The Tinnitus Research Initiative (TRI) database: A new approach for delineation of tinnitus subtypes and generation of predictors for treatment outcome

Tinnitus, the phantom perception of sound, is a frequent disorder that causes significant morbidity and treatment is elusive. A large variety of different treatment options have been proposed and from most of them some patients benefit. However, a particular treatment that helps one patient may fail for others. This suggests that there are different forms of tinnitus which differ in their pathophysiology and their response to specific treatments. Therefore, it is a major challenge for tinnitus treatment to identify the most promising therapy for a specific patient

Risk Attitudes and Birth Order

Risk attitudes play important roles in health behavior and everyday decision making. It is unclear, however, whether these attitudes can be predicted from birth order. We investigated 200 mostly male volunteers from two distinct settings. After correcting for multiple comparisons, for the number of siblings and for confounding by gender, ordinal position predicted perception of health-related risks among participants in extreme sports (p < .01). However, the direction of the effect contradicted Adlerian theory. Except for alcohol consumption, these findings extended to self-reported risk behavior. Together, the data call for a cautious stand on the impact of birth order on risk attitudes

Nightly treatment of primary insomnia with prolonged release melatonin for 6 months: a randomized placebo controlled trial on age and endogenous melatonin as predictors of efficacy and safety

&lt;p&gt;Background: Melatonin is extensively used in the USA in a non-regulated manner for sleep disorders. Prolonged release melatonin (PRM) is licensed in Europe and other countries for the short term treatment of primary insomnia in patients aged 55 years and over. However, a clear definition of the target patient population and well-controlled studies of long-term efficacy and safety are lacking. It is known that melatonin production declines with age. Some young insomnia patients also may have low melatonin levels. The study investigated whether older age or low melatonin excretion is a better predictor of response to PRM, whether the efficacy observed in short-term studies is sustained during continued treatment and the long term safety of such treatment.&lt;/p&gt; &lt;p&gt;Methods: Adult outpatients (791, aged 18-80 years) with primary insomnia, were treated with placebo (2 weeks) and then randomized, double-blind to 3 weeks with PRM or placebo nightly. PRM patients continued whereas placebo completers were re-randomized 1:1 to PRM or placebo for 26 weeks with 2 weeks of single-blind placebo run-out. Main outcome measures were sleep latency derived from a sleep diary, Pittsburgh Sleep Quality Index (PSQI), Quality of Life (World Health Organzaton-5) Clinical Global Impression of Improvement (CGI-I) and adverse effects and vital signs recorded at each visit.&lt;/p&gt; &lt;p&gt;Results: On the primary efficacy variable, sleep latency, the effects of PRM (3 weeks) in patients with low endogenous melatonin (6-sulphatoxymelatonin [6-SMT] ≤8 μg/night) regardless of age did not differ from the placebo, whereas PRM significantly reduced sleep latency compared to the placebo in elderly patients regardless of melatonin levels (-19.1 versus -1.7 min; P = 0.002). The effects on sleep latency and additional sleep and daytime parameters that improved with PRM were maintained or enhanced over the 6-month period with no signs of tolerance. Most adverse events were mild in severity with no clinically relevant differences between PRM and placebo for any safety outcome.&lt;/p&gt; &lt;p&gt;Conclusions: The results demonstrate short- and long-term efficacy and safety of PRM in elderly insomnia patients. Low melatonin production regardless of age is not useful in predicting responses to melatonin therapy in insomnia. The age cut-off for response warrants further investigation.&lt;/p&gt

Cariprazine in the management of negative symptoms of schizophrenia : state of the art and future perspectives

In schizophrenia, dopaminergic hyperactivity in the mesolimbic regions, or possibly even selectively so in the dorsal striatum, seems to cause the emergence of psychotic symptoms, whereas dopaminergic hypoactivity in cortical regions underlies the negative symptoms and cognitive deficits. Managing the negative symptoms is a major current challenge in the treatment of schizophrenia with a dearth of novel modalities to address this clinical issue. Cariprazine is a novel second-generation antipsychotic that specifically targets the D3 receptor mainly associated to negative symptoms. The review summarizes the main issues regarding negative symptom management and the role of cariprazine treatment

Comparison of nutrient intake by sleep status in selected adults in Mysore, India

Insomnia has become a major public health issue in recent times. Although quality of sleep is affected by environmental, psychophysiological, and pharmacological factors, diet and nutrient intake also contribute to sleep problems. This study investigated the association between nutrient intake and co-morbid symptoms associated with sleep status among selected adults. Subjects in this study included 87 men and women aged 21-45 years. Presence of insomnia was assessed using the Insomnia Screening Questionnaire, and dietary intake was measured over three consecutive days by dietary survey. Descriptive analysis, ANOVA, and Chi-Square tests were performed to compute and interpret the data. Approximately 60% of the participants were insomniacs. People with insomnia consumed significantly lesser quantities of nutrients as compared to normal sleepers. Differences in intakes of energy, carbohydrates, folic acid, and B12 were highly significant (P < 0.002). Further, intakes of protein, fat, and thiamine were significantly different (P < 0.021) between insomniacs and normal sleepers. The nutrient intake pattern of the insomniacs with co-morbid symptoms was quite different from that of the normal sleepers. Based on these results, it is probable that there is an association between nutrition deficiency, co-morbid symptoms, and sleep status. More studies are required to confirm these results

Orexin Receptor Antagonism, a New Sleep-Enabling Paradigm: A Proof-of-Concept Clinical Trial

Peer reviewe

Moral Reasoning in Psychopaths

Patienten mit der psychischen Störung „Psychopathie&ldquo; zeigen ein Muster von emotionaler Abgestumpftheit, Impulsivität und unmoralischem Verhalten. Zur Untersuchung moralischen Urteilens wurden in der vorliegenden Studie alltagsrelevante Konflikte mit moralischem bzw. neutralem Inhalt entwickelt und 12 „psychopathischen&ldquo; forensischen Patienten sowie 12 nicht-psychopathischen forensischen Patienten präsentiert. „Psychopathische&ldquo; im Vergleich zu nicht-psychopathischen Patienten berichteten signifikant positivere Gefühle bei unmoralischen Entscheidungen als Nicht-Psychopathen. Außerdem wurden in der Gruppe der „Psychopathen&ldquo; im Vergleich zu den Nicht-Psychopathen signifikant häufiger unmoralische Entscheidungen auf moralische Konflikte getroffen. Diese Befunde deuten darauf hin, dass eine Störung der Emotionsverarbeitung ursächlich für dissoziales Verhalten bei „Psychopathen&ldquo; sein könnte.Psychopathic patients show a behavioral pattern that is characterized by indifference, impulsivity and antisocial behavior. To investigate moral reasoning we developed conflicts of everyday life with either moral or neutral content. These conflicts were then presented to a group of 12 psychopathic forensic patients as well as to a group of 12 non-psychopathic forensic patients.Psychopathic compared to non-psychopathic patients reported significantly higher positive feelings when choosing an immoral response alternative than non-psychopaths. Furthermore, psychopaths picked significantly more often an immoral response alternative in the conflicts with moral content than did the non-psychopaths. These results indicate that impairment in emotional processing abilities may be at the core of antisocial behavior in psychopathy

NISAS-2000 - die "Nationwide Insomnia Screening and Awareness Study": Insomnien und Schlafstörungen in der allgemeinärztlichen Versorgung

ZIEL: Ermittlung der Stichtagsprävalenz von Insomnie und anderen Schlafstörungen in deutschen Allgemeinarztpraxen sowie Bestimmung hausärztlicher Erkennensraten. METHODIK: Bundesweite Zufallsauswahl von 539 Arztpraxen. Charakterisierung der Arzt- und Praxismerkmale mittels initialer Vorstudie. Darauf folgend eine Stichtagsbefragung aller Hausarzt-Patienten mittels Schlaffragebogen (PSQI) und klinischen Fragen (N = 19155 Fälle) sowie klinisch-ärztliche Beurteilung durch den behandelnden Artz mittels CGI und Fragebogen. ERGEBNISSE: 1. Trotz nur moderater Kompetenzeinschätzungen hinsichtlich Diagnose und Therapie behandeln Hausärzte Insomnien und andere Schlafstörungen vorwiegend selbst, auch wenn diese einen hohen Behandlungsaufwand erfordern. 2. Die Stichprobe kann als typisch für die Hausarzt-Klientel angesehen werden. 3. Schlafstörungen sind der dritthäufigste Konsultationsanlass. Nahezu jeder zweite Patient berichtete, in den vergangenen 2 Wochen unter Schlafbeschwerden gelitten zu haben, 26,5% erfüllten aufgrund der subjektiven Angaben die Studienkriterien (DSM-IV) für Insomnie. 4. Auch die Ärzte beurteilten 46,4% aller ihrer Patienten mittels CGI zumindest als Grenzfälle einer Schlafstörung, 85,6% wurden als chronisch eingeordnet. Die ärtzlich beurteilte Insomnieprävalenz betrug 25,9%, die anderer Schlafstörungen 13,7%. 5. Nur 54,3% aller Insomniepatienten wurden auch als solche vom Hausarzt diagnostiziert. DISKUSSION: Die Studie liefert erstmals bundesrepräsentative, differenzierte epidemiologische Daten zu der Prävalenz, dem Schweregrad, den Einschränkungen und den Verlaufsmustern von Insomnien und Schlafstörungen. Die außerordentlich große Häufigkeit und die zum Teil markanten Defizite hinsichtlich Erkennen und Diagnostik in der primärärztlichen Versorgungen werden diskutiert.AIM: To estimate the point prevalence of insomnia, recognition and prescription behavior in primary care. METHODS: Nationwide sample of 539 primary care settings along with their characterization (stage 1). Standardized assessment of all attenders (N = 19.155 patients) on the NISAS target day using a sleep questionnaire (PSQI) and additional questions to cover psychosocial and additional clinical variables. All patients were evaluated by the primary care doctors using a standardized clinical appraisal questionnaire, including a CGI-rating. RESULTS: Prevalence insomnia according to DSM-IV was 26.5%. Recognition of presence of any clinically significant sleep disorder was 72%, recognition of insomnia was poor 54.3%. 85.6% of insomnia patients were rated as chronic. Close to 50% of all insomnia cases did not receive a specific insomnia therapy. Herbals, followed by hypnotics and sedatives and antidepressants were the three most frequent treatments applied, psychotherapy was only seldomly indicated. DISCUSSION: NISAS provides for the first time nationally representative estimates of interventions for insomnia in primary care. The relatively low treatment rates and the high proportion of chronic patients receiving longterm prescription of benzodiazepines seem to be critical. Priorities for future agenda to improve this situation are discussed

Amygdalohippocampal neuroplastic changes following neuroleptic treatment with quetiapine in first-episode schizophrenia

Schizophrenia is a severe, debilitating, chronic disease that is accompanied by morphologic changes within the brain. However, it is unclear to what extent alterations of grey and white matter in schizophrenia are linked to the disease itself, or whether they are a consequence of neuroleptic treatment. Typical and atypical antipsychotics exert differential effects on brain structure. Moreover, atypical antipsychotics may have distinct profiles with respect to grey matter in schizophrenic patients. Findings on drug-induced grey matter changes are heterogeneous due to variation in stage of illness, duration of treatment and use of multiple antipsychotics. Using voxel-based morphometry applied to high-resolution magnetic resonance images, we show that monotherapy with the atypical agent quetiapine (mean daily dose = 445 mg ± 200 s.d.) may induce structural brain changes in first-episode schizophrenia patients (N = 20) within 21 d of treatment. Specifically, we demonstrate longitudinal macroscopic changes (i.e. grey matter increases) in the left amygdalohippocampal region that were predicted by drug plasma levels but not daily doses. These structural alterations were accompanied by a clinical improvement of schizophrenic symptoms. Comparison with healthy controls (n = 30) showed that grey matter amount in the respective amygdalar region was significantly reduced in unmedicated first-episode schizophrenia patients. These findings suggest that drug-induced neuroplastic changes in schizophrenia can occur quickly and are dependent on pharmacokinetics

Antidepressants for insomnia in adults

Background Insomnia disorder is a subjective condition of unsatisfactory sleep (e.g. sleep onset, maintenance, early waking, impairment of daytime functioning). Insomnia disorder impairs quality of life and is associated with an increased risk of physical and mental health problems including anxiety, depression, drug and alcohol abuse, and increased health service use. hypnotic medications (e.g. benzodiazepines and 'Z' drugs) are licensed for sleep promotion, but can induce tolerance and dependence, although many people remain on long-term treatment. Antidepressant use for insomnia is widespread, but none is licensed for insomnia and the evidence for their efficacy is unclear. This use of unlicensed medications may be driven by concern over longer-term use of hypnotics and the limited availability of psychological treatments. Objectives To assess the effectiveness, safety and tolerability of antidepressants for insomnia in adults. Search methods This review incorporated the results of searches to July 2015 conducted on electronic bibliographic databases: the Cochrane Central Register of Controlled Trials (CENTRAL, 2015, Issue 6), MEDLINE (1950 to 2015), Embase (1980 to 2015) and PsycINFO (1806 to 2015). We updated the searches to December 2017, but these results have not yet been incorporated into the review. Selection criteria Randomised controlled trials (RCTs) of adults (aged 18 years or older) with a primary diagnosis of insomnia and all participant types including people with comorbidities. Any antidepressant as monotherapy at any dose whether compared with placebo, other medications for insomnia (e.g. benzodiazepines and 'Z' drugs), a different antidepressant, waiting list control or treatment as usual. Data collection and analysis Two review authors independently assessed trials for eligibility and extracted data using a data extraction form. A third review author resolved disagreements on inclusion or data extraction. Main results The search identified 23 RCTs (2806 participants). Selective serotonin reuptake inhibitors (SSRIs) compared with placebo: three studies (135 participants) compared SSRIs with placebo. Combining results was not possible. Two paroxetine studies showed significant improvements in subjective sleep measures at six (60 participants, P = 0.03) and 12 weeks (27 participants, P < 0.001). There was no difference in the fluoxetine study (low quality evidence). There were either no adverse events or they were not reported (very low quality evidence). Tricyclic antidepressants (TCA) compared with placebo: six studies (812 participants) compared TCA with placebo; five used doxepin and one used trimipramine. We found no studies of amitriptyline. Four studies (518 participants) could be pooled, showing a moderate improvement in subjective sleep quality over placebo (standardised mean difference (SMD) -0.39, 95% confidence interval (CI) -0.56 to -0.21) (moderate quality evidence). Moderate quality evidence suggested that TCAs possibly improved sleep efficiency (mean difference (MD) 6.29 percentage points, 95% CI 3.17 to 9.41; 4 studies; 510 participants) and increased sleep time (MD 22.88 minutes, 95% CI 13.17 to 32.59; 4 studies; 510 participants). There may have been little or no impact on sleep latency (MD -4.27 minutes, 95% CI -9.01 to 0.48; 4 studies; 510 participants). There may have been little or no difference in adverse events between TCAs and placebo (risk ratio (RR) 1.02, 95% CI 0.86 to 1.21; 6 studies; 812 participants) (low quality evidence). 'Other' antidepressants with placebo: eight studies compared other antidepressants with placebo (one used mianserin and seven used trazodone). Three studies (370 participants) of trazodone could be pooled, indicating a moderate improvement in subjective sleep outcomes over placebo (SMD -0.34, 95% CI -0.66 to -0.02). Two studies of trazodone measured polysomnography and found little or no difference in sleep efficiency (MD 1.38 percentage points, 95% CI -2.87 to 5.63; 169 participants) (low quality evidence). There was low quality evidence from two studies of more adverse effects with trazodone than placebo (i.e. morning grogginess, increased dry mouth and thirst). Authors' conclusions We identified relatively few, mostly small studies with short-term follow-up and design limitations. The effects of SSRIs compared with placebo are uncertain with too few studies to draw clear conclusions. There may be a small improvement in sleep quality with short-term use of low-dose doxepin and trazodone compared with placebo. The tolerability and safety of antidepressants for insomnia is uncertain due to limited reporting of adverse events. There was no evidence for amitriptyline (despite common use in clinical practice) or for long-term antidepressant use for insomnia. High-quality trials of antidepressants for insomnia are needed