Clinical trial of doriden, a new hypnotic; with note on use of ranking methods in assessing therapeutic effect.
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Patients in general practice complaining of insomnia of recent origin have been studied in order to ascertain which factors may be of value in the detection of those more susceptible to drug dependence. The type of sleep disturbance was found to be of importance and a personal disturbance scale was found useful as a screening test in two-thirds of the patients. No difference was found in the development of dependence on amylobarbitone and nitrazepam. One of the most important factors in the prevention of drug dependence seems to be frequent review by the doctor after the first prescription and his cautionary advice to the patient.
Of the patients in an industrial general practice 1.3% required hypnotic drugs regularly. They were predominantly in the older age groups (mean 62.7 years), with an excess of widows. Only 0.02% were severely dependent; the remainder were mildly so, though they had been taking hypnotics for long periods (mean 5.6 years). There were three main original indications for hypnotics-namely, medical (pain), psychiatric, and onset insomnia in anxious personality disorder. One-fifth of the patients first took hypnotics while in hospital. The group as a whole manifested a high degree of abnormal psychological disposition.It is suggested that many patients who take hypnotics regularly may be placebo reactors, and a more critical attitude to hypnotic prescribing is required both in hospital and in general practice.
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The characteristics of newly synthesized tertiary aromatic amines as accelerators for restorative resins have been evaluated. Comparison of the composites prepared with these and presently used accelerators indicate that resins formulated with 4-N,N-dimethylaminophenylacetic acid, its methyl ester or N,N-dimethylaminoglutethimide have properties generally better than comparable resins prepared with commercially used amines.
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Tobacco smoking may interact with the metabolism of a number of drugs. This has been demonstrated clearly in pharmacokinetic studies in animals and man. HOwever, tobacco smoking as a variant has been studied with relatively few clinically essential drugs and these studies do not always demonstrate a consistent effect of smoking. This review therefore not only records what data have emerged from pharmacokinetic or other studies, but it also attempts to determine whether such interactions have clinical significance. The main finding of this review is that, in the majority of examples, there is little evidence that there is a recognizable hazard from the interaction per se. The exceptions to this general conclusion are limited to four drugs: insulin, propoxyphene, propranolol, and theophylline preparations. With these drugs, there is some evidence of clinical importance of an interaction with tobacco smoking.
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