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Concept: Insomnia


Abstract Objective - Silexan is a lavender oil preparation in gelatine capsules containing 80 mg. We review clinical trials investigating the anxiolytic efficacy and tolerability of Silexan as well as its safety and potential for drug interactions. Methods - 7 trials were included. 4 therapeutic trials had a treatment duration of 6 or 10 weeks. Results - In patients with subsyndromal anxiety or generalised anxiety disorder (GAD) an anxiolytic effect of Silexan was evident after 2 weeks. Patients treated with Silexan showed Hamilton Anxiety Scale (HAMA) total score decreases by between 10.4 ? 7.1 and 12.0 ? 7.2 points at Week 6 and between 11.8 ? 7.7 and 16.0 ? 8.3 points at Week 10. HAMA total score reductions between baseline and end of treatment were significantly superior to placebo in patients with subsyndromal anxiety and comparable to lorazepam in its starting dose in patients with GAD. Conclusions - Silexan had beneficial effects on typical co-morbidity symptoms of anxiety disorders, e. g., disturbed sleep, somatic complaints, or decreased quality of life. Except for mild gastrointestinal symptoms the drug was devoid of adverse effects and did not cause drug interactions or withdrawal symptoms at daily doses of 80 or 160 mg.

Concepts: Pharmacology, Generalized anxiety disorder, Panic disorder, Alprazolam, Anxiety disorders, Social anxiety disorder, Insomnia, Anxiolytic


Background Sleep disturbances are commonly reported in the psychosis prodrome, but rarely explored in relation to psychotic experiences. Aims To investigate the relationship between specific parasomnias (nightmares, night terrors and sleepwalking) in childhood and later adolescent psychotic experiences. Method The sample comprised 4720 individuals from a UK birth cohort. Mothers reported on children’s experience of regular nightmares at several time points between 2 and 9 years. Experience of nightmares, night terrors and sleepwalking was assessed using a semi-structured interview at age 12. Psychotic experiences were assessed at ages 12 and 18 using a semi-structured clinical interview. Results There was a significant association between the presence of nightmares at 12 and psychotic experiences at 18 when adjusted for possible confounders and psychotic experiences at 12 (OR = 1.62, 95% CI 1.19-2.20). The odds ratios were larger for those who reported persistent psychotic experiences. Conclusions The presence of nightmares might be an early risk indicator for psychosis.

Concepts: Sleep, Sleep deprivation, Sleep disorder, Narcolepsy, Sleep disorders, Insomnia, Parasomnia, Night terror


To investigate the structural changes in patients with chronic primary insomnia and the relationships with clinical features of insomnia.

Concepts: Medicine, Insomnia


The present study aimed to evaluate the effects of Pilates exercise program on pain, functional status and quality of life in women with postmenopausal osteoporosis.

Concepts: Osteoporosis, Hormone replacement therapy, Vitamin D, Menopause, Estrogen, Programming language, Insomnia, Roy Thomas Baker


INTRODUCTION: Fasting during the Ramadan month is a cornerstone of Islam. Several disorders of the chronobiological rhythms occur during this month and impact on mood. Through this paper the authors provide a literature review of the impact of fasting on patients with bipolar disorders. MATERIALS AND SUBJECTS: A literature review using Mesh keywords through Medline database. From 1970 to 2011, articles in French and English were selected. RESULTS: Circadian rhythm refers to the approximately 24-hour cycles that are generated by an organism. Most physiological systems demonstrate circadian variations. Many hormones and other metabolisms, such as gastric pH, insulin, glucose, calcium and plasmatic gastrine, have been shown to exhibit circadian oscillation. The role of social rhythm in behaviors and its influence on circadian rhythms in humans is now obvious. It has been shown that the lack of concentration and irritability increased continuously during Ramadan month and reached its peak at the end of the month. Mood and vigilance are significantly decreased during the fasting month. Several authors have stated that the course of bipolar illness may be affected by the changes in social rhythm that occur during Ramadan (fasting month). Studies which have been devoted to this topic are sparse. Kadri et al., in 2000, studied 20 bipolar patients during the fasting month of Ramadan of 1417 (Hegirian calendar, corresponding to January 1997). Diagnosis of bipolar disorder was made according to ICD-10 criteria. Patients were assessed during the week before Ramadan, the second and the fourth weeks of the fasting month and the first week after its end, with the Hamilton Depression and Bech-Rafaelsen scales. The plasma concentration of lithium was also assessed. The main finding of the study was that 45% of the patients relapsed, 70% during the second week, and the remaining patients at the end of Ramadan. These relapses were not related to plasma concentration of lithium. Most of the relapses were manic (71,4%). Patients who did not relapse had more insomnia and anxiety during the second and third weeks of the study. The side effects of lithium increased and were seen in 48% of the sample, mostly dryness of the mouth with thirst and tremor. However, Farooq et al. in 2006 studied 62 bipolar patients during the fasting month of Ramadan 1427 (from 25 September to 24 October 2006). Serum lithium, electrolytes, Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS) were assessed, one week before Ramadan, mid Ramadan and one week after Ramadan. The side effects and toxicity were measured by symptoms and signs checklist. There was no significant difference in mean serum lithium levels at three time points. The scores on HDRS and YMRS showed significant decrease during Ramadan (F=34,12, P=0,00, for HDRS and F=15,6, P=0,000 for YMRS). Also the side effects and toxicity did not differ significantly at the three point’s assessment. CONCLUSION: All physiologic parameters are influenced by the circadian rhythm, which is influenced in its turn by the food rhythm. So far, the results of these two main studies, with opposite results, do not help us advise bipolar patients to fast or not to fast. Other studies in this field are badly needed.

Concepts: Sleep, Relapse, Bipolar disorder, Mania, Insomnia, Melatonin, Ramadan, Ultradian


STUDY OBJECTIVES: To evaluate efficacy and safety of 3.5-mg zolpidem tartrate sublingual tablets (ZST) on latency to sleep onset after middle-of-the-night (MOTN) awakenings in patients with insomnia characterized by difficulty returning to sleep after MOTN awakenings. DESIGN: Multicenter randomized, double-blind, placebo-controlled, parallel-group. SETTING: Outpatient. PATIENTS: There were 295 adults (median age 43 y; 68.1% female) with primary insomnia and difficulty returning to sleep after MOTN awakenings (three or more MOTN awakenings/wk during screening). INTERVENTIONS: After a 2-wk, single-blind placebo eligibility period, participants were randomized 1:1 to as-needed MOTN dosing with 3.5 mg ZST or placebo for 28 nights. An interactive voice response system determined if the study drug could be taken and recorded sleep/wake efficacy measures. RESULTS: ZST significantly (P < 0.0001) decreased latency to sleep onset over 4 wk (baseline 68.1 min; ZST 38.2 min) compared with placebo (baseline 69.4 min; placebo 56.4 min). Ratings of morning sleepiness/alertness significantly (P = 0.0041) favored the ZST group on nights medication was taken but not on other nights. Participants in the ZST group took the study drug on 62% of nights during the 4 wk; members of the placebo group took study medication on 64% of nights. Adverse events were generally mild and at the same rate (19.3% of participants) in both groups. There were no treatment-related serious adverse events (SAEs), and one adverse event-related study discontinuation from the placebo group. Dosing/week did not increase across the study. CONCLUSIONS: 3.5 mg ZST used as needed significantly reduced latency to return to sleep in comparison with placebo in these patients with insomnia. Sleep quality was improved, and morning sleepiness/alertness scores also improved. ZST was well tolerated. These data demonstrate the utility of a sleep-promoting agent when used as needed in the MOTN. CLINICAL TRIAL INFORMATION: CLINICAL TRIALS REGISTRATION: NCT00466193: "A Study of Zolpidem Tartrate Tablet in Adult Patients with Insomnia" CITATION: Roth T; Krystal A; Steinberg FJ; Singh NN; Moline M. Novel sublingual low-dose zolpidem tablet reduces latency to sleep onset following spontaneous middle-of-the-night awakening in insomnia in a randomized, double-blind, placebo-controlled, outpatient study. SLEEP 2013;36(2):189-196.

Concepts: Clinical trial, Placebo, Benzodiazepine, Hypnotic, Insomnia, Zolpidem, Zopiclone, Nonbenzodiazepine


A 43 year old caucasion gentleman had been receiving Botulinum toxin type A injections (BOTOX(®) , Allergan) for his axillary hyperhidrosis since 2004 with good effect. In June 2009 he gave an 18 month history of developing small prutitic wheals on his chest, arms and to a lesser extent his legs and back.. The lesions lasted between 5 and 120mins. There was no dermographism. Triggers included anxiety, physical exercise and hot showers.

Concepts: Physical exercise, Insomnia, Urticaria, Botulinum toxin, Hyperhidrosis, Microbial toxins, Cholinergic urticaria, Allergan


The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the management of chronic insomnia disorder in adults.

Concepts: Medicine, Mental disorder, Insomnia


This study aimed to provide preliminary evidence on the efficacy of an early minimal cognitive-behavioural therapy for acute insomnia (mCBT-I) comorbid with cancer.

Concepts: Insomnia


High impact training is essential for building and maintaining strong bones throughout life. Adequate load will stimulate strength independently of age, sex and hormonal production, but the effect may be small (elderly) or pronounced (certain athletes, prepubertal children). Gained bone mass is partly preserved with age. Walking has no osteogenic effect except in very inactive persons. In postmenopausal women the effect of added training to estrogen-treatment is modest. Exercises to prevent falls are important in this group. Hormonal contraceptives may reduce the effect of training in premenopausal women.

Concepts: Osteoporosis, Bone, Bone density, Density, Skeletal system, Hormonal contraception, Menstrual cycle, Insomnia