According to an article reported in General Hospital Psychiatry (March-April 2005), patients with insomnia may be dealing with more than lost sleep. Chronic insomnia may in fact be a marker for a psychiatric disorder, particularly depression or anxiety. At least 40% of patients with chronic insomnia also have an underlying psychiatric disorder. Comorbid insomnia in patients with major depressive episodes often is manifested by difficulty in maintaining sleep. With generalized anxiety disorder, a patient's sleep is often shortened and fragmented. Unfortunately, the medications used to treat depression or anxiety actually may exacerbate the patient's inability to sleep soundly.
When insomnia and a psychiatric disorder coexist, it often is difficult to know which came first. Whereas a psychiatric disorder may cause insomnia, insomnia may be a factor in developing a psychiatric disorder. A history of insomnia is associated with a 4-fold increase in the risk of developing a new depressive disorder and a 2-fold increase in the risk of developing a new anxiety disorder. In fact, emerging data suggest that resolution of insomnia may improve psychiatric outcomesunderscoring the importance of a vigorous approach to treating insomnia. Because of the impact on insomnia of many medications for psychiatric conditions, an ideal approach would be a monotherapy that treats both insomnia and the psychiatric disorder.
One study linked multiple pregnancies to an increased risk of developing atrial fibrillation later in life, and another investigated the association between premature delivery and cardiovascular disease.
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