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Query: UMLS:C0917801 (insomnia)
 10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intranasal delivery of flurazepam, midazolam, and triazolam was studied in a dog model as a possible alternate route of drug administration for treatment of insomnia. Four beagles received each hypnotic by both intranasal and oral routes on two separate occasions. Plasma concentrations for each hypnotic after dosing were measured by electron-capture gas-liquid chromatography. The mean intranasal absorption rates (tmax) of flurazepam, midazolam, and triazolam were 1.7, 2.0, and 2.6 times faster, respectively, compared with oral dosing. The mean dose-normalized peak concentrations (Cmax) after intranasal delivery were 16.4, 2.9, and 3.4 times higher, respectively, versus oral administration. The mean dose-normalized AUCs estimated for these compounds after nasal administration were 2.4-, 2.5-, and at least 2-fold larger than after oral administration for midazolam, triazolam, and flurazepam, respectively. If these observations can be extrapolated to humans, the faster absorption achieved by the intranasal route would appear to benefit insomniacs characterized by difficulty in falling asleep because of an anticipated faster sedative effect onset. The higher peak concentrations and larger amounts absorbed in the case of intranasal midazolam and triazolam delivery may lead to dose reduction.
J Pharm Sci 1991 Dec
PMID:Intranasal absorption of flurazepam, midazolam, and triazolam in dogs. 181 70

Twenty-six patients with mild-to-moderate essential hypertension participated in a 6-week outpatient, multicenter, randomized, double-blind, placebo-controlled two-way crossover study to assess the hemodynamic effects of bisoprolol (20 mg QD) at steady state. Hemodynamic assessments included sitting blood pressure, heart rate, and left-ventricular ejection fraction by radionuclide ventriculography after 7 days of bisoprolol or placebo at trough (24 h post-dose) and peak (3 h post-dose) values. The group adjusted mean ejection fraction was not significantly different in patients receiving bisoprolol compared with the placebo group at either peak or trough measurements; in fact, means in patients taking bisoprolol were slightly higher than in the placebo group. No symptomatic hypotension was documented. Blood pressure, measured 24 hours after dosing, was significantly lower in those receiving bisoprolol when compared with the placebo group, by 7.7 mm Hg and 9 mm Hg for diastolic and systolic blood pressure, respectively. Similarly, mean values of heart rate were 10 beats/min lower in the bisoprolol patients than in the placebo group. Only headache and insomnia occurred as adverse events. Bisoprolol (20 mg QD) effectively lowered blood pressure over a 24-hour period without significantly reducing ejection fraction or causing adverse clinical or biochemical events.
J Clin Pharmacol 1990 Dec
PMID:Multicenter evaluation of the hemodynamic effects of bisoprolol in patients with mild to moderate hypertension. 198 Feb 78

Based on evidence available at present, it appears that heterogeneity does exist within bipolar disorder. Persons with mania differ in family history of affective illness, their age at the onset of illness, sex, and organic cause and course of the illness. The question of how these variables influence an individual's response to treatment has never been systematically studied. Multicenter trials of the various antimanic agents need to be conducted to determine whether the various subgroups of manic patients have different pharmacological response profiles. At present, the clinical management of mania is best approached using lithium carbonate in a dosage adequate to achieve a 12-hour serum lithium level to 1.0 to 1.2 mEq/L. The time to response is usually 2 to 3 weeks, and during this period an antipsychotic or benzodiazepine agent may be added to help control symptoms such as agitation or sleeplessness. Prophylactic maintenance with 12-hour serum lithium levels between 0.8 and 1.0 mEq/L should be used for at least 6 to 12 months after resolution of the manic episode. In patients with more than one episode, lithium maintenance therapy may need to be continued indefinitely. In patients who are not responsive to lithium, the most prominent alternative therapies include anticonvulsants and calcium-channel blocking agents. Anticonvulsants (e.g., carbamazepine, valproic acid, clonazepam) are generally first used as alternative therapy (either alone, or in combination with lithium), followed by a calcium-channel blocker (e.g., verapamil). Clinical practice would generally suggest first using the alternative agent alone, then adding lithium if response is inadequate.(ABSTRACT TRUNCATED AT 250 WORDS)
Compr Ther 1990 Dec
PMID:Perspectives on bipolar illness. 198 97

In spite of the difficulties inherent in the study of traumatic stress in disaster victims, the benefit of obtaining more knowledge on the subject is potentially great, especially considering the numbers of individuals affected. Recent estimates of the frequency of world-wide traumatic events have determined that almost two million households annually experience damages and/or injuries from fire, floods, hurricanes, tornadoes, and earthquakes alone. The population that is at risk is expected to grow exponentially with our expanding technology, making it even more vital to acquire knowledge to help the growing number of future disaster victims. Additionally, disaster research can contribute to a better understanding of PTSD and human coping processes that can be generalized to more ordinary stress situations. In the meantime, survivors of major catastrophes who experience acute symptoms of PTSD such as insomnia, nightmares, and jumpiness should be observed for nonresolution of symptoms over time, especially if there is a premorbid history of psychopathology or character problems. Otherwise, survivors may benefit from reassurance that PTSD symptoms are common in the short-term postdisaster period and that they can usually be expected to dissipate with time.
Compr Ther 1990 Dec
PMID:Post-traumatic stress disorder in disaster survivors. 207

An analysis was carried out on the extent to which staff responded to the relatives of cancer patients who had been admitted to the Consie Walters Hospice Care Centre, and the Pain Centre, both located in Kingston, Jamaica. Although no relationship was found between frequency of intervention and relatives' (caregivers') health, grief reactions were found to be related to a need for staff interaction. The more caregivers reported that they needed staff emotional support and practical assistance, the more intensely they reported grief, and the greater were their reports of anxiety and insomnia. Age was found to influence the relationship between adjustment and receiving intervention.
West Indian Med J 1990 Dec
PMID:Do relatives of terminally ill patients also benefit from hospice care? 208 69

Traditional beliefs about climacteric symptoms and widespread imaginations about unwanted effects of estrogens in the pill have long been interfering with the recommendation of an early onset of effective replacement therapy. The somatic symptoms of rush or genital atrophia have later on been classified as hard evidence to justify a therapy, much more than the predominant psychic signs occurring in the postmenopausal years as mental depressions, decrease or lacking of libido, nervousness, insomnia. Those signs were neglected as weaker indications responding even to a placebo treatment. The present knowledge understands somatic and psychosomatic signs as an entiety, both being accessible to hormonal replacement therapy. 85% of the postmenopausal signs can effectively be treated with hormones. What is now known about atherosclerosis, lipid metabolism and osteoporosis in ageing woman adds further justification to even the prophylactic use of estrogens. Natural estrogens administered orally, transdermally or parenterally are the means of choice. The dosage might be tailored on the relief of symptoms (and afterwards reduced to a mere maintaining dosage), or given in a fixed cyclic regimen. The treatment cycle will be three or four weeks, a progestogen should be added for the last 12-14 days. Only one estrogen-androgen combination has survived (Gynodian). The transdermal application (in three different concentrations) with administration twice a week is in progress. Indications and contraindications for transdermal estrogens are similar to estrogens administered orally.
Ther Umsch 1990 Dec
PMID:[Hormone substitution in the female climacteric--goals, means, effects]. 209 81

While insomnia is a familiar management problem for most doctors, disorders of hypersomnolence are much less familiar. The evolution of sleep monitoring at a major South African teaching hospital is described and the classification of sleep disorders reviewed. Analysis of the first 5 years' experience revealed that 27 of 46 patients had sleep apnoea (all obstructive, but 13 with a central component), while 3 had narcolepsy. Contributing causes of sleep apnoea included obesity (25 patients), tonsillar enlargement (3), acromegaly (3), rheumatoid cervical spondylosis (1), Hunter's syndrome (1) and haemangioma of the throat (1). Death from sleep apnoea occurred in 3 cases. Treatment of specific causes was effective in abolishing sleep apnoea, although attempts at weight loss were effective in a minority only. Nasal continuous positive airway pressure was effective in achieving symptomatic relief. Sleep monitoring was found to be valuable, provided all-night study facilities are available, and provided that patients who simply snore are excluded by prior clinical evaluation.
S Afr Med J 1990 Dec 15
PMID:The diagnosis and management of respiratory sleep disorders--the first 5 years at Groote Schuur Hospital. 225 27

Two hundred forty-one elderly depressed patients entered the 8-week, double-blind phase of this parallel-group, multicenter study; 161 patients were randomized to receive sertraline (50-200 mg/day) and 80 were randomized to receive amitriptyline (50-150 mg/day). Among evaluable patients, there were no statistically significant differences between treatments in any of the primary efficacy variables: change in total Hamilton Rating Scale for Depression (HAM-D) score (17 items), percentage change in HAM-D score, change in HAM-D Item 1, change in Clinical Global Impressions (CGI) Severity score, change in the Depression Factor of the 56-item Hopkins Symptom Checklist, and the CGI Improvement score at the last visit. Similar results were obtained using data from all patients (intention-to-treat analysis), except that amitriptyline was superior in HAM-D Total score (p = .044). The two drugs produced a similar degree of response: on the basis of the HAM-D criterion, 69.4% of sertraline patients and 62.5% of amitriptyline patients responded, and, on the basis of CGI criterion, 79.5% of sertraline and 73.4% of amitriptyline patients responded. Twenty-eight percent of the sertraline patients withdrew from the study because of a treatment-related side effect and 2.5% (4) because of a laboratory abnormality. In comparison, 35% of the amitriptyline patients withdrew because of treatment-related side effects. Sertraline was associated with a statistically lower frequency of somnolence, dry mouth, constipation, ataxia, and pain and a higher frequency of nausea, anorexia, diarrhea/loose stools, and insomnia; thus, anticholinergic effects were less common and gastrointestinal effects were more common with sertraline than with amitriptyline.(ABSTRACT TRUNCATED AT 250 WORDS)
J Clin Psychiatry 1990 Dec
PMID:Double-blind, multicenter comparison of sertraline and amitriptyline in elderly depressed patients. 225 79

During the past four years the author has seen six cases of chronic persistent insomnia with onset in childhood. Four of these cases had delayed sleep phase syndrome, a disturbance in sleep-wake schedule characterized by the inability to fall asleep, and by continuous sleep of normal length later in the night. The article describes the case histories of two adolescent patients and experience from using chronotherapy. It appeared that chronotherapy was effective, but the demands on the sleep-wake schedule discipline were difficult to accept. It is suggested that delayed sleep phase syndrome may be the most frequent cause of chronic insomnia with onset in childhood.
Tidsskr Nor Laegeforen 1990 Dec 10
PMID:[Delayed sleep phase syndrome. The most frequent cause of primary chronic insomnia?]. 228 46

Insomnia is a common symptom in family practice, and hypnotics are frequently prescribed for its treatment. A survey was performed in an urban clinic serving 1900 persons in order to detect the prevalence of this disorder and to reassess the need for hypnotics. Sixty-one patients were identified who were taking prescribed hypnotic drugs, mainly benzodiazepines. All were over the age of 40, and they comprised 8.1% of this age group. Forty-five were chronic users, taking hypnotics for more than 4 months during a 6-month study period. Eighty-nine percent of these chronic users were above 60 years of age. Seventy-seven percent had difficulty initiating sleep and 23% had problems maintaining sleep. Information was given to these patients on the side effects and possible addictive nature of chronic hypnotic use. Different kinds of psychological support were offered as alternatives to drug treatment, but these were refused by all. We conclude that in view of the addiction associated with chronic use and the difficulty of weaning patients off the sleeping pill, there is a place for more careful evaluation and management before hypnotics are prescribed.
Fam Pract 1990 Dec
PMID:Chronic use of hypnotics in a family practice--patients' reluctance to stop treatment. 228 35


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