Because of its high prevalence and implications for quality of life and possibly even disease progression, depression has been intensively studied in multiple sclerosis (MS) over the past 25 years. ...Despite the publication of numerous excellent empirical research papers on this topic during that time, the publication of theoretical work that attempts to explain depression in a comprehensive way is scarce. In this study, we present a theoretical model that attempts to integrate existing work on depression in MS and provide testable hypotheses for future work. The model suggests that risk for depression begins with the onset of MS. MS results in disease-related changes such as increased lesion burden/brain atrophy and immunological anomalies that are associated with depression in MS, but explain only a relatively limited proportion of the variance. Common sequelae of MS including fatigue, physical disability, cognitive dysfunction, and pain, have all been shown to have an inconsistent or relatively weak relationship to depression in the literature. In the model, we propose that four variables--social support, coping, conceptions of the self and illness, and stress--may moderate the relationship between the above common MS sequelae with depression and help to explain inconsistencies in the literature.
Highlights ► Prolonged administration of neuropsychological testing induces increased self-reported and performance-related fatigue. ► Modulation of EEG activity during neuropsychological testing is ...an index of fatigue rather than a training effect. ► Fatigue effect should be taken into consideration during administration of a neuropsychological test battery in clinical populations.
The potential effect modification of sleep on the relationship between anxiety and elevated blood pressure (BP) in pregnancy is understudied. We evaluated the relationship between anxiety, insomnia, ...and short sleep duration, as well as any interaction effects between these variables, on BP during pregnancy.
This was a prospective pilot cohort of pregnant people between 23 to 36 weeks' gestation at a single institution between 2021 and 2022. Standardized questionnaires were used to measure clinical insomnia and anxiety. Objective sleep duration was measured using a wrist-worn actigraphy device. Primary outcomes were systolic (SBP), diastolic (DBP), and mean (MAP) non-invasive BP measurements. Separate sequential multivariable linear regression models fit with generalized estimating equations (GEE) were used to separately assess associations between anxiety (independent variable) and each BP parameter (dependent variables), after adjusting for potential confounders (Model 1). Additional analyses were conducted adding insomnia and the interaction between anxiety and insomnia as independent variables (Model 2), and adding short sleep duration and the interaction between anxiety and short sleep duration as independent variables (Model 3), to evaluate any moderating effects on BP parameters.
Among the 60 participants who completed the study, 15 (25%) screened positive for anxiety, 11 (18%) had subjective insomnia, and 34 (59%) had objective short sleep duration. In Model 1, increased anxiety was not associated with increases in any BP parameters. When subjective insomnia was included in Model 2, increased DBP and MAP was significantly associated with anxiety (DBP: β 6.1, p = 0.01, MAP: β 6.2 p < 0.01). When short sleep was included in Model 3, all BP parameters were significantly associated with anxiety (SBP: β 9.6, p = 0.01, DBP: β 8.1, p < 0.001, and MAP: β 8.8, p < 0.001). No moderating effects were detected between insomnia and anxiety (p interactions: SBP 0.80, DBP 0.60, MAP 0.32) or between short sleep duration and anxiety (p interactions: SBP 0.12, DBP 0.24, MAP 0.13) on BP.
When including either subjective insomnia or objective short sleep duration, pregnant people with anxiety had 5.1-9.6 mmHg higher SBP, 6.1-8.1 mmHg higher DBP, and 6.2-8.8 mmHg higher MAP than people without anxiety.
The purpose of this study was to examine the relationship between postconcussion symptom complaint (PCS) severity and positive coping factors (knowledge, self-efficacy, and attributions) in a sample ...of individuals who have sustained a mild TBI, above and beyond the demographic and psychiatric predictors that have been most commonly examined. Ninety-one people with a history of reported mild TBI were surveyed. Hierarchical regression analyses revealed that demographic variables and psychiatric symptom severity predicted PCS severity. Consistent with our hypotheses, knowledge, self-efficacy, and attributions, when taken together, made an independent and significant contribution to prediction of PCS severity (21% of additional variance). The most potent factor was attribution, or the extent to which one attributes symptoms to mild TBI versus other causes. Those who attribute their symptoms to TBI are more likely to report greater symptom severity overall. Taken together, knowledge, self-efficacy, and attributions contribute independently to PCS severity. Additional research is needed to determine if these factors are amenable to intervention.
Abstract
Introduction
Individuals who undergo Cognitive Behavioral Therapy for Insomnia (CBT-I) show different trajectories during treatment and different outcomes after treatment. However, the ...factors contributing to this interindividual variability have not been adequately identified. Daily sleep logs might help us understand some of these factors.
Methods
Patients with insomnia (N=34), as confirmed by clinical evaluation and Insomnia Severity Index score >10, completed 4 weeks of group CBT-I conducted in Mandarin via telehealth. Participants completed daily sleep logs and self-reported sleep quality, sleep effort and anxiety before and after treatment. Predictor variables included daily sleep efficiency and daily sleep anxiety. Response variables included pre-post changes in sleep quality, sleep effort and anxiety. Multilevel structural equation modeling was performed to examine the relationship between trajectories of change in predictors and response variables.
Results
Dynamic features of sleep log data significantly predicted individual differences in response variables. The growth rate of daily sleep efficiency during treatment significantly predicted reduced sleep effort (p=.012), decreased anxiety (p=.046), and improved sleep quality (p<.01) after treatment. Conversely, the growth rate of daily sleep anxiety during treatment significantly predicted increases in sleep effort (p<.01). In addition, daily sleep anxiety had a significant negative effect on daily sleep efficiency (p<.001), and the weaker this negative effect, the greater the reduction in sleep effort (p<.001) and anxiety (p<.01) after treatment.
Conclusion
Individuals exhibit different trajectories during treatment, which are related to different outcomes after treatment. Those who experience less wakefulness at night across treatment become less anxious about sleep and exert less effort to manage sleep, leading to better sleep quality. However, those who experience increasing anxiety across treatment exert more effort to control sleep. Finally, individuals whose anxiety is not as closely associated with sleep efficiency show greater reductions in anxiety and sleep effort post-treatment. Thus, different trajectories and treatment outcomes appear to distinguish between those individuals who are less anxious about sleep during CBT-I, and thus more willing to implement recommendations, which leads to better outcomes, and those individuals who are more anxious about sleep during treatment, and thus less willing to implement recommendations, which leads to worse outcomes.
Support (If Any)
Although most neuropsychological batteries used with multiple sclerosis (MS) patients now exclude tests that require significant motor writing or manual manipulation speed, many of the most sensitive ...commonly used cognitive tests nonetheless require some type of rapid oral motor response. The aim of this study is to examine the extent to which primary oral motor articulation speed problems of individuals with MS contribute to performance and group differences on neuropsychological tasks requiring a rapid spoken response. Fifty MS patients and 50 healthy controls were administered the PASAT, COWAT, Animal Naming, and SDMT tests, in addition to a measure of rudimentary oral motor speed known as the maximum repetition rate of syllables and multisyllabic combinations (MRR) task. Regression analyses revealed that the amount of variance accounted for by the group (MS-Control) variable was reduced the following amounts for the tasks when the MRR was entered before the group variable: SDMT, 10% to 6%; PASAT, 4% to 2%; COWAT, 5% to 2%; Animal Naming, 11% to 7%. Our data suggest that rudimentary oral motor speed is slowed in MS patients and makes an important contribution to group differences in performance on commonly used neuropsychological tasks requiring a rapid spoken response.
Cognitive impairment and depressed mood are common symptoms in multiple sclerosis (MS), which significantly impact patients' role functioning and quality of life. Cross-sectional studies indicate a ...modest association between cognitive impairment and depressive symptoms in MS. Longitudinal studies show inconsistent results but provide some data indicating a relationship between increasing global cognitive decline and increasing depressive symptoms over time. Establishing whether such a relationship exists represents an important first step in understanding the temporal nature of that relationship along with any treatment implications. The current study investigated this relationship by using the adjusted difference between a demographic estimate of premorbid intellectual functioning (Barona) and a performance measure of current intellectual functioning (Shipley Institute of Living) to capture long-term global cognitive decline in MS patients. Degree of global cognitive decline was then related to a self-report measure of mood, evaluative, and vegetative depression symptoms (Chicago Multiscale Depression Inventory). Global cognitive decline accounted for 5% of the variance in mood-evaluative symptoms but none of the variance in vegetative symptoms. When groups experiencing moderate, mild, and no global cognitive decline were compared on depression symptom subscales, MS patients experiencing moderate cognitive decline reported significantly higher mood and evaluative, but not vegetative, depressive symptoms than MS patients with stable cognitive functioning.
Identifying factors that improve the assessment of athletes' psychological functioning is imperative to make proper return-to-play decisions following concussion. Prior research indicates that an ...individual's affect is related to symptom reporting. The present study examines two novel methods of affect assessment in college athletes at baseline participating in a sports-concussion management program. A total of 256 athletes completed a neuropsychological baseline battery with measurements of psychological symptoms (BDI-Fast Screen, Post-Concussion Symptom Scale, and ImPact Total Symptom Score) and a measure of affective memory bias (the Affective Verbal Learning Test; AVLT). Examiners completed an observation-based rating of affect. Multivariate analysis of variance and χ2 analyses were conducted to examine the effect of affect on symptom reports. Examiners' Affect Ratings were predictive of broad symptom reporting, while the performance based index of affect (Affective Verbal Learning Test, AVLT) was more predictive of depressive symptoms. These findings suggest that performance on the AVLT may be a useful indicator of self-reported depression in a collegiate athlete sample. Additionally, these results demonstrate that examiners' behavioral assessments of affect are important in the assessment of psychological functioning in athletes. Continued work should focus on developing objective measures that are sensitive and valid for the evaluation of outcomes from concussion.
Although fatigue is common in insomnia, the clinical associates of fatigue in patients with insomnia are largely unknown. We aimed to investigate the clinical associates of fatigue in patients with ...insomnia. Patients visiting the Stanford Sleep Medicine Center completed the Insomnia Severity Index (ISI), Insomnia Symptom Questionnaire (ISQ), the Fatigue Severity Scale (FSS), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ-9). Among 6367 patients, 2024 were diagnosed with insomnia (age 43.06 ± 15.19 years; 1110 women and 914 men) according to the ISI and the ISQ. Insomnia patients with severe fatigue (n = 1306) showed higher insomnia symptoms, daytime sleepiness, depression and longer habitual sleep duration than those without severe fatigue (n = 718). Higher insomnia symptoms, daytime sleepiness and depressive symptoms, and longer habitual sleep duration, independently predicted higher fatigue scores. Among insomnia patients with daytime sleepiness (ESS≥10), only habitual sleep duration and depression predicted fatigue scores. The interaction between insomnia severity and daytime sleepiness significantly predicted the severity of fatigue. Depression was a significant mediator between insomnia and fatigue. For 598 insomnia patients undergoing overnight polysomnography (PSG), no significant correlations were found between fatigue and any PSG parameters. The current study suggests that managing insomnia or depression may reduce the fatigue of insomnia patients, whereas arbitrary efforts to prolong sleep duration may worsen their fatigue.
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