Andrew D Krystal, Professor of Psychiatry and Behavioral Sciences

Office Location:  54221 Hosp South
Office Phone:  +1 919 681 8742, +1 919 684 2057
Email Address: send me a message
Web Page:  http://faculty.duke.edu/faculty/info?pid=1061

Teaching (Fall 2008):

Education:

M.D.Duke University School of Medicine1987
Research Interests:

My research is focused on better understanding the pathophysiology of sleep disorders and mood disorders and developing improved treatments for these conditions. My primary research tools are: electroencepahlography (EEG), polysomnography (PSG), computer signal analysis and modeling, functional magnetic resonance imaging (fMRI), and positron emission tomograophy (PET). Nearly all of my projects have been carried out with humans, however, projects are ongoing with gene knock-out models in mice, and lemurs in collaboration with the Duke Primate Center. A few representative current studies are: 1) Defining physiologic (EEG, PSG, PET, fMRI) correlates of sleep complaints and subtyping insomnia on the basis of the associated pathophysiology, 2) Studying the relationship of EEG data recorded during non-REM sleep, daytime function, and insomnia treatment response, 3) Developing new pharmacologic and non-pharmacologic treatments for insomnia, 4) Studying the relationship of natural sleep and hibernation-like phenomena (torpor), 5) Predicting depression treatment response on the basis of pre-treatment EEG and structural MRI data.

Keywords:

Electroencephalography • Anesthesia, General • Electroconvulsive Therapy • Practice Guidelines • Anti-Anxiety Agents, Benzodiazepine • Signal Processing, Computer-Assisted • Electromagnetic Fields • Models, Biological • Electrocardiography • Affect • Nonlinear Dynamics • Insomnia • Sleep Disorders • Neurobiology • Psychopharmacology • Sleepiness • Neuroimaging • Circadian Rhythm • Models, Neurological

Representative Publications

  1. J Singh, CA Zarate, AD Krystal, Case report: Successful riluzole augmentation therapy in treatment-resistant bipolar depression following the development of rash with lamotrigine., Psychopharmacology, Germany, vol. 173 no. 1-2 (April, 2004), pp. 227-8, ISSN 0033-3158
  2. Krystal, A.D., Zoldi, S., Prado, R., Greenside, H.S., West, M. The spatiotemporal dynamics of generalized tonic-clonic seizure EEG data: Relevance to the clinical practice of electroconvulsive therapy. IN: Proceedings of the International Conference on Nonlinear Dynamics and Brain Functioning (Rapp, P., Ed.). In Press.
  3. S Ancoli-Israel, RM Benca, JD Edinger, AD Krystal, W Mendelson, H Moldofsky, J Petrie, T Roth, JK Walsh, J Winkelman, Special Issues Board Panel Members, Panel discussion: changing how we think about insomnia., The Journal of clinical psychiatry, United States, vol. 65 Suppl 8 (2004), pp. 44-6, ISSN 0160-6689
  4. Weiner RD, Coffey CE and Krystal AD. Electroconvulsive therapy in the medical and neurological patient. 2nd edition. IN: Psychiatric Care of the Medical Patient. (Stoudemire A, Fogel BS, Eds.), New York, Oxford University Press, in press.
  5. AD Krystal, The changing perspective on chronic insomnia management., The Journal of clinical psychiatry, United States, vol. 65 Suppl 8 (2004), pp. 20-5, ISSN 0160-6689  [abs]
  6. Weiner, R.D., Krystal, A.D. The cognitive side-effects of ECT. Progress in Neuro- Psychopharmacology & Biological Psychiatry, in press.
  7. AD Krystal, RD Weiner, MD Dean, VH Lindahl, LA Tramontozzi, G Falcone, CE Coffey, Comparison of seizure duration, ictal EEG, and cognitive effects of ketamine and methohexital anesthesia with ECT., The Journal of neuropsychiatry and clinical neurosciences, United States, vol. 15 no. 1 (2003), pp. 27-34, ISSN 0895-0172  [abs]
  8. West, M., Prado, R., Krystal, A.D. Evaluation and comparison of EEG traces: Latent structure in non-stationary time series. Journal of the American Statistical Association, in press.
  9. AD Krystal, Insomnia in women., Clinical cornerstone, United States, vol. 5 no. 3 (2003), pp. 41-50, ISSN 1098-3597  [abs]
  10. Krystal, A.D., Coffey, C.E., Weiner, R.D., Holsinger, T. Changes in seizure threshold over the ECT course affect therapeutic response and are detected by ictal EEG ratings. J. Neuropsychiatry & Clin. Neurosci. in press.
  11. JD Edinger, AD Krystal, Subtyping primary insomnia: is sleep state misperception a distinct clinical entity?, Sleep medicine reviews, England, vol. 7 no. 3 (June, 2003), pp. 203-14, ISSN 1087-0792  [abs]
  12. Krystal, A.D., Holsinger, T., Weiner, R.D., Coffey, C.E., Predicting unilateral ECT response and the utility of a switch to bilateral ECT with treatment 2 ictal EEG indices.
  13. AD Krystal, JK Walsh, E Laska, J Caron, DA Amato, TC Wessel, T Roth, Sustained efficacy of eszopiclone over 6 months of nightly treatment: results of a randomized, double-blind, placebo-controlled study in adults with chronic insomnia., Sleep, United States, vol. 26 no. 7 (November, 2003), pp. 793-9, ISSN 0161-8105  [abs]
  14. Krystal, A.D., Watts, B.V., Weiner, R.D., Moore, S., Steffens, D., Lindahl, V. The use of flumazenil in the anxious and benzodiazepine dependent ECT patient. Convulsive Therapy 13(4)xx-xx, 1997.
  15. AD Krystal, JD Edinger, WK Wohlgemuth, GR Marsh, NREM sleep EEG frequency spectral correlates of sleep complaints in primary insomnia subtypes., Sleep, United States, vol. 25 no. 6 (September, 2002), pp. 630-40, ISSN 0161-8105  [abs]
  16. Krystal, A.D., Weiner, R.D. EEG Correlates of the response to ECT: A possible antidepressant role of brain derived neurotrophic factor, Journal of ECT.
  17. Prado R, West M, Krystal AD  Multichannel electroencephalographic analyses via dynamic regression models with time-varying lag-lead structure J. Royal Statistical Society C-APP Part I. 2001;50: 95-109.
  18. Krystal, A.D., Weiner, R.D., Lindahl, V, Massie, R. Dosing ECT treatments on the basis of the ictal EEG: A preliminary study.
  19. AD Krystal, MD Dean, RD Weiner, LA Tramontozzi, KM Connor, VH Lindahl, RW Massie, ECT stimulus intensity: are present ECT devices too limited?, The American journal of psychiatry, UNITED STATES, vol. 157 no. 6 (June, 2000), pp. 963-7, ISSN 0002-953X  [abs]
  20. Krystal, A.D., Greenside, H.S. Low Dimensional Chaos in Bipolar Disorders? (Letter to the Editor) Arch. Gen. Psychiatry (in press).
  21. AD Krystal, M West, R Prado, H Greenside, S Zoldi, RD Weiner, EEG effects of ECT: implications for rTMS., Depression and anxiety, United States, vol. 12 no. 3 (2000), pp. 157-65, ISSN 1091-4269  [abs]
  22. Krystal, A.D., Weiner, R.D., Coffey, C.E., McCall, W.V. The effect of ECT treatment number on the ictal EEG. Psychiatry Research 62:179-189, 1996.
  23. AD Krystal, T Holsinger, RD Weiner, CE Coffey, Prediction of the utility of a switch from unilateral to bilateral ECT in the elderly using treatment 2 ictal EEG indices., The journal of ECT, United States, vol. 16 no. 4 (December, 2000), pp. 327-37, ISSN 1095-0680  [abs]
  24. Krystal, A.D., Weiner, R.D., Gassert, D., McCall, W.V., Coffey, C.E., Sibert, T., Holsinger, T. The relative ability of 3 ictal EEG frequency bands to differentiate ECT seizures on the basis of electrode placement, stimulus intensity, and therapeutic response. Convulsive Therapy 12:13-24, 1996..
  25. SM Zoldi, A Krystal, HS Greenside, Stationarity and redundancy of multichannel EEG data recorded during generalized tonic-clonic seizures., Brain topography, UNITED STATES, vol. 12 no. 3 (2000), pp. 187-200, ISSN 0896-0267  [abs]
  26. Krystal, A.D., Zaidman, C., Greenside, H.S., Weiner, R.D., Coffey, C.E. The largest Lyapunov exponent of the EEG during ECT seizures as a measure of therapeutic adequacy.
  27. AD Krystal, RD Weiner, V Lindahl, R Massie, The development and retrospective testing of an electroencephalographic seizure quality-based stimulus dosing paradigm with ECT., The journal of ECT, United States, vol. 16 no. 4 (December, 2000), pp. 338-49, ISSN 1095-0680  [abs]
  28. Krystal, A.D., Greenside, H.S., Weiner, R.D., Gassert, D. A comparison of EEG signal dynamics in waking, after anesthesia induction and during ECT seizures.
  29. AD Krystal, RD Weiner, EEG correlates of the response to ECT: a possible antidepressant role of brain-derived neurotrophic factor., The journal of ECT, UNITED STATES, vol. 15 no. 1 (March, 1999), pp. 27-38, ISSN 1095-0680  [abs]
  30. Krystal, A.D., Weiner, R.D., Gassert, D., McCall, W.V., Coffey, C.E., Sibert, T., Holsinger, T. The relative ability of 3 ictal EEG frequency bands to differentiate ECT seizures on the basis of electrode placement, stimulus intensity, and therapeutic response. Convulsive Therapy (In Press).
  31. AD Krystal, R Prado, M West, New methods of time series analysis of non-stationary EEG data: eigenstructure decompositions of time varying autoregressions., Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, NETHERLANDS, vol. 110 no. 12 (December, 1999), pp. 2197-206, ISSN 1388-2457  [abs]
  32. Review of John S. Barlow, The Electroencephalogram: It's Patterns and Origins, MIT Press, Cambridge, 1993, Biomedical Instrumentation & Technology 29:363, 1995.
  33. West, M. Prado, R. and Krystal, A.  Evaluation and comparison of EEG traces: Latent structure in non-staionary time series.  Journal of the American Statistical Association, 94:375-387, 1999.
  34. Coffey CE, Lucke J, Weiner RD, Krystal AD, Aque M: Seizure threshold in electroconvulsive therapy. I. Initial seizure threshold. Biological Psychiatry, in press.
  35. GM Asnis, A Chakraburtty, EA DuBoff, A Krystal, PD Londborg, R Rosenberg, B Roth-Schechter, MB Scharf, JK Walsh, Zolpidem for persistent insomnia in SSRI-treated depressed patients., The Journal of clinical psychiatry, UNITED STATES, vol. 60 no. 10 (October, 1999), pp. 668-76, ISSN 0160-6689  [abs]
  36. Krystal AD, Weiner RD: ECT seizure therapeutic adequacy. Convulsive Therapy 10: 153-164, 1994.
  37. AD Krystal, CE Coffey, RD Weiner, T Holsinger, Changes in seizure threshold over the course of electroconvulsive therapy affect therapeutic response and are detected by ictal EEG ratings., The Journal of neuropsychiatry and clinical neurosciences, UNITED STATES, vol. 10 no. 2 (1998), pp. 178-86, ISSN 0895-0172  [abs]
  38. Krystal H, Krystal AD: Psychoanalysis and neuroscience in relationship to dreams and creativity. In (eds., Shaw MP, Runco MA), Creativity and Affect. New Jersey: Ablex Publishing Corp., 1994.
  39. Krystal AD. The clinical utility of ictal EEG seizure adequacy models. Psychiatric Annals 1:30- 35, 1998.
  40. Krystal, A.D., (member of the U.S. Modafinil in Narcolepsy Study Group). HLA-DQB1*0602 homozygosity increases relative risk for narcolepsy but not disease severity in two ethnic groups. Tissue Antigens 51:96-100, 1998.
  41. Krystal, A.D., (member of the U.S. Modafinil in Narcolepsy Study Group). Randomized trial of modafinil for the treatment of pathological somnolence in narcolepsy. Annals of Neurology 43:88-97, 1998.
  42. Krystal, A.D., Edinger, J., Wohlgemuth, W., Marsh, G.R. Sleep in peri-menopausal and post- menopausal women. Sleep Medicine Reviews, 2:243-253, 1998.
  43. Krystal, A.D., Zoldi, S., Greenside, H., Prado, R., West, M., Weiner, R. The effects of ECT on the EEG: implicatons for rTMS. Progress in Neuro-Psychopharmacology & Biological Psychiatry, in press.
  44. AD Krystal, HS Greenside, Low-dimensional chaos in bipolar disorder?, Archives of general psychiatry, UNITED STATES, vol. 55 no. 3 (March, 1998), pp. 275-6, ISSN 0003-990X
  45. AD Krystal, BV Watts, RD Weiner, S Moore, DC Steffens, V Lindahl, The use of flumazenil in the anxious and benzodiazepine-dependent ECT patient., The journal of ECT, UNITED STATES, vol. 14 no. 1 (March, 1998), pp. 5-14, ISSN 1095-0680  [abs]
  46. Edinger, J.D., Fins, A.I., Goeke, J.M., McMillan, D.K., Gersh, T.L., Krystal, A.D., McCall, W.V. The empirical identification of insomnia subtypes: A cluster analytic approach. Sleep (in press).
  47. Krystal, A.D. The clinical utility of ictal EEG seizure adequacy models. Psychiatric Annals, 1:30-35, 1998.
  48. Krystal, A.D., Coffey, C.E. Neuropsychiatric considerations in the use of Electroconvulsive Therapy. Journal of Neuropsychiatry and Clinical Neurosciences 9:283-292, 1997.
  49. Krystal, A.D., Greenside, H.S. Low Dimensional Chaos in Bipolar Disorders? (Letter to the Editor) Arch. Gen. Psychiatry (in press).
  50. Krystal, A.D., Zaidman, C., Greenside, H.S., Weiner, R.D., Coffey, C.E. The largest Lyapunov exponent of the EEG during ECT seizures as a measure of therapeutic adequacy. Electroencephalography and Clinical Neurophysiology 103:599-606, 1997.
  51. AD Krystal, CE Coffey, Neuropsychiatric considerations in the use of electroconvulsive therapy., The Journal of neuropsychiatry and clinical neurosciences, UNITED STATES, vol. 9 no. 2 (1997), pp. 283-92, ISSN 0895-0172  [abs]
  52. AD Krystal, C Zaidman, HS Greenside, RD Weiner, CE Coffey, The largest Lyapunov exponent of the EEG during ECT seizures as a measure of ECT seizure adequacy., Electroencephalography and clinical neurophysiology, IRELAND, vol. 103 no. 6 (December, 1997), pp. 599-606, ISSN 0013-4694  [abs]
  53. AD Krystal, HS Greenside, RD Weiner, D Gassert, A comparison of EEG signal dynamics in waking, after anesthesia induction and during electroconvulsive therapy seizures., Electroencephalography and clinical neurophysiology, IRELAND, vol. 99 no. 2 (August, 1996), pp. 129-40, ISSN 0013-4694  [abs]
  54. AD Krystal, RD Weiner, CE Coffey, WV McCall, Effect of ECT treatment number on the ictal EEG., Psychiatry research, IRELAND, vol. 62 no. 2 (May, 1996), pp. 179-89, ISSN 0165-1781  [abs]
  55. Krystal, A.D., Coffey, C.E., Weiner, R.D., Holsinger, T. Changes in seizure threshold over the ECTcourse affect therapeutic response and are detected by ictal EEG ratings.
  56. Krystal, A.D., Greenside, H.S., Weiner, R.D., Gassert, D. A comparison of EEG signal dynamics in waking, after anesthesia induction and during ECT seizures. Electroencephalography and Clinical Neurophysiology 99:129-140, 1996.
  57. JD Edinger, AI Fins, JM Goeke, DK McMillan, TL Gersh, AD Krystal, WV McCall, The empirical identification of insomnia subtypes: a cluster analytic approach., Sleep, UNITED STATES, vol. 19 no. 5 (June, 1996), pp. 398-411, ISSN 0161-8105  [abs]
  58. AD Krystal, RD Weiner, D Gassert, WV McCall, CE Coffey, T Sibert, T Holsinger, The relative ability of three ictal EEG frequency bands to differentiate ECT seizures on the basis of electrode placement, stimulus intensity, and therapeutic response., Convulsive therapy, UNITED STATES, vol. 12 no. 1 (March, 1996), pp. 13-24, ISSN 0749-8055  [abs]
  59. JD Edinger, CW Erwin, AI Fins, GR Marsh, AD Krystal, Ambulatory cassette polysomnography: findings from a large cohort of drug-free insomnia patients., Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society, UNITED STATES, vol. 12 no. 3 (May, 1995), pp. 302-9, ISSN 0736-0258  [abs]
  60. AD Krystal, RD Weiner, ECT seizure duration: reliability of manual and computer-automated determinations., Convulsive therapy, UNITED STATES, vol. 11 no. 3 (September, 1995), pp. 158-69, ISSN 0749-8055  [abs]
  61. Krystal, A.D., Weiner, R.D., Coffey, C.E. The ictal EEG as a marker of adequate stimulus intensity with unilateral ECT. J. Neuropsychiatr. and Clin. Neurosciences 7:295-303, 1995.
  62. CE Coffey, J Lucke, RD Weiner, AD Krystal, M Aque, Seizure threshold in electroconvulsive therapy (ECT) II. The anticonvulsant effect of ECT., Biological psychiatry, UNITED STATES, vol. 37 no. 11 (June, 1995), pp. 777-88, ISSN 0006-3223  [abs]
  63. CE Coffey, J Lucke, RD Weiner, AD Krystal, M Aque, Seizure threshold in electroconvulsive therapy: I. Initial seizure threshold., Biological psychiatry, UNITED STATES, vol. 37 no. 10 (May, 1995), pp. 713-20, ISSN 0006-3223  [abs]
  64. AD Krystal, RD Weiner, CE Coffey, The ictal EEG as a marker of adequate stimulus intensity with unilateral ECT., The Journal of neuropsychiatry and clinical neurosciences, UNITED STATES, vol. 7 no. 3 (1995), pp. 295-303, ISSN 0895-0172  [abs]
  65. AD Krystal, RD Weiner, ECT seizure therapeutic adequacy., Convulsive therapy, UNITED STATES, vol. 10 no. 2 (June, 1994), pp. 153-64, ISSN 0749-8055  [abs]
  66. Krystal AD, Weiner RD, McCall WV, Shelp F, Arias R, Smith P: The effects of ECT stimulus dose and electrode placement on the ictal electroencehpalogram: An intraindividual crossover study. Biological Psychiatry 34: 759-767, 1993.
  67. Krystal AD, Weiner RD: Low frequency ictal EEG activity and ECT therapeutic impact. Convulsive Therapy 9: 220-224, 1993.
  68. McCall WV, Edinger JD, Krystal AD, Marsh GR: Ambulatory polysomnogrophic differences in healthy and insomniac older men. Ambulatory monitoring 6: 135-140, 1993.
  69. RD Weiner, AD Krystal, The present use of electroconvulsive therapy., Annual review of medicine, UNITED STATES, vol. 45 (1994), pp. 273-81, ISSN 0066-4219  [abs]
  70. Weiner RD, Krystal AD: EEG monitoring of ECT seizures. In (ed Coffey CE), The Clinical Science of Electroconvulsive Therapy. Washington DC: American Psychiatric Press, Inc., pp 93-109, 1993.
  71. AD Krystal, RD Weiner, WV McCall, FE Shelp, R Arias, P Smith, The effects of ECT stimulus dose and electrode placement on the ictal electroencephalogram: an intraindividual crossover study., Biological psychiatry, UNITED STATES, vol. 34 no. 11 (December, 1993), pp. 759-67, ISSN 0006-3223  [abs]
  72. WV McCall, CW Erwin, JD Edinger, AD Krystal, GR Marsh, Ambulatory polysomnography: technical aspects and normative values., Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society, UNITED STATES, vol. 9 no. 1 (January, 1992), pp. 68-77, ISSN 0736-0258  [abs]
  73. AD Krystal, RD Weiner, CE Coffey, P Smith, R Arias, E Moffett, EEG evidence of more "intense" seizure activity with bilateral ECT., Biological psychiatry, UNITED STATES, vol. 31 no. 6 (March, 1992), pp. 617-21, ISSN 0006-3223
  74. RD Weiner, AD Krystal, CE Coffey, P Smith, The electrophysiology of ECT: relevance to mechanism of action., Clinical neuropharmacology, UNITED STATES, vol. 15 Suppl 1 Pt A (1992), pp. 671A-672A, ISSN 0362-5664
  75. RD Weiner, CE Coffey, AD Krystal, The monitoring and management of electrically induced seizures., The Psychiatric clinics of North America, UNITED STATES, vol. 14 no. 4 (December, 1991), pp. 845-69, ISSN 0193-953X  [abs]
  76. A Krystal, KR Krishnan, M Raitiere, R Poland, JC Ritchie, NR Dunnick, K Hanada, CB Nemeroff, Differential diagnosis and pathophysiology of Cushing's syndrome and primary affective disorder., The Journal of neuropsychiatry and clinical neurosciences, UNITED STATES, vol. 2 no. 1 (1990), pp. 34-43, ISSN 0895-0172  [abs]
  77. AD Krystal, JP McEvoy, Shared features of neuroleptic malignant syndrome and alcohol abuse complications., The Journal of clinical psychiatry, UNITED STATES, vol. 51 no. 12 (December, 1990), pp. 523, ISSN 0160-6689