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Sleep apnea: how is it recognised & what can be done about it?

I have already written a couple of posts on sleep apnea -"Sleep apnea - what is it, how common is it and how does it affect mortality & physical health?" and "Sleep apnea - how does it affect psychological health?".  In this third & last post of the sequence, I'll explore how we can recognise sleep apnea and what we can do about it.

Sleep apnea - how does it affect psychological health?

I have already written a first post "Sleep apnea - what is it, how common is it and how does it affect mortality & physical health?" which highlights that sleep apnea is a common, regularly unrecognised disorder, occurring in approaching 1 in 5 adults and that, particularly as it becomes more severe - probably approximately 1 in 10 sufferers (Li et al, 2015) - sleep apnea is linked with a wide range of serious diseases and with significantly increased death rates.  In this second post, I'll look at the relevance of sleep apnea for psychiatric disorders.

Non-drug treatments for bipolar disorder (2nd post) - sleep, light & exercise

I have just given a talk on "Recent research on non-drug treatments for bipolar disorder" to the Lothian branch of "Bipolar Scotland".  There is a description of the first part of the talk at "Non-drug treatments for bipolar disorder (1st post) - the value of psychotherapy" and you can download the full sequence of slides here.  Points touched on in the second part of the talk are illustrated below:

Non-drug treatments for bipolar disorder (1st post) - the value of psychotherapy

I am due to give a talk for the Lothian branch of "Bipolar Scotland" on "Recent research on non-drug treatments for bipolar disorder".  Here is the downloadable Powerpoint presentation (with pictures removed to reduce the size of the file) and here is a slide illustrating the main points that I touch on:

Recent research: CBT for a variety of conditions – back pain, PTSD, obsessions, bipolar disorder, schemas & social anxiety

Here are six recent papers on CBT treatment for a variety of disorders - for fuller details, abstracts and links, see further down this page.  Lamb et al explored the value of "Group cognitive behavioural treatment for low-back pain in primary care".  That their results were reported in the Lancet, highlights the importance of their findings.  The active treatment group received an additional assessment and then six 1.5 hour group therapy sessions (average group size, eight participants).  Therapy focused on "guided discovery, identifying and countering negative automatic thoughts, pacing, graded activity, relaxation, and other skills."   Outcomes demonstrated that "Over 1 year, the cognitive behavioural intervention had a sustained effect on troublesome subacute and chronic low-back pain at a low cost to the health-care provider."

Handouts & questionnaires for outcome tracking: depression, mania, side-effects, anxiety, worry, alcohol, sleep, gambling & more

Well, well, well ... what a lot of amazing information there is out there on the internet.  I was trawling to try to find the copyright position of the Panic Disorder Severity Scale (more on this soon in a future post) when I tumbled into Mark Zimmerman's "Outcome Tracker" website.  Mark is "Associate Professor of Psychiatry and Human Behavior at Brown University, the Director of Outpatient Psychiatry at Rhode Island Hospital, and Principal Investigator of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project."

Recent research: free June edition of "Clinical Psychology: Science and Practice" focuses on bipolar disorder

The June edition of the journal "Clinical psychology: science and practice"  focused on bipolar disorder.  This is very valuable and the fact that all the articles are freely viewable in full text makes the publication even more helpful.  As Youngstrom & Kendall write in their introductory article (see below) "Knowledge about bipolar disorder is rapidly advancing. One consequence is that current evidence about the diagnostic definitions, prevalence, phenomenology, associated features and underlying processes, risk factors and predictors, and assessment or treatment strategies for bipolar disorder is often markedly different than the conventional wisdom reflected even in recent textbooks and clinical training."  Karam & Fayyad (see below for all articles mentioned, with abstracts and links) discuss diagnosis and the boundaries of the bipolar spectrum.  Merikangas & Pato review recent research on bipolar epidemiology and write "During the past decade, there has been increasing recognition of the dramatic personal and societal impact of bipolar disorder I and II (DSM-IV).

Recent research: six studies on prevalence of depression & anxiety, and risk factors for depression, bipolar disorder & suicide

Here are a couple of studies on the prevalence of depression and anxiety, and four on risk factors for depression, bipolar disorder and suicide.  Strine et al report on a major survey of depression and anxiety in the United States.  They found "The overall prevalence of current depressive symptoms was 8.7% (range by state and territory, 5.3%-13.7%); of a lifetime diagnosis of depression, 15.7% (range, 6.8%-21.3%); and of a lifetime diagnosis of anxiety, 11.3% (range, 5.4%-17.2%)."  Smoking, lack of exercise, and excessive drinking were all associated with increased likelihood of mental disorders, as too was physical ill health.  Young et al, in a separate study, looked at the likelihood of depression and anxiety becoming persistent.  They estimated - at nearly 3 year follow-up - that the US prevalence of persistent depressive or anxiety disorder was 4.7%.  Only about a quarter of these sufferers were using appropriate medication and only about a fifth appropriate counselling.

Recent research: six studies on depression – bereavement, pregnancy, bipolar disorder, suicide, & stress in hospital staff

Five of these six studies are from last month's American Journal of Psychiatry.  Kendler et al discuss the many similarities and only occasional differences between bereavement-related and other life event-related depression - an issue explored further in Maj's editorial.  Li et al show that depression in pregnancy (exacerbated further by stressful life events and obesity) increases the risk of preterm delivery.  Miklowitz reviews research on the value of adjunctive psychotherapy for bipolar disorder sufferers (already taking medication) and discusses the various ways it can be helpful.  Oquendo et al (in a freely viewable editorial) argue that suicidal behaviour should be placed on a "separate axis" in the next version of the DSM diagnostic system.  Finally Vertanen et al, in an interesting study, demonstrate that increased hospital overcrowding - measured by bed occupancy rates - is associated with increased use of antidepressants by hospital staff.

Kendler, K. S., J. Myers, et al. (2008). "Does Bereavement-Related Major Depression Differ From Major Depression Associated With Other Stressful Life Events?" Am J Psychiatry 165(11): 1449-1455.  [Abstract/Full Text]  

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