Dora Zalai

Psychological Distress and Depression in Patients with Chronic Kidney Disease

Depressive disorders are 1.5–4 times more prevalent in medically ill patients than in the general population. Mood disorders can be regarded as the final common pathway developing from the interaction among multiple pathophysiological, psychological, and socioeconomic stressors that chronic illness imposes on the individual. Symptoms of clinical depression affect approximately 25% patients on hemodialysis and can be associated with low quality of life and increased mortality. The epidemiology of depressive disorders is less well studied in the renal transplant population. However, depression is a risk factor for poor outcomes, such as graft failure and death after renal transplantation. A high prevalence of severe psychological distress in patients with advanced CKD and its impact on CKD outcomes call for screening and intervention integrated in routine renal care. Preliminary data indicate that some of the selective serotonin reuptake inhibitor agents and time‐limited, manualized, structured psychotherapies can be safe and effective for treating depression in this population.

Sleep and melatonin secretion abnormalities in children and adolescents with fetal alcohol spectrum disorders

OBJECTIVES Caregivers describe significant sleep disturbances in the vast majority of children and adolescents, which is diagnosed as fetal alcohol spectrum disorders (FASD), but objective data on sleep disorders in this population are almost completely lacking. Animal models suggest that intrauterine alcohol exposure may disrupt sleep wake patterns, cause sleep fragmentation, and specifically affect the suprachiasmatic nucleus, thus disrupting melatonin secretion. The objective of this pioneering study was to evaluate sleep and melatonin abnormalities in children with FASD using objective, gold-standard measures. METHODS Children and adolescents (N = 36, 6-18 years) with FASD participated in clinical assessments by sleep specialists, overnight polysomnography (PSG), and a dim light melatonin onset (DLMO) test in a pediatric sleep laboratory. PSG was analyzed according to standardized scoring guidelines and sleep architecture was compared with normative data. DLMOs were determined and melatonin secretion curves were evaluated qualitatively to classify melatonin profiles. Sleep disorders were evaluated according to international diagnostic criteria. RESULTS There was a high prevalence (58%) of sleep disorders. The most common sleep problems were parasomnias (27.9%) and insomnia (16.8%). The sleep studies showed lower than normal sleep efficiency and high rates of sleep fragmentation. Most participants (79%) had an abnormal melatonin profile. CONCLUSIONS This study led to the recognition that both sleep and melatonin secretion abnormalities are present in children with FASD. Therefore, to be effective in managing the sleep problems in children with FASD, one needs to consider both the sleep per se and a possible malfunction of the circadian regulation.

Sleepiness in the Elderly

Excessive daytime sleepiness has pathologic causes and numerous adverse consequences; therefore, it requires medical attention in older adults. Excessive sleepiness in older adults is often multifactorial and may signal an underlying sleep disorder, chronic medical condition, undiagnosed mood disorder, or side effects of medications. It is associated with increased risk for cognitive decline and dementia in the elderly. Excessive sleepiness often requires a multi-method assessment in this age group. It is pertinent to take a systematic, step-by-step treatment approach geared toward the underlying cause, and to treat sleepiness directly, when the cause cannot be eliminated to prevent adverse outcomes.

Circadian Rhythm Sleep-Wake Disorders

The circadian system regulates a range of behavioural, physiological and cellular rhythms that allow organisms to anticipate changes in their physical environment, such as cycles of day and night. These predictive near-24-h oscillations persist in the absence of all environmental cues and are driven by the endogenous master pacemaker located in the suprachiasmatic nucleus (SCN) of the anterior hypothalamus in mammals (Stephan and Zucker 1972; Ralph et al. 1990; Edgar et al. 1993). Within individual SCN neurons, cyclic core clock genes and proteins establish a molecular basis of circadian control through transcriptional, translational and post-translational feedback loops (Reppert and Weaver 2002). This intracellular clock is not only found in the SCN, but in nearly all peripheral tissues of the mammalian body where it establishes tissue-specific gene expression to temporally coordinate physiology. Signals from the central SCN are relayed throughout the brain and body to synchronize these peripheral clocks to appropriate phases through neuronal, hormonal and physiological mechanisms (Buhr and Takahashi 2013). In this manner, the SCN regulates many diverse processes, including daily patterns of sleep, endocrine secretion, glucose homeostasis and core body temperature.

T-O-137 THE EVOLUTION, ROLE AND SCOPE OF COUNSELING SERVICES AT THE SLEEP AND ALERTNESS CLINIC IN TORONTO, CANADA

Results: The overall fibromyalgia sample (N=2196) had a mean age of 53.32 (SD=12.63). Patients experiencing severe or general sleep difficulties were significantly more likely to be on disability (severe=28.01% vs. general=23.17% vs. none=14.87%; p<0.05) and less likely to possess insurance coverage (87.09% vs. 90.07% vs. 93.68%; p<0.05) compared with patients without sleep difficulties. After adjustment for demographic and health characteristics, patients experiencing severe or general sleep difficulties reported higher mean direct costs (

W-O-115 DEVELOPMENT OF A PATIENT TRACKING AND REPORTING SYSTEM

5,947.34 vs.

The importance of fatigue cognitions in chronic hepatitis C infection

5,951.51 vs.

When insomnia is not just insomnia: The deeper correlates of disturbed sleep with reference to DSM-5

4,205.72; p<0.05) than patients without sleep difficulties. Patients with severe symptoms reported higher indirect costs (

Fatigue in chronic hepatitis C infection: Understanding patients' experience from a cognitive‐behavioural perspective

15,043.48 vs.

Fatigue in Chronic Medical Conditions: A Psychosomatic Perspective

11,505.72 vs.