Polysomnographic parameters associated with cognitive function in patients with major depression and insomnia.

OBJECTIVE: To examine whether objective sleep parameters are associated with cognitive function (CF) in patients with major depressive disorder (MDD) with chronic insomnia (CI) and whether the severity of these disorders is related to CF. METHOD: Thirty patients with MDD with CI attending a tertiary care institution underwent two consecutive nights of polysomnographic (PSG) recording and a battery of neuropsychological tests, which included episodic memory, sustained attention, working memory, and executive function. The severity of MDD and CI was assessed by clinical scales. We examined the relationship between PSG parameters and CF, as well as whether the severity of the disorders is related to CF. RESULTS: Linear regression analysis revealed that total sleep time (TST) was positively associated with higher learning and recall of episodic memory, as well as better attention. Slow-wave sleep (SWS) showed a positive association with better working memory. Furthermore, wake after sleep onset (WASO) was negatively associated with episodic memory and lower attention. No significant relationships were found between the severity of MDD or CI with CF. CONCLUSION: Both sleep duration and depth are positively associated with several aspects of CF in patients with MDD with CI. Conversely, a lack of sleep maintenance is negatively related to CF in these patients. These findings could help identify modifiable therapeutic targets to reduce CF impairment.

Psychometric properties of the Diurnal Insomnia Symptoms Response Scale (DISRS) in a Mexican population sample APPENDIX / Propiedades psicométricas de la Escala de Respuestas a los Síntomas Diurnos del Insomnio (DISRS) en una muestra de población mexicana

Abstract Introduction Increased rumination is associated with longer night-time sleep onset latency and poorer sleep quality and efficiency in people with insomnia symptoms. Objective To validate the Diurnal Insomnia Symptoms Response Scale (DISRS) in a general population sample. Method 102 participants (women = 67 and men = 35) comprising patients and relatives who attended an outpatient consultation at a health center in Mexico City were evaluated. The English-Spanish-English translation system was used by two Spanish-speaking experts on the subject, an independent bilingual expert translated the new version of the scale into English, which was then compared with the original. The following self-administered questionnaires were used to evaluate the convergent, discriminant validity of this tool: the Ruminative Response Scale (RRS), the Insomnia Severity Index (ISI), and Penn State Worry Questionnaire (PSWQ). Results The internal consistency of the scale items was α = .93. Principal components factor analysis yielded three factors with an eigenvalue of greater than one, which together explain 59.5% of the variance. Correlations between the total DISRS score and the cognitive-motivational dimensions (r = .938, p < .01), negative state (r = .898, p < .01) and tiredness (r = .853, p < .01) were statistically significant. Insomnia symptoms (SCC = .89) outweighed worries (SCC = .33) and ruminant responses (SCC = .33) when discriminating between cases with low and high levels of rumination associated with insomnia symptoms. Discussion and conclusion Our results suggest that the DISRS scale has adequate psychometric properties that make it valid and reliable for use with the Mexican population.

Resumen Introducción Los pensamientos rumiativos se asocian con mayor latencia del sueño, peor calidad y eficiencia de sueño en personas con insomnio. Objetivo Realizar la validación de la escala de respuestas a los síntomas diurnos del insomnio (DISRS) en una muestra de población general en México. Método Se evaluaron a 102 participantes (mujeres = 67 y hombres = 35) que acudieron a consulta externa de un centro de salud de la Ciudad de México. Se utilizó el sistema de traducción inglés-español-inglés, un experto bilingüe independiente tradujo al inglés la nueva versión de la escala y se verificó con el original. Para evaluar la validez convergente y discriminante del DISRS, se aplicó la Escala de Respuestas Rumiativas (RRS), el Índice de Severidad del Insomnio (ISI) y el Cuestionario de Preocupaciones de Pensilvania (PSWQ). Resultados La consistencia interna de los ítems fue α = .93. El análisis factorial de componentes principales determinó tres factores con valor propio superior a uno, que explican 59.5% de la varianza. Las correlaciones del puntaje del DISRS con las dimensiones cognitivo-motivacional (r = .938, p < .01), estado negativo (r = .898, p < .01) y cansancio (r = .853, p < .01) resultaron significativas. Los síntomas de insomnio (CCE =.89) tuvieron más peso que las preocupaciones (CCE = .33) y las respuestas rumiativas (CCE = .33) al discriminar a los casos con bajos y altos niveles de rumiación asociada al insomnio. Discusión y conclusión La escala DISRS en español tiene adecuadas propiedades psicométricas que la hacen válida y confiable para ser utilizada en población mexicana.

Sleep hygiene practices in patients with major depression with comorbid insomnia, primary insomnia, and good sleepers / Prácticas de higiene de sueño en pacientes con depresión mayor con insomnio comórbido, insomnio primario y buenos durmientes

Abstract Introduction Inadequate sleep hygiene (SH) is considered factor contributing to insomnia. However, the practice of SH by depressed patients with comorbid insomnia has not been explored. Objective We aimed to compare the practice of SH between patients with major depression, comorbid insomnia, primary insomnia, and good sleepers. Method One hundred and eighty-two adult individuals participated: 62 outpatients with major depressive disorder with comorbid insomnia (MDD), 56 outpatients with primary insomnia (PI), and 64 good sleepers (GS). All participants were assessed with a structured psychiatric interview, an insomnia interview, the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and the Sleep Hygiene Practice Scale. We compared the practice of SH as a whole and by domains between the groups and the relation between SH practice, insomnia, and sleep quality. Results Patients with PI and MDD showed a significantly worse practice of global SH. In the comparison by SH domains, MDD and PI groups had significantly worse scores than GS in all domains. Individuals with MDD showed a significantly worse practice of sleep schedule and arousal related behaviors than PI group. Although, SH practice was significantly related with insomnia and sleep quality in the whole sample, this association remained significant only in the PI. The arousal-related behaviors domain was the main predictor of insomnia and sleep quality. Discussion and conclusion Although patients with insomnia comorbid with MDD or with PI have a worse SH practice than GS, only arousal-related behaviors and drinking/eating habits contribute significantly to insomnia severity and sleep quality.

Resumen Introducción Una inadecuada higiene de sueño (HS) se considera como un factor que contribuye al insomnio, incluido el insomnio comórbido con trastornos mentales. Sin embargo, no se ha estudiado la práctica de HS en pacientes con depresión e insomnio comórbido. Objetivo Comparar la práctica de HS entre pacientes con depresión mayor con insomnio comórbido, insomnio primario y buenos durmientes. Método Participaron 182 individuos: 62 pacientes ambulatorios con trastorno depresivo mayor con insomnio comórbido (TDM), 56 pacientes con insomnio primario (IP) y 64 buenos durmientes (BD). A todos se les realizó una entrevista psiquiátrica estructurada, una entrevista sobre insomnio, el Índice de Calidad de Sueño de Pittsburgh, el Índice de Severidad de Insomnio y la Escala de Prácticas de Higiene de Sueño. Comparamos la práctica de HS tanto global como por dominios entre los grupos, y la relación entre la práctica de HS, el insomnio y la calidad de sueño. Resultados Los pacientes con IP y con TDM mostraron una práctica global de la HS significativamente peor. En la comparación por dominios, los grupos con TDM e IP alcanzaron peores calificaciones que los BD en todos. La práctica de HS se relacionó significativamente con el insomnio y calidad de sueño en la muestra total, sin embargo, solamente en el grupo con IP se mantuvo significativa. El dominio de conductas relacionadas con el alertamiento fue el principal predictor de insomnio y calidad de sueño. Discusión y conclusión Aunque los pacientes con insomnio comórbido con TDM o con IP tienen peores hábitos de HS que los BD, solamente las conductas relacionadas con el alertamiento y los hábitos de alimentación contribuyen significativamente a la gravedad del insomnio y calidad de sueño.

Reliability and factorial analysis of the Dysfunctional Beliefs and Attitudes Scale About Sleep in Mexican population. / Confiabilidad y análisis factorial de la Escala de Creencias y Actitudes Disfuncionales acerca del Dormir en población Mexicana.

BACKGROUND: The behaviors and thoughts that individuals have about sleep have an influence on the persistence or improvement of insomnia. The Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) was developed with the aim to measure them. OBJECTIVE: To assess the reliability and factorial composition of the Spanish version of the 16-item DBAS. METHOD: A cross-sectional design of two independent samples was used: one group with insomnia and a control group without it. We estimated the DBAS internal consistency coefficient and compared scores between groups; we also performed an exploratory factorial analysis of the scale. RESULTS: 166 patients with insomnia and 115 control individuals filled-out the DBAS. The scale showed a satisfactory reliability coefficient (with a Cronbach's alpha of 0.85) and we found it was composed by three factors which explained 49.2% of the variance. Insomnia patients had significantly higher scores on the total DBAS score and in each one of the 3 factors. CONCLUSIONS: The Spanish version of the 16-item DBAS is a reliable instrument to measure several behaviors and beliefs about sleep in insomnia patients.

INTRODUCCIÓN: Los comportamientos y pensamientos que un individuo tiene acerca del sueño tienen influencia en la persistencia o la resolución del insomnio. Con el fin de evaluarlos se desarrolló la Escala de Actitudes y Creencias Disfuncionales acerca del Dormir (DBAS, Dysfunctional Beliefs and Attitudes about Sleep Scale). OBJETIVO: Evaluar la confiabilidad y la composición factorial de la versión en español de 16 reactivos de la DBAS. MÉTODO: Se utilizó un diseño transversal de dos muestras independientes: un grupo clínico con insomnio y un grupo control. Se estimó el coeficiente de consistencia interna, se hizo el análisis factorial exploratorio de la escala y se compararon las puntuaciones entre los grupos. RESULTADOS: Se incluyeron 166 pacientes con insomnio y 115 individuos control que completaron la DBAS. La escala mostró un coeficiente de confiabilidad satisfactorio (con un alfa de Cronbach de 0.85) y una estructura de tres factores que explicaron el 49.2% de la varianza. Los pacientes con insomnio tuvieron calificaciones significativamente mayores que los sujetos control en la puntuación total y en los tres factores. CONCLUSIONES: La versión en español de la DBAS de 16 reactivos es un instrumento confiable para evaluar algunos comportamientos y creencias relacionadas con el dormir que se presentan en el insomnio.

Características clínicas de mujeres con depresión mayor que sufrieron abuso sexual en la infancia.

INTRODUCCIÓN: Aunque el abuso sexual en la infancia (ASI) es un factor de riesgo para desarrollar depresión mayor en la vida adulta de las mujeres, la información sobre las características clínicas asociadas con este evento es escasa. OBJETIVO: Evaluar la historia de ASI y su asociación con algunas manifestaciones clínicas en mujeres con depresión mayor. MÉTODO: Se seleccionaron 71 mujeres adultas con depresión mayor en un centro comunitario de salud mental. Fueron evaluadas con Mini Entrevista Neuropsiquiátrica Internacional, Inventario de Depresión de Beck, Escala de Autoevaluación de Adaptación Social, Índice de Maltrato Físico e Índice de Abuso Sexual en la Infancia. RESULTADOS: 53.5 % había sufrido alguna forma de ASI. No hubo diferencias significativas en edad, escolaridad, sintomatología depresiva, adaptación social o maltrato físico en la infancia entre las mujeres con y sin historia de ASI, solo mayor frecuencia de comorbilidad con el trastorno por ansiedad social (26 versus 6 %) y mayor proporción de riesgo suicida (68 versus 45.4 %) distinguió a los grupos. CONCLUSIÓN: Pocas características distinguen a las mujeres con depresión mayor con historia de ASI, sin embargo, el pronóstico y las implicaciones terapéuticas del mayor riesgo suicida subrayan la importancia de investigar sistemáticamente la historia de ASI entre las mujeres con depresión mayor. INTRODUCTION: Even when child sexual abuse (CSA) is a risk factor for the development of major depression in adult women, data on the clinical features associated with this traumatic event are scarce. OBJECTIVE: To assess the history of CSA and its association with some clinical manifestations in women with major depression. METHOD: Seventy-one adult women with major depression were selected in a community-based mental health center. They were assessed with the Mini International Neuropsychiatric Interview, the Beck Depression Inventory, the Social Adaptation Self-evaluation Scale, and childhood physical maltreatment and child sexual abuse indices. RESULTS: Some form of CSA had been suffered by 53.5%. There were no significant differences in age, level of education, depressive symptoms, social adaptation or physical maltreatment during childhood between the women with or without a history of CSA, only a higher frequency of comorbid social anxiety disorder (26% versus 6%) and a higher proportion of suicide risk (68% versus 45.4%) differentiated the groups. CONCLUSION: Few characteristics distinguish women with major depression with a history of CSA; however, the prognosis and therapeutic implications of a higher suicide risk underscore the importance of systematically investigating the history of CSA among women with major depression.

Crude and Adjusted Prevalence of Sleep Complaints in Mexico City.

OBJECTIVE: To estimate the crude prevalence rates of several sleep complaints and the prevalence for each one adjusted for the coexistence of symptoms in other sleep domains in a representative sample of adult individuals from Mexico City. METHODS: A probabilistic sample of 1933 adult individuals living in Mexico City was surveyed using fourteen questions of the Sleep Disorders Questionnaire to assess sleep-related symptoms and sleep complaints. Estimates of crude prevalence rates for each sleep disturbance and adjusted for a score ≥ the 80th. percentile in the questionnaire were calculated. RESULTS: The following prevalence rates were found: insomnia 39.7%; excessive diurnal sleepiness (EDS) 20.9%; obstructive sleep apnea syndrome (EDS plus snoring) 7.7%; habitual snoring 9.9%; restless legs syndrome (RLS) 4.4%; narcolepsy 0.9%; sleep paralysis (SP) 13.2%; and hypnotic use 1.2%. When prevalence rates were calculated accounting for symptoms in other sleep domains, notable reductions were observed in complaints of insomnia (17.3%), EDS (10.3%), and SP (8.7%), while minor decreases were observed for complaints of snoring (7.4%), OSAS (5%), and RLS (3.8%); narcolepsy prevalence practically did not change (0.9%). CONCLUSIONS: Sleep complaints are highly prevalent in Mexican adult population. More than a half of the individuals with a given sleep disturbance have a global sleep deterioration associated to psychosocial and health impairments.

Trichotillomania and non-epileptic seizures as sleep-related dissociative phenomena.

ABSTRACT: The occurrence of non-epileptic seizures (NES) and trichotillomania during sleep is rare. We describe the case of an adult woman with a personal history of childhood maltreatment and psychiatric morbidity (major depression, trichotillomania, and conversion disorder), who was referred to the sleep unit because of nocturnal hair-pulling and psychomotor agitation during sleep. An all-night PSG recording with audiovisual monitoring documented seven episodes of trichotillomania and one NES, all of which arose from unequivocal wakefulness. Improvement of nocturnal behaviors was observed after long-term psychotherapy. This case illustrates that nocturnal trichotillomania and NES may be symptoms of a sleep-related dissociative disorder.

[Validation of the Epworth sleepiness scale in Mexican population]. / Validación de la escala de somnolencia de Epworth en población mexicana.

INTRODUCTION: The Epworth sleepiness scale (ESS) is a widely used instrument in the subjective assessment of sleepiness. Although there are several translations into Spanish, their equivalence to the original version is questionable. OBJECTIVE: To assess the reliability and validity of a true translation into Spanish of the ESS in Mexican population. METHOD: The ESS was translated into Spanish with the use of standard translation methodology: forward translation, back translation and bilingual committee consensus. It was administered to six groups of subjects of the following categories: narcolepsy, obstructive sleep apnea syndrome (OSAS), major depression with OSAS risk, major depression without OSAS risk, good sleepers and insomniac patients without OSAS risk. Internal consistency and factorial structure of the ESS was estimated. In addition, a comparison between groups of the ESS scores was conducted. RESULTS: The ESS showed to be composed by only one factor and it also showed a high reliability coefficient (0.89). Likewise patients with narcolepsy or OSAS had the highest scores while good sleepers obtained the lowest scores. CONCLUSION: The true translation into Spanish of the ESS showed similar psychometric properties to the original version and, superior to previous Spanish adaptations. Therefore, the ESS is a reliable instrument for the assessment of sleepiness in our population.

[Efficacy and safety of modified release zolpidem in patients with chronic insomnia]. / Zolpidem de liberación modificada para insomnio crónico. Eficacia y seguridad.

OBJECTIVE: to assess the efficacy and safety of zolpidem modified release (MR) on an "as per needed basis" in patients with chronic insomnia. METHODS: one hundred and thirty five adult patients with chronic insomnia were recruited. Participants received zolpidem MR 12.5 mg during a 12 weeks period. Severity and improvement of insomnia were assessed at baseline and at the end of study using the clinical global impression scale; sleep quality was assessed by the application of the Pittsburgh Sleep Quality Index; drug consumption behavior was evaluated through tablet counting; in addition its security was assessed by the registry of the adverse effects. RESULTS: one hundred and fifteen patients completed the study; 83.7 % were considered improved or very improved, so that 66 % reached a normal or borderline condition. Twenty percent of subjects experienced adverse reactions; the most frequent were headache, excessive sleepiness, nausea and dizziness. CONCLUSIONS: these data support the efficacy, safety and acceptance of zolpidem MR administered on an "as per needed" regimen for the treatment of chronic insomnia.

[Sleep medicine: development, contributions and perspectives. Report of the work group on sleep medicine]. / Medicina del dormir: desarrollo, contribuciones y perspectivas. Reporte del grupo de trabajo en medicina del dormir.

Sleep is a basic biological process that has an impact on all the functions of the body, and interacts bidirectionally with virtually all of the body systems, so that the sleep disorders are associated with disturbances in other systems, either respiratory, neurological, cardiovascular, endocrine, immune, etc., and vice versa. The complexity of the regulatory mechanisms of sleep and the variety of their disorders, together with the clinical evidence accumulated in recent decades, have led to the birth of a new branch in medicine: the Sleep Medicine, with well defined intrinsic disorders. The consequences of sleep deprivation or fragmentation induced by changes in social and work dynamics, as well as sleep disorders have harmful effects on individuals in the short and long-term, the most important are an elevated risk for vehicular and occupational accidents, cardiovascular damage, cognitive impairment, obesity, diabetes mellitus, among others, impacting individuals of all ages. The sleep clinics and laboratories in Mexico, have made significant contributions, at both the basic and clinical levels, for the diagnosis and treatment of sleep disorders; however, without a specific health policy, we will continue to commit resources only on the attention of its effects and not on prevention, making the impact on the economy and quality of life of patients with sleep disorders, much higher than in developed countries. It is necessary to build a program of medical care to incorporate the Sleep Medicine in the priorities of medical care in the National Institutions of Health at all levels. Solutions and guides to optimize the achievement of the proposed results, and increase efficiency and effectiveness of the resources applied in this new field of Medicine are offered.

Correlatos del maltrato físico en la infancia en mujeres adultas con trastorno distímico o depresión mayor / Correlates of childhood physical maltreatment in adult women with dysthymic disorder or major depression

Epidemiologic studies have found that childhood physical maltreatment affects 31% and 21% of males and females, respectively, and almost one half of cases correspond to severe physical abuse. A recent study carried out in population from four representative regions of our country found that 14% to 21% of adolescents reported a history of physical abuse during childhood. Childhood maltreatment experiences have been found to be associated to development of psychopathology during childhood. In regard to mood disorders, interest has been focused on the relationship between depression and sexual abuse. An explanation to this situation is that both conditions predominantly affect women while physical abuse is more frequent among men. However, physical abuse produces more negative consequences on women's health; severe physical abuse equally affects men and women; moreover, child physical abuse has been significantly associated with depression only in women. The experiences of adverse events during childhood also seem to be associated with dysthymic disorder, a depressive condition of lower symptomatic severity but longer duration than major depression. Nevertheless, data about childhood physical abuse among patients with dysthymic disorder are scarce. One study found that physical and sexual abuses were significantly more frequent among dysthymic and depressed patients in comparison with control subjects. This finding suggests an association between physical abuse and both acute and chronic forms of depression. On the basis of this knowledge, the aims of this study were: a) to determine and compare the frequency of childhood physical abuse among women with major depression or dysthymic disorder in a community mental health centre; b) to determine psychiatric comorbidity in relation to the history of physical abuse; and c) to compare the severity of depressive symptoms and suicide risk between depressed patients (major depression or dysthymic disorder) with or without a history of childhood physical maltreatment. Subjects were recruited from the population seeking psychiatric attention in a community mental health centre. To be included, patients were required to be females, 18-65 years old, literate, meet DSM IV criteria for major depressive disorder or dysthymic disorder, and give their written informed consent. All patients were assessed with the Mini International Neuropsychiatric Interview, the Beck Depression Inventory and the Childhood Physical Maltreatment Index. This self-report instrument was developed as part of the study. It consists of five questions and it showed satisfactory psychometric properties (e. g., inter-item score correlations .54-.67, item-total score correlations .78-.85 and Cronbach's alpha = .88). Eighty patients were studied: 42 with major depression (MD) and 38 with dysthymic disorder (DD). Patients with MD were not significantly different from DD subjects in age (38.0±11.3 vs. 39.8±12.9, respectively; t = -.64, gl 78, p = .52), civil status (64.2% vs 55.2% living with a partner; x² = .67, gl 1, p = .49), education years (9.5±3.2 vs. 10.3±3.1, respectively; t = -1.1, gl 78, p = .25) and occupation (50% vs. 60% dedicated to housework; x² = .89, gl 1, p = .37). Seventy six percent of patients reported a history of childhood physical abuse; there were no significant differences between MD and DD patients (75% vs. 72%, respectively). However, severity of maltreatment showed a tendency to be significantly higher among MD patients (4.88 [DE 4.81] vs. 3.18 [DE 3.10]; t = 1.8, gl 78, p= 07). Women with a history of physical abuse obtained significantly higher scores on depression than patients without it. This association was not dependent on diagnosis. In contrast, suicide risk was not significantly different between patients with or without child physical abuse. The number of comorbid psychiatric disorders showed a marginal association with the history of physical abuse (1.2 -DE 1.0] vs. 0.78 -DE 0.91], t= -1.6, gl 78, p=.09). According to these results, three out of four women with major depression or dysthymic disorder suffered from physical abuse during childhood. This proportion is notably higher than the one found in general population, and it also differs from the prevalence rate reported in previous studies with depressed patients. In one study where authors examined 1019 patients admitted in a psychiatric hospital, they identified a history of child physical abuse in 12.3% and 8.3% of MD and DD patients, respectively. Later, a rate of 16% and 29% among MD and DD patients was reported. More recently, an epidemiologic study found a rate of 40.3% among women with major depression. The disparity in the reported prevalence rates might have several explanations. Some studies have used definitions of childhood physical maltreatment which seem to correspond to a severe form. For example, in one study it was defined as the experience of being hit hard or often enough to leave bruises, draw blood, or require medical attention. Another one included some other aggressive behaviors (being pushed, grabbed or shoved), but they were not considered as maltreatment if they had had a low frequency. The inclusion of these behaviors, which could be classified as <

De acuerdo con estudios epidemiológicos en México, 18% de los adultos y de 14 a 21% de los adolescentes afirman haber recibido golpes durante su niñez por parte de alguno de sus padres. Las experiencias de maltrato en la infancia se han asociado con el desarrollo de psicopatología en la edad adulta. Sin embargo, en el caso particular de la depresión mayor, el interés se ha concentrado en la relación existente con la historia de abuso sexual. Uno de los argumentos que se han planteado es que ambas condiciones son más frecuentes en la mujer, mientras que el maltrato físico lo es en hombres. No obstante, el abuso físico tiene más consecuencias negativas en la salud de las mujeres. Se ha identificado que no existen diferencias significativas entre las mujeres adultas con historia de abuso sexual y aquéllas con antecedente de abuso físico, con respecto a los síntomas físicos y psicológicos que experimentan. Además, la historia de maltrato físico se asocia significativamente con la presencia de depresión sólo en las mujeres. En conjunto, esta información sugiere que el maltrato físico puede cumplir un papel más importante del que se ha pensado en el desarrollo de la depresión. La experiencia de eventos adversos en la infancia también parece asociarse con el curso y pronóstico del trastorno distímico, aunque la información con respecto a este trastorno es escasa. Por lo anterior, en el presente trabajo nos propusimos: a) determinar y comparar la frecuencia del maltrato físico en la infancia en mujeres con trastorno depresivo mayor y trastorno distímico en un centro comunitario de salud mental; b) determinar la comorbilidad psiquiátrica asociada con la historia de maltrato físico; y c) comparar la gravedad de la sintomatología depresiva y del riesgo suicida en función de la historia de maltrato físico y el diagnóstico. Se estudiaron mujeres, de 18 a 65 años de edad, alfabetas, con diagnóstico de trastorno depresivo mayor o trastorno distímico (DSM-IV) y que aceptaran participar otorgando su consentimiento informado por escrito. Las participantes fueron evaluadas con la Mini Entrevista Neuropsiquiátrica y respondieron el Inventario de Depresión de Beck (IDB) y el Índice de Maltrato Físico Infantil (IMFI). El IMFI es un instrumento autoaplicable que se desarrolló como parte de la investigación. Inicialmente se elaboraron 59 reactivos sobre experiencias de maltrato en la infancia, los cuales fueron clasificados por cuatro jueces clínicos. Cinco reactivos se clasificaron como maltrato físico por tres de los cuatro jueces, por lo que éstos se emplearon para conformar el IMFI. El instrumento mostró propiedades psicométricas satisfactorias: coeficientes de correlación elevados entre los reactivos y la suma total, un alto coeficiente de confiabilidad, y en el análisis factorial produjo un solo componente que explicaba casi 70% de la varianza. Participaron en la investigación ochenta mujeres, 42 con trastorno depresivo mayor (TDM) y 38 con trastorno distímico (TD). El 75 y 72%, respectivamente, reportaron una historia positiva de maltrato físico. La intensidad del maltrato experimentado mostró una tendencia a ser significativamente mayor entre las mujeres con TDM (4.88 [DE 4.81] vs. 3.18 [DE 3.10]; t=1.8, gl 78, p=.07). Las mujeres con historia de maltrato físico obtuvieron calificaciones significativamente más elevadas en el IDB en comparación con las que no lo habían sufrido. Este resultado fue independiente del diagnóstico. En contraste, el riesgo suicida no varió significativamente en función de la historia de maltrato físico. Las pacientes con historia de maltrato físico tendieron a presentar un mayor número de trastornos psiquiátricos comórbidos. En este mismo grupo, la gravedad de la sintomatología depresiva se relacionó significativamente con la gravedad del maltrato (r=0.27, p=.03). Los resultados muestran que aproximadamente tres de cada cuatro mujeres con TDM o TD experimentaron maltrato físico en la infancia. Éste se asocia, además, con una mayor gravedad de los síntomas depresivos y posiblemente con una mayor comorbilidad psiquiátrica. La elevada proporción de mujeres con TDM o TD con una historia de maltrato contrasta con los datos obtenidos en estudios previos. El origen de la discrepancia puede estar, al menos en parte, en la definición empleada, ya que en este estudio se usó una definición más estricta que incluye el maltrato considerado <

Excessive daytime sleepiness in depressed women.

Excessive daytime sleepiness (EDS) is a symptom with high public health importance. Within psychiatric settings, depression is the most significant risk factor for EDS; however, this relationship has not been clearly detailed. The aim of this study was to describe the quality of sleep of depressed patients with and without EDS and to investigate the association between EDS and depression severity. A cross-sectional study with 78 female depressed outpatients (34.17 +/- 11.37 years; range 18-60) was performed. The Epworth Sleepiness Scale, the Athens Insomnia Scale, the Pittsburgh Sleep Quality Index, and the Hamilton Rating Scale for Depression (HRSD) were administered. Patients were classified in two groups: with (43.5%) and without (56.5%) EDS. There were no differences with regard to comorbidity, socio-demographic (except for employment), or HRSD variables. The two groups were homogeneous in sleep patterns, with no difference in quality or sleep efficiency. EDS was not associated with reduced sleep efficiency or severity of depressive symptoms. Limitations of the present study include the small sample size and the use of self-report measurements. These results offer valuable information to clinicians in the sense of the need to deeply investigate the etiology of EDS before attributing it to bad sleep quality or depression severity.

Sleep paralysis in adolescents: the 'a dead body climbed on top of me' phenomenon in Mexico.

AIMS: The aim of the present study was to evaluate the prevalence and characteristics of sleep paralysis in adolescents using a folk expression. METHODS: Three hundred and twenty-two adolescents (mean age, 15.9 +/- 0.88 years; 66.8% female) from three high schools in Mexico City completed both a self-reported questionnaire, including a colloquial definition of sleep paralysis and the Epworth Sleepiness Scale. RESULTS: A high proportion of the adolescents (92.5%) had heard about the 'a dead body climbed on top of me' expression and 27.6% of them had experienced the phenomenon. Sleep paralysis was present in 25.5% while the prevalence rate for hypnagogic/hypnopompic hallucinations was 22%; 61% had experienced >or=2 episodes in their lifetime. The mean age of onset was 12.5 +/- 3 years. Sleepiness scores for the subjects who had experienced at least one event were not significantly different from subjects who had not experienced any. In 72% of cases, the episodes were composed of both sleep paralysis and hallucinations while 20.2% consisted of only sleep paralysis and 7.8% of only hallucinations. The number and characteristics of events were not significantly different between adolescents with only one episode and those with two or more episodes. CONCLUSIONS: The characteristics of the 'a dead body climbed on top of me' phenomenon suggest that is identical to sleep paralysis and a frequent experience among Mexican adolescents. During adolescence, sleep paralysis seems to be a recurrent phenomenon frequently accompanied by hallucinatory experiences.

[Reliability and factorial analysis of the Spanish version of the Pittsburg Sleep Quality Index among psychiatric patients]. / Confiabilidad y análisis factorial de la versión en español del Indice de Calidad De Sueño de Pittsburgh en pacientes psiquiátricos.

INTRODUCTION: The Pittsburgh Sleep Quality Index (PSQI) has become a standard instrument to measure sleep quality. However, its factor structure has not been fully explored and the available Spanish versions have revealed the need to make adaptations. Our objective was to assess the factor structure and reliability of the PSQI. METHODS: Eighty seven psychiatric patients without treatment and 48 control subjects underwent psychiatric structured assessment and completed the PSQI. Internal consistency and factor structure of PSQI was measured and the scale scores were compared between groups and by gender. Association with age was also calculated. RESULTS: There were no significant differences between psychiatric patients and control subjects on age and gender. Subjects had no problem understanding and answering the questions in the instrument. The PSQI displayed a satisfactory reliability coefficient (0.78) and component-total score correlations were all significant (0.53-0.77). The PSQI showed two main factors: sleep duration and sleep quality. Patients obtained significantly higher scores than controls, in both the global and the component scores, with the exception of sleep duration. The PSQI scores were not significantly different between males and females and were not associated with age. CONCLUSIONS: The PSQI is a reliable instrument to measure sleep quality in Mexican subjects.

Confiabilidad y análisis factorial de la versión en español del Indice de Calidad De Sueño de Pittsburgh en pacientes psiquiátricos / Reliability and factorial analysis of the Spanish version of the Pittsburg Sleep Quality Index among psychiatric patients

Introducción: El Índice de Calidad de Sueño de Pittsburgh (ICSP) se ha convertido en un instrumento estándar para la medición de la calidad del sueño. No obstante, no se ha evaluado su estructura factorial y, además, la existencia de dos versiones en castellano ha puesto de manifiesto la necesidad de realizar adaptaciones. El objetivo de este estudio fue evaluar la confiabilidad y composición factorial del ICSP. Material y métodos: Ochenta y siete pacientes psiquiátricos y 48 sujetos control se sometieron a una entrevista psiquiátrica y completaron el ICSP. Se estimó la consistencia interna y composición factorial del ICSP, se compararon las calificaciones por grupo y sexo, y se estimó la relación con la edad. Los grupos no difirieron significativamente en edad y sexo. Resultados: El ICSP obtuvo un coeficiente de confiabilidad satisfactorio (0.78) y coeficientes de correlación significativos (0.53 a 0.77) entre los componentes y la suma total, quedando conformado por dos factores: calidad de sueño per se y duración del sueño. Los pacientes presentaron calificaciones más altas que los sujetos control, tanto en la suma total como en los componentes, excepto en la duración del sueño. No se identificaron diferencias por sexo, ni relación significativa con la edad. Conclusiones: Estos resultados indican que el ICSP es un instrumento confiable para la evaluación de la calidad del sueño en población mexicana.

INTRODUCTION: The Pittsburgh Sleep Quality Index (PSQI) has become a standard instrument to measure sleep quality. However, its factor structure has not been fully explored and the available Spanish versions have revealed the need to make adaptations. Our objective was to assess the factor structure and reliability of the PSQI. METHODS: Eighty seven psychiatric patients without treatment and 48 control subjects underwent psychiatric structured assessment and completed the PSQI. Internal consistency and factor structure of PSQI was measured and the scale scores were compared between groups and by gender. Association with age was also calculated. RESULTS: There were no significant differences between psychiatric patients and control subjects on age and gender. Subjects had no problem understanding and answering the questions in the instrument. The PSQI displayed a satisfactory reliability coefficient (0.78) and component-total score correlations were all significant (0.53-0.77). The PSQI showed two main factors: sleep duration and sleep quality. Patients obtained significantly higher scores than controls, in both the global and the component scores, with the exception of sleep duration. The PSQI scores were not significantly different between males and females and were not associated with age. CONCLUSIONS: The PSQI is a reliable instrument to measure sleep quality in Mexican subjects.

Coexistence of epileptic nocturnal wanderings and an arachnoid cyst.

Episodic nocturnal wanderings (ENWs) have rarely been associated with gross abnormalities of brain structures. We describe the case of a patient with ENWs in coexistence with an arachnoid cyst (AC). The patient was a 15-year-old boy who presented with nocturnal attacks characterized by complex motor behaviors. An MRI revealed a left temporal cyst and a SPECT Tc99 scan showed left temporal hypoperfusion and bilateral frontal hyperperfusion, more evident on the right side. During an all-night polysomnographic recording with audiovisual monitoring, dystonic posture followed by sleepwalking-like behavior was documented. The sleepwalking-like behavior was preceded by a spike discharge over the left frontocentral region with contralateral projection and secondary generalization during stage 2 sleep. Treatment with levetiracetam produced a striking remission of seizures. This supports a conservative management of an AC, considering that it may be an incidental finding. In epileptic patients, an AC may not necessarily be related to the location of the seizure focus.