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Pandi-Perumal SR, Zaki NF, Qasim M, Elsayed Morsy N, Manzar MD, BaHammam AS, Jahrami H, Ramasubramanian C, Karthikeyan R, Supasitthumrong T, Moscovitch A, Trakht I, Gupta R, Narasimhan M, Partonen T, Reiter RJ, Morris G, Berk M, Kennedy SH, Stein DJ, Stahl SM, Charney DS, Seeman MV. Neuropsychiatric Consequences of COVID-19 Pandemic: A Synthetic Review from a Global Perspective. Alpha Psychiatry 2022; 23:144-154. [PMID: 36425743 PMCID: PMC9590656 DOI: 10.5152/alphapsychiatry.2022.21783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/11/2022] [Indexed: 08/30/2023]
Abstract
Some research suggests that distress, secondary to isolation and fear following COVID-19 infection, can negatively affect the long-term more than the COVID-19 infection itself. This narrative review aims to provide a global view on the neuropsychiatric consequences of COVID-19 that can be ascribed to several factors, ranging from the direct effect of infection, to the body's responses against the infection, or to the psychological sequelae of social isolation, unemployment, and fear for one's health and livelihood. Current findings show that the more severe the respiratory infection, the more likely are central nervous system (CNS) complications regarding the infection itself. The immune reactions to the infection may result in symptoms similar to chronic fatigue as well as neurocognitive deficits, which last long after the infection is gone. An increase in symptoms of depression, anxiety, and trauma-related stress may also follow upon economic fears and isolation from friends and family. The consequences of the pandemic are not limited to adults; children learning remotely and away from classmates and routine activities may develop adjustment disorders, acute stress disorder, and a variety of manifestations of grief. A summary of case reports suggests that COVID-19-related stress, economic recession, and political unrest increase the risk of suicidal behaviors and acts of violence. However, it is unknown whether manifestations of mental disorders result from social causes or whether CNS complications may be responsible.
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Affiliation(s)
- Seithikurippu R. Pandi-Perumal
- Somnogen Canada Inc., College Street, Toronto, Canada
- Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - Nevin F.W. Zaki
- Sleep research unit, Department of Psychiatry, Faculty of Medicine, Mansoura University, Egypt
- Department of Psychiatry, North Area Armed Forces Hospital (NAAFH) KSA, Saudi Arabia
| | - Mohammad Qasim
- Department of Rehabilitation Medicine, North Area -Armed Forces Hospital (NAAFH)-KSA, Saudi Arabia
| | | | - Md. Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - Ahmed S. BaHammam
- University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia
| | - Haitham Jahrami
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
- Ministry of Health, Manama, Kingdom of Bahrain
| | | | | | | | - Adam Moscovitch
- Department of Psychiatry, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ilya Trakht
- Department of Medicine, Columbia University, New York, NY, USA
| | - Ravi Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Meera Narasimhan
- Department of Neuropsychiatry and Behavioral Science, Columbia, University of South Carolina, South Carolina, USA
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Timo Partonen
- Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, Texas USA
| | - Russel J. Reiter
- The Institute for Mental and Physical Health and Clinical Translation Strategy Research Centre, Deakin University School of Medicine, Geelong Victoria, Australia
| | - Gerwyn Morris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael Berk
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Australia
- Orygen Youth Health Research Centre, Parkville, Australia
- Department of Psychiatry, University of Toronto, Canada
| | - Sidney H. Kennedy
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, South Africa
| | - Dan J. Stein
- Neuroscience Education Institute, University of California San Diego, San Diego, CA, USA
| | - Stephen M. Stahl
- Departments of Psychiatry, Neuroscience, and Pharmacological Sciences, Mount Sinai School of Medicine, New York, NY, USA
| | - Dennis S. Charney
- Departments of Psychiatry, Neuroscience, and Pharmacological Sciences, Mount Sinai School of Medicine, New York, NY, USA
| | - Mary V. Seeman
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, South Africa
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Pandi-Perumal SR, Vaccarino SR, Chattu VK, Zaki NF, BaHammam AS, Manzar D, Maestroni GJM, Suchecki D, Moscovitch A, Zizi F, Jean-Louis G, Narasimhan M, Ramasubramanian C, Trakht I, Seeman MV, Shneerson JM, Maes M, Reiter RJ, Kennedy SH. 'Distant socializing,' not 'social distancing' as a public health strategy for COVID-19. Pathog Glob Health 2021; 115:357-364. [PMID: 34057046 PMCID: PMC8592617 DOI: 10.1080/20477724.2021.1930713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Social distancing, also referred to as physical distancing, means creating a safe distance of at least two meters (six feet) between yourself and others. This is a term popularized during the COVID-19 pandemic, as it is one of the most important measures to prevent the spread of this virus. However, the term 'social distancing' can be misleading, as it may imply that individuals should stop socializing. However, socializing in a safe context (i.e. over the phone, video-chat, etc.) is especially important during this time of crisis. Therefore, in this narrative review, we suggest the term 'distant socializing' as more apt expression, to promote physical distancing measures while also highlighting the importance of maintaining social bonds. Further, articles discussing the practice, implementation, measurement, and mental health effects of physical distancing are reviewed. Physical distancing is associated with psychiatric symptoms (such as anxiety and depression), suicidal ideation, and domestic violence. Further, unemployment and job insecurity have significantly increased during COVID-19, which may exacerbate these negative mental health effects. Governments, medical institutions, and public health bodies should therefore consider increasing mental health resources both during and after the pandemic, with a specific focus on frontline workers, COVID-19 survivors, and marginalized communities.
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Affiliation(s)
| | - Sophie R. Vaccarino
- Centre for Depression and Suicide Studies, St. Michael’s Hospital, Toronto, Canada
| | | | - Nevin F.W. Zaki
- Department of Psychiatry, Mansoura University, Mansoura, Egypt
| | - Ahmed S. BaHammam
- Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia
- The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Saudi Arabia
| | - Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
| | - G J M Maestroni
- Center of Research in Medical Pharmacology, University of Insubria, Varese, Italy
| | - Deborah Suchecki
- Departamento De Psicobiologia, Escola Paulista De Medicina, Universidade Federal De São Paulo, São Paulo, Brazil
| | - Adam Moscovitch
- Department of Psychiatry, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ferdinand Zizi
- Department of Population Health, Center for Healthful Behavioral Change, NYU Grossman School of Medicine, New York, USA
| | - Girardin Jean-Louis
- Department of Population Health, Center for Healthful Behavioral Change, NYU Grossman School of Medicine, New York, USA
- Department of Psychiatry, NYU Grossman School of Medicine, New York, USA
| | - Meera Narasimhan
- Department of Psychiatry and Behavioral Science, Columbia, University of South Carolina, South Carolina, USA
- Department of Neuropsychiatry and Behavioral Science, Columbia, University of South Carolina, South Carolina, USA
| | | | - Ilya Trakht
- Department of Medicine, Columbia University, New York, NY, USA
| | | | - John M Shneerson
- Respiratory Support & Sleep Center, Royal Papworth Hospital, Cambridge, England, UK
| | - Michael Maes
- Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
| | - Russel J Reiter
- Department of Cellular & Structural Biology, UT Health San Antonio, TX, USA
| | - Sidney H. Kennedy
- Centre for Depression and Suicide Studies, St. Michael’s Hospital, Toronto, Canada
- Department of Psychiatry, University of Toronto, Canada
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Manzar MD, Sony P, Salahuddin M, Kumalo A, Geneto M, Pandi-Perumal SR, Moscovitch A, BaHammam AS. Electrolyte imbalance and sleep problems during anti-retroviral therapy: an under-recognized problem. Sleep Sci 2017; 10:64-67. [PMID: 28966741 PMCID: PMC5612038 DOI: 10.5935/1984-0063.20170011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/12/2017] [Indexed: 12/19/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection, and the anti-retroviral therapy (ART) associated complications necessitate that the medical care system keeps evolving for proper management of this group of patients. Electrolyte imbalance and sleep problems are common in patients on ART. Both of these conditions are associated with increased morbidity (such as acute kidney injury, chronic kidney disease, low CD4 count, non-adherence and depression) and mortality. Therefore, screening for both sleep problems and electrolytes imbalance may help to decrease the risk of complications in patients on ART.
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Affiliation(s)
- Md Dilshad Manzar
- Department of Biomedical Sciences, College of Health
Sciences, Mizan-Tepi University (Mizan Campus), ETHIOPIA Mizan-Aman -
Etiópia
| | - Peter Sony
- Department of Biomedical Sciences, College of Health
Sciences, Mizan-Tepi University (Mizan Campus), ETHIOPIA Mizan-Aman -
Etiópia
| | - Mohammed Salahuddin
- Department of Biomedical Sciences, College of Health
Sciences, Mizan-Tepi University (Mizan Campus), ETHIOPIA Mizan-Aman -
Etiópia
| | - Abera Kumalo
- Department of Biomedical Sciences, College of Health
Sciences, Mizan-Tepi University (Mizan Campus), ETHIOPIA Mizan-Aman -
Etiópia
| | - Mathewos Geneto
- Department of Biomedical Sciences, College of Health
Sciences, Mizan-Tepi University (Mizan Campus), ETHIOPIA Mizan-Aman -
Etiópia
| | | | - Adam Moscovitch
- The University of Calgary, Sleep and Fatigue Institute -
Calgary - Alberta - Canadá
| | - Ahmed S BaHammam
- College of Medicine, King Saud University, The
University Sleep Disorders Center - Riyadh - Riyadh - Arábia Saudita
- King Saud Univeristy, National Plan for Science and
Technology - Riyadh - Riyadh - Arábia Saudita
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Manzar MD, Salahuddin M, Sony P, Maru TT, Pandi-Perumal SR, Moscovitch A, Bahammam AS. Sleep disturbances and memory impairment among pregnant women consuming khat: An under-recognized problem. Ann Thorac Med 2017; 12:247-251. [PMID: 29118856 PMCID: PMC5656942 DOI: 10.4103/atm.atm_24_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Khat (Catha edulis) is a evergreen flowering shrub that is cultivated at high altitudes, especially in East Africa and the southwest of the Arabian Peninsula. The plant contains alkaloids, of which cathinone and cathine have structural similarity and pharmacological action similar to amphetamines. The leaves are, therefore, consumed in some regions as a psychoactive stimulant due to cultural beliefs and misperceptions on the health benefits of khat consumption. This resulted in a growing prevalence of khat consumption among pregnant women. The myriad of physiological changes associated with pregnancy impairs sleep and memory. Moreover, khat has also been shown to have adverse effects on memory and sleep. Therefore, its use during pregnancy may further aggravate those impairments. The purpose of this mini-review is to summarize the changes in sleep and memory during pregnancy and the evidence supporting a relationship between khat consumption and neurocognitive deficits and sleep dysfunctions. The misperceptions of beneficial effects of khat, the high prevalence of consumption among pregnant women, and the possibility of under-reporting of khat abuse do necessitate the development of alternative methodologies to identify cases of unreported khat abuse in pregnant women. It is proposed that screening for sleep problems and memory deficits may help identify under-reported cases of khat abuse in pregnant women.
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Affiliation(s)
- Md Dilshad Manzar
- Department of Biomedical Sciences, College of Health Sciences, Mizan-Tepi University, (Mizan Campus), Mizan Teferi, Ethiopia
| | - Mohammed Salahuddin
- Department of Pharmacy, College of Health Sciences, Mizan-Tepi University, (Mizan Campus), Mizan Teferi, Ethiopia
| | - Peter Sony
- Department of Biomedical Sciences, College of Health Sciences, Mizan-Tepi University, (Mizan Campus), Mizan Teferi, Ethiopia
| | - Tarekegn Tesfaye Maru
- Department of Pharmacy, College of Health Sciences, Mizan-Tepi University, (Mizan Campus), Mizan Teferi, Ethiopia
| | - Seithikurippu R Pandi-Perumal
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,National Plan for Science and Technology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Adam Moscovitch
- Sleep and Fatigue Institute, The University of Calgary, Calgary, Canada
| | - Ahmed S Bahammam
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,National Plan for Science and Technology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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BaHammam AS, Kendzerska T, Gupta R, Ramasubramanian C, Neubauer DN, Narasimhan M, Pandi-Perumal SR, Moscovitch A. Comorbid depression in obstructive sleep apnea: an under-recognized association. Sleep Breath 2015; 20:447-56. [DOI: 10.1007/s11325-015-1223-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 03/29/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
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de Almeida EA, Di Mascio P, Harumi T, Warren Spence D, Moscovitch A, Hardeland R, Cardinali DP, Brown GM, Pandi-Perumal SR. Measurement of melatonin in body fluids: standards, protocols and procedures. Childs Nerv Syst 2011; 27:879-91. [PMID: 21104186 PMCID: PMC3128751 DOI: 10.1007/s00381-010-1278-8] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 09/07/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The circadian rhythm of melatonin in saliva or plasma, or of the melatonin metabolite 6-sulfatoxymelatonin (a6MTs) in urine, is a defining feature of suprachiasmatic nucleus (SCN) function, the body's endogenous oscillatory pacemaker. The primary objective of this review is to ascertain the clinical benefits and limitations of current methodologies employed for detection and quantification of melatonin in biological fluids and tissues. DATA IDENTIFICATION A search of the English-language literature (Medline) and a systematic review of published articles were carried out. STUDY SELECTION Articles that specified both the methodology for quantifying melatonin and indicated the clinical purpose were chosen for inclusion in the review. DATA EXTRACTION The authors critically evaluated the methodological issues associated with various tools and techniques (e.g. standards, protocols, and procedures). RESULTS OF DATA SYNTHESIS Melatonin measurements are useful for evaluating problems related to the onset or offset of sleep and for assessing phase delays or advances of rhythms in entrained individuals. They have also become an important tool for psychiatric diagnosis, their use being recommended for phase typing in patients suffering from sleep and mood disorders. Additionally, there has been a continuous interest in the use of melatonin as a marker for neoplasms of the pineal region. Melatonin decreases such as found with aging are or post pinealectomy can cause alterations in the sleep/wake cycle. The development of sensitive and selective methods for the precise detection of melatonin in tissues and fluids has increasingly been shown to have direct relevance for clinical decision making. CONCLUSIONS Due to melatonin's low concentration, as well as the coexistence of numerous other compounds in the blood, the routine determination of melatonin has been an analytical challenge. The available evidence indicates however that these challenges can be overcome and consequently that evaluation of melatonin's presence and activity can be an accessible and useful tool for clinical diagnosis.
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Affiliation(s)
- Eduardo Alves de Almeida
- Departamento de Química e Ciências Ambientais, IBILCE, UNESP, Rua Cristóvão Colombo 2265, CEP 15054-000 São José do Rio Preto, SP Brazil
| | - Paolo Di Mascio
- Departamento de Bioquímica, Instituto de Química, USP Av. Prof. Lineu Prestes, 748, CEP 05513-970 São Paulo, SP Brazil
| | - Tatsuo Harumi
- Department of Anatomy, Asahikawa Medical College, Nishikagura, Asahikawa Japan
| | | | - Adam Moscovitch
- Sleep and Fatigue Institute, 106 Codsell Ave, Toronto, ON Canada M3H 3W1
| | - Rüdiger Hardeland
- Johann Friedrich Blumenbach Institute of Zoology and Anthropology, University of Göttingen, Göttingen, Germany
| | - Daniel P. Cardinali
- Departamento de Docencia e Investigación, Facultad de Ciencias Médicas, Pontificia Universidad Católica Argentina, 1107 Buenos Aires, Argentina
| | - Gregory M. Brown
- Centre for Addiction and Mental Health, 250 College Street, Toronto, ON Canada M5T 1R8
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Srinivasan V, Pandi-Perumal SR, Spence DW, Moscovitch A, Trakht I, Brown GM, Cardinali DP. Potential use of melatonergic drugs in analgesia: mechanisms of action. Brain Res Bull 2010; 81:362-71. [PMID: 20005925 DOI: 10.1016/j.brainresbull.2009.12.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 12/01/2009] [Accepted: 12/02/2009] [Indexed: 12/12/2022]
Abstract
Melatonin is a remarkable molecule with diverse physiological functions. Some of its effects are mediated by receptors while other, like cytoprotection, seem to depend on direct and indirect scavenging of free radicals not involving receptors. Among melatonin's many effects, its antinociceptive actions have attracted attention. When given orally, intraperitoneally, locally, intrathecally or through intracerebroventricular routes, melatonin exerts antinociceptive and antiallodynic actions in a variety of animal models. These effects have been demonstrated in animal models of acute pain like the tail-flick test, formalin test or endotoxin-induced hyperalgesia as well as in models of neuropathic pain like nerve ligation. Glutamate, gamma-aminobutyric acid, and particularly, opioid neurotransmission have been demonstrated to be involved in melatonin's analgesia. Results using melatonin receptor antagonists support the participation of melatonin receptors in melatonin's analgesia. However, discrepancies between the affinity of the receptors and the very high doses of melatonin needed to cause effects in vivo raise doubts about the uniqueness of that physiopathological interpretation. Indeed, melatonin could play a role in pain through several alternative mechanisms including free radicals scavenging or nitric oxide synthase inhibition. The use of melatonin analogs like the MT(1)/MT(2) agonist ramelteon, which lacks free radical scavenging activity, could be useful to unravel the mechanism of action of melatonin in analgesia. Melatonin has a promising role as an analgesic drug that could be used for alleviating pain associated with cancer, headache or surgical procedures.
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Abstract
Malaria, which infects more than 300 million people annually, is a serious disease. Epidemiological surveys indicate that of those who are affected, malaria will claim the lives of more than one million individuals, mostly children. There is evidence that the synchronous maturation of Plasmodium falciparum, the parasite that causes a severe form of malaria in humans and Plasmodium chabaudi, responsible for rodent malaria, could be linked to circadian changes in melatonin concentration. In vitro melatonin stimulates the growth and development of P. falciparum through the activation of specific melatonin receptors coupled to phospholipase-C activation and the concomitant increase of intracellular Ca2+. The Ca2+ signaling pathway is important to stimulate parasite transition from the trophozoite to the schizont stage, the final stage of intraerythrocytic cycle, thus promoting the rise of parasitemia. Either pinealectomy or the administration of the melatonin receptor blocking agent luzindole desynchronizes the parasitic cell cycle. Therefore, the use of melatonin antagonists could be a novel therapeutic approach for controlling the disease. On the other hand, the complexity of melatonin's action in malaria is underscored by the demonstration that treatment with high doses of melatonin is actually beneficial for inhibiting apoptosis and liver damage resulting from the oxidative stress in malaria. The possibility that the coordinated administration of melatonin antagonists (to impair the melatonin signal that synchronizes P. falciparum) and of melatonin in doses high enough to decrease oxidative damage could be a novel approach in malaria treatment is discussed.
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Pandi-Perumal SR, Moscovitch A, Srinivasan V, Spence DW, Cardinali DP, Brown GM. Bidirectional communication between sleep and circadian rhythms and its implications for depression: Lessons from agomelatine. Prog Neurobiol 2009; 88:264-71. [DOI: 10.1016/j.pneurobio.2009.04.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 03/09/2009] [Accepted: 04/29/2009] [Indexed: 02/04/2023]
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Walsh JK, Moscovitch A, Burke J, Farber R, Roth T. Efficacy and tolerability of indiplon in older adults with primary insomnia. Sleep Med 2007; 8:753-9. [PMID: 17825616 DOI: 10.1016/j.sleep.2006.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Revised: 12/04/2006] [Accepted: 12/04/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of indiplon in elderly patients with primary insomnia. PATIENTS AND METHODS Elderly patients, 65-80 years (N=358; 55% female; mean age, 71 years) who met the criteria for primary insomnia according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) for three months were randomized to two weeks of double-blind nightly treatment with 5 mg or 10 mg indiplon or placebo. Daily self-assessments by the patients included latency to sleep onset (LSO), total sleep time (TST), number of awakenings (NAW), wake time after sleep onset (WASO), and sleep quality. Data were collected between July, 2002, and October, 2003, at 52 clinical research sites in North America. RESULTS Treatment with indiplon was associated with significant reduction in LSO at Week 1 for the 5 mg (34.6+/-1.8 min) and 10 mg doses (30.4+/-1.6 min) relative to placebo (47.4+/-2.5 min; p<0.0001 for both comparisons). During Week 2, LSO remained shorter on both indiplon doses compared to placebo (5 mg, p=0.016; and 10 mg, p=0.0028). During both study weeks, treatment with indiplon was also associated with significant improvement, relative to placebo, in TST, NAW, WASO, and sleep quality. The frequency of adverse events was similar in the indiplon 5 mg and placebo groups; somnolence, nausea, depression and decreased appetite were slightly more common in the indiplon 10 mg group. CONCLUSION In elderly patients with primary insomnia, indiplon 5 mg and 10 mg were efficacious in inducing and maintaining sleep and improving sleep quality during the two weeks of treatment. Indiplon 5mg was well-tolerated, with no serious adverse events and no significant changes in electrocardiogram (ECG) or routine clinical laboratory evaluations; the 10mg dose produced slightly greater efficacy as well as somewhat increased adverse events.
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Affiliation(s)
- James K Walsh
- Sleep Medicine and Research Center, St. John's/St. Luke's Hospitals, 232 S. Woods Mill Road, Chesterfield, St. Louis, MO 63017, USA.
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Moscovitch A, Blashko CA, Eagles JM, Darcourt G, Thompson C, Kasper S, Lane RM. A placebo-controlled study of sertraline in the treatment of outpatients with seasonal affective disorder. Psychopharmacology (Berl) 2004; 171:390-7. [PMID: 14504682 DOI: 10.1007/s00213-003-1594-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2002] [Accepted: 07/07/2003] [Indexed: 11/30/2022]
Abstract
RATIONALE Seasonal affective disorder (SAD) is a relatively common cyclical depressive illness characterized by seasonal depressions during winter. The disorder is commonly responsive to light therapy, but antidepressant drug efficacy has not been definitely established. Serotonin selective re-uptake inhibitors are potentially efficacious treatments for SAD. OBJECTIVES The objective of this study was to evaluate the efficacy, tolerability and safety of sertraline treatment for SAD. METHODS One hundred and eighty seven outpatients with seasonal pattern recurrent winter depression (DSM-III-R defined) and a minimum 29-item Hamilton depression scale (SIGH-SAD version) score of 22 were randomized to 8 weeks treatment with either sertraline or placebo in a double-blind, multi-country, multi-center, parallel-group, flexible dose (50-200 mg once daily) study. Efficacy was investigated using physician and patient-rated scales measuring depression, anxiety and symptoms characteristic of seasonal affective disorder. RESULTS Sertraline produced a significantly greater response than placebo at endpoint as measured by changes in the 29-item and 21-item Hamilton depression scales, the clinical global impression (CGI) severity scale, the Hamilton anxiety scale, and the hospital anxiety and depression scale. The proportion of sertraline-treated subjects achieving a response on the CGI improvement rating (ratings of 1 or 2) at endpoint (last observation carried forward) was significantly greater than that of the placebo group. Overall sertraline was well tolerated with the most frequent placebo adjusted adverse events, being nausea, diarrhea, insomnia and dry mouth. Adverse events were mostly mild to moderate and transient. CONCLUSIONS Sertraline pharmacotherapy has been demonstrated to be an effective and well-tolerated therapy for out patients with SAD. As such, sertraline offers an important pharmacological option in the clinical management of this condition.
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Affiliation(s)
- Adam Moscovitch
- Canadian Sleep Institute, Unit 300, 295 Midpark Way, South East, Calgary, Alberta, T2X 2A8, Canada.
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12
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Brownlee K, Devins GM, Flanigan M, Fleming JAE, Morehouse R, Moscovitch A, Plamondon J, Reinish L, Shapiro CM. Are there gender differences in the prescribing of hypnotic medications for insomnia? Hum Psychopharmacol 2003; 18:69-73. [PMID: 12532317 DOI: 10.1002/hup.452] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Gender differences in the prescribing patterns of general classes of medications for insomnia were examined. The classes of medications included: zopiclone, antidepressants, benzodiazepines, antihistamines and no medication. The sample comprised a sub-set of respondents from 2620 questionnaires of the Canadian Multicentre Sleep Database. Respondents for this database were contacted through physicians, announcements in the media and local pharmacies. The results indicated that gender alone was not associated with differential prescribing for insomnia, nor was gender associated with patterns of medication use such as frequency of taking medication, length of use, taking more or less medication than prescribed or attempts to stop taking medication. Demographic factors were included in the analysis and age and marital status were associated with different prescribing patterns for men and women with insomnia. It is possible that physicians refer to stereotypic expectations when prescribing hypnotics.
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Affiliation(s)
- K Brownlee
- Department of Social Work, Lakehead University, Oliver Road, Thunder Bay, ON, Canada.
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Shapiro CM, Flanigan M, Fleming JAE, Morehouse R, Moscovitch A, Plamondon J, Reinish L, Devins GM. Development of an adjective checklist to measure five FACES of fatigue and sleepiness. Data from a national survey of insomniacs. J Psychosom Res 2002; 52:467-73. [PMID: 12069871 DOI: 10.1016/s0022-3999(02)00407-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Development and initial validation of the FACES of fatigue and sleepiness adjective checklist. An initial item pool of 65 adjectives, descriptive of fatigue, sleepiness and related deprivation states, was developed and administered to 372 individuals referred by their family physicians for psychiatric investigation and treatment of severe insomnia. Participants attended one of six Canadian university-affiliated sleep clinics where they completed a psychiatric assessment and a 766-item questionnaire, including a number of standard indices of sleep-related behavior and symptoms, medical history, sleep hygiene, psychosocial well-being and psychopathology. Principal-components and item analyses were undertaken to refine the initial 65-item pool to a smaller 50-item set, consisting of five subscales: Fatigue, Anergy, Consciousness, Energized and Sleepiness. Coefficient alpha was calculated and indicated high internal consistency reliability for all subscales. Convergent and discriminant validity were also evaluated by calculating correlations between FACES subscales and a number of independent indices. The resulting five-scale FACES questionnaire appears to offer a promising self-report instrument for the measurement of fatigue and related subjective experiences.
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Affiliation(s)
- Colin M Shapiro
- Department of Psychiatry, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, Canada.
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Abstract
OBJECTIVE This article reports a case series of atypical sexual behavior during sleep, which is often harmful to patients or bed partners. METHODS Eleven subjects underwent clinical evaluation of complaints of sleep-related atypical sexual behavior. Complaints included violent masturbation, sexual assaults, and continuous (and loud) sexual vocalizations during sleep. One case was a medical-legal case. Sleep logs, clinical evaluations, sleep questionnaires, structured psychiatric interviews, polysomnography, actigraphy, home electroencephalographic monitoring during sleep, and clinical electroencephalographic monitoring while awake and asleep were used to determine clinical diagnoses. RESULTS Atypical sexual behaviors during sleep were associated with feelings of guilt, shame, and depression. Because of these feelings, patients and bed partners often tolerated the abnormal behavior for long periods of time without seeking medical attention. The following pathologic sleep disorders were demonstrated on polysomnography: partial complex seizures, sleep-disordered breathing, stage 3 to 4 non-rapid eye movement (REM) sleep parasomnias, and REM sleep behavior disorder. These findings were concurrent with morning amnesia. CONCLUSIONS The atypical behaviors were related to different syndromes despite the similarity of complaints from bed partners. In most cases the disturbing and often harmful symptoms were controlled when counseling was instituted and sleep disorders were treated. In some cases treatment of seizures or psychiatric disorders was also needed. Clonazepam with simultaneous psychotherapy was the most common successful treatment combination. The addition of antidepressant or antiepileptic medications was required in specific cases.
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Affiliation(s)
- Christian Guilleminault
- Sleep Disorders Center, Stanford University, 401 Quarry Road, Suite 3301, Stanford, CA 94305, USA.
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Broughton RJ, Fleming JA, George CF, Hill JD, Kryger MH, Moldofsky H, Montplaisir JY, Morehouse RL, Moscovitch A, Murphy WF. Randomized, double-blind, placebo-controlled crossover trial of modafinil in the treatment of excessive daytime sleepiness in narcolepsy. Neurology 1997; 49:444-51. [PMID: 9270575 DOI: 10.1212/wnl.49.2.444] [Citation(s) in RCA: 209] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Seventy-five patients meeting international diagnostic criteria for narcolepsy enrolled in a 6-week, three-period, randomized, crossover, placebo-controlled trial. Patients received placebo, modafinil 200 mg, or modafinil 400 mg in divided doses (morning and noon). Evaluations occurred at baseline and at the end of each 2-week period. Compared with placebo, modafinil 200 and 400 mg significantly increased the mean sleep latency on the Maintenance of Wakefulness Test by 40% and 54%, with no significant difference between the two doses. Modafinil, 200 and 400 mg, also reduced the combined number of daytime sleep episodes and periods of severe sleepiness noted in sleep logs. The likelihood of falling asleep as measured by the Epworth Sleepiness Scale was equally reduced by both modafinil dose levels. There were no effects on nocturnal sleep initiation, maintenance, or architecture, nor were there any effects on sleep apnea or periodic leg movements. Neither dose interfered with the patients' ability to nap voluntarily during the day nor with their quantity or quality of nocturnal sleep. Modafinil produced no changes in blood pressure or heart rate in either normotensive or hypertensive patients. The only significant adverse effects were seen at the 400-mg dose, which was associated with more nausea and more nervousness than either placebo or the 200-mg dose. As little as a 200-mg daily dose of modafinil is therefore an effective and well-tolerated treatment of excessive daytime somnolence in narcoleptic persons.
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Affiliation(s)
- R J Broughton
- Division of Neurology, Ottawa General Hospital, ON, Canada
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Abstract
Forty-one subjects between 12 and 63 years of age with a complaint of nocturnal wandering were reviewed retrospectively, and a prospective investigation of their compliance to treatment was performed. Twenty-nine of 41 subjects committed violence against themselves or others ("violent group"). Clinical investigation of their problem involved polysomnography, wake and sleep EEGs and ambulatory EEG recording in the home environment. The nocturnal wandering may have started from NREM sleep or REM sleep, and violence was observed in both of these sleep states. Arousal from sleep may have been triggered by sleep-disordered breathing or may have been related to temporal lobe abnormalities, and, in some cases, no abnormal polygraphic features were noted. Violence was always preceded by many instances of nocturnal wandering that had received little clinical attention. Temporal lobe abnormalities, a rare cause of nocturnal wandering, were present only in the "violent" group. This group also had a higher percentage of men than the "nonviolent" group. In both groups, the frequency of nocturnal wandering increased with an increase in daytime stressors. Pharmacological and psychiatric treatment approaches were beneficial in both groups.
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Affiliation(s)
- C Guilleminault
- Stanford University Sleep Disorders Center, California 94304, USA
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Abstract
We studied the validity of cataplexy and number of sleep-onset rapid-eye-movement periods (SOREMPs) during one Multiple Sleep Latency Test (MSLT) as determinants of narcolepsy in 306 subjects with excessive daytime sleepiness not related to obstructive sleep apnea or other known syndromes. The subgroup defined by a history of cataplexy was the most homogeneous in clinical and polygraphic variables. However, only 83% of these subjects had two or more SOREMPs in one MSLT. The subgroup defined by two or more SOREMPs included many patients without cataplexy. A disproportionate number of these subjects were older women whose chances of developing cataplexy are remote. This group of older women had a higher number of periodic leg movements during sleep than the other groups. Patients with both cataplexy and two or more SOREMPs have the greatest chance of being DR2 DQw1 positive. Thus, the combination of history of cataplexy and two or more SOREMPs is the best clinical determinant of narcolepsy. However, two or more SOREMPs is a poorer discriminant of narcolepsy than history of cataplexy.
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Affiliation(s)
- A Moscovitch
- Stanford University Sleep Research Center, Palo Alto, CA 94304
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Abstract
There have been fairly limited reports in the literature of assaults on residents in psychiatric facilities. Assaults on residents and staff tend to be underreported and, for a variety of reasons, not adequately dealt with by the administration. For this reason, security in psychiatric facilities may be lacking in many instances. In order to prepare a position paper of guidelines specifying minimum security requirements for psychiatric facilities in Canada, the Residents' Section of the Canadian Psychiatric Association gathered data on this issue from psychiatric residents. We present the results of a questionnaire sent to all psychiatric residents who are members of the Canadian Psychiatric Association. Results indicate that 40.2% of residents have been assaulted at least once. We present some interesting findings that relate to the residents' perception of their training and the appropriateness of the facilities for assessing patients. Requests for improved security were made by 36.9% of the residents, but only 22.9% of this group found the response by acceptable. Some of the residents' explanations for the assaults suggest interesting dynamics. These and other findings suggest an urgent need to address this issue.
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Moscovitch A, Chaimowitz GA, Patterson PG. Trainee safety in psychiatric units and facilities. The position of the Canadian Psychiatric Association. Can J Psychiatry 1990; 35:634-8. [PMID: 2268846 DOI: 10.1177/070674379003500715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This position statement was prepared by the Professional Standards and Practice Council, chaired by Dr. Paul C.R. Patterson, and approved by the Board of Directors of the Canadian Psychiatric Association on March 31, 1990.
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