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PubMed1985

Effect of hospitalization on hypnotic drug use.

Hypnotics are widely prescribed and used in the hospital setting. Patients receiving bedtime sedation regularly during hospitalization might feel a need for continued hypnotic therapy after discharge. The present study investigates patient use of hypnotics before, during and after hospitalization. The purpose was to determine whether hospitalization leads to a change in hypnotic drug use in patients admitted to the Acute Care Unit of the UBC Health Sciences Centre Hospital (UBC HSCH-ACU). Patients were selected to take part in the study according to established criteria. They were interviewed about their pre-hospitalization use of hypnotics and their charts were reviewed to determine in-hospital use. Fourteen to 29 days after discharge, patients were telephoned to ascertain their post-hospitalization hypnotic use. Patient use of hypnotics was categorized as regular (two or more times a week), occasional (one or less times a week up to once a year) and rare (less than once a year). One hundred and one patients completed the study. Seventeen percent used hypnotics regularly, 20% used hypnotics occasionally and 63% rarely used hypnotics before coming to hospital. Twenty percent of males and 15% of females took hypnotics regularly prior to hospitalization: hypnotic use increased with age for both sexes. During hospitalization, regular hypnotic usage rose to 48% for both males and females (p less than 0.005); 56% of medical in-patients and 42% of surgical in-patients took bedtime sedation regularly. Following discharge, 21% of patients were using hypnotics on a regular basis. Overall, there was a 4% increase (p greater than 0.1) in the number of patients using hypnotics regularly after discharge. Admission to UBC HSCH-ACU did not significantly increase the post-hospitalization use of hypnotics in these patients. The variables of age, sex and hospital service did not have an effect on post-hospitalization hypnotic drug use.

Aftercare↗
PubMed1990

The effect of hypnotically induced analgesia on flare reaction of the cutaneous histamine prick test.

The effect of psychological pain reduction on the cutaneous inflammatory process was investigated by studying the effect of hypnotically induced analgesia on the flare reaction of cutaneous histamine prick tests. Ten highly hypnotically susceptible volunteers had their cutaneous reactivity against histamine prick tests on both arms measured before hypnosis. Their pain-related brain potentials were measured on the basis of eight argon laser stimulations. These measurements were repeated in the hypnotic condition, where subjects were given repeated suggestions of analgesia in one arm. Final measurements were performed in the post-hypnotic condition. Subjectively felt pain was measured on a visual analogue scale. Results showed a mean reduction in subjectively felt pain of 71.7% compared to the baseline condition. A significant (P less than 0.01) mean reduction of the evoked potentials was found in the hypnotic analgesic condition compared to both the pre-hypnotic (49.9%) and the post-hypnotic condition (36.9%). A significant difference was measured in the histamine flare area between the pre-hypnotic and the hypnotic analgesic condition (P = 0.01-0.02) and between the hypnotic analgesic and the post-hypnotic condition when compared with the control arm. The mean ratio of flare area between the analgesic arm and the control arm was 1.04 (SD, 0.16) in the pre-hypnotic condition, 0.78 (SD, 0.22) in the hypnotic analgesic condition, and 1.37 (SD, 0.49) in the post-hypnotic condition. The results support the hypothesis that higher cortical processes can be involved in the interaction of inflammatory and pain processes.

Adult↗
PubMed1996

Patients' knowledge and attitudes regarding sleep and hypnotics.

OBJECTIVE: To examine attitudes, opinions and knowledge regarding hypnotics and their use, sleep and sleep requirements among patients who have used hypnotics. DESIGN: A mailed questionnaire. SETTING: A primary health care centre serving 18,500 inhabitants. PATIENTS: 143 randomly selected patients for whom hypnotics had been prescribed at the health care centre at any time during the year previous to the study. MAIN OUTCOME MEASURES: Answers to 21 questions about sleep, sleep requirement, use and effect of hypnotics. RESULTS: Regular use of hypnotics over long periods is common. Participants endure sleeping problems before beginning to use hypnotics. Once on pills most patients take hypnotics without first trying to fall asleep. Knowledge about sleeping hygiene was good and household remedies are much used. Feelings of guilt about using hypnotics were not common. Elderly people were less informed than younger about the effects and disadvantages of use of hypnotics. CONCLUSION: Most patients are well informed about the benefits of hypnotics and possible abuse or addictive effects. Most begin using hypnotics after long-standing sleep problems and after trying various household remedies. Doctors have a lot of influence on patients' use of hypnotics and need to inform their patients well when hypnotics are first prescribed.

Adult↗
PubMed2001

Assessing the effects of an intervention by a pharmacist on prescribing and administration of hypnotics in nursing homes.

INTRODUCTION: We have previously reported sub optimal use of hypnotics in geriatric institutions. In the present study we examined the intervention by a pharmacist on the prescribing and administration of hypnotics in nursing homes. Thus a follow up study was performed in 5 nursing homes included in the previous study. METHOD: In the period between the two surveys the pharmacist provided drug information on the rational use of hypnotics, both written and verbal, to the staff of the institutions. Data on the administration of hypnotics was obtained from the Cardex system in the institutions. Data were compared to a control group in other nursing homes, where no intervention was carried out. RESULTS: Although the population was older in 2000 than in 1995, the proportion of patients using hypnotics (24%) was similar. Use of benzodiazepines was reduced from 81% to 40%, use of long acting benzodiazepines was reduced from 62% to 22%, and use of short-acting hypnotics (zopiclone, zolpidem) increased from 9% to 53%. Furthermore, hypnotics administered before 9 p.m. were reduced from 40% to 14%, and the time of administration showed less variation than before. In the control population we also observed the use of short acting hypnotics in favour of benzodiazepines, similar to the results in the 5 institutions. However, in this population a significantly higher proportion of patients used hypnotics, used more than 1 hypnotic and the hypnotics were administered earlier in the evening. CONCLUSION: The results demonstrate an important effect of written and verbal drug information provided by a pharmacist to improve the prescribing and administration on the use of hypnotics in nursing homes.

Aged↗
PubMed1982

The effect of rating scale descriptors on hypnotic depth reports.

The effect of varying number of response descriptors on hypnotic depth ratings was assessed. Following hypnotic susceptibility testing, subjects in one group (n = 111) rated their hypnotic depth on a unidimensional four-point scale with alternatives ranging from "not hypnotized" to "highly hypnotized." A second group (n = 111) responded to a four-point scale that confounded the two descriptors, hypnotic depth and degree of absorption. The alternatives on this scale ranged from "neither hypnotized nor absorbed" to "highly hypnotized and absorbed." Finally, those in a third group (n = 111) were given a scale that included degree of hypnosis and degree of absorption as separate descriptors. Thus, these subjects could rate themselves either as hypnotized to some degree or as "absorbed to some degree but not hypnotized." Substantially fewer subjects at all susceptibility levels rated themselves as "hypnotized to some degree" when given the scale with alternative descriptors as opposed to a scale that did not permit choice of descriptors. These data challenge the validity of measures of hypnotic depth and suggest caution in their interpretation.

Awareness↗
PubMed1995

An assessment of short-acting hypnotics.

Insomnia, the experience of poor quality or quantity of sleep, is a very common complaint. Approximately 65 million adults (36% of the American population) complain of poor sleep, and of this group, 25% have insomnia on a chronic basis. These chronic insomniacs not only report higher rates of difficulty with concentration, memory and the ability to cope with minor irritations but also have 2.5 times more fatigue-related automobile accidents than do good sleepers. Despite its ubiquity, insomnia is often either untreated or inadequately treated. Short-acting hypnotics are advocated for transient insomnia, which lasts less than 3 weeks, and in patients with chronic insomnia as an adjunctive treatment where nonpharmacological treatment is not sufficient to alleviate insomnia and the related daytime detrimental effects. The putative adverse effects of hypnotics must be weighted against the severe health effects caused by continued sleep impairment. If hypnotic agents are used, they should be taken nightly only for brief use, or intermittently in longer term use. Benzodiazepines, zolpidem and zopiclone (in countries where the latter is available) remain the recommended hypnotic agents, although in the past few years there has been much criticism in lay magazines and on television about the use of benzodiazepines. However, this review of the efficacy and tolerability data of the short-acting hypnotics suggests that triazolam is comparable with other short-acting hypnotics at equipotent doses while taking into consideration that for every hypnotic, different study populations display different degrees of efficacy. In addition, contrary to previous suggestions that such adverse effects are rebound insomnia and anterograde amnesia are unique to triazolam, hypnotically equivalent doses of tirazolam have not been shown to produce these effects more frequently than other short-acting hypnotics. The newer nonbenzodiazepine hypnotics seem to be equally efficacious as the short-acting benzodiazepines; whether they will truly have a better adverse effect profile will be determined as more clinical experience accumulates. Despite the availability, relative safety and efficacy of these newer hypnotic agents, they should not be perceived as the sole treatment for insomnia and should be used in conjunction with nonpharmacological techniques (such as adherence to good sleep hygiene, sleep restriction, stimulus control and biofeedback therapy).

Adult↗
PubMed2004

Psychological treatment for insomnia in the regulation of long-term hypnotic drug use.

OBJECTIVES: To evaluate the clinical and cost impact of providing, in routine general practice settings, a cognitive-behaviour therapy (CBT) package for insomnia to long-term hypnotic drug users with chronic sleep difficulties; and to identify factors associated with variations in clinical outcomes. DESIGN: A pragmatic cluster randomised controlled trial with two treatment arms (a CBT-treated 'sleep clinic' group, and a 'no additional treatment' control group), with post-treatment assessments starting at 3, 6 and 12 months. SETTING: Twenty-three general practices in Sheffield, UK. PARTICIPANTS: In total, 209 patients (aged 31-92 years) with chronic sleep problems who had been receiving repeat hypnotic drug prescriptions for at least 1 month (mean = 13.4 years) were recruited into the trial. INTERVENTIONS: The intervention consisted of six 50-minute sessions as follows: introduction and sleep assessment, basic sleep hygiene, stimulus control and sleep restriction procedures, progressive relaxation, cognitive treatments, and review and discharge. MAIN OUTCOME MEASURES: These included: global sleep quality [as measured by the Pittsburgh Sleep Quality Index (PSQI)], frequency of hypnotic drug use, mean dose of hypnotics consumed, health-related quality of life [as measured by the Short-Form 36 (SF-36)], NHS service costs and overall cost utility. RESULTS: At 3- and 6-month follow-ups, patients treated with CBT showed improved global PSQI scores as well as improvements in the SF-36 dimensions of vitality at 3 months and physical functioning and mental health at 6 months. CBT-treated patients also reported reductions in the frequency of hypnotic drug use compared with the control group, with many CBT-treated patients reporting zero drug use at the follow-up assessments. Clinical improvements were maintained within the CBT group at the 12-month follow-up, with PSQI scores and the frequency of hypnotic drug use continuing to show significant reductions relative to the control group. Multiple regression analyses of PSQI scores within the sleep clinic group alone indicated that the magnitude of pre- to post-treatment change in overall sleep quality was closely related to Hospital Anxiety and Depression Scale depression scores at 3-, 6-and 12-month follow-ups. In each model higher depression scores at baseline were associated with poorer treatment outcomes. No significant relationship was found between the patient's age and PSQI outcomes in any of these analyses. Within the sleep clinic group, reductions in drug use showed no significant association with the hypnotic product consumed. At the 3-month follow-up low-frequency drug use was reported by 22.9% (8/35) of temazepam users, 33.3% (5/15) of nitrazepam users and 38.9% (7/18) of zopiclone users. The total cost of service provision was GBP154.40 per patient (1999/2000 prices). The mean incremental cost per quality-adjusted life-year (QALY) at 6 months was GBP3418; this figure was insensitive to changes in costs. A simple model also showed that extending the evaluation period beyond 6 months may improve the cost-effectiveness of CBT. The incorporation of hidden costs associated with hypnotic drug treatment (e.g. accidents) also reduces the cost per QALY ratio, although to a much lesser degree. CONCLUSIONS: In routine general practice settings, psychological treatment for insomnia can improve sleep quality, reduce hypnotic drug use, and improve health-related quality of life at a favourable cost among long-term hypnotic users with chronic sleep difficulties. These positive outcomes appear robust over time, persisting for at least 1 year among the more treatment-adherent patients. While these benefits may be reduced among those patients presenting with higher levels of psychological distress, the present study clearly indicates that older age per se presents no barrier to successful treatment outcomes. Further research should assess the long-term clinical and cost-effectiveness of psychological treatments for insomnia among non-hypnotic-using patients, and establish the minimum psychological treatment input required.

Adult↗
PubMed1998

Effects of an opioid antagonist on pain intensity and withdrawal reflexes during induction of hypnotic analgesia in high- and low-hypnotizable volunteers.

The aim of this investigation was to study the effect of suggestions of hypnotic analgesia on spinal pain transmission and processing. Pain intensity and amplitude of nociceptive withdrawal reflexes to electrical stimuli were measured in 10 high- and 10 low-hypnotizable subjects during two sessions taking place at least 24 h apart under five conditions of: (1) pre-hypnosis; (2) neutral hypnotic relaxation; (3) suggestions of hypnotic analgesia; (4) suggestions of hypnotic analgesia after injections of either naloxone (1 ml, 1 mg/ml) or saline (1 ml) under double-blinded conditions; and (5) post-hypnosis. The conditions of naloxone or saline were allocated at random to either Day 1 or Day 2 in a double-blinded fashion. Results showed significant reductions of pain intensity during hypnotic analgesia, and a significant reduction in nociceptive reflexes during hypnotic analgesia on Day 1 in the highly hypnotizable group. No differences were found for low-hypnotizable subjects. The results support previous findings that pain intensity as well as the nociceptive reflex can be modulated by suggestions of hypnotic analgesia. While no effect of naloxone on pain intensity was found during hypnotic analgesia, naloxone significantly reversed the suppressive effect of suggestions of hypnotic analgesia on reflexes in high-hypnotizable subjects. Subsequent analysis showed that the effect of naloxone was associated with the intensity of the stimulus needed to elicit a reflex, and was unrelated to hypnotic susceptibility when controlling for stimulus intensity. These results suggest that the effect of naloxone was related to the greater stimulus intensities needed to elicit a reflex in the high-hypnotizable group, rather than to hypnosis or hypnotic susceptibility in itself. It is unclear why greater stimulus intensities were needed in high-hypnotizable subjects and further studies are needed. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.

Journal Article↗