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Potentially Lethal Behaviors Associated With Rapid Eye Movement Sleep Behavior Disorder: Review of the Literature and Forensic Implications

Authors

  • Carlos H. Schenck M.D.,

    1. Minnesota Regional Sleep Disorders Center, Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN 55415. [SAL, research assistant.]
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  • Samuel Adams Lee B.A.,

    1. Minnesota Regional Sleep Disorders Center, Department of Psychiatry, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN 55415. [SAL, research assistant.]
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  • Michel A. Cramer Bornemann M.D.,

    1. Minnesota Regional Sleep Disorders Center, Department of Neurology, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN 55415.
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  • Mark W. Mahowald M.D.

    1. Minnesota Regional Sleep Disorders Center, Department of Neurology, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, MN 55415.
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Additional information and reprint requests:
Carlos H. Schenck, M.D.
Minnesota Regional Sleep Disorders Center
Hennepin County Medical Center
701 Park Ave.
Minneapolis
MN 55415
E-mail: schen010@umn.edu

Abstract

Abstract:  Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by loss of the muscle atonia of REM sleep, with release of complex and violent behaviors that are often attempted dream-enactments. This study reviewed the literature on RBD with regard to potentially lethal behavior. A total of 39–41 clinical cases of RBD associated with potentially lethal behaviors to self and/or others were found, involving a child and adults of all age groups, that manifested as choking/headlock (n = 22–24), defenestration/near-defenestration (n = 7), and diving from bed (n = 10). A total of 80.8% (n = 21) were males; 19.2% (n = 5) were females; mean age was 65.6 ± (SD) 13.8 years (range: 27–81 years, and a child). (Gender/age data were not listed in the remaining cases.) An etiologic association of RBD with a neurologic disorder (or with pharmacotherapy of psychiatric disorders, n = 4) was present in 21–23 patients. Thus, RBD carries well-documented, potential forensic consequences during RBD episodes that could possibly have been misinterpreted as suicidal or homicidal behavior.

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