Nocturnal Sleep-Related Eating Disorder (NSRED) is a well-documented sleeping disorder where the person is reported to experience bizarre eating behavior during sleep. Although various causes are implicated in this disorder, role of drugs cannot be ruled out. Here we narrate an interesting rare case report of a drug-induced new onset NSRED, where a 45-year-old man on zolipdem performed an unexpected and bizarre eating behavior during somnambulistic state, type of which has not been reported earlier in the literature. The case falls under even rarer category as such behavior in sleep is reported mainly in woman.

Background: Critical appraisal of published literature for hospital clinicians has never been taken as an initiative in developing countries. Objective: This study was aimed at evaluating the nature of pharmacotherapy consultations from the drug information center (DIC) of the Postgraduate Institute of Medical Education and Research, Chandigarh, India. Methods: The DIC received pharmacotherapy consultation requests from January 2016 to December 2017. Various aspects such as clinical queries, patient-related factors, and disease-related information in these requests were recorded and analyzed. Descriptive statistics and χ2 test were used for the analysis of the data and feedback evaluation, respectively. Results: During the study, a total of 179 consultation requests were documented. On 19 (10.61%) encounters, pharmacotherapy consultations occurred for emergency patient care. Of the 179 queries, 31 (17.3%) were answered immediately while 148 (82.68%) were answered within an average time of 1.6 hours. The most common type of query was the pharmacotherapy of disease, followed by dose calculation and dose modification. Communications with DIC staff took place for timely critical appraisal of the medical literature, followed by a judicious selection of higher antimicrobials and other drugs. The time taken for answering a query was found to be a statistically significant determinant of user satisfaction ( P < .05). Conclusion: The evidence level–specific drug information service was established and catered to hospital clinicians through critical evaluation of offline and online resources. DIC services have the potential to revolutionize the pharmacy and pharmacology curriculum in developing countries.

A 21-year-old medical student was prescribed mirtazapine 15 mg once daily at bed time for his depressive symptoms. After taking the drug for approximately 2 weeks, he again presented to the psychiatry outpatient department with a history of severe nightmares almost every night.During history taking, he could recollect few of the horrifying experiences that he dreamt of. In one of the dreams he saw an unknown person trying to stab him with a knife. In another, he saw himself tied up to a pole over the bridge and gun shots hitting him from the sides. In the third, he visualized his girlfriend dead under a collapsed building. He also reported dreaming about his own cremation proceedings going on at a barren place, while he was still alive.Each time he woke up with confusion, palpitations, sweating and fear. In addition, he complained of malaise, confusion and increased sedation during day time, while on therapy. The drug was consequently stopped and, not surprisingly, the nightmares disappeared completely within a couple of days. Thereafter, he was put on fluoxetine and no such episodes were reported. On careful evaluation of past history, it was found that the patient had shown poor compliance to mirtazapine a few years back and had experienced similar nightmares.There was no history of concomitant use of other medications (including herbal medicines) or alcohol intake. The temporal relationship between the initiation of treatment with mirtazapine and onset of nightmares and their disappearance with discontinuation of the drug, and also their occurrence during a previous episode of mirtazapine treatment suggest a causal aetiology and puts this extremely rare adverse drug reaction (ADR) in a 'highly probable' category according to the Naranjo Algorithm with a score of 9 [1].

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