Complaints of poststroke insomnia and its treatment with mianserin

We assessed the prevalence and associations of symptoms of insomnia in patients with acute ischemic stroke, and evaluated whether mianserin as a sedative antidepressant is beneficial in the treatment of poststroke insomnia. One hundred consecutively hospitalized patients were randomized to receive 60 mg/day of mianserin (n = 51) or placebo for 1 year in a double-blind trial with a 6-month follow-up after the therapy. Symptoms of insomnia were assessed with the three insomnia-related items of the Hamilton Depression Scale; patients were defined as insomniacs if any of these items was positive. Complaints of insomnia occurred in 68% of patients on admission, and in 49% at 18 months, and they were as frequent in all subgroups of patients. From 2 months, symptoms of insomnia were associated independently with depression. Living alone before stroke (at 0 and 2 months) and age (at 12 months) were other independent predictors of insomnia. The rate of recovery as evaluated by the insomnia score was more rapid in patients on mianserin than in those on placebo. At 2 months, the scores were significantly different favoring mianserin treatment (1.3 vs. 0.8, p = 0.02). We conclude that insomnia is a common complaint after ischemic stroke. Mianserin had a beneficial influence on the recovery from symptoms of insomnia, even though the intensity of poststroke depression was low.     

The significance and management of persistent primary insomnia: the past, present and future of behavioral insomnia therapies

Persistent primary insomnia (PPI) is a prevalent and potentially serious condition that compromises the functioning, health status, and quality of lives of millions of individuals around the world. This condition is typically perpetuated by a host of psychological and behavioral mechanisms that often require behavioral interventions. Nonetheless, all too commonly, practitioners underestimate the seriousness of this condition or rely too heavily on symptom focused sedative hypnotic therapy for its treatment. Herein we briefly review the epidemiology of PPI and consider the inadequacies of sedative hypnotics for treating this disorder. Subsequently, we provide rationale for the use of behavioral interventions with this condition and we describe the gradual evolution of the currently available behavioral insomnia treatments and consider promising recent developments such as the emergence of cognitive-behavioral and specially tailored, patient-specific approaches. In closing, we consider the potential usefulness of a combined pharmacological/behavioral intervention for PPI and present a number of important research questions to address in future studies of the behavioral insomnia therapies.     

The life circumstances of aged people with an intellectual disability

This paper reports the results of a survey of people over the age 50 years who have a mild or moderate intellectual disability as their primary disability. The objective of the study was to depict the range of residential options available and to examine the life circumstances and characteristics of these aged individuals. Two samples were drawn for the study: one was from a rural community and the other was from a suburban/metropolitan area. Fifty participants were recruited and interviewed by a member of the research team. Questions addressed participants' present residential setting, access to, and use of, facilities within the residence and the local community, the availability of training programs within the residence, the richness of social contact with family and friends and medical and financial status. The results of the survey indicated notable differences between participants living in the rural versus city regions and the need for new initiatives to develop their skills to improve the quality of life after age 50 years.     

The present and future management of childhood craniopharyngioma

Childhood craniopharyngiomas are rare tumours that present formidable difficulties in their treatment if cure is to be achieved without producing severe hypothalamic damage. Experience with our own cases suggests that the morbidity from an attempted radical removal can be predicted - allowing a treatment algorithm to be devised that combines both surgery (radical and "conservative") and radiotherapy (both external fractionated and intra-cyst instillations) in order to achieve long-term tumour control that is not at the expense of a severe functional disability.     

Fatigue, insomnia and nervousness: gender disparities and roles of individual characteristics and lifestyle factors among economically active people

Background

Individuals with certain personal, family and job characteristics are at elevated risk of poor mental health. Yet, the respective role of obesity, smoking, alcohol abuse, low education, income, living and family conditions, and socio-occupational category in fatigue/insomnia (FI), nervousness (N) and frequent drug use for those disorders (DFI and DN) among men and women and in gender disparities are not well known.

Methods

We studied gender differences in FI, N, DFI, DN, and in their correlated, and whether the gender differences were mediated by individual and lifestyle factors among 3,450 active subjects aged 18–64, randomly selected from North-eastern France. Subjects completed a post-mailed questionnaire. Data were analyzed via adjusted odds ratio (ORa) computed with the logistic regression model.

Results

Women were more affected than men for FI (21.3 vs. 13.1%, OR adjusted for age ORa 1.80, 95% CI 1.50–2.16), DFI (11.6 vs. 7.1%, ORa 1.74, 1.38–2.21), N (14.7 vs. 9.9%, ORa 1.58, 1.28–1.94), and for DN (12.1 vs. 5.7%, ORa 2.29, 1.79–2.94). These differences were not mediated by the individual characteristics studied. Multivariate analysis showed that the risk patterns varied between the two sexes. Smoking was related to N in men as well as in women; alcohol abuse to DFI in men only; lack of family support to all outcome variables in men and women; low educational level to DFI in men only; low income to FI, N and DN in men and to FI and DN in women; being unmarried to DN in men; being divorced/separated to N and DN in women; being a manual worker to FI and being a farmer to DFI in men; and being a manual worker to DN and being an employee to FI in women (1.50 ≤ ORa ≤ 2.95).

Conclusions

Women suffered more from fatigue/insomnia and nervousness and used more drug for those disorders than men. Socio-demographic and lifestyle factors played significant roles among men and women but they did not explain the gender disparities.     

Pharmacologic management of insomnia: past, present, and future.

Views on the etiology and morbidities associated with insomnia are evolving and affect clinicians' approach to the pharmacologic management of insomnia. Currently, benzodiazepine receptor agonists (BzRAs) and a single melatonin receptor agonist are recognized as safe and efficacious hypnotics. Variability in BzRAs, pharmacokinetics, and manipulation of dose provide clinicians with options that meet the needs of most patients. Other drugs (eg, sedating antidepressants) also are used commonly in clinical practice to treat insomnia, but evidence is lacking to support this most cases. Improvement in managing insomnia will result from systematic research with these drugs, with drugs in development, and with novel uses, such as co-therapy.     

Associations between childhood living circumstances and schizophrenia: a population-based cohort study.

OBJECTIVE: It has been suggested that household crowding may constitute an environmental risk factor for schizophrenia. The present population-based cohort study explores the associations of childhood family size and living conditions to schizophrenia. METHOD: The cohort comprised people born at Helsinki University Central Hospital from 1924 to 1933, who went to school in the city and were still living in Finland in 1971. Prospectively gathered data from birth and school health records of these 7086 individuals were collected and linked to the Finnish Hospital Discharge Register. RESULTS: Ninety-eight cases of schizophrenia were identified in the cohort. Number of siblings at school start was significantly associated with schizophrenia when adjusted for sex and age of mother. Number of siblings was negatively correlated with body mass index at age 7. Childhood household crowding, defined as number of people per room, and total number of rooms in household were not significantly associated with schizophrenia. CONCLUSION: Our study indicates that the total number siblings in household during childhood is of greater importance than childhood number of inhabitants per room. Subjects who originated from families with many children had been leaner, which may imply that childhood nutritional factors partly is the mediating factor between number of siblings and schizophrenia. Other possible underlying mechanisms of the associations found include infectious and psychological factors.     

Autobiographical memory specificity among people with recovered memories of childhood sexual abuse

Individuals who report to have recovered memories of childhood sexual abuse (CSA) almost by definition believe that these memories were previously inaccessible for them. We examined whether poor autobiographical memory specificity for all kinds of events (i.e., events not necessarily related to CSA) may underlie such impressions of amnesia. Thus, we examined whether people who report recovered memories of CSA (n = 44) would exhibit more difficulty retrieving specific autobiographical memories compared to people who never forgot their abuse experiences (continuous memory group; n = 42) and people without a history of abuse (controls; n = 26). The standard Autobiographical Memory Test (AMT) was administered to these 3 groups along with measures of depression and posttraumatic stress disorder symptomatology. Controls were significantly better at retrieving specific autobiographical memories relative to individuals with continuous and recovered CSA memories, who did not differ from each other. Thus, reduced autobiographical memory specificity was not particularly pronounced in people with recovered memories of CSA. Poor autobiographical memory specificity is unlikely to explain the impression of amnesia reported by this group.     

Predictors of intellectual functioning after epilepsy surgery in childhood: The role of socioeconomic status

ObjectiveThe objective of this study was to evaluate the association between socioeconomic status and intellectual functioning in children with medically refractory epilepsy, before and after resective epilepsy surgery. Family environment is a strong contributor to cognitive development in children and has been recently shown to play a significant role in intellectual outcome after surgery in children with epilepsy.MethodsOne hundred children who had undergone resective epilepsy surgery and completed preoperative and postoperative assessments of IQ as part of clinical care were included in the study. We evaluated the impact of epilepsy-related variables, income quintile, and residence location on IQ.ResultsGreater improvements in IQ after surgery were associated with an older age at surgery (β = .235, p = .018). Higher IQ scores at follow-up were associated with an older age of seizure onset (β = .371, p < .001), older age at surgery (β = .356, p < .001), unilobar epileptogenic focus (β = .394, p < .001), and mesial temporal sclerosis (β = .338, p = .001) or tumor (β = .457, p < .001) in comparison with malformation of cortical development; age at seizure onset did not remain as a significant predictor in multivariable regression analysis. Income quintile, residence location, seizure control, and antiepileptic medication use were not significant predictors.ConclusionsEpilepsy-related variables were the strongest predictors of IQ and postoperative change in IQ. We were unable to identify a significant association between IQ and socioeconomic status. Future research should evaluate the impact of multiple aspects of family environment.     

河北省中年人短睡眠者和失眠障碍患者合并慢性病的现况研究

目的 分析河北省中年人不同睡眠特征人群现患慢性病情况以及生活饮食、行为方式, 探究睡眠与躯体慢性疾病的潜在关系。方法 2018 年6—9 月采用分层、整群随机抽样方法对河北 省18 岁及以上人群进行调查,共纳入5 733 名被试。评估工具包括一般情况调查表、既往躯体疾病与 精神科疾病史、阿森斯失眠量表问卷、不宁腿综合征问卷、睡眠呼吸暂停-柏林问卷、发作性睡病量表 等。根据是否为短睡眠、失眠障碍分为4 组［对照组（4 343 名,75.8%）、单纯短睡眠组（526 名,9.2%）、非 短睡眠的失眠障碍组（365 名,6.4%）、短睡眠的失眠障碍组（499 名,8.7%）］,分析4 组慢性病患病率及慢 性病的风险因素。结果 各组间高血压、糖尿病、脑血管疾病患病率差异有统计学意义（均P ＜ 0.05）, 对照组慢性病患病率最低,单纯短睡眠组、非短睡眠的失眠障碍组、短睡眠的失眠障碍组分别与对照组 比较,慢性病患病率差异均有统计学意义（均P ＜ 0.05）。不同年龄、性别、体质指数、城乡居民、教育程 度、职业、摄盐习惯、是否吸烟、饮酒情况、体育锻炼情况4 组间差异均有统计学意义（均P ＜ 0.05）。在 调整了年龄、性别、体质指数、城乡、居住方式、教育程度、职业、摄盐习惯、吸烟饮酒情况、体育锻炼情 况后,Logistic 回归分析结果显示非短睡眠的失眠障碍和短睡眠的失眠障碍是患高血压［OR（95%CI）值 分别为2.074（1.606～2.679）、1.689（1.346～2.121）］和糖尿病［OR（95%CI）值分别为2.273（1.508～3.426）、 1.805（1.244～2.621）］的危险因素（均P＜ 0.01）;单纯短睡眠、非短睡眠的失眠障碍和短睡眠的失眠障 碍均是脑血管疾病的危险因素［OR（95%CI）值分别为1.826（1.203～2.770）,2.149（1.389～3.324）,1.613 （1.068～2.434）;均P＜ 0.05］。结论 短睡眠者与失眠障碍对躯体的影响可能不同,失眠障碍是高血压、 糖尿病的危险因素,而短睡眠和失眠障碍均是脑血管疾病的危险因素     

Depressive symptoms among older adults: The impact of early and later life circumstances and marital status

Objective: This article contributes to the literature on depression and the life course by examining the impact of both early and later life circumstances on depressive symptoms among men and women aged 65 and over in Ireland.

Method: Data are from the first wave of The Irish Longitudinal Study on Ageing, a nationally representative sample of 8504 community-dwelling adults aged 50 years and older. About 3507 respondents aged 65 years and over were included in the analysis. Multinomial logistic regression was used to examine the childhood and early adult life circumstances associated with marital status. A series of nested models were estimated to evaluate which childhood and adulthood circumstances are associated with depressive symptoms. Models were estimated separately for men and women.

Results: Ill health in childhood and in later life has a strong and direct effect on depression in later life for both men and women. Other early stressors are mediated by later circumstances. Marital status is a significant independent predictor of depression in later life. Later life circumstances mediate between some marital statuses and depressive symptoms. When later life circumstances are included, widowhood and, for men, divorce, are directly associated with depression, but singlehood is not. Income in later life is strongly associated with depressive symptoms for women.

Conclusion: Both early and later life circumstances affect late-life depressive symptoms. Our findings indicate that previous studies which did not consider both may have underestimated or overestimated the effect of marital status, education, current health and education on depressive symptoms.     

Long-term health and socioeconomic consequences of childhood and adolescent-onset of narcolepsy

ObjectivesThere is limited information about the long-term consequences of childhood- and adolescent-onset narcolepsy on educational and social factors. Here, we estimate the long-term socioeconomic consequences and health care costs of narcolepsy.MethodsThe prospective cohort study included Danish individuals with narcolepsy onset in childhood or adolescence, diagnosed between 1994 and 2015. Health care costs and socioeconomic data were obtained from nationwide administrative and health registers. One hundred seventy-one patients were compared with 680 controls (mean index age, 15.2 years; SD, 3.4 years) matched for age, gender, and other sociodemographic characteristics.ResultsComparing the narcolepsy patient and control groups at age 20 years we found: (1) no differences in parental educational level; (2) patients had a significantly lower educational level than controls; (3) patients had significantly lower grade-point averages; (4) patients had a lower employment rate and lower-income, even when transfer payments were considered; and (5) patients' initial health care costs were higher. Patients had a higher mortality rate than controls, although the difference was not statistically significant.ConclusionNarcolepsy is associated with a significant influence on educational level, grading, social outcome, and welfare consequences. The development of narcolepsy is independent of parental social level.     

Child and family predictors of insomnia from early childhood to adolescence

BackgroundInsomnia is prevalent among children and adolescents and is associated with a wide range of negative outcomes. Knowledge about its determinants is therefore important, but due to the lack of longitudinal studies, such knowledge is limited. The aim of the present inquiry is to identify child and family predictors of future pediatric insomnia within a psycho-bio-behavioral framework.MethodsA representative community sample (n = 1,037) was followed biennially from 4 to 14 years of age (2007–2017). Insomnia was defined based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria and was diagnosed by a semistructured clinical interview of children (from age eight years of age) and parents (all ages). Predictors included parent ratings of child emotional reactivity, family functioning, and marital conflict; self-reports of personality; and teacher-rated emotion regulation skills.ResultsRandom intercept cross-lagged analyses revealed that within-person increases (ie, relative to the child's typical levels across childhood) in emotional reactivity and decreases in emotion regulation skills predicted insomnia diagnosis two years later from ages 4 to 14 after adjusting for previous insomnia and all unmeasured time-invariant factors. Previous insomnia was the strongest predictor of later insomnia, whereas family functioning and marital conflict did not predict insomnia.ConclusionsIncreases in emotional reactivity and decreases in emotion regulation skills predicted insomnia above and beyond all unmeasured time-invariant factors and could be targets for interventions. Previous insomnia predicted later insomnia, thereby underscoring the importance of detecting, preventing, and treating insomnia at an early age.     

The natural history of insomnia: Focus on prevalence and incidence of acute insomnia

Despite Acute Insomnia being classified as a distinct nosological entity since 1979/1980 (ASDC/DSM III-R), there are no published estimates of its prevalence and incidence or data regarding transition to chronic insomnia or remission. This lack of data prevents an understanding of: a) the pathogenesis of insomnia and b) when and how treatment should be initiated. The aim of the present study was to provide such data from two community samples. Samples were recruited in the USA (n = 2861) and the North East of the UK (n = 1095). Additionally, 412 Normal Sleepers from the UK sample were surveyed longitudinally to determine prospectively incidence, transition, and remission rates for acute insomnia and assess whether the acute insomnia was a first episode, recurrent episode, or co-morbid with symptoms of other illnesses. The prevalence of acute insomnia was 9.5% (USA) and 7.9%(UK). The prevalence of three acute insomnia subtypes in the UK were; First-Onset Acute Insomnia 2.6%; Recurrent Acute Insomnia 3.8%; and 1.4% Co-morbid Acute Insomnia. The annual incidence of acute insomnia in the UK sample was between 31.2% and 36.6%. Remission rates fluctuated depending upon the definition of acute insomnia and whether the current episode was first-onset or recurrent. These findings provide preliminary insights into the natural history of insomnia. Such data will serve to inform how and when acute insomnia should be managed and whether such interventions may serve to diminish subsequent morbidity, particularly with respect to Major Depression.