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1.
Medicine (Baltimore) ; 99(40): e22462, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019437

RESUMO

PURPOSE: To review the literature on the efficacy and safety of Chaihu Longgu Muli decoction (CLMD) for insomnia. METHODS: A systematic literature search was performed for five databases up to May of 2019 to identify randomized control trials involving CLMD for patients with insomnia. The experimental group was CLMD monotherapy or CLMD plus conventional treatment. Comparators were placebo, no treatment, or conventional medicine. The main comparison was CLMD against conventional drugs. The primary outcome was sleep quality (assessed using the Pittsburgh Sleep Quality Index, PSQI). The secondary outcomes were clinical effectiveness rate, total sleep time, and adverse event rate. RevMan 5.3 software was used for meta-analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with 95% confidence interval (CI). RESULTS: A total of 22 studies involving 2029 patients were included. All the included studies presented some risk of bias, especially risks of performance, and detection bias. The main meta-analysis showed that CLMD alone was more effective than conventional medications by reducing PSQI (MD = -2.80, 95% CI [-5.48, -0.13], P = .04), improving the clinical effectiveness rate (RR = 1.23, 95% CI [1.16, 1.31], P < .00001), and prolonging total sleep time (MD = 1.01, 95% CI [0.19, 1.83], P = .002). The adverse event rate in the CLMD group was lower than that of the control group (RR = 0.22, 95% CI [0.09, 0.51], P = .0005). CLMD also improved sleep quality better than conventional medications as an adjunct therapy (P < .05). The funnel plot was symmetrical, representing a low risk of publication bias. CONCLUSION: CLMD presented better efficacy and safety than conventional medications and had the potential to become an alternative to conventional medications for the treatment of insomnia. However, as the included studies showed significant risks of bias, these results will need to be confirmed by future double-blind randomized controlled trials. PROSPERO REGISTRATION NUMBER: CRD42019133103.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Humanos
2.
Am J Alzheimers Dis Other Demen ; 35: 1533317520960875, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32969235

RESUMO

We present a case report to showcase that behavioral, cognitive, and functional decline may be associated with COVID-19 stay-home guidance among older adults with pre-existent cognitive impairment. In a functionally independent and physically active older adult with Mild Cognitive Impairment, there was worsening in depression and anxiety symptoms associated with the restrictions of COVID-19. Functional decline was also noted as assessed by Instrumental Activities of Daily Living. We discuss solutions to mitigate the effects of COVID-19 restrictions in this vulnerable population.


Assuntos
Atividades Cotidianas , Ansiedade/psicologia , Disfunção Cognitiva/psicologia , Infecções por Coronavirus , Depressão/psicologia , Transtorno Depressivo/psicologia , Pandemias , Pneumonia Viral , Isolamento Social/psicologia , Idoso , Antidepressivos/uso terapêutico , Betacoronavirus , Disfunção Cognitiva/fisiopatologia , Transtorno Depressivo/tratamento farmacológico , Exercício Físico , Humanos , Vida Independente , Corrida Moderada , Solidão , Masculino , Mirtazapina/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Telemedicina , Trazodona/uso terapêutico
3.
Am J Clin Oncol ; 43(9): 636-639, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32889833

RESUMO

OBJECTIVES: Cancer patients are using medical cannabis (MC) to address symptoms; however, little data exist to guide clinicians when counseling patients. We seek to define the patterns of MC use among cancer patients, as well as efficacy and safety of MC. MATERIALS AND METHODS: Cancer patients attending oncology office visits at Beaumont Hospital, Michigan from July to December 2018 were anonymously surveyed. The survey included data regarding demographics, diagnosis, treatment, symptom burden, and MC use. Patients who reported MC use since their cancer diagnosis completed a section on patterns of use, efficacy, and safety. RESULTS: The response rate was 188 of 327 (57.5%). MC use was reported by 46 of 188 (24.5%). A median composite baseline symptom score ranging from 8 (best) to 32 (worst) was higher in patients using MC versus nonusers; 17.5 versus 14.4 (P<0.001). Pain was the symptom with the highest frequency of improvement 34/42 (81%), followed by appetite 34/44 (77.3%), and anxiety 32/44 (73%). MC improved the ability to tolerate treatment in 24/44 (54.5%). Cloudy thinking is the symptom that worsened the most 7/42 (16.7%), with decreased energy being experienced by 4/41 (9.8%) of the users. CONCLUSIONS: MC was utilized by a significant portion of cancer patients in this sample, across age, diagnosis, stage, and treatment. Patients with a higher severity of baseline symptoms were more likely to use MC and report a favorable efficacy profile of MC. Minimal toxicity was reported in this cohort. Prospective studies are needed to define the efficacy and safety of MC.


Assuntos
Maconha Medicinal/uso terapêutico , Neoplasias/complicações , Neoplasias/terapia , Fitoterapia , Preparações de Plantas/uso terapêutico , Adolescente , Adulto , Idoso , Anorexia/tratamento farmacológico , Anorexia/etiologia , Ansiedade/tratamento farmacológico , Ansiedade/etiologia , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Dor do Câncer/tratamento farmacológico , Cannabis , Feminino , Neoplasias Gastrointestinais/complicações , Neoplasias Gastrointestinais/terapia , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/terapia , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/terapia , Masculino , Maconha Medicinal/efeitos adversos , Pessoa de Meia-Idade , Náusea/tratamento farmacológico , Preparações de Plantas/efeitos adversos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/etiologia , Inquéritos e Questionários , Adulto Jovem
4.
Medicine (Baltimore) ; 99(34): e21658, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846778

RESUMO

BACKGROUND: Chinese herbal medicine has been widely used to relieve insomnia. Among them, Suan-Zao-Ren decoction (SZRD) has a significant effect in alleviating insomnia. The purpose of this systematic review is to evaluate the effectiveness and safety of SZRD in treating insomnia. METHODS: Relevant randomized controlled trials (RCTs) will be searched from the databases of Embase, PubMed, the Cochrane Library, the China National Knowledge Infrastructure, Wanfang Database and Chinese Science and Technology Periodical Database from their inception to July 2020. Two independent reviewers will select studies, collect data, and assess the methodology quality by the Cochrane risk of bias tool. Statistical analysis is processed by RevMan V.5.3 software. RESULTS: The results of this systematic review will provide an assessment of SZRD treatment of insomnia, and aims to prove the effectiveness and safety of SZRD. CONCLUSION: This study will provide a credible Evidence-based for the treatment of Insomnia with SZRD.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Metanálise como Assunto , Projetos de Pesquisa , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Revisões Sistemáticas como Assunto , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
Medicine (Baltimore) ; 99(27): e21031, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629727

RESUMO

BACKGROUND: Insomnia is a common sleep disorder with symptoms including difficulty falling asleep and early awakening. Guipi decoction is widely used in clinical treatment of insomnia in China. However, there is a lack of systematic evaluation and analysis of Guipi decoction. Therefore, our study will provide efficacy assessments and adverse events assessments. METHODS: A comprehensive search for randomized controlled trials of Gupi decoction treatments for insomnia will be carried in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trial (CENTRAL), CINAHL, AMED and Chinese databases include CBM, CNKI, CQVIP, and Wanfang from their inceptions to May 2020. Relevant reference lists, Baidu Scholar and grey literature will also be checked. Two experienced reviewers will independently search all databases. Primary outcomes include Pittsburgh sleep quality index and clinical effective rate, and secondary outcomes include traditional Chinese medicine syndrome, adverse events, and Epworth Sleepiness Scale. Review Manager 5.3 software will be used analyze all data. RESULTS: This article will be dedicated to assessing the efficacy and safety of Guipi decoction for insomnia. CONCLUSION: The conclusion of this systematic review will provide evidence to judge whether Guipi Decoction is an effective therapeutic intervention for patient with insomnia. Maybe these results could potentially be helpful for improving the therapeutic strategy of patients with insomnia. PROSPERO REGISTRATION NUMBER: CRD 42020164911.


Assuntos
Medicamentos de Ervas Chinesas/efeitos adversos , Medicina Tradicional Chinesa/efeitos adversos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , China/epidemiologia , Medicamentos de Ervas Chinesas/uso terapêutico , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Síndrome , Resultado do Tratamento
7.
Health Qual Life Outcomes ; 18(1): 212, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631438

RESUMO

BACKGROUND: Insomnia continues to be neglected globally, despite its high prevalence. Guidelines by the health regulatory agencies call for studies to evaluate the effect of sedative-hypnotics on sleep quality. METHODS: We conducted a pre-post observational study to evaluate sleep quality among 186 inpatients receiving short-term oral sedative-hypnotic therapy in a tertiary care teaching hospital in Kozhikode (Kerala), India. Using Pittsburgh Sleep Quality Index_Past-Week (PSQI_PW) questionnaire, patients were interviewed upon hospital admission and at follow up after ≥1-week of sedative-hypnotic therapy. Additionally, we interviewed 36 physicians to understand the current clinical perception about sedative-hypnotics. RESULTS: Mean (SD) age of the study patients was 59 (7.5) years. Majority (63.4%) of the patients were men. Of the various primary diagnoses for hospitalization, cardiovascular disease was the most common (22.6%, n = 49). Sedative-hypnotic therapy improved the mean (SD) PSQI_PW overall score by 6.79 points (pre: 12.70 (3.5) vs. post: 5.91 (2.8); p < 0.0001). Statistically significant improvements in sleep duration, latency, efficacy, and day dysfunction were observed. Higher proportion of study patients were prescribed benzodiazepines (73.7%) compared to zolpidem (26.3%). Patients treated with zolpidem reported higher improvements in mean overall PSQI_PW scores compared to those treated with benzodiazepines, however these differences were not statistically significant upon adjusting for age, gender and primary diagnosis for hospitalization. Qualitative interviews indicate that that physicians consider zolpidem to be safer and more efficacious. CONCLUSIONS: In our study, sedative-hypnotic therapy helped improve sleep quality among the hospitalized patients. More studies evaluating the comparative efficacy and safety of zolpidem vs. benzodiazepines - including among patient groups with varying demographic and clinical characteristics - are needed. India must develop evidence-based treatment guidelines to inform the clinical practice around the use of sedative-hypnotics.


Assuntos
Benzodiazepinas/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Pacientes Internados/estatística & dados numéricos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Sono/efeitos dos fármacos , Zolpidem/uso terapêutico , Adulto , Idoso , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
8.
Medicine (Baltimore) ; 99(29): e21166, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702872

RESUMO

INTRODUCTION: Insomnia is a major public health problem. Due to the side effects of pharmacological therapy, people are seeking to choose complementary and alternative therapies for insomnia disorder. Traditional Chinese herbal bath therapy is an important complementary therapy which combines advantages of Chinese herbs and bathing therapy. This protocol describes the methodology of a systematic review assessing the effectiveness and safety of traditional Chinese herbal bath therapy for insomnia. METHODS AND ANALYSIS: Reporting of this review will be adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We will electronically search the following seven databases from inception to January 23, 2020: PubMed, Cochrane database (CENTRAL), EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP Database, and Wanfang Database. Parallel randomized controlled trials evaluating the effectiveness and safety of traditional Chinese herbal bath therapy for insomnia will be included. Study selection, data extraction and assessment of risk of bias will be performed independently by two researchers. The sleep quality will be assessed as the primary outcome. Global symptom improvement, anxiety and depression, and adverse events will be evaluated as secondary outcomes. The Cochrane's risk of bias tool will be utilized for assessing the methodological quality of included studies. Revman software (v.5.3) will be used for data synthesis and statistical analysis. Data will be synthesized by either fixed-effects or random-effects model according to a heterogeneity test. If it is not appropriate for a meta-analysis, a descriptive analysis will be conducted. GRADE system will be used to assess the quality of evidence. PROSPERO REGISTRATION NUMBER: CRD42020168507.


Assuntos
Banhos/normas , Protocolos Clínicos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Banhos/métodos , Medicina Herbária/métodos , Medicina Herbária/normas , Humanos , Medicina Tradicional Chinesa/métodos , Medicina Tradicional Chinesa/normas , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Revisões Sistemáticas como Assunto
11.
Sleep Med Clin ; 15(2): 133-145, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32386689

RESUMO

The scope of this article is to review the effects on sleep of prescription drugs that are commonly prescribed for chronic insomnia in adults. The following groups are discussed: benzodiazepines and its receptor agonists, the dual orexin receptor antagonist suvorexant, melatonin and its receptor agonists, sedating antidepressants, and antipsychotics. Together with the neurobiologic and pharmacologic properties of these drugs, clinical effects are described, including subjective and objective effects on sleep duration, continuity, and architecture. Medical prescription information is given when available. Recently published American and European guidelines for the treatment of insomnia serve as reference frame.


Assuntos
Benzodiazepinas/uso terapêutico , Melatonina/uso terapêutico , Medicamentos Indutores do Sono/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Sono/efeitos dos fármacos , Antipsicóticos/farmacologia , Antipsicóticos/uso terapêutico , Azepinas/farmacologia , Azepinas/uso terapêutico , Benzodiazepinas/farmacologia , Humanos , Melatonina/farmacologia , Antagonistas dos Receptores de Orexina/farmacologia , Antagonistas dos Receptores de Orexina/uso terapêutico , Medicamentos sob Prescrição/farmacologia , Medicamentos sob Prescrição/uso terapêutico , Medicamentos Indutores do Sono/farmacologia , Triazóis/farmacologia , Triazóis/uso terapêutico
12.
Sleep Med Clin ; 15(2): 147-154, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32386690

RESUMO

Patients with chronic insomnia are commonly prescribed hypnotic medications. The long-term effects of chronic hypnotics are not known and discontinuation is encouraged but often difficult to achieve. A gradual taper is preferred to abrupt cessation to avoid rebound insomnia and withdrawal symptoms. Written information provided to the patient about medication discontinuation may be helpful. Cognitive behavioral therapy or behavioral therapies alone can improve hypnotic discontinuation outcomes. There is limited evidence for adjunct medications to assist in hypnotic cessation for insomnia.


Assuntos
Hipnóticos e Sedativos/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Terapia Cognitivo-Comportamental , Humanos , Hipnóticos e Sedativos/efeitos adversos , Distúrbios do Início e da Manutenção do Sono/induzido quimicamente , Síndrome de Abstinência a Substâncias/terapia , Suspensão de Tratamento
13.
Int J Nanomedicine ; 15: 2059-2070, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32273702

RESUMO

Purpose: Ferulic acid (FA) is a natural compound which is used to treat insomnia. However, its use is limited because of its poor oral bioavailability caused by extremely rapid elimination. The current study aimed to develop a self-microemulsifying drug delivery system (SMEDDS) to improve the oral delivery of FA and to enhance its hypnotic efficacy. Methods: FA-SMEDDS was prepared, and its morphology and storage stability were characterized. The formulation was also subjected to pharmacokinetic and tissue distribution studies in rats. The hypnotic efficacy of FA-SMEDDS was evaluated in p-chlorophenylalanine-induced insomnia mice. Results: FA-loaded SMEDDS exhibited a small droplet size (15.24 nm) and good stability. Oral administration of FA-SMEDDS yielded relative bioavailability of 185.96%. In the kidney, SMEDDS decreased the distribution percentage of FA from 76.1% to 59.4% and significantly reduced its metabolic conversion, indicating a reduction in renal elimination. Interestingly, FA-SMEDDS showed a higher distribution in the brain and enhanced serotonin levels in the brain, which extended the sleep time by 2-fold in insomnia mice. Conclusion: This is the first study to show that FA-loaded SMEDDS decreased renal elimination, enhanced oral bioavailability, increased brain distribution, and improved hypnotic efficacy. Thus, we have demonstrated that SMEDDS is a promising carrier which can be employed to improve the oral delivery of FA and facilitate product development for the therapy of insomnia.


Assuntos
Ácidos Cumáricos/administração & dosagem , Sistemas de Liberação de Medicamentos/métodos , Emulsões/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Administração Oral , Animais , Disponibilidade Biológica , Ácidos Cumáricos/química , Ácidos Cumáricos/farmacocinética , Portadores de Fármacos/química , Emulsões/química , Hipnóticos e Sedativos/química , Hipnóticos e Sedativos/farmacocinética , Masculino , Camundongos , Ratos Wistar , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Solubilidade , Distribuição Tecidual
14.
Neurology ; 94(21): e2222-e2232, 2020 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-32341187

RESUMO

OBJECTIVE: To assess the dose-response of daridorexant, a new dual orexin receptor antagonist, on wake after sleep onset (WASO). METHODS: Elderly (≥65 years) participants (n = 58) with insomnia were randomly allocated (Latin square design) to receive 5 treatments (5, 10, 25, and 50 mg daridorexant and placebo) during 5 treatment periods, each consisting of 2 treatment nights followed by a 5- to 12-day washout period. Main efficacy endpoints were the absolute change from baseline in WASO (primary) and latency to persistent sleep (LPS; secondary) to days 1 and 2 (mean of 2 treatment nights assessed by polysomnography) in each period. Safety and tolerability were also assessed. RESULTS: Of 58 participants included, 67% were female, and the median age was 69 years (range 65-85 years). WASO and LPS were dose-dependently reduced from baseline to days 1 and 2 after daridorexant administration (multiple comparison procedure modeling, p < 0.0001 and p = 0.004, respectively); reductions were statistically significant for doses ≥10 mg compared with placebo (WASO: -32.0, -45.1, -61.4 minutes; LPS: -44.9, -43.8, -45.4 minutes for 10, 25, and 50 mg, respectively, p ≤ 0.025). Treatment-emergent adverse events were similar for daridorexant and placebo; the most frequent were fatigue, nasopharyngitis, gait disturbance, and headache (≤7% in any group). CONCLUSIONS: Daridorexant was well tolerated. Dose-dependent improvements in WASO and LPS were statistically significant (dose range 10-50 mg) in elderly people with insomnia disorder. CLINICALTRIALSGOV IDENTIFIER: NCT02841709. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that, for elderly people with insomnia, daridorexant reduced WASO.


Assuntos
Benzimidazóis/uso terapêutico , Pirrolidinas/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Triazóis/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Benzimidazóis/efeitos adversos , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Masculino , Antagonistas dos Receptores de Orexina/uso terapêutico , Polissonografia , Pirrolidinas/efeitos adversos , Resultado do Tratamento , Triazóis/efeitos adversos
15.
Medicine (Baltimore) ; 99(11): e19410, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176067

RESUMO

BACKGROUND: Insomnia is a global public problem, which has a significant negative impact on both physical and mental health, while increasing the economic burden placed on both sufferers and society. Western medicine has a fast treatment on sleep, but it leads to side effects and strong dependence. Long Dan Xie Gan Tang(LDXGT) is a representative Chinese herbal medicine for the treatment of insomnia especially which has a bad-tempered symptom, and its effectiveness and safety has been validated clinically. However, there is yet to be any evidence-based medicine. Therefore, the effectiveness and safety of LDXGT in the treatment of insomnia are studied and systematically evaluated in this study. It will provide a theoretical support for the treatment of insomnia compared to western medicine. OBJECTIVE: The study is purposed to evaluate the effectiveness and safety of LDXGT for the treatment of insomnia. METHODS: Search was conducted for various databases including Pubmed, Chinese Biomedicine Database(CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wan-fang. Randomized-controlled trials (RCTs) were identified for insomnia treatment involving LDXGT and LDXGT combined with ordinary Western medicine. The quality of literature was evaluated by Cochrane assessing tool to reduce the risk of bias. RevMan 5.3 software and STATA 12.0 software were applied to perform the meta-analysis. RESULTS: Thirteen studies involving 1181 participants were identified in this systematic review. Few studies described the details of random principle. No placebo was involved in treatment. LDXGT was compared with ordinary Western medicine in 11 trials and with LDXGT combined with conventional Western medicine in 2 trials. The results of our meta-analysis showed the relative benefits in effective rates compared with conventional western medicine. (Odds Ratio [OR]= 4.32, I = 0%,95% confidence interval CI [3.05 to 6.13], P < .00001) and recovery rate was (Odds Ratio [OR] = 2.67, I = 0%,95% confidence interval CI [2.04 to 3.48], P < .00001). In two trials, adverse events were reported, but no serious adverse effects were reported. CONCLUSION: Our systematic evaluation will provide evidence for the clinical effectiveness and safety of LDXGT in the treatment of insomnia, and the side effects of western medicine are addressed. Further trials are necessary to collect the evidence for the use of LDXGT.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Fitoterapia/métodos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos
16.
Am J Gastroenterol ; 115(6): 853-858, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32195733

RESUMO

OBJECTIVES: The prevalence of psychiatric disease in patients with eosinophilic esophagitis (EoE) is not fully characterized. We aimed to determine the prevalence of psychiatric disease and centrally acting medication use in a cohort of children and adults with EoE and evaluated whether psychiatric disease affects the EoE clinical presentation. METHODS: We conducted a retrospective study of newly diagnosed cases with EoE at the University of North Carolina from 2002 to 2018. Psychiatric comorbidities and relevant treatments were extracted from the medical records. The demographic and clinical features of patients with EoE with and without psychiatric diagnoses, and those with and without psychiatric medication use, were compared. RESULTS: Of 883 patients (mean age 26.6 years, 68% men, 79% white), 241 (28%) had a psychiatric comorbidity. The most common diagnosis was anxiety (23%) followed by depression (17%); 28% of patients were treated pharmacologically. There were 45 patients (5%) treated pharmacologically without a psychiatric diagnosis for chronic pain syndromes, insomnia, and/or epilepsy. Cases with EoE with a psychiatric diagnosis were more likely to be women, white, and 18 years or older and to have a longer symptom duration before diagnosis. DICUSSION: Psychiatric comorbidities were common in EoE, seen in a third of adults and more than 1 in 7 children, and with similar proportions receiving a prescription medication. These illnesses affected the EoE presentation because psychiatric comorbidities were more likely in older, female, and white patients with a longer duration of symptoms preceding diagnosis.


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtorno Depressivo/epidemiologia , Esofagite Eosinofílica/epidemiologia , Psicotrópicos/uso terapêutico , Adolescente , Adulto , Distribuição por Idade , Transtornos de Ansiedade/tratamento farmacológico , Benzodiazepinas/uso terapêutico , Dor no Peito/fisiopatologia , Criança , Dor Crônica/tratamento farmacológico , Dor Crônica/epidemiologia , Comorbidade , Transtornos de Deglutição/fisiopatologia , Transtorno Depressivo/tratamento farmacológico , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/fisiopatologia , Antagonistas de Aminoácidos Excitatórios/uso terapêutico , Feminino , Gabapentina/uso terapêutico , Azia/fisiopatologia , Humanos , Masculino , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Convulsões/tratamento farmacológico , Convulsões/epidemiologia , Inibidores de Captação de Serotonina/uso terapêutico , Distribuição por Sexo , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adulto Jovem
17.
Expert Opin Pharmacother ; 21(9): 1035-1043, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32202451

RESUMO

INTRODUCTION: Chronic insomnia, whether it is primary or in combination with another medical or psychiatric disorder, is a prevalent condition associated with significant morbidity, reduced productivity, increased risk of accidents, and poor quality of life. Pharmacologic and behavioral treatments have equivalent efficacy with each having its own advantages and limitations. AREAS COVERED: The purpose of this perspective is to delineate the limitations encountered in implementing cognitive behavioral therapy (CBT) and to review the pharmacological treatments designed to target the different phenotypes of insomnia. The discussions address how to choose the optimal medication or combination thereof based on patients' characteristics, available medications, and the presence of comorbid conditions. Selective nonbenzodiazepine sedative 'Z-drug' hypnotics, melatonin receptor agonist-ramelteon, and low-dose doxepin are the agents of choice for treatment of primary and comorbid insomnia. EXPERT OPINION: A pharmacological intervention should be offered if cognitive behavioral therapy for insomnia is not available or has failed to achieve its goals. Increasing evidence of the significant adverse consequences of long-term benzodiazepines should limit the prescription of these agents to specific conditions. Testing novel dosing regimens with a combination of hypnotic classes augmented with CBT deserve further investigation.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Qualidade de Vida/psicologia , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Humanos
18.
Medicine (Baltimore) ; 99(9): e19198, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118720

RESUMO

BACKGROUND: Insomnia is a prevalent and bothersome disorder of sleep initiation and maintenance. Although efficacious treatments for insomnia have been available for decades, they all have their own limitations. Guizhi Gancao Longgu Muli Decoction (GGLMD), a popular complementary and alternative therapy, has been widely applied to treat insomnia in some Asian countries for centuries. Yet no systematic reviews have comprehensively assessed the efficacy and safety of GGLMD as a treatment for insomnia. METHODS: A comprehensive search up to November, 2019 will be conducted in the following electronic databases: the Cochrane Library, Embase, PubMed, Web of Science, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Database (CBM), the Chinese Scientific Journal Database (VIP), and the Wanfang Database. The primary outcomes will be sleep quality including Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG). Stata 15 will be used for data analysis as well. RESULTS: This study will provide the current evidence of insomnia treated with GGLMD from the several points including PSQI and PSG. CONCLUSION: The consequence of this summary will furnish proof to evaluate if GGLMD is effective in the treatment of insomnia. ETHICS AND DISSEMINATION: Without personal information involved, ethical approval and informed consent form is no need. The review will be submitted to a peer-reviewed journal prospectively to spread our findings. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42018118336.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Humanos , Revisões Sistemáticas como Assunto
19.
Medicine (Baltimore) ; 99(6): e19033, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028417

RESUMO

BACKGROUND: Zaoren Anshen capsules (ZRAS) have been widely used to treat patients with insomnia. However, the efficacy and safety of ZRAS for insomnia treatment is not entirely clear. Therefore, it is necessary to clarify the effect of ZRAS for the treatment of insomnia by a systematic meta-analysis. METHODS: We searched PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), and WanFang databases and performed a manual search to retrieve relevant articles (available through January 2019) describing randomized controlled trials (RCTs) of ZRAS for the treatment of insomnia. The quality of the selected articles was assessed with the Cochrane risk-of-bias tool. A meta-analysis of the selected articles was performed with RevMan 5.3 software. RESULTS: A total of 13 articles including 1175 patients were included in the study. Overall, our results showed that ZRAS was slightly higher than that of the conventional Western medicine for insomnia in terms of clinical efficacy rate; but there was no statistical difference between the 2 groups (relative risk [RR] = 1.03, 95% confidence interval [CI] = [0.97, 1.09], P = .34). However, it should be noted that ZRAS treatment causes far fewer adverse reaction than treatment with conventional Western medicine (RR = 0.20, 95% CI = [0.14, 0.28], P < .00001). CONCLUSION: Our results suggested that ZRAS is an effective and safe treatment for insomnia, especially in adverse reaction. However, multi-regional and well-designed RCTs studies are needed in the future to validate the results.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Cápsulas , Medicamentos de Ervas Chinesas/administração & dosagem , Medicamentos de Ervas Chinesas/efeitos adversos , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32015180

RESUMO

Phenotypic and biological characterization of rare monogenic disorders represents 1 of the most important avenues toward understanding the mechanisms of human disease. Among patients with SH3 and multiple ankyrin repeat domains 3 (SHANK3) mutations, a subset will manifest neurologic regression, psychosis, and mood disorders. However, which patients will be affected, when, and why are important unresolved questions. Authors of recent studies suggest neuronal SHANK3 expression is modulated by both inflammatory and hormonal stimuli. In this case series, we describe 4 independent clinical observations of an immunotherapy responsive phenotype of peripubertal-onset neuropsychiatric regression in 4 girls with pathogenic SHANK3 mutations. Each child exhibited a history of stable, mild-to-moderate lifelong developmental disability until 12 to 14 years of age, at which time each manifested a similar, subacute-onset neurobehavioral syndrome. Symptoms included mutism, hallucinations, insomnia, inconsolable crying, obsessive-compulsive behaviors, loss of self-care, and urinary retention and/or incontinence. Symptoms were relatively refractory to antipsychotic medication but improved after immunomodulatory treatment. All 4 patients exhibited chronic relapsing courses during a period of treatment and follow-up ranging from 3 to 6 years. Two of the 4 girls recovered their premorbid level of functioning. We briefly review the scientific literature to offer a conceptual and molecular framework for understanding these clinical observations. Future clinical and translational investigations in this realm may offer insights into mechanisms and therapies bridging immune function and human behavior.


Assuntos
Transtorno do Espectro Autista/genética , Deficiências do Desenvolvimento/genética , Mutação da Fase de Leitura , Imunoterapia/métodos , Proteínas do Tecido Nervoso/genética , Comportamento Estereotipado , Adolescente , Agressão/efeitos dos fármacos , Antipsicóticos/uso terapêutico , Ansiedade , Catatonia/tratamento farmacológico , Criança , Comportamento Compulsivo/tratamento farmacológico , Choro , Feminino , Alucinações/tratamento farmacológico , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/uso terapêutico , Humor Irritável/efeitos dos fármacos , Metilprednisolona/uso terapêutico , Mutismo/tratamento farmacológico , Fármacos Neuroprotetores/uso terapêutico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Recidiva , Autocuidado , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Comportamento Estereotipado/efeitos dos fármacos , Síndrome , Incontinência Urinária , Retenção Urinária
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