Acceptability, tolerability, and potential efficacy of cognitive behavioural therapy for Insomnia Disorder subtypes defined by polysomnography: A retrospective cohort study

Objectives(1) To explore the role of ethnicity in receiving cognitive–behavioural therapy (CBT) for people with psychosis or bipolar disorder while adjusting for differences in risk profiles and symptom severity. (2) To assess whether context of treatment (inpatient vs community) impacts on the relationship between ethnicity and access to CBT.DesignCohort study of case register data from one catchment area (January 2007–July 2017).SettingA large secondary care provider serving an ethnically diverse population in London.ParticipantsData extracted for 30 497 records of people who had diagnoses of bipolar disorder (International Classification of Diseases (ICD) code F30-1) or psychosis (F20–F29 excluding F21). Exclusion criteria were: <15 years old, missing data and not self-defining as belonging to one of the larger ethnic groups. The sample (n=20 010) comprised the following ethnic groups: white British: n=10 393; Black Caribbean: n=5481; Black African: n=2817; Irish: n=570; and ‘South Asian’ people (consisting of Indian, Pakistani and Bangladeshi people): n=749.Outcome assessmentsORs for receipt of CBT (single session or full course) as determined via multivariable logistic regression analyses.ResultsIn models adjusted for risk and severity variables, in comparison with White British people; Black African people were less likely to receive a single session of CBT (OR 0.73, 95% CI 0.66 to 0.82, p<0.001); Black Caribbean people were less likely to receive a minimum of 16-sessions of CBT (OR 0.83, 95% CI 0.71 to 0.98, p=0.03); Black African and Black Caribbean people were significantly less likely to receive CBT while inpatients (respectively, OR 0.76, 95% CI 0.65 to 0.89, p=0.001; OR 0.83, 95% CI 0.73 to 0.94, p=0.003).ConclusionsThis study highlights disparity in receipt of CBT from a large provider of secondary care in London for Black African and Caribbean people and that the context of therapy (inpatient vs community settings) has a relationship with disparity in access to treatment.

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Clinical practice guidelines for insomnia disorder

South African Family Practice ◽

10.4102/safp.v59i3.4691 ◽

2017 ◽

Vol 59 (3) ◽

pp. 45-51

Author(s):

Lucille Malan ◽

Nokuthula Dlamini

Keyword(s):

Cognitive Behavioural Therapy ◽

Treatment Options ◽

Early Morning ◽

Behavioural Therapy ◽

Pharmacological Therapy ◽

Chronic Insomnia ◽

First Line Therapy ◽

Insomnia Disorder ◽

Cognitive Behavioural ◽

Falling Asleep

Insomnia disorder is defined as difficulty in falling asleep, maintaining sleep, and early morning awakenings. Common daytime consequences experienced are fatigue, mood instability and impaired concentration. In chronic insomnia these symptoms persist over a period of at least three months. Chronic insomnia can also be a symptom of a variety of disorders. The pathophysiology of insomnia is theorised as a disorder of nocturnal and daytime hyper-arousal as a result of increased somatic, cortical and cognitive activation. The causes of insomnia can be categorized into situational, medical, psychiatric and pharmacologically-induced. To diagnose insomnia, it is required to evaluate the daytime and nocturnal symptoms, as well as psychiatric and medical history. The Diagnostic and Statistical Manual 5 Criteria (DSM-5) also provides guidelines and criteria to be followed when diagnosing insomnia disorder. Goals of treatment for insomnia disorder are to correct the underlying sleep complaint and this, together with insomnia symptoms, their severity and duration, as well as co-morbid disorders will determine the choice of treatment. In the majority of patients, insomnia can be treated without pharmacological therapy and cognitive behavioural therapy is considered first-line therapy for all patients with insomnia. The most common pharmacological insomnia treatments include benzodiazepines and benzodiazepines receptor agonists. To avoid tolerance and dependence, these hypnotics are recommended to be used at the lowest possible dose, intermittently and for the shortest duration possible. A combination of cognitive behavioural therapy and pharmacological treatment options is recommended for chronic insomnia.

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Relapse and Recurrence of Common Mental Health Problems after Low Intensity Cognitive Behavioural Therapy: The WYLOW Longitudinal Cohort Study

Psychotherapy and Psychosomatics ◽

10.1159/000485386 ◽

2018 ◽

Vol 87 (2) ◽

pp. 116-117 ◽

Cited By ~ 5

Author(s):

Jaime Delgadillo ◽

Laura Rhodes ◽

Omar Moreea ◽

Dean McMillan ◽

Simon Gilbody ◽

...

Keyword(s):

Mental Health ◽

Cohort Study ◽

Cognitive Behavioural Therapy ◽

Mental Health Problems ◽

Behavioural Therapy ◽

Health Problems ◽

Longitudinal Cohort Study ◽

Low Intensity ◽

Cognitive Behavioural ◽

Common Mental Health Problems

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Characterizing inpatient care for adults with schizophrenia using the Health Quality Ontario indices: A single-centre retrospective cohort study

Clinical & Investigative Medicine ◽

10.25011/cim.v41i4.32222 ◽

2019 ◽

Vol 41 (4) ◽

pp. E196-E203

Author(s):

Anees Bahji ◽

Jennifer L Pikard ◽

Dane Mauer-Vakil ◽

Tariq Munsh ◽

Farooq Naeem

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Inpatient Care ◽

Average Length ◽

Medication Management ◽

Standard Of Care ◽

Quality Standard ◽

Behavioural Therapy ◽

Health Quality

Purpose: This single-center retrospective cohort study is one of the first reports to evaluate the inpatient care provided to persons diagnosed with schizophrenia in Canada. Methods: This study examined all admissions for adults diagnosed with schizophrenia over a 6-month period in 2017 to an inpatient psychiatric unit situated in a nonprofit general hospital in Kingston, Ontario, Canada. The Health Quality Ontario standards for the inpatient care of adults with schizophrenia were used to assess the quality of care provided in hospital. Standards were determined to have been met by doing a thorough chart review for each patient, reviewing all documentation in progress notes, admission notes, discharge notes and emergency room notes for quality standard completion. Results: The average length of stay per patient was 18.64 days. The treatment at this facility largely focused on medication management of schizophrenia; however, it was found that several areas of care did not meet the standard of care as set by the Health Quality Ontario Quality Standards for Schizophrenia Care for Adults in Hospitals, which was set in 2016. Problematic areas were promoting physical activity and healthy eating (4.9% compliance), treatment with clozapine (13.1% compliance) and cognitive behavioural therapy (9.8% compliance). The study site is fully accredited and attending physicians were all psychiatrists. How pervasive these deficiencies are in other settings is not known.

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Attribution, cognition and psychopathology in persistent insomnia disorder: outcome and mediation analysis from a randomized placebo-controlled trial of online cognitive behavioural therapy

Sleep Medicine ◽

10.1016/j.sleep.2014.03.001 ◽

2014 ◽

Vol 15 (8) ◽

pp. 913-917 ◽

Cited By ~ 46

Author(s):

Colin A. Espie ◽

Simon D. Kyle ◽

Christopher B. Miller ◽

Jason Ong ◽

Peter Hames ◽

...

Keyword(s):

Cognitive Behavioural Therapy ◽

Mediation Analysis ◽

Controlled Trial ◽

Behavioural Therapy ◽

Insomnia Disorder ◽

Cognitive Behavioural

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Evaluation of internet cognitive behavioural therapy for insomnia disorder

http://isrctn.org/> ◽

10.1186/isrctn44615689 ◽

2013 ◽

Author(s):

Colin Espie

Keyword(s):

Cognitive Behavioural Therapy ◽

Behavioural Therapy ◽

Insomnia Disorder ◽

Cognitive Behavioural ◽

Internet Cognitive Behavioural Therapy

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P068 Improving patient streaming for Chronic insomnia: Single centre retrospective cohort study

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.112 ◽

2021 ◽

Vol 2 (Supplement_1) ◽

pp. A43-A43

Author(s):

L Krebs ◽

C Ellender

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Service Provision ◽

Retrospective Cohort ◽

Data Extraction ◽

Improve Patient Care ◽

Severity Index ◽

Behavioural Therapy ◽

Medical Review ◽

Ethical Approval

Abstract Background Insomnia is a common sleep disorder associated with significant morbidity and psychological distress. Cognitive Behavioural Therapy for insomnia (CBTi) is the gold standard intervention typically delivered by sleep psychologists. High demand has driven an interest in determining the case mix and characteristics of patients referred with insomnia to identify patients that may be suitable for an alternative direct-to-psychology model of care. Methods A retrospective cohort study was performed, including cases referred to the Princess Alexandra Hospital Sleep Centre in 2016 – 2020. Patients were categorised as either “suitable for direct-to-psychology” or “required medical review”. “Direct to psychology” patients were defined as (i) referred for insomnia; or (ii) Insomnia Severity Index score ≥15/28; or (iii) diagnosed with insomnia per ICSD-3 by treating specialist; or (iv) patients referred for sleep psychology. Exclusion criteria were significant sleep disordered breathing (mean SpO2 <85%, Epworth sleepiness scale >16, driving inattention), highly co-morbid patients (neuromuscular weakness, COPD) and diagnosis of hypersomnia. These patients were categorised as “requiring medical review”. The demographic and polysomnographic characteristics of these two groups were then compared. Progress The study protocol is complete, ethical approval obtained (EX/2021QMS/76783), and data extraction has been competed. Analysis underway currently. Intended outcome/impact We aim to establish the characteristics of patients suitable for a direct to psychology pathway. This data will be used for service provision planning, could reduce patient waiting list times, and improve patient care. This model could then be explored for safety and efficacy and form the basis of future service provision work.

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