Behavioural therapy for shift work disorder improves shift workers' sleep, sleepiness and mental health: A pilot randomised control trial.

The present study evaluates the efficacy of behavioural therapy adapted for shift work disorder with a randomised control design in a healthcare population. Forty-three night shift workers (m. age: 34 years; 77% women) experiencing shift work disorder were randomised to either the behavioural therapy for shift work disorder (BT-SWD) or a waiting-list control group offered after the waiting period. Participants completed questionnaires on insomnia, sleepiness and mental health pre- and post-treatment, pre- and post-waiting, and at follow-up, and a sleep diary. As night shift workers alternate between sleeping during the day after their night shifts and transitioning to nighttime sleep on days off, insomnia severity and sleep variables were analysed for daytime and nighttime sleep. The BT-SWD involved sleep restriction therapy, stimulus control and fixed sleep periods in the dark. Statistical analyses were performed under intent-to-treat and per-protocol approaches. Repeated-measures two-way ANCOVA analysis, controlling for age, sex and pre-treatment daytime total sleep time, was performed with Bonferroni corrections, and between-group effect sizes computed. Fourteen participants dropped out after randomisation. Under the intent-to-treat analysis, BT-SWD participants had a significant greater decrease in daytime insomnia severity and an increase in daytime total sleep time at post-treatment than the control group, with large between-group effect sizes (-1.25 and 0.89). These corresponding results were also significant with large effect sizes under the per-protocol analysis. Sleepiness, anxiety and depression levels improved at post-treatment and maintained at follow-up when the BT-SWD treated controls were added to the BT-SWD group. The behavioural therapy for shift work disorder can be used to improve the sleep and mental health of healthcare night workers.

Developmental trajectories of speech and language in neglected children aged 3 to 5 years: Results of the ELLAN study.

BACKGROUND: Neglected children are at high risk for significant difficulties in speech and language development. Because no longitudinal study has been conducted to date, the dynamic description of development during the preschool period is unknown. OBJECTIVES: Establish the developmental trajectories of speech sounds, receptive and expressive vocabulary, and morphosyntax among neglected children during the preschool years and compare them with those of non-neglected children. PARTICIPANTS AND SETTING: Participants are 69 neglected children and 99 same age non-neglected peers (37 and 46 males respectively) recruited at 36 months of age. Data were collected at home. METHODS: Data were collected at six-month intervals between the ages of 3 and 5.5 years using psychometrically robust tools. Neglected and control groups were compared according to age using repeated measures ANOVAs on all variables. A discrete mixture model for clustering longitudinal data was used for testing the heterogeneity of the language trajectories among neglected children. RESULTS: The language development of the neglected children as a whole group is lower than that of the control group for all variables. Two subgroups are identified within the neglected group: one with a developmental trajectory similar to that of the non-neglected children, and another whose trajectory is far below that of the control group. The effect sizes of these differences vary between 1.4 and 3 standard deviations under the mean. CONCLUSIONS: A large proportion of neglected children present significant speech and language difficulties from the age of 3, but some of them catch up and develop similarly to non-neglected children.

Evaluation of electroretinography (ERG) parameters as a biomarker for ADHD.

BACKGROUND: The retina is recognized as an accessible part of the brain due to their common embryonic origin. The electroretinogram (ERG) has proven to be a valuable tool for detecting schizophrenia and bipolarity. We therefore investigated its ability to detect ADHD. METHODS: The cone and rod luminance response functions of the ERG were recorded in 26 ADHD subjects (17 women and 9 men) and 25 controls (16 women and 9 men). RESULTS: No significant differences were found between the mixed groups, but sexual dysmorphia was observed in the significant results. In males, a significant prolonged cone a-wave latency was observed in the ADHD group. In females, we observed a significant decrease in the cone a- and b-wave amplitudes and a trend for a prolonged cone b-wave latency as well as a higher scotopic mixed rod-cone a-wave in the ADHD group. CONCLUSION: The data obtained in this study show the potential of the ERG to detect ADHD, warranting further large-scale studies.

The 5-year longitudinal diagnostic profile and health services utilization of patients treated with electroconvulsive therapy in Quebec: a population-based study.

PURPOSE: Electroconvulsive therapy (ECT) is effective for treating several psychiatric disorders. However, only a minority of patients are treated with ECT. It is of primary importance to characterize their profile for epidemiological purposes and to inform clinical practice. We aimed to characterize the longitudinal profile of psychopathology and services utilization of patients first treated with ECT. METHODS: We conducted a population-based comparative study using data from a national administrative database in Quebec. Patients who received a first ECT between 2002 and 2016 were compared to controls who were hospitalized in psychiatry but did not receive ECT. We performed descriptive analyses to compare psychiatric diagnoses, domains of psychopathology (internalizing, externalizing and thought/psychotic disorders), medical services and medication use in the 5 years prior to the ECT or hospitalization. RESULTS: 5 080 ECT patients were compared with 179 594 controls. Depressive, anxiety, bipolar and psychotic disorders were more frequent in the ECT group. 96.2% of ECT patients had been diagnosed with depression and 53.8% with a primary psychotic disorder. In the ECT group, 1.0% had been diagnosed exclusively with depression and 47.0% had disorders from that belong to all three domains of psychopathology. Having both internalizing and thought/psychotic disorders was associated with an increased likelihood of receiving ECT vs having internalizing disorders alone (unadjusted OR = 2.93; 95% CI = 2.63, 3.26). All indicators of mental health services utilization showed higher use among ECT patients. CONCLUSION: Our results provide robust evidence of complex longitudinal psychopathology and extensive services utilization among ECT patients.

Developing a clinical decision tool based on electroretinogram to monitor the risk of severe mental illness.

BACKGROUND: We have shown that electroretinograms can discriminate between patients with severe mental illness (SMI) and healthy controls in previous studies. We now intend to enhance the development and clinical utility of ERG as a biological tool to monitor the risk of SMI. METHODOLOGY: A sample of 301 SMI patients (bipolar disorder or schizophrenia) and 200 controls was first split into a training (N = 401) and testing dataset (N = 100). A logistic regression using ERG was modeled in the training data, while external validation and discriminative ability were assessed in the testing data. A decision curve analysis was used to test clinical usefulness. Moreover, the identification of thresholds of uncertainty based on the two-graph ROC and the interval of uncertainty was used to enhance prediction. RESULTS: The discriminative assessment of the ERG showed very high sensitivity (91%) and specificity (89%) after considering uncertainty levels. Furthermore, for prediction probabilities ranging from 0.14 to 0.95 in the testing data, the net benefit of using our ERG model to decide whether to intervene or not exceeded that of never or always intervening. CONCLUSION: The ERG predicted SMI risk with a high level of accuracy when uncertainty was accounted for. This study further supports the potential of ERG to become a useful clinical decision tool to decide the course of action for subjects at risk of SMI. However, further investigation is still needed in longitudinal studies to assess the external validity of the instrument.

For a structured response to the psychosocial consequences of the restrictive measures imposed by the global COVID-19 health pandemic: the MAVIPAN longitudinal prospective cohort study protocol.

INTRODUCTION: The COVID-19 pandemic and associated restrictive measures have caused important disruptions in economies and labour markets, changed the way we work and socialise, forced schools to close and healthcare and social services to reorganise. This unprecedented crisis forces individuals to make considerable efforts to adapt and will have psychological and social consequences, mainly on vulnerable individuals, that will remain once the pandemic is contained and will most likely exacerbate existing social and gender health inequalities. This crisis also puts a toll on the capacity of our healthcare and social services structures to provide timely and adequate care. The MAVIPAN (Ma vie et la pandémie/ My Life and the Pandemic) study aims to document how individuals, families, healthcare workers and health organisations are affected by the pandemic and how they adapt. METHODS AND ANALYSIS: MAVIPAN is a 5-year longitudinal prospective cohort study launched in April 2020 across the province of Quebec (Canada). Quantitative data will be collected through online questionnaires (4-6 times/year) according to the evolution of the pandemic. Qualitative data will be collected with individual and group interviews and will seek to deepen our understanding of coping strategies. Analysis will be conducted under a mixed-method umbrella, with both sequential and simultaneous analyses of quantitative and qualitative data. ETHICS AND DISSEMINATION: MAVIPAN aims to support the healthcare and social services system response by providing high-quality, real-time information needed to identify those who are most affected by the pandemic and by guiding public health authorities' decision making regarding intervention and resource allocation to mitigate these impacts. MAVIPAN was approved by the Ethics Committees of the Primary Care and Population Health Research Sector of CIUSSS de la Capitale-Nationale (Committee of record) and of the additional participating institutions. TRIAL REGISTRATION NUMBER: NCT04575571.

Psychosocial Features of Shift Work Disorder.

To better understand Shift Work Disorder (SWD), this study investigates insomnia, sleepiness, and psychosocial features of night workers. The study compares night workers with or without SWD to day workers with or without insomnia. Seventy-nine night workers and 40 day workers underwent diagnostic interviews for sleep disorders and for psychopathologies. They completed questionnaires and a sleep diary for 14 days. The design was observatory upon two factors: Work schedule (night, day work) and sleep (good sleep, SWD/insomnia). Two-way ANCOVAs were conducted on psychosocial variables, and effect size were calculated. The clinical approach chosen led to distinct groups of workers. Night workers slept several periods (main sleep period after work, naps, nights on days off). High total wake time and low total sleep time characterized sleep in SWD. Most night workers with SWD still complained of sleepiness after main sleep. Cognitive activation distinguished groups of night workers. All other differences in psychosocial variables between night workers groups were similar to, but smaller than, the ones between day workers. The evaluation of SWD should consider all sleep periods of night workers with particular attention to self-reported total wake time, state sleepiness, and level of cognitive activation.

The Pattern of Change in Depressive Symptoms and Inflammatory Markers After Electroconvulsive Therapy: A Systematic Review.

ABSTRACT: Depression is a major mental health disorder, and its pathophysiology is still largely unknown, as is the action mechanism of electroconvulsive therapy (ECT). Some evidence suggests that inflammation might play a role in depression, and several studies have attempted to demonstrate a link between ECT and cytokines. This systematic review used a qualitative analysis to assess the effect of ECT on inflammatory markers as it relates to the clinical response of depressive symptoms in major depressive disorders. The bibliographic search engines CINAHL, Embase, PsychInfo, and PubMed were used to identify articles published up to July 2020. Search terms related to depression, ECT, and inflammation were used. Descriptive statistical analyses were performed to relate changes in inflammatory markers to clinical response to ECT. Twenty-five studies were included in the analysis. No systematic increases or decreases were found in a given inflammatory marker over the ECT; however, we observed that tumor necrosis factor α and interleukin-6 (IL-6) were more often found to be decreased after ECT, whereas IL-8 and IL-10 were more often found to be increased after treatment. No trend in correlation was found between the degree of clinical improvement of depressive symptoms and the variation of any inflammatory markers, despite positive clinical response to ECT. Great heterogeneity with regard to methodology used and lack of power of the studies included in this review could explain the lack of systematic change and correlation found in this study. Future research conducted on this subject should take into account these methodological limitations to allow subsequent meta-analysis.

The Quality of Life in Bipolar Disorder (QoL.BD) Scale: Validation of a French Cross-Cultural Adaptation.

OBJECTIVE: The goal of this study was to validate the French version of the Quality of Life in Bipolar Disorder (QoL.BD) scale, a condition-specific measure for bipolar disorder (BD). METHOD: The QoL.BD scale was translated into French in accordance with the recommendations for transcultural adaptation. It was administered to 125 participants with BD living in Quebec, Canada. Construct validity was evaluated through correlations with other measures of self-reported quality of life (QoL), functioning, and symptoms. Factorial structure was examined through an exploratory factor analysis. RESULTS: Internal reliability and test-retest reliability standards were met. Correlations in expected directions with other QoL, functioning, and depressive symptom scales supported convergent validity. The item loadings structure of the French QoL.BD largely replicated the original English version, with some modifications. CONCLUSION: The French version of the QoL.BD (full and brief) is comparable in its psychometric properties to the English version. It is a valid and sound measure for the evaluation of the QoL of French-speaking patients with BD.

Incidence, Persistence, and Remission Rates of Insomnia Over 5 Years.

Importance: Insomnia is a significant public health problem, but there is little information on its natural history. Objective: To assess the incidence, persistence, and remission rates of insomnia over a 5-year naturalistic follow-up period. Design, Setting, and Participants: This cohort study included participants with and without sleep problems selected from the adult population in Canada from August 2007 to June 2014. Participants completed an annual survey about their sleep and health status for 5 consecutive years. Exposure: Using validated algorithms, participants were classified at each assessment as being good sleepers (n = 1717), having an insomnia disorder (n = 538), or having subsyndromal insomnia (n = 818). Main Outcomes and Measures: Survival analyses were used to derive incidence rates of new insomnia among the subgroup of good sleepers at baseline and persistence and remission rates among those with insomnia at baseline. Sleep trajectories were examined by looking at year-person transitions between each consecutive year summed over the 5-year follow-up period. All inferential analyses were weighted according to normalized sampling weights. Results: The sample included 3073 adults (mean [SD] age, 48.1 [15.0] years; range, 18.0-95.0 years; 1910 [62.2%] female). Overall, 13.9% (95% CI, 11.0%-17. 5%) of initial good sleepers developed an insomnia syndrome during the 5-year follow-up period, and incidence rates were higher among women than among men (17.6% [95% CI, 13.6%-22.7%] vs 10.1% [95% CI, 6.6%-15.3%; χ2 = 4.43; P = .03). A total of 37.5% (95% CI, 32.6%-42.5%) of participants with insomnia at baseline reported insomnia persisting at each of the 5 annual follow-up times. For subsyndromal insomnia, rates were 62.5% at 1 year to 26.5% at 5 years. For syndromal insomnia, rates were 86.0% at 1 year to 59.1% at 5 years. Conversely, remission rates among those with subsyndromal insomnia were almost double the rates among those with an insomnia syndrome at 1 year (37.5% [95% CI, 31.7%-44.0%] vs 14.0% [95% CI, 9.3%-20.8%]), 3 years (62.7% [95% CI, 56.7%-68.7%] vs 27.6% [95% CI, 20.9%-35.9%]), and 5 years (73.6% [95% CI, 68.0%-78.9%%] vs 40.9% [95% CI, 32.7%-50.4%]). Yearly trajectories showed that individuals who were good sleepers at baseline were 4.2 (95% CI, 3.51-4.89) times more likely to stay good sleepers in the subsequent year, but once they developed insomnia, they were equally likely to report symptoms (47% probability) than to return to a good sleeper status (53% probability) 1 year later. Similarly, those with an insomnia syndrome at any given assessment were more likely (adjusted odds ratio, 1.60; 95% CI, 1.19-2.60) to remain in that status (persistence) than to improve (remittance) at the next assessment; even among those who improved, the odds of relapse were greater (adjusted odds ratio, 2.04; 95% CI, 1.23-3.37) than those to improve in the following year. Conclusions and Relevance: The findings suggest that insomnia is often a persistent condition. Considering the long-term adverse outcomes associated with persistent insomnia, these findings may have important implication for the prognosis and management of insomnia.

Electroretinography may reveal cognitive impairment among a cohort of subjects at risk of a major psychiatric disorder.

INTRODUCTION: Almost a third of the offspring of parents diagnosed with schizophrenia or bipolar disorder could develop a mental disorder or related symptoms. The objectives of this study were to test the existence of two distinct subgroups of youth at-risk, according to their retinal response to luminance measured with electroretinography (ERG), and to relate the resulting cluster memberships with the cognitive clusters previously reported. METHODOLOGY: A clustering analysis was performed with ERG measurements in 107 at-risk offspring. Each subgroup was compared to a healthy control group of 203 individuals. The ERG subgroup memberships were then associated with the cognitive clusters. RESULTS: A two-cluster solution was obtained: HR-Cluster1 (n=53) showed a control-like ERG profile and HR-Cluster2 (n=54) showed reduced rod amplitudes and prolonged cone latencies of the b-wave. Subjects in the HR-Cluster2 were 2.7 times more likely to belong to the most detrimental cognitive subgroup than subjects in the HR-Cluster1 (49% Vs 18%). CONCLUSION: At-risk offspring showed two distinct ERG profiles: a control-like and an altered profile. A higher risk of impaired cognitive function was observed in subjects with the altered ERG profile, suggesting the ERG as a potential biomarker of susceptibility to mental illness among youth at risk.

Insomnia, hypnotic use, and road collisions: a population-based, 5-year cohort study.

STUDY OBJECTIVES: The study objectives were to examine accidental risks associated with insomnia or hypnotic medications, and how these risk factors interact with sex and age. METHODS: A population-based sample of 3,413 adults (Mage = 49.0 years old; 61.5% female), with or without insomnia, were surveyed annually for five consecutive years about their sleep patterns, sleep medication usage, and road collisions. RESULTS: There was a significant risk of reporting road collisions associated with insomnia (hazard ratio [HR] = 1.20; 95% confidence interval [CI] = 1.00-1.45) and daytime fatigue (HR = 1.21; 95% CI = 1.01-1.47). Insomnia and its daytime consequences were perceived to have played some contributory role in 40% of the reported collisions. Both chronic (HR = 1.50; 95% CI = 1.17-1.91) and regular use of sleep medications (HR = 1.58; 95% CI = 1.16-2.14) were associated with higher accidental risks, as well as being young female with insomnia and reporting excessive daytime sleepiness. CONCLUSIONS: Both insomnia and use of sleep medications are associated with significant risks of road collisions, possibly because of or in association with some of their residual daytime consequences (i.e. fatigue and poor concentration). The findings also highlight a new group of at-risk patients, i.e. young women reporting insomnia and excessive daytime sleepiness.

The Electroretinogram May Differentiate Schizophrenia From Bipolar Disorder.

BACKGROUND: The retina is recognized as an approachable part of the brain owing to their common embryonic origin. The electroretinogram (ERG) has proved to be a valuable tool to investigate psychiatric disorders. We therefore investigated its accuracy as a tool to differentiate schizophrenia (SZ) from bipolar disorder (BP) even after balancing patients for their main antipsychotic medication. METHODS: ERG cone and rod luminance response functions were recorded in 150 patients with SZ and 151 patients with BP and compared with 200 control subjects. We created a subgroup of subjects-45 with SZ and 45 with BP-balanced for their main antipsychotic medication. RESULTS: A reduced cone a-wave amplitude and a prolonged b-wave latency were observed in both disorders, whereas a reduced cone b-wave amplitude was present in SZ only. Reduced mixed rod-cone a- and b-wave amplitudes were observed in both disorders. Patients with SZ were distinguishable from control subjects with 0.91 accuracy, 77% sensitivity, and 91% specificity with similar numbers for patients with BP (0.89, 76%, and 88%, respectively). Patients with SZ and patients with BP could be differentiated with an accuracy of 0.86 (whole sample) and 0.83 (subsamples of 45 patients with 80% sensitivity and 82% specificity). Antipsychotic dosages were not correlated with ERG parameters. CONCLUSIONS: The ERG waveform parameters used in this study provided a very accurate distinction between the two disorders when using a logistic regression model. This supports the ERG as a tool that could aid the clinician in the differential diagnosis of SZ and BP in stabilized medicated patients.

Children and Teens in Charge of their Health (CATCH): A protocol for a feasibility randomised controlled trial of solution-focused coaching to foster healthy lifestyles in childhood disability.

INTRODUCTION: Children with physical disabilities are rarely included in interventions to promote healthy lifestyles, despite being at higher risk for suboptimal dietary and physical activity behaviours. The Children and Teens in Charge of their Health study explores the feasibility and acceptability of conducting a randomised controlled trial (RCT) of a strengths-based, solution-focused coaching intervention for improving and sustaining physical activity and healthy dietary habits in children and young people with physical disabilities. METHODS AND ANALYSIS: Thirty children aged 10-18 years with a diagnosis of spina bifida or cerebral palsy who are able to set healthy lifestyle goals will be recruited from two children's rehabilitation hospitals in Ontario, Canada. Participants will be enrolled in the study for twelve months. All participants will receive standard care and printed information about healthy lifestyles. Of the 30 participants, 15 will be randomised to receive a coaching intervention for the first 6 months. Health indicators and psychosocial outcomes will be assessed by blinded assessors four times: at the start of the trial, immediately postintervention (6 months after randomisation), and at 3 and 6 months postintervention (9 and 12 months after randomisation, respectively). Predefined success criteria will be used to assess the feasibility of trial processes such as recruitment, attrition, stratification and intervention fidelity. Acceptability and perceived impact of the intervention will be explored qualitatively. ETHICS AND DISSEMINATION: The study has been approved by Holland Bloorview Kids Rehabilitation Hospital's Research Ethics Board (Ref: 17-752). A knowledge translation planning template will be used to ensure our findings have maximum reach. TRIAL REGISTRATION NUMBER: NCT03523806.

Polygenic risk scores distinguish patients from non-affected adult relatives and from normal controls in schizophrenia and bipolar disorder multi-affected kindreds.

Recent studies have used results on SNP association with schizophrenia (SZ) and bipolar disorder (BD) to create polygenic risk scores (PRS) discriminating non-familial unrelated patients from controls. Little is known about the role of PRS in densely affected multigenerational families. We tested PRS differences between affected SZ and BD family members from their non-affected adult relatives (NAARs) in Eastern Quebec Kindreds and from controls. We examined 1227 subjects: from 17 SZ and BD kindreds, we studied 153 patients (57 SZ, 13 schizoaffective, and 83 BD) and 180 NAARs, and 894 unrelated controls from the Eastern Quebec population. PRS were derived from published case-control association studies of SZ and BD. We also constructed a combined SZ and BD PRS by using SNPs from both SZ and BD PRS. SZ patients had higher SZ PRS than controls (p = 0.0039, R2 = 0.027) and BD patients had higher BD PRS than controls (p = 0.013, R2 = 0.027). Differences between affected subjects and NAARs and controls were significant with both SZ and BD PRS. Moreover, a combined SZ-BD PRS was also significantly associated with SZ and BD when compared to NAARs (p = 0.0019, R2 = 0.010) and controls (p = 0.0025, R2 = 0.028), revealing a SZ-BD commonality effect in PRS at the diagnosis level. The SZ and the BD PRS, however, showed a degree of specificity regarding thought disorder symptoms. Overall, our report would confirm the usefulness of PRS in capturing the contribution of common genetic variants to the risk of SZ and BD in densely affected families.

Familial Aggregation of Insomnia.

Study Objectives: There is little information about familial aggregation of insomnia; however, this type of information is important to (1) improve our understanding of insomnia risk factors and (2) to design more effective treatment and prevention programs. This study aimed to investigate evidence of familial aggregation of insomnia among first-degree relatives of probands with and without insomnia. Methods: Cases (n = 134) and controls (n = 145) enrolled in a larger epidemiological study were solicited to invite their first-degree relatives and spouses to complete a standardized sleep/insomnia survey. In total, 371 first-degree relatives (Mage = 51.9 years, SD = 18.0; 34.3% male) and 138 spouses (Mage = 55.5 years, SD = 12.2; 68.1% male) completed the survey assessing the nature, severity, and frequency of sleep disturbances. The dependent variable was insomnia in first-degree relatives and spouses. Familial aggregation was claimed if the risk of insomnia was significantly higher in the exposed (relatives of cases) compared to the unexposed cohort (relatives of controls). The risk of insomnia was also compared between spouses in the exposed (spouses of cases) and unexposed cohort (spouses of controls). Results: The risk of insomnia in exposed and unexposed biological relatives was 18.6% and 10.4%, respectively, yielding a relative risk (RR) of 1.80 (p = .04) after controlling for age and sex. The risk of insomnia in exposed and unexposed spouses was 9.1% and 4.2%, respectively; however, corresponding RR of 2.13 (p = .28) did not differ significantly. Conclusions: Results demonstrate evidence of strong familial aggregation of insomnia. Additional research is warranted to further clarify and disentangle the relative contribution of genetic and environmental factors in insomnia.

Patient Satisfaction with In-Home Telerehabilitation After Total Knee Arthroplasty: Results from a Randomized Controlled Trial.

Background and Introduction: Telerehabilitation after total knee arthroplasty (TKA) is supported by strong evidence on the effectiveness of such intervention and from a cost-benefit point of view. Satisfaction of patients toward in-home telerehabilitation after TKA has not yet been examined thoroughly in large-scale clinical trials. This study aims to compare satisfaction level of patients following in-home telerehabilitation (TELE) after TKA to one of the patients following a usual face-to-face home visit (STD) rehabilitation. Secondarily, to determine if any clinical or personal variables were associated to the level of satisfaction. MATERIALS AND METHODS: This study was embedded in a multicenter randomized controlled trial with 205 patients randomized into two groups. Rehabilitation intervention was the same for both groups; only approach for service delivery differed (telerehabilitation or home visits). Participants were assessed at baseline (before TKA), at hospital discharge, and at 2 and 4 months postdischarge (E4) using functional outcomes. Patient satisfaction was measured using the validated Health Care Satisfaction Questionnaire (HCSQ) at E4. RESULTS: Characteristics of all participants were similar at baseline. Satisfaction level of both groups did not differ and was very high (over 85%). It was neither correlated to personal characteristics nor to improvements of functional level from preoperative to E4. Satisfaction was rather found associated to walking and stair-climbing performances. CONCLUSIONS: These results, in conjunction with evidences of clinical effectiveness and cost benefits demonstrated in the same sample of patients, strongly support the use of telerehabilitation to improve access to rehabilitation services and efficiency of service delivery after TKA.

Electroretinographic anomalies in medicated and drug free patients with major depression: Tagging the developmental roots of major psychiatric disorders.

The retina is tagged as an approachable part of the brain due to its common embryonic origin and appears as a promising site of investigation for psychiatric disorders. Retinal function is assessed best with the electroretinogram (ERG), which was obtained in a large sample of patients with major depressive disorder and matched controls. ERG cone and rod luminance response functions were recorded in non-dilated eyes in 100 major depressive disorder patients (MDD) and 100 controls, (mean age of 42.8 and 40.9y. o. respectively). Amongst MDD patients, 17 were drug free (mean age 41.2y. o). In medicated patients, at the cone level, a prolonged b-wave was observed (p≤0.01). In drug free patients a prolonged b-wave was discovered only when averaging the implicit time of the 3 highest b-wave amplitudes of the photopic hill. For the medicated patients, the mixed rods/cones a-wave was reduced (p=0.01) whereas a trend (p=0.06) was observed for the pure rod b-wave (reduced) and the mixed rods/cones (reduced and prolonged; p=0.05). In drug free patients, a similar pattern could be observed in terms of effect sizes. Overall, medicated and drug free MDD patients shared some deficits suggesting that some anomalies are present above and beyond the effect of medication. Of interest, the prolonged cone and reduced rod amplitude were reported by our group in schizophrenia patients, suggesting a common neurodevelopmental root of major psychiatric disorders.

Cognitive-behavior therapy singly and combined with medication for persistent insomnia: Impact on psychological and daytime functioning.

While impairment of daytime functioning due to poor sleep is often the main determinant for seeking treatment, few studies have examined the clinical impact of insomnia therapies on daytime outcomes. The main objective of this study was to evaluate the impact of cognitive-behavior therapy (CBT), alone and combined with medication, on various indices of daytime and psychological functioning. Participants were 160 individuals with chronic insomnia who received CBT alone or CBT plus medication (zolpidem) for an initial six-week therapy, followed by an extended six-month therapy. Participants treated with CBT initially received maintenance CBT or no additional treatment and those treated with combined therapy initially continued with CBT plus intermittent medication (prn) or CBT without medication (taper). Measures of anxiety and depressive symptoms, fatigue, quality of life, and perceived impact of sleep difficulties on various indices of daytime functioning were completed at baseline, after each treatment stage, and at six-month follow-up. Following acute treatment, significant improvements of fatigue, quality of life (mental component), anxiety, and depression were obtained in the CBT alone condition but not in the combined CBT plus medication condition. Following extended treatment, further improvements were noted for the subgroup receiving extended CBT relative to that with no additional treatment, and for the subgroup receiving CBT and intermittent medication relative to that with CBT but no medication. Improvements were well maintained at the 6-month follow-up. These findings indicate that insomnia-specific therapy is effective at improving daytime and psychological functioning in the short term, and that maintenance therapy produces an added value to optimize long-term outcomes. TRIAL REGISTRATION: www.clinicaltrials.gov (#NCT 00042146).

Impact of comorbid anxiety and depressive disorders on treatment response to cognitive behavior therapy for insomnia.

OBJECTIVE: To evaluate the impact of comorbid anxiety or depressive disorders on treatment response to cognitive-behavior therapy (CBT) for insomnia, behavior therapy (BT), or cognitive therapy (CT). METHOD: Participants were 188 adults (117 women; Mage = 47.4 years) with chronic insomnia, including 45 also presenting a comorbid anxiety or mild to moderate depressive disorder. They were randomized to BT (n = 63), CT (n = 65), or CBT (n = 60). Outcome measures were the proportion of treatment responders (decrease of ≥8 points on the Insomnia Severity Index; ISI) and remissions (ISI score < 8) and depression and anxiety symptoms. RESULTS: Proportion of treatment responders and remitters in the CBT condition was not significantly different between the subgroups with and without comorbidity. However, the proportion of responders was lower in the comorbidity subgroup compared to those without comorbidity in both the BT (34.4% vs. 81.6%; p = .007) and CT (23.6% vs. 57.6%; p = .02) alone conditions, although remission rates and prepost ISI change scores were not. Pre to post change scores on the depression (-10.6 vs. -3.9; p < .001) and anxiety measures (-9.2 vs. -2.5; p = .01) were significantly greater in the comorbidity subgroup relative to the subgroup without comorbidity but only for those treated with the full CBT; no difference was found for those treated with either BT or CT alone. CONCLUSIONS: The presence of a comorbid anxiety or mild to moderate depressive disorder did not reduce the efficacy of CBT for insomnia, but it did for its single BT and CT components when used alone. (PsycINFO Database Record