Insomnia in male veterans with and without military sexual trauma receiving care within a VA medical center.

STUDY OBJECTIVES: This study evaluated the prevalence and correlates of insomnia in male veterans with military sexual trauma (MST) who currently receive care within a VA medical center. METHODS: We evaluated cross-sectional data from a VA medical center (n = 138) using the following instruments: Insomnia Severity Index, Posttraumatic Stress Disorder Checklist, Quick Inventory of Depressive Symptomatology-Self Report, Alcohol Use Disorders Identification Test for Consumption, and a nightmare question for insomnia, posttraumatic stress disorder, depression, and drinking, respectively. Bivariate and multivariable analyses assessed the relationship between Insomnia Severity Index and other clinical variables. RESULTS: About 31.9% screened positive for MST. When compared to those without MST (MST-), those with MST (MST+) had a higher prevalence of insomnia (95.5% vs 81.9%) and higher Insomnia Severity Index (20 ± 5.1 vs 16.7 ± 7.2, P = .003) and Posttraumatic Stress Disorder Checklist (48.5 ± 14.4 vs 38.2 ± 19.8, P = .0008) total scores. In the multivariable models, the Insomnia Severity Index total score was associated with the Posttraumatic Stress Disorder Checklist total score (P = .015) in MST+ individuals and with Quick Inventory of Depressive Symptomatology-Self Report (P < .001) in MST- individuals. CONCLUSIONS: Most veterans with MST within the Veterans Health Administration had insomnia, which was associated with their underlying psychiatric comorbidity. CITATION: Makar K, Mills A, Rivera LA, Aguiar TL, He S, Subhajit C. Insomnia in male veterans with and without military sexual trauma receiving care within a VA medical center. J Clin Sleep Med. 2024;20(6):991-994.

Mirtazapine-associated acute pancreatitis in a patient with insomnia and co-occurring psychiatric disorders.

We report the case of an African American patient who developed drug-associated acute pancreatitis without hypertriglyceridemia, after being treated with mirtazapine for major depressive disorder (MDD). Acute pancreatitis is characterized by rapid inflammation and autodigestion of the pancreas, which may become life-threatening. Although heavy alcohol use and gallstones are the most common causes of acute pancreatitis, some medications are also known to cause drug-induced acute pancreatitis. This report describes a 47-year-old African American female with a history of MDD, insomnia, posttraumatic stress disorder (PTSD), and alcohol use disorder, who was prescribed mirtazapine. A literature search implicated mirtazapine as a rare cause of drug-induced acute pancreatitis. Some reports have suggested that mirtazapine-associated acute pancreatitis may be due to hypertriglyceridemia. This case report instead presents with a normal lipid panel, which is consistent with the majority of prior reports, and it is noteworthy for introducing an alternative mechanism. The Naranjo Adverse Drug Reaction (ADR) Probability Scale calculated an ADR of 5, indicating mirtazapine as the probable cause of the patient's drug-associated acute pancreatitis.