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PubMed1990

The use of sedative-hypnotic drugs in a university teaching hospital.

We reviewed the charts of 476 patients admitted to a university teaching hospital to determine whether sedative-hypnotic drugs (SHDs) were being used excessively and to examine the use of SHDs as hypnotics. The frequency of medical and surgical indications for barbiturates and benzodiazepines or other minor tranquillizers as well as the use of such drugs were compared among different groups of patients and specialty wards. Of the patients 29% had a regular order and 40% had a PRN order; only 77% of the PRN orders were administered. A total of 215 patients (45%) received an SHD during their hospital stay, and 160 (34%) received the drug as a hypnotic. Medical indications accounted for 49% of the regular orders but only 2% of the PRN orders; moreover, 89% of all the PRN orders were for insomnia. On average, patients receiving SHDs as hypnotics were older (p less than 0.05) and stayed longer in hospital (p less than 0.01) than those who did not; however, no patient on the geriatric or pediatric ward received an SHD as a hypnotic during the hospital stay. The differences in use between patient groups may have been influenced by orientation of ward staff. Physicians should review their rationale for prescribing hypnotics and avoid routine orders on admission.

Adult↗

PubMed1989

[Prescription of tranquilizers and hypnotics in the municipality of Holbaek].

On the basis of an investigation of prescriptions of tranquillizers and hypnotics for individuals resident in the Municipality of Holbaek, a description was made of which tranquillizers and which hypnotics were prescribed and the quantities provided. 96% of the prescriptions were written by the general practitioners in the town. Only 2% of the patients had obtained medicine from various doctors. Benzodiazepine derivatives constituted 93% of all tranquilizers and 96% of the hypnotics prescribed. Diazepam, nitrazepam and triazolam were the preparations most frequently prescribed. Diazepam, flunitrazepam and the older hypnotics were prescribed in quantities which suggested that these preparations were preferred by chronic users with massive drug intake. The smallest portions available were employed for 17% of the prescriptions for tranquillizers and in 2% of the prescriptions for hypnotics. The favourite amount prescribed was 100 tablets. Where triazolam was concerned, strikingly high defined daily dosages were prescribed. As only brief or episodic use is rational, half of all the tranquilizers and four out of five prescriptions for hypnotics are considered unsuitable.

Aged↗

PubMed1989

[An analysis of massive prescription of tranquilizers and hypnotics].

Investigation of the prescriptions for tranquilizers and hypnotics issued in a provincial Danish town with approximately 30,000 inhabitants, revealed that 12% of all users over 40 years had received massive quantities of tranquilizers and hypnotics within one month, viz more than 100 defined daily doses/user. Only four recipients of massive prescriptions were found in the age group 16-39 years. In the group of recipients of massive prescriptions over the age of 60 years, it was found that persons entitled to medicine free-of-charge comprised every third or forth user. Recipients of massive prescriptions over the age of 40 years did not differ as regards age and sex from recipients of ordinary quantities, viz less than or equal to 100 defined daily doses/user/month. Differences in the frequencies of prescription of massive quantities could be demonstrated between the various general practices. These differences could not be correlated with differences in the ages of the general practitioners, types of practice or sizes of practice. A series of prescribing habits on the part of the practitioner appear to be of particular significance for prescription of massive quantities of tranquillizers and hypnotics. These include; the decision to prescribe hypnotics, choice of hypnotic and prescription of several tranquillizers and/or hypnotics simultaneously.

Adolescent↗

PubMed1986

Zolpidem, a novel nonbenzodiazepine hypnotic. I. Neuropharmacological and behavioral effects.

Zolpidem [N,N,6-trimethyl-2-(4-methylphenyl)imidazo[1,2-a]pyridine-3-acetamide hemitartrate] is reported to be a rapid onset, short duration hypnotic that interacts at the benzodiazepine recognition site. The present report establishes the neuropsychopharmacological profile of zolpidem and compares it with those of benzodiazepine hypnotics. Although in mice the effects of zolpidem are qualitatively similar to those of midazolam, triazolam and flunitrazepam, sedation with zolpidem occurs at doses 10 and 20 times lower than those inducing anticonvulsant and myorelaxant effects, respectively. In contrast, the benzodiazepines studied induce sedation at doses causing myorelaxation and which are 2 to 6 times superior to those antagonizing pentetrazole-induced convulsions. In the rat, zolpidem induces sleep (as indicated behaviorally and electrocorticographically) and displays anticonflict activity in a punished drinking paradigm, as do the benzodiazepines. However, whereas benzodiazepine hypnotics induce EEG sleep patterns in curarized rats at doses similar or inferior to those active in the conflict test (in freely moving animals), the hypnotic effect of zolpidem is seen at doses 10 times lower than those producing an anticonflict effect. Moreover, a qualitative difference between the effects of zolpidem and benzodiazepines is observed in electrocorticographic recordings obtained in curarized rats: electrocorticographic hypersynchronization induced by zolpidem is dominated by the energy increase within the 2 to 4 Hz band whereas the benzodiazepines increase predominantly energy levels within the 12 to 14 Hz band. Studies of the sleep-wakefulness cycle in the rat and the cat revealed that hypnotic doses of zolpidem do not alter the pattern of physiological sleep, although elevated doses of the drug decrease paradoxical sleep and increase slow wave sleep. In rats trained to discriminate chlordiazepoxide, zolpidem fails to generalize with the chlordiazepoxide-associated lever indicating that the compound and benzodiazepines do not share the same discriminative stimulus properties. Nevertheless, the anticonvulsant, hypnotic, myorelaxant and anticonflict effects of zolpidem are antagonized by benzodiazepine receptor antagonist Ro 15-1788 and CGS 8216 indicating an involvement of the benzodiazepine recognition site in the action of this drug. The highly selective sedative effect of zolpidem (as compared to myorelaxant and anticonvulsant effects) suggests that it may possess a specificity for certain subtypes of benzodiazepine receptors.

Animals↗

PubMedDate not supplied

Pharmacodynamics and pharmacokinetics of some hypnotic drugs in spontaneously hypertensive rats (SHR).

Hypnotic action of barbiturates (hexobaribtal, cyclobarbital-Ca, phenobarbital, barbital) chloral hydrate, glutethimide was investigated in spontaneously hypertensive Okamoto-Aoki rats (SHR). Hypnotic effect of investigated drugs was decreased in hypertensive rats comparing with normotensive animals. The decrease in the hypnotic effect was related to the increase of the threshold hypnotic dose. No changes were observed in the pharmacokinetic parameters of hexobarbital and barbital and in the rate of crossing of blood-brain barrier by the latter drug in SHR rats. The results suggested that the decrease of hypnotic activity of investigated drugs did not depend on the hypertension but they were produced by the hyposensitivity of CNS to hypnotic agents. The latter phenomenon appeared as the result of some biochemical changes in the brain tissue.

Animals↗

PubMed1997

Nifedipine, an L-type calcium channel blocker, restores the hypnotic response in rats made tolerant to the alpha-2 adrenergic agonist dexmedetomidine.

Rats were made tolerant to the hypnotic effects of the alpha-2 adrenergic agonist dexmedetomidine by a 7- or 14-day continuous systemic administration of the same, and the ability of nifedipine to reverse dexmedetomidine tolerance was assessed. Acute administration of nifedipine (10 mg/kg i.p.) restored the hypnotic response to dexmedetomidine in the alpha-2 tolerant rats. Concurrent administration of nifedipine during induction of tolerance, either partially (continuous administration 10 mg/kg/day delivered by minipumps) or completely (twice daily injections, 20 mg/kg s.c.) restored hypnotic responsiveness to control levels. Induction of tolerance reduced the affinity of [3H]PN200-110 for the L-type calcium channel. Chronically administered nifedipine treatment (20 mg/kg s.c. twice daily), at doses that partially restored the behavioral response to normal, did not change ligand binding affinity of [3H]PN200-110. An increase in Bmax for [3H]PN200-110 was noted in the dexmedetomidine tolerant state which did not change with chronic nifedipine. In naive rats, the phosphodiesterase inhibitor rolipram (275 microg/kg i.p.), mimicked the state of tolerance, as it resulted in a decreased hypnotic response to dexmedetomidine. Nifedipine (10 mg/kg i.p.) also reversed the rolipram-induced attenuation of the hypnotic response to dexmedetomidine. These data implicate a role for the L-type calcium channel in the mechanism of the hypnotic response in alpha-2 tolerant rats and suggest the involvement of the cAMP pathway.

Adrenergic alpha-2 Receptor Agonists↗

PubMed1998

[Recent progress in development of hypnotic drugs].

The patient of insomnia in the advanced countries come up to 25 approximately 33% in populations. The pharmaco-therapy, especially hypnotic drug is useful treatment in insomnia. I reviewed the developing hypnotic drugs in Japan. One benzodiazepine and 2 non-benzodiazepines. These hypnotics have selective affinity to benzodiazepine receptor omega 1 subtype. The half-life-time of the developing benzodiazepine hypnotic drug is long, therefore the rebound insomnia can not be recognized. Those of non-benzodiazepine hypnotics are short, namely 1-3 hours. The former drug has finished the clinical studies and waiting the permission for marketing from the government. The latter have still been under the clinical studies. We can expect these hypnotics will bring a certain advantages for our insomnia treatment in future.

Acetamides↗

PubMed1991

EEG correlates of hypnotic susceptibility based upon fast Fourier power spectral analysis.

The purpose of the present study was to determine if there were differences between high and low hypnotic susceptible subjects based upon fast Fourier power spectral analysis of the EEG recorded both before and during hypnotic tasks from frontal-temporal and occipital-parietal locations. Significant differences were obtained based upon EEG recording electrode location, EEG frequency within six different frequency domains, and hypnotic tasks. However, no main effect differences were obtained based upon hypnotic susceptibility. In contrast to some evoked potential studies in which a few differences have been obtained based on hypnotic susceptibility the lack of any EEG differences in this study even when positive and negative hallucination tasks were employed may have implications for the role of the neocortex in mediating hypnotic phenomena.

Electroencephalography↗

PubMed2006

Focused hypnotic analgesia: local and remote effects.

Suggestion for hypnotic analgesia aimed at a specific body area is termed "focused hypnotic analgesia". It is not clear, however, whether this analgesia is limited to a specific body location or spread all over the body. Focused hypnotic analgesia was studied, in response to ascending electrical stimuli, when analgesia and stimulation were applied to the same area (local), and when analgesia was applied to one location and stimulation was delivered to a different area (remote). The face or leg served alternately as the local or remote areas, and the effect was tested in 12 high-hypnotizable (HH) and 13 low-hypnotizable (LH) subjects. Hypnotic analgesia in the local site produced a significant pain reduction compared to the remote site in HH subjects (P<0.0001) but not in LH subjects (P=0.68). As stimuli increased in intensity the reduction in pain as a result of hypnosis was larger both in HH and LH subjects (P<0.0001). Nevertheless, significant analgesia occurred in the 3 highest intensities in the local and remote location of HH subjects, but only in 2 highest intensities in the local and 1 in the remote of LH subjects. We conclude that in HH subjects focused hypnotic analgesia is mostly confined to the area aimed at, but some spread of analgesia to remote areas cannot be dismissed all together. Alternatively, this "spread" of analgesia could be due to a placebo effect in the remote area. Focused hypnotic analgesia requires increased attention to the body area aimed at, unlike analgesia achieved by distraction of attention.

Adult↗

PubMed1998

Different strategies of modulation can be operative during hypnotic analgesia: a neurophysiological study.

Nociceptive electrical stimuli were applied to the sural nerve during hypnotically-suggested analgesia in the left lower limb of 18 highly susceptible subjects. During this procedure, the verbally reported pain threshold, the nociceptive flexion (RIII) reflex and late somatosensory evoked potentials were investigated in parallel with autonomic responses and the spontaneous electroencephalogram (EEG). The hypnotic suggestion of analgesia induced a significant increase in pain threshold in all the selected subjects. All the subjects showed large changes (i.e., by 20% or more) in the amplitudes of their RIII reflexes during hypnotic analgesia by comparison with control conditions. Although the extent of the increase in pain threshold was similar in all the subjects, two distinct patterns of modulation of the RIII reflex were observed during the hypnotic analgesia: in 11 subjects (subgroup 1), a strong inhibition of the reflex was observed whereas in the other seven subjects (subgroup 2) there was a strong facilitation of the reflex. All the subjects in both subgroups displayed similar decreases in the amplitude of late somatosensory evoked cerebral potentials during the hypnotic analgesia. No modification in the autonomic parameters or the EEG was observed. These data suggest that different strategies of modulation can be operative during effective hypnotic analgesia and that these are subject-dependent. Although all subjects may shift their attention away from the painful stimulus (which could explain the decrease of the late somatosensory evoked potentials), some of them inhibit their motor reaction to the stimulus at the spinal level, while in others, in contrast, this reaction is facilitated.

Adult↗

PubMed2002

Hypnotic susceptibility in patients with conversion disorder.

Conversion disorder has been associated with hypnotic susceptibility for over a century and is currently still believed to be a form of autohypnosis. There is, however, little empirical evidence for the relation between hypnotic susceptibility and conversion symptoms. The authors compared 50 patients with conversion disorder with 50 matched control patients with an affective disorder on measures of hypnotic susceptibility, cognitive dissociation, and somatoform dissociation. Conversion patients were significantly more responsive to hypnotic suggestions than control patients. In addition, conversion patients showed a significant correlation between hypnotic susceptibility and the number of conversion complaints. These results provide the first evidence of a relationship between hypnotic susceptibility and the presence and number of conversion symptoms.

Adult↗

PubMed1990

Improved obstetric outcomes using hypnotic analgesia and skill mastery combined with childbirth education.

The benefits of hypnotic analgesia as an adjunct to childbirth education were studied in 60 nulliparous women. Subjects were divided into high and low hypnotic susceptibility groups before receiving 6 sessions of childbirth education and skill mastery using an ischemic pain task. Half of the Ss in each group received a hypnotic induction at the beginning of each session; the remaining control Ss received relaxation and breathing exercises typically used in childbirth education. Both hypnotic Ss and highly susceptible Ss reported reduced pain. Hypnotically prepared births had shorter Stage 1 labors, less medication, higher Apgar scores, and more frequent spontaneous deliveries than control Ss' births. Highly susceptible, hypnotically treated women had lower depression scores after birth than women in the other 3 groups. We propose that repeated skill mastery facilitated the effectiveness of hypnosis in our study.

Adolescent↗

PubMed1989

Effects of instructional set on attributions of nonvolition during hypnotic and nonhypnotic analgesia.

Fifty highly hypnotizable subjects were assigned to four treatment groups or a no-treatment control group and then underwent two pain stimulation trials. Half the treated subjects were administered hypnotic analgesia, half waking analgesia. Within hypnotic and nonhypnotic treatments, half the subjects were given actively worded analgesia instructions, half passively worded instructions. Subjects in the four treated groups reported equivalent pain reduction and equivalent use of coping imagery, although hypnotic subjects rated themselves as more deeply hypnotized than did nonhypnotic subjects. Both hypnotic and nonhypnotic subjects given passive instructions rated their pain reduction as occurring involuntarily, whereas those given active instructions reported that their pain was reduced through their active use of coping strategies. These findings support sociocognitive formulations of hypnotic responding that view ratings of involuntariness as reflecting contextually guided interpretations of behavior.

Adolescent↗

PubMed2003

Hypnotic enhancement of cognitive-behavioral interventions for pain: an analogue treatment study.

Recent meta-analyses have shown that adding hypnosis enhances the effectiveness of cognitive-behavioral psychotherapy. This hypnotic enhancement effect was evaluated in the analogue treatment of pain. Individuals scoring in the high (n = 135) and low (n = 150) ranges of hypnotic suggestibility were randomly assigned to 1 of 6 conditions: Stress Inoculation Training, the same treatment provided hypnotically, nonhypnotic analgesia suggestions, hypnotic analgesia suggestions, a hypnotic induction treatment, or a control condition. The 5 analogue treatments reduced experimental pain more than the control condition, but were not different from one another. Under circumstances optimized to detect an enhancement effect, neither Stress Inoculation Training nor analgesia suggestions produced more relief when delivered in a hypnotic context than identical treatments provided nonhypnotically.

Adult↗

PubMed2003

Negative and positive visual hypnotic hallucinations: attending inside and out.

Hypnotic perceptual alteration affects brain function. Those hypnotic instructions that reduce perception by creating an illusory obstruction to it reduce brain response to perception in the cognate sensory cortex, as measured by event-related potential (ERP) amplitude and regional blood flow (PET). Those hypnotic instructions that affect the subject's reaction to perception activate the anterior attentional system, especially the anterior cingulate cortex in PET studies. Hypnosis involves activation without arousal and may be particularly mediated via dopaminergic pathways. Hypnotic alteration of perception is accompanied by measurable changes in both perceptual and attentional function of those specific regions of the brain that process these activities, modulated by the nature of the specific hypnotic instruction. Positive obstructive hallucinations seem to allow for a hypnotic focus inward, activating the functioning of attentional neural systems and reducing perceptual ones.

Affect↗

PubMed1990

Hypnotic susceptibility and experimental pain reduction.

We exposed 24 subjects high in hypnotic susceptibility and 24 subjects low in hypnotic susceptibility to a cold-pressor pain stimulus under either hypnotic or waking conditions, using each of two pain-reduction strategies (analgesia and distraction) separately. Trance depth level was held constant for hypnotized subjects. We used pain-tolerance levels as measures of pain, and we analyzed them by survival analysis. High susceptibles reported significantly lower pain ratings and kept their hands immersed longer in the cold water than low-susceptible subjects. There were no significant differences between hypnotic and waking condition subjects or between the different strategies. We have discussed the results in terms of a relationship in the literature between choice of experimental design (between-subjects or within-subjects) and the effectiveness of a hypnotic induction for suggested pain reduction.

Arousal↗

PubMed1991

An exploratory study of hypnotic capacity of schizophrenic and borderline patients in a clinical setting.

A review of current clinical and experimental research discloses that psychotic patients display hypnotic capacity. There is disagreement about the degree of this capacity. The most recent research indicates that schizophrenic populations are comparable to normal populations on the Stanford Scales of Hypnotic Susceptibility and the Harvard Group Scale of Hypnotic Susceptibility. However, on the Hypnotic Induction Profile the mean scores of schizophrenics are significantly lower than normals. To investigate these inconsistencies, I undertook and exploratory study of the hypnotizability of schizophrenic and borderline patients in a clinical setting. Test results in this clinical setting, using the Stanford Scale of Hypnotic Susceptibility: Form A and the Hypnotic Induction Profile, indicated higher than usual hypnotizability. The effects of transference in the clinical setting may be a possible explanation for some of the differences in the test results. Posttest questioning revealed response patterns and conflicts that may be unique to the severely disturbed patient population. These response patterns may influence the test norms for this population and may further help explain differences in findings.

Borderline Personality Disorder↗

PubMed1993

Hypnotic susceptibility, mood state, and cardiovascular reactivity.

In this study we explored the relationship between hypnotic susceptibility measured with the Harvard Group Scale of Hypnotic Susceptibility (HGSHS) and cardiovascular parameters. After assessing their degree of hypnotic susceptibility, we induced 21 female students into happy mood states and into sad mood states. During the mood state induction we monitored blood pressure, heart rate, and cardiac vagal tone continuously. The study demonstrated a strong relationship between hypnotic susceptibility and both cardiac vagal tone and heart rate reactivity. Subjects with lower heart rate and greater vagal tone during baseline and greater heart rate increases during mood induction were more susceptible to hypnosis. Multiple regression analyses indicated that approximately 40% of the individual difference variance of hypnotic susceptibility was accounted for by baseline cardiac vagal tone and heart rate reactivity during mood state. The data demonstrate that autonomic tone, assessed by cardiac vagal tone and heart rate reactivity, are related to hypnotic susceptibility as measured by the HGSHS.

Adult↗