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BackgroundThe clinical value of the identification of mood disorders in patients with acute coronary syndrome (ACS) is well established. However, assessment based on DSM criteria presents some limitations. This study aimed to provide an innovative strategy for evaluating the spectrum of mood disturbances in ACS.MethodsA total of 288 patients with a first episode of ACS underwent interviews based on DSM-IV-TR criteria (major depressive disorder, minor depression, and dysthymia), Diagnostic Criteria for Psychosomatic Research-DCPR (demoralization and type A behavior), and the Clinical Interview for Depression-CID. Additional self-report inventories (psychological well-being and distress) were administered. A total of 100 consecutive patients who satisfied criteria for DSM-IV-TR depression or DCPR demoralization were enrolled in a randomized controlled trial on a sequential combination of cognitive-behavioral and well-being therapy (CBT/WBT) vs clinical management (CM) and reassessed up to 30-month post-intervention.ResultsA total of 29.9% of patients showed a DSM-IV-TR depressive syndrome. Inclusion of demoralization and type A identified psychological distress in 58% of the sample. According to CID, reactivity to social environment, fatigue, depressed mood, and somatic anxiety were the most common symptoms. Somatic symptoms were significantly associated with DSM-IV-TR depression (fatigue and changes of appetite), whereas environmental reactivity with demoralization. Both depression and demoralization were associated with higher distress and lower well-being. Unlike CM, CBT/WBT was significantly associated with decrease of guilt, pessimism, fatigue, and early insomnia (CID).ConclusionsThe findings indicate that standard psychiatric approach identifies only a narrow part of mood disturbances affecting ACS patients. A more articulated assessment unravels specific clinical configurations that may entail prognostic and therapeutic implications.

Prospective memory (PM) is essential in everyday life because it concerns the ability to remember to perform an intended action in the future. This ability could be influenced by poor sleep quality, the role of which, however, is still being debated. To examine the role of sleep quality in PM in depth, we decided to perform a retrospective naturalistic study examining different clinical populations with a primary sleep disorder or comorbid low sleep quality. If sleep is important for PM function, we could expect poor sleep to affect PM performance tasks both directly and indirectly. We examined a total of 3600 nights, recorded using actigraphy in participants belonging to the following groups: primary insomnia (731 nights), narcolepsy type 1 (1069 nights), attention deficit hyperactivity disorder (152 nights in children and 239 in adults), severe obesity (232 nights), essential hypertension (226 nights), menopause (143 nights), healthy controls (808 nights). In a naturalistic activity-based PM task, each participant originally wore an actigraph around the non-dominant wrist and was requested to push the event-marker button at two specific times of day: bedtime (activity 1) and get-up time (activity 2). Each clinical group showed significantly lower sleep quality in comparison to the control group. However, only narcolepsy type 1 patients presented a significantly impaired PM performance at get-up time, remembering to push the event-marker button around half the time compared not only to healthy controls but also to the other clinical groups. Overall, the present results seem to point to sleep quality having no effect on the efficiency of a naturalistic activity-based PM task. Moreover, the data indicated that narcolepsy type 1 patients may show a disease-specific cognitive deficit of PM.

Aiming to verify which is the most effective screening approach for sleep disorders between the serial (first step: sleep self-report measure; second step only in case of positive outcome at the first: objective tool) and parallel (unique step, with the concurrent use of sleep self-report measure and objective tool), a first secondary analysis of previously collected data (study 1) was carried out examining primary insomniacs (PI) and healthy controls (HC). Aiming to verify the implementation of such approaches in clinical populations presenting high comorbidity with sleep disorder, an additional secondary analysis (study 2) was carried out, investigating hypertensive patients (HP) and severe obese patients (SOP). 84 HC and 47 PI were examined in study 1, while 36 SOP, and 30 HP in study 2. All participants originally underwent actigraphic recordings for seven consecutive days, using the Actiwatch device (objective tool). At the end of the recording week, participants filled the Mini Sleep Questionnaire (sleep self-report measure). As regards the study 1, the parallel and serial approaches allowed to correctly identify the 97.87% and 55.32% of PI, respectively. With reference to the study 2, the 36.11% and 80.56% of SOP were identified as positive at the serial and parallel approaches, respectively, while the corresponding percentages of HP were 30% and 70%. Study 1 showed that parallel screening approach is the most effective in PI, allowing to correctly identifying almost the entirety of these patients. Study 2 highlighted that serial screening approach is more useful in SOP and HP, identifying a percentage of positive patients overall in line with the documented comorbidity with sleep disorder in these clinical populations.