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Scott KM, Saha S, Lim CC, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Benjet C, Bromet EJ, Bruffaerts R, Caldas-de-Almeida JM, de Girolamo G, de Jonge P, Degenhardt L, Florescu S, Gureje O, Haro JM, Hu C, Karam EG, Kovess-Masfety V, Lee S, Lepine JP, Mneimneh Z, Navarro-Mateu F, Piazza M, Posada-Villa J, Sampson NA, Stagnaro JC, Kessler RC, McGrath JJ. Psychotic experiences and general medical conditions: a cross-national analysis based on 28 002 respondents from 16 countries in the WHO World Mental Health Surveys. Psychol Med 2018; 48:2730-2739. [PMID: 29478433 PMCID: PMC6109618 DOI: 10.1017/s0033291718000363] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Previous work has identified associations between psychotic experiences (PEs) and general medical conditions (GMCs), but their temporal direction remains unclear as does the extent to which they are independent of comorbid mental disorders. METHODS In total, 28 002 adults in 16 countries from the WHO World Mental Health (WMH) Surveys were assessed for PEs, GMCs and 21 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders. Discrete-time survival analyses were used to estimate the associations between PEs and GMCs with various adjustments. RESULTS After adjustment for comorbid mental disorders, temporally prior PEs were significantly associated with subsequent onset of 8/12 GMCs (arthritis, back or neck pain, frequent or severe headache, other chronic pain, heart disease, high blood pressure, diabetes and peptic ulcer) with odds ratios (ORs) ranging from 1.3 [95% confidence interval (CI) 1.1-1.5] to 1.9 (95% CI 1.4-2.4). In contrast, only three GMCs (frequent or severe headache, other chronic pain and asthma) were significantly associated with subsequent onset of PEs after adjustment for comorbid GMCs and mental disorders, with ORs ranging from 1.5 (95% CI 1.2-1.9) to 1.7 (95% CI 1.2-2.4). CONCLUSIONS PEs were associated with the subsequent onset of a wide range of GMCs, independent of comorbid mental disorders. There were also associations between some medical conditions (particularly those involving chronic pain) and subsequent PEs. Although these findings will need to be confirmed in prospective studies, clinicians should be aware that psychotic symptoms may be risk markers for a wide range of adverse health outcomes. Whether PEs are causal risk factors will require further research.
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Affiliation(s)
- Kate M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Sukanta Saha
- Queensland Centre for Mental Health Research and Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia
| | - Carmen C.W. Lim
- Queensland Centre for Mental Health Research and Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre, Via Pilastroni 4, Brescia, Italy
| | - Peter de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, NL; Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, NL
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Jean-Pierre Lepine
- Hôpital Lariboisière- Fernand Widal, Assistance Publique Hôpitaux de Paris; Universités Paris Descartes-Paris Diderot; INSERM UMR-S 1144, Paris, France
| | - Zeina Mneimneh
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
| | - Marina Piazza
- Universidad Cayetano Heredia, Lima, Peru; National Institute of Health, Lima, Peru
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - John J. McGrath
- Queensland Centre for Mental Health Research, and Queensland Brain Institute, University of Queensland, St. Lucia, Queensland, Australia; and National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
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352
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Amorim L, Magalhães R, Coelho A, Moreira PS, Portugal-Nunes C, Castanho TC, Marques P, Sousa N, Santos NC. Poor Sleep Quality Associates With Decreased Functional and Structural Brain Connectivity in Normative Aging: A MRI Multimodal Approach. Front Aging Neurosci 2018; 10:375. [PMID: 30524267 PMCID: PMC6257343 DOI: 10.3389/fnagi.2018.00375] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/29/2018] [Indexed: 12/19/2022] Open
Abstract
Sleep is a ubiquitous phenomenon, essential to the organism homeostasis. Notwithstanding, there has been an increasing concern with its disruption, not only within the context of pathological conditions, such as neurologic and psychiatric diseases, but also in health. In fact, sleep complaints are becoming particularly common, especially in middle-aged and older adults, which may suggest an underlying susceptibility to sleep quality loss and/or its consequences. Thus, a whole-brain modeling approach to study the shifts in the system can cast broader light on sleep quality mechanisms and its associated morbidities. Following this line, we sought to determine the association between the standard self-reported measure of sleep quality, the Pittsburgh Sleep Quality Index (PSQI) and brain correlates in a normative aging cohort. To this purpose, 86 participants (age range 52–87 years) provided information regarding sociodemographic parameters, subjective sleep quality and associated psychological variables. A multimodal magnetic resonance imaging (MRI) approach was used, with whole-brain functional and structural connectomes being derived from resting-state functional connectivity (FC) and probabilistic white matter tractography (structural connectivity, SC). Brain regional volumes and white matter properties associations were also explored. Results show that poor sleep quality was associated with a decrease in FC and SC of distinct networks, overlapping in right superior temporal pole, left middle temporal and left inferior occipital regions. Age displayed important associations with volumetric changes in the cerebellum cortex and white matter, thalamus, hippocampus, right putamen, left supramarginal and left lingual regions. Overall, results suggest that not only the PSQI global score may act as a proxy of changes in FC/SC in middle-aged and older individuals, but also that the age-related regional volumetric changes may be associated to an adjustment of brain connectivity. These findings may also represent a step further in the comprehension of the role of sleep disturbance in disease, since the networks found share regions that have been shown to be affected in pathologies, such as depression and Alzheimer's disease.
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Affiliation(s)
- Liliana Amorim
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Ricardo Magalhães
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Ana Coelho
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Pedro Silva Moreira
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Carlos Portugal-Nunes
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Teresa Costa Castanho
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Paulo Marques
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
| | - Nadine Correia Santos
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal.,Clinical Academic Center-Braga, Braga, Portugal
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353
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Gee B, Orchard F, Clarke E, Joy A, Clarke T, Reynolds S. The effect of non-pharmacological sleep interventions on depression symptoms: A meta-analysis of randomised controlled trials. Sleep Med Rev 2018; 43:118-128. [PMID: 30579141 DOI: 10.1016/j.smrv.2018.09.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/07/2018] [Accepted: 09/20/2018] [Indexed: 01/28/2023]
Abstract
Poor sleep is a significant risk factor for depression across the lifespan and sleep problems have been hypothesised to contribute to the onset and maintenance of depression symptoms. However, sleep problems are usually not a direct target of interventions for depression. A range of non-pharmacological treatments can reduce sleep problems but it is unclear whether these interventions also reduce other depression symptoms. The aim of this review was to examine whether non-pharmacological interventions for sleep problems are effective in reducing symptoms of depression. We carried out a systematic search for randomised controlled trials of non-pharmacological sleep interventions that measured depression symptoms as an outcome. Forty-nine trials (n = 5908) were included in a random effects meta-analysis. The pooled standardised mean difference for depression symptoms after treatment for sleep problems was -0.45 (95% CI: -0.55,-0.36). The size of the effect on depression symptoms was moderated by the size of the effect on subjective sleep quality. In studies of participants with mental health problems, sleep interventions had a large effect on depression symptoms (d = -0.81, 95% CI: -1.13,-0.49). The findings indicate that non-pharmacological sleep interventions are effective in reducing the severity of depression, particularly in clinical populations. This suggests that non-pharmacological sleep interventions could be offered as a treatment for depression, potentially improving access to treatment.
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Affiliation(s)
- Brioney Gee
- Norfolk and Suffolk NHS Foundation Trust, UK; Norwich Medical School, University of East Anglia, UK.
| | - Faith Orchard
- School of Psychology and Clinical Language Sciences, University of Reading, UK
| | | | - Ansu Joy
- Norfolk and Suffolk NHS Foundation Trust, UK
| | - Tim Clarke
- Norfolk and Suffolk NHS Foundation Trust, UK; Norwich Medical School, University of East Anglia, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, UK
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354
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Perez Algorta G, Van Meter A, Dubicka B, Jones S, Youngstrom E, Lobban F. Blue blocking glasses worn at night in first year higher education students with sleep complaints: a feasibility study. Pilot Feasibility Stud 2018; 4:166. [PMID: 30410784 PMCID: PMC6211454 DOI: 10.1186/s40814-018-0360-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 10/22/2018] [Indexed: 01/25/2023] Open
Abstract
Background Late adolescence and early adulthood is a period of highest incidence for onset of mental health problems. Transition to college environment has been associated with many risk factors such as the initial disruption—and subsequent irregularity—of the student’s sleep and activity schedule. We tested the feasibility of using blue blocking glasses (BBG) at night in first year higher education students with sleep complaints, to obtain preliminary evidence for the impact of BBG on sleep, activity, and mood. Methods Participants were 13 first year undergraduates (from 10 different academic courses) living on campus for the first time with sleep complaints/disorders confirmed at screening via the Duke Structured Interview Schedule for Sleep Disorders. We used a 2-week, balanced crossover design (BBG vs placebo glasses; participants were unaware which was the active intervention) with computer-generated random allocation. Exploratory analyses provided descriptive and frequency summaries to evaluate feasibility of the intervention. Results Preliminary evidence supports the feasibility and acceptability of the trial; almost all screened participants consented and completed the protocol with high adherence; missing data were negligible. Additionally, the effectiveness of BBGs to enhance sleep, mood, and activity levels in young adults was supported. Conclusions The results of this feasibility trial suggest that BBG have potential as an inexpensive and feasible intervention for reducing sleep and circadian dysregulation in young adult students. A larger trial, following this successfully implemented protocol, is necessary to fully test the efficacy of BBG.
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Affiliation(s)
- Guillermo Perez Algorta
- 1Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Furness Building C73, Lancaster, LA14YT UK
| | | | | | - Steven Jones
- 1Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Furness Building C73, Lancaster, LA14YT UK
| | - Eric Youngstrom
- 4University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Fiona Lobban
- 1Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Furness Building C73, Lancaster, LA14YT UK
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355
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Insomnia, negative affect, and psychotic experiences: Modelling pathways over time in a clinical observational study. Psychiatry Res 2018; 269:673-680. [PMID: 30216919 PMCID: PMC6215774 DOI: 10.1016/j.psychres.2018.08.090] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/09/2018] [Accepted: 08/24/2018] [Indexed: 01/10/2023]
Abstract
Insomnia has been shown to contribute to the development of psychotic experiences, predominantly via increasing negative affect. However, the role of insomnia in the persistence of psychotic experiences is yet to be investigated in a clinical population. Furthermore, other plausible influences, such as psychotic experiences contributing to insomnia, remain to be evaluated. This study tests the role of insomnia as a predictor of persistence of psychotic experiences versus other potential causal routes. Twenty-nine patients aged 18-30 with non-affective psychosis completed three assessments over three months of their insomnia, negative affect, and psychotic experiences. Mixed effect models allowed comparisons between hypothesis-based models (comprising insomnia as predictor, negative affect as mediator, and psychotic experiences as outcome) and oppositional models, where relationships were reversed. The results supported the hypothesised mediation model above models where negative affect was primary. Insomnia was also found to be a stronger predictor of later hallucinations than vice versa, although a bidirectional relationship was indicated between insomnia and paranoia. In conclusion, insomnia predicts persistence of psychotic experiences over time to the same or greater extent than psychotic experiences contribute to insomnia. This supports insomnia as a potential intervention target in psychosis.
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356
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Prenatal stress and the development of psychopathology: Lifestyle behaviors as a fundamental part of the puzzle. Dev Psychopathol 2018; 30:1129-1144. [PMID: 30068418 DOI: 10.1017/s0954579418000494] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Maternal psychological stress, depression, and anxiety during pregnancy (prenatal stress; PNS) are thought to impact fetal development with long-term effects on offspring outcome. These effects would include physical and mental health, including psychopathology. Maternal sleep, diet, and exercise during pregnancy are lifestyle behaviors that are understudied and often solely included in PNS studies as confounders. However, there are indications that these lifestyle behaviors may actually constitute essential mediators between PNS and fetal programming processes. The goal of this theoretical review was to investigate this idea by looking at the evidence for associations between PNS and sleep, diet, and exercise, and by piecing together the information on potential underlying mechanisms and causal pathways through which these factors may affect the offspring. The analysis of the literature led to the conclusion that sleep, diet, and exercise during pregnancy, may have fundamental roles as mediators between PNS and maternal pregnancy physiology. By integrating these lifestyle behaviors into models of prenatal programming of development, a qualitatively higher and more comprehensive understanding of the prenatal origins of psychopathology can be obtained. The review finalizes by discussing some of the present challenges facing the field of PNS and offspring programming, and offering solutions for future research.
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357
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Meyer N, Kerz M, Folarin A, Joyce DW, Jackson R, Karr C, Dobson R, MacCabe J. Capturing Rest-Activity Profiles in Schizophrenia Using Wearable and Mobile Technologies: Development, Implementation, Feasibility, and Acceptability of a Remote Monitoring Platform. JMIR Mhealth Uhealth 2018; 6:e188. [PMID: 30377146 PMCID: PMC6234334 DOI: 10.2196/mhealth.8292] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/19/2017] [Accepted: 06/21/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is growing interest in the potential for wearable and mobile devices to deliver clinically relevant information in real-world contexts. However, there is limited information on their acceptability and barriers to long-term use in people living with psychosis. OBJECTIVE This study aimed to describe the development, implementation, feasibility, acceptability, and user experiences of the Sleepsight platform, which harnesses consumer wearable devices and smartphones for the passive and unobtrusive capture of sleep and rest-activity profiles in people with schizophrenia living in their homes. METHODS A total of 15 outpatients with a diagnosis of schizophrenia used a consumer wrist-worn device and smartphone to continuously and remotely gather rest-activity profiles over 2 months. Once-daily sleep and self-rated symptom diaries were also collected via a smartphone app. Adherence with the devices and smartphone app, end-of-study user experiences, and agreement between subjective and objective sleep measures were analyzed. Thresholds for acceptability were set at a wear time or diary response rate of 70% or greater. RESULTS Overall, 14 out of 15 participants completed the study. In individuals with a mild to moderate symptom severity at baseline (mean total Positive and Negative Syndrome Scale score 58.4 [SD 14.4]), we demonstrated high rates of engagement with the wearable device (all participants meeting acceptability criteria), sleep diary, and symptom diary (93% and 86% meeting criteria, respectively), with negative symptoms being associated with lower diary completion rate. The end-of-study usability and acceptability questionnaire and qualitative analysis identified facilitators and barriers to long-term use, and paranoia with study devices was not a significant barrier to engagement. Comparison between sleep diary and wearable estimated sleep times showed good correspondence (ρ=0.50, P<.001). CONCLUSIONS Extended use of wearable and mobile technologies are acceptable to people with schizophrenia living in a community setting. In the future, these technologies may allow predictive, objective markers of clinical status, including early markers of impending relapse.
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Affiliation(s)
- Nicholas Meyer
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley National Health Service Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, United Kingdom
| | - Maximilian Kerz
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Amos Folarin
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Dan W Joyce
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley National Health Service Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, United Kingdom
| | - Richard Jackson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Chris Karr
- Audacious Software, Chicago, IL, United States
- Center for Behavioural Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Richard Dobson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - James MacCabe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley National Health Service Foundation Trust, Bethlem Royal Hospital, Beckenham, Kent, United Kingdom
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358
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Maple AM, Rowe RK, Lifshitz J, Fernandez F, Gallitano AL. Influence of Schizophrenia-Associated Gene Egr3 on Sleep Behavior and Circadian Rhythms in Mice. J Biol Rhythms 2018; 33:662-670. [PMID: 30318979 DOI: 10.1177/0748730418803802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Up to 80% of people meeting DSM-IV definitions for schizophrenia will exhibit difficulties with sleep, along with a breakdown in circadian entrainment and rhythmicity. The changes to the sleep and circadian systems in this population are thought to be interdependent, as evidenced by the frequent use of the combined term "sleep and circadian rhythm disruption" or "SCRD" to describe their occurrence. To understand links between sleep and circadian problems in the schizophrenia population, we analyzed the duration and rhythmicity of sleep behavior in mice lacking function of the immediate early gene early growth response 3 ( Egr3). EGR3 has been associated with schizophrenia risk in humans, and Egr3-deficient (-/-) mice display various features of schizophrenia that are responsive to antipsychotic treatment. While Egr3-/- mice slept less than their wildtype (WT) littermates, they showed no evidence of circadian disorganization; in fact, circadian rhythms of activity were more robust in these mice compared with WT, as measured by time series analysis and the relative amplitude index of Van Someren's suite of non-parametric circadian rhythm analyses. Differences in circadian robustness were maintained when the animals were transferred to several weeks of housing under constant darkness or constant light. Together, our results suggest that Egr3-/- mice retain control over the circadian timekeeping of sleep and wake, while showing impaired sleep. The findings are compatible with those from a surprising array of mouse models of schizophrenia and raise the possibility that SCRD may be 2 separate disorders in the schizophrenia population requiring different treatment strategies.
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Affiliation(s)
- Amanda M Maple
- Department of Basic Medical Sciences, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
| | - Rachel K Rowe
- Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona.,Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona.,Phoenix Veteran Affairs Health Care System, Phoenix, Arizona
| | - Jonathan Lifshitz
- Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona.,Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona.,Phoenix Veteran Affairs Health Care System, Phoenix, Arizona.,Interdisciplinary Graduate Program in Neuroscience, Arizona State University, Tempe, Arizona
| | - Fabian Fernandez
- Departments of Psychology and Neurology, BIO5 Institute, and The Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, Arizona
| | - Amelia L Gallitano
- Department of Basic Medical Sciences, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona.,Interdisciplinary Graduate Program in Neuroscience, Arizona State University, Tempe, Arizona
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359
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Severity, Prevalence, Predictors, and Rate of Identification of Insomnia Symptoms in a Sample of Hospitalized Psychiatric Patients. J Nerv Ment Dis 2018; 206:765-769. [PMID: 30273272 DOI: 10.1097/nmd.0000000000000888] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Insomnia is a risk factor for new onset, exacerbation, and relapse of mental illness. The goal of this study was to examine the prevalence, severity, and predictors of insomnia in hospitalized psychiatric patients. Ninety-seven consecutive psychiatric inpatients were administered the Insomnia Severity Index (ISI) to evaluate the presence and severity of insomnia. Patients' hospital charts were reviewed for demographic and medical information. ISI scores in 79.4% of the patients reached the threshold criterion of 8 for insomnia. Insomnia was not mentioned as a clinical problem in the discharge notes problem list in any of these patients. Multivariate analysis indicated that age (p = 0.009), recent suicide attempt or ideation (P < 0.001), tobacco use (p = 0.024), and recreational drug use during the past month (p = 0.040) were significant predictors of insomnia severity. Insomnia was highly prevalent in this population. Identification and management of insomnia would be an important clinical goal in hospitalized psychiatric patients.
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360
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Affiliation(s)
- Dieter Riemann
- Department of Psychiatry and Psychotherapy, University Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg 79104, Germany.
| | - Colin Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
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361
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Vancampfort D, Stubbs B, Smith L, Hallgren M, Firth J, Herring MP, Probst M, Koyanagi A. Physical activity and sleep problems in 38 low- and middle-income countries. Sleep Med 2018; 48:140-147. [DOI: 10.1016/j.sleep.2018.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/26/2018] [Accepted: 04/11/2018] [Indexed: 10/16/2022]
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362
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Murphy J, Wulff K, Catmur C, Bird G. Alexithymic traits, independent of depression and anxiety, are associated with reduced sleep quality. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2018.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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363
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Sheaves B, Freeman D, Isham L, McInerney J, Nickless A, Yu LM, Rek S, Bradley J, Reeve S, Attard C, Espie CA, Foster R, Wirz-Justice A, Chadwick E, Barrera A. Stabilising sleep for patients admitted at acute crisis to a psychiatric hospital (OWLS): an assessor-blind pilot randomised controlled trial. Psychol Med 2018; 48:1694-1704. [PMID: 29108526 PMCID: PMC6088775 DOI: 10.1017/s0033291717003191] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND When patients are admitted onto psychiatric wards, sleep problems are highly prevalent. We carried out the first trial testing a psychological sleep treatment at acute admission (Oxford Ward sLeep Solution, OWLS). METHODS This assessor-blind parallel-group pilot trial randomised patients to receive sleep treatment at acute crisis [STAC, plus standard care (SC)], or SC alone (1 : 1). STAC included cognitive-behavioural therapy (CBT) for insomnia, sleep monitoring and light/dark exposure for circadian entrainment, delivered over 2 weeks. Assessments took place at 0, 2, 4 and 12 weeks. Feasibility outcomes assessed recruitment, retention of participants and uptake of the therapy. Primary efficacy outcomes were the Insomnia Severity Index and Warwick-Edinburgh Mental Wellbeing Scale at week 2. Analyses were intention-to-treat, estimating treatment effect with 95% confidence intervals. RESULTS Between October 2015 and July 2016, 40 participants were recruited (from 43 assessed eligible). All participants offered STAC completed treatment (mean sessions received = 8.6, s.d. = 1.5). All participants completed the primary end point. Compared with SC, STAC led to large effect size (ES) reductions in insomnia at week 2 (adjusted mean difference -4.6, 95% CI -7.7 to -1.4, ES -0.9), a small improvement in psychological wellbeing (adjusted mean difference 3.7, 95% CI -2.8 to 10.1, ES 0.3) and patients were discharged 8.5 days earlier. One patient in the STAC group had an adverse event, unrelated to participation. CONCLUSIONS In this challenging environment for research, the trial was feasible. Therapy uptake was high. STAC may be a highly effective treatment for sleep disturbance on wards with potential wider benefits on wellbeing and admission length.
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Affiliation(s)
- Bryony Sheaves
- Sleep & Circadian Neuroscience Institute (SCNi), Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Daniel Freeman
- Sleep & Circadian Neuroscience Institute (SCNi), Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Louise Isham
- Sleep & Circadian Neuroscience Institute (SCNi), Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Josephine McInerney
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
| | - Alecia Nickless
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Ly-Mee Yu
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Stephanie Rek
- Sleep & Circadian Neuroscience Institute (SCNi), Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
| | - Jonathan Bradley
- Sleep & Circadian Neuroscience Institute (SCNi), Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
| | - Sarah Reeve
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
| | - Caroline Attard
- Berkshire Healthcare NHS Foundation Trust, Prospect Park Hospital, Honey End Lane, Tilehurst, Reading, Berkshire, RG30 4EJ, UK
| | - Colin A. Espie
- Sleep & Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, OMPI, Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Russell Foster
- Sleep & Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neurosciences, OMPI, Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford, OX1 3RE, UK
| | - Anna Wirz-Justice
- Centre for Chronobiology, Psychiatric Hospital, University of Basel, Wilhelm Klein Strasse 27, CH-4012 Basel, Switzerland
| | - Eleanor Chadwick
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
| | - Alvaro Barrera
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
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364
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Importance of investing in adolescence from a developmental science perspective. Nature 2018; 554:441-450. [PMID: 29469094 DOI: 10.1038/nature25770] [Citation(s) in RCA: 422] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/23/2018] [Indexed: 12/17/2022]
Abstract
This review summarizes the case for investing in adolescence as a period of rapid growth, learning, adaptation, and formational neurobiological development. Adolescence is a dynamic maturational period during which young lives can pivot rapidly-in both negative and positive directions. Scientific progress in understanding adolescent development provides actionable insights into windows of opportunity during which policies can have a positive impact on developmental trajectories relating to health, education, and social and economic success. Given current global changes and challenges that affect adolescents, there is a compelling need to leverage these advances in developmental science to inform strategic investments in adolescent health.
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365
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Barton J, Kyle SD, Varese F, Jones SH, Haddock G. Are sleep disturbances causally linked to the presence and severity of psychotic-like, dissociative and hypomanic experiences in non-clinical populations? A systematic review. Neurosci Biobehav Rev 2018; 89:119-131. [DOI: 10.1016/j.neubiorev.2018.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/26/2018] [Accepted: 02/12/2018] [Indexed: 12/15/2022]
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366
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Vancampfort D, Stubbs B, Firth J, Hagemann N, Myin-Germeys I, Rintala A, Probst M, Veronese N, Koyanagi A. Sedentary behaviour and sleep problems among 42,489 community-dwelling adults in six low- and middle-income countries. J Sleep Res 2018; 27:e12714. [DOI: 10.1111/jsr.12714] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Davy Vancampfort
- Department of Rehabilitation Sciences; KU Leuven; Leuven Belgium
- University Psychiatric Center KU Leuven; KU Leuven; Kortenberg Belgium
| | - Brendon Stubbs
- Physiotherapy Department; South London and Maudsley NHS Foundation Trust; London UK
- Health Service and Population Research Department; Institute of Psychiatry, Psychology and Neuroscience; King's College London; London UK
- Faculty of Health, Social Care and Education; Anglia Ruskin University; Chelmsford UK
| | - Joseph Firth
- NICM; School of Science and Health; University of Western Sydney; Sydney Australia
- Division of Psychology and Mental Health; Faculty of Biology, Medicine and Health; University of Manchester; Manchester UK
| | - Noemi Hagemann
- Department of Rehabilitation Sciences; KU Leuven; Leuven Belgium
- Department of Neurosciences; Center for Contextual Psychiatry; KU Leuven; Leuven Belgium
| | - Inez Myin-Germeys
- Department of Neurosciences; Center for Contextual Psychiatry; KU Leuven; Leuven Belgium
| | - Aki Rintala
- Department of Neurosciences; Center for Contextual Psychiatry; KU Leuven; Leuven Belgium
| | - Michel Probst
- Department of Rehabilitation Sciences; KU Leuven; Leuven Belgium
| | - Nicola Veronese
- National Research Council; Aging Branch; Neuroscience Institute; Padova Italy
- Geriatrics Unit; Department of Geriatric Care; OrthoGeriatrics and Rehabilitation; E.O. Galliera Hospital; National Relevance and High Specialization Hospital; Genova Italy
| | - Ai Koyanagi
- Instituto de Salud Carlos III; Centro de Investigación Biomédica en Red de Salud Mental; CIBERSAM; Madrid Spain
- Research and Development Unit; Universitat de Barcelona; Fundació Sant Joan de Déu; Barcelona Spain
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367
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Reinertsen E, Clifford GD. A review of physiological and behavioral monitoring with digital sensors for neuropsychiatric illnesses. Physiol Meas 2018; 39:05TR01. [PMID: 29671754 PMCID: PMC5995114 DOI: 10.1088/1361-6579/aabf64] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Physiological, behavioral, and psychological changes associated with neuropsychiatric illness are reflected in several related signals, including actigraphy, location, word sentiment, voice tone, social activity, heart rate, and responses to standardized questionnaires. These signals can be passively monitored using sensors in smartphones, wearable accelerometers, Holter monitors, and multimodal sensing approaches that fuse multiple data types. Connection of these devices to the internet has made large scale studies feasible and is enabling a revolution in neuropsychiatric monitoring. Currently, evaluation and diagnosis of neuropsychiatric disorders relies on clinical visits, which are infrequent and out of the context of a patient's home environment. Moreover, the demand for clinical care far exceeds the supply of providers. The growing prevalence of context-aware and physiologically relevant digital sensors in consumer technology could help address these challenges, enable objective indexing of patient severity, and inform rapid adjustment of treatment in real-time. Here we review recent studies utilizing such sensors in the context of neuropsychiatric illnesses including stress and depression, bipolar disorder, schizophrenia, post traumatic stress disorder, Alzheimer's disease, and Parkinson's disease.
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Affiliation(s)
- Erik Reinertsen
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States of America
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368
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Sex Differences in Hippocampal Memory and Kynurenic Acid Formation Following Acute Sleep Deprivation in Rats. Sci Rep 2018; 8:6963. [PMID: 29725029 PMCID: PMC5934413 DOI: 10.1038/s41598-018-25288-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/17/2018] [Indexed: 02/07/2023] Open
Abstract
Inadequate sleep is a prevalent problem within our society that can result in cognitive dysfunction. Elevations in kynurenic acid (KYNA), a metabolite of the kynurenine pathway (KP) of tryptophan degradation known to impact cognition, in the brain may constitute a molecular link between sleep loss and cognitive impairment. To test this hypothesis, we investigated the impact of 6 hours of sleep deprivation on memory and KP metabolism (brain and plasma) in male and female rats. Sleep-deprived males were impaired in a contextual memory paradigm, and both sexes were impaired in a recognition memory paradigm. After sleep deprivation, hippocampal KYNA levels increased significantly only in males. The response in hippocampal KYNA levels to sleep loss was suppressed in gonadectomized males, delineating a role of circulating gonadal hormones. Circulating corticosterone, which has previously been linked to KP metabolism, correlated negatively with hippocampal KYNA in sleep-deprived females, however the relationship was not significant in male animals. Taken together, our study introduces striking sex differences in brain KYNA formation and circulating corticosterone in response to sleep deprivation. Relating these findings to sex differences in cognitive outcomes after sleep deprivation may further advance the development of novel therapeutic agents to overcome sleep loss-induced cognitive dysfunction.
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369
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Espie CA, Pawlecki B, Waterfield D, Fitton K, Radocchia M, Luik AI. Insomnia symptoms and their association with workplace productivity: cross-sectional and pre-post intervention analyses from a large multinational manufacturing company. Sleep Health 2018; 4:307-312. [PMID: 29776626 DOI: 10.1016/j.sleh.2018.03.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 03/26/2018] [Accepted: 03/29/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Symptoms of insomnia are common and might impact work productivity. We investigated the relationship between insomnia symptoms and workplace productivity in a global manufacturing company. METHODS Within an uncontrolled, cross-sectional study, employees from a US-based company were invited to participate in an online evaluation comprising the Sleep Condition Indicator (SCI) measuring symptoms of insomnia (high score indicating better sleep), 2 items of the Work Productivity and Impairment Index (WPAI) measuring 'presenteeism' and 'absenteeism' (high score indicating loss of work productivity) and 1 item of the Perceived Stress Scale (PSS) from January 2015 onwards. Pre-post, within-subject data were collected to preliminary test effects of 'sleep tips' and digital cognitive behavioral therapy (dCBT). RESULTS In 2798 employees [72% male; mean age 46.3(SD11.8) yrs] sleep was poorest in plant staff [SCI = 3.70(2.73)], then retail staff [4.34(3.02)], then office staff [4.95(2.83): overall F(2,2786) = 43.7, P < .0001]. More insomnia symptoms were associated with WPAI presenteeism (r = -.489, P < .0001; R2 = 23.9%). Insomnia symptoms also were the strongest predictor of work-related productivity, with stress only contributing a further 9%. A regression model for 'absenteeism' was statistically significant but of limited predictive value (R2 = 3.4%). In a sample of 214 employees with pre- and post-intervention data, the SCI of those exposed to sleep tips significantly increased from 5.36(3.28) to 6.01(3.22), [t(123) = -3.02, P = .003] and from 3.08(2.24) to 6.03(2.97) for those who accessed dCBT [t(89) = -8.40, P < .001). CONCLUSION Symptoms of insomnia are associated with poor work productivity. Additionally, targeted insomnia interventions may offer potential to improve sleep and work productivity.
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Affiliation(s)
- Colin A Espie
- Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Big Health Inc, San Francisco, USA.
| | | | | | | | | | - Annemarie I Luik
- Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Big Health Inc, San Francisco, USA
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370
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Markwald RR, Iftikhar I, Youngstedt SD. Behavioral Strategies, Including Exercise, for Addressing Insomnia. ACSM'S HEALTH & FITNESS JOURNAL 2018; 22:23-29. [PMID: 31467475 PMCID: PMC6715137 DOI: 10.1249/fit.0000000000000375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
UNLABELLED Cognitive-behavioral therapy for insomnia is superior to sleeping pills for treating insomnia, and its accessibility is rapidly improving. Exercise can also promote sleep in insomnia. A list of recommendations on good sleep practices can be applied prior to consulting with a clinician and can often resolve insomnia symptoms. SUMMARY STATEMENT Insomnia is associated with negative psychological and physiological health outcomes. Established behavioral strategies for addressing insomnia such as adoption of good sleep habits and engagement in Cognitive Behavioral Therapy for Insomnia have documented efficacy. Exercise is also efficacious with unique health benefits.
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Affiliation(s)
| | | | - Shawn D Youngstedt
- College of Health Solutions, Arizona State University
- College of Nursing and Health Innovation, Arizona State University
- Phoenix VA Health Care System
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371
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Pocivavsek A, Rowland LM. Basic Neuroscience Illuminates Causal Relationship Between Sleep and Memory: Translating to Schizophrenia. Schizophr Bull 2018; 44:7-14. [PMID: 29136236 PMCID: PMC5768044 DOI: 10.1093/schbul/sbx151] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with schizophrenia are often plagued by sleep disturbances that can exacerbate the illness, including potentiating psychosis and cognitive impairments. Cognitive dysfunction is a core feature of schizophrenia with learning and memory being particularly impaired. Sleep disruptions often accompanying the illness and may be key mechanism that contribute to these core dysfunctions. In this special translational neuroscience feature, we highlight the role of sleep in mediating cognitive function, with a special focus on learning and memory. By defining dysfunctional sleep architecture and rhythms in schizophrenia, we focus on the disarray of mechanisms critical to learning and memory and postulate an association between sleep disturbances and cognitive impairments in the disorder. Lastly, we review preclinical models of schizophrenia and highlight exciting translational research that may lead to new therapeutic approaches to alleviating sleep disturbances and effectively improving cognitive function in schizophrenia.
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Affiliation(s)
- Ana Pocivavsek
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Laura M Rowland
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
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372
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Izuhara M, Matsuda H, Saito A, Hayashida M, Miura S, Oh-Nishi A, Azis IA, Abdullah RA, Tsuchie K, Araki T, Ryousuke A, Kanayama M, Hashioka S, Wake R, Miyaoka T, Horiguchi J. Cognitive Behavioral Therapy for Insomnia as Adjunctive Therapy to Antipsychotics in Schizophrenia: A Case Report. Front Psychiatry 2018; 9:260. [PMID: 29946274 PMCID: PMC6005892 DOI: 10.3389/fpsyt.2018.00260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/25/2018] [Indexed: 11/13/2022] Open
Abstract
The authors present the case of a 38-year-old man with schizophrenia and with severe insomnia, who attempted suicide twice during oral drug therapy with risperidone. The patient slept barely 2 or 3 h per night, and he frequently took half days off from work due to excessive daytime sleepiness. As a maladaptive behavior to insomnia, he progressively spent more time lying in bed without sleeping, and he repeatedly thought about his memories, which were reconstructed from his hallucinations. His relatives and friends frequently noticed that his memories were not correct. Consequently, the patient did not trust his memory, and he began to think that the hallucinations controlled his life. During his insomniac state, he did not take antipsychotic drugs regularly because of his irregular meal schedule due to his excessive daytime sleepiness. The authors started cognitive behavioral therapy for insomnia (CBT-i) with aripiprazole long acting injection (LAI). CBT-i is needed to be tailored to the patient's specific problems, as this case showed that the patient maladaptively use chlorpromazine as a painkiller, and he exercised in the middle of the night because he believed he can fall asleep soon after the exercise. During his CBT-i course, he learned how to evaluate and control his sleep. The patient, who originally wanted to be short sleeper, began to understand that adequate amounts of sleep would contribute to his quality of life. He finally stopped taking chlorpromazine and benzodiazepine as sleeping drugs while taking suvorexant 20 mg. Through CBT-i, he came to understand that poor sleep worsened his hallucinations, and consequently made his life miserable. He understood that good sleep eased his hallucinations, ameliorated his daytime sleepiness and improved his concentration during working hours. Thus, he was able to improve his self-esteem and self-efficacy by controlling his sleep. In this case report, the authors suggest that CBT-i can be an effective therapy for schizophrenia patients with insomnia to the same extent of other psychiatric and non-psychiatric patients.
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Affiliation(s)
- Muneto Izuhara
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Hiroyuki Matsuda
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Ami Saito
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Maiko Hayashida
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Syoko Miura
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Arata Oh-Nishi
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | | | | | - Keiko Tsuchie
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Tomoko Araki
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Arauchi Ryousuke
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Misako Kanayama
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Sadayuki Hashioka
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Rei Wake
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Tsuyoshi Miyaoka
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Jun Horiguchi
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
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373
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Waite F, Bradley J, Chadwick E, Reeve S, Bird JC, Freeman D. The Experience of Sleep Problems and Their Treatment in Young People at Ultra-High Risk of Psychosis: A Thematic Analysis. Front Psychiatry 2018; 9:375. [PMID: 30197607 PMCID: PMC6117428 DOI: 10.3389/fpsyt.2018.00375] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/26/2018] [Indexed: 01/17/2023] Open
Abstract
We view sleep disruption as a contributory causal factor in the development of psychotic experiences. Clinical trials indicate that psychological interventions targeting insomnia result in improvements in both sleep and psychotic experiences. The aim of this study was to gain the perspective of young people at ultra-high risk of psychosis on their sleep problems and associated psychological treatment. Interviews were conducted with 11 patients, aged 15-22 years, at ultra-high risk of psychosis who had received a psychological sleep intervention. Responses were analyzed using thematic analysis. Disrupted sleep timing and a lack of routine were the characteristic hallmarks of participants' sleep problems. Sleep disturbance, psychological wellbeing, and functioning had a reciprocal relationship. There were negative expectations prior to therapy, however meaningful improvements occurred in sleep, mood, and functioning. The active implementation of therapy techniques was highlighted as important. These findings indicate that the treatment of sleep problems is highly valued and has a meaningful impact on wellbeing in young people at ultra-high risk of psychosis.
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Affiliation(s)
- Felicity Waite
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Jonathan Bradley
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Eleanor Chadwick
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Sarah Reeve
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Jessica C Bird
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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374
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Owen JE, Kuhn E, Jaworski BK, McGee-Vincent P, Juhasz K, Hoffman JE, Rosen C. VA mobile apps for PTSD and related problems: public health resources for veterans and those who care for them. Mhealth 2018; 4:28. [PMID: 30148141 PMCID: PMC6087876 DOI: 10.21037/mhealth.2018.05.07] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 05/18/2018] [Indexed: 11/06/2022] Open
Abstract
Many public health agencies, including the U.S. Department of Veterans Affairs (VA), have identified the use of mobile technologies as an essential part of a larger strategy to address major public health challenges. The VA's National Center for PTSD (NCPTSD), in collaboration with VA's Office of Mental Health and Suicide Prevention and the Defense Health Agency inside the U.S. Department of Defense (DoD), has been involved in the development, evaluation, and testing of 15 mobile apps designed specifically to address the needs and concerns of veterans and others experiencing symptoms of posttraumatic stress disorder (PTSD). These applications include seven treatment-companion apps (designed to be used with a provider, in conjunction with an evidence-based therapy) and eight self-management apps (designed to be used independently or as an adjunct or extender of traditional care). There is growing evidence for the efficacy of several of these apps for reducing PTSD and other symptoms, and studies of providers demonstrate that the apps are engaging, easy-to-use, and provide a relative advantage to traditional care without apps. While publicly available apps do not collect or share personal data, VA has created research-enabled versions of many of its mental health apps to enable ongoing product enhancement and continuous measurement of the value of these tools to veterans and frontline providers. VA and DoD are also collaborating on provider-based implementation networks to enable clinicians to optimize implementation of mobile technologies in care. Although there are many challenges to developing and integrating mHealth into care, including cost, privacy, and the need for additional research, mobile mental health technologies are likely here to stay and have the potential to reach large numbers of those with unmet mental health needs, including PTSD-related concerns.
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Affiliation(s)
- Jason E. Owen
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Eric Kuhn
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Beth K. Jaworski
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Pearl McGee-Vincent
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Katherine Juhasz
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Julia E. Hoffman
- Office of Mental Health Services, U.S. Department of Veterans Affairs, Washington, DC, USA
| | - Craig Rosen
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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375
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Rehman A, Gumley A, Biello S. Sleep quality and paranoia: The role of alexithymia, negative emotions and perceptual anomalies. Psychiatry Res 2018; 259:216-222. [PMID: 29080493 DOI: 10.1016/j.psychres.2017.09.066] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 09/19/2017] [Accepted: 09/25/2017] [Indexed: 01/19/2023]
Abstract
Recent evidence suggests that sleep problems are associated with psychotic like experiences including paranoia. However, the mechanisms underpinning this association are not well understood and thus studies modelling hypothesised mediating factors are required. Alexithymia, the inability to recognise and describe emotions within the self may be an important candidate. In two separate studies we sought to investigate factors mediating the relationship between sleep quality and paranoia using a cross-sectional design. Healthy volunteers without a mental health diagnosis were recruited (study 1, N = 401, study 2, N = 402). Participants completed a series of measures assessing paranoia, negative emotions, alexithymia and perceptual anomalies in an online survey. In study 1, regression and mediation analyses showed that the relationship between sleep quality and paranoia was partially mediated by alexithymia, perceptual anomalies and negative affect. In contrast, study 2 found that the relationship between sleep quality and paranoia was fully mediated by negative affect, alexithymia and perceptual anomalies. The link between sleep quality and paranoia is unclear and reasons for discrepant results are discussed. Novel findings in this study include the link between alexithymia and paranoia.
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Affiliation(s)
- Aliyah Rehman
- School of Psychology, University of Glasgow, 58 Hillhead Street, Glasgow, Scotland, UK.
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Stephany Biello
- School of Psychology, University of Glasgow, 58 Hillhead Street, Glasgow, Scotland, UK
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376
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Patel D. In this issue of Occupational Medicine. Occup Med (Lond) 2017. [DOI: 10.1093/occmed/kqx163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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377
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The Associations among Psychological Distress, Coping Style, and Health Habits in Japanese Nursing Students: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111434. [PMID: 29165395 PMCID: PMC5708073 DOI: 10.3390/ijerph14111434] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/15/2017] [Accepted: 11/19/2017] [Indexed: 12/20/2022]
Abstract
Background: Nursing students in many countries have been reported to experience high levels of stress and psychological distress. Health habits could potentially mediate the association between coping styles and psychological status. The purpose of this study was to evaluate the mediation effect of health habits in the relationship between stress coping styles and psychological distress in Japanese nursing students. Methods: A total of 181 nursing students completed anonymous self-reported questionnaires comprised of the General Health Questionnaire-12 (GHQ-12), the Brief Coping Orientation questionnaire, and an additional questionnaire on health behavior. A mediation analysis using path analysis with bootstrapping was used for data analysis. Results: Multivariate linear regression analysis showed that psychological distress was significantly and positively associated with “Avoidance coping” (β = 0.39, p < 0.001), and was negatively associated with “Active coping” (β = −0.30, p < 0.001), “exercise habit” (β = −0.25, p = 0.001), and “sleeping” (β = −0.24, p = 0.002). In the path model, “Active coping” and “Avoidance coping” had significant or marginally significant associations with “exercise habits” (active: β = 0.19, p = 0.008, avoidance: β = −0.12, p = 0.088), and psychological distress (active: β = −0.25, p < 0.001, avoidance: β = 0.363, p < 0.001). However, these coping style variables did not have a significant association with “sleep”. In general, the size of the correlations was below 0.4. Conclusions: Exercise habits mediated the relationship between coping styles and psychological distress to a greater extent than sleep. The present study suggests the possibility that complex interactions between health habits and coping styles may influence the psychological status of nursing students.
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378
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Treating Sleep Problems in Young People at Ultra-High Risk of Psychosis: A Feasibility Case Series. Behav Cogn Psychother 2017; 46:276-291. [PMID: 29081329 PMCID: PMC5906720 DOI: 10.1017/s1352465817000601] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background: Our view is that sleep disturbance may be a contributory causal factor in the development and maintenance of psychotic experiences. A recent series of randomized controlled intervention studies has shown that cognitive-behavioural approaches can improve sleep in people with psychotic experiences. However, the effects of psychological intervention for improving sleep have not been evaluated in young people at ultra-high risk of psychosis. Improving sleep might prevent later transition to a mental health disorder. Aims: To assess the feasibility and acceptability of an intervention targeting sleep disturbance in young people at ultra-high risk of psychosis. Method: Patients were sought from NHS mental health services. Twelve young people at ultra-high risk of psychosis with sleep problems were offered an eight-session adapted CBT intervention for sleep problems. The core treatment techniques were stimulus control, circadian realignment, and regulating day-time activity. Participants were assessed before and after treatment and at a one month follow-up. Results: All eligible patients referred to the study agreed to take part. Eleven patients completed the intervention, and one patient withdrew after two sessions. Of those who completed treatment, the attendance rate was 89% and an average of 7.6 sessions (SD = 0.5) were attended. There were large effect size improvements in sleep. Post-treatment, six patients fell below the recommended cut-off for clinical insomnia. There were also improvements in negative affect and psychotic experiences. Conclusion: This uncontrolled feasibility study indicates that treating sleep problems in young people at ultra-high of psychosis is feasible, acceptable, and may be associated with clinical benefits.
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379
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A structural equation model of the relationship between insomnia, negative affect, and paranoid thinking. PLoS One 2017; 12:e0186233. [PMID: 29049381 PMCID: PMC5648154 DOI: 10.1371/journal.pone.0186233] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/27/2017] [Indexed: 12/13/2022] Open
Abstract
Background A growing body of evidence points to relationships between insomnia, negative affect, and paranoid thinking. However, studies are needed to examine (i) whether negative affect mediates the relation between insomnia and paranoid thinking, (ii) whether different types of insomnia exert different effects on paranoia, and (iii) to compare the impact of objective and self-reported sleeping difficulties. Method Structural equation modelling was therefore used to test competing models of the relationships between self-reported insomnia, negative affect, and paranoia. n = 348 participants completed measures of insomnia, negative affect and paranoia. A subset of these participants (n = 91) went on to monitor their sleep objectively (using a portable sleep monitor made by Zeo) for seven consecutive nights. Associations between objectively recorded sleep, negative affect, and paranoia were explored using linear regression. Results The findings supported a fully mediated model where self-reported delayed sleep onset, but not self-reported problems with sleep maintenance or objective measures of sleep, was directly associated with negative affect that, in turn, was associated with paranoia. There was no evidence of a direct association between delayed sleep onset or sleep maintenance problems and paranoia. Conclusions Taken together, the findings point to an association between perceived (but not objective) difficulties initially falling asleep (but not maintaining sleep) and paranoid thinking; a relationship that is fully mediated by negative affect. Future research should seek to disentangle the causal relationships between sleep, negative affect, and paranoia (e.g., by examining the effect of an intervention using prospective designs that incorporate experience sampling). Indeed, interventions might profitably target (i) perceived sleep quality, (ii) sleep onset, and / or (iii) emotion regulation as a route to reducing negative affect and, thus, paranoid thinking.
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380
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Lallukka T, Sivertsen B. Sleep improvement by internet-based cognitive behavioural therapy might help prevent mental health disorders. Lancet Psychiatry 2017; 4:734-735. [PMID: 28888926 DOI: 10.1016/s2215-0366(17)30360-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Tea Lallukka
- Finnish Institute of Occupational Health, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland.
| | - Børge Sivertsen
- The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway; Department of Research and Innovation, Helse-Fonna HF Haugesund Hospital, Haugesund, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Oslo, Norway
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381
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Kripke DF. Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit. F1000Res 2016; 5:918. [PMID: 27303633 PMCID: PMC4890308 DOI: 10.12688/f1000research.8729.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 09/02/2023] Open
Abstract
This is a review of hypnotic drug risks and benefits, reassessing and updating advice presented to the Commissioner of the Food and Drug Administration (United States FDA). Almost every month, new information appears about the risks of hypnotics (sleeping pills). The most important risks of hypnotics include excess mortality, especially overdose deaths, quiet deaths at night, infections, cancer, depression and suicide, automobile crashes, falls, and other accidents, and hypnotic-withdrawal insomnia. Short-term use of one-two prescriptions is associated with greater risk per dose than long-term use. Hypnotics have usually been prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse, not better, and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders offer safer and more effective alternative approaches to insomnia.
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Affiliation(s)
- Daniel F. Kripke
- University of California, San Diego, La Jolla, CA, 92037-2226, USA
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382
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Kripke DF. Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit. F1000Res 2016; 5:918. [PMID: 27303633 PMCID: PMC4890308 DOI: 10.12688/f1000research.8729.1] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 12/14/2022] Open
Abstract
This is a review of hypnotic drug risks and benefits, reassessing and updating advice presented to the Commissioner of the Food and Drug Administration (United States FDA). Almost every month, new information appears about the risks of hypnotics (sleeping pills). This review includes new information on the growing USA overdose epidemic, eight new epidemiologic studies of hypnotics' mortality not available for previous compilations, and new emphasis on risks of short-term hypnotic prescription. The most important risks of hypnotics include excess mortality, especially overdose deaths, quiet deaths at night, infections, cancer, depression and suicide, automobile crashes, falls, and other accidents, and hypnotic-withdrawal insomnia. The short-term use of one-two prescriptions is associated with greater risk per dose than long-term use. Hypnotics are usually prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse, not better, and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders might offer safer and more effective alternative approaches to insomnia.
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Affiliation(s)
- Daniel F. Kripke
- University of California, San Diego, La Jolla, CA, 92037-2226, USA
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383
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Abstract
This is a review of hypnotic drug risks and benefits. Almost every month, new information appears about the risks of hypnotics (sleeping pills). The most important risks of hypnotics include excess mortality (especially overdose deaths, quiet deaths at night, and suicides), infections, cancer, depression, automobile crashes, falls, other accidents, and hypnotic-withdrawal insomnia. Short-term use of one-two prescriptions is associated with even greater risk per dose than long-term use. Hypnotics have usually been prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse (not better) and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders offer safer and more effective alternative approaches to insomnia.
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Affiliation(s)
- Daniel F. Kripke
- University of California, San Diego, La Jolla, CA, 92037-2226, USA
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