Language delay in severely neglected children : a cumulative or specific effect of risk factors?

Objectives. This research sought to determine if the language delay of severely neglected children under three years old was better explained by a cumulative risk model or by the specificity of risk factors. The objective was also to identify the risk factors with the strongest impact on language delay among various biological, psychological and environmental factors. Methods. Sixty-eight severely neglected children and their mothers participated in this crosssectional study. Children were between 2 and 36 months of age. Data included information about the child's language development and biological, psychological and environmental risk factors. Results. Prevalence of language delays is significantly higher in this subgroup of children than in the population as a whole. Although we observed that the risk of language delay significantly increased with an increase in the cumulative count of the presence of the child’s biologicalpsychological risk factors, the one-by-one analysis of the individual factors revealed that the cumulative effect mainly reflected the specific impact of the child’s cognitive development. When we considered also the environmental risk factors, multivariate logistic regression established that cognitive development, the mother’s own physical and emotional abuse experience as a child, and the mother’s low acceptability level towards her child are linked to language delays in severely neglected children. Conclusions. Language development is the result of a complex interaction between risk factors. The language delay in severely neglected children is better explained by the specificity of risk factors than by the cumulative risk model. Practice implications. Most prevention and early intervention programs promote and target an increase in the quantity and quality of language stimulation offered to the child. Our results suggest that particular attention should be given to other environmental factors, specifically the mother’s psychological availability and her sensitivity towards the child. It is essential to suggest interventions targeting various ecological dimensions of neglectful mothers to help break the intergenerational neglect transmission cycle. It is also important to develop government policies and ensure that efforts among the various response networks are concerted since in-depth changes to neglect situations can only come about when all interested parties become involved

Prevalence of insomnia and its treatment in Canada

Objectives : To estimate the prevalence of insomnia and examine its correlates (for example, demographics and physical and mental health) and treatments. Methods : A sample of 2000 Canadians aged 18 years and older responded to a telephone survey about sleep, health, and the use of sleep-promoting products. Respondents with insomnia were identified using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and the International Classification of Diseases, Tenth Edition, criteria. Results : Among the sample, 40.2% presented at least 1 symptom of insomnia (that is, trouble falling or staying asleep, or early morning awakening) for a minimum of 3 nights per week in the previous month, 19.8% were dissatisfied with their sleep, and 13.4% met all criteria for insomnia (that is, presence of 1 insomnia symptom 3 nights or more per week for at least 1 month, accompanied by distress or daytime impairment). Insomnia was associated with female sex, older age, and poorer self-rated physical and mental health. Thirteen per cent of respondents had consulted a health care provider for sleep difficulties once in their lifetime. Moreover, 10% had used prescribed medications for sleep in the previous year, 9.0% used natural products, 5.7% used over-the-counter products, and 4.6% used alcohol. There were differences between French- and English-speaking adults, with the former group presenting lower rates of insomnia (9.5%, compared with 14.3%) and consultation (8.7%, compared with 14.4%), but higher rates of prescribed medications (12.9%, compared with 9.3%) and the use of natural products (15.6%, compared with 7.4%). Conclusions : Insomnia is a prevalent condition, although few people seek professional consultation for this condition. Despite regional differences in the prevalence and treatments used to manage insomnia, prescribed medications remain the most widely used therapeutic option.Objectifs : Estimer la prévalence de l'insomnie et examiner ses corrélats (par exemple, les données démographiques et la santé physique et mentale) et les traitements. Méthodes : Un échantillon de 2000 Canadiens de 18 ans et plus ont répondu à une enquête téléphonique sur le sommeil, la santé et l'utilisation de produits qui favorisent le sommeil. Les répondants souffrant d'insomnie ont été identifiés à l'aide des critères du Manuel diagnostique et statistique des troubles mentaux, 4e édition révisée, et de la Classification internationale des maladies, 10e édition. Résultats : Dans l'échantillon, 40,2 % présentaient au moins 1 symptôme d'insomnie (c'est-à-dire, difficulté à s'endormir ou à rester endormi, ou réveil tôt le matin) pour un minimum de 3 nuits par semaine durant le mois précédent, 19,8 % étaient insatisfaits de leur sommeil, et 13,4 % satisfaisaient à tous les critères de l'insomnie (c'est-à-dire, la présence d'un symptôme d'insomnie 3 nuits ou plus par semaine pendant au moins 1 mois, accompagnée de détresse ou d'incapacité durant le jour). L'insomnie était associée avec le sexe féminin, l'âge avancé, et une mauvaise santé physique et mentale auto-déclarée. Treize pour cent des répondants avaient consulté un prestataire de soins de santé pour des difficultés de sommeil une fois dans leur vie. En outre, 10 % avaient utilisé des médicaments prescrits pour le sommeil dans l'année précédente, 9,0 % avaient utilisé des produits naturels, 5,7 % avaient utilisé des produits en vente libre, et 4,6 % avaient utilisé de l'alcool. Il y avait des différences entre les adultes francophones et anglophones, le premier groupe présentant des taux plus faibles d'insomnie (9,5 %, comparé à 14,3 %) et de consultations (8,7 %, comparé à 14,4 %), mais des taux plus élevés de médicaments prescrits (12,9 %, comparé à 9,3 %) et d'utilisation de produits naturels (15,6 %, comparé à 7,4 %). Conclusions : L'insomnie est une affection prévalente, bien que peu de gens aient recours à une consultation professionnelle pour ce problème. Malgré des différences régionales de prévalence et des traitements utilisés pour gérer l'insomnie, les médicaments prescrits demeurent l'option thérapeutique la plus utilisée

Monthly fluctuations of insomnia symptoms in a population-based sample

Study Objectives: To document the monthly changes in sleep/insomnia status over a 12-month period; to determine the optimal time intervals to reliably capture new incident cases and recurrent episodes of insomnia and the likelihood of its persistence over time. Design: Participants were 100 adults (mean age = 49.9 years; 66% women) randomly selected from a larger population-based sample enrolled in a longitudinal study of the natural history of insomnia. They completed 12 monthly telephone interviews assessing insomnia, use of sleep aids, stressful life events, and physical and mental health problems in the previous month. A total of 1,125 interviews of a potential 1,200 were completed. Based on data collected at each assessment, participants were classified into one of three subgroups: good sleepers, insomnia symptoms, and insomnia syndrome. Results: At baseline, 42 participants were classified as good sleepers, 34 met criteria for insomnia symptoms, and 24 for an insomnia syndrome. There were significant fluctuations of insomnia over time, with 66% of the participants changing sleep status at least once over the 12 monthly assessments (51.5% for good sleepers, 59.5% for insomnia syndrome, and 93.4% for insomnia symptoms). Changes of status were more frequent among individuals with insomnia symptoms at baseline (mean = 3.46, SD = 2.36) than among those initially classified as good sleepers (mean = 2.12, SD = 2.70). Among the subgroup with insomnia symptoms at baseline, 88.3% reported improved sleep (i.e., became good sleepers) at least once over the 12 monthly assessments compared to 27.7% whose sleep worsened (i.e., met criteria for an insomnia syndrome) during the same period. Among individuals classified as good sleepers at baseline, risks of developing insomnia symptoms and syndrome over the subsequent months were, respectively, 48.6% and 14.5%. Monthly assessment over an interval of 6 months was found most reliable to estimate incidence rates, while an interval of 3 months proved the most reliable for defining chronic insomnia. Conclusions: Monthly assessment of insomnia and sleep patterns revealed significant variability over the course of a 12-month period. These findings highlight the importance for future epidemiological studies of conducting repeated assessment at shorter than the typical yearly interval in order to reliably capture the natural course of insomnia over time

Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia : a randomized controlled trial

Context: Cognitive behavioral therapy (CBT) and hypnotic medications are efficacious for short-term treatment of insomnia, but few patients achieve complete remission with any single treatment. It is unclear whether combined or maintenance therapies would enhance outcome. Objectives: To evaluate the added value of medication over CBT alone for acute treatment of insomnia and the effects of maintenance therapies on long-term outcome. Design, Setting, and Patients: Prospective, randomized controlled trial involving 2-stage therapy for 160 adults with persistent insomnia treated at a university hospital sleep center in Canada between January 2002 and April 2005. Interventions: Participants received CBT alone or CBT plus 10 mg/d (taken at bedtime) ofzolpidemforaninitial6-weektherapy,followedbyextended6-monththerapy.Patients initially treated with CBT attended monthly maintenance CBT for 6 months or received no additional treatment and those initially treated with combined therapy (CBT plus 10 mg/d of zolpidem) continued with CBT plus intermittent use of zolpidem or CBT only. Main Outcome Measures: Sleep onset latency, time awake after sleep onset, total sleep time, and sleep efficiency derived from daily diaries (primary outcomes); treatment response and remission rates derived from the Insomnia Severity Index (secondary outcomes). Results: Cognitive behavioral therapy used singly or in combination with zolpidem produced significant improvements in sleep latency, time awake after sleep onset, and sleep efficiency during initial therapy (all P .001); a larger increase of sleep time was obtained with the combined approach (P=.04). Both CBT alone and CBT plus zolpidem produced similar rates of treatment responders (60% [45/75] vs 61% [45/74], respectively; P=.84) and treatment remissions (39% [29/75] vs 44% [33/74], respectively; P=.52) with the 6-week acute treatment, but combined therapy produced a higher remission rate compared with CBT alone during the 6-month extended therapy phase and the 6-month follow-up period (56% [43/74 and 32/59] vs 43% [34/75 and 28/68]; P=.05). The best long-term outcome was obtained with patients treated with combined therapy initially, followed by CBT alone, as evidenced by higher remission rates at the 6-month follow-up compared with patients who continued to take zolpidem during extended therapy (68% [20/30] vs 42% [12/29]; P=.04). Conclusion: In patients with persistent insomnia, the addition of medication to CBT produced added benefits during acute therapy, but long-term outcome was optimized when medication is discontinued during maintenance CBT

The natural history of insomnia : a population-based 3-year longitudinal study

Background Despite its high prevalence, little information is available about the natural history of insomnia. The extent to which episodes of insomnia will persist or remit over time is difficult to predict. We examined the natural history of insomnia and describe the most common trajectories over 3 years. Methods Three hundred eighty-eight adults (mean [SD] age, 44.8 [13.9] years; 61% women) were selected from a larger population-based sample on the basis of the presence of insomnia at baseline. They completed standardized sleep/insomnia questionnaires at 3 annual follow-up assessments. For each follow-up assessment, participants were classified into 1 of 3 groups (individuals with an insomnia syndrome, individuals with insomnia symptoms, and individuals with good sleep) on the basis of algorithms using standard diagnostic criteria for insomnia. Rates of persistent insomnia, remission, and relapse were computed for each group. Results Of the study sample, 74% reported insomnia for at least 1 year (2 consecutive assessments) and 46% reported insomnia persisting over the entire 3-year study. The course of insomnia was more likely to be persistent in those with more severe insomnia at baseline (ie, insomnia syndrome) and in women and older adults. Remission rate was 54%; however, 27% of those with remission of insomnia eventually experienced relapse. Individuals with subsyndromal insomnia at baseline were 3 times more likely to remit than worsen to syndrome status, although persistence was the most frequent course in that group as well. Conclusion These findings indicate that insomnia is often a persistent condition, in particular when it reaches the diagnostic threshold for an insomnia disorder

Verbal and Visual Memory Impairments Among Young Offspring and Healthy Adult Relatives of Patients With Schizophrenia and Bipolar Disorder: Selective Generational Patterns Indicate Different Developmental Trajectories

Objective: Memory deficits have been shown in patients affected by schizophrenia (SZ) and bipolar (BP)/mood disorder. We recently reported that young high-risk offspring of an affected parent were impaired in both verbal episodic memory (VEM) and visual episodic memory (VisEM). Understanding better the trajectory of memory impairments from childhood to adult clinical status in risk populations is crucial for early detection and prevention. In multigenerational families densely affected by SZ or BP, our aim was to compare the memory impairments observed in young nonaffected offspring with memory functioning in nonaffected adult relatives and patients. Methods: For 20 years, we followed up numerous kindreds in the Eastern Québec population. After having characterized the Diagnostic and Statistical Manual of Mental Disorders phenotypes, we assessed cognition (N = 381) in 3 subsamples in these kindreds and in controls: 60 young offspring of a parent affected by SZ or BP, and in the adult generations, 92 nonaffected adult relatives and 40 patients affected by SZ or BP. VEM was assessed with the California Verbal Learning Test and VisEM with the Rey figures. Results: The VEM deficits observed in the offspring were also found in adult relatives and patients. In contrast, the VisEM impairments observed in the young offspring were present only in patients, not in the adult relatives. Conclusion: Implications for prevention and genetic mechanisms can be drawn from the observation that VEM and VisEM would show distinct generational trajectories and that the trajectory associated with VisEM may offer a better potential than VEM to predict future risk of developing the disease

Solving genetic heterogeneity in extended families by identifying sub-types of complex diseases

Familial dependence, Pedigree peeling, Triplet-transmission probability, Latent class model,

Génétique de la schizophrénie et de la maladie bipolaire

Des résultats indiquant des liaisons sur deux chromosomes pour la schizophrénie (SZ) et la maladie bipolaire (BP) furent trop hâtivement rapportés dans la revue Nature à la fin des années 1980. Les connaissances accumulées à partir des insuccès de la première génération d’études génétiques moléculaires de la SZ et de la BP ont toutefois permis de jeter les bases de la seconde génération d’études de liaison, qui donnent maintenant des résultats convergents fort encourageants. Cet article présente une douzaine de sites génomiques de susceptibilité pour la SZ et la BP, certains d’entre eux étant probablement partagés par ces deux psychoses majeures, tandis que d’autres seraient spécifiques à chacune