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  • Author: Paulina Wróbel-Knybel x
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Summary

Introduction: Sleep paralysis (SP) is a condition that widely occurs among people all over the world. It has been known for thousands of years and is rooted in the culture of many countries. It arouses strong emotions, though still little is known about it. The clinical picture of the disorder can be very diverse. It is often accompanied by hypnopompic and hypnagogic hallucinations, somatic complaints and the feeling of intense anxiety. A feeling of paralysis in the body with inhibited consciousness is always observed with the experience. SP pathophysiology is not fully understood, however, most theories explaining this phenomenon are based on the assumption that it results from dysfunctional overlap of REM sleep and wakefulness. It is experienced by healthy people, but it is more often associated with somatic and mental disorders, which is why it is becoming an object of interest for researchers.

Aim: The aim of this work is to present the most important information about the disorder known as sleep paralysis - its history, cultural context, pathophysiology, prevalence, symptomatology, coexistence with other somatic and mental disorders as well as diagnostics and available forms of prevention and treatment.

Materials and methodology: The available literature was reviewed using the Google Scholar bibliographic databases searching the following keywords: sleep paralysis, REM sleep parasomnias, sleep disorder, night terrors and time descriptors: 1980-2018.

Results 1. Sleep paralysis has already been described in antiquity, and interpretations related to its occurrence are largely dependent on culture and beliefs.

2. Symptomatology of the disorder is very diverse: both mental and somatic symptoms are present.

3. The pathophysiology of the disorder has not been fully explained. The basis of most theories regarding sleep paralysis is the assumption that it results from the dysfunctional overlap of REM sleep and wakefulness.

4. The prevalence of SP at least once in a lifetime is 7.6% in the general population, although it is estimated that it is much more frequent in people with various mental and somatic disorders.

5. Treatment of SP is associated with a change in lifestyle and the use of pharmacotherapy and psychotherapy.

Abstract

The issue of parental neglect is a constantly topical one. Neglect is not only the lack of satisfying basic needs, but also the lack of ensuring a sense of security, belonging, and insufficient physical, emotional or verbal closeness with the child. Poor parental care, lack of a sense of closeness and availability of the parent, along with other environmental factors (e.g. addictions, diseases and mental disorders in the family) result in abnormal formation of the child’s personality, and can also be associated with depression, anxiety, self-harm or suicide attempts.

The aim of the study was to present the clinical cases of two teenage patients (AA. – 13 years old, BB. – 16 years old) staying in the I Department of Psychiatry, Psychotherapy and Early Intervention in Lublin (Department for Children and Youth), whose mental health problems were caused by a constant neglect on the part of parents.

Case reports: The patients came from dysfunctional families in which members showed a tendency to addiction (alcohol) and were emotionally and physically absent from the lives of the girls. Due to considerable upbringing problems, girls were hospitalized many times, both in paediatric wards and in psychiatric wards for children and adolescents, with various medical diagnoses.

Conclusions: The presented cases of two patients indicate a potential cause-and-effect relationship between parental neglect, coexisting environmental factors (addictions of family members) and abnormal formation of the child’s personality, self-harm or suicide attempts. In such family systems, it is extremely important, apart from a court-appointed family guardian, to introduce a family assistant to provide emotional or advisory support.

Abstract

Introduction: Warfarin has been considered as a “gold standard” in the prevention and treatment of thromboembolic events since 1954. Since the introduction of direct oral anticoagulants in the last few years (NOAC-Non-Vitamin K antagonist Oral Anticoagulants) prescriptions volume for apixaban, edoxaban, dabigatran and rivaroxaban have been gradually surpassing warfarin. The benefits include: anticoagulation from day one, fixed daily dosing, elimination for the need of international normalised ratio (INR) monitoring, fewer interactions with food and co-administered medicines with reduced risk of bleeding and better overall life quality.

Objectives: Assessing evidence for the safe use of Non-vitamin K Oral Anticoagulants (NOAC) with Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Noradrenaline Reuptake Inhibitors (SNRI).

Method: Review of literature published between 2014 and 2016 was made using the key words: Selective Serotonin Reuptake Inhibitor, Serotonin and Noradrenaline Reuptake Inhibitors, apixaban, dabigatran, edoxaban, rivaroxaban, bleeding, interaction, depression with time description from 2014 to 2018. Evidence within the literature was then compared with guidelines from the National Institute for Health and Care Excellence (UK), British National Formulary (UK), Clinical Excellence Commission (Australia), Thrombophilia and Anticoagulation Clinic (USA) and Summaries of Product Characteristics (SPC).

Results: 1. Serotonin plays a critical role in maintaining homeostasis. Use of SSRI/SNRI compromises its platelet reuptake increasing risk of bleeding. 2. Increased tolerability and safety of NOAC over Warfarin, although caution is advised when NOAC is used with SSRI/SNRI with less evidence suggesting pharmacodynamic interactions. 3. It is not recommended to use NOAC with strong CYP and P-gp inhibitors.

Conclusions: With limited literature evidence, caution is advised when co-prescribed NOACs with SSRI/SNRI, especially with other cofactors and interacting medicines further increasing risk of bleeding.