Stress, trauma and personality correlates of nightmare frequency and nightmare distress.

Four studies were conducted with the following samples a): people with frequent nightmares; b) people with sleep apnoea; c) fire-fighters and d) people with traumatic brain injury. Nightmare frequency was significantly elevated in these groups compared to the normal population. Correlations between nightmare frequency and various measures of psychopathology and individual differences were similar in size to those found in student samples. However, partialling out nightmare distress did not render nightmare frequency - psychopathology correlations negligible. Indeed, in the fire-fighters study, only one fire-fighter reported having a problem with nightmares. Nightmare frequency is thus not an artifact of nightmare distress in these samples. Defining nightmares as having to wake up the sleeper made no difference to between subjects correlations with the individual difference and psychopathology variables, and to within subjects correlations with state mood. However, requiring the dream to be very unpleasant as opposed to just moderately unpleasant to be classed as a nightmare did result in increased sizes of correlations. Within subjects correlations of pre-sleep mood with the presence/absence of a nightmare that night were small in comparison to between subjects analyses. Nightmares are thus more likely to be caused by general trait or long-term poor well being than by acute poor well-being. None of the individual difference variables assessed in this study predispose individuals to have nightmares under conditions of high anxiety or high depression. This was despite the individual difference variables in many cases having significant between subjects correlations with nightmare frequency. Ratings of PTSD correlated with nightmare frequency in individuals who had undergone repeated exposure to trauma (emergency service workers), and in individuals who had had one severe trauma (individuals with traumatic head injury). Despite sleep fragmentation there was no indication of cessation of dreaming in the patients with apnoea, but approximately one third of the participants with brain injury had complete cessation of dreaming. These results are discussed in terms of theories of nightmare formation, and of the continuity of waking and sleeping cognition

The relationship between sleep and glucose control in gestational diabetes

This study set out to investigate the association between sleep among pregnant women with gestational diabetes (GDM) and their glucose control. Functional data analysis (FDA) methods were applied to glucose data collected via continuous glucose monitoring (CGM) systems. FDA is an advanced statistical method that respects the complexity of the dense auto-correlated data produced from repeated measurement of glucose over time. 192 pregnant women with GDM at their third trimester were recruited. Over a period of one week participants wore an actigraph (Actiwatch2 Respironics) which is a watch-like device on their non-dominant wrist to objectively measure their sleep, have a professional CGM system (iPro2 Medtronic) attached to them to continuously measure and record their interstitial glucose every 5 minutes, and complete the Pittsburgh Sleep Quality Index (PSQI) questionnaire to self-report their habitual sleep pattern for the previous month. Their demographic data and type of treatment they received were also collected. 152 participants had sufficient data retrieved from them, i.e. the PSQI questionnaire data and at least one night actigraphy-derived sleep data and one 24-hour day of CGM data. Using FDA methods, sequential glucose values data-points recorded over time with the CGM system were converted into a smooth 24-hour glucose curves with a functional form (as a function of time). The glucose curve was then used as one value, instead of the multiple data-points values it represents. Glucose control was assessed using the smooth glucose curves, as well as, a conventional summary metrics. The associations between participants’ actigraphy-derived and self-reported sleep characteristics and glucose control, were evaluated using standard and multilevel regression modelling for the conventional CGM data summary metrics and functional regression modelling for the smooth glucose curves. The study discovered a positive association between sleep disturbances and glucose control. Sleep disturbances were measured as poor sleep quality, short and long sleep durations compared to an average 6-8 hours sleep duration and difficulties in initiating and maintaining sleep. The timing and the amplitude of these associations were more apparent with FDA regression models than regression models with summary metrics. This study recommends the use of FDA in research involving the use of CGM systems, and encourages the clinician and the policy makers to consider sleep disturbances as a risk factor in glycaemic dysregulation in GDM

Hypothyroidism

Hypothyroidism is the most common thyroid disorder and it is significantly more frequent than presented - millions of people suffer from this disease without knowing it. People with this condition will have symptoms associated with slow metabolism. Estimates of subclinical hypothyroidism range between 3 to 8 %, increasing with age, whereas it more likely affects women than men. About 10% of women may have some degree of thyroid hormone deficiency. Hypothyroidism may affect lipid metabolism, neurological diseases or other clinical conditions. The book includes studies on advancements in diagnosis, regulation and replacement therapy, thyroid ultrasonography and radioiodine therapy for hypothyroidism. "Hypothyroidism - Influences and Treatments" contains many important specifications, results of scientific studies and innovations for endocrine practice

The role of posttraumatic stress disorder in explaining the psychosocial outcome of subarachnoid haemorrhage patients and their informal carers in both the short- and long-term

Surviving subarachnoid haemorrhage (SAH) patients' experience significantly reduced health-related quality of life (HRQoL) in both the short- and long-term, as well as mysterious symptoms of fatigue and sleep dysfunction. Patients’ family members and friends - who often act as their informal carers - can also experience psychosocial disability. The cause for these poor outcomes remains unknown. Traditional explanations focusing on the neurological sequelae associated with SAH or the characteristics of the illness are not satisfactory; nor are attempts to explain family members' difficulties on the basis of carer burden. The hypothesis which is tested in this thesis is that post-traumatic stress disorder (PTSD) may be abnormally high in both the SAH patient and 'significant other' (SO) population and that this may explain their outcomes. SAH patients are known to be at risk of suffering from PTSD, but it is unknown if this explains their outcome. In terms of patients' SOs, they are known to experience psychiatric symptoms and I suggest these could be caused by their development of PTSD, but this has never been examined. In Part One (Chapter 2-5), I focus on patients' outcomes. Before examining my PTSD hypothesis, I present a meta-analysis (Chapter 2) I conducted of studies which have tried to explain patients' outcome using neurological factors. I conducted the meta-analysis as a tendency for prior studies to be underpowered and use unreliable statistics could have meant that the actual importance of traditional factors was obscured. The results of my meta-analysis however did not support this possibility and instead showed traditional neurological variables did not explain patients' outcome. With this in mind, I then present a longitudinal study (Chapter 5) in which I examined one of the largest prospective series of SAH patients to establish PTS D's explanative importance. Using regression analyses, this study showed PTSD was the best predictor for patients' mental HRQoL - the domain most persistently impaired. It also helped predict patients' physical HRQoL. Moreover, PTSD was linked to sleep problems and may therefore cause fatigue. Crucially, to establish the cause of PTSD, logistic regression was performed. This showed that maladaptive stress coping strategies were the best predictor for PTSD development. In Part Two of the thesis (Chapter 6), I present my longitudinal study of one of the largest prospective samples of SOs. All SOs were assessed with a diagnostic PTSD measure and coping skills were assessed. An elevated incidence of PTSD was found in both the short- and long-term. Although SOs' PTSD did not impinge on the recovery of the SAH patients being cared for, given that it is important to ensure SOs continue caring, regression results are presented which show the cause of SOs' PTSD was (at least in the short- term) due to the use of maladaptive coping strategies. The overarching conclusion is that the elevated incidence of PTSD in SAH patients and SOs helps explain why they experience psychosocial disability. In the final part of the thesis (Chapter 8) the clinical and theoretical implications of this conclusion are considered, such as that teaching patients and their SOs more effective coping skills might prevent PTSD and psychosocial disability

Long-Term Health Effects of the 9/11 Disaster

The terrorist attacks on the World Trade Center towers on September 11, 2001, also referred as 9/11, was an iconic event in US history that altered the global and political response to terrorism. The attacks, which involved two planes hitting the twin towers in Lower Manhattan, New York City, resulted in the collapse of the buildings and over 2800 deaths of occupants of the buildings, fire, police and other responders and persons on the street in the vicinity of the collapsing buildings. The destroyed towers and the surrounding buildings have since been replaced but the health effects that resulted from the release of tons of dust, gases and debris as well as the life threat trauma are ongoing, and represent a major health burden among persons directly exposed. Hundreds of scientific publications have documented the physical and mental health effects attributed to the disaster. The current state-of-the-art in understanding the ongoing interactions of physical and mental health, especially PTSD, and the unique mechanisms by which pollutants from the building collapse, have resulted in long term pulmonary dysfunction, course of previously reported conditions, potential emerging conditions (e.g., heart disease and autoimmune diseases), as well as quality of life, functioning and unmet health care needs would be in the purview of this Special Issue on the 9/11 Disaster

Lifestyle and Chronic Pain

Cumulating evidence shows that lifestyle factors such as physical (in)activity, stress, poor sleep, unhealthy diet, and smoking are associated with chronic pain severity and sustainment across all age categories. A paradigm shift from a tissue- and disease-based approach towards individually tailored multimodal lifestyle interventions should lead to improved outcomes and decrease the psychological and socioeconomic burden of chronic pain. Such an approach fits well into the global move towards precision pain medicine for patients with chronic pain. For these reasons, this book is dedicated to Lifestyle and Chronic Pain

A Personalized Medicine Approach to the Diagnosis and Management of Autism Spectrum Disorder

This collection of articles provides an overview of the current and future methods for applying a personalized medicine approach to the diagnosis, management, and treatment of autism spectrum disorder

Dissociation, victimisation, and their associations with voice hearing in young adults experiencing first-episode psychosis

Background: It has been proposed that voice hearing, even in the context of psychosis, is associated with high levels of dissociation - especially amongst individuals with a history of childhood abuse. This thesis studies these relationships using more rigorous research methods than have been applied in much existing observational work, and contributes original evidence for understanding the incidence of, and associations between, voice hearing, dissociation, and life adversity (particularly childhood sexual abuse: CSA) in a first-episode psychosis sample. Study 1 and 2: Evaluates current knowledge on associations between (1) voice hearing and dissociation, and (2) voice hearing and CSA using systematic, critical literature review. Both studies found strong associations between key variables, although methodological limitations in the literature preclude assumptions of causal relationships. Study 3: Employs self-report measures and a retrospective case-control design to assess voice hearing, dissociation, psychological distress, and adversity exposure within a pseudo-random sample of voice hearers (n=31) and non-voice hearing controls (n=31). CSA and dissociation were significantly higher amongst case participants. Dissociation retained a significant association with voice hearing when controlling for pre-illness adversity exposures and psychological distress. Study 4: Employs self-report measures and a cross-sectional between-groups design to assess dissociation, distress, and voice phenomenology within a pseudo-random sample of voice hearers with (n=23) and without (n=23) self-reported CSA exposure. CSA severity was associated with higher dissociation. Both groups reported similar voice characteristics, although CSA survivors perceived voices as more omnipotent. Emotional responses to voices showed strongest associations with psychological distress when controlling for dissociation and adversity exposure. Summary: Considerable heterogeneity was apparent for all measures between and within groups of voice hearers and non-voice hearers, and voice hearers with and without CSA exposure. Associations between voice hearing and dissociation remain significant when controlling for adversity exposure and the type of stress, anxiety, and depression that occurs in the more general context of psychosis. However, while dissociation increases the likelihood of voice hearing per se, psychological distress has stronger associations for experiencing voices as negative. The datasets are interpreted within the context of wider clinical/conceptual debates around the role of dissociation, distress, and adverse life events in psychosis, and are used to generate recommendations for both therapeutic intervention and future research