Misdiagnoses of Epilepsy as Ekbom Syndrome, Mood Instability, and Nocturnal Visual Hallucinations.

Epileptic seizures may be misdiagnosed if they manifest as psychiatric symptoms. We report three female patients with no preexisting history of epilepsy that were unsuccessfully treated as primary psychiatric disorder: one patient was initially diagnosed with somatization and Ekbom syndrome; the second was referred to psychiatrist due to mood instability and visual hallucinations; and the third one was referred for anxiety and hallucinations related to sleep. A carefully taken medical history clarified diagnoses of epilepsy. None of the patients responded to medications aimed at treating psychiatric symptoms, and all the patients had favorable response to antiepileptic treatment. These cases illustrate that epileptic patients may experience nonconvulsive seizures that might be misdiagnosed as primary psychiatric disorder.

Diagnostic relevance of sleep complaints in anxiety and mood disorders.

Clinical assessments of sleep and subjective state upon waking were performed in normal controls and patients with generalised anxiety disorder, panic disorder, obsessive-compulsive disorder, primary dysthymia and major depression. Subjects were selected according to DSM-III-R criteria. As compared to normal controls, patients with generalised anxiety, dysthymia and major depression exhibit pervasive and intense complaints of insomnia, and no clear distinctions can be drawn among these groups. Patients with panic disorder do not differ from normal controls, whereas obsessive compulsive patients present limited sleep symptoms. These findings suggest that subjective sleep variables are relevant for the diagnostic discrimination of panic and obsessive-compulsive disorders.

[The applications of sleep studies in psychiatry]. / Aplicações dos estudos do sono em psiquiatria.

In the last two decades considerable progress has been made in defining sleep changes in mental disorders, as well as in studying the relationship between sleep and psychiatric treatments. The pathophysiological significance of those changes has also been investigated, with some theoretical models of mental disorders indicating a direct role of sleep. In psychiatric research, sleep studies have contributed to the clarification of a variety of issues in relation to taxonomy, aetiology, pathogenesis and treatment. Furthermore, clinical and EEG aspects of sleep have proven useful for practical diagnostic and treatment purposes. This article aims to provide a systematic and critical review of current applications of sleep studies in psychiatry, both in research and clinical fields.

EEG sleep characteristics in dysthymia and major depressive disorder.

All night EEG sleep recordings were compared in patients with dysthymia and major depressive disorder. Subjects were selected according to DSM-IV and underwent 2 weeks of treatment with placebo before the sleep evaluations. All patients with major depressive disorder were classified as nonmelancholic and belonged to the recurrent subtype, without full interepisode recovery. Patients with major depressive disorder have a shorter duration of total sleep time, a longer sleep latency and a lower sleep efficiency. However, similar sleep architecture and REM sleep characteristics were found in the two groups. These EEG sleep data seem to favor the existence of a biological overlap between the two forms of nonmelancholic unipolar depression. The validity of dysthymia is still unclear and therefore the nosological implications of our observations are discussed.

The sleep of non-depressed patients with panic disorder: a comparison with normal controls.

All-night sleep EEG recordings were performed in non-depressed patients with panic disorder, agoraphobia, and a group of age- and sex-matched normal controls. Patients were selected according to DSM-IV and all subjects were studied under drug-free conditions. In addition to sleep continuity disturbances, patients with panic disorder have a reduced percentage of slow wave sleep, mainly due to diminished amounts of stage 4. REM sleep characteristics are identical in the two groups. When depressive co-morbidity and non-specific causes of insomnia are excluded, the sleep EEG of panic patients seems to be characterized by modest changes in sleep continuity and sleep architecture. These findings favour the existence of a neurophysiological frontier between anxiety disorders and depressive illness.