Behavioral and psychological treatments for NREM parasomnias: A systematic review.

BACKGROUND: Non-rapid eye movement (NREM) parasomnias are often benign and transient, requiring no formal treatment. However, parasomnias can also be chronic, disrupt sleep quality, and pose a significant risk of harm to the patient or others. Numerous behavioral strategies have been described for the management of NREM parasomnias, but there have been no published comprehensive reviews. This systematic review was conducted to summarize the range of behavioral and psychological interventions and their efficacy. METHODS: We conducted a systematic search of the literature to identify all reports of behavioral and psychological treatments for NREM parasomnias (confusional arousals, sexsomnia, sleepwalking, sleep terrors, sleep-related eating disorder, parasomnia overlap disorder). This review was conducted in line with PRISMA guidelines. The protocol was registered with PROSPERO (CRD42021230360). The search was conducted in the following databases (initially on March 10, 2021 and updated February 24, 2023): Ovid (MEDLINE), Cochrane Library databases (Wiley), CINAHL (EBSCO), PsycINFO (EBSCO), and Web of Science (Clarivate). Given a lack of standardized quantitative outcome measures, a narrative synthesis approach was used. Risk of bias assessment used tools from Joanna Briggs Institute. RESULTS: A total of 72 publications in four languages were included, most of which were case reports (68%) or case series (21%). Children were included in 32 publications and adults in 44. The most common treatment was hypnosis (33 publications) followed by various types of psychotherapy (31), sleep hygiene (19), education/reassurance (15), relaxation (10), scheduled awakenings (9), sleep extension/scheduled naps (9), and mindfulness (5). Study designs and inconsistent outcome measures limited the evidence for specific treatments, but some evidence supports multicomponent CBT, sleep hygiene, scheduled awakenings, and hypnosis. CONCLUSIONS: This review highlights the wide breadth of behavioral and psychological interventions for managing NREM parasomnias. Evidence for the efficacy of these treatments is limited by the retrospective and uncontrolled nature of most research as well as the infrequent use of validated quantitative outcome measures. Behavioral and psychological treatments have been studied alone and in various combinations, and recent publications suggest a trend toward preference for multicomponent cognitive behavioral therapies designed to specifically target priming and precipitating factors of NREM parasomnias.

Study of the pattern of mortality caused by Traffic Accidents (TAs) in The South of Iran.

OBJECTIVE: To investigate the pattern of mortality caused by road traffic accidents and its associated factors. METHODS: The retrospective cross-sectional study was conducted in the Fars province of Iran and comprised data of all people having died in road traffic accidents from March 21, 2011, to March 19, 2012. Using census method, all files related to deaths in road accidents were reviewed at the Legal Medicine Centre. Data was analysed using SPSS20. RESULTS: Of the 1668 people dead, 1291(77.4%) were male and 377(22.6 %) were female. The highest rate related to the age group 21-30 with 454(27%) killed. As for education level, the highest rate of mortality was 410(24.5%) for illiterate people and the least was 9(0.5%) for those having Masters degree or higher. In terms of time of year, the highest rate of mortality was 167(10%) between August 23and September 22, while the least was 82(5%) between July 23and August22. Head trauma was reported as the most important cause of death in 1191(71.4%) cases. CONCLUSIONS: Despite some minor differences, all provinces in Iran have the same patterns of death related to road traffic accidents.