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By B. Ningal. Shimer College.

The binding of a drug to plasma proteins will primarily be a function of the affinity of the protein for the drug himplasia 30 caps fast delivery earthsong herbals. The percentage of protein binding of a drug in plasma can be determined experimentally as follows: where [total] is the total plasma drug concentration (unbound drug + bound drug) and [unbound] refers to the unbound or free plasma drug concentration purchase himplasia 30 caps visa rumi herbals chennai. Another way of thinking about the relationship between free and total drug concentration in the plasma is to consider the fraction of unbound drug in the plasma (Fp) purchase 30 caps himplasia otc lotus herbals 3 in 1. Fp is determined by the following relationship: Although the protein binding of a drug will be determined by the affinity of the protein for the drug, it will also be affected by the concentration of the binding protein. Two frequently used methods for determining the percentage of protein binding of a drug are equilibrium dialysis and ultrafiltration. Three plasma proteins are primarily responsible for the protein binding of most drugs. Although only the unbound portion of drug exerts its pharmacologic effect, most drug assays measure total drug concentrationboth bound and unbound drug. Therefore, changes in the binding characteristics of a drug could affect pharmacologic response to the drug. For example, the anticonvulsant and toxic effects of phenytoin are more closely related to the concentration of free drug in plasma than to the concentration of total drug in plasma. In most patients, the free phenytoin concentration is approximately 10% of the total concentration. However, in patients with low serum albumin concentrations, a lower fraction of phenytoin is bound to protein, and the free portion is up to 20% of the total concentration (Table 8-3). With hypoalbuminemia, therefore, a patient with a total phenytoin concentration of 15 mg/L may experience side effects (nystagmus and ataxia) usually seen at a total concentration of 30 mg/L. The plasma concentration of the two major plasma-binding proteins, albumin and alpha-1-acid glycoprotein, are known to be influenced by various disease states as illustrated in Table 8-4. Obviously, such changes could have a significant impact on the plasma protein binding of many drugs. Clinical Correlate For certain drugs that are highly protein bound and have a narrow therapeutic index, it may be useful to obtain an unbound plasma drug concentration rather than a total plasma drug concentration. The extent of protein binding does not consistently predict tissue distribution or half-life. In other words, because an agent has a high fraction bound to protein does not mean it achieves poor tissue penetration. The distribution characteristics of a drug have implications for therapeutic drug monitoring. For drugs whose plasma concentrations are monitored, sites of action are usually recognized. It is important to understand the distribution of an agent from plasma to its site of action. Protein binding is certainly an important consideration in the interpretation of plasma drug concentration data. However, a considerable amount of intra- and interpatient variability exists in the plasma concentration of binding proteins (albumin and alpha-1-acid glycoprotein) as well as their affinity for a specific drug. A major contributor to this variability is the presence of a disease or altered physiologic state, which can affect the plasma concentration or affinity of the binding protein. For example, albumin concentrations are decreased with hepatic or renal dysfunction, and alpha-1-acid glycoprotein concentrations are increased with myocardial infarction. These considerations are important because most plasma drug concentration data available to the clinician are measured as total plasma concentration (bound plus unbound). In addition, most of the therapeutic and toxic plasma concentration ranges available in reference texts are expressed in terms of total drug concentration. Free or unbound drug concentration analysis can also be done but often requires equipment and techniques to separate the protein from the plasma sample that is not available in smaller hospitals. Consequently, these requests may be sent to a reference laboratory, which may delay the final report. Free plasma drug concentrations are also much more expensive than the standard total drug concentrations. Changes in plasma protein binding of drugs can have considerable influence on therapeutic or toxic effects that result from a drug regimen. Provided below are practical considerations regarding plasma protein binding, with examples of specific agents for which these considerations are important to therapeutics. The following questions should be considered when assessing the clinical importance of protein binding for a given drug: • Does the drug possess a narrow therapeutic index? Answers to these questions will help you establish a basis on which to evaluate the clinical significance of changes in plasma protein binding due to drug-drug or drug-disease state interactions.

Moricizine is highly protein-bound generic 30 caps himplasia with amex herbal viagra, leaving only a small portion of the drug free to produce its antiar- rhythmic effect generic himplasia 30caps without a prescription herbs used for anxiety. Moricizine decreases the fast inward current of sodium ions of the action potential buy 30caps himplasia overnight delivery herbals essences, depressing the de- polarization rate and the effective refractory period. They’re also used to treat supraventricular arrhythmias (abnormal heart rhythms that originate above the bundle branches of the heart’s conduction system). Moricizine is used to manage life- threatening ventricular arrhythmias such as sustained ventricular tachycardia. They’re avoided in patients with structural heart de- fects because of a high incidence of mortality. Adverse reactions to moricizine The most serious adverse reaction is the appearance of new arrhyth- mias or the worsening of an existing arrhythmia. Other cardiovascular adverse reactions include palpitations, short- ness of breath, chest pain, heart failure, and cardiac arrest. That means that they can’t penetrate the highly fatty cells that act as barriers be- tween the blood and brain, called the blood-brain barrier. Propranolol has high lipid solubility and readily crosses the blood-brain barrier. No leftovers Propranolol undergoes significant first-pass effect, leaving only a small portion of these drugs available to reach circulation and be distributed to the body. When the heart beats less forcefully, it doesn’t re- quire as much oxygen to do its work. Adverse • The risk of digoxin toxicity increases when digoxin is taken with esmolol. The drugs in this class are amiodarone, dofetilide, ibutilide, • bradycardia and sotalol. Nonselective means that the drug nausea, vomiting, and doesn’t have a specific affinity for a receptor. Slow going After oral administration, amiodarone is absorbed slowly at wide- ly varying rates. The drug is distributed extensively and accumu- lates in many sites, especially in organs with a rich blood supply and fatty tissue. Sotalol’s absorption is slow and varies between 60% and 100%, with minimal protein-binding. Rather, these drugs slow repolarization, prolonging the refractory period and duration of the action potential. Amiodarone is the first-line drug of choice for ventricular tachy- cardia and ventricular fibrillation. When a patient Drug interactions has ventricular • Amiodarone increases phenytoin, procainamide, and quinidine tachycardia, I levels. Sotalol may cause atrioventricular block, bradycardia, ventric- Severe pulmonary toxicity occurs in 15% of patients and can be ular arrhythmias, bronchospasm, and hypotension. The calcium channel blockers verapamil and diltiazem are used to treat supraventricular arrhythmias with a rapid ven- tricular response (rapid heart rate in which the rhythm originates above the ventricles). For a thorough discussion of calcium channel blockers and how they work, see “Calcium channel blockers,” page 138. It’s typi- cally used to treat arrhythmias associated with accessory bypass tracts, as in Wolff-Parkinson-White syndrome (brief periods of rapid heart rate in which the rhythm originates above the ventri- cle). Drug interactions • Methylxanthines antagonize the effects of adenosine, so larger doses of adenosine may be necessary. Common adverse reac- Instead, antianginal drugs treat angina by reducing myocar- tions to adenosine in- dial oxygen demand (reducing the amount of oxygen the heart clude: needs to do its work), by increasing the supply of oxygen to the • facial flushing heart, or both. How antianginal drugs work Angina occurs when the coro- nary arteries (the heart’s pri- mary source of oxygen) supply insufficient oxygen to the myo- cardium. This increases the Afterload heart’s workload, increasing Decreased by heart rate, preload (blood vol- calcium channel blockers and nitrates ume in the ventricle at the end of diastole), afterload (pres- Heart rate sure in the arteries leading Decreased by beta- adrenergic blockers from the ventricle), and force and some calcium of myocardial contractility. This diagram summarizes adrenergic blockers how antianginal drugs affect and calcium channel the cardiovascular system. Ni- trates commonly prescribed to treat angina include: • amyl nitrite • isosorbide dinitrate • isosorbide mononitrate • nitroglycerin. All absorbed… Nitrates given sublingually (under the tongue), buccally (in the pocket of the cheek), as chewable tablets, as lingual aerosols (sprayed onto or under the tongue), or by inhalation (amyl nitrite) are absorbed almost completely because the mucous membranes of the mouth have a rich blood supply. Transdermal nitrates (a patch or ointment placed on the skin) are absorbed slowly and in varying amounts, depending on the quantity of drug applied, the location of its application, the sur- face area of skin used, and circulation to the skin. Pharmacodynamics Nitrates cause the smooth muscle of the veins and, to a lesser ex- tent, the arteries to relax and dilate.

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As a result discount himplasia 30 caps free shipping herbs collinsville il, the body does not just stop growing buy 30caps himplasia mastercard jovees herbals, but also loses its ability to replace dying cells with new 30 caps himplasia overnight delivery herbals summit, which leads to accelerated aging. The phenotype of patients is extremely characteristic: small stature, "bird person" with beak profile, the prevalence of brain the size of the skull on the front, alopecia. Observed defects in shape and number of teeth, dry, thinning skin, the almost complete absence of subcutaneous fat, developmental delays, especially physical. Negative processes are accompanied by the complications inherent to more elderly people: stroke, cardiovascular disease, osteoporosis, joint stiffness, generalized atherosclerosis. The cause of death is usually myocardial infarction with detection at autopsy generalized atherosclerosis and myocardial fibrosis, as well as concretion of lipoid in in the brain tissue and parenchyma organs. There is a wide range of pathology that accompanies normal aging: canities, alopecia, atherosclerosis, osteoporosis, cataracts, diabetes, cancer, geratic skin changes, infertility, impotence. Therefore, there is genetically determined instability of chromosomes, which is expressed in changing of the structure of chromosomes, that arise spontaneously or under the influence of some agents. Histological examination reveals atrophy of the epidermis and appendages of skin, dermis is thickened, collagen fibers are hyalinized, glucosamine contents is increased, the nerve fibers and blood vessels prone to degradation. Today, in the world it is recorded 42 cases of the disease progeria, in Ukraine - only 2. All methods of treatment used today, unfortunately, are not effective and pursued a single goal - to "freeze" the disease to the best of the possibilities of modern medicine. The minimal dose of aspirin is being used – in order to prevent heart attack, statins reduce cholesterol, anticoagulants inhibit the formation of clots, growth hormone increases height and weight, physiotherapy and exercises allow you to develop joints. Carboxytherapy is a method of treating diseases of different etiologies in the application of carbon dioxide. More than 30 years for the treatment and prevention of these diseases carboxytherapy used to eliminate inflammation, chronic articular and muscular pain. Until today, it was impossible to find a single universal method for the majority of diseases. According to pharmacological effects, the carbon dioxide can improve all the body systems, to improve the delivery of oxygen and nutrients, break down fats, eliminate toxins, regenerate tissue and contributing to the widening of capillary network. Also, carboxytherapy eliminate muscular and vascular spasms, relieves myofascial pain syndrome, eliminate venous stasis limfaticheskty that contributes to the improvement of health, improving health and quality of life. The topicality of this topic is that the traditional treatment of diseases associated with the musculoskeletal system, unfortunately, is not always effective. Carboxytherapy in combined administration with drugs widely used therapy at a pathology of the musculoskeletal system. Thus carboxytherapy through physiological mechanisms carbon action provides a number of therapeutic effects: antihypoxic, anti-inflammatory, antihypertensive, cardiotonic, metabolic, reparative and regenerative, antianginal, antispasmodic, analgesic, lipolytic and therefore primenenietsya not only in the treatment of pathologies of joints, but also in other diseases. Besides a high pharmacological activity, one of the most important requirements for medications is their safety. Ulcers of the gastric mucosa have been caused by the intragastric administration of 5 ml/kg of absolute alcohol to the animals fasted for 24 hours. To ensure effective treatment of burns the medicines of local action should identify antioxidant, anti-inflammatory, antimicrobial, reparative activity. But despite the wide range of other medicines on the pharmaceutical market of Ukraine actuality it`s the development of more effective treatments that extend the range of local medicines. Thermal burn is burn, which obtained by contact with a liquid, solid or gaseous heat source. The first place in the statistics occupy flame burns (about 84% of all thermal burns). Second-degree burns are superficial burns, since their depth is not sprout affects the skin layer, thus in places such skin burns itself is able to recover. The stabilization of membrane antioxidants in the 1st phase of wound healing ensures prevention of secondary necrosis, and in the 2nd is stimulate regeneration processes, so the purpose of the study was to investigate the intensity lipid and protein peroxidation in rats with burn wounds in the treatment of study medecines. Second-degree burn modeled in rats under tiopental anesthesia on the dehaired skin of back. To simulate second-degree burn using a special device with a metal plate with a diameter of 2. Blood sampling for analysis performed in two periods: the early discharge of crusts (7th days) and 21th days. In the experiment stick "General ethical animal experimentation" (Ukraine, 2001) harmonized with the "European Convention for the Protection of vertebrate animals used for experimental and other scientific purposes" (Strasbourg, 1985). In the treatment of animals studied gels observed activation of healing burn wounds. Complete epithelization was held for 15th day (gel with glucosamine and glucosamine with nanoparticles of silver) in the group treated with cream "Dermazin" - for 17th day, the control group pathology - in 21th day. This indicates termination of destructive processes in the wound and does not prevent the process of tissue regeneration. Thus, biochemical blood serum tests of animals with burn wounds in the treatment of experimental gels demonstrate the presence membrane stabilizing and antioxidant effect of nanoparticles of silver and glucosamine.

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The premises and the equipment installed there are apparently not completely standardized cheap himplasia 30 caps with visa 18 herbals, although certain principles in the use of the instruments limit fexibility order himplasia 30caps herbals 4 play. They thus refect a degree of diversity stemming from the complexity of different intervening levels buy discount himplasia 30caps line herbals for liver. As the examination of these organizations shows, instrumentation affects strategic choices: either a laboratory maximizes its return from the technologies at its disposal, or it tries to acquire the instrumentation to meet its research objectives, in which case the political/fnancial and technical/clinical levels intervene, levels that bring into play concepts representing different disciplines. In fact, the number of pathways increases in accordance with the instrumentation used, the complexity and/or novelty of the substance under study and the unpredictability of its effects. But a more important aspect is the movement back and forth between the different levels. In addition, the knowledge derived from all the operations is not the product of the observation of a direct effect, for it is not possible to observe the behaviour of cells or proteins directly under a microscope. Indeed, staining and coupling with light-emitting particles are used to provide indicators of the effect under study because they are the only way of verifying cell behaviour. Knowledge may therefore follow variable pathways, particularly circular ones regulated by a systemic mode of organization. Through the relationships that emerge from its physical organization, the laboratory delivers the means by which the knowledge wanted and needed to accomplish its mission may be appropriated and may operate. The networks of actors The networks of actors associated with publications produced by the laboratories were reconstructed for the entire scientifc career of the director of the two related Montreal- area laboratories. We found that, over the 8-year period, the great majority of links emerge from the university-hospital community; the linkages with the other three sectors (university, pharmaceuticals and the Institut) are more limited. Most of these links developed in the felds of expertise of cell and molecular biology, biotechnology and bioengineering, and to a lesser extent in neurosurgery, biochemistry and very occasionally pharmacy. A closer examination of the development of this network over time shows a frst network established in the frst six years of the laboratory director’s career (1979–1984) that was drawn mainly from the university area of activities and the felds of expertise of cell and molecular biology and biotechnology and bioengineering. The network of the next six years proved to be somewhat denser with signifcant growth in ties established with the university-hospital area of activities and the same areas of expertise as in the earlier period: cell and molecular biology and biotechnology/bioengineering. On the other hand, in the university area of activities, the biochemistry feld of expertise assumes greater prominence. The last 16 years display a density that has developed exponentially through the proliferation of ties in the university-hospital sector, bringing into play numerous felds of expertise and the emergence of molecular oncology and endocrinology as a new, predominant feld. The links established in the frst six years are dominated by the hospital sector and to a lesser extent by the university sector, mainly in the felds of expertise of cell and molecular biology and to a lesser extent of biotechnology and bioengineering. This trend is reversed in the next six years; the university overtakes the hospital area of activities and the cell and molecular biology feld of expertise expands across the entire network, while there is stability in the biotechnology and bioengineering felds. In the hospital area of activities, chemistry (chemical engineering) comes into play as a new feld of expertise, while in the university sector, oceanography is added. The pharmaceutical and Institute areas do not account for much in this phase of the construction and circulation of knowledge. The “territory” covered by the two networks is permeated more with cell- and molecular-biology knowledge than with biotechnology and bioengineering. The most marked difference remains the signifcant growth in the feld of expertise of molecular oncology- endocrinology for the two Montreal laboratories. This cannot be explained entirely by the stronger presence of the hospital sector, since it is strong in all three laboratories. The increased signifcance 301 Catherine Garnier of this feld in the evolution of the network may however be accounted for by the development over the past few years of direct relations between the head of the two Montreal laboratories with pediatric-hospital oncologists who have to cope with the expectations of desperate parents. This hypothesis was corroborated by interviews conducted with some of members of the laboratories. The analysis thus reveals the great diversity of disciplines and collaborations that is necessary at this stage of drug development. All this serves to confrm the contextualization of the construction and circulation of knowledge in terms of differential principles of action. The Object Analyses of Publications As we pointed out earlier, scholarly papers are of major importance for laboratories, and so we frst systematically analyzed the scientifc articles and left the popular articles for later examination. The analysis dealt with the scientifc articles published by the three laboratories about Neovastat, green tea catechin and essential oils, including balsam fr. For Neovastat, the descending hierarchical cluster analysis produced 6 clusters of discourse grouping together 304 elementary context units (e. Looking at the clusters in terms of their segmentation by hierarchical level, we fnd ffth- and sixth-cluster groupings at the frst level. In the frst of these (cluster 5), we fnd terms related to metalloprotease, an enzyme particularly involved in angiogenesis, and a metalloprotease activator. The second (cluster 6) is much broader and is related more to cells, especially the integration of the different mechanisms involving cells and receptors. On the second level, the frst grouping is linked to cluster , which concerns angiogenesis itself; it involves, on the one hand, the concept of how cells propagate, proliferate, migrate, and grow; and on the other, the growth factors closely involved in angiogenesis. On the third level, the clusters from the preceding levels join cluster 2, which has to do with apoptosis, or programmed cell death.

The incidences of thymic lymphoma were 0% buy 30 caps himplasia with visa yavapai herbals, 15% himplasia 30 caps low cost herbals for hair loss, 55% and 47% in males in the control buy discount himplasia 30caps on-line bajaj herbals fze, low-dose, high-dose and recovery groups and 0%, 44%, 87% and 90% [effective numbers not reported for either sex] for females in these groups, respectively. Thymic atrophy was the commonest non-neoplastic lesion in treated mice, with incidences of 4%, 19%, 26% and 6% in males in the control, low-dose, high-dose and recovery groups and 0%, 2%, 10% and 2% in females in these groups, respectively. Both males and females in the recovery group had a lower incidence of thymic atrophy than those given the high dose conti- nuously, indicating that cessation of treatment resulted in reversal of thymic atrophy (Rao et al. This dose range is much lower than the 400- and 600-mg daily doses of didanosine and zidovudine, respectively, but the antiviral potency of zalcitabine in cell cultures is much greater than that of these other drugs. Zalcitabine is well absorbed when administered orally, with a bioavailability of the order of 80% (Klecker et al. About 75% of an oral dose is excreted unchanged in the urine, and measurable levels have been found in plasma and cerebrospinal fluid. The peak concentration of zalcitabine in cerebrospinal fluid 2 h after dosing has been reported to be 14% of that in plasma (Klecker et al. Zalcitabine is transported across the cell membrane by nucleoside carrier-mediated and non-carrier- mediated mechanisms, and < 5% is bound to protein (Burger et al. About 10% of the drug appears in the faeces and ~75% is excreted unchanged in the urine, suggesting that renal integrity is important for clearance (Klecker et al. The first step is the formation of zalcitabine monophosphate by the enzyme 2′- deoxycytidine kinase, which is followed by formation of the diphosphate and triphosphate metabolites through the action of the cytosine monophosphate kinase and nucleotide diphosphate kinase enzymes, respectively (Broder, 1990; Burger et al, 1995). Although phos- phorylation is critical for the antiviral activity, it accounts for only a small fraction (probably ~1%) of the total drug disposition. The pharmacokinetics of zalcitabine has been extensively reviewed (Yarchoan et al. Like that of zidovudine and didanosine, the pharmacokinetics of zalcitabine appears to be linear over a broad dose range, and the maximum concentration in plasma is reached by 1–2 h in adults (5–8 ng/mL after a 0. Because a lower dose is given, the peak plasma concentration is only about 10% of those found with zidovudine and 20% of those found with didanosine (Yarchoan et al. The mean rate of plasma clearance was 14–25 L/h, but it decreased with increasing age and weight (Yarchoan et al. Renal clearance is also closely linked to creatinine clearance and body weight (Burger et al. The pharmacokinetics appeared to be similar after an inital dose and during long-term dosing, and there were no significant interactions between zalcitabine and concomitantly administered zidovudine (Vanhove et al. During a 3-h sampling of both the mother and the fetus, the fetal:maternal ratio of the integrated area under the curve of plasma concentration–time was 0. Four pregnant pigtailed macaques (Macaca nemestrina) that were near term (126 days) received an infusion of zalcitabine at a constant rate of 1. The authors concluded that passive transplacental transfer of zalcitabine occurred, with a fetal:maternal concentration ratio of 0. A review of data for several species (Devineni & Gallo, 1995) suggested that the phar- macokinetics in experimental animals and humans were essentially similar. Virtually no zalcitabine was found in cerebrospinal fluid (< 1%) in rats, dogs or monkeys. Approximately 50–80% of the drug was excreted unchanged in the urine, but urinary metabolites were detected only in monkeys. In four microswine given an intravenous bolus dose of 5 mg/kg bw zalcitabine (Swagler et al. Microswine are a good model for the pharmacokinetics of zalcitabine in humans but a less desirable model for the metabolism of zidovudine and didanosine, for which the clearance rates are signifi- cantly lower. In rats, the pharmacokinetics of zalcitabine was stable over a dose range of 10–500 mg/kg bw. It bound to plasma proteins, and 50% of the original dose was excreted unchanged in the urine. Renal clearance exceeded the glomerular filtration rate, suggesting active renal tubular secretion (Ibrahim & Budinot, 1989, 1991). Zalcitabine accumulated preferentially in the liver and spleen of rats (Makabi-Panzu et al. Interspecies scaling indicated that the concentrations in humans can be predicted from the pharmacokinetics in rats. The plasma concentrations reached a maximum of about 15 μg/mL 45 min after oral dosing, and the half-time for plasma clearance was 67 min. About 80% of the drug was recovered unchanged in the urine after intravenous dosing, and about 60% of the drug was found in faeces after oral dosing. High concentrations of the drug were found in mouse kidney, pancreas and liver, and there was low penetration to the central nervous system (Kelley et al. In three rhesus monkeys given 100 mg/kg bw zalcitabine, recovery in the urine was about 75% by five days, as in humans, but only about 9% of the drug was excreted as dideoxyuridine, which is in contrast to the human metabolic pattern. Deamination of zalcitabine to dideoxyuridine does not appear to be a significant reaction in either mice or humans but is measurable in monkeys. The studies suggest that non-human primates are an appro- priate model for studying the pharmacokinetics of zalcitabine in humans. In some of the first clinical trials, peripheral neuropathy manifested as pain, numbness and weakness occurred in 70% of patients receiving doses of ≥ 4.

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The Accuracy of Information Obtained in Hypnosis Considerably less material is available about the veracity of the material furnished by a subject in hypnosis order himplasia 30caps line herbals images. As the preceding discussion indicates order 30 caps himplasia amex herbals postums perses 16, subjects in deep hypnosis tend to confabulate in the direction of what they perceive to be expected of them himplasia 30caps visa yam herbals mysore. We should like to examine the extent to which subjects in hypnosis can purposely misrepresent material, although it has been suggested to them that they cannot do this. As we have already indicated, Young (84) has shown that subjects can resist specific suggestions if they have decided in advance that they will do so. Beigel (6, 7) reports three cases of hypnosis used in an effort to ascertain the facts in marriage counseling situations. In a personal communication, he maintains that people in hypnosis may lie, refuse to answer, or wake up when asked direct questions on sensitive matters. However, he claims to have successfully elicited information which subjects were reluctant to reveal in the waking state by means of a hypnotic reliving of the situation. However, this approach utilizes a form of age regression, and is, as such, subject to the criticisms already made with regard to this technique. It is, perhaps, not too far fetched to assume that psychotherapy patients "want," at some level, to reveal information to their therapist. In reviewing the existing literature we have found only one author who deals with prevarication under hypnosis (Beigel). However, our own clinical work has amply convinced us that subjects are -194- fully capable of deliberately lying when motivated to do so. Although this report deals specifically with hypnosis, it may, at this juncture, be useful to consider also the question of prevarication under the influeuce of drugs commonly used in narcosynthesis. Its relevance is confirmed by the findings of Grinker and Spiegel (28) and others who, in the treatment of traumatic neurosis by narcosynthesis, obtainod results which closely paralleled those observed by hypnotic treatment of these neuroses (17). Individual differences in response to treatment are found both in narcosynthesis and hypnosis, whereas treatment techniques show marked similarities. Friedlander (24), Schilder (63), and others have described trance-induction techniques utilizing sleep-inducing drugs. With these similarities in manner we feel that it is appropriate to mention here some of the work done on the question of prevarication under the influence of these drugs, which as treated in more detail in Chapter 3. In a study of malingering soldiers Ludwig (42) reports that they remained negativistic and uncommunicative while under drugs. Nevertheless, narcoanalysis, when correctly used, may enable the psychiatrist to probe more deeply and quickly into the psychological characteristics of the subject. Thus the bare results of an interview under the influence of drugs should not, standing alone, be considered a valid and reliable indicator of the facts. We feel that these conclusions apply not only to narcoanalysis but to hypnosis as well. If, as we have proposed, an individual under the influence of these drags is in a state akin to hypnosis, then the results of these drug studies support our theory that some subjects may lie, confabulate, or withhold information while in trance. Even those informants who believe they are telling the truth may in fact be offering a composite of delusion, fantasy, and reality. Thus, the convincing delivery of -195- information obtained under hypnosis may easily lead an interrogator astray. There is no evidence to indicate that this technique is anything more than a convincing form of role-playing, real only on an emotional level. Hypnosis does not improve recall for nonmeaningful material, and does so only slightly for meaningful material. However, there is evidence that emotionally laden material that is not normally accessible can be recovered in hypnosis. Inaccuracies may be the result of deliberate prevarication, or of an unwitting confusion of fantasy and reality. The determination of the truth or falsity of information obtained in hypnosis would have to be based on outside criteria. Defensive Uses of Hypnosis Simulation of Hypnosis An interrogator who employs hypnosis may find that his subject apparently enters trance and gives the desired information. The classical view holds that subjects are unable to deceive experienced hypnotists because hypnotic behavior "looks different" in a number of ways. Furthermore, claims have been made that in order to detect fraud the hypnotist need only suggest anesthesia to the subject and test for it with a painful stimulus. However, there are some indications in the literature that the detection of simulation is not a simple task. For example, Pattie (55), a thoroughly experienced investigator, felt that it was necessary to request his subjects sign forms reading as follows: I, realizing that the experiment performed on me will probably be published in a scientific journal, solemnly declare that I was not faking or imitating the hypnotic trance but that I was genuinely hypnotized and do not remember the events of the experimental periods.