The Diagnosis and Work-Up of Insomnia

CNS Spectrums ◽  
2009 ◽  
Vol 14 (S13) ◽  
pp. 4-6
Author(s):  
John W. Winkelman
Keyword(s):  
Sleep Disturbance ◽  
The United States ◽  
Elevated Risk ◽  
Major Depressive ◽  
Nonrestorative Sleep ◽  
Insomnia Disorder ◽  
Falling Asleep ◽  
The Status ◽  
Substance Abuse Disorders ◽  
Work Up

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.

Sleep Disturbance in Palliative Care

2018 ◽  
Author(s):  
Rebecca Burke ◽  
Sriram Yennurajalingam
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Sleep Disturbance ◽  
Poor Sleep ◽  
Primary Care Population ◽  
Nonrestorative Sleep ◽  
Falling Asleep ◽  
High Index Of Suspicion ◽  
Prevalent Symptom

Sleep disturbance is a persistent source of suffering in palliative care patients. Symptoms such as difficulty falling asleep, staying asleep, early awakening, or nonrestorative sleep are all indicative of sleep disorders. Poor sleep can have consequential effects on perception of pain, fatigue, mood, and quality of life. It is not only a prevalent symptom in the primary care population but also may in fact affect more than 60% of the palliative care population. In addition to the complexities of treatment, insomnia often serves as a red herring to alarm physicians of underlying conditions. Therefore, it is essential that palliative care physicians maintain a high index of suspicion for such confounding conditions as restless leg syndrome, sleep apnea, and delirium. This chapter highlights the intricacies of sleep disturbance and focuses on the most common patient presentations.

Multicultural Assessment of Personality and Psychopathology in the United States: Still Art, Not Yet Science, and Controversial

1998 ◽  
Vol 14 (1) ◽  
pp. 62-70 ◽  
Author(s):  
Richard H. Dana
Keyword(s):  
United States ◽  
Racial Identity ◽  
The United States ◽  
Therapeutic Assessment ◽  
Culturally Competent ◽  
Research Attention ◽  
The Status ◽  
Training Research ◽  
Multicultural Assessment ◽  
Personality Description

This paper describes the status of multicultural assessment training, research, and practice in the United States. Racism, politicization of issues, and demands for equity in assessment of psychopathology and personality description have created a climate of controversy. Some sources of bias provide an introduction to major assessment issues including service delivery, moderator variables, modifications of standard tests, development of culture-specific tests, personality theory and cultural/racial identity description, cultural formulations for psychiatric diagnosis, and use of findings, particularly in therapeutic assessment. An assessment-intervention model summarizes this paper and suggests dimensions that compel practitioners to ask questions meriting research attention and providing avenues for developments of culturally competent practice.

Varied Responses to Human-Induced Seismicity in the City of Azle, Texas

2019 ◽  
Vol 3 (1) ◽  
pp. 1-8
Author(s):  
Sarmistha R. Majumdar
Keyword(s):  
State Government ◽  
Induced Seismicity ◽  
Oil And Gas ◽  
The United States ◽  
The State ◽  
Prior History ◽  
Small Community ◽  
Regulatory Policies ◽  
The Status

Fracking has helped to usher in an era of energy abundance in the United States. This advanced drilling procedure has helped the nation to attain the status of the largest producer of crude oil and natural gas in the world, but some of its negative externalities, such as human-induced seismicity, can no longer be ignored. The occurrence of earthquakes in communities located at proximity to disposal wells with no prior history of seismicity has shocked residents and have caused damages to properties. It has evoked individuals’ resentment against the practice of injection of fracking’s wastewater under pressure into underground disposal wells. Though the oil and gas companies have denied the existence of a link between such a practice and earthquakes and the local and state governments have delayed their responses to the unforeseen seismic events, the issue has gained in prominence among researchers, affected community residents, and the media. This case study has offered a glimpse into the varied responses of stakeholders to human-induced seismicity in a small city in the state of Texas. It is evident from this case study that although individuals’ complaints and protests from a small community may not be successful in bringing about statewide changes in regulatory policies on disposal of fracking’s wastewater, they can add to the public pressure on the state government to do something to address the problem in a state that supports fracking.

Rebranding China

2019 ◽  
Author(s):  
Xiaoyu Pu
Keyword(s):  
International Relations ◽  
The United States ◽  
Chinese Foreign Policy ◽  
First Century ◽  
Theoretical Argument ◽  
Status Signaling ◽  
Status Seeking ◽  
Military Transformation ◽  
The Status ◽  
Offensive Realism

China plays a variety of status games, sometimes emphasizing its status as an emerging great power and other times highlighting its status as a fragile developing country. The reasons for this are unclear. Drawing on original Chinese sources, social psychological theories, and international relations theories, this book provides a theoretically informed analysis of China’s global rebranding and repositioning in the twenty-first century. Contrary to offensive realism and power transition theory, the book argues that China is not always a status maximizer eager to replace the United States as the new global leader. Differing from most constructivist and psychological studies that focus on the status seeking of rising powers, this study develops a theory of status signaling that combines both rationalist and constructivist insights. The book argues that Chinese leaders face competing pressure from domestic and international audiences to project different images. The book suggests that China’s continual struggle for international status is primarily driven by domestic political calculations. Meanwhile, at the international level, China is concerned about over-recognition of its status for instrumental reasons. The theoretical argument is illustrated through detailed analysis of Chinese foreign policy. Examining major cases such as China’s military transformation, China’s regional diplomacy, and China’s global diplomacy during the 1997 Asian and 2008 global financial crises, this book makes important contributions to international relations theory and Asian studies.

scholarly journals Accessibility in Inclusive Tourism? Hotels Distributed Through Online Channels

Societies ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 34
Author(s):  
Eva Martin-Fuentes ◽  
Sara Mostafa-Shaalan ◽  
Juan Pedro Mellinas
Keyword(s):  
United Arab Emirates ◽  
Local Level ◽  
Descriptive Analysis ◽  
Distribution Channel ◽  
People With Disabilities ◽  
The United States ◽  
Travel Agency ◽  
International Studies ◽  
The Status ◽  
Accommodation Sector

There is a lack of comprehensive international studies on accommodations for people with disabilities; only small, local-level studies exist. This study aims to show the status of the tourist accommodation sector through the online distribution channel in terms of accessibility to offer more inclusive tourism. A descriptive analysis has been carried out with more than 31,000 hotels from the online travel agency Booking.com, in the 100 most touristic cities in the world. For the first time, an accurate picture of adaptation in the hotel sector for people with disabilities is presented. Results show that the adapted hotel infrastructures by countries are uneven. The main adaptations are those that help to avoid mobility barriers, and in contrast, hotels offer very few adaptations for sensory disabilities such as visual disabilities. Moreover, this study shows that, worldwide, countries with the highest income per capita, such as the United States of America, Canada, Ireland, Australia, New Zealand, Qatar or the United Arab Emirates, have the highest degree of hotel adaptation.

scholarly journals Discursive Strategies and Sequenced Institutional Change: The Case of Marriage Equality in the United States

2021 ◽  
pp. 003232172110205
Author(s):  
Giulia Mariani ◽  
Tània Verge
Keyword(s):  
United States ◽  
Institutional Change ◽  
The United States ◽  
Marriage Equality ◽  
Agent Based ◽  
Discursive Strategies ◽  
Policy Debates ◽  
The Status ◽  
Private Actors

Building on historical and discursive institutionalism, this article examines the agent-based dynamics of gradual institutional change. Specifically, using marriage equality in the United States as a case study, we examine how actors’ ideational work enabled them to make use of the political and discursive opportunities afforded by multiple venues to legitimize the process of institutional change to take off sequentially through layering, displacement, and conversion. We also pay special attention to how the discursive strategies deployed by LGBT advocates, religious-conservative organizations and other private actors created new opportunities to influence policy debates and tip the scales to their preferred policy outcome. The sequential perspective adopted in this study allows problematizing traditional conceptualizations of which actors support or contest the status quo, as enduring oppositional dynamics lead them to perform both roles in subsequent phases of the institutional change process.

scholarly journals The status of neurology fellowships in the United States: clinical needs, educational barriers, and future outlooks

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Harini Sarva ◽  
Gustavo A. Patino ◽  
Mehmood Rashid ◽  
James W. M. Owens ◽  
Matthew S. Robbins ◽  
...  
Keyword(s):  
United States ◽  
American Academy ◽  
Neurodegenerative Disorders ◽  
Disease Burden ◽  
Neurological Diseases ◽  
The United States ◽  
Educational Barriers ◽  
The Status

AbstractThe need for subspecialty-trained neurologists is growing in parallel with increasing disease burden. However, despite the immense burden of neurological diseases, like headache and neurodegenerative disorders, recruitment into these subspecialties remains insufficient in the United States. In this manuscript, a group of educators from the American Academy of Neurology’s A.B. Baker Section on Neurological Education sought to review and discuss the current landscape of neurology fellowships in the United States, the factors driving fellowship recruitment and the educational barriers. Moreover, suggestions to potentially improve recruitment for under-selected fellowships, which can contribute towards an alignment between neurological education and neurological needs, and future educational scenarios are discussed.

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