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Olatunji BO, Knowles KA, Adamis AM, Cole DA. Linking a latent variable trait-state-occasion model of emotion regulation to cognitive control. Cogn Emot 2024:1-15. [PMID: 38525828 DOI: 10.1080/02699931.2024.2332594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Abstract
Emotion dysregulation (ED) is a vulnerability factor for affective disorders that may originate from deficits in cognitive control (CC). Although measures of ED are often designed to assess trait-like tendencies, the extent to which such measures capture a time-varying (TV) or state-like construct versus a time-invariant (TI) or trait-like personality characteristic is unclear. The link between the TV and TI components of ED and CC is also unclear. In a 6-wave, 5-month longitudinal study, community participants (n = 1281) completed the Difficulties in Emotion Regulation Scale (DERS-16), a commonly used measure of ED and measures of CC. A latent variable (trait-state-occasion) model showed that the proportion of TI factor variance (.80) was greater than the TV factor variance (.19). Although TV factor stability was significant, the coefficients were small in magnitude. Furthermore, regression weights for the ED TI factor (average β = -.62) were significant and larger than those for the TV factor (average β = -.10) in predicting latent CC at each of the six-time points. These findings suggest that ED, as assessed by the DERS-16, is largely TI and this TI component is more strongly linked to CC than the TV component.
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Affiliation(s)
- Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Kelly A Knowles
- Anxiety Disorders Center, Institute of Living/Hartford Hospital, Connecticut, CT, USA
| | | | - David A Cole
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
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2
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Zhao X, Shen L, Pei Y, Wu X, Zhou N. The relationship between sleep disturbance and obsessive- compulsive symptoms: the mediation of repetitive negative thinking and the moderation of experiential avoidance. Front Psychol 2023; 14:1151399. [PMID: 37476089 PMCID: PMC10354645 DOI: 10.3389/fpsyg.2023.1151399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/21/2023] [Indexed: 07/22/2023] Open
Abstract
Background Studies have found that sleep disturbance is associated with obsessive-compulsive symptoms. This study aimed to elaborate on the mediating and moderating mechanisms between these two variables. We hypothesized that repetitive negative thinking plays a mediating role in the relationship between sleep disturbance and obsessive-compulsive symptoms, and experiential avoidance plays a moderating role. Method This study included 639 Chinese adults. A questionnaire survey was used to assess sleep quality, obsessive-compulsive symptoms, experiential avoidance, repetitive negative thinking, and depression symptoms. A moderated mediation model was established. Results After controlling for depressive symptoms, repetitive negative thinking partially mediated the positive correlation between sleep disturbance and obsessive-compulsive symptoms. This indirect relationship was significant in individuals with lower experiential avoidance levels. Particularly, the relationship between sleep disturbance and repetitive negative thinking was significant among individuals with lower experiential avoidance levels, but not among individuals with higher experiential avoidance levels. Conclusion This study demonstrated that repetitive negative thinking partially mediated the impact of sleep disturbance on obsessive-compulsive symptoms. The findings suggest that when providing support to individuals with sleep disturbance and obsessive-compulsive symptoms, assessing their level of experiential avoidance is necessary for performing targeted interventions. Individuals with low experiential avoidance may benefit from a clinical intervention targeting repetitive negative thinking to improve sleep quality and obsessive-compulsive symptoms.
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Affiliation(s)
- Xudong Zhao
- Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, Huzhou, China
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liao Shen
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Yufei Pei
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Xiaojun Wu
- Department of Clinical Psychology, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, Huzhou, China
| | - Ningning Zhou
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
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3
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Morrison CL, Winiger EA, Rieselbach MM, Vetter C, Wright KP, LeBourgeois MK, Friedman NP. Sleep Health at the Genomic Level: Six Distinct Factors and Their Relationships With Psychopathology. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:530-540. [PMID: 37519468 PMCID: PMC10382696 DOI: 10.1016/j.bpsgos.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022] Open
Abstract
Background Poor sleep is associated with many negative health outcomes, including multiple dimensions of psychopathology. In the past decade, sleep researchers have advocated for focusing on the concept of sleep health as a modifiable health behavior to mitigate or prevent these outcomes. Sleep health dimensions often include sleep efficiency, duration, satisfaction, regularity, timing, and daytime alertness. However, there is no consensus on how to best operationalize sleep health at the phenotypic and genetic levels. In some studies, specific sleep health domains were examined individually, while in others, sleep health domains were examined together (e.g., with an aggregate sleep health score). Methods Here, we compared alternative sleep health factor models using genomic structural equation modeling on summary statistics from previously published genome-wide association studies of self-reported and actigraphic sleep measures with effective sample sizes up to 452,633. Results Our best-fitting sleep health model had 6 correlated genetic factors pertaining to 6 sleep health domains: circadian preference, efficiency, alertness, duration, noninsomnia, and regularity. All sleep health factors were significantly correlated (|rgs| = 0.11-0.51), except for the circadian preference factor with duration and noninsomnia. Better sleep health was generally significantly associated with lower genetic liability for psychopathology (|rgs| = 0.05-0.48), yet the 6 sleep health factors showed divergent patterns of associations with different psychopathology factors, especially when controlling for covariance among the sleep health factors. Conclusions These results provide evidence for genetic separability of sleep health constructs and their differentiation with respect to associations with mental health.
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Affiliation(s)
- Claire L. Morrison
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, Colorado
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado
| | - Evan A. Winiger
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Maya M. Rieselbach
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, Colorado
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado
| | - Céline Vetter
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Kenneth P. Wright
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | | | - Naomi P. Friedman
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, Colorado
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado
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4
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Cox RC, Olatunji BO. Delayed circadian rhythms and insomnia symptoms in obsessive-compulsive disorder. J Affect Disord 2022; 318:94-102. [PMID: 36057288 PMCID: PMC10201922 DOI: 10.1016/j.jad.2022.08.118] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/09/2022] [Accepted: 08/26/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Accumulating evidence implicates sleep and circadian rhythm disturbance in obsessive-compulsive disorder (OCD). However, a multimethod characterization of sleep and circadian rhythms in OCD, their association with symptom severity, and the functional relationship between these variables is lacking. METHODS The present study measured multiple indicators of sleep and circadian rhythms in a sample of adults with OCD, adults without OCD, and healthy controls (n = 74). Participants completed measures of morningness-eveningness, delayed sleep-wake phase disorder (DSWPD), insomnia symptoms, and OCD symptoms, as well as one week of sleep monitoring via a sleep diary and actigraphy. RESULTS Delayed circadian rhythms (higher eveningness, later mid-sleep timing, and higher rates of DSWPD) and higher insomnia symptoms were observed in those with OCD compared to healthy controls, as well as associations between delayed circadian rhythms and insomnia symptoms and OCD symptom severity across the full sample. Further, insomnia symptoms mediated the relationship between delayed circadian rhythms and OCD symptoms. In contrast, there were no links between total sleep time or sleep quality and OCD. LIMITATIONS Data collection during COVID-19 pandemic, correlational data, no physiological measure of circadian rhythms. CONCLUSIONS These findings highlight a robust association between delayed circadian rhythms and OCD and suggest insomnia symptoms may be one mechanism in this relationship. Sleep and circadian rhythm disturbance may be novel targets for OCD treatment.
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Affiliation(s)
- Rebecca C Cox
- Vanderbilt University, United States of America; University of Colorado Boulder, United States of America.
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5
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Lucifora C, Grasso GM, Nitsche MA, D'Italia G, Sortino M, Salehinejad MA, Falzone A, Avenanti A, Vicario CM. Enhanced fear acquisition in individuals with evening chronotype. A virtual reality fear conditioning/extinction study. J Affect Disord 2022; 311:344-352. [PMID: 35561887 DOI: 10.1016/j.jad.2022.05.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/09/2022] [Accepted: 05/05/2022] [Indexed: 11/18/2022]
Abstract
Circadian rhythms have received increasing attention within the context of mental disorders. Evening chronotype has been associated with enhanced risk to develop anxiety and post-traumatic stress disorder (PTSD). The classical fear conditioning paradigm is a powerful tool to reveal key mechanisms of anxiety and PTSD. We used this paradigm to study the neurocognitive basis of the association between chronotype and fear responses in healthy humans. 20 participants with evening chronotype and 20 controls (i.e., intermediate chronotype) completed a 2-day Pavlovian fear learning and extinction virtual reality task. Participants received fear conditioning, and extinction learning on day 1. Extinction memory recall was tested on day 2. To address interactions between chronotype and time of day of the fear conditioning, and extinction performance, half of the participants were tested in the morning, and the other half in the evening. Skin conductance response (SCR) and subjective fear ratings were measured as primary outcomes. Chronotype was established via the morningness-eveningness questionnaire (MEQ). We found an overall higher SCR for fear acquisition in participants with the evening chronotype profile, compared to controls. Moreover, the higher the MEQ scores -indicative of less eveningness - the lower the SCR was. No effects of chronotype were found for extinction and extinction recall. The higher vulnerability of the evening chronotype for anxiety and related disorders may thus be explained by enhanced fear acquisition of this group.
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Affiliation(s)
- Chiara Lucifora
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy
| | - Giorgio M Grasso
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Center for Working Environment and Human Factors, Ardeystr. 67, 44139 Dortmund, Germany
| | - Giovanni D'Italia
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy
| | - Mauro Sortino
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy
| | - Mohammad A Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Center for Working Environment and Human Factors, Ardeystr. 67, 44139 Dortmund, Germany
| | - Alessandra Falzone
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy
| | - Alessio Avenanti
- Centro Studi e Ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia, Alma Mater Studiorum - Università di Bologna, Campus di Cesena, 47521 Cesena, Italy; Centro de Investigación en Neuropsicología y Neurociencias Cognitivas, Universidad Católica Del Maule, 346000 Talca, Chile
| | - Carmelo M Vicario
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università Degli Studi di Messina, 98121 Messina, Italy.
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Possible actions of cannabidiol in obsessive-compulsive disorder by targeting the WNT/β-catenin pathway. Mol Psychiatry 2022; 27:230-248. [PMID: 33837269 DOI: 10.1038/s41380-021-01086-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/13/2021] [Accepted: 03/26/2021] [Indexed: 02/02/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder characterized by recurrent and distinctive obsessions and/or compulsions. The etiologies remain unclear. Recent findings have shown that oxidative stress, inflammation, and glutamatergic pathways play key roles in the causes of OCD. However, first-line therapies include cognitive-behavioral therapy but only 40% of the patients respond to this first-line therapy. Research for new treatment is mandatory. This review focuses on the potential effects of cannabidiol (CBD), as a potential therapeutic strategy, on OCD and some of the presumed mechanisms by which CBD provides its benefit properties. CBD medication downregulates GSK-3β, the main inhibitor of the WNT/β-catenin pathway. The activation of the WNT/β-catenin could be associated with the control of oxidative stress, inflammation, and glutamatergic pathway and circadian rhythms dysregulation in OCD. Future prospective clinical trials could focus on CBD and its different and multiple interactions in OCD.
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7
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Brierley MEE, Thompson EM, Albertella L, Fontenelle LF. Lifestyle Interventions in the Treatment of Obsessive-Compulsive and Related Disorders: A Systematic Review. Psychosom Med 2021; 83:817-833. [PMID: 34334731 DOI: 10.1097/psy.0000000000000988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Lifestyle medicine is increasingly important in psychiatry for its efficacy as a transdiagnostic treatment, its preventative potential, and its increased tolerability compared with first-line strategies. Although the impact of lifestyle medicine is strong across many psychiatric illnesses, our understanding of the effectiveness of lifestyle interventions in treating obsessive-compulsive and related disorders (OCRDs) is minimal. We aimed to conduct a systematic review examining the effect of lifestyle interventions (targeting diet, exercise, sleep, stress management, and tobacco/alcohol use) on OCRD symptoms. METHODS We systematically searched four electronic databases for published randomized controlled trials reporting on lifestyle interventions for OCRDs. We qualitatively synthesized results of eligible studies and calculated mean changes in symptom severity from baseline to end point and standardized between-group effect sizes. RESULTS We identified 33 eligible studies. Poor efficacy was noted across a number of rigorous dietary supplement interventions with some promising data in four (of six) studies regarding N-acetylcysteine for trichotillomania, skin picking, and obsessive-compulsive disorder. Stress management interventions, generally characterized by high risk of bias, reported mild effectiveness with greater effects noted for mind-body exercises (yoga) for obsessive-compulsive disorder. Greater improvements may be achieved when lifestyle intervention is adjunct to first-line treatments and delivered by facilitators. CONCLUSIONS Diet (particularly N-acetylcysteine) and stress management interventions seem promising avenues for OCRDs treatment. We present an action plan to move the lifestyle interventions for OCRDs field forward. Further high-quality lifestyle interventions are required to improve the certainty of findings and to inform clinical treatment guidelines.Review Registration Number: CRD42020151407.
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Affiliation(s)
- Mary-Ellen E Brierley
- From the BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences (Brierley, Thompson, Albertella, Fontenelle), Monash University, Victoria, Australia; Obsessive, Compulsive, and Anxiety Spectrum Research Program. Institute of Psychiatry (Fontenelle), Federal University of Rio de Janeiro (UFRJ); and D'Or Institute for Research and Education (Fontenelle), Rio de Janeiro, Brazil
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Cox RC, Olatunji BO. Linking insomnia and OCD symptoms during the coronavirus pandemic: Examination of prospective associations. J Anxiety Disord 2021; 77:102341. [PMID: 33285369 PMCID: PMC7689352 DOI: 10.1016/j.janxdis.2020.102341] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/18/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
There is considerable concern in the mental health community about the psychological consequences of the coronavirus pandemic and who may be most vulnerable. Obsessive-compulsive disorder (OCD) symptoms may be particularly sensitive to the context of the pandemic. Previous research suggests insomnia symptoms may contribute to increased OCD symptoms over time, particularly during times of stress, such as the pandemic. The present study examined pre-coronavirus outbreak insomnia symptoms as a predictor of post-coronavirus outbreak OCD symptoms in a sample of community adults who completed a 2016 survey study and were re-contacted on April 1, 2020 (N = 369). Results revealed a small significant increase in OCD symptoms following the coronavirus outbreak and a small significant decrease in insomnia symptoms. Pre-coronavirus outbreak insomnia symptoms significantly predicted increases in post-coronavirus outbreak OCD symptoms. Similar results were found for specific OCD symptom facets with the exception of washing and hoarding symptoms, which were unrelated to pre-coronavirus insomnia symptoms. There was no evidence for a reverse effect of prior OCD symptoms on insomnia symptoms during the pandemic. These findings suggest those with insomnia symptoms prior to the coronavirus pandemic may be vulnerable to increases in some OCD symptoms during the pandemic. The implications for preventing adverse psychological responses during the coronavirus pandemic are discussed.
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Affiliation(s)
- Rebecca C. Cox
- Corresponding author at: Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, United States
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9
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Cox RC, Parmar AM, Olatunji BO. Sleep in obsessive-compulsive and related disorders: a selective review and synthesis. Curr Opin Psychol 2020; 34:23-26. [DOI: 10.1016/j.copsyc.2019.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 02/07/2023]
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Nota JA, Potluri S, Kelley KN, Elias JA, Krompinger JW. Delayed Bedtimes Are Associated With More Severe Obsessive-Compulsive Symptoms in Intensive Residential Treatment. Behav Ther 2020; 51:559-571. [PMID: 32586430 DOI: 10.1016/j.beth.2019.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 12/27/2022]
Abstract
Delays in behavioral and biological circadian rhythms (e.g., sleep timing, melatonin secretion) are found more frequently in individuals with severe and treatment-resistant obsessive-compulsive disorder (OCD). In recent years, it has been documented that these delays in behavioral and biological circadian rhythms are associated with more severe OCD symptoms and poorer response to some OCD treatments. This study examined self-reported sleep behaviors in individuals taking part in an intensive treatment for OCD and the relations between these and OCD symptoms (both at admission to and discharge from the treatment program). Replicating previous findings in less severe populations, delayed sleep phases were relatively common in this group and later bedtimes were associated with more severe OCD symptoms at admission. Sleep onset latency and sleep duration were not associated with OCD symptom severity at admission. Later bedtimes were not associated with self-reported depression or worry symptom severity. There was no evidence of sleep behaviors affecting change in OCD symptoms from admission to discharge from treatment-however, later bedtimes at admission were associated with more severe OCD symptoms at admission and discharge from treatment. There was no evidence of sleep onset latency or sleep duration having a similar predictive effect. More severe OCD symptoms at admission were also associated with later bedtimes at admission and discharge from treatment. These bidirectional predictive relations between late bedtimes and OCD symptoms were of small effect size but support the potential value of evaluating sleep timing in individuals with severe and/or treatment-resistant OCD.
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11
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Linking inhibition and anxiety symptoms following sleep restriction: The moderating role of prior sleep efficiency. Behav Res Ther 2020; 127:103575. [PMID: 32085985 DOI: 10.1016/j.brat.2020.103575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 11/21/2022]
Abstract
Although sleep loss increases state anxiety, the effects of partial sleep restriction on specific anxiety symptoms and mechanisms that may influence this relation remain unknown. It is also unknown whether prior sleep buffers the impact of sleep restriction on anxiety symptoms. Thus, the present study examined the relations between inhibition and repetitive negative thinking (RNT), obsessions, and other OCD symptoms following sleep restriction and the moderating role of prior night's sleep efficiency. Healthy sleeping adults (n = 73) completed measures of inhibition, anxiety symptoms, and sleep before and after one night of sleep restriction (4 h between 4:00am and 8:00am). Results indicate significant associations between decreased post-sleep restriction inhibition and increased post-sleep restriction RNT and obsessions. Prior night's subjective and objective sleep efficiency significantly moderated these relations, such that the highest post-sleep restriction anxiety symptoms were reported by those with the lowest post-sleep restriction inhibition and the lowest pre-sleep restriction sleep efficiency. These findings suggest decreased inhibition may be one mechanism by which sleep loss affects anxiety, and those with worse sleep prior to acute sleep loss may be particularly vulnerable. The implications for the prevention and treatment of anxiety-related disorders characterized by intrusive cognition are discussed.
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12
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Gonzalez R, Gonzalez SD, McCarthy MJ. Using Chronobiological Phenotypes to Address Heterogeneity in Bipolar Disorder. MOLECULAR NEUROPSYCHIATRY 2020; 5:72-84. [PMID: 32399471 DOI: 10.1159/000506636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/18/2020] [Indexed: 12/12/2022]
Abstract
Bipolar disorder (BD) is a neuropsychiatric mood disorder characterized by recurrent episodes of mania and depression in addition to disruptions in sleep, energy, appetite, and cognitive functions-rhythmic behaviors that typically change on daily cycles. BD symptoms can also be provoked by seasonal changes, sleep, and/or circadian disruption, indicating that chronobiological factors linked to the circadian clock may be a common feature in the disorder. Research indicates that BD exists on a clinical spectrum, with distinct subtypes often intersecting with other psychiatric disorders. This heterogeneity has been a major challenge to BD research and contributes to problems in diagnostic stability and treatment outcomes. To address this heterogeneity, we propose that chronobiologically related biomarkers could be useful in classifying BD into objectively measurable phenotypes to establish better diagnoses, inform treatments, and perhaps lead to better clinical outcomes. Presently, we review the biological basis of circadian time keeping in humans, discuss the links of BD to the circadian clock, and pre-sent recent studies that evaluated chronobiological measures as a basis for establishing BD phenotypes. We conclude that chronobiology may inform future research using other novel techniques such as genomics, cell biology, and advanced behavioral analyses to establish new and more biologically based BD phenotypes.
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Affiliation(s)
- Robert Gonzalez
- Department of Psychiatry and Behavioral Health, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Suzanne D Gonzalez
- Department of Psychiatry and Behavioral Health, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.,Department of Pharmacology, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Michael J McCarthy
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry and Center for Chronobiology, University of California, San Diego, La Jolla, California, USA
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Vitale JA, Briguglio M, Galentino R, Dell'Osso B, Malgaroli A, Banfi G, Porta M. Exploring circannual rhythms and chronotype effect in patients with Obsessive-Compulsive Tic Disorder (OCTD): A pilot study. J Affect Disord 2020; 262:286-292. [PMID: 31733921 DOI: 10.1016/j.jad.2019.11.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/25/2019] [Accepted: 11/09/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND The aim of this study was to test, through a chronobiologic approach, the existence of a significant circannual rhythm of tics and obsessive-compulsive symptoms in patients with Obsessive-Compulsive Tic Disorder (OCTD). The chronotype effect on tics and OC symptoms during seasons was also studied. METHODS Patients with a diagnosis of OCTD (N = 37; mean age = 18.78 ± 8.61) underwent four clinical evaluations: Winter (WIN), Spring (SPR), Summer (SUM) and Autumn (AUT). Tics were evaluated through Yale Global Tic Severity Scale (YGTSS) and OC symptoms through Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Patients' chronotype was assessed by the Horne-Ostberg morningness-eveningness questionnaire (MEQ), which categorizes subjects according to the individuals'chronotype, being morning-type, evening-type, and neither-type. RESULTS A statistically significant circannual rhythm was observed for OC symptoms (p = 0.007), with the acrophase occurring between AUT and WIN. Y-BOCS differed along the year (p = 0.0003 and η2p = 0.40) with lower results in SUM compared to WIN (p < 0.05) and AUT (p < 0.01). Tics displayed no circannual rhythm and YGTSS scores were comparable among seasons. Patients were classified as 15 morning-types (40.5%) 15 neither-types (40.5%) and 7 evening-types (19.0%). YGTSS data were similar for all chronotypes while Y-BOCS results were greater during SUM in evening-types than morning-type patients (p < 0.05; 15.7 ± 5.2 vs 3.4 ± 6.0). LIMITATIONS It is essential to investigate the existence of tics and OC symptoms circannual rhythms over the course of more than one year with a larger sample. CONCLUSIONS OC symptoms displayed a significant circannual rhythm and were influenced by patients' chronotype. On the contrary, tics resulted similar among seasons and chronotypes.
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Affiliation(s)
- Jacopo A Vitale
- IRCCS Orthopedic Institute Galeazzi, Laboratory of Movement and Sport Science, 20161, Milan, Italy.
| | - Matteo Briguglio
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Via Riccardo Galeazzi, 4 20161, Milan, MI, Italy.
| | - Roberta Galentino
- IRCCS Orthopedic Institute Galeazzi, Tourette's Syndrome and Movement Disorders Centre, 20161, Milan, Italy
| | - Bernardo Dell'Osso
- "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutic, University of Milan, 20142, Milan, Italy; Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA 94305-5717, USA.
| | - Antonio Malgaroli
- Neurobiology of Learning Unit, Vita-Salute San Raffaele University, Milan, Italy.
| | - Giuseppe Banfi
- IRCCS Orthopedic Institute Galeazzi, Scientific Direction, Via Riccardo Galeazzi, 4 20161, Milan, MI, Italy.
| | - Mauro Porta
- IRCCS Orthopedic Institute Galeazzi, Tourette's Syndrome and Movement Disorders Centre, 20161, Milan, Italy
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Richards A, Kanady JC, Neylan TC. Sleep disturbance in PTSD and other anxiety-related disorders: an updated review of clinical features, physiological characteristics, and psychological and neurobiological mechanisms. Neuropsychopharmacology 2020; 45:55-73. [PMID: 31443103 PMCID: PMC6879567 DOI: 10.1038/s41386-019-0486-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 02/08/2023]
Abstract
The current report provides an updated review of sleep disturbance in posttraumatic stress disorder and anxiety-related disorders. First, this review provides a summary description of the unique and overlapping clinical characteristics and physiological features of sleep disturbance in specific DSM anxiety-related disorders. Second, this review presents evidence of a bidirectional relationship between sleep disturbance and anxiety-related disorders, and provides a model to explain this relationship by integrating research on psychological and neurocognitive processes with a current understanding of neurobiological pathways. A heuristic neurobiological framework for understanding the bidirectional relationship between abnormalities in sleep and anxiety-related brain pathways is presented. Directions for future research are suggested.
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Affiliation(s)
- Anne Richards
- The San Francisco VA Health Care System, San Francisco, CA, USA.
- The University of California, San Francisco, San Francisco, CA, USA.
| | - Jennifer C Kanady
- The San Francisco VA Health Care System, San Francisco, CA, USA
- The University of California, San Francisco, San Francisco, CA, USA
| | - Thomas C Neylan
- The San Francisco VA Health Care System, San Francisco, CA, USA
- The University of California, San Francisco, San Francisco, CA, USA
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Cox RC, Olatunji BO. Differential associations between chronotype, anxiety, and negative affect: A structural equation modeling approach. J Affect Disord 2019; 257:321-330. [PMID: 31302521 PMCID: PMC6711779 DOI: 10.1016/j.jad.2019.07.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/23/2019] [Accepted: 07/04/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Increasing evidence implicates circadian rhythms, including chronotype, in anxiety symptoms and disorders. However, it remains unclear whether this relation is accounted for by sleep disturbance. Likewise, given overlap between anxiety and negative affect, a unique link between chronotype and anxiety remains to be established. The present study addressed these questions using a multimethod approach to determine whether there is a unique relation between chronotype and anxiety symptoms, controlling for sleep disturbance. METHODS Indicators of chronotype, sleep disturbance, anxiety, and negative affect were collected in a sample of adults (N = 151) using a combination of subjective and behavioral measures both within and outside the laboratory over a 9-day period. Structural equation modeling was used to examine associations between latent constructs. RESULTS Results revealed significant associations between sleep disturbance and both anxiety and negative affect. A significant association was found between chronotype and anxiety, over and above the effect of sleep disturbance. In contrast, the relation between chronotype and negative affect was nonsignificant after controlling for sleep disturbance. LIMITATIONS Unselected sample, lack of experimental manipulation, cross-sectional design. CONCLUSIONS These findings suggest a unique role of chronotype in anxiety and point to circadian disruption as a potential biological mechanism in anxiety-related disorders.
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Affiliation(s)
- Rebecca C. Cox
- Correspondence concerning this article should be addressed to Rebecca Cox, Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN 37240,
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Circadian Rhythms in Obsessive-Compulsive Disorder: Recent Findings and Recommendations for Future Research. Curr Psychiatry Rep 2019; 21:54. [PMID: 31165330 DOI: 10.1007/s11920-019-1033-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Circadian rhythms are a topic of growing interest in mental health, particularly in obsessive-compulsive disorder. However, the consistency of this link has not been carefully examined. Thus, the present review integrates findings from the past 5 years in order to determine the strength of such a relationship and identify areas for clarification and extension. RECENT FINDINGS Findings revealed inconsistent evidence for a link between circadian rhythms and OCD. Chronotype is unrelated to OCD symptoms in adolescents but predicts OCD symptoms in adults. Results on delayed sleep timing are equivocal. Circadian rhythm disorders predict OCD treatment outcome. Preliminary evidence implicates decreased light exposure and diurnal symptom variability in OCD. The relationship between circadian rhythms and OCD may vary by age, diagnostic status, and assessment method. Recent findings are limited by an overreliance on convenience samples and singular self-report methods. Recommendations for future research on the role of circadian rhythms in OCD are discussed.
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