mystery of yawning
Le bâillement, du réflexe à la pathologie
Le bâillement : de l'éthologie à la médecine clinique
Le bâillement : phylogenèse, éthologie, nosogénie
 Le bâillement : un comportement universel
La parakinésie brachiale oscitante
Yawning: its cycle, its role
Warum gähnen wir ?
 
Fetal yawning assessed by 3D and 4D sonography
Le bâillement foetal
Le bâillement, du réflexe à la pathologie
Le bâillement : de l'éthologie à la médecine clinique
Le bâillement : phylogenèse, éthologie, nosogénie
 Le bâillement : un comportement universel
La parakinésie brachiale oscitante
Yawning: its cycle, its role
Warum gähnen wir ?
 
Fetal yawning assessed by 3D and 4D sonography
Le bâillement foetal
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mise à jour du
19 décembre 2011
Gen Hosp Psychiatry.
2011
Propranolol in yawning prophylaxis:
a case report
Ghanizadeh A.

Chat-logomini

 
Abstract
 
Yawning is a frequent behavior with circadian effects. Sometimes, its frequency is very high and it is disturbing. However, there is no evidence-based treatment for yawning.
 
This is a case report of a man with severe yawning from about 2 years ago. Yawning reduced after taking propranolol.
 
Current evidence suggests that propranolol may decrease yawning through its thermoregulation effect. It is worthwhile conducting controlled clinical trials to study whether propranolol is an effective treatment for yawning.
 
 
1. Introduction
 
Yawning is an unresolved medical and psychological problem. Central dopamine or serotonin receptor agonists may induce yawning in humans [1]. The antagonists of dopaminergic and serotonergic receptors selectively antagonize yawning induced by dopamine or serotonin agonists [2]. Contagious yawning is suggested to be in association with empathic processing [3]. Yawning is correlated with migraine headache [4]. Meanwhile, there is an argument that yawning is a brain cooling mechanism [4&endash;6]. There are some behavioral, physiological and medical evidence supporting the brain-cooling hypothesis [7]. Temperature recordings by implanted thermocoupled probes in the frontal cortex of rats show that yawns and stretches occur during increases in brain temperature [8].
 
Many studies about yawning behavior were conducted in animals. It is suggested that intraperitoneal injection of physostigmine-induced yawning in rats is decreased by alpha1- and alpha2-adrenoceptor stimulation. However, propranolol does not decrease physostigmine-induced yawning in rat [9]. Others reported that propranolol increased physostigmine-induced yawn in rats [10,11]. Only one study was found that reported the association of landiolol, a beta1-adrenoceptor antagonist, and yawning in humans. It reported that beta 1-adrenoceptor antagonist decreased the thiopental-induced yawning response [12]. To the best of the author's knowledge, the role of propranolol, a nonselective beta blocker, for treatment of yawning has never been reported before.
 
2. Case report
 
R.D. is a 48-year-old highly educated man. He referred to clinic with depression, sadness, thought preoccupation, lack of refreshing sleep, irritability, decreased concentration, memory impairment and a significant decreased personal and occupational function level about 3 months ago. He reported that he was suffering from these symptoms from about 1.5 to 2 years ago. He had referred to psychiatrist and he had taken fluoxetine 20 mg/day for 2 months. He felt that his problems were markedly decreased and he discontinued the medication. There was not any remarkable finding in physical and laboratory examination. Positive history for general medical condition such as epilepsy was unremarkable. He denied abuse of any medication or substance. He did not used to take coffee. He does not smoke. The patient did not suffer from obstructive sleep apnea syndrome and migraine headache. There was no positive history for remarkable head trauma. He had headache episodes during his depression period. His headache and yawning disappeared concurrently. Yawning was not related to his sleep duration. However, stress and anxiety enhanced yawning.
 
He reported that he used to yawn frequently. Yawning started from about 2 years ago. Its severity was more when he felt to be more depressed and sad. Yawning was not related to any specific time or place. The score of yawning on a visual analogue scale decreased from 10 to 5 during taking fluoxetine. Then, he stopped fluoxetine. Yawning severity increased after discontinuation of fluoxetine. He was diagnosed as a case with major depressive disorder. Therefore, sertraline (100 mg/day) and propranolol (40 mg/ day) were administered since 3 months ago. He reported that yawning dramatically reduced in a few days after the administration of the medications. Its severity decreased from 10 to 0&endash;1. He has continually taken sertraline for the last 3 months. Now, he is in the remission phase of major depressive disorder. He was advised to stop propranolol. He stopped it. But yawning immediately reappeared. He restarted taking propranolol again. These trials and stops of propranolol administration were repeated several times. Yawning remitted and reappeared after administration and discontinuation of propranolol in all of these trials, respectively. He provided his informed consent for publication of this report.
 
3. Discussion
 
To the best of the author's knowledge, there was not any published clinical trial found for treatment of yawning. Therefore, evidence-based information is required for treatment of yawning. There is evidence that propranolol is effective for prevention of migraine headache [13]. It is speculated that yawning is a symptom related to some types of migraine headache. One explanation for the role of propranolol in this patient is that propranolol prevented headache and its related symptoms. However, yawning reoccurred after discontinuing of propranolol, while headache did not come back. In every trial, yawning remitted after administering propranolol. This supports the possible role of propranolol for the treatment of yawning. In a case report, it is shown that excessive yawning is triggered by mild hyperthermia and that following bouts of yawning body temperature, as measured by an oral thermometer, actually reduced by 0.4°C [14]. It is consistent with the view that propranolol may diminish yawning frequency by reducing brain and/or body temperature. Moreover, propranolol reduces centrally mediated fevers after traumatic brain injury [15] and decreases skin temperatures [16]. Furthermore, propranolol prevents psychological stress-induced elevation in body temperature [17]. In addition, injected propranolol into the cerebral ventricles of the mouse reduces body temperature [18]. The above-mentioned evidence supports the hypothesis that propranolol may reduce yawning frequency through its brain-cooling effects. It is important that this patient took fluoxetine and sertraline, which are selective serotonin reuptake inhibitors used to treat depression. These medications increase brain temperature and produce excessive yawning [19,20]. However, it should be explained why propranolol decreases yawning in humans while propranolol rather increases or does not decrease physostigmine-induced yawning in rats [9]. Is this dissociation only due to species-related differences? Is pathophysiology of physostigmine-induced yawning in rats different from yawning in human? It seems worthwhile conducting controlled clinical trial to investigate the possible therapeutic role of propranolol for the treatment of yawning.
 
References
 
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