Efficacy and Side Effects of Chloral Hydrate and Tryptophan
as Sleeping Aids in Psychogeriatric Patients

Linnoila, Markku; Viukari, M; Numminen, A; Auvinen, Jussi

doi:10.1159/000468423

Cited by 25 publications

(8 citation statements)

References 3 publications

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“…The present communication reports observations made to verify our clinical impression that, while LT can be an extremely effective hypnotic agent, this important action occurs in only a minority of those who receive the agent 4–5 . These pilot observations, which support this fact, form the basis for an ongoing study of biochemical factors that not only attempts to characterize LT‐responders but will, in addition, serve as a reference point in a search for clinically applicable strategies concerned with increasing an individual's hypnotic respon‐sivity to LT 6 …”

supporting

confidence: 52%

l‐Tryptophan as a Hypnotic in Special Patients

Fitten

Profita

Bidder

1985

J American Geriatrics Society

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The authors briefly review prevalence and current treatment trends of sleep disorders in the elderly, underlining the need for the development of a more suitable hypnotic for this population. The use of L-tryptophan (LT) as a physiologic hypnotic in aged responders is considered and the hypnotic effect of 1- to 4-g bedtime doses on ten male inpatients and outpatients aged 30 to 72 years is evaluated. Results suggest a dramatic and sustained relief of insomnia for 3 weeks in 30 per cent of the patients and the absence of side effects in 90 per cent of those who took the agent. The authors conclude that despite its long therapeutic history, L-tryptophan has not been more successful because only a minority of humans appear to be responsive to its hypnotic actions. They point to the need to replicate their current preliminary observations in a larger controlled geriatric population and to delineate biochemical characteristics of LT responders in order to increase LT sensitivity in some patients and convert nonresponders to responders.

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supporting

confidence: 52%

l‐Tryptophan as a Hypnotic in Special Patients

Fitten

Profita

Bidder

1985

J American Geriatrics Society

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“…Chloral hydrate usually has been studied as a sedative in the elderly 136–138 . One placebo‐controlled study of chloral hydrate in a mixed patient group showed a decrease in agitation, 139 whereas two other studies reported significant problems with side effects in organic mental disorder patients during short‐term use 140 or withdrawal of the drug 141 . If agitation in the dementia patient is due to coexisting major depression, treatment with antidepressants may alleviate the behavioral problems 142,143 …”

Section: Other Drugsmentioning

confidence: 99%

Pharmacologic Treatment of Agitation Associated With Dementia

Risse

Barnes

1986

J American Geriatrics Society

120

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Pharmacotherapy of aggressive or agitated behaviors in the dementia patient has not been studied extensively, despite the prevalence of this problem. Neuroleptics have the most support for efficacy, with shorter acting benzodiazepines demonstrating benefit on occasion. However, studies done to date indicate that these drugs are effective only for a minority of patients and that side effects frequently make patients worse. Other medications, such as propranolol, carbamazepine, or lithium, may be helpful, but their efficacy in dementia patients has not been demonstrated in placebo-controlled studies. Until such studies are done, their use is most appropriate in special patient groups or in patients who have failed neuroleptic or benzodiazepine treatment. More studies are needed in elderly patients evaluating effectiveness of pharmacologic agents in specific types of dementia, particularly Alzheimer's disease. Most studies done to date have been of relatively short duration, usually two months or less. Because these medications often are given to dementia patients for prolonged periods, studies are needed to define the long-term clinical efficacy of these agents. In the clinical setting, these agents should be reduced periodically or discontinued to determine ongoing need. In addition, environmental, social, or behavioral methods of reducing agitated behaviors need to be explored as an adjunct to any medication trial.

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“…Subjective evaluation of sleep quality was improved, but this effect did not reach statistical significance. Linnoila et al (1980) administered 3 g L-tryptophan for 7 nights to 19 female psychogeriatric inpatients, mean age of 77.4 years. Sleep was assessed by ratings made by ward nurses every 15 min.…”

Section: Questionnaire and Self-report Studiesmentioning

confidence: 99%

Evaluation of l-tryptophan for treatment of insomnia: A review

Schneider-Helmert

Spinweber

1986

Psychopharmacology

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Sleep laboratory and outpatient studies of the hypnotic efficacy of the amino acid L-tryptophan are reviewed, with particular emphasis on evaluation of therapeutic effectiveness in the treatment of insomnia. In younger situational insomniacs, whose sleep problem consists solely of longer than usual sleep latencies, L-tryptophan is effective in reducing sleep onset time on the first night of administration in doses ranging from 1 to 15 g. In more chronic, well-established sleep-onset insomnia or in more severe insomnias characterized by both sleep onset and sleep maintenance problems, repeated administration of low doses of L-tryptophan over time may be required for therapeutic improvement. In these patients, hypnotic effects appear late in the treatment period or, as shown in some studies, even after discontinuation of treatment. The improvement in sleep measures post-treatment has given rise to use of a treatment regimen known as "interval therapy", in which L-tryptophan treatment alternates with an L-tryptophan-free interval until improvement occurs. The absence of side effects and lack of development of tolerance in long-term use are important factors in the decision to embark upon a trial of L-tryptophan treatment. In addition, L-tryptophan administration is not associated with impairment of visuomotor, cognitive, or memory performance, nor does it elevate threshold for arousal from sleep.

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Efficacy and Side Effects of Chloral Hydrate and Tryptophan as Sleeping Aids in Psychogeriatric Patients

Cited by 25 publications

References 3 publications

l‐Tryptophan as a Hypnotic in Special Patients

l‐Tryptophan as a Hypnotic in Special Patients

Pharmacologic Treatment of Agitation Associated With Dementia

Evaluation of l-tryptophan for treatment of insomnia: A review

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