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PubMed1988

Hypnotic susceptibility, visual distraction, and reports of Necker cube apparent reversals.

Subjects, either susceptible (n = 50) or resistant (n = 50) to hypnotic suggestion, were asked to report on frequency of apparent reversals (ARs) to the Necker cube illusion. Such reports were made in the presence or absence of various types of visual, geometric surrounds (squares, triangles, crosses, or parallelograms). In agreement with a number of previous experiments, susceptible subjects reported perceiving more ARs than did resistant subjects. This difference held whether visual surrounds were present or absent. The presence of surrounds did serve to reduce AR reports regardless of hypnotic susceptibility level. The results are examined in terms of the ability of subjects to selectively attend when confronted with potential visual distractors.

Attention↗
PubMed1987

Hypnotic metaphor and sexual dysfunction.

Although hypnosis can be very effective in alleviating sexual problems, few sex therapists use hypnotic methods. This paper seeks to encourage a greater use of hypnosis among clinicians by presenting: a description of the new hypnosis exemplified in the work of Milton H. Erickson; an explanation of one of Erickson's most important and innovative methods, the use of multiple embedded metaphors; and case histories illustrating the application of hypnotic approaches to sexual dysfunction.

Adult↗
PubMed1984

Side-effect 'tolerance' in elderly long-term recipients of benzodiazepine hypnotics.

The outcome of long-term benzodiazepine hypnotic therapy has been investigated in a group of elderly patients in the community; 220 receiving nitrazepam and 33 flurazepam. The estimated duration of therapy was as long as 15 years in some cases. More than half were taking doses greater than 5 mg and 15 mg, respectively, the majority on a regular nightly basis in accordance with the instructions on containers. The plasma concentrations of nitrazepam and the active desalkyl metabolite of flurazepam correlated positively with weight-related dose. In the case of desalkyl-flurazepam, but not nitrazepam, the levels were substantially higher than those previously reported in young individuals. There was sustained patient satisfaction with the effectiveness of the hypnotics and, despite the high plasma levels, little subjective or objective evidence of unwanted sedation, confusion or unsteadiness. The findings of the survey suggest the development of both pharmacodynamic tolerance to the unwanted sedative effects of these drugs and a degree of dependence in long-term recipients.

Aged↗
PubMed1991

Thiopentone-propofol hypnotic synergism in patients.

The hypnotic effects of thiopentone, propofol and their combination were studied in 120 unpremedicated ASA group I patients. The end-point for induction of anaesthesia was taken as inability to open the eyes to command 60 s after the end of injection. The dose-response curves were determined by probit analysis. Isobolographic and algebraic (fractional) analyses were used to assess quantitatively the combined hypnotic effect of thiopentone and propofol and to define the type of interaction between these two drugs. The interaction between thiopentone and propofol was found to be synergistic.

Adult↗
PubMed2001

EEG bispectral index and hypnotic component of anaesthesia induced by sevoflurane: comparison between children and adults.

This prospective study was designed to evaluate the correlation between the electroencephalographic bispectral index (BIS) and the hypnotic component of anaesthesia (CA) induced by sevoflurane in 27 children and 27 adult patients. BIS and CA were compared at loss of consciousness (LOC) and on recovery of consciousness (ROC). Mean (SD) BIS decreased significantly at LOC in children and adults from 94 (2.7) to 87.4 (4) and from 96.2 (2) to 86.7 (4.4), respectively, without any difference between groups. Correlation coefficients (p) between BIS and CA at LOC were -0.761 in children and -0.911 in adults. BIS increased significantly at ROC in children and adults from 74.1 (4.2) to 86.7 (2) and from 80.2 (5) to 90.7 (3), respectively, without any difference between groups. Correlation coefficients between BIS and CA in ROC were -0.876 in children and -0.837 in adults. BIS values at ROC were not different from those at LOC in either group. These data demonstrate that BIS correlates with the hypnotic component of anaesthesia induced by sevoflurane in children as well as in adults.

Adolescent↗
PubMed1995

How "blind" are double-blind placebo-controlled trials of benzodiazepine hypnotics?

This study examined the accuracy of insomnia patients and their treating physicians in rating whether an active hypnotic drug or a placebo was given in treatment. Forty older adults with primary insomnia were randomly assigned to either an active (temazepam) or a placebo condition using a double-blind strategy. Ratings of treatment conditions were obtained at 1 week (early treatment), 4 weeks (midtreatment), and 8 weeks (late treatment). Patients were able to accurately discriminate (beyond chance levels) between the active and placebo medications at the early (76.9% accuracy) and late treatment assessment timepoints (78.1% accuracy), but not at midtreatment (51.5% accuracy). Therapists, however, were able to make accurate discriminations at the late treatment assessment timepoint only (80% accuracy); early (69.2% accuracy) and midtreatment (47.2% accuracy) ratings did not exceed chance levels. Patients who had used hypnotic drugs prior to this trial were more accurate in their judgments of treatment conditions than those without prior exposure. The findings raise an important issue about the internal validity of the double-blind strategy, which may in fact be only a single-blind procedure.

Aged↗
PubMed1983

Daytime sleepiness as a criterion in hypnotic medication trials: comparison of triazolam and flurazepam.

Sleep laboratory hypnotic medication trials typically determine efficacy by examining changes in polysomnographically recorded sleep. We introduce the use of daytime sleepiness, as assessed by the Multiple Sleep Latency Test (MSLT), as a criterion for daytime functioning in such trials. Two benzodiazepine hypnotics, triazolam (0.5 mg) and flurazepam (30 mg), with short and long half-lives respectively, were compared in a multicentered, double-blind crossover study. Results indicated these medications had virtually indistinguishable nocturnal effects, but differed dramatically during the day. Flurazepam decreased sleep latency on the MSLT, whereas triazolam did not. These results could indicate that daytime sleepiness is a concomitant effect of flurazepam.

Adult↗
PubMed1985

Eligibility requirements in hypnotic trials.

Forty-eight patients complaining of insomnia were studied at two sleep laboratories using an identical protocol to evaluate hypnotic efficacy. All met the screening requirement of a mean sleep latency of 30 min or greater on 3 laboratory nights following an adaptation night. Of these patients 34 still complaining of insomnia were screened a second time 2 to 6 months later. Sixteen of the 34 failed the second screen. Sleep parameters for the 34 on screen 1 compared with screen 2 were the same except for sleep latency (the eligibility criteria), which was significantly shorter. There was no evidence of a systematic difference between laboratories, a change in procedure from screen 1 to 2, or a systematic loss of patients from screen 1 to 2. The data show that the statistical phenomenon of regression toward the mean must be considered in designing hypnotic efficacy studies.

Adult↗
PubMed1986

Hypnotic residual effects of benzodiazepines with repeated administration.

Performance measures were compared to the multiple sleep latency test (MSLT) as indices to assess tolerance to the residual effects of benzodiazepine hypnotics during repeated nightly administration. Twelve healthy, normal sleepers received flurazepam 30 mg, temazepam 30 mg, and placebo for nine nights in a repeated measures, Latin-square design with 19 nights of recovery separating the treatments. As compared to placebo, both drugs altered sleep stage parameters in the early (nights 1-2) and late (nights 8-9) phases of the study. Hypnotic effects were found for both drugs in the early phase, but diminished for both in the late phase. The subjects' performance the next day was disrupted following treatment with flurazepam, but not with temazepam, during the early phase. Mean sleep latency on the MSLT was reduced by both drugs during the early phase. During the late phase, flurazepam did not disrupt performance but still affected the MSLT. Temazepam affected neither index the next day during the late phase.

Adult↗
PubMed1979

Perfusion of naloxone through the fourth cerebral ventricle reverses the circulatory and hypnotic effects of halothane in dogs.

To determine whether naloxone when perfused through the cerebroventricular system would modify the circulatory and hypnotic effects of halothane, the authors studied its effect in six trained dogs. Naloxone, 20 microgram/ml, was perfused through the fourth cerebral ventricle in three and through the third cerebral and lateral ventricles in three other dogs when awake and during halothane anesthesia (0.75--0.82 vol per cent in oxygen). Blood pressure, heart rate, and circulatory responses to bilateral occlusion of the carotid arteries were measured. The state of consciousness was evaluated by the animals behavior and the EEG. Arterial hypotension, bradycardia, depressed baroreceptor responses, and EEG synchronization associated with halothane anesthesia were reversed when naloxone was perfused through the fourth ventricle. To maintain comparable depths of anesthesia the halothane concentration had to be doubled during naloxone perfusion. No change in the circulatory or hypnotic effects of halothane occurred when the third ventricle was perfused with naloxone. It is concluded that opiate receptors in structures bordering the fourth cerebral ventricle may be important modulators of inhalational anesthesia.

Animals↗
PubMed1981

Sedative-hypnotic tolerance testing and withdrawal comparing diazepam to barbiturates.

A study was conducted to assess the feasibility of substituting diazepam for pentobarbital and phenobarbital in sedative-hypnotic tolerance testing and withdrawal of tolerant patients. Nineteen patients potentially dependent on sedative-hypnotics were tolerance tested with either diazepam or pentobarbital and, if tolerant, were withdrawn with diazepam or phenobarbital, respectively. Seventy-eight subjects previously described in the literature with drug dependencies similar to the diazepam and barbiturate groups provided a basis for comparing the diazepam group to untreated patients to determine whether diazepam was able to prevent abstinence symptoms. Withdrawal was successfully completed in all patients. The expected and observed incidence of seizures, delirium, and minor withdrawal for the barbiturate group and seizures and delirium for the diazepam group did not differ significantly, although a large type II error compromised these conclusions. A significant difference was seen between the observed and expected incidence of minor withdrawal symptoms in the diazepam-withdrawn patients.

Adult↗
PubMed1987

The psychomotor effects of single and repeated doses of hypnotic benzodiazepines.

Benzodiazepine hypnotics are used for short periods in low doses in healthy people when stressed and in patients with insomnia. This study examined psychomotor impairment in healthy young males and females after 1 and 7 nights of flunitrazepam (1 mg), nitrazepam (2.5 mg) and temazepam (10 mg). There were substantial inter-individual variations. Results showed that no drug significantly affected psychomotor performance at these doses after single or repeated administration. The number and severity of side-effects were significantly greater after the first night with temazepam and 7 nights with nitrazepam, although this may reflect a statistical artefact rather than a significant clinical finding. The difficulties in performing adequately controlled psychopharmacological studies at low doses are highlighted. Given the large intra- and inter-subject variances, small drug effects would necessitate large sample sizes (21 to 600 subjects at the 95% level of chance of detection) depending on the variable. The study suggests there is minimal impairment with low dose hypnotic drugs and a need to individualize treatment.

Adult↗
PubMed1977

Dynamics of hypnotic analgesia: some new data.

Following two surgical operations under hypnotic anesthesia, it was possible, during subsequent recall under hypnosis, to elicit a representation of the past operative experience. It would seem that under hypnosis there is a persistence of the preception of nociceptive information and of its recognition as such by the subject. From an analysis of these two experiments in recall, it is possible to formulate several hypotheses concerning the psychological processes involved in hypnotic analgesia. In consequence of an affective relationship, in which the hypnotist's word assumes a special importance for the subject, the latter has recourse to two kinds of mechanism: a) internal (assimilation to an analogous sensation, not, however, registered as dangerous-rationalization); and b) external (total compliance with the interpretations proposed by the hypnotist), which lead to a qualitative transformation of nocieceptive information, as also the inhibition of the behavioral manifestations normally associated with a painful stimulus.

Awareness↗
PubMedDate not supplied

Effects of hypnotic, placebo, and salicylic acid treatments on wart regression.

Subjects with warts on their hands and/or feet were randomly assigned to a hypnotic suggestion, topical salicylic acid, placebo, or no treatment control condition. Subjects in the three treated groups developed equivalent expectations of treatment success. Nevertheless, at the six-week follow-up interval only the hypnotic subjects had lost significantly more warts than the no treatment controls. Theoretical implications are discussed.

Administration, Topical↗
PubMed2004

Critique of claims of improved visual acuity after hypnotic suggestion.

Psychological approaches to improving vision present an enticing alternative to invasive procedures and corrective lenses; hypnotic suggestion is one such technique. During the past 60 years, multiple studies have documented improvements in the vision of myopic individuals after hypnotic interventions. Given the increasing interest in behavioral and alternative approaches, we have reviewed the pertinent studies to evaluate their validity. We delineate various shortcomings in these reports, including potential methodological caveats, problems with experimental controls, and controversial data interpretation. Overall, the data do not seem to support hypnosis as a viable option for significant long-term improvement of myopia. However, hypnosis can increase one's subjective feeling of enhanced visual acuity by affecting higher cognitive functions, such as attention, memorization, and perceptual learning, which could influence performance on visual tasks.

Attention↗
PubMed1996

Effect of bupivacaine-induced spinal block on the hypnotic requirement of propofol.

The hypnotic dose-response of propofol was compared with its combination with either bupivacaine-induced spinal block or intramuscular bupivacaine 12.5 mg in 105 men, divided into three groups of 35, undergoing lower abdominal, pelvic or lower limb surgery. Dose-response curves were determined for each group using bootstrap analysis. Bupivacaine-induced spinal block at the level of T8-T9 was found to reduce the ED50 of propofol by 39%. While this enhancement of hypnotic effect by spinal block is mostly attributable to reduced afferent input, differences in its potency between drugs suggest a role for additional factors.

Adult↗
PubMed1994

Hypnotic drugs, psychomotor performance and ageing.

This review examines studies, reported since 1976, in which the residual effects of hypnotic drugs on psychomotor performance have been evaluated in older people. The 33 studies involved a total of 934 subjects (aged 60-96 y), evaluated 21 different products, utilized 26 test procedures, and reported 169 drug versus placebo (or drug versus drug) comparisons, of which 42 were associated with significant residual impairment. While performance decrements were more associated with longer half-life drugs, repeated dosing, and frailty, these characteristics were often unreliable in predicting outcome. Significant improvements in performance were rare, and usually consistent with practice effects. While this literature provides a useful basis for clinical caution, it is not characterized by experimental rigour, and provides little or no empirical basis for predicting those real-life skills most likely to be affected. Issues of subject selection, experimental design, testing strategies, and data analysis need to be addressed if the risks and benefits of hypnotic drug use in later life are to be more clearly understood.

Journal Article↗