Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “DREAM complex”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 307 records · Page 17Linked to original sources
PubMed2006

Pediatric highly active antiretroviral therapy in Mozambique: an integrated model of care.

AIM: To test the impact of a public health model to implement HIV pediatric care in Limited Resource Settings. METHODS: A retrospective study on the clinical files of 679 Mozambican children (mean age 4.4 years; SD 3.2), has been carried out. The pediatric patients received HAART (Highly Active Anti-Retroviral Therapy) in the framework of DREAM, a nationwide public health program offering an integrated model of care to HIV patients including free-of-charge HAART and monitoring, nutritional assessment and supplementation, peer-to-peer education, active tracing of the dropped out patients. RESULTS: HAART was started in 297 subjects out of 679. The median time of treatment was 286 (IQ 25-75:125-465). Mortality rate was lower in the sub-sample receiving HAART (8.4%; CI 95%: 5.2-11.6 vs 13.1%; CI 95%: 9.7-16.5). After 6 months of treatment the percentage of viral load lower than 400 copies/mL rose from 4.9% to 46.3%. The percentage of patients with less than 15% of CD4 cells out of the total lymphocyte count and the percentage of patients below the 2 z-score decreased from 56.4% and 58.1% to 8.8% and 38.1% respectively. CONCLUSIONS: Pediatric HAART in limited resource settings often face difficulties to handle complex treatment schemes, but the implemented model seems to be an effective tool to reduce mortality rate in HIV positive pediatric population.

Antiretroviral Therapy, Highly Active↗
PubMed1976

Sleep orgasm in women.

Some of the recent most challenging contributions to our knowledge of female sexuality were provided by direct observations as early as during the second year of life concerning genital self-stimulation and masturbation in girls. Other investigators have advanced the proposition that girls are capable of vaginal masturbation and possibly of experiencing vaginal sensation and stimulation very early in life. Our own clinical study on sleep orgasm, based mainly on data obtained from the analysis of one woman, leads to formulating the hypothesis that in some instances the nursing situation may provide sensations in the genitals (vagina), not only for the mother, but also for the baby. We assume that such sensations in the genitals of the infant female are not the result of mechanical stimulation of the genital organs--as described during the second year and later--but are the result of a "resonance" phenomenon whereby the infant's genitals, including the vagina, are stimulated from within. The observations of orgasm made by others and by the author should be considered the first tentative steps toward an understanding of the complex nature of female orgasm. Eventually, further studies might lead to distinguishing more clearly a sexual orgasm in a narrower sense from a sucking orgasm, from an anger orgasm, and from a stress orgasm--i.e. an unspecific genital discharge. Sleep orgasm can represent gratification of unacceptable disguised sexual wishes and can therefore occur after intercourse and orgasm experienced when awake. The study of sleep orgasm might be of value in relation to the general problems of female orgasm. I would like to close with a reminder that some of the formulations presented in this paper are quite obviously largely speculative.

Adult↗
PubMed1992

Sleep-terror disorder in children: the role of self-hypnosis in management.

This paper describes four children, ages 8 to 12 years, with frequent, prolonged, or dangerous disorders of arousal. None had any significant psychological or behavioral problems. Each had a polysomnogram that showed sudden arousals out of slow-wave sleep associated with complex behavior. All responded to a short course of imipramine, 20 to 60 mg at bedtime, followed by and in conjunction with training in relaxation and mental imagery (self-hypnosis). Once the correct diagnosis was made, the treatment strategy was to (1) demystify the symptom complex through education, (2) establish prompt control of the symptoms with the use of imipramine, (3) train the children in self-regulation with self-hypnosis, and (4) discontinue the medication while maintaining control of the arousals. Over a 2-3 year follow-up all children remain asymptomatic. This is the first report of successful use of self-hypnosis for the treatment of polysomnogram-proven disorders of arousal in the pediatric population. Also reported are seven additional children who were treated equally successfully with hypnosis without the use of medication.

Adolescent↗
PubMed1996

Memory, sleep, and dynamic stabilization of neural circuitry: evolutionary perspectives.

Some aspects of the evolution of mechanisms for enhancement and maintenance of synaptic efficacy are treated. After the origin of use-dependent synaptic plasticity, frequent synaptic activation (dynamic stabilization, DS) probably prolonged transient efficacy enhancements induced by single activations. In many "primitive" invertebrates inhabiting essentially unvarying aqueous environments, DS of synapses occurs primarily in the course of frequent functional use. In advanced locomoting ectotherms encountering highly varied environments, DS is thought to occur both through frequent functional use and by spontaneous "non-utilitarian" activations that occur primarily during rest. Non-utilitarian activations are induced by endogenous oscillatory neuronal activity, the need for which might have been one of the sources of selective pressure for the evolution of neurons with oscillatory firing capacities. As non-sleeping animals evolved increasingly complex brains, ever greater amounts of circuitry encoding inherited and experiential information (memories) required maintenance. The selective pressure for the evolution of sleep may have been the need to depress perception and processing of sensory inputs to minimize interference with DS of this circuitry. As the higher body temperatures and metabolic rates of endothermy evolved, mere skeletal muscle hypotonia evidently did not suffice to prevent sleep-disrupting skeletal muscle contractions during DS of motor circuitry. Selection against sleep disruption may have led to the evolution of further decreases in muscle tone, paralleling the increase in metabolic rate, and culminating in the postural atonia of REM (rapid eye movement) sleep. Phasic variations in heart and respiratory rates during REM sleep may result from superposition of activations accomplishing non-utilitarian DS of redundant and modulatory motor circuitry on the rhythmic autonomic control mechanisms. Accompanying non-utilitarian DS of circuitry during sleep, authentic and variously modified information encoded in the circuitry achieves the level of unconscious awareness as dreams and other sleep mentation.

Animals↗
PubMed1994

Transference: erotised, erotic, loving, affectionate.

Within a set of phenomena traditionally problematic for psychoanalysis, four types of erotic transference are outlined with a description of their dynamic genesis and related case histories (transference and countertransference developments, fundamental treatment procedures): erotised, erotic, loving, and affectionate transference. The first type is based mostly on psychotic modalities, the second on neurotic modalities. Both the loving and the affectionate transference, on the other hand, turn out to be clinical forms corresponding to a normal substantially same development, different from each other by virtue of a diverse level of maturation in the Oedipus complex: they often provoke--in analysts--a defensive stiffening which is harmful and--from the theoretical point of view--not above reproach. The work is particularly focused on the analytic evolution of a female patient who develops an amorous transference in which the defensive aspects prove to be less important than the potentially evolutionary ones. The treatment has been based--in particular--on the analytic utilisation of this transference. The last part of the contribution is devoted to the analysts' 'guarantee factors', which permit them to work in psychoanalysis with the 'highly explosive forces' of these transference configurations, maintaining a useful, rigorous, sensitive and sufficiently creative framework.

Adult↗
PubMed2002

The psychological puzzle presented by physiological acts.

Physiological acts present the puzzle that we are unable to explain how we performed them, how we solved the technical difficulties involved in their execution. For instance, when we sing, we produce various musical notes by changing the shape of the larynx. The normal person does not even know what the larynx looks like, let alone its configurations corresponding to various notes and the combination of the 19 muscles acting on the larynx that has to be activated to bring about the required configuration. Some psychologists offer the explanation that the technical details are worked out by a computer-like mechanism. But how could a computer start controlled cell proliferation in the repair of an injury? Another idea (originally put forward by Leibniz around 1700) is the complex character of the mind. The mind may incorporate a multitude of personalities. Subordinate personalities, some, perhaps, specialising on various tasks, may carry out the orders of the commanding personality. Objection: most physiological tasks, for instance digestion or the fight against invading microorganisms, are completely unconscious. The 'myself' personality could not even issue commands regarding the repair of injuries or the fight against microorganisms. PROPOSED SOLUTION: At an early stage of evolution the body of a higher animal divides itself into three compartments, each specialising on a different task of life. The three parts correspond to the entoderm, mesoderm and ectoderm appearing at an early part of ontogenetic development. The task of the entoderm is metabolism, that of the mesoderm mainly the mechanical aspects of life, that of the ectoderm gathering information from and reacting to the outside world. Each of these is probably of a composite character. The myself personality is the equivalent of the ectoderm, not of the whole body. The technical details of its commands are worked out by subordinate personalities. So are the commands of the mesodermal and entodermal divisions. Dreams could be attempts of communication between the germ layers.

Humans↗
PubMed1982

Perverse relationships between parts of the self: a clinical illustration.

In this paper I have presented clinical material which emphasized the way a narcissistic part of the personality can acquire a disproportionate power by gaining a hold on the healthier parts of the personality, and I have suggested that it does this to the extent that it can persuade these parts to enter into a perverse liaison. An understanding of these liaisons can help the analyst to resist some of the pressure to act out with his patient. I have tried to show that we are dealing here not with a split between good and bad, but with the consequences of a breakdown in splitting and a reassembling of the fragments into a complex mixture under the dominance of an omnipotent narcissistic structure. In order to free the healthy, sane part of the patient we have to understand the whole situation. I believe this includes the propensity of the patient to present himself as the innocent victim. We have to recognize the sense of helplessness, but also those occasions when a collusion develops and the patient gets a perverse gratification from the domination of the narcissistic organization. Insight into the domination may then not be enough, and the collusion has also to be exposed. If this can be achieved, the patient can sometimes come to accept the existence of a part of himself as truly destructive, which he has to learn to live with, which can be contained and modified but which cannot be disowned.

Adult↗
PubMed1979

The technical significance and application of Mahler's separation-individuation theory.

Greater knowledge and integration of developmental concepts and of the frame of reference of separation-individuation, add to the analyst's richer insights and to his more complete interpretations and reconstructions. Freud recognized the complexity of preoedipal development and the importance of the object and of object relations. Contemporary contributions have enabled us to proceed beyond the preoedipal conceptualizations of and since Freud, to better understand ego- and drive regression and evidence of fixations or ego distortions which may appear parallel to "normal neurotic" findings. I question whether we encounter different patients today and suggest that we understand our patients better, thus making our analytic assessments and practices so different from 50 years ago. Separation-individuation theory encompasses and organizes findings from many sources, research and clinical, and permits us to perceive and process material in a multifaceted way. It must affect the timing and content of interpretations and reconstruction, and has a profound influence upon the understanding of psychopathology as well as normal development.

Adult↗
PubMedDate not supplied

The fear of being fat and anorexia nervosa.

It was found in the analysis of patients with anorexia nervosa that when they resumed normal weight and began menstruating again, analysis focused on their complex and pathological body image, which was manifested consciously by an intense fear of being fat. Scrutiny of nonanorexic women in analysis showed them to have a less intensely cathected fear of being fat or body-image disturbance, and observation and questioning of normal women in our culture showed many of them to also have this fear. Unconsciously caused by their feminine identification, many male homosexuals and men with severe latent homosexual conflicts were found to have the fear of being fat, in contrast to other men who do not evidence the fear. The fear of being fat is greatly overdetermined, and clinical material is presented to demonstrate that conflicts from every level of development--pre-Oedipal, Oedipal, adolescent, and adult--are displaced onto and masked by the fear.

Anorexia Nervosa↗
PubMed1994

Narrative scripts: composing a life with ambition and desire.

The "formative and deformative narratives" and the psychodynamics of male-female relations permeate us all, and are revealed in theme and variations in our consulting rooms. Conventional narrative forms are largely androcentric, action-oriented, and point single-mindedly toward a goal (Van Buren, 1991), whereas women's stories and their identities--digressive and complex weavings--are built around the significant relationships in their lives (Gilligan, 1982; Kaplan, 1984; Bernay, 1986). As clinicians, we must be mindful of derangements of our own desire, shaped by our biological mothers and fathers, our psychoanalytic fathers, Freud, and his early followers, and sometimes our own analysts. We must attend to the voice of our own ambition and trace its flourishes and derailments, understanding female ambition from a woman's point of view in order to assist our patients in reconstructing deformative narratives into healthier and more enabling ones. We need to take responsibility for our own ambition, stilling the disabling voices of the characters in our own intrapsychic dramas, maintaining consciousness of the deformative voices in the culture at large, and attunement to voices of support for ambition integrated with nurturance and aggression.

Assertiveness↗
PubMed1998

Neuronal phenomena associated with vigilance and consciousness: from cellular mechanisms to electroencephalographic patterns.

The neuroanatomical substrates controlling and regulating sleeping and waking, and thus consciousness, are located in the brain stem. Most crucial for bringing the brain into a state conducive for consciousness and information processing is the mesencephalic part of the brain stem. This part controls the state of waking, which is generally associated with a high degree of consciousness. Wakefulness is accompanied by a low-amplitude, high-frequency electroencephalogram, due to the fact that thalamocortical neurons fire in a state of tonic depolarization. Information can easily pass the low-level threshold of these neurons, leading to a high transfer ratio. The complexity of the electroencephalogram during conscious waking is high, as expressed in a high correlation dimension. Accordingly, the level of information processing is high. Spindles, and alpha waves in humans, mark the transition from wakefulness to sleep. These phenomena are related to drowsiness, associated with a reduction in consciousness. Drowsiness occurs when cells undergo moderate hyperpolarizations. Increased inhibitions result in a reduction of afferent information, with a lowered transfer ratio. Information processing subsides, which is also expressed in a diminished correlation dimension. Consciousness is further decreased at the onset of slow wave sleep. This sleep is controlled by the medullar reticular formation and is characterized by a high-voltage, low-frequency electroencephalogram. Slow wave sleep becomes manifest when neurons undergo a further hyperpolarization. Inhibitory activities are so strong that the transfer ratio further drops, as does the correlation dimension. Thus, sensory information is largely blocked and information processing is on a low level. Finally, rapid eye movement sleep is regulated by the pontine reticular formation and is associated with a "wake-like" electroencephalographic pattern. Just as during wakefulness, this is the expression of a depolarization of thalamocortical neurons. The transfer ratio of rapid eye movement sleep has not yet been determined, but seems to vary. Evidence exists that this type of sleep, associated with dreaming, with some kind of perception and consciousness, is involved in processing of "internal" information. In line with this, rapid eye movement sleep has higher correlation dimensions than slow-wave sleep and sometimes even higher than wakefulness. It is assumed that the "near-the-threshold" depolarized state of neurons in the thalamus and cerebral cortex is a necessary condition for perceptual processes and consciousness, such as occurs during waking and in an altered form during rapid eye movement sleep.

Consciousness↗
PubMed2004

Episodic memory and the hippocampus: another view.

A popular view of the function of the hippocampus maintains that this structure temporarily encodes the neocortical representation of the experience of an episode. It uses the encoding to recreate repeatedly the neocortical representation. It is said that in time the episodic memory becomes consolidated in the neocortex and can be retrieved independent of the hippocampus. This paper is critical of that view and begins by raising four concerns. These include a question of how the hippocampus could encode the rich complexity of neocortical representations in sufficient detail to recreate them. And it observes that some data indicate episodic memories remain dependent on the hippocampus for life. Another view of hippocampal function is presented which addresses these concerns. Basically, this view hypothesizes that the ability to retrieve episodic memories involves the interplay between two modes of hippocampal function. Processes during the theta mode facilitate the development of context memory in the hippocampus and the registration of unique events in the neocortex, but block the influence of context memory upon the neocortex. By contrast, during the non-theta mode, context memory is projected onto the neocortex, creating a contextual framework. It is proposed that the ability to retrieve memory of episodes depends on the development, through contiguity, of associations between the representation of the episode (created during theta) and a contextual framework (evoked during non-theta). From this perspective, the episode does not need to be encoded in the hippocampus, but remains dependent indefinitely on associations formed between the episodic memory in the neocortex and a context memory maintained in hippocampal structures. However, for the associations that enable retrieval to form, the creation of the representation of an episode during theta must be followed quickly by the evocation of a contextual framework. During an extended period of the theta mode as occurs during REM sleep dreaming, these associations cannot usually be formed, resulting in amnesia for most dreams.

Animals↗
PubMed1990

Interhemispheric EEG coherence during sleep and wakefulness in left- and right-handed subjects.

REM sleep is associated with the production of complex imagery sequences. Yet research is divided as to whether different brain regions are more or less coordinated in their functioning at this time. Some research suggests that there may occur a functional disconnection of the left and right cerebral hemispheres during REM sleep which is similar to the disconnection syndrome seen after corpus callosotomy. Other research suggests that an increase in interhemispheric coordination occurs. On the assumption that hemispheric coordination is reflected in the EEG coherence measure, we explored differences in interhemispheric coherence recorded in six left- and six right-handed normal subjects during periods of wakefulness, stage REM, stage 2, and stage 3/4 sleep. Strong evidence was found that mean EEG coherence values are larger during sleep than during waking and that they are approximately equal for the different stages of sleep. Frontal electrode placements demonstrated a slightly different pattern of coherence than central, parietal, or occipital placements. Furthermore, coherence values were larger for left-handed subjects over the occipital region during wakefulness, stage 2, and stage REM sleep, but not during stage 3/4 sleep. Coherence was not different for male and female subjects. These findings oppose the interpretation that a functional disconnection of hemispheres occurs during REM sleep and favor the interpretation that sleep in general is a state of heightened cortical coordination. Moreover, greater interhemispheric coherence over occipital brain regions in left-handed subjects suggests possible differences in the cognitive processes of these subjects during waking and dreaming states.

Brain Mapping↗
PubMed2002

Experimental facilitation of the sensed presence: possible intercalation between the hemispheres induced by complex magnetic fields.

This experiment was designed to test the hypothesis that the sensed presence, the feeling of a proximal sentient being, can be evoked within the laboratory. Under double-blind conditions, 48 university men and women were exposed to weak (100 nT to 1 muT), complex, pulsed magnetic fields that were applied primarily over the right temporoparietal region, primarily over the left temporoparietal region, or equally across both hemispheres (one treatment per group) for 20 minutes while wearing opaque goggles in a very quiet room. A fourth group was exposed to a sham-field condition. Subjects who received greater stimulation over the right hemisphere or equal stimulation across both hemispheres reported more frequent incidences of presences, fears, and odd smells than did the subjects who received greater stimulation over the left hemisphere or who were exposed to the sham-field condition. The results suggest that the sensed presence is subject to experimental manipulation. This experimental procedure could be employed to explore the idea that the experience of a sensed presence is a resident property of the human brain and may be the fundamental source for phenomena attributed to visitations by gods, spirits, and other ephemeral phenomena.

Adult↗
PubMed2001

Medication effects on sleep.

Each person spends one third of his or her life asleep. It is not surprising that such a complex and pervasive cognitive state should be affected by drugs in many different ways. A philosophy that remains cogent for the CNS is that new research almost always shows this system to be more complex than previously thought. Only a few years ago, if patients complained of difficulty sleeping, they were given pills, often dangerous and addictive pills, to induce sleep no matter what the basis of the complaint might be. Sleeping pills may be safer now, and the understanding of the sleep state itself has increased rapidly. Diagnoses are still diffuse, however, and treatments are often poorly directed. Depression is the offspring of the phlegmatic disposition and the melancholia of another era. Clinically, diagnosis is based on a global assessment of symptoms. It is likely that a diagnosis of depression may include a spectrum of underlying diseases that cannot now be clinically differentiated. Medications have multiple effects on sleep and have many side effects. Progress has, however, been made beyond mother's little pills. Insomnia is no longer a diagnosis but a complaint to be addressed--a symptom of 1 of 60 potential sleep disorders. Each of these disorders has specific and appropriate treatments.

Awareness↗
PubMed2001

Combining genetic and genomic approaches to study mood disorders.

Recent technological advances in genetic manipulations and DNA microarrays are profoundly altering the landscape of biological research, offering opportunities to investigate biological questions that were only dreamed of a few years ago. With this revolution comes the hope of being able to tackle some of the more arduous challenges that the central nervous system has presented to the research community. Specifically, a major goal in the study of neuropsychiatric disorders has been to identify underlying mechanisms of brain dysfunction with the expectation that these insights may allow a better diagnosis, prevention and effective treatments for these disorders. For the most part, treatments of these disorders have relied on serendipitous discovery of pharmacological entities with therapeutic efficacy, while the causes of the disorders have remained unknown. The serotonin system, and the serotonin(1A) (5-HT(1A)) receptor in particular, have been under intense investigation, mostly due to the fact that serotonergic drugs that directly or indirectly affect the 5-HT(1A) receptor, are effective therapeutic agents in treating patients with various neuropsychiatric disorders, including anxiety and depression. Genetic deletion of the receptor in mouse results in increased anxiety, thus supporting an active role for this receptor in mood regulation. However, the analysis of genetic deletion experiments can be confounded by hidden developmental roles of the missing receptor, by adaptive compensatory mechanisms, as well by the fact that the genes or gene products that are responsible for the cellular and molecular aspects of the phenotype may be several steps removed from the genetic intervention. Here, we present a combined methodological approach of tissue specific and conditional genetic manipulations, with large-scale search for altered gene expression, as an experimental framework to investigate the role of genes with complex functions and/or complex expression patterns. The 5-HT(1A) receptor is used as a model of gene product with complex functions and distributions, and as a prototypical system to which these new genetic approaches are currently being applied.

Animals↗
PubMed2004

Prevention of type 2 diabetes mellitus through inhibition of the Renin-Angiotensin system.

Type 2 diabetes mellitus is becoming a major health problem associated with excess morbidity and mortality. As the prevalence of type 2 diabetes is rapidly increasing, prevention of the disease should be considered as a key objective in the near future. Besides lifestyle changes, various pharmacological treatments have proven their efficacy in placebo-controlled clinical trials, including antidiabetic drugs such as metformin, acarbose and troglitazone, or antiobesity agents such as orlistat. Arterial hypertension, a clinical entity in which insulin resistance is common, is strongly associated with type 2 diabetes and may precede the disease by several years. While antihypertensive agents such as diuretics or beta-adrenoceptor antagonists may worsen insulin resistance and impair glucose tolerance, newer antihypertensive agents exert neutral or even slightly positive metabolic effects. Numerous clinical trials have investigated the effects of ACE inhibitors or angiotensin II receptor antagonists (ARAs) on insulin sensitivity in hypertensive patients, with or without diabetes, with no consistent results. Almost half of the studies with ACE inhibitors in hypertensive nondiabetic individuals demonstrated a slight but significant increase in insulin sensitivity as assessed by insulin-stimulated glucose disposal during a euglycaemic hyperinsulinaemic clamp, while the other half failed to reveal any significant change. The effects of ARAs on insulin sensitivity are neutral in most studies. Mechanisms of improvement of glucose tolerance and insulin sensitivity through the inhibition of the renin-angiotensin system (RAS) are complex. They may include improvement of blood flow and microcirculation in skeletal muscles and, thereby, enhancement of insulin and glucose delivery to the insulin-sensitive tissues, facilitating insulin signalling at the cellular level and improvement of insulin secretion by the beta cells. Six recent large-scale clinical studies reported a remarkably consistent reduction in the incidence of type 2 diabetes in hypertensive patients treated with either ACE inhibitors or ARAs for 3-6 years, compared with a thiazide diuretic, beta-adrenoceptor antagonist, the calcium channel antagonist amlodipine or even placebo. The relative risk reduction averaged 14% (p = 0.034) in the CAPPP (Captopril Prevention Project) with captopril compared with a thiazide or beta1-adrenoceptor antagonist, 34% (p < 0.001) in the HOPE (Heart Outcomes Prevention Evaluation) study with ramipril compared with placebo, 30% (p < 0.001) in the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) with lisinopril compared with chlortalidone, 25% (p < 0.001) in the LIFE (Losartan Intervention For Endpoint reduction in hypertension study) with losartan compared with atenolol, and 25% (p = 0.09) in the SCOPE (Study on Cognition and Prognosis in the Elderly) with candesartan cilexetil compared with placebo, and 23% (p < 0.0001) in the VALUE (Valsartan Antihypertensive Long-term Use Evaluation) trial with valsartan compared with amlodipine. All these studies considered the development of diabetes as a secondary endpoint, except the HOPE trial where it was a post hoc analysis. These encouraging observations led to the initiation of two large, prospective, placebo-controlled randomised clinical trials whose primary outcome is the prevention of type 2 diabetes: the DREAM (Diabetes REduction Approaches with ramipril and rosiglitazone Medications) trial with the ACE inhibitor ramipril and the NAVIGATOR (Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research) trial with the ARA valsartan. Finally, ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) will also investigate as a secondary endpoint whether it is possible to prevent the development of type 2 diabetes by blocking the RAS with either an ACE inhibitor or an ARA or a combination of both. Thus, the recent consistent observations of a 14-34% reduction of the development of diabetes in hypertensive patients receiving ACE inhibitors or ARAs are exciting. From a theoretical point of view, they emphasise that there are many aspects of the pathogenesis, prevention and treatment of type 2 diabetes that still need to be uncovered. From a practical point of view, they may offer a new strategy to reduce the ongoing epidemic and burden of type 2 diabetes.

Angiotensin II Type 2 Receptor Blockers↗
PubMed2001

Complex insomnia: insomnia and sleep-disordered breathing in a consecutive series of crime victims with nightmares and PTSD.

BACKGROUND: Sleep disturbance in posttraumatic stress disorder is very common. However, no previous posttraumatic stress disorder studies systematically examined sleep breathing disturbances, which might influence nightmares, insomnia, and posttraumatic stress disorder symptoms. METHODS: Forty-four consecutive crime victims with nightmares and insomnia underwent standard polysomnography coupled with a nasal pressure transducer to measure airflow limitation diagnostic of obstructive sleep apnea and upper airway resistance syndrome. RESULTS: Forty of 44 participants tested positive on objective sleep studies based on conservative respiratory disturbance indices of more than 15 events per hour; 22 patients suffered from obstructive sleep apnea and 18 suffered from upper airway resistance syndrome. CONCLUSIONS: In an uncontrolled study, insomnia and sleep-disordered breathing were extremely prevalent in this small and select sample of crime victims. Research is needed to study 1) prevalence of sleep-disordered breathing in other posttraumatic stress disorder populations using appropriate controls and nasal pressure transducers and 2) effects of sleep treatment on posttraumatic stress symptoms in trauma survivors with comorbid obstructive sleep apnea or upper airway resistance syndrome. In the interim, some posttraumatic stress disorder patients may benefit from sleep medicine evaluations.

Adult↗