Survey on the usefulness of trazodone in patients with PTSD with insomnia or nightmares
2001; 34 (4): 128-131
Comparison of lesbian and heterosexual women's response to newly diagnosed breast cancer
2001; 10 (1): 40-51
Trazodone is commonly used in the treatment of insonmia and nightmares in patients with PTSD. There is little evidence in the literature for this practice.Seventy-four patients from the Palo Alto Veterans Affairs Health Care System in California who were admitted to a specialized 8 week inpatient treatment program for PTSD were surveyed regarding their use of trazodone in the treatment of insomnia or nightmares. Patients were asked to complete a questionnaire regarding trazodone's effectiveness, side effects, and optimal doses.Of 74 patients surveyed, 60 patients were able to maintain an effective dose of trazodone. The other 14 patients were unable to tolerate the medication. Seventy-two percent of the 60 patients assessed found trazodone helpful in decreasing nightmares, from an average of 3.3 to 1.3 nights per week (p<.005). Ninety-two percent found it helped with sleep onset, and 78% reported improvement with sleep maintenance. There was a significant correlation between the effectiveness in decreasing nightmares and improving sleep (r= .57, p < .005). The effective dose range of trazodone for 70% of patients was 50 to 200 mg nightly. Of the 74 patients surveyed, 9 (12%) reported priapism.Trazodone appears effective for the treatment of insomnia and nightmares associated with chronic PTSD. However, controlled trials are needed before any definite conclusions can be drawn. The higher than expected occurrence of priapism warrants clinicians asking directly about this side effect.
View details for Web of Science ID 000170268300002
View details for PubMedID 11518472
Hypnosis enhances recall memory: A test of forced and non-forced conditions
AMERICAN JOURNAL OF CLINICAL HYPNOSIS
1998; 40 (4): 297-305
In a study comparing lesbian and heterosexual women's response to newly diagnosed breast cancer, we compared data from 29 lesbians with 246 heterosexual women with breast cancer. Our hypotheses were that lesbian breast cancer patients would report higher scores of mood disturbance; suffer fewer problems with body image and sexual activity; show more expressiveness and cohesiveness and less conflict with their partners; would find social support from their partners and friends; and would have a poorer perception of the medical care system than heterosexual women. Our predictions regarding sexual orientation differences were supported for results regarding body image, social support, and medical care. There were no differences in mood, sexual activity or relational issues. Not predicted were differences in coping, indicating areas of emotional strength and vulnerability among the lesbian sample.
View details for Web of Science ID 000166703200004
View details for PubMedID 11180576
CLINICAL RELEVANCE OF DRUG-INTERACTIONS WITH LITHIUM
1995; 29 (3): 172-191
Visual memory recall in hypnosis was investigated. To address criterion shift problems in previous studies, both forced and non-forced recall procedures were used. Previous methodological weaknesses with regard to hypnotizability and hypnotic depth were also addressed. Over 300 volunteers were screened for hypnotizability using the Harvard Group Scale of Hypnotic Susceptibility: Form A (Shor & Orne, 1962). Final high and low hypnotizability groups were selected using the Stanford Hypnotic Susceptibility Scale: Form C (Weitzenhoffer & Hilgard, 1962). Participants in each hypnotizability group were randomly assigned to either forced or non-forced recall conditions and to hypnosis or waking conditions. Participants were shown 60 slides of line drawings and then tested immediately in 3 recall periods. Analysis of variance results showed that those exposed to hypnosis and to a forced recall procedure were significantly more confident of their responses to correct items than those exposed to a non-forced recall procedure or a waking condition. Participants exposed to hypnosis and forced recall procedures recalled more correct items than those exposed to a waking condition. The findings support the hypermnesic effects of hypnosis when participants are required to provide a fixed number of responses.
View details for Web of Science ID 000076937600005
View details for PubMedID 9868810
OXYTOCIN AND PROLACTIN-RELEASE AFTER ELECTROCONVULSIVE-THERAPY - A PILOT-STUDY
CURRENT THERAPEUTIC RESEARCH-CLINICAL AND EXPERIMENTAL
1995; 56 (3): 226-230
POTENTIAL IMPACT OF VALPROIC ACID THERAPY ON CLOZAPINE DISPOSITION
1994; 36 (7): 487?88
EFFECT OF NEUROLEPTIC-INDUCED HYPERPROLACTINEMIA ON SERUM DEHYDROEPIANDROSTERONE-SULFATE CONCENTRATIONS
1994; 2 (2): 123-125
POTENTIAL ABNORMALITIES IN MOLECULAR-FORMS OF GROWTH-HORMONE IN SCHIZOPHRENIA - A PILOT-STUDY
1993; 34 (7): 487-491
Although lithium continues to be regarded as the treatment of choice for bipolar disorders, the clinical use of this mood stabiliser is associated with an extremely narrow therapeutic range. Relatively minor increases in serum concentrations may induce serious adverse sequelae, and concentrations within the therapeutic range may result in toxic reactions. The safety of combining lithium with other medications, therefore, is a major concern, and extensive clinical experience has served to identify several significant drug interactions. Lithium removal from the body is achieved almost exclusively via renal means. As a result, any medication that alters glomerular filtration rates or affects electrolyte exchange in the nephron may influence the pharmacokinetic disposition of lithium. Concomitant use of diuretics has long been associated with the development of lithium toxicity, but the risk of significant interactions varies with the site of pharmacological action of the diuretic in the renal tubule. Thiazide diuretics have demonstrated the greatest potential to increase lithium concentrations, with a 25 to 40% increase in concentrations often evident after initiation of therapy. Osmotic diuretics and methyl xanthines appear to have the opposite effect on lithium clearance and have been advocated historically as antidotes for lithium toxicity. Loop diuretics and potassium-sparing agents have minor variable effects. Nonsteroidal anti-inflammatory drugs (NSAIDs) have also been associated with lithium toxicity, although the relative interactive potential of specific NSAIDs is difficult to determine. Small prospective studies have demonstrated large interindividual differences in lithium clearance values associated with different NSAIDs. A growing body of evidence also suggests that ACE inhibitors may impair lithium elimination, but further investigations are needed to identify patients at risk. Anecdotal reports have linked numerous medications with the development of neurotoxicity without an apparent effect on the pharmacokinetic disposition of lithium. Antipsychotics, anticonvulsants and calcium antagonists have all be implicated in a sufficient number of case reports to warrant concern. As these medications have all been commonly coadministered with lithium, the relative risk of serious interactions appears to be quite low, but caution is advised.
View details for Web of Science ID A1995RT95100004
View details for PubMedID 8521679
PROLACTIN BIOASSAY BEFORE AND AFTER TREATMENT WITH NORTRIPTYLINE
CURRENT THERAPEUTIC RESEARCH-CLINICAL AND EXPERIMENTAL
1993; 54 (3): 272-274
THE P50 COMPONENT OF THE AUDITORY-EVOKED POTENTIAL AND SUBTYPES OF SCHIZOPHRENIA
1993; 47 (3): 243-254
Growth hormone has been investigated in numerous studies involving patients with schizophrenia but has been measured only by radioimmunoassay (RIA). There have been no consistent abnormalities differentiating patients with schizophrenia from normal controls. In the current study, growth hormone (GH) variants were measured by Western blotting techniques, which resulted in the quantitation of 4 GH size variants: 27K (27,000 Daltons), 22K, 20K, and 17K. In the entire sample of 17 schizophrenic subjects, all GH variants were significantly higher than in the 14 normal controls. While there were no significant differences between the 2 groups in RIA GH values, the RIA values were generally higher in the schizophrenic group. In a subset of 12 schizophrenic patients whose RIA values were approximately equal to the controls, both the 27K and 22K GH variants remained significantly higher in the patient group. In the schizophrenic group, none of the GH variants or RIA GH changed significantly after 1 week of treatment with neuroleptic medication. These preliminary results suggest that certain GH forms may be elevated in schizophrenia, but further studies are needed.
View details for Web of Science ID A1993MC09200009
View details for PubMedID 7903555
GROWTH-HORMONE RESPONSE TO GROWTH-HORMONE RELEASING HORMONE IN DEPRESSION AND SCHIZOPHRENIA
1990; 33 (3): 269-276
Decreased amplitude of the P50 component of the averaged evoked potential has been reported in schizophrenic patients. In an attempt to determine the relationship of this decrease to subtype diagnosis, we compared P50 amplitudes in 24 neuroleptic-free schizophrenic patients with paranoid (n = 13) versus nonparanoid (n = 11) subtype diagnoses. Eleven normal subjects and 11 cocaine users served as control groups. The schizophrenic patients were studied again after they had been treated with neuroleptics for 2 weeks. The control groups were studied again at least 2 weeks later. At baseline, the nonparanoid patients had significantly lower P50 amplitudes than did the normal subjects. The paranoid patients did not differ from the normal control subjects. The cocaine users had significantly decreased P50 amplitudes as compared with the normal control subjects. Neuroleptic treatment had no effect on P50 amplitudes in the paranoid patients but normalized amplitudes in the nonparanoid patients. The data suggest that P50 measurements may be useful in identifying subtypes of schizophrenia.
View details for Web of Science ID A1993LK86800004
View details for PubMedID 8372162
ALPRAZOLAM AS AN ANTIDEPRESSANT
JOURNAL OF CLINICAL PSYCHIATRY
1988; 49 (4): 148-150
Growth hormone releasing hormone, a 44-amino acid peptide (GHRH-44), was administered (1 micrograms/kg i.v.) to 6 normal controls, 10 schizophrenic subjects, and 7 depressed subjects. A significantly lower growth hormone (GH) response was found in the schizophrenic and depressed groups. Two molecular forms of GH, 22K GH and 20K GH, were also measured but did not further differentiate the three groups of subjects.
View details for Web of Science ID A1990EA31200006
View details for PubMedID 2243902
MAINTENANCE THERAPIES IN SCHIZOPHRENIA
MEDICAL JOURNAL OF AUSTRALIA
1987; 147 (5): 240-242
TRH STIMULATION TEST AND DEPRESSION
1987; 22 (1): 21-28
Alprazolam appears to be an effective antidepressant in the treatment of outpatients who have a diagnosis of major depressive disorder. The authors have reviewed six controlled double-blind studies of alprazolam in the treatment of depression. Four of the six studies included only outpatients and clearly demonstrated a clinical effectiveness comparable to that of the tricyclics but with fewer, less severe side effects and better tolerance. The other two studies involved both inpatients and outpatients, so no conclusions can be drawn regarding the effectiveness of alprazolam in an inpatient population; further controlled studies are needed to answer this question. No satisfactory explanation exists for the mechanism of alprazolam's proposed antidepressant action.
View details for Web of Science ID A1988N025600005
View details for PubMedID 3281931
TRAZODONE AND PRIAPISM
JOURNAL OF CLINICAL PSYCHIATRY
1987; 48 (6): 244-245
A thyrotropin-releasing hormone (TRH) stimulation test was performed in 52 male inpatients with major depressive disorder. Twenty-nine percent of the 52 subjects had a delta thyroid-stimulating hormone (delta TSH) less than 5 microU/ml. The cerebrospinal fluid (CSF) amine metabolites, 3-methoxy-4-hydroxyphenylglycol (MHPG), homovanillic acid (HVA), and 5-hydroxyindoleacetic acid (5HIAA), were measured in 29 subjects, and a dexamethasone suppression test (DST) was performed in 48 subjects. Of the three CSF amine metabolites, only MHPG correlated significantly with baseline TSH and none correlated with delta TSH. The baseline TSH correlated positively with the TSH response at 30 minutes. Neither baseline TSH nor delta TSH correlated with cortisol levels before or after dexamethasone. The correlation between CSF MHPG and serum TSH suggests a relationship between central norepinephrine and baseline TSH.
View details for Web of Science ID A1987K306900003
View details for PubMedID 2443941
ELEVATED BASE-LINE AND POSTDEXAMETHASONE CORTISOL-LEVELS - A REFLECTION OF SEVERITY OR ENDOGENEITY
JOURNAL OF AFFECTIVE DISORDERS
1987; 12 (3): 199-202
The association of priapism with trazodone is reviewed based on data reported to the Food and Drug Administration. The data suggest that priapism may be most likely to occur within the first 28 days of treatment and that the majority of cases occur with doses of 150 mg/day or less. All age groups appear to be vulnerable to this adverse effect. Patients should be informed of this potential side effect and instructed to discontinue the medication if any unusual erectile problems develop.
View details for Web of Science ID A1987H764100007
View details for PubMedID 3584080
NEUROLEPTICS AND THE ELDERLY
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
1987; 35 (3): 233-238
This study investigated whether elevated baseline and postdexamethasone cortisol levels were more strongly related to severity of depression or presence of endogenous symptoms. In 43 inpatients with major depressive disorder, a positive correlation was found between the total score on the Hamilton Rating Scale for Depression and 8.00 a.m. and 4.00 p.m. baseline and 8.00 a.m. and 4.00 p.m. postdexamethasone cortisol levels. Only the 8.00 a.m. postdexamethasone cortisol level was significantly correlated with the number of Research Diagnostic Criteria (RDC) endogenous items present. Despite a statistically significant relationship between severity and endogeneity, our results suggest elevated baseline and postdexamethasone cortisol levels may be more closely related to severity of depression, rather than the presence of a cluster of symptoms referred to as endogenous.
View details for Web of Science ID A1987J359200003
View details for PubMedID 2956304