Global Insomnia Research Articles

Spiritual awakening. Substance abuse, dual pathology

IntroductionKambó is considered an “ancestral medicine” by the indigenous tribes of the western region of the Amazon.ObjectivesThrough this clinical case, the aim is to present the particularities of the symptoms and management of patients with consumption of not so common substances, such as Kambo or salvia divinorum, as well as the evolution that will occur in a patient with a previous diagnosis of a Depressive Episode.MethodsWe present the case of a 23-year-old male, Gestalt therapy student. History of tobacco, THC, and recent use of salvia divinorum and Kambo. He began follow-up by psychiatry in a private setting three years ago due to a severe depressive episode, having required treatment with antidepressants, antipsychotics and benzodiazepines, and having been triggered by a serious assault. The episode is resolved and follow-up is discontinued. Family history of depressive syndrome and suicide.He resumed contact through the Emergency Department, requiring hospital admission due to symptoms compatible with a manic episode with psychotic symptoms. It begins with behavioral alterations and global insomnia that are related to the consumption of some substance, initially unknown to them, making the skin lesions they presented suspect the consumption of kambo.ResultsWe assess the risk of consuming these substances, which are sometimes used as alternative therapies, and especially in this type of patient, who is more vulnerable and perhaps seeks a way out of the problems they present.ConclusionsIn our case, it triggered a manic episode with psychotic symptoms, which consisted of delusional ideation of mystical content accompanied by auditory hallucinations. The episode took about a month to subside, despite treatment. Subsequently, there have been more episodes with similar characteristics, and they have not been associated with the consumption of kambó, but have been linked to the consumption of “natural medicinal substances.”Disclosure of InterestNone Declared

Emotionally charged events as a trigger for the acute development of psychotic symptomatology. A case report

IntroductionA 21-year-old male presented to the emergency room due to strange behaviorObjectivesShow how emotionally intense events can be a stress factor leading to dissociative or psychotic symptoms.MethodsCase report and literature reviewResultsThe patient is in Spain after having attended the meeting with the Pope at the World Youth Day in Portugal. He is an engineering student who, in the week prior to the trip, had high levels of stress related to exam time. He also explained that he had recently had conflicts with his partner. In the psychocopathological examination of the patient, a global insomnia of 3 days of duration stands out. In addition, a disorganized and disjointed speech focused on high concern that something bad could happen to his family and partner. In the interview he appears restless, nervous, with a perplexed contact. The patient’s companion says that he has been very worried and obsessed about his relationship with his partner, with constant doubts about asking her to marry him. It is decided to start olanzapine, receiving up to 15 mg per day. In the following interviews he shows better contact and a more organized speech.Conclusions It is known that emotionally intense situations can be a trigger for the development of psychotic symptoms. There are different manifestations of these stressful situations such as physical symptoms like fainting or but mental symptoms are also described such as dissociative amnesias, or less frequent as in this case psychotic symptoms. They are usually of sudden onset and early remission with good response to anxiolytics or antipsychotics.Disclosure of InterestNone Declared

A complex polymorphous psychosis or a cycloid psychosis with a different onset?

IntroductionAcute and transitory psychotic disorders comprise a polymorphous picture such as Leonhard’s cycloid psychoses, which alternate episodes of affective symptoms such as psychosis between two poles (anguish/happiness, incoherence/stupor, or akinesia/hyperkinesia).ObjectivesTo describe a case report of a 20-year-old man, in outpatient psychiatric follow-up, after debuting at age 18 with a severe depressive episode of endogenomorphic characteristics without psychotic symptoms, with subsequent complete remission. Two years after clinical stability, he required prolonged hospitalization due to polymorphous psychotic syndrome of abrupt onset in a context of previous continuous use of cannabis and cocaine. Suspicion towards parents, bizarre behaviors, rushing desires, unmotivated laughter, fixed gaze, bewilderment, anguish with a feeling of imminent death, alternates with euphoria and senseless purchases.MethodsWe present the case report of this patient with a mental examination of conscious, scattered attention with marked distractibility, confusion and experiences of strangeness, memory gaps, subjective sensation of well-being with tachypsychia, which fluctuates with thymic oscillations and alternates with episodes of marked indefinite anguish, intense anxiety with delusional fear of the death of him or his family. Little systematized ideas of reference and prejudice based on intuitions or delusional occurrences in their environment. Megalomaniac and religious-messianic ideation. No sensory perception disturbances. Disintegrated course of thought, with frequent illogical associations, ambivalence of thought, affectivity and psychomotricity. Motor restlessness and behavioral disorganization. Global insomnia. Judgment of reality and superior functions diminished. No auto/heteroaggressiveness.ResultsVarious psychoactive drugs were tested for two months, obtaining a response only with valproic acid 1500mg, pregabalin 450mg and olanzapine 15mg, presenting slow improvement in a situation of absence of consumption, with a predominance of symptomatic polymorphism, decreasing fluctuation between episodes of expansiveness and psychotic anguish, remitting disorganization and motility alterations, persisting poor awareness of the disease and cognitive complaints. He was referred for follow-up at the mental health center where his gradual recovery continued.A differential diagnosis of polymorphous psychosis is proposed, compatible with a cycloid psychosis of the anxiety-happiness type with marked affective symptoms, precipitated by substance use.ConclusionsCycloid anxiety-happiness psychosis stands out for intense and fluctuating anxiety, oscillating with feelings of happiness, ecstasy, and placidity, mystical-religious delusions, and preoccupation with death, which may comprise a different psychotic debut.Disclosure of InterestNone Declared

DOCTOR, I’M PREGNANT. Psychopharmacological treatment of depression in pregnant women. A clinical case of a pregnant woman and major depressive disorder

IntroductionDepression during pregnancy can appear with a prevalence of up to 11% of pregnant women. Psychotherapeutic treatment in these cases is considered the first option, but treatment with antidepressants is sometimes required in these cases.ObjectivesTo present a clinical case of a pregnant patient diagnosed with depression.MethodsLiterature review of the psychopharmacological treatment of depression during pregnancy and possible complications.ResultsA 25y Year old woman, 22 weeks pregnant, who lives with her partner. She has no background in mental health. Paternal aunt diagnosed with type I Bipolar Disorder. She goes to the Mental Health Center for evaluation, due to anxiety and depressive symptoms of 4 weeks of evolution, she refers sadness and apathy, continuous crying, somatic anxiety and obsessive ruminations in relation to childbirth and inability to care for your child. Suicidal ideation as a resolution of her discomfort. She presents with global insomnia and a significant loss of appetite, with a weight loss of 3 kg. Treatment with sertraline 50 mg/day was started, with good tolerance and clinical responseConclusionsThe psychopharmacological treatment of antenatal depression is a challenge for the psychiatric professional. In all cases, an adequate balance must be made between the risks and complications for the fetus and the psychopathological stability of the pregnant woman. Among the main risks of untreated depression are: preterm delivery and low birth weight, an increased risk of suicide and alterations in the development during the baby’s infancy. The most used antidepressants are the SSRIs, with sertraline being a good option. Paroxetine has been associated with cardiac defects in the newborn. There are studies with tricyclics and duals but no specific teratogenic pattern has been seen. They are associated with an increased risk of spontaneous abortion. Exposure during the third trimester may be associated with obstetric complications.Disclosure of InterestNone Declared

I am the best and I have everything in life

IntroductionMegalomanic ideas in a patient with limited intellectual functioning may be due to the psychotic clinic or be the result of their disability.ObjectivesThis case is intended to highlight the importance of a joint approach between psychiatrists and psychologists to assess functionality before and after the psychotic episode.Methods34-year-old woman with no mental health history. She came to the emergency department for an episode of aggression at home. Her parents report that they have observed strange behaviour, she is more aggressive, speaks alone, changing voices and global insomnia in the last few days. Her language is incoherent and disorganised, with a long response latency. Megalomaniacal and catastrophic delusions. Possible auditory hallucinations and thought control phenomena.ResultsDuring admission, antipsychotic treatment was introduced with good tolerance and response on the part of the patient. She has been distancing herself from the ideas and has become somewhat critical. A psychological evaluation was carried out with different scales that showed borderline IQ.ConclusionsIt is important to make a good assessment of the patient’s symptoms in order to make a differential diagnosis. In this case, it is advisable to carry out a control and follow-up, as well as a neuropsychological assessment before and after the acute episode. In addition, a multidisciplinary approach with psychologists, psychiatrists and social workers is important.DisclosureNo significant relationships.

“I’ve discovered the COVID-19 vaccine”. Approach of a bipolar disorder clinical case in the Mental Health Day Hospital of Salamanca during the pandemic

IntroductionA 21-year-old woman diagnosed with bipolar disorder was hospitalized in the Mental Health Day Hospital of Salamanca during the Covid pandemic. The patient engaged with 4 different jobs and a master’s degree, beginning with verbose speech, dysphoria, global insomnia, grandiose delusions, extremely high energy and thinking she has the vaccine. She works the following objectives:illness insight, risk factors, psychopathological stabilization, social skills, slowing down of activities and taking responsibilities.ObjectivesThe objective is do a follow-up of the patient during her hospitalization in the Mental Health Day Hospital and to carry out a structured search in PubMed and Up-to-Date about psychotherapy and bipolar disorder.Methods3-month follow-up of a 21-year-old woman diagnosed with bipolar disorder during her hospitalization in the Mental Health Day Hospital in Salamanca and a structured search in PubMed and Up-to-Date in April 2021 in English, French and Spanish, including the last 10 years with the keywords “psychotherapy”, “psychotherapies” and “bipolar disorder “.77 studies were analyzed: 12 included, 65 excluded.ResultsSeveral randomized trials highlight the efficacy of group psychoeducation and cognitive-behavioural therapy in relapse prevention, improving illness insight, medical adherence and less hospitalizations. Therapeutic alliance plays a significant role in the process. Our patient improved her knowledge of her illness and treatment, her social skills and reconnected with her relatives and slowed down her activity. She then was referred to her community mental heath center psychiatrist.ConclusionsThe insight in bipolar disorder plays an important role in medical adherence and prevention of relapses. Therapeutic alliance improves their insight, their functionality in their daily life and enables close monitoring. Medical treatment should be accompanied by psychotherapy for a complete approach of the treatment.DisclosureNo significant relationships.

P 92 Limbic encephalitis with Contactin-associated protein like-2 (CASPR2) -antibodies: acute psychosis with late onset and abnormal EEG

Introduction: Contactin-associated protein like-2 (CASPR2)- autoantibodies are associated with distinctive syndromes 1 , such as agrypnia excitata, psychosis, neuromytonia and limbic encephalitis. All of them are highly responsive to immunotherapy. The target of these directly pathogenetic autoantibodies are surface-exposed domains of CASPR2 2 . Due to the fact of multiple variations of clinical presentations, it may be challenging to distinguish particular an autoimmune encephalitis associated with anti-neuronal autoantibodies, from primary psychiatric disorders such as psychosis. First medical treatment should be immediate immunotherapy, such as steroids, intravenous antibodies or plasma exchange given fast diagnosis of encephalitis is made. In our case the EEG showed focal slow waves with the clinical presentation of an acute psychosis which leaded to an admission to the neurology ward and further investigations. Patient and methods: A 75-years-old man was hospitalized on a psychiatric ward for psychotic symptoms characterized by psychomotor agitation, thought disorganization, persecutory delusions and auditory hallucinations with commanding voices and global insomnia. Cerebral Imaging with cMRI and cCT scan showed no acute abnormalities. EEG showed focal intermittent slow delta-theta wave activity (4-6 Hz) on the left temporal lobe, reactive to visual stimuli and provided focal cerebral dysfunction and pathology. CSF did not reveal any evidence of infection, but CASPR2- autoantibodies (1:10.000) were indentified and the diagnosis of limbic encephalitis with CASPR2-antibodies was made. Treatment with high dose dexamethasone and intravenous immunoglobulin (IVIG) was made and the clinical conditions improved. Conclusion: Fast and first medical treatment of autoimmune encephalitis should be initiated in early stages. To avoid an unnecessary delay in diagnosis and treatment, EEG, cMRI and expanded CSF examination should be performed as soon as possible to prevent severe disability in patients with limbic encephalitis with CASPR2-antibodies.

The relationship between the HDRS insomnia items and polysomnographic (PSG) measures in individuals with treatment-resistant depression

The Hamilton Depression Rating Scale (HDRS), which includes several insomnia-related items, is potentially valuable in evaluating both depressive and sleep symptoms. However, the HDRS insomnia items have not been fully assessed by objective measures. This study compared the three HDRS insomnia items (Early, Middle, and Late) with the corresponding objective polysomnography (PSG) measures of Sleep Latency (SL), middle wakefulness, and late wakefulness. The study used HDRS and PSG data from 130 baseline nights, drawn from 80 participants enrolled in clinical trials for treatment-resistant depression (TRD). Mixed models evaluated the relationship between the HDRS and PSG, and primary analyses examined the Early, Middle, and Late Insomnia HDRS items and the PSG variables SL and Waking After Sleep Onset (WASO). To approximate the Middle and Late HDRS Insomnia items more closely, WASO was divided into WASO before 4:00 a.m. (waking between Sleep Onset and 0400 h) and WASO after 4:00 a.m. (waking between 0400 h and 0700 h). Secondary analyses included summed HDRS Global Insomnia score. HDRS Early and Late Insomnia items predicted objective PSG measures of early and late wakefulness. For Early Insomnia, each additional point in severity was associated with 61% [95%CI: 35%, 93%] longer SL. For Late Insomnia, each additional point was associated with a 35% [95% CI: 13%, 63%] increase in WASO after 4:00 a.m. Middle Insomnia was marginally related to WASO before 4:00 a.m. HDRS Early and Late Insomnia items may thus provide an index of wakefulness in TRD and help monitor treatment response when objective measures such as PSG are not feasible. Clinical trials identifierwww.clinicaltrials.gov (NCT01204918, NCT00054704, NCT00088699).

Temperament, sleep quality, and insomnia severity in university students: Examining the mediating and moderating role of sleep hygiene.

University students commonly experience sleep problems which have implications for daily functioning and academic achievement. For this reason, research is needed to identify modifiable individual difference variables that may contribute to better sleep in this population. Temperament and sleep hygiene may be two such factors. As part of a larger study, 167 university students (61.7% female) completed online questionnaires that inquired about temperament (the Adult Temperament Questionnaire; ATQ), sleep hygiene behavior (the Sleep Hygiene Index; SHI), global sleep quality (the Pittsburgh Sleep Quality Index; PSQI), and insomnia severity (the Insomnia Severity Index; ISI). Correlations amongst the included measures were in the predicted direction: effortful control was negatively associated with the SHI composite, PSQI global scores, and ISI scores; extraversion was negatively related to PSQI global scores; and negative affect was positively associated with the SHI composite and ISI scores. In addition, the SHI composite mediated the association between effortful control and the PSQI global scores as well as the association between negative affect and PSQI global scores; similar patterns of mediation were found when considering ISI scores, although the direct effects differed. That is, negative affect was directly associated with ISI scores but not PSQI global scores. These findings suggest that interventions designed enhance effortful control, reduce negative affect, and improve sleep hygiene may contribute to better global sleep quality and decrease insomnia in university students.

Treating insomnia symptoms with medicinal cannabis: a randomized, crossover trial of the efficacy of a cannabinoid medicine compared with placebo.

Study ObjectivesThis randomized, double-blind, placebo-controlled, crossover study was conducted to evaluate the safety and efficacy of 2 weeks of nightly sublingual cannabinoid extract (ZTL-101) in treating chronic insomnia (symptoms ≥3 months).MethodsCo-primary study endpoints were safety of the medication based on adverse event reporting and global insomnia symptoms (Insomnia Severity Index [ISI]). Secondary endpoints included: self-reported (sleep diary), actigraphy-derived, and polysomnography measurements of sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), sleep efficiency (SE); and self-reported assessments of sleep quality (sSQ) and feeling rested upon waking. Adjusted mean differences between placebo and ZTL-101 were calculated.ResultsTwenty-three of 24 randomized participants (n = 20 female, mean age 53 ± 9 years) completed the protocol. No serious adverse events were reported. Forty mild, nonserious, adverse events were reported (36 during ZTL-101) with all but one resolving overnight or soon after waking. Compared to placebo, ZTL-101 decreased ISI (−5.07 units [95% CI: −7.28 to −2.86]; p = 0.0001) and self-reported SOL (−8.45 min [95% CI: −16.33 to −0.57]; p = 0.04) and increased self-reported TST (64.6 min [95% CI: 41.70 to 87.46]; p < 0.0001), sSQ (0.74 units [95% CI: 0.51 to 0.97]; p < 0.0001), and feeling of being rested on waking (0.51 units [95% CI: 0.24 to 0.78]; p = 0.0007). ZTL-101 also decreased actigraphy-derived WASO (−10.2 min [95% CI: −16.2 to −4.2]; p = 0.002), and increased actigraphy-derived TST (33.4 min [95% CI: 23.07 to 43.76]; p < 0.001) and SE (2.9% [95% CI: 2.0 to 3.8]; p = 0.005).ConclusionsTwo weeks of nightly sublingual administration of a cannabinoid extract (ZTL-101) is well tolerated and improves insomnia symptoms and sleep quality in individuals with chronic insomnia symptoms.Clinical TrialANZCTR; anzctr.org.au; ACTRN12618000078257.

Focusing on insomnia symptoms to better understand depression: A STAR*D report

BackgroundDisturbed sleep is a core symptom of major depressive disorder (MDD), with nearly 90% of those with MDD reporting disturbed sleep. However, combining insomnia and hypersomnia into a single diagnostic domain ignores distinct biological differences between those symptom presentations. To better understand depression it may be necessary to explore these symptoms independently, beginning with the more prevalent insomnia. MethodThe present study evaluated global insomnia symptom severity in a broad sample of MDD outpatients from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, excluding patients who reported hypersomnia symptoms. The three insomnia-related symptoms from the 16-item Quick Inventory of Depressive Symptomatology- clinician rated (QIDS-C) were combined to create a global insomnia score to classify baseline insomnia severity. A modified depression severity score was then used to assess depression severity (mQIDS-C), excluding sleep-related items. ResultsA repeated measures ANCOVA revealed a significant improvement in insomnia score over the acute phase treatment (F = 33.1, d.f. = 6, 9897, p < 0.0001). Improvement in insomnia score over the acute phase treatment remained statistically significant even after controlling for change in depression severity (p = 0.0004). Participants with one point higher insomnia score at baseline were significantly less likely to remit at study exit (odds ratio = 0.88, 95% confidence interval = 0.85, 0.92, p < 0.0001) even after controlling for baseline depression severity. LimitationsObjective confirmation of sleep profiles was not available. ConclusionGreater severity of insomnia reduces likelihood of MDD remission, and insomnia symptoms improved independent of depression remission.

Cognitive and behavioral therapy for insomnia increases the use of continuous positive airway pressure therapy in obstructive sleep apnea participants with comorbid insomnia: a randomized clinical trial.

Insomnia and obstructive sleep apnea (OSA) commonly co-occur which makes OSA difficult to treat with continuous positive airway pressure (CPAP). We conducted a randomized controlled trial in participants with OSA and co-occurring insomnia to test the hypothesis that initial treatment with cognitive and behavioral therapy for insomnia (CBT-i), versus treatment as usual (TAU) would improve insomnia symptoms and increase subsequent acceptance and use of CPAP. One hundred and forty-five participants with OSA (apnea-hypopnea index ≥ 15) and comorbid insomnia were randomized to either four sessions of CBT-i, or TAU, before commencing CPAP therapy until 6 months post-randomization. Primary between-group outcomes included objective average CPAP adherence and changes in objective sleep efficiency by 6 months. Secondary between-group outcomes included rates of immediate CPAP acceptance/rejection, and changes in; sleep parameters, insomnia severity, and daytime impairments by 6 months. Compared to TAU, participants in the CBT-i group had 61 min greater average nightly adherence to CPAP (95% confidence interval [CI] = 9 to 113; p = 0.023, d = 0.38) and higher initial CPAP treatment acceptance (99% vs. 89%; p = 0.034). The CBT-i group showed greater improvement of global insomnia severity, and dysfunctional sleep-related cognitions by 6 months (both: p < 0.001), and greater improvement in sleep impairment measures immediately following CBT-i. There were no between-group differences in sleep outcomes, or daytime impairments by 6 months. In OSA participants with comorbid insomnia, CBT-i prior to initiating CPAP treatment improves CPAP use and insomnia symptoms compared to commencing CPAP without CBT-i. OSA patients should be evaluated for co-occurring insomnia and considered for CBT-i before commencing CPAP therapy. Treating comorbid insomnia with obstructive sleep apnea (COMSIA) study: A new treatment strategy for patients with combined insomnia and sleep apnea, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365184 Australian New Zealand Clinical Trials Registry: ACTRN12613001178730. Universal Trial Number: U1111-1149-4230.

Fatigue at baseline is associated with geriatric impairments and represents an adverse prognostic factor in older patients with a hematological malignancy

Prospective data on fatigue in elderly persons with a hematological malignancy are rare. We aimed to determine the prevalence of fatigue and its association with clinical outcome and geriatric impairments in older individuals newly diagnosed with blood cancer. The EORTC QLQ-C30 and a multidimensional geriatric assessment (MGA) were performed in parallel in 149 consecutive patients aged > 67 years (median 77.8 years) at Innsbruck Medical University between January 2009 and April 2016. Fatigue as defined by EORTC QLQ-C30 was the most prevalent symptom (84%) and was significantly associated with self-reported role and physical functioning, global health status and insomnia, dyspnea, and loss of appetite (p < 0.001). Remarkably, pronounced fatigue was associated with impaired performance status and objective functional capacities in MGA, with altered depression scoring, G8 screening, and elevation of serum inflammation markers (p < 0.001). Patients with minor fatigue had a median overall survival (OS) of 26.4 months, whereas those with marked fatigue displayed an OS of 7.0 months (p < 0.001). The association between fatigue and shortened OS was supported in multivariate analyses (HR 1.74, CI 1.09–2.76; p = 0.021). Fatigue is seen to have a high prevalence and to be an adverse prognostic factor in elderly patients with a hematological malignancy. The strong impact of fatigue on clinical performance and OS emphasizes the relevance of patient-reported outcomes in individualized treatment algorithms. Patients will benefit from identification of fatigue, allowing timely interventions. The correlation between fatigue, impaired performance, nutritional status, and inflammation might suggest an underlying common pathway.

Does comorbid obstructive sleep apnea impair the effectiveness of cognitive and behavioral therapy for insomnia?

AimsComorbid insomnia and obstructive sleep apnea (OSA) represents a highly prevalent and debilitating condition; however, physicians and researchers are still uncertain about the most effective treatment approach. Several research groups have suggested that these patients should initially receive treatment for their insomnia before the sleep apnea is targeted. The current study aims to determine whether Cognitive and Behavioral Therapy for Insomnia (CBT-i) can effectively treat insomnia in patients with comorbid OSA and whether its effectiveness is impaired by the presence of OSA. MethodsA retrospective chart review was conducted to examine 455 insomnia patients entering a CBT-i treatment program in a hospital out-patient setting. Three hundred and fourteen patients were diagnosed with insomnia alone and 141 with insomnia and comorbid OSA. Improvements in average sleep diary parameters, global insomnia severity, and several daytime functioning questionnaires from baseline, to post-treatment, to 3-month follow-up were compared between insomnia patients with and without comorbid OSA. ResultsInsomnia patients with comorbid OSA experienced significant improvements in insomnia symptoms, global insomnia severity, and other daytime functioning measures during and following treatment. Furthermore, improvements were no different between patients with or without comorbid OSA. Sleep apnea presence and severity were not related to rates of insomnia-remission or treatment-resistance following treatment. ConclusionsCBT-i is an effective treatment in the presence of comorbid OSA. This information offers support for the suggestion that patients with comorbid insomnia and OSA should be treated with CBT-i prior to the treatment of the OSA.

Report of clinical case: Catatonic symptoms as a result of cerebral venous sinus thrombosis

Clinical caseWe present the case of an 18-year-old woman attending the emergency room due to behavioral disorders that appeared 24 hours ago. The clinic was of restlessness, uninhibited behavior, stereotyped movements, global insomnia, semimutism and negativism. Initially she was diagnosed with catatonia, and was admitted to the Mental Health Hospitalization Unit. There were no previous psychopathological antecedents, although relatives reported that she had several stressors. During admission, she had a partial response to benzodiazepine treatment, and a loss of strength in the left upper limb was evidenced, and venous sinus thrombosis was diagnosed. With the anticoagulant treatment, the psychiatric symptomatology presented was markedly improved.Medical examinationNormal vital signs, afebrile. Absence of focal neurological signs. Stereotyped movements, oral-buccal dyskinesia. Negativism, disinhibition and oppositional behaviour. Supplementary tests with results within the normal range. Cranial MRI: Upper, transverse and sigmoid right sagittal sinus thrombosis.ConclusionsNumerous cases of thrombosis have been documented as a result of a catatonic state, mainly due to the immobilization and the risk involved. However, in this case, sudden onset of psychiatric symptoms, absence of psychiatric antecedents, and excellent response to anticoagulant therapy, leads us to conclude that catatonic symptoms could be considered as a consequence of cerebral edema caused by thrombosis. The presentation of catatonia as the sole cause of a somatic disorder is not common, but would be stimulated by certain factors, such as excessive stress and personality disorders, documented as vulnerability factors for such symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The relationship between sleep disturbances and depression in daytime workers: a cross-sectional structured interview survey.

The aim of this study was to clarify the relationship between sleep disturbances and depression in daytime workers using a structured interview. A total of 1,184 daytime workers were enrolled. We evaluated difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), and global insomnia scores (ISs) in all participants. As a result, the prevalences of DIS, DMS, and EMA were 16%, 46%, and 22%, respectively. IS was significantly correlated with depression score. Additionally, although all IS subscales (i.e., DIS, DMS, and EMA) were significantly associated with depression score, the main factor contributing to depression score was DIS. Thus, the present study reveals that sleep disturbances and especially DIS are associated with depression in daytime workers.

Major depressive disorder with psychotic symptoms in elderly. A case report

IntroductionThe proportion of elderly people and affective syndromes are more and more common in developed countries. Elderly people have physiological conditions that may limit our intervention.ObjectivesTo present a case of a major depressive disorder with psychotic symptoms in a 72-year-old woman.MethodsMedline search and review of the clinical history and the related literature.ResultsWe present the case of a 72-year-old woman with psychiatric history of a major depressive disorder 14 years ago with ad integrum restitution after pharmacological treatment. In 2015, our patient was admitted to the psychiatry ward due to major depressive symptomatology (apathy, anhedonia, global insomnia, weight loss) that associated mood-congruent delusions (nihilistic, ruin, guilt, catastrophic) with deregulated behaviour. The patient was resistant to combined pharmacological treatment with aripiprazole, desvenlafaxine, mirtazapine and lorazepam, therefore, we decided to administer ECT, with successful results after 5 sessions. Brain tomography, blood and urine tests were normal. Clinical signs of dementia were not present.ConclusionsInpatients with deregulated behaviour; it is important to rule out organic causes, especially in elderly, in whom dementia, brain tumors or metabolic disturbances may simulate psychiatric syndromes.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Sleep Duration and Insomnia Symptoms as Risk Factors for Suicidal Ideation in a Nationally Representative Sample.

Suicidal behavior (suicidal ideation, suicide attempts, and suicide completion) has been increasingly linked with difficulty initiating sleep, maintaining sleep, and early morning awakenings. However, the relationship between suicidal behavior and sleep duration abnormalities is unclear, especially at the population level. The present study used a nationally representative sample to examine the association of suicidal ideation with extreme sleep durations and insomnia symptoms. Cross-sectional data from adult respondents (≥ 18 years of age, N = 6,228) were extracted from the 2007-2008 wave of the National Health and Nutritional Examination Survey. Ordinal logistic regression analyses were used to evaluate the relationship of suicidal ideation with sleep duration, global insomnia, and individual insomnia symptoms in models adjusted for sociodemographic, socioeconomic, and health-related covariates. Suicidal ideation was associated with abnormalities of sleep duration. This relationship ceased to exist once the model was adjusted for depressive symptoms. As expected, an increased level of suicidal ideation was consistently associated with insomnia. Of the insomnia symptoms, difficulty maintaining sleep was found to be the most predictive of suicidal ideation, followed by difficulty initiating sleep (P< .05). Abnormalities of sleep duration and continuity should prompt a clinical assessment for suicide risk.

EPA-1056 – Factors related to relapse in drug-dependent patients in hospital detoxification: the relevance of insomnia

Introduction The objective of our study is to describe the prevalence of insomnia during active consumption and hospitalisation for detoxification, and its influence on relapses at 3 and 6 months in drug-dependent patients. Methods We conducted a prospective study of drug-dependence inpatients admitted to the hospital detoxification unit between June 2008 and November 2012, and performed psychiatric follow-up on an outpatient basis over the six months following discharge. Insomnia prior to admission was measured by clinical interview from the patient concerning sleep habits, and during hospital stay using a sleep log filled out by nurse team. Demographic, clinical and diagnostic variables were recorded and a structured clinical interview (SCID) was conducted to assess psychiatric diagnoses. Relapse was deemed to be renewed use of the substance that brought about admission, which was assessed by alcohol testing and/or urinalysis. Results We included 434 patients. Insomnia during consumption was reported by 64.3% of patients and 66.1% reported insomnia during hospital stay. Of the patients with preadmission insomnia, 68.3% relapsed at 3 months from discharge, as did 71% of patients with insomnia during hospital stay. Patients who relapsed at 3 months of follow-up showed significantly greater sleep initiation dysfunction prior to and during hospitalisation. Of the patients with preadmission insomnia, 69.2% had relapsed at 6 months from discharge. Patients who relapsed at 6 months of follow-up showed significantly greater sleep initiation dysfunction and global insomnia prior to and during hospitalisation. Conclusions Sleep disorders should be study as a prognostic factor in drugdependent patients.

Tired minds, tired ideas? Exploring insomnia and creativity

Do tired minds have tired ideas? In two studies, we explored the role of insomnia and personality in divergent thinking, everyday creative behavior, and creative achievement. Using a well-validated measure of insomnia—the Bergen Insomnia Scale—the present work explored the differential effects of nighttime and daytime insomnia symptoms. Structural equation models found a moderate effect of a global insomnia factor on divergent thinking (β=.19). Further analysis showed time-of-day effects: nighttime sleep disturbances positively predicted divergent thinking more strongly (β=.15) than daytime disturbances (β=.03). A similar pattern emerged regarding everyday creative behavior: nighttime impairments showed a positive effect (β=.15) and daytime impairments showed a negative effect (β=−.15). Global insomnia and the time-of-day variables had small and negative effects on creative achievement. The present research highlights the importance of taking a nuanced approach to the study of insomnia and creativity.