Physicians

Department / Division
Psychiatry / Psychiatry-Outpatient

Address
DUMC 3309
Durham, NC 27710

Appointment Telephone
919-681-8742

Office Telephone
919-681-8742

Fax Telephone
919-681-8744

Training

• MD, Duke University School of Medicine, 1987

Residency

• Psychiatry, Duke University Medical Center, 1987-1991
• Clinical Research Methodology, Duke University Medical Center, 1991-1993

Fellowship

• Clinical Neurophysiology, Duke University Medical Center, 1992-1994

Clinical Interests
Sleep and affective disorders

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.

Industry Relationships and Collaborations (What's this?)

This faculty member (or a member of their immediate family) has a working relationship (i.e. consulting, research, and/or educational services) with the companies listed below. These relations have been reported to the health system leadership and, when appropriate, management plans are in place to address potential conflicts.

• ANS St. Jude Medical
• American Academy of Sleep Medicine
• Astellas Pharma Inc.
• Attentiv
• Brainsway
• Cephalon, Inc. (Teva Pharmaceuticals)
• MECTA Corp
• Merck & Co. USA (not assoc'd with Merck KGaA)
• Neosync
• Neurocrine
• Novartis
• Somaxon Pharmaceuticals, Inc.
• Sunovion

Representative Publications
Ancoli-Israel, S; Benca, RM; Edinger, JD; Krystal, AD; Mendelson, W; Moldofsky, H; Petrie, J; Roth, T; Walsh, JK; Winkelman, J; Special Issues Board Panel Members. Panel discussion: changing how we think about insomnia. Journal of Clinical Psychiatry. 2004;65 Suppl 8:44-46. (2004) Abstract

Krystal, AD. The changing perspective on chronic insomnia management. Journal of Clinical Psychiatry. 2004;65 Suppl 8:20-25. (2004) Abstract

Singh, J; Zarate, CA; Krystal, AD. Case report: Successful riluzole augmentation therapy in treatment-resistant bipolar depression following the development of rash with lamotrigine. Psychopharmacology. 2004;173:227-228. (2004) Abstract

Edinger, JD; Krystal, AD. Subtyping primary insomnia: is sleep state misperception a distinct clinical entity?. Sleep Medicine Reviews. 2003;7:203-214. (2003) Abstract

Krystal, AD. Insomnia in women. Clinical Cornerstone. 2003;5:41-50. (2003) Abstract

Krystal, AD; Walsh, JK; Laska, E; Caron, J; Amato, DA; Wessel, TC; Roth, T. 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. 2003;26:793-799. (2003) Abstract

Krystal, AD; Weiner, RD; Dean, MD; Lindahl, VH; Tramontozzi, LA; Falcone, G; Coffey, CE. Comparison of seizure duration, ictal EEG, and cognitive effects of ketamine and methohexital anesthesia with ECT. Journal of Neuropsychiatry and Clinical Neurosciences. 2003;15:27-34. (2003) Abstract

Krystal, AD; Edinger, JD; Wohlgemuth, WK; Marsh, GR. NREM sleep EEG frequency spectral correlates of sleep complaints in primary insomnia subtypes. Sleep. 2002;25:630-640. (2002) Abstract

Krystal, AD; Dean, MD; Weiner, RD; Tramontozzi, LA; Connor, KM; Lindahl, VH; Massie, RW. ECT stimulus intensity: are present ECT devices too limited?. American Journal of Psychiatry. 2000;157:963-967. (2000) Abstract

Krystal, AD; Holsinger, T; Weiner, RD; Coffey, CE. Prediction of the utility of a switch from unilateral to bilateral ECT in the elderly using treatment 2 ictal EEG indices. The Journal of Electroconvulsive Therapy. 2000;16:327-337. (2000) Abstract

Krystal, AD; Weiner, RD; Lindahl, V; Massie, R. The development and retrospective testing of an electroencephalographic seizure quality-based stimulus dosing paradigm with ECT. The Journal of Electroconvulsive Therapy. 2000;16:338-349. (2000) Abstract

Krystal, AD; West, M; Prado, R; Greenside, H; Zoldi, S; Weiner, RD. EEG effects of ECT: implications for rTMS. Depression and Anxiety. 2000;12:157-165. (2000) Abstract

Zoldi, SM; Krystal, A; Greenside, HS. Stationarity and redundancy of multichannel EEG data recorded during generalized tonic-clonic seizures. Brain Topography: journal of functional neurophysiology. 2000;12:187-200. (2000) Abstract

Asnis, GM; Chakraburtty, A; DuBoff, EA; Krystal, A; Londborg, PD; Rosenberg, R; Roth-Schechter, B; Scharf, MB; Walsh, JK. Zolpidem for persistent insomnia in SSRI-treated depressed patients. Journal of Clinical Psychiatry. 1999;60:668-676. (1999) Abstract

Krystal, AD; Prado, R; West, M. New methods of time series analysis of non-stationary EEG data: eigenstructure decompositions of time varying autoregressions. Clinical Neurophysiology. 1999;110:2197-2206. (1999) Abstract

Krystal, AD; Weiner, RD. EEG correlates of the response to ECT: a possible antidepressant role of brain-derived neurotrophic factor. The Journal of Electroconvulsive Therapy. 1999;15:27-38. (1999) Abstract

Krystal, AD; Coffey, CE; Weiner, RD; Holsinger, T. Changes in seizure threshold over the course of electroconvulsive therapy affect therapeutic response and are detected by ictal EEG ratings. Journal of Neuropsychiatry and Clinical Neurosciences. 1998;10:178-186. (1998) Abstract

Krystal, AD; Greenside, HS. Low-dimensional chaos in bipolar disorder?. Archives of General Psychiatry. 1998;55:275-276. (1998) Abstract

Krystal, AD; Watts, BV; Weiner, RD; Moore, S; Steffens, DC; Lindahl, V. The use of flumazenil in the anxious and benzodiazepine-dependent ECT patient. The Journal of Electroconvulsive Therapy. 1998;14:5-14. (1998) Abstract

Krystal, AD; Coffey, CE. Neuropsychiatric considerations in the use of electroconvulsive therapy. Journal of Neuropsychiatry and Clinical Neurosciences. 1997;9:283-292. (1997) Abstract

Krystal, AD; Zaidman, C; Greenside, HS; Weiner, RD; Coffey, CE. The largest Lyapunov exponent of the EEG during ECT seizures as a measure of ECT seizure adequacy. Electroencephalography and Clinical Neurophysiology. 1997;103:599-606. (1997) Abstract

Edinger, JD; Fins, AI; Goeke, JM; McMillan, DK; Gersh, TL; Krystal, AD; McCall, WV. The empirical identification of insomnia subtypes: a cluster analytic approach. Sleep. 1996;19:398-411. (1996) Abstract

Krystal, AD; Greenside, HS; Weiner, RD; Gassert, D. A comparison of EEG signal dynamics in waking, after anesthesia induction and during electroconvulsive therapy seizures. Electroencephalography and Clinical Neurophysiology. 1996;99:129-140. (1996) Abstract

Krystal, AD; Weiner, RD; Coffey, CE; McCall, WV. Effect of ECT treatment number on the ictal EEG. Psychiatry Research. 1996;62:179-189. (1996) Abstract

Krystal, AD; Weiner, RD; Gassert, D; McCall, WV; Coffey, CE; Sibert, T; Holsinger, T. 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. 1996;12:13-24. (1996) Abstract

Coffey, CE; Lucke, J; Weiner, RD; Krystal, AD; Aque, M. Seizure threshold in electroconvulsive therapy (ECT) II. The anticonvulsant effect of ECT. Biological Psychiatry. 1995;37:777-788. (1995) Abstract

Coffey, CE; Lucke, J; Weiner, RD; Krystal, AD; Aque, M. Seizure threshold in electroconvulsive therapy: I. Initial seizure threshold. Biological Psychiatry. 1995;37:713-720. (1995) Abstract

Edinger, JD; Erwin, CW; Fins, AI; Marsh, GR; Krystal, AD. Ambulatory cassette polysomnography: findings from a large cohort of drug-free insomnia patients. Journal of Clinical Neurophysiology. 1995;12:302-309. (1995) Abstract

Krystal, AD; Weiner, RD. ECT seizure duration: reliability of manual and computer-automated determinations. Convulsive Therapy. 1995;11:158-169. (1995) Abstract

Krystal, AD; Weiner, RD; Coffey, CE. The ictal EEG as a marker of adequate stimulus intensity with unilateral ECT. Journal of Neuropsychiatry and Clinical Neurosciences. 1995;7:295-303. (1995) Abstract

Krystal, AD; Weiner, RD. ECT seizure therapeutic adequacy. Convulsive Therapy. 1994;10:153-164. (1994) Abstract

Weiner, RD; Krystal, AD. The present use of electroconvulsive therapy. Annual Review of Medicine. 1994;45:273-281. (1994) Abstract

Krystal, AD; Weiner, RD; McCall, WV; Shelp, FE; Arias, R; Smith, P. The effects of ECT stimulus dose and electrode placement on the ictal electroencephalogram: an intraindividual crossover study. Biological Psychiatry. 1993;34:759-767. (1993) Abstract

Krystal, AD; Weiner, RD; Coffey, CE; Smith, P; Arias, R; Moffett, E. EEG evidence of more "intense" seizure activity with bilateral ECT. Biological Psychiatry. 1992;31:617-621. (1992) Abstract

McCall, WV; Erwin, CW; Edinger, JD; Krystal, AD; Marsh, GR. Ambulatory polysomnography: technical aspects and normative values. Journal of Clinical Neurophysiology. 1992;9:68-77. (1992) Abstract

Weiner, RD; Krystal, AD; Coffey, CE; Smith, P. The electrophysiology of ECT: relevance to mechanism of action. Clinical Neuropharmacology. 1992;15 Suppl 1 Pt A:671A-672A. (1992) Abstract

Weiner, RD; Coffey, CE; Krystal, AD. The monitoring and management of electrically induced seizures. Psychiatric Clinics of North America. 1991;14:845-869. (1991) Abstract

Krystal, A; Krishnan, KR; Raitiere, M; Poland, R; Ritchie, JC; Dunnick, NR; Hanada, K; Nemeroff, CB. Differential diagnosis and pathophysiology of Cushing's syndrome and primary affective disorder. Journal of Neuropsychiatry and Clinical Neurosciences. 1990;2:34-43. (1990) Abstract

Krystal, AD; McEvoy, JP. Shared features of neuroleptic malignant syndrome and alcohol abuse complications. Journal of Clinical Psychiatry. 1990;51:523. (1990) Abstract