[Determination of consequences of chronic insomnia: a qualitative study]

Background and Aim: Insomnia is a common disorder with a chronic course. Consequences of chronic insomnia can affect quality of life. Determination of these consequences can be useful in designing treatment plans for these patients. This study aimed to determine the consequences of chronic insomnia

Martial and Methods: The study was performed by a qualitative approach via conventional content analysis. Using purposeful sampling, we selected 17 patients with chronic insomnia from sleep disorders research center of Kermanshah University of Medical Sciences. Data were collected by semi structure interview over a 6 month period [March to September 2014]. All interviews were recorded, transcribed verbatim and analyzed qualitatively

Results: Insomnia consequences were categorized in three main levels, health, functional and financial consequences. Health related consequences included wide spectrum of physical, psychological, and cognitive problems. The functional and financial consequences consisted of several aspects of impairment in individual and family function, and costs associated with chronic insomnia

Conclusion: The results showed that chronic insomnia not only affected physical, mental, and cognitive status, but also individual and family function, and resulted in increased costs. Attention to these consequences is recommended for treatment planning

Gene and environment interaction in familial suicidal behavior: a single family with 4 committed suicides

Family history of suicide is among the strongest predictors of suicide risk. From the context of gene by environment interactions, this manuscript presents a case study of the "M" family, which experienced 4 committed suicides within a short time period. Over the course of 5 years, the father and 3 sons committed suicide. Suicidal ideations developed in several other members of the family. The family's suicide risk appears to have stemmed from both environmental and genetic factors, and likely from an interactive effect between both. Environmental factors included low level of education, opium dependency among male family members, unemployment, and poverty, and limited access to mental health services. Genotype analyses of A218C polymorphism among surviving family members revealed that all individuals were associated with the gene variation [genotypes CC and AC] in tryptophan hydroxylase. The genetic by environmental interaction influence is discussed

Prevalence of symptoms and risk of obstructive sleep Apnea syndrome in the general population

Obstructive sleep apnea [OSA] syndrome is one of the most common sleep breathing disorders with significant consequences. The present study aims to determine prevalence of symptoms and risk of OSA in the general population of Kermanshah, Iran. From 2007-2008 by random-cluster-sampling, 527 adult subjects were selected from the urban region of Kermanshah. The age range of the sample was from 20 to 87 years. Assessment was carried-out using the Berlin questionnaire, a valid scale that determined those at [high risk] and [low risk] for OSA symptoms. Common symptoms were later defined. There were 144 [27.3%] out of the 527 subjects with a mean age of 48.6_16.6 years and a body mass index [BMI] of 25.1 +/- 3.3 at high risk for OSA [men 19%; women 8.3%]; 261 [49.5%] suffered from snoring with a higher frequency among women [51.5%]. From those who snored during sleep, 51 [10%] reported a breathing pause more than once per week. Subjects considered at high risk had a clinical history of diabetes [15.3%] and heart failure [16.7%].Prevalence of symptoms, risk of OSA and associated factors in Kermanshah are noticeable. Considering the adverse effects of this condition on quality of life, further research in an effort for early diagnosis and treatment are recommended

Insomnia treatment by Olanzapine. Is sleep state misperception a psychotic disorder?

Offering a new perspective on sleep state misperception, we discuss a patient who presented with sleep state misperception and was ultimately diagnosed with delusional disorder. A 60- year -old woman with chief complaints of insomnia, agitation, and suicidal ideation, was admitted to an inpatient psychiatric ward. Based on information from her family and a mental state examination, her primary diagnosis was sleep state misperception. She was treated with Trazodone. Because she was unresponsive to the treatment, a full psychiatric evaluation and wrist actigraphy report were undertaken, resulting in a revised diagnosis of delusional disorder. She was started on Olanzapine and, after 6 weeks was discharged with good improvement. Sleep state misperception might be considered not just as a sleep disorder, but also as a psychiatric disorder with psychotic symptoms. Further research is recommended