OBJECTIVES: This study aimed to evaluate the clinical efficacy of individual cognitive behavioral therapy (CBT) for Patients with Primary or Secondary Insomnia. METHODS: Participants were recruited from a primary care sleep clinic from January 2008 to June 2009. The study sample included 64 outpatients with primary insomnia (n=30) and secondary insomnia (n=34) according to the criteria of DSM-IV. Participants completed sleep diaries, Dysfunctional Beliefs and Attitudes about Sleep Scale-16 (DBAS), State-Trait Anxiety Inventory (STAI) before CBT and shortly after completion of CBT. CBT was provided in 7 weekly, 40-50-minute individual therapy sessions. RESULTS: Both groups of patients with primary and secondary insomnia showed significant improvement in the DBAS and sleep parameters including sleep onset latency, total sleep time, and sleep efficiency. Repeated-measures ANOVA of the DBAS and sleep parameters showed no significant group-by-time interactions between patients with primary and secondary insomnia, suggesting the efficacy of CBT for patients with secondary insomnia was equivalent to that of CBT for patients with primary insomnia. CONCLUSION: This study suggests that CBT is effective for the management of primary and secondary insomnia in a primary care setting.
Anxiety ; Cognitive Therapy ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Outpatients ; Primary Health Care ; Sleep Initiation and Maintenance Disorders

OBJECTIVES: Shift work is a stressful situation. It is important to know the factors associated with the ability to adapt to a shift work schedule. The aim of the present study was to investigate the association between sleep, as well as personality variables, and the resilience of shift work nurses. METHOD: Self-report questionnaires were administered to 95 nurses who worked in one national university hospital. Connor-Davidson resilience scale, hospital anxiety and depression scale, morningness-eveningness scale, Pittsburgh sleep quality index, other sleep-related questionnaires, and Korean defense style questionnaires were used. RESULTS: Age, shift work duration, off-day oversleep, depression, anxiety, adaptive defense style, and self-suppressive defense style were significantly associated with resilience (p < 0.05). Multiple regression analysis showed that age (beta = 0.34, p < 0.05), depression (beta = -0.25, p < 0.05), adaptive defense style (beta = 0.45, p < 0.001), and self-suppressive defense style (beta = -0.19, p < 0.05) significantly predicted the resilience of shift work nurses. Concerning individual defense mechanisms, resignation (beta = -0.20, p < 0.05), sublimation (beta = 0.19, p < 0.05), omnipotence (beta = 0.19, p < 0.05), and humor (beta = 0.20, p < 0.05) significantly predicted the resiliency. CONCLUSION: The findings indicate that a specific defense style and other mechanisms were associated with the resilience of shift work nurses. A future prospective study with more participants could further clarify the relationship between sleep-related variables, as well as personality factors, and resilience of shift work nurses.
Anxiety ; Appointments and Schedules ; Defense Mechanisms ; Depression ; Surveys and Questionnaires ; Sublimation

OBJECTIVE: The pharmacotherapy of bipolar disorder not otherwise specified (BP-NOS) has been insufficiently studied. The aim of this prospective naturalistic study was to explore the effectiveness of lamotrigine adjunctive treatment in patients with BP-NOS. METHODS: Data from 50 patients diagnosed with BP-NOS were analyzed. On the basis of the prospective mood chart methodology, the efficacy of lamotrigine adjunctive treatment was assessed by changes in the mean Clinical Global Impressions-Bipolar Version (CGI-BP) depression scores. A paired t-test was used to test the statistical significance of the changes in CGI-BP depression scores. Repeated-measures analysis of variance (RM ANOVA) with simple effect analysis was performed to explore the sequential changes during a 52-week period. Cohen's d was calculated to measure the magnitude of the treatment effects on the changes in depression severity. Time to lamotrigine discontinuation was also calculated using the Kaplan-Meier estimates. Lamotrigine-associated adverse events were monitored every two weeks. RESULTS: A significant decrease, with a large effect size (Cohen's d=1.6), in the mean CGI-BP depression scores was associated with lamotrigine adjunctive treatment in intent-to-treat analysis (t=8.7, df=49, p<0.001). Twenty-four patients (48.0%) completed 52-week lamotrigine adjunctive treatment. Analysis of the data obtained from those completing the treatment revealed a large effect (Cohen's d=4.0) on improvement in the severity of depression (t=16.8, df=32, p<0.001). Sixty percent of patients achieved remission (n=30), and 64% of patients (n=32) showed some clinical response to lamotrigine adjunctive treatment. The mean time to lamotrigine discontinuation was 31.3+/-3.1 weeks (CI=25.2-37.4). Lamotrigine adjunctive treatment was well tolerated, with no serious rashes reported. CONCLUSION: Lamotrigine seems to be effective in the management of depressive symptoms in BP-NOS. Long-term use of lamotrigine was generally safe and well tolerated. Large-scale controlled trials might be needed to confirm the findings of this naturalistic study.
Bipolar Disorder ; Depression ; Exanthema ; Humans ; Prospective Studies ; Triazines

Good sleepers tend to more resilient than poor sleepers. As sleep and resilience may have a bidirectional relationship, it is important to explore the relationship between healthy sleep and resilience. Objectively and subjectively measured sleep quality showed positive association with resiliency. In one study, more resilient adolescents had higher sleep efficiency, less light sleep, more slow-wave sleep, and a smaller number of awakenings after sleep onset. Circadian typology, jetlag and circadian misalignment may be associated with the capacity to deal with adversity. Eveningness, exposure to chronic jetlag and circadian misalignment might be risk factors for development of psychological problems and mental disorders. Additional studies are needed to evaluate whether promoting healthy sleep behaviors results in increased resilience.
Adolescent ; Circadian Rhythm ; Humans ; Jet Lag Syndrome ; Mental Disorders ; Mental Health ; Risk Factors

OBJECTIVES: Suicide is one of the leading causes of death among young adults. We investigated whether anxiety level and sleep quality were related to suicide ideation among university students. METHODS: Questionnaires were distributed to 1094 students at a local college. The scale for suicide Ideation, the Hospital Anxiety-Depression scale, the Pittsburgh Sleep Quality Index, and Morningness-eveningness questionnaires were used. Multiple linear regression analysis was conducted to examine the relationship between these variables and suicide ideation. RESULTS: Among the 292 students who answered the suicide ideation questionnaire, 31 students had a high suicide ideation score and 261 patients had a low suicide ideation score. Demographic variables that showed significant differences between the two groups were gender, exercise, chronotype, sleep quality, depression and anxiety. The results of multiple linear regression analysis showed that suicidal ideation increased as the level of sleep quality decreased. There was no significant relationship between depression and suicidal ideation. Another multiple linear regression analysis was performed to evaluate the relationship between sleep quality sleep related factors. This suggested the quality of sleep decreased as weekend oversleep increased. CONCLUSION: The results of this study showed that when anxiety was higher and the quality of sleep was lower, the more suicide ideation increased. Therefore, improving sleep quality and reducing anxiety are important strategies for reducing suicidal ideation.
Anxiety* ; Cause of Death ; Depression ; Humans ; Linear Models ; Suicidal Ideation* ; Suicide ; Young Adult

OBJECTIVE: Bipolar disorder (BD) is characterized by elevated impulsivity, even during periods of remission. Many recovered BD patients have functional impairments, which can lead to poor quality of life (QoL). The aim of this study was to investigate the association between impulsivity and QoL in euthymic BD patients. METHODS: A total of 56 remitted or recovered patients with type I or II BD, diagnosed based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, were recruited. Psychiatrists administered the Clinical Global Impression (CGI) for BD and the Global Assessment of Functioning (GAF) scales and then interviewed the subjects to assess clinical variables. Patients completed the Barratt Impulsiveness Scale (BIS-11) and the World Health Organization Quality of Life Assessment Instrument-Brief Form (WHOQoL-BREF). Pearson correlations, univariate regression analyses, and multiple linear regression analyses were performed. RESULTS: The BIS-11 total score was significantly correlated with the WHOQoL-BREF total score (r=-0.55, p<0.01) and with the WHOQoL-BREF subscales. After controlling for GAF score and other clinical variables, the BIS-11 total score (beta=-0.43, p=0.001) was independently associated with overall QoL. Additionally, the BIS-11 total score was particularly strongly associated with the physical, psychological, and social domains of the multi-dimensional QoL scale. CONCLUSION: Our results suggest that high impulsivity is related to low QoL in euthymic BD patients. Further studies are needed to examine whether interventions for high impulsivity effectively improve QoL in patients with BD.
Impulsive Behavior ; Bipolar Disorder* ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Linear Models ; Psychiatry ; Quality of Life* ; Weights and Measures ; World Health Organization

OBJECTIVE: The current study explored the relationship between the polarity of the first episode and the timing of eventual diagnosis of bipolar I disorder, and associated clinical implications. METHODS: Twelve years of clinical data from the medical records of 258 inpatients meeting DSM-III-R or DSM-IV criteria for bipolar I disorder were analyzed. Subjects were divided into two groups according to the polarity of the first episode: those with depressive polarity (FE-D), and those with manic polarity (FE-M). Comparisons were made between the two groups on variables associated with the timing of diagnosis and related outcomes. RESULTS: In population with bipolar I disorder, a significant longer time lapse from the first major mood episode to the confirmed diagnosis was associated with the FE-D group compared to the FE-M group [5.6 (+/-6.1) vs. 2.5 (+/-5.5) years, p<0.001]. FE-D subjects tended to have prior diagnoses of schizophrenia and major depressive disorder while FE-M subjects tended to have prior diagnoses of bipolar disorder and schizophrenia. A significantly higher rate of suicide attempts was associated with the FE-D group compared to the FE-M group (12.7 vs. 1.7%, p<0.001). CONCLUSION: The results of this study indicate that first-episode depressive polarity is likely to be followed by a considerable delay until an eventual confirmed diagnosis of bipolar I disorder. Given that first-episode depressive patients are particularly vulnerable to unfavorable clinical outcomes such as suicide attempts, a more systematic approach is needed to differentiate bipolar disorder among depressed patients in their early stages.
Bipolar Disorder ; Depressive Disorder, Major ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Inpatients ; Medical Records ; Schizophrenia ; Suicide

OBJECTIVE: This study investigated whether the resilience of males with probable bipolar depression (PBD) can be strengthened and compared it to that of males with probable unipolar depression (PUD). METHODS: Prospective data for 198 participants (PBD: 66, PUD: 66, normal control: 66) were analyzed. The participants' resilience, bipolarity and severity of depressive symptoms were evaluated at baseline and after 5 weeks. Analysis of variance (ANOVA) and repeated measure ANOVA was performed for comparing resilience between three groups through a basic military training. RESULTS: The PBD group demonstrated more resilience than the PUD group at baseline. Participants with PBD became significantly more resilient than participants with PUD after 5 weeks (p<0.01, F=6.967, η²(p)=0.052). CONCLUSION: The study indicates that interventions that strengthen resilience need to be developed for males with PBD and that such interventions are more effective for males with PBD than PUD.
Bipolar Disorder* ; Depression ; Depressive Disorder* ; Humans ; Male* ; Military Personnel ; Prospective Studies

OBJECTIVES: Despite the increased popularity of highly caffeinated beverages, there is little research examining psychiatric adverse effects. The purpose of this study was to investigate the relationships among pattern of highly caffeinated beverage intake and depressive symptom, suicidal ideation, suicidal plan, suicidal attempt in Korean adolescents. METHODS: The data was obtained from the 2014 Korean Youth's Risk Behavior Web-based Study by Korea Centers for Disease Control & Prevention. All participants conducted web-based questionnaire survey. Chisquare test and multiple logistic regression analysis were performed to determine the association among highly caffeinated beverage intake pattern, depressive symptom, suicidal ideation, suicidal plan and suicidal attempt adjusting for differences in age, gender, academic achievement, socioeconomic status. RESULTS: A total of 71,638 participants were enrolled in this study. Depressive symptom, suicidal ideation, suicidal plan and suicidal attempt were significantly more frequent in the group with presence of highly caffeinated beverage intake within 1 week than in non-drinker group(p<0.01). Highly caffeinated beverage intake was significantly associated with suicidal attempt(OR=1.99 ; 95% CI, 1.77–2.22). In addition, depressive symptom, suicidal ideation, suicidal plan and suicidal attempt were significantly more common in the group with heavydrinker who exceed recommended daily intake dose of caffeine than in the group with light-drinker(p<0.01). Heavy drinking of caffeinated beverage was significantly associated with suicidal attempt(OR=4.05 ; 95% CI, 3.02–5.43). CONCLUSIONS: We found that highly caffeinated beverage intake was related to more frequent depressive symptom, suicidal ideation, plan, attempt in adolescents. Also, caffeine intake which exceed recommended daily intake dose identified the predictor of suicidal attempt. Our result suggested that clinicians need to be aware of the possible psychiatric adverse effects of highly caffeinated beverage in vulnerable population including young adolescents.
Adolescent* ; Beverages* ; Caffeine ; Centers for Disease Control and Prevention (U.S.) ; Depression* ; Drinking ; Humans ; Korea ; Logistic Models ; Recommended Dietary Allowances ; Risk-Taking ; Social Class ; Suicidal Ideation ; Suicide* ; Vulnerable Populations

OBJECTIVES: We investigated whether sleep behaviors, severity of insomnia and circadian typology are associated with quality of life among Gyeongsang National University (GNU) medical students. METHODS: Questionnaires were distributed to 46 fourth-year students of GNU Medical School. The hospital anxiety-depression scale, insomnia severity index (ISI), morningness-eveningness questionnaire (MEQ) and WHO Quality of Life-BREF (WHOQOL-BREF) were used. RESULTS: Quality of life in terms of physical health was associated with age, weekday total sleep time (TST), weekend TST, catch up sleep, depression, ISI score, and MEQ score. Quality of life in terms of psychological health was correlated to weekday and weekend TST, anxiety, ISI score and MEQ score. Sex, weekday TST, depression, and ISI score were revealed to influence the social aspect of quality of life, and weekday and weekend TST, and ISI score were associated with quality of life in terms of environment. Multiple regression analysis showed that better sleep quality predicted to a higher quality of life in terms of physical, psychological and environmental health, and eveningness was associated with a better quality of life in terms of physical and psychological health. CONCLUSION: It is concluded that physical, psychological, and environmental aspects of quality of life were associated with quality of sleep and that physical and psychological aspects of quality of life were related to eveningness in GNU medical students. Therefore, it is equally important to treat emotional problem as well as improve sleep quality.
Anxiety ; Circadian Rhythm ; Depression ; Environmental Health ; Humans ; Quality of Life* ; Schools, Medical ; Sleep Initiation and Maintenance Disorders ; Students, Medical*