MMW Fortschritte der Medizin
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Taking care of the dying is an important and demanding concern for the general physician. In addition to the amelioration of pain, he also has to help the patient to cope with dyspnea, vomiting, constipation, depression and anxiety. To this end, not only morphine but also anti-emetic drugs, laxatives and peristalsis-stimulating suppositories, benzodiazepines and neuroleptics with a sedating effect can make it easier for the patient during the terminal phase of his life. As least as important as the support provided by medication, however, are sympathetic communication with the patient and human warmth.
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Sleep disorders could be the symptoms of organic or non-organic conditions. The diagnostics comprises a detailed medical history of the patient complemented by a sleep diary, as well as organic medical and psychological/psychiatric examinations. ⋯ Nondrug strategies include sleep hygiene, stimulus control, sleep restriction and cognitive techniques. For sleep disturbances due to a psychological or organic disease, the primary condition must be treated.
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The diagnosis of restless legs syndrome is made on the basis of the clinical symptoms and, if applicable, complemented with a polysomnography. This is followed by neurophysiological examinations and laboratory diagnostics and permits a differentiation between idiopathic and secondary RLS. ⋯ An idiopathic RLS is treated with drugs. Primarily, L-dopa/benserazide and dopaminergic agonists are used, but opioids and anticonvulsants are also successful.