Zolpidem for persistent insomnia in SSRI-treated depressed patients.

BACKGROUND: Depressed individuals effectively treated with selective serotonin reuptake inhibitors (SSRIs) often report persistent insomnia and require adjunctive sleep-promoting therapy. METHOD: Men (N = 40) and women (N = 150) with a mean age of 41.6 years who had persistent insomnia in the presence of effective and stable treatment (at least 2 weeks) with fluoxetine (< or =40 mg/day), sertraline (< or =100 mg/day), or paroxetine (< or =40 mg/day) for DSM-IV major depressive disorder, dysthymic disorder, or minor depressive disorder of mild-to-moderate severity (and score of < or =2 on item 3 of the Hamilton Rating Scale for Depression [HAM-D]) participated in this randomized, double-blind, parallel-group study. At study entry, patients were required to score < or =12 on the HAM-D. During a 1-week single-blind placebo period, patients had to report on at least 3 nights a latency of > or =30 minutes or a sleep time of <6.5 hours and clinically significant daytime impairment. Patients received either placebo (N = 96) or zolpidem, 10 mg (N = 94) nightly, for 4 weeks and single-blind placebo for 1 week thereafter. Sleep was measured with daily questionnaires and during weekly physician visits. RESULTS: Compared with placebo, zolpidem was associated with improved sleep: longer sleep times (weeks 1 through 4, p<.05), greater sleep quality (weeks 1 through 4, p<.01), and reduced number of awakenings (weeks 1, 2, and 4; p<.05), together with feeling significantly more refreshed, less sleepy, and more able to concentrate. After placebo substitution, the zolpidem group showed significant worsening relative to pretreatment sleep on the first posttreatment night in total sleep time and sleep quality, reverted to pretreatment insomnia levels on the other hypnotic efficacy measures, or maintained improvement (fewer number of awakenings). There was no evidence of dependence or withdrawal from zolpidem (DSM-IV criteria). Incidence rates of adverse events were similar in both treatment groups (74% and 83% for placebo and zolpidem, respectively), but 7 zolpidem patients discontinued compared with 2 placebo patients. CONCLUSION: In this defined patient population, zolpidem, 10 mg, was effectively and safely co-administered with an SSRI, resulting in improved self-rated sleep, daytime functioning, and well-being.

Interventions in a heart transplant recipient with a histrionic personality disorder.

Organ transplantation is a psychosocially demanding process. Patients must undergo a comprehensive evaluation to await a donor organ that may never become available. After transplantation, recipients must deal with the acceptance of a new organ and comply with a medical regimen that includes numerous medications, follow-up exams, and procedures. Emotional well-being is monitored throughout the transplant process. However, despite the best of efforts and thorough pretransplant bio-psycho-social evaluations, it is possible for patients to have significant psychopathology that remains undetected. Following the stress of transplantation, such patients may present with exacerbation of symptomatology, which has the potential to negatively affect compliance and long-term outcome.

The separation of W(V) from HCl-KSCN medium on polyurethane foam sorbents for its spectrophotometric determination in steels and silicates.

A simple procedure for selective sorption of tungsten is described. The method involves reduction of W(VI) to W(V) with tin(II) chloride (2%, w/v) at 8-9M hydrochloric acid, formation of the W(V)-SCN complex with 0.2M KSCN and its sorption on polyurethane foam within 20 min. The sorbed complex is then eluted with acidified acetone (1 ml of 1M hydrochloric acid and 8 ml of acetone) followed by addition of 1 ml of 0.1M KSCN to the eluent. The method has been applied to the spectrophotometric determination of tungsten in steels and silicates by measuring the absorbance of the eluted solution at 400 nm. Beer's law is obeyed for the range 0.1-12 mug W/ml. Other elements, e.g., Co(III) (50 mug/ml), Cu(II) (10 mug/ml), Ti(IV) (20 mug/ml), V(V) (10 mug/ml) and Mo(VI) (0.5 mug/ml) have no effect on the method. Interference of copper, up to 100 mug/ml has been eliminated by masking with thiourea and that due to molybdenum by prior separation with thioglycollic acid on PUF. The method has been verified with standard samples.