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07-SEPTEMBER-2008 03:17:44 - Rapid eye movement behavior disorder July 2007 For other uses, see Eye movement disambiguation. Rapid eye movement behavior disorder Classification and external resources MeSH D020447 Rapid eye movement sleep behaviour disorder RBD is a sleep disorder more specifically a parasomnia that involves abnormal behavior during the sleep phase with rapid eye movements REM sleep. It was first described in 1986. The major and arguably only abnormal feature of RBD is loss of muscle atonia paralysis during otherwise intact REM sleep. This is the stage of sleep in which most vivid dreaming occurs. The loss of motor inhibition leads to a wide spectrum of behavioural release during sleep. This extends from simple limb twitches to more complex integrated movements where sufferers appear to be unconsciously acting out their dreams. These behaviours can be violent in nature and in some cases will result in injury to either the patient or their bed partner. Epidemiology The most comprehensive assessment so far has estimated RBD prevalence to be around 0.5% in individuals aged 15 to 1001. It is far more common in males: most studies report that only around a tenth of sufferers are female. This may partially be due to a referral bias, as violent activity carried out by men is more likely to result in harm and injury and is more likely to be reported than injury to male bed partners by women, or it may reflect a true difference in prevalence as a result of genetic or androgenic factorscitation needed. The mean age of onset is estimated to be around 60 years of age2. Various conditions are very similar to RBD in that sufferers exhibit excessive sleep movement and potentially violent behaviour. Such disorders include sleepwalking and sleep terrors, which are associated with other stages of sleep, nocturnal seizures and obstructive sleep apnea which can induce arousals from REM sleep associated with complex behaviours. Because of the similarities between the conditions, polysomnography plays an important role in confirming RBD diagnosis. It is now apparent that RBD appears in association with a variety of different conditions. Narcolepsy has been reported as a related disorder. This is unsurprising, as both RBD and narcolepsy involve dissociation of sleep states probably arising from a disruption of sleep control mechanisms. RBD has also been reported following cerebrovascular accident and neurinoma tumour, indicating that damage to the brain stem area may precipitate RBD. RBD is usually chronic, however may be acute and sudden in onset if associated with drug treatment or withdrawal particularly with alcohol withdrawal 60% of RBD is idiopathic. This includes RBD that is found in association with conditions such as Parkinson's disease and dementia with Lewy bodies, where it is often seen to precede the onset of neurodegenerative disease. Monoamine oxidase inhibitors, tricyclic antidepressants, serotonergic synaptic reuptake inhibitors, and noradrenergic antagonists can induce or aggravate RBD symptoms and should be avoided in patients with RBD. Treatment RBD is a treatable condition. The standard therapy is the anti-convulsant drug clonazepam, and this is generally received very well. How this drug works to restore REM atonia is unclear, however it is thought to suppress muscle activity, rather than directly restoring atonia. References ^ Ohayonet M.M. et al. 1997. Violent behavior during sleep. Journal of Clinical Psychiatry 58: 369-376. ^ Olson EJ et al. 2000. Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain 123: 331-339. PMID 10648440 v d e WHO ICD-10 mental and behavioral disorders F · 290-319 Neurological/symptomatic Dementia Alzheimer's disease, multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, AIDS dementia complex, Frontotemporal dementia, Elopement, Sundowning, Wandering · Delirium · Post-concussion syndrome · Organic brain syndrome Psychoactive substance alcohol drunkenness, alcohol dependence, alcoholic hallucinosis, Alcohol withdrawal, delirium tremens, Korsakoff's syndrome, alcohol abuse · opioids opioid dependency · sedative/hypnotic benzodiazepine withdrawal · cocaine cocaine dependence · general Intoxication, Drug abuse, Physical dependence, Withdrawal Psychotic disorder Schizophrenia disorganized schizophrenia · Schizophreniform disorder · Schizotypal personality disorder · Delusional disorder · Folie à deux · Schizoaffective disorder Mood affective Mania · Bipolar disorder · Clinical depression · Cyclothymia · Dysthymia Neurotic, stress-related and somatoform Anxiety disorder Agoraphobia, Panic disorder, Panic attack, Generalized anxiety disorder, Social anxiety, Social phobia · OCD · Acute stress reaction · PTSD · Adjustment disorder · Conversion disorder Ganser syndrome · Somatoform disorder Somatization disorder, Body dysmorphic disorder, Hypochondriasis, Nosophobia, Da Costa's syndrome, Psychalgia · Neurasthenia Physiological/physical behavioral Eating disorder: Anorexia nervosa · Bulimia nervosa Sleep disorder: Dyssomnia Hypersomnia, Insomnia · Parasomnia REM behavior disorder, Night terror · Nightmare Sexual dysfunction: Erectile dysfunction · Premature ejaculation · Vaginismus · Dyspareunia · Hypersexuality · Female sexual arousal disorder Postpartum depression · Postnatal psychosis Adult personality and behavior Personality disorder · Passive-aggressive behavior · Kleptomania · Trichotillomania · Voyeurism · Factitious disorder · Munchausen syndrome · Ego-dystonic sexual orientation · Fetishism Mental retardation Mental retardation Psychological development developmental disorder Specific: speech and language expressive language disorder, aphasia, expressive aphasia, receptive aphasia, Landau-Kleffner syndrome, lisp · Scholastic skills dyslexia, dysgraphia, Gerstmann syndrome · Motor function developmental dyspraxia Pervasive: Autism · Rett syndrome · Asperger syndrome Behavioral and emotional, childhood and adolescence onset ADHD · Conduct disorder · Oppositional defiant disorder · Separation anxiety disorder · Selective mutism · Reactive attachment disorder · Tic disorder · Tourette syndrome · Speech stuttering · cluttering Retrieved from http://en..org/wiki/Rapid_eye_movement_behavior_disorder Categories: Sleep disordersHidden categories: Articles needing additional references from July 2007 | All articles with statements | Articles with statements since July 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page This page was last modified on 12 August 2008, at 15:21
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