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Management of chronic insomnia in elderly persons.

BACKGROUND: Chronic insomnia is common among the elderly These elderly patients are often viewed as difficult to treat, yet they are among the groups with the greatest need of treatment. OBJECTIVE: This article reviews the literature on the management of chronic insomnia in elderly persons. METHODS: A search of MEDLINE was conducted for articles published in English between January 1966 and March 2006 using the terms insomnia, behavioral therapy, estsazolsam, fluvsazepsam, qusazepsam, teMsazepsam, tvisazolsam, eszopiclone, zaleplon, zolpidem, mirtazapine, nefazodone, trazodone, and ramelteon…

Modified Suanzaoren decoction in treating post-stroke cognitive impairment with comorbid insomnia symptoms: A clinical trial.

BACKGROUND: Cognitive impairment and insomnia are common complications for stroke patients, and often coexist without effective therapy. Mod … group (treated with modified Suanzaoren decoction) and 40 cases in the control group (treated with zolpidem). The intervention period was 4 weeks. Cognitive function, sleep quality, depression, and anxiety disorders were evaluated in both groups before and after treatment. Clinical assessment of patients with stroke included National Institutes of Health …

Trajectories of Benzodiazepine Use among Older Adults from a Concordance-with-Guidelines Perspective: A Nationwide Cohort Study.

BACKGROUND AND OBJECTIVE: Benzodiazepines (including zolpidem and zopiclone) are often associated with higher-than-recommended intake and durations of use, especially in older adults. The objective of this study was to characterize trajectories of benzodiazepine use according to recommended patterns in older adults, and to assess predictors of the risk of developing each of these trajectories. METHODS: Using the French Health Insurance database, we constituted a cohort of adults aged ≥ 65 years who initiated benzodiazepines in 2007 and were followed for up to 8 years. Concordance with benzodi…

LC-MS-MS Determination of 88 Psychotropic Drugs in 1,865 Hair Samples from Addicts in Drug Abstinence.

The emergence of novel drugs and the continuous expansion of the scope of the types of drugs under control have greatly increased requests f … ne, the sedative-hypnotic and psychotherapeutic drugs, including clonazepam, alprazolam, estazolam, zolpidem and quetiapine, were detected in 26% of the hair samples, suggesting that these addicts may have insomnia and mental problems such as depression and psychosis, probably due to the long-term effects of drugs and withdrawal reactions. Three synthetic …

Sleep-HD trial: short and long-term effectiveness of existing insomnia therapies for patients undergoing hemodialysis.

BACKGROUND: Patients with end-stage kidney disease (ESKD) treated with hemodialysis (HD) experience many distressing symptoms. One frequentl … are unsafe as they are associated with a higher risk for death for HD patients (benzodiazepines and zolpidem-like drugs). The efficacy and safety of other medications (trazodone) for the treatment of insomnia has never been tested for patients treated with HD. METHODS: This trial tests the short- and long-term comparative effectiveness of 6-week treatment …

Efficacy and Acceptability of Licensed and Off-Label Pharmacological Interventions for Insomnia in Patients With Severe Mental Illness: A Systematic Review and Meta-Analysis of Randomised Trials.

BACKGROUND: A wide range of drugs is used to alleviate insomnia symptoms in individuals with severe mental illness (SMI), including licensed … frequently studied drugs were agomelatine (RCTs = 3, n = 686), eszopiclone (RCTs = 3, n = 599) and zolpidem (RCTs = 3, n = 601). Compared to placebo, pharmacological interventions for insomnia were associated with improved sleep quality by a small effect size (RCTs = 8, g = 0.24, 95% CI = 0.05-0.43) and improved TST (RCTs = 10, MD = 30.82 min, 95% CI = 19 …

Integrative management of insomnia during cancer chemotherapy: A case report.

INTRODUCTION: Insomnia is common among cancer patients, affecting about 50% undergoing cancer treatment. Insomnia can be due to various reas … urnam with Kshirabala 101 and Padabhyangam (foot massage) using Kshirabala thailam as add-on to Tab Zolpidem5mg. Assessment was conducted on baseline and after 14 days of intervention. RESULTS: Assessment for insomnia before and after intervention was conducted with Insomnia-Severity-Index. The score improved from 21 to 2. Quality of sleep before and afte …

Systematic assessment of non-medical use of prescription drugs using doctor-shopping indicators: A nation-wide, repeated cross-sectional study.

AIMS: The aim of this study was to present the first nation-wide, systematic, repeated assessment of doctor-shopping (i.e. visiting multiple … and fentanyl), benzodiazepines and non-benzodiazepine hypnotics (Z-drugs) (e.g. diazepam, oxazepam, zolpidem and clonazepam) had the highest proportions doctor-shopped during the study period. In most cases, the proportion and the quantity doctor-shopped increased for opioids and decreased for benzodiazepines and Z-drugs. Pregabalin had the sharpest increa …

Detection of Drugs in Nails: Three Year Experience.

Nails (fingernails and toenails) are made of keratin. As the nail grows, substances incorporate into the keratin fibers where they can be de … Other drugs found in nails included barbiturates, benzodiazepines, ketamine, meperidine, tramadol, zolpidem, propoxyphene, naltrexone and buprenorphine. Nail analyses have become a reliable way of determining the long-term use and abuse of drugs. Extraction techniques are simple and produce accurate and precise results. Sensitive analytical instrumentatio …

Case Report: A case of post-viral inflammatory insomnia: observed sleep restoration associated with histamine-targeted interventions and implications for mast cell pathways.

BACKGROUND: Mast cell-mediated inflammation has been proposed as a potential contributor to neuroinflammatory insomnia and dysautonomia, but … ine reactivity. Despite optimal CPAP use and multiple pharmacological trials for sleep disturbance (zolpidem, trazodone, gabapentin, diazepam, lemborexant), Oura Ring data demonstrated persistently low sleep scores, often in the 30-40 range, and minimal REM and deep sleep. Routine laboratory studies (CBC, CMP, thyroid, cortisol, testosterone) were normal e …

Exploring Drug Use and Healthcare Utilization Among Adult Suicide Attempters: A Decision Tree Approach Using National Survey Data.

BACKGROUND: Korea has one of the highest suicide rates among OECD countries, ranking first for several consecutive years, with a rate of app … tropic medications-particularly hypnotics and sedatives-appeared in all four pathways. Among these, zolpidem was most commonly prescribed for insomnia, underscoring the strong link between sleep disturbance and suicide risk. Of particular concern, nearly nine out of 10 suicide attempters were prescribed at least one medication carrying suicide-related warn …

Potentially harmful drug-drug interactions in the elderly: a review.

BACKGROUND: Elderly patients are vulnerable to drug interactions because of age-related physiologic changes, an increased risk for disease a … E inhibitors or angiotensin receptor blockers and sulfamethoxazole/trimethoprim, benzodiazepines or zolpidem and interacting medications, calcium channel blockers and macrolide antibiotics, digoxin and macrolide antibiotics, lithium and loop diuretics or ACE inhibitors, phenytoin and sulfamethoxazole/trimethoprim, sulfonylureas and antimicrobial agents, th …

Long-term benzodiazepines and z-drug prescribing in Australian general practice between 2011 and 2018: A national study.

Despite reducing benzodiazepine prescribing, benzodiazepine-involving deaths have substantially increased in Australia. This study aimed to explore patterns in long-term prescribing of medications (benzodiazepine and z-drugs [BZD]) used for sleep-issues/insomnia in Australia to better understand these changes. Open cohort study using de-identified electronic health records of 1 414 593 adult patients regularly attending 404 Australian general practices from 2011 to 2018 (MedicineInsight). We used logistic regression adjusted for patient and practice characteristics to; (1) estimate long-term B

Pharmacologic approaches for the management of symptoms and cardiovascular consequences of obstructive sleep apnea in adults.

INTRODUCTION: Obstructive sleep apnea (OSA) is characterized by intermittent hypoxemia, arousals from sleep, and daytime sleepiness. Accumulating evidence indicates that hypoxemia and sleep disruption contribute to the development of cardiovascular abnormalities in OSA. OSA is effectively treated with continuous positive airway pressure (CPAP) therapy that splints open the airway during sleep. Studies have shown that CPAP therapy improves daytime sleepiness and attenuates cardiovascular abnormalities in patients with OSA. However, not all patients with OSA tolerate or adhere to CPAP therapy. E

Последствия применения обеспеченных предписаний для амбулаторного использования прегабалина во Франции: региональная оценка во Французском Нувеле-Аквитане.

AIM: Французские власти разрешили использовать в мае безопасные рецепты на догабалин. 2021. Цель этого исследования заключалась в оценке воздействия этой меры на использование и неправильное использование догабалинов в Нувеле-Акитане, юго-западном французском регионе, расположенном вокруг six million Жители. МЕТОДЫ: Это исследование было проведено на основе региональных баз данных французской системы медицинского страхования " Нувел-Аквитейн " . В нее входят все лица, которые получают по крайней мере one Возмещение расходов на догабалин между 24 Май 2020 и 24 Май 2022. Мы проанализир

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… In France, the implementation of secure prescriptions for zolpidem in 2017 led to notable changes in its use. … Consequences of the new zolpidem prescription regulations: a cohort study from the French national healthcare database . …

The prevalence and prescribing patterns of benzodiazepines and Z-drugs in older nursing home residents in different European countries and Israel: retrospective results from the EU SHELTER study.

BACKGROUND: Benzodiazepines (BZDs) and Z-drugs have high potential for developing frequent adverse drug events in older adults (e.g., psycho … 3%). Lorazepam, oxazepam and diazepam were used in most of the countries. Brotizolam, temazepam and zolpidem showed highest prevalence in Israel (99.4% of all regular users of this medication in the sample), the Netherlands (72.6%) and France (50.0%), respectively. Residing in Israel was the most significant factor associated with the use of BZDs/Z-drugs o …

Nonmedical use of benzodiazepines and Z-drugs in the UK.

AIMS: To estimate prevalence of last 12-month nonmedical use (NMU) of benzodiazepines and Z-drugs (the nonbenzodiazepine hypnotics zaleplon, zolpidem and zopiclone) in the UK. METHODS: Data were collected using the Non-Medical Use of Prescription Drugs survey with poststratification weighting applied to be representative of the UK population (≥16 years). Participants were questioned about whether they had nonmedically used benzodiazepines and/or Z-drugs in the last 12-months and from where they had obtained the drug (including via a prescription, or illicitly from a friend/family member, a de…

Primary carcinoma of the fallopian tubes: Analysis of sixteen patients.

Subjective reports of sleep disturbance indicate that 70-91% of patients with post-traumatic stress disorder (PTSD) have difficulty falling … tmares and insomnia, although adverse effects can be significant. Additional medications, including zolpidem, buspirone, gabapentin and mirtazapine, have been found to improve sleep in patients with PTSD. Large randomised, placebo-controlled trials are needed to confirm the above findings. In contrast, evidence suggests that benzodiazepines, TCAs and MAOIs …

Low serum 25-hydroxyvitamin D concentrations in chronic insomnia patients and the association with poor treatment outcome at 2months.

BACKGROUND: The association between low 25-hydroxyvitamin D [25(OH)D] and sleep disorder has been reported. We investigated whether serum concentrations of 25(OH)D are altered in chronic insomnia patients. The relationship between serum concentrations of 25(OH)D and the treatment outcome in patients at 2months was also investigated. METHODS: In total, 181 chronic insomnia patients were consecutively recruited. All patients received pharmacotherapy for the treatment of chronic insomnia. Serum 25(OH)D concentrations were quantified by a competitive electrochemiluminescence protein binding assay

The challenge of treating (and supervising) patients with borderline pathology in a residents' clinic.

Outpatients with borderline personality disorder (BPD) comprise up to 20% of psychiatry clinics, to which they are usually referred for treatment, not of their Axis II pathology but for comorbid Axis I conditions. The complex and intense transference and countertransference dynamics that patients with even "secondary" BPD evoke in psychotherapy treatments require careful handling and supervision. Cases can quickly lose focus, with resultant morbidity for both patient and treater alike. Little literature exists to guide supervision of psychiatry trainees treating outpatients with BPD and Axis I