The Different Faces of Insomnia.

Objectives: The identification of clinically relevant subtypes of insomnia is important. Including a comprehensive literature review, this study also introduces new phenotypical relevant parameters by describing a specific insomnia cohort. Methods: Patients visiting the sleep center and indicating self-reported signs of insomnia were examined by a sleep specialist who confirmed an insomnia diagnosis. A 14-item insomnia questionnaire on symptoms, progression, sleep history and treatment, was part of the clinical routine. Results: A cohort of 456 insomnia patients was described (56% women, mean age 52 ± 16 years). They had suffered from symptoms for about 12 ± 11 years before seeing a sleep specialist. About 40-50% mentioned a trigger (most frequently psychological triggers), a history of being bad sleepers to begin with, a family history of sleep problems, and a negative progression of insomnia. Over one third were not able to fall asleep during the day. SMI (sleep maintenance insomnia) symptoms were most frequent, but only prevalence of EMA (early morning awakening) symptoms significantly increased from 40 to 45% over time. Alternative non-medical treatments were effective in fewer than 10% of cases. Conclusion: Our specific cohort displayed a long history of suffering and the sleep specialist is usually not the first point of contact. We aimed to describe specific characteristics of insomnia with a simple questionnaire, containing questions (e.g., ability to fall asleep during the day, effects of non-medical therapy methods, symptom stability) not yet commonly asked and of unknown clinical relevance as yet. We suggest adding them to anamnesis to help differentiate the severity of insomnia and initiate further research, leading to a better understanding of the severity of insomnia and individualized therapy. This study is part of a specific Research Topic introduced by Frontiers on the heterogeneity of insomnia and its comorbidity and will hopefully inspire more research in this area.

Outcome of a four-hour smoking cessation counselling workshop for medical students.

BACKGROUND: Lack of smoking cessation education in undergraduate medical training hinders healthcare professionals in providing adequate tobacco cessation counselling. We developed a comprehensive 4-h smoking cessation counselling course for medical students that is easy to incorporate in a medical school curriculum, and assessed its short-term outcome for knowledge, skills, and attitudes. METHODS: Eighty-eight medical students (53f, 35 m) were educated by a doctoral student in five identical 4-h courses. A 45-min theoretical introduction was followed by patient-physician role-playing by student pairs. Knowledge, skills, and attitude were assessed before and 4 weeks after the course by questionnaires, and by blinded analysis of pre- and post-course videos of a five-minute standardized patient situation. RESULTS: Knowledge: Before the course 10.6 (mean, SD: 2.7) questions out of 29 were answered correctly, and increased to 19.2 (3.6) after the course (p < 0.0005). Major features of the students' counselling skills improved. Significant and highly relevant attitude changes reflected increased motivation to counselling smokers. CONCLUSION: Implementing a four-hour smoking intervention workshop into a medical curriculum was highly effective in improving students' knowledge, skills and attitudes towards smoking counselling, as well as providing them with additional clinical competencies.

Mental symptoms in patients with cardiac symptoms and normal coronary arteries.

OBJECTIVES: Patients with chest pain and normal coronary arteries often suffer from physical and psychological symptoms. Therefore, this study aimed to examine the incidence of mental symptoms in patients with angiographic exclusion of a coronary heart disease. DESIGN: In 253 patients with angiographic exclusion of a coronary heart disease the type and intensity of their symptoms were evaluated before and after coronary angiography. In addition, the incidence of psychopathological symptoms was quantified by standardised questionnaires such as general anxiety and depression (HADS), heart-focused anxiety (CAQ), hypochondria (Whiteley Index) and somatoform disorder (SOMS) and quality of life (SF-12). Finally, the incidence of psychological symptoms in these patients was compared to the incidence in the normal population. RESULTS: Despite the absence of a coronary artery disease, 70% of patients continue to suffer from cardiac symptoms. The incidence of general anxiety was increased by 37% in women and by 22% in men in comparison to the normal population. Heart-focused anxiety was raised by 27%. Somatoform disorder appeared 120% more often in patients after cardiac catheterisation in comparison to the normal population. In addition, the incidence of hypochondria was elevated by 68% in patients after coronary angiography compared to normal population. This increased appearance of psychological symptoms was reflected in a significantly lower quality of life (SF-12) in patients with inconspicuous coronary angiography. CONCLUSIONS: Patients with cardiac symptoms and normal coronary arteries more often suffer from mental symptoms in comparison to the healthy population.