Insomnia and depression prior to myocardial infarction

Insomnia is common among patients who subsequently experience an acute myocardial infarction (MI), and is a major symptom of psychiatric depression. The purpose of this study was to determine what proportion of patients reporting insomnia prior to MI have depression. Of 70 patients with a recent MI, 27 (39%) reported having had insomnia for two weeks or longer prior to their MI, 13 of whom (48%) met diagnostic criteria for a major depressive episode (MDE). MDE accounted for a significant proportion of the patients reporting insomnia prior to MI (p less than 0.0001). Furthermore, those patients with insomnia who did not meet diagnostic criteria for MDE nevertheless had three times as many depressive symptoms, excluding sleep disturbance, as did those patients who did not experience insomnia prior to their MI (p less than 0.0009). The implications of this finding are discussed, as well as possible explanations for the relationship between insomnia, depression, and subsequent MI.     

Primary immune surveillance: some like it hot

The thermal element of fever has been found to be beneficial in models of infectious disease. The contributions of fever-range temperatures to the efficacy of the adaptive immune response have only begun to be delineated. There is accumulating evidence that fever-range thermal stress bolsters primary immune surveillance of lymph nodes and Peyer patches by augmenting lymphocyte extravasation across specialized vessels termed high endothelial venules. Molecular mechanisms have recently come to light by which the thermal component of fever alone may promote lymphocyte trafficking, and thereby the probability of mounting a defense against microbial infection. Acquired knowledge of the molecular changes associated with thermal stress may allow for the development of novel therapies for a variety of disease processes.

Opportunistic health promotion: do patients like it?

In a five doctor general practice 100 adults attending routine surgeries were given questionnaires to assess the influence of discussing health promotion on their satisfaction with the consultation. Health promotion topics were discussed in 74% of the 86 consultations analysed. Of these consultations, blood pressure was mentioned in the largest number (48%) and breast self-examination in the smallest (6%). Patient satisfaction was not significantly influenced by the inclusion or omission of such topics. The highest mean satisfaction score was for those discussing smoking and the lowest for those discussing alcohol. Most patients (84%) found discussion of health promotion helpful and felt comfortable (62%); only two patients felt uncomfortable doing so.     

Insomnia and incident depression: role of objective sleep duration and natural history

Longitudinal studies that have examined the association of insomnia with incident depression using objective sleep measures are very limited. The aim of this study was to examine the predictive role of the severity of insomnia for incident depression in a general population sample using psychometric and polysomnographic data. From a random, general population sample of 1741 individuals of the Penn State Adult Cohort, 1137 adults without depression were followed up with a structured telephone interview after 7.5 years. All subjects completed a full medical evaluation, 1‐night polysomnogram and Multiphasic Minnesota Personality Inventory at baseline. The incidence of depression was 15%. Poor sleep (odds ratio = 1.5, P = 0.001) and insomnia (odds ratio = 1.9, P = 0.031) were significantly associated with incident depression. The odds of incident depression were highest (odds ratio = 2.2, P = 0.019) in insomnia with objective short sleep duration and independent of Multiphasic Minnesota Personality Inventory Ego Strength scores, an index of poor coping resources. The persistence of insomnia and worsening of poor sleep into insomnia significantly increased the odds of incident depression (odds ratios ranged from 1.8 to 6.3), whereas their full remission did not (odds ratio ranged from 1.2 to 1.8). Insomnia with short sleep duration is associated with incident depression independent of poor coping resources, whereas the association of insomnia with normal sleep duration with incident depression was mediated by poor coping resources. Persistence and worsening of poor sleep or insomnia, but not their full remission, are significant predictors of incident depression. These data suggest that there is a significant relationship between the severity of insomnia and incident depression.     

Insomnia as a risk factor for onset of depression in the elderly

There are at least 9 studies that provide evidence that insomnia is a significant risk factor for recurrent and new onset major depressive disorder (MDD), two of which suggest that this association also exists specifically for the elderly. In this study, archival data from a community sample of healthy elderly participants were used to assess the extent to which insomnia predicts future illness in this age cohort. Out of the 147 participants with no prior history of mental illness, 66 participants were classified as having no insomnia, 47 had indeterminate insomnia, and 34 had persistent insomnia. Twelve participants developed MDD during the 1-year follow-up period. Two had no insomnia, 4 had indeterminate insomnia, and 6 had persistent insomnia. Persistent insomnia with onset of depression occurred only in female participants and was significantly associated with middle insomnia. These data suggest that elderly participants with persistent insomnia are at greater risk for the development of new onset depression.     

Catastrophe and what to do about it if you are a bacterium: the importance of frameshift mutants

Key problems that bacteria have historically faced are the challenges of the lack of essential nutrients and the presence of antibiotics produced naturally, but there are many other challenges. It appears that for many of these challenges the bacteria have mechanisms encoded in their genomes that are not usually functioning, but may be "turned on" when needed, even if the need only occurs once in hundreds of thousands of generations. Such mechanisms at other times somehow need to be "turned off" because they may cause a slight disadvantage, or even a grave disadvantage to the cell compared with wild-type cells during the time the population is not being challenged. On the other hand, a gene cannot simply be discarded because it might be needed again. How do microorganisms solve the problem of responding to challenges that only occur rarely? I suggest that in most cases, the mutation must occur by the existence of a readily reversible mutation. The mutation in likely the result of a frameshift mutation that caused the response and later another frameshift occurs to return the genome to its original state.     

LIP responses to a popout stimulus are reduced if it is overtly ignored

Bright objects capture our attention by virtue of 'popping out' from their surroundings. This correlates with strong responses in cortical areas thought to be important in attentional allocation. Previous studies have suggested that with the right mindset or training, humans can ignore popout stimuli. We studied the activity of neurons in monkey lateral intraparietal area while monkeys performed a visual search task. The monkeys were free to move their eyes, and a distractor, but never the search target, popped out. On trials in which the monkeys made a saccade directly to the search target, the popout distractor evoked a smaller response than the non-popout distractors. The intensity of the response to the popout correlated inversely with the monkeys' ability to ignore it. We suggest that this modulation corresponds to a top-down mechanism that the brain uses to adjust the parietal representation of salience.     

Immunity and depression: Insomnia,Retardation, and reduction of natural killer cell activity

Depressed patients show a reduction of natural killer (NK) cell activity which may be associated with specific depressive symptoms. The present study demonstrated that sleep disturbance and retardation, but not other depressive symptoms, were negatively correlated with NK activity in 38 depressed patients. Specific behavioral changes in depression such as sleep disturbance and retardation were found to predict 16% of the variance of cytotoxicity levels in depression.     

Insomnia and hypersomnia associated with depressive phenomenology and comorbidity in childhood depression

STUDY OBJECTIVES: To examine sleep disturbance (insomnia and hypersomnia) and associated clinical profiles among depressed children and adolescents in terms of illness history, depressive severity, depressive phenomenology, and psychiatric comorbid disorders. DESIGN: Clinical profiles from standardized clinical evaluations were compared. SETTING: Twenty-three mental health facilities in Hungary between April 2000 and December 2004. PATIENTS AND MEASUREMENTS: Five hundred fifty-three children with a current episode of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition major depressive disorder: 55% were boys, mean age was 11.7 years (SD = 2.0, range = 7.3-14.9), and 94% were Caucasian. Sleep and depressive symptoms were assessed with the Interview Schedule for Children and Adolescents-Diagnostic Version. INTERVENTIONS: N/A. RESULTS: Of the total sample, 72.7% had sleep disturbance: 53.5% had insomnia alone, 9.0% had hypersomnia alone, and 10.1% had both disturbances. Depressed girls were more likely to have sleep disturbance than boys (77.0% vs 69.2%, p < .05), but age had no significant effects. Compared with children without sleep disturbance, sleep-disturbed children were more severely depressed and had more depressive symptoms and comorbid anxiety disorders. Across sleep-disturbed children, those with both insomnia and hypersomnia had a longer history of illness, were more severely depressed, and were more likely to have anhedonia, weight loss, psychomotor retardation, and fatigue than were those with either insomnia or hypersomnia. CONCLUSION: Clinical profiles differ between depressed children without and with sleep disturbance, with those presenting insomnia plus hypersomnia being most severely depressed. Differentiating depressed children with different sleep disturbances may have important implications for research efforts on the etiology and therapeutics of child depression.     

Some like it specific: The difference between treatment goals of anxious and depressed patients

Objectives. While clinical diagnoses are the primary criteria for differential indication in psychotherapy, treatment‐goal themes may provide additional information on diagnosis‐specific and extra‐diagnostic aspects of treatment motivation. It is hypothesized that the goals of anxiety patients focus on symptom relief, while the goals of depression patients are thematically more heterogeneous. Additionally, it is hypothesized that patients with various specific anxiety disorders can be differentiated on their treatment‐goal themes. Design. To obtain a sufficiently large number of diagnostically non‐comorbid patients, a sample of 328 patients with non‐comorbid anxiety and depression patients was merged from two subsamples: 255 outpatients from a university‐based clinic in Germany and 73 outpatients from a comparable clinic in German‐speaking Switzerland. Methods. The treatment‐goal themes of the 328 outpatients were coded using the Bern inventory of treatment goals. Results. Patients with non‐comorbid diagnoses of depression or anxiety differed as hypothesized. Anxiety patients' treatment goals predominantly focused on symptom relief, while depression patients' treatment goals were thematically more heterogeneous. In addition, patients with various specific anxiety disorders differed in their treatment‐goal themes. Conclusions. Implications for clinical assessment and treatment planning are discussed.     

Insomnia as predictor versus outcome of PTSD and depression among Iraq combat veterans

Objectives: The study conducted a longitudinal assessment of insomnia as an antecedent versus consequence of posttraumatic stress disorder (PTSD) and depression symptoms among combat veterans. Design: Two postdeployment time points were used in combination with structural equation modeling to examine the relative strength of two possible directions of prediction: insomnia as a predictor of psychological symptoms, and psychological symptoms as a predictor of insomnia. Participants were active duty soldiers (N = 659) in a brigade combat team who were assessed 4 months after their return from a 12‐month deployment to Iraq, and then again eight months later. Results: Although both insomnia and psychological symptoms were associated at both time periods and across time periods, insomnia at 4 months postdeployment was a significant predictor of change in depression and PTSD symptoms at 12 months postdeployment, whereas depression and PTSD symptoms at 4 months postdeployment were not significant predictors of change in insomnia at 12 months postdeployment. Conclusions: Results support the role of insomnia in the development of additional psychological problems and highlight the clinical implications for combat veterans, to include the importance of longitudinal assessment and monitoring of sleep disturbances, and the need for early intervention. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1–19, 2011.