The epidemiology of insomnia: Associations with physical and mental health.: The HUNT-2 study

Objective

The aim of the present study was to examine the association of insomnia symptoms with demographic and physical and mental conditions in a large population-based study.

Methods

Cross-sectional data on insomnia and comorbid conditions were gathered from 47,700 individuals aged 20-89 in Norway. Comorbid conditions included anxiety and depression and the following physical conditions: asthma, allergy, cancer, hypertension, diabetes, migraine, headache, osteoporosis, fibromyalgia rheumatoid arthritis, arthrosis, Bechterew's disease, musculoskeletal disorders, and obesity (body mass index >30).

Results

Insomnia symptoms were found in 13.5% of the population and were more prevalent among women, older adults, and in individuals with less education. Reporting insomnia symptoms significantly increased the associations with a range of conditions, especially mental conditions, pain conditions with uncertain etiology and, to a lesser extent, chronic pain conditions. These findings remained significant also when adjusting for a range of potential confounders, whereas the association between insomnia and somatic conditions was largely reduced to a nonsignificant level in the fully adjusted analyses.

Conclusion

This study demonstrates that insomnia symptoms are associated with a range of different conditions. The findings suggest that the independent contribution of insomnia is strongest on conditions characterized by some level of psychological or psychosomatic properties.     

Effects of a behavioural intervention on quality of life and related variables in angioplasty patients : Results of the EXhaustion Intervention Trial

Objectives

The EXhaustion Intervention Trial investigated the effect of a behavioural intervention programme on exhaustion, health-related quality of life (HRQL), depression, anxiety, hostility, and anginal complaints in angioplasty patients who felt exhausted after percutaneous coronary intervention (PCI).

Methods

Seven hundred ten patients were randomized into an intervention group and a usual care control group. The group intervention focused on stressors leading to exhaustion and on support of recovery. HRQL (measured by the MacNew questionnaire), exhaustion [measured by the Maastricht Questionnaire and the Maastricht Interview Vital Exhaustion (MIVE)], anxiety (measured by the State-Trait Inventory), and depression (measured by the structured clinical interview for DSM-IV) were assessed at intake and at 6 and 18 months. Presence of anginal complaints was assessed at 18 months.

Results

The intervention had a significant beneficial effect on all psychological factors except hostility and on the presence of anginal complaints. The effect of the intervention on exhaustion, as assessed by the MIVE, was modified by a previous history of coronary artery disease (CAD). Gender modified the effect of the intervention on exhaustion and on anxiety, the strongest effect being observed in women.

Conclusions

The behavioural intervention improved HRQL and related psychological factors. Somatic comorbidity and a history of CAD limited the effect of the intervention.     

Depressive and anxiety disorders and risk of subclinical atherosclerosis: Findings from the Netherlands Study of Depression and Anxiety (NESDA)

Objective

Current evidence regarding the association between psychopathology and subclinical atherosclerosis show inconsistent results. The present study examined whether subclinical atherosclerosis was more prevalent in a large cohort of persons with depressive or anxiety disorders as compared to non-depressed and non-anxious controls.

Methods

Baseline data from the Netherlands Study of Depression and Anxiety were used, including 2717 persons, free of clinical cardiovascular disease. Participants had a DSM-IV-based current or remitted depressive (major depressive disorder, dysthymia) or anxiety (social phobia, generalized anxiety disorder, panic disorder, agoraphobia) disorder (n=2115) or were healthy controls (n=602). Additional clinical characteristics (severity, duration, age of onset and medication) were assessed. Ankle-brachial index (ABI) was used as a measure of vascular risk and was categorized as low (≤0.90) and mildly low ABI (0.90-1.11) indicating subclinical atherosclerosis, and high ABI (>1.40), which was previously designated as a cardiovascular risk factor, reflecting arterial stiffness and wall calcification.

Results

As compared to normal controls, persons with current (i.e., past year) depressive, anxiety or comorbid depressive and anxiety disorders showed a two- to threefold increased odds of low ABI (OR=2.78, 95% CI=1.05-7.35; OR=3.14, 95% CI=1.25-7.85; OR=2.67, 95% CI=1.09-6.51, respectively). No associations were found with mildly low or high ABI. Also, we did not further find a differential role for symptoms severity, duration, age of onset, and use of psychotropic medication in the link between psychopathology and subclinical atherosclerosis.

Conclusion

Persons with current depressive or anxiety disorders were more likely to have subclinical atherosclerosis compared to healthy controls.     

Health care costs in persons with asthma and comorbid mental disorders : A systematic review

Objective

The aim of this study was to systematically review the impact of comorbid mental disorders on health care costs in adult persons with asthma.

Method

A comprehensive search for studies investigating adult persons (≥18 years) with asthma was conducted. All studies were included, which allowed a comparison of health care utilization and costs between asthma patients with mental disorders and asthma patients without.

Results

The literature search revealed 1977 potentially relevant studies. Eighteen primary studies (20 publications) fulfilled the inclusion criteria. Mood disorders (n=14) and anxiety disorders (n=9) were studied most often. Increased rates of hospitalizations (odds ratio range, 0.9-6.1; n=7), emergency department visits (odds ratio range, 1.8-17.2; n=7) and general practitioner visits (standardized mean difference range, 0.1-1.1; n=6) were found in asthma patients with mental comorbidity. Indirect costs of work absence were investigated in two studies pointing in the same direction of increased costs. Evidence is sparse regarding other outcomes due to a lack of primary studies.

Conclusion

The present systematic review highlights a meaningful impact of comorbid mental disorders on health care utilization and costs in adult patients with asthma. Thus, psychodiagnostic routines and appropriate mental health treatments are needed to reduce health care costs in asthma care.     

La force injuste de la loi : Antisociaux, Déviants et Indésirables

“Dissocial ”personalities are non-schizophrenic adults characterized by an inability to conform to moral and social limits, to such an extent that they break legal behaviours. Generally, the cares they are given are based on the notion of “recall to the law”, implicitly referring to hypothetical moral standards that are supposed to determine human behaviour. Neglecting the concept of Freedom, such an approach rejects any autonomy they have a right to claim to “Dissocial” personalities, in the name of dignity due to every human being. It is to be shown that the concept of transgression or denial of the Law is inappropriate to understand those personalities, for there are no supernatural moral standards the origin of which would be external to mankind. The debate will focus on the question of the “anti-social” committing finality in relation to the unity of Reason, since to maintain the latter is a concern, which the “dissocial” personalities do not refute, in the name of a respect for their own dignity. As they are always in search of recognition, antisocial personalities do not withdraw challenge, but are not able to get through. Against the current opinion, the author propose to base the treatment approach on values, instead of law, such as self esteem and trust, in order to support Antisocial personalitie’s surch for dignity.     

Une image semblable à sa mère : La Vierge et Jésus

The interdiction to represent what is at the heart of Islam gives birth to a considerable work dealing with its image. The author of this article deals with the question concerning the image of islam in a comparative study of islam and christianity using the example of the virgin Mary and the birth of Jesus Christ. The later is analysed under a christian perspective, which presents him as the most pure image of the holy father. Ibn Arabi, however, breaks with this christian scholasticism, focusing only on the body as well as with the aristotelian philosophy concerning the question of the similarity of this model. For Ibn Arabi, the son is the image of his mother without limiting the power of the former. Holy Mary's body represents one changed and reflecting her power. It is, at this point, the above-presented image, is rehabilitated by breaking with the classical theological interpretation of the female and material in relation to its image as well as in what we call, according to Sigmund Freud: construction in analysis.     

Sensory abnormalities in autism: A brief report

Sensory abnormalities were assessed in a population-based group of 208 20-54-month-old children, diagnosed with autism spectrum disorder (ASD) and referred to a specialized habilitation centre for early intervention. The children were subgrouped based upon degree of autistic symptoms and cognitive level by a research team at the centre. Parents were interviewed systematically about any abnormal sensory reactions in the child. In the whole group, pain and hearing were the most commonly affected modalities. Children in the most typical autism subgroup (nuclear autism with no learning disability) had the highest number of affected modalities. The children who were classified in an “autistic features” subgroup had the lowest number of affected modalities. There were no group differences in number of affected sensory modalities between groups of different cognitive levels or level of expressive speech. The findings provide support for the notion that sensory abnormality is very common in young children with autism. This symptom has been proposed for inclusion among the diagnostic criteria for ASD in the upcoming DSM-V.