Predicting Treatment Response in Older Adults with Insomnia
Tóm tắt
This study examined potential predictors of treatment outcome in late-life insomnia. Fifty-four older adults with chronic insomnia were treated with cognitive–behavior therapy (CBT), pharmacotherapy (PCT), or combined CBT plus PCT. Pretreatment characteristics such as demographic, clinical, psychometric, and sleep variables were examined as correlates or potential predictors of treatment response. Treatment response was defined by posttreatment sleep efficiency as measured subjectively by daily sleep diary and objectively by polysomnography. The results indicate that age, insomnia duration, medical illness, and previous use of sleep medications can moderate subjective or objective treatment outcome or both of these in late-life insomnia. However, there are no reliable predictors of outcome across all treatment and assessment modalities. The implications of these findings for the treatment of insomnia in older adults seen in primary care settings are discussed.
Tài liệu tham khảo
Alperson, J., and Biglan, A. (1979). Self administered treatment of sleep onset insomnia and the importance of age. Behav. Ther.10: 337–346.
American Psychiatric Association (1993). Diagnostic and Statistical Manual of Mental Disorders(4th Ed.), American Psychiatric Association, Washington, DC.
Beck, A.T., Epstein, N., Brown, G., and Steer, R. (1988).An inventory for measuring clinical anxiety: Psychometric properties. J. Consult. Clin. Psychol.56: 893–897.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., and Erbaugh, J. (1961). An inventory for measuring depression. Arch. Gen. Psychiat.4: 561–571.
Bliwise, D. L., Friedman, L., Nekich, J. C., and Yesavage, J. A. (1995). Prediction of outcome in behaviorally based insomnia treatments. J. Behav. Ther. Experim. Psychiat.26: 17–23.
Chambers, M. J., and Alexander, S. D. (1992). Assessment and prediction of outcome for a brief behavioral insomnia treatment program. J. Behav. Ther. Experim. Psychiat.23: 289–297.
Davies, R., Lacks, P., Storand, M., and Bertelson, A. M. (1986). Countercontrol treatment of sleep maintenance insomnia in relation to age. Psychol. Aging1: 233–238.
Edinger, J. D., Stout, A. L., and Hoelscher, T. J. (1988). Cluster analysis of insomniacs MMPI profiles: Relation of subtypes to sleep history and treatment outcome. Psychosom. Med.50: 77–87.
Espie, C. A., Lindsay, W. R., and Brooks, D. N. (1988). Substituting behavioural treatment for drugs in the treatment of insomnia: An exploratory study. J. Behav. Ther. Experim. Psychiat.19: 51–56.
Espie, C. A., Inglish, S. J., Tessier, S., and Harvey, L. (in press). Predicting clinically significant response to cognitive-behavior therapy for chronic insomnia in general medical practice: Analyses of outcome data at 12 months post-treatment. J. Consult. Clin. Psychol.
Foley, D. J., Monjan, A. A., Brown, S. L., Simonsick, E. M., Wallace, R. B., and Blazer, D. G. (1995). Sleep complaints among elderly persons. Sleep18: 425–432.
Ford, D. E., and Kamerow, D. B. (1989). Epidemiologic study of sleep disturbances and psychiatric disorders: An opportunity for prevention? J. Am. Med. Assoc.262: 1479–1484.
Friedman, R. R., Bliwise, D. L., Yesavage, J. A., and Salom, S. R. (1991). A preliminary study comparing sleep restriction and relaxation treatments for insomnia in older adults. J. Gerontol.46: P1–P8.
Hamilton, M. (1959). The assessment of anxiety states by rating. Br. J. Med. Psychol.32: 50.
Hamilton, M. (1960). A rating scale for depression. J. Neurol. Neurosurg. Psychiat.23: 56–61.
Hohagen, F., Kappler, C., Schramm, E., Rink, K., Weyerer, S., Riemann, D., and Berger, M. (1994). Prevalence of insomnia in elderly general practice attenders and the current treatment modalities. Acta Psychiatrica Scandinavica90: 102–108.
Lacks, P., Bertelson, A. D., Gans, L., and Kunkel, J. (1983). The effectiveness of three behavioral treatments for different degrees of sleep onset insomnia. Behav. Ther.14: 593–605.
Lacks, P., and Powlishta, K. (1989). Improvement following behavioral treatment for insomnia: Clinical significance, long term maintenance, and predictors of outcome. Behav. Ther.20: 117–134.
Lichstein K. L., and Johnson, R. S. (1993). Relaxation for insomnia and hypnotic medication use in older women. Psychol. Aging8: 103–111.
Lichstein, K. L., and Morin, C. M. (2000). Treatment of Late-Life Insomnia.Sage, Thousand Oaks, CA.
Mellinger, G. D., Balter, M. B., and Uhlenhuth, E. H. (1985). Insomnia and its treatment: Prevalence and correlates. Arch. Gen. Psychiat.42: 225–232.
Morawetz, D. (1989). Behavioral self help treatment for insomnia: A controlled evaluation. Behav. Ther.20: 365–379.
Morgan, K., and Clarke, D. (1997). Risk factors for late-life insomnia in a representative general practice sample. Br. J. Gen. Pract.47: 166–169.
Morin, C. M. (1993). Insomnia: Psychological Assessment and Management, Guilford, New York.
Morin, C. M. (1994). Dysfunctional beliefs and attitudes about sleep: Preliminary scale development and description. Behav. Therap.163–164.
Morin, C. M., and Azrin, N. H. (1988). Behavioral and cognitive treatments of geriatric insomnia. J. Consult. Clin. Psychol.56: 748–753.
Morin, C. M., Colecchi, C. A., Stone, J., Sood, R. K., and Brink D. (1999). Behavioral and pharmacological therapies for late-life insomnia. J. Am. Med. Assoc.281: 991–999.
Morin, C. M., Culbert, J. P., and Schwartz, S. M. (1994). Nonpharmacological intervention for insomnia: A meta-analysis of treatment efficacy. Am. J. Psychiat.151: 1172–1180.
Morin, C. M., Kowatch, R. A., Barry, T., and Walton, E. (1993a). Cognitive behavior therapy for late-life insomnia. J. Consult. Clin. Psychol.61: 137–146.
Morin, C. M., Stone, J., McDonald, K., and Jones, S. (1994). Psychological management of insomnia: A clinical replication series with 100 patients. Behav. Ther.25: 291–309.
Morin, C. M., Stone, J., Trinkle, D., Mercer, J., and Remsberg, S. (1993b). Dysfunctional beliefs and attitudes about sleep among older adults with and without insomnia complaints. Psychol. Aging8: 463–467.
Murtagh, D. R., and Greenwood, K. M. (1995). Identifying effective psychological treatments for insomnia: A meta-analysis. J. Consult. Clin. Psychol.63: 79–89.
National Institutes of Health (NIH). (1991). Consensus development conference statement: The treatment of sleep disorders of older people. Sleep14: 169–177.
Nowell, P. D., Mazumdar, S., Buysse, D. J., Dew, M. A., Reynolds, C. F., and Kupfer, D. J. (1997). Benzodiazepines and zolpidem for chronic insomnia: A meta-analysis of treatment efficacy. J. Am. Med. Assoc.278: 2170–2177.
Puder, R., Lacks, P., Bertelson, A. D., and Storandt, M. (1983). Short term stimulus control treatment of insomnia in older adults. Behav. Ther.14: 424–429.
Regenstein, Q. R. (1980). Insomnia and sleep disturbances in the aged: Sleep and insomnia in the elderly. J. Geriat. Psychiat.13: 153–171.
Shealy, R. C., Lowe, J., and Ritzler, B. (1980). Sleep onset insomnia: Personality characteristics and treatment outcome. J. Consult. Clin. Psychol.48: 659–661.
Simon, G., and Vonkorff, M. (1997). Prevalence, burden, and treatment of insomnia in primary care. Am. J. Psychiat.154: 1417–1423.
Steketee, G., and Chambless, D. L. (1992). Methodological issues in prediction of treatment outcome. Clin. Psychol. Rev.12: 387–400.