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Biomedical subjects

G Hajak

Publications and source records attributed to G Hajak.

At least 91 records · Page 5Linked to original sources
PubMed1996

[Coincidence of anxiety and sleep disorders. Overview and case reports].

Anxiety disorders and sleep disorders show various interrelations. This paper stresses the clinical importance of sleep problems in relation to anxiety disorders and of anxiety symptoms in patients with sleep disorders, in context with the relevant literature. Differential diagnostic aspects of overlapping of anxiety, sleep disturbances and organic diseases with anxiety-like symptoms are presented. Sleep-related panic attacks and anxiety in insomnia provide examples of the development of pathophysiological concepts coming from the coupling of sleep and anxiety. Case reports illustrate the relevance for clinical practice.

Adult↗
PubMed1996

Sleep apnea syndrome and cerebral hemodynamics.

The dynamics of cerebral blood flow velocity (CBFV) during sleep were investigated in the right middle cerebral artery of 10 patients with sleep apnea syndrome (SAS) (mean age, 37 years) and 10 healthy control subjects (mean age, 32 years) throughout the entire sleep period. A computer-assisted pulsed (2 MHz) transcranial Doppler ultrasonography system was modified for continuous long-term and on-line recording of cerebral hemodynamics. Concurrently, simultaneous polysomnography, continuous BP recordings, and measurement of the end-expiratory carbon dioxide were undertaken. CBFV showed comparable nocturnal profiles in both groups with decreases during non-rapid eye movement (NREM) sleep and increases during rapid eye movement (REM) sleep, indicating that the general pattern of brain perfusion during normal sleep is maintained in SAS. Sleep stage changes were not regularly accompanied by corresponding changes in CBFV. This reflected a quantitative uncoupling between cerebral electrical activity and cerebral perfusion during sleep and indicated a dissociation in the activity of central regulatory mechanisms. Sleep stage-related analysis showed slightly reduced CBFV in patients with SAS compared with healthy control subjects during wakefulness and the first NREM sleep period, suggesting depressed brain activity in the patient group. The higher CBFV values observed in patients with SAS compared with control subjects during REM sleep and sleep stage 2, both preceding and following REM sleep, underline the influence of dynamically changing sleep patterns on cerebral perfusion in these patients. Reproducible rapid decreases in CBFV were related to EEG arousals. Since apneas are terminated by arousals, these results showed that direct neuronal influences on brain perfusion during apnea are evident.

Adult↗
PubMed1996

Clinical management of patients with insomnia. The role of zopiclone.

Insomnia, especially when chronic, is associated with disturbances in daytime well-being and performance, resulting in a poor quality of life for those affected. Zopiclone has been proven as a drug that favourably balances sleep induction and maintenance as well as an improvement in daytime well-being (efficacy) with a low potential for adverse effects (safety) in the symptomatic treatment of insomnia. Management of chronic insomnia with zopiclone needs a multidimensional approach involving the proper diagnosis of possible underlying causes, and combined use of causal treatment, general sleep hygiene measures, basic elements of psychological treatment and adjunctive medication. It is recommended that therapy with the nonbenzodiazepine hypnotic zopiclone should conform to the guidelines for the use of hypnotics, which are valid for all benzodiazepine receptor agonists.

Azabicyclo Compounds↗
PubMed1996

[Acute inpatient treatment of manias. Effects of independent variables on neuroleptic dosage and length of stay].

Investigations of drug therapy regimens in the treatment of acute mania are rare, selective, methodically problematic, and contradictory. The goal of the present study is to describe the practice of mania treatment in a large unselected collective of patients for the first time, and, following reduction of the data to global parameters such as length of stay, neuroleptic daily and total doses, to determine sources of variance and the strength of their effects by means of explorative data analysis. In contrast to widely held opinions, neuroleptics are used as primary medication in all grades of severity of manic illness. The daily dose comprises 496 +/- 379 mg of chlorpromazine (CPZ) equivalents; this result supports the first dose determination study and is at odds with other studies with much higher dosages. The amount of mean daily medication is only influenced by the severity of illness according to variance analysis, the effect is moderately strong. Neuroleptics appear to have causal effects, a property that has so far only been attributed to prophylactic medication, which is given in 80% of cases; the different application forms have no effect on the neuroleptic dosage, although they do affect the length of stay slightly. The mean length of stay is 46.6 +/- 35.7 days and is slightly affected by age, sex, severity of illness and compliance.

Acute Disease↗
PubMed1996

[Interpersonal psychotherapy in treatment of patients with primary insomnia--preliminary data of polysomnographic macro-analysis].

There has not been done much research on psychotherapeutic treatment of patients with primary insomnia. Interpersonal psychotherapy for insomnia (IPT-I) represents a new causal strategy in the treatment of insomnia, which has been evaluated in this study. 25 patients were treated in 12 single sessions either with IPT-I or with progressive relaxation training. Preliminary polysomnographic data show significant improvement of total sleep time, sleep efficiency and wake after sleep onset of the IPT-I-patients, while the PR-patients only improved slightly. IPT-I therefore was shown to be a promising strategy in the treatment of patients with primary insomnia.

Adult↗
PubMed1996

[Sleep complaints and hypnotic use by the elderly--results of a representative survey in West Germany].

For the first time, a country-wide group of West-Germans were interviewed regarding their sleep complaints and hypnotic intake. Therefore 344 persons who were older than 65 years and 1653 subjects between the age of 14 and 65 years were representatively selected by a random route system. Around the age of 45 the prevalence of sleep-disturbances starts rising continuously and dramatically. Over the age of 65 nearly half of the West-Germans (43%) suffer from difficulties in initiating and/or maintaining sleep (DIMS) at least sometimes, 15% suffer frequently or always from these complaints. 79% of the sleep disturbed elderly (over the age of 65) are chronically ill, having sleep-complaints for more than 2 years or since childhood. The hypnotika intake increases with age as well. Around 45 years of age the irregular hypnotika intake (several times the year or month), and after 55 years of age, regular hypnotic intake (daily or several times the week) rapidly rises. After 65 years of age hypnotic intake increases much more than the sleep complaints do. So, every third elderly person (34%) takes hypnotics at least irregularly. The results of this study indicate that sleep complaints in the elderly are three times more common and more severe than in younger persons, and that they tend to chronify while treated with hypnotics.

Adolescent↗
PubMed1996

[Functional palatoraphy and modified genioplasty in obstructive sleep apnea].

10 patients with obstructive sleep apnea syndrome (OSAS) have been treated with the new surgical procedure functional palatoraphy and modified genioplasty. 5 months after surgery 7 patients with an apnea hypopnea index under 10 were cured. Three therapy refractory patients were all overweight with a body mass index of more than 29 kg/m2. Excessively overweight patients should therefore not be operated. Following the selection criteria we introduced an effective new treatment method for OSAS.

Adult↗
PubMed1995

Single photon emission tomography (SPET) imaging of dopamine D2 receptors in the course of dopamine replacement therapy in patients with nocturnal myoclonus syndrome (NMS).

Single photon emission tomography (SPET) permits the in vivo measurements of regional cerebral radioactivity in the human brain following the administration of compounds labeled with photon-emitting isotopes. According to our SPET findings of a reduced binding of [123I]labeled (S)-2-hydroxy-3-iodo-6-methoxy-([1-ethyl-2-pyrrolidinyl]methyl) benzamide (IBZM) (a highly selective CNS D2 dopamine receptor ligand) to D2 dopamine receptors in striatal structures in untreated patients with nocturnal myoclonus syndrome (NMS) it seemed to be of interest to investigate whether there are changes in D2 receptor binding under dopamine replacement therapy or not. We studied the uptake and distribution of [123I]IBZM before and in the course of dopamine replacement therapy in four patients with severe insomnia caused by a nocturnal myoclonus syndrome (NMS). We found an increase of the IBZM binding to D2 receptors in the course of treatment, which was associated with an improvement of sleep quality. Reasons for this are discussed. The [123I]IBZM SPET technique in conclusion offers an intersting tool for in vivo investigations of functional changes in the dopaminergic neurotransmitter system in longitudinal studies.

Aged↗
PubMed1995

Nocturnal myoclonus syndrome (periodic movements in sleep) related to central dopamine D2-receptor alteration.

The nocturnal myoclonus syndrome (NMS) consists of stereotyped, repetitive jerks of the lower limbs that occur during sleep or wakefulness. NMS is often related with restless-legs syndrome (RLS) and can cause severe sleep disturbances and daytime sleepiness. The efficacy of dopamine agonists in the treatment points to a dopaminergic dysfunction in NMS. We investigated the central dopamine D2-receptor occupancy with [123I] labeled (S)-2-hydroxy-3-iodo-6-methoxy-([1-ethyl-2-pyrrolidinyl]methyl) benzamide (IBZM) (a highly selective CNS D2 dopamine receptor ligand) ([123I]IBZM) and single photon emission tomography (SPET) in 20 patients with NMS and in 10 healthy controls. In most of the patients with NMS there was a lower [123I]IBZM binding in the striatal structures compared to controls. The results indicate that NMS is related to a decrease of central D2-receptor occupancy.

Adult↗
PubMed1995

What treatments do patients with panic disorder and agoraphobia get?

In a retrospective study 100 patients with DSM-III-R/ICD-10 panic disorder and agoraphobia (PDA) were interviewed about the psychopharmacological, psychological and 'alternative' treatments they had received in the course of their illness. Patients gave global statements about how satisfied they were with the various treatments they had experienced. Many patients received treatments that have never been investigated under controlled conditions. The most common drug treatments, in descending order, were: 48% benzodiazepines, 42% tricyclic antidepressants, 32% herbal preparations, 29% neuroleptics, 7% selective serotonin reuptake inhibitors and 6% beta blockers. Of the drug prescriptions, 63% were according to international standards. Of the neuroleptics, two-thirds (63.3%) were prescribed by nonpsychiatric physicians, and only one-third by psychiatrists (33.3%). Tricyclic antidepressants were prescribed more often by psychiatrists (64.7%) than by non-psychiatrists (31.4%). Among psychological treatments, autogenic training (43% of the patients) and psychodynamic therapy (33%) were used far more frequently than behavioural/cognitive therapy (20%). These results confirm the underutilisation of available effective treatments for panic disorder (e.g. tricyclic antidepressants or behavioural therapy) and the overutilisation of treatments without proven efficacy (e.g. herbal preparations or autogenic training). Patients were most satisfied with treatments that have been proven effective in controlled studies. Among drug treatments, benzodiazepines, selective serotonin inhibitors and tricyclic antidepressants were favoured (mean on a 0-4 scale indicating effectiveness: 2.6, 2.6 and 2.4). Neuroleptics (1.4), beta-blockers (1.0) and herbal preparations (0.9) were not rated highly effective by the patients. Among psychological treatments, patients were more satisfied with behavioural/cognitive therapy (2.6) than with psychodynamic therapies (1.5).(ABSTRACT TRUNCATED AT 250 WORDS)

Agoraphobia↗
PubMed1995

Dynamics of cerebral blood flow velocities during normal human sleep.

Bilateral flow patterns of the middle cerebral artery (MCA) were recorded continuously throughout the night in 18 healthy male subjects (mean age 27.4 years) by a computer-assisted pulsed Doppler (2 MHz) system together with simultaneous polysomnography. After inception of sleep, mean flow velocity (MFV) decreased steadily during deepening sleep stages reaching -15.0 +/- 3.6% (p < 0.001) in the right MCA and -16.2 +/- 3.4% in the left MCA (p < 0.001) in stage 4 of the first sleep cycle compared to the waking state. Lowest MFV values were found in stage 2 preceding the last REM period (right MCA: -19.2 +/- 4.1%: left MCA: -19.7 +/- 5.1%). Changing from non-REM into REM sleep, a sudden rise of MFV, which varied from 8.9% (first sleep cycle, left MCA) to 18% (last sleep cycle, right MCA), could be consistently detected indicating a coupling of cerebral electrical activity and cerebral perfusion in REM sleep. During non-REM sleep this concomitant change of MFV and EEG activity was only found in the first sleep cycle, whereas no parallel changes could be observed in later sleep cycles. These results indicate a decoupling of EEG measured cerebral electrical activity and perfusion and suggest that factors other than metabolic mechanisms contribute to the regulation of cerebral perfusion during human non-REM sleep.

Adult↗
PubMed1995

[Sleep disorders--what can be done when hypnotics no longer help? Overview and case report].

We report on the case of a 45-year old female with chronic insomnia and refractory to hypnotics, who also has a - polygraphically documented - tolerance to the imidazopyridine "zolpidem". We discuss the main differential diagnosis and demonstrate a therapeutic regimen which allows a step-by-step replacement of hypnotics by sedative antidepressants. This interval replacement treatment reduces on the one hand the risk of developing a severe withdrawal syndrome. On the other hand the replacement by sedative antidepressants improves insomnia and insomnia-associated depressive symptoms. Finally, the clinical implications and rationale of a therapeutic approach with sedative antidepressants in chronic insomnia are discussed.

Antidepressive Agents↗
PubMed1995

[Panic disorder and agoraphobia: what is effective?].

The present survey of controlled studies on the treatment of panic disorder and agoraphobia (PDA) reveals that treatment with tricyclic antidepressants (e.g., imipramine and clomipramine), benzodiazepines (e.g., alprazolam), serotonin reuptake inhibitors (e.g., fluvoxamine) and the monoamine oxidase inhibitor phenelzine has been proven effective. Among psychological therapies, cognitive therapy and exposure therapy in agoraphobia have been shown to be effective. There is an insufficient number of comparisons between pharmacological and psychological treatments. From the existing studies it can be assumed that none of these treatment modalities is superior to the other. The few existing follow-up studies do not suffice to prove a longer lasting effect for the psychological therapies, compared with drug therapies. Because of the low number of investigations, it cannot be clearly stated whether it is useful or harmful do treat patients with psychopharmacological drugs during psychological therapy. It is more likely that this combination is advantageous.

Agoraphobia↗
PubMed1995

Assessing the efficacy of treatments for panic disorder and agoraphobia. I. Methodological problems.

An assessment of the efficacy of treatments in panic disorder and agoraphobia (PDA) is complicated by methodological problems resulting from the complexity of these disorders. In this paper, commonly used anxiety scales are discussed with regard to their relevance in the assessment of PDA. Although there are already many scales for assessing anxiety and agoraphobia, a qualified instrument for measuring the severity of PDA is still lacking. A survey of the instruments used in recent treatment studies of PDA shows that rather inhomogeneous efficacy criteria were applied. Most often, panic attack frequency was taken as a severity criterion, although this measure showed little power to differentiate between treatments. To deal with the special features of PDA, a battery of different scales was usually employed and non-standardized scales were sometimes used additionally. A new rating scale designed to overcome the methodological problems associated with the assessment of severity in PDA was introduced. The use of the psychiatrist-rated Panic and Agoraphobia (P&A) scale in patients with DSM-III-R panic disorder and/or agoraphobia (n = 235) shows that this scale has the highest correlation with the psychiatrists' clinical global impression of PDA patients (r = 0.79, p < 0.0001), compared with other commonly used observer-rated anxiety scales. The self-rating version of the P&A again had the highest correlation with a patient-rated clinical global impression (r = 0.82, p < 0.0001), whereas the other patient-rated anxiety questionnaires correlated only moderately or poorly. By means of logistic regression, it was shown that the five subscores of the scale contribute independently and almost equally to the prediction of PDA severity.

Adult↗
PubMed1995

Cerebral perfusion during sleep-disordered breathing.

Snoring, a leading symptom of the sleep apnoea syndrome (SAS), has been reported to be one of the risk factors for sleep-related cerebral strokes. Episodes of apnoea are accompanied by hypoxaemia as well as hypercapnia. As CO2 constitute a major regulatory factor controlling cerebral blood flow, it is likely that changes in cerebral perfusion are to be found in patients with SAS, which may be related to nocturnal stroke. A computer-assisted pulsed (2 mHz) Doppler ultrasonography system has been modified for continuous long-term and on-line recording of cerebral haemodynamics together with simultaneous polysomnography, continuous blood pressure recordings, and measurement of the end-expiratory CO2. The dynamics of cerebral blood flow velocity (CBFV) during sleep were measured in the right middle cerebral artery in 10 SAS patients. CBFV showed a characteristic nocturnal pattern with decreases during non-rapid eye movement (NREM) sleep and increases during REM sleep. Changes in sleep stage patterns as well as awakenings from NREM sleep were not regularly accompanied by corresponding changes in CBFV. Dramatic increases in CBFV could be observed during apnoeic episodes, with maximum increases during REM sleep. CO2 reactivity and changes in CBFV related to apnoea duration were markedly increased during sleep compared with the waking state in SAS patients. The dynamic feature of CBFV in relation to sleep patterns reflects quantitative uncoupling between cerebral electrical activity and cerebral perfusion during sleep in SAS patients as has been previously reported for normal subjects (Hajak et al. 1994). It supports a dissociation in the activity of central regulatory mechanisms during human sleep which might cause abnormal cerebral perfusion under certain circumstances. The increased CO2 reactivity during sleep in SAS suggests a 'hypersensitivity' of intracranial vasoactive receptors and/or disturbances in the central autonomic control of cerebrovascular functions. It may be concluded that, under certain conditions, the interaction of decreased cerebral perfusion in SAS patients with sleep-related cerebral perfusion patterns and haemodynamic changes during apnoeic episodes might lead to a critical reduction in cerebral perfusion.

Journal Article↗