The majority of individuals with Psychiatric disorders receive their health care from nonpsychiatrists. The proposed research proposal will examine whether identification of primary care patients with sleep disturbances can lead to improved recognition of existing psychiatric disorders and offer an opportunity for early intervention to prevent the development of more severe psychiatric morbidity. There are three interrelated projects within this FIRST application: 1) An analysis of the Epidemiological Catchment Area study to determine the cross-sectional and longitudinal relationships between sleep disturbances, chronic medical disorders, functional status and psychiatric disorders. These relationships will be investigated for individuals, stratified by age, who reported receiving general medical health care services. 2) A prospective, observational study of 120 patients with sleep disturbances to identify persons at risk for subsequent psychiatric morbidity and deterioration in functional status. Primary care patients with sleep disturbances, and matched control patients without sleep disturbances, will be followed for one year to determine the course of their sleep symptoms, psychiatric status, medical condition, functional status, and health care services utilization. Both behavioral and pharmacological treatment will be considered as covariates in the analysis of outcomes. 3) Results from these two projects will provide information on which individuals with sleep disturbances are at particularly high risk for developing a psychiatric disorder and which treatment regimens appear to be most effective. These results will be used to formulate a pilot for a randomized clinical trial which will assess the effectiveness of treatment of sleep disturbances to prevent psychiatric morbidity. At this time, the planned treatment regimens include low dose triazolam (.25mg), low dose imipramine (25mg) and a placebo group. The specific treatments may change in light of information gathered from the earlier projects. The results of these studies will have direct value for the primary care physician trying to manage the many patients with sleep disturbances and psychiatric symptoms seen in practice and will provide data on the role of sleep disturbances in the development of psychiatric disorders.
