Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy.

OBJECTIVE: Because of the role of psychological factors in insomnia, the shortcomings of hypnotic medications, and patients' greater acceptance of nonpharmacological treatments for insomnia, the authors conducted a meta-analysis to examine the efficacy and durability of psychological treatments for the clinical management of chronic insomnia. METHOD: A total of 59 treatment outcome studies, involving 2,102 patients, were selected for review on the basis of the following criteria: 1) the primary target problem was sleep-onset, maintenance, or mixed insomnia, 2) the treatment was nonpharmacological, 3) the study used a group design, and 4) the outcome measures included sleep-onset latency, time awake after sleep onset, number of nighttime awakenings, or total sleep time. RESULTS: Psychological interventions, averaging 5.0 hours of therapy time, produced reliable changes in two of the four sleep measures examined. The average effect sizes (i.e., z scores) were 0.88 for sleep latency and 0.65 for time awake after sleep onset. These results indicate that patients with insomnia were better off after treatment than 81% and 74% of untreated control subjects in terms of sleep induction and sleep maintenance, respectively. Stimulus control and sleep restriction were the most effective single therapy procedures, whereas sleep hygiene education was not effective when used alone. Clinical improvements seen at treatment completion were well maintained at follow-ups averaging 6 months in duration. CONCLUSIONS: The findings indicate that nonpharmacological interventions produce reliable and durable changes in the sleep patterns of patients with chronic insomnia.

Effect of hydrochlorothiazide, enalapril, and propranolol on quality of life and cognitive and motor function in hypertensive patients.

The effect of hydrochlorothiazide, propranolol, and enalapril on cognitive and motor function and quality of life (QOL) in hypertensive patients was studied. Patients > or = 55 years of age with asymptomatic essential hypertension were included in a randomized, double-blind, placebo-controlled, crossover study. Subjects discontinued their previous antihypertensive agents and started hydrochlorothiazide 25 mg, extended-release propranolol hydrochloride 120 mg, enalapril maleate 10 mg, or placebo. One capsule was taken for three days and then the dosage was doubled for the remainder of a four-week period. Subsequent crossover treatments were begun without a washout period. In each treatment phase, a battery of psychometric tests was used to assess cognitive and motor function and quality of life; all tests but one were self-administered via computer terminal. Pulse rate and blood pressure were recorded, and compliance was monitored by capsule count. Sixteen of 30 patients interviewed completed the trials; one additional patient was evaluated after receiving all treatments except hydrochlorothiazide. Mean +/- S.D. age of the subjects was 66 +/- 6.1 years; 10 were black and 7 white; 9 were men. Except for the hydrochlorothiazide group, blood pressure in the active treatment groups did not differ significantly from placebo; hydrochlorothiazide significantly reduced systolic but not diastolic blood pressure compared with placebo. Compared with placebo, hydrochlorothiazide was associated with fewer incorrect responses in a test of complex reaction time and with greater discriminant reaction time response rates; otherwise, no difference between groups was noted in cognitive or motor performance. There were no significant differences between active treatments and placebo on individual QOL measures.(ABSTRACT TRUNCATED AT 250 WORDS)

Head-injured parents and their children. Psychosocial consequences of a traumatic syndrome.

Traumatic brain injury, a prevalent health problem in contemporary society, poses complex adaptational challenges for victims' families. The sequelae most disruptive to family functioning appear to be residual psychiatric symptoms. With a peak incidence among young adults, brain trauma also befalls many parents of dependent children; these children are vulnerable to subsequent emotional and behavioral difficulties. An approach to these problems must recognize the broad spectrum of clinical outcomes from brain injury. Valuable insights may also be gained from earlier work on children's responses to more familiar parental psychiatric disorders. Three case reports of children with head-injured parents are presented, followed by a discussion of treatment considerations for this emerging "at-risk" population.

Increasing adherence to behavioral homework assignments.

Behavior change through psychotherapy is frequently accomplished through the use of homework assignments conducted by patients between treatment sessions. There has been little attention directed at adherence to such behavioral prescriptions. This study compares the effects of Verbal versus Written behavioral prescriptions on recall of self-reported adherence to therapeutic homework assignments. Thirty subjects were randomly assigned to the Verbal and Written conditions in a counterbalanced, within-subjects, crossover design. Written prescriptions led to significantly better recall of and adherence to homework assignments.

Retina viability in the Necturus.

Electroretinograms (ERG's) were recorded from the eyes of paralyzed normal and decapitated mudpuppies (Necturus maculosus). Fully dark-adapted responses to a range of stimulus intensities were compiled hourly under both conditions. Statistical analyses indicate no significant change in responsiveness in paralyzed normal animals during periods up to 6 hours. After decapitation, there was a significant decline of sensitivity to light during the first 3 hours. An oxygen-sensitive component similar to the c-wave was observed with DC recording but only in normal eyes. Anoxic mudpuppy eyes show an ERG decline with an average time constant of 1.5 hours.