Autonomous Disorders Research Articles

Clinical aspects of binge eating disorder: A cross-sectional mixed-methods study of binge eating disorder experts' perspectives.

Research on binge eating disorder continues to evolve and advance our understanding of recurrent binge eating. This mixed-methods, cross-sectional survey aimed to collect information from experts in the field about clinical aspects of adult binge eating disorder pathology. Fourteen experts in binge eating disorder research and clinical care were identified based on receipt of relevant federal funding, PubMed-indexed publications, active practice in the field, leadership in relevant societies, and/or clinical and popular press distinction. Anonymously recorded semi-structured interviews were analyzed by ≥2 investigators using reflexive thematic analysis and quantification. Identified themes included: (1) obesity (100%); (2) intentional/voluntary or unintentional/involuntary food/eating restriction (100%); (3) negative affect, emotional dysregulation, and negative urgency (100%); (4) diagnostic heterogeneity and validity (71%); (5) paradigm shifts in understanding binge eating disorder (29%); and (6) research gaps/future directives (29%). Overall, experts call for a better understanding of the relationship between binge eating disorder and obesity, including a need for clarification around the extent to which the two health issues are separate vs. related/overlapping. Experts also commonly endorse food/eating restriction and emotion dysregulation as important components of binge eating disorder pathology, which aligns with two common models of binge eating disorder conceptualization (e.g., dietary restraint theory and emotion/affect regulation theory). A few experts spontaneously identified several paradigm shifts in our understanding of who can have an eating disorder (beyond the anorexi-centric "thin, White, affluent, cis-gendered neurotypical female" stereotype), and the various factors that can drive binge eating. Experts also identified several areas where classification issues may warrant future research. Overall, these results highlight the continual advancement of the field to better understand adult binge eating disorder as an autonomous eating disorder diagnosis.

Why Mental Disorders are not Like Software Bugs

AbstractAccording to the Argument for Autonomous Mental Disorder (AAMD), mental disorder can occur in the absence of brain disorder, just as software problems can occur in the absence of hardware problems in a computer. This article argues that the AAMD is unsound. I begin by introducing the “natural dysfunction analysis” of disorder, before outlining the AAMD. I then analyze the necessary conditions for realizer autonomous dysfunction. Building on this, I show that software functions disassociate from hardware functions in a way that mental functions do not disassociate from brain functions. It follows that mental disorders are brain disorders necessarily.

Meteocorrective effect of physical and balneal factors in patients with joint diseases

To identify the patterns of meteotropic reactions to biotropic weather conditions and evaluate the meteocorrective efficacy of physical and balneal factors in patients with joint diseases. We studied the features of weather-related disorders in 165 patients diagnosed with osteoarthrosis/osteoarthritis, including those after total hip and knee arthroplasty. Most patients (55.7%) had cardiovascular comorbidities. All patients received balneal and physiotherapeutic procedures in addition to background drug therapy and exercise therapy. The patients were divided into 3 groups: Group 1 (55 patients) received general sodium chloride baths and exposure to alternating magnetic field (AMF); Group 2 (54 patients) received «dry» carbon dioxide baths and AMF; Group 3 (56 patients) received general baths with the antioxidant and antihypoxic agent Mitofen, and AMF. The weather-sensitivity and severity of meteorological reactions were evaluated using questionnaires, and self-observation diaries, correlated with medical and meteorological weather forecasts. We used the WAM method (well-being, activity, mood), the Abbreviated Multifactor Personality Inventory (AMPI), and the Hospital Anxiety and Depression Scale (HADS). Medical and meteorological weather assessment was performed using a modern medical and meteorological complex (AMMC). Increased weather sensitivity of varying severity was confirmed in 140 (84.8%) patients, and 25 (15.2%) patients were classified as conditionally weather-sensitive. The most severe meteotropic reactions were noted in patients with cardiovascular comorbidities (55.7%) and older individuals with a compromised medical history (29.1%). The use of balneal and physiotherapeutic methods in the medical rehabilitation programs had a positive effect on the manifestations of autonomous disorders and psychological dysadaptation; also, they contributed to the increase of adaptation and functional reserves of the organism exposed to biotropic weather conditions. The effects of the factors were manifested by the reduction of severity of meteotropic reactions. The high effectiveness of general baths with antioxidant and antihypoxic action was revealed in 71.8% of patients with cardiovascular comorbidities. The meteocorrective effect of sodium chloride baths was less pronounced (29.7%), although the majority of patients after the treatment course showed an improvement in their psychoemotional status (39.7%) and a decrease in severe weather-related exacerbations during spastic weather (from 17.6 to 6.7%). The meteocorrective efficacy of complex non-drug methods in patients with joint diseases, including concomitant cardiovascular diseases, has been proved.

Therapeutic Feasibility of the Natural Products in the Heart Complaints: An Overview.

Heart pain is the most frequent complaint leading patients to seek medical help. Functional heart symptoms, especially chest pain, are prevalent and, according to the International Classification of Diseases (ICD-10), are described as "somatoform autonomous functional disorders of the cardiovascular system." The problem lies in the fact that pain does not always have a somatic background, that is, it may be related to crucial underlying heart disease. The population does not know how to differentiate somatic pain from significant ischemic symptoms, and based on the patient's complaints, traditional medicine ends up treating other underlying cardiac diseases. Many unsuccessful unconventional therapies have been proposed in recent years, including herbal medicines that seek to disrupt the disease's pathogenesis. The present review summarizes research carried out in the last 5 years on natural products' heart complaints, including myocardial ischemia, arrhythmia, and heart failure. Several herbal medicines may be used as a replacement or complementary treatment strategy. A total of 17 medicinal plants have shown promising results in preclinical studies. However, human clinical trials are scarce; only two have been presented. Generally, the data are bland, and many issues have been raised about herbal therapies' safety, efficacy, and mode of action. Besides, relevant clinical trials, future perspectives, and possible clinical applications are discussed.

Leptospirosis Case Report with Renal Insufficiency

Introduction: Leptospirosis is an international zoonotic condition relay and rising prevalencethe causes of the infection Leptospira spirochete with popular exhibition of polluted clean water.Most asymptomatic diseases, but the symptoms are moderate, autonomous, specific febrile and respiratory non-specific disorder high mortality rates of renal failure.
 Case: A 33-years-old woman from rural area came to the hospital in casualty with a history of high grade fever (40 degree Celsius), with chilling, headache, stiff neck. Urinary retention along with productive cough for three days.
 Intervention: The patient underwent inpatient management, which included tablet Ceftriaxone 1gm twice a day, Tablet Doxycycline 100 mg bd given and intravenous fluids 5% dextrose and dextrose/sodium chloride solution, Injection Furosemide20 mg intravenously twice a day were given to the patients.
 Nursing management: monitoring the vital sign, maintain the O2 levels as well as the consumption and output. All basic nursing care has been provided. Her symptoms cured after two weeks of treatment, she was discharged.
 Results: Fever has been minimized. The therapy is reacted to and restored.
 Conclusion: Management was mainly aimed at protecting patient wellbeing, preventing complications and improving the quality of life. The patient received all medical therapy and the results show that the therapy and care was effective.

Aberrant Bone Marrow Microenvironment in Therapy Related Myeloid Neoplasm (t-MN)

Introduction: Therapy-related myeloid neoplasm (t-MN) is a lethal second hematological malignancy following chemotherapy (CT) and radiotherapy (RT) for primary cancers. It accounts for 15-20% of myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). AML and MDS are considered to be hematopoietic stem cell (HSC)-autonomous disorders, in which initiation and progression are mainly driven by HSC-intrinsic genetic events. However, emerging data suggest that bone marrow (BM) microenvironment plays critical role in initiation and evolution of MDS and AML (Raaijmakers et al., 2010). Malignant clones can also shape the BM-microenvironment conducive for its survival and proliferation (Medyouf et al., Cell Stem Cell 2014). Although CT/RT can damage BM-microenvironment, very limited studies assessed role of BM-microenvironment in t-MN pathogenesis. Aim: To assess BM-microenvironment changes induced by malignant HSC and changes induced by previous genotoxic stress on BM-microenvironment, we compared BM-mesenchymal stromal cells (MSC) from t-MN patients, with BM-MSC from 1) patients with two unrelated cancers, one of the cancer being MDS/AML, without prior exposure to CT/RT (Double cancers, DC), 2) primary MDS patients (pMDS) and 3) age matched healthy controls (HC). Methods: We characterized BM-MSC from t-MN (n=10), DC (n=8), pMDS (n=6) and age-matched healthy controls (n=10). Morphology (Fei et al., 2014), clonogenic potential (Geyh et al., 2013), proliferation (Prata et al., 2010) and cellular senescence was assessed using previously described methodology. Differentiation potential was assessed by the respective lineage cytochemical staining and quantification of positive cells (mineral quantification for osteogenic cells, and Nile red for adipocytes). DNA damage response was determined by assessing H2AX phosphorylation in the MSC. Results: Only 70% of BM-MSC from t-MN cohort could be expanded to passage 6 compared to 100% of MSC cultures from pMDS, DC and HC. Proliferation rate, assessed by population doubling time, and clonogenic potential was significantly reduced in t-MN patients compared to p-MDS, DC and HC (Fig 1Ai-ii). This was further substantiated by higher senescence rates, assessed by β-galactosidase positive cells at passage 3 (HC 7%±1.9%; pMDS 39%±6%; DC 27%±1%; t-MN 68%±4%) (Fig 1B). Together, it demonstrates that MSC from t-MN have significantly impaired proliferation capacity and higher senescence rate compared to HC, pMDS and DC patients. Interestingly, proliferation capacity and senescence rate was not significantly different between MSC from DC and pMDS patients. We also compared DNA damage repair, following sub-lethal dose of RT, in MSC from t-MN, pMDS and HC. DNA damage repair in t-MN MSC was significantly impaired compared to pMDS and HC (Fig. 1F). Impaired DNA repair could be due to pathogenic germline mutation in DNA repair pathways in some t-MN patients (Singhal et al., ASH 2018). Although MSC from pMDS and DC appeared disorganized, they maintain fibroblast-like morphology similar to HC-MSC. Whereas, most of the MSCs from t-MN cases lost spindle shape morphology and were significantly larger than DC, pMDS and HC (p<0.0001; Fig 1C). Further characterization of the MSC's phenotype revealed that ability to form a mineralized matrix was significantly increased in t-MN MSC compared to HC, pMDS and DC (p=0.04; Fig 1Di-ii). In contrast, quantification of lipid-laden Nile-red-stained adipocytes in t-MN MSCs showed a 5-fold decrease in adipocytes formation compared to HC and ~2-fold compare to pMDS and DC (Fig 1Ei-ii). Conclusions: Our data demonstrate that BM-MSCs from patients with myeloid malignancies are significantly abnormal as compared to age-matched healthy controls. BM-MSCs from T-MN patients have significantly reduced proliferative, clonogenic and DNA repair capacity and have higher senescence rate as compared to BM-MSCs from patients with double cancers. The critical difference between t-MN and DC is previous exposure to CT/RT, providing evidence that prior CT/RT leads to long-term damage to BM-microenvironment, which could be contributing t-MN pathogenesis. Disclosures No relevant conflicts of interest to declare.

Analysis of Catecholamines and Pterins in Inborn Errors of Monoamine Neurotransmitter Metabolism-From Past to Future.

Inborn errors of monoamine neurotransmitter biosynthesis and degradation belong to the rare inborn errors of metabolism. They are caused by monogenic variants in the genes encoding the proteins involved in (1) neurotransmitter biosynthesis (like tyrosine hydroxylase (TH) and aromatic amino acid decarboxylase (AADC)), (2) in tetrahydrobiopterin (BH4) cofactor biosynthesis (GTP cyclohydrolase 1 (GTPCH), 6-pyruvoyl-tetrahydropterin synthase (PTPS), sepiapterin reductase (SPR)) and recycling (pterin-4a-carbinolamine dehydratase (PCD), dihydropteridine reductase (DHPR)), or (3) in co-chaperones (DNAJC12). Clinically, they present early during childhood with a lack of monoamine neurotransmitters, especially dopamine and its products norepinephrine and epinephrine. Classical symptoms include autonomous dysregulations, hypotonia, movement disorders, and developmental delay. Therapy is predominantly based on supplementation of missing cofactors or neurotransmitter precursors. However, diagnosis is difficult and is predominantly based on quantitative detection of neurotransmitters, cofactors, and precursors in cerebrospinal fluid (CSF), urine, and blood. This review aims at summarizing the diverse analytical tools routinely used for diagnosis to determine quantitatively the amounts of neurotransmitters and cofactors in the different types of samples used to identify patients suffering from these rare diseases.

Гестаційний процес та пологова діяльність у вагітних з різними типами вегетативної регуляції

The objective: is to analyze the frequency of gestational complications and labor abnormalities in pregnant women with different types of autonomic regulation disorders. Materials and methods. 129 women were examined. The type of autonomic regulation was determined by recording the time and spectral parameters of heart rate variability by computer cardiointervalography with use of CardioLab Bebicard diagnostic system. The main group consisted of 66 pregnant women with established autonomic regulation disorders. 63 patients with a normal autonomic state, a balanced level of sympathetic and parasympathetic activity formed a control group. To assess the status of the mother-placenta-fetus, an ultrasound examination with doplerometry was performed. Results. A significant increase of the central regulatory activity in pregnant women with autonomic dysfunction was established. The cardiointervalography indicate a balanced activity of the autonomic nervous system in the control group. The gestational complications were significantly more frequent in women of the main group in the context of detected autonomic dysfunction than in the control group. Labor anomalies were more common in pregnant women of the main group. Women with high parasympathetic astivity noted an increased frequency of labor dystocia. In patients with a superiority of sympathetic and humoral regulation, an increased frequency of labour activity weakness was observed. The fast deliveries often determined in pregnant women with decreased activity of both departments of autonomic nervous system. The incidence of urgent caesarian deliveries was significantly higher in the main group, including due to the ineffectiveness of the medical correction of labor abnormalities. Conclusions. The cardiointervalography is informative for the diagnosis of autonomous regulation and adaptive disorders, which may be the prerequisites for the gestational complications and labor abnormalities development. Using the heart rate variability analys is in pregnant women will improve the early prediction of gestational pathology and pathological birth process, reduce the risk of obstetric and perinatal complications. Key words: heart rate variability, autonomic regulation, gestational complications, labor activity abnormalities.

Pregnancy-specific health anxiety: symptom or diagnosis?

Anxiety is an innate human response to situations that cause fear, worry or concern. One such type is health anxiety. Health anxiety is a term derived from hypochondriasis and divided into two disorders: illness anxiety disorder and somatic symptom disorder. Symptoms can range from mild-to-moderate expressions of worry to clinical diagnoses. Previous research has shown pregnancy-specific anxiety to be an autonomous anxiety disorder. When a woman conceives, immediate somatic changes are experienced, and although all pregnancies are different, these changes could cause either illness anxiety disorder or somatic symptom disorder. This review explores the possibility of pregnancy-specific health anxiety in greater detail.

Инфузионная терапия при хронических заболеваниях печени

Aim of review. To present modern options of comprehensive infusion therapy at various liver diseases, indications and contraindications for application of basic blood substitute groups, and pathogenically justified approaches for their use. Summary. Chronic and acute liver diseases are associated to end the genius intoxication, electrolyte disorders, shift of acid-base state, tissue and cellular hypoxia. Infusion therapy with application of modern plasma substitute solutions provide increase in treatment efficacy for this group of patients. Application of basic group infusion solutions along with complex anti-hypoxia agents helps to correct water and electrolyte imbalance as well as disorders of acid-base state, carry out body detoxication, normalize blood pressure, treat edema and ascites syndrome, protein-energy malnutrition, prevent renal value and other complications in liver cirrhosis patients. Comprehensive treatment of liver diseases includes application of modern infusion agents (anti-hypoxia/anti-oxidation) containing pharmacologically active metabolic substances that include succinate-containing drugs developed on the basis of succinic acid and its salts. Succinic acid is presumed to act as the paracrine agent produced by damage hepatocytes (e.g. at ischemia), affecting pericytes (Ito's cell) in the liver through SUCNR1receptors. It results activation of pericytes providing synthesis of extracellular matrix components that are involved in metabolism and regeneration of liver parenchyma cells. Conclusion. Addition of succinic acid-based medications to infusion therapy program for chronic liver diseases provides alleviation of basic clinical syndromes (intoxication, asthenic and autonomous nervous disorders, dyspeptic, cholestatic), and at patients with hepatocellular failure improvement of protein-synthetic liver function.

Botulinum neurotoxin for sialorrhea: a first choice therapy

This article emphasizes the therapeutic potential of botulinum neurotoxin (BoNT) in the autonomous nerve system disorder of sialorrhea, a pathologic situation found mainly in patients with neurologic deficits. Major applications that are well known to be treated with botulinum toxin in the head and neck area, include undesirable muscular dysfunctions and spasms, based on the toxins blocking effect on the neuromuscular junction transmitter acetylcholine. In the 90’s it became clear that BoNT could block the release of acetylcholine in gland tissues, too. A new era in the management of autonomic dysfunctions began. There have been numerous of treatments such as Frey’s syndrome, sialorrhea, facial and cranial hyperhidrosis reviewed. Ultrasound guided intraglandular injections of botulinum toxin type A into both the submandibular and parotid glands, have been noted to be effective at controlling sialorrhea in practice. The doses and injection techniques are described and further discussed in this article. The option of the minimal invasive, well tolerated BoNT injections into the major salivary glands is crucial for the best management of sialorrhea patients, avoiding the side-effects of anticholinergic medications. The indications of BoNT in the head and neck region are still expanding as physicians are finding out the therapeutic valuability of the toxin in otorhinolaryngology.

Arterial blood pressure and heart rate response in patients with acute ischemic stroke - Correlation with the severity of cardiovascular autonomic dysfunction

Background and purpose: Despite numerous studies, the mechanisms of blood pressure and heart rate regulation in cerebrovascular diseases remain not completely understood. The aim of the study was to determine the changes in blood pressure (BP) and heart rate (HR) in patients with an acute hemispheric ischemic stroke and to seek a relation to the severity of the cardiovascular autonomic dysfunction. Methods: 20 healthy volunteers and 50 patients with an acute hemispheric ischemic stroke participated in the study. The values of BP and HR were registered. Cardiovascular autonomous disorders were examined with Ewing battery tests. Patients were divided into two groups according to the severity of the autonomous disorders. Results: Elevated BP values at admission were observed in 56% of our patients, and significantly higher values of systolic blood pressure (SBP) (p <0,001), diastolic blood pressure (DBP) (p = 0,001), and mean arterial pressure (p <0,001), as well as of the heart rate (p = 0,027) were found, compared to the control group. The most significantly increased values of the indicators were reported in patients with a stroke in the territory of the right middle cerebral artery with an involvement of the insular cortex. The results of the t-test performed, showed correlation only between the systolic blood pressure and the severity of the autonomic dysfunction, the values being significantly higher in patients with severe autonomic disorders (t = -2,14; p = 0.036). Conclusion: A variability in BP and HR with a tendency to increase was observed in patients with an acute hemispheric ischemic stroke (ICS) compared to controls, with the highest values reported in patients with ICS in the territory of right middle cerebral artery (TRMCA) with the involvement of the insular cortex (IC). A positive correlation was found between the values of systolic blood pressure (SBP) and the severity of autonomic dysfunction (AD).

Physiological parameters as a tool in the diagnosis of fibromyalgia syndrome in females: A preliminary study

AimsAlthough fibromyalgia (FM) syndrome is associated with many symptoms, there is as yet no specific finding or laboratory test diagnostic of this syndrome. The physical examination and laboratory tests may be helpful in figuring out this syndrome. Materials and methodsThe heart rate, respiration rate, body temperature (TEMP), height, body weight, hemoglobin level, erythrocyte sedimentation rate, white blood cell count, platelet count (PLT), rheumatoid factor and C-reactive protein levels and electrocardiograms (ECG) of FM patients were compared with those of control individuals. In addition, the predictive value of these tests was evaluated via receiver operating characteristic (ROC) analysis. Key findingsThe results showed that the TEMP and the PLT were higher in the FM group compared with the control group. Also, ST heights in ECGs which corresponds to a period of ventricle systolic depolarization, showed evidence of a difference between the FM and the control groups. There was no difference observed in terms of the other parameters. According to the ROC analysis, PLT, TEMP and ST height have predictive capacities in FM. SignificanceChanges in hormonal factors, peripheral blood circulation, autonomous system activity disorders, inflammatory incidents, etc., may explain the increased TEMP in the FM patients. The high PLT level may signify a thromboproliferation or a possible compensation caused by a PLT functional disorder. ST depression in FM patients may interrelate with coronary pathology. Elucidating the pathophysiology underlying the increases in TEMP and PLT and the decreases in ST height may help to explain the etiology of FM.

Central and humoral mechanisms for arterial hypertension in women

The article discusses various mechanisms of arterial hypertension (AH) development in postmenopausal women. It includes literature data on the sexual hormones, namely estrogen and progesterone deficit and androgen overproduction, influence on the blood pressure level and metabolic disorder. Special focus is on the role of renin-angiotensin-aldosterone system in AH pathogenesis. Separate paragraph is focused on the role autonomous nervous system dysfunction and disorders of biogenic amines metabolism in the vascular and autonomic disorders in climacteric syndrome, as well as the contribution of the humoral shifts typical for central obesity, such as hyperinsulinemia, and hyperleptinemia.

Центральные и гуморальные механизмы формирования артериальной гипертензии у женщин

The article discusses various mechanisms of arterial hypertension (AH) development in postmenopausal women. It includes literature data on the sexual hormones, namely estrogen and progesterone deficit and androgen overproduction, influence on the blood pressure level and metabolic disorder. Special focus is on the role of renin-angiotensin-aldosterone system in AH pathogenesis. Separate paragraph is focused on the role autonomous nervous system dysfunction and disorders of biogenic amines metabolism in the vascular and autonomic disorders in climacteric syndrome, as well as the contribution of the humoral shifts typical for central obesity, such as hyperinsulinemia, and hyperleptinemia.

Recent Advances in the Understanding of Insomnia

Whereas once thought to be a benign malady, recent advances in sleep research confirm that insomnia is a common condition with a host of associated risks and consequences. Our view of insomnia is also shifting from a symptomatic complaint, to a distinct disorder with a host of psychological, neurophysiological, and genetic correlates. Recently completed longitudinal studies have also altered our view of the relationship between co-occurring insomnia and medical/psychiatric disorders, from a model of unidirectional causality to one of autonomous disorders interacting in a bidirectional fashion. These conceptual changes have served as the foundations of substantive changes in the diagnostic guidelines for insomnia in DSM−5.

From the Guest Editor

Back to table of contents Next article From the Guest EditorFull AccessFrom the Guest EditorKarl Doghramji, M.D.Karl DoghramjiSearch for more papers by this author, M.D.Published Online:1 Jan 2014https://doi.org/10.1176/appi.focus.12.1.1AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This issue of Focus is dedicated to the update and review of major developments in our understanding and management of sleep disorders, with an emphasis on those disorders that are commonly confronted by psychiatrists and other mental health practitioners. A staggering one-third of all humans are affected by sleep disorders. Sleep-related complaints are also disproportionately high in prevalence in psychiatric practice, and are actively expressed by patients suffering from almost all major psychiatric conditions. Proper identification, clinical evaluation, and effective management of sleep disorders are, therefore, of significant importance for psychiatrists.In the first paper, “Recent Advances in the Understanding of Insomnia,” I explore key developments in clarifying the pathophysiology of insomnia, and explain how these have led to an evolution of our view of the relationship between co-occurring insomnia and medical/psychiatric disorders from a model of unidirectional causality to one of autonomous disorders interacting in a bidirectional fashion. I also clarify how these constructs are reflected in the newly introduced DSM-5 diagnostic nosology. Pharmacological agents have played a crucial role in the management of insomnia for many decades; in his paper, “Novel Developments in the Pharmacological Management of Insomnia,” Dr. David Neubauer explores the many available agents and provides an evidence-based approach in their selection and use. Whereas GABA receptor agonists have dominated the therapeutic armementarium, Dr. Neubauer reviews novel and investigational agents with mechanisms traversing the receptor systems that are involved in the control of sleep and arousal, such as selective histamine H1 receptor antagonists, selective melatonin receptor agonists, and dual orexin receptor antagonists. “Natural” compounds enjoy a significant allure by virtue of their widespread availability, and the perception that they are safer than prescription medications for insomnia. In his “Ask the Expert” column, Dr. Milton Erman explores the array of products most commonly utilized for sleep-related complaints and provides empirical data to guide practitioners through the morass of widespread claims regarding the benefits of these agents. Although less widely utilized than pharmacological agents, cognitive and behavioral therapies are of clear benefit in insomnia. In her paper entitled, “Psychological and Behavioral Treatments for Insomnia,” Dr. Brenda Byrne explores the principles underlying these techniques and guidelines in their implementation. She also reviews exciting new evidence demonstrating the lasting benefit of these therapies for extended periods of time following termination of treatment. Dr. John Khoury and myself, in our paper entitled, “Circadian Rhythms in Health and Disease,” review our current understanding of the neurophysiology of the circadian regulation system, which encompasses a complex array of physiological and psychological variables including core body temperature, hormone secretion, hunger, mood, and sleep, among others. We then explain how misalignments in the timing of these variables can lead to circadian rhythm disorders, and explore many of the treatment modalities that can be utilized in the context of psychiatric practice for these disorders. Finally, in their paper, entitled “Parasomnias, A Review for Psychiatrists,” Drs. Thomas Hurwitz, Michael Howell, and Imran Khawaja review a fascinating group of behavioral disturbances that occur in the borderlands between sleep and wakefulness that are often confused with psychiatric disorders. The authors explore a systematic approach for the evaluation and management of these disorders, which can lead to serious injury, and which often disrupt relationships.I am grateful to the contributors of this issue of Focus, all of whom are prominent researchers, educators, and clinicians in the field of sleep medicine. I am confident that you will find their state-of-art papers to be informative and clinically relevant. FiguresReferencesCited byDetailsCited ByNone Volume 12Issue 1 Winter 2014Pages 1-1Disorders of Sleep PDF download

The state of the autonomous (vegetative) nervous system and heart rhythm disorders under exercise conditions

Ingenious methods of exercise cardiac rhythmgram math simulation are used to study the autonomic regulation of the heart rate. Changes in a number of autonomic nervous system (ANS) - an increase in activity in general, and the manifestation of parasympathetic dominance reflects improved exercise tolerance. Supraventricular extrasystole, a typical heart beat disorder which is not observed at rest and manifesting under exercise conditions, is a consequence of its excess (overload) independently of the endurance development level. Improvement of adaptive mechanisms in the formation of endurance reduces the possibility of extrasystole due to the increase of a potentially dangerous load threshold, manifestation time and decrease in the number of extrasystole complexes. In turn, heart beat disorders have fundamental differences in the vegetative base depending on the endurance development level.

AB0432 Overlapping neuropsychiatric manifestations in patients with systemic lupus erythematosus

BackgroundSystemic lupus erythematosus (SLE) is a systemic disease of the connective tissue that is characterized bydamages of all organs and systems. Lesions of the nervous system in relation to the...

Reduced elastogenesis: a clue to the arteriosclerosis and emphysematous changes in Schimke immuno-osseous dysplasia?

BackgroundArteriosclerosis and emphysema develop in individuals with Schimke immuno-osseous dysplasia (SIOD), a multisystem disorder caused by biallelic mutations in SMARCAL1 (SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily a-like 1). However, the mechanism by which the vascular and pulmonary disease arises in SIOD remains unknown.MethodsWe reviewed the records of 65 patients with SMARCAL1 mutations. Molecular and immunohistochemical analyses were conducted on autopsy tissue from 4 SIOD patients.ResultsThirty-two of 63 patients had signs of arteriosclerosis and 3 of 51 had signs of emphysema. The arteriosclerosis was characterized by intimal and medial hyperplasia, smooth muscle cell hyperplasia and fragmented and disorganized elastin fibers, and the pulmonary disease was characterized by panlobular enlargement of air spaces. Consistent with a cell autonomous disorder, SMARCAL1 was expressed in arterial and lung tissue, and both the aorta and lung of SIOD patients had reduced expression of elastin and alterations in the expression of regulators of elastin gene expression.ConclusionsThis first comprehensive study of the vascular and pulmonary complications of SIOD shows that these commonly cause morbidity and mortality and might arise from impaired elastogenesis. Additionally, the effect of SMARCAL1 deficiency on elastin expression provides a model for understanding other features of SIOD.