社区心理健康中的睡眠与昼夜节律功能障碍跨诊断干预（TranS-C）：显微镜下的共病情况及模块使用情况
The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) in community mental health: Comorbidity and use of modules under the microscope.
作者信息
Sarfan Laurel D, Hilmoe Heather E, Gumport Nicole B, Harvey Allison G
机构信息
University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA 94720.
University of California, Berkeley, Department of Psychology, 2121 Berkeley Way #1650, Berkeley, CA 94720-1650.
出版信息
Cogn Behav Pract. 2023 Nov;30(4):692-706. doi: 10.1016/j.cbpra.2022.03.007. Epub 2022 Apr 22.
Sleep and circadian problems are intertwined with serious mental illness (SMI). Thus, optimizing treatments that target comorbid sleep and circadian problems and SMI is critical. Among adults with sleep and circadian problems and SMI, the present study conducted a secondary data analysis of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C). TranS-C targets a range of sleep and circadian problems and SMI with 15 modules, seven of which are optional. In a 'real world' sample recruited from a community setting (=121, 52.07% female, 42.97% African American or Black), we aimed to (1) elucidate patterns of sleep and circadian problems that met criteria for full diagnoses and subdiagnostic symptoms across (a) the full sample and (b) SMI diagnoses, and (2) determine whether TranS-C optional modules were delivered as intended based on participants' sleep and circadian problems. Results indicated that most participants (> 85.0%) had full diagnoses or subdiagnostic symptoms of two or more sleep and circadian problems. Further, participants exhibited heterogenous comorbidities between sleep and circadian problems and SMI diagnoses. Specifically, participants with a schizophrenia spectrum disorder (n=50), bipolar disorder (n=35), and major depressive disorder (n=26) exhibited 25, 24, and 21 patterns of sleep and circadian comorbidity, respectively. Notably, most participants with insomnia, hypersomnia, and an advanced or delayed circadian rhythm phase disorder did receive the intended TranS-C optional modules designed to target these problems. Results underscore sleep and circadian and SMI diagnostic complexity in the community. Additionally, findings reveal discrepancies between intended and 'real-world' use of treatment modules. Future research investigating clinician decision-making-particularly when treating patients with comorbidities or using modularized treatments-is needed.
睡眠和昼夜节律问题与严重精神疾病（SMI）相互交织。因此，优化针对共病的睡眠和昼夜节律问题以及严重精神疾病的治疗至关重要。在患有睡眠和昼夜节律问题以及严重精神疾病的成年人中，本研究对睡眠和昼夜节律功能障碍的跨诊断干预（TranS-C）进行了二次数据分析。TranS-C通过15个模块针对一系列睡眠和昼夜节律问题以及严重精神疾病，其中7个模块是可选的。在从社区环境招募的“真实世界”样本中（n = 121，52.07%为女性，42.97%为非裔美国人或黑人），我们旨在（1）阐明在（a）整个样本和（b）严重精神疾病诊断中符合完全诊断标准和亚诊断症状的睡眠和昼夜节律问题模式，以及（2）根据参与者的睡眠和昼夜节律问题确定TranS-C可选模块是否按预期提供。结果表明，大多数参与者（> 85.0%）有两种或更多睡眠和昼夜节律问题的完全诊断或亚诊断症状。此外，参与者在睡眠和昼夜节律问题与严重精神疾病诊断之间表现出异质性共病情况。具体而言，患有精神分裂症谱系障碍（n = 50）、双相情感障碍（n = 35）和重度抑郁症（n = 26）的参与者分别表现出25、24和21种睡眠和昼夜节律共病模式。值得注意的是，大多数患有失眠、嗜睡以及昼夜节律相位提前或延迟障碍的参与者确实接受了旨在针对这些问题的预期TranS-C可选模块。结果强调了社区中睡眠、昼夜节律和严重精神疾病诊断的复杂性。此外，研究结果揭示了治疗模块预期使用与“真实世界”使用之间的差异。需要未来的研究来调查临床医生的决策过程——特别是在治疗合并症患者或使用模块化治疗时。
Zotero 插件