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IntroductionPoor sleep is prevalent among individuals with social anxiety disorder (SAD) and may negatively affect exposure therapy outcomes. Poor sleep may impair memory and learning, and thus compromise fear extinction learning thought to take place in exposure therapy. We examined poor sleep as a predictor of exposure therapy outcomes for SAD and the moderating role of d-cycloserine (DCS) on this relationship.MethodsParticipants were 152 individuals with a primary diagnosis of SAD. As part of a randomized clinical trial evaluating the efficacy of DCS for enhancing the effects of exposure therapy, they completed self-report baseline measure of sleep quality, and self-report sleep diaries assessing sleep duration (total sleep time [TST]) and sleep quality the nights before and after treatment sessions.ResultsPoorer baseline sleep quality was significantly associated with slower improvement over time and worse symptom outcomes at the end of treatment and follow-up after controlling for baseline symptoms of depression and social anxiety. Greater TST the night before treatment predicted lower SAD symptoms at the next session, after controlling for symptoms at the previous session. There was no relation between prior or subsequent night sleep quality on symptoms at the next session. No associations were moderated by DCS.ConclusionsWe replicated and extended findings indicating that poor sleep quality is associated with poorer exposure therapy outcomes for SAD. Assessing for sleep difficulties before treatment initiation and incorporating sleep interventions into treatment may enhance exposure therapy outcomes for SAD.

BackgroundSleep disturbance is a core feature of post-traumatic stress disorder (PTSD). Given the relationship between sleep disturbance and PTSD, there has been a relative paucity of studies examining the potential therapeutic impact of using pharmacotherapy to target sleep disturbance in patients with PTSD. Eszopiclone (ESZ) is a non-benzodiazepine y-aminobutyric acid-A receptor agonist indicated for the treatment of sleep and may affect sleep in patients with PTSD.AimTo evaluate the efficacy of ESZ vs placebo (PBO) for patients with PTSD and insomnia.MethodsThe study was a 12-wk, double blind, randomized controlled trial with 3 mg of ESZ (n = 13) or PBO (n = 12).ResultsPatients in both arms experienced significant improvement in PTSD symptoms as assessed by the Clinician-Administered PTSD Scale for DSM-IV (CAPS): ESZ (t11 = -3.12, P = 0.005) and PBO (t11 = -3.5, P = 0.002) and by self-report with the Short PTSD Rating Interview (ESZ t11 = -3.38, P = 0.003 and PBO t11 = -4.48, P = 0.0005). There were no significant differences between treatments on the CAPS (t22 = -0.13, P = 0.70) or the Short PTSD Rating Interview (t22 = -0.58, P = 0.56). Similarly, both treated groups improved on sleep measures as assessed by the Pittsburgh Sleep Quality Index with PTSD Addendum (PSQI) and on total sleep time (TST) and sleep latency assessed by actigraphy with no significant differences between groups (PSQI t22 = -0.24, P = 0.81; total sleep time t10 = 0.13, P = 0.90 and sleep latency t10 = 0.68, P = 0.50). There was a significant correlation between improvement in sleep and overall improvement in PTSD as measured by change scores on the PSQI and CAPS, r(8) = 0.79, P = 0.01 for ESZ treated subjects, but not for those treated with PBO r(9) = 0.16, P = 0.69. Adverse events of ESZ were consistent with the known profile of the medication including dysgeusia (30%, mild), sedation (20%, mild) and headache (20%, moderate to severe).ConclusionResults do not support the hypothesis of a specific positive effect of ESZ compared to PBO for measures of PTSD and associated sleep disturbance.

Cites findings of a study conducted to determine how long after administration of Klonopin or benzodiazepine clonazepam (CLO) the drug and its major metabolite 7-aminoclonazepam (7-ACLO) could be detected in urine. Benefits of the experiment in investigation of sexual assault cases; Methodology adopted by researchers for the study; Finding that the urine for every subject of the study was positive for 7-ACLO even 14 days after administration of the drug.

The objective of this paper was to determine whether benzodiazepine clonazepam (CLO) and its major metabolite 7-aminoclonazepam (7-ACLO) could be detected in hair collected from healthy volunteers after receiving a single 3-mg dose of Klonopin (clonazepam). Such data would be of great importance to law enforcement agencies trying to determine the best time interval for hair collection from a victim of drug-facilitated sexual assault (DFSA) in order to reveal drug use. Ten healthy volunteers (6 women and 4 men, 23-49 years old) participated in the study. The following hair samples were collected from each volunteer: one before CLO administration, and 1, 3, 5, 14, 21, and 28 days after. All hair samples were pulverized and 50-mg aliquots were sonicated in methanol and digested with 0.1 N HCl at 55 degrees C for 18-24 h. Internal standard, diazepam-d5 (DIAZ-d5) was used. Both extracts were combined and extracted using HCX solid-phase extraction columns. After derivatization with HFBA all extracts were analyzed using highly sensitive negative chemical ionization gas chrometography-mass spectrometry. Standard curves for CLO (20-100 pg/mg) and 7-ACLO (1-20 pg/mg) were prepared by spiking aliquots (50 mg) of negative hair and had correlation coefficients of 0.985 and 0.989, respectively. In addition, two levels of control hair were prepared for CLO and 7-ACLO. All method validation parameters were within acceptable limits. 7-ACLO was detected in hair of 6 out of 10 volunteers. In two cases 7-ACLO appeared in hair three days after CLO intake and remained detectable for the entire 28-day study period (3.6-8.4 pg/mg and 2.7-3.0 pg/mg), and in two subjects it was detectable 21 days later (4.9 and 2.7 pg/mg and 1.2 and 23 pg/mg). In two volunteers 7-ACLO was detected only on day 28 (1.8 and 3.3 pg/mg). CLO was not detected in any of the samples.