Biomedical subjects

M M Ohayon

Publications and source records attributed to M M Ohayon.

At least 37 records · Page 2Linked to original sources

PubMed1999

Night terrors, sleepwalking, and confusional arousals in the general population: their frequency and relationship to other sleep and mental disorders.

BACKGROUND: Arousal parasomnias (night terrors, sleepwalking, and confusional arousals) have seldom been investigated in the adult general population. Clinical studies of parasomnias, however, show that these disorders may be indicators of underlying mental disorders and may have serious consequences. METHOD: A representative sample of the United Kingdom population (N = 4972) was interviewed by telephone with the Sleep-EVAL system. RESULTS: Night terrors were reported by 2.2% (95% CI = 1.8% to 2.6%) of the sample, sleepwalking by 2.0% (1.6% to 2.4%), and confusional arousals by 4.2% (3.6% to 4.8%). The rate of these 3 parasomnias decreased significantly with age, but no gender difference was observed. Multivariate models identified the following independent factors as associated with confusional arousals (odds ratio [OR]): age of 15-24 years (OR = 4.1), shift work (OR = 2.1), hypnagogic hallucinations (OR = 3.3), deep sleep (OR = 1.6), daytime sleepiness (OR = 1.9), sleep talking (OR = 1.7), daily smoking (OR = 1.7), adjustment disorder (OR = 3.1), and bipolar disorder (OR = 13.0). Factors associated with night terrors were subjective sense of choking or blocked breathing at night (OR = 5.1), obstructive sleep apnea syndrome (OR = 4.1), alcohol consumption at bedtime (OR = 3.9), violent or injury-causing behaviors during sleep (OR = 3.2), hypnagogic hallucinations (OR = 2.2), and nightmares at least 1 night per month (OR = 4.0). Factors associated with sleepwalking were age of 15-24 years (OR = 5.2), subjective sense of choking or blocked breathing at night (OR = 5.1), sleep talking (OR = 5.0), and a road accident in the past year (OR = 3.9) after controlling for possible effects of sleep deprivation, life stress, and mental and sleep disorders. CONCLUSION: Arousal parasomnias, especially night terrors and confusional arousals, are often the expression of a mental disorder. Other life or medical conditions, such as shift work or excessive need of sleep for confusional arousals and stressful events for sleepwalking, may also trigger parasomnias. Prevalence rates are based on self-reported data and, consequently, are likely underestimated.

Adolescent↗

PubMed1998

Psychotropic medication consumption patterns in the UK general population.

The prevalence of psychotropic medication consumption was assessed in the UK by surveying a representative sample of 4972 non-institutionalized individuals 15 years of age or older (participation rate, 79.6%). A questionnaire was administered over the telephone with the help of the Sleep-Eval Expert System. Topics covered included: type and name of medication, indication, dosage, duration of intake, and medical specialty of prescriber. Also collected were data pertaining to sociodemographics, physical illnesses, and DSM-IV mental disorders. Overall, 3.5% [95% CI: 3-4] of the sample reported current use of psychotropic medication. Consumption was higher among women [4.6% (3.8-5.4)] than men [2.3% (1.7-2.9)], and among the elderly (> or = 65 years of age). The distribution of psychotropics was: hypnotics 1.5%, antidepressants 1.1%, and anxiolytics 0.8%. The median duration of psychotropic intake was 52 weeks. General practitioners were the most common prescribers of psychotropics (over 80% for each class of drug). Nearly half the antidepressant users were diagnosed by the system with a DSM-IV anxiety disorder, and one-fifth the anxiolytic users with a depressive disorder. A marked improvement in sleep quality was reported by half the subjects using a psychotropic for sleep-enhancing purposes. Psychotropic users were more likely than non-users to report episodes of memory loss, vertigo, or anomia. Psychotropic medication consumption is lower and patterns of psychotropic prescription differ in the UK compared with other European and North American countries. Results suggest that physicians may not be sufficiently trained to deal with the overlap between general practice and psychiatry.

Adolescent↗

PubMed1998

Fitness, responsibility, and judicially ordered assessments.

OBJECTIVE: To compare the characteristics of individuals assessed for fitness to stand trial (FST) with those assessed for criminal responsibility (CR). METHOD: This study examines all the consecutive requests of FST or CR addressed to the only forensic psychiatric hospital in the province of Quebec and 2 prisons in the Montreal area over a 1-year period. RESULTS: In all, 170 FST, 52 CR, and 29 both FST and CR assessment requests were received (251 subjects). Psychiatrists' recommendations and court verdicts of unfitness to stand trial or not criminally responsible on account of mental disorders were mostly related to the presence of a psychotic-spectrum disorder. There is generally a good agreement between psychiatric recommendations and verdicts of the court, with the exception of unfitness recommendations. CONCLUSIONS: Defendants referred for a FST or a CR assessment displayed similar characteristics. However, although subjects with psychotic disorders represented more than one-half of the unfit or not criminally responsible verdicts, most of the subjects with psychoses were found competent to stand trial or responsible.

Analysis of Variance↗

PubMed1998

[Multidimensional aspect of proposed hypotheses accounting for the prevalence of mental disorders in prisons].

OBJECTIVE: This paper summarizes the hypotheses accounting for the prevalence of mental disorder in prison. The hypotheses about the migration of prisoners, the criminalization of individuals with mental disorders, and the clinical specificity of subjects with mental disorders are introduced and discussed. A new hypothesis is proposed to account for the prevalence of mental disorder in prison, stating that the first instances of case management, either legal or medical, affect subsequent case management. DISCUSSION: The 4 aspects (political, administrative, individual, and cognitive) of the hypotheses enable the development of a multidimensional approach to account for the prevalence of mental disorder in prison.

Case Management↗

PubMed1998

Nocturnal wandering and violence: review of a sleep clinic population.

Sleep consists of two complex states--NREM and REM sleep--and disturbances of the boundaries between the states of sleep and wakefulness may result in violence. We investigated our population for reports of violence associated with sleep. REM behavior disorder is rarely associated with injury to the sufferer or others. NREM sleep related nocturnal wandering associated with self-inflicted injuries has variable etiologies. In the elderly, it is associated with dementia. In young individuals, it may be associated with mesio-temporal or mesio-frontal foci and an indication of a complex partial seizure. It also may be related to abnormal alertness and is associated with excessive daytime sleepiness, micro-sleeps, and hypnagogic hallucinations in sleep disorders such as narcolepsy or sleep disordered breathing.

Adult↗

PubMed1997

Snoring and breathing pauses during sleep: telephone interview survey of a United Kingdom population sample.

OBJECTIVES: To determine the prevalence of snoring, breathing pauses during sleep, and obstructive sleep apnoea syndrome and determine the relation between these events and sociodemographic variables, other health problems, driving accidents, and consumption of healthcare resources. DESIGN: Telephone interview survey directed by a previously validated computerised system (Sleep-Eval). SETTING: United Kingdom. SUBJECTS: 2894 women and 2078 men aged 15-100 years who formed a representative sample of the non-institutionalised population. MAIN OUTCOME MEASURES: Interview responses. RESULTS: Forty per cent of the population reported snoring regularly and 3.8% reported breathing pauses during sleep. Regular snoring was significantly associated with male sex, age 25 or more, obesity, daytime sleepiness or naps, night time awakenings, consuming large amounts of caffeine, and smoking. Breathing pauses during sleep were significantly associated with obstructive airways or thyroid disease, male sex, age 35-44 years, consumption of anxiety reducing drugs, complaints of non-restorative sleep, and consultation with a doctor in the past year. The two breathing symptoms were also significantly associated with drowsiness while driving. Based on minimal criteria of the International classification of Sleep Disorders (1990), 1.9% of the sample had obstructive sleep apnoea syndrome. In the 35-64 year age group 1.5% of women (95% confidence interval 0.8% to 2.2%) and 3.5% of men (2.4% to 4.6%) had obstructive sleep apnoea syndrome. CONCLUSIONS: Disordered breathing during sleep is widely underdiagnosed in the United Kingdom. The condition is linked to increased use of medical resources and a greater risk of daytime sleepiness, which augments the risk of accidents. Doctors should ask patients and bed partners regularly about snoring and breathing pauses during sleep.

Accidents, Traffic↗

PubMed1997

Is hypnotic withdrawal facilitated by the transitory use of a substitute drug?

PURPOSE: Long-term consumption of hypnotics may lead to various side-effects, including impaired daytime and cognitive functioning and increased risk of accidents. Unfortunately, few guidelines exist for physicians to apply when attempting to withdraw hypnotics from patients. This study investigated whether withdrawal is facilitated by using zopiclone as a substitute drug and evaluated abrupt and gradual substitution techniques. METHODS: This open, multicentre and randomized study involved 1,002 male and female outpatients aged 18 years or over recruited by psychiatrists in Lyon, France. Patients had a mean age of 44 years, and 65.9% were women. Outpatients were chronic insomniacs being treated with a hypnotic for at least three weeks. The study included a substitution (D0-D35) and a withdrawal (D36-D56) stage. Patients were randomly drawn into three parallel groups: Group A underwent gradual substitution of zopiclone for the initial BZD; Group B was subjected to complete and immediate withdrawal of the initial BZD in favor of zopiclone; and Group C remained on the initial BZD, though told otherwise. The withdrawal stage began on D36 with a 50% reduction in medication and ended on D50 with complete withdrawal. RESULTS: Groups A (gradual substitution) and B (abrupt substitution) presented a net improvement in sleep during the substitution stage. However, Group B displayed a better improvement in sleep-onset period, a decrease in nocturnal awakenings and an increased quantity of sleep. In the withdrawal stage, Groups A and B were similar but Group C displayed a deterioration in sleep. Following the withdrawal stage, 29% of patients in Group C, 18% in Group A and 19% in Group B resumed hypnotic use. CONCLUSIONS: Discontinuation of this type of medication is possible in over three quarters of cases, provided that the prescribing physician adheres to a precise withdrawal protocol. Patients on zopiclone were less likely to resume consumption of hypnotics during the week of full withdrawal and were more satisfied with sleep than when treated with a BZD hypnotic. Finally, the results of the study showed that abrupt substitution yielded better results for chronic users of hypnotics.

Adolescent↗

PubMed1997

An international study on sleep disorders in the general population: methodological aspects of the use of the Sleep-EVAL system.

The comparability among epidemiological surveys of sleep disorders has been encumbered because of the array of methodologies used from study to study. The present international initiative addresses this limitation. Many such studies using the exact same methodology are being completed in six European countries (France, the United Kingdom, Germany, Italy, Portugal, and Spain), two Canadian cities (metropolitan areas of Montreal and Toronto), New York State, and the city of San Francisco. These surveys have been undertaken with the aim of documenting the prevalence of sleep disorders in the general population according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) and the International Classification of Sleep Disorders (ICSD-90). Data are gathered over the telephone by lay interviewers using the Sleep-EVAL expert system. This paper describes the methodology involved in the realization of these studies. Sample design and selection procedures are discussed.

Adolescent↗

PubMed1997

Prevalence of nightmares and their relationship to psychopathology and daytime functioning in insomnia subjects.

A representative sample of 5,622 subjects between 15 and 96 years of age from the noninstitutionalized general population of France were interviewed by telephone concerning their sleeping habits and sleep disorders. The interviews were conducted using the Sleep-Eval knowledge-based system, a nonmonotonic, level 2 expert system with a causal reasoning mode. Questions investigated nightmares, based on the Diagnostic and Statistical Manual, fourth edition (DSM-IV), definition, psychopathological traits, and included 12 other groups of information, including sociodemographics, sleep-wake schedule, daytime functioning, psychiatric and medical history, and drug intake. The data from 1,049 subjects suffering from insomnia were considered for this analysis. Bivariate analyses, logistic regression analysis using the method of indicator contrasts for the investigation of independent variables, and calculation of significant odds ratios were performed. Nightmares were reported in 18.3% of the surveyed insomniac population and were two times higher in women than in men. The following factors were found to be significantly associated with nightmares 1) sleep with many awakenings, 2) abnormally long sleep onset, 3) daytime memory impairment following poor nocturnal sleep, 4) daytime anxiety following poor nocturnal sleep, and 5) being a woman. There was a strong association between the report of nightmares in women and the presence of either a depressive disorder, anxiety disorder, or both disorders together. When the effects of major psychiatric disorders were controlled for, nightmares were significantly associated with being a woman, feeling depressed after a poor night's sleep, and complaining of a long sleep latency. Nightmares can lead to a negative conditioning toward sleep and to chronic sleep complaints. Considering the frequency of nightmares in an adult insomniac population and the significant relationship between nightmares and certain subgroups, nightmares should receive more attention in patients, especially women complaining of disrupted sleep, as high rates of psychiatric disorders were found in this specific group.

Adolescent↗

PubMed1997

How a general population perceives its sleep and how this relates to the complaint of insomnia.

The traditional indicators of insomnia (i.e. difficulty initiating sleep, difficulty maintaining sleep, nonrestorative sleep, early morning awakening) were assessed in a representative sample of 1,722 French-speaking Montrealers (Canada) aged 15 to 100 years. These subjects were interviewed over the telephone (81.3% of contacted sample) by means of the Sleep-Eval software. Subjects were classified as either satisfied or dissatisfied with quality of sleep (SQS or DQS), with or without insomnia indicators (+I or -I). Sociodemographics, sleep-wake schedules, evening activities, medication intake, recent medical consultations, and social life were also investigated. DQS subjects composed 17.8% of the population (DQS + I: 11.2%; DQS - I: 6.5%), and 21.7% of subjects were classified as either DQS + I or SQS + I. Overall, 3.8% of subjects reported using a sleep-enhancing medication. Nonrestorative sleep did not significantly distinguish SQS and DQS subjects. The complaint of nonrestorative sleep is not a useful indicator of insomnia, despite its inclusion in all medical classifications. DQS - I and SQS + I subjects defy traditional classifications. A better understanding of sleep complaints and more accurate classifications will help physicians identify patients with insomnia and meet their needs more appropriately.

Adolescent↗

PubMed1997

DSM-IV and ICSD-90 insomnia symptoms and sleep dissatisfaction.

BACKGROUND: The complex nature of insomnia and its relationship with organic and mental disorders render diagnosis problematic for epidemiologists and physicians. METHOD: A representative UK sample (non-institutionalised, > 14 years old) was interviewed by telephone (n = 4972; 79.6% participation rate) with the Sleep-EVAL system. Subjects fell into three groups according to presence of insomnia symptom(s) and/or sleep dissatisfaction. RESULTS: Insomnia symptoms occurred in 36.2% of subjects. Most of these (75.9%), however, reported no sleep dissatisfaction. In comparison, those also with sleep dissatisfaction had higher prevalence of sleep and mental disorders and longer duration of insomnia symptoms, and were more likely to take sleep-promoting medication, dread bedtime, and complain of light sleep, poor night-time sleep and daytime sleepiness. CONCLUSIONS: Insomnia sufferers differ as to whether they are satisfied or dissatisfied with sleep. Although insomnia symptoms are common in the general population, sleep disturbances among sleep-dissatisfied individuals are more severe. Sleep dissatisfaction seems a better indicator of sleep pathology than insomnia symptoms.

Adolescent↗

PubMed1997

Violent behavior during sleep.

BACKGROUND: Although the relative incidence of violent behavior during sleep (VBS) is presumed to be low, no epidemiologic data exist to evaluate the prevalence of the phenomenon or to begin to understand its precursors or subtypes. This study examined the frequency of violent or injurious behavior during sleep and associated psychiatric risk factors. METHOD: A representative United Kingdom sample of 2078 men and 2894 women between the ages of 15 to 100 years (representing 79.6% of those contacted) participated in a telephone interview directed by the Sleep-EVAL expert system specially designed for conducting such diagnostic telephone surveys. RESULTS: Two percent (N = 106) of respondents reported currently experiencing VBS. The VBS group experienced more night terrors and daytime sleepiness than the non-VBS group. Sleep talking, bruxism, and hypnic jerks were more frequent within the VBS than the other group, as were hypnagogic hallucinations (especially the experience of being attacked), the incidence of smoking, and caffeine and bedtime alcohol intake. The VBS group also reported current features of anxiety and mood disorders significantly more frequently and reported being hospitalized more often during the previous 12 months than the non-VBS group. Subjects with mood or anxiety disorders that co-occurred with other nocturnal symptoms had a higher risk of reporting VBS than all other subjects. CONCLUSION: We have identified a number of sleep, mental disorder, and other general health factors that characterize those experiencing episodes of VBS. These findings suggest that specific factors, perhaps reflecting an interaction of lifestyle and hereditary contributions, may be responsible for the observed variability in this rare but potentially serious condition.

Adolescent↗

PubMed1996

Psychotropic medication and insomnia complaints in two epidemiological studies.

OBJECTIVE: This study compared prescribed psychotropic medication patterns for reported sleep disorders in French and Quebec samples. METHOD: The first study was undertaken in France (N = 5622) and the second in the metropolitan area of Montreal (N = 1722). Lay interviewers used a specialized knowledge-based system for the purpose of evaluating sleep disorders by telephone. RESULTS: Results showed similar prevalence of insomnia complaints in both samples (20.1% and 17.8%, respectively). A higher level of psychotropic consumption was found in France (11.7% [95% confidence interval (CI), 10.9 to 12.5]) compared with Quebec, however, where consumption was less than half the French rate (5.5% [95% CI, 4.4 to 6.6]). Both studies identified females and the elderly as the primary consumers of these drugs. For approximately two-thirds of both samples, sleep-promoting medications were prescribed for a year or longer, revealing a chronicity of the consumption. Approximately 4 out of 5 prescriptions for sleeping medications were ordered by general practitioners in both samples. CONCLUSION: These findings clearly show a higher prevalence of psychotropic drug use in the French compared with the Quebec population. The patterns of consumption and prescription, however, are quite similar in both studies.

Adolescent↗

PubMed1996

Hypnagogic and hypnopompic hallucinations: pathological phenomena?

BACKGROUND: Hypnagogic and hypnopompic hallucinations are common in narcolepsy. However, the prevalence of these phenomena in the general population is uncertain. METHOD: A representative community sample of 4972 people in the UK, aged 15-100, was interviewed by telephone (79.6% of those contacted). Interviews were performed by lay interviewers using a computerised system that guided the interviewer through the interview process. RESULTS: Thirty-seven per cent of the sample reported experiencing hypnagogic hallucinations and 12.5% reported hypnopompic hallucinations. Both types of hallucinations were significantly more common among subjects with symptoms of insomnia, excessive daytime sleepiness or mental disorders. According to this study, the prevalence of narcolepsy in the UK is 0.04%. CONCLUSIONS: Hypnagogic and hypnopompic hallucinations were much more common than expected, with a prevalence that far exceeds that which can be explained by the association with narcolepsy. Hypnopompic hallucinations may be a better indicator of narcolepsy than hypnagogic hallucinations in subjects reporting excessive daytime sleepiness.

Adolescent↗

PubMed1995

Insomnia and psychotropic drug consumption.

1. During an epidemiological study conducted by telephone on sleep disorders in the metropolitan area of Montreal (Quebec, Canada), the authors found that 5% of subjects used psychotropic drugs. These drugs were usually prescribed by a general practitioner (72.9%). 2. From this population, the authors drew three groups of subjects: users with sleeping difficulties (USD); non users with sleeping difficulties (NUSD) and, non users without sleeping difficulties (NUWSD). 3. Results showed that the utilization of psychotropics was usually chronic and more frequent among the elderly and women. 4. In multivariate models, when users were compared to NUWSD, the authors found eight variables significantly associated with psychotropic consumption: age (> or = 55), sex (female), presence of physical illness, medical consultation, dissatisfaction with sleep onset period and sleep quantity, sleep onset period greater than 15 minutes, and to never or rarely dream. 5. When users were compared to NUSD, three variables were found to be associated with psychotropic consumption: age, to be formerly married, and to experience regular nighttime awakenings. 6. It appears that the utilization of psychotropic drugs does not increase the quality of sleep when consumers are compared to non treated insomniacs (NUSD) on parameters of sleep satisfaction.

Adolescent↗

PubMed1995

Validation of expert systems: examples and considerations.

The problem of a medical expert system validation is generally complex. It requires a rigorous methodology of validation and must show proof of its practical competency in order to be used currently. Validation concerns the quality of conclusions provided by the system, the quality of the deductive process leading to these conclusions as well as the validity of its utilization. In this paper, some reflections, questions, and requirements are exposed that must be addressed to proceed to the validation of a knowledge base system in the field of medicine, especially the psychiatric field.

Computer Systems↗

PubMed1993

[Utilization of expert systems in psychiatry].

Are expert systems liable to be used as consultants in psychiatry? Most expert systems deal with an over-restricted part of psychiatry and cannot be a real help in everyday care. Moreover, most of them are not actually validated (the comparison between the system's and the expert's conclusions in a few cases is not enough). Another problem is that they reflect the uncertainties of nosographic problems. Validation of such systems needs the careful checking of the logical structure of the underlying nosography, the fitness of the structure's knowledge base and the fitness of the inference engine. Moreover, the naïve use of the system by untrained clinicians is the best means of validation since it provides real life proof of the ability of expert systems to make diagnoses in unselected cases where the need for a common diagnostic reference is clear (for example, epidemiologic, psychopharmacological ornosographic research). Some of the best known expert systems in the field of psychiatry are reviewed and another expert system, Adinfer, is presented. Developed since 1982, Adinfer is a forward-tracking level O system (in its simplified version for micro-computers). The knowledge base is a translation of the DSM-III-R into production rules. The program has been included in several software packages and used in many clinical studies, both among psychiatrists and physicians. The program has been validated with 1,141 unselected cases, and with 47 physicians: an 83% agreement rate was found between the system's and the physician's diagnoses, taking into account that the clinicians were asked to give their conclusions according to their usual nosography.(ABSTRACT TRUNCATED AT 250 WORDS)

Artificial Intelligence↗

PubMedDate not supplied

Comorbidity of mental and insomnia disorders in the general population.

The co-occurrence of insomnia and mental disorders constitutes the most prevalent diagnosis pattern found in sleep disorder clinics. Yet, there remains a paucity of epidemiological information regarding comorbidity of mental disorders and sleep disorder symptomatology in the general population. The present study showed results based on a large representative French cohort (n = 5,622; 80.7% of the contacted stratified sample). A total of 997 (17.7%) individuals with insomnia complaints were identified and divided into six diagnostic categories: (1) Insomnia related to a Depressive Disorder; (2) Insomnia related to an Anxiety Disorder; (3) Depressive Disorder accompanied by insomnia symptomatology; (4) Anxiety Disorder accompanied by insomnia symptomatology; (5) Primary Insomnia; and (6) isolated insomnia symptomatology. Telephone interviews were conducted using the Sleep-Eval System. Subjects with insomnia related to a Mental Disorder have a longer history of insomnia complaints and are usually younger than those with Depressive or Anxiety Disorders accompanied by insomnia symptoms. Subjects with Insomnia related to a Depressive Disorder experienced more repercussions than any other group. A surprisingly high percentage of individuals with depressive symptomatology had sought independent medical treatment specifically for their sleep problems, which raises the unsettling possibility that many cases of depression go undetected by the general medical community. The distinct predictability of commonly undiagnosed depression leading to chronic depression speaks directly to the imperative that physicians receive additional training in this area of community mental health.

Adolescent↗