Classifying Psychiatric, Medical, and Primary Insomnias

描述（由申请人提供）：临床医生和研究人员早就认识到慢性失眠是由多种原因引起的，包括原发性睡眠障碍、医学疾病、精神疾病、药物/药物滥用以及一系列行为和环境因素。这一认识反过来又强调了需要一个分类系统来帮助沟通，结构诊断实践，并最终指导失眠患者的治疗决策。不幸的是，关于需要定义的失眠亚型的性质和数量以及失眠诊断应该建立的方法的显著争议导致了两种不同的失眠分类学的出现。在DSM-IV中提出的一个系统，假设全球失眠亚型的数量有限，并主张依靠临床访谈进行诊断确定。另一篇发表在《国际睡眠障碍分类》（ICSD）上，描述了许多高度特异性的失眠亚型，并鼓励在诊断时考虑睡眠实验室数据。尽管这些系统都是狂热的支持者，但尚未进行大型前瞻性研究来测试这些分类学及其所鼓励的诊断方法的可靠性和有效性。拟议的项目需要一项前瞻性的、双地点的调查，有一个相当大的（N = 448）研究队列，旨在：(1)确定并比较这两种疾病分类所描述的亚型的可靠性和有效性；(2)评估睡眠实验室（多导睡眠图- PSG）结果对指定诊断模式的贡献。主要的研究方法将包括多特征-多方法策略，其中三位经验丰富的临床医生通过结构化访谈、非结构化临床访谈或非结构化访谈结合PSG结果得出DSM-IV和ICSD失眠诊断印象。将为每个病种建立一个多特征-多方法矩阵，以评估其各种失眠亚型的信度，收敛效度和判别效度。此外，所有参与者将在研究入组后不久完成全面的心理测试和结构化精神病学访谈（SCID），以评估DSM-IV和ICSD诊断亚型的并发有效性。这个项目将为这两种失眠分类学及其定义的亚型提供急需的比较。结果也可能为未来失眠分类工作提供重要信息。

DESCRIPTION (provided by applicant): Clinicians and researchers have long recognized that chronic insomnia arises from varied causes including primary sleep disorders, medical diseases, psychiatric illnesses, medication/substance abuse, and a host of behavioral and environmental factors. This recognition, in turn, has highlighted the need for a classification system to aid communication, structure diagnostic practice, and ultimately guide treatment decision-making among those who care for insomnia patients. Unfortunately, notable controversies over the nature and number of insomnia subtypes needing definition and the methods whereby insomnia diagnoses should be established have led to the emergence of two distinctive insomnia nosologies. One system, presented in the DSM-IV, postulates a limited number of global insomnia subtypes and advocates reliance on the clinical interview for diagnostic ascertainment. The other, presented in the International Classification of Sleep Disorders (ICSD), delineates many more highly specific insomnia subtypes and encourages consideration of sleep laboratory data in deriving diagnoses. Despite each of these system's fervent supporters, large prospective studies to test the reliability and validity of these nosologies and the diagnostic methods they encourage have yet to be conducted. The project proposed entails a prospective, dual-site investigation with a sizable (N = 448) research cohort designed to: (1) ascertain and compare the reliability and validity of the subtypes these two nosologies delineate; and (2) evaluate the contribution of sleep lab (polysomnographic - PSG) findings on the pattern of diagnoses assigned. The primary research methodology will consist of a multitrait-multimethod strategy in which three experienced clinician dyads derive DSM-IV and ICSD insomnia diagnostic impressions either through structured interviews, unstructured clinical interviews, or unstructured interviews combined with PSG findings. A resulting multitrait-multimethod matrix will be established for each nosology to evaluate the reliability, convergent validity, and discriminant validity of its various insomnia subtypes. In addition, all participants will complete a comprehensive psychometric battery and structured psychiatric interview (SCID) shortly after study enrollment to assess the concurrent validity of the DSM-IV and ICSD diagnostic subtypes. This project will provide a much-needed comparison of these two insomnia nosologies and the subtypes they define. Results also likely will provide important information for future insomnia classification efforts.