***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In 30 physically and mentally healthy volunteers , 7-chloro-1,3-dihydro-3-hydroxy-1-methyl-5 - 2H-1,4-benzodiazepin-2-one ( temazepam , K 3917 ) was tested for its sleep inducing action , the subjective quality of sleep and any post-medication effects .  Temazepam was orally administered at doses of 15 , 20 or 30 mg in hard gelatin capsules or 20 mg in soft gelatin capsules . Nitrazepam ( 5 mg ) and amylobarbitone sodium ( 100 mg ) were used for comparison as well as a placebo . Temazepam showed very much the same effects as they are known from conventional 1,4-benzodiazepines except for its lack of impairment in early morning behavior following night time medication In this paper the psychometric properties of the multidimensional fatigue inventory ( MFI-20 ) are established further in cancer patients . The MFI is a 20-item self-report instrument design ed to measure fatigue . It covers the following dimensions : general fatigue , physical fatigue , reduced activity , reduced motivation and mental fatigue . The instrument was used in a Dutch and Scottish sample of cancer patients receiving radiotherapy .  The dimensional structure was assessed using confirmatory factor analyses ( Lisrel 's unweighted least-squares method ) . The hypothesised five-factor model appeared to fit the data in both sample s ( adjusted goodness of fit ; AGFI : 0.97 and 0.98 ) . Internal consistency of the separate scales was good in both the Dutch and Scottish sample s with Cronbach 's alpha coefficients ranging from 0.79 to 0.93 . Construct validity was assessed by correlating the MFI-20 to activities of daily living , anxiety and depression . Significant relations were assumed . Convergent validity was investigated by correlating the MFI scales with a visual analogue scale measuring fatigue and with a fatigue-scale derived from the Rotterdam Symptom Checklist . Results support the validity of the MFI-20 . The highly similar results in the Dutch and Scottish sample suggest that the portrayal of fatigue using the MFI-20 is quite robust In the absence of a golden st and ard for the diagnosis of narcolepsy , the clinical spectrum of disorder remains controversial . The aims of this study were ( 1 ) to determine frequency and characteristics of sleep-wake symptoms in patients with narcolepsy with cataplexy , ( 2 ) to compare clinical characteristics with results of ancillary tests , and ( 3 ) to identify factors that discriminate narcolepsy from other conditions with excessive daytime sleepiness ( EDS ) . We prospect ively studied 57 narcoleptics with cataplexy , 56 patients with non-narcoleptic hypersomnia ( H ) , and 40 normal controls ( No ) . Based on suggested and published criteria , we differentiated between narcoleptics with definite cataplexy ( N ) and narcoleptics without definite cataplexy ( possible cataplexy , NpC ) . Assessment consisted of question  naires [ all patients and controls , including the  Ullanlinna Narcolepsy Score  ( UNS ) ] ,  polysomnography  ( all patients ) ,  multiple sleep latency test ( MSLT ) and  human leukocyte antigen typing  ( in most narcoleptics ) . A new narcolepsy score based on five questions was developed . Data were compared with those of 12 hypocretin-deficient narcoleptics ( N-hd ) . There were significant differences between N and NpC ( including mean sleep latency on MSLT ) , but none between N and N-hd . A score of sleep propensity during active situations ( SPAS ) and the frequency of sleep paralysis/hallucinations at sleep onset , dreams of flying , and history of sleep shouting discriminated N from H and No ( P < 0.001 ) . Cataplexy-like symptoms in H ( 18 % ) and No ( 8 % ) could be discriminated from ' true ' cataplexy in N on the basis of topography of motor effects , triggering emotions and triggering situations ( P < 0.001 ) . Our narcolepsy score had a similar sensitivity ( 96 % versus 98 % ) but a higher specificity ( 98 % versus 56 % ) than the UNS . Analysis of co-occurring symptoms in narcolepsy revealed two symptom complexes : EDS , cataplexy , automatic behaviors ; and sleep paralysis , hallucinations , parasomnias . Low/undetectable cerebrospinal fluid hypocretin-1 levels and a history of definite cataplexy identify similar subgroups of narcoleptics . Specific questions on severity of EDS ( SPAS score ) and characteristics of cataplexy allow the recognition of subgroups of narcoleptics and their differentiation from non-narcoleptic EDS patients , including those reporting cataplexy-like episodes . The existence of co-occurring symptoms supports the hypothesis of a distinct pathophysiology of single narcoleptic symptoms Fichtenberg NL , Putnam SH , Mann NR , Zafonte RD , Millard AE : Insomnia screening in postacute traumatic brain injury : utility and validity of the Pittsburgh Sleep Quality Index . Am J Phys Med Rehabil 2001;80:339–345 . Objective To assess insomnia in a rehabilitation population , the authors examined the utility and validity of the Pittsburgh Sleep Quality Index ( PSQI ) . The assessment of insomnia is relevant to the treatment of traumatic brain injury at the postacute level and routine screening for insomnia may be enhanced by the availability of a st and ardized , conveniently used , self-report sleep question naire . Design The authors prospect ively studied 91 consecutive patients with traumatic brain injury who were admitted to an outpatient neurorehabilitation program . Besides administering the PSQI , Beck Depression Inventory , Epworth Sleepiness Scale  , and  Multidimensional Pain Inventory  , sleep diary and interview data were obtained and used to divide subjects into insomnia and noninsomnia groups according to the criteria established by the Diagnostic and Statistical Manual of Mental Disorders , ed 4 . Results Sensitivity and specificity rates to the clinical diagnosis of insomnia were 93 % and 100 % , respectively , for a PSQI Global Score of > 8 , and 83 % and 100 % for a diagnosis of insomnia based exclusively on PSQI-derived sleep variable data . Sleep diary data provided concurrent validity for PSQI estimates of sleep-onset latency , sleep duration , and sleep efficiency . The Beck Depression Inventory , Epworth Sleepiness Scale , and Multidimensional Pain Inventory established concurrent validity for individual PSQI items pertaining to mood , hypersomnia , and pain disturbance . Conclusion The PSQI was demonstrated to be a valid and useful screening tool for assessing insomnia among postacute patients with traumatic brain injury Dysfunctional beliefs and attitudes about sleep are presumed to play an important mediating role in perpetuating insomnia . The present study evaluated the impact of cognitive-behavioral and pharmacological treatments for insomnia on sleep-related beliefs and attitudes and the relationship between those changes and sleep improvements . The participants were older adults with chronic and primary insomnia . They received cognitive-behavior therapy ( CBT ) , pharmacotherapy ( PCT ) , combined CBT+PCT ( COMB ) , or a medication placebo ( PLA ) . In addition to daily sleep diaries and sleep laboratory measures , the participants completed the dysfunctional beliefs and attitudes about sleep scale ( DBAS ) at baseline and posttreatment , and at 3- , 12- and 24-month follow-up assessment s. The results showed that CBT and COMB treatments produced greater improvements of beliefs and attitudes about sleep at posttreatment than PCT and PLA . Reductions of DBAS scores were significantly correlated with improvements of sleep efficiency as measured by daily sleep diaries and by polysomnography . In addition , more adaptive beliefs and attitudes about sleep at posttreatment were associated with better maintenance of sleep improvements at follow-ups . These findings highlight the importance of targeting sleep-related beliefs and attitudes in the treatment of insomnia BACKGROUND This study aim ed to investigate the effects of methylpheni date and sertraline compared with placebo on various neuropsychiatric sequelae associated with traumatic brain injury ( TBI ) . METHODS This was a 4 week , double-blind , parallel-group trial . Thirty patients with mild to moderate degrees of TBI were r and omly allocated to one of three treatment groups ( n = 10 in each group ) with matching age , gender and education , i.e. methylpheni date ( starting at 5 mg/day and increasing to 20 mg/day in a week ) , sertraline ( starting at 25 mg/day and increasing to 100 mg/day in a week ) or placebo . At the baseline and at the 4 week endpoint , the following assessment s were administered : subjective ( Beck Depression Inventory ) and objective ( Hamilton Depression Rating Scale ) measures of depression ; Rivermead Postconcussion Symptoms Question naire for postconcussional symptoms ; SmithKline Beecham Quality of Life Scale for quality of life ; seven performance tests ( Critical Flicker Fusion , Choice Reaction Time , Continuous Tracking , Mental Arithmetic , Short-Term memory , Digit Symbol Substitution and Mini-Mental State Examination ) ; subjective measures of sleep ( Leeds Sleep Evaluation Question naire ) and daytime sleepiness ( Epworth Sleepiness Scale ) . All adverse events during the study period were recorded and their relationships to the drugs were assessed . RESULTS Neuropsychiatric sequelae seemed to take a natural recovery course in patients with traumatic brain injury .  Methylpheni date had significant effects on depressive symptoms compared with the placebo , without hindering the natural recovery process of cognitive function . Although sertraline also had significant effects on depressive symptoms compared with the placebo , it did not improve many tests on cognitive performances . Daytime sleepiness was reduced by methylpheni date , while it was not by sertraline . CONCLUSIONS Methylpheni date and sertraline had similar effects on depressive symptoms . However , methylpheni date seemed to be more beneficial in improving cognitive function and maintaining daytime alertness .  Methylpheni date also offered a better tolerability than sertraline Objective : Evaluate the association between neuroendocrine findings and fatigue after traumatic brain injury ( TBI ) Research design : Prospect i ve , observational . Methods and procedures : Sixty-four individuals at least 1 year post-TBI underwent neuroendocrine testing including thyroid , adrenal , gonadal axes and growth hormone ( GH ) after glucagon stimulation with assessment of fatigue using the Global Fatigue Index  ( GFI ) and the  Fatigue Severity Scale  ( FSS ) . Main outcomes and results : GFI and FSS scores were significantly higher within this sample compared to published control data . At least one pituitary axis was abnormal in 90 % of participants . Higher GH levels were significantly associated with higher FSS scores . There was a noted trend between lower basal cortisol and higher scores on both the FSS and GFI . Conclusions : The association between higher GH levels and greater fatigue contradicted the prevailing hypothesis that post-acute TBI fatigue is associated with GH deficiency . The association between lower basal cortisol and greater fatigue was in the expected direction . While no other trends were noted , the fatigue derived from neuroendocrine abnormalities alone may be masked by fatigue induced by other factors commonly experienced following TBI . Given the high prevalence of pituitary abnormalities , screening for hypopituitarism after TBI is a reasonable recommendation . The contribution of GH deficiency to diminished quality of life post-TBI remains unclear Objective : The purpose was to establish the frequency of insomnia within the post-acute TBI population and compare it with insomnia rates among other rehabilitation out patients . Design : A prospect i ve study was undertaken of 50 consecutive post-acute TBI admissions and a comparison group of 50 rehabilitation out patients evenly divided between spinal cord injury ( SCI ) and musculoskeletal ( MSK ) cases . Setting : Subjects were recruited at various outpatient clinics of a major rehabilitation hospital . Patients : Among the TBI subjects , the predominant cause of injury was motor vehicle accident ; both mild and severe injuries were well represented in the sample ; and , on average , patients were almost 4 months post-injury . The comparison and TBI groups did not differ significantly with respect to education or marital status . However , the MSK group was older and a higher proportion of the SCI group was female . Measures : The Pittsburgh Sleep Quality Index ( PSQI ) , Beck Depression Inventory ( BDI ) , and sleep diaries  were administered to the TBI group . Only the PSQI and BDI were completed by the comparison group . Results : Thirty per cent of the patients were found to suffer from insomnia . Sleep initiation was a problem almost twice as often as sleep duration . An additional 12 % did not meet the DSM-IV criteria for insomnia but , nevertheless , experienced a degradation of sleep quality , as measured by the PSQI . Conversely , only slightly more than half ( 58 % ) of the TBI sample reported sleep to be relatively normal and satisfactory . Insomnia was also commonly reported by the patients in the rehabilitation comparison groups . They generated significantly higher mean PSQI Global Scores relative to the TBI group and the frequency of poor sleep quality was elevated significantly above the TBI rate . Relative to the TBI cases , twice as many comparison group patients were classified by the PSQI as insomniacs . Conclusion : Poor sleep quality and insomnia were definitely problems for the TBI group , although the magnitude of these problems was much greater for the rehabilitation comparison group . De grade d and disordered sleep may represent widespread challenges within 
    Output:
    
The Pittsburgh sleep quality index and Epworth sleepiness scale were partially vali date d in post-acute TBI .
Although no instrument has been specifically developed for TBI patients , there are scientific benefits to using the existing measures .