Sleep-related attentional bias in insomnia: The mediating role of arousal.

BACKGROUND AND OBJECTIVES: Characterize the nature of attentional biases toward nocturnal and diurnal sleep-related stimuli in individuals with insomnia disorder. We investigated the contributing role of sleep-related attentional biases in insomnia severity and whether their effects on insomnia severity were mediated by arousal and valence levels of the presented stimuli. METHODS: Sixty-four individuals with insomnia disorder and 70 controls completed two Posner spatial cueing tasks including both nocturnal (alarm clocks) and diurnal (fatigue) pictorial stimuli associated with neutral cues. Arousal and valence of the sleep-related stimuli were assessed using a 5-point Likert type scale. RESULTS: Attention biases characterized by difficulty disengaging from and increased avoidance for daytime fatigue, and by difficulty disengaging from alarm clocks were observed in individuals with insomnia disorder compared to controls. On the whole sample, difficulty to disengage from diurnal and nocturnal sleep-related stimuli were related mostly to higher arousal rating of sleep-related stimuli and insomnia severity. Higher arousal rating for sleep-related stimuli mediates the relationship between difficulty disengaging and insomnia severity. LIMITATIONS: The cross-sectional nature of the study. CONCLUSIONS: We provide first initial evidence for an attentional bias characterized by on one side, avoidance for diurnal sleep-related stimuli and on other side, disengagement for both diurnal and nocturnal sleep-related stimuli in patients with insomnia. Disengagement difficulties for both diurnal and nocturnal sleep-related stimuli indirectly affected insomnia severity through arousal elicited by these stimuli. It appears important to develop and apply attentional bias modification training therapeutic interventions that can effectively reduce sleep-related arousal and attentional biases.

Validation of a French version of the Vancouver Obsessional Compulsive Inventory-Mental Contamination scale (VOCI-MC) and the Contamination Thought-Action Fusion scale (CTAF) in non-clinical and clinical samples.

The Vancouver Obsessional Compulsive Inventory-Mental Contamination scale (VOCI-MC) and the Contamination Thought-Action Fusion scale (CTAF) are two self-report instruments that assess symptoms of mental contamination and fusion between thoughts, and feelings and behaviours associated with contamination, respectively. The aim of this study was to investigate the psychometric properties of the French version of these two scales in non-clinical and clinical samples. We included 79 participants diagnosed with obsessive-compulsive disorder (OCD), 31 diagnosed with anxiety disorders, who were recruited from the University Department of Adult Psychiatry in Montpellier, and 320 non-clinical participants recruited from the general population. Psychometric properties of the French VOCI-MC and CTAF were investigated. Results showed that the French versions of the VOCI-MC and the CTAF had high internal consistency, good convergent and divergent validity, as well as good temporal stability. Exploratory and confirmatory factor analyses showed a one-factor structure for the two scales in both non-clinical and OCD samples. Adequate discriminative validity was established by comparing OCD patients with contamination-related symptoms and OCD patients who did not report contamination-related symptoms. The French VOCI-MC and CTAF are valid and appropriate tools for measuring mental contamination in both clinical and research contexts.

Validation of the French Clinical Assessment Interview for Negative Symptoms in a Sample of Stable French Individuals With Schizophrenia.

Objectives: The Clinical Assessment Interview for Negative Symptoms (CAINS) is an interview-based instrument evaluating the existence and severity of negative symptoms in people diagnosed with schizophrenia or schizoaffective disorder. The aim of this study is to translate and validate a French version of the CAINS in a French sample of outpatients diagnosed with schizophrenia or schizoaffective disorder. Methods: In this study, we included 84 outpatients with a diagnosis of schizophrenia from the University Department of Adult Psychiatry in Montpellier, France. All participants were assessed for the severity of negative symptoms as well as level of depression. Psychometric properties of the French CAINS were investigated including its factor structure, internal consistency, and interrater and test-retest reliabilities. We also determined the discriminant and convergent validity. Results: Exploratory factor analysis and parallel analysis reproduced the two-factor model, and explained 43.55% of the total score variation with good internal consistency (Cronbach α of 0.87). Both interrater and test-retest reliabilities were high for the CAINS and its subscales (intraclass correlation coefficient range, 0.89-0.99). The standard errors of measurement and minimal detectable change were also investigated. Convergent validity of the CAINS was underpinned by correlations obtained with various measures of negative symptoms. Adequate discriminant validity was established by showing that the CAINS did not correlate with positive symptoms. Conclusion: Overall, our results obtained were similar to those found in the original study of the CAINS. Structural analyses also replicated the two-factor model of the CAINS. Our results indicate that the French CAINS has robust psychometric properties and is a valid tool for evaluating negative symptoms in French-speaking individuals diagnosed with schizophrenia.

Acquisition and maintenance of disgust reactions in an OCD analogue sample: Efficiency of extinction strategies through a counter-conditioning procedure.

BACKGROUND: Obsessive-compulsive disorder (OCD) has long been considered as an anxiety disorder, disgust is the dominant emotion in contamination-based OCD. However, disgust seems resistant to exposure with response prevention partly due to the fact that disgust is acquired through evaluative conditioning. AIMS: The present research investigates a counter-conditioning intervention in treating disgust-related emotional responses in two groups of individuals with high (High contamination concerns, HCC, n = 24) and low (Low contamination concerns LCC, n = 23) contamination concerns. METHODS: The two groups completed a differential associative learning task in which neutral images were followed by disgusting images (conditioned stimulus; CS+), or not (CS-). Following this acquisition phase, there was a counter-conditioning procedure in which CS+ was followed by a very pleasant unconditional stimulus while CS- remained unreinforced. RESULTS: Following counter-conditioning, both groups reported significant reduction in their expectancy of US occurrence and reported less disgust with CS+. For both expectancy and disgust, reduction was lower in the HCC group than in the LCC group. Disgust sensitivity was highly correlated with both acquisition and maintenance of the response acquired, while US expectation was predicted by anxiety. CONCLUSION: Counter-conditioning procedure reduces both expectations and conditioned disgust.

Diagnostic Validity of the Sleep Condition Indicator to Screen for Diagnostic and Statistical Manual-5 Insomnia Disorder in Patients with Parkinson's Disease.

BACKGROUND: Insomnia is a highly common sleep disorder in patients with Parkinson's disease (PD). Yet, no screening questionnaires following the Diagnostic and Statistical Manual-5 (DSM-5) criteria have been validated in PD patients. OBJECTIVES: We assessed the validity and reliability of the French version of the sleep condition indicator (SCI), in patients with PD. METHODS: In a sample of 65 patients (46% women, mean age 63.8 ± 7.9 years) with PD, but without dementia, insomnia was assessed with a clinical interview and the SCI. Statistical analyses were performed to determine the reliability, construct validity, and divergent validity of the SCI. In addition, an explanatory factor analysis was performed to assess the underlying structure of the SCI. RESULTS: Of the 65 patients (mean duration PD 9.7 ± 6.9 years), 51% met the criteria for insomnia disorder when measured with a clinical interview. The mean SCI score was 18.05 ± 8.3. The internal consistency (α = 0.89) of the SCI was high. Using the previously defined cutoff value of ≤16, the area under the receiver operating characteristic curve was 0.86 with a sensitivity of 86% and a specificity of 87%. Exploratory factor analysis showed a 2-factor structure with a focus on sleep and daytime effects. Additionally, good construct and divergent validity were demonstrated. CONCLUSION: The SCI can be used as a valid and reliable screener for DSM-5 insomnia disorder in PD patients. Due to its short length, it is useful in both clinical practice and scientific research.

BeatWalk: Personalized Music-Based Gait Rehabilitation in Parkinson's Disease.

Taking regular walks when living with Parkinson's disease (PD) has beneficial effects on movement and quality of life. Yet, patients usually show reduced physical activity compared to healthy older adults. Using auditory stimulation such as music can facilitate walking but patients vary significantly in their response. An individualized approach adapting musical tempo to patients' gait cadence, and capitalizing on these individual differences, is likely to provide a rewarding experience, increasing motivation for walk-in PD. We aim to evaluate the observance, safety, tolerance, usability, and enjoyment of a new smartphone application. It was coupled with wearable sensors (BeatWalk) and delivered individualized musical stimulation for gait auto-rehabilitation at home. Forty-five patients with PD underwent a 1-month, outdoor, uncontrolled gait rehabilitation program, using the BeatWalk application (30 min/day, 5 days/week). The music tempo was being aligned in real-time to patients' gait cadence in a way that could foster an increase up to +10% of their spontaneous cadence. Open-label evaluation was based on BeatWalk use measures, questionnaires, and a six-minute walk test. Patients used the application 78.8% (±28.2) of the prescribed duration and enjoyed it throughout the program. The application was considered "easy to use" by 75% of the patients. Pain, fatigue, and falls did not increase. Fear of falling decreased and quality of life improved. After the program, patients improved their gait parameters in the six-minute walk test without musical stimulation. BeatWalk is an easy to use, safe, and enjoyable musical application for individualized gait rehabilitation in PD. It increases "walk for exercise" duration thanks to high observance. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02647242.

Insomnia comorbid to Parkinson's disease Part II: Therapeutic approaches.

Insomnia is four times more frequent in patients with Parkinson's disease (PD) than in the general population. In PD, insomnia is associated with a very significant decrease in quality of life and has deleterious consequences on both patients' and caregivers' health. When insomnia is comorbid to PD, the main therapeutic response is the prescription of benzodiazepines or related drugs. As in the general population, these sedative-hypnotic molecules have very low efficacy in PD and are associated with adverse effects. They are highly addictive and are also associated with drowsiness, a risk of falling and decreased life expectancy. These side effects may in themselves be symptoms associated with PD in the absence of insomnia. In this clinical context, it is clear that sedative-hypnotic drugs are likely to potentiate these clinical symptoms in PD. We recently documented that insomnia disorder comorbid to PD is associated with the classic psychological factors that perpetuate insomnia in neurologically disease-free individuals with insomnia. These results enabled us to emphasise that target-oriented interventions, such as cognitive-behavioural therapy for chronic insomnia (CBT-i), should be considered as a treatment for insomnia comorbid to PD. As a reminder, for decades CBT-i has been considered to be the most effective first-line treatment for the management of chronic insomnia, whether or not it is associated with a comorbidity. In this context, we demonstrated the acceptability of CBT-i in the treatment of insomnia comorbid to PD and its effectiveness for the management of noctural and diurnal symptoms of insomnia associated with this neurological condition. The objective of this paper is to raise awareness among health professionals of the relevance of psychological therapies (mostly CBT) for insomnia in PD. Unlike drug treatments, these therapies are safe for patients who are already weakened by PD itself.

Validation of the French Version of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) in a French Sample of Individuals with Schizophrenia: Validation de la version française de l'instrument d'évaluation des compétences MacArthur-traitement (MacCAT-T) dans un échantillon français de personnes souffrant de schizophrénie.

BACKGROUND: Assessing an individual's capacity to consent to treatment is a complex and challenging task for psychiatrists and health-care professionals. Diminished capacity to consent to pharmacological treatment is a common concern in individuals with schizophrenia. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) is the most common tool used in individuals with schizophrenia to evaluate the decision-making abilities for judgments about competence to consent to treatment. This instrument assesses patients' competence to make treatment decisions by examining their capacities in 4 areas: understanding information relevant to their condition and the recommended treatment, reasoning about the potential risks and benefits of their choices, appreciating the nature of their situation and the consequences of their choices, and expressing a choice. Despite its importance, there is no French version of this scale. Furthermore, its factor structure has never been explored, although validated measures are strongly needed to further detect deficits in patients' decision-making abilities. The goal of this study was thus to empirically validate a French version of the MacCAT-T in a French sample of individuals with schizophrenia. METHOD: In this cross-sectional study, we included 125 inpatients with a diagnosis of schizophrenia from the University Department of Adult Psychiatry in Montpellier. The MacCAT-T was administered to patients by a trained psychologist. Patients were also assessed for severity of symptoms, insight into illness, and depressive and anxiety symptoms. Inter-rater reliability and psychometric properties including internal consistency, construct validity, and discriminant and divergent validity were also investigated. RESULTS: The MacCAT-T's internal consistency was high (Cronbach α of 0.91). A high degree of inter-rater reliability was found for all the areas of the MacCAT-T (intraclass correlation coefficient range, 0.92 to 0.98). Exploratory factor analysis revealed a 2-factor model. The factor analysis explained 50.03% of the total score variation. Component 1 included all subparts of "understanding." Component 2 included all subparts of "appreciation" and "reasoning" and was therefore labeled "reflexivity." After Bonferroni corrections, decision-making capacity was positively associated with insight and the severity of psychotic symptoms but not with sociodemographic variables except for education. CONCLUSIONS: The MacCAT-T demonstrated a high degree of inter-rater reliability and strong psychometric properties. The French version of the MacCAT-T is a valid instrument to assess the decision-making capacity to consent to treatment in a French sample of individuals with schizophrenia.

Adverse Events in Intensive Care and Continuing Care Units During Bed-Bath Procedures: The Prospective Observational NURSIng during critical carE (NURSIE) Study.

OBJECTIVES: Standard nursing interventions, especially bed-baths, in ICUs can lead to complications or adverse events defined as a physiologic change that can be life-threatening or that prolongs hospitalization. However, the frequency and type of these adverse events are rarely reported in the literature. The primary objective of our study was to describe the proportion of patients experiencing at least one serious adverse event during bed-bath. The secondary objectives were to determine the incidence of each type of serious adverse event and identify risk factors for these serious adverse events. DESIGN: Prospective multicenter observational study. SETTING: Twenty-four ICUs in France, Belgium, and Luxembourg. PATIENTS: The patients included in this study had been admitted to an ICU for less than 72 hours and required at least one of the following treatments: invasive ventilation, vasopressors, noninvasive ventilation, high-flow oxygen therapy. Serious adverse events were defined as cardiac arrest, accidental extubation, desaturation and/or mucus plugging/inhalation, hypotension and/or arrhythmia and/or agitation requiring therapeutic intervention, acute pain, accidental disconnection or dysfunction of equipment, and patient fall requiring additional assistance. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The study included 253 patients from May 1, 2018, to July 31, 2018 in 24 ICUs, representing 1,529 nursing procedures. The mean Simplified Acute Physiology Score II was 54 ± 19. Nursing care was administered by an average of 2 ± 1 caregivers and lasted between 11 and 20 minutes. Of the 253 patients included, 142 (56%) experienced at least one serious adverse event. Of the 1,529 nursing procedures, 295 (19%) were complicated by at least one serious adverse event. In multivariate analysis, the factors associated with serious adverse event were as follows: presence of a specific protocol (p = 0.011); tracheostomy (p = 0.032); administration of opioids (p = 0.007); presence of a physician (p = 0.0004); duration of nursing care between 6 and 10 minutes (p = 0.003), duration of nursing care between 11 and 20 minutes (p = 0.005), duration of nursing care greater than 40 minutes (p = 0.04) with a reference duration of nursing care between 20 and 40 minutes. CONCLUSIONS: Serious adverse events were observed in one-half of patients and concerned one-fifth of nurses, confirming the need for caution. Further studies are needed to test systematic serious adverse event prevention strategies.

[Insomnia comorbid to Parkinson's disease Part II: Therapeutic approaches]. / L'insomnie dans la maladie de Parkinson Partie II : Approches thérapeutiques.

Insomnia disorder is four times more frequent in Parkinson's disease (PD) than in the general population. In PD, insomnia is associated with a very significant decrease in quality of life and deleterious consequences on both patients and caregivers' health. The main therapeutic option in response to insomnia comorbid to PD is the prescription of benzodiazepines or related drugs. As in the general population, these sedative-hypnotic molecules have very low efficacy in PD and are associated with adverse effects. They are highly addictive and are also associated with drowsiness, risk of falling and decreased life expectancy. These side effects may in themselves be symptoms associated with PD in the absence of insomnia. In this clinical context, we can easily conceive that sedative-hypnotics are likely to potentiate these clinical symptoms in PD. We have recently documented that insomnia disorder comorbid to PD is associated with the classical psychological factors perpetuating insomnia in neurological disease-free individuals with insomnia. These results have allowed us to emphasize that target-oriented interventions for instance cognitive-behavioral therapy for chronic insomnia (CBT-i) should be considered as a treatment approach for insomnia disorder comorbid to PD. As a reminder, for decades, CBT-i is considered the most effective first-line treatment for the management of chronic insomnia associated or not with comorbidity. In this context, we demonstrated the acceptability of CBT-i in the treatment of insomnia comorbid to PD and its effectiveness for the management of night and daytime symptoms of insomnia associated with this neurological condition. The objective of this synthesis is to raise awareness among health professionals of the relevance of psychological therapies (mostly CBT) for insomnia in PD. Unlike drug treatments, these therapies are safety for patients who are already weakened by the PD itself.

Self-Awareness Deficits of Cognitive Impairment in Individuals With Schizophrenia. Really?

OBJECTIVE: Misestimation of cognitive functioning has been largely described in individuals with schizophrenia. There is large evidence that correlations between subjectively assessed cognitive functioning and objectively determined cognitive functioning are weak in non clinical individuals and may be more closely related to other psychoaffective or clinical factors than to objective neuropsychological functioning. Surprisingly, no study to date has compared the associations between cognitive complaint and objective measures of cognitive functioning in individuals with schizophrenia and healthy controls. The main objective of this study was to 1) compare cognitive complaint between individuals with schizophrenia and non clinical controls, 2) explore the relationships between cognitive complaint and psychoaffective and clinical factors in the clinical group and 3) compare the relationships between subjective awareness of cognitive functioning and objective neuropsychological assessment in individuals with schizophrenia and non-clinical participants. METHOD: In this study 30 individuals with schizophrenia and 20 non-clinical matched controls were included. In addition to objective cognitive measures and subjective cognition assessed by the Subjective Scale To Investigate Cognition In Schizophrenia, measures of psychotic symptoms, depression, and anxiety were included. RESULTS: Schizophrenia patients reported higher cognitive complaints in comparison with controls. In individuals with schizophrenia, cognitive complaint subscores were differently associated with depression, anxiety, and negative symptoms. When depression was controlled for, the same number of correlations between self-rated measures of cognition and objective measures of cognition were found in both groups, but accuracy of self-assessment of cognition was lower in the schizophrenia group.When the schizophrenia group was divided into a high cognitive complaint group (SZ High CC) and a low cognitive complaint group (SZ Low CC), findings indicated that self-assessment of cognition in the SZ high CC was highly accurate (correlations with large effect sizes). By contrast the SZ low CC group severely misjudge their cognition. CONCLUSION: A significant proportion of patients with schizophrenia can accurately estimate their cognitive skills. Self-awareness of cognitive deficits in individuals with schizophrenia is an heterogenous phenomenon and misestimation of cognitive functioning might have been overestimated, partly due to secondary psychoaffective factors. Caution is warranted before jumping to the conclusion that all individuals with schizophrenia misjudge their cognitive functioning.

[Insomnia comorbid to Parkinson's disease Part I: Epidemiology, assessment, and related factors]. / L'insomnie dans la maladie de Parkinson Partie I : épidémiologie, évaluation et facteurs associés.

Insomnia is a common complaint in Parkinson's disease (PD) affecting more than three-quarters of patients. Longitudinal studies show that insomnia complaint is a persistent condition in PD, especially in patients with more severe insomnia at baseline. When international and standardized criteria are used, it is estimated that more than half of the patients meet the criteria for insomnia disorder. These data define insomnia as the most prevalent sleep disorder in PD. Given that background, it is surprising that none of the scales recommended by the International Parkinson and movement disorder society to assess sleep disturbances in PD is specifically dedicated to the assessment of insomnia disorder. In this insufficient methodological context, we have recently established the discriminant validity of the Sleep condition indicator for insomnia disorder in PD, as diagnosed with a clinical interview according to the DSM-5 criteria. As in the general population, female sex, symptoms of depression, anxiety, fatigue and daytime sleepiness have been associated with insomnia complaint severity in PD. Insomnia also reduces the quality of life of patients affected by PD and that of their caregivers. In contrast, clinical features of the disease were very slightly related to insomnia with small effect sizes. These features include motor fluctuations, autonomic problems, cardiovascular and thermoregulatory dysfunctions and doses of dopaminergic medications. This observation implies not systematically considering insomnia as a symptomatic manifestation secondary to PD but as a clinical entity requiring specific treatment. The objective of this synthesis is to raise awareness among health professionals of the importance of early detection of insomnia in PD in order to limit the consequences associated with its chronicity. Identifying and assessing insomnia in PD is therefore a major health issue.

Mind-wandering and sleepiness in adults with attention-deficit/hyperactivity disorder.

Sleepiness and mind-wandering are frequently experienced by patients with attention-deficit/hyperactivity disorder (ADHD), without ever having been jointly explored. We aimed to investigate the co-occurrence of these two phenomena in ADHD adults. Drug-free ADHD adults (n = 25) and healthy controls (n = 28) underwent an online experience sampling of mind-wandering episodes and subjective sleepiness. Participants completed self-reported measures of mind-wandering and sleepiness in daily life. Higher trait of mind-wandering was observed in ADHD patients compared to controls. On the whole sample, self-reported mind-wandering propensity was strongly associated with the severity of inattentive, impulsive and hyperactive symptoms. During the probes, patients reported more frequent episodes of mind-wandering and mind-blanking, and higher sleepiness. Their mind-wandering episodes were less intentional and belonged less frequently to a structured succession of thoughts. In both groups, mind-wandering and mind-blanking were associated with higher sleepiness. On the SART, patients were less accurate than controls. We provide first initial evidence for higher propensity of mind-wandering and mind-blanking using experience sampling in patients with formal ADHD diagnosis. This propensity was associated with sleepiness without negatively impacting attention performances. Mind-wandering and sleepiness have common determinants potentially involved in ADHD pathophysiology. Correlates of mind-blanking in ADHD adults remain to be characterized.

Rhythm disturbances as a potential early marker of Parkinson's disease in idiopathic REM sleep behavior disorder.

OBJECTIVE: We aimed to identify timing distortions in production and perception of rhythmic events in patients with idiopathic REM sleep behavior disorder (iRBD) as early markers of Parkinson's disease (PD). METHODS: Rhythmic skills, clinical characteristics, dysautonomia, depression, and olfaction were compared in 97 participants, including 21 participants with iRBD, 38 patients with PD, and 38 controls, matched for age, gender, and education level. Rhythmic disturbances can be easily detected with dedicated motor tasks via a tablet application. Rhythm production was tested in two conditions: to examine the ability to generate a spontaneous endogenous rhythm, tapping rate and variability in a finger tapping task without external stimulation was measured, while the ability to synchronize to an external rhythm was tested with finger tapping to external auditory cues. Rhythm perception was measured with a task, in which the participants had to detect a deviation from a regular rhythm. Participants with iRBD had dopamine transporter imaging. RESULTS: Participants with iRBD and PD revealed impaired spontaneous rhythm production and poor rhythm perception compared to controls. Impaired rhythm production was correlated with olfaction deficits, dysautonomia, impaired non-motor aspects of daily living, and dopamine uptake measures. CONCLUSIONS: Participants with iRBD show impaired rhythm production and perception; this impairment is correlated with other early markers for PD. Testing rhythmic skills with short and inexpensive tests may be promising for screening for potential future PD in iRBD patients.

Assessing Sleep-Related Safety Behaviors: Adaptation and Validation of a French Version of the Sleep-Related Behaviors Questionnaire in a Nonclinical Sample.

Objective/Background: Safety behaviors play a prominent role in the development and maintenance of insomnia. The Sleep-Related Behaviors Questionnaire (SRBQ) is a self-report questionnaire designed to assess safety behaviors employed to cope with fatigue or to improve sleep. Despite its frequent use in insomnia, no systematic psychometric validation of the SRBQ has been conducted; its factor structure has never been explored. Furthermore, there is no French version of this scale. The goal of this study was to empirically validate a French version of the SRBQ. Participants/Methods: A total of 539 French-speaking community-dwelling participants from the general population completed a face-to-face clinical interview to determine insomnia disorder against DSM-5 criteria and several questionnaires including the French SRBQ. Results: SRBQ items with poor psychometric properties were removed, thus leading to a 20-item version (SRBQ-20). Exploratory factor analysis and parallel analysis revealed three distinct factors with good internal consistency. The results supported the internal temporal stability of the SRBQ-20. The construct validity of that instrument was underpinned by correlations obtained with various measures of insomnia and related constructs. Adequate discriminative validity was established by comparing individuals with insomnia and individuals without insomnia. Conclusions: This study demonstrated that the French version of the SRBQ-20 has good psychometric properties.

Efficacy of cognitive behavioral therapy for insomnia comorbid to Parkinson's disease: A focus on psychological and daytime functioning with a single-case design with multiple baselines.

OBJECTIVE: To test the efficacy of cognitive behavioral therapy for insomnia (CBT-i) in Parkinson's Disease (PD) and to evaluate its impact on indices of daytime and psychological functioning. METHOD: Fifteen patients with insomnia disorder (ID) comorbid to PD were enrolled in a single-case design with multiple baselines. Total wake time, sleep efficiency, and daytime sleepiness were recorded on a sleep diary. Self-reported measures of insomnia, anxiety and depressive symptoms, health-related quality of life, and psychological variables perpetuating ID were completed. All patients also underwent a clinical interview for ID diagnosis. RESULTS: CBT-i was associated with significant changes in sleep variables and ID criteria. Significant positive treatment-related effects were also noted for all indices of daytime and psychological functioning, and for variables perpetuating ID. All of these improvements were well maintained at 3-month follow-up. CONCLUSION: CBT-i is a promising therapeutic avenue for patients with PD.

A moderated mediation model of the link between counterfactual processing at bedtime and insomnia diagnosis: The role of depressive symptoms and nocturnal maladaptive strategies of mental control.

This study investigated the relationship between bedtime counterfactual thoughts, depressive symptoms, nocturnal counterproductive thought-control strategies and insomnia disorder. Six hundred and fifty adults from the general population were recruited and provided data on their counterfactual thoughts' frequency at bedtime, depressive symptoms and use of nocturnal maladaptive strategies of thought control. In addition, all participants followed a face-to-face clinical interview for the diagnosis of insomnia disorder. A model positing moderated mediation was tested using conditional process modelling. Overall, 19% of participants met diagnostic criteria for a chronic insomnia diagnosis. Bootstrapped mediation analyses indicated that the association of bedtime counterfactual processing and insomnia diagnosis is mediated by depressive symptoms (B = 0.035, SE = 0.007, bootstrapped 95% CI = 0.023, 0.051). Furthermore, the effects of such a mediation model were significantly larger among individuals with high levels of aggressive suppression than those with low levels of aggressive suppression (B = 0.002, SE = 0.001, bootstrapped 95% CI = 0.001, 0.004). A second model in which a worry strategy moderates the relationship between bedtime counterfactual processing and depressive symptoms was not statistically significant (B = 0.0036, SE = 0.013, p = .78). The present study adds to the literature on the importance of self-attacking thoughts and negative affects at bedtime. We recommend the evaluation of the impact of adding self-attacks management strategies to cognitive behavior therapy for individuals with an insomnia disorder.

Presleep Cognitive Arousal and Insomnia Comorbid to Parkinson Disease: Evidence for a Serial Mediation Model of Sleep-Related Safety Behaviors and Dysfunctional Beliefs About Sleep.

STUDY OBJECTIVES: Insomnia disorder (ID) is highly associated with Parkinson disease (PD) with great negative effect on health-related quality of life. Nonetheless, the relevance of psychological processes involved in the maintenance of insomnia is yet to be established in the context of this neurological condition. Our aim was to examine a serial meditation model of sleep-related safety behaviors and dysfunctional beliefs about sleep in association with presleep cognitive arousal and ID in patients with PD. METHODS: A total of 68 patients with PD completed self-report measures including the Sleep-Related Behaviors Questionnaire (SRBQ-20), Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16), and the cognitive subscale of the Presleep Arousal Scale (PSAS-C). ID was assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Bootstrapped serial mediation analyses were conducted to test indirect effects. RESULTS: Overall, 55.6% of patients with PD met diagnostic criteria for ID. The association between presleep cognitive arousal (PSAS-C) and ID was serially mediated by sleep-related safety behaviors (SRBQ-20) and strong endorsement of dysfunctional beliefs about sleep (DBAS-16) (bias-corrected 95% confidence interval for the indirect effect = 0.013, 0.093). An alternate serial mediation model in which dysfunctional beliefs about sleep precede sleep-related safety behaviors was not statistically significant (bias-corrected 95% confidence interval for the indirect effect = -0.001, 0.046). CONCLUSIONS: ID comorbid to PD is associated with the classic psychological factors perpetuating ID in neurological disease-free individuals with insomnia. Target-oriented interventions for instance cognitive behavioral therapy for chronic insomnia should be considered as a treatment approach for ID comorbid to PD. CITATION: Lebrun C, Gély-Nargeot M-C, Maudarbocus KH, Rossignol A, Geny C, Bayard S. Presleep cognitive arousal and insomnia comorbid to parkinson disease: evidence for a serial mediation model of sleep-related safety behaviors and dysfunctional beliefs about sleep. J Clin Sleep Med. 2019;15(9):1217-1224.

Disgust assessment: Factorial structure and psychometric properties of the French version of the Disgust Propension and Sensibility Scale Revised-12.

The present study examined the internal and external validity of the French version of the 12-item Disgust Propensity and Sensitivity Scale-Revised (DPSS-12) in a nonclinical sample from the general population. Two hundred and eighty-two participants completed the DPSSf-12 questionnaire as well as the Anxiety Sensitivity Index (ASI), Anxiety Trait (STAI B), Obsessional Belief Questionnaire 44 items (OBQ 44), Obsessive Compulsive Inventory-Revised (OCI-R) and Positive and Negative Affect Schedule (PANAS). Confirmatory Factor Analysis supported a 2-factor structure after two sensitivity items were removed. The 10-item scale showed good internal consistency, construct validity and test-retest reliability. These adequate psychometric properties make the DPSSf-10 appropriate for use by researchers and practitioners.

Psychological processes associated with insomnia in patients with multiple sclerosis.

Study Objectives: Despite the high comorbidity of insomnia disorder (ID) with multiple sclerosis (MS), the relevance of psychological processes involved in the maintenance of insomnia is yet to be established in this neurological disorder. This study aimed to ascertain to what extent the suggested emotional, cognitive, and behavioral processes maintaining insomnia are relevant in people with insomnia and MS. Methods: A between-subjects design was used to compare 26 patients with insomnia and MS, with 31 patients with MS only, and with 26 matched neurological disease-free individuals with insomnia. All patients participated in a standardized clinical interview and completed a battery of self-reported measures of cognitive and somatic presleep arousal experienced at bedtime, sleep- or insomnia-related unhelpful beliefs, and sleep-related safety behaviors. All patients with MS underwent a neurological examination. Results: ID comorbid to MS was strongly associated with increased levels of cognitive and somatic arousal, higher endorsement of dysfunctional beliefs about the consequences of insomnia on daytime functioning, and worry about insomnia and more frequent engagement in sleep-related safety behaviors. Patients with MS with ID did not differ from neurological disease-free individuals with insomnia on these measures. No link was found between MS clinical peculiarities and ID diagnosis. Conclusions: ID comorbid to MS is associated with the classical psychological factors perpetuating ID in neurological disease-free individuals with insomnia. Primary care providers and neurologists should consider target-oriented therapies like cognitive behavioral therapy for chronic insomnia as a treatment approach for ID comorbid to MS.