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PubMed2005

Specific serotonergic reuptake inhibition impairs vigilance performance acutely and after subchronic treatment.

Subchronic treatment with the selective serotonergic reuptake inhibitors (SSRIs) fluoxetine, venlafaxine and paroxetine, but not sertraline, were previously shown to specifically impair vigilance performance. The current study was designed to compare the vigilance effects of subchronic treatment with the SSRIs sertraline and citalopram in healthy volunteers, according to a placebo-controlled, double-blind, three-way cross-over design. Twenty-four healthy subjects, aged 30-50 years, of whom 21 completed the study, underwent three treatment periods of 2 weeks in which they received sertraline (50 mg on days 1-8, 100 mg on days 8-15), citalopram (20 mg on days 1-8, 40 mg on days 8-15) and placebo. Treatment periods were separated by 14 days washout periods. Vigilance performance was assessed through a 45-min Mackworth Clock Test at days 1, 8 and 15 of each treatment period. It was found that citalopram impaired vigilance performance acutely after the first 20 mg dose and subchronically after 40 mg daily doses. By contrast, no vigilance impairment was found during sertraline treatment. Sertraline is the only SSRI studied so far with no detrimental effects on vigilance. This may be due to the affinity of sertraline for the dopamine reuptake site. Because citalopram is the most specific SSRI showing this effect, it is concluded that the SSRI-induced decrement of vigilance performance is specifically associated with serotonergic reuptake inhibition.

Adult↗
PubMed2003

Vigilance. Evolution and definition for caregivers of family members with Alzheimer's disease.

The language of caregiving relies heavily on terms that are frequently negative such as caregiver stress and burden, but these are not universally accepted phenomenon. The purpose of this article is to report on the development of caregiver vigilance and to suggest it offers both neutral terminology and a means to include caregivers' perceptions of their supervisory role. The concept of vigilance emerged from a qualitative study of caregivers of family members with Alzheimer's disease. Vigilance is defined as the caregivers' continual oversight of their care recipients' activities. The five key components of vigilance were watchful supervision, protective intervening, anticipating, always on duty, and being there. Vigilant caregivers saw themselves as "on duty" even when they were not "doing things." The findings of this study support caregivers' perceptions of 24-hour-a-day responsibility. Nurses need to realize that caregiver vigilance is not necessarily diminished when professional caregivers intervene or institutionalization occurs. Debriefing caregivers about their unique family caregiving knowledge and incorporating it into caregiving is a key strategy for nurses to use to build caregiver trust and reduce their vigilance time.

Adaptation, Psychological↗
PubMed1984

[Vigilance--its EEG determination].

The definition of vigilance was based primarily on criteria of overt behaviour and concomitant electrographic patterns of functional states as well as on psychometrically tested performance. It turned out that the combination of well defined electroencephalographic activity patterns is an utile and reliable measure for the classification of different vigilance levels, even when there is no experimental testing of performance possible or the observation of behaviour misleading. We know today defined mixtures of characteristic regional EEG activities for the estimation on different levels of vigilance between supervigilance and subvigilance. There are however also deviations from regularly observed combinations of signs with dissociations between behaviour, performance and EEG-activity patterns. For the theory of vigilance one can use the analyses of topological and chronological organization of EEG-activities as starting point. Not only characteristic frequency mixtures are correlated with given vigilance levels; moreover the diffusion of regional activities interfering with all other regional activities builds up the socalled "vigilance profile". This profile varies with time slowly or quickly. The regular topological process distribution of activities is commonly the expression of a dominating mental process interfering with other submental processes. The chronological variations of vigilance profiles show their dynamism with transitions from fixed, strictly bound interest or "concentration" on selected objects to freely fluctuating interest, rapidly jumping from object to the other.

Alpha Rhythm↗
PubMed1984

[Clarification of the concepts vigilance and activation in pharmacopsychology and electrophysiology].

Nine significant concepts and definitions of vigilance and activation from the fields of psychology and neurophysiology are introduced. The term "vigilance" stands out as a neurophysiological, and especially as an electrophysiological construct which is designated a mediating role (disposition) in the optimal preparation and adaptation of behaviour to the environment. In accordance with this central idea, the term vigilance should be operationalised and parametrised primarily with neurophysiological methods. The various forms of the electroencephalogram are held to be the most accurate indicators of the state of vigilance. For the sake of semantic clarity, the term vigilance should be avoided in psychological research, and instead the terms attentiveness, concentration etc. should be used. On the basis of the tests selected for the paper, it becomes apparent that "vigilant" = attentive behaviour designates a working construct with wide applicability. The term serves to describe a preparatory state for optimal adaptation to and performance in the environment, which must be precisely defined from one experimental situation to another. These considerations apply particularly to human pharmacological experiments in which pharmacopsychological and psychopharmacological questions come into contact. The term vigilance fits into the concept of activation.

Arousal↗
PubMed1990

The validity of vigilance tasks in differential diagnosis of children referred for attention and learning problems.

This study was conducted to evaluate the convergent and discriminant validity of vigilance measures of attention and impulsivity in children. One hundred children referred for evaluation of attention and learning problems were administered a battery of tests including two vigilance tasks, other laboratory measures of inattention and impulsivity, and parent and teacher ratings. It was predicted that vigilance task performance would correlate with teacher ratings and laboratory measures of inattention while correlations with ratings of aggressive behavior were predicted to be lower. Moderate correlations were obtained between the vigilance task scores and other laboratory measures of inattention and impulsivity. However, the vigilance scores did not correlate with teacher or parent ratings of behavior. A factor analysis, conducted to identify underlying dimensions of attention in the battery of tests, revealed strong source effects. The implications for use of vigilance measures in diagnosis are discussed.

Aggression↗
PubMed2001

Improving compliance with nasal CPAP and vigilance in older adults with OAHS.

The present study examined the efficacy of a cognitive-behavioral intervention at improving compliance with CPAP and vigilance in older adults with obstructive sleep apnea/hypopnea syndrome (OSAHS). Participants included 12 subjects who were randomized into one of two groups controlling for age, education, disease severity, and vigilance. The experimental group received two 45-min sessions designed to educate subjects on the consequences of OSAHS and the efficacy of CPAP. The control group received the same extent of therapist contact but did not receive information on OSAHS or CPAP. All subjects were administered a test of vigilance both before and after the study. Compliance data were collected using CPAP devices with internal microprocessors at were read at 1, 4, and 12 weeks after treatment initiation. The results showed that the experimental condition did not enhance compliance after 1 week of treatment but did so by the 12-week follow-up. Subjects in the experimental condition had a run time of 3.2-h per night longer than did those in the control group. Those using CPAP more regularly at 12 weeks also showed greater improvement on vigilance at follow-up. Performance on vigilance testing before the introduction of CPAP was predictive of CPAP use at 12 weeks. In conclusion, a modest cognitive-behavioral intervention may substantially increase CPAP use and vigilance in older adults.

Aged↗
PubMed1987

Changes in electrical activity of the brain with vigilance.

The relationship between EEG and vigilance was studied in subjects performing tasks of differing complexity over a 15 h period by examining the structural changes of the EEG as vigilance deteriorates. Calculation of canonical variates indicated that two directions explained the changes in vigilance, though one direction was dominant across subjects and tasks, and likely to reflect decreased arousal. The second direction indicated some evidence for a second underlying change in the EEG related to vigilance in some subjects particularly in the more complex task, and this would reflect mechanisms other than drowsiness. The relationship between EEG and vigilance was modelled by fitting a linear function of EEG variables to the proportion of missed responses. The coefficient of multiple correlation was significant for most subjects, and the relationship is likely to represent changes in arousal. The most useful discriminator of worsening vigilance common to both tasks was beta activity (14-21 Hz).

Adolescent↗
PubMed1996

Severe hypoglycaemia unawareness is associated with an early decrease in vigilance during hypoglycaemia.

To elucidate neurophysiological characteristics in hypoglycaemia unawareness, we investigated the relationship between electroencephalography (EEG) parameters of vigilance and awareness of various symptom categories early in response to hypoglycaemia in intensively treated diabetic patients with different degrees of hypoglycaemia unawareness. Hypoglycaemia (venous plasma glucose below 2.2 mmol/1) was induced with an intravenous insulin bolus in seven patients with insulin-dependent diabetes mellitus (IDDM) with a history of hypoglycaemia unawareness and repeated severe hypoglycaemia, as well as in a group of seven IDDM patients with good awareness of hypoglycaemia. Both groups were comparable in age, treatment strategy, glycaemic control and level of late complications. Basic cognitive performance and other symptom categories were estimated serially during a period of 2 h following the insulin bolus. A vigilance-controlled EEG was recorded continuously; its automatic analysis included the evaluation of vigilance indices. In the baseline prehypoglycaemic state, hypoglycaemia unaware patients showed higher initial vigilance (p = .05) than the aware group. Unaware patients reported fewer neurogenic (p = .002, mainly cholinergic, p = .009) hypoglycaemia symptoms during hypoglycaemia, and developed an impairment in cognitive performance over time (p = .002). EEG analysis indicated a more rapid decrease in vigilance after the hypoglycaemic stimulus for unaware patients than for aware patients. The lowering of plasma glucose to 3.06-3.89 mmol/l already induced a significant increase in delta and theta, as well as a decrease in alpha relative power only in the unaware group. Differences between groups with regards to the degree of deceleration were most pronounced early, during only slight hypoglycaemia, and topographically spread over central and parietal brain regions. Further lowering of plasma glucose induced an even more pronounced, abrupt increase in slow waves in unaware patients at higher plasma glucose levels than in hypoglycaemia aware subjects (for delta waves at 2.41 +/- 0.16 vs. 1.96 +/- 0.1 mmol/l, p = .04). This preceded the worsening of cognitive performance during hypoglycaemia in unaware patients by 19 +/- 3 min. Hypoglycaemia unawareness associated with previous unconsciousness is associated with- and may be the result of-an early hypoglycaemia-induced reduction in vigilance and an early EEG deceleration, which seems to be a teleologically effective measure for delaying eventual cerebral energy failure in hypoglycaemia.

Adult↗
PubMed2005

Mental and physical effort affect vigilance differently.

Both physical and mental effort are thought to affect vigilance. Mental effort is known for its vigilance declining effects, but the effects of physical effort are less clear. This study investigated whether these two forms of effort affect the EEG and subjective alertness differently. Participants performed a physical task and were subsequently presented with a mental task, or vice versa. Mental effort decreased subjective alertness and increased theta power in the EEG. Both results suggest a vigilance decline. Physical effort, however, increased subjective alertness and alpha and beta1 power in the EEG. These findings point towards an increase in vigilance. Beta2 power was reduced after physical effort, which may reflect a decrease in active cognitive processing. No transfer effects were found between the effort conditions, suggesting that the effects of mental and physical effort are distinct. It is concluded that mental effort decreases vigilance, whereas physical effort increases vigilance without improving subsequent task performance.

Adult↗
PubMed2004

Valence-related vigilance biases in anxiety studied through event-related potentials.

INTRODUCTION: Behavioral experiments on reaction time indicate that anxious subjects' vigilance-related attention is biased towards threatening words, though direct data on cerebral activity associated to this bias are conspicuously scarce. METHODS: In the present study, event-related potentials (ERPs) were recorded from 30 subjects, grouped according to their scores in trait and state anxiety questionnaires. The specific role of the arousal and valence content of the stimulation in the vigilance bias was investigated by blocking the arousal content. Stimulation with high biological significance was employed. An S1 (sound)-S2 (emotional picture) task ensured that subjects were vigilant towards positive, negative or control (neutral) images. RESULTS: Only subjects presenting high state scores and high state-trait combination scores showed significantly higher amplitudes in the Early Contingent Negative Variation during vigilance towards negative stimuli. This ERP component typically appears between S1 and S2 and reflects the intensity of vigilance. CONCLUSIONS: ERP activity detects cerebral indices that confirm the presence of valence-related vigilance biases in anxiety.

Adult↗
PubMed1999

[Quantification of postoperative vigilance by evoked potentials].

OBJECTIVE: Patients will be discharged from the postoperative recovery room mostly on subjective clinical assessment. In this study an approach to a more quantitative judgment of postoperative vigilance is made by recording the P300-latency and neuropsychological tests. METHODS: 22 adult patients undergoing a disc operation were examined. For induction of anesthesia thiopental (4-5 mg/kg), fentanyl (0.1 mg) and a musclerelaxant (atracurium 0.4 mg/kg or succinylcholine 1-2 mg/kg after precurarisation with atracurium 5 mg) were given. Anesthesia was then continued with enflurance (1.0-1.2 MAC) in a mixture of 67% nitrous oxide in oxygen. If postoperative analgesia was needed, piritramid was injected in boli à 3-6 mg. The P300 was acoustically stimulated with an oddball-paradigm and recorded at Fz and Cz. Afterwards the latencies were measured and compared with a vigilance score composed of clinical parameters and neuropsychological tests. Recordings were done preoperatively and every 30 minutes up to 2 hours postoperatively. A correlation between P300-latencies and vigilance score was made with the coefficient of Spearman. Comparison of pre- and postoperative values was managed by using Wilcoxon test for matched pairs with Bonferroni-correction. RESULTS: Immediately after operation, P300 was obtained only in 8 patients (36%). The latencies were delayed (394 +/- 35 ms versus 326 +/- 12 ms preoperatively). During follow-up patients recovered and 2 hours postoperatively only one patient had no P300. At the end of the examination period P300-latencies of most patients had not yet reached the preoperative levels. The vigilance score in parallel showed decreases immediately after the operation and increases later on. However there were discrepancies between P300 latencies and neuropsychological findings, in some cases possibly due to the sedative effects of postoperative analgetics. CONCLUSION: Recording of P300-latencies showed remarkable cognitive deficits because of subclinical anesthesia hangover even 2 hours after a routine inhalational anesthesia. It is a good quantifiable method for assessment of postoperative vigilance. In some cases P300-latency is a more sensitive parameter for vigilance phenomena than clinical and neuropsychological scores.

Adult↗
PubMed2004

Protection from ischemic heart injury by a vigilant heme oxygenase-1 plasmid system.

Although human heme oxygenase-1 (hHO-1) could provide a useful approach for cellular protection in the ischemic heart, constitutive overexpression of hHO-1 may lead to unwanted side effects. To avoid this, we designed a hypoxia-regulated hHO-1 gene therapy system that can be switched on and off. This vigilant plasmid system is composed of myosin light chain-2v promoter and a gene switch that is based on an oxygen-dependent degradation domain from the hypoxia inducible factor-1-alpha. The vector can sense ischemia and switch on the hHO-1 gene system, specifically in the heart. In an in vivo experiment, the vigilant hHO-1 plasmid or saline was injected intramyocardially into myocardial infarction mice or sham operation mice. After gene transfer, expression of hHO-1 was only detected in the ischemic heart treated with vigilant hHO-1 plasmids. Masson trichrome staining showed significantly fewer fibrotic areas in vigilant hHO-1 plasmids-treated mice compared with saline control (43.0%+/-4.8% versus 62.5%+/-3.3%, P<0.01). The reduction of interstitial fibrosis is accompanied by an increase in myocardial hHO-1 expression in peri-infarct border areas, concomitant with higher Bcl-2 levels and lower Bax, Bak, and caspase 3 levels in the ischemic myocardium compared with saline control. By use of a cardiac catheter, heart from vigilant hHO-1 plasmids-treated mice showed improved recovery of contractile and diastolic performance after myocardial infarction compared with saline control. This study documents the beneficial regulation and therapeutic potential of vigilant plasmid-mediated hHO-1 gene transfer. This novel gene transfer strategy can provide cardiac-specific protection from future repeated bouts of ischemic injury.

Apoptosis↗
PubMed1993

Cognitive predictors of vigilance.

Three studies are reported of individual differences in performance of high event rate vigilance tasks. In each study, measures of attentional resource availability and elementary cognitive components of sustained attention were correlated with vigilance performance. It was predicted that correlates of vigilance should vary with two parameters of the task: the type of target discrimination required (simultaneous or successive) and the type of stimuli used (sensory or symbolic). Speed and accuracy of controlled, resource-demanding visual search predicted overall perceptual sensitivity on three out of four successive tasks used, but only one out of four simultaneous tasks, partially confirming the hypothesis that successive tasks are more strongly resource-limited than simultaneous tasks. Other correlates of overall level vigilance did not appear to vary systematically with task parameters. Few correlates of temporal decrement in perceptual sensitivity were found, possibly for statistical reasons. The data suggest that measures of controlled search may be useful in predicting vigilance on certain real-world tasks, although a substantial part of the variance of vigilance tasks may not be predictable from short cognitive tasks.

Adult↗
PubMed2002

Additional dopamine reuptake inhibition attenuates vigilance impairment induced by serotonin reuptake inhibition in man.

There is evidence for a specific impairment of human vigilance following enhancement of serotonergic activity by antidepressant drugs. In the present study, we investigated the putative role of serotonergic-dopaminergic interactions in diminished vigilance by comparing the attentional effects of sertraline, a selective serotonin reuptake inhibitor (SSRI) with additional mild dopamine stimulating effects, with those of paroxetine, a SSRI without dopamine activity, using a placebo-controlled, double-blind, three-way cross-over design. Twenty-one (of 24) healthy middle-aged subjects completed the three treatment periods of 2 weeks in which sertraline (50 mg, days 1-7; 100 mg, days 8-14), paroxetine (20 mg, days 1-7; 40 mg, days 8-14) and placebo were administered. Vigilance (Mackworth Clock Test), selective (Stroop, Dichotic Listening) and divided attention (Dichotic Listening) were assessed at baseline and on days 7 and 14 of each treatment period. Selective and divided attention were unaffected by SSRI treatment. Subchronic administration of paroxetine impaired vigilance performance at each investigated dose. Sertraline did not produce a significant decline in vigilance performance, presumably due to its concomitant effects on dopamine activity, counteracting the negative effects of serotonin on dopamine neurotransmission. It is concluded that a serotonergically mediated reduction of dopamine activity plays an important role in the reduction of human vigilance following SSRI administration.

Adult↗
PubMed2003

The vigilance decrement reflects limitations in effortful attention, not mindlessness.

Robertson, Manly, Andrade, Baddeley, and Yiend (1997) proposed that the decline in performance efficiency over time in vigilance tasks (the vigilance decrement) is characterized by "mindlessness" or a withdrawal of attentional effort from the monitoring assignment. We assessed that proposal using measures of perceived mental workload (NASA-TLX) and stress (Dundee Stress State Questionnaire). Two types of vigilance task were employed: a traditional version, wherein observers made button-press responses to signify detection of rarely occurring critical signals, and a modified version, developed by Robertson et al. to promote mindlessness via routinization, wherein button-press responses acknowledged frequently occurring neutral stimulus events and response withholding signified critical signal detection. The vigilance decrement was observed in both tasks, and both tasks generated equally elevated levels of workload and stress, the latter including cognitions relating to performance adequacy. Vigilance performance seems better characterized by effortful attention (mindfulness) than by mindlessness. Actual or potential applications of this research include procedures to reduce the information-processing demand imposed by vigilance tasks and the stress associated with such tasks.

Adult↗
PubMed2002

[Drug vigilance].

The goal of drug vigilance is to identify, analyse and anticipate adverse reactions resulting from the use of a drug. It is of utmost importance to ensure that a drug remains safely used, and to update its prescription when necessary. Vigilance is based on professional judgments by specialists who flag putative side effects to the network. To ascertain causality between drug use and possible side-effects, the available evidence is discussed within the vigilance network, closely involving the health professional who originally identified a possible effect, and with reference to the French drug vigilance database, as well as the existing relevant literature. The possibility of a side-effect triggers an alarm, and generates an investigation, which must often he completed by an epidemiological analysis when the risk associated with the drug is low. Drug vigilance is crucial to public health. It currently collects data both from the relevant units in pharmaceutical companies and the public drug vigilance networks.

Adverse Drug Reaction Reporting Systems↗
PubMed2002

Proof of safety of drugs: focus on vigilance.

It is well accepted that all new compounds, before administration to patients, should undergo safety evaluations in healthy subjects, including central nervous system (CNS) toxicity and as such the assessment of vigilance effects a relevant hallmark. The original concept of vigilance as a phenomenon observed only under conditions of monotony and signal regularity is increasingly falling into disfavor, embracing at present a much broader spectrum of behavior. Currently, vigilance may be regarded as a "readiness to adopt the appropriate behavior in a given situation, which thus finds outward expression through the quality and quantity of the behavior occurring in response to a given (internal or external) stimulus situation". The assumption that vigilance is a multifactorial phenomenon and not merely EEG data should be taken into account in order to study it accurately. Specifically, in drug research, apart from subjective reports and psychomotor performance tests, neurophysiological evaluations are regularly used such as Multiple Sleep Latency Test, Vigilance Epoch Classification or Parameters within a continuous scale. Although with limitations, temporal patterns of changes in activity of different frequency bands, indexes as the alpha slow-wave or the alpha anteriorization, computed from the EEG quantification, yielded different definitions of the intermediate states of the transition from wakefulness to sleep through the so-called subvigil stages. Spatial patterns are less documented. The recently proposed mathematical models to explain and predict variations in alertness are presented. Examples of the effects of different classes of drugs with the methods reported and its theoretical and practical relevance to vigilance research are introduced.

Arousal↗
PubMed2003

Quality analysis of medical device vigilance reports.

The quality of the notifications issued within the European Medical Device Vigilance system were retrospectively reviewed and the adequacy of the recommended guidelines evaluated. The study material comprised all 589 vigilance notifications the Finnish competent authority received from manufacturers and other national competent authorities during 1997, 1999, and 2001. The number of vigilance reports, particularly the reports issued by national competent authorities, has increased from 82 in 1997 up 166 in 2001 while the proportion of reports with demonstrated bearing on health risk has decreased from about 40% down to 20% during the last five years. The number of manufacturers' reports has also increased from 28 in 1997 up to 98 in 2001 while the information given in the reports have become somewhat more incoherent. The time needed to close a device-related incident has increased, too. It is obvious that the present vigilance guidelines provide adequate guidance for both the manufacturers and competent authorities to manage vigilance cases efficiently and appropriately. It is crucial that all pertinent parties should adopt the recommended procedures and act accordingly. The vigilance system underpinned with high quality notifications only assures the continuous enhancement of patient safety, the bottom line.

Equipment Safety↗