scholarly journals Modafinil in the treatment of selected mental disorders

2021 ◽  
Vol 21 (3) ◽  
pp. 204-212
Author(s):  
Wacław Dyrda ◽  
Daria Smułek ◽  
Adam Wichniak ◽  
Keyword(s):  
Cognitive Impairment ◽  
Mental Disorders ◽  
Negative Symptoms ◽  
Depressive Disorders ◽  
Bipolar Depression ◽  
Sleep Apnoea ◽  
Psychotic Symptoms ◽  
Manic Symptoms ◽  
Obstructive Sleep ◽  
Increased Risk

Modafinil belongs to a class of wakefulness promoting agents. It is widely used in the treatment of sleep disorders. Although narcolepsy is the main indication for its use, hypersomnia from obstructive sleep apnoea and shift work sleep disorder are also indications in some countries. Due to its efficacy in the treatment of hypersomnia, the drug has also been clinically assessed in patients with mental disorders to reduce the severity of symptoms such as fatigue, hypersomnolence and cognitive impairment. The aim of this paper is to present the potential clinical applications of modafinil in the treatment of selected mental disorders. The use of modafinil in depressive disorders to enhance the treatment applied may improve mood, anhedonia and apathy, fatigue, hypersomnolence and executive cognitive impairment. In severe episodes of bipolar depression, modafinil may improve depressive symptoms, fatigue, and hypersomnia. Despite the potential risk of manic symptoms during modafinil treatment, recent studies show no increased risk of switching from depressive to manic phase. In schizophrenia, there is no evidence for the beneficial effect of modafinil on the negative symptoms, but improvement in selected cognitive functions accompanied by exacerbation of psychotic symptoms was observed in some patients. Furthermore, modafinil is used as an alternative to standard therapy in attention-deficit/hyperactivity disorder. Despite lacking evidence for the efficacy of modafinil in cocaine addiction, an analysis of selected studies indicates a potential benefit in the form of maintained abstinence. Modafinil is well tolerated and safe in most cases. The risk of dependence is lower than with other psychostimulants.

scholarly journals The relationships between obstructive sleep apnea and psychiatric disorders: a narrative review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Kaja Hanna Karakuła ◽  
Aleksander Ryczkowski ◽  
Elżbieta Sitarz ◽  
Jacek Januszewski ◽  
Dariusz Juchnowicz
Keyword(s):  
Obstructive Sleep Apnea ◽  
Cognitive Impairment ◽  
Sleep Apnea ◽  
Mental Disorders ◽  
Psychotic Disorders ◽  
Psychotic Symptoms ◽  
List Type ◽  
Study Protocols ◽  
Obstructive Sleep ◽  
Increased Risk

Abstract Introduction: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Its prevalence tends to increase worldwide. Untreated sleep apnea is associated with a higher risk of metabolic diseases, cardiovascular diseases, stroke, road accidents, and death, but also it is suggested that it increases the risk of mental disorders. Method: The literature review was based on a search of articles on Medline, Pubmed, and Google Scholar from 2003 to 2021 using the keywords: obstructive sleep apnea; mental disorders; cognitive functions; affective disorders; depression; bipolar disorder; schizophrenia; psychotic disorders. The analysis included original studies, meta-analysis, and review articles. Discussion: The result obtained from researches published so far does not allow for drawing unequivocal conclusions. There is a lot of bias present in study protocols and inclusion/exclusion criteria. Nonetheless, it seems that some disorders have a better proven correlation with OSA. Cognitive impairment, depression, and anxiety disorders are linked to OSA not only in terms of the overlapping of symptoms but also of a causal relationship. Psychotic disorders and bipolar disorders connections with OSA are confirmed, but they are not yet well understood. All correlations are found to be possibly bidirectional. Conclusion: 1. Multiple lines of evidence increasingly point towards a bidirectional connection between OSA and mental disorders, and the cause and effect relationship between these two groups of disorders requires further research. 2. Due to reports of an increased risk of OSA with antipsychotic drugs, caution should be exercised when initiating therapy with this type of drug in patients with known risk factors for it. 3. Screening for OSA in psychiatric patients should be introduced as OSA can increase cognitive impairment, affective, and psychotic symptoms.

Use of cannabis components in the treatment of mental disorders

2016 ◽  
Vol 33 (S1) ◽  
pp. S552-S552
Author(s):  
C. Tsopelas ◽  
M. Dimitraka ◽  
P. Ntounas ◽  
A. Gatos-Gatopoulos ◽  
D. Karadima ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mental Disorders ◽  
Web Search ◽  
Brain Activity ◽  
Activity Patterns ◽  
Cannabis Use ◽  
Psychotic Symptoms ◽  
Repeated Treatment ◽  
Increased Risk ◽  
Competing Interest

IntroductionThere is evidence that supports the increased risk of developing psychosis or psychotic like symptoms in vulnerable populations after use of cannabis. Cannabis’ main psychoactive component, Δ9-tetrahydrocannabinol (THC), induces acute psychotic effects and cognitive impairment. But there is also evidence to suggest that molecules in the cannabis plant could have an antipsychotic affect.AimsIn this review we are trying to explore the possibilities of cannabis use as a therapeutic agent in mental disorders.MethodsThorough research of the main databases, and web search engines for relevant studies, using appropriate keywords. We scrutinize them independently, before reaching consensus about appropriateness.ResultsIn animal models repeated treatment with cannabis constituent cannabidiol CBD or the atypical antipsychotic clozapine attenuates or reverses the schizophrenia-like behavioral disruption.In humans there are data that CBD counteracts psychotic symptoms and cognitive impairment associated with cannabis use. Also CBD may lower the risk for developing cannabis use associated psychosis. There are opposite effects of CBD and THC on brain activity patterns in key regions implicated in the pathophysiology of schizophrenia, such as the striatum, hippocampus and prefrontal cortex.ConclusionsThe possible mechanism of action of GBD is not fully clarified, as it may involve anti-inflammatory or neuroprotective properties. These initial clinical studies with CBD treatment of psychotic symptoms argument the potential of CBD as an effective antipsychotic compound. Mechanisms responsible for these effects need to be further investigated.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Obstructive Sleep Apnoea and Type 2 Diabetes

2014 ◽  
Vol 10 (01) ◽  
pp. 35 ◽  
Author(s):  
Abd A Tahrani ◽  
Asad Ali ◽  
◽  
Keyword(s):  
Type 2 Diabetes ◽  
Risk Factor ◽  
Medical Condition ◽  
Diabetes Type 2 ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Osa Treatment ◽  
The Impact

With the growing prevalence of obesity, the burden of type 2 diabetes is increasing. Obstructive sleep apnea (OSA) is a very common medical condition that is associated with increased risk for cardiovascular disease and mortality. Obesity is a common risk factor for OSA and type 2 diabetes and hence it is not surprising that OSA and type 2 diabetes are interlinked. OSA has been shown to be an independent risk factor for the development of incident pre-diabetes/type 2 diabetes. OSA is also associated with worse glycemic control and vascular disease in patients with type 2 diabetes. However, evidence for the benefits of OSA treatment in patients with type 2 diabetes is still lacking. The aim of this article is to provide an overview of OSA, the relationships between OSA and dysglycemia and the impact of OSA in patients with type 2 diabetes, highlighting recent advances in the field.

scholarly journals Detection of mild cognitive impairment in middle-aged and older adults with obstructive sleep apnoea

2018 ◽  
Vol 52 (5) ◽  
pp. 1801137 ◽  
Author(s):  
Katia Gagnon ◽  
Andrée-Ann Baril ◽  
Jacques Montplaisir ◽  
Julie Carrier ◽  
Sirin Chami ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Obstructive Sleep Apnoea ◽  
Mental State ◽  
Cognitive Assessment ◽  
Mini Mental State Examination ◽  
Sleep Apnoea ◽  
Screening Tests ◽  
Obstructive Sleep ◽  
State Examination

Obstructive sleep apnoea increases the risk for mild cognitive impairment and dementia. The present study aimed to characterise the ability of two cognitive screening tests, the Mini-Mental State Examination and the Montreal Cognitive Assessment, to detect mild cognitive impairment in adults aged 55–85 years with and without obstructive sleep apnoea.We included 42 subjects with mild and 67 subjects with moderate-to-severe obstructive sleep apnoea. We compared them to 22 control subjects. Mild cognitive impairment was diagnosed by a comprehensive neuropsychological assessment. We used receiver operating characteristic curves to assess the ability of the two screening tests to detect mild cognitive impairment.The two screening tests showed similar discriminative ability in control subjects. However, among the mild and the moderate-to-severe obstructive sleep apnoea groups, the Mini-Mental State Examination was not able to correctly identify subjects with mild cognitive impairment. The Montreal Cognitive Assessment's discriminant ability was acceptable in both sleep apnoea groups and was comparable to what was observed in controls.The Mini-Mental State Examination should not be used to screen for cognitive impairment in patients with obstructive sleep apnoea. The Montreal Cognitive Assessment could be used in clinical settings. However, clinicians should refer patients for neuropsychological assessment when neurodegenerative processes are suspected.

scholarly journals Increased liver stiffness in patients with severe sleep apnoea and metabolic comorbidities

2018 ◽  
Vol 51 (6) ◽  
pp. 1800601 ◽  
Author(s):  
Wojciech Trzepizur ◽  
Jérôme Boursier ◽  
Marc Le Vaillant ◽  
Pierre-Henri Ducluzeau ◽  
Séverine Dubois ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Liver Disease ◽  
Liver Fibrosis ◽  
Liver Stiffness ◽  
Sleep Apnoea ◽  
Screening Tools ◽  
The Metabolic Syndrome ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Metabolic Comorbidities

The goal of this study was to assess the relationship between the severity of obstructive sleep apnoea (OSA) and liver stiffness measurement (LSM), one of the most accurate noninvasive screening tools for liver fibrosis in nonalcoholic fatty liver disease.The study included 147 patients with at least one criterion for the metabolic syndrome, assessed by polysomnography for suspected OSA. LSM was performed using transient elastography (FibroScan). Significant liver disease and advanced liver fibrosis were defined as LSM ≥7.3 and ≥9.6 kPa, respectively.23 patients were excluded because of unreliable LSM. Among 124 patients, 34 (27.4%) had mild OSA, 38 (30.6%) had moderate OSA and 52 (42.0%) had severe OSA. LSM values were 7.3– <9.6 kPa in 18 (14.5%) patients and ≥9.6 kPa in 15 (12.1%) patients. A dose–response relationship was observed between OSA severity and LSM values (p=0.004). After adjustment for age, sex, metabolic syndrome and insulin resistance, severe OSA was associated with an increased risk of LSM ≥7.3 kPa (OR 7.17, 95% CI 2.51–20.50) and LSM ≥9.6 kPa (OR 4.73, 95% CI 1.25–17.88).In patients with metabolic comorbidities, severe OSA is independently associated with increased liver stiffness, which may predispose to a higher risk of significant liver disease and poorer prognosis.

scholarly journals Severe desaturations increase psychomotor vigilance task-based median reaction time and number of lapses in obstructive sleep apnoea patients

2020 ◽  
Vol 55 (4) ◽  
pp. 1901849 ◽  
Author(s):  
Samu Kainulainen ◽  
Brett Duce ◽  
Henri Korkalainen ◽  
Arie Oksenberg ◽  
Akseli Leino ◽  
...  
Keyword(s):  
Reaction Time ◽  
Obstructive Sleep Apnoea ◽  
Significant Risk ◽  
Sleep Apnoea ◽  
Type I ◽  
Median Reaction Time ◽  
Diagnostic Parameters ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Psychomotor Vigilance

Current diagnostic parameters estimating obstructive sleep apnoea (OSA) severity have a poor connection to the psychomotor vigilance of OSA patients. Thus, we aimed to investigate how the severity of apnoeas, hypopnoeas and intermittent hypoxaemia is associated with impaired vigilance.We retrospectively examined type I polysomnography data and corresponding psychomotor vigilance tasks (PVTs) of 743 consecutive OSA patients (apnoea–hypopnoea index (AHI) ≥5 events·h−1). Conventional diagnostic parameters (e.g. AHI and oxygen desaturation index (ODI)) and novel parameters (e.g. desaturation severity and obstruction severity) incorporating duration of apnoeas and hypopnoeas as well as depth and duration of desaturations were assessed. Patients were grouped into quartiles based on PVT outcome variables. The odds of belonging to the worst-performing quartile were assessed. Analyses were performed for all PVT outcome variables using binomial logistic regression.A relative 10% increase in median depth of desaturations elevated the odds (ORrange 1.20–1.37, p<0.05) of prolonged mean and median reaction times as well as increased lapse count. Similarly, an increase in desaturation severity (ORrange 1.26–1.52, p<0.05) associated with prolonged median reaction time. Female sex (ORrange 2.21–6.02, p<0.01), Epworth Sleepiness Scale score (ORrange 1.05–1.07, p<0.01) and older age (ORrange 1.01–1.05, p<0.05) were significant risk factors in all analyses. In contrast, increases in conventional AHI, ODI and arousal index were not associated with deteriorated PVT performance.These results show that our novel parameters describing the severity of intermittent hypoxaemia are significantly associated with increased risk of impaired PVT performance, whereas conventional OSA severity and sleep fragmentation metrics are not. These results underline the importance of developing the assessment of OSA severity beyond the AHI.

scholarly journals Screening for obstructive sleep apnoea in professional drivers

Breathe ◽  
2020 ◽  
Vol 16 (1) ◽  
pp. 29364 ◽  
Author(s):  
Sophia E. Schiza ◽  
Izolde Bouloukaki
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Early Identification ◽  
Sleep Apnoea ◽  
Screening Tools ◽  
List Type ◽  
Objective Data ◽  
Sleep Study ◽  
Professional Drivers ◽  
Obstructive Sleep ◽  
Increased Risk

Professional drivers show a higher prevalence of obstructive sleep apnoea (OSA) compared with the general population. Furthermore, there is concern about the association between OSA and car crash risk given that drivers with OSA show an increased risk for car accidents. Despite this risk, OSA is often underdiagnosed and undertreated in this population, mainly due to lack of appropriate screening and sleep study referrals. Polysomnography (PSG), the gold standard test, is inappropriate for systematic screening because of its high expense, complexity and relative inaccessibility in this population. Therefore, there is a strong demand for good screening tools, including both subjective and objective data that may assist in early identification of possible OSA among professional drivers and, thus, aid in PSG examination referral and OSA management in an accredited sleep centre. However, there is considerable disagreement over screening methods and criteria for triggering a sleep study referral in different countries. There is also a strong need for further research in the area of OSA screening of commercial drivers in order to improve the diagnostic accuracy of screening tools and ensure that patients with OSA are accurately identified.Key pointsObstructive sleep apnoea (OSA) is often undiagnosed and undertreated in professional drivers.Professional drivers often under-report and are reluctant to report OSA symptoms.Barriers to OSA diagnosis include appropriate screening and sleep study referrals.Screening tools including both subjective and objective data may assist in early identification of possible OSA among professional drivers.Educational aimsTo evaluate screening instruments currently used to identify OSA risk in professional drivers.To provide guidance for developing an assessment strategy for OSA by professional driver medical examiners.

scholarly journals Relationship of Obstructive Sleep Apnoea with Diabetic Retinopathy: A Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Zhenliu Zhu ◽  
Fengying Zhang ◽  
Yunxia Liu ◽  
Shuqin Yang ◽  
Chunting Li ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Sensitivity Analysis ◽  
Diabetic Retinopathy ◽  
Publication Bias ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Relationship Of ◽  
The Relationship

Until now, the relationship of obstructive sleep apnoea (OSA) with diabetic retinopathy (DR) was controversial. This meta-analysis was performed to obtain definitive conclusion on this topic. Relevant articles were searched on databases of Pubmed, Google Scholar, and Chinese National Knowledge Infrastructure (CNKI). The articles were selected according to inclusion and exclusion criteria. Odds ratio (OR) with 95% confidence interval (CI) was used to evaluate the relationship of OSA with risk of DR.I2andPvalue were used to assess the presence of heterogeneity.I2≥ 50% orP<0.05indicated significant heterogeneity. Sensitivity analysis was performed to evaluate the robustness of pooled results. Begg’s funnel plot and Egger’s regression analysis were adopted to assess publication bias. 6 eligible studies were selected in the present meta-analysis. The pooled results indicated that OSA was significantly associated with increased risk of DR (OR = 2.01, 95% CI = 1.49–2.72). Subgroup analysis based on type of diabetes mellitus suggested that OSA was related to DR in both Type 1 and Type 2 diabetes mellitus. Sensitivity analysis demonstrated that pooled results were robust. No significant publication bias was observed (P=0.128). The results indicate that OSA is related to increased risk of DR.

Upper airway obstruction in the critically ill

2016 ◽  
Author(s):  
Edmond Cohen
Keyword(s):  
Airway Obstruction ◽  
Pulmonary Function Tests ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Upper Airway Obstruction ◽  
Breath Sounds ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Facial Swelling ◽  
Conscious Patient

Upper airway obstruction (UAO) from any cause should be considered a life-threatening emergency. In a conscious patient, UAO may present as respiratory distress, stridor, dyspnoea, altered voice, cyanosis, cough, decreased or absent breath sounds, wheezing, the hand-to-the-throat choking sign in the case of a foreign body, facial swelling, and distended neck veins. The cause of UAO should be identified and airway management devices must be immediately available prior to any airway manipulation CT scan, flexible bronchoscopy, and pulmonary function tests should be performed to evaluate the cause and the extent of the obstruction. Obstructive sleep apnoea (OSA) patients are at increased risk of developing UAO. Endotracheal intubation, insertion of a supraglottic device, laser therapy, and endotracheal stents maybe life-saving

Sign in / Sign up

Export Citation Format

Share Document