Depressive disorders are 1.5–4 times more prevalent in medically ill patients than in the general population. Mood disorders can be regarded as the final common pathway developing from the interaction among multiple pathophysiological, psychological, and socioeconomic stressors that chronic illness imposes on the individual. Symptoms of clinical depression affect approximately 25% patients on hemodialysis and can be associated with low quality of life and increased mortality. The epidemiology of depressive disorders is less well studied in the renal transplant population. However, depression is a risk factor for poor outcomes, such as graft failure and death after renal transplantation. A high prevalence of severe psychological distress in patients with advanced CKD and its impact on CKD outcomes call for screening and intervention integrated in routine renal care. Preliminary data indicate that some of the selective serotonin reuptake inhibitor agents and time‐limited, manualized, structured psychotherapies can be safe and effective for treating depression in this population.

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What is already known on this subject? Fatigue is a key patient-reported outcome measure of chronic hepatitis C virus (HCV) infection. Fatigue management is not part of the standard care, because fatigue is poorly characterized in this population. What does this study add? A cognitive-behavioural approach can be applied to understand fatigue in HCV infection. Identified aspects of fatigue (antecedents, consequences, cognitions, behaviours) that can be treatment targets. Cognitive-behavioural therapy would open a new treatment avenue to alleviate fatigue in HCV infection.

raumatic brain injury (TBI) is the leading cause of disability among young adults, and the incidence is increasing in Canada. 1,2 Mild TBI (mTBI), including concussion, accounts for the majority (70%-90%) of treated TBI cases and has the largest contribution to injuryrelated disability. 3 Early detection and effective management of medical conditions that hinder recovery could prevent disability and substantially reduce societal costs. In this regard, sleep disruptions are key modifiable targets that magnify the sequelae of mTBI. 4 Insomnia-difficulties falling or staying asleep, or early-morning final awakening-is the most common persistent sleep symptom after mTBI 5,6 and is particularly prevalent following mTBI compared to more severe forms. 4 Moreover, insomnia after concussion worsens fatigue, pain, cognition and mood, and predicts poor overall prognosis for recovery, greater disability and mental disorders. 7-11 Given that disorders of sleep and wakefulness can be treated effectively, treatment holds the promise of improving the management of persistent postconcussive symptoms and hastening recovery from mTBI. Recent reports 4,12,13 emphasize the need for multimodal sleep and circadian assessments; however, these are not common practice, and research remains limited. Standard assessment of insomnia relies on patients' subjective report, and the recommended first-line treatment is cog-nitive behavioural therapy. 14,15 Importantly, however, circadian rhythm sleep-wake disorders (CRSWDs) that may underlie symptoms of insomnia require fundamentally different assessment and treatment (Appendix 1, available at www. cmajopen.ca/content/8/1/E142/suppl/DC1). These disorders arise if there is a disruption of the endogenous circadian system or a misalignment between the internal circadian rhythm and the external environment. The best biologic marker of CRSWDs is abnormal dim-light onset of melatonin production, and the behavioural diagnostic feature is that the sleep phase is markedly delayed, advanced or irregular relative to environmental time and social norms 16 (Appendix 1). Rates and mechanisms of CRSWDs in mTBI are not well characterized, but evidence indicates that brain trauma can disrupt systems that regulate circadian rhythms, such as suprachiasmatic nucleus function, gene expression, neural plasticity,

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