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Objective To test the efficacy of cognitive behavioral self-help therapy (CBTI-SH) on patients with chronic insomnia vs.a zolpidem control condition.Methods A total of 60 adults with chronic insomnia and common comorbidities were recruited from our hospital from July 2011 to October 2012.Participants were randomly assigned to either intervention group (n=30),consisting of sleep hygiene plus four-week CBTI-SH with printed material and 2 telephone instruction-calls,or control group (n=30),consisting of sleep hygiene plus a four-week supervised zolpidem tapering therapy.The CBTI-SH included cognitive restruction,stimulus control therapy,sleep restriction therapy and relaxation therapy.The primary outcome was self-report symptom,based on sleep diaries (including Sleep Latency-SL,Total Sleep Time-TST,Time In Bed-TIB,Sleep Efficiency-SE,Wake after Sleep Onset-WASO),Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleeping Scale (ESS) which were evaluated at baseline and at the end of the 2th,4th,6th week treatment.Continuous variables were evaluated by repeated-measures multivariate analyses of variance (MANOVA).At the end of every two weeks,each participant was asked to assess treatment adherence to the six core recommendations of CBTI-SH or sleep hygiene.Results The multivariate analysis of variance showed a significant treatment group plus time interaction,and time main effects for PSQI,ESS,SL,SE,TST,TIB and WASO in the two groups (P＜0.05).The patients in the intervention group had significantly better outcomes than those in control group.Effect sizes (Cohen d)were 1.93,0.04,1.00,0.98,0.11,0.57 and 0.43,respectively.The intervention group reported higher average adherence scores in "use of the bed only for sleeping,not worrying in bed",and lower average scores in "adherence to TIB prescription,getting out of bed when unable to sleep",compared with those in the control group.Conclusion CBTI-SH is effective for treating chronic insomnia and daytime sleepiness as compared with supervised zolpidem tapering therapy,but the treatment adherence needs to be improved.
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Objective To explore the relationship between the course of disease and glycolipid metabolic parameters in drug-naive schizophrenia patients. Methods All 186 drug-naive schizophrenia patients,admired to our hospital from March 2010 to October 2011,were chosen in our study; relative glycolipid metabolic parameters at baseline were tested and Positive and Negative Syndrome Scale (PANSS) was performed on these patients; and the relationships between relative glycolipid metabolic indexes and both the course of disease and manipulated variable (age,gender,education level and severity of the disease) were assessed.Results Gender might play a significant role to some glycolipid metabolic parameters (waist-hip ratio [WHR]:β=0.364; high-density lipoprotein [HDL]:β=-0.248; triacyiglycerol [TG]:β=0.167 and lysophosphatidic acid (LPA):β=-0.198,P＜0.05); age might play an important role to some glycolipid metabolic parameters (body mass index [BMI]: β=0.213; WHR: β=0.286 and apolipoprotein B 100 [apoB100]:β=0.221,P＜0.05).Simultaneously,the severity of disease appeared to affect some glycolipid metabolic parameters (BMI:β-0.167; WHR:β=-0.150 and fasting blood-glucose [FBG]:β=0.172, P＜0.05). The course of disease hardly affected the majorities of relative glycolipid metabolic indices of drug-naive schizophrenia but LPa (β=0.173, P＜0.05). Conclusion The high metabolic abnormality incidence in schizophrenia patients maybe result from multi-factor interactions.
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ObJective To study the hypothalamic-pituitary-adrenal (HPA) axis function with dexamethasone suppression test (DST) in inpatients with unipolar depression or bipolar disorder at different mood states. Methods DST was performed in 38 inpatients with unipolar depression and 63 with bipolar disorder ([19 with type Ⅰ, 44 with type Ⅱ], [33 with depressive episode, 18 with manic episode and 12 with combined episodes]). After 4 weeks' treatment, DST was performed again on 17 patients with unipolar depression and 35 with bipolar disorder to compare the negative suppression ratio. Results Before treatment, the negative suppression rate of DST was significantly different between unipolar depression (36.8%) and bipolar disorder (14.3%), type Ⅰ bipolar disorder (10.5%), type Ⅱ bipolar disorder (15.9%) or bipolar disorder with current depressive episode (15.2%) (P<0.05). However, no statistic differences were showed among type Ⅰ bipolar disorder and type Ⅱ bipolar disorder, depressive episode of bipolar disorder (15.2%), manic episode of bipolar disorder (16.7%) or combined episodes of bipolar disorder (11.1%) (P>0.05). After treatment, the same comparison was performed, but negative suppression rate of DST was not significantly different among all the groups (P>0.05). With the clinical improvement, negative suppression rate of DST decreased in patients with unipolar disorder;while no significant differences were found between pre-treatment and post-treatment in patients with both unipolar and bipolar disorders (P>0.05). Conclusion At the status of illness, the negative suppression rate of DST in the unipolar depression, being independent from the clinical subtypes, types of episode and severity of the illness in bipolar disorder, is much higher than that in the bipolar disorder.