Psychiatric diagnoses of patients visiting a sleep disorder clinic due to dyssomnias
Chang Gung University, Hsin-chu-hsien, Taiwan, Taiwan Psychological Reports
(Impact Factor: 0.53).
07/2006; 98(3):789-97. DOI: 10.2466/PR0.98.3.789-797
This study analyzed the demographic characteristics and psychiatric diagnoses of 90 consecutive patients who visited a sleep disorder clinic in Taiwan with complaints of insomnia (difficulty initiating or maintaining sleep, or nonrestorative sleep) or hypersomnia (excessive sleepiness as evidenced by either prolonged sleep episodes or daytime sleep episodes that occur almost daily). All subjects were interviewed using a sleep disturbance questionnaire and the structured Mini-International Neuropsychiatric Interview supplemented by the DSM-IV criteria for psychiatric diagnoses. Among 90 patients, 79 were classified as having insomnia and 11 had hypersomnia. 53 patients also had psychiatric diagnoses other than sleep disorders. Patients with insomnia had a significantly higher rate of comorbidities with other psychiatric diagnoses (65.8%) than did subjects with hypersomnia (9.1%). These results emphasize the importance of psychiatric evaluation of patients with complaints of sleep disturbance.
Available from: annals.edu.sg
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ABSTRACT: In this study, the pathways patients followed to treatment in an Insomnia Clinic in a psychiatric hospital were compared over 2 periods. The time interval to specialist referrals and patient clinical presentations were also studied. The aim was to better understand referrers' knowledge, needs and accessibility to services.
A retrospective review of cases seen between 2002 and 2005 was compared with an earlier review of cases referred between 1997 and 2000. The information gathered from medical records was similar for the 2 periods.
There were no significant differences in the socio-demographic profiles of patients in the 2 periods. Primary Insomnia was diagnosed in 48.2% of the first period cohort and in 47.5% of the second period cohort. However, among the remaining patients there was a shift from more depressive disorders in the first period to neurosis in the second period. Significantly, there was no difference in alcohol or substance abuse or dependence between the 2 periods. More than three-quarters of the patients had received treatment prior to the referral and for 51.8% in both periods, the providers were family physicians. Treatment was mainly pharmacotherapy with an increase in the use of Sleep Hygiene measures in the second period.
There is a need for continuing medical education on insomnia as well as a need to highlight the risks of untreated insomnia and assessment for other psychiatric disorders in this common complaint.
Annals of the Academy of Medicine, Singapore 10/2008; 37(9):733-7. · 1.15 Impact Factor
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ABSTRACT: The aim of this study was to investigate the impact of anxiety disorders and migraine on sleep quality and to find the independent factors that predict sleep quality among patients with major depressive disorder (MDD).
Psychiatric outpatients diagnosed with MDD were enrolled in the study. Major depressive disorder and 7 anxiety disorders were diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Migraine was diagnosed based on the International Classification of Headache Disorders, Second Edition. Headache intensity and frequency were reported by the subjects. The Pittsburgh Sleep Quality Index and Hamilton Depression Rating Scale were used to evaluate quality of sleep and depression severity, respectively. Multiple linear regressions were used to identify independent factors related to sleep quality.
One hundred thirty-five subjects (34 men and 101 women) with MDD were enrolled in the study. Subjects with panic disorder and agoraphobia were found to have poorer Pittsburgh Sleep Quality Index scores. Subjects with panic disorder, agoraphobia, and migraine had higher scores for items relating to sleep quality in the Hamilton Depression Rating Scale. Headache intensity and frequency correlated with sleep disturbance. Panic disorder was independently predictive of poor sleep quality. Both migraine and panic disorder independently predicted a greater severity of depression.
Our study demonstrates the negative impact of panic disorder and migraine on MDD and some of the interrelations between depression, anxiety, and sleep quality. Future studies should further explore these interactions and consider possible therapeutic interventions.
Comprehensive psychiatry 03/2009; 50(2):151-7. DOI:10.1016/j.comppsych.2008.07.002 · 2.25 Impact Factor
Available from: Ching-Yen Chen
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ABSTRACT: Study objectives:
The present study investigated whether bright light exposure during the first half of the evening/night shift combined with light attenuation in the morning is effective in improving sleep problems in nurses undertaking rotating shift work who suffer from clinical insomnia.
This was a prospective, randomized control study. The Insomnia Severity Index (ISI) and the Hospital Anxiety Depression Scale (HADS) were used to evaluate insomnia and anxiety/depression severity, respectively. Female hospital nurses on rotating shifts during the evening or night shift with an ISI score > 14 were enrolled. Subjects in the treatment group (n = 46) were exposed to bright light at 7,000-10,000 lux for ≥ 30 minutes. Exposure was continued for at least 10 days during 2 weeks, and the subjects avoided daytime outdoor sun exposure after work by wearing dark sunglasses. Subjects in the control group (n = 46) were not exposed to bright light, but also wore sunglasses after work. Statistical analyses were performed to examine group differences and differences across treatments.
After treatment, the treatment group showed significant improvements in the ISI score and the HADS total and subscale scores as compared with pre-treatment. The ISI, HADS, and subscales of the HADS scores were significantly improved across treatments in the treatment group as compared with the control group.
The design of this study is easy to put into practice in the real world. This is the first study to document that a higher intensity and briefer duration of bright light exposure during the first half of the evening/night shift with a daytime darkness procedure performed in rotating shift work female nurses suffering from clinical insomnia could improve their insomnia, anxiety, and depression severity.
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 07/2013; 9(7):641-6. DOI:10.5664/jcsm.2824 · 3.05 Impact Factor
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