[Show abstract][Hide abstract] ABSTRACT: To compare NREM EEG power in primary insomnia (PI) and good sleeper controls (GSC), examining both sex and NREM period effects; to examine relationships between EEG power, clinical characteristics, and self-reports of sleep.
Overnight polysomnographic study.
PI (n=48; 29 women) and GSC (n=25; 15 women).
EEG power from 1-50 Hz was computed for artifact-free sleep epochs across four NREM periods. Repeated measures mixed effect models contrasted differences between groups, EEG frequency bands, and NREM periods. EEG power-frequency curves were modeled using regressions with fixed knot splines.
Mixed models showed no significant group (PI vs. GSC) differences; marginal sex differences (delta and theta bands); significant differences across NREM periods; and group*sex and group*NREM period interactions, particularly in beta and gamma bands. Modeled power-frequency curves showed no group difference in whole-night NREM, but PI had higher power than GSC from 18-40 Hz in the first NREM period. Among women, PI had higher 16 to 44-Hz power than GSC in the first 3 NREM periods, and higher 3 to 5-Hz power across all NREM periods. PI and GSC men showed no consistent differences in EEG power. High-frequency EEG power was not related to clinical or subjective sleep ratings in PI.
Women with PI, but not men, showed increased high-frequency and low-frequency EEG activity during NREM sleep compared to GSC, particularly in early NREM periods. Sex and NREM period may moderate quantitative EEG differences between PI and GSC.
[Show abstract][Hide abstract] ABSTRACT: The aim of this pilot study was to quantify the impact of sleep deprivation on psychophysiological reactivity to emotional stimuli. Following an adaptation night of sleep in the lab, healthy young adults were randomly assigned to either one night of total sleep deprivation or to a normal sleep control condition. The next afternoon, responses to positive, negative, and neutral picture stimuli were examined with pupillography, an indicator of cognitive and affective information processing. Only the sleep-deprived group displayed significantly larger pupil diameter while viewing negative pictures compared to positive or neutral pictures. The sleep-deprived group also showed anticipatory pupillary reactivity during blocks of negative pictures. These data suggest that sleep deprivation is associated with increased reactions to negative emotional information. Such responses may have important implications for psychiatric disorders, which may be triggered or characterized by sleep disturbances.
[Show abstract][Hide abstract] ABSTRACT: Although psychological stress has been associated with disturbed sleep in younger populations, little is known about the stress-sleep relationship in late-life. In the present study, we evaluated relationships among a chronic stressor, ongoing financial strain, and sleep in a heterogenous sample (n=75) of community-dwelling elders (mean age=74.0 years). Self-report measures included ongoing financial strain, mental health, physical health and subjective sleep quality. Sleep duration, continuity, and architecture were measured by polysomnography (PSG). Analysis of variance and regression were used to test the hypothesis that ongoing financial strain is a significant correlate of disturbed sleep in the elderly. Covariates included age, sex, mental health and physical health. Analyses revealed that ongoing financial strain is a significant correlate of PSG-assessed sleep latency, wakefulness after sleep onset, and sleep efficiency. After adjusting for the effects of age, sex, mental health, and physical health on sleep, ongoing financial strain was associated with lower sleep efficiency (p<.01). Our results show that chronic stress, as measured by ongoing financial strain, is a significant correlate of sleep disturbances in the elderly, even after adjusting for factors known to impact sleep in late-life.
[Show abstract][Hide abstract] ABSTRACT: This study examined whether predictors of timely follow-up care after inpatient psychiatric discharge in non-Medicaid populations also predicted timely follow-up care among Medicaid-enrolled adults.
The study examined the rates of seven- and 30-day follow-up care for 6,730 Medicaid-enrolled adults discharged from inpatient psychiatric facilities during 2004 and 2005 by using claims data from the largest Medicaid managed behavioral health organization in a large mid-Atlantic state. The relationship between predictor variables and timely aftercare was examined by using multiple logistic regression.
Thirty percent of individuals received follow-up care within seven days, and 49% received follow-up care within 30 days. After the analysis controlled for age and gender, those receiving clinical services in the 30 days before hospitalization were significantly more likely to receive follow-up care within seven days (odds ratio [OR]=3.59, 95% confidence interval [CI]=3.20-4.03) than individuals with longer inpatient stays (ten or more days) (OR=1.34, CI=1.15-1.57) and individuals from urban communities (OR=1.18, CI=1.05-1.34). African Americans (OR=.69, CI=.60-.78), individuals with co-occurring behavioral health and substance use disorders (OR=.78, CI=.68-.89), individuals involuntarily admitted (OR=.79, CI=.68-.91), and individuals discharged against medical advice (OR=.59, CI=.39-.87) were significantly less likely than their comparison groups to receive follow-up care within seven days. Thirty-day follow-up care results were similar.
Patient sociodemographic, clinical, and service utilization characteristics predicted timely follow-up care. Efforts to improve follow-up care utilization should target higher-risk individuals while developing and evaluating interventions to address specific barriers in these groups.
[Show abstract][Hide abstract] ABSTRACT: To prospectively characterize and compare daytime symptoms in primary insomnia (PI) and good sleeper control (GSC) subjects using ecological momentary assessment; to examine relationships between daytime symptom factors, retrospective psychological and sleep reports, and concurrent sleep diary reports.
Subjects included 47 PI and 18 GSC. Retrospective self-reports of daytime and sleep symptoms were collected. Daytime symptoms and sleep diary information were then collected for 1 week on hand-held computers. The Daytime Insomnia Symptom Scale (DISS) consisted of 19 visual analog scales completed four times per day. Factors for the DISS were derived using functional principal components analysis. Nonparametric tests were used to contrast DISS, retrospective symptom ratings, and sleep diary results in PI and GSC subjects, and to examine relationships among them.
Four principal components were identified for the DISS: Alert Cognition, Negative Mood, Positive Mood, and Sleepiness/Fatigue. PI scored significantly worse than GSC on all four factors (p<0.0003 for each). Among PI subjects DISS scales and retrospective psychological symptoms were related to each other in plausible ways. DISS factors were also related to self-report measures of sleep, whereas retrospective psychological symptom measures were not.
Daytime symptom factors of alertness, positive and negative mood, and sleepiness/fatigue, collected with ecological momentary assessment, showed impairment in PI versus GSC. DISS factors showed stronger relationships to retrospective sleep symptoms and concurrent sleep diary reports than retrospective psychological symptoms. The diurnal pattern of symptoms may inform studies of the pathophysiology and treatment outcome of insomnia.
Sleep Medicine 05/2007; 8(3):198-208. DOI:10.1016/j.sleep.2006.10.006 · 3.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Major depressive disorder is characterized by increased and sustained emotional reactivity, which has been linked to sustained amygdala activity. It is also characterized by disruptions in executive control, linked to abnormal dorsolateral prefrontal cortex (DLPFC) function. These mechanisms have been hypothesized to interact in depression. This study explored relationships between amygdala and DLPFC activity during emotional and cognitive information processing in unipolar depression.
Twenty-seven unmedicated patients with DSM-IV unipolar major depressive disorder and 25 never-depressed healthy control subjects completed tasks requiring executive control (digit sorting) and emotional information processing (personal relevance rating of words) during event-related functional magnetic resonance imaging (fMRI) assessment.
Relative to control subjects, depressed subjects displayed sustained amygdala reactivity on the emotional tasks and decreased DLPFC activity on the digit-sorting task. Decreased relationships between the time-series of amygdala and DLPFC activity were observed within tasks in depression, but different depressed individuals showed each type of bias.
Depression is associated with increased limbic activity in response to emotional information processing and decreased DLPFC activity in response to cognitive tasks though these may reflect separate mechanisms. Depressed individuals also display decreased relationships between amygdala and DLPFC activity, potentially signifying decreased functional relationships among these structures.
[Show abstract][Hide abstract] ABSTRACT: Numerous studies have pointed to the failure of prophylaxis with pharmacotherapy alone in the treatment of bipolar I disorder. Recent investigations have demonstrated benefits from the addition of psychoeducation or psychotherapy to pharmacotherapy in this population.
To compare 2 psychosocial interventions: interpersonal and social rhythm therapy (IPSRT) and an intensive clinical management (ICM) approach in the treatment of bipolar I disorder.
Randomized controlled trial involving 4 treatment strategies: acute and maintenance IPSRT (IPSRT/IPSRT), acute and maintenance ICM (ICM/ICM), acute IPSRT followed by maintenance ICM (IPSRT/ICM), or acute ICM followed by maintenance IPSRT (ICM/IPSRT). The preventive maintenance phase lasted 2 years.
Research clinic in a university medical center.
One hundred seventy-five acutely ill individuals with bipolar I disorder recruited from inpatient and outpatient settings, clinical referral, public presentations about bipolar disorder, and other public information activities.
Interpersonal and social rhythm therapy, an adaptation of Klerman and Weissman's interpersonal psychotherapy to which a social rhythm regulation component has been added, and ICM.
Time to stabilization in the acute phase and time to recurrence in the maintenance phase.
We observed no difference between the treatment strategies in time to stabilization. After controlling for covariates of survival time, we found that participants assigned to IPSRT in the acute treatment phase survived longer without a new affective episode (P = .01), irrespective of maintenance treatment assignment. Participants in the IPSRT group had higher regularity of social rhythms at the end of acute treatment (P<.001). Ability to increase regularity of social rhythms during acute treatment was associated with reduced likelihood of recurrence during the maintenance phase (P = .05).
Interpersonal and social rhythm therapy appears to add to the clinical armamentarium for the management of bipolar I disorder, particularly with respect to prophylaxis of new episodes.
Archives of General Psychiatry 10/2005; 62(9):996-1004. DOI:10.1001/archpsyc.62.9.996 · 14.48 Impact Factor