Poor sleep at baseline predicts worse mood outcomes in patients with co-occurring bipolar disorder and substance dependence

The Impact of Qigong and Tai Chi Exercise on Drug Addiction: A Systematic Review and Meta-Analysis

BACKGROUND

Previous preliminary studies have found that qigong exercises produced significant effects in healthy people and in various clinical populations. The purpose of this study was to systematically review the effects of qigong and tai chi exercise on individuals with drug addiction.

METHODS

A systematic search of seven English databases and three Chinese databases was conducted to identify randomized controlled trials (RCTs) and non-randomized comparative studies (NRS) assessing the effects of qigong and tai chi on drug addiction. Study quality was assessed using the Checklist for the Evaluation of Non-Pharmaceutical Trial Reports (CLEAR-NPT).

RESULTS

Two RCTs and nine NRS studies were included in this study, including a total of 1072 patients with drug addiction (age range, 27-43 years). The results showed that qigong and tai chi exercise had a significant overall effect on depression (SMD = -0.353, 95%CI [-0.548, -0.159]), anxiety (SMD = -0.541, 95%CI [-0.818, -0.264]), quality of life (SMD = 0.673, 95%CI [0.438, 0.907]), and sleep quality (SMD = -0.373, 95%CI [-0.631, -0.116]). The subgroup analysis found that qigong outperformed tai chi on the improving depression, anxiety, and sleep quality.

CONCLUSION

Existing studies suggest that qigong and tai chi are effective at improving depression, anxiety, and quality of life in drug users; however, the evidence from rigorous randomized controlled group trials is lacking.

Client-Therapist Convergence on Sleep Difficulty and its Impact on Treatment Outcomes

While agreement between clients and their clinicians on therapy goals has frequently been investigated as a process-level variable (i.e., working alliance), dyadic convergence on presenting concerns is also important for initial case formulation. Transdiagnostic presenting problems, like sleep difficulty, pose a particular challenge for client-therapist convergence. The current study describes sleep difficulty in a treatment-seeking college population and investigates the impact of client and therapist baseline sleep problem reports on therapy outcomes.

Data were collected through a large practice research network, with the sample comprising 47,023 clients from 99 university counseling centers across the United States.

A larger proportion of clients (49.3%) had self-reported high baseline sleep difficulty than those with a clinician-identified sleep concern (16.0%). Clients with baseline sleep difficulty were more likely to end treatment with greater self-reported sleep difficulty and psychological symptom distress, although they may experience larger gross symptom change than clients without baseline sleep difficulty. Clinician-identified sleep concerns were significantly associated with client outcomes, particularly when clients did not report baseline sleep difficulty themselves.

Findings from this study suggest that it may be efficacious and efficient with limited time for treatment to address sleep concerns in a college setting.

Clinicians' attendance to their clients' transdiagnostic presenting concerns, like sleep difficulty, may increase clients' own awareness of problematic patterns of behavior. When time for therapy is short, as is often the case in college counseling, it may be efficient to prioritize these concerns with the potential to impact a broad range of symptoms.

Molecular Mechanism of Neuroprotective Effect of Melatonin on Morphine Addiction and Analgesic Tolerance: an Update

Drug addiction is a global health problem and continues to place an enormous financial burden on society. This addiction is characterized by drug dependence sensitization and craving. Morphine has been widely used for pain relief, but chronic administration of morphine causes analgesic tolerance, hyperalgesia, and addiction, all of which limit its clinical usage. Alterations of multiple molecular pathways have been reported to be involved in the development of drug addiction, including mitochondrial dysfunction, excessive oxidative stress and nitric oxide stress, and increased levels of apoptosis, autophagy, and neuroinflammation. Preclinical and clinical studies have shown that the co-administration of melatonin with morphine leads to a reversal of these affected pathways. In addition, murine models have shown that melatonin improves morphine-induced analgesic tolerance and addictive behaviors, such as behavioral sensitization, reward effect, and physical dependence. In this review, we attempt to summarize the recent findings about the beneficial effect and molecular mechanism of melatonin on mitochondrial dysfunction, uncontrolled autophagy, and neuroinflammation in morphine addiction and morphine analgesic tolerance. We propose that melatonin might be a useful supplement in the treatment opiate abuse.

Perceived cognitive failures and quality of life for older adults with bipolar disorder

BACKGROUND

Older adults with bipolar disorder (BD) commonly present with cognitive deficits (e.g., attention, memory, verbal fluency). Concomitantly, older adults with BD commonly report subjective or perceived cognitive failures. For this study, we confirmed a 3-factor model of cognitive failures first validated with older adults free of mental illness (i.e., forgetfulness, distractibility, false triggering). We then computed a structural equation model (SEM) demonstrating the construct validity of perceived cognitive errors in relation to quality of life with BD. Use of SEM enabled us to measure quality of life broadly and germane to BD (i.e., well-being, life satisfaction, alcohol misuse, sleep quality).

METHODS

We obtained responses from an international sample of 350 older adults with BD (M = 61.26 years of age, range 50-87), recruited via micro-targeted social media advertising. Most lived in Canada, the U.S., U.K., Ireland, Australia and South Africa.

RESULTS

As hypothesized, perceived cognitive failures were predicted by BD symptoms (depression and hypo/mania). And cognitive failures directly and indirectly predicted quality of life.

LIMITATIONS

Future research is needed to replicate this QoL model over time with younger patients and those recruited using more traditional methods.

CONCLUSIONS

Perceived cognitive failures may not be strongly correlated with objective indices of cognitive deficits; nonetheless perceived cognitive failures are significantly associated with quality of life for older adults with BD. For both cognitive errors and BD symptoms, their indirect effect on quality of life (via suicide ideation) is greater than the direct effect.

Lifetime Methamphetamine Use Disorder and Reported Sleep Quality in Adults Living with HIV

This study evaluated whether a history of lifetime methamphetamine (MA) use disorder increases risk for poor sleep quality in people with or without HIV infection (HIV+/HIV-). Participants (n = 313) were stratified into four groups based on HIV status and lifetime MA use disorder diagnosis [HIV+/MA+ (n = 84); HIV+/MA- (n = 141); HIV-/MA+ (n = 16); and HIV-/MA- (n = 72)] and compared on global sleep outcomes using the Pittsburgh Sleep Quality Index (PSQI). Significant differences on global sleep were observed between HIV+/MA+ and HIV+/MA- groups, but not between the HIV- groups. Follow-up multiple regression analyses within the HIV+ subgroups examined global sleep scores as a function of MA status and clinical covariates, including those related to HIV disease and demographics. HIV+ individuals with a history of MA use disorder evidenced significantly poorer sleep quality and were more likely to be classified as problematic sleepers than those without a lifetime disorder. This was independent of depressed mood, body mass index, and viral suppression while on treatment. Poorer reported sleep quality among HIV+/MA+ was associated also with multiple adverse functional outcomes, including greater objective cognitive impairment, unemployment, clinical ratings of functional impairment, and self-reported cognitive difficulties, decreased independence in activities of daily living, and poorer overall life quality. Interventions to avoid or curtail MA use in HIV+ individuals may help protect sleep quality and improve functioning.

Shorter and longer durations of sleep are associated with an increased twelve-month prevalence of psychiatric and substance use disorders: Findings from a nationally representative survey of US adults (NESARC-III)

The lack of comprehensive data on the association between psychiatric and substance use disorders and habitual sleep duration represents a major health information gap. This study examines the 12-month prevalence of mental disorders stratified by duration of sleep. Data were drawn from face-to-face interviews conducted in the National Epidemiologic Survey on Alcohol and Related Conditions III, a nationally representative survey of US adults (N = 36,309). There were 1893 (5.26%) participants who reported <5h of sleep/night; 2434(6.76%) 5 h/night; 7621(21.17%) 6 h/night; 9620(26.72%) 7 h/night; 11,186(31.07%) 8 h/night, and 3245(9.01%) ≥9 h/night. A U-shaped association was observed between sleep duration and all mental disorders. The prevalence of mental disorders was 55% for individuals with <5 h/night and 47.81% for ≥9 h/night, versus 28.24% for the 7 h/night (aOR = 1.90 and 1.39 respectively). The greatest odds ratios were for the <5 h/night group, with an increased risk above 3-fold for panic disorder (PD), post-traumatic stress disorder (PTSD), psychotic disorder, and suicide attempt; between 2 and 3 fold for major depressive disorder (MDD), bipolar disorder (BD), and generalized anxiety disorder (GAD); and between 1 and 2 fold for tobacco and drug use disorders, specific and social phobias. The ≥9 h/night group had an increased risk above 1 to 2-fold regarding tobacco and drug use disorders, MDD, BD, PD, social phobia, GAD, PTSD, psychotic disorder, and suicide attempt. U-shaped associations exist between sleep duration and mental disorders, calling for respect to recommendations for adequate sleep duration in routine clinical care as well as to actions for primary prevention in public health settings.

Shuangxia decoction alleviates p-chlorophenylalanine induced insomnia through the modification of serotonergic and immune system

As a Traditional Chinese Medicine (TCM), Shuangxia Decoction (SXD) has been used to treat insomnia in oriental countries for more than thousands of years and it presents remarkable clinical effects. However, its active pharmacological fraction and the mechanism of sedative-hypnotic effects have not been explored. In this paper, we investigated active pharmacological fraction and revealed the detailed mechanisms underlying the sedative-hypnotic effects of SXD. It showed that SXD water extract compared to ethanol extract possessed better sedative effects on locomotion activity in normal mice and increased sleep duration in subhypnotic dose of sodium pentobarbital-treated mice. SXD alleviated p-chlorophenylalanine (PCPA) -induced insomnia by increasing the content of 5-HT in cortex [F (4, 55) = 12.67], decreasing the content of dopamine (DA) and norepinephrine (NE). Furthermore, SXD enhanced the expression of 5-HT_1A and 5-HT_2A receptors in hypothalamic and reduced serum levels of IL-1,TNF-α [F (5, 36) = 15.58]. In conclusion, these results indicated that SXD produced beneficial sedative and hypnotic bioactivities mediated by regulating the serotonergic and immune system.

Long-Term Effects of Tai Chi Intervention on Sleep and Mental Health of Female Individuals With Dependence on Amphetamine-Type Stimulants

Previous studies provide evidence that Tai Chi (TC) can reduce the symptoms of sleep problems and be of benefit for the rehabilitation of substance abusers. In this study, we investigated if TC practice can improve sleep quality and mood of females who are dependent on amphetamine-type stimulant (ATS). Eighty subjects were randomly assigned to TC intervention and standard care (SC) for 6 months. We applied analysis of variance on repeated-measure with the year of drug dependence as the covariate to test the changes of the self-rated Pittsburg Sleep Quality Index (PSQI), Self-Rating Depression Scale (SDS), as well as fitness after 3 and 6 months. Relapse investigation was conducted by checking the database of China's National Surveillance System on Drug Abuse and that of the Shanghai Drug Control Committee's illicit drug dependents. Our investigation focused on the relapse of participants who had undergone and completed treatment in the Shanghai Mandatory Detoxification and Rehabilitation Center in 2015. The result showed that the PSQI scores of sleep duration [F_{(2, 92)} = 9.86], need for sleep medications [F_{(2, 92)} = 36.44] and daytime dysfunction [F_{(2, 92)} = 5.15] were found to have a significant difference by time × group interaction after 6 months. SDS showed no significant difference between the two groups; however, the score of SDS in TC decreased after 6-month intervention, and no changes were observed in SC. Pulse rate had significantly decreased in the TC group compared with the SC group after 6 months. 9.5% (4) ATS dependents in TC and 26.3% (10) ATS dependents in SC were found to have relapsed. Our result suggested that TC had positive effects on sleep quality, depression and fitness. Long-term study demonstrated that TC may be a cheap and potential supplementary treatment for ATS-dependent individuals. TC may also be considered as an alternative exercise to escalate abstinence for ATS-dependent females.

CLINICAL TRIAL REGISTRATION

ChiCTR-IPR-14005343 chictr. org.cn.

Sleep disturbances as predictors of prolonged exposure therapy effectiveness among veterans with PTSD

Sleep disturbances (SD) are pronounced in Veterans with posttraumatic stress disorder (PTSD). In clinical trials, SD have been shown to limit the effectiveness of evidence-based treatments for non-PTSD disorders. The purpose of this study was to investigate the relationships between pretreatment SD and the effectiveness of Prolonged Exposure (PE) therapy for Veterans with PTSD. Twenty-one Veterans completed the Pittsburgh Sleep Quality Index (PSQI) and the Clinician Administered PTSD Scale upon presenting to a PTSD specialty clinic. Veterans completed the PTSD Symptom Checklist-Civilian (PCL-C) at the initiation of PE and biweekly thereafter for the duration of treatment (96 total assessments). Correlations and hierarchical linear modeling were utilized to examine the potential impact of baseline sleep variables on the slope and magnitude of treatment outcomes. Higher PSQI total scores, and higher sleep latency and sleep medication use subscale scores were associated with higher PCL-C scores at baseline. Veterans evidenced significant reductions in PTSD symptoms during the course of the treatment study. Total PSQI scores and composites were not associated with reduced effectiveness of PE treatment or the slope of PTSD symptom changes. Sleep disturbances do not preclude Veterans from benefits derived from engagement in this gold standard PTSD intervention.

Bipolar disorder in Asia: Illness course and contributing factors

BACKGROUND

Epidemiological studies analysing the course of Bipolar Disorder (BD) are relatively rare in the Asian context, contributing to the uncertainty regarding the prevalent course patterns and factors influencing such patterns. The current review identifies the regional characteristics of BD course patterns and the associated factors.

METHODS

A review of the existing literature was done using 'PubMed' and 'Cochrane' databases which yielded 145 studies including those from all 48 Asian countries. Relevant discussions from the Western literature were incorporated.

RESULTS

Regional and cross-national studies reveal a mania-predominant course in BD in Asian countries. Prolonged depressive episodes and comorbid anxiety disorders worsen the course of BD-II. Certain risk factors such as the young age of onset and greater episode frequency are useful predictors of bipolar diatheses. Substance use disorder comorbidity is more prevalent in males whereas depression and suicidal behaviours are more frequent in females with BD. Comorbid anxiety and personality disorders also encumber the illness course. Logistic reasons and ignorance of side-effects were specifically associated with poor adherence. An 'eveningness' chronotype and poor sleep quality were associated with frequent recurrences. Seasonal patterns vary among men and women, especially for depressive episodes.

LIMITATIONS

The effects of treatment and childhood BD course features were not discussed.

CONCLUSIONS

There are region-specific characteristics in bipolar illness course and factors influencing such course patterns compared to the rest of the World. Future research from Asia shall attempt to study the neurobiological underpinnings of such characteristics and plan appropriate strategies to address the same.

Gan-Dan-Liang-Yi-Tang alleviates p-chlorophenylalanine-induced insomnia through modification of the serotonergic and immune system

Gan-Dan-Liang-Yi-Tang (GDLYT) is a Traditional Chinese Medicine that has been historically used for the treatment of insomnia. However, investigations into its pharmacological ingredients and the mechanism underlying its sedative and hypnotic effects remain limited. The present study reported the detailed mechanisms underlying the sedative and hypnotic effects of GDLYT. Kunming mice were administered GDLYT at various sub-hypnotic doses, which underwent sodium pentobarbital treatment test, pentetrazole induced convulsant studies and p-chlorophenylalanine (PCPA) induced insomnia model. Potentiated hypnotic and sedative effects in mice was studied, and also the changes in related neurotransmitter and immune factors were evaluated. The results suggested that GDLYT possessed weak sedative effects on pentetrazole-induced convulsive activity in normal mice at a dose of 1.3 mg/kg, with an increase in sleep onset in subhypnotic dose of sodium pentobarbital-treated mice. GDLYT was also able to alleviate insomnia induced by PCPA in the rodent models, and increased 5-hydroxytryptamine levels in the prefrontal cortex, hippocampus, hypothalamus and corpus striatum of PCPA-treated rats. Furthermore, the hypnotic effects of GDLYT were modified, which allowed for PCPA-induced immune system changes, including increased interleukin (IL)-1β, tumor necrosis factor-α and IL-2 expression levels. The results of the present study indicated that GDLYT induced sedative and hypnotic bioactivity by regulating serotonergic activity in the central nervous system and immune system.

Review: psychiatric and medical consequences of disordered sleep

OBJECTIVES

The aim of this article is to draw attention to the clinical importance of disordered sleep in psychiatry and to demonstrate the growing awareness of medical illness as a complication of disordered sleep. As background to these main objectives, some general points are made to illustrate present-day approaches to the common and often serious problem of sleep disturbance.

METHODS

The review is based on a literature search from which key publications were selected to illustrate, in turn, main connections between disordered sleep and psychiatric and medical conditions.

RESULTS

Many such connections are described. Throughout psychiatry, regarding patients whatever their age, these connections have implications for clinical assessment and management. Emphasis is placed on the risk of misdiagnosis of sleep disorders as psychiatric or medical conditions. Examples of this are provided. The growing evidence that disordered sleep can predispose to medical illness is discussed.

CONCLUSION

As the subject of sleep and its disorders is particular relevant in psychiatry, a working knowledge of modern sleep medicine is important in all branches of psychiatric and other medical practice as well as in clinical research.

Sleeping problems in Chinese illicit drug dependent subjects

BACKGROUND

Illicit drug use/dependence has been recognized as a major problem. Clinical studies demonstrate that poor sleep quality is associated with increased frequency of drug use and relapse. However, few studies have addressed the issue of sleep quality among illicit drug dependent subjects.

METHODS

This cross-sectional study explored sleep quality in drug dependent subjects in China. We studied 2178 illicit drug dependent subjects from drug rehabilitation centres in Changsha and 2236 non-drug-using subjects, all of whom completed the self-report Pittsburgh Sleep Quality Index (PSQI).

RESULTS

We found that the prevalence of sleep disturbance was much higher in drug users (68.5%, PSQI >5; specifically, 80.24% in heroin users, 54.16% in methamphetamine users and 81.98% in ketamine users with PSQI >5) than non-users (26.4%, PSQI >5). Drug users had approximately twice the sleep latency than nondrug users (37.7 minutes V.S 18.4 minutes). Although drug users and non-users reported similar sleep duration (about 7.4 hours), drug users showed poorer subjective sleep quality and habitual sleep efficiency. They reported more sleep disturbance and need for sleep medications, more daytime dysfunction and poorer subjective sleep quality compared with nondrug users. The total PSQI score positively correlated with the duration of drug use (rp = 0.164, p < 0.001). We also found a link between sleep problems and cigarette smoking, alcohol drinking, and duration of drug use.

CONCLUSIONS

Poor sleep quality is common among illicit drug dependent subjects. Long-term substance users had more sleep problems. Future research aiming at quantifying the benefits of treatment interventions should not neglect the influence of sleep problems. Gaining more insight into the impact of sleep quality on the addiction treatment could also help to target future intervention measures more effectively.

The development and course of bipolar spectrum disorders: an integrated reward and circadian rhythm dysregulation model

In this article, we present and review the evidence for two major biopsychosocial theories of the onset and course of bipolar spectrum disorders (BSDs) that integrate behavioral, environmental, and neurobiological mechanisms: the reward hypersensitivity and the social/circadian rhythm disruption models. We describe the clinical features, spectrum, age of onset, and course of BSDs. We then discuss research designs relevant to demonstrating whether a hypothesized mechanism represents a correlate, vulnerability, or predictor of the course of BSDs, as well as important methodological issues. We next present the reward hypersensitivity model of BSD, followed by the social/circadian rhythm disruption model of BSD. For each model, we review evidence regarding whether the proposed underlying mechanism is associated with BSDs, provides vulnerability to the onset of BSDs, and predicts the course of BSDs. We then present a new integrated reward/circadian rhythm (RCR) dysregulation model of BSD and discuss how the RCR model explains the symptoms, onset, and course of BSDs. We end with recommendations for future research directions.

Clinical applications of herbal medicines for anxiety and insomnia; targeting patients with bipolar disorder

OBJECTIVES

Patients with bipolar disorder frequently continue to experience residual anxiety and insomnia between mood episodes. In real-world practice, patients increasingly self-prescribe alternative medicines.

METHODS

We reviewed case reports, open-label, and placebo-controlled trials investigating the use of herbal medicines to treat anxiety and insomnia, and discussed their potential applications for bipolar disorder.

RESULTS

Eleven herbal medicines that have been studied in human subjects are included in this review. Mechanisms of action, efficacy, side effects, and drug-drug interactions are discussed. Based on currently available evidence, valerian seems to be the most promising candidate for insomnia and anxiety in bipolar disorder.

CONCLUSIONS

Adjunctive herbal medicines may have the potential to alleviate these symptoms and improve the outcomes of standard treatment, despite limited evidence. Physicians need to have a more in-depth understanding of the evidence of benefits, risks, and drug interactions of alternative treatments.