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This chapter discusses the case of a 46-year-old female with a 5-year history of distressing, unpleasant and bizarre dreams that occurred from a few times a week to once a month, depending on her stress level. It presents the clinical history, examination, diagnosis, follow-up, general remarks and the results of the procedures performed on the patient. Nocturnal polysomnography (PSG) was carried out, and the thyroid-stimulating hormone level in plasma was determined. The diagnosis was nightmare disorder with primary snoring. The relationship between daytime stress, anxiety and nightmares was emphasized. The treatment plan centered on addressing daily stress and anxiety. Recurrent nightmares are frequent in children (20-39%) and less frequent in adults (5-8%). Nightmares also occur in patients with psychiatric illnesses such as anxiety, depression and schizophrenia, as well as in individuals with poor coping mechanisms and creative tendencies.
This chapter discusses the case of a 17-year-old girl who was admitted for the evaluation of excessive daytime sleepiness (EDS). It presents the clinical history, examination, follow-up, treatment, diagnosis, and the results of the procedures performed on the patient. She suffered developmental delay, and was later diagnosed with mild mental retardation. Nocturnal polysomnography (PSG) and a multiple sleep latency test (MSLT) were carried out. The diagnosis was childhood-onset narcolepsy with cataplexy. The parents declined CSF testing for hypocretin. The onset of narcolepsy may occur with any of the four cardinal symptoms (excessive sleepiness, sleep paralysis, hypnagogic hallucinations and cataplexy), the most frequent being EDS. Childhood onset of narcolepsy is uncommon, but has been reported. The usual age of onset is mid- to late teens up to mid-20s. Occasionally patients may become ill after the age of 40.
Violent behaviors during sleep may result in events which have forensic science implications. The apparent suicide (for example, leap to death from a second-storey window), assault or murder (for example, molestation, strangulation, stabbing, shooting) may be the unintentional, non-culpable but catastrophic result of disorders of arousal, sleep-related seizures, REM sleep behavior disorder (RBD), or psychogenic dissociative states. Violent sleep-related behaviors have been reviewed in the context of automatic behavior in general, with many well-documented cases resulting from a wide variety of disorders. Conditions associated with sleep-period-related violence fall into two major categories: neurologic and psychiatric. Psychogenic dissociative disorders may arise exclusively or predominantly from the sleep period. Recent interest in the forensic aspects of parasomnias provides sleep medicine professionals with an opportunity to educate and assist the legal profession in cases of sleep-related violence. One infrequently used tactic to improve scientific testimony is to use a court-appointed impartial expert.
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