우울과 관련된 불면증에 관한 논문

우울과 관련된 불면증에 관한 논문

우울과 관련된 불면증에 관한 논문.hwp

본문 sec1-1content __pid4337391 Insomnia is a common problem and affects nearly 10% of individuals. The relationship between insomnia and depression is complex, and our knowledge has changed substantially in the past decade regarding the relationship between these two entities. Earlier, an epidemiological study has shown that persons with insomnia are at a higher risk of developing depression and anxiety disorders. This is not a one-way relationship, as Buysee et al. have shown that depression also predicts future insomnia. It was further shown that depression has not only qualitative but also quantitative effect on the sleep; severely depressed people have the worse sleep pattern as compared with those with mild-to-moderate depression. Furthermore, insomnia with depression can be considered as an intermediate subtype between pure depression and isolated insomnia. Thus, it appears that these two disorders are independent entities but they co-occur more than by chance. __pid4212229 A number of factors may contribute to their co-occurrence : hyperarousal and stress are common in both disorders; depressed persons may engage in poor sleep hygiene practices. They may be due to an effect of some untreated illness or emerges because of drugs. In addition, in substance abusers, addictive substance may be responsible for either of them. However, sleep hygiene practices and hyperarousal do not differ between depressed and psychophysiological insomniac patients. In addition, symptoms of chronic insomnia and depression frequently overlap and it may sometimes be difficult to differentiate between them. However, the 'preoccupation with sleep' and other features of depression may be considered while differentiating between these two groups. Another report suggested that treatment of insomnia improves depression by an unknown mechanism. __pid4380735 It has also been reported that when the depression is treated, some of its symptoms remain unresolved and manifest as residual symptoms of depression, with sleep problems forming a major chunk. Moreover, addition of behavioral therapy for insomnia to pharmacotherapy for depression resulted in improvement of sleep. __pid4413966 Although recent literature talks about comorbid insomnia and blurred the boundaries between primary and secondary insomnia, International Classification of Sleep Disorders-2 (ICSD-2) still keeps primary insomnia and secondary insomnia to psychiatric illness categories. We could not find any study that has attempted to diagnose primary insomnia in subjects with depressive illness. Thus, this study was planned with the aim of finding the type of insomnia (primary or secondary) in patients suffering from depression; ascertaining the onset of insomnia relative to the onset of depressive illness; and lastly measuring the effect of insomnia on the course of depressive disorder. sec1-2 sec1-2titletitle MATERIALS AND METHODS sec1-2content __pid4158480 This study was conducted after seeking ethical approval from the ethics committee of our institution. All consecutive subjects attending the psychiatry outpatient department of a tertiary care teaching hospital between January 2011 and March 2011 and complaining of depressive illness were included in the present study. Depressive illness was defined as the presence of either major depressive disorder (MDD) or dysthymia or recurrent depressive disorder according to DSM-IV-TR criteria. All patients were subjected to structured clinical interview using Mini International Neuropsychiatric Interview Plus. However, the following subjects were excluded from the study : t0 hose developing depression or insomnia after the onset of any medical or neurological disorder (i.e., having a temporal relationship); those ever suffered from any kind of psychotic disorder; those presently meeting the criteria of substance abuse, dependence, or withdrawal; those consuming any medicine that is known to induce depression, sleep disturbances, or movement disorders; those not willing to participate; those having history suggestive of any other sleep disorder (e.g., sleep apnea and parasomnia). Similarly, pregnant women, those within postpartum period (12 months since last childbirth) and having symptoms of postmenopausal syndrome, were also excluded from the study. __pid4414964 All included subjects were explained about the rationale of the study in detail, and their written informed consent was taken. Thereafter, their demographic data were recorded and clinical history regarding course of their illness, treatment history, and family history of psychiatric illness was sought. Two independent episodes of depression were diagnosed when the subject was asymptomatic for at least 2 months in between consequent episodes. If somebody reported reemergence of symptoms of depression within this period, he was considered as continuing the previous episode of MDD or dysthymia. sec2-1 Diagnosis of insomnia 하고 싶은 말 좀 더 업그레이드하여 자료를 보완하여, 과제물을 꼼꼼하게 정성을 들어 작성했습니다. 위 자료 요약정리 잘되어 있으니 잘 참고하시어 학업에 나날이 발전이 있기를 기원합니다 ^^ 구입자 분의 앞날에 항상 무궁한 발전과 행복과 행운이 깃들기를 홧팅 키워드 논문, 불면증, 우울, 관련