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Journal Article 2014; 35(3): 186-197 PubMed PMID: 24977966 Citation  Keywords:  Disorders of Excessive Somnolence:drug therapy, Drug Therapy:trends, Humans, Hypnotics and Sedatives:therapeutic use, Movement Disorders:drug therapy, Sleep Apnea Syndromes:drug therapy, Sleep Disorders, Circadian Rhythm:drug therapy, Sleep Initiation and.   

: Sleep disorders are frequent and disturbing, mostly chronic conditions. Despite the fact practice of sleep medicine is a young field. Sleep disorders were reduced to insomnia and even insomnia was not well studied until 1960ies. This article maps amazing development of sleep disorders treatment from the beginning till current date. The text covers both scientific and clinical perspectives on most frequent sleep related disorders including insomnias, hypersomnias, parasomnias, sleep related movement and breathing disorders, restless legs syndrome and circadian rhythm sleep disorders....

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Clinical Trial 2011; 32(4): 526-529 PubMed PMID: 21876518 Citation  Keywords:  17-alpha-Hydroxyprogesterone:blood, Aged, Aged, 80 and over, Analgesics, Opioid:administration & dosage, Aortic Aneurysm, Abdominal:surgery, Endovascular Procedures:methods, Fentanyl:administration & dosage, Humans, Hydrocortisone:blood, Hypnotics and Sed.   

OBJECTIVES: Endovascular abdominal aortic aneurysm (AAA) repair was performed with local anaesthesia and intravenous analgesia. The objective of the study was to evaluate how two analgesia protocols affected stress response, measured as cortisol, 17-OH progesterone (17OHP) and prolactin (PRL) concentration during the procedure.

METHODS: 44 patients undergoing elective AAA endovascular repair were included to either receive regular boluses of fentanyl midazolam or remifentanil continuous infusion, analgesia was monitored by Visual Analogue Scale (VAS) measurement; cortisol, 17OHP and PRL were sampled preoperatively, at skin incision, endovascular prosthesis release and skin suture.

RESULTS: 42 patients were included. Mean VAS values were lower in the remifentanil group 0.50±0.68 vs 1.48±1.20, p=0.002 at incision, 0.24±0.58 vs 1.45±1.18, p<0.001 prosthesis release, 0.51±0.90 vs 1.73±1.45, p=0.002 suture. No statistically significant difference was found among cortisol and 17OHP levels; PRL was significantly lower in the fentanyl-midazolam group (23.83±16.92 ng/ml vs 40.81±22.45 p=0.009 at prosthesis release and 28.23±15.05 vs 41.37±14.54, p=0.007 at suture).

CONCLUSIONS: Although statistically significant VAS difference had a limited clinical impact due to its small entity. The group that experienced less pain showed a more intense PRL response, while cortisol and 17OHP did not reach statistical significance....

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Comparative Study 2008; 29(6): 895-901 PubMed PMID: 19112384 Citation  Keywords:  Adult, Antidepressive Agents, Second-Generation:therapeutic use, Cognitive Therapy:methods, Combined Modality Therapy, Female, Humans, Hypnotics and Sedatives:therapeutic use, Male, Middle Aged, Polysomnography, Sleep Initiation and Maintenance Disorders:.   

OBJECTIVES: Cognitive behaviour therapy (CBT) of primary insomnia is frequently combined with various pharmacological treatments, including sedative antidepressants. The present study was undertaken to evaluate the clinical efficacy of CBT, singly and combined with trazodone pharmacotherapy, for primary insomnia.

DESIGN AND SETTING: Randomised, comparative clinical trial, at a single academic medical centre.

METHODS: Twenty outpatients (15 women, 5 men) with chronic primary insomnia were randomly assigned to CBT or CBT +100mg trazodone and treated for 8 weeks. The treatment outcome was estimated by mean changes from baseline in self-reported clinical scales, sleep continuity data and sleep architecture parameters.

RESULTS: All patients perceived significant subjective sleep improvements. Sleep latency significantly shortened (p=0.03), sleep efficiency increased (p=0.004) and the total sleep time was significantly prolonged (p=0.006) after the CBT treatment in both groups. Sleep architecture showed that the combined approach (CBT + trazodone) resulted in a significant increase in slow wave sleep duration compared to treatment by CBT only (p=0.04).

CONCLUSIONS: CBT, singly and combined with the sedative antidepressant trazodone, is effective for the short-term management of chronic primary insomnia. Trazodone combined with CBT significantly increases slow wave sleep duration and this influence seems to be unrelated to its antidepressant effect....

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Case Reports 2006; 27(1-2): 260-262 PubMed PMID: 16648780 Citation  Keywords:  Anticonvulsants:therapeutic use, Antidepressive Agents:therapeutic use, Carbamazepine:therapeutic use, Catatonia:classification, Depression:complications, Electroencephalography, Female, Humans, Hypnotics and Sedatives:therapeutic use, Middle Aged, Moclob.   

: We describe a patient who was ill for more than 15 years. She was treated predominantly as a neurological case because of multiple motor signs. The diagnosis of catatonia was considered at the time when she was hospitalized in a psychiatric hospital after a suicidal attempt. The "therapeutic blindness", which was obviously present during 15 years of her illness, is discussed: the ICD--10 is perhaps misleading regarding this diagnosis while it associates it too tightly only to schizophrenia....

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