Introduction: Rare and unusual andrologic syndromes that clinicians should be aware of.

There are conditions that are rare and that most providers are unaware of or conditions that consist of a series of symptoms for which there is no agreement that they are even a medical condition. These include painful nocturnal erections, post-orgasmic illness syndrome, body dysmorphic disorder, and post-finasteride syndrome. While some have a psychiatric basis, others clearly have an organic pathophysiology, while for others, there remains much controversy. This month's Views and Reviews will inform the reader of these conditions so they may recognize affected patients and direct them towards appropriate resources for their care.

Rare disorders of penile erection.

This literature review presents two unusual and mystifying disorders of penile erection: painful nocturnal erections, alternatively termed sleep-related painful erections, and idiopathic stuttering priapism, a variant of recurrent ischemic priapism in which no cause is discernible. The disorders are closely related although they are distinct clinically and pathologically. The main subject areas of discussion are recognition, clinical evaluation and management although current concepts surrounding their causes and mechanisms are also addressed. It is acknowledged that despite the perceived rarities of these disorders they are impactful in terms of their disease profiles and consequences. Future advances in their management will require continued development of evidence-based treatments.

Prevalence and correlates of frequent nightmares: a community-based 2-phase study.

STUDY OBJECTIVES: To determine the prevalence of frequent nightmares and their correlates in a large community-based cohort of middle-aged Hong Kong Chinese. DESIGN: A 2-phase design involving a cross-sectional survey of 8558 subjects (men, 47.6%) with a mean age of 40.9 years (SD 5.5, range 20-78) and subsequently followed by a detailed clinical evaluation of the psychopathology and personality profile of 252 subjects. SETTING: Community. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The prevalence of frequent nightmares, as defined by at least once per week, was 5.1%. Female sex, low monthly family income, insomnia symptoms, sleep-disordered breathing symptoms, and sleep-related daytime consequences were significantly associated with nightmare frequency. The risk of having a psychiatric disorder was 5.74 times greater for subjects with frequent nightmares (95% confidence interval 2.03-16.26), especially mood disorders (odds ratio = 15.57, 95% confidence interval 3.77-64.37). After exclusion of concomitant psychiatric morbidities, subjects with frequent nightmares still scored significantly higher on neuroticism in the personality scale (p < 0.05). CONCLUSIONS: Frequent nightmares were not uncommon in the general population and were associated with a constellation of factors, including sociodemographic characteristics and comorbid sleep and psychiatric disorders. Moreover, frequent nightmares were independently related to the neuroticism personality trait, irrespective of psychiatric diagnosis. Prospective studies should be conducted to investigate various predisposing, precipitating, and perpetuating factors and the associated repercussions of nightmares.

Parasomnias and movement disorders in children and adolescents.

Childhood parasomnias and movement disorders arise from a variety of etiologic factors. For some children, psychopathology plays a causal role in sleep disorders; in other cases, recurrent parasomnia episodes induce psychopathology. Current research reveals complex interconnections between sleep and mental health. As such, it is important that clinicians consider the impact psychiatric disorders have on childhood parasomnias. This article describes common parasomnias and movement disorders in children and adolescents, with emphasis on psychologic and behavioral comorbidities.

Evaluación de pesadillas en un hospital general / Tittle

Objetivo: Evaluar la frecuencia de pesadillas en pacientes sin antecedentes psiquiátricos internados en un hospital general comparada con pacientes que consultan ambulatoriamente en el servicio de psiquiatría del mismo hospital. Material y Método: Se entrevistaron 50 pacientes internados sin antecedentes psiquiátricos previos (grupo I) y 100 pacientes psiquiátricos ambulatorios (grupo II). En el grupo I se interrogó sobre la presencia de pesadillas durante la internación y en el grupo II durante los dos meses previos a la consulta. Resultados: Pesadillas grupo I: 16%, grupo II: 31%. Pesadillas en grupo I: 25% de pacientes internados en cirugía, 25% en terapia intensiva, 20% en oncología y 6% en clínica médica. Pesadillas en grupo II: 50% de pacientes con trastornos alimentarios, 35% trastornos depresivos, 29% con diagnóstico de VIH, 29% con trastorno adaptativo, 26% evaluados para cirugía por obesidad y 20 % trastorno de ansiedad. Conclusiones: Los pacientes con trastornos psiquiátricos padecen pesadillas con mayor frecuencia que los pacientes internados. Es importante su investigación ya que si no se trata puede ocasionar malestar significativo

Objective: To evaluate the frequency of nightmares in inpatients without psychiatric antecedents at a general hospital compared with outpatients that consulted at the psychiatric department of the same hospital. Material and Method: 50 inpatients without psychiatric antecedents (group I) and 100 outpatients (group II) were interviewed. The presence of nightmares were asked during the admission in group I and during the previous two months of the consultation in group II. Results: Nightmares, group I: 16%, group II: 31%. Nightmares in group I: 25% surgery inpatients, 25% intensive care inpatients, 20% oncology inpatients and 6% general medicine inpatients. Nightmares in group II: 50% patients with eating disorders, 35% depressive disorders, 29% with AIDS diagnosis, 29 % adjustment disorder, 26% evaluated for obesity surgery and 20% anxiety disorder. Conclusions: Psychiatric patients have nightmares more frequently than inpatients. Nightmares research is important since, if they are not treated, they may cause significant discomfort

REM sleep behaviour disorder.

REM sleep behaviour disorder (RBD) is a parasomnia characterised by nocturnal complex motor activity associated with dream mentation. RBD, which affects mainly older men, may be idiopathic or associated with other neurological disorders. A strong association between RBD and alpha-synucleinopathies has been recently observed, with the parasomnia often heralding the clinical onset of the neurodegenerative disease. The idiopathic form accounts for up to 60% of the cases reported in the three largest series of RBD patients. Follow-up studies in small samples revealed that a proportion of RBD patients will eventually develop Parkinson's disease and/or a dementia of Lewy bodies type in the years following the RBD diagnosis. Recently, neurophysiological and neuropsychological studies in idiopathic RBD have found evidence of central nervous system dysfunction. An impairment of cortical activity, specific neuropsychological deficits, signs of autonomic dysfunction and olfactory impairment have been observed in these patients, challenging the concept of idiopathic RBD. The detection of early markers of neurodegenerative disorders in idiopathic RBD, and the evaluation of their value by the combined application in prospective studies may be crucial for developing early intervention strategies.

Sleepwalking violence: a sleep disorder, a legal dilemma, and a psychological challenge.

OBJECTIVE: The purpose of this article is to further an understanding of the psychological state when aggression follows an episode of partial arousal from early non-REM sleep during which some areas of the brain appear to be functioning as in waking while others appear to remain in a state of sleep. To illustrate this, the author examines a case of homicide for which the defense argued lack of responsibility due to sleepwalking. METHOD: A review of the forensic literature on sleepwalking aggression and sleep studies suggests that these fall into one or both of two DSM-IV-TR diagnoses: sleepwalking disorder and sleep terror disorder. The new case, which would meet criteria for an overlap disorder in which sleepwalking is followed by sleep terror, is compared to one previously published. RESULTS: These findings support sleepwalking violence as a distinct overlap disorder with common disturbed psychological functioning during and for a period up to 1 hour following an aggressive episode. CONCLUSIONS: Research clarifies the pathology of this disorder and highlights the need to both refine the differential diagnosis and test the efficacy of treatment protocols.

Sleep in posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is often associated with sleep disturbances. In this review, we focus on the published literature on subjective and objective findings of sleep in patients with PTSD. Insomnia and nightmares are most commonly reported subjective sleep disturbances. Polysomnographic investigations have frequently reported rapid eye movement (REM) sleep abnormalities in PTSD. However, studies have not been consistent about the type of REM sleep dysfunction in PTSD patients. Antidepressants such as nefazodone, trazodone, fluvoxamine, and imagery rehearsal therapy are found to be beneficial in the treatment of PTSD associated sleep disturbances as well as core symptoms of this anxiety disorder. We propose use of such modalities of treatment in PTSD patients with predominant sleep disturbances. Further studies are required to clarify polysomnographic sleep changes especially role of REM sleep dysregulation and treatment of sleep disturbances in PTSD.