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1.
J Consult Clin Psychol ; 89(6): 537-550, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34264701

RESUMO

OBJECTIVE: To determine if the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) improves functional impairment, psychiatric symptoms, and sleep and circadian functioning. METHOD: Adults diagnosed with serious mental illness (SMI) and sleep and circadian dysfunction (N = 121) were randomly allocated to TranS-C plus usual care (TranS-C + UC; n = 61; 8 individual weekly sessions) or 6 months of Usual Care followed by Delayed Treatment with TranS-C (UC-DT; n = 60). Schizophrenia (45%) and anxiety disorders (47%) were common. Blind assessments were conducted pre-treatment, post-treatment, and 6 months later (6FU). The latter two were the post-randomization points of interest. The location was Alameda County Behavioral Health Care Services (ACBHCS), a Community Mental Health Center (CMHC) in California. RESULTS: For the primary outcomes, relative to UC-DT, TranS-C + UC was associated with reduction in functional impairment (b = -3.18, p = 0.025, d = -0.58), general psychiatric symptoms (b = -5.88, p = 0.001, d = -0.64), sleep disturbance (b = -5.55, p < .0001, d = -0.96), and sleep-related impairment (b = -9.14, p < .0001, d = -0.81) from pre-treatment to post-treatment. These effects were maintained to 6-month follow-up (6FU; d = -0.42 to -0.82), except functional impairment (d = -0.37). For the secondary outcomes, relative to UC-DT, TranS-C + UC was associated with improvement in sleep efficiency and on the Sleep Health Composite score from pre-treatment to 6FU. TranS-C + UC was also associated with reduced total wake time and wake time variability from pre-treatment to post-treatment, as well as reduced hallucinations and delusions, bedtime variability, and actigraphy measured waking activity count variability from pre-treatment to 6FU. CONCLUSIONS: A novel transdiagnostic treatment, delivered within a CMHC setting, improves selected measures of functioning, symptoms of comorbid disorders, and sleep and circadian outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Centros Comunitários de Saúde Mental , Transtornos Mentais/terapia , Psicoterapia/métodos , Transtornos do Sono do Ritmo Circadiano/terapia , Transtornos do Sono-Vigília/terapia , Adulto , Ansiedade/terapia , Transtornos de Ansiedade/terapia , California , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Pessoa de Meia-Idade , Esquizofrenia/terapia , Sono , Transtornos do Sono do Ritmo Circadiano/complicações , Transtornos do Sono-Vigília/complicações , Resultado do Tratamento
2.
Psychoneuroendocrinology ; 129: 105241, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33932814

RESUMO

BACKGROUND: Inflammation-related processes have emerged as a biological pathway related to adolescent development. This study examined cross-sectional and longitudinal associations of baseline inflammatory markers with sleep, circadian preference, and health at baseline and following treatment. METHODS: Participants included 165 adolescents (58.2% female, mean age 14.7 years, 42.4% taking medication) "at-risk" in at least one domain (emotional, cognitive, behavioral, social, and physical health) who received a sleep-based intervention. Self-reported eveningness as well as total sleep time (TST) and bedtime from sleep diary were assessed at baseline and following treatment. Baseline soluble tumor necrosis factor receptor-2 (sTNF-R2) and interleukin (IL)-6 were assayed from oral mucosal transudate. Baseline C-reactive protein (CRP) was assayed from saliva. RESULTS: At baseline, shorter TST was associated with more emotional risk among adolescents with higher CRP (b = -0.014, p = 0.007). Greater eveningness was related to more behavioral risk in the context of lower IL-6 (b = -0.142, p = 0.005). Following treatment, lower baseline IL-6 was associated with reduced behavioral risk (Χ2 = 8.06, p = 0.045) and lower baseline CRP was related to reduced physical health risk (Χ2 = 9.34, p = 0.025). Baseline inflammatory markers were not significantly associated with sleep, circadian, or other health domain change following treatment. CONCLUSIONS: There was cross-sectional evidence that sleep and circadian dysfunction differentially relate to emotional and behavioral health risk for high and low levels of inflammatory markers. Longitudinal analyses indicated that lower levels of baseline inflammatory markers may be related to better treatment response to a sleep-based intervention.

4.
Sleep Med ; 79: 166-174, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33262011

RESUMO

STUDY OBJECTIVES: The aim of the present study is to examine the relationship between light and sleep, in adolescents with an evening circadian preference. METHODS: For a period of seven days, ninety-nine adolescents wore a wrist actigraph to assess light exposure and objective sleep and completed a sleep diary to assess subjective sleep. RESULTS: Lower average light intensity across the preceding 24 h was associated with a later sleep onset (p < 0.01) and a later next-day sleep offset (p < 0.05). A later time of last exposure to more than 10 lux was associated with a later sleep onset (p < 0.001) and a shorter objective total sleep time (p < 0.001), as well as a later bedtime (p < 0.001) and a shorter subjective total sleep time (p < 0.001). Furthermore, exploratory analyses found that lower average early morning light exposure (between 4 and 9 AM) was associated with later sleep onset (p < 0.05), a later next-day sleep offset (p < 0.05), and a later next-day waketime (p < 0.01), lower average afternoon light exposure (between 2 and 7 PM) was associated with a later next-day sleep offset (p < 0.05), and lower average evening light exposure (between 7 PM and 12 AM) was associated with longer subjective total sleep time (p < 0.01). CONCLUSION: This study highlights the importance of light exposure, particularly the timing of light exposure, for establishing healthy patterns of sleep among adolescents with a propensity for a delayed bedtime and waketime. These findings provide additional evidence for targeting light exposure when designing interventions to improve adolescent sleep.


Assuntos
Ritmo Circadiano , Sono , Adolescente , Humanos , Polissonografia
5.
Evid Based Ment Health ; 24(1): 33-40, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33355291

RESUMO

QUESTION: The context for the implementation of evidence-based psychological treatments (EBPTs) often differs from the context in which the treatment was developed, which necessitates adaptations. In this systematic review we build on, and add to, prior approaches by examining the method used to guide such adaptations. In particular, we sought to elucidate the extent to which an empirical process is used. STUDY SELECTION AND ANALYSIS: We focused on publications describing adaptations made to EBPTs for adults diagnosed with a mental illness. We searched PubMed, PsycINFO, Embase and Web of Science from database inception to July 2018. Two raters independently coded the articles for the method used to conduct the adaptation, the reason for and nature of the adaptation, and who made the adaptation. FINDINGS: The search produced 20 194 citations, which yielded 152 articles after screening. The most commonly used methods for planned adaptations were literature review (57.7%), clinical intuition (47.0%) and theory (38.9%). The use of data from stakeholder interviews ranked fourth (21.5%) and the use of other types of data (eg, pilot study, experiment, survey, interview) ranked last at fifth (12.1%). Few publications reporting ad hoc adaptations were identified (n=3). CONCLUSIONS: This review highlights a need to (a) educate providers and researchers to carefully consider the methods used for the treatment adaptation process, and to use empirical methods where possible and where appropriate, (b) improve the quality of reporting of stakeholder interviews and (c) develop reporting standards that articulate optimal methods for conducting treatment adaptations.

6.
Psychol Med ; : 1-10, 2020 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-32321599

RESUMO

BACKGROUND: Sleep disturbance has been consistently identified as an independent contributor to suicide risk. Inflammation has emerged as a potential mechanism linked to both sleep disturbance and suicide risk. This study tested associations between sleep duration, insomnia, and inflammation on suicidal ideation (SI) and history of a suicide attempt (SA). METHODS: Participants included 2329 adults with current or remitted depression and/or anxiety enrolled in the Netherlands Study of Depression and Anxiety. Sleep duration, insomnia, past week SI, and SA were assessed with self-report measures. Plasma levels of C-reactive protein, interleukin-6, and tumor necrosis factor-α were obtained. RESULTS: Short sleep duration (⩽6 h) compared to normal sleep duration (7-9 h) was associated with reporting a prior SA, adjusting for covariates [adjusted odds ratio (AOR) 1.68, 95% CI 1.13-2.51]. A higher likelihood of SI during the past week was observed for participants with long sleep duration (⩾10 h) compared to normal sleep duration (AOR 2.22, 95% CI 1.02-4.82), more insomnia symptoms (AOR 1.44, 95% CI 1.14-1.83), and higher IL-6 (AOR 1.31, 95% CI 1.02-1.68). Mediation analyses indicated that the association between long sleep duration and SI was partially explained by IL-6 (AOR 1.02, 95% CI 1.00-1.05). CONCLUSIONS: These findings from a large sample of adults with depression and/or anxiety provide evidence that both short and long sleep duration, insomnia symptoms, and IL-6 are associated with the indicators of suicide risk. Furthermore, the association between long sleep duration and SI may operate through IL-6.

7.
J Child Psychol Psychiatry ; 61(6): 653-661, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31773734

RESUMO

BACKGROUND: This study examined the 6-month follow-up outcomes of the Transdiagnostic Sleep and Circadian Intervention (TranS-C), compared to Psychoeducation about sleep and health (PE). METHODS: Adolescents (mean [SD] = 14.77 [1.84] years) with eveningness chronotype and "at-risk" in at least one of five health domains were randomized to receive TranS-C (n = 89) or PE (n = 87) at a university-based clinic. Primary outcomes were average weeknight total sleep time and bedtime calculated from sleep diary, a questionnaire measure of circadian preference, and composite risks in five health domains. Secondary outcomes were selected sleep diary indices, sleepiness, and self- and parent-reported sleep, parent-reported risks in five health domains. RESULTS: Relative to PE, TranS-C showed treatment effects through 6-month follow-up on only one primary outcome; namely eveningness circadian preference. TranS-C also showed treatment effects on two sleep and circadian secondary outcomes, including the Pittsburgh Sleep Quality Index and sleep-diary measured weeknight-weekend discrepancy in wakeup time. TranS-C did not show treatment effects on self-report or parent-report composite risks in five health domains. PE showed benefit, relative to TranS-C, from posttreatment to 6-month follow-up for reducing parent-reported behavioral health risk (secondary outcome). CONCLUSIONS: In at-risk adolescents, the evidence supports the TranS-C treatment effects over six months on improving sleep and circadian functioning on selected outcomes but not on reducing risk in five health domains.

8.
Behav Res Ther ; 123: 103504, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31678861

RESUMO

OBJECTIVE: Existing research has demonstrated that patient ratings of usefulness and ratings of utilization of treatment elements are associated with treatment outcome. Few studies have examined this relationship among adolescents and with an extended follow-up. This study examined the extent to which elements of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) were rated by youth as useful and utilized 6-months and 12-months after treatment. METHOD: Participants were 64 adolescents with an evening circadian preference who were given TranS-C as a part of their participation in a NICHD-funded study. At 6-month and 12-month follow-up, they completed the Usefulness Scale, the Utilization Scale, a 7-day sleep diary assessing total sleep time (TST) and bedtime, and the Children's Morningness-Eveningness Preference Scale (CMEP). RESULTS: On average, adolescents rated treatment elements as moderately useful and they utilized the treatment elements occasionally. Ratings of usefulness were associated with TST at 6-month follow-up, but not with bedtime or CMEP. Ratings of utilization were associated with a change in bedtime from 6-month to 12-month follow-up, but not with TST or CMEP. Ratings of usefulness and utilization were associated with selected treatment outcome measures at both follow-ups. CONCLUSIONS: These findings have implications for understanding mechanisms of change following treatment.


Assuntos
Ritmo Circadiano , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Psicoterapia , Sono , Adolescente , Criança , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Humanos , Masculino , Inquéritos e Questionários
9.
Curr Psychiatry Rep ; 21(2): 8, 2019 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-30729328

RESUMO

PURPOSE OF REVIEW: Inflammation has emerged as an important biological process in the development of many age-related diseases that occur at different frequencies in men and women. The aim of this review was to examine the current evidence linking stress and sleep with inflammation with a focus on sex differences. RECENT FINDINGS: Psychosocial stress that occurs either acutely or chronically is associated with elevated levels of systemic inflammation. While not as robust, insufficient sleep, particularly sleep disturbances, appears to be associated with higher levels of inflammatory activity as well. In several contexts, associations of stress and insufficient sleep with inflammation appear stronger in women than in men. However, this should be interpreted with caution as few studies test for sex differences. Stress and poor sleep often predict elevations in systemic inflammation. While there is some evidence that these associations are stronger in women, findings are largely mixed and more systematic investigations of sex differences in future studies are warranted.


Assuntos
Inflamação/complicações , Inflamação/fisiopatologia , Caracteres Sexuais , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Estresse Psicológico/complicações , Estresse Psicológico/fisiopatologia , Feminino , Humanos , Masculino , Sono/fisiologia
10.
J Adolesc Health ; 64(4): 523-529, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30514653

RESUMO

PURPOSE: Puberty influences biological and psychological development during adolescence. This includes a shift toward an evening circadian preference, which is characterized by greater physical and mental activity at night compared to the morning. This study examines how pubertal hormones are related to risk across key health domains among adolescents with an evening circadian preference. METHODS: Participants were adolescents with an evening circadian preference (n = 165, 96 female and 69 male, mean age = 14.8) from an NICHD-funded study. Hormones included testosterone, dehydroepiandrosterone (DHEA), and estradiol (females only). Sleep measures included weeknight total sleep time and weeknight bedtime. Circadian preference was assessed with the Children's Morningness-Eveningness Preferences Scale. Health domains included emotional, cognitive, behavioral, social, and physical health. RESULTS: For female adolescents, estradiol was related to higher risk in the emotional domain. Among female adolescents with later bedtimes, higher estradiol was associated with higher behavioral domain risk (specifically alcohol and substance use). For male adolescents with a more extreme evening circadian preference, higher DHEA and testosterone were associated with higher behavioral domain risk, specifically greater alcohol and substance use or sensation seeking (DHEA only). Among female adolescents with a more extreme evening circadian preference, higher DHEA was associated with greater physical health risk. CONCLUSIONS: Pubertal hormones may be associated with heightened risk across select health domains. Specifically, higher levels of hormones may contribute to increased risk for alcohol and substance use as well as sensation seeking in the context of an evening circadian preference.


Assuntos
Ritmo Circadiano/fisiologia , Puberdade/psicologia , Saliva/química , Transtornos do Sono-Vigília/psicologia , Adolescente , Cognição , Desidroepiandrosterona/análise , Emoções , Estradiol/análise , Feminino , Humanos , Masculino , Fatores de Risco , Comportamento Social , Inquéritos e Questionários , Testosterona/análise
11.
J Clin Child Adolesc Psychol ; 48(3): 480-490, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29368957

RESUMO

Sleep and circadian rhythm changes during adolescence contribute to increased risk across emotional, behavioral, cognitive, social, and physical health domains. This study examines if sleep and dim light melatonin onset (DLMO) are related to greater risk in these 5 health domains. Participants were 163 (93 female, age = 14.7 years) adolescents with an evening circadian preference from a study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Sleep and circadian measures included weekday total sleep time (TST), bedtime, and shut-eye time assessed via sleep diary, the Children's Morningness-Eveningness Preferences scale, and DLMO. Health domains included self-reported emotional, cognitive, behavioral, social, and physical health. Later DLMO was significantly associated with shorter weekday TST, later weekday bedtime, and later weekday shut-eye time, as well as lower risk in the behavioral domain. At the trend level, later DLMO was related to fewer physical health problems. Earlier DLMO combined with a later bedtime, later shut-eye time, or shorter TST predicted greater risk in the cognitive domain. Later DLMO and shorter TST or a later bedtime predicted worse physical health. DLMO timing was not related to the emotional or social domain. There is evidence that a discrepancy between sleep behaviors and the endogenous circadian rhythm may be related to risk in the cognitive domain for adolescents with an evening circadian preference. Preliminary evidence also indicated that a delayed DLMO and shorter TST or a later bedtime may be related to vulnerability to physical health risk.


Assuntos
Ritmo Circadiano/fisiologia , Transtornos do Sono-Vigília/psicologia , Sono/fisiologia , Adolescente , Feminino , Humanos , Masculino , Fatores de Risco , Autorrelato , Fatores de Tempo
12.
J Am Acad Child Adolesc Psychiatry ; 57(10): 742-754, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30274649

RESUMO

OBJECTIVE: To determine whether an intervention to reduce eveningness chronotype improves sleep, circadian, and health (emotional, cognitive, behavioral, social, physical) outcomes. METHOD: Youth aged 10 to 18 years with an evening chronotype and who were "at risk" in 1 of 5 health domains were randomized to: (a) Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C; n = 89) or (b) Psychoeducation (PE; n = 87) at a university-based clinic. Treatments were 6 individual, weekly 50-minute sessions during the school year. TranS-C addresses sleep and circadian problems experienced by youth by integrating evidence-based treatments derived from basic research. PE provides education on the interrelationship between sleep, stress, diet, and health. RESULTS: Relative to PE, TranS-C was not associated with greater pre-post change for total sleep time (TST) or bed time (BT) on weeknights but was associated with greater reduction in evening circadian preference (pre-post increase of 3.89 points, 95% CI = 2.94-4.85, for TranS-C, and 2.01 points, 95% CI = 1.05-2.97 for PE, p = 0.006), earlier endogenous circadian phase, less weeknight-weekend discrepancy in TST and wakeup time, less daytime sleepiness, and better self-reported sleep via youth and parent report. In terms of functioning in the five health domains, relative to PE, TranS-C was not associated with greater pre-post change on the primary outcome. However, there were significant interactions favoring TranS-C on the Parent-Reported Composite Risk Scores for cognitive health. CONCLUSION: For at-risk youth, the evidence supports the use of TranS-C over PE for improving sleep and circadian functioning, and improving health on selected outcomes. CLINICAL TRIAL REGISTRATION INFORMATION: Triple Vulnerability? Circadian Tendency, Sleep Deprivation and Adolescence. https://clinicaltrials.gov; NCT01828320.


Assuntos
Ritmo Circadiano/fisiologia , Privação do Sono/prevenção & controle , Sono/fisiologia , Adolescente , Criança , Feminino , Nível de Saúde , Humanos , Masculino , Autorrelato , Fatores de Tempo
13.
Psychosom Med ; 80(1): 87-94, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28914726

RESUMO

OBJECTIVE: Proinflammatory cytokines are associated with bipolar disorder (BD), but less is known about how cytokines function during the interepisode period. This study examined cytokines, mood symptoms, and sleep in individuals with interepisode BD with complaints of insomnia. We also investigated the effects of a BD-specific modification of cognitive behavior therapy for insomnia (CBTI-BP) on cytokine levels. METHODS: Twenty-two adults with interepisode BD type I and insomnia were drawn from a subset of a National Institute of Mental Health funded study. Participants were randomly allocated to CBTI-BP (n = 11) or psychoeducation (n = 11). Participants completed a sleep diary, rated self-report measures of mania and depression, and provided samples assayed for interleukin (IL)-6 and tumor necrosis factor soluble receptor 2 (sTNF-R2). RESULTS: IL-6 was associated with mania symptoms (rs = 0.44, p = .041) and total sleep time (rs = -0.49, p = .026). IL-6 was related to depression symptoms at the trend level (rs = 0.43, p = .052). sTNF-R2 was not significantly related to mood or sleep measures. From pretreatment to posttreatment, CBTI-BP compared with psychoeducation was associated with a nonsignificant, large effect size decrease in IL-6 (z = -1.61, p = .13, d = -0.78) and a nonsignificant, small-medium effect size decrease in sTNF-R2 (z = -0.79, p = .44, d = -0.38). CONCLUSIONS: These findings provide preliminary evidence that IL-6 is related to mania symptoms and shorter total sleep time in interepisode BD. A treatment that targets sleep in BD could potentially decrease IL-6 although replication is warranted.


Assuntos
Afeto/fisiologia , Transtorno Bipolar/sangue , Inflamação/sangue , Interleucina-6/sangue , Distúrbios do Início e da Manutenção do Sono/sangue , Sono/fisiologia , Adulto , Transtorno Bipolar/fisiopatologia , Transtorno Bipolar/terapia , Terapia Cognitivo-Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/terapia
14.
J Adolesc Health ; 62(1): 94-99, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29056434

RESUMO

PURPOSE: A shift toward an evening circadian preference and the onset of mood problems often occur during adolescence. Although these changes are linked to poorer outcomes, few studies have considered how positive and negative affect are related to the circadian rhythm during adolescence. This study examined the relationship between evening and morning affect ratings and dim light melatonin onset (DLMO), a measure of endogenous circadian rhythm. Age and sex were tested as moderators. METHODS: This study is based on a subset of 163 (94 female, age = 14.7) adolescents with an evening circadian preference from a National Institute of Child Health and Human Development-funded study. Participants provided saliva for melatonin analysis and rated evening and morning affect. RESULTS: Higher evening negative affect was related to a later DLMO. Evening positive affect was not significantly related to DLMO timing. Age but not sex was a significant moderator such that higher negative and lower positive affect were related to a later DLMO for 10- to 13-year-olds, whereas higher positive affect was related to a later DLMO for 17- to 18-year-olds. DLMO was not significantly related to morning affect ratings. CONCLUSIONS: There is evidence that higher negative and lower positive affect may be related to the shift toward an evening circadian preference observed in adolescents, particularly for younger adolescents.


Assuntos
Afeto , Ritmo Circadiano/fisiologia , Melatonina/biossíntese , Sono/fisiologia , Adolescente , Comportamento do Adolescente , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Saliva , Fatores de Tempo
15.
J Consult Clin Psychol ; 85(6): 647-652, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28394172

RESUMO

OBJECTIVE: Sleep prepares key neural structures for next-day learning, and sleep obtained after learning promotes subsequent memory consolidation supporting long-term retention. This study examined whether sleep the night before and after a therapy session predicts aspects of treatment adherence. METHOD: As part of a randomized clinical trial, 188 adults (62.7% female, mean age = 47.5, 80.5% Caucasian) with persistent insomnia received cognitive-behavioral therapy for insomnia. Patients completed a sleep diary before and after treatment sessions. Minutes spent awake during the night (total wake time; TWT) and total sleep time (TST) were used as measures of sleep disturbance. At each treatment session, therapists rated participant understanding of the session and homework compliance from the previous session. RESULTS: Compared to longer TWT, before session shorter TWT was associated with increased treatment understanding the next day. After session shorter TWT was also associated with increased understanding, but not homework compliance the subsequent session compared to participants with longer TWT. Similar results were obtained for TST. CONCLUSIONS: Improving sleep may benefit patient adherence to treatment. Sleep may influence processes related to initial learning and subsequent consolidation of treatment information. Future studies should examine whether improved sleep within other psychiatric disorders is also an ingredient to the successful outcome of psychosocial interventions. (PsycINFO Database Record


Assuntos
Terapia Cognitivo-Comportamental/métodos , Cooperação do Paciente/psicologia , Distúrbios do Início e da Manutenção do Sono/terapia , Sono , Adulto , Feminino , Humanos , Aprendizagem , Masculino , Pessoa de Meia-Idade , Distúrbios do Início e da Manutenção do Sono/psicologia
16.
J Affect Disord ; 212: 160-166, 2017 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-28192765

RESUMO

BACKGROUND: Suicide is a major public health concern, and a barrier to reducing the suicide rate is the lack of objective predictors of risk. The present study considers whether quantitative sleep electroencephalography (EEG) may be a neurobiological correlate of suicidal ideation. METHODS: Participants included 84 (45 female, mean age=26.6) adults diagnosed with major depressive disorder (MDD). The item that measures thoughts of death or suicide on the Quick Inventory of Depressive Symptomatology (QIDS) was used to classify 47 participants as low suicidal ideation (24 females, mean age=26.1) and 37 as high suicidal ideation (21 females, mean age=27.3). Data were obtained from archival samples collected at the University of Michigan and University of Texas Southwestern Medical Center between 2004 and 2012. Sleep EEG was quantified using power spectral analysis, and focused on alpha, beta, and delta frequencies. RESULTS: Results indicated that participants with high compared to low suicidal ideation experienced 1) increased fast frequency activity, 2) decreased delta activity, and 3) increased alpha-delta sleep after adjusting for age, sex, depression, and insomnia symptoms. LIMITATIONS: Limitations include the exclusion of imminent suicidal intent, a single suicidal ideation item, and cross-sectional archival data. CONCLUSIONS: This is one of the first studies to provide preliminary support that electrophysiological brain activity during sleep is associated with increased suicidal ideation in MDD, and may point toward central nervous system (CNS) hyperarousal during sleep as a neurobiological correlate of suicidal ideation.


Assuntos
Transtorno Depressivo Maior/fisiopatologia , Sono/fisiologia , Ideação Suicida , Adulto , Sistema Nervoso Central/fisiologia , Estudos Transversais , Eletroencefalografia , Feminino , Humanos , Masculino , Risco , Transtornos do Sono-Vigília/fisiopatologia
17.
Addiction ; 112(6): 1104-1111, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28127809

RESUMO

AIMS: To examine the association between a life-time history of insomnia and hypersomnia compared with no sleep disturbance and substance use patterns and amounts before and after a substance use treatment episode. DESIGN: Secondary analysis of data from the Drug Abuse Treatment Outcome Studies conducted from 1991 to 1994. SETTING: Data were collected at 96 substance use treatment programs in 11 United States cities, including short-term in-patient, long-term residential, methadone maintenance and out-patient drug-free treatment modalities. PARTICIPANTS: Study samples included 7168 adults at treatment entry and 2965 at 12 months post-treatment entry whose primary substance use at entry was alcohol (14.7%), cocaine (62.7%) or heroin (22.6%). MEASUREMENTS: Life-time history of insomnia and hypersomnia was assessed via self-report. Type and frequency of substance use were assessed at treatment entry. Substance use was also assessed 12 months following treatment completion. Associations were examined using linear and logistic regression with age, sex, race, education level, depression history, treatment modality and in-treatment substance use as covariates. FINDINGS: Life-time history of insomnia, hypersomnia, both or neither was reported by 26.3, 9.5, 28.0 and 36.2% of participants, respectively. Compared with no sleep disturbance, life-time insomnia and hypersomnia were associated at treatment entry with unique substance use patterns and a higher frequency of any substance use (P < 0.001). All types of sleep disturbance were associated with higher rates of cocaine use at 12-month post-entry (odds ratios: 1.30-1.57). CONCLUSIONS: There is evidence of an adverse association between substance use and sleep disturbance including higher frequency of all substance use before substance abuse treatment and higher rates of cocaine use after a treatment episode.


Assuntos
Alcoolismo/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Distúrbios do Sono por Sonolência Excessiva/epidemiologia , Dependência de Heroína/epidemiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adulto , Alcoolismo/terapia , Transtornos Relacionados ao Uso de Cocaína/terapia , Comorbidade , Feminino , Dependência de Heroína/terapia , Humanos , Masculino , Estudos Prospectivos , Recidiva , Estados Unidos
18.
Behav Res Ther ; 81: 35-46, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27089159

RESUMO

Patients exhibit poor memory for treatment. A novel Memory Support Intervention, derived from basic science in cognitive psychology and education, is tested with the goal of improving patient memory for treatment and treatment outcome. Adults with major depressive disorder (MDD) were randomized to 14 sessions of cognitive therapy (CT)+Memory Support (n = 25) or CT-as-usual (n = 23). Outcomes were assessed at baseline, post-treatment and 6 months later. Memory support was greater in CT+Memory Support compared to the CT-as-usual. Compared to CT-as-usual, small to medium effect sizes were observed for recall of treatment points at post-treatment. There was no difference between the treatment arms on depression severity (primary outcome). However, the odds of meeting criteria for 'response' and 'remission' were higher in CT+Memory Support compared with CT-as-usual. CT+Memory Support also showed an advantage on functional impairment. While some decline was observed, the advantage of CT+Memory Support was evident through 6-month follow-up. Patients with less than 16 years of education experience greater benefits from memory support than those with 16 or more years of education. Memory support can be manipulated, may improve patient memory for treatment and may be associated with an improved outcome.


Assuntos
Terapia Cognitivo-Comportamental , Transtorno Depressivo Maior/terapia , Aprendizagem , Adulto , Feminino , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
19.
Curr Psychiatry Rep ; 16(9): 471, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25030972

RESUMO

Insomnia is a major public health concern, and is highly comorbid with a broad range of psychiatric disorders. Although insomnia has historically been considered a symptom of other disorders, this perspective has shifted. Epidemiological and experimental studies suggest that insomnia is related to the onset and course of several psychiatric disorders. Furthermore, several randomized controlled trials show that cognitive behavioral therapy for insomnia delivered to individuals who meet diagnostic criteria for insomnia and another psychiatric disorder improves the insomnia as well as the symptoms of the comorbid psychiatric disorder. Taken together, these results encompassing a range of methodologies have provided encouraging evidence and point toward insomnia as a transdiagnostic process in psychiatric disorders.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtornos Mentais/terapia , Distúrbios do Início e da Manutenção do Sono/terapia , Comorbidade , Humanos , Transtornos Mentais/complicações , Transtornos Mentais/diagnóstico , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/diagnóstico
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