Chronic Barbiturate Intoxication

Abstract

ISBELL and co-workers, in 1950, showed that the behavior and neurological status of five patients experimentally intoxicated with large amounts of barbiturates for 92 to 144 days resembled that of patients chronically intoxicated with alcohol. Also, convulsions and/or a delirium followed abrupt withdrawal of barbiturates from these chronically intoxicated persons. The purpose of the present communication is to extend the series of Isbell and co-workers, from 5 to 19 cases, in order that the variations in the clinical picture of barbiturate addiction, withdrawal, and recovery can be more completely delineated. In addition, a larger series would provide sufficient controls to permit evaluation of therapeutic regimens. SUBJECTS AND METHODSFive of the subjects included in this study were those used by Isbell and co-workers,1 and they have been identified in both reports by the same code numbers, SI, S2, P3, P4, and A5. Fourteen additional male volunteers in general good physical state were selected for study shortly after their admission to the U. S. Public Health Service Hospital, in Lexington, Ky. All gave histories of addiction to opiates and chronic intoxication with large amounts of bar¬ biturates, but, after the study was completed, Patients 7, 11, and 16 retracted the history of barbiturate intoxication prior to admission. None of the patients studied had personal or familial histories of epilepsy or psychoses.The patients were continuously observed in a special closed ward throughout the study. The precautions taken have been described by Isbell and co-workers.1 Since the patients were all addicted to opiates as well as being chronically intoxicated with barbiturates, it was necessary to convert their mixed addictions to a chronic intoxication with a single barbiturate. Following transfer to the special ward, secobarbital was administered orally six times daily in the highest dosage compatible with safe ambulatory management. Secobarbital was chosen as the drug to be used in these investigations because our patients seem to prefer this barbiturate to all others. Methadone was substituted for whatever opiate the patient had been using, and then it was gradually withdrawn over a period of 10 to 14 days ; thereafter, no opiates were prescribed. Administration of secobarbital was continued at the same level during and after withdrawal of methadone. The nutritional status of all patients was evaluated. All received supplements of milk and fruit juice in addition to

Rebound Insomnia and Rebound Anxiety: A Review

“…Development of a clinical sy ndrome fol lowing withdrawal from chronically adminis tered large doses of sedative-hypnotics and tranquilizers has been recognized for many years [1][2][3][4][5][6][7][8][9][10]. Clinical observations docu mented withdrawal sy ndromes characterized by symptoms opposite to those for which drug treatment was intended (agitation, tre mulousness.…”

“…Clinical observations docu mented withdrawal sy ndromes characterized by symptoms opposite to those for which drug treatment was intended (agitation, tre mulousness. insomnia, hyperpyrexia, and even convulsive seizures) [1][2][3][4][5][6][7][8][9][10].…”