RESUMO

Study Objectives: The mechanisms linking short sleep duration to cardiovascular disease (CVD) are poorly understood. Emerging evidence suggests that endothelial dysregulation may lie along the causal pathway linking sleep duration to cardiovascular risk, although current evidence in humans is based on cross-sectional studies. Our objective was to evaluate the prospective association between objectively assessed sleep duration and clinical indices of endothelial health. Methods: A total of 141 medically healthy adults underwent an overnight laboratory sleep study when they were between the ages of 21 and 60 years. Total sleep time was objectively assessed by polysomnography at study entry. Endothelial health, including brachial artery diameter (BAD) and flow-mediated dilation (FMD), was measured 18.9 ± 4.6 years later. Medical health and psychiatric status were assessed at both time points. Approximately half of the sample had a lifetime history of major depressive disorder. Results: In univariate analyses, shorter sleep duration was associated with increased BAD (ß = -0.24, p = .004) and decreased FMD (ß = 0.17, p = .042). BAD, but not FMD, remained significantly associated with sleep duration after adjusting for sex, age, body mass index (BMI), smoking, diabetes, hypertension, and lifetime history of major depressive disorder (MDD) at T2. The association between sleep duration and BAD was stronger than the association between BAD and an aggregate measure of CVD risk including three or more of the following risk factors: male sex, age ≥ 65 years, smoker, BMI ≥ 30, diabetes, hypertension, and MDD. Conclusions: Objectively assessed short sleep duration was prospectively associated with increased BAD over a 12- to 30-year period.

Assuntos

Artéria Braquial/patologia , Artéria Braquial/fisiologia , Endotélio Vascular/patologia , Endotélio Vascular/fisiologia , Sono/fisiologia , Adulto , Índice de Massa Corporal , Artéria Braquial/fisiopatologia , Transtorno Depressivo Maior/complicações , Diabetes Mellitus , Endotélio Vascular/fisiopatologia , Feminino , Voluntários Saudáveis , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Fumar , Fatores de Tempo , Adulto Jovem

RESUMO

Daytime and nighttime symptoms of posttraumatic stress disorder (PTSD) are common among combat veterans and military service members. However, there is a great deal of heterogeneity in how symptoms are expressed. Clarifying the heterogeneity of daytime and nighttime PTSD symptoms through exploratory clustering may generate hypotheses regarding ways to optimally match evidence-based treatments to PTSD symptom profiles. We used mixture modeling to reveal clusters based on six daytime and nighttime symptoms of 154 combat veterans with insomnia and varying levels of PTSD symptoms. Three clusters with increasing symptom severity were identified (N1=50, N2=70, N3=34). These results suggest that, among veterans with insomnia, PTSD symptoms tend to exist on a continuum of severity, rather than as a categorical PTSD diagnosis. Hypotheses regarding possible targeted treatment strategies for veterans within each identified cluster, as well as ways to generalize these methods to other groups within the military, are discussed.

RESUMO

OBJECTIVE: This article describes the adaptation of a rating scale of interpersonal psychotherapy problem areas to include a fifth problem area appropriate to bipolar disorder and an interrater agreement study in identifying interpersonal problem areas and selecting a primary treatment focus if patients were to engage in treatment. METHOD: Five research interpersonal psychotherapists assessed nine audiotapes of a single interview with five bipolar and four unipolar patients in which the interpersonal inventory and identification of problem areas were undertaken. RESULTS: Raters agreed on presence and absence of problem areas in seven tapes. Kappas for identification of problem areas were 1.00 (grief), 0.77 (role dispute), 0.61 (role transition), 0.57 (interpersonal deficits) and 1.00 (loss of healthy self). Kappa for agreement on a primary clinical focus if patients were to engage in interpersonal psychotherapy treatment was 0.64. CONCLUSIONS: The adaptation of the original scale to include an area pertinent to bipolar disorder proved to be applicable and relevant for use with this population. The results show substantial interrater agreement in identifying problem areas and potential treatment focus.

---

OBJETIVO: Este artigo descreve a adaptação de uma escala de avaliação de áreas problema da psicoterapia interpessoal que inclui uma área própria ao transtorno bipolar e um estudo de concordância em identificar áreas problema e selecionar um foco primário de tratamento caso os pacientes fossem participar de tratamento. MÉTODO: Cinco terapeutas interpessoais avaliaram nove audiotapes de uma única entrevista com cinco pacientes bipolares e quatro pacientes unipolares em que o inventário interpessoal e identificação de áreas problema foram empreendidos. RESULTADOS: Os avaliadores concordaram na presença e ausência de áreas problema em sete fitas. Kappas para identificação de áreas problema foram 1,00 (luto), 0,77 (disputa de papel), 0,61 (transição de papel), 0,57 (déficits interpessoais) e 1,00 (perda do self sadio). Kappa para concordância num foco de tratamento clínico foi 0,64. CONCLUSÕES: A adaptação da escala original para incluir área pertinente ao transtorno bipolar mostrou-se relevante para o uso com tal população. Os resultados demonstram uma concordância substancial entre avaliadores na identificação de áreas problema e foco de tratamento.

Assuntos

Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Transtorno Bipolar/terapia , Transtorno Depressivo/terapia , Relações Interpessoais , Psicoterapia/métodos , Terapia Comportamental , Prontuários Médicos , Variações Dependentes do Observador , Projetos Piloto , Processos Psicoterapêuticos , Adulto Jovem

RESUMO

OBJECTIVE: This article describes the adaptation of a rating scale of interpersonal psychotherapy problem areas to include a fifth problem area appropriate to bipolar disorder and an interrater agreement study in identifying interpersonal problem areas and selecting a primary treatment focus if patients were to engage in treatment. METHOD: Five research interpersonal psychotherapists assessed nine audiotapes of a single interview with five bipolar and four unipolar patients in which the interpersonal inventory and identification of problem areas were undertaken. RESULTS: Raters agreed on presence and absence of problem areas in seven tapes. Kappas for identification of problem areas were 1.00 (grief), 0.77 (role dispute), 0.61 (role transition), 0.57 (interpersonal deficits) and 1.00 (loss of healthy self). Kappa for agreement on a primary clinical focus if patients were to engage in interpersonal psychotherapy treatment was 0.64. CONCLUSIONS: The adaptation of the original scale to include an area pertinent to bipolar disorder proved to be applicable and relevant for use with this population. The results show substantial interrater agreement in identifying problem areas and potential treatment focus.

Assuntos

Transtorno Bipolar/terapia , Transtorno Depressivo/terapia , Relações Interpessoais , Psicoterapia/métodos , Adulto , Terapia Comportamental , Feminino , Humanos , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Variações Dependentes do Observador , Projetos Piloto , Processos Psicoterapêuticos , Adulto Jovem

RESUMO

The authors treated 115 elderly patients (ambulatory and without dementia) with recurrent major depression, by means of combined nortriptyline and interpersonal psychotherapy. They contrasted Cumulative Illness Rating Scale-Geriatric (CIRS-G) scores (for medical burden) in recovered and nonrecovered patients and generated a Cox proportional-hazards model of time-to-remission. The authors found no association between pretreatment chronic medical burden and acute treatment outcome in recovered (83 of 115) and nonrecovered patients and no relation of pretreatment CIRS-G scores with time-to-recovery. Findings support recent recommendations that practitioners be optimistic in treating elderly depressed, ambulatory patients whether or not significant medical burden coexists.

RESUMO

The authors determined differential clinical correlates of active suicidal ideation vs. passive death wish in elderly patients with recurrent major depression. Measures of lifetime suicidal behavior and ratings of suicidal ideation, hopelessness, and depression determined "ideator" status. Active and Passive Ideators as well as Non-Ideators were then compared. Sixty percent of Active Ideators endorsed disgust or self-hatred items on the Beck Depression Inventory, compared with only 25% of Passive Ideators and 20% of Non-Ideators. However, these data challenge the clinical utility of distinguishing active and passive suicidal ideation among such patients because the two groups overall appear to be more alike than different, and ideator status (passive vs. active) may change during an episode. Clinicians should therefore not be less clinically vigilant if such patients' suicidal ideation is "only" passive.