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Biomedical subjects

A Kales

Publications and source records attributed to A Kales.

At least 109 records · Page 6Linked to original sources
PubMed1983

Early morning insomnia with rapidly eliminated benzodiazepines.

Early morning insomnia, a significant increase in wakefulness during the final hours of drug nights, occurred after 1 or 2 weeks of nightly administration of benzodiazepine hypnotics with short elimination half-lives, when tolerance had begun to develop. Early morning insomnia may be a variant of rebound insomnia and therefore specific to benzodiazepines, or it may occur with any rapidly eliminated sedative-hypnotic agent.

Anti-Anxiety Agents↗
PubMed1983

Brotizolam: a sleep laboratory evaluation.

Brotizolam 0.25 mg was evaluated in a sleep laboratory study of 10 normal subjects. The study covered 10 consecutive nights and included 4 placebo-baseline nights, 3 nights on the drug and 3 placebo-withdrawal nights, which permitted assessment of initial drug effects, side effects and withdrawal phenomena, such as rebound insomnia. There was a significant increase in total sleep time with drug administration; the improvement in sleep occurred primarily in the first third of the night following the onset of sleep. During the day after nightly drug administration, the presence of rebound anxiety was suggested by an increase in reports of anxiety/tension as compared to baseline. Following drug withdrawal there was a significant increase in total wake time above baseline level, to 40% above baseline on the first and third nights of withdrawal.

Azepines↗
PubMed1983

Sleep laboratory studies of hypnotic drugs: efficacy and withdrawal effects.

Flurazepam, temazepam, and triazolam are compared in terms of initial and short term efficacy, effectiveness during intermediate and long term use, withdrawal effects, and general side effects. The usefulness of temazepam is considerably restricted since the drug is slowly absorbed; peak blood concentrations are not reached until 2 to 3 hours after ingestion. Consequently, while the majority of insomniac patients complain primarily of difficulty falling asleep, temazepam is not effective for this sleep complaint. Further, the drug has an intermediate elimination half-life and induces a significant degree of morning sleepiness (hang-over). Rebound insomnia of a moderate degree occurs with some frequency following withdrawal of temazepam. Triazolam is effective initially and with short term use both for inducing and maintaining sleep. However, much of this effectiveness is lost with continued nightly use over an intermediate period (2 weeks). The drug has a rapid elimination rate; during drug administration, sleep may worsen in the final hours of the night (early morning insomnia), and following drug withdrawal, rebound insomnia is frequent, immediate, and severe. Side effects are frequent and include some morning sleepiness (before tolerance develops) and significant memory impairment and even episodes of amnesia. Triazolam may have a narrow margin of safety in that serious behavioral symptoms have been reported even with a 1-mg dose. Flurazepam is effective both for initiating and maintaining sleep with initial and short term drug administration. Further, its efficacy is maintained not only with intermediate term use but with long term drug use (4 weeks). Flurazepam is a long elimination half-life drug, and there is significant daytime sedation during short term use; with continued use this effect diminishes. Rebound insomnia has not been noted following withdrawal of flurazepam; there is a carry-over effectiveness into the first and second nights of withdrawal, and any withdrawal sleep disturbance would be expected to be infrequent, delayed in appearance, and mild in degree.

Anti-Anxiety Agents↗
PubMed1983

Biopsychobehavioral correlates of insomnia. II. Pattern specificity and consistency with the Minnesota Multiphasic Personality Inventory.

In a study designed to assess personality patterns of patients with chronic insomnia, a total of 528 subjects (428 insomniacs and 100 controls) completed the Minnesota Multiphasic Personality Inventory (MMPI). Comparison of the MMPI profiles of insomniacs from a semirural area and of those from an urban area, each in a completely different geographic region, showed results consistent for high levels of psychopathology as well as for specific personality patterns within and between groups. The personality patterns of insomniac subjects were remarkably homogeneous: only a few MMPI code types accounted for about one-half of each insomniac sample. The insomniac profiles were consistently characterized by the presence of neurotic depression, rumination, chronic anxiety, inhibition of emotions, and an inability to discharge anger outwardly. The results of this study confirm the original hypothesis that the handling of stresses and conflicts through an internalization of emotions leads to physiologic activation and is a major factor underlying the development and maintenance of chronic insomnia.

Adolescent↗
PubMed1983

Rebound insomnia and rebound anxiety: a review.

Rebound insomnia and rebound anxiety are clinical conditions related to withdrawal of certain benzodiazepine drugs. Numerous studies of benzodiazepine and nonbenzodiazepine hypnotics conducted in our sleep laboratory demonstrated that rebound insomnia developed following withdrawal from benzodiazepines with a rapid or intermediate elimination rate. Several studies conducted by other investigators also indicated the development of rebound insomnia under similar conditions. Rebound insomnia and rebound anxiety are discussed in terms of their interrelationship, clinical implications, and receptor mechanisms. Evidence suggests that drugs producing rebound insomnia and rebound anxiety also show a more rapid development of tolerance and greater potential for drug dependence than benzodiazepines where the parent compound or its metabolites have a long elimination half-life.

Anti-Anxiety Agents↗
PubMed1983

Midazolam: dose-response studies of effectiveness and rebound insomnia.

Midazolam, an investigational hypnotic, was evaluated for effectiveness, side effects, and withdrawal phenomena in doses of 10, 20, and 30 mg in three separate sleep laboratory studies, each including 4 placebo-baseline nights, 7 drug nights, and 3 placebo-withdrawal nights. Only a slight to moderate degree of effectiveness was shown across the three doses; this effectiveness was much more pronounced during the first third of the night. There was no dose-response effect for effectiveness with either initial or continued drug administration. In general, there was less effectiveness on the last 3 drug nights, indicating a potential for the development of tolerance over a relatively short period of time. Following withdrawal there was a marked dose-related worsening of sleep above baseline levels (rebound insomnia).

Adult↗
PubMed1982

Narcolepsy-cataplexy. I. Clinical and electrophysiologic characteristics.

The development, clinical course, and electrophysiologic characteristics of narcolepsy were evaluated in 50 adults who had a current complaint of sleep attacks and cataplexy. In most of the patients, the first symptoms, usually excessive daytime sleepiness and sleep attacks, developed during childhood or adolescence. The condition was invariably chronic. Patients frequently had family histories of some disorder of excessive daytime sleepiness. In nocturnal sleep or daytime nap recordings, all but three of the patients demonstrated a rapid-eye-movement (REM) period at sleep onset. Sleep apnea was found in only one patient. Our findings indicate that sleep laboratory recordings to detect a sleep-on-set REM period are of little diagnostic value when the narcoleptic patient has cataplexy. Furthermore, narcoleptic patients require sleep laboratory evaluation for sleep apnea only when the presence of apnea is suggested by the sleep history.

Adolescent↗
PubMed1982

Narcolepsy-cataplexy. II. Psychosocial consequences and associated psychopathology.

The emotional and psychosocial correlates of narcolepsy were evaluated in 50 adults who had a current complaint of sleep attacks and cataplexy. The psychosocial consequences of narcolepsy were extensive; most patients reported that the condition seriously affected their interpersonal, marital, work, and social relationships. Many of these consequences were caused by others' misunderstanding of the symptoms of the disorder, which resulted in negative attitudes toward the patients. Th narcoleptic patients showed high levels of psychopathology compared with controls, but this difference is considered to be primarily a reaction to the disorder and its effects. The narcoleptic patients were overly concerned with emotional control, which appeared to lead to their generalized lack of expressiveness and tendency to build up emotional pressure. Based on these findings, recommendations are given for the psychosocial management of the narcoleptic patient.

Adolescent↗
PubMed1982

Insomnia and other sleep disorders.

In treating the symptomatology of patients who are chronically ill, it is likely that the physician will encounter a significant number of patients who have sleep disorders. This article has described an approach for the assessment, differential diagnosis, and clinical management of the most prevalent sleep disorders, which are often chronic in nature and have significant psychosocial or medical consequences for the patient and his or her family. We have emphasized the importance for the physician to complement his general medical and diagnostic skills by taking a careful sleep history from the patient (and, in some instances from the bed partner or caretakers). There is no justification for the physician to routinely request costly sleep laboratory hypnopolygraphic evaluations to screen patients with sleep disorders. However, in those instances where the sleep history is highly suggestive of sleep apnea, a sleep laboratory evaluation is indicated. By incorporating the use of the sleep history in the general evaluation of patients with sleep disorders, the physician is better able to develop rational pharmacologic and non-pharmacologic approaches to managing these patients, including the judicious use of medication as an adjunctive treatment.

Aging↗
PubMed1982

Quazepam and flurazepam: long-term use and extended withdrawal.

Two investigation benzodiazepine hypnotics with long half-lifes, (30 and 15 mg quazepam and 30 mg flurazepam) were evaluated in 47-night sleep laboratory studies. The effectiveness and side effects of these benzodiazepines were assessed during short-, intermediate-, and long-term use. Subjects were also assessed for presence of rebound insomnia during the 15 days following abrupt withdrawal. Quazepam, 15 and 30 mg, and flurazepam, 30 mg, each were effective in sleep induction and maintenance after short- and intermediate-term use. Some loss of effectiveness was noted during long-term use of both doses of quazepam and, to a lesser extent, of flurazepam. Subjective reports of improvement in sleep latency and total sleep time were in general agreement with the objective data. During the 15 nights after abrupt withdrawal of these two long-half-life drugs there was no rebound insomnia, either immediate or delayed. Both drugs exerted carry-over effectiveness on the first 2 to 3 nights after withdrawal; with quazepam this effect persisted throughout the withdrawal period. Quazepam, 30 mg, induced frequent side effects related to sleepiness. Side effects noted with 30 mg flurazepam were less frequent and severe, while the side effects with 15 mg quazepam were minimal. These data suggest that the optimal dose of quazepam is 15 mg.

Adult↗
PubMed1982

Lorazepam-efficacy, side effects, and rebound phenomena.

Lorazepam, 4 mg, was evaluated in an 18-night sleep-laboratory study involving five insomniac subjects. Hypnotic effectiveness and effects on sleep stages and related parameters were assessed. Placebo was given on baseline nights 1 to 4, lorazepam on nights 5 to 11, and placebo was given again on withdrawal nights 12 to 18. Subjective and objective data clearly demonstrated that lorazepam was effective for both inducing and maintaining sleep. Sleep latency was reduced from a baseline value of 34.6 min to 17.9 min (P less than 0.01) and total wake time was reduced from 75.9 to 38.5 min (P less than 0.01). On the third and fifth nights of drug withdrawal total wake time rose above baseline levels (termed rebound insomnia) and sleep latency increased by 77% and 60% over baseline (P less than 0.01). Subjective estimates of daytime anxiety also increased above baseline (rebound anxiety) during the withdrawal period. All subjects experienced severe hangover and varying degrees of impaired functioning during the first 3 days on drug. Three subjects also experienced anterograde amnesia during the day after the first drug night. These side effects diminished in intensity over the course of the study. Our results suggest that while 4 mg lorazepam may be effective in inducing and maintaining sleep, this dose induces clinically significant side effects that are followed by consistent rebound phenomena after withdrawal.

Amnesia↗
PubMed1982

Sleep disorders: research in psychopathology and its practical implications.

This is a summary of research studies indicating a primary role of psychotherapy in the etiology of certain sleep disorders. Thus, chronic insomnia is associated with high levels of psychopathology and a personality profile characterized by internalization of emotions. Also, a greater number of stressful life events occurs at the year of onset of insomnia. Two additional sleep disorders (sleep-walking and night terrors in adults) are similarly associated with high levels of psychopathology. Although these two disorders share many common clinical and psychopathological characteristics, their psychological profiles and psychopathological correlates differ considerably. Sleepwalkers show a high incidence of personality disorders with generally active, outward behavioral patterns, whereas night terror sufferers are mostly anxious, depressed and phobic with an inhibition of outward expression of aggression. Based on these research findings a series of therapeutic recommendations is presented for the effective management of patients with insomnia, sleepwalking or night terrors.

Dreams↗
PubMed1982

Psychotherapy with night-terror patients.

This is the first report of the effectiveness of psychotherapy in treating adult night-terror patients. Night terrors were eliminated or drastically reduced in two patients who completed psychotherapy. A third patient discontinued therapy and showed no improvement. Thus, the primary role of psychopathology in the production of night terrors in adulthood was illustrated.

Adult↗