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    • Conversely the implementation of CBT i

    2018-10-26

    Conversely, the implementation of CBT (i.e., the systematic application of the principles and learning techniques needed to evaluate and improve behavior) has not been well studied with regard to narcolepsy, most likely because As Fig. 1 shows, however, 32.4% of psychologists who are trained in CBT are interested in applying it to cases of narcolepsy (American Association of Sleep Medicine AASM, [16]). This figure is similar to the interest in the use of CBT for other sleep disorders (e.g., sleep-disordered breathing and circadian rhythm disorders), and is surpassed only by insomnia.
    Methodology
    Discussion
    Conclusions Despite the limitations of the reviewed publications, psychological interventions are both ancillary and primary therapeutic strategies to control the symptoms of narcolepsy when presented in an organized way. Specifically,
    Potential Competing Interest / Disclosure Statement
    Acknowledgments
    Introduction Moebius syndrome (MS) is a congenital syndrome characterized by uni or bilateral aplasia of the VI and VII cranial nerves, with subsequent convergent strabismus and bilateral facial paralysis. Other cranial nerves might also be affected with minor frequency as the IX and X nerves. Mental and psychotic disturbances are also observed in these patients. MS might also be the result of maternal exposure to drugs such as benzodiazepines or misoprostol during the 4th to 8th week of pregnancy. Anatomopathological studies have shown a nuclear hypoplasia of the VI and VII nerves in patients with MS, suggesting malformation of the compound library stem. Image studies such as cranial computerized tomography and nuclear magnetic resonance might reveal significant alterations in these patients [1–3]. Authors point out that, at polysonogram, these patients do not present REM sleep and there is the registry of low amplitude electromyogram of the mandible during all the sleep stages. The audible potential of the brain stem (APBS) frequently show an elongation of the evoked potential waves in this population with MS, indicating a dysfunction at the level of the brain stem. MS might still be associated with diurnal excessive sleepiness (DES) and cataplexy, which make it a differential diagnostic for narcolepsy [1]. Narcolepsy is a rare disease that may occur during any age. The onset of symptoms appears between 15 and 25 years of age. It is characterized by incontrollable attacks of sleep (with frequent naps with REM sleep) during the day, being classically described by an association between diurnal excessive sleepiness, sleep fragmentation, cataplexy, sleep paralysis and hypnagogic or hypnopompic hallucinations [4]. Although there is an association between the histocompatibility complex DR2/DQB1⁎0602 and narcolepsy, its etiology remains unknown. There are papers describing the symptoms of narcolepsy in patients with pathologies such as temporal processes, brain vascular episodes or demyelinazation of the brain stem and diencephalon [5–7].
    Case dissertation Her sleep routine was marked by 3–4 awakening during the night, waking up tired, invariably. She used to go to bed at 23h and 30min and wake up at 06h and 00min, taking approximately 10min to initiate sleep. Denied use of alcohol or any other drugs. During the anamnesis, there were identified episodes of anxiety and depression due to prejudice concerning her physical appearance. As comorbidities, she also presented asthma and rhinitis. Family maternal history of snoring and her grandmother showed sleep apneas. She was being treated with inhaled budesonide, nasal budesonide and loratadine. Physically, her weight was of 56.8Kg, height of 1.54m, corporeal mass index (CMI) of 24.2kg/m2, abdominal circumference of 72cm and cervical circumference of 31cm. Demonstrated Mallanpati II degree and tonsils grade I. Nasal evaluation showed hypertrophy and pallor of the inferior nasal cavities, septal deviation of II degree in the right area II. No other alterations were observed and at neurological examination the patient demonstrated peripheral facial paralysis with bilateral convergent strabismus. Brain magnetic resonance revealed nonspecific findings. It were not characterized the facial colliculi either the bilateral seventh cranial nerve. The neurological exam demonstrated bilateral convergent strabismus and bilateral peripheral paralysis.