As part of the National Institute of Mental Health Epidemiologic Catchment Area study, 7954 respondents were questioned at baseline and 1 year later about sleep complaints and psychiatric symptoms using the Diagnostic Interview Schedule. Of this community sample, 10.2% and 3.2% noted insomnia and hypersomnia, respectively, at the first interview. Forty percent of those with insomnia and 46.5% of those with hypersomnia had a psychiatric disorder compared with 16.4% of those with no sleep complaints. The risk of developing new major depression was much higher in those who had insomnia at both interviews compared with those without insomnia (odds ratio, 39.8; 95% confidence interval, 19.8 to 80.0). The risk of developing new major depression was much less for those who had insomnia that had resolved by the second visit (odds ratio, 1.6; 95% confidence interval, 0.5 to 5.3). Further research is needed to determine if early recognition and treatment of sleep disturbances can prevent future psychiatric disorders.

Epidemiologic study of sleep disturbances and psychiatric disorders : an opportunity for prevention

Advanced Statistical Methods in Biometric Research.

The objective of clinical prediction rules is to reduce the uncertainty inherent in medical practice by defining how to use clinical findings to make predictions. Clinical prediction rules are derived from systematic clinical observations. They can help physicians identify patients who require diagnostic tests, treatment, or hospitalization. Before adopting a prediction rule, clinicians must evaluate its applicability to their patients. We describe methodological standards that can be used to decide whether a prediction rule is suitable for adoption in a clinician's practice. We applied these standards to 33 reports of prediction rules; 42 per cent of the reports contained an adequate description of the prediction rules, the patients, and the clinical setting. The misclassification rate of the rule was measured in only 34 per cent of reports, and the effects of the rule on patient care were described in only 6 per cent of reports. If the objectives of clinical prediction rules are to be fully achieved, authors and readers need to pay close attention to basic principles of study design.

Clinical prediction rules. Applications and methodological standards.

Despite considerable advances in research and practice over the past three decades, cardiovascular disease and, in particular, coronary heart disease (CHD) remains the primary cause of premature death in the United States. This chapter will illustrate the various methods and concepts within health psychology that have been applied to further our understanding of the factors that contribute to CHD and the various prevention and intervention strategies used to reduce the risk of CHD morbidity and mortality. This chapter will first provide an overview of etiological considerations, including a definition of CHD and specification of risk factors. The remainder of the chapter will focus on “coronary-prone behavior pattern,” or the Type A behavior pattern, as it relates to the development and maintenance of CHD. As was discussed in Chapter 1, this behavior pattern represents the first well-defined psychological or behavioral risk factor in the history of risk factor research in health and illness. Therefore, the Type A behavior pattern will be emphasized, with a focus on (1) defining the pattern and presenting it in historical perspective, (2) describing the pattern and the methods used to measure and identify it, (3) reviewing the research validating the Type A construct and providing an overview of the psychological aspects of the behavior pattern, and (4) reviewing the psychophysiological

Coronary heart disease. Clinical, cinearteriographic and metabolic correlations.

We conducted a multicenter randomized double-blind clinical trial among 626 men with mild to moderate hypertension to determine the effects of captopril, methyldopa, and propranolol on their quality of life. Hydrochlorothiazide was added if needed to control blood pressure. After a 24-week treatment period, all three groups had similar blood-pressure control, although fewer patients taking propranolol required hydrochlorothiazide. Patients taking captopril alone or in combination with a diuretic were least likely to withdraw from treatment because of adverse effects (8 percent vs. 20 percent for methyldopa and 13 percent for propranolol). The treatment groups were similar in scores for sleep dysfunction, visual memory, and social participation. However, patients taking captopril, as compared with patients taking methyldopa, scored significantly higher (P<0.05 to <0.01) on measures of general well-being, had fewer side effects, and had better scores for work performance, visual–motor functioning, ...

The Effects of Antihypertensive Therapy on the Quality of Life

A scale for the estimation of sleep problems in clinical research.

Prospective study of 2750 employed men who completed a computer-scored test questionnaire measuring the coronary-prone Type A behavior pattern showed that high scorers had twice the incide...

https://www.nejm.org/doi/pdf/10.1056/NEJM197406062902301?listPDF=true

Prediction of clinical coronary heart disease by a test for the coronary-prone behavior pattern.

• The question, "How well do people remember life changes?" was approached in a longitudinal study of nearly 400 healthy men in a responsible profession. Three scales for assessing life changes were administered by questionnaire at two examinations nine months apart. The subjects were asked to report life change events occurring during a specific six-month period—that which immediately preceded the first examination. For all three life change scales there was substantial forgetting over the interval between reports, with a second report yielding total scores 34% to 46% less than those from the first report for the same period. The amount of change over time varied greatly across persons. These findings raise serious questions about the validity of retrospective studies of life change and illness when the period being reported is greater than six months in the past. They do not, however, jeopardize the potential of the method for prospective studies.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/492080/archpsyc_36_4_001.pdf

Life changes. Do people really remember

Neuropsychological dysfunction following elective cardiac operation: I. Early assessment

To evaluate the benefits of coronary artery bypass graft (CABG) surgery, we interviewed and tested 318 patients (268 men and 50 women) younger than age 70 before and six months after elective CABG at four university medical centers. Biomedical, psychoneurological, physical function, role function, occupational, social, family, sexual, emotional, and attitudinal variables were assessed. Quantitative comparisons showed improvement on many factors. Angina was completely relieved for 69% to 85% of persons, depending on whether it had been induced by exertion or other events. Disability days were reduced more than 80%. Seventy-five percent of employed persons had returned to work. Anxiety, depression, fatigue, and sleep problems declined. Vigor and well-being scores rose significantly. When losses were expected (eg, psychoneurological function, marital adjustment), they generally were not found. For none of the more than 60 outcome variables was widespread serious worsening found. The findings suggest that the great majority of patients are able to resume normal economic and social functioning within six months after CABG. ( JAMA 1983;250:782-788)

https://jamanetwork.com/journals/JAMA/articlepdf/387654/jama_250_6_027.pdf

C. David Jenkins

Papers

A scale for the estimation of sleep problems in clinical research.

Prediction of clinical coronary heart disease by a test for the coronary-prone behavior pattern.

Life changes. Do people really remember

Neuropsychological dysfunction following elective cardiac operation: I. Early assessment

Coronary artery bypass surgery. Physical, psychological, social, and economic outcomes six months later