Tuesday, July 6, 2010

Treating insomnia in women

Vithyalakshmi Selvaraj, MD,
PGY-4 resident, Department of psychiatry, Creighton University, Omaha, NE

Sriram Ramaswamy, MD,
Assistant professor, Department of psychiatry, Creighton University, Omaha, NE

Daniel R. Wilson, MD, PhD,
Professor and chair of psychiatry, Department of psychiatry, Creighton University, Omaha, NE

Compared with men, women have a 1.3- to 1.8-fold greater risk for developing insomnia. Multiple factors contribute to this increased risk of insomnia, including:
  • hormonal changes across the reproductive cycle
  • predilection to mood and anxiety disorders
  • psychosocial factors, such as being single, separated, or widowed.
Furthermore, the higher prevalence of psychiatric disorders during the reproductive stages may confer additional risk for sleep problems.

Insomnia has tremendous impact on health and quality of life, resulting in reduced work productivity and increased absenteeism, accidents, and health care costs. This article examines the factors that contribute to women’s sleep difficulties throughout the life cycle, and suggests evaluation and treatment approaches appropriate for each phase.

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Cholesterol, mood, and vascular health

Jess G. Fiedorowicz, MD, MS,
Assistant professor, Departments of psychiatry and epidemiology, Roy A. and Lucille J. Carver College of Medicine, College of Public Health, University of Iowa, Iowa City, IA

William G. Haynes, MD,
Professor, Department of internal medicine, Institute for Clinical and Translational Science, Roy A. and Lucille J. Carver College of Medicine, University of Iowa, Iowa City, IA

Does low cholesterol predispose to depression and suicide, or vice versa? A growing body of literature examining the putative links among cholesterol, mood disorders, and suicide has produced inconsistent findings and unclear clinical implications that may leave psychiatrists unsure of how to interpret the data. Understanding cholesterol’s role in mood disorders may be relevant to the 2 primary causes of excess deaths in patients with mood disorders: suicide and vascular disease health.

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Psychiatric futurology

Henry A. Nasrallah, MD


Few things capture the imagination like the future. I recall how after reading Alvin Toffler’s seminal book Future Shock in college, I was fascinated by how the future could change us as people and as a culture.

During medical school and psychiatric residency, the breathless pace of scientific discoveries—especially in neuroscience—prompted me to dream about the potentially stunning medical breakthroughs of the future. My frustrations about severe, disabling psychiatric brain disorders were tempered by hope that tomorrow will unfold new knowledge that will unravel the dark mysteries of psychotic delusions, obsessive-compulsive disorder (OCD) rituals, intractable narcissism, suicidal urges, and homicidal impulses. The future, I frequently mused, will provide all answers for definitive diagnoses, effective treatments, prevention, and cures for all psychiatric disorders.

Hope for restoring wellness for our suffering patients continues to sustain me and my fellow psychiatrists. The ongoing gush of neuroscience advances that elucidate the divine details of brain and mind continue to inspire us. However, we are getting impatient with the slow translation of groundbreaking basic science discoveries into new and dramatic clinical applications for our long-suffering patients. A collective mantra is building up: We want our future and we want it now!

Evolving advances are lurking in our future, some of which already are palpable and we hope may soon become clinical realities