Search

Functional somatic syndromes are mostly associated with pain and emotional distress. As one marker for the autonomic stress response, the distal skin temperature decreases during psychological stress. In patients with functional somatic syndromes, the distal skin temperature under baseline conditions (without stress induction) is usually lower than in healthy subjects, which could be due to the sustained presence of pain-related stress in such patients. The aim of our study was to investigate whether patients with functional somatic syndromes show altered skin temperatures also under everyday life conditions. 14 patients with functional somatic syndromes and 14 matched healthy control subjects were investigated under ambulatory conditions over six consecutive days. During this time, distal and proximal skin temperatures were continuously recorded and sleep-wake cycles were monitored by actimetry and sleep-wake diaries. Unexpectedly, the patients showed higher distal skin temperatures than control subjects in the afternoon. The objective temperature data did not match the patients' subjective experience: ratings of thermal comfort did not vary between the two groups. Moreover, similar levels of daytime activity were recorded in the two samples, even though patients reported more tiredness and more body tension than controls. We interpret the observed dissociation between objective skin temperature measurements and subjective ratings of the bodily thermal comfort as support for the notion of an alexisomia account (reduced bodily awareness) for functional somatic syndromes. Moreover, findings indicate that subjective complaints of tiredness and tension do not necessarily result in physical avoidance behaviour.

Melatonin, secreted nocturnally by the pineal gland, is an endogenous sleep regulator. Impaired melatonin production and complaints on poor quality of sleep are common among the elderly. Non-restorative sleep (perceived poor quality of sleep) and subsequently poor daytime functioning are increasingly recognized as a leading syndrome in the diagnostic and therapeutic process of insomnia complaints. The effects of 3-weeks prolonged-release melatonin 2 mg (PR-melatonin) versus placebo treatment were assessed in a multi-center randomized placebo-controlled study in 170 primary insomnia outpatients aged > or =55 years. Improvements in quality of sleep (QOS) the night before and morning alertness (BFW) were assessed using the Leeds Sleep Evaluation Questionnaire and changes in sleep quality (QON) reported on five categorical unit scales. Rebound insomnia and withdrawal effects following discontinuation were also evaluated. PR-melatonin significantly improved QOS (-22.5 versus -16.5 mm, P = 0.047), QON (0.89 versus 0.46 units; P = 0.003) and BFW (-15.7 versus -6.8 mm; P = 0.002) compared with placebo. The improvements in QOS and BFW were strongly correlated (Rval = 0.77, P < 0.001) suggesting a beneficial treatment effect on the restorative value of sleep. These results were confirmed in a subgroup of patients with a greater symptom severity. There was no evidence of rebound insomnia or withdrawal effects following treatment discontinuation. The incidence of adverse events was low and most side-effects were judged to be of minor severity. PR-melatonin is the first drug shown to significantly improve quality of sleep and morning alertness in primary insomnia patients aged 55 years and older-suggesting more restorative sleep, and without withdrawal symptoms upon discontinuation.

Objective: Patients with major depressive disorder (MDD) experience sleep disturbances that may be worsened by some antidepressant drugs early in treatment. The aim of this study was to assess the subjective quality of sleep of patients receiving agomelatine, a new antidepressant with melatonergic MT(1) and MT(2) receptor agonist and 5-HT(2C) antagonist properties, compared with that of patients receiving venlafaxine, a serotonin-norepinephrine reuptake inhibitor., Method: This double-blind, randomized study involved 332 patients with MDD (DSM-IV criteria), lasted 6 weeks, and compared the effects of agomelatine 25-50 mg/day and venlafaxine 75-150 mg/day, with a possible dose adjustment at 2 weeks. Subjective sleep was assessed with the Leeds Sleep Evaluation Questionnaire (LSEQ), and the main efficacy criterion was the "getting to sleep" score. Antidepressant efficacy was assessed with the 17-item Hamilton Rating Scale for Depression (HAM-D) and the Clinical Global Impressions (CGI) global improvement scale. The study was performed between November 2002 and June 2004., Results: After 6 weeks, the antidepressant efficacy of agomelatine was similar to that of venlafaxine. The LSEQ "getting to sleep" score was significantly better with agomelatine (70.5 +/- 16.8 mm) than with venlafaxine (64.1 +/- 18.2 mm); the between-treatment difference at the last visit was 6.36 mm (p = .001), and the difference was already significant at week 1. Secondary sleep items, including LSEQ quality of sleep (p = .021), sleep awakenings (p = .040), integrity of behavior (p = .024), and sum of HAM-D items 4, 5, and 6 (insomnia score) (p = .044), were also significantly improved compared to venlafaxine, as was the CGI global improvement score (p = .016). Incidence of adverse events was 52.1% with agomelatine and 57.1% with venlafaxine, and withdrawals due to adverse events were more common with venlafaxine than with agomelatine (13.2% vs. 4.2%)., Conclusion: Agomelatine showed similar antidepressant efficacy with earlier and greater efficacy in improving subjective sleep than venlafaxine in MDD patients.

The effects of milnacipran (50 mg bid) on sleep patterns of eight depressed inpatients, treated for 4 weeks, were studied during the initial (days 1-3) and terminal (days 26-28) treatment periods and compared with those obtained from three sleep recordings performed just prior to the initiation of the treatment. The clinical evolution of patients was evaluated weekly using the MADRS depression scale and the Spiegel and Norris sleep scales. Clinical improvement, shown by a mean reduction of 58% in MADRS scale scores, was accompanied by an improvement of disturbed sleep parameters. From the beginning of treatment, there was an increase in the total duration of sleep and stage II sleep, a decrease in sleep latency and an increase in sleep efficiency. Total REM sleep was not modified although, since there was an increase in total sleep time, the percent REM sleep was significantly reduced. REM latency was increased early in the study, an effect classically associated with antidepressant treatment. This study suggests that milnacipran improves disturbed sleep parameters in depressed patients without any additional disturbance at the onset of treatment., (Copyright 2004 John Wiley & Sons, Ltd.)

En gélule, en comprimé, sous forme de gomme, de spray ou encore de tisane, parfois associée à des plantes, la mélatonine s'est fait une place sur les linéaires des officines. Nombreux sont les clients qui s'y intéressent dans le but de résoudre leurs problèmes de sommeil. In capsule, tablet, gum, spray or herbal tea form, sometimes combined with plants, melatonin has found its place on pharmacy shelves. Many customers are interested in it to solve their sleep problems. [ABSTRACT FROM AUTHOR]