Nov 242012
 

Definition

Insomnia is defined as inadequate or poor-quality sleep characterized by one or more of the following: difficulty falling asleep, difficulty maintaining sleep, waking up too early in the morning, or sleep that is not refreshing. Insomnia also involves daytime consequences such as fatigue, difficulty concentrating, and irritability.

Acute Insomnia

Periods of insomnia lasting between 1 night and a few weeks are defined as acute insomnia.

Chronic Insomnia

Chronic insomnia refers to sleep difficulty occurring at least 3 nights per week for 1 month or more.

Causes

Insomnia may be associated with specific sleep disorders, including restless legs syndrome, periodic limb movement disorder, sleep apnea, and circadian rhythm sleep disorders.

  • Restless legs syndrome is characterized by unpleasant sensations in the legs or feet that are temporarily relieved by movement. Symptoms are worse in the evening, especially when a person is lying down and remaining still. The sensations cause difficulty falling asleep and are often accompanied by periodic limb movements.
  • Periodic limb movement disorder is characterized by bilateral repeated and rhythmic, small-amplitude jerking or twitching movements in the lower extremities and, less frequently, in the arms. These movements occur every 20 to 90 seconds and can lead to awakenings, which are usually not noticed by the patient. Often the patient reports that sleep is not refreshing. In many cases, the bed partner is more likely to report the movement problem.
  • Obstructive sleep apnea is most commonly associated with snoring, daytime sleepiness and obesity but occasionally presents with insomnia. Continue reading »
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Aug 272012
 

Panic disorder is an anxiety disorder that is characterized by sudden attacks of fear and panic.  A panic attack may be defined has a sudden, intense experience of fear coupled with an overwhelming feeling of danger and death.

Incidence

It occurs in 1-3 % of the population ; female to male ratio is 2 : 1. Familial aggregation is common. Onset is usually in the second or third decade of life.

Clinical Presentation

Initial presentation is almost always to a non psychiatric doctor , frequently in the ER as a possible heart attack or serious respiratory problem. The disorder is often intially unrecognized or misdiagnosed.

Attacks are sudden, unexpected paroxysms of terror and apprehension with multiple associated somatic symptoms.

Usually reach a peak within 10 minutes , then slowly resolve spontaneously.

Panic disorder is often associated with concomitant major depression.

Diagnostic Criteria for Panic disorder 

The diagnostic criteria for panic disorder requires four or more panic attacks within 4 weeks occurring in non threatening  or non exertional settings and attacks must be accompanied by atleast 4 of the following ;

  • Dyspnea
  • Palpitations
  • Chest pain or Discomfort
  • Feeling of being choked
  • Dizziness/ vertigo/ unsteady feelings
  • Sweating
  • Faintness
  • Trembling.
  • Fear of dying
  • Going crazy or doing something uncontrolled.

Medical Conditions that may mimic Panic attacks

Panic disorders must be differentiated from cardiovascular and respiratory disorders. Conditions that may mimic or worsen panic attacks include

  • Hyperthyroidism
  • Pheochromocytoma
  • Hypoglycemia
  • Drug ingestion ( amphetamines, cocaine, caffeine ) Continue reading »
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Aug 242012
 

Dementia may be defined as acquired deterioration in brain’s neuronal function that is characterized by impaired performance of daily living activities including disturbances of memory, thinking, orientation, comprehension, learning and judgement. Memory is the most common cognitive ability lost with dementia.

Dementia has many causes and it is important to identify and exclude the treatable causes.

A list of different causes of dementia is given in a simplified way as follows:

Most Common Causes To Be Listed First

  1. Alzheimer’s disease
  2. Vascular Dementia
  3. Alcoholism
  4. Parkinson’s disease
  5. Drug/Medication intoxication

Causes Listed According To Different Etiologies 

1. Degenerative

  • Alzheimer’s disease
  • Pick’s disease
  • Huntington’s disease
  • Parkinson’s disease
  • Normal pressure Hydrocephalus

2. Vascular

  • Cerebrovascular disease
  • Cranial arteritis
  • Multi infarct dementia
  • Cardiac arrest

3. Traumatic

  • Post head injury
  • Punch drunk syndrome ( seen in Boxers )

4. Intracranial Space Occupying Lesions Continue reading »

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