Guided imagery: an innovative approach to improving maternal sleep quality.

Mothers of preterm infants are at risk for poor sleep quality, which may adversely affect their health, maternal-infant attachment, and infant caretaking activities. This study examined the relationship of an 8-week relaxation guided imagery intervention on sleep quality and the association between sleep quality and maternal distress (perceived stress, depressive symptoms, and state anxiety) in 20 mothers of hospitalized preterm infants. Mothers received a CD (compact disc) with three 20-minutes recordings and were asked to listen to at least 1 recording daily for 8 weeks. This analysis used self-report data gathered at baseline and 8 weeks. Pearson correlations were used to examine the relationships between mean cumulative relaxation guided imagery use and measures of maternal distress and sleep quality scores at 8 weeks. Complete data on 19 mothers were available for analysis. At 8 weeks, higher mean relaxation guided imagery use was inversely correlated with sleep quality scores (r = -0.30); sleep quality scores were positively correlated with stress (r = 0.42), depressive symptoms (r = 0.34), and anxiety (r = 0.39) scores. In mothers of preterm infants, sleep quality was negatively affected by mental distress and may be improved by a guided imagery intervention.

An open trial of pregabalin as an acute and maintenance adjunctive treatment for outpatients with treatment resistant bipolar disorder.

BACKGROUND: Pregabalin is a structural analog of GABA, similar to gabapentin. It does not have a FDA indication for any psychiatric disorder in the USA. There has been one case report of the successful use of pregabalin as an augmenting agent in a patient with Bipolar Disorder (BD). In the present open label study, not subsidized by the manufacturer, the investigators prospectively evaluated the acute and maintenance efficacy of pregabalin as an adjunctive medication for a group of treatment refractory outpatients with BD. METHODS: Older adolescent and adult outpatients with any type of DSM-IV diagnosed BD, who were considered treatment nonresponders to multiple standard medications for BD, were treated with adjunctive pregabalin. The baseline mood state before initiation of pregabalin was compared to the mood state after an acute trial of pregabalin using the Clinical Global Impression-Bipolar Version Scale (CGI-BP). All acute responders were treated for a minimum of two months. Follow-up maintenance treatment data was obtained for the acute pregabalin responders for three years after the 18 month acute phase of the study. RESULTS: Fifty-eight total patients were treated adjunctively with pregabalin. Twenty-four (41%) were rated as acute responders. For the acute responders, pregabalin produced either a mood stabilizing effect, antidepressant effect or antimanic effect. Intolerable side-effects were the most common reason (79%) for a failed acute trial of pregabalin. None of the side effects resulted in serious medical complications. No patient abused pregabalin, and there were no adverse drug-drug interactions despite an average of 3.3 concurrent other psychiatric medications. The maintenance data revealed that 10 (42%) of the original 24 acute pregabalin responders were still taking pregabalin as an add-on medicine for an average of 45.2 months (range 42-48, SD: 2.35). LIMITATIONS: This study has an open label observation design. CONCLUSIONS: The results of this preliminary open study suggest that pregabalin is a safe and effective acute and maintenance adjunctive treatment for a significant number of treatment-resistant outpatients with any type of BPD. It appears to have mood stabilizing and antidepressant properties in addition to antimanic effects. Similar studies using a double-blind, randomly controlled design would be useful to confirm the reliability and validity of the results of this study.

Efficacy and safety of nonbenzodiazepine hypnotics for chronic insomnia in patients with bipolar disorder.

BACKGROUND: Insomnia in patients with bipolar disorder (BD) can cause distress, daytime dysfunction, cognitive impairment, worsening of hypomanic/manic symptoms and increased suicide risk. Physicians often prescribe hypnotics for BD patients with insomnia although no hypnotic has a specific FDA indication for this use. In this study, the patterns of use, efficacy and safety of five nonbenzodiazepine hypnotics (NBZHs) were assessed in a large group of outpatients with BD. METHOD: A chart review was performed for all older adolescents and adult BD outpatients in a private outpatient clinic. Clinical data was collected for any patient who had ever been prescribed a NBZH for insomnia and included successful current use, past unsuccessful treatments, side effects, duration of use, concurrent psychiatric medications, and absence or presence of untoward events often associated with chronic use of hypnotics. RESULTS: A significant number of BD patients take NBZHs as needed or on a daily basis. Four NBZHs had adequate success rates; ramelteon was limited in efficacy. Some patients experienced satisfactory results from a NBZH after unsuccessful trials with one or more other NBZHs. About half of the current NBZH users are taking them on a daily long-term basis, and none of these patients have experienced unacceptable untoward events. About three quarters of the chronic NBZH users are taking antimanic medications concurrently, and less than half of the chronic users are taking antidepressants. LIMITATIONS: The results may not be generalizable to other BD populations. A control group was not included in the design. Chronic users of NBZHs were not asked to discontinue their NBZH in order to confirm indication for long-term use. CONCLUSIONS: Most NBZHs can be effective and safe agents for selected BD outpatients with episodic or chronic insomnia. Failure to respond to one or more NBZH does not preclude a satisfactory response to a different NBZH. Some BD patients who take maintenance antimanic agents also require NBZH treatment. Overactivation from antidepressant treatment does not contribute to chronic NBZH use in most BD patients.

Experimental and modeling study of thermal rate coefficients and cross sections for electron attachment to C(60).

Thermal electron attachment to C(60) has been studied by relative rate measurements in a flowing afterglow Langmuir probe apparatus. The rate coefficients of the attachment k(1) are shown to be close to 10(-6) cm(3) s(-1) with a small negative temperature coefficient. These results supersede measurements from the 1990s which led to much smaller values of k(1) with a large positive temperature coefficient suggesting an activation barrier. Theoretical modeling of k(1) in terms of generalized Vogt-Wannier capture theory shows that k(1) now looks more consistent with measurements of absolute attachment cross sections sigma(at) than before. The comparison of capture theory and experimental rate or cross section data leads to empirical correction factors, accounting for "intramolecular vibrational relaxation" or "electron-phonon coupling," which reduce k(1) below the capture results and which, on a partial wave-selected level, decrease with increasing electron energy.

Psychiatric reactions to isotretinoin in patients with bipolar disorder.

BACKGROUND: Isotretinoin (Accutane(R)) has been available for the treatment of severe cystic acne for about twenty-five years. There have been several reports of adverse psychiatric reactions to isotretinoin, including depressive symptoms and suicide. However, there have been only three case reports of patients with bipolar disorder (BD) who experienced an untoward psychiatric side effect while receiving isotretinoin treatment. In this study, the psychiatric side effects from isotretinoin were assessed in a larger group of BD patients than has previously been reported. METHODS: A retrospective chart review of 300 BD outpatients identified ten patients treated with isotretinoin. RESULTS: Nine of these ten patients experienced a significant worsening of mood symptoms, and three developed suicidal ideation. Eight experienced a reversal of the relapsed mood symptoms when the isotretinoin was discontinued, whether prematurely or after a full course. LIMITATIONS: The limitations of this study include small sample size, retrospective data collection, absence of double-blind controlled design, and inability to control for spontaneous mood episodes in patients with BD. CONCLUSIONS: These results indicate that BD patients treated with isotretinoin for acne are at risk for clinically significant exacerbation of mood symptoms, including suicidal ideation, even with concurrent use of psychiatric medicines for BD. The clinical implications of this study are especially relevant to the treatment of patients with BD because acne usually occurs during adolescence, which is often the age of onset of BD and because a common side effect of lithium (a standard treatment for BD) is acne.

Electron attachment to halomethanes at high temperature: CH(2)Cl(2), CF(2)Cl(2), CH(3)Cl, and CF(3)Cl attachment rate constants up to 1100 K.

We have used a high-temperature flowing-afterglow Langmuir-probe apparatus to measure rate constants for electron attachment to halomethanes which attach electrons very inefficiently at room temperature, yielding Cl(-) ion product. We studied CH(2)Cl(2) (495-973 K), CF(2)Cl(2) (291-1105 K), and CF(3)Cl (524-1004 K) and include our recent measurement for CH(3)Cl (700-1100 K) in the discussion of the electron attachment results. The measured attachment rate constants show Arrhenius behavior in the temperature ranges examined, from which estimates of rate constants at 300 K may be made: CH(2)Cl(2) (1.8x10(-13) cm(3) s(-1)), CH(3)Cl (1.1x10(-17) cm(3) s(-1)), and CF(3)Cl (4.2x10(-14) cm(3) s(-1)), all of which are difficult to measure directly. In the case of CF(2)Cl(2), the room temperature rate constant was sufficiently large to be measured (1.6x10(-9) cm(3) s(-1)). The Arrhenius plots yield activation energies for the attachment reactions: 390+/-50 meV (CH(2)Cl(2)), 124+/-20 meV (CF(2)Cl(2)), 670+/-70 meV (CH(3)Cl), and 406+/-50 meV (CF(3)Cl). Comparisons are made with existing data where available. G3 calculations were carried out to obtain reaction energetics. They show that the parent anions of CH(2)Cl(2) CF(2)Cl(2), CH(3)Cl, and CF(3)Cl are stable, though CH(3)Cl(-) exists only as an electrostatically bound complex.

A new instrument for thermal electron attachment at high temperature: NF3 and CH3Cl attachment rate constants up to 1100 K.

A new high temperature flowing afterglow Langmuir probe (HT-FALP) apparatus is described. A movable Langmuir probe and a four-needle reactant gas inlet were fitted to an existing high temperature flowing afterglow apparatus. The instrument is suitable for study of electron attachment from 300-1200 K, the upper limit set to avoid softening of the quartz flow tube. We present results for two reactions over extended ranges: NF(3) (300-900 K) and CH(3)Cl (600-1100 K). Electron attachment rate constants for NF(3) had been measured earlier using our conventional FALP apparatus. Those measurements were repeated with the FALP and then extended to 900 K with the HT-FALP. CH(3)Cl attaches electrons too weakly to study with the low temperature FALP but reaches a value of approximately 10(-9) cm(3) s(-1) at 1100 K. F(-) is produced in NF(3) attachment at all temperatures and Cl(-) in CH(3)Cl attachment, as determined by a quadrupole mass spectrometer at the end of the flow tube. Future modifications to increase the plasma density should allow study of electron-ion recombination at high temperatures.

Mood-elevating effects of opioid analgesics in patients with bipolar disorder.

Opioids can have mood-elevating effects in healthy subjects and have been used successfully to treat refractory depressed patients. A few case reports indicate that opioid analgesics can induce mania. The authors investigated the mood reaction of opioid analgesics in patients with bipolar disorder. Nine (27%) of 33 patients who took opioid analgesics for medical reasons experienced a significant hypomanic/manic reaction, and two other patients reported an antidepressant effect. None of the comparison subjects reported a significant mood reaction from opioid analgesics. These results indicate that opioid analgesics can have an important mood-altering effect on patients with known bipolar disorder.

An open case series on the utility of tiagabine as an augmentation in refractory bipolar outpatients.

BACKGROUND: Tiagabine (Gabitril) is a GABA uptake inhibitor recently introduced in the United States as an adjunctive treatment for partial complex seizures. Three published studies have addressed the use of tiagabine for bipolar disorder (BPD); two described positive results and one negative results. We assessed the efficacy of add-on tiagabine in a larger sample of adult BPD outpatients. METHODS: Twenty-two adult outpatients with DSM-IV diagnosed BPD of some type who were considered unsatisfactory responders to standard medications for BPD were treated in an open fashion with adjunctive tiagabine in a low-dose range. After baseline demographic data and mood state at the time of entry were documented, each patient was monitored clinically for at least 6 months while the dose of tiagabine was adjusted according to the patient's clinical status. The subjects were rated using the clinical global impression-bipolar version scale (CGI-BP). RESULTS: After 6 months, eight (36%) of the patients were responders to tiagabine by CGI-BP rating. The dose range of tiagabine for responders was 1-8 mg per day. All 14 nonresponders had to discontinue tiagabine because of unacceptable but reversible side effects; one nonresponder experienced breakthrough absence seizures. LIMITATIONS: This study was performed in a nonrandom, open naturalistic clinical setting. The sample size was small. CONCLUSIONS: Low-dose tiagabine appears to have mood-stabilizing and antimanic properties as an add-on medication for some adult outpatients who have BPD refractory to standard medications. Tiagabine appears to be safe for most adult BPD outpatients. The results of this preliminary open study await confirmation by double-blind controlled studies.