The Effects of Eszopiclone on Sleep Spindles and Memory Consolidation in Schizophrenia: a Randomized Placebo-Controlled Trial Erin J
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2015-16 59. On-Line Learning Bipolar Medications
Pharmacology/Therapeutics II Block II Handouts – 2015‐16 59. On‐Line learning Bipolar Medications ‐ Schilling 60. On‐Line Learning Anti‐Depressants ‐ Schilling 61. On‐Line Learning Sedative Hypnotics ‐ Battaglia 62. On‐Line Learning Treatment of Insomnia ‐ Battaglia 63. On‐Line Learning AntiPsychotics ‐ Schilling 64. On‐Line Only Drugs of Abuse, tolerance & Dependence – Bakowska 65. Active Learning Session: Mood Disorders & Treatment – Schilling 66. Active Learning Session – Anxiety Disorders – Schilling 67. Active Learning Session – Psychotic Illness & Treatment – Schilling 68. Drugs to Treat Rheumatoid Arthritis & Gout ‐ Clipstone Pharmacology & Therapeutics Bipolar Medications February 15, 2016 David Schilling, M.D. Bipolar Disorder Medications Goals & Objectives: Describe the pharmacologic profiles of major drugs/drug classes used in the treatment of bipolar disorder. These drugs include: Lithium, Divalproex (Depakote), Carbamazepine (Tegretol), Lamotrigine (Lamictal) 1. List the major drugs/drug classes used in the treatment of bipolar disorder 2. Describe the mechanism of action of each of the major drugs/drug classes used in the treatment of bipolar disorder 3. Describe the principle pharmacokinetic properties of the major drugs used to treat bipolar disorder. This includes: half-life & time to steady state, trough levels, metabolic auto-induction, P450 system induction, therapeutic index 4. Describe the pharmacodynamics (common adverse effects) of the major drugs used to treat bipolar disorder. 5. Describe the pharmacodynamics (serious adverse effects) of the major drugs used to treat bipolar disorder. This includes: lithium toxicity, agranulocytosis, aplastic anemia, hepatic failure, exfoliative dermatitis, pancreatitis, Steven’s Johnson syndrome 6. Identify the laboratory tests that may be used to monitor for common and serious major adverse effects of the major drugs used to treat bipolar disorder. -
Slow Waves and Sleep Spindles in Unaffected First-Degree Relatives
www.nature.com/npjschz ARTICLE OPEN Sleep endophenotypes of schizophrenia: slow waves and sleep spindles in unaffected first-degree relatives Armando D’Agostino 1,2, Anna Castelnovo1, Simone Cavallotti2, Cecilia Casetta1, Matteo Marcatili1, Orsola Gambini1,2, Mariapaola Canevini1,2, Giulio Tononi3, Brady Riedner3, Fabio Ferrarelli4 and Simone Sarasso 5 Sleep spindles and slow waves are the main brain oscillations occurring in non-REM sleep. Several lines of evidence suggest that spindles are initiated within the thalamus, whereas slow waves are generated and modulated in the cortex. A decrease in sleep spindle activity has been described in Schizophrenia (SCZ), including chronic, early course, and early onset patients. In contrast, slow waves have been inconsistently found to be reduced in SCZ, possibly due to confounds like duration of illness and antipsychotic medication exposure. Nontheless, the implication of sleep spindles and slow waves in the neurobiology of SCZ and related disorders, including their heritability, remains largely unknown. Unaffected first-degree relatives (FDRs) share a similar genetic background and several neurophysiological and cognitive deficits with SCZ patients, and allow testing whether some of these measures are candidate endophenotypes. In this study, we performed sleep high-density EEG recordings to characterise the spatiotemporal features of sleep spindles and slow waves in FDRs of SCZ probands and healthy subjects (HS) with no family history of SCZ. We found a significant reduction of integrated spindle activity (ISAs) in FDRs relative to HS, whereas spindle density and spindle duration were not different between groups. FDRs also had decreased slow wave amplitude and slopes. Altogether, our results suggest that ISAs deficits might represent a candidate endophenotype for SCZ. -
Lunesta: Uses, Dosage, Side Effects Drugs.Com
4/5/2017 Lunesta: Uses, Dosage, Side Effects Drugs.com Lunesta ﴿Generic Name: eszopiclone ﴾e ZOP i klone Brand Names: Lunesta What is Lunesta? Lunesta ﴾eszopiclone﴿ is a sedative, also called a hypnotic. It affects chemicals in your brain that may be unbalanced in people .﴿with sleep problems ﴾insomnia Lunesta is used to treat insomnia. This medicine causes relaxation to help you fall asleep and stay asleep. Lunesta may also be used for purposes not listed in this medication guide. Important information Lunesta may cause a severe allergic reaction. Stop taking this medicine and get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Lunesta will make you fall asleep. Never take this medication during your normal waking hours, unless you have at least 8 hours to dedicate to sleeping. Some people using this medicine have engaged in activity such as driving, eating, or making phone calls and later having no memory of the activity. If this happens to you, stop taking Lunesta and talk with your doctor about another treatment for your sleep disorder. Lunesta can cause sie effects that may impair your thinking or reactions. You may still feel sleepy the morning after taking the medication. Until you know how this medication will affect you during waking hours, be careful if you drive, operate machinery, pilot an airplane, or do anything that requires you to be awake and alert. Do not drink alcohol while you are taking this medication. It can increase some of the side effects, including drowsiness. -
Herbal Remedies and Their Possible Effect on the Gabaergic System and Sleep
nutrients Review Herbal Remedies and Their Possible Effect on the GABAergic System and Sleep Oliviero Bruni 1,* , Luigi Ferini-Strambi 2,3, Elena Giacomoni 4 and Paolo Pellegrino 4 1 Department of Developmental and Social Psychology, Sapienza University, 00185 Rome, Italy 2 Department of Neurology, Ospedale San Raffaele Turro, 20127 Milan, Italy; [email protected] 3 Sleep Disorders Center, Vita-Salute San Raffaele University, 20132 Milan, Italy 4 Department of Medical Affairs, Sanofi Consumer HealthCare, 20158 Milan, Italy; Elena.Giacomoni@sanofi.com (E.G.); Paolo.Pellegrino@sanofi.com (P.P.) * Correspondence: [email protected]; Tel.: +39-33-5607-8964; Fax: +39-06-3377-5941 Abstract: Sleep is an essential component of physical and emotional well-being, and lack, or dis- ruption, of sleep due to insomnia is a highly prevalent problem. The interest in complementary and alternative medicines for treating or preventing insomnia has increased recently. Centuries-old herbal treatments, popular for their safety and effectiveness, include valerian, passionflower, lemon balm, lavender, and Californian poppy. These herbal medicines have been shown to reduce sleep latency and increase subjective and objective measures of sleep quality. Research into their molecular components revealed that their sedative and sleep-promoting properties rely on interactions with various neurotransmitter systems in the brain. Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter that plays a major role in controlling different vigilance states. GABA receptors are the targets of many pharmacological treatments for insomnia, such as benzodiazepines. Here, we perform a systematic analysis of studies assessing the mechanisms of action of various herbal medicines on different subtypes of GABA receptors in the context of sleep control. -
MEDICATION GUIDE ESZOPICLONE TABLETS CIV (Es″ Zoe Pik′ Lone
MEDICATION GUIDE ESZOPICLONE TABLETS CIV (es″ zoe pik′ lone) 1 mg, 2 mg and 3 mg Read the Medication Guide that comes with eszopiclone tablets before you start taking it and each time you get a refill. There may be new information. This Medication Guide does not take the place of talking to your doctor about your medical condition or treatment. What is the most important information I should know about eszopiclone tablets? • Do not take more eszopiclone tablets than prescribed. • Do not take eszopiclone tablets unless you are able to stay in bed a full night (7 to 8 hours) before you must be active again. • Take eszopiclone tablets right before you get in bed, not sooner. Eszopiclone tablets may cause serious side effects that you may not know are happening to you. These side effects include: • sleepiness during the day • not thinking clearly • act strangely, confused, or upset • "sleep-walking" or doing other activities when you are asleep like: o eating o talking o having sex o driving a car Call your healthcare provider right away if you find out that you have done any of the above activities after taking eszopiclone tablets. The morning after you take eszopiclone tablets your ability to drive safely and think clearly may be decreased. Do not take eszopiclone tablets if you: • drank alcohol that evening or before bed • take other medicines that can make you sleepy. Talk to your doctor about all of your medicines. Your doctor will tell you if you can take eszopiclone tablets with your other medicines • cannot get a full night’s sleep What are eszopiclone tablets? Eszopiclone tablets are a sedative-hypnotic (sleep) medicine. -
The Safety Risk Associated with Z-Medications to Treat Insomnia in Substance Use Disorder Patients
Riaz U, et al., J Addict Addictv Disord 2020, 7: 054 DOI: 10.24966/AAD-7276/100054 HSOA Journal of Addiction & Addictive Disorders Review Article Introduction The Safety Risk Associated Benzodiazepine receptor agonist is divided in two categories: with Z-Medications to Treat a) Benzodiazepine hypnotics and Insomnia in Substance Use b) Non-benzodiazepine hypnotics. The prescription of Z-medications which is non-benzodiazepine Disorder Patients hypnotic is common in daily clinical practice, particularly among primary medical providers to treat patients with insomnia. This trend Usman Riaz, MD1* and Syed Ali Riaz, MD2 is less observed among psychiatrist, but does exist. While treating substance use disorder population the prescription of Z-medications 1 Division of Substance Abuse, Department of Psychiatry, Montefiore Medical should be strongly discouraged secondary to well documented Center/Albert Einstein College of Medicine, Bronx NY, USA safety risks. There is sufficient data available suggesting against the 2Department of Pulmonology/Critical Care and Sleep Medicine, Virtua Health, prescription of Z-medications to treat insomnia in substance abuse New Jersey, USA patients. Though treating insomnia is essential in substance use disorder patients to prevent relapse on alcohol/drugs, be mindful of risk associated with hypnotics particularly with BZRA (Benzodiazepines Abstract and Non benzodiazepines hypnotics). Z-medications are commonly prescribed in clinical practices Classification of Z-medications despite the safety concerns. Although these medications are Name of medication Half-life (hr) Adult dose (mg). considered safer than benzodiazepines, both act on GABA-A receptors as an allosteric modulator. In clinical practice, the risk Zaleplon 1 5-20 profile for both medications is not any different, particularly in Zolpidem 1.5-4.5 5-10 substance use disorder population. -
Manual Characterization of Sleep Spindle Index in Patients with Narcolepsy and Idiopathic Hypersomnia
Hindawi Publishing Corporation Sleep Disorders Volume 2014, Article ID 271802, 4 pages http://dx.doi.org/10.1155/2014/271802 Research Article Manual Characterization of Sleep Spindle Index in Patients with Narcolepsy and Idiopathic Hypersomnia Lourdes M. DelRosso, Andrew L. Chesson, and Romy Hoque Division of Sleep Medicine, Department of Neurology, Louisiana State University School of Medicine, Shreveport, LA 71103, USA Correspondence should be addressed to Romy Hoque; [email protected] Received 24 November 2013; Revised 22 February 2014; Accepted 8 March 2014; Published 1 April 2014 Academic Editor: Michael J. Thorpy Copyright © 2014 Lourdes M. DelRosso et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This is a retrospective review of PSG data from 8 narcolepsy patients and 8 idiopathic hypersomnia (IH) patients, evaluating electrophysiologic differences between these two central hypersomnias. Spindles were identified according to the AASM Manual fortheScoringofSleepandAssociatedEvents;andcountedperepochinthefirst50epochsofN2sleepandthelast50epochs of N2 sleep in each patient’s PSG. Spindle count data (mean ± standard deviation) per 30 second-epoch (spindle index) in the 8 narcolepsy patients was as follows: 0.37 ± 0.73 for the first 50 epochs of N2; 0.65 ± 1.09 for the last 50 epochs of N2; and 0.51 ± 0.93 for all 100 epochs of N2. Spindle index data in the 8 IH patients was as follows: 2.31 ± 2.23 for the first 50 epochs of N2; 2.84 ± 2.43 for the last 50 epochs of N2; and 2.57 ± 2.35 for all 100 epochs of N2. -
Manual Characterization of Sleep Spindle Index in Patients with Narcolepsy and Idiopathic Hypersomnia
Hindawi Publishing Corporation Sleep Disorders Volume 2014, Article ID 271802, 4 pages http://dx.doi.org/10.1155/2014/271802 Research Article Manual Characterization of Sleep Spindle Index in Patients with Narcolepsy and Idiopathic Hypersomnia Lourdes M. DelRosso, Andrew L. Chesson, and Romy Hoque Division of Sleep Medicine, Department of Neurology, Louisiana State University School of Medicine, Shreveport, LA 71103, USA Correspondence should be addressed to Romy Hoque; [email protected] Received 24 November 2013; Revised 22 February 2014; Accepted 8 March 2014; Published 1 April 2014 Academic Editor: Michael J. Thorpy Copyright © 2014 Lourdes M. DelRosso et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This is a retrospective review of PSG data from 8 narcolepsy patients and 8 idiopathic hypersomnia (IH) patients, evaluating electrophysiologic differences between these two central hypersomnias. Spindles were identified according to the AASM Manual fortheScoringofSleepandAssociatedEvents;andcountedperepochinthefirst50epochsofN2sleepandthelast50epochs of N2 sleep in each patient’s PSG. Spindle count data (mean ± standard deviation) per 30 second-epoch (spindle index) in the 8 narcolepsy patients was as follows: 0.37 ± 0.73 for the first 50 epochs of N2; 0.65 ± 1.09 for the last 50 epochs of N2; and 0.51 ± 0.93 for all 100 epochs of N2. Spindle index data in the 8 IH patients was as follows: 2.31 ± 2.23 for the first 50 epochs of N2; 2.84 ± 2.43 for the last 50 epochs of N2; and 2.57 ± 2.35 for all 100 epochs of N2. -
Abnormal Sleep Spindles, Memory Consolidation, and Schizophrenia
CP15CH18_Manoach ARjats.cls April 17, 2019 13:18 Annual Review of Clinical Psychology Abnormal Sleep Spindles, Memory Consolidation, and Schizophrenia Dara S. Manoach1,2 and Robert Stickgold3 1Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA; email: [email protected] 2Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts 02129, USA 3Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215; email: [email protected] Annu. Rev. Clin. Psychol. 2019. 15:451–79 Keywords First published as a Review in Advance on cognition, endophenotype, genetics, memory, schizophrenia, sleep, spindles February 20, 2019 The Annual Review of Clinical Psychology is online at Abstract clinpsy.annualreviews.org There is overwhelming evidence that sleep is crucial for memory consol- https://doi.org/10.1146/annurev-clinpsy-050718- idation. Patients with schizophrenia and their unaffected relatives have a 095754 specific deficit in sleep spindles, a defining oscillation of non-rapid eye Access provided by 73.61.23.229 on 05/29/19. For personal use only. Copyright © 2019 by Annual Reviews. movement (NREM) Stage 2 sleep that, in coordination with other NREM All rights reserved oscillations, mediate memory consolidation. In schizophrenia, the spindle Annu. Rev. Clin. Psychol. 2019.15:451-479. Downloaded from www.annualreviews.org deficit correlates with impaired sleep-dependent memory consolidation, positive symptoms, and abnormal thalamocortical connectivity. These re- lations point to dysfunction of the thalamic reticular nucleus (TRN), which generates spindles, gates the relay of sensory information to the cortex, and modulates thalamocortical communication. -
Naps Reliably Estimate Nocturnal Sleep Spindle Density in Health and Schizophrenia
Received: 25 August 2019 | Revised: 21 November 2019 | Accepted: 23 November 2019 DOI: 10.1111/jsr.12968 SHORT PAPER Naps reliably estimate nocturnal sleep spindle density in health and schizophrenia Dimitrios Mylonas1,2,3 | Catherine Tocci1 | William G. Coon1,2,3 | Bengi Baran1,2,3 | Erin J. Kohnke1 | Lin Zhu1 | Mark G. Vangel4,5 | Robert Stickgold3,6 | Dara S. Manoach1,2,3 1Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA Abstract 2Athinoula A. Martinos Center for Sleep spindles, defining oscillations of non-rapid eye movement stage 2 sleep (N2), Biomedical Imaging, Charlestown, MA, USA mediate memory consolidation. Spindle density (spindles/minute) is a stable, herit- 3Harvard Medical School, Boston, MA, USA able feature of the sleep electroencephalogram. In schizophrenia, reduced spindle 4Department of Radiology, Massachussets General Hospital, Charlestown, MA, USA density correlates with impaired sleep-dependent memory consolidation and is a 5Department of Biostatistics, Harvard promising treatment target. Measuring sleep spindles is also important for basic stud- Medical School, Boston, MA, USA ies of memory. However, overnight sleep studies are expensive, time consuming and 6Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, require considerable infrastructure. Here we investigated whether afternoon naps USA can reliably and accurately estimate nocturnal spindle density in health and schizo- Correspondence phrenia. Fourteen schizophrenia patients and eight healthy controls had polysom- Dimitrios Mylonas, Department of nography during two overnights and three afternoon naps. Although spindle density Psychiatry, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, was lower during naps than nights, the two measures were highly correlated. For USA. both groups, naps and nights provided highly reliable estimates of spindle density. -
Sleep Is for Forgetting
464 • The Journal of Neuroscience, January 18, 2017 • 37(3):464–473 Dual Perspectives Dual Perspectives Companion Paper: Sleep to Remember, by Susan J. Sara Sleep Is for Forgetting Gina R. Poe Department of Integrative Biology and Physiology, University of California, Los Angeles, Los Angeles, California 90095-7246 It is possible that one of the essential functions of sleep is to take out the garbage, as it were, erasing and “forgetting” information built up throughout the day that would clutter the synaptic network that defines us. It may also be that this cleanup function of sleep is a general principle of neuroscience, applicable to every creature with a nervous system. Key words: depotentiation; development; mental health; noradrenaline; REM sleep; spindles; theta; TR sleep Introduction was for forgetting useless tidbits of information learned through- In this article, I discuss and illustrate the importance of forgetting out the day that, if not eliminated, would soon saturate the mem- for development, for memory integration and updating, and for ory synaptic network with junk. Therefore, the type of forgetting resetting sensory-motor synapses after intense use. I then intro- we will discuss here is also not the global synaptic weight down- duce the mechanisms whereby sleep states and traits could serve scaling of the synaptic homeostasis hypothesis (SHY) (Tononi this unique forgetting function separately for memory circuits and Cirelli, 2003), although evidence from excellent experiments within reach of the locus coeruleus (LC) and those formed and used to support the idea of sleep for synaptic homeostasis will be governed outside its noradrenergic net. Specifically, I talk about used to make points here. -
Last Review Status/Date
Federal Employee Program® 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.60.11 Section: Prescription Drugs Effective Date: January 1, 2020 Subsection: Central Nervous System Drugs Original Policy Date: December 7, 2011 Subject: Sedative Hypnotics Page: 1 of 7 Last Review Date: December 6, 2019 Sedative Hypnotics Description Ambien (zolpidem), Ambien CR (zolpidem extended-release), Dalmane (flurazepam), Edluar (zolpidem sublingual), Halcion (triazolam), Intermezzo (zolpidem sublingual) Lunesta (eszopiclone), Prosom (estazolam), Restoril (temazepam), Sonata (zaleplon), Zolpimist (zolpidem) Oral Spray Background Insomnia is defined as complaints of disturbed sleep in the presence of adequate opportunity and circumstance for sleep. The disturbance can consist of one or more of three features: difficulty in initiating sleep; difficulty in maintaining sleep; or waking up too early. Insomnia can be primary or secondary to a variety of medical illnesses, psychiatric disorders, or drug use. Identifying and treating potential underlying conditions or comorbid diagnoses are priorities in the treatment of insomnia. In order to treat insomnia, various treatment modalities should be considered, such as sleep hygiene, sleep restriction, stimulus control and cognitive behavioral therapy, prior to the addition of pharmacotherapy, and continued throughout pharmacotherapy treatment (1-2). The treatment of insomnia should be individualized and is dependent on the differential diagnosis. Although short-term therapy is appropriate for most patients, some patients may benefit from long-term use. Patients with insomnia that occurs several days per week and lasts for more than a month may have the diagnosis of chronic insomnia. There are indications that long-term management of chronic insomnia may be beneficial.