Sleep and schizophrenia: From epiphenomenon to treatable causal target

Background: Sleep disturbance is a common clinical issue for patients with psychosis. It has been identified as a putative causal factor in the onset and persistence of psychotic experiences (paranoia and hallucinations). Hence sleep disruption may be a potential treatment target to prevent the onset of psychosis and reduce persistent psychotic experiences. The aim of this review is to describe developments in understanding the nature, causal role, and treatment of sleep disruption in psychosis. Method: A systematic literature search was conducted to identify studies, published in the last five years, investigating subjective sleep disruption and psychotic experiences. Results: Fifty-eight papers were identified: 37 clinical and 21 non-clinical studies. The studies were correlational (n = 38; 20 clinical, 18 non-clinical), treatment (n = 7; 1 non-clinical), qualitative accounts (n = 6 clinical), prevalence estimates (n = 5 clinical), and experimental tests (n = 2 non-clinical). Insomnia (50%) and nightmare disorder (48%) are the most prevalent sleep problems found in patients. Sleep disruption predicts the onset and persistence of psychotic experiences such as paranoia and hallucinations, with negative affect identified as a partial mediator of this relationship. Patients recognise the detrimental effects of disrupted sleep and are keen for treatment. All psychological intervention studies reported large effect size improvements in sleep and there may be modest resultant improvements in psychotic experiences. Conclusions: Sleep disruption is a treatable clinical problem in patients with psychosis. It is important to treat in its own right but may also lessen psychotic experiences. Research is required on how this knowledge can be implemented in clinical services

Sleep restriction therapy: experimental studies

Insomnia is a common disturbance of sleep which can be treated effectively with cognitive behavioural therapy; a multicomponent ‘package’ of cognitive and behavioural strategies. Sleep restriction therapy is thought to be one of the most potent behavioural components of cognitive behavioural therapy. Subjective measures of sleep and daytime functioning improve not only with cognitive behavioural therapy, but also during and following sleep restriction therapy. However, it is unknown when these changes occur or if there are associated objective changes. This thesis addresses these issues, and presents: 1. a review of the literature of therapy and original research; 2. evaluates the nature and timing of changes in self-reported daytime functioning during therapy; 3. profiles potential objective changes (in measurements of sleep, plasma and salivary cortisol concentrations and temperature); and 4. compares patients with different subtypes of insomnia and healthy good sleeping controls for possible differences within the brain that might serve as future targets for treatment. The final general discussion ties together the results of these data-based chapters. The following section aims to provide a brief summary of the overall thesis. This Ph.D. was undertaken as Cotutelle Agreement between the Universities of Glasgow, United Kingdom and Sydney, Australia. Specific chapters relate to the data collection performed at these two sites. Consequently this thesis has been split into specific chapters from where the data were obtained. Chapters four and five consist of data acquired from Glasgow, United Kingdom whilst in chapters six and seven the data were acquired in Sydney, Australia

Daytime functioning and quality of life in chronic insomnia: a multi-method, multi-level approach

Insomnia disorder is characterised by difficulties with initiating and/or maintaining sleep. Similar to most psychiatric and mental health conditions, insomnia is defined according to subjective complaint, and achieves disorder ‘status’ when associated daytime functioning impairment is present. Yet, ironically, it is these two cornerstones of insomnia disorder, combined, that have achieved relatively minimal attention in the literature. That is, perhaps surprisingly, the subjective experience, and impact of insomnia, at least from the patient (‘expert’) perspective, has been under-researched. Night-time symptoms and sleep parameters have typically been the target of both treatment and non-treatment (clinical, epidemiological, mechanistic) research. In this thesis, a multi-method, multi-level approach is adopted to better understand the daytime experience of those with chronically disturbed sleep. First, a brief overview (chapter one) of insomnia is provided to familiarise the reader with the ‘problem of insomnia’. A narrative review (chapter two) then sets the scene in relation to the assessment and measurement of health-related quality of life (HRQoL) and daytime functioning. This work reveals several inadequacies and limitations of existing work, and outlines a prospective research agenda. Chapter three describes the first ever phenomenological study carried out in primary insomnia patients. Here, two qualitative methodologies, focus groups and audio-diaries, are combined to help better understand the proximal and distal impairments attributed to chronic sleep disturbance. Chapter four builds on this work by describing the creation of two new clinical scales, developed to quantify, in both valid and novel ways, the impact of poor sleep on aspects of daytime functioning and insomnia-related quality of life. Chapter five combines the aforementioned qualitative and questionnaire approaches to explore the experience of an effective behavioural intervention for insomnia, sleep restriction therapy (SRT). The application of these refined methods provided insight into the effects of SRT on both sleep and daytime functioning, but also permitted exploration of treatment-related issues - such as adherence, side-effects, and mechanisms of action - that have otherwise been difficult to probe using traditional quantitative methodologies. Chapter six tackles the issue of objective daytime impairment, typically assessed using computerised reaction time tasks. Through ‘mining’ an existing brain and behavioural database, and applying an algorithm to select poor and normal sleepers, it was possible to investigate cognitive functioning at two broad stages of processing – event-related potentials generated from the scalp-recorded electroencephalogram (EEG), and performance output using neuropsychological testing. The results provide some interesting hypotheses concerning possible cognition-arousal and -effort interactions. Importantly, as a by-product of this work, a methodological template for the future standardized assessment of brain and behavioural function in insomnia is considered. Finally, chapter seven synthesises the results of each preceding experimental chapter, with particular emphasis on how this work will advance research, measurement and understanding of insomnia-related functioning. Immediate clinical implications and relevance to other areas of insomnia research are also briefly considered

Supplement to Lauri Lahti’s conference article "Educational framework for adoption of vocabulary based on Wikipedia linkage and spaced learning"

A supplement to Lauri Lahti’s conference article in 2012 "Educational framework for adoption of vocabulary based on Wikipedia linkage and spaced learning" so that this supplement was referenced to by the original publication.Not reviewe

The Objective Measurement of Sleep-Wake Disturbance in Parkinson's Disease

Parkinson’s disease (PD) is an increasingly prevalent neurodegenerative disease affecting older adults. Motor symptoms, including tremor, rigidity and tremor were classically predominant. However, troublesome non-motor symptomatology are known to impair quality of life for patients with PD and there carers. Sleep-wake disturbances are gaining attention in PD encompassing disturbances of the circadian, homeostatic and ultradian sleep systems. These symptoms have been linked to the troublesome problems of cognitive deficits, mood disturbance and visual hallucinations. Mechanisms exploring the interaction of sleep-wake disturbance and other non-motor symptoms in PD are not well understood. Bidirectional causality between sleep-wake disturbance and concomitant symptoms in PD provide insights into common chemical and neural mechanisms which prior to the development of therapy, must be understood. Furthermore, sleep-wake disorders in PD at present provide a maker of early diagnosis for which future disease modifying treatment can be targeted. However objective and reliable measurement techniques are yet to be devised in this field. This thesis aims to utilise the objective measurement of sleep-wake disturbances across the circadian, homeostatic and ultradian sleep systems in PD through four empiric experiments to help inform our understanding of these critical symptoms. While the usefulness of self-report data is not doubted as a means of engaging the patient and hearing their voice they cannot serve the same identification and measurement uses of objective data. Given our ageing population, the need for diagnostic, predictive and sensitive monitoring biomarkers in Parkinson’s disease has never been greater. Objective, accurate and reliable measurement techniques, as demonstrated in this thesis, underpins further research in this field

Behavioural sleep medicine conceptualisations and associated treatment of clinical insomnia disorder in adults

This thesis summarises a selection of forty-two studies [1-42], published by the author during the period 2000-2012, investigating the conceptual basis of Insomnia Disorder, and its evaluation and treatment, principally using cognitive and behavioural interventions. The work reflects a range of research methodologies including experimental, psychometric, qualitative and population-based studies, and randomised controlled trials. Important theoretical contributions to the literature published in this period are also included and reference is made to major textbooks, position papers, and influential chapter contribution

Täydennysosa väitöskirjaan "Tietokoneavusteinen oppiminen perustuen karttuviin sanastoihin, käsiteverkostoihin ja Wikipedian linkitykseen"

A supplement to Lauri Lahti’s doctoral dissertation in 2015 "Computer-Assisted Learning Based on Cumulative Vocabularies, Conceptual Networks and Wikipedia Linkage" so that this supplement was referenced to by the original publication.Täydennysosa väitöskirjaan "Tietokoneavusteinen oppiminen perustuen karttuviin sanastoihin, käsiteverkostoihin ja Wikipedian linkitykseen"Not reviewe

Become an American Board of Professional Psychology (ABPP) Board Certified Specialist in Behavioral and Cognitive Psychology

This workshop will focus on how to become a Board Certified Specialist in Behavioral and Cognitive Psychology. Certification by ABPP demonstrates psychologists have met their specialty’s standards and competencies. Board Certification is valuable for several reasons: (a) it is increasingly becoming an expectation in our profession; (b) it enhances practitioner credibility for patients; (c) it distinguishes you from other psychologists; (d) there are potential salary increases by the VA, hospitals, the military, and other health care facilities; (e) it enhances qualifications as an expert witness; (f) it facilitates inter-jurisdictional licensing and practice mobility; and (g) it streamlines the credentialing process for licensing boards, and insurance companies. The application process for regular, early entry (graduate students, interns, and residents), and senior option candidates will be reviewed

Maintenance of Relationship Functioning For ePREP and OurRelationship for Low-income Couples

Symposium Title: Relationship Health Across Diverse and Underserved Communities: Connecting Theory and Practice to Inform Therapeutic Processes for Couple Distress Chairs: Judith Biesen, M.A., University of Notre Dame; Binghuang A. Wang, M.S., Binghamton University, State University of New York Discussant: Emily Georgia Salivar, Ph.D., Nova Southeastern Universit

Religion/Spirituality as a Predictor of Attrition from a Culturally Informed Family Treatment for Schizophrenia that Targets Religious Coping

Symposium Title: The Integration of Religion/Spirituality into Culturally-Informed, Cognitive-Behavioral Mental Health Treatments Chair: Kayla K. Thayer, Ph.D., Nova Southeastern University Discussant: Stevan Lars Nielsen, Ph.D., Brigham Young Universit