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Journal of Clinical Pharmacology Jul 2023This article discusses the rare but serious occurrence of sedative hypnotic drug-induced sexual thoughts. We searched PubMed from the earliest date to February 7, 2023.... (Review)
Review
This article discusses the rare but serious occurrence of sedative hypnotic drug-induced sexual thoughts. We searched PubMed from the earliest date to February 7, 2023. Articles were selected if they provided data on sexual assault hallucinations or sexual fantasies associated with the use of sedative hypnotic drugs including benzodiazepines, propofol, nitric oxide, ether, chloroform, ketamine, or esketamine. Twenty-two citations provided useful information, including 87 cases of hallucinations about sexual assault or sexual fantasy. In several of the cases, the environment and monitoring made the actual occurrence of sexual assault unlikely, but there was still significant anguish for the patients and the accused clinicians. In many of the cases, the places of the body where procedures were conducted coincided with the area of the body where the patients perceived the sexual assault or fantasy occurred. The higher the dose of sedative hypnotic administered, the greater the risk of experiencing a hallucination about sexual assault or sexual fantasy. The US Food and Drug Administration Adverse Events Reporting System has numerous occurrences in which "excessive sexual fantasies" and "abnormal dreams" were associated with the use of sedative hypnotic medication but also occurrences of "sexual abuse." While sexual assault hallucinations or fantasies associated with sedative hypnotics are rare, it is imperative that health care providers take the necessary precautions and follow recommendations to provide safety for themselves and their patients.
Topics: United States; Humans; Fantasy; Hypnotics and Sedatives; Sex Offenses; Hallucinations; Health Personnel
PubMed: 36895011
DOI: 10.1002/jcph.2233 -
Sleep Medicine Reviews Apr 2024This review critically analyzes the forensic application of the Parasomnia Defense in homicidal incidents, drawing from medical literature on disorders of arousal (DOA)... (Review)
Review
This review critically analyzes the forensic application of the Parasomnia Defense in homicidal incidents, drawing from medical literature on disorders of arousal (DOA) and rapid-eye-movement sleep behavior disorder (RBD). A systematic search of PubMed, Scopus, Embase, and Cochrane databases was conducted until October 16, 2022. We screened English-language articles in peer-reviewed journals discussing murders committed during sleep with a Parasomnia Defense. We followed PRISMA guidelines, extracting event details, diagnosis methods, factors influencing the acts, perpetrator behavior, timing, motives, concealment, mental experiences, victim demographics, and court verdicts. Three sleep experts evaluated each case. We selected ten homicides, four attempted homicides, and one homicide/attempted homicide that met inclusion/exclusion criteria. Most cases were suspected DOA as unanimously confirmed by experts. RBD cases were absent. Among aggressors, a minority reported dream-like experiences. Victims were primarily female family members killed in or near the bed by hands and/or with sharp objects. Objective sleep data and important crime scene details were often missing. Verdicts were ununiform. Homicides during DOA episodes, though rare, are documented, validating the Parasomnia Defense's use in forensics. RBD-related fatal aggression seems very uncommon. However, cases often lack diagnostic clarity. We propose updated guidelines to enhance future reporting and understanding of such incidents.
Topics: Humans; Female; Parasomnias; Sleep; REM Sleep Behavior Disorder; Homicide; Aggression
PubMed: 38364685
DOI: 10.1016/j.smrv.2024.101898 -
Trauma, Violence & Abuse Jan 2024Trauma exposure places refugees at serious risk of developing mental health difficulties. However, research also recognizes that refugees can respond to trauma with... (Review)
Review
Trauma exposure places refugees at serious risk of developing mental health difficulties. However, research also recognizes that refugees can respond to trauma with psychological development and growth, commonly referred to as post-traumatic growth (PTG). An updated systematic review was conducted to investigate PTG across different refugee populations, including the processes that mediate this phenomenon, and the use of therapy in promoting PTG. A systematic search of CINAHL Complete, Proquest 5000, PsychINFO, Scopus, and Web of Science was performed to identify studies exploring PTG in refugee populations, published between June 2013 and November 2021. In all, 26 studies met the inclusion criteria for this review. Quantitative results reveal a positive correlation between PTG and religious commitment and coping, and the effectiveness of narrative and community-based interventions in facilitating PTG. Qualitative results facilitate insight into the complex ways refugees find meaning and strength after trauma through religion, comparison-based thinking, helping others, and storytelling. Findings highlight the need for future research and interventions to recognize the distinct PTG experiences of different refugee populations.
Topics: Humans; Posttraumatic Growth, Psychological; Refugees; Dreams; Stress Disorders, Post-Traumatic; Mental Health
PubMed: 37097092
DOI: 10.1177/15248380231163641 -
European Journal of Psychotraumatology 2024Clonidine is a centrally acting anti-adrenergic agent that may have applications in post-traumatic stress disorder (PTSD), particularly for sleep. In this systematic... (Review)
Review
Clonidine is a centrally acting anti-adrenergic agent that may have applications in post-traumatic stress disorder (PTSD), particularly for sleep. In this systematic review, we aimed to summarize the effect of clonidine on sleep quality and duration, nightmares, and PTSD symptom severity in adults with PTSD. PubMed (Medline), Embase, PsycINFO, CINAHL, and clinicaltrials.gov were searched up to April 2023. Studies on clonidine use in adult PTSD patients reporting data on the effect on sleep, nightmares, and PTSD symptoms were included. A narrative summary and a meta-analysis of the study findings are presented. Ten reports, accounting for = 569 patients with PTSD (145 on clonidine and 436 controls), were included in the final selection. There were four case reports, four observational studies, one non-blind clinical trial, and one crossover randomized controlled trial (RCT). Median clonidine dose was 0.15 mg/day (range: 0.1-0.5 mg/day). Median follow-up time was 31 days (range: 3 days to 19 months). The quality of the evidence was rated from very low to low. There was marked between-study heterogeneity and low power in the individual studies, but many reported improved sleep quality, nightmare reduction, and improvement of PTSD symptoms for patients treated with clonidine. Meta-analysis was only possible for two studies reporting the effect of clonidine on nightmares, and showed no difference from the comparator (i.e. prazosin or terazosin) (odds ratio: 1.16; 95% confidence interval: 0.66 to 2.05), potentially pointing towards non-inferiority between these medications. Future research, such as well-powered RCTs, is needed to identify the efficacy in the lower dose range and the most suitable treatment group, and to obtain good evidence on the effects of clonidine in the treatment of sleep disorders related to PTSD.
Topics: Clonidine; Humans; Stress Disorders, Post-Traumatic; Dreams; Sleep Quality; Adrenergic alpha-2 Receptor Agonists
PubMed: 38941125
DOI: 10.1080/20008066.2024.2366049