INSOMNIA IN JAIL INMATES: A STUDY FROM THE SUB HIMALAYAN REGION OF NORTH INDIA.

Introduction: Insomnia has been defined as having difficulty in initiating or maintaining sleep, or experiencing early morning awakenings, with resultant daytime impairment.1,2,3 Insomnia is a serious condition that affects over 60% of the prison population and has been associated with aggression, anger, impulsivity, suicidality, and increased prison health care use. 4 Hence management of insomnia in jail inmates become important. Benzodiazepines are commonly prescribed medications for insomnia. According to the FDA, fast-onset, short acting benzodiazepines should not be prescribed for more than five consecutive weeks, to avoid the risk of dependency. Though in reality, they are commonly used for longer durations which can lead to complications.5 Mirtazapine is an antidepressant drug with US Food and Drug Administration approval for the management of major depressive disorder. At lower doses mirtazapine is often used for management of insomnia. Methods: This study consisted of a sample of 40 jail inmates who were on benzodiazepine for insomnia. Benzodiazepine was cross tapered with mirtazapine. Insomnia was studied using daily sleep diary which was assessed weekly. Results: The study identified that mirtazapine at lower dose can be used for long term management of insomnia. Discussion: In long term management of insomnia not only medications but sleep hygiene, regular exercise and education regarding the effects of long term use of sedatives should be included as is done in general population. Keywords: jail inmates, insomnia, mirtazapine, benzodiazepine.

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Morphine in slow-release tablets

Drug and Therapeutics Bulletin ◽

10.1136/dtb.19.11.44 ◽

1981 ◽

Vol 19 (11) ◽

pp. 44-44

Keyword(s):

Aqueous Solution ◽

Severe Pain ◽

Slow Release ◽

Early Morning ◽

Morphine Sulphate ◽

Intractable Pain ◽

Release Formulation ◽

Slow Release Formulation ◽

Term Management

Slow-release tablets containing 10 mg morphine sulphate (MST-1 Continus - Napp) have recently been introduced for the long-term management of patients with severe and intractable pain. Morphine is the analgesic of choice for severe pain in cancer,1 but when given by mouth as an aqueous solution it needs to be taken every 4 hours. This solution is convenient for most patients, but those who are forgetful, live alone or have poor eyesight may find their therapy difficult to manage. The aim of a slow-release formulation of morphine is to allow a reduction in the frequency of analgesic administration, and given at bedtime it may also help patients who would otherwise wake in pain in the early morning.

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Ultrastructural investigations of MDL 19,660-induced effects on the canine platelet and megakaryocyte

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100159412 ◽

1990 ◽

Vol 48 (3) ◽

pp. 374-375

Author(s):

D.E. Loudy ◽

J. Sprinkle-Cavallo ◽

J.T. Yarrington ◽

F.Y. Thompson ◽

J.P. Gibson

Keyword(s):

Antidepressant Drug ◽

Beagle Dogs ◽

Long Term Effects ◽

Short Term ◽

Platelet Counts ◽

Toxicological Studies ◽

Induced Aggregation ◽

Internal Architecture

Previous short term toxicological studies of one to two weeks duration have demonstrated that MDL 19,660 (5-(4-chlorophenyl)-2,4-dihydro-2,4-dimethyl-3Hl, 2,4-triazole-3-thione), an antidepressant drug, causes a dose-related thrombocytopenia in dogs. Platelet counts started to decline after two days of dosing with 30 mg/kg/day and continued to decrease to their lowest levels by 5-7 days. The loss in platelets was primarily of the small discoid subpopulation. In vitro studies have also indicated that MDL 19,660: does not spontaneously aggregate canine platelets and has moderate antiaggregating properties by inhibiting ADP-induced aggregation. The objectives of the present investigation of MDL 19,660 were to evaluate ultrastructurally long term effects on platelet internal architecture and changes in subpopulations of platelets and megakaryocytes.Nine male and nine female beagle dogs were divided equally into three groups and were administered orally 0, 15, or 30 mg/kg/day of MDL 19,660 for three months. Compared to a control platelet range of 353,000- 452,000/μl, a doserelated thrombocytopenia reached a maximum severity of an average of 135,000/μl for the 15 mg/kg/day dogs after two weeks and 81,000/μl for the 30 mg/kg/day dogs after one week.

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