摘要:

Much of what is known about sleep disorders has been uncovered in the last forty years. As scientists, we consider these discoveries to be landmarks. Yet there is a tremendous amount of information written about sleep in the Bible and its commentaries. Sleep, and even sleep disorders, are referred to in many instances and can be directly interpreted by what we know today. Our forefathers and foremothers generally viewed sleep as both pleasant and necessary and were aware that sleep was not one continuous stage. They referred to the function of sleep as being restorative. They deplored sleep deprivation, believing that it impaired life. They felt that excessive sleepiness was harmful. They understood that insomnia could be caused by stress and anxiety and by excessive alcohol, and that physical activity (exercise) and drinking milk could improve sleep. They suggested cures for insomnia, including some of the ideas included in today’s sleep hygiene rules. They understood that there was a rhythm or timing to sleep. They even understood that it is easier to delay the circadian rhythm that to advance it. Although naps are not recommended, they sometimes took naps in the afternoon, but suggested just how long that nap should last—about one-half hour. And they knew that with age, although sleep is advanced, healthy elderly do not have difficulty sleeping. Although we think we have discovered many new features about sleep disorders, much of what we know today was suggested thousands of years ago and documented in the Bible and the Talmud.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveA number of sympathetic nervous system (SNS) parameters have been used in cardiovascular psychophysiology. This study aimed to describe the pattern and redundancy of a set of SNS parameters during peripherally induced changes of cardiac sympathetic activation and reflex modulation of central SNS control. Preejection period (PEP) was assessed as a marker of peripheral sympathetic activation. Low-frequency blood pressure variability (BPV) was assessed as an estimate of central SNS control.MethodsPeripheral &bgr;-sympathetic stimulation and blockade were achieved with epinephrine and esmolol hydrochloride (&bgr;1-blockade), respectively. Changes in central SNS output were induced by loading and unloading arterial baroreceptors with norepinephrine and nitroprusside sodium, respectively. This single-blinded, crossover study in 24 healthy men also included two placebo control periods. PEP was derived from impedance cardiography and adjusted individually for heart rate. BPV was calculated by power spectral analyses of beat-to-beat heart rate and systolic blood pressure (Finapres system) data.ResultsPEP decreased during epinephrine infusion (−40.1 ± 3.8 ms,p< .0001) and increased during esmolol infusion (+6.6 ± 3.5 ms,p= .05). PEP was shortened after central SNS activation by nitroprusside (−16.8 ± 2.9 ms,p< 0.0001). Systolic BPV in the low-frequency range (0.07–0.14 Hz, Mayer waves) increased during nitroprusside infusion (+0.44 ± 0.19 ln mm Hg2,p= .03) and decreased during norepinephrine infusion (−0.67 ± 0.13 ln mm Hg2,p< 0.0001). Low-frequency BPV did not change significantly during epinephrine or esmolol infusion.ConclusionsOur data provide empirical evidence of separable peripheral and central sympathetic response components. The combined report of low-frequency BPV and PEP gives distinct information on both central SNS control and the level of sympathetic cardiac activation achieved.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectivesTo study the relation of type A behavior pattern and job-related psychosocial factors to the risk of myocardial infarction.MethodsStudy subjects comprised 290 cases (173 male workers and 117 women) of nonfatal acute myocardial infarction (AMI) and 489 controls (303 male workers and 186 women) recruited from among residents of the study area. Participation rates of cases and controls were 86% and 50%, respectively. Type A behavior pattern, job-related psychosocial factors, and other coronary risk factors were ascertained by interview using a questionnaire. Type A behavior pattern was measured by 12 questions, and job strain by the method of Karasek. Logistic regression analysis was used to calculate odds ratio and 95% confidence interval with adjustment for potential confounding variables. The relation to job strain was examined only in men.ResultsType A behavior pattern was significantly associated with an increased risk of AMI in male workers (adjusted OR = 1.9, 95% CI, 1.2–2.9) and in women (adjusted OR = 2.8, 95% CI, 1.6–4.9). Although job control and job demand showed no material association with AMI, job strain, a combination of low job control and high job demand was associated with an increased risk of AMI (adjusted OR = 2.2, 95% CI, 1.1–4.5). Abbreviated type A score and job demand score were higher among nonparticipant control candidates than participant controls in male workers.ConclusionsType A behavior pattern may be an important risk factor for AMI especially in Japanese women. The present study also revealed persons in stressful psychosocial circumstances were less likely to participate in the study.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo investigate the psychological (affective and symptomatic) and physiological (autonomic and cortisol) responses to postprandial mental stress in women with irritable bowel syndrome (IBS). It was hypothesized that patients with IBS would show exaggerated autonomic and cortisol responses to the psychological stressor and that the stressor would enhance gastrointestinal symptoms.MethodTwenty-four women with IBS and 20 healthy women participated in the two-day study protocol. Both days were identical, with the exception that on one day, a stressful mental task was completed after ingestion of a standard meal. Heart rate variability, cortisol, affective, and symptomatic responses were measured before and after application of the stressor.ResultsPatients with IBS demonstrated increased negative affect at baseline and in response to the stressor. Gastrointestinal symptoms were not affected by the stressor. Appraisal of the stressor by patients with IBS was not different from that of controls. There were no group differences in the autonomic response to the stressor. There was no overall cortisol response to the stressor in either group.ConclusionsPatients with IBS respond with greater negative affect to postprandial psychological stress as well as to food intake alone, and they can be distinguished from controls on the basis of self-report data. Patients with IBS cannot be differentiated from controls on the basis of the pattern of changes in sympathetic activation after the mental stressor. The stressor used in this study did not elicit a cortisol response in either group.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveLactation has been associated with attenuated hormonal responses to exercise stress in humans. This study was designed to determine the effect of lactation on hypothalamic-pituitary-adrenal axis, autonomic nervous system, and anxiety responses to psychological stress.MethodThe Trier Social Stress Test was administered to 24 lactating women, 13 postpartum nonlactating women, and 14 healthy control women in the early follicular phase of the menstrual cycle. Lactating women were stressed at least 40 minutes after last feeding their infant.ResultsACTH, cortisol, heart rate, diastolic blood pressure, systolic blood pressure, and subjective anxiety ratings were all significantly increased in response to the psychological stress (allp< .0001). There were no differences among the three groups in any of these responses to the stress. However, postpartum nonlactating women did have a persistently higher systolic blood pressure and lower cardiac vagal tone than the lactating women and control subjects. In addition, the typical negative correlation between cardiac vagal tone and heart rate was consistently higher in lactating women than nonlactating postpartum women and controls, which suggests stronger vagal control of heart rate in lactating women. In addition, there was no change in oxytocin or allopregnanolone in response to the stress, and baseline oxytocin and allopregnanolone levels did not differ among the three groups.ConclusionsThese results indicate that physiological and subjective responses to social stress are not attenuated in lactating women tested at least one hour after feeding their infant. However, enhanced vagal control of cardiac reactivity was observed in lactating women. In addition, postpartum women who did not lactate showed evidence of increased sympathetic and decreased parasympathetic nervous system tone.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveWe investigated whether the psychiatric symptoms and clinical features of schizophrenia change during the premenstrual phase in female patients.MethodsWe observed 30 female schizophrenic inpatients over one menstrual cycle. All subjects met DSM-IV criteria for schizophrenia, and all had a regular menstrual cycle. All subjects completed the Daily Rating Form (DRF) every evening, and one psychiatrist rated the subjects (using the Brief Psychiatric Rating Scale [BPRS]) once during each of the three menstrual phases (premenstrual, menstrual, and postmenstrual). Serum levels of estradiol (E2) and progesterone were measured on the fifth to seventh day of both the premenstrual and postmenstrual phases. Data from the 24 subjects who completed the DRF correctly and completely were used for statistical analysis.ResultsThe mean total BPRS score for the 24 subjects was highest in the premenstrual phase and lowest in the postmenstrual phase, and a statistically significant difference was found among the three menstrual phases. Mean subtotal BPRS scores showed statistically significant differences among the three menstrual phases in anxiety/depression and withdrawal/retardation, but not in the psychotic symptom subscales. Mean serum E2level showed a trend of increasing from the premenstrual phase to the postmenstrual phase. However, there was no significant correlation between &Dgr;BPRS and &Dgr;E2. When the criterion of 30% change was applied, the DRF items of depressed mood, anxious/nervous/restless, hostile/aggressive, and less/impaired work showed high frequencies of change in the premenstrual phase. Somatic items of abdominal pain, breast pain, and headache showed significant change with the 30% change rule on the DRF. On both the BPRS and DRF scores, premenstrual change of affective and behavioral symptoms was prominent, whereas the change of psychotic symptoms was minimal on the BPRS. In addition, in the premenstrual phase, there was a statistically significant correlation between the total BPRS score and the mean total DRF score. There was no correlation between premenstrual change in symptoms and hormonal levels of E2, progesterone, and the estradiol/progesterone (E/P) ratio.ConclusionsThe findings of this study suggest that premenstrual exacerbation of schizophrenic symptoms in female patients may not be a worsening of the schizophrenic symptoms but a concurrence of affective, behavioral, and somatic symptoms.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe purpose of this study was to examine if depressive symptomatology in pregnancy is associated with adverse obstetric and neonatal outcomes.MethodIn a prospective observational study, 959 women were followed up longitudinally from early pregnancy to postpartum. The level of depression was measured at baseline (first antepartum visit) and in late pregnancy using the Beck Depression Inventory (BDI). Adverse obstetric and neonatal outcomes were recorded at delivery.ResultsDepression in late pregnancy was associated with increased risk of epidural analgesia (33% vs. 19%,p= .01, adjusted RR = 2.56, 95% CI 1.24–5.30), operative deliveries (caesarean sections and instrumental vaginal deliveries) (39% vs. 27%,p= .02, adjusted RR = 2.28, 95% CI 1.15–4.53), and admission to neonatal care unit (24% vs. 19%,p= .03, adjusted RR = 2.18, 95% CI 1.02–4.66). These effects remained significant even when controlled for potential confounders, such as antepartum complications.ConclusionPrevious studies have shown that antepartum anxiety or stress was associated with growth retardation, premature delivery, and epidural analgesia. Our findings add to this body of evidence, which together suggest an adverse impact of antepartum psychological morbidity on maternal and neonatal well-being.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectivePrior research has demonstrated increased use of medical services among persons with anxiety and depression. This investigation examined the possible association of posttraumatic stress disorder (PTSD) with the use of nonmental health services.MethodA case-comparison design enrolled 102 high users of health services and 54 low users who were assessed for PTSD diagnosis and severity of PTSD symptoms. Subjects were male veterans receiving services from the primary care clinics of the VA Boston Healthcare System during an 18-month period. Data were collected by interview by use of standardized instruments including the Clinician Administered PTSD Scale for DSM-IV, the Life Events Checklist, and the Beck Depression Inventory. Data analysis employed odds ratios, linear and logistic regression, and path analyses.ResultsHigh users of health care were almost twice as likely as low users (27.5% vs. 14.8%) to meet diagnostic criteria for current PTSD. The two groups differed significantly on both symptom frequency and intensity. Path analyses showed an indirect positive association between PTSD and health services use, with physician-diagnosed health conditions as a mediating variable. Auxiliary analysis demonstrated that the combined mental health burden of PTSD and depression symptoms also is positively associated with number of health conditions.ConclusionsThe findings indicate that PTSD, alone and in combination with depression, has a direct negative relationship with physical health that, in turn, is associated with more frequent use of primary health care services. These results do not suggest that PTSD leads to inappropriate (eg, distress-motivated) use of services.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveControversy exists concerning unexplained illness in Persian Gulf War veterans, especially regarding the contribution of psychological trauma. We sought to determine if war zone trauma or posttraumatic stress symptomatology (PTSS) are associated with illnesses reported by Gulf War veterans that were documented by medical examination but not attributable to a medical diagnosis.MethodsA total of 1119 (55% response rate) of 2022 randomly sampled veterans of the United States Persian Gulf War were screened and 237 cases and 113 controls were identified by medical examination for a case-control study comparing Persian Gulf War military veterans with or without medically documented, but unexplained, symptoms. Multivariate logistic regression and cross-validation analyses examined self-report measures of demographics, subjective physical symptoms and functioning, psychiatric symptoms, stressors, war zone trauma, and PTSS, to identify correlates of case-control status.ResultsPosttraumatic stress symptomatology and somatic complaints were independently associated with case status, as were (although less consistently) war zone trauma and depression. Age, education, and self-reported health, stress-related somatization, pain, energy/fatigue, illness-related functional impairment, recent stressors, and anxiety were univariate (but not multivariate) correlates of case status.ConclusionsPTSS related to war zone trauma warrants additional prospective research study and attention in clinical screening and assessment as a potential contributor to the often debilitating physical health problems experienced by Persian Gulf War veterans.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe present study prospectively investigated the role of self-efficacy in predicting disease symptomatology and health services utilization for adult patients with sickle cell disease.MethodsThese data are derived from a 12-month prospective cohort study of African American adults with sickle cell disease. Disease-specific perceptions of coping self-efficacy and indices of disease severity, health care utilization, and psychosocial adjustment were assessed by use of standardized questionnaires administered by trained clinicians.ResultsPerceptions of self-efficacy for coping with sickle cell disease were moderately stable across the 12-month study period. At baseline (N= 147), significant inverse relationships, measured with Pearson correlations, were noted between self-efficacy and the following variables: physical symptoms, psychological symptoms, pain severity, and number of physician visits over the preceding 12 months (p< .01). Similar relationships with self-efficacy were noted at the 1-year follow-up (N= 104) period for measures of physical symptoms, psychological symptoms, and pain severity (p< .01). In multiple-regression models, baseline self-efficacy scores predicted changes over the 1-year study period in physical and psychological sickle cell disease symptomatology. Moreover, changes in self-efficacy from baseline to 1-year follow-up were significantly and independently related to changes in physical symptoms, psychological symptoms, and pain ratings from baseline to 1-year follow-up.ConclusionsSelf-efficacy beliefs among African American adults with sickle cell disease are inversely related to reported disease symptomatology, and these relationships persist across time. Future investigations should examine the mechanisms through which relationships between self-efficacy and adjustment to sickle cell disease are effected, as well as the feasibility and effectiveness of enhancing self-efficacy beliefs as a means of improving adjustment to sickle cell disease.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID