Night terrors in adults: phenomenology and relationship to psychopathology.

BACKGROUND: Night terrors have been classically described in children. Night terrors occurring in adults have been linked to psychopathology. Recent descriptions of sleep panic attacks have raised questions about their relationship to night terrors. METHOD: Evaluations from a medically affiliated sleep disorders program were reviewed to identify adult patients presenting with events consistent with night terrors. Eleven patients were identified, 10 of whom had polysomnographic evaluation, and their records were reviewed for information relevant to night terrors and psychiatric symptoms. Six of these patients were available for further assessment which included inquiry regarding sleep events, a Structured Clinical Interview (SCID) for psychiatric disorders, and the Millon Clinical Multiaxial Inventory II (MCMI-II) for personality-related measurements. RESULTS: In the original sample, night terror episodes featured confused behaviors, motor activity, and absent or fragmented recall. Polysomnography documented arousals from slow wave sleep in 9 of 10 patients. All of the original patients reported psychiatric symptoms. All 6 patients who received the subsequent structured evaluation met lifetime criteria for Axis I conditions (most commonly affective and substance use disorders) and had elevated scores on the personality scales of the MCMI-II. Night terrors were not limited to psychiatric episodes. CONCLUSION: Night terrors occur in adults that are similar to episodes described in children. While distinct from sleep panic attacks, night terrors appear to occur in adults with histories of psychopathology.

Electroconvulsive therapy for post-stroke depressed geriatric patients.

Medical records were retrospectively reviewed for 20 medically ill geriatric patients who received electroconvulsive therapy (ECT) for post-stroke depression from January 1982 to January 1991 at Massachusetts General Hospital. Of the 19 patients (95%) who improved with ECT, 7 patients (37%) suffered relapses despite maintenance anti-depressant medications. Relapses typically developed approximately 4 months after ECT. Five patients (23%) developed ECT-related medical complications. Three patients (15%) developed transient interictal confusion or amnesia. No patient experienced an exacerbation of preexisting neurologic deficits. These findings indicate that ECT is a generally well tolerated and effective treatment for depressed, medically ill post-stroke geriatric patients.