A Practical Guide to the Therapy of Narcolepsy and Hypersomnia Syndromes.
A Practical Guide to the Therapy of Narcolepsy and Hypersomnia Syndromes.
Filed under: Addiction Rehab
Neurotherapeutics. 2012 Oct 11;
Mignot EJ
Narcolepsy and other syndromes associated with excessive daytime sleepiness can be challenging to treat. New classifications now distinguish narcolepsy/hypocretin deficiency (also called type 1 narcolepsy), a lifelong disorder with well-established diagnostic procedures and etiology, from other syndromes with hypersomnolence of unknown causes. Klein-Levin Syndrome, a periodic hypersomnia associated with cognitive and behavioral abnormalities, is also considered a separate entity with separate therapeutic protocols. Non hypocretin-related hypersomnia syndromes are diagnoses of exclusion. These diagnoses are only made after eliminating sleep deprivation, sleep apnea, disturbed nocturnal sleep, and psychiatric comorbidities as the primary cause of daytime sleepiness. The treatment of narcolepsy/hypocretin deficiency is well-codified, and involves pharmacotherapies using sodium oxybate, stimulants, and/or antidepressants, plus behavioral modifications. These therapies are almost always needed, and the risk-to-benefit ratio is clear, notably in children. Detailed knowledge of the pharmacological profile of each compound is needed to optimize use. Treatment for other syndromes with hypersomnolence is more challenging and less codified. Preferably, therapy should be conservative (such as modafinil, atomoxetine, behavioral modifications), but it may have to be more aggressive (high-dose stimulants, sodium oxybate, etc.) on a case-by-case, empirical trial basis. As cause and evolution are unknown in these conditions, it is important to challenge diagnosis and therapy over time, keeping in mind the possibility of tolerance and the development of stimulant addiction. Kleine-Levin Syndrome is usually best left untreated, although lithium can be considered in severe cases with frequent episodes. Guidelines are provided based on the literature and personal experience of the author.
HubMed – addiction
Young Poker Faces : Compliance with the Legal Age Limit on Multiple Gambling Products in the Netherlands.
Filed under: Addiction Rehab
J Gambl Stud. 2012 Oct 12;
Gosselt JF, Neefs AK, van Hoof JJ, Wagteveld K
Gambling is an activity that can be performed on-premise (slot machines in casinos, bars and restaurants) or off-premise (scratch cards and lottery tickets). Although the addictive potential may depend on the specific gambling product, early onset increases the likelihood for future pathological gambling. To delay the onset of gambling behavior and to reduce gambling-related problems, many countries have introduced age limits that should decrease the availability of gambling products to underage individuals. In this study we evaluated compliance to the legal age limit, making use of a mystery shopping method. We distinguished between (1) off-premise scratch cards (n = 51); (2) off-premise lottery tickets (n = 49); (3) on-premise slot machines in casinos (n = 88); and (4) on-premise slot machines in the catering industry (n = 100), and we focus on the factors, such as characteristics of the establishment, buyer, and vendor, that may account for possible differences. The 288 visits demonstrate that gambling products are highly available and accessible to under-aged customers; young customers are still able to gamble despite the legal regulations. The compliance rates fluctuate and appear to be related to the specific gambling product in question. Furthermore, age verification activities and certain outlet- and buyer characteristics, as well as characteristics associated with the purchase attempt, may influence compliance.
HubMed – addiction
Occupational functioning, symptoms and neurocognition in patients with psychotic disorders: investigating subgroups based on social security status.
Filed under: Addiction Rehab
Soc Psychiatry Psychiatr Epidemiol. 2012 Oct 13;
Tandberg M, Sundet K, Andreassen OA, Melle I, Ueland T
PURPOSE: Reported employment rates for patients with psychosis are low, but vary partly depending on illness phase. Illness-related factors such as neurocognition and negative symptoms are associated with occupational functioning, while external factors may also act as barriers for employment. The current study investigated the relationship between neurocognition, symptoms and employment using a threefold division of employment status: employed, receiving temporary benefits and receiving disability benefits. The latter group was divided into two based on level of social functioning. METHODS: A total of 155 patients with broad DSM-IV schizophrenia spectrum disorder were assessed with clinical, neurocognitive and social and occupational functioning measures. Group differences were analyzed with ANOVAs and hierarchical regression analysis. RESULTS: Thirteen percent were employed, 52 % received temporary benefits and 35 % received disability benefits. There were no differences in symptom level and neurocognitive functioning between groups. Among patients on disability benefits, the subgroup with higher social functioning had fewer negative and general symptoms and a trend for better neurocognition compared with those with lower social functioning, thus being more similar to employed patients. Negative symptoms and executive functioning explained 26 % of the variance in social functioning for patients receiving disability benefits. CONCLUSIONS: The association between neurocognition and employment may not be as strong as previously assumed, due to external factors that may influence this relationship. Patients on disability benefits rated high on social functioning showed similarities with employed patients. This could imply that these patients have some work capacity. This issue needs further investigation.
HubMed – addiction
Corticotropin-releasing factor in the mouse central nucleus of the amygdala: Ultrastructural distribution in NMDA-NR1 receptor subunit expressing neurons as well as projection neurons to the bed nucleus of the stria terminalis.
Filed under: Addiction Rehab
Exp Neurol. 2012 Oct 11;
Beckerman MA, Van Kempen TA, Justice NJ, Milner TA, Glass MJ
Corticotropin-releasing factor (CRF) and glutamate are critical signaling molecules in the central nucleus of the amygdala (CeA). Central amygdala CRF, acting via the CRF type 1 receptor (CRF-R1), plays an integral role in stress responses and emotional learning, processes that are generally known to involve functional NMDA-type glutamate receptors. There is also evidence that CRF expressing CeA projection neurons to the bed nucleus of the stria terminalis (BNST) play an important role in stress related behaviors. Despite the potentially significant interactions between CRF and NMDA receptors in the CeA, the synaptic organization of these systems is largely unknown. Using dual labeling high resolution immunocytochemical electron microscopy, it was found that individual somata and dendrites displayed immunoreactivity for CRF and the NMDA-NR1 (NR1) subunit in the mouse CeA. In addition, CRF-containing axon terminals contacted postsynaptic targets in the CeA, some of which also expressed NR1. Neuronal profiles expressing the CRF type 1 receptor (CRF-R1), identified by the expression of green fluorescent protein (GFP) in bacterial artificial chromosome (BAC) transgenic mice, also contained NR1, and GFP immunoreactive terminals formed synapses with NR1 containing dendrites. Although CRF and GFP were only occasionally co-expressed in individual somata and dendritic profiles, contacts between labeled axon terminals and dendrites were frequently observed. A combination of tract tracing and immunocytochemistry revealed that a population of CeA CRF neurons projected to the BNST. It was also found that CRF, or GFP expressing terminals directly contacted CeA-BNST projection neurons. These results indicate that the NMDA receptor is positioned for the postsynaptic regulation of CRF expressing CeA neurons and the modulation of signals conveyed by CRF inputs. Interactions between CRF and NMDA receptor mediated signaling in CeA neurons, including those projecting to the BNST, may provide the synaptic basis for integrating the experience of stress and relevant environmental stimuli with behaviors that may be of particular relevance to stress-related learning and the emergence of psychiatric disorders, including drug addiction.
HubMed – addiction
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