Competence Centre for Transcultural Psychiatry,
Mental Health Centre Ballerup,
Mental Health Services of the Capital Region of Copenhagen, Denmark
TREATMENT OF SLEEP DISTURBANCES
IN TRAUMA-AFFECTED REFUGEES –
A RANDOMISED CONTROLLED TRIAL
Hinuga Sandahl1, Poul Jennum3, Lone Baandrup, Jessica Carlsson1,2
1. Competence Centre for Transcultural Psychiatry (CTP), Mental Health Centre Ballerup
2. University of Copenhagen
3. Danish Center for Sleep Medicine
The study is performed in collaboration between Competence Centre for Transcultural Psychiatry and Danish Center for Sleep Medicine.
BACKGROUND
MATERIAL AND METHOD
The study will include 230 refugees, diagnosed with
PTSD, referred to CTP. Patients who give informed
consent will be randomised to four treatment groups:
A need for evidence based treatment of sleep
disturbances for trauma-affected refugees
 70-87% of persons suffering from PTSD describe sleep
disturbances
 Sleep disturbances may affect the efficacy of first-line
PTSD treatment and constitute a risk factor for poor
outcome of psychiatric treatment
 Sleep disturbances affect functioning, parenting and
quality of life
A. Treatment as usual (TAU); pharmacological treatment
according to algorithm, physiotherapy and manual
based Cognitive Behavioural Therapy
B. TAU and add-on treatment with mianserin
C. TAU and add-on treatment with Imagery Rehearsal
Therapy (IRT)
D. TAU and add-on treatment with mianserin and IRT
Trial endpoints are sleep, nightmare, PTSD and
depression symptoms, quality of life and functioning. All
measured on validated ratings scales.
AIM
RESULTS
The overall aim of this study is to examine sleep enhancing
treatment in refugees with PTSD in a randomised controlled
trial.
The study is planned to begin including patients during
2016, so no data are available.
CONCLUSION
OBJECTIVE
• To estimate treatment effects of Imagery Rehearsal
Therapy (IRT) and mianserin on sleep quality, sleep length
and nightmares compared to treatment as usual (TAU) at
CTP (Se description below)
• To study the relationship between enhanced sleep, PTSDsymptoms, observer-rated functioning and self-rated quality
of life
• To examine predictors for positive outcome of treatment
This study is expected to bring forward new knowledge
on both medical and therapeutic treatment of sleep
disturbances in trauma-affected refugees.
FLOWCHART
A. TAU1
B. TAU1 +
MIANSERIN
PHASE 1
2 months
Physician
Physiotherapist
Medicine3
Physiotherapy
Psychoeducation4
Medicine3
Physiotherapy
Psychoeducation4
MIANSERIN
Medicine3
Physiotherapy
Psychoeducation4
Medicine3
Physiotherapy
Psychoeducation4
MIANSERIN
PHASE 2
4-6 months
Physician
Psychologist
Physiotherapist
Medicine3
Physiotherapy
Psychoeducation4
Manual-based CBT5
Medicine3
Physiotherapy
Psychoeducation4
Manual-based CBT5
MIANSERIN
Medicine3
Physiotherapy
Psychoeducation4
Manual-based CBT5
IRT2
Medicine3
Physiotherapy
Psychoeducation4
Manual-based CBT5
IRT2 + MIASERIN
1
D. TAU1 +
MIANSERIN + IRT2
C. TAU1 + IRT2
Treatment as usual at CTP
2 Imagery Rehearsal Therapy
3 Medicine according to standard in CTP with either sertraline or venlafaxine. Other antidepressants will be substituted.
4 Psychoeducation on sleep is performed in sessions with both physician and physiotherapist
5 Manual-based Cognitive Behavioural Therapy
Author for correspondence:
Hinuga Sandahl, M.D.
[email protected]
Competence Centre for Transcultural Psychiatry
www.ctp-net.dk