Maladaptive sleep-related cognitions and behaviors have been recognized as important etiological factors for primary insomnia. The contribution of these factors in insomnia comorbid with mood disturbances, however, is controversial. This study compared sleep-related beliefs and sleep hygiene practices among primary insomnia and insomnia comorbid with depression and/or anxiety. A total of 292 participants, including 97 good sleepers (GS), 73 primary insomnia patients (PI), 17 insomnia patients with anxiety (AI), 39 insomnia patients with depression (DI), and 66 insomnia patients with anxiety and depression (ADI) were included in the study. All participants went through a clinical interview and completed a package of questionnaires, including the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) to assess anxiety and depression levels, as well as the Dysfunctional Belief and Attitude about Sleep Scale (DBAS) and the Sleep Hygiene Practice Scale (SHPS) to assess sleep-related cognitions and sleep hygiene practices. The results showed that there were no significant differences between PI group and the groups with comorbid mood disturbances on the DBAS and the SHPS scores, even with control of the influences of mood symptoms. The results suggest that patients with comorbid insomnia have similar dysfunctional sleep beliefs and maladaptive sleep hygiene practices as in those with primary insomnia. Sleep related cognition and behavior also play an important role in the pathology of comorbid insomnia. In addition to their mood symptoms, interventions targeting these factors might be helpful to alleviate the insomnia in comorbid populations.

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BackgroundObesity is a common health problem among patients with schizophrenia, but the precise mechanisms are not fully understood. There has been much interest in the relationship between gut microbiome and development of obesity. Gender-dependent microbial alteration has been reported in previous studies. However, the gender factor in gut microbiome composition of schizophrenia patients has been less investigated. Our study aimed to identify differences in gut microbiota between schizophrenia patients with normal weight and central obesity and investigate the gender specific features.MethodTwenty participants (10 males, 10 females) with central obesity (CO) and 20 participants (10 males, 10 females) with normal weight (NW) were recruited from two rehabilitation wards in a psychiatric hospital in central Taiwan. Fecal samples from 40 participants were processed for microbiota analysis. The intestinal microbiota composition was analyzed using next-generation sequencing and QIIME software.ResultsSignificantly higher richness of gut microbiota at the class level (measured by the number of observed OTUs) was observed in female NW subjects than in female CO subjects (P = 0.033). Furthermore, female NW subjects showed higher alpha diversity at both phylum and class levels (measured by the Shannon, Simpson, and Inverse-Simpson indexes) compared with female CO subjects. Males showed no significant difference in alpha diversity between groups. Taxonomic analysis showed that female CO subjects had significantly lower abundance of Verrucomicrobia (P = 0.004) at the phylum level, reduced abundance of Akkermansia (P = 0.003) and elevated level of Prevotella (P = 0.038) and Roseburia (P = 0.005) at the genus level.ConclusionsThe present results evidenced altered microbiome composition in schizophrenia patients with central obesity and further suggested the role of the gender factor in the process of gut dysbiosis.