A diagnosis of depression should be considered in patients with multiple physical symptoms in primary care clinics.

Although the vast majority of depressed patients visit primary health care clinics, they often remain undiagnosed and untreated. Therefore, early detection in primary care settings is important. There is a high correlation between number of physical symptoms and the presence of depression, yet little has been reported regarding this relationship in Japanese primary care clinics. We examined number of physical symptoms and depression in a department of general medicine of a Japanese hospital. We included patients with unexplained symptoms after multiple tests to rule out organic diseases. Twenty-one common symptoms were assessed using a symptom checklist. Depression was diagnosed using the Patient Health Questionnaire-9, a self-administered questionnaire designed to diagnose depression. Among 386 patients, 105 (27.2%) (average age: 49.7 ± 20.9 years, 28 men and 77 women) met the criteria for depression. Among the 21 symptoms, 14 were significantly more frequent in patients with depression than in those without depression. When patients had neither general fatigue, nor sleep disturbance nor appetite loss, none met the criteria for depression. Number of symptoms was significantly higher in patients with compared with those without depression. The prevalence of depression increased with number of symptoms: 2% (2/100) for 0 or 1 symptom, 42.4% (42/99) for four to five symptoms and 68.7% (22/32) for more than nine symptoms. Japanese primary care physicians can often rule out depression when patients have neither general fatigue, nor sleep disturbance nor appetite loss. A diagnosis of depression should be considered in patients who report multiple physical symptoms.

Effect of morning school schedule on sleep and anthropometric variables in adolescents: a follow-up study.

The aim of this study was to assess whether the shift from afternoon to morning classes reduces the duration of sleep and whether this reduction has any relation to body fat measurements. This is a follow-up study in which students (n = 379), 12.4 (SD(+/-)0.7) yrs old, were evaluated before and after the school schedule shift, with a 1-yr interval between the first and second data collections. Adolescents were divided into two groups: an afternoon-morning group (students who shifted from afternoon to morning classes) and an afternoon-afternoon group (students who remained in afternoon classes). The morning schedule of classes lasted from 07:30 and 12:00?h, and the afternoon schedule of classes lasted from 13:00 and 17:30?h. Self-reported bedtime, wake-up time, and time-in-bed were obtained. Body mass index, waist circumference, and body fat percentage were obtained by direct measures. The results showed a reduction of time-in-bed during weekdays for those students who changed to the morning session (p < .001). Analysis of covariance (ANCOVA) for repeated measures of anthropometric differences between afternoon-afternoon and afternoon-morning groups showed no effect of the school schedule change on weight gain. In conclusion, the time-in-bed reduction in the period analyzed cannot be considered to be a mediating factor to modifications in overweight anthropometric indicators.

Nocturnal choking episodes: under-recognized and misdiagnosed.

Causes of nocturnal paroxysmal events include a variety of disorders such as epileptic seizures, parasomnias, sleep-related movement disorders, and psychiatric disturbances. Timing and semiology of the events, simultaneous video-electroencephalographic observation, presence of any daytime events, and relevant psychiatric and medical history may help in sorting out various possibilities considered in the differential diagnosis of such events. Timely diagnosis of these events is crucial for appropriate management; under-recognition and misdiagnosis of nonepileptic events is not uncommon. Described here are two cases within the spectrum of nocturnal paroxysmal events, one with nocturnal panic attacks and the other with frontal lobe epilepsy, each presenting with choking episodes.

Nocturnal road traffic noise: A review on its assessment and consequences on sleep and health.

Research on the impact of nocturnal road traffic noise on sleep and the consequences on daytime functioning demonstrates detrimental effects that cannot be ignored. The physiological reactions due to continuing noise processing during night time lead to primary sleep disturbances, which in turn impair daytime functioning. This review focuses on noise processing in general and in relation to sleep, as well as methodological aspects in the study of noise and sleep. More specifically, the choice of a research setting and noise assessment procedure is discussed and the concept of sleep quality is elaborated. In assessing sleep disturbances, we differentiate between objectively measured and subjectively reported complaints, which demonstrates the need for further understanding of the impact of noise on several sleep variables. Hereby, mediating factors such as noise sensitivity appear to play an important role. Research on long term effects of noise intrusion on sleep up till now has mainly focused on cardiovascular outcomes. The domain might benefit from additional longitudinal studies on deleterious effects of noise on mental health and general well-being.

A combination of valerian and lemon balm is effective in the treatment of restlessness and dyssomnia in children.

Efficacy and tolerability of a combined valerian/lemon balm preparation were investigated in an open, multicentre study in children less than 12 years suffering from restlessness and nervous dyskoimesis. Patients were dosed individually by the investigators. In total, 918 children were evaluated for therapeutic efficacy and tolerability. A distinct and convincing reduction in severity was found for all symptoms in the investigators' and parents' ratings. The core symptoms dyssomnia and restlessness were reduced from "moderate/severe" to "mild" or "absent" in most of the patients. In total, 80.9% of the patients who suffered from dyssomnia experienced an improvement for this symptom and 70.4% of the patients with restlessness improved clearly. For the other listed symptoms the total improvement was 37.8% on average. Both, parents and investigators assessed efficacy as to be "very good" or "good" (60.5% and 67.7%, respectively). The tolerability of Euvegal forte was considered as "good" (in 96.7% of the patients it was judged to be "very good" or "good"). No study medication-related adverse events occurred. In conclusion, Euvegal forte was effective in the treatment of younger children with restlessness and dyssomnia and it was very well tolerated.