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Tetanus is a nervous system disorder characterized by muscular spasms and autonomic hyperactivity, such as unstable blood pressure. We herein report a case of tetanus in a patient in shock complicated with a rectus sheath hematoma caused by rupture of a pseudo-aneurysm of the inferior epigastric artery. A rectus sheath hematoma might be misdiagnosed as unstable blood pressure associated with autonomic hyperactivity, which is usually observed in patients with tetanus. The possibility of the occurrence of bleeding complications should be considered if a patient with tetanus has severe and persistent blood pressure reduction.

Introduction Agrypnia Excitata (AE) is a syndrome characterized by loss of sleep with permanent motor and autonomic hyper activation. This case describes this peculiar syndrome in a patient with paraneoplastic autoimmune encephalitis. Report of Case DG is a 35 yr old male with a history of anti-Ma2 limbic encephalitis secondary to cystic teratoma of the left testis diagnosed 6 months prior to presenting in Sleep Clinic. His parents described significant sleep disturbances including short sleep and wake periods throughout the day and night with no apparent pattern, acting out dreams, motor activity during sleep including pulling at his clothes or using his hands to manipulate invisible objects. Additionally they described low-grade fevers, and severe hyperphagia. Polysomnogram showed absence of slow-wave sleep and what appeared to be an admixture of stage 1 non-rapid eye movement (NREM) with rapid-eye movement (REM) sleep. Multiple sleep-latency testing (MSLT) demonstrated a mean sleep latency of 5.2 minutes and four sleep-onset REM periods (SOREMPs). Magnetic resonance imaging of the brain revealed persistent inflammation of the mesial temporal lobes and hippocampal region. Cerebral spinal fluid testing showed persistent anti-Ma2 antibodies. Based on this clinical presentation we made a diagnosis of Agrypnia Excitata. Conclusion Agrypnia Excitata is a syndrome characterized by loss of the normal sleep-wake rhythm. Sleep consists of the disappearance of spindle-delta activities, and persistent stage 1 NREM sleep mixed with recurrent episodes of REM sleep. The second hallmark of AE is persistent motor and autonomic hyperactivity observed during wake and sleep. AE has been described in three distinct clinical syndromes: Morvan Syndrome (autoimmune encephalitis), Fatal Familial Insomnia, and Delirium tremens. The pathogenesis of AE consists of intra-limbic disconnection releasing the hypothalamus and brainstem reticular formation from cortico-limbic inhibitory control. In autoimmune encephalitis, antibodies that act on voltage-gated potassium channels within the limbic system have been implicated in the pathophysiology.

[Purpose] This study aimed to classify the fear that occurs during the process of a squat-like movement by persons with visual impairment. [Subjects and Methods] Fifteen persons with a visual impairment, 45 years and older, who were independent in daily living were recruited for the study. The study utilized a field experiment design. The setting was the Kusatsumachi Welfare Center, and the study period was from March through August 2015. Outcome measures included the presence or absence of fear during attempt of a squat-like movement on a force plate. Metrics included the ratio of low and high frequency components of heart rate variability spectra (cm2/Hz) based on resting rate intervals (ActiGraph wGT3X-BT, USA). Autonomic hyperactivity was defined as the occurrence of objective fear with LF/HF ratio of over 2.0. Statistics included Fischer’s exact test. [Results] Four fear types included the combination of danger and objective fear factors. The frequencies of occurrence of clinically categorized subjective fear across the four fear types were two (danger, fear), seven (no danger, fear), six (danger, no fear), and zero (no danger, no fear) persons. [Conclusion] This procedure of classifying fear might be feasible during evaluation of a squat-like movement by persons with a visual impairment.

Autonomic hyperactivities are severe life-threatening conditions, which require intensive management. Treatment is mainly symptomatic, eventually supported with a variable degree of sedation and stimulus deprivation. Stabilization of blood pressure, heart rate, and temperature is a challenge in these patients.

Objective We aimed to examine the effect of emotion regulation training in patients with panic disorder (PD) by measuring heart rate variability (HRV). Methods Forty-eight patients with PD were randomly divided into emotion regulation group (n = 25) and no-regulation group (n = 23). Three five-minute ECG recordings were taken in the following states: 1) baseline, 2) while subjects viewed 15 aversive pictures (active stimulus), 3) resting state after aversive pictures (post-stimulus). The emotion regulation group briefly received acceptance technique training for five minutes before performing the experimental task. Spectral analysis measures included a high-frequency (HF; 0.15–0.4 HZ) component, a low-frequency (LF; 0.04–0.15 Hz) component, and an LF/HF ratio. Results The mean change in LF/HF ratio from baseline to active stimulus was significantly lower in the emotion regulation group than in the no-regulation group (emotion regulation group, 0.13; no-regulation group, 2.31; t =− 2.67; P Conclusion This suggests that brief emotion acceptance training could decrease aversive stimulus-induced sympathetic hyperactivity in patients with PD.

It is well known that patients with peripheral neuropathy along with autonomic involvement can also exhibit autonomic hyperactivity. There are rare cases in which these patients developed posterior reversible encephalopathy syndrome (PRES). Patients with primary Sjogren's syndrome (pSS) may be more likely to exhibit autonomic hypofunction rather than autonomic hyperfunction, which is a rare event. In the present work, we report the first known case of PRES as an initial neurological manifestation of pSS.

Buckley and colleagues discuss the serotonin syndrome.1 Hunter serotonin toxicity criteria include neuromuscular hyperactivity, autonomic hyperactivity, and altered mental state.2 Mild symptoms of serotonin toxicity can be …

Recent models suggest that worry is primarily a verbal-linguistic process that enables images to be avoided and reduces somatic activation. Five-hundred and two subjects completed a questionnaire that assessed variables related to generalized anxiety disorder (GAD) criteria and also asked subjects to indicate the percentage of thoughts and images while worrying. Subjects were divided into excessive worriers (worry excessively about two or more topics more days than not for at least the last 6 months) and ordinary worriers (those who did not meet the previous criteria). As predicted, worry was reported as being composed predominantly of thoughts rather than images, and excessive worriers reported a significantly higher percentage of thoughts compared to ordinary worriers. The number of somatic symptoms was positively correlated with the percentage of images. This relationship was stronger among excessive worriers than ordinary worriers, specifically for autonomic hyperactivity symptoms. Further, in the excessive worry group only there was a significant negative correlation between the number of autonomic hyperactivity symptoms and the percentage of thoughts.

Ephedra extract is used in a number of dietary supplements taken for a variety of purposes including weight loss. Although recent events have led to calls for Ephedra to be removed from the market and the FDA has had over 18,000 adverse event reports, newspaper reports cite only a few instances of clearly associated adverse events associated with Ephedra use. In this communication, we review the literature and present a case report of Ephedra use associated with the onset of psychosis and autonomic hyperactivity after administration of risperidone. We conclude that the behavioral effects of Ephedra are a public health concern.

The frequency and severity of the symptoms of generalized anxiety disorder (GAD) were determined in a sample of 49 patients with the DSM-III-R diagnosis of GAD. The frequency of the symptoms was considered to meet the DSM-III-R requirement of "often" if the symptoms were present for at least 3 days in every week over a 6-month period. The severity of the symptoms was rated on a 5-point scale. Seven symptoms, all of which belong to the clusters of motor tension and vigilance and scanning, were identified as both frequent and at least moderate in terms of their intensity. They were provisionally designated as the "criterion symptoms" of GAD, in contrast to the symptoms of autonomic hyperactivity, which were found to be less frequent and, especially, less intense. A more simplified conceptualization of GAD was proposed on the basis of these findings.

To review the current literature regarding the relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), and the role of phosphodiesterase-5 (PDE5) inhibitors for the treatment of LUTS. Review of recently published (1990-2009) data regarding epidemiologic and pathophysiologic mechanisms are involved in LUTS-ED, focusing on PDE5 inhibitors particularly evidenced from level 1 clinical trials. Search terms included phosphodiesterase inhibitors, nitric oxide, autonomic hyperactivity, Rho-kinase, atherosclerosis, LUTS, benign prostatic hypertrophy, and ED. Results of several epidemiologic studies show a possible causal relationship between LUTS and ED. Four possible mechanisms have been proposed to explain this association. Multiple large clinical trials have shown a benefit in LUTS after PDE5-inhibitors treatment. PDE5 inhibitors show promise as a future treatment for LUTS, either in conjunction with existing therapies or as a primary treatment.

Many therapeutic drugs, illicit drugs, and toxins of various kinds interact with the autonomic nervous system, producing changes in function. In some cases, these changes are the desired effect of the drug and lead to therapeutic outcomes (e.g., in the treatment of high blood pressure or asthma).

The authors investigated the types and rates of trauma exposure and differences in symptom endorsement in a clinical sample of patients diagnosed with generalized anxiety disorder (GAD). Fifty-eight patients with GAD were assessed using the Structured Clinical Interview (SCID) and Trauma Assessment for Adults. In order to explore the relationship between specific traumatic event(s) and clinical presentation, the presence of somatic symptoms associated with GAD, including muscle tension, autonomic hyperactivity, and vigilance/scanning clusters (using DSM-III-R criteria), were examined. Patients with a history of sexual assault before 18 years (25.9%) endorsed fewer somatic symptoms, specifically fewer motor tension and autonomic GAD symptoms, than patients with other types of trauma. These findings indicate that early exposure to serious trauma, specifically childhood sexual assault, may lead to a different clinical presentation in GAD patients.

Background Sinus node dysfunction (SND) is caused not only by intrinsic sinus node disease, but also by the extrinsic factors. Among the extrinsic factors, autonomic imbalance is most common. Symptomatic SND usually requires permanent pacemaker therapy. However, the clinical characteristics and patient response to medical therapy for hypervagotonic SND have not been properly clarified. Materials and methods Thirty two patients (14 men, 18 women, 51 +/- 14 years) with hypervagotonic SND were included in this study, but those patients who had taken calcium antagonists, beta-blockers or other antiarrhythmic drugs were excluded. Hypervagotonic SND was diagnosed if the abnormal electrophysiologic properties of the sinus node were normalized after the administration of atropine (0.04 mg/kg). Results The presenting arrhythmias were 16 cases of sinus bradycardia (50.0%), 12 of sinus pause (37.5%), 3 of sinoatrial block (9.4%) and 1 of tachy-bradycardia (3.1%). Nine (28.1%) patients had hypertension, 7 (21.9%) smoked, 2 (6.3%) had diabetes mellitus, and 1 (3.1%) had hypercholesterolemia. Among the patients, 3 had no remarkable symptoms, 13 had dizziness, 7 had syncope, 3 had weakness and 6 had shortness of breath. Twenty five (78.1%) patients were treated with theophylline, 1 patient with tachy-bradycardia syndrome was treated with digoxin and propafenone, and 6 (18.8%) were treated with no medication. During the 43 +/- 28 month follow-up, 25 patients remained asymptomatic, but 6 who took no medication developed mild dizziness. One patient needed permanent pacemaker implantation owing to recurrent syncope despite of theophylline treatment. Conclusion These results show that hypervagotonic SND has a benign course and most of the patients can be managed safely without implanting a pacemaker. (Ed note: I like the abstract. It is short and direct, as it should be.)

Mixed autonomic hyperactivity disorder (MAHD) among patients with acquired brain injury can be rare. A delayed diagnosis of MAHD might exacerbate the clinical outcome and increase healthcare expenses with unnecessary testing. However, MAHD is still an underrecognized and evolving disease entity. A 25-yr-old woman was admitted the clinic due to craniopharyngioma. After an extensive tumor resection, she complained of sustained fever, papillary contraction, hiccup, lacrimation, and sighing. An extensive evaluation of the sustained fever was conducted. Finally, the cause for MAHD was suspected, and the patient was successfully treated with bromocriptine for a month.

A case is presented in which a young man with no psychiatric history and no previous exposure to psychotropic medication rapidly developed severe catatonia and autonomic hyperactivity, and an elevated creatine kinase level. He was treated with electroconvulsive therapy and recovered completely. This case suggests that a subgroup of patients who presentated with symptoms resembling those of neuroleptic malignant syndrome and who have been treated with neuroleptics may suffer from severe psychogenic catatonia.

Sympathetic overactivity is a well-recognized complication of generalized tetanus in humans. In this clinical situation, a variety of drugs with primary or secondary actions on the cardiovascular system has been used with varying success. We show successful management of severe generalized tetanus in adults associated with autonomic hyperactivity with large doses of intravenous fentanyl.

This study was designed to test and extend previous reports of differences in autonomic responsivity between offspring of schizophrenic patients and control subjects. In specific, greater galvanic skin response (GSR) to stimuli and quicker GSR recovery have been reported in high-risk children. In the present study we found no evidence of autonomic hyperactivity, as evidenced by GSR to tones, in high-risk as compared to control subjects. There was some trend for index subjects to show slower GSR recoveries than control subjects, which is opposite to findings from earlier studies. Subjects were also presented with the Information Detection Test, in which GSR responses to emotionally meaningful vs. neutral stimuli were compared. Index children were less reactive than control subjects to the meaningful stimuli, and they discriminated between meaningful and neutral stimuli more poorly. Our findings do not confirm the learning theory of schizophrenia suggested by Mednick, but do suggest that developmental lags in high-risk as compared to control children may contribute to the psychophysiological differences that we found.

Systemic hypertension has been reported as common during coronary artery bypass surgery. The coronary-prone Type A behavior pattern has been associated with heightened reactivity of the sympathetic nervous system. Therefore, the possible relationships between the two was explored. Significant correlations were found between systolic blood pressure rise during surgery and interview ratings of overall Type A (p < 0.05), aggressive content (p < 0.01), and job commitment (p < 0.001). A statistically association was also found between diastolic pressure rise and the job commitment rating (p < 0.01). Significant correlations were still present after controlling for the role of physical predictors of blood pressure rise by statistical multiple regression analysis. The data suggest that patients with Type A behavior characteristics manifest an autonomic hyperactivity which is present under general anesthesia. This hyperactivity may contribute to the association of Type A behavior pattern and coronary heart disease.

A patient is described with operationally diagnosed chronic schizophrenia who simultaneously experienced repeated "attacks" during which times he had intense apprehension and autonomic hyperactivity entirely similar to that usually described under the rubric of "panic attacks" in nonschizophrenic patients. Delusional and hallucinatory symptoms were also transiently exacerbated during these episodes. Alprazolam, as an adjunct to fluphenazine decanoate, was effective in ameliorating these symptoms. Diagnostic and treatment implications are discussed.