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5 results

  • A new insomnia treatment service: the benefits and challenges of establishing a trainee-led service

  • Lauren Z. Waterman, Michael Creed
  • Journal:
    BJPsych Bulletin / Volume 48 / Issue 2 / April 2024
    Published online by Cambridge University Press:
    29 June 2023, pp. 127-133
    Print publication:
    April 2024
    • Article
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  • Chronic insomnia is undertreated in the UK despite being a common mental disorder that severely affects quality of life. The lead author, a psychiatry trainee, implemented a new group cognitive–behavioural therapy for insomnia (CBT-I) service for secondary care patients in London with chronic insomnia and comorbid mental illness. Expertise was propagated by trainees teaching other trainees. Nine patients completed all sessions, all with moderate-to-severe insomnia on the Insomnia Severity Index (ISI) at baseline assessment (mean score 21.6). All patients seen at follow-up had improved, scoring in the ‘subthreshold’ or ‘no clinically significant insomnia’ ranges on the ISI (mean 6.6), and all with improvements in comorbid psychiatric symptoms and functioning. This evaluation demonstrates that group CBT-I can be easily learned and delivered by those without formal CBT or sleep medicine training. This could increase the availability and accessibility of treatment. However, bureaucratic challenges were faced, and trainee-led innovations should be better facilitated.

  • The association between melatonin and suicide: a nationwide cohort study

  • N. Høier, T. Madsen, A. Spira, K. Hawton, P. Jennum, M. Nordentoft, A. Erlangsen
  • Journal:
    European Psychiatry / Volume 65 / Issue S1 / June 2022
    Published online by Cambridge University Press:
    01 September 2022, p. S843
    • Article
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      • Open access
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  • Introduction

    Melatonin is often prescribed to patients experiencing sleep disturbances, which has been linked to elevated risks of suicide. However, it remains to be assessed whether melatonin is associated with suicide and suicide attempts.

    Objectives

    We aimed to investigate whether individuals in treatment with melatonin had higher rates of suicide and suicide attempt when compared to individuals not in treatment.

    Methods

    Using longitudinal data on all persons aged 10+ years living in Denmark between 2007-2016 were obtained. Data from the National Prescription Register was used to identify periods of being in treatment with melatonin based on number of tablets and daily defined dose. Suicide and suicide attempt were identified in hospital and cause of death registries.

    Results

    Among 5,798,923 included individuals, 10,577 (0.18%) were in treatment with melatonin (mean treatment length 50 days). Out of 5,952 individuals who died by suicide, 22 (0.37%) were in melatonin treatment, while 134 (0.53%) out of 25,136 had a first suicide attempt. After adjustment for sex and age-group, people in treatment with melatonin were found to have a higher rate of suicide (IRR: 4.2; 95% CI, 2.7-6.4) and suicide attempt (IRR: 6.7-fold (95% CI, 5.7-7.9) when compared to those not in treatment.

    Conclusions

    Treatment with melatonin was associated with higher rates of suicide and suicide attempt. The association might be explained through mediators, such as psychiatric comorbidity and sleep disorders. Our findings indicate that attention towards these issues might be warranted.

    Disclosure

    No significant relationships.

  • The association between benzodiazepine and non-benzodiazepine and suicide: a nationwide cohort study

  • N. Høier, T. Madsen, A. Spira, K. Hawton, P. Jennum, M. Nordentoft, A. Erlangsen
  • Journal:
    European Psychiatry / Volume 65 / Issue S1 / June 2022
    Published online by Cambridge University Press:
    01 September 2022, p. S181
    • Article
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      • Open access
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  • Introduction

    Benzodiazepines and non-benzodiazepines have been linked to a variety of adverse effects including addiction. Long term use of these drugs has been associated with an increased risk of suicide.

    Objectives

    We assessed if individuals in treatment with non-benzodiazepine (n-BZD) and benzodiazepine (BZD) had higher rates of suicide when compared to individuals not in treatment with these drugs.

    Methods

    We utilized a cohort design and national longitudinal data on all individuals aged 10 or above who lived in Denmark between 1995 and 2018. Treatment with either n-BZD or BZD was identified via the Danish National Prescription Registry and suicide deaths were identified in the national cause of death registries.

    Results

    In a total of 6,494,206 individuals, 10,862 males and 4,214 females died by suicide. Of these, 1,220 (11.2%) males and 792 (18.8%) females had been in treatment with n-BZD, resulting in adjusted IRR for suicide of 4.2 (95% CI, 4.0 – 4.5) and 3.4 (95% CI, 3.1 – 3.7) for males and females, respectively, when compared to those not in treatment. In all, 529 (4.8%) males and 395 (9.3%) females who died by suicide had been in treatment with BZD. The IRRs for suicide were 2.4 (95% CI, 2.2 – 2.6) and 2.5 (95% CI, 2.3 – 2.8) for males and females, respectively, and compared to those not in treatment.

    Conclusions

    In this study we find that those in treatment experienced higher suicide rates than those not in treatment, this persisted when also adjusting for a large variety of covariates.

    Disclosure

    No significant relationships.

  • 21 - Capnography and pulmonary embolism

  • from 1 - Ventilation
  • Edited by J. S. Gravenstein, University of Florida, Michael B. Jaffe, Nikolaus Gravenstein, University of Florida, David A. Paulus, University of Florida
  • Book:
    Capnography
    Published online:
    05 August 2011
    Print publication:
    17 March 2011, pp 195-207

  • Summary

    This chapter focuses on the importance of the potential role of capnography during sleep. It provides a clear definition of the unique changes in ventilation that accompany the sleep state and its various components. With the evolution of significant clinical interest in sleep-related breathing disorders, the use of polysomnography has been expanded to include more detailed assessment of breathing during sleep. Capnometry is the measurement of CO2 concentration in a gas mixture denoted by a continuous waveform display. Sleep serves multiple functions in humans, including biochemical (anabolic hormone secretion, protein synthesis, energy conservation), physiologic, and neurological. It is extensive in its monitoring capacity, but retains significant limitations in its capability to evaluate changes in ventilation and breathing outside of frank obstructive sleep apnea (OSA) for which it was designed. Comprehensive incorporation of capnography into clinical practice has great potential for enhancing the sleep evaluation in many patients.