As the findings demonstrate, in some cases CRSDs might be taken into consideration as a possible side effect. When iatrogenic CRSD is suspected, changing therapy and/or adding melatonin might be initiated. CRSDs ami psychiatric misdiagnosis Difficulties in daytime functioning are one of the prominent characteristics of CRSDs. Individuals with CRSDs frequently fall to

adjust to the activity hours accepted in most social, occupational, and academic settings, due to incompatibility of their internal biological rhythms with the environmental timetable. Consider, for example, a patient with DSPS who is Inhibitors,research,lifescience,medical expected to arrive at his workplace by 8 or 9 am. In order to fulfill this requirement, this individual is forced to wake up at what might be the middle of his internal night. It is not surprising, therefore, that he will be frequently late and/or absent, a pattern that will most likely subject him to disciplinary actions up to dismissal.

If, however, he manages to meet the attendance Inhibitors,research,lifescience,medical standards, his performance will be liable to the detrimental effects of sleep loss and time of day. In childhood Inhibitors,research,lifescience,medical and adolescence, when CRSDs usually emerge, the impairment of daytime functioning can be even more remarkable than in adults. Unlike adults, who can at times choose a lifestyle that corresponds to their sleep-wake cycle, the activity hours of persons of younger age are constrained by a strictly predetermined school timetable.

The inability to adjust to this timetable may be associated with deteriorated school performance. In a recent study, Inhibitors,research,lifescience,medical we found that the vast majority of young patients with DSPS complained of frequent late arrivals and absences at school, underachievement, Inhibitors,research,lifescience,medical and behavioral/social difficulties. Importantly, treatment with melatonin significantly reduced the number of children and adolescents complaining of malfunctioning at school.63 In some cases, the daytime functional difficulties might be severe enough to be mistakenly interpreted as symptoms of psychiatric disorders. A case of a 14-year-old boy provides a dramatic Illustration Oxalosuccinic acid of such a scenario.64 During the 4 years prior to his referral to our sleep clinic, the patient suffered from major functioning difficulties, including conflicts with teachers, parents, and peers. At the age of 12, the patient dropped out of school and was sent to an inpatient chlld-psychiatry center. Three months of psychiatric evaluation yielded diagnoses of atypical depressive Vorinostat datasheet disorder with possible schizotypal personality disorder. Due to excessive daytime sleepiness, he was referred to our sleep clinic for assessment of a potential sleep disorder. A thorough sleep study revealed that the patient had a 26-h sleepwake schedule and dissociation between oral temperature and salivary melatonin rhythms.