Maternal hypothalamus-pituitary-adrenal (HPA) system activity and stress during pregnancy: Effects on gestational age and infant's anthropometric measures at birth

BACKGROUND

Prenatal maternal stress might be a risk for the developing fetus and may have long-lasting effects on child and adult vulnerability to somatic and psychiatric disease. Over-exposure of the unborn to excess glucocorticoids and subsequent alteration of fetal development is hypothesized to be one of the key mechanisms linking prenatal stress with negative child outcome.

METHODS

In this prospective longitudinal study, mothers-to-be (n = 405) in late pregnancy (36.8 ± 1.9 weeks of gestational age) and their singleton neonates were studied. We investigated the impact of different prenatal stress indices derived from six stress variables (perceived stress, specific prenatal worries, negative life events, symptoms of depression, trait anxiety, neuroticism) and diurnal maternal saliva cortisol secretion on gestational age and anthropometric measures at birth.

RESULTS

Maternal prenatal distress during late gestation was associated with significant reduction in birth weight (-217 g; p = .005), birth length (-1.2 cm; p = .005) and head circumference (-0.8 cm; p = .001). Prenatal stress was modestly but significantly associated with altered diurnal cortisol pattern (flattened cortisol decline and higher evening cortisol), which in turn was significantly related to reduced length of gestation. No evidence for a profound interaction between maternal cortisol level in late pregnancy and infant's anthropometric measures at birth (i.e., birth weight, length, head circumference) was found.

CONCLUSION

Prenatal stress is associated with flattened circadian saliva cortisol profiles and reduced infant's anthropometric measures at birth. HPA system activity during pregnancy may be related to low gestational age. The effect of prenatal stress might be partly mediated by maternal-placental-fetal neuroendocrine mechanisms especially the dysregulation of diurnal cortisol profile.

Nightmare Themes: An Online Study of Most Recent Nightmares and Childhood Nightmares

STUDY OBJECTIVES

Even though the common diagnostic criteria (ICSD-3, DSM-5) acknowledge that nightmares do not only contain anxiety/fear (definition of the ICD-10) but also other emotions such as grief, disgust, and anger, the definition of a nightmare still focuses on threats to survival, security, or physical integrity. However, empirical studies on nightmare content in larger samples are scarce.

METHODS

The current study elicited 1,216 of the most recent nightmares including childhood nightmares of a population-based sample.

RESULTS

The findings show that nightmares encompass a diversity of different topics, being chased, physical aggression, including death/injury of close persons. Infrequent themes like being the aggressor and suicide are of special interest as they might be related to waking-life psychopathology.

CONCLUSIONS

The variety of nightmare topics clearly indicate that current definitions of nightmare content are too narrow. Future studies should look into nightmare content of persons in whom nightmare disorder has been diagnosed.

Pain Dreams and Dream Emotions in Patients with Chronic Back Pain and Healthy Controls

Background:

Although some theorists have suggested that pain sensations cannot be part of the dreaming world, research has shown that pain sensations occur in about 1% of the dreams in healthy persons and in about 30% of patients with acute, severe pain.

Objective:

The present study is the first to study pain dreams in patients with chronic pain.

Method:

A questionnaire was administered to 100 patients with chronic lower back pain and 270 controls.

Results:

The patients reported more pain dreams and more negatively toned dreams compared to healthy controls. In addition, patients reported more often that the dreamed pain persisted into waking state.

Conclusion:

In patients, pain dreams might be instigated by actual pain whereas for healthy persons pain dreams might be pain memories (self-experienced pain and/or seeing persons in pain). Future research should clarify how pain is processed during sleep. As patients with chronic pain experience negatively toned dreams, it will be beneficial to ask chronic pain patients about their dreams and, if necessary, offer specific treatment options like imagery rehearsal treatment.

Serum brain-derived neurotrophic factor (BDNF) in sleep-disordered patients: relation to sleep stage N3 and rapid eye movement (REM) sleep across diagnostic entities

Experimental and clinical evidence suggests an association between neuroplasticity, brain-derived neurotrophic factor and sleep. We aimed at testing the hypotheses that brain-derived neurotrophic factor is associated with specific aspects of sleep architecture or sleep stages in patients with sleep disorders. We included 35 patients with primary insomnia, 31 patients with restless legs syndrome, 17 patients with idiopathic hypersomnia, 10 patients with narcolepsy and 37 healthy controls. Morning serum brain-derived neurotrophic factor concentrations were measured in patients and controls. In patients, blood sampling was followed by polysomnographic sleep investigation. Low brain-derived neurotrophic factor levels were associated with a low percentage of sleep stage N3 and rapid eye movement sleep across diagnostic entities. However, there was no difference in brain-derived neurotrophic factor levels between diagnostic groups. Our data indicate that serum levels of brain-derived neurotrophic factor, independent of a specific sleep disorder, are related to the proportion of sleep stage N3 and REM sleep. This preliminary observation is in accordance with the assumption that sleep stage N3 is involved in the regulation of neuroplasticity.

Dream Recall and the Full Moon

There is ongoing debate on whether the full moon is associated with sleep and dreaming. The analysis of diaries kept by the participants ( N = 196) over 28 to 111 nights showed no association of a full moon and dream recall. Psychological factors might explain why some persons associate a full moon with increased dream recall.

Dream Recall Frequency by Socioeconomic Status of Chinese Students

Whereas the effect of sex and age on dream recall have been studied widely, socioeconomic status has rarely been investigated. However, two studies reported that higher socioeconomic status was related to greater frequency of dream recall. In the present sample of 612 Chinese students from three different schools, one elite (high socioeconomic status), one rural (low socioeconomic status) and one intermediate, analysis of variance indicated no significant association between frequency of dream recall and socioeconomic status. Researchers could investigate whether “dream socialization,” e.g., encouragement of a child to remember his dreams, depends on socioeconomic background, whether these processes are mediated by culture.

Dream Recall and Sleep Duration: State or Trait Factor

Previous research regarding the relationship between habitual sleep duration and frequency of dream recall yielded conflicting results, whereas experimental manipulation of sleep duration showed a significant effect on dream recall. In this study analyzing both effects simultaneously, the findings from diaries kept by the 196 participants over 28 to 111 days indicated that intra-individual fluctuations in sleep duration were significantly related to dream recall whereas interindividual differences in dream recall were not associated with differences in sleep duration. Sleep inertia might be an explanation for this finding.

Frequency of Dream Recall by Children and Their Mothers

The present study investigated frequency of dream recall in children and their mothers. Overall, 88 mothers ( M age: 38.7 yr., SD = 5.0) and their children (45 girls, 43 boys; M age: 9.9 yr., SD = 1.3) participated. A small but significant positive Pearson correlation of .19 between the frequency of dreams reported by mothers and by their children is consistent with Cohen's 1973 hypothesis of a socialization effect on the frequency of dream recall.

Daytime Sleepiness in Adults With ADHD: A Pilot Trial With a Multiple Sleep Latency Test

OBJECTIVE

To evaluate sleep latency (SL) during the multiple sleep latency test (MSLT) and subjective daytime sleepiness in adult ADHD and controls.

METHOD

Subjective daytime sleepiness was assessed by Epworth Sleepiness Scale (ESS) in 27 unmedicated adults with ADHD and in 182 controls. Thirteen ADHD patients and 26 controls underwent MSLT after one night of polysomnography (PSG).

RESULTS

Mean MSLT-SL was 10.6 ± 4.8 min in ADHD and 12.2 ± 4.2 min in controls (n.s.). Mean ESS score was 9.3 ± 4.9 points in ADHD and 6.9 ± 3.4 points in controls (p < .005). MSLT-SL and ESS scores correlated inversely by trend (r = -.45, p < .1) but not with ADHD symptoms or ADHD subtype.

CONCLUSION

Adults with ADHD do not differ from controls in mean MSLT-SL but experience increased subjective daytime sleepiness. Patients with subjective higher daytime tiredness fell asleep faster during MSLT.

Dream Recall: State or Trait Variable? Part I: Model, Theories, Methodology and Trait Factors

The aim of the present article is to carefully review the research carried out hitherto regarding factors influencing dream recall. With respect to the hypotheses explaining the variation in dream recall frequency (DRF) and a model of the dream recall process, the empirical data has been divided into two groups, trait factors and state factors. In the first part of the article the studies on the influence of trait factors are reviewed. The second part incudes data concerning state factors, new empirical data and some final conclusions. State factors such as nocturnal awakening and focusing on dreams in the morning and trait factors such as fantasy life, creativity and visual memory play a major role in explaining variability in dream recall.

Dream Recall: State or Trait Variable? Part II: State Factors, Investigations and Final Conclusions

The first part of a two article series presented the hypotheses explaining the variation in dream recall, a model of the dream recall process and the empirical data concerning trait factors. The present article includes earlier data concerning state factors, new empirical data on how these influence dream recall, and some final conclusions. State factors such as nocturnal awakenings and focusing on dreams in the morning along with trait factors of fantasy life, creativity and visual memory all play an important part in explaining the variability in dream recall. Additionally, some suggestions for future research in explaining why there is such variability in our ability to recollect what we dreamt in a given night are presented.

Nightmare frequency in last trimester of pregnancy

Background

Pregnancy-related dreams are often found in pregnant women but also the number of negatively toned dreams seems to be increased in this challenging phase of a woman’s life.

Methods

Nightmare frequency and subjectively experienced stress was elicited via questionnaires. The mothers-to-be were approached during their application visit about 4–8 weeks prior to delivery in three obstetric hospitals. The present analysis included 406 women aged 16–40 years in the last trimester of their pregnancy. Women with severe somatic illnesses and/or psychiatric disorders were excluded. The representative sample included 496 women (age range: 14–93 years.).

Results

The findings clearly indicate that pregnant women report nightmares more often compared to a representative sample and that nightmare frequency is closely related to subjectively experienced stress during daytime. Moreover, baby-related dreams were correlated with nightmare frequency but not with day-time stress.

Conclusions

Future studies should investigate the prevalence of nightmare disorders in pregnancy and study whether brief interventions like Imagery Rehearsal Therapy are beneficial for pregnant women suffering from nightmares.

Factors Influencing the Gender Difference in Dream Recall Frequency

The results of the present study confirmed earlier findings of heightened dream recall frequency in women. The variables “meaningfulness of dreams” and “occurrence of problem-solving dreams” significantly reduced the correlation coefficient between gender and dream recall frequency. However, the question of causality remains unsolved. Other variables such as emotional intensity of dreams or nightmare frequency did not affect the relationship between gender and dream recall in a substantial way. Future research should manipulate systematically the variables under consideration, e.g., attitude toward dreams in order to observe the effects of this procedure on dream recall frequency and focus on the development of the gender difference during childhood and adolescence in relation to the child's understanding of the dream phenomenon.

Dreams as the Expression of Conceptions and Concerns: A Comparison of German and American College Students

Past research shows there are more similarities than differences in the dream content of college students in several industrialized democracies. This study uses new results from dreams collected in Germany to support this past finding and suggest that dreams are more similar than different because they dramatize people's conceptions and concerns in relation to personal issues, which probably do not vary as much from country to country as culture does. It is further argued that this continuity between dream content and waking concerns, when combined with other parallels between dreaming and waking cognition, can be used to develop a cognitive theory of dreams. In addition, suggestions for future research with college students in Germany, the United States, and other countries are presented as a way to link personal conceptions and cultural changes.

Interest in Information about Nightmares in Patients with Sleep Disorders

STUDY OBJECTIVES

Despite the considerable prevalence of the nightmare disorder and its burden on the patient, nightmares are underdiagnosed and undertreated, even in sleep centers.

METHODS

A total of 1,125 patients in a sleep center undergoing routine diagnostic procedures for their sleep disorders completed a questionnaire about nightmares.

RESULTS

About 20% of the sample indicated an interest in more information about nightmare etiology and nightmare therapy-even patients who had never sought professional help previously.

CONCLUSIONS

From a clinical viewpoint, health care professionals should be encouraged to ask about nightmares and, as a first step, internet-based self-help programs should be implemented for this patient group.

Associations of pineal volume, chronotype and symptom severity in adults with attention deficit hyperactivity disorder and healthy controls

The pineal gland, as part of the human epithalamus, is the main production site of peripheral melatonin, which promotes the modulation of sleep patterns, circadian rhythms and circadian preferences (morningness vs. eveningness). The present study analyses the pineal gland volume (PGV) and its association with circadian preferences and symptom severity in adult ADHD patients compared to healthy controls. PGV was determined manually using high-resolution 3T MRI (T1-magnetization prepared rapid gradient echo) in medication free adult ADHD patients (N=74) compared to healthy controls (N=86). Moreover, the Morningness-Eveningness Questionnaire (MEQ), the ADHD Diagnostic Checklist and the Wender-Utah Rating Scale were conducted. PGV differed between both groups (patients: 59.9±33.8mm(3); healthy controls: 71.4±27.2mm(3), P=0.04). In ADHD patients, more eveningness types were revealed (patients: 29%; healthy controls: 17%; P=0.05) and sum scores of the MEQ were lower (patients: 45.8±11.5; healthy controls 67.2±10.1; P<0.001). Multiple regression analyses indicated a positive correlation of PGV and MEQ scores in ADHD (β=0.856, P=0.003) but not in healthy controls (β=0.054, P=0.688). Patients' MEQ scores (β=-0.473, P=0.003) were negatively correlated to ADHD symptoms. The present results suggest a linkage between the PGV and circadian preference in adults with ADHD and an association of the circadian preference to symptom severity. This may facilitate the development of new chronobiological treatment approaches for the add-on treatment in ADHD.

Dreams and Nightmares in Personality Disorders

Although the relationship between dreaming and psychopathology has been studied quite extensively, research on dreaming in patients with personality disorders has been very scarce. In patients with borderline personality disorder, negatively toned dreams and heightened nightmare frequency have been found-characteristics not determined by co-morbid depression or posttraumatic stress disorder. The review includes suggestions for future studies as the existing results clearly indicate that this line of research is most interesting. Lastly, clinical recommendations especially regarding the treatment of the often found co-morbid nightmare disorder will be given.

[Forensic Implications of Sleep-Associated Behavior Disorders]

Parasomnias represent a category of disorders that involve complex behaviors or emotional experiences, arising from or occurring during sleep, which might be also associated with (incomplete) awakening. These phenomena are classified as REM- or Non-REM-parasomnias. In particular the latter, including confusional arousal, sleepwalking and sleep terrors but also REM-sleep behavior disorder might result in criminal consequences. Using polysomnography, the pathophysiological mechanisms of these disorders have been investigated thoroughly. Nevertheless, in German literature, forensic implications of complex behaviors arising from sleep disorders have only been described insufficiently. Here we describe the most relevant parasomnias and also how to proceed in the context of forensic assessments.

Increased lucid dreaming frequency in narcolepsy

STUDY OBJECTIVE

Nightmares are a frequent symptom in narcolepsy. Lucid dreaming, i.e., the phenomenon of becoming aware of the dreaming state during dreaming, has been demonstrated to be of therapeutic value for recurrent nightmares. Data on lucid dreaming in narcolepsy patients, however, is sparse. The aim of this study was to evaluate the frequency of recalled dreams (DF), nightmares (NF), and lucid dreams (LDF) in narcolepsy patients compared to healthy controls. In addition, we explored if dream lucidity provides relief during nightmares in narcolepsy patients.

DESIGN

We interviewed patients with narcolepsy and healthy controls.

SETTING

Telephone interview.

PATIENTS

60 patients diagnosed with narcolepsy (23-82 years, 35 females) and 919 control subjects (14-93 years, 497 females).

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

Logistic regression revealed significant (P < 0.001) differences in DF, NF, and LDF between narcolepsy patients and controls after controlling for age and gender, with effect sizes lying in the large range (Cohen's d > 0.8). The differences in NF and LDF between patients and controls stayed significant after controlling for DF. Comparison of 35 narcolepsy patients currently under medication with their former drug-free period revealed significant differences in DF and NF (z < 0.05, signed-rank test) but not LDF (z = 0.8). Irrespective of medication, 70% of narcolepsy patients with experience in lucid dreaming indicated that dream lucidity provides relief during nightmares.

CONCLUSION

Narcolepsy patients experience a markedly higher lucid dreaming frequency compared to controls, and many patients report a positive impact of dream lucidity on the distress experienced from nightmares.

Sleep electroencephalography and heart rate variability interdependence amongst healthy subjects and insomnia/schizophrenia patients

The quantification of interdependencies within autonomic nervous system has gained increasing importance to characterise healthy and psychiatric disordered subjects. The present work introduces a biosignal processing approach, suggesting a computational resource to estimate coherent or synchronised interactions as an eventual supportive aid in the diagnosis of primary insomnia and schizophrenia pathologies. By deploying linear, nonlinear and statistical methods upon 25 electroencephalographic and electrocardiographic overnight sleep recordings, the assessment of cross-correlation, wavelet coherence and [Formula: see text]:[Formula: see text] phase synchronisation is focused on tracking discerning features amongst the clinical cohorts. Our results indicate that certain neuronal oscillations interact with cardiac power bands in distinctive ways responding to standardised sleep stages and patient groups, which promotes the hypothesis of subtle functional dynamics between neuronal assembles and (para)sympathetic activity subject to pathophysiological conditions.

Post-amputation pain is associated with the recall of an impaired body representation in dreams-results from a nation-wide survey on limb amputees

The experience of post-amputation pain such as phantom limb pain (PLP) and residual limb pain (RLP), is a common consequence of limb amputation, and its presence has negative effects on a person’s well-being. The continuity hypothesis of dreams suggests that the presence of such aversive experiences in the waking state should be reflected in dream content, with the recalled body representation reflecting a cognitive proxy of negative impact. In the present study, we epidemiologically assessed the presence of post-amputation pain and other amputation-related information as well as recalled body representation in dreams in a sample of 3,234 unilateral limb amputees. Data on the site and time of amputation, residual limb length, prosthesis use, lifetime prevalence of mental disorders, presence of post-amputation pain, and presence of non-painful phantom phenomena were included in logistic regression analyses using recalled body representation in dreams (impaired, intact, no memory) as dependent variable. The effects of age, sex, and frequency of dream recall were controlled for. About 22% of the subjects indicated that they were not able to remember their body representation in dreams, another 24% of the amputees recalled themselves as always intact, and only a minority of less than 3% recalled themselves as always impaired. Almost 35% of the amputees dreamed of themselves in a mixed fashion. We found that lower-limb amputation as well as the presence of PLP and RLP was positively associated with the recall of an impaired body representation in dreams. The presence of non-painful phantom phenomena, however, had no influence. These results complement previous findings and indicate complex interactions of physical body appearance and mental body representation, probably modulated by distress in the waking state. The findings are discussed against the background of alterations in cognitive processes after amputation and hypotheses suggesting an innate body model.

Nightmares affect the experience of sleep quality but not sleep architecture: an ambulatory polysomnographic study

BACKGROUND

Nightmares and bad dreams are common in people with emotional disturbances. For example, nightmares are a core symptom in posttraumatic stress disorder and about 50% of borderline personality disorder patients suffer from frequent nightmares. Independent of mental disorders, nightmares are often associated with sleep problems such as prolonged sleep latencies, poorer sleep quality, and daytime sleepiness. It has not been well documented whether this is reflected in objectively quantifiable physiological indices of sleep quality.

METHODS

Questionnaires regarding subjective sleep quality and ambulatory polysomnographic recordings of objective sleep parameters were collected during three consecutive nights in 17 individuals with frequent nightmares (NM) and 17 healthy control participants (HC).

RESULTS

NM participants reported worse sleep quality, more waking problems and more severe insomnia compared to HC group. However, sleep measures obtained by ambulatory polysomnographic recordings revealed no group differences in (a) overall sleep architecture, (b) sleep cycle duration as well as REM density and REM duration in each cycle and (c) sleep architecture when only nights with nightmares were analyzed.

CONCLUSIONS

Our findings support the observation that nightmares result in significant impairment which is independent from disturbed sleep architecture. Thus, these specific problems require specific attention and appropriate treatment.

Factors of Home Dream Recall and Nightmare Frequency in a Non-Student Sample

Home dream recall frequencies and nightmare frequencies show great inter-individual differences. Most of the studies trying to explain these differences, however, studied young participants, so these findings might not be true for persons older than 25 years. The present study investigated the relationship between dream recall, nightmare frequency, age, gender, sleep parameters, stress, and subjective health in a community-based sample ( N = 455) with a mean age of about 55 years. Some of the factors that have been shown to be associated with dream recall and nightmare frequency were also associated with these variables in non-student sample like frequency of nocturnal awakenings, current stress, and tiredness during the day. We were not able to replicate the effect of sex-role orientation on dream recall and nightmare frequency, supporting the idea that age might mediate the effect of daytime variables on dream recall and nightmare frequency. As nightmare frequency was related to sleep quality, stress, health problems, and tiredness during the day, it would be desirable that clinicians include a question about nightmares in their anamneses.

Pineal gland volume in primary insomnia and healthy controls: a magnetic resonance imaging study

Little is known about the relation between pineal volume and insomnia. Melatonin promotes sleep processes and, administered as a drug, it is suitable to improve primary and secondary sleep disorders in humans. Recent magnetic resonance imaging studies suggest that human plasma and saliva melatonin levels are partially determined by the pineal gland volume. This study compares the pineal volume in a group of patients with primary insomnia to a group of healthy people without sleep disturbance. Pineal gland volume (PGV) was measured on the basis of high-resolution 3 Tesla MRI (T1-magnetization prepared rapid gradient echo) in 23 patients and 27 controls, matched for age, gender and educational status. Volume measurements were performed conventionally by manual delineation of the pineal borders in multi-planar reconstructed images. Pineal gland volume was significantly smaller (P < 0.001) in patients (48.9 ± 26.6 mm(3) ) than in controls (79 ± 30.2 mm(3) ). In patients PGV correlated negatively with age (r = -0.532; P = 0.026). Adjusting for the effect of age, PGV and rapid eye movement (REM) latency showed a significant positive correlation (rS  = 0.711, P < 0.001) in patients. Pineal volume appears to be reduced in patients with primary insomnia compared to healthy controls. Further studies are needed to clarify whether low pineal volume is the basis or the consequence of functional sleep changes to elucidate the molecular pathology for the pineal volume loss in primary insomnia.

Time for actions in lucid dreams: effects of task modality, length, and complexity

The relationship between time in dreams and real time has intrigued scientists for centuries. The question if actions in dreams take the same time as in wakefulness can be tested by using lucid dreams where the dreamer is able to mark time intervals with prearranged eye movements that can be objectively identified in EOG recordings. Previous research showed an equivalence of time for counting in lucid dreams and in wakefulness (LaBerge, 1985; Erlacher and Schredl, 2004), but Erlacher and Schredl (2004) found that performing squats required about 40% more time in lucid dreams than in the waking state. To find out if the task modality, the task length, or the task complexity results in prolonged times in lucid dreams, an experiment with three different conditions was conducted. In the first condition, five proficient lucid dreamers spent one to three non-consecutive nights in the sleep laboratory. Participants counted to 10, 20, and 30 in wakefulness and in their lucid dreams. Lucidity and task intervals were time stamped with left-right-left-right eye movements. The same procedure was used for the second condition where eight lucid dreamers had to walk 10, 20, or 30 steps. In the third condition, eight lucid dreamers performed a gymnastics routine, which in the waking state lasted the same time as walking 10 steps. Again, we found that performing a motor task in a lucid dream requires more time than in wakefulness. Longer durations in the dream state were present for all three tasks, but significant differences were found only for the tasks with motor activity (walking and gymnastics). However, no difference was found for relative times (no disproportional time effects) and a more complex motor task did not result in more prolonged times. Longer durations in lucid dreams might be related to the lack of muscular feedback or slower neural processing during REM sleep. Future studies should explore factors that might be associated with prolonged durations.

Linear and non-linear interdependence of EEG and HRV frequency bands in human sleep

The characterisation of functional interdependencies of the autonomic nervous system (ANS) stands an evergrowing interest to unveil electroencephalographic (EEG) and Heart Rate Variability (HRV) interactions. This paper presents a biosignal processing approach as a supportive computational resource in the estimation of sleep dynamics. The application of linear, non-linear methods and statistical tests upon 10 overnight polysomnographic (PSG) recordings, allowed the computation of wavelet coherence and phase locking values, in order to identify discerning features amongst the clinical healthy subjects. Our findings showed that neuronal oscillations θ, α and σ interact with cardiac power bands at mid-to-high rank of coherence and phase locking, particularly during NREM sleep stages.

Morphology and function: MR pineal volume and melatonin level in human saliva are correlated

PURPOSE

To investigate the relation between circadian saliva melatonin levels and pineal volume as determined by MRI. Plasma melatonin levels follow a circadian rhythm with a high interindividual variability.

MATERIALS AND METHODS

In 103 healthy individuals saliva melatonin levels were determined at four time points within 24 h and MRI was performed once (3.0 Tesla, including three-dimensional T2 turbo spin echo [3D-T2-TSE], susceptibility-weighted imaging [SWI]). Pineal volume as well as cyst volume were assessed from multiplanar reconstructed 3D-T2-TSE images. Pineal calcification volume tissue was determined on SWI. To correct for hormonal inactive pineal tissue, cystic and calcified areas were excluded. Sleep quality was assessed with the Landeck Inventory for sleep quality disturbance.

RESULTS

Solid and uncalcified pineal volume correlated to melatonin maximum (r = 0.28; P < 0.05) and area under the curve (r = 0.29; P < 0.05). Of interest, solid and uncalcified pineal volume correlated negatively with the sleep rhythm disturbances subscore (r = -0.17; P < 0.05) despite a very homogenous population.

CONCLUSION

Uncalcified solid pineal tissue measured by 3D-T2-TSE and SWI is related to human saliva melatonin levels. The analysis of the sleep quality and pineal volume suggests a linkage between better sleep quality and hormonal active pineal tissue.

[Coping with nightmares in the General population: an online study]

The present study elicited a variety of coping strategies for nightmares in the general population and asked whether these coping strategies were helpful. A large-scale online survey (N=2 872, mean age: 43 years) was carried out. About 11.5% of the participants reported nightmares once a week or more often. The results indicate that sharing of nightmares was the most prevalent coping strategy, followed by re-writing the nightmare and reading about nightmares. Seeking professional help was rarely listed, even by persons with frequent nightmares and for the majority without benefit. The findings clearly show that there is a lot of work ahead providing adequate help for persons suffering from nightmares.

[Adult attention deficit/hyperactivity disorder, associated symptoms and comorbid psychiatric disorders: diagnosis and pharmacological treatment]

Adult attention deficit/hyperactivity disorder (ADHD) is characterised by inattention and/or hyperactivity and impulsivity and is a frequent psychiatric disorder with childhood onset. In addition to core symptoms, patients often experience associated symptoms like emotional dysregulation or low self-esteem and suffer from comorbid disorders, particularly depressive episodes, substance abuse, anxiety or sleep disorders. It is recommended to include associated symptoms and comorbid psychiatric disorders in the diagnostic set-up and in the treatment plan. Comorbid psychiatric disorders should be addressed with disorder-specific therapies while associated symptoms also often improve with treatment of the ADHD core symptoms. The most impairing psychiatric disorder should be treated first. This review presents recommendations for differential diagnosis and treatment of adult ADHD with associated symptoms and comorbid psychiatric disorders with respect to internationally published guidelines, clinical trials and expert opinions.