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Differential effect of benzodiazepine sedation in high and low anxious patients in a real life stress setting

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TLDR
The results are interpreted as providing support in a “real life” human stress setting for Gray's neuropsychological model of anxiety in patients referred for surgical removal of impacted third molars.
Abstract
In a randomised, double-blind, parallel groups study, 40 patients referred for surgical removal of impacted third molars received either (a) temazepam 40 mg orally followed at 35 min by IV saline or (b) oral placebo followed by IV diazepam 10 mg (Diazemuls). Patients were divided into High-Anxious and Low-Anxious groups by median split of their anxiety scores on the Speilberger State Anxiety Scale at the time of oral medication. Compared with placebo, temazepam significantly attenuated anticipatory anxiety in the High-Anxious group while in the Low-Anxious group no difference was found between the treatments. Preoperative but not intraoperative heart-rate distinguished between the High-Anxious and Low-Anxious groups and neither oral temazepam nor IV diazepam abolished the heart-rate response to the traumatic stages of the surgical procedure. The results are interpreted as providing support in a “real life” human stress setting for Gray's neuropsychological model of anxiety.

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Citations
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The Effects of Early Rearing Environment on the Development of GABAA and Central Benzodiazepine Receptor Levels and Novelty-Induced Fearfulness in the Rat

TL;DR: It is suggested that early life events influence the development of the GABAA receptor system, thus altering the expression of fearfulness in adulthood.
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Decreased GABA A -receptor clustering results in enhanced anxiety and a bias for threat cues

TL;DR: The γ2+/– mice represent a model of anxiety characterized by harm avoidance behavior and an explicit memory bias for threat cues, resulting in heightened sensitivity to negative associations.
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GABAergic Control of Adult Hippocampal Neurogenesis in Relation to Behavior Indicative of Trait Anxiety and Depression States

TL;DR: It is suggested that modestly reduced GABAA receptor function in immature neurons of the developing and adult brain can serve as a common molecular substrate for deficits in adult neurogenesis and behavior indicative of anxious and depressive-like mood states.
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Preoperative anxiolytic effect of melatonin and clonidine on postoperative pain and morphine consumption in patients undergoing abdominal hysterectomy: a double-blind, randomized, placebo-controlled study.

TL;DR: The preoperative anxiolysis with melatonin or clonidine reduced postoperative pain and morphine consumption in patients undergoing abdominal hysterectomy and the effects these 2 drugs were equivalent and greater than with placebo.
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The clinical impact of preoperative melatonin on postoperative outcomes in patients undergoing abdominal hysterectomy.

TL;DR: This finding suggested that preoperative melatonin produced clinically relevant anxiolytic and analgesic effects, especially in the first 24 postoperative hours, and improved the recovery of the potency of the rest/activity circadian rhythm.
References
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Manual for the State-Trait Anxiety Inventory

TL;DR: The STAI as mentioned in this paper is an indicator of two types of anxiety, the state and trait anxiety, and measure the severity of the overall anxiety level, which is appropriate for those who have at least a sixth grade reading level.
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Précis of The Neuropsychology of Anxiety: An Enquiry into the Functions of the Septo-Hippocampal System..

TL;DR: It is proposed that these drugs reduce anxiety by impairing the functioning of a widespread neural system including the septo-hippocampal system (SHS), the Papez circuit, the prefrontal cortex, and ascending monoaminergic and cholinergic pathways which innervate these forebrain structures.
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Circulatory, Plasma Catecholamine, Cortisol, Lipid, and Psychological Responses to a Real-Life Stress (Third Molar Extractions): Effects of Diazepam Sedation and of Inclusion of Epinephrine with the Local Anesthetic

TL;DR: The elimination of sympathetic recruitment by diazepam‐induced sedation, however, without concomitant reductions in heart rate or systolic pressure responses, suggests that other systems besides the sympathetic nervous system influence the circulatory response to this real‐life stress.
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