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Biomedical subjects

M B Scharf

Publications and source records attributed to M B Scharf.

At least 37 records · Page 2Linked to original sources
PubMed1990

Estazolam and flurazepam: a multicenter, placebo-controlled comparative study in outpatients with insomnia.

A multicenter, double-blind placebo-controlled clinical trial was designed to compare the safety and efficacy of estazolam compared with flurazepam as hypnotics. Outpatients complaining of insomnia were randomized to receive either estazolam 2 mg, flurazepam 30 mg or placebo for 7 consecutive nights. The analysis of efficacy was based on the patients' daily assessments of sleep and the investigators' global evaluations. Adverse events which were considered by the investigator to be attributable to, or of unknown relationship to the test medication were analyzed. The patient subjective questionnaire indicated that estazolam and flurazepam significantly improved all parameters (P less than .05) as compared to placebo. A marked or moderate improvement in sleep was reported by 81% (58/72), 78% (63/81) and 36% (27/76) of estazolam, flurazepam, and placebo recipients, respectively. There were no significant differences in hypnotic effect between estazolam and flurazepam. All efficacy parameters of the investigators' global evaluation improved significantly more (P less than .05) for patients receiving estazolam or flurazepam (except quality of sleep) than for those receiving placebo. The percentage of patients reporting any adverse experience was greatest for flurazepam (72%), followed by estazolam (59%), and placebo (43%). Somnolence and hypokinesia were the most commonly reported adverse events. An analysis of the global evaluation of side effects showed that flurazepam had a significantly worse side effect profile than estazolam (P less than .05) or placebo (P = .001). Estazolam and flurazepam effectively, and comparably, relieved insomnia when administered for 7 nights in adult patients complaining of insomnia. Estazolam demonstrated a more favorable side effect profile than flurazepam.

Ambulatory Care↗
PubMed1990

Sleep laboratory evaluation of the effects and efficacy of trazodone in depressed insomniac patients.

Trazodone (150 mg to 400 mg) was administered to six depressed patients with significant sleep disturbances in an 8-week single-blind study design. Patients were evaluated psychologically by means of the Hamilton Rating Scales for Anxiety and Depression. Polysomnographic monitoring in the sleep laboratory was conducted at each of the time points corresponding to the psychiatric evaluations. Five of the six subjects completed treatment. Patients showed a significant improvement in symptoms of depression and in their polysomnographic-determined sleep architecture. There was a 44% improvement in persistent sleep latency, decreasing from a mean +/- SD of 51.0 +/- 59.3 minutes at baseline to 28.5 +/- 24.2 minutes after 5 weeks of active treatment. Total sleep time improved 14% from 387.1 +/- 59.2 minutes at baseline to 441.3 +/- 23.7 minutes after 5 weeks. Stage IV sleep more than doubled with an increase of 153% from 1.9 +/- 3.0% at baseline to a more normal 4.8 +/- 5.5%. There was no change in percentage of rapid eye movement (REM); however, REM latency increased 28% from a mean of 74.6 +/- 35.9 minutes at baseline to a mean of 95.6 +/- 28.8 minutes. Sleep efficiency improved from 80.6 +/- 12.3%, considered clinically significant insomnia, to 91.9 +/- 4.9%, which is well within normal sleep patterns.

Adult↗
PubMed1989

Comparative effects of prazosin and hydrochlorothiazide on sexual function in hypertensive men.

Evidence suggests that there may be differences in the incidence of drug-induced sexual dysfunction among the antihypertensive agents. This study assessed objective and subjective aspects of sexual dysfunction in hypertensive male patients in relation to two antihypertensive agents--prazosin and hydrochlorothiazide. A total of 12 hypertensive patients were evaluated in a crossover study utilizing a sleep laboratory to obtain polysomnographic evaluations of sleep patterns along with changes in nocturnal penile tumescence and buckling pressure. Objectively, no significant changes were observed between the two antihypertensive agents in relation to rapid eye movement-related sleep architecture, serum testosterone levels, or penile blood flow. Decrements in buckling pressure and subjective aspects of sexual dysfunction were greater during hydrochlorothiazide treatment than during prazosin treatment. Both drugs were effective in controlling blood pressure.

Blood Pressure↗
PubMed1988

Comparative amnestic effects of benzodiazepine hypnotic agents.

The effects of triazolam 0.5 mg and temazepam 30 mg on immediate and delayed recall in normal and insomniac subjects were evaluated in three separate, randomized, placebo-controlled, parallel group studies. Neither drug caused significant impairment of immediate recall. In the tests of delayed recall, triazolam caused a consistent anterograde amnestic effect. No significant impairment of delayed recall was observed in the temazepam study. Anterograde amnesia is thought to be a dose-related effect of benzodiazepines. Compounds with high benzodiazepine receptor affinity such as triazolam are thought to cause this type of amnesia more often than the lower-affinity compounds such as temazepam.

Adult↗
PubMed1988

Current pharmacologic management of narcolepsy.

Narcolepsy is an incurable sleep disorder characterized by attacks of sleepiness and a series of auxiliary symptoms: cataplexy, sleep paralysis and hypnagogic hallucinations. Classic treatment has included stimulants to control sleepiness and tricyclic antidepressants to control the auxiliary symptoms. Polysomnography is necessary to confirm the diagnosis and to detect other sleep disorders. Recent developments in treatment include the use of codeine for sleepiness and gamma-hydroxybutyrate for auxiliary symptoms.

Amphetamines↗
PubMed1987

Childhood enuresis. A comprehensive treatment program.

Enuresis is a common, often misunderstood, condition that affects millions of children in the United States. For most children with primary enuresis, preventing secondary psychological sequelae associated with guilt and shame is an important consideration in the decision whether or not to treat. Because the spontaneous resolution rate is 15 per cent per year, the older the child, the more important treatment becomes. It is important to distinguish primary from secondary enuresis, as most psychogenically induced enuresis is of secondary nature. A careful history can usually elicit the etiology, as well as the exacerbatory factors in both types of conditions, providing direction for treatment. Treatments include pharmacologic, behavioral, and psychotherapeutic. In some cases, surgical intervention of either a urologic or otolaryngologic nature is indicated. A multidimensional approach is often best, and we have described our program with its success rate. Treating the enuretic child can be frustrating, but is usually quite gratifying for the child, parents, and the clinician.

Behavior Therapy↗
PubMed1986

Treatment of narcolepsy with gamma-hydroxybutyrate. A review of clinical and sleep laboratory findings.

Previous studies on the effects of gamma-hydroxybutyrate (GHB) on the sleep and clinical response of patients with narcolepsy are reviewed. New information on 48 patients treated with GHB for as long as 9 years is presented. These studies indicate that 2.25 to 3.00 g of GHB, taken in conjunction with a low dose of a stimulant during the day, rapidly alleviate the symptoms of narcolepsy in most patients. Tolerance does not develop to this treatment regimen; neither have any patients discontinued the treatment because of side effects. In poor responders, daytime drowsiness and not cataplexy has been the most common residual symptom. Sleep studies reveal that GHB induces REM followed by slow wave sleep. Although total sleep time at night may be unchanged, sleep is less fragmented. GHB appears to be effective because it can induce the symptoms of narcolepsy and contain them at night. It is noteworthy, therefore, that the central biochemical changes induced by GHB also appear comparable to those found naturally in narcolepsy.

Female↗
PubMed1986

Comparative effects of limbitrol and amitriptyline on sleep efficiency and architecture.

Chlordiazepoxide-amitriptyline (Limbitrol) has been shown to be more rapidly effective than amitriptyline alone for treating depression. A double-blind, randomized study was designed to compare the effects of Limbitrol and amitriptyline on insomnia, anxiety, and depression. The rate of improvement of symptoms was faster with Limbitrol. No differences were noted between groups in the degree or rate of improvement of the sleep laboratory parameters nor in sleep Stages 1 to 4. Percentages of rapid eye movement (REM) sleep and REM latency were similarly affected by the drugs, but REM density showed a significantly greater decrease with Limbitrol. Phasic REM factors may be crucial in the role of REM sleep and depression.

Adult↗
PubMed1986

Possible efficacy of alprazolam in restless leg syndrome.

Restless leg syndrome is a frequently misdiagnosed and often misunderstood condition contributing to a complaint of insomnia in geriatric patients. Various pharmacologic agents used to treat the condition are often ineffective and have not consistently provided relief for the majority of patients with this condition. Our recent experience with Xanax suggests its possible effectiveness in controlling symptoms of the restless leg syndrome. Further, more controlled double blind studies--especially comparing other benzodiazepines at appropriate dosages--are called for.

Aged↗
PubMed1986

Morning amnestic effects of triazolam.

The effects of triazolam on immediate and delayed recall were evaluated in a double-blind placebo controlled study in 22 normal volunteers. Subjects were randomized to receive triazolam or a placebo as a single dose administered at bedtime. Immediate and delayed recall are tested using a modified version of the "Williams Word Memory Task" before and at .5, 8, and 14 hours after drug administration. Delayed recall was evaluated at the 14 hour time point for words recalled at the pre drug and 1/2 and 8 hour time points. No significant difference was noted between the triazolam and placebo group with regard to their immediate recall ability at any of the time points. The placebo group demonstrated no decrease in their delayed recall ability during any of the various post drug time points. However, when evaluating delayed recall in the triazolam group, a statistically significant (p less than .05) decrease compared to baseline in their recall ability of words remembered at the .5 and 8 hour time points was noted. This study suggests that triazolam's amnestic effect may extend beyond the duration of its generally accepted hypnotic efficacy. This is consistent with the hypothesis that amnestic potency among the benzodiazepines is related to benzodiazepine receptor binding affinity and lipophilicity.

Adult↗
PubMed1985

Lack of amnestic effects of clorazepate on geriatric recall.

Significant amnestic effects in young adults have been found with the short-acting sedative-hypnotic triazolam and the intermediate-acting lorazepam, but not with the longer-acting clorazepate. The effects of placebo and clorazepate 3.75 and 7.5 mg were compared in 43 nonanxious geriatric subjects. Results were consistent with earlier studies, and no significant impairment of immediate or delayed recall was found.

Aged↗
PubMed1985

The effects and effectiveness of gamma-hydroxybutyrate in patients with narcolepsy.

Thirty patients with polysomnographically confirmed narcolepsy were treated with GHB (gamma-hydroxybutyrate) for up to 30 weeks. The number of nightly awakenings significantly decreased, while Stages 3 and 4 sleep substantially increased. The clinical symptoms of cataplexy, sleep paralysis, hypnogogic hallucinations, daily naps, and sleep attacks all showed significant improvements. Daytime sleepiness, while not completely eliminated, was controlled with lower doses of stimulant medication than patients were taking before the study. No patient developed tolerance to the drug, and no serious side effects were noted.

Adult↗
PubMed1984

Differential amnestic properties of short- and long-acting benzodiazepines.

It has been demonstrated previously that orally administered lorazepam can cause anterograde amnesia in young adults. In this study, the effects of 7.5 and 15 mg clorazepate and 1 and 2 mg lorazepam on recall were compared in 74 healthy adults. Word list presentation tests were administered to subjects at selected intervals to measure immediate and delayed recall. Statistically significant memory impairment was found with 2 mg lorazepam during both immediate and delayed recall testing. Clorazepate produced no statistically significant amnestic effects. The data suggest that benzodiazepines differ in their potential for causing memory impairment.

Administration, Oral↗
PubMed1983

Acute effects of drug administration and withdrawal on the benzodiazepine receptor.

Effects of one week of benzodiazepine drug administration on central benzodiazepine receptor binding characteristics were evaluated in a series of experiments in male Sprague-Dawley rats. Administration of short- and intermediate-acting benzodiazepines was observed to increase the number of available receptor binding sites (Bmax) without changing affinity of drug for receptor. Furthermore, these changes did not occur after administration and withdrawal of long-acting benzodiazepines. In addition, there appeared to be a relationship between the affinity of the different benzodiazepines for the receptor and the degree of increase in the number of receptor binding sites. The results may help to explain the relationship between withdrawal of certain benzodiazepine drugs and the occurrence of rebound phenomena in clinical situations.

Animals↗
PubMed1983

Nocturnal oxygen desaturation in patients with sickle cell anemia.

The sleep of two patients with sickle cell disease was punctuated by periods with notably reduced arterial O2 saturation despite simultaneous normal respiratory rates. The O2 levels returned to baseline during intermittent wakefulness. Gas exchange patterns during sleep may contribute to the morbidity of sickle cell disease.

Adult↗
PubMed1983

Penile tumescence in temporally normal and pathologic rapid eye movement sleep.

The present study was conducted to determine whether the usual temporal relationship between rapid eye movement and penile tumescence was present in a group of narcoleptic patients who had demonstrated the abnormal phenomenon of sleep onset rapid eye movement. We studied 5 men with a clinical history of sleep attacks and at least 1 auxiliary symptom of narcolepsy. Results indicated that penile tumescence occurred during temporally normal and abnormal rapid eye movement sleep. These findings provide further evidence of the strong temporal relationship between rapid eye movement sleep and penile tumescence.

Adult↗
PubMed1983

Anterograde amnesia with oral lorazepam.

The use of intravenous benzodiazepines often results in amnesia for events subsequent to drug administration (anterograde amnesia). To asses the effects of oral administration, a single 2 mg dose of lorazepam was given to 6 normal subjects. No substantial effect on immediate recall of word lists was seen in comparison with 6 placebo control subjects. However, the active drug significantly hindered the delayed recall of words. These findings indicate that lorazepam, taken orally as a daytime tranquilizer, can have amnestic action.

Administration, Oral↗