of hypersomnolence in these disorders that remain mysterious and deserve further exploration.

Treatment Given Near the End of Life in Castration-Resistant Prostate Cancer

2012 ◽  
Vol 29 (7) ◽  
pp. 536-540 ◽  
Author(s):  
Hanna A. Zaghloul ◽  
Jose R. Murillo
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
End Of Life ◽  
Treatment Options ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Related Quality ◽  
Impact On Survival ◽  
New Treatments

Chemotherapy treatment options are limited for patients with castration-resistant prostate cancer (CRPC). The purpose of this study is to report treatment use and adverse effects (AEs) within the last three months of life in patients with CRPC. Of the 88 patients identified, 32% received treatment within 3 months of death, and documented AEs occurred in 25% of patients. Of those, neutropenia (18.3%), nausea/vomiting (18.3%), and febrile neutropenia (13.6%) were the most frequent. Results of this study show high treatment utility towards the end-of-life in patients with CRPC, with one fourth of patients experiencing AEs. Attention to health-related quality of life becomes increasingly important as new treatments appear to have small impact on survival, and AEs of those treatments may significantly impact patient quality of life.

scholarly journals Esophageal Sarcoidosis: A Review of Cases and an Update

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Albin Abraham ◽  
Rabab Hajar ◽  
Ravi Virdi ◽  
Jaspreet Singh ◽  
Paul Mustacchia
Keyword(s):  
Treatment Options ◽  
The Body ◽  
Mononuclear Phagocytes ◽  
Cranial Neuropathy ◽  
Esophageal Wall ◽  
Esophageal Involvement ◽  
Extrinsic Compression ◽  
Chronic Disorder ◽  
Noncaseating Granulomas ◽  
Future Therapy

Sarcoidosis is a chronic disorder that can virtually affect any organ system in the body. Histologically, it is characterized by the presence of T lymphocytes, mononuclear phagocytes, and noncaseating granulomas. Most commonly affected are the intrathoracic structures, with 90% of the reported cases involving the lungs. Esophageal involvement in sarcoidosis is extremely rare. Dysphagia is the most common presentation in these patients and can be attributed to various mechanisms such as direct esophageal wall infiltration, extrinsic compression, cranial neuropathy, and brainstem involvement. A thorough online literature review revealed only 23 reported cases of esophageal involvement in sarcoidosis. This paper reviews these reported cases in detail along with newer diagnostic and treatment options, including direction of future therapy.

Nocturnal Hypertension and Heart Failure: Mechanisms, Evidence, and New Treatments

Hypertension ◽  
2021 ◽  
Author(s):  
Kazuomi Kario ◽  
Bryan Williams
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiovascular Events ◽  
Treatment Options ◽  
Left Ventricular ◽  
Nocturnal Hypertension ◽  
Reduced Ejection Fraction ◽  
Nighttime Blood Pressure ◽  
Evidence Based Treatments ◽  
New Treatments

Heart failure (HF) is a common condition with an increasing prevalence. Despite a variety of evidence-based treatments for patients with HF with reduced ejection fraction, morbidity and mortality rates remain high. Furthermore, there are currently no treatments that have yet been shown to reduce complication and death rates in patients who have HF with preserved ejection fraction. Hypertension is a common comorbidity in patients with HF, contributing to disease development and prognosis. For example, hypertension is closely associated with the development of left ventricular hypertrophy, which an important precursor of HF. In particular, nighttime blood pressure (BP) appears to be an important, modifiable risk factor. Both nighttime BP and an abnormal circadian pattern of nighttime BP dipping have been shown to predict development of HF and the occurrence of cardiovascular events, independent of office BP. Key mechanisms for this association include sodium handling/salt sensitivity and increased sympathetic activation. These pathogenic mechanisms are targeted by several new treatment options, including sodium-glucose cotransporter 2 inhibitors, angiotensin receptor neprilysin inhibitors, mineralocorticoid receptor antagonists, and renal denervation. All of these could form part of antihypertensive strategies designed to control nighttime BP and contribute to the goal of achieving perfect 24-hour BP management. Nevertheless, additional research is needed to determine the effects of reducing nighttime BP and improving the circadian BP profile on the rate of HF, other cardiovascular events, and mortality.

Hypersomnolence Disorders

2020 ◽  
pp. 134-157
Author(s):  
Sulaiman Alhifzi ◽  
Nevin Zaki ◽  
Aljohara S. Almeneesier ◽  
Ahmed S. BaHammam
Keyword(s):  
Substance Use ◽  
Psychiatric Disorder ◽  
Treatment Strategies ◽  
Classification Systems ◽  
Common Symptom ◽  
Clinical Investigations ◽  
Idiopathic Hypersomnia ◽  
Multiple Sleep Latency

Despite varied classification systems, hypersomnolence disorders (or central disorders of hypersomnolence) are a group of disorders with a common symptom of excessive daytime sleepiness. In addition to a thorough clinical interview and examination, the assessment of hypersomnolence may require clinical investigations such as polysomnography and the multiple sleep latency test. This chapter examines the disorders of hypersomnolence with an emphasis on their clinical features and treatment strategies. The authors discuss the four main types of hypersomnolence disorders, narcolepsy type 1, narcolepsy type 2, idiopathic hypersomnia and Kleine–Levin syndrome, as well as hypersomnia due to a medical disorder, medication, or substance use; a psychiatric disorder; and insufficient sleep syndrome. It also discusses the relationships between hypersomnolence and psychiatric disorders.

scholarly journals Update on the Treatment of Idiopathic Hypersomnia

2019 ◽  
Vol 5 (4) ◽  
pp. 207-214
Author(s):  
M. S. Schinkelshoek ◽  
R. Fronczek ◽  
G. J. Lammers
Keyword(s):  
Treatment Options ◽  
Pharmacological Therapy ◽  
Small Sample ◽  
Treatment Modalities ◽  
Lifestyle Advice ◽  
Pharmacological Interventions ◽  
First Choice ◽  
Idiopathic Hypersomnia ◽  
Small Sample Sizes

Abstract Purpose of Review Idiopathic hypersomnia is an incapacitating disorder with a profound impact on daytime performance and quality of life. The most commonly used treatment modalities are lifestyle advice and pharmacological therapy. We present an update on the evidence concerning treatment options for idiopathic hypersomnia. Recent Findings Evidence for non-pharmacological interventions is lacking; improvement in symptoms on introducing these interventions is often less pronounced than in narcolepsy. Additional pharmacological treatment is therefore usually initiated. The few treatment studies that have been performed are hampered by small sample sizes and the use of variable and often insufficiently validated outcome parameters for the whole spectrum of idiopathic hypersomnia symptoms. Conclusion Evidence on treatment is scarce. Since the efficacy of modafinil is consistently described and there is much experience with this substance, it is reasonable to start with modafinil as a first choice treatment. Methylphenidate and dexamphetamine are good alternatives. In the future, newer drugs such as sodium oxybate, pitolisant, and solriamfetol might be authorized for use in idiopathic hypersomnia.

scholarly journals Liver Cancer Gene Discovery Using Gene Targeting, Sleeping Beauty, and CRISPR/Cas9

2019 ◽  
Vol 39 (02) ◽  
pp. 261-274 ◽  
Author(s):  
Julia Kieckhaefer ◽  
Flavio Maina ◽  
Rebecca Wells ◽  
Kirk Wangensteen
Keyword(s):  
Cancer Biology ◽  
Treatment Options ◽  
A Priori ◽  
Sleeping Beauty ◽  
Model Systems ◽  
Gene Interactions ◽  
Genetic Screens ◽  
Technological Advances ◽  
New Treatments ◽  
Crispr Activation

AbstractHepatocellular carcinoma (HCC) is a devastating and prevalent cancer with limited treatment options. Technological advances have enabled genetic screens to be employed in HCC model systems to characterize genes regulating tumor initiation and growth. Relative to traditional methods for studying cancer biology, such as candidate gene approaches or expression analysis, genetic screens have several advantages: they are unbiased, with no a priori selection; can directly annotate gene function; and can uncover gene–gene interactions. In HCC, three main types of screens have been conducted and are reviewed here: (1) transposon-based mutagenesis screens, (2) knockdown screens using RNA interference (RNAi) or the CRISPR/Cas9 system, and (3) overexpression screens using CRISPR activation (CRISPRa) or cDNAs. These methods will be valuable in future genetic screens to delineate the mechanisms underlying drug resistance and to identify new treatments for HCC.

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