Staff training decreases use of seclusion and restraint in an acute psychiatric hospital.

Rates of seclusion and restraint in an urban psychiatric hospital were compared during the 12-month periods before and after implementing the recommendations of a multidisciplinary quality improvement work-group convened to reduce the hospital's use of physical containment. Interventions included a mandatory staff training session on the management of assaultive behavior, weekly discussion items during team meetings for each local ward, and hospital-wide publicity charting the ongoing progress of the effort. Total annual rates of restraint dropped 13.8%. The average duration of restraint per admission decreased 54.6%. Staff injuries were reduced by 18.8% during the study period.

Effects of exercise on sleep.

We tested the hypothesis that EEG sleep stages 3 and 4 (slow-wave sleep, SWS) would be increased as a function of either acute of chronic exercise. Ten distance runners were matched with 10 nonrunners, and their sleep was recorded under both habitual (runners running and nonrunners not running, 3 night) and abruptly changed (runners not running and nonrunners running, 1 night) conditions. Analyses of both visually scored SWS and computer measures of delta activity during non-rapid eye-movement (NREM) sleep failed to support the SWS-exercise hypothesis. The runners showed a significantly higher proportion and a greater absolute amount of NREM sleep than the nonrunners. The runners showed less rapid eye-movement activity during sleep than the nonrunners under both experimental conditions, indicating a strong and unexpected effect of physical fitness on this measure. Modest afternoon exercise in nonrunners was associated with a strong trend toward elevated heart rate during sleep. Mood tests and personality profiles revealed few differences, either between groups or within groups, as a function of exercise.

Effects of marijuana extract and tetrahydrocannabinol on electroencephalographic sleep patterns.

Marijuana extract, given in daily doses containing 70 to 210 mg delta-9-tetrahydrocannabinol (THC), induced effects on sleep that were virtually identical to those produced by the same doses of relatively pure (96%) THC. Both drugs reduced eye movements density with some tolerance developing to this effect. Stage 4 tendend to increase with drug administration. Abrupt withdrawal led to extremely high densities of eye movement, increased rapid eye movement (REM) durations, and a sharp but transient fall in stage 4 to baseline levels. These effects may be useful in the elucidation of the pharmacology of sleep. The effects on sleep of THC administration (but not withdrawal) closely resemble those induced by lithium. For this reason, we suggest further studies of THC in affective disorders. Evidence available thus far suggests that THC produces dysphoric symptoms in unipolar but not in bipolar depressed patients; these differences in response may prove of diagnostic value. An adequate therapeutic trial of THC in bipolar depressed patients has not yet been carried out.

Effects of high dosage delta-9-tetrahydrocannabinol on sleep patterns in man.

Electroencephalographic readings and eye movement were recorded in experienced marijuana users under placebo and tetrahydrocannabinol (THC). Four subjects were studied for 3 baseline nights, 3 nights under initial dosage of 70 mg/day, the last 3 nights of a 2-wk period of 210 mg/day, and the first 3 nights of withdrawal. Three other subjects were studied only during the latter 2 conditions. Administration of THC significantly reduced eye movement activity during sleep with rapid eye movements (REM) and, to a lesser extent, the duration of REM itself. Withdrawal led to increases above baseline in both measures but the "rebound" effect was greater for eye movement. Stage 4 sleep tended to increase on drug, but this effect was not statistically significant. On withdrawal, stage 4 sleep decreased significantly; this change was marked only on the first withdrawal night. The functional or biological significance of these changes is unclear. Nevertheless, these are the most marked effects of THC on brain electrical activity demonstrated thus far. Since its pattern of effects on sleep appears unique to THC, this drug may prove to be a valuable tool in the elucidation of the pharmacology of sleep. Possible relations between effects on sleep pattern and on behavior are discussed.

Absence of REM rebound after barbiturate withdrawal.

Administration of three different barbiturates reduced rapid eye movement (REM) sleep. Drug withdrawal led to a return to baseline REM] values without significant overshoot. Similar results are observed with administration of benzodiazepines in pharmacologically equivalent dosages; therefore, a distinction between these two drug classes on the basis of withdrawal effects on the sleep electroencephalogram appears unwarranted. Further investigation is required determine why high REM levels are sometimes associated with the withdrawal of sedative-hypnotic agents.