Dados do Trabalho

Título

VIDEO-POLYSOMNOGRAPHIC FINDINGS OF PSYCHOTIC SYMPTOMS IN THE PRESENCE OF SELECTIVE GABA RECEPTOR AGONIST: A CASE REPORT.

Introdução

Insomnia is the most common sleep disorder, with a worldwide prevalence ranging from 3.9% to 22.1%. It is defined as a persistent difficulty in sleep initiation, maintenance or consolidation that occurs despite the appropriate circumstances for sleep and daytime impairment. The pharmacological treatment is based on drugs that act on neural pathways that control the sleep-wake cycle, such as the selective GABA receptor agonists, known as the "Z-drugs". Zolpidem is one of these medications. In recent years, an increase in reports of adverse effects has been observed.

Objetivo

To report a video-polysomnographic case that demonstrates the findings of hallucinations related to the use of Z-drugs.

Métodos

Anamnesis, physical examination and video-polysomnography.

Resultados

We describe a case of a 92-year-old female patient, referred to our sleep laboratory to perform a videopolysomnography (vPSG) exam, as part of an investigation of behavioral disorder as a prodromal phase of dementia with Lewy Bodies. She had complaints of recurrent hallucinations at night, with no report of functional or cognitive changes nor infectious conditions. On the night of the exam, she had normal sleep latency but a latter increased wake after sleep onset (WASO). On that occasion, her son offered 5 mg of Zolpidem, which she had been using for 4 years. About 16 minutes later, she reported visual and auditory hallucinations of unknown people, with well-defined faces, colorful clothes and friendly content that persisted for 47 minutes. While hallucinating, she had consciousness of the episode and partial memory of the event. During the investigation, electroencephalogram, cranial tomography, laboratory examination, psychiatric and geriatric evaluations were performed, and no other causes of hallucinations were identified. The drug was discontinued, and the patient denied the return of hallucinations.

Conclusões

Most patients have mild effects from the use of Z-drugs, however some patients have greater effects with potential risks to their own health. Special care should be taken in elderly individuals, whose hepatic metabolism of the drug is slower, resulting in elevated serum concentrations. The psychotic symptoms induced by the Z-drugs are rarely reported and the vPSG recording is even rarer. With this report, we draw attention to adverse effects of the Z-drugs, a growing public health problem with hallucinations, falls, increased mortality, morbidity and healthcare costs.

Palavras -chave

hallucination; insomnia; zolpidem; adverse events.