Cognitive behavioral therapy showed to help with insomnia, even with other health conditions

A study shows that talk therapy, specifically cognitive behavioral therapy, helps people with insomnia, even if they have other health conditions.

Talk therapy may help treat insomnia in people with physical or mental health problems, a new study suggests.

With cognitive behavioral therapy, people talk with a therapist to identify the negative thoughts and feelings that cause them problems, and to learn ways to solve their problems, according to the U.S. National Institute of Mental Health.

Past studies have found cognitive behavioral therapy for insomnia can improve sleep. But, many of those studies didn't include people with psychiatric and medical conditions.

For the new study, researchers from Rush University Medical Center in Chicago looked at 37 previous studies. The research included nearly 2,200 people and looked at cognitive behavioral therapy for insomnia in people who had depression, alcoholism and post-traumatic stress disorder and/or with medical conditions such as cancer, chronic pain and fibromyalgia.

The new analysis showed that cognitive behavioral therapy for insomnia reduced insomnia symptoms and sleep disturbances. Twice as many people who received the therapy no longer had insomnia, compared to people who didn't have the therapy, the researchers said.

Cognitive behavioral therapy was also associated with positive effects on co-existing psychiatric and medical conditions, but it showed the strongest benefit with psychiatric disorders.

This may be due to a stronger link between psychiatric disorders and insomnia, the researchers said.

The findings provide support for using talk therapy as a treatment for insomnia in people who have other psychiatric conditions, study author Jason Ong, a behavioral sleep medicine specialist at Rush University Medical Center, and colleagues concluded in a university news release.

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The link between sleep and children's mental health is...complicated...

A study indicates that a link exists between children with sleep disorders and their mental health.

Toddlers who take a long time to fall asleep or wake up many times during the night have put many a desperate mom and dad to the test. Tired parents are often told that night waking is part of toddlerhood, and that it will soon pass on its own, but this is not the case for everyone.

Researchers at NTNU's Department of Psychology have conducted a comprehensive survey of nearly 1,000 toddlers that shows that serious sleep disorders in young children can have long-term consequences.

The study shows that four-year-olds with sleep disorders have a higher risk of developing symptoms of psychiatric problems as six-year-olds, compared with children who sleep soundly.

At the same time, four-year-olds with psychiatric symptoms have a greater risk of developing a sleep disorder as six-year-olds, compared with children who do not have these kind of symptoms.

Reciprocal relationship

"It is common for children to have periods when they sleep poorly, but for some children, the problems are so extensive that they constitute a sleep disorder. Our research shows that it is important to identify children with sleep disorders, so that remedial measures can be taken. Sleeping badly or too little affects a child's day-to-day functioning, but we are seeing that there are also long term repercussions," says Silje Steinsbekk, an Associate Professor and Psychologist in NTNU's Department of Psychology.

Her previous research on the relationship between sleep disorders and psychological problems in children has shown that four-year-olds with sleep disorders often also show symptoms of psychiatric problems.

The new study, which was recently published in the Journal of Developmental & Behavioral Pediatrics, shows that the correlation between sleep disorders and psychiatric disorders is also found over time and that the relationship is reciprocal.

Thorough interviews and diagnoses

We know that 20-40 per cent of young children struggle with sleep in one way or another, but we lack data on how many of them are suffering from a diagnosable sleep disorder.

NTNU researchers conducted diagnostic interviews with the parents of the children participating in the study. The interview was based on the DSM-IV diagnostic manual, which contains the official diagnostic criteria for mental disorders.

One thousand four-year-olds participated in the study. Parents of around 800 of these children were interviewed again two years later. The comprehensive study is part of a longitudinal study in Trondheim that examines the incidence, progression and risk factors for the development of mental health problems in children. The project conducts follow-up visits with the children and their parents every other year.

"Previous studies of sleep problems in children have mainly used a questionnaire format, with questions like, "Does your child have trouble sleeping?" But what parents define as sleep problems will vary. In the diagnostic interview we ask parents questions until we are confident that we have enough information to assess whether a symptom is present or not. The information we've collected is more reliable than information obtained from the questionnaire," says Steinsbekk.

What comes first?

Can we say that poor sleep causes psychiatric problems -- or do psychiatric problems cause poor sleep? The findings from the study suggest that the relationship goes both ways.

One possible explanation for this reciprocity may be that both conditions are biologically determined, by common underlying genetics, for example.

Another explanation may be that insufficient sleep creates general functional impairment, and that the risk of other problems therefore increases -- in the same way that psychiatric symptoms often result in poorer everyday functioning, which in turn may negatively affect sleep.

Vicious cycle

Perhaps sleep disorders and mental health issues share the same risk factors. A child who shows signs of anxiety or a behavioural disorder may easily end up in a vicious cycle, where conflict with adults triggers anxiety and in turn leads to trouble falling asleep.

It may also be that difficult and negative thoughts steal both energy and sleep and make us restless and depressed if we fail to gain control over them.

"Given that so many children suffer from insomnia, and only just over half 'outgrow it,' it is critical for us to be able to provide thorough identification and good treatment. Perhaps early treatment of mental health problems can also prevent the development of sleep disorders, since psychiatric symptoms increase the risk of developing insomnia," says Steinsbekk, stressing that this is something that must be examined in further research.

Insomnia is most prevalent The study shows that insomnia is the most prevalent sleep disorder. Children who suffer from insomnia struggle with falling asleep and frequent waking. Insomnia was diagnosed in 16.6 per cent of the four-year-olds surveyed, and 43 per cent of these still had insomnia as six- year olds.

Insomnia in four-year olds increases the risk for symptoms of anxiety, depression, ADHD and behavioural problems as six-year-olds. After the researchers had taken into account the children's psychiatric symptoms at age four, the relationship between insomnia and ADHD disappeared.

Similarly, children who show symptoms of anxiety, depression, ADHD and behavioural disturbances as four-year-olds have a greater risk of developing insomnia as six-year-olds. When symptoms of insomnia at age four were adjusted for, the relationship between insomnia and anxiety disappeared.

Examples of other types of sleep disorders are hypersomnia, i.e. an extreme urge to sleep, and various cases of parasomnia, such as nightmares, night terrors and sleepwalking. These conditions are uncommon, and the study also shows that, with the exception of sleepwalking, they are shorter-lived.

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Premature babies predisposed to depression

A recent study claims that premature babies have a high risk of depression later in life.

People born extremely premature have a significantly higher risk of developing psychiatric problems later in life, a new Canadian study says.

Researchers at McMaster University in Hamilton, Ont., studied 174 people born in Ontario between 1977 and 1982 — 84 of whom weighed less than 1 kg (2.2 lbs.) at birth, and 90 of whom fell into the range of normal birth weight.

The low-birth-weight babies were 2.5 times more likely to develop a mental health problem such as depression, an anxiety disorder or attention-deficit/hyperactivity disorder (ADHD), the study found.

The likelihood is even higher — nearly 4.5 times — for those whose mothers received a high dose of steroids before giving birth.

At the same time, the research found a positive outcome: the low-birth-weight babies were nearly three times less likely to develop an alcohol or substance abuse disorder.

The study was published in the journal Pediatrics.

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Study: Sleep issues common for children with psychiatric disorders

A study found that sleep issues are more common for children with a psychiatric disorder.

John Boekamp, Ph.D., clinical director of the Pediatric Partial Hospital Program (PPHP) at Bradley Hospital recently led a study that found sleep difficulties - particularly problems with falling asleep - were very common among toddlers and preschool-aged children who were receiving clinical treatment for a wide range of psychiatric disorders. The study, titled "Sleep Onset and Night Waking Insomnias in Preschoolers with Psychiatric Disorders," is now published online in the journal Child Psychiatry & Human Development.

"The most common sleep difficulties reported nationally for toddlers and preschoolers are problems of going to bed, falling asleep and frequent night awakenings – collectively, these problems are referred to as behavioral insomnias of childhood," said Boekamp. "Sleep problems in young children frequently co-occur with other behavioral problems, with evidence that inadequate sleep is associated with daytime sleepiness, less optimal preschooladjustment, and problems of irritability, hyperactivity and attention."

Boekamp's team was interested in learning more about sleep and sleep problems in young children with behavior problems, as early sleep problems may be both a cause and consequence of children's difficulties with behavioral and emotional self-regulation. "Essentially, these young children might be caught in a cycle, with sleep disruption affecting their psychiatric symptoms and psychiatric symptoms affecting their sleep-wake organization," said Boekamp.

The partial program that Boekamp leads at Bradley Hospital is a family-centered, intensive day treatment program for very young children aged from newborn to six who have serious emotional, behavioral or relationship disturbances. This study examined the nature and prevalence of diagnostically defined sleep disorders, including Sleep Onset Insomnia (SOI) and Night Waking Insomnia (NWI), in a group of 183 young children admitted to the program. Diagnosable sleep disorders, particularly SOI, were quite common in the group, exceeding previous estimates obtained in community settings. Overall, 41 percent of children in the study also met diagnostic criteria for a sleep disorder. Sleep problems were especially common in children with disruptive behavior, attention, anxiety and mood problems.

"It is important for families to be aware of how important sleep is to the behavioral adjustment and wellbeing of young children," said Boekamp. "Sleep disorders may be unrecognized and under-diagnosed in young children, particularly when other behavioral or emotional problems are present."

Difficulties with sleep may be particularly important to address when children are also struggling with challenging daytime behaviors, such as problems with compliance, aggression, attention and mood. Sleepiness and fatigue may exacerbate these problem behaviors.

"This study is a great reminder that it's critical for mental health providers working with young children and their families to ask about children's sleep," said Boekamp. "Simple questions about children's sleep patterns, including how long it takes a child to fall asleep at night and how frequently a child awakens after falling asleep, may yield important information that is relevant to clinical care, even when sleep problems are not the primary focus of treatment."

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Study: Epilepsy indicates a person is 11 times more likely to die prematurely

A study from the UK claims that a person with epilepsy is 11 times more likely to die prematurely than a person without epilepsy. A person with epilepsy is also more likely to commit suicide than a person without epilepsy.

Nine per cent of people with epilepsy died young compared with just 0.7 per cent of those without the condition, the 41-year research discovered.

And the findings, published in The Lancet, showed that people with both epilepsy and alcohol or drug disorders were 22 times more likely to die than someone who did not have either.

Someone who has epilepsy is also four times more likely to commit suicide than someone who does not, the team from Oxford University said.

Only half of the UK’s 600,000 epilepsy sufferers are seizure-free, and one in 20 people will have an epileptic seizure at some point in their life.

Dr Seena Fazel from Oxford University, who led the study, said standard checks could help reduce the risk of premature deaths in people with epilepsy.

Dr Fazel commented: "Our results have significant public health implications as around 70 million people worldwide have epilepsy, and emphasise that carefully assessing and treating psychiatric disorders as part as part of standard checks in persons with epilepsy could help reduce the risk of premature death in these patients.

"Our study also highlights the importance of suicide and non-vehicle accidents as major preventable causes of death in people with epilepsy."

The study, which tracked 69,995 people with epilepsy born in Sweden between 1954 and 2009 for a 41-year period, found suicides and accidents accounted for almost 16 per cent of all deaths in people with epilepsy.

Of these, three-quarters also had been diagnosed with a psychiatric condition such as depression. They were the most common cause of death not linked to the underlying disease process.

The researchers also found that the risk of premature death in people with epilepsy compared similarly to their unaffected siblings and the general population. This suggests that epilepsy is an independent cause of early deaths, the academics said.

Simon Wigglesworth, deputy chief executive of Epilepsy Action, said the study was cause for concern.

"The findings of this research are concerning and highlight the need for excellent healthcare for people with epilepsy", Mr Wigglesworth said.

"Getting the best possible support and treatment is important to help to reduce the likelihood of people with epilepsy experiencing mental illness. And a holistic approach to managing the condition should help ensure that people with epilepsy get the best possible treatment for both their epilepsy and any associated conditions.”

A separate study published last week warned that children whose mothers take anti-epilepsy drugs during their pregnancy face an increased risk of developing autism.

By the age of three, children were four times more likely to show traits associated with autism if their mothers had taken drugs to control their epileptic seizures.

According to Epilepsy Research UK, around two-thirds of epileptic seizures can be successfully treated with anti-epileptic drugs.

In the latest study, the causes of death were compared with 660,869 people of the same age and sex from the general population, and 81,396 unaffected siblings of people with epilepsy, to account for the potential influence of genetic or environmental factors.

While in some 60 per cent of cases the cause for epilepsy is not known, some types are inherited and common causes are brain damage, scarring of the brain tissue, a tumour, or chemical and hormonal imbalances in the body.

Epilepsy is a neurological condition defined as the tendency to have recurrent seizures. There are around 40 different sorts of seizure and a person can suffer from more than one type.

Every day 87 people in the UK are diagnosed with epilepsy, and many people who develop epilepsy when they are below the age of 20 will “grow out of it” in adult life, according to Epilepsy Action.

While only 52 per cent of people with epilepsy in this country are seizure-free, the charity estimates that with the right treatment seven in 10 could avoid seizures.

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Children with temporal lobe epilepsy and depression

Psychiatric evaluation is shown to be important for children with temporal lobe epilepsy.

Depressive symptoms, behavioural problems and psychiatric illnesses are common among children and adolescents with temporal lobe epilepsy, a new study has shown.

Researchers at the Children's National Medical Centre in Washington DC, US, say their findings underline the importance of carrying out full psychiatric evaluations on children with epilepsy, particularly if they are not responding to anti-seizure medications and may be eligible for epilepsy surgery.

The research team looked at case records for 40 children, aged six to 17 years, who were not benefiting from anti-seizure medications.

Patients received psychiatric evaluations prior to undergoing epilepsy surgery, while their parents completed questionnaires aimed at assessing their children's behaviour.

Previous research suggests that up to 40 per cent of children with chronic epilepsy have mental illnesses, with depression, anxiety, attention issues and learning difficulties being most common.

However, the latest study found the rate of psychiatric and behavioural problems to be far higher.

Overall, nearly 80 per cent of the children had significant psychiatric symptoms.

The researchers also observed that children with temporal lobe epilepsy were more likely to have depressive symptoms and significant behavioural issues than those whose seizures originated in other parts of the brain.

Their study, which is published in the journal Epilepsia, is not the first to suggest a link between temporal lobe epilepsy and depression, as previous research in a 2009 issue of the same journal found an association in adult patients.

However, the latest study indicates that this link extends to children with epilepsy as well.

"Understanding the paediatric patient's mental health status is important, as the severity of psychiatric illness may impact the overall risk-benefit of epilepsy surgery," explained Dr Jay Salpekar, the study's lead author.

"Given that psychiatric illness, particularly depression, is so prominent in those with temporal lobe seizures, routine psychiatric evaluation appears to be important not only for adults, but also for children and adolescents prior to epilepsy surgery.

"In fact, it may be beneficial for most patients with medically refractory epilepsy to have a psychiatric assessment, regardless of seizure localisation, to improve quality of life."

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Childhood ADHD Lasts Into Adulthood

A study that followed children with ADHD into adulthood shows their ADHD symptoms lasted in adulthood and are associated with other psychiatric issues.

The first large, population-based study to follow children with attention-deficit hyperactivity disorder into adulthood shows that ADHD often doesn't go away and that children with ADHD are more likely to have other psychiatric disorders as adults. They also appear more likely to commit suicide and to be incarcerated as adults. The findings appear in the March 4 online issue ofPediatrics.

"Only 37.5 percent of the children we contacted as adults were free of these really worrisome outcomes," says lead investigator William Barbaresi, M.D., of Boston Children's Hospital, who started the study when he was at Mayo. "That's a sobering statistic that speaks to the need to greatly improve the long-term treatment of children with ADHD and provide a mechanism for treating them as adults."

The study is unique because it followed a large group of ADHD patients from childhood to adulthood, says Slavica Katusic, M.D., an epidemiologist and Mayo Clinic's lead researcher on the study.

ADHD is the most common neuro-developmental disorder of childhood, affecting about 7 percent of all children and three times as many boys as girls. Most prior follow-up studies of ADHD have been small and focused on the severe end of the spectrum -- such as boys referred to pediatric psychiatric treatment facilities -- rather than a cross-section of the ADHD population.

The study followed all children in Rochester who were born between 1976 and 1982, were still in Rochester at age 5 and whose families allowed access to their medical records. That amounted to 5,718 children, including 367 diagnosed with ADHD. Of this group, 232 participated in the follow-up study. About three-quarters received ADHD treatment as children.

At follow-up, the researchers found:

*29 percent of children with ADHD still had ADHD as adults.

*57 percent of children with ADHD had at least one other psychiatric disorder as adults, as compared with 35 percent of those studied who didn't have childhood ADHD. The most common were substance abuse/dependence, antisocial personality disorder, hypomanic episodes, generalized anxiety and major depression.

*Of the children who still had ADHD as adults, 81 percent had at least one other psychiatric disorder, as compared with 47 percent of those who no longer had ADHD and 35 percent of those without childhood ADHD.

*Seven of the 367 children with ADHD (1.9 percent) had died by the time the study began, three of them from suicide. Of the 4,946 children without ADHD whose outcomes could be ascertained, 37 children had died, five by suicide.

*Ten adults who had childhood ADHD (2.7 percent) were incarcerated when the study started.

"We suffer from the misconception that ADHD is just an annoying childhood disorder that's overtreated," Dr. Barbaresi says. "This couldn't be further from the truth. We need to have a chronic disease approach to ADHD as we do for diabetes. The system of care has to be designed for the long haul."

Dr. Barbaresi thinks the study findings may underestimate the bad outcomes of childhood ADHD. Most of those studied were white and middle class, with good educations and access to health care.

"One can argue that this is potentially a best-case scenario," Dr. Barbaresi says. "Outcomes could be worse in socioeconomically challenged populations."

He advises parents of children with ADHD to ensure that their children are in high-quality treatment -- and remain in treatment as they enter adolescence. Children also should be assessed for learning disabilities and monitored for conditions associated with ADHD, including substance use, depression and anxiety.

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