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Query: UMLS:C0917801 (insomnia)
 10,606 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Insomnia is a common problem in situations of stress. Some forms of stress, however, may contraindicate the use of traditional, pharmacological interventions. Working in a combat zone is such a situation. Alternative means of improving sleep are clearly needed for Service Members. We report a case involving a medical provider who was serving in a military, emergency-services facility in Iraq, and who presented with anxiety, depressed mood, and insomnia. Symptoms were sub-threshold for major depressive disorder or acute stress disorder. Mood and anxiety symptoms responded to traditional therapy techniques, but problems with insomnia remained. The patient was given a portable biofeedback device that employs an infrared sensor photoplethysmograph to measure heart rate variability (HRV) from peripheral finger pulse. One week later, sleep was significantly improved. Symptom improvement lasted to at least 6 weeks while in theater. One year later, a check-in with the patient revealed that after returning home, he had been diagnosed with post traumatic stress disorder (PTSD). PTSD symptoms had resolved after 6 months of psychopharmacology and cognitive behavioral therapy. These results indicate that biofeedback may be a useful means of improving sleep in a combat zone, but that such improvements may not necessarily prevent the development of more serious symptoms later. No clear causality can be inferred from a single case, and further study is needed to determine if this finding have wider applicability.
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PMID:Use of a portable biofeedback device to improve insomnia in a combat zone, a case report. 1965 43

Most psychiatric disorders, such as schizophrenia, mood disorders, or neurotic disorders are associated with sleep disorders of various kinds, among which insomnia is most prevalent and important in psychiatric practice. Almost all patients suffering from major depression complain of insomnia. Pharmacological treatment of insomnia associated with major depression shortens the duration to achieve remission of depression. Insomnia has been recently reported to be a risk factor for depression. In patients with schizophrenia, insomnia is often an early indicator of the aggravation of psychotic symptoms. Electroencephalographic sleep studies have also revealed sleep abnormalities characteristic to mood disorders, schizophrenia and anxiety disorders. A shortened REM sleep latency has been regarded as a biological marker of depression. Reduced amount of deep non-REM sleep has been reported to be correlated with negative symptoms of schizophrenia. Recently, REM sleep abnormalities were found in teenagers having post-traumatic stress disorder after a boat accident. Although these facts indicate that insomnia plays an important role in the development of psychiatric disorders, there are few hypotheses explaining the cause and effect of insomnia in these disorders. Here, we reviewed recent articles on insomnia associated with psychiatric disorders together with their clinical managements.
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PMID:[Insomnia associated with psychiatric disorders]. 1976 32

Insomnia and nightmares are hallmarks of posttraumatic stress disorder (PTSD). Sleep disturbances in PTSD negatively impact clinical course and functioning. In this open clinical trial, the preliminary effects of a combined treatment for insomnia and nightmares in combat veterans with PTSD were assessed. Ten combat veterans participated in a 10-session group treatment combining cognitive-behavioral therapy for insomnia with exposure, rescripting, and relaxation therapy. Participants maintained daily sleep and dream diaries and completed self-report measures of sleep quality and PTSD symptoms pre- and posttreatment. Participants reported improvements in sleep and nightmares following treatment. Future research using controlled designs to evaluate this treatment is warranted.
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PMID:A combined group treatment for nightmares and insomnia in combat veterans: a pilot study. 1990 22

Imagery Rehearsal Therapy (IRT) has been shown to be efficacious in reducing nightmares, but the treatment has not been well-studied in veterans. The effectiveness of IRT was assessed from a chart review of veterans seeking outpatient treatment for chronic, trauma-related nightmares. Of those offered IRT, veterans who completed a full course of treatment for PTSD in the past year were more likely to initiate treatment. However, completion of IRT was not related to previous treatment, demographic variables, or nightmare severity reported at the first treatment session. Treatment completers reported significant reductions in nightmare frequency and intensity, severity of insomnia, and subjective daytime PTSD symptoms. Insomnia and PTSD symptoms, on average, were below clinical cutoffs following treatment, and 23% of patients showed a complete treatment response (< or =1 nightmare/week). Findings suggest IRT may be an effective short-term treatment for nighttime and daytime PTSD symptoms among veterans who complete a full course of treatment.
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PMID:Effectiveness of imagery rehearsal therapy for the treatment of combat-related nightmares in veterans. 2041 88

Recent evidences suggest that posttraumatic stress disorder (PTSD) is associated with sleep disturbances following the traumatic events. However, the exact nature of the relationship between disturbed sleep and PTSD is unclear. The present study examined the development of PTSD and insomnia in the population subjected to force displacement from Shida Kartli, Georgia (Caucasus). Detailed subjective information on sleep-wake habits and demographic parameters were obtained from 45 displaced persons. Posttraumatic Stress Diagnostic Scale was administered to all participants. Complete information could only be obtained from 27 individuals categorized into PTSD (19 subjects) and non-PTSD (8 subjects) groups. Sleep complaints were presented among all PTSD individuals, also 50% of non-PTSD subjects were still suffering from insomnia. Most of the subjects were not satisfied with their current sleep. They mostly complained on sleep maintenance difficulties and the appearing of nightmares, as disturbing factors of sleep. The difference between PTSD and non-PTSD groups on nightmare frequency did not reach the significance. Our results support a view that sleep mechanisms may contribute to the pathophysiology of PTSD, but insomnia following trauma exposure may exist even in the absence of full-blown PTSD.
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PMID:Posttraumatic stress disorder and insomnia development in individuals displaced from Shida Kartli, Georgia. 2041 21

PTSD is a complex disorder, which frequently occurs in comorbidity with anxious disorder, personality disorder, addiction or substance abuse disorder, depressive disorder with or without psychotic symptoms and psychotic disorder. PTSD symptoms may result from deregulation of several different neurotransmitter systems. Pharmacotherapy of PTSD depends on clinical features and the presence of comorbid disorders. Pharmacotherapy of PTSD involves use of anxiolytics, adrenergic receptor antagonists, antidepressants, anticonvulsants and novel antipsychotics. Serotoninergic effect of antidepressants is not only effective in treating depression, but also appears to be helpful in PTSD treatment, particularly in reduction of intrusive symptoms, emotional reactivity, impulsiveness, aggression and suicidal ideation. Anypsychotics with serotoninergic-dopaminergic antagonism are being prescribed often in treatment of psychotic depression, while in PTSD treatment they are proved to be efficient in relieving intrusive symptoms and nightmares. Quetiapine as serotoninergic-dopaminergic antagonist is efficient in treatment of chronic insomnia as well as in reduction of aggressiveness. Considering PTSD refractoriness to therapy, high incidence of comorbidity and significant functional impairment, it is important to search for new psychopharmacological combinations in order to improve mental status of the patient. The paper presents 46 years old male patient with the diagnosis of Enduring personality changes following war PTSD (F62.0) in comorbidity with Recurrent depressive disorder with psychotic symptoms (F33.3), who was treated with combination of venlafaxine and quetiapine.
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PMID:Venlafaxine - quetiapine combination in the treatment of complicated clinical picture of enduring personality changes following PTSD in comorbidity with psychotic depression. 2056 83

Many studies have reported gender differences in nightmare frequency. In order to study this difference systematically, data from 111 independent studies have been included in the meta-analysis reported here. Overall, estimated effect sizes regarding the gender difference in nightmare frequency differed significantly from zero in three age groups of healthy persons (adolescents, young adults, and middle-aged adults), whereas for children and older persons no substantial gender difference in nightmare frequency could be demonstrated. There are several candidate variables like dream recall frequency, depression, childhood trauma, and insomnia which might explain this gender difference because these variables are related to nightmare frequency and show stable gender differences themselves. Systematic research studying the effect of these variables on the gender difference in nightmare frequency, though, is still lacking. In the present study it was found that women tend to report nightmares more often than men but this gender difference was not found in children and older persons. Starting with adolescence, the gender difference narrowed with increasing age. In addition, studies with binary coded items showed a markedly smaller effect size for the gender difference in nightmare frequency compared to the studies using multiple categories in a rating scale. How nightmares were defined did not affect the gender difference. In the analyses of all studies and also in the analysis for the children alone the data source (children vs. parents) turned out to be the most influential variable on the gender difference (reporting, age). Other results are also presented. Investigating factors explaining the gender difference in nightmare frequency might be helpful in deepening the understanding regarding nightmare etiology and possibly gender differences in other mental disorders like depression or posttraumatic stress disorder.
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PMID:Gender differences in nightmare frequency: a meta-analysis. 2081 9

This study retrospectively reviewed records from current members of the U.S. military who had completed the PTSD Checklist (PCL) at 0 and 3-months after returning from deployments. Insomnia was the most commonly reported symptom of PTSD on the PCL and had the highest average severity scores. At initial screen, 41% of those who had been to Iraq or Afghanistan reported sleep problems. Those who had initially reported any insomnia had significantly higher overall scores for PTSD severity at follow-up than did service members without such a complaint. These results show that insomnia is a particularly frequent, severe, and persistent complaint in service members returning from deployment. Such complaints merit particular attention in relation to the possibility of PTSD.
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PMID:Insomnia is the most commonly reported symptom and predicts other symptoms of post-traumatic stress disorder in U.S. service members returning from military deployments. 2096 66

Most psychiatric disorders, such as schizophrenia, mood disorders, or neurotic disorders are associated with sleep disorders of various kinds, among which insomnia is most prevalent and important in psychiatric practice. Almost all patients suffering from major depression complain of insomnia. Pharmacological treatment of insomnia associated with major depression shortens the duration to achieve remission of depression. Insomnia has been recently reported to be a risk factor for depression. Hypersomnia is also a major sleep problem in patient suffering from depression. There have been no clinical guide to treat the symptoms of hypersomnia in depression, but some clinical trials treating them with NDRI or adjunctive administration of psychostimulants. In patients with schizophrenia, insomnia is often an early indicator of the aggravation of psychotic symptoms. Electroencephalographic sleep studies have also revealed sleep abnormalities characteristic to mood disorders, schizophrenia and anxiety disorders. A shortened REM sleep latency has been regarded as a biological marker of depression. Reduced amount of deep Non-REM sleep has been reported to be correlated with negative symptoms of schizophrenia. Recently, REM sleep abnormalities were found in teenagers having post-traumatic stress disorder after a boat accident. Although these facts indicate that insomnia plays an important role in the development of psychiatric disorders, there are few hypotheses explaining the cause and effect of insomnia in these disorders. Here, we reviewed recent articles on insomnia and hypersomnia associated with psychiatric disorders together with their clinical managements.
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PMID:[Management of insomnia and hypersomnia associated with psychiatric disorders]. 2107 97

Blast-related head injuries are one of the most prevalent injuries among military personnel deployed in service of Operation Iraqi Freedom. Although several studies have evaluated symptoms after blast injury in military personnel, few studies compared them to nonblast injuries or measured symptoms within the acute stage after traumatic brain injury (TBI). Knowledge of acute symptoms will help deployed clinicians make important decisions regarding recommendations for treatment and return to duty. Furthermore, differences more apparent during the acute stage might suggest important predictors of the long-term trajectory of recovery. This study evaluated concussive, psychological, and cognitive symptoms in military personnel and civilian contractors (N = 82) diagnosed with mild TBI (mTBI) at a combat support hospital in Iraq. Participants completed a clinical interview, the Automated Neuropsychological Assessment Metric (ANAM), PTSD Checklist-Military Version (PCL-M), Behavioral Health Measure (BHM), and Insomnia Severity Index (ISI) within 72 hr of injury. Results suggest that there are few differences in concussive symptoms, psychological symptoms, and neurocognitive performance between blast and nonblast mTBIs, although clinically significant impairment in cognitive reaction time for both blast and nonblast groups is observed. Reductions in ANAM accuracy were related to duration of loss of consciousness, not injury mechanism.
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PMID:Comparison of concussive symptoms, cognitive performance, and psychological symptoms between acute blast-versus nonblast-induced mild traumatic brain injury. 2108 63


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