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22 results

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  • The Diagnosis and Work-Up of Insomnia

  • John W. Winkelman
  • Journal:
    CNS Spectrums / Volume 14 / Issue S13 / December 2009
    Published online by Cambridge University Press:
    07 November 2014, pp. 4-6

  • Most adults have difficulty sleeping at some time in their lives, with problems falling asleep, staying asleep, or having nonrestorative sleep. When these symptoms continue for ≥1 month and are associated with daytime dysfunction or distress, they reach the status of an insomnia disorder. Roughly 10% of adults in the United States have an insomnia disorder (hereafter referred to as insomnia), ie, that which is present on most nights and lasts ≥4 weeks. Insomnia can be primary, in which the sleep disturbance exists in the absence of co-existing medical or psychiatric disorders, or comorbid, when it is accompanied by one of these disorders.

    Although a diagnosis of insomnia requires difficulty with sleep, insomnia is a 24-hour disorder. Individuals with insomnia describe difficulties with concentration, fatigue, and mood, which both influence, and are influenced by, the sleep disturbance. In addition, insomnia is associated with a substantially elevated risk of incident major depressive disorder (MDD), panic disorder, and substance abuse disorders. There is also emerging evidence that insomnia increases the risk for incident hypertension and diabetes.

  • The Relationship Between Attachment Style, Anxiety Sensitivity and Interpretive Bias Among Adolescent Nonclinical Panickers

  • David W. Austin, Rachel S. Jamieson, Jeffrey C. Richards, John Winkelman
  • Journal:
    Behaviour Change / Volume 23 / Issue 1 / 01 March 2006
    Published online by Cambridge University Press:
    22 February 2012, pp. 31-41

  • Elevated anxiety sensitivity and the tendency to catastrophically misinterpret ambiguous bodily sensations has been demonstrated in people who experience nonclinical levels of panic (Richards, Austin, & Alvarenga, 2001), and anxiety sensitivity has been shown to be associated with insecure attachment in adolescents and young adults (Weems, Berman, Silverman, & Saavedra, 2001). This study investigated the relationship between attachment style, anxiety sensitivity and catastrophic misinterpretation among 11 nonclinical panickers and 58 nonanxious controls aged 18 to 19 years. Participants completed the Brief Bodily Sensations Interpretation Questionnaire (BBSIQ), Anxiety Sensitivity Index (ASI) and an attachment questionnaire. The hypothesis that insecurely attached individuals would demonstrate greater catastrophic misinterpretation and higher anxiety sensitivity than securely attached individuals was not supported; however, nonclinical panickers gave more anxiety-related interpretations of ambiguous internal stimuli than nonanxious controls. Results do not support the notion that attachment style is related to anxiety sensitivity or catastrophic misinterpretation (regardless of panic experience). Results do, however, support the notion that anxiety-related misinterpretation of ambiguous somatic sensations precedes the onset of panic disorder.

Foundations of Psychiatric Sleep Medicine
  • Edited by John W. Winkelman, David T. Plante
  • Published online:
    01 June 2011
    Print publication:
    23 December 2010
  • Sleep-related complaints are extremely common across the spectrum of psychiatric illness. Accurate diagnosis and management of sleep disturbances requires an understanding of the neurobiological mechanisms underlying sleep and wakefulness, the characteristics of sleep disturbance inherent to psychiatric illness and primary sleep disorders, as well as the psychopharmacologic and behavioral treatments available. Foundations of Psychiatric Sleep Medicine provides a uniquely accessible, practical, and expert summary of current clinical concepts at the sleep-psychiatry interface. Topics covered include: basic principles in sleep science, clinical sleep history taking, primary sleep disorders in psychiatric contexts, and sleep disturbance across a range of mood, anxiety, psychotic, substance use, cognitive and developmental disorders. Written by outstanding experts in the field of sleep medicine and psychiatry, this academically rigorous and clinically useful text is an essential resource for psychiatrists, psychologists and other health professionals interested in the relationship between sleep and mental illness.

  • Chapter 16 - Bipolar disorder

  • from Section VI - Sleep Disturbance in Psychiatric Illness
  • Edited by John W. Winkelman, David T. Plante, University of Wisconsin, Madison
  • Book:
    Foundations of Psychiatric Sleep Medicine
    Published online:
    01 June 2011
    Print publication:
    23 December 2010, pp 266-285

  • Summary

    Sleep disturbance has long been recognized as an essential aspect of bipolar disorder. The relationship between sleep and the manic phase of bipolar illness involves the following aspects: decreased need for sleep is a marker of mania; sleep deprivation can induce mania; sleep duration may predict manic episodes; and sleep time may be a marker of response in mania. Although less is known about sleep disturbance in bipolar as compared to unipolar depression, this chapter highlights the phenomenology of sleep in bipolar depression and the potential of sleep deprivation as a theraputic strategy in the depressive phase of bipolar illness. Euthymia, the absence of mood symptoms sufficient to warrant the diagnosis of a depressive, hypomanic, or manic episode, is the goal of treatment of bipolar disorder. It has long been appreciated that bipolar disorder tends to run in families, suggesting it is a heritable disorder.

  • Chapter 24 - The future at the sleep–psychiatry interface

  • from Section VII - Future Directions
  • Edited by John W. Winkelman, David T. Plante, University of Wisconsin, Madison
  • Book:
    Foundations of Psychiatric Sleep Medicine
    Published online:
    01 June 2011
    Print publication:
    23 December 2010, pp 387-397

  • Summary

    This chapter discusses future clinical and research directions in psychiatric sleep medicine. Older models in which sleep complaints were assumed to be caused by an underlying psychiatric disorder are insufficient to explain the more complex interrelationships between sleep and mental illness. Pharmacotherapies at the nexus of sleep medicine and psychiatry are slowly moving from agents discovered largely through serendipity to those developed using translational approaches due to an enhanced understanding of the processes involved in the regulation of sleep and the pathophysiology of sleep disorders. One of the greatest challenges faced at the interface of psychiatry and sleep medicine is the need for communication between the fields of addiction, eating disorder, and obesity research. Without a common language to classify sleep disorder, it becomes a significant challenge to communicate findings from one field to researchers in the other.

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