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PubMed2003

Implicit memory varies as a function of hypnotic electroencephalogram stage in surgical patients.

UNLABELLED: Previous studies have observed a correlation of implicit memory with certain electroencephalogram (EEG) measures during anesthesia. Here, we tested the relationship between hypnotic depth determined by computer system (Narcotrend(TM)) and implicit memory in anesthetized patients, assessed by a postoperative reading speed test. Thirty-two patients undergoing laparoscopic herniotomy and 30 age-matched volunteer controls were included the study. All patients received IV midazolam 2-3 mg followed by an induction dose of propofol and remifentanil. The anesthesia was maintained with propofol and remifentanil infusions and cisatracurium. Each patient was exposed to 2 of 4 stories, repeated 6 times. The first story was presented during light to moderate hypnotic EEG stages, and the second story was presented during deep hypnosis. Presentation of stories was balanced between patients and hypnotic stages. The controls listened to the two stories without receiving anesthesia. The reading speed for the previously presented stories and two new stories was measured approximately 7 h later with a computer program. No signs of inadequate anesthesia were observed, and no explicit memories of intraoperative events were revealed by a structured interview. No change of reading speed was observed for words presented during deep hypnotic stages. In contrast, an increased reading speed of 20 ms per word was found for content words (i.e., nouns, verbs, and adjectives), but not for function words (conjunctions, prepositions, and so on), presented during light to moderate hypnotic stages. Increased reading speed for semantically rich content words indicates that anesthetized patients are able to process acoustic information during light and moderate, but not deep, hypnosis. IMPLICATIONS: In this study, implicit memory was observed during general anesthesia at light to moderate, but not deep, hypnotic stages. Hypnotic stages were determined by a commercial electroencephalogram device, and implicit memory was measured by using a postoperative reading speed task. During lighter phases of anesthesia, patients should be protected against acoustic information that could negatively influence their postoperative outcome.

Adult↗
PubMed1984

Rationale for the use of hypnotic agents in a general hospital.

A survey at a teaching hospital found that 46% of medical patients had prescriptions written specifically for sleep and 31% received a hypnotic agent at least once during hospitalization. Physicians for 96% of surgical patients ordered hypnotic agents and 88% received such a drug. The rationale for prescribing hypnotic agents was not well documented. Administration did not correlate with requests by patients, with previous use of hypnotic agents, or with recorded indications of sleep disturbance; however, the chance of receiving a hypnotic agent was greater if the patient was on a private instead of a ward service and if nurses were more inclined to fill as-needed prescriptions. Patients who received a hypnotic agent did not rate the quality of their sleep as being any better than those who did not, and they complained of as many awakenings during the night. Further studies are necessary to ascertain the indications and efficacy of hypnotic agents for hospitalized patients.

Adult↗
PubMed1999

A survey of hypnotic use in geriatric institutions in Sogn og Fjordane, Norway.

We investigated the use of hypnotics in nursing homes and old age homes in the county of Sogn og Fjordane, Norway. Data on administration of hypnotics on 3 separate days within a week in August 1995 was obtained from the drug administration records in 31 institutions. Twenty-five percent of the 1062 patients in the institutions used hypnotics, with no difference between patients from nursing homes and old age homes. The number of patients treated with hypnotics, the doses administered, and the time of administration were similar for weekends and workdays. About 100% of the hypnotics were used as scheduled, and 29% of the doses administered were higher than the recommended lowest dose for elderly patients. Furthermore, about 50% of the hypnotics administered were long-acting benzodiazepines. The results indicate a need for a review of the prescribing of hypnotics in geriatric institutions.

Aged↗
PubMed2006

[Sleep-modulation and hypnotics: effects of benzodiazepine-receptor's agonists].

As binding sites of the alpha-amino butyric acid receptor complexes benzodiazepine-receptors offer a possibility to enhance hyperpolarization-based inhibition by allosteric modulation. Most of the hypnotic drugs are compounds that bind to benzodiazepine receptors. The effects of these drugs are usually characterized at a descriptive level, without deliberation of the basic processes involved in sleep regulation. This review follows the analysis of hypnotic's effect from a perspective of homeostatic, circadian, ultradian and microstructural regulation of sleep. In contrast to their expected effect benzodiazepines produce a decrease in most of the markers of homeostatic sleep regulation. Ligands with non-benzodiazepine structure (cyclopyrrolones, imidazopyridines, pyrazolopyrimidines) have a permissive or even stimulating effect in some measures of homeostatic sleep regulation. Some benzodiazepines have marked chronobiotic effects, while others interfere with circadian rhythms. The non- benzodiazepine-type hypnotics are mostly free of chronobiotic effects, although zaleplon may increase melatonin release. Given their acute hypothermic effect all hypnotic sedatives mimic the circadian signal of sleep initiation. Ultradian sleep regulation is largely unaffected by hypnotics. The microstructure of sleep as quantified by arousal instability is a sensitive measure of the effect of most of the hypnotics. Hypnotic sedatives decrease arousal instability. Zolpidem has the strongest effects in microstructural terms.

Animals↗
PubMed1989

Masseter inhibitory periods and sensations evoked by electrical tooth-pulp stimulation in subjects under hypnotic anesthesia.

Sensation and masseter inhibitory periods (MIP) to electrical tooth-pulp stimulation were recorded under hypnotic anesthesia and placebo to local anesthesia. In the first experiment, 8 subjects were tested for the effect of hypnotic anesthesia on sensory detection and MIP at non-painful stimulus levels (mean = 42.1 microA) and painful levels (mean = 86.5 microA). The percentage of detection for non-painful stimuli changed from 94.3% to 14.1% and for painful stimuli from 100% to 28%; both changes were significant (P less than 0.001). Hypnotic anesthesia blocked sensation without interrupting the initiation of the early component of the MIP, but did suppress its late component. In the second experiment, 8 subjects were tested for the perceived intensity of 5 levels of electrical tooth-pulp stimulation under hypnotic anesthesia and placebo. Sensory intensity was measured by the visual analog scale (VAS). Hypnotic anesthesia was significantly more effective than placebo (P less than 0.001) in reducing sensation. The differential effect of hypnotic anesthesia on the early and late component of the MIP lends further support to the hypothesis that hypnotic anesthesia operates primarily at suprasegmental, higher levels in the brain.

Adolescent↗
PubMed1994

Is the hypnotized subject lying?

Do the verbal reports of deeply hypnotized Ss truthfully reflect their subjective experiences of hypnotic suggestions? Experiment 1 established that the electrodermal skin conductance response (SCR) provides an effective method for detecting deception in the laboratory equally well in hypnotized and nonhypnotized Ss. In Experiment 2, deeply hypnotized and simulating Ss were administered a number of hypnotic suggestions in a typical hypnotic session, without mention of deception, and were questioned about their experiences while SCR measures were recorded concurrently. Results indicate that 89% of the hypnotized Ss' reports met the criterion for truthfulness, whereas only 35% of the simulators' reports met this criterion. Implications for the theory of hypnosis are discussed.

Adult↗
PubMed2003

Could empathy be a predictor of hypnotic ability?

This study examined whether trait empathy is related to hypnotic ability and absorption. Sixty-four graduate students and mental health professionals completed the Harvard Group Scale of Hypnotic Susceptibility, Form A; the Davis Interpersonal Reactivity Index; and the Tellegen Absorption Scale as measures of hypnotic ability, empathy, and absorption. Correlation analysis determined that statistically significant relationships exist between empathy and hypnotic ability (r = .41); empathy and absorption (r = .43); and absorption and hypnotic ability (r = .31). The results also indicate that empathy and absorption are both predictors of hypnotic ability, although absorption does not appear to contribute a statistically significant amount of the explained variance in hypnotizability that is independent of empathy. It may be that the conceptual ground shared by both empathy and absorption is what predicts hypnotic ability.

Adult↗
PubMedDate not supplied

The efficacy of the Waterloo-Stanford Group Scale of hypnotic susceptibility: form C.

This study explored whether the Waterloo-Stanford Group Scale of Hypnotic Susceptibility Form: C (WSGC) approximates the predictive power of the individually administered Stanford Hypnotic Susceptibility Scale: Form C (SHSS: C). Seventy-one undergraduates were administered the WSGC in a group setting and then tested individually on the SHSS: C. The participants were then hypnotized and tested on four types of targeted hypnotic behaviors sampled from the Revised Stanford Profile Scale of Hypnotic Susceptibility: I & II (RSPSHS: I & II). The following four factors were chosen: (a) cognitive distortion; (b) positive hallucination; (c) negative hallucination, and (d) dreams and regression. The items from these factors were matched on difficulty level. A series of multiple regression and logistic regression analyses were performed. The Waterloo: C was found to match the SHSS: C on predictive power for only one of the four hypnotic factors: "dreams and regression." On the other three factors, the SHSS: C was clearly superior in predictive efficacy. These results mirror previous research (Kurtz & Strube, 1996) that examined other group scales of hypnotic susceptibility in relation to the individually administered SHSS: C. In general, group scales such as the WSGC are poor substitutes for the SHSS: C.

Adult↗
PubMed1992

Imagination and dissociation in hypnotic responding.

A neodissociative model of mind is better equipped than a social-psychological model to deal with the complexities of hypnosis, and of human behavior generally. It recognizes, as Coe's (1992) model does not, that behavior can be more automatically activated than strategically enacted. In particular, Coe's emphasis on human behavior as purposeful and goal directed does not distinguish between goal-directed behavior that serves a purpose, and goal-directed behavior that is performed on purpose. It is this distinction that permits goal-directed behavior to be dissociated from a person's conscious plans and intentions. In addition to offering a critique of Coe's "limited process" view of hypnosis, 4 main points are made in the interest of developing a slightly modified, neodissociation view of hypnosis. First, it is argued that goal-directed fantasies are more limited in their ability to mediate hypnotic responding than is commonly appreciated; as well, they do not seem to account for the nonvolitional quality of hypnotic responding. Second, it is argued that hypnotic ability is not unidimensional, with compliance and social influence more apt to account for the low than for the high hypnotizable's responsiveness to suggestion. Third, compared to low hypnotizables, the hypnotic responsiveness of high hypnotizables seems more likely to result from dissociated control. In other words, for high hypnotizables, hypnotic suggestions may often directly activate subsystems of cognitive control. Consequently, the need for executive initiative and effort to produce hypnotically suggested behavior is minimized, and such responses are therefore experienced as nonvolitional. Fourth and finally, while goal-directed fantasies typically accompany hypnotically suggested responses, they are in many cases more a marker of dissociated control than a mediator of suggested effects.

Awareness↗
PubMed1979

Hypnotic deafness: a psychophysical study of responses to tone intensity as modified by hypnosis.

Hypnotic deafness was suggested for 1000 Hz tones presented in random orders at seven intensities between 17 and 70 db. Subjects were 70 college students stratified into four levels of hypnotic susceptibility, ranging from low to high. Four conditions were presented within a single session. Two conditions tested normal hearing, one in waking and one in hypnosis; two tested reported loudness of the tones as reduced by hypnotic suggestion. The method of magnitude estimation was employed. Hearing reduction was found to correlate .59 with hypnotic susceptibility in the total sample. Few high hypnotizables reduced their hearing to zero; their mean residual hearing during the deafness conditions was 55% of normal. Power functions for the relationship between tone intensity and magnitude estimates for conditions of normal hearing and deafness were found to be relatively parallel and orderly, differing primarily in intercept value. Order effect anomalies are discussed. The "hidden observer" method showed that for 4 of the 70 subjects the covert hearing was found to be at least 20% greater than that reported overtly within hypnotic deafness and approached normal hearing. As in our previous hypnotic analgesia research, not all subjects who reduced their hearing significantly gave subsequent covert reports which differed from reported overt hearing. Discussion is given for evidence of two levels of information processing during hypnotically suggested perceptual distortions.

Audiometry↗
PubMed1993

[Does clonidine modify the hypnotic effect of propofol?].

The administration of alpha 2-adrenoceptor agonists before the induction of anaesthesia leads to a significant reduction in the amount of anaesthetic medication required, probably due to an attenuation of haemodynamic stress responses in centrally mediated sympathicolysis. However, it is not yet known whether alpha 2-adrenoceptor agonists influence the hypnotic action of anaesthetics. Therefore, this study was performed to evaluate the influence of the alpha 2-adrenoceptor agonist clonidine on the potency and the duration of the hypnotic action of anaesthetic agents. METHOD. The study was approved by the local ethical committee. To study the effect of clonidine on the potency of propofol we determined the ED50 of propofol with and without clonidine pretreatment. To this end, 100 unpremedicated patients (ASA I or II) were randomly assigned to receive 4 micrograms/kg body weight clonidine or placebo, each of which was dissolved in 100 ml NaCl and infused over a period of 15 min starting 30 min before the induction of anaesthesia. According to the results of a pilot study, patients who had been treated with clonidine received either 0.25, 0.5, 0.75, 1 or 1.25 mg/kg propofol for anaesthesia induction. Patients in the placebo group received 0.5, 1, 1.5, 2 or 2.5 mg/kg propofol. The success of anaesthesia induction was evaluated clinically (eye opening on command, eyelid reflex). On the basis of these data the ED50 of propofol with and without clonidine pretreatment was calculated using the modified probit analysis according to Spearman and Kärber. The effect of clonidine on the duration of anaesthesia was compared in six groups of 10 patients each, who received 1, 1.5 or 2 mg/kg propofol for anaesthesia induction with and without prior clonidine treatment. RESULTS. In the placebo group a dose of 0.5 mg propofol per kg did not produce a hypnotic effect in any patient, while 2.5 mg propofol per kilogram of body weight was effective in all patients. In the clonidine group 0.25 mg propofol per kilogram of body weight had no hypnotic effect, while 1.25 mg propofol per kilogram of body weight was effective in all patients. Increasing the dose of propofol resulted in an increasing number of successful anaesthesia inductions in the placebo as well as in the clonidine group. According to these data, the ED50 of propofol with clonidine was calculated at 0.675 +/- 0.23 mg/kg with clonidine and 1.5 +/- 0.58 mg/kg without clonidine pretreatment. Increasing the dose of propofol did not result in a significant increase in the duration of anaesthesia (1 mg/kg: 260 +/- 114 s; 1.5 mg/kg: 270 +/- 103 s; 2 mg/kg: 295 +/- 152 s). However, premedication with clonidine almost doubled the duration of the hypnotic action of propofol (1 mg/kg: 457 +/- 239 s; 1.5 mg/kg: 501 +/- 249 s; 2 mg/kg: 582 +/- 254 s) (P < 0.01). CONCLUSION. According to these findings the administration of clonidine prior to anaesthesia induction significantly increases the potency and the duration of the hypnotic action of propofol. From our data we conclude that the influence of clonidine on the hypnotic action of anaesthetics is an important factor in the reduction of anaesthetic requirements observed after clonidine pretreatment.

Adrenergic alpha-Agonists↗
PubMed2006

Anxiolytics, hypnotics, and antidepressants dispensed to adolescents in a French region in 2002.

PURPOSE: This study proposes to complete declarative studies by describing the prescriptions of anxiolytics, hypnotics, and antidepressants dispensed to adolescents in a French region in 2002. METHODS: This cross-sectional study analyzes all the hypnotic, anxiolytic, and antidepressant prescriptions (ATC codes beginning with N05B, N05C, and N06A, respectively) sent by adolescents (aged 13-17 years) to the French Health Insurance system of the study region for reimbursement during one year (2002). It was performed in a southern France area with 120,908 adolescents covered by this insurance scheme. Adverse drug reactions (ADRs) recorded in the Pharmacovigilance database were also studied. RESULTS: Three thousand two hundred and eighty-six adolescents (2.7% of adolescent population) had at least one prescription of the studied drugs. This prevalence increased with age and female sex, leading to a maximum of 6.3% for the 17-year-old girls. Two thousand four hundred and thirty-one of adolescents were dispensed anxiolytics, 935 antidepressants, and 548 hypnotics. The most dispensed drugs were zolpidem, zopiclone, and niaprazine for hypnotics; hydroxyzine, etifoxine, and bromazepam for anxiolytics; and paroxetine, sertraline, and fluoxetine for antidepressants. Zolpidem, hydroxyzine, and paroxetine accounted, respectively, for 82.9%, 57.1%, and 59.8% of the prescriptions. 75.5% of hypnotics users had only one prescription, 77.4% for anxiolytics, and 57.4% for antidepressants. Three ADRs were reported. CONCLUSIONS: This study confirms the large use of psychotropics in French adolescents and the influence of age and sex. Also, the results underline treatment for most adolescents is short, which may be beneficial for hypnotics and anxiolytics but not for antidepressants.

Adolescent↗
PubMed1989

Longitudinal study on the consumption of analgesics, tranquilizers and hypnotics by healthy Swiss men over a 13-year period (1972-1985).

This study describes the course of medical drug consumption (analgesics, tranquilizers, and hypnotics) in 843 identical, healthy men between the ages of 20 and 33 years. In 1972-1973, 4082 randomly selected 20-year-old Swiss military recruits were interviewed with a standardized questionnaire about parental drug consumption and their own consumption of tobacco, alcohol, analgesics, tranquilizers, hypnotics, and illegal drugs. In 1979, 1658 and, in 1985, 1554 men from the original sample were asked identical and similar questions via questionnaires sent by mail. The results presented concern the 843 men who took part in all three phases. The medical drugs these men consumed most often were analgesics. However, there was a significant decrease in the number of men who took these drugs either seldom or repeatedly during the observation period (28.6% vs 21.0%; P less than 0.001). There was also a significant decrease in the proportion of men who used tranquilizers (8.7% vs 4.9%; P less than 0.01); however, the proportions of men taking hypnotics were the same in 1972-1973 and in 1985 (5.4% vs 5.2%). In the study population, repeated consumption of analgesics and/or hypnotics and/or tranquilizers at the age of 20 significantly increased the probability that the subjects would habitually consume analgesics at the age of 33. Repeated parental consumption of hypnotics increased the probability that the sons would significantly increase their consumption of hypnotics and/or tranquilizers between the ages of 20 and 33. The results are discussed against the background of other findings concerning the epidemiology of drug consumption.

Adult↗
PubMed1993

Subjective evaluation of sleep and the use of hypnotics in nursing homes.

The purpose of the study was to evaluate the sleep habits and the use of hypnotics in the elderly living in nursing homes. The study population consisted of 60 subjects aged 61-99 years who were interviewed by a geriatrician. The use of hypnotics was frequent (53%), but not associated with gender, memory impairment, moving disability, depression, quality of sleep or sleep behaviour. Users of hypnotics had shorter total sleep time (TST) and got up earlier from bed in the morning than the non-users. Most of the subjects perceived their sleep as interrupted but satisfactory. The elderly with impaired memory slept longer, stayed in bed longer, and took their hypnotics significantly earlier than those with normal memory. As we found no explaining factors for the use of hypnotics, we suggest regular evaluation of their administration in nursing homes. The subjective need for hypnotics, not the nursing home practices, should decide the necessity of these drugs and the medication times in nursing home residents.

Aged↗
PubMed1997

Subjective quality of sleep and use of hypnotics in an elderly urban population.

To investigate the characteristics and subjective quality of sleep, the use of hypnotics and their correlates in an urban elderly population, a structured interview was administered to a stratified random sample of 600 elderly subjects in five age groups. Interrupted sleep and napping were common; nonetheless, 88% of the subjects considered their sleep at least satisfactory. According to specific criteria, 17% were good, 72% moderate and 11% poor sleepers. Habitual insomnia was reported by 12% of the subjects. Quality of sleep did not differ between age groups or genders. Hypnotics were habitually used by 8% of the men and 25% of the women. Consumption increased with age in both sexes, and 77% of the hypnotics were benzodiazepines. In multivariate regression analyses, insomnia and habitual use of hypnotics were associated with poor health, but only the latter with age and gender. As a conclusion, most of the subjects considered their sleep satisfactory, and aging itself did not seem to have an effect on the quality of sleep. The use of hypnotics was common, more prevalent in women and increased with age. Aging and poor health were independently associated with the use of hypnotics, but not with poor quality of sleep or insomnia.

Age Factors↗
PubMed2004

'Hypnotic' prescription patterns in a large managed-care population.

BACKGROUND AND PURPOSE: Medical treatment of insomnia has declined over the past decade and, when treated, use of non-hypnotic medications has increased. This study assessed the characteristics of the prescriptions for insomnia and of the patients receiving those prescriptions. PATIENTS AND METHODS: The outpatient pharmacy database of the Henry Ford Hospital, Health Alliance Plan (HAP) was searched from 1/1/98 to 6/30/99 for mentions of the 10 most frequently used drugs for the treatment of insomnia listed in the National Disease and Therapeutic Index for 1987-1996. The 10 drugs were alprazolam, amitriptyline, clonazepam, doxepin, flurazepam, lorazepam, temazepam, trazodone, triazolam, and zolpidem. These were classified by their indication as antidepressant, anxiolytic, or hypnotic and the three indication groupings were compared on patient and prescription characteristics. RESULTS: Over the 18 month period the total patient population covered by HAP was 287,456; 20,014 (7%) patients received one or more prescriptions for insomnia. Of these, anxiolytics were most frequently prescribed (55%), then antidepressants (25%), and hypnotics least frequently (20%). Patients receiving hypnotics were more likely to be male, older, and to receive a narrower dose range, in smaller quantities and with fewer refills than patients receiving anxiolytics or antidepressants. CONCLUSIONS: In this large managed-care population, hypnotics are prescribed conservatively, while the non-hypnotics, for which there is limited efficacy and safety data, are prescribed on a more chronic basis.

Anti-Anxiety Agents↗
PubMedDate not supplied

Concomitant use of anxiolytics and hypnotics with selective serotonin reuptake inhibitors.

A retrospective drug utilization analysis was conducted to compare concomitant use of anxiolytics and hypnotics among patients who received selective serotonin reuptake inhibitors (SSRIs). Data were extracted from an administrative prescription claims database. Patients must have been 18 to 64 years of age, without antidepressant, anxiolytic, or hypnotic use before SSRI therapy initiation, and without the use of antidepressants, other than the original SSRI, after SSRI therapy initiation. The study sample included 117,319 patients. Concomitant anxiolytic use for the total sample was 9.8%. Concomitant anxiolytic use rates for the comparison groups were: fluoxetine, 9.5%; paroxetine, 11.4%; and sertraline, 9.5%. Concomitant hypnotic use for the total sample was 2.8%. Concomitant hypnotic use rates for the comparison groups were: fluoxetine, 2.5%; paroxetine, 3.5%; and sertraline, 2.8%. The majority of concomitant anxiolytic and hypnotic use was initiated on the same day as SSRI therapy initiation. The anxiolytic and hypnotic concomitant use rates for fluoxetine and sertraline patients were significantly lower than the concomitant use rates for paroxetine patients. An understanding of the clinical, quality-of-life, and economic implications of the concomitant use differences will require further study.

Adolescent↗
PubMedDate not supplied

Prescribing of selective serotonin reuptake inhibitors, anxiolytics, and sedative-hypnotics by general practitioners in The Netherlands: a multivariate analysis.

A study of the prescribing of anxiolytics and sedative-hypnotics and the occurrence of anxiety or sleep disorders before and after the initiation of selective serotonin reuptake inhibitor (SSRI) therapy may provide insight into differences in individual SSRIs. The purpose of our study was to evaluate whether and in what way the likelihood of being prescribed an anxiolytic or sedative-hypnotic or receiving a diagnosis of an anxiety or sleep disorder differed in patients prescribed either fluoxetine or paroxetine by a general practitioner (GP) in the Netherlands, where these two agents are the most commonly prescribed SSRIs. Episodes of SSRI treatment were constructed from a recently available GP database in the Netherlands. Logistic regression analysis was used to determine whether, after controlling for other observable factors, the receipt of paroxetine or fluoxetine was a statistically significant determinant for receipt of an anxiolytic or sedative-hypnotic or a diagnosis of an anxiety or sleep disorder. We found that patients who were prescribed fluoxetine as their index drug were less likely to receive a concomitant sedative-hypnotic on their index date compared with patients receiving paroxetine. After controlling for other observable factors, such as use of anxiolytics and sedative-hypnotics before SSRI therapy or on the index date or the existence of comorbid anxiety or sleep disorders, patients starting fluoxetine therapy were no more likely than patients starting paroxetine therapy to receive an anxiolytic or sedative-hypnotic or a diagnosis of an anxiety or sleep disorder during the 60-day post period. The likelihood of a patient's being diagnosed with or receiving a prescription for an anxiety or sleep disorder does not appear to be a differentiating factor between the prescribing of fluoxetine or paroxetine by GPs in the Netherlands.

Aged↗