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At least 919 records · Page 51Linked to original sources
PubMed1999

Zaleplon, A Novel Nonbenzodiazepine Hypnotic, Effectively Treats Insomnia in Elderly Patients Without Causing Rebound Effects.

BACKGROUND: Insomnia is a very common symptom, particularly in the elderly. Thus, all hypnotic medications should be carefully evaluated in the elderly population. Zaleplon, a new nonbenzodiazepine hypnotic with a short elimination half-life (approximately 1 hour), was evaluated in the current study. METHOD: This multicenter, randomized, placebo-controlled outpatient study evaluated the efficacy and safety of zaleplon, 5 and 10 mg, in elderly patients with insomnia (as defined by DSM-IV); zolpidem, 5 mg, was the active comparator. Sleep was assessed in 549 elderly patients (>/= 65 years old) by using morning questionnaires completed after each of 7 baseline nights during which placebo was given, 14 nights of double-blind treatment, and 7 nights of placebo after discontinuation of active treatment. RESULTS: Zaleplon, 10 mg, and zolpidem, 5 mg, significantly reduced sleep latency during both weeks of the study. Zaleplon, 5 mg, reduced sleep latency only during week 2. Sleep duration was increased with zolpidem, 5 mg, during weeks 1 and 2 and with zaleplon, 10 mg, during week 1. No clinically significant rebound insomnia was observed after discontinuation of treatment with zaleplon, whereas evidence of rebound effects was seen with zolpidem. There was no significant difference between either zaleplon dose and placebo in the frequency of any central nervous system adverse events. CONCLUSION: Zaleplon is effective in reducing latency to sleep without evidence of undesired effects in elderly patients with insomnia.

Journal Article↗
PubMed2001

The Importance of Residual Effects When Choosing a Hypnotic: The Unique Profile of Zaleplon.

BACKGROUND: Insomnia is a prevalent medical disorder that has significant effects on occupational performance, health, and quality of life. Insomnia places an enormous burden on society through increased visits to physicians, loss of productivity in the workplace, and an increased rate of accidents. An estimated sum of $100 million is spent each year on direct treatment of unresolved insomnia. Physicians need to initiate early effective treatment to prevent development of chronic insomnia and its associated morbidity. Institution of good sleep hygiene practices may be useful in some patients but may not be adequate for resolution of all sleep problems. Behavioral treatments, while effective and durable, are time consuming and not widely utilized in clinical practice. Pharmacotherapy includes benzodiazepine hypnotics, but concerns regarding adverse effects (e.g., residual sedation) prompted the search for safer options. DATA SOURCES: Published and presented studies containing clinical data on zaleplon, a new nonbenzodiazepine sleep medication, were identified via MEDLINE, Current Contents (ISI database), bibliographic reviews, and consultation with sleep specialists. RESULTS: Zaleplon effectively shortens sleep onset time and improves the quality of sleep in patients with insomnia. Whether administered at bedtime or later at night, zaleplon is devoid of residual sedative effects that impair next-day functioning. Follow-up studies evaluating the long-term efficacy and safety of zaleplon showed that decreased time to sleep onset was maintained during therapy lasting up to 52 weeks, without a withdrawal syndrome after discontinuation. CONCLUSION: Insomnia is recurrent and unpredictable in nature. Despite the long-term morbidity of this sleep disorder, research evidence and practice guidelines have not explored long-term use of hypnotics. Many patients could benefit from long-term drug therapy with a sleep medication that is devoid of residual effects and can be taken at bedtime or later as symptoms occur, rather than nightly in anticipation of a sleep problem.

Journal Article↗
PubMed1999

Constitutional rights and hypnotically elicited testimony.

Despite the former popularity of hypnosis as a way of "improving" eyewitness memory, many courts almost always regard the use of this testimony to be inadmissible, whereas others allow it only when strict procedural guidelines have been followed. Although the U.S. Supreme Court recognized a defendant's constitutional right to admit his own hypnotically elicited testimony, others have recognized a constitutional basis to exclude hypnotically elicited testimony in most other circumstances.

Civil Rights↗
PubMed1999

Correlation of EEG asymmetry and hypnotic susceptibility.

Hypnosis research of the last decades confirmed that some cortical regions show characteristic modification of spontaneous brain electrical activity as a function of hypnotic responsiveness. Using FFT spectrum of 16 channel EEG recording, it was demonstrated that in highly susceptible subjects the right parieto-temporal region show more electric power than the left one while the low susceptibles have left side predominance or equilibrated power in all derivations. If a specific (Ericksonian) indirect hypnosis induction was administered, the same right side preponderance could be recorded in low susceptibles, too. On the basis of these results we can confirm the importance of the right parieto-temporal associative area in the alteration of consciousness characterizing hypnotic state.

Adult↗
PubMed2001

[A case of awareness during propofol anesthesia using bispectral index as an indicator of hypnotic effect].

A 77-year old, woman weighing 44 kg with mild liver dysfunction underwent lower abdominal surgery. Anesthesia was induced with propofol 60 mg and fentanyl 0.1 mg. Tracheal intubation was facilitated with vecuronium 8 mg, and the lungs were ventilated with 33% oxygen in air. The bispectral index (BIS) was continuously monitored. Anesthesia was maintained with propofol infusion and analgesia was provided by thoracic epidural infusion of lidocaine 1.5%. The infusion rate of propofol was altered to maintain the BIS value between 40 and 50. The patient was hemodynamically stable with propofol 1.5 mg.kg-1.hr-1 and the BIS value was maintained about 40 during the operation. Near the end of the operation the patient moved suddenly. Suspecting inadequate anesthesia, a total of 40 mg of propofol i.v. and 5 ml of the epidural infusion were given. Immediately before the movement the BIS value was about 40. The operation was completed 30 min later. On discharge from the operating room the patient declared that she had been awake. She had heard voices and felt the surgeon working, but had suffered no pain. The BIS is a useful indicator for hypnotic effect, but this case demonstrates that awareness might occur even when BIS value indicates adequate hypnotic state.

Aged↗
PubMed2002

Neural network modeling to predict the hypnotic effect of propofol bolus induction.

Dose requirements of propofol to achieve loss of consciousness depend on the interindividual variability. Until now when propofol was administered by a single bolus, how to define the optimal individual dose and to assess its hypnotic effect have not been clearly studied. The goal of this study is to develop an artificial neural network model to predict the hypnotic effect of propofol on the basis of common clinical parameters. Ten parameters were chosen as the input factors based on the related literatures and clinical experiences. The bispectral index of EEG was used to record the consciousness level of patients and served as the output factor. The predictive results of neural net models were superior to that of clinician. This model could potentially help determine the optimal dose of propofol and thus reduce the anesthetic cost.

Anesthesia, Intravenous↗
PubMed2003

A model of hypnotic intervention for palliative care.

The World Health Organization defines palliative care as "the active total care of patients whose disease is not responsive to curative treatment." One of the primary issues of palliative care for patients with advanced cancer is symptom control and quality-of-life issues. The purpose of the hypnotic model presented here is to improve the patient's total psychological, social, and spiritual well-being. There exists a need for a broad and inclusive model of mind-body interventions for palliative care. This is supported by the observation that symptoms related to psychological distress and existential concerns are even more prevalent than pain and other physical symptoms among those with life-limiting conditions. The following model integrates naturalistic, solution-oriented hypnosis within the framework of a situational 4-stage crisis matrix. The four stages of the matrix are: (1) The Initial Crisis, (2) Transition, (3) Acceptance, and (4) Preparation for Death. Hypnotic interventions are tailored to each stage in the crisis matrix.

Adaptation, Psychological↗
PubMed2004

Sensory-motor cortex activity modulation by hypnotic susceptibility and hypnosis during finger movement.

The aim of the experiment was to study whether the activity of the primary sensory-motor (S1/M1), supplementary motor (SMA) and pre-motor (PMA) areas during fingers movement is modulated by hypnotic susceptibility and hypnosis. Cortical activity was studied through functional Magnetic Resonance Imaging (fMRI) during a finger-to-thumb opposition task in awake (Highs) and hypnotized highly susceptible (H-Highs) as well as in awake non susceptible subjects (Lows). Results did not show any significant difference in sensory-motor areas activation between Highs and Lows (trait effect) and between Highs and H-Highs (state effect). The activation in 3 subjects among Highs and only 1 among Lows (out of 5) of the caudal S1, receiving the most part of the cutaneous input, appears noteworthy and prompts further investigation on possible hypnotizability-related differences in sensory-motor integration.

Adult↗
PubMedDate not supplied

Involvement of nitricoxidergic system in the hypnotic effects of benzodiazepines in mice.

The influence of nitric oxide (NO) on hypnotic activity of diazepam, chlordiazepoxide and clonazepam was studied in mice. Administration of both non-selective NO synthase inhibitors: N(G)-nitro-L-arginine methyl ester (L-NAME), N(G)-nitro-L-arginine (L-NOARG) and selective NO synthase inhibitor 7-nitroindazole (7-NI) resulted in significant increase in the duration of diazepam-, chlordiazepoxide- and clonazepam-induced sleep. The effects of co-administration of the examined inhibitors with benzodiazepines were not changed by L-arginine, a substrate for NO formation. Administration of L-arginine alone had no effect on the duration of sleep induced by benzodiazepines. Methylene blue, the guanyl cyclase inhibitor, was able to increase the duration of benzodiazepine-induced sleep. These findings suggest that the cGMP/NO system may participate in hypnotic effects of benzodiazepines.

Animals↗
PubMed1992

Clinical uses and advantages of low doses of benzodiazepine hypnotics.

The most common adverse effects associated with the use of benzodiazepine hypnotics are residual daytime effects (daytime sedation and daytime performance decrements), anterograde amnesia, and rebound insomnia. Studies show that these adverse effects are related to dose. Hence, benzodiazepine hypnotics should be used in low doses so as to minimize or prevent these common adverse effects. It is now generally accepted that benzodiazepines should not be administered long-term for the treatment of chronic "idiopathic" insomnia. Two noncontinuous sleep disturbances, insomnia in the elderly and transient insomnia in young and middle-aged adults, are probably the most acceptable indications for the use of benzodiazepines. Low doses of short- and intermediate-acting benzodiazepines (triazolam and temazepam) are efficacious in the treatment of insomnia in the elderly, and preliminary evidence suggests that they are efficacious in the treatment of transient insomnia in young and middle-aged adults.

Adult↗
PubMed1991

[Study of the topographic organization of cortical electric activity during hypnotic analgesia].

Experiments on 10 right-handed subjects were carried out to study the topographic organization of cortical activation processes by means of toposcopy of synchronous electric activity in hypnotic analgesia. The authors demonstrate the priority role of the anterior cortical areas of the left hemisphere in analgesia effects, which is connected with their importance in data realization and formation of the motivation affective component of painful sensation. Experiments have shown different manifestations of the functioning of diffuse nonspecific and local specific activation processes maintaining sensory analysis of painful stimuli and their affective cognitive estimation in the systems responsible for individual tolerance to painful sensations and analgesia effects and demonstrated a possibility of observing at the level of objective electrophysiological parameters of the phenomenon of pain components dissociation as one of the mechanisms of hypnotic analgesia.

Action Potentials↗
PubMedDate not supplied

[Study of a new hypnotic drug: Ro 5-4200 (flunitrazepam)].

The Authors carried out a clinical study of a new benzodiazepinic derivative (Ro 5-4200) presenting hypnotic properties particularly "interesting". The results emerged from this study confirmed the hypnotic efficacy of the preparation also in case of insomnia of a certain seriousness, as well as its excellent tolerance.

Adult↗
PubMedDate not supplied

[Hypnotic doses of midazolam administered by continuous perfusion. Analysis of predictive factors].

The hypnotic dose of midazolam administered in continuous perfusion was investigated in 76 patients undergoing programmed traumatologic or orthopedic surgery. In all cases an infusion of midazolam at a rate of mg-1 kg-1 h-1 was administered until patients closed eyes but opened them under auditive stimuli (hypnotic dose of midazolam). This dose was 5.25 +/- 2.78 mg (0.08 +/- 0.04 mg/kg) and showed a statistically significant correlation with age (r = 0.43, p = 0.002) and weight (r = 0.3, p = 0.02). There was no significant correlation with sex, ASA class, premedication, plasma proteins, and plasma albumin. Interindividual variability, especially in young patients, was high.

Adolescent↗
PubMed1990

Low-dose trazodone as a hypnotic in patients treated with MAOIs and other psychotropics: a pilot study.

In open trials, 20 of 21 patients with major depression who developed insomnia during treatment with monoamine oxidase inhibitors (MAOIs) reported sustained hypnotic effects from trazodone 50 to 75 mg. Similarly, 26 of 27 mood disorder patients with insomnia unrelated to MAOIs reported improved sleep with low-dose trazodone. No negative interactions with MAOIs and other psychotropics were observed, side effects were minimal, and no tolerance to the hypnotic effects of trazodone occurred. Low-dose trazodone may be a safe and effective agent for treating MAOI-induced and other insomnias.

Administration, Oral↗
PubMed1988

[The amount of histamine released in vivo by hypnotics (thiopental, methohexital, propofol) studied by assays of plasma histamine].

Accidents observed during induction of anaesthesia are most often linked to non-specific histamine liberation. The sale of new hypnotics (Methohexital and Propofol), has brought the hope that their histamine-liberation potential would be lower. The study was done in patients who were at risk of histamine-liberation (atopics, drug allergies etc.). Two series of patients were studied after anti H1 and tranquilizer premedication. Histamine liberation by Propofol versus Thiopental as the inducer was studied in the first group. In the second, the combination was Methohexital versus Thiopental. In both series studied the new hypnotics Propofol and Methohexital did not release histamine non-specifically in atopics at risk. Neither clinical reactions non increase of histamineamia were seen. It is concluded that these two new drugs are safe.

Drug Hypersensitivity↗
PubMed1989

Hypnotic susceptibility in kavadi carriers in Singapore.

A group of fourteen Hindu devotees, who participated in a religious ceremony involving piercing of tongue and body by metal skewers, and the carrying of 'kavadis' were examined to ascertain their hypnotisability, and to compare their experiences during hypnosis and a trance. They were found to have a low mean score of 3.85 on the Revised Stanford Profile Scales of Hypnotic Susceptibility. Those who have higher scores had experiences during the religious ritual which appeared to be similar to those in the hypnotic state.

Adolescent↗
PubMed1985

Effect of benzodiazepine hypnotics on all-night sleep EEG spectra.

The effect of a single, oral bedtime dose of the benzodiazepine hypnotics flunitrazepam (FR; 2 mg), flurazepam (FR; 30 mg), and triazolam (TR; 0.5 mg) on the sleep stages and the sleep EEG was investigated in eight healthy, young subjects. In comparison to the placebo night, all drugs reduced the percentage of stage 1 and REM sleep, increased stage 2, and decreased the number of stage shifts. For FN and FR, some of these changes persisted in the postdrug night. All-night spectral analysis of the EEG showed a reduction of low-frequency activity (0.25-10.0 Hz) in stages 2, 3 + 4 and REM sleep, changes that persisted for all three drugs in the post-drug night. In the drug nights, activity in the spindle frequency range (11-14 Hz) was enhanced particularly in stage 2 and 3 + 4, activity in the high frequency range (17-25 Hz) particularly in REM sleep and stage 1. In the first third of the drug night, the depression of low-frequency activity in stage 2 was either absent (FR) or less prominent (FN, TR) than in the following part of the night. The results demonstrate that benzodiazepine hypnotics induce specific changes in the EEG spectra which reflect the immediate and residual drug effects more sensitively than conventional sleep scores.

Adult↗