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Cohen LS et al Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment JAMA 2006 Feb 1;295(5):499 507 [PMID: 16449615] Fava M et al Efficacy and safety of sildenafil in men with serotonergic antidepressant-associated erectile dysfunction: results from a randomized, double-blind, placebo-controlled trial J Clin Psychiatry 2006 Feb;67(2):240 6 [PMID: 16566619] Lesperance F et al Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial JAMA 2007 Jan 24;297(4):367 79 Errata in JAMA 2007 Jul 4;298(1):40 [PMID: 17244833] Rush AJ et al Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report Am J Psychiatry 2006 Nov;163(11):1905 17 [PMID: 17074942] Weissman et al Remissions in maternal depression and child psychopathology: STAR*D-child report JAMA 2006 Mar 22; 295(12):1389 98 [PMID: 16551710] Williams M et al Paroxetine (Paxil) and congenital malformations CMAJ 2005 Nov 22;173(11):1320 1 [PMID: 16272192]

Sleep consists of two distinct states as shown by electroencephalographic studies: (1) REM (rapid eye movement) sleep, also called dream sleep, D state sleep, paradoxic sleep, and (2) NREM (non-REM) sleep, also called S stage sleep, which is divided into stages 1, 2, 3, and 4 and is recognizable by different electroencephalographic patterns Stages 3 and 4 are delta sleep Dreaming occurs mostly in REM and to a lesser extent in NREM sleep Sleep is a cyclic phenomenon, with four or five REM periods during the night accounting for about one-fourth of the total night s sleep (15 2 hours) The first REM period occurs about 80 120 minutes after onset of sleep and lasts about 10 minutes Later REM periods are longer (15 40 minutes) and occur mostly in the last several hours of sleep Most stage 4 (deepest) sleep occurs in the first several hours Age-related changes in normal sleep include an unchanging percentage of REM sleep and a marked decrease in stage 3 and stage 4 sleep, with an increase in wakeful periods during the night These normal changes, early bedtimes, and daytime naps play a role in the increased complaints of insomnia in older people Variations in sleep patterns may be due to circumstances (eg, jet lag ) or to idiosyncratic patterns ( night owls ) in persons who perhaps because of different biologic rhythms habitually go to bed late and sleep late in the morning Creativity and rapidity of response to unfamiliar situations are impaired by loss of sleep There are also rare individuals who have chronic difficulty in adapting to a 24-hour sleep-wake cycle (desynchronization sleep disorder), which can be resynchronized by altering exposure to light The three major sleep disorders are discussed below

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The operand on the right doesn t have to be a constant; it can be another variable. For example, if myVariable is set to 15, you can then write this:

Calcium channel blockers (eg, verapamil) have been used in bipolar states that have failed to respond to lithium, carbamazepine, or valproic acid This has come about with the realization that a number of drugs used in psychiatry (eg, lithium, antidepressants, neuroleptics, and carbamazepine) have calcium channel blocking activity Verapamil may be safer than lithium or carbamazepine during pregnancy, although it decreases uterine contractility and must be discontinued before delivery

Reactive depressions are usually time-limited, and the prognosis with treatment is good if a pathologic pattern of adjustment does not intervene Major affective disorders frequently respond well to a full trial of drug treatment Mania and bipolar disorder have a good prognosis with adequate treatment

Patients may complain of difficulty getting to sleep or staying asleep, intermittent wakefulness during the night, early morning awakening, or combinations of any of these Transient episodes are usually of little significance Stress, caffeine, phys-

myOtherVariable = myVariable;

adverse reactions of medications The elderly population is at risk for complaints of insomnia because sleep becomes lighter and more easily disrupted with aging Medical disorders that become more common with age may also predispose to insomnia

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