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Yupanqui-Lorenzo DE, Caycho-Rodríguez T, Baños-Chaparro J, Arauco-Lozada T, Palao-Loayza L, Rivera MEL, Barrios I, Torales J. Mapping of the network connection between sleep quality symptoms, depression, generalized anxiety, and burnout in the general population of Peru and El Salvador. PSICOLOGIA-REFLEXAO E CRITICA 2024; 37:27. [PMID: 39009857 PMCID: PMC11250734 DOI: 10.1186/s41155-024-00312-3] [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: 03/27/2024] [Accepted: 07/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND A meta-analysis of randomized controlled trials has suggested a bidirectional relationship between sleep problems and mental health issues. Despite these findings, there is limited conclusive evidence on the relationship between sleep quality, depression, anxiety, and burnout. OBJECTIVE The current study aimed to evaluate the relationships between sleep quality symptoms, anxiety, depression, and burnout in samples of adult individuals from two Latin American countries, Peru and El Salvador, through network analysis and to identify key symptoms that reinforce the correlation and intensify the syndromes. METHODS A total of 1012 individuals from El Salvador and Peru participated, with an average age of 26.5 years (SD = 9.1). Symptom networks were constructed for both countries based on data from the Jenkins Sleep Scale, Patient Health Questionnaire-2, General Anxiety Disorder-2, and a single burnout item. RESULTS The results indicated that Depressed Mood, Difficulty Falling Asleep, and Nervousness were the most central symptoms in a network in the participating countries. The strongest conditional associations were found between symptoms belonging to the same construct, which were similar in both countries. Thus, there is a relationship between Nervousness and Uncontrollable Worry, Anhedonia and Depressed Mood, and Nighttime Awakenings and Difficulty in Staying Asleep. It was observed that burnout is a bridge symptom between both countries and presents stronger conditional associations with Tiredness on Awakening, Depressed Mood, and Uncontrollable Worry. Other bridge symptoms include a Depressed Mood and Nervousness. The network structure did not differ between the participants from Peru and El Salvador. CONCLUSION The networks formed by sleep quality, anxiety, depression, and burnout symptoms play a prominent role in the comorbidity of mental health problems among the general populations of Peru and El Salvador. The symptom-based analytical approach highlights the different diagnostic weights of these symptoms. Treatments or interventions should focus on identifying central and bridge symptoms.
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Affiliation(s)
| | - Tomás Caycho-Rodríguez
- Universidad Científica del Sur, Facultad de Psicología, Campus Villa II, Ctra. Panamericana S 19, Villa El Salvador, Lima, Perú.
| | - Jonatan Baños-Chaparro
- Universidad Científica del Sur, Facultad de Psicología, Campus Villa II, Ctra. Panamericana S 19, Villa El Salvador, Lima, Perú
| | | | | | | | - Iván Barrios
- Universidad Sudamericana, Facultad de Ciencias de la Salud, Salto del Guairá, Paraguay
- Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Filial Santa Rosa del Aguaray, Cátedra de Bioestadística, Santa Rosa del Aguaray, Paraguay
| | - Julio Torales
- Universidad Nacional de Asunción, Facultad de Ciencias Médicas, Cátedra de Psicología Médica, San Lorenzo, Paraguay
- Universidad Sudamericana, Facultad de Ciencias de la Salud, Salto del Guairá, Paraguay
- Universidad Nacional de Caaguazú, Instituto Regional de Investigación en Salud, Coronel Oviedo, Paraguay
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Sayson LV, Jeon SJ, Ortiz DM, Lee HJ, Campomayor NB, Kim HJ, Kim M. Heukharang ( Lactuca sativa L.) extracts enhanced the sleep behavior of mice: potential involvement of adenosine A 1 and A 2A receptors. Sleep Biol Rhythms 2024; 22:385-394. [PMID: 38962793 PMCID: PMC11217248 DOI: 10.1007/s41105-024-00522-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/27/2024] [Indexed: 07/05/2024]
Abstract
A significant proportion of the world's population suffers from insomnia, a disorder characterized by complications in initiating and maintaining sleep. Many medications used to treat insomnia target the γ-aminobutyric acid (GABA) neurotransmitter system. However, these substances, such as benzodiazepines, induce significant adverse consequences, including dependence and memory impairment, after prolonged use. Thus, current studies are aimed at developing therapeutic hypnotics derived from natural sources that may cause less severe side effects. Heukharang is a variety of lettuce from Korea that was discovered to contain sleep-promoting compounds. Therefore, we investigated the potential effects of sub-chronic administration of Heukharang extract (FSD-LS) on sleep behavior (pentobarbital-induced sleeping test), brain wave activity and sleep architecture (electroencephalography), and physiological behavior (open-field test and rota-rod) in mice, along with radioligand binding assays (GABAA, adenosine A1 and A2A receptors). We found that FSD-LS prolonged the total sleep duration and reduced the onset time of sleep, and enhanced delta wave power and non-rapid eye movement (NREM) sleep duration, all indicating persistent sleep-enhancing effects. FSD-LS lacked adverse effects on the spontaneous locomotor activity and motor coordination of mice, unlike diazepam. Pharmacological blocking using caffeine and bicuculline supported the possible involvement of adenosine receptors in the sleep-promoting effects of FSD-LS, with partial contribution from GABA receptor activity. Overall, our study recommends FSD-LS as a potential source for the development of sleep-aiding therapeutics.
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Affiliation(s)
- Leandro Val Sayson
- Department of Pharmacy, Uimyung Research Institute for Neuroscience, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul, 01795 Republic of Korea
| | - Se Jin Jeon
- Department of Pharmacology, College of Medicine, Hallym University, 1 Hallymdaehak-gil, Chuncheon, Gangwon-do 24252 Republic of Korea
| | - Darlene Mae Ortiz
- Department of Pharmacy, Uimyung Research Institute for Neuroscience, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul, 01795 Republic of Korea
- College of Pharmacy, Dongduk Women’s University, 60 Hwarang-ro, Seongbuk-gu, Seoul, 02748 Republic of Korea
| | - Hyun Jun Lee
- Department of Pharmacy, Uimyung Research Institute for Neuroscience, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul, 01795 Republic of Korea
| | - Nicole Bon Campomayor
- Department of Chemistry & Life Science, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul, 01795 Republic of Korea
| | - Hee Jin Kim
- Department of Pharmacy, Uimyung Research Institute for Neuroscience, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul, 01795 Republic of Korea
| | - Mikyung Kim
- Department of Chemistry & Life Science, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul, 01795 Republic of Korea
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Song YM, Jeong J, de Los Reyes AA, Lim D, Cho CH, Yeom JW, Lee T, Lee JB, Lee HJ, Kim JK. Causal dynamics of sleep, circadian rhythm, and mood symptoms in patients with major depression and bipolar disorder: insights from longitudinal wearable device data. EBioMedicine 2024; 103:105094. [PMID: 38579366 PMCID: PMC11002811 DOI: 10.1016/j.ebiom.2024.105094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/14/2024] [Accepted: 03/17/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Sleep and circadian rhythm disruptions are common in patients with mood disorders. The intricate relationship between these disruptions and mood has been investigated, but their causal dynamics remain unknown. METHODS We analysed data from 139 patients (76 female, mean age = 23.5 ± 3.64 years) with mood disorders who participated in a prospective observational study in South Korea. The patients wore wearable devices to monitor sleep and engaged in smartphone-delivered ecological momentary assessment of mood symptoms. Using a mathematical model, we estimated their daily circadian phase based on sleep data. Subsequently, we obtained daily time series for sleep/circadian phase estimates and mood symptoms spanning >40,000 days. We analysed the causal relationship between the time series using transfer entropy, a non-linear causal inference method. FINDINGS The transfer entropy analysis suggested causality from circadian phase disturbance to mood symptoms in both patients with MDD (n = 45) and BD type I (n = 35), as 66.7% and 85.7% of the patients with a large dataset (>600 days) showed causality, but not in patients with BD type II (n = 59). Surprisingly, no causal relationship was suggested between sleep phase disturbances and mood symptoms. INTERPRETATION Our findings suggest that in patients with mood disorders, circadian phase disturbances directly precede mood symptoms. This underscores the potential of targeting circadian rhythms in digital medicine, such as sleep or light exposure interventions, to restore circadian phase and thereby manage mood disorders effectively. FUNDING Institute for Basic Science, the Human Frontiers Science Program Organization, the National Research Foundation of Korea, and the Ministry of Health & Welfare of South Korea.
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Affiliation(s)
- Yun Min Song
- Department of Mathematical Sciences, KAIST, Daejeon, 34141, Republic of Korea; Biomedical Mathematics Group, Pioneer Research Center for Mathematical and Computational Sciences, Institute for Basic Science, Daejeon, 34126, Republic of Korea
| | - Jaegwon Jeong
- Department of Psychiatry, Korea University College of Medicine, Seoul, 02841, Republic of Korea; Chronobiology Institute, Korea University, Seoul, 02841, Republic of Korea
| | - Aurelio A de Los Reyes
- Biomedical Mathematics Group, Pioneer Research Center for Mathematical and Computational Sciences, Institute for Basic Science, Daejeon, 34126, Republic of Korea; Institute of Mathematics, University of the Philippines Diliman, Quezon City, 1101, Philippines
| | - Dongju Lim
- Department of Mathematical Sciences, KAIST, Daejeon, 34141, Republic of Korea; Biomedical Mathematics Group, Pioneer Research Center for Mathematical and Computational Sciences, Institute for Basic Science, Daejeon, 34126, Republic of Korea
| | - Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, 02841, Republic of Korea; Chronobiology Institute, Korea University, Seoul, 02841, Republic of Korea
| | - Ji Won Yeom
- Department of Psychiatry, Korea University College of Medicine, Seoul, 02841, Republic of Korea; Chronobiology Institute, Korea University, Seoul, 02841, Republic of Korea
| | - Taek Lee
- Division of Computer Science and Engineering, Sun Moon University, Asan, 31460, Republic of Korea
| | - Jung-Been Lee
- Division of Computer Science and Engineering, Sun Moon University, Asan, 31460, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, 02841, Republic of Korea; Chronobiology Institute, Korea University, Seoul, 02841, Republic of Korea.
| | - Jae Kyoung Kim
- Department of Mathematical Sciences, KAIST, Daejeon, 34141, Republic of Korea; Biomedical Mathematics Group, Pioneer Research Center for Mathematical and Computational Sciences, Institute for Basic Science, Daejeon, 34126, Republic of Korea.
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Xu Y, Deng J, Tan W, Yang W, Deng H. Mental health of general practitioners in Chongqing, China during COVID-19: a cross-sectional study. BMJ Open 2023; 13:e068333. [PMID: 38035743 PMCID: PMC10689386 DOI: 10.1136/bmjopen-2022-068333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES In the context of the COVID-19 pandemic, general practitioners (GPs) continue to face unprecedented challenges that affect their mental health. However, few studies have assessed the mental health status of GPs. This study aimed to provide preliminary understanding of stress, job burn-out and well-being levels among GPs to train and manage them during public health emergencies. DESIGN We conducted a cross-sectional online self-report survey. SETTING The survey was conducted in Chongqing, China from July to August 2022. PARTICIPANTS Data were collected from 2145 GPs, with an effective response rate of 91.0%. PRIMARY AND SECONDARY OUTCOME MEASURES The main evaluation indicators were stress (Cohen's Perceived Stress Scale), job burn-out (Maslach Burnout Inventory-Human Services Survey Scale) and well-being (WHO-5 Well-Being Index). Multiple linear regression analysis was used to compare the effect of different demographic characteristics on the impact of stress, job burn-out and decreased well-being. RESULTS Stress, job burn-out and decreased well-being were common among GPs. In this study, 59.7% experienced job burn-out, 76.1% experienced high levels of stress and 52.0% may have experienced depression. The main factors that influenced stress, burn-out and well-being were differences in age, working hours per week, title, part-time management work, work-life balance, sleep disorders, whether GPs received adequate recognition by patients and the work team and mental toughness (p<0.05). CONCLUSION This survey is the first to investigate stress, job burn-out and well-being levels among local GPs in China during the COVID-19 pandemic. Curbing stress and job burn-out levels and ensuring well-being among GPs could be achieved by reducing paperwork, management work and working hours; promoting life and work balance; and increasing resilience among GPs. The findings provide a basis for policy-makers to formulate strategies for developing general practice.
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Affiliation(s)
- Yang Xu
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - JingZhi Deng
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenhao Tan
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wen Yang
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huisheng Deng
- Department of General Practice, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Vuelvas-Olmos CR, Sánchez-Vidaña DI, Cortés-Álvarez NY. Gender-Based Analysis of the Association Between Mental Health, Sleep Quality, Aggression, and Physical Activity Among University Students During the COVID-19 Outbreak. Psychol Rep 2023; 126:2212-2236. [PMID: 35437090 PMCID: PMC9019504 DOI: 10.1177/00332941221086209] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
COVID-19 has spread throughout the world, resulting in significant morbidity, mortality, and negative psychological effects among general population. However, university students are particularly vulnerable in terms of mental health. The present study evaluated the association between mental health, quality of sleep, aggression, and physical activity in university students in Mexico after 1 year of dealing with the COVID-19 pandemic in Mexico, including a gender-sensitive analysis. Participants (935 university students) completed an online questionnaire which collected information regarding demographic data, psychological distress (IES-R scale), depression, anxiety, and stress (DASS-21), aggressiveness Buss-Perry Aggressive Questionnaire, sleep quality (PSQI) and physical activity (IPAQ-S). Findings showed that female students showed significantly higher scores in psychological distress, anxiety, stress scores and sleep quality, as compared to male students. By contrast, male students showed significantly higher scores on aggressiveness than female students. In addition, on physical activity, females performed significantly higher MET-min/week on moderate and high levels. Finally, liner regression model accounted for approximately 73.5% of the variance in DASS-21 scores, with the body mass index, IES-R, Pittsburgh Sleep Quality Index, and IPAQ subscales, emerging as significant individual (positive) predictors. Therefore, the pandemic affected female and male students differently. Female students reported more psychological distress, anxiety, and stress while male students reported higher aggressiveness. The differences observed may be due to physiological differences, the response to stress, and differences in sensitivity to life events.
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Affiliation(s)
| | | | - Nadia Yanet Cortés-Álvarez
- Department of Nursing and Midwifery, Division of Natural and Exact Sciences, University of Guanajuato, Mexico
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Lin Y, Roy K, Ioka S, Otani R, Amezawa M, Ishikawa Y, Cherasse Y, Kaushik MK, Klewe-Nebenius D, Zhou L, Yanagisawa M, Oishi Y, Saitoh T, Lazarus M. Positive allosteric adenosine A 2A receptor modulation suppresses insomnia associated with mania- and schizophrenia-like behaviors in mice. Front Pharmacol 2023; 14:1138666. [PMID: 37153764 PMCID: PMC10155833 DOI: 10.3389/fphar.2023.1138666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023] Open
Abstract
Background: Insomnia is associated with psychiatric illnesses such as bipolar disorder or schizophrenia. Treating insomnia improves psychotic symptoms severity, quality of life, and functional outcomes. Patients with psychiatric disorders are often dissatisfied with the available therapeutic options for their insomnia. In contrast, positive allosteric modulation of adenosine A2A receptors (A2ARs) leads to slow-wave sleep without cardiovascular side effects in contrast to A2AR agonists. Methods: We investigated the hypnotic effects of A2AR positive allosteric modulators (PAMs) in mice with mania-like behavior produced by ablating GABAergic neurons in the ventral medial midbrain/pons area and in a mouse model of schizophrenia by knocking out of microtubule-associated protein 6. We also compared the properties of sleep induced by A2AR PAMs in mice with mania-like behavior with those induced by DORA-22, a dual orexin receptor antagonist that improves sleep in pre-clinical models, and the benzodiazepine diazepam. Results: A2AR PAMs suppress insomnia associated with mania- or schizophrenia-like behaviors in mice. A2AR PAM-mediated suppression of insomnia in mice with mania-like behavior was similar to that mediated by DORA-22, and, unlike diazepam, did not result in abnormal sleep. Conclusion: A2AR allosteric modulation may represent a new therapeutic avenue for sleep disruption associated with bipolar disorder or psychosis.
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Affiliation(s)
- Yang Lin
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Koustav Roy
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Shuji Ioka
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Rintaro Otani
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Mao Amezawa
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Yukiko Ishikawa
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Yoan Cherasse
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Mahesh K. Kaushik
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Daniela Klewe-Nebenius
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Li Zhou
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Masashi Yanagisawa
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
| | - Yo Oishi
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Tsuyoshi Saitoh
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- *Correspondence: Tsuyoshi Saitoh, ; Michael Lazarus,
| | - Michael Lazarus
- International Institute for Integrative Sleep Medicine (WPI-IIIS), Tsukuba, Ibaraki, Japan
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- *Correspondence: Tsuyoshi Saitoh, ; Michael Lazarus,
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Wang Y, Minami Y, Ode KL, Ueda HR. The role of calcium and CaMKII in sleep. Front Syst Neurosci 2022; 16:1059421. [PMID: 36618010 PMCID: PMC9815122 DOI: 10.3389/fnsys.2022.1059421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Sleep is an evolutionarily conserved phenotype shared by most of the animals on the planet. Prolonged wakefulness will result in increased sleep need or sleep pressure. However, its mechanisms remain elusive. Recent findings indicate that Ca2+ signaling, known to control diverse physiological functions, also regulates sleep. This review intends to summarize research advances in Ca2+ and Ca2+/calmodulin-dependent protein kinase II (CaMKII) in sleep regulation. Significant changes in sleep phenotype have been observed through calcium-related channels, receptors, and pumps. Mathematical modeling for neuronal firing patterns during NREM sleep suggests that these molecules compose a Ca2+-dependent hyperpolarization mechanism. The intracellular Ca2+ may then trigger sleep induction and maintenance through the activation of CaMKII, one of the sleep-promoting kinases. CaMKII and its multisite phosphorylation status may provide a link between transient calcium dynamics typically observed in neurons and sleep-wake dynamics observed on the long-time scale.
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Affiliation(s)
- Yuyang Wang
- Department of Systems Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoichi Minami
- Department of Systems Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji L. Ode
- Department of Systems Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki R. Ueda
- Department of Systems Pharmacology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan,Laboratory for Synthetic Biology, RIKEN Center for Biosystems Dynamics Research, Suita, Japan,*Correspondence: Hiroki R. Ueda,
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Divergence of dose-response with asenapine: a cluster analysis of randomized, double-blind, and placebo control study. CNS Spectr 2022; 27:369-377. [PMID: 33461636 DOI: 10.1017/s1092852921000043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Differences in psychiatric background and dose-response to asenapine in patients with schizophrenia were examined based on efficacy and safety, using data obtained in a double-blind, placebo-controlled trial. METHODS Patients with schizophrenia were classified into three clusters by a cluster analysis based on the Positive and Negative Symptom Scale (PANSS) subscores at baseline, using the data from a 6-week, double-blind, placebo-controlled trial. PANSS Marder factor scores were calculated for each cluster. The efficacy of 10 or 20 mg/day of asenapine on PANSS score was used as the primary endpoint, with the incidence of adverse events evaluated as the secondary endpoint. RESULTS A total of 529 asenapine-treated patients were classified into 3 clusters: Cluster-P with the higher scores in positive symptoms, disorganized thoughts, and hostility/excitement, Cluster-N with higher scores in negative symptoms, and Cluster-L with overall lower scores. In Cluster-N and Cluster-L, both 10 and 20 mg/day groups showed significant improvement in PANSS scores, while only the 20 mg/day group showed a significant difference in Cluster-P. Cluster-N and Cluster-L had differences in the incidence of adverse events, but this was not seen in Cluster-P. CONCLUSIONS The efficacy and safety of asenapine 10 and 20 mg/day differed between the 3 clusters of patients. This suggests that background information regarding baseline psychiatric symptoms may affect the therapeutic response in patients with schizophrenia.
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Esan O, Fela-Thomas A. The significance of sleep quality in euthymic bipolar patients from Nigeria. S Afr J Psychiatr 2022; 28:1739. [PMID: 35281965 PMCID: PMC8905369 DOI: 10.4102/sajpsychiatry.v28i0.1739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background Bipolar disorder is highly under-researched in Africa. Existing studies show that racial/ethnic disparities exist for sleep quality. Poor sleep quality in bipolar disorder causes significant morbidity and mortality even during periods of euthymia. Aim This study aimed to assess sleep quality and its correlates amongst euthymic patients with bipolar I disorder from Nigeria. Setting The study was carried out in a teaching hospital, and state hospital, in Ibadan, Nigeria. Method This cross-sectional study was conducted amongst 76 euthymic bipolar patients aged between 18 and 60 years, meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria for bipolar disorder. Euthymia was defined as having a score of ≤ 5 on the Young Mania Rating Scale and < 8 on the Hamilton Depression Rating Scale. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Results A total of 37 (48.7%) participants had poor quality sleep. Sleep quality was associated with marital status (p = 0.013) and suicide plan (p = 0.047). Participants with good sleep quality had higher total sleep duration, lower time to fall asleep (sleep latency), better subjective quality of sleep, were less likely to use sleep medications and had less daytime dysfunction than participants with poor sleep quality. All p-values were < 0.05. Subjective quality of sleep, ongoing use of sleep medication, daytime dysfunction were independently associated with poor sleep quality. Conclusion Poor sleep quality frequently persists during euthymic periods in patients with bipolar disorder. The correlates identified can be targeted for intervention during treatment.
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Affiliation(s)
- Oluyomi Esan
- Department of Psychiatry, Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
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Scott AJ, Webb TL, Martyn-St James M, Rowse G, Weich S. Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Med Rev 2021; 60:101556. [PMID: 34607184 PMCID: PMC8651630 DOI: 10.1016/j.smrv.2021.101556] [Citation(s) in RCA: 260] [Impact Index Per Article: 86.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 02/07/2023]
Abstract
The extent to which sleep is causally related to mental health is unclear. One way to test the causal link is to evaluate the extent to which interventions that improve sleep quality also improve mental health. We conducted a meta-analysis of randomised controlled trials that reported the effects of an intervention that improved sleep on composite mental health, as well as on seven specific mental health difficulties. 65 trials comprising 72 interventions and N = 8608 participants were included. Improving sleep led to a significant medium-sized effect on composite mental health (g+ = -0.53), depression (g+ = -0.63), anxiety (g+ = -0.51), and rumination (g+ = -0.49), as well as significant small-to-medium sized effects on stress (g+ = -0.42), and finally small significant effects on positive psychosis symptoms (g+ = -0.26). We also found a dose response relationship, in that greater improvements in sleep quality led to greater improvements in mental health. Our findings suggest that sleep is causally related to the experience of mental health difficulties. Future research might consider how interventions that improve sleep could be incorporated into mental health services, as well as the mechanisms of action that explain how sleep exerts an effect on mental health.
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Affiliation(s)
| | - Thomas L Webb
- Department of Psychology, The University of Sheffield, UK
| | | | - Georgina Rowse
- Clinical Psychology Unit, Department of Psychology, The University of Sheffield, UK
| | - Scott Weich
- School of Health and Related Research (ScHARR), The University of Sheffield, UK
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Jalbrzikowski M, Hayes RA, Scully KE, Franzen PL, Hasler BP, Siegle GJ, Buysse DJ, Dahl RE, Forbes EE, Ladouceur CD, McMakin DL, Ryan ND, Silk JS, Goldstein TR, Soehner AM. Associations between brain structure and sleep patterns across adolescent development. Sleep 2021; 44:zsab120. [PMID: 33971013 PMCID: PMC8503824 DOI: 10.1093/sleep/zsab120] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/21/2021] [Indexed: 01/05/2023] Open
Abstract
STUDY OBJECTIVES Structural brain maturation and sleep are complex processes that exhibit significant changes over adolescence and are linked to many physical and mental health outcomes. We investigated whether sleep-gray matter relationships are developmentally invariant (i.e. stable across age) or developmentally specific (i.e. only present during discrete time windows) from late childhood through young adulthood. METHODS We constructed the Neuroimaging and Pediatric Sleep Databank from eight research studies conducted at the University of Pittsburgh (2009-2020). Participants completed a T1-weighted structural MRI scan (sMRI) and 5-7 days of wrist actigraphy to assess naturalistic sleep. The final analytic sample consisted of 225 participants without current psychiatric diagnoses (9-25 years). We extracted cortical thickness and subcortical volumes from sMRI. Sleep patterns (duration, timing, continuity, regularity) were estimated from wrist actigraphy. Using regularized regression, we examined cross-sectional associations between sMRI measures and sleep patterns, as well as the effects of age, sex, and their interaction with sMRI measures on sleep. RESULTS Shorter sleep duration, later sleep timing, and poorer sleep continuity were associated with thinner cortex and altered subcortical volumes in diverse brain regions across adolescence. In a discrete subset of regions (e.g. posterior cingulate), thinner cortex was associated with these sleep patterns from late childhood through early-to-mid adolescence but not in late adolescence and young adulthood. CONCLUSIONS In childhood and adolescence, developmentally invariant and developmentally specific associations exist between sleep patterns and gray matter structure, across brain regions linked to sensory, cognitive, and emotional processes. Sleep intervention during specific developmental periods could potentially promote healthier neurodevelopmental outcomes.
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Affiliation(s)
- Maria Jalbrzikowski
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Rebecca A Hayes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kathleen E Scully
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Peter L Franzen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Brant P Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
- Department of Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Greg J Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
- Department of Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ronald E Dahl
- Department of Public Health, University of California, Berkeley, CA
| | - Erika E Forbes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
- Department of Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Cecile D Ladouceur
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Dana L McMakin
- Department of Psychology, Florida International University, Miami, FL
| | - Neal D Ryan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jennifer S Silk
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Tina R Goldstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Adriane M Soehner
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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12
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Circadian Characteristics in Patients under Treatment for Substance Use Disorders and Severe Mental Illness (Schizophrenia, Major Depression and Bipolar Disorder). J Clin Med 2021; 10:jcm10194388. [PMID: 34640406 PMCID: PMC8509477 DOI: 10.3390/jcm10194388] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/18/2021] [Accepted: 09/23/2021] [Indexed: 12/15/2022] Open
Abstract
Dual disorders (substance use and mental illness comorbidity) are a condition that has been strongly associated with severe symptomatology and clinical complications. The study of circadian characteristics in patients with Severe Mental Illness or Substance Use Disorder (SUD) has shown that such variables are related with mood symptoms and worse recovery. In absence of studies about circadian characteristics in patients with dual disorders we examined a sample of 114 male participants with SUD and comorbid Schizophrenia (SZ+; n = 38), Bipolar Disorder (BD+; n = 36) and Major Depressive Disorder (MDD+; n = 40). The possible differences in the sample of patients according to their psychiatric diagnosis, circadian functioning with recordings of distal skin temperature during 48 h (Thermochron iButton®), circadian typology and sleep-wake schedules were explored. MDD+ patients were more morning-type, while SZ+ and BD+ had an intermediate-type; the morning-type was more frequent among participants under inpatient SUD treatment. SZ+ patients had the highest amount of sleeping hours, lowest arousal and highest drowsiness followed by BD+ and MDD+, respectively. These observed differences suggest that treatment for patients with dual disorders could include chronobiological strategies to help them synchronize patterns with the day-light cycle, since morning-type is associated with better outcomes and recovery.
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13
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Xu Q, Wu K, Yang Y, Chang R, Qiu H, Wang Y, Lin T, Fu C, Chen Y, Wang N, Ruan X. Association Between Sleep Quality and Pain Intensity in Mild Patients with COPD: A Community Study. J Pain Res 2021; 14:2641-2649. [PMID: 34471380 PMCID: PMC8403565 DOI: 10.2147/jpr.s310036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/22/2021] [Indexed: 01/21/2023] Open
Abstract
Purpose Poor sleep quality and pain were common and had been proved as an important influenced factor of quality of life for patients with COPD. The association of sleep quality with pain has been observed in other population but remains unclear in mild patients with COPD from a community setting. Methods A cross-sectional study was conducted to include eligible mild patients with COPD in Pudong New District of Shanghai. A structured questionnaire was used to collect general and clinical information for the patients. The Chinese version of Pittsburgh Sleep Quality Index (PSQI) and the short form of McGill Pain Questionnaire (SF-MPQ) was used to assess sleep quality and intensity of pain. Logistic regression was performed to test the association between sleeping quality and pain intensity. Results Two hundred and sixty-four patients with COPD, with an average age of 64 years (SD 5.78 years), were enrolled, and of 52% were women. Seventy-one (26.9%) participants reported at least one exacerbation during the past year. About 28.2% of the patients were classified as having poor sleep quality. Sleep quality was significantly associated with PRI score (adjusted odds ratio (ORad)=2.16, 95% CI: 1.16–4.00) and PPI rank (ORad=1.90, 95% CI: 1.08–3.34). People with daytime disturbance were more likely to have pain (ORad =2.03, 95% CI: 1.18–3.50). Conclusion Poor sleep quality was common in mild patients with COPD in community and was associated with higher pain intensity. Pain may involve an impairment of sleep quality.
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Affiliation(s)
- Qian Xu
- School of Public Health, Fudan University, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200032, People's Republic of China
| | - Kang Wu
- Pudong New Area Center for Disease Control and Prevention, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200136, People's Republic of China
| | - Yi Yang
- Pudong New Area Center for Disease Control and Prevention, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200136, People's Republic of China
| | - Rui Chang
- School of Public Health, Fudan University, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200032, People's Republic of China
| | - Hua Qiu
- Pudong New Area Center for Disease Control and Prevention, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200136, People's Republic of China
| | - Yingying Wang
- School of Public Health, Fudan University, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200032, People's Republic of China
| | - Tao Lin
- Pudong New Area Center for Disease Control and Prevention, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200136, People's Republic of China
| | - Chaowei Fu
- School of Public Health, Fudan University, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200032, People's Republic of China
| | - Yue Chen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Na Wang
- School of Public Health, Fudan University, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200032, People's Republic of China
| | - Xiaonan Ruan
- Pudong New Area Center for Disease Control and Prevention, Pudong Preventive Medicine Research Institute of Fudan University, Shanghai, 200136, People's Republic of China
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Skokou M, Asimakopoulou R, Andreopoulou O, Kolettis G, Perrou S, Gourzis P, Daskalaki S. Reliability, validity and psychometric properties of the Greek version of the Altman self rating mania scale. Compr Psychiatry 2021; 109:152243. [PMID: 34271257 DOI: 10.1016/j.comppsych.2021.152243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 03/17/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although self-rating mania scales have been developed, a lack of such instruments validated for the Greek population is noted. This study aims to examine the validity, reliability and psychometric properties of the Altman Self Rating Mania Scale (ASRM) adapted in Greek (G-ASRM). METHODS A sample of 86 consecutive inpatient and outpatient bipolar patients diagnosed by the DSM-5 criteria and 37 healthy controls were assessed by using the Young Mania Rating Scale (YMRS) and the Montgomery Asberg Depression Rating Scale (MADRS), and self-administered the G-ASRM. Factor analysis, test-retest analysis, measurement invariance tests, mean differences, Pearson's Correlation analysis and ROC analysis were used to confirm the validity of G-ASRM as a scale, test its reliability, study its psychometric properties in different subgroups and establish a cut-off value for indicating the presence of (hypo)mania in BD patients. Also, regression models were built to expose dependencies between YMRS and G-ASRM items. RESULTS Monofactoriality of the scale was verified, based on Exploratory Factor Analysis (EFA). Cronbach's alpha was 0.895. G-ASRM is highly correlated with YMRS (r = 0.856, p < 0.0005) and uncorrelated with MADRS (r = -0.051, p = 0.623). Test- retest r-coefficient was calculated at 0.85. The optimal cut-off score, set at ≥6 for (hypo)mania assessment, is in agreement with the results reported for the original version. Limitations of the study are that the scale was not normed on diagnostic groups other than bipolar, nor was it administered longitudinally, so as to assess its sensitivity to symptom changes overtime. CONCLUSION The G-ASRM can be validly and reliably used in the Greek population for the assessment of (hypo)mania in bipolar patients.
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Affiliation(s)
- Maria Skokou
- Department of Psychiatry, University Hospital of Patras, Patras, Greece.
| | - Rafailia Asimakopoulou
- Department of Electrical and Computer Engineering, School of Engineering, University of Patras, Greece
| | - Ourania Andreopoulou
- Department of Psychiatry, University Hospital of Patras, School of Medicine, University of Patras, Greece.
| | | | - Sofia Perrou
- School of Medicine, University of Patras, Greece
| | - Philippos Gourzis
- Department of Psychiatry, University Hospital of Patras, School of Medicine, University of Patras, Greece.
| | - Sophia Daskalaki
- Department of Electrical and Computer Engineering, School of Engineering, University of Patras, Greece.
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15
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Quality of life and subjective sleep-related measures in bipolar disorder and major depressive disorder. Qual Life Res 2021; 31:117-124. [PMID: 34263443 PMCID: PMC8800916 DOI: 10.1007/s11136-021-02929-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/30/2022]
Abstract
Purpose Diminished quality of life (QoL) has been reported in patients with mood disorders. QoL has also been shown to be decreased by sleep disturbances. Since sleep disorders are common in mood disorders, the aim of this study was to determine whether sleep characteristics are associated to QoL among patients with Bipolar Disorder (BD) and unipolar Major Depressive Disorders (MDD). Methods QoL was assessed in 170 patients with mood disorders (61 BD and 109 MDD), who also completed questionnaires measuring the severity of insomnia, sleepiness, chronotype preference and obstructive sleep apnea (OSA) probability index. Results Analyses showed that BD and MDD groups had similar QoL and sleep measures but the MDD group had higher OSA scores. In BD, correlations indicated a relationship between QoL and insomnia complaints and sleepiness, whereas in MDD, correlations indicated an association between QoL and insomnia complaints and OSA score. In both groups, QoL was related to depressive symptomatology. Linear regressions showed that, in BD, QoL was related to insomnia complaints and sleepiness even in the euthymic state, whereas in MDD, QoL was related to insomnia complaints but not in euthymic patients. Conclusion QoL is related to sleep differently in BD and MDD. The results suggest that insomnia and sleepiness are particularly high in BD even when patients are euthymic. These findings suggest that focusing on insomnia and sleepiness during different mood states of BD could increase QoL.
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16
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Haddad C, Obeid S, Ghanem L, Kazour F, Chok A, Azar J, Hallit S, Tahan F. Association of insomnia with mania in Lebanese patients with bipolar disorder. Encephale 2021; 47:314-318. [PMID: 33541713 DOI: 10.1016/j.encep.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/17/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess: (1) the association between insomnia experienced at admission, sociodemographic and other patients' characteristics and mania; and (2) the variation of insomnia and mania before and after treatment in bipolar patients with manic episodes (type I). METHODS Sixty-two patients were interviewed shortly after their admission to the hospital (after 3 to 5 days). The current symptoms experienced by the patients were assessed upon admission and again at discharge from the hospital. RESULTS A poorer quality of sleep (higher PSQI scores) (Beta=0.590) was significantly associated with higher mania, whereas the intake of SSRIs (Beta=-5.952) and TCAs (Beta=-8.181) was significantly associated with lower mania. Furthermore, highly significant reductions were reported in the PSQI scores (4.96 vs. 2.75, P<0.001), ISI scores (8.30 vs. 3.45, P<0.001) and YMRS scores (8.60 vs. 3.06, P<0.001) between admission to and discharge from the hospital. CONCLUSION Insomnia in patients with bipolar disorder type I is associated with mania, with a significant reduction of sleep problems seen during a period of approximately 20 days of hospitalization. Further longitudinal studies are needed to confirm the validity of our results and identify the causes. In the meantime, this research recommends a strategy to improve sleeplessness experienced during inter-episode phases may be helpful in preventing manic episodes in BD.
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Affiliation(s)
- C Haddad
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon; Inserm, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, centre hospitalier Esquirol, University Limoges, Limoges, France
| | - S Obeid
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon; INSPECT-LB: Institut national de santé publique, épidemiologie clinique et toxicologie-Liban, Beirut, Lebanon; Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - L Ghanem
- Faculty of Sciences, Lebanese University, Beirut, Lebanon
| | - F Kazour
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon; Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon; Faculty of Medicine, Lebanese American University, Byblos, Lebanon
| | - A Chok
- Faculty of Sciences, Lebanese University, Beirut, Lebanon
| | - J Azar
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon; INSPECT-LB: Institut national de santé publique, épidemiologie clinique et toxicologie-Liban, Beirut, Lebanon; Faculty of Medicine, Lebanese American University, Byblos, Lebanon
| | - S Hallit
- INSPECT-LB: Institut national de santé publique, épidemiologie clinique et toxicologie-Liban, Beirut, Lebanon; Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
| | - F Tahan
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon; Faculty of Sciences, Lebanese University, Beirut, Lebanon.
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Lussier-Valade M, Desautels A, Godbout R. Troubles psychotiques et troubles du sommeil : revue de la littérature. SANTE MENTALE AU QUEBEC 2020. [DOI: 10.7202/1073528ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Contexte La disparition de la nomenclature des troubles du sommeil dits primaires ou secondaires, rendue obsolète par le Manuel diagnostique et statistique des troubles mentaux (DSM-5), représente bien l’engouement académique actuel pour ce domaine de recherche. Il est de plus en plus reconnu que les troubles du sommeil sont plus que de simples conséquences d’un trouble psychiatrique et qu’ils peuvent persister malgré un traitement adéquat de la condition comorbide et même précéder ou exacerber cette dernière. Les troubles du sommeil dans les troubles psychotiques, très fréquents, sont donc devenus un sujet d’actualité, représentant une cible d’intervention jusqu’ici sous-estimée.
Objectif Cet article vise à présenter l’état des connaissances actuelles sur la relation entre les troubles du sommeil et les troubles psychotiques ainsi que sur l’utilisation de la thérapie cognitivo-comportementale (TCC) pour traiter les troubles du sommeil dans ce contexte.
Méthode L’article fait une recension narrative de la littérature pour décrire la relation bidirectionnelle entre la psychose et les troubles du sommeil, les corrélations cliniques et les traitements ciblant l’insomnie chez les patients psychotiques.
Résultats Malgré la présence d’une relation entre les troubles du sommeil et les troubles psychotiques, les mécanismes neuronaux, hormonaux et socioculturels régissant cette relation demeurent encore incertains. Bien que l’association reliant les troubles du sommeil et les troubles psychotiques demeure à clarifier, les études démontrent qu’elle serait bidirectionnelle et peut engendrer un cercle vicieux où ces deux composantes s’aggravent mutuellement. Dans ce contexte de comorbidités, les modèles unifiés en TCC deviennent un traitement de choix, à condition d’adapter les protocoles de TCC pour insomnie (TCC-i) à une population avec trouble psychotique (TCC-ip).
Conclusion Malgré la complexité de la relation entre les troubles psychotiques et ceux du sommeil, la TCC-i a été démontrée efficace pour traiter les troubles du sommeil dans une population psychotique et pourrait, dans certains cas, permettre d’alléger la symptomatologie psychotique. De futures études sur ce domaine pourraient permettre le développement de protocoles de thérapie cognitivo-comportementale pour les troubles du sommeil mieux adaptés à la population avec troubles psychotiques.
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Affiliation(s)
| | - Alex Desautels
- M.D., FRCPC, Ph. D., neurologue, Service de neurologie, Hôpital du Sacré-Coeur de Montréal, directeur du Centre d’études avancées en médecine du sommeil (CÉAMS), Professeur adjoint, Département de neurosciences, Université de Montréal
| | - Roger Godbout
- Ph. D., Psychologue, Laboratoire et clinique du sommeil, Hôpital-Rivières-des-Prairies, Professeur titulaire, Département de psychiatrie, Université de Montréal
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18
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Wehrmeister FC, Wendt A, Tavares PDS, Santos FSD, Dias MDS, Carpena MX, Weber P, Reyes Matos Ú, Barros F, Gonçalves H, Menezes AMB. Short and long sleep duration and associated factors in pre-adolescence and early adulthood: evidence from the 1993 Pelotas birth cohort study. Sleep Med 2020; 75:477-483. [PMID: 33007718 DOI: 10.1016/j.sleep.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of the present study was to investigate the associated factors with short and long sleep duration at ages 11 (pre-adolescence) and 22 years old (early adulthood). METHODS Participants of the 1993 Pelotas birth cohort with self-reported sleep records at 11 (n = 4442) and 22 (n = 3800) years were included. The total sleep time duration was categorised as short (<9 h for 11 years and <7 h for 22 years), long (>11 for 11 years and >9 for 22 years) and recommended according to the National Sleep Foundation criteria. Multinomial regression analyses were applied according to a hierarchical approach in order to investigate the associated factors with sleep duration patterns. All analyses were stratified by sex. RESULTS Higher income was associated with higher odds of short sleep duration in 11-year-old boys [OR = 1.54 (CI95%: 1.08; 2.19)] and girls [OR = 1.45 (CI95%: 1.03; 2.06)] and also with lower odds of long sleep duration in both ages. At 22 years, common mental health disorders were associated with higher odds of short sleep duration in both men [OR = 1.56 (CI95%: 1.18; 2.06)] and women [OR = 1.48 (CI95%: 1.11; 1.99)]. Sleep duration was also related to screen time and physical activity showing different association patterns according to sex and age. CONCLUSIONS Different factors may be associated with sleep duration patterns in pre-adolescence and early adulthood. Our results emphasise the importance of considering stratification analyses to identify associated factors with sleep duration since they may vary according to age and sex.
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Affiliation(s)
| | - Andrea Wendt
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
| | - Patrice de Souza Tavares
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil; Postgraduate Program in Psychology, Federal University of Rio Grande do Sul, Brazil
| | | | - Mariane da Silva Dias
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Marina Xavier Carpena
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Priscila Weber
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Úrsula Reyes Matos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Fernando Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Helen Gonçalves
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Ana Maria B Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Waite F, Sheaves B, Isham L, Reeve S, Freeman D. Sleep and schizophrenia: From epiphenomenon to treatable causal target. Schizophr Res 2020; 221:44-56. [PMID: 31831262 PMCID: PMC7327507 DOI: 10.1016/j.schres.2019.11.014] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Sleep disturbance is a common clinical issue for patients with psychosis. It has been identified as a putative causal factor in the onset and persistence of psychotic experiences (paranoia and hallucinations). Hence sleep disruption may be a potential treatment target to prevent the onset of psychosis and reduce persistent psychotic experiences. The aim of this review is to describe developments in understanding the nature, causal role, and treatment of sleep disruption in psychosis. METHOD A systematic literature search was conducted to identify studies, published in the last five years, investigating subjective sleep disruption and psychotic experiences. RESULTS Fifty-eight papers were identified: 37 clinical and 21 non-clinical studies. The studies were correlational (n = 38; 20 clinical, 18 non-clinical), treatment (n = 7; 1 non-clinical), qualitative accounts (n = 6 clinical), prevalence estimates (n = 5 clinical), and experimental tests (n = 2 non-clinical). Insomnia (50%) and nightmare disorder (48%) are the most prevalent sleep problems found in patients. Sleep disruption predicts the onset and persistence of psychotic experiences such as paranoia and hallucinations, with negative affect identified as a partial mediator of this relationship. Patients recognise the detrimental effects of disrupted sleep and are keen for treatment. All psychological intervention studies reported large effect size improvements in sleep and there may be modest resultant improvements in psychotic experiences. CONCLUSIONS Sleep disruption is a treatable clinical problem in patients with psychosis. It is important to treat in its own right but may also lessen psychotic experiences. Research is required on how this knowledge can be implemented in clinical services.
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Affiliation(s)
- Felicity Waite
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK; Sleep and Circadian Neuroscience Institute, University of Oxford, UK.
| | - Bryony Sheaves
- Department of Psychiatry, University of Oxford, UK,Oxford Health NHS Foundation Trust, UK,Sleep and Circadian Neuroscience Institute, University of Oxford, UK
| | - Louise Isham
- Department of Psychiatry, University of Oxford, UK,Oxford Health NHS Foundation Trust, UK
| | | | - Daniel Freeman
- Department of Psychiatry, University of Oxford, UK,Oxford Health NHS Foundation Trust, UK,Sleep and Circadian Neuroscience Institute, University of Oxford, UK
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20
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Morton E, Murray G. Assessment and treatment of sleep problems in bipolar disorder—A guide for psychologists and clinically focused review. Clin Psychol Psychother 2020; 27:364-377. [DOI: 10.1002/cpp.2433] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/21/2020] [Accepted: 02/04/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Emma Morton
- Department of Psychiatry, Faculty of MedicineUniversity of British Columbia Vancouver British Columbia Canada
- Centre for Mental Health, Faculty of Health, Arts and DesignSwinburne University of Technology Melbourne Victoria Australia
| | - Greg Murray
- Centre for Mental Health, Faculty of Health, Arts and DesignSwinburne University of Technology Melbourne Victoria Australia
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21
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Yu SH, Gumport NB, Mirzadegan IA, Mei YJ, Hein K, Harvey AG. Addressing the Challenges of Recruitment and Retention in Sleep and Circadian Clinical Trials. Behav Sleep Med 2020; 18:23-34. [PMID: 31030562 PMCID: PMC6819244 DOI: 10.1080/15402002.2018.1518230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective/Background: Sleep and circadian disorders are prevalent worldwide and frequently comorbid with physical and mental illnesses. Thus, recruiting and retaining samples for sleep and circadian research are high priorities. The aims of this paper are to highlight barriers to recruitment and retention for participants with sleep or circadian dysfunction, and to share strategies used across two randomized controlled trials (RCTs) testing the efficacy of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) to address these challenges. Participants: The first RCT recruited 176 adolescents with an evening circadian chronotype, who were at risk in at least one of five health domains: behavioral, cognitive, emotional, physical, and social. The second RCT recruited 121 low-income, racial or ethnic minority adults diagnosed with severe mental illness (SMI) and comorbid sleep or circadian dysfunction. Methods: The current study examined participant, environment, and research factors that impacted recruitment and retention of participants with sleep or circadian dysfunction, and identified strategies to enhance recruitment and retention. Results: Strategies used to recruit participants included community-based recruiting, reducing stigma, and alleviating burdensome sleep data collection. Strategies used to retain participants in our studies included flexible scheduling, mitigating participant barriers, building rapport with participants through empathic and positive interactions, creative problem solving, consulting participant networks, and utilizing incentives and other positive engagement tools. Conclusion: Both at-risk adolescents and low-income, minority adults with comorbid SMI and sleep or circadian dysfunction experience significant barriers to research participation. Recruitment and retention strategies were creatively tailored to meet the unique barriers of these diverse populations.
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Affiliation(s)
| | | | | | - Yuh-Jang Mei
- University of California, Berkeley, California, USA
| | - Kerrie Hein
- University of California, Berkeley, California, USA
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22
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Gottlieb JF, Benedetti F, Geoffroy PA, Henriksen TEG, Lam RW, Murray G, Phelps J, Sit D, Swartz HA, Crowe M, Etain B, Frank E, Goel N, Haarman BCM, Inder M, Kallestad H, Jae Kim S, Martiny K, Meesters Y, Porter R, Riemersma-van der Lek RF, Ritter PS, Schulte PFJ, Scott J, Wu JC, Yu X, Chen S. The chronotherapeutic treatment of bipolar disorders: A systematic review and practice recommendations from the ISBD task force on chronotherapy and chronobiology. Bipolar Disord 2019; 21:741-773. [PMID: 31609530 DOI: 10.1111/bdi.12847] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS To systematically review the literature on the efficacy and tolerability of the major chronotherapeutic treatments of bipolar disorders (BD)-bright light therapy (LT), dark therapy (DT), treatments utilizing sleep deprivation (SD), melatonergic agonists (MA), interpersonal social rhythm therapy (IPSRT), and cognitive behavioral therapy adapted for BD (CBTI-BP)-and propose treatment recommendations based on a synthesis of the evidence. METHODS PRISMA-based systematic review of the literature. RESULTS The acute antidepressant (AD) efficacy of LT was supported by several open-label studies, three randomized controlled trials (RCTs), and one pseudorandomized controlled trial. SD showed rapid, acute AD response rates of 43.9%, 59.3%, and 59.4% in eight case series, 11 uncontrolled, studies, and one RCT, respectively. Adjunctive DT obtained significant, rapid anti-manic results in one RCT and one controlled study. The seven studies on MA yielded very limited data on acute antidepressant activity, conflicting evidence of both antimanic and maintenance efficacy, and support from two case series of improved sleep in both acute and euthymic states. IPSRT monotherapy for bipolar II depression had acute response rates of 41%, 67%, and 67.4% in two open studies and one RCT, respectively; as adjunctive therapy for bipolar depression in one RCT, and efficacy in reducing relapse in two RCTs. Among euthymic BD subjects with insomnia, a single RCT found CBTI-BP effective in delaying manic relapse and improving sleep. Chronotherapies were generally safe and well-tolerated. CONCLUSIONS The outcome literature on the adjunctive use of chronotherapeutic treatments for BP is variable, with evidence bases that differ in size, study quality, level of evidence, and non-standardized treatment protocols. Evidence-informed practice recommendations are offered.
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Affiliation(s)
- John F Gottlieb
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Chicago Psychiatry Associates, Chicago, IL, USA
| | | | - Pierre A Geoffroy
- Department of Psychiatry and Addictive Medicine, University Hospital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Paris Diderot University - Paris VII, Paris, France
| | - Tone E G Henriksen
- Faculty of Medicine, Section for Psychiatry, Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Faculty of Psychology, Bergen Stress and Sleep Group, University of Bergen, Bergen, Norway.,Valen Hospital, Fonna Health Authority, Division of Mental Health Care, Valen, Norway
| | - Raymond W Lam
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Greg Murray
- Swinburne University of Technology, Hawthorn, VIC, Australia
| | | | - Dorothy Sit
- Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Holly A Swartz
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Bruno Etain
- Department of Psychological Medicine, Universite Paris Diderot UFR de Medecine, Paris, France
| | - Ellen Frank
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Namni Goel
- Department of Psychiatry Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Bartholomeus C M Haarman
- Department of Psychiatry Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maree Inder
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Håvard Kallestad
- Faculty of Medicine and Health Sciences, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Psychiatry, Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway
| | - Seong Jae Kim
- Department of Psychiatry, Doeun Hospital, Jincheon, Korea
| | - Klaus Martiny
- Department of Clinical Medicine, University of Copenhagen, Kobenhavns, Denmark
| | - Ybe Meesters
- Department of Psychiatry Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard Porter
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Rixt F Riemersma-van der Lek
- Department of Psychiatry Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Philipp S Ritter
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitatsklinikum Carl Gustav Carus, Dresden, Germany
| | | | - Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Joseph C Wu
- Department of Psychiatry & Human Behavior, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Xin Yu
- Department of Public Mental Health, Peking University Institute of Mental Health, Beijing, China
| | - Shenghao Chen
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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23
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Soehner AM, Chase HW, Bertocci M, Greenberg T, Stiffler R, Lockovich JC, Aslam HA, Graur S, Bebko G, Phillips ML. Unstable wakefulness during resting-state fMRI and its associations with network connectivity and affective psychopathology in young adults. J Affect Disord 2019; 258:125-132. [PMID: 31401540 PMCID: PMC6710159 DOI: 10.1016/j.jad.2019.07.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/19/2019] [Accepted: 07/29/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Drifts between wakefulness and sleep are common during resting state functional MRI (rsfMRI). Among healthy adults, within-scanner sleep can impact functional connectivity of default mode (DMN), task-positive (TPN), and thalamo-cortical networks. Because dysfunctional arousal states (i.e., sleepiness, sleep disturbance) are common in affective disorders, individuals with affective psychopathology may be more prone to unstable wakefulness during rsfMRI, hampering the estimation of clinically meaningful functional connectivity biomarkers. METHODS A transdiagnostic sample of 150 young adults (68 psychologically distressed; 82 psychiatrically healthy) completed rsfMRI and reported whether they experienced within-scanner sleep. Symptom scales were reduced into depression/anxiety and mania proneness dimensions using principal component analysis. We evaluated associations between within-scanner sleep, clinical status, and functional connectivity of the DMN, TPN, and thalamus. RESULTS Within-scanner sleep during rsfMRI was reported by 44% of participants (n = 66) but was unrelated to psychiatric diagnoses or mood symptom severity (p-values > 0.05). Across all participants, self-reported within-scanner sleep was associated with connectivity signatures akin to objectively-assessed sleep, including lower within-DMN connectivity, lower DMN-TPN anti-correlation, and altered thalamo-cortical connectivity (p < 0.05, corrected). Among participants reporting sustained wakefulness (n = 84), depression/anxiety severity positively associated with averaged DMN-TPN connectivity and mania proneness negatively associated with averaged thalamus-DMN connectivity (p-values < 0.05). Both relationships were attenuated and became non-significant when participants reporting within-scanner sleep were included (p-values > 0.05). LIMITATIONS Subjective report of within-scanner sleep. CONCLUSIONS Findings implicate within-scanner sleep as a source of variance in network connectivity; careful monitoring and correction for within-scanner sleep may enhance our ability to characterize network signatures underlying affective psychopathology.
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Affiliation(s)
| | | | | | | | | | | | | | - Simona Graur
- University of Pittsburgh, Department of Psychiatry
| | - Genna Bebko
- University of Pittsburgh, Department of Psychiatry
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24
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Robertson I, Cheung A, Fan X. Insomnia in patients with schizophrenia: current understanding and treatment options. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:235-242. [PMID: 30707986 DOI: 10.1016/j.pnpbp.2019.01.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 01/11/2019] [Accepted: 01/28/2019] [Indexed: 12/21/2022]
Abstract
In patients with schizophrenia, insomnia is a common yet often overlooked comorbidity. With sleep disturbances inextricably linked to increased severity of schizophrenia and worsening clinical outcomes, insomnia is an important therapeutic target within this patient population. Thus, through a review of the current literature, this paper reiterates the important etiological link between these two conditions, while evaluating the safety, efficacy, and limitations of current therapeutic options for the treatment of comorbid insomnia in schizophrenia. Despite the continued use of benzodiazepine receptor agonists (BZRAs) for insomnia, the use of other therapies such as Cognitive Behavioral Therapy for Insomnia (CBT-I) and suvorexant warrants increased consideration. More large-scale clinical trials are needed to assess the efficacy of such therapeutic options in the schizophrenia patient population.
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Affiliation(s)
- Ian Robertson
- Uniformed Services, University of the Health Sciences, School of Medicine, Bethesda, MD, USA
| | - Amy Cheung
- University of Massachusetts, Medical School/UMass Memorial Medical Center, Worcester, MA, USA
| | - Xiaoduo Fan
- University of Massachusetts, Medical School/UMass Memorial Medical Center, Worcester, MA, USA.
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25
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Liou KT, Ahles TA, Garland SN, Li QS, Bao T, Li Y, Root JC, Mao JJ. The Relationship Between Insomnia and Cognitive Impairment in Breast Cancer Survivors. JNCI Cancer Spectr 2019; 3:pkz041. [PMID: 31355357 PMCID: PMC6640530 DOI: 10.1093/jncics/pkz041] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/17/2019] [Accepted: 05/31/2019] [Indexed: 11/14/2022] Open
Abstract
Background Cancer-related cognitive impairment is an emerging public health burden. Growing research suggests that sleep disturbances contribute to poor cognition. Our study aimed to evaluate the association between insomnia and cognitive impairment in breast cancer survivors. Methods We analyzed cross-sectional data from a cohort study of postmenopausal women with stage 0–III hormone receptor-positive breast cancer on aromatase inhibitor therapy. The study was conducted between November 2011 and April 2015 at an academic cancer center (Philadelphia, PA). Insomnia was assessed with the Insomnia Severity Index. Perceived cognitive impairment was assessed with the cognitive subscale of the Breast Cancer Prevention Trial Symptom Checklist. We used linear regression to evaluate the association between insomnia and perceived cognitive impairment. Results Among 1072 patients, 556 (51.9%) reported insomnia and 847 (79.0%) were bothered by cognitive symptoms (forgetfulness, difficulty concentrating, distractibility). Greater perceived cognitive impairment was reported by patients with mild insomnia (regression coefficient [β] = 0.35, 95% confidence interval [CI] = 0.23 to 0.46, P < .001), moderate insomnia (β = 0.51, 95% CI = 0.36 to 0.65, P < .001), and severe insomnia (β = 0.94, 95% CI = 0.67 to 1.21, P < .001), compared with those without insomnia. Greater perceived cognitive impairment was also associated with patients younger than 55 years (β = 0.30, 95% CI = 0.15 to 0.45, P < .001), taxane-based chemotherapy (β = 0.11, 95% CI = 0.004 to 0.22, P = .04), anxiety (β = 0.47, 95% CI = 0.30 to 0.64, P < .001), and depression (β = 0.65, 95% CI = 0.35 to 0.94, P < .001). Conclusions Among postmenopausal breast cancer survivors receiving aromatase inhibitor therapy, insomnia and cognitive impairment are prevalent and characterized by a graded association, in which severity of perceived cognitive impairment increases as insomnia severity increases. Our findings warrant further research to determine whether addressing sleep is a strategy to improve management of cancer-related cognitive impairment.
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Affiliation(s)
- Kevin T Liou
- Integrative Medicine Service
- Correspondence to: Jun J. Mao, MD, MSCE, Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Ave, New York, NY 10021 (e-mail: )
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences
| | - Sheila N Garland
- Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | | | - Ting Bao
- Integrative Medicine Service
- Breast Medicine Service
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences
- Department of Epidemiology and Biostatistics
| | - James C Root
- Department of Psychiatry and Behavioral Sciences
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26
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Chan KKS, Fung WTW. The impact of experienced discrimination and self-stigma on sleep and health-related quality of life among individuals with mental disorders in Hong Kong. Qual Life Res 2019; 28:2171-2182. [DOI: 10.1007/s11136-019-02181-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2019] [Indexed: 01/12/2023]
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27
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Klingaman EA, Lucksted A, Crosby ES, Blank Y, Schwartz E. A phenomenological inquiry into the experience of sleep: Perspectives of US military veterans with insomnia and serious mental illness. J Sleep Res 2019; 28:e12833. [PMID: 30891868 DOI: 10.1111/jsr.12833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/27/2018] [Accepted: 01/10/2019] [Indexed: 12/20/2022]
Abstract
The majority of people with serious mental illness experience insomnia, and insomnia is one of the most frequent reasons for mental health referrals in the Veterans Health Administration. Insomnia also represents a critical obstacle to mental health recovery. Little is known about how military veterans with mental health problems conceptualize their sleep and sleep problems; such information may uncover new avenues for research and treatment. Therefore, the purpose of this study was to explore how veterans with serious mental illness and insomnia experience and understand their sleep, towards the aim of identifying these new avenues. Participants included 20 veterans with insomnia and serious mental illness (i.e. schizophrenia spectrum, bipolar or major depressive disorders, with serious functional impairments). Data were collected via an inductive phenomenological approach using semi-structured interviews. We identified five themes: Sleep to Recharge; Sleep as a Fight; Sleep as Safety or Escape; Sleep as Dangerous; and Military Influence. Participants' relationship with sleep was complex; many associated it with intrusive and troubling hallucinations, paranoia and military experiences, yet at the same time desired sleep for its potential to liberate them from distress. Military mindsets both helped and hindered sleep. These results extend existing models of insomnia development and maintenance, and illuminate phenomena previously unidentified in this underserved veteran population. Clinical and theoretical implications are discussed, as well as new research directions for enhancing therapeutic efficacy.
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Affiliation(s)
- Elizabeth A Klingaman
- VA Capitol Health Care Network Mental Illness Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA.,Department of Psychiatry, School of Medicine, University of Maryland, College Park, Maryland, USA
| | - Alicia Lucksted
- VA Capitol Health Care Network Mental Illness Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA.,Department of Psychiatry, School of Medicine, University of Maryland, College Park, Maryland, USA
| | - Eric S Crosby
- VA Capitol Health Care Network Mental Illness Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA
| | - Yelena Blank
- Palo Alto VA Health Care System, Palo Alto, California, USA
| | - Elana Schwartz
- VA Capitol Health Care Network Mental Illness Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA
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28
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Winsky-Sommerer R, de Oliveira P, Loomis S, Wafford K, Dijk DJ, Gilmour G. Disturbances of sleep quality, timing and structure and their relationship with other neuropsychiatric symptoms in Alzheimer’s disease and schizophrenia: Insights from studies in patient populations and animal models. Neurosci Biobehav Rev 2019; 97:112-137. [DOI: 10.1016/j.neubiorev.2018.09.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 08/31/2018] [Accepted: 09/30/2018] [Indexed: 02/06/2023]
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29
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Ghrouz AK, Noohu MM, Dilshad Manzar M, Warren Spence D, BaHammam AS, Pandi-Perumal SR. Physical activity and sleep quality in relation to mental health among college students. Sleep Breath 2019; 23:627-634. [PMID: 30685851 DOI: 10.1007/s11325-019-01780-z] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/29/2018] [Accepted: 01/08/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To examine the associations and interactive effects of physical activity and sleep quality on mental health among Indian college students. METHOD A cross-sectional study was conducted among Indian college students. The sociodemographic data and body mass index were obtained from a convenience sample of 617 college students, age range from 18 to 30 years, including both genders (314 men, 51%). All participants completed three questionnaires: the Hospital Anxiety and Depression Scale, the International Physical Activity Questionnaire-Short Form, and the Pittsburgh Sleep Quality Index. Questionnaires were evaluated to ascertain the subjects' mental health level, physical activity level, and sleep quality. Analyses were conducted with binary logistic regression models. RESULT The mean (± S.D.) anxiety and depression scores were 9.3 ± 4.4 and 7.4 ± 2.5 respectively, with anxiety and depression scores ranging from 0 to 20 and 0-17, respectively. The prevalence of anxiety (30%) was more than that of depression (18%). Out of the total participants, 51% reported having low physical activity levels, and 51% had poor sleep quality. Odds ratio calculations indicated that the participants physical activity levels (moderate and high) were significantly and inversely associated with scores for anxiety (OR = 0.16 and 0.96; p = 0.001) and for depression (OR = 0.11 and 0.96; p = 0.001).The poor sleep quality was significantly positively associated with anxiety (OR = 1.38) and depression OR = 1.58 (p = 0.001). CONCLUSION Mental health problems are common among both male and female college students. Significant associations were found between physical activity levels and sleep quality with mental health.
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Affiliation(s)
- Amer K Ghrouz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India
| | - Majumi Mohamad Noohu
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India.
| | - Md Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah, 11952, Saudi Arabia
| | | | - Ahmed S BaHammam
- The University Sleep Disorders Center, College of Medicine, King Saud University, Box 225503, Riyadh, 11324, Saudi Arabia.,National Plan for Science and Technology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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30
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Si TM, Cai SL, Zhuo JM, Zhang LL. Switching to paliperidone extended release in patients with schizophrenia dissatisfied with previous olanzapine treatment: Post hoc analysis of an open-label, prospective study. Medicine (Baltimore) 2019; 98:e13688. [PMID: 30653088 PMCID: PMC6370113 DOI: 10.1097/md.0000000000013688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This post hoc analysis of an open-label, single-arm, multicenter study was designed to assess the efficacy, safety, and tolerability of paliperidone extended release (ER) in Chinese patients with non-acute schizophrenia, after switching from olanzapine. METHODS Patients with schizophrenia who were dissatisfied with prior olanzapine treatment switched to flexible paliperidone ER (3-12 mg/day) based on clinical judgment. Change from baseline to week 12 in Positive and Negative Syndrome Scale (PANSS) total scores (primary endpoint), PANSS subscale scores, response rate, Clinical Global Impression-Severity (CGI-S) score, personal and social performance (PSP) scores, patient satisfaction with treatment score, change in sleep quality, level of daytime sleepiness and safety were evaluated. RESULTS Out of 118 enrolled patients, 95 (81%) completed the study. Mean duration of study was 76.9 (23.85) days. The primary endpoint, mean (SD) PANSS total score changed significantly from baseline to endpoint (-19.6 [18.71], P <.0001). Secondary endpoints including PANSS subscale score, PSP, patient satisfaction and daytime drowsiness also significantly improved (P <.001). Most commonly reported (≥1%) treatment-emergent adverse events were akathisia (n = 14 [12%]) and insomnia (n = 9 [8%]). CONCLUSIONS Switching to flexible-dosed paliperidone ER in patients dissatisfied with prior olanzapine treatment achieved good efficacy and tolerability consistently over 12 weeks.
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Affiliation(s)
- Tian Mei Si
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental Health, Ministry of Health (Peking University)
- Peking University Institute of Mental Health/The Sixth Hospital
| | | | - Jian Min Zhuo
- Janssen Research & Development Center, Johnson & Johnson Investment Ltd, Shanghai, People's Republic of China
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31
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Ruppert E, Kilic-Huck U. [Diagnosis and comorbidities of Circadian Rhythm Sleep Disorders]. Presse Med 2018; 47:969-976. [PMID: 30391268 DOI: 10.1016/j.lpm.2018.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022] Open
Abstract
Circadian rhythm sleep disorders (CRSD) result from a disturbed endogenous clock (intrinsic CRSD) or from a misalignment between the biological clock and an imposed environment (extrinsic CRSD). Among intrinsic CRSD, one distinguishes the delayed sleep-wake phase disorder, the advanced sleep-wake phase disorder, the irregular sleep-wake rhythm disorder and the non-24-hour sleep-wake rhythm disorder. Shift work disorder, jet lag disorder and circadian sleep-wake disorder not otherwise specified are extrinsic CRSD. Prevalences of the different CRSD remain largely unknown. Some CRSD are particularly frequent such as sleep delayed phase syndrome in adolescents. Overall, CRSD are probably under-diagnosed. CRSD generate insomnia and excessive daytime somnolence. A biological clock dysfunction has to be evoked in case of insomnia or sleepiness. Furthermore, as CRSD can overlap with other sleep disorders, their diagnosis and treatment are essential. CRSD cause significant mental, physical or socio-professional sufferings. They are frequently associated with comorbidities, mainly neurodevelopmental, psychiatric and neurodegenerative disorders. Regarding neurodevelopmental comorbidities, therapy using a chronobiological approach is complementary to the usual clinical care. It helps to limit the significant impact of CRSD on quality of live, daytime functioning, social interactions and neurocognitive difficulties in the children. In psychiatry, sleep disorders and circadian rhythms sleep-wake disorders are a factor of vulnerability, of suicidal risk, of relapse and pharmacoresistance. Thus, diagnosis of CRSD associated with a psychiatric disorder is of major importance. Treatment using a chronobiological approach reinforcing the entrainment of the sleep-wake cycle is complementary to usual treatments. Sleep disorders and circadian sleep-wake rhythm disorders can be a preclinical sign of Alzheimer's and Parkinson's disease. In the elderly, a beginning neurodegenerative disorder can be associated with a CRSD and complaints of sleepiness, nocturnal awakenings and/or irregular sleep-wake cycles. Patients affected by neurogenerative disorders are particularly vulnerable for having CRSD. Data from different studies suggest that CRSD participate in pathophysiology of Alzheimer's disease. Even though treatment of CRSD associated with neurodegenerative disorders is entirely part of the treatment strategy, it remains uncertain to which extend this treatment may impact disease progression.
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Affiliation(s)
- Elisabeth Ruppert
- Hôpital Civil, centre des troubles du sommeil-CIRCSom, département neurologique, 1, place de l'Hôpital, 67091 Strasbourg, France; Université de Strasbourg, institut des neurosciences cellulaires et intégratives, CNRS - UPR 3212, 5, rue Blaise-Pascal, 67000 Strasbourg, France.
| | - Ulker Kilic-Huck
- Hôpital Civil, centre des troubles du sommeil-CIRCSom, département neurologique, 1, place de l'Hôpital, 67091 Strasbourg, France; Université de Strasbourg, institut des neurosciences cellulaires et intégratives, CNRS - UPR 3212, 5, rue Blaise-Pascal, 67000 Strasbourg, France
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32
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Sleep profiles and CBT-I response in schizophrenia and related psychoses. Psychiatry Res 2018; 268:279-287. [PMID: 30077955 DOI: 10.1016/j.psychres.2018.07.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 02/05/2023]
Abstract
This study investigated sleep subtypes in schizophrenia, and their response to Cognitive Behavioural Therapy for Insomnia (CBT-I) treatment. Sleep profiling was conducted using latent class analysis on baseline Pittsburgh Sleep Quality Index data (N = 74 outpatients with schizophrenia who were poor sleepers, 52% male, mean age = 41.4 years). Of these, 40 took part in CBT-I treatment. Analyses revealed three sleep subtypes based on total sleep time (TST), sleep efficiency (SE), and sleep onset latency (SOL) parameters: Cluster 1 ('classic severe insomnia', 44.6%), Cluster 2 ('insomnia with normal sleep duration', 37.8%), and Cluster 3 ('insomnia with hypersomnia', 17.6%). Gains analysis of pre- and post-treatment data from CBT-I participants revealed improvements in sleep and psychopathology in all three clusters, although there were some group differences in the areas and magnitude of improvement. Cluster 1 showed the greatest benefits with longer TST and improved SE. Cluster 2 showed a comparatively blunted treatment response although TST moved closer to recommended sleep guidelines. Cluster 3 showed significant reductions in TST. Altogether, this is the first demonstration of different sleep profiles in schizophrenia and their influence on treatment response to CBT-I. It also supports the notion that therapies should be tailored to the person and their insomnia presentation.
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33
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Soehner AM, Goldstein TR, Gratzmiller SM, Phillips ML, Franzen PL. Cognitive control under stressful conditions in transitional age youth with bipolar disorder: Diagnostic and sleep-related differences in fronto-limbic activation patterns. Bipolar Disord 2018; 20:238-247. [PMID: 29441653 PMCID: PMC6002960 DOI: 10.1111/bdi.12583] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/09/2017] [Accepted: 10/21/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Adults with bipolar disorder (BD) display aberrant activation in fronto-limbic neural circuitry during cognitive control. However, fronto-limbic response to cognitive control, and factors destabilizing this circuitry, remain under-studied during the transition from adolescence to young adulthood in BD. Sleep patterns are disturbed in BD, undergo change in adolescence, and support brain function. Among transitional age youth, BD diagnosis and sleep (duration and variability) were tested as predictors of fronto-limbic response to a stressful cognitive control task. METHODS Two groups of youth (13-22 years old) participated: 15 with BD type I, II or not otherwise specified (NOS) [BD; age 18.1 ± 2.7 years (mean ± standard deviation, SD); 17 female] and 25 healthy controls [CTL; age 19.4 ± 2.7 years (mean ± SD); 17 female]. Sleep was monitored with actigraphy for at least 1 week prior to an adaptive multi-source interference functional magnetic resonance imaging (fMRI) paradigm (a Stroop-like cognitive interference task). Group status and sleep duration (average and intra-individual variability) were examined as predictors of activation in response to incongruent>congruent trials within the bilateral amygdala, anterior cingulate (ACC), ventrolateral prefrontal and dorsolateral prefrontal cortical regions of interest. RESULTS The BD group displayed greater right amygdala activation than the CTL group. Average sleep duration and rostroventral ACC (rvACC) activity were negatively associated in the CTL group, but exhibited a quadratic relationship in the BD group such that short and long sleep were related to greater rvACC activation. Sleep duration variability and dorsal ACC activity were negatively associated in the BD group, and unrelated in the CTL group. Findings remained significant after controlling for age, sex, and mood symptoms. CONCLUSIONS Subjects with BD displayed a hyper-limbic response during cognitive control, and sleep was a source of variability in ACC engagement. Stabilizing sleep may be one avenue for improving cognitive control in BD.
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Affiliation(s)
- Adriane M. Soehner
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tina R. Goldstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sarah M. Gratzmiller
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary L. Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Peter L. Franzen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Schmutte T, Davidson L, O'Connell M. Improved Sleep, Diet, and Exercise in Adults with Serious Mental Illness: Results from a Pilot Self-Management Intervention. Psychiatr Q 2018; 89:61-71. [PMID: 28455555 DOI: 10.1007/s11126-017-9516-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Compared to the general population, adults with serious mental illnesses have elevated rates of medical morbidity resulting in a reduced life expectancy of approximately 15 years. Chronic disease self-management programs for adults with serious mental and chronic medical illnesses show some promise in improving physical health-related outcomes, yet none of them address sleep quality. Poor sleep affects a majority of adults with serious mental illness and is robust risk factor for physical morbidity and premature mortality. This pilot project examined the impact of a 14-week educational and support group that included sleep quality as a cornerstone in promoting wellness and self-management in 78 adults with serious mental illness and poor health. Results provide preliminary data that the self-management program was associated with significant improvements in self-reported sleep quality at post-intervention. At 3-month follow-up, participants reported additional increases in sleep quality as well as in healthy diet and exercise frequency. Addressing sleep quality as part of self-management and wellness programs may be a viable approach to assist adults with chronic mental and physical illnesses to adopt health-promoting changes.
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Affiliation(s)
- Timothy Schmutte
- Yale Program for Recovery and Community Health, Yale University, 319 Peck Street, Erector Square, Building 1, New Haven, CT, 06513, USA.
| | - Larry Davidson
- Yale Program for Recovery and Community Health, Yale University, 319 Peck Street, Erector Square, Building 1, New Haven, CT, 06513, USA
| | - Maria O'Connell
- Yale Program for Recovery and Community Health, Yale University, 319 Peck Street, Erector Square, Building 1, New Haven, CT, 06513, USA
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Scott AJ, Webb TL, Rowse G. Does improving sleep lead to better mental health? A protocol for a meta-analytic review of randomised controlled trials. BMJ Open 2017; 7:e016873. [PMID: 28928187 PMCID: PMC5623526 DOI: 10.1136/bmjopen-2017-016873] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Sleep and mental health go hand-in-hand, with many, if not all, mental health problems being associated with problems sleeping. Although sleep has been traditionally conceptualised as a secondary consequence of mental health problems, contemporary views prescribe a more influential, causal role of sleep in the formation and maintenance of mental health problems. One way to evaluate this assertion is to examine the extent to which interventions that improve sleep also improve mental health. METHOD AND ANALYSIS Randomised controlled trials (RCTs) describing the effects of interventions designed to improve sleep on mental health will be identified via a systematic search of four bibliographic databases (in addition to a search for unpublished literature). Hedges' g and associated 95% CIs will be computed from means and SDs where possible. Following this, meta-analysis will be used to synthesise the effect sizes from the primary studies and investigate the impact of variables that could potentially moderate the effects. The Jadad scale for reporting RCTs will be used to assess study quality and publication bias will be assessed via visual inspection of a funnel plot and Egger's test alongside Orwin's fail-safe n. Finally, mediation analysis will be used to investigate the extent to which changes in outcomes relating to mental health can be attributed to changes in sleep quality. ETHICS AND DISSEMINATION This study requires no ethical approval. The findings will be submitted for publication in a peer-reviewed journal and promoted to relevant stakeholders. PROSPERO REGISTRATION NUMBER CRD42017055450.
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Affiliation(s)
- Alexander J Scott
- School of Health and Related Research, Sheffield University, Sheffield, UK
| | - Thomas L Webb
- Department of Psychology, Sheffield University, Sheffield, UK
| | - Georgina Rowse
- Clinical Psychology Unit, Sheffield University, Sheffield, UK
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Abstract
STUDY OBJECTIVES Insomnia is pervasive among people with serious mental illnesses (SMI) and has a profound negative impact on their psychiatric symptom management and recovery. However, little is known about the factors that affect severity of insomnia in those with SMI. In addition, very few studies have explored whether evidence-based interventions developed for those without SMI are appropriate for or applicable to individuals with SMI. The purpose of this study was to test the role of arousal, dysfunctional cognitions about sleep, and sleep-related behaviors in predicting severity of insomnia in a sample of 60 Veterans who were receiving care in Veterans Health Administration mental health and psychosocial rehabilitation programs and who reported subjective insomnia. In addition, information was collected regarding the types of insomnia treatments provided to these Veterans. METHODS Participants completed assessments of insomnia severity and sleep-related arousal, behaviors, and cognitions. Medical records were reviewed to determine whether participants had been screened/assessed for insomnia and whether treatments for insomnia were provided before the date of referral to the study. Multiple regression was used to predict insomnia severity on the basis of these factors. RESULTS Most participants (81.7%) reported moderate to severe insomnia, although only 3.3% had a diagnosis of insomnia in their medical records. Worry and helplessness about sleep were predictive of insomnia severity; better self-reported sleep hygiene and higher levels of arousal were also associated with greater severity of insomnia. Education about sleep hygiene and medication were the only types of insomnia treatment received. CONCLUSIONS Similar to insomnia among individuals without SMI, insomnia in Veterans with SMI is associated with dysfunctional sleep-related behaviors and cognitions. Many of the Veterans also lacked access to settings and resources conducive to healthy sleep. Veterans with SMI should be regularly assessed for insomnia. Research is needed concerning optimal evidence-based insomnia interventions for addressing behaviors and cognitions in this population in the context of these challenges.
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An examination of sleep quality in veterans with a dual diagnosis of PTSD and severe mental illness. Psychiatry Res 2017; 247:15-20. [PMID: 27863313 DOI: 10.1016/j.psychres.2016.07.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/25/2016] [Accepted: 07/12/2016] [Indexed: 11/21/2022]
Abstract
Poor sleep quality is one of the most frequently reported symptoms by veterans with Posttraumatic Stress Disorder (PTSD) and by veterans with severe mental illness (SMI; i.e., schizophrenia spectrum disorders, bipolar disorder, major depression with or without psychotic features). However, little is known about the compounding effects of co-occurring PTSD/SMI on sleep quality in this population. Given the high rates of comorbidity and poor functional outcomes associated with sleep dysfunction, there is a need to better understand patterns of poor sleep quality in this population. The present study provides a description of sleep quality in veterans with a dual diagnosis of PTSD/SMI relative to veterans with PTSD only. Results indicated that, despite similar reports of PTSD symptom severity between the groups, veterans with PTSD/SMI reported higher levels of poor sleep quality than veterans only diagnosed with PTSD. Specifically, veterans with PTSD/SMI reported significantly greater difficulties with sleep onset and overall more sleep disturbance than their non-SMI counterparts. Implications of the findings are discussed within the context of an existing model of insomnia and suggest that more comprehensive sleep assessment and the provision of targeted sleep interventions may be helpful for those with a dual diagnosis of PTSD/SMI.
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Horváth A, Montana X, Lanquart JP, Hubain P, Szűcs A, Linkowski P, Loas G. Effects of state and trait anxiety on sleep structure: A polysomnographic study in 1083 subjects. Psychiatry Res 2016; 244:279-83. [PMID: 27512915 DOI: 10.1016/j.psychres.2016.03.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 12/30/2015] [Accepted: 03/01/2016] [Indexed: 10/21/2022]
Abstract
Anxiety affects millions of people and has been shown to co-occur in combination with sleep disturbances, generating heavy medical costs and a huge socio-medico-economic burden. Sleep-studies in anxiety disorders are inconsistent and the effects of state and trait anxiety are unexplored. We selected 1083 patients from the database of a hospital sleep laboratory. The patients had polysomnography for different sleep disorders; their sleep initiation (sleep onset latency), sleep maintenance (total sleep time), non-rapid eye movement sleep-, and rapid eye movement sleep parameters; as well as their State-Trait Anxiety Inventory and Beck depression scale were measured. In order to be included in our study, individuals needed to score in the low or high range on the State and/or Trait Subscales of the State-Trait Anxiety Inventory. We found that both state and trait anxiety affected non-rapid eye movement sleep parameters. Sleep onset latency changes predominantly associated to state anxiety while rapid eye movement parameters related to trait anxiety.
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Affiliation(s)
- András Horváth
- Sleep Laboratory, Department of Psychiatry, Erasme Academic Hospital & Laboratory of Psychiatric Research (ULB 266) Université Libre de Bruxelles, 808 Route de Lennik, B-1070 Brussels, Belgium; Department of Neurology, National Institute of Clinical Neurosciences, 57 Amerikai út, 1145 Budapest, Hungary; Semmelweis University School of PhD Studies, János Szentágothai Doctoral School of Neurosciences, 26 Üllői út, 1085 Budapest, Hungary.
| | - Xavier Montana
- Sleep Laboratory, Department of Psychiatry, Erasme Academic Hospital & Laboratory of Psychiatric Research (ULB 266) Université Libre de Bruxelles, 808 Route de Lennik, B-1070 Brussels, Belgium
| | - Jean-Pol Lanquart
- Sleep Laboratory, Department of Psychiatry, Erasme Academic Hospital & Laboratory of Psychiatric Research (ULB 266) Université Libre de Bruxelles, 808 Route de Lennik, B-1070 Brussels, Belgium
| | - Philippe Hubain
- Sleep Laboratory, Department of Psychiatry, Erasme Academic Hospital & Laboratory of Psychiatric Research (ULB 266) Université Libre de Bruxelles, 808 Route de Lennik, B-1070 Brussels, Belgium
| | - Anna Szűcs
- Department of Neurology, National Institute of Clinical Neurosciences, 57 Amerikai út, 1145 Budapest, Hungary
| | - Paul Linkowski
- Sleep Laboratory, Department of Psychiatry, Erasme Academic Hospital & Laboratory of Psychiatric Research (ULB 266) Université Libre de Bruxelles, 808 Route de Lennik, B-1070 Brussels, Belgium
| | - Gwenolé Loas
- Sleep Laboratory, Department of Psychiatry, Erasme Academic Hospital & Laboratory of Psychiatric Research (ULB 266) Université Libre de Bruxelles, 808 Route de Lennik, B-1070 Brussels, Belgium
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Duclos C, Dumont M, Potvin MJ, Desautels A, Gilbert D, Menon DK, Bernard F, Gosselin N. Evolution of severe sleep-wake cycle disturbances following traumatic brain injury: a case study in both acute and subacute phases post-injury. BMC Neurol 2016; 16:186. [PMID: 27677675 PMCID: PMC5039911 DOI: 10.1186/s12883-016-0709-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 09/21/2016] [Indexed: 11/18/2022] Open
Abstract
Background Sleep-wake disturbances are frequently reported following traumatic brain injury (TBI), but they remain poorly documented in the acute stage of injury. Little is known about their origin and evolution. Case presentation This study presents the case of a patient in the acute phase of a severe TBI. The patient was injured at work when falling 12 m into a mine and was hospitalized in the regular wards of a level I trauma centre. From days 31 to 45 post-injury, once he had reached a level of medical stability and continuous analgosedation had been ceased, his sleep-wake cycle was monitored using actigraphy. Results showed significant sleep-wake disturbances and severe sleep deprivation. Indeed, the patient had an average nighttime sleep efficiency of 32.7 ± 15.4 %, and only an average of 4.8 ± 1.3 h of sleep per 24-h period. After hospital discharge to the rehabilitation centre, where he remained for 5 days, the patient was readmitted to the same neurological unit for paranoid delusions. During his second hospital stay, actigraphy recordings resumed from days 69 to 75 post-injury. A major improvement in his sleep-wake cycle was observed during this second stay, with an average nighttime sleep efficiency of 96.3 ± 0.9 % and an average of 14.1 ± 0.9 h of sleep per 24-h period. Conclusion This study is the first to extensively document sleep-wake disturbances in both the acute and subacute phases of severe TBI. Results show that prolonged sleep deprivation can be observed after TBI, and suggest that the hospital environment only partially contributes to sleep-wake disturbances. Continuous actigraphic monitoring may prove to be a useful clinical tool in the monitoring of patients hospitalized after severe TBI in order to detect severe sleep deprivation requiring intervention. The direct impact of sleep-wake disturbances on physiological and cognitive recovery is not well understood within this population, but is worth investigating and improving. Electronic supplementary material The online version of this article (doi:10.1186/s12883-016-0709-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catherine Duclos
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, 5400 boul. Gouin Ouest, local E-0300, Montréal, Québec, H4J 1C5, Canada.,Department of Psychiatry, Université de Montréal, Montréal, Canada
| | - Marie Dumont
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, 5400 boul. Gouin Ouest, local E-0300, Montréal, Québec, H4J 1C5, Canada.,Department of Psychiatry, Université de Montréal, Montréal, Canada
| | - Marie-Julie Potvin
- Traumatology program, Hôpital du Sacré-Coeur de Montréal, 5400 boul. Gouin Ouest, Montréal, Québec, H4J 1C5, Canada
| | - Alex Desautels
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, 5400 boul. Gouin Ouest, local E-0300, Montréal, Québec, H4J 1C5, Canada.,Department of Neuroscience, Université de Montreal, Montréal, Canada
| | - Danielle Gilbert
- Traumatology program, Hôpital du Sacré-Coeur de Montréal, 5400 boul. Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.,Department of Radiology, Hôpital du Sacré-Cœur de Montréal, 5400 boul. Gouin Ouest, local E-0330, Montréal, Québec, H4J 1C5, Canada
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Box 93, Cambridge, CB2 2QQ, UK
| | - Francis Bernard
- Traumatology program, Hôpital du Sacré-Coeur de Montréal, 5400 boul. Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.,Department of Medicine, Université de Montreal, Montréal, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, 5400 boul. Gouin Ouest, local E-0300, Montréal, Québec, H4J 1C5, Canada. .,Department of Psychology, Université de Montréal, Montréal, Canada.
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Garbarino S, Lanteri P, Durando P, Magnavita N, Sannita WG. Co-Morbidity, Mortality, Quality of Life and the Healthcare/Welfare/Social Costs of Disordered Sleep: A Rapid Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E831. [PMID: 27548196 PMCID: PMC4997517 DOI: 10.3390/ijerph13080831] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 12/15/2022]
Abstract
Sleep disorders are frequent (18%-23%) and constitute a major risk factor for psychiatric, cardiovascular, metabolic or hormonal co-morbidity and mortality. Low social status or income, unemployment, life events such as divorce, negative lifestyle habits, and professional requirements (e.g., shift work) are often associated with sleep problems. Sleep disorders affect the quality of life and impair both professional and non-professional activities. Excessive daytime drowsiness resulting from sleep disorders impairs efficiency and safety at work or on the road, and increases the risk of accidents. Poor sleep (either professional or voluntary) has detrimental effects comparable to those of major sleep disorders, but is often neglected. The high incidence and direct/indirect healthcare and welfare costs of sleep disorders and poor sleep currently constitute a major medical problem. Investigation, monitoring and strategies are needed in order to prevent/reduce the effects of these disorders.
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Affiliation(s)
- Sergio Garbarino
- Center of Sleep Medicine, Genoa 16132, Italy.
- Department of Neuroscience, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16132, Italy.
| | - Paola Lanteri
- Child Neurology and Psychiatry Unit, Istituto Giannina Gaslini, Genoa 16148, Italy.
| | - Paolo Durando
- Department of Health Sciences, Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, IRCCS AOU San Martino IST, Genoa 16132, Italy.
| | - Nicola Magnavita
- Department of Public Health, Università Cattolica del Sacro Cuore, Rome 00168, Italy.
| | - Walter G Sannita
- Center of Sleep Medicine, Genoa 16132, Italy.
- Department of Neuroscience, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16132, Italy.
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Tang VK, Pato MT, Sobell JL, Hammond TC, Valdez MM, Lane CJ, Pato CN. Substance use associated with short sleep duration in patients with schizophrenia or schizoaffective disorder. Am J Med Genet B Neuropsychiatr Genet 2016; 171:525-33. [PMID: 26345478 DOI: 10.1002/ajmg.b.32374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/18/2015] [Indexed: 11/05/2022]
Abstract
STUDY OBJECTIVES To examine the association between substance use and short sleep duration in individuals with schizophrenia or schizoaffective disorder, depressive type (SADD). DESIGN Cross-sectional, retrospective study. SETTING Urban, suburban, and rural centers across the United States. PARTICIPANTS 2,462 consented, adult individuals with schizophrenia or schizoaffective disorder, depressive type (SADD). Participants included inpatients in acute or chronic care settings as well as outpatients and residents in community dwellings. MEASUREMENTS Substance use was assessed with 10 questions adopted from well-validated measures (e.g., CAGE questionnaire) for alcohol, marijuana, and illicit drugs. Short sleep duration was defined as <6 hr of self-reported sleep per night. RESULTS Close to 100% of our sample used nicotine while 83% used substances other than nicotine. More importantly, there was a significant association between substance use and short sleep duration. Interestingly, this association was strongest among African-Americans with schizophrenia or SADD. CONCLUSIONS Because psychiatric medications often target chemical receptors involved with both sleep and substance use, understanding the association between short sleep duration and substance use in individuals with schizophrenia and SADD is important. Given that the majority of premature deaths in individuals with psychotic illness are due to medical conditions associated with modifiable risk factors, prospective studies designed to examine the effect of short sleep duration on behaviors like substance use should be undertaken. Finally, analyzing genetic and environmental data in a future study might help illuminate the strong association found between short sleep duration and substance use in African-Americans with schizophrenia and SADD. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Vivian K Tang
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, Los Angeles, California
| | - Michele T Pato
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, Los Angeles, California
| | - Janet L Sobell
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, Los Angeles, California
| | - Terese C Hammond
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, Los Angeles, California
| | - Mark M Valdez
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, Los Angeles, California
| | - Christianne J Lane
- Department of Preventive Medicine, Keck School of Medicine, Los Angeles, California
| | | | - Carlos N Pato
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, Los Angeles, California
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Abstract
Bipolar disorder is a serious mental illness characterized by alternating periods of elevated and depressed mood. Sleep disturbances in bipolar disorder are present during all stages of the condition and exert a negative impact on overall course, quality of life, and treatment outcomes. We examine the partnership between circadian system (process C) functioning and sleep-wake homeostasis (process S) on optimal sleep functioning and explore the role of disruptions in both systems on sleep disturbances in bipolar disorder. A convergence of evidence suggests that sleep problems in bipolar disorder result from dysregulation across both process C and process S systems. Biomarkers of depressive episodes include heightened fragmentation of rapid eye movement (REM) sleep, reduced REM latency, increased REM density, and a greater percentage of awakenings, while biomarkers of manic episodes include reduced REM latency, greater percentage of stage I sleep, increased REM density, discontinuous sleep patterns, shortened total sleep time, and a greater time awake in bed. These findings highlight the importance of targeting novel treatments for sleep disturbance in bipolar disorder.
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Affiliation(s)
| | - Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital; Harvard Medical School, Boston, MA, USA
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Parletta N, Aljeesh Y, Baune BT. Health Behaviors, Knowledge, Life Satisfaction, and Wellbeing in People with Mental Illness across Four Countries and Comparisons with Normative Sample. Front Psychiatry 2016; 7:145. [PMID: 27597833 PMCID: PMC4993073 DOI: 10.3389/fpsyt.2016.00145] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/05/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND People with chronic mental illness have poorer physical health and higher mortality than the general population. We investigated lifestyle factors in people with mental illness across four countries and compared with a normative sample. DESIGN AND METHODS Data were collected from N = 672 people (Germany, n = 375; Palestine, n = 192; London, n = 63; Australia, n = 42) with substance abuse disorder (n = 224), schizophrenia (n = 158), mood disorders (n = 227), and somatoform disorders (n = 63). The General Health Behaviour Questionnaire measured behaviors and knowledge related to nutrition, physical activity, alcohol, smoking, sleep, life satisfaction, and wellbeing. The normative samples were derived from a German population (N = 1,019). Data were analyzed using ANOVAs and t-tests. RESULTS The Palestine sample did not differ from the Western samples on reported life satisfaction and wellbeing. However, they reported unhealthier diets, less physical activity, and lower knowledge about the impact of diet, physical activity, smoking, and sleep on health than the Western samples. Comparing the Western and normative samples, people with mental illness reported lower intake of healthy foods/drinks, higher intake of unhealthy foods, higher exercise, higher alcohol consumption, less cigarettes, less sleep, and more sleep problems. Their knowledge was lower for nutrition, physical activity, and smoking. All participants reported lower life satisfaction and wellbeing than the normative sample (P-values <0.001). CONCLUSION Education on health-related lifestyle factors present important targets for primary care, quality of life and prevention of illness in people with mental illness. Further research will clarify specific predictors of health behaviors in each country.
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Affiliation(s)
- Natalie Parletta
- Centre for Population Health Research, School of Health Sciences, University of South Australia , Adelaide, SA , Australia
| | - Yousef Aljeesh
- Faculty of Nursing, Islamic University of Gaza , Gaza , Palestine
| | - Bernhard T Baune
- Department of Psychiatry, University of Adelaide , Adelaide, SA , Australia
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Rosenblat JD, Brietzke E, Mansur RB, Maruschak NA, Lee Y, McIntyre RS. Inflammation as a neurobiological substrate of cognitive impairment in bipolar disorder: Evidence, pathophysiology and treatment implications. J Affect Disord 2015; 188:149-59. [PMID: 26363613 DOI: 10.1016/j.jad.2015.08.058] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/05/2015] [Accepted: 08/26/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bipolar disorder (BD) has been associated with cognitive impairment during depressed, manic and euthymic periods. Inflammation has been shown to be involved in the pathophysiology of BD and cognitive impairment. METHODS For this systematic review, the MEDLINE/PubMed, Embase, Google Scholar and ClinicalTrials.gov databases were searched for relevant articles assessing the association between cognitive function and inflammatory markers in BD subjects. A discussion of potential mechanisms and therapeutic implications is also included to provide further context to the subject matter. RESULTS Eight studies, including a total of 555 BD subjects, assessing the association between cognitive function and inflammatory markers were identified. Cognitive dysfunction was associated with elevated levels of pro-inflammatory markers YKL40, IL-6, sCD40L, IL-1Ra, hsCRP and TNF-α. Mechanistically, elevation in inflammatory cytokines alters monoamine levels leading to cognitive and affective dysfunction. Neuro-inflammation, manifesting as microglial activation, leads to increased oxidative stress, pathologic synaptic pruning and impaired neuroplasticity in key brain regions sub-serving mood and cognition. Immune dysfunction also activates the hypothalamic-pituitary-adrenal (HPA) axis leading to hypercortisolemia and metabolic dysfunction, further promoting neuronal dysfunction. Anti-inflammatory agents are therefore currently being investigated in the treatment of BD and appear to exert an antidepressant effect; however, cognitive outcomes have yet to be reported. CONCLUSION Several studies suggest that immune dysfunction is associated with cognitive impairment in BD. Several neurobiological pathways have been identified whereby immune dysfunction may promote cognitive impairment in BD. Future investigations of anti-inflammatory agents targeting cognitive function as a treatment outcome are merited.
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Affiliation(s)
- Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Elisa Brietzke
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Federal University of Sao Paulo, Sao Paulo, Brazil; Program of Recognition and Intervention in Individuals in AT-Risk Mental States (PRISMA), Department of Psychiatry, Universidade FeInterdisciplinary Laboratory of Clinical Neurosciences (LINC), Federal University of Sao Pauloderal de São Paulo, São Paulo, Brazil
| | - Rodrigo B Mansur
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Federal University of Sao Paulo, Sao Paulo, Brazil; Program of Recognition and Intervention in Individuals in AT-Risk Mental States (PRISMA), Department of Psychiatry, Universidade FeInterdisciplinary Laboratory of Clinical Neurosciences (LINC), Federal University of Sao Pauloderal de São Paulo, São Paulo, Brazil
| | - Nadia A Maruschak
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Yena Lee
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Gao XB, Hermes G. Neural plasticity in hypocretin neurons: the basis of hypocretinergic regulation of physiological and behavioral functions in animals. Front Syst Neurosci 2015; 9:142. [PMID: 26539086 PMCID: PMC4612503 DOI: 10.3389/fnsys.2015.00142] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 10/02/2015] [Indexed: 12/22/2022] Open
Abstract
The neuronal system that resides in the perifornical and lateral hypothalamus (Pf/LH) and synthesizes the neuropeptide hypocretin/orexin participates in critical brain functions across species from fish to human. The hypocretin system regulates neural activity responsible for daily functions (such as sleep/wake homeostasis, energy balance, appetite, etc.) and long-term behavioral changes (such as reward seeking and addiction, stress response, etc.) in animals. The most recent evidence suggests that the hypocretin system undergoes substantial plastic changes in response to both daily fluctuations (such as food intake and sleep-wake regulation) and long-term changes (such as cocaine seeking) in neuronal activity in the brain. The understanding of these changes in the hypocretin system is essential in addressing the role of the hypocretin system in normal physiological functions and pathological conditions in animals and humans. In this review, the evidence demonstrating that neural plasticity occurs in hypocretin-containing neurons in the Pf/LH will be presented and possible physiological, behavioral, and mental health implications of these findings will be discussed.
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Affiliation(s)
- Xiao-Bing Gao
- Section of Comparative Medicine, Yale University School of Medicine New Haven, CT, USA ; Program on Integrative Cell Signaling and Neurobiology of Metabolism (ICSNM), Yale University School of Medicine New Haven, CT, USA
| | - Gretchen Hermes
- Department of Psychiatry, Yale University School of Medicine New Haven, CT, USA
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Klingaman EA, Palmer-Bacon J, Bennett ME, Rowland LM. Sleep Disorders Among People With Schizophrenia: Emerging Research. Curr Psychiatry Rep 2015; 17:79. [PMID: 26279058 DOI: 10.1007/s11920-015-0616-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Up to 80 % of individuals with schizophrenia spectrum disorders experience sleep disturbances, which impact physical and mental health, as well as quality of life. In this paper, we review and integrate emerging literature, published between 2012 and 2014, regarding approaches to diagnosis and treatment of major sleep disorders for people with schizophrenia spectrum disorders, including insomnia, obstructive sleep apnea (OSA), circadian rhythm dysfunction, and restless legs syndrome (RLS). We advocate for (1) the need to evaluate the utility of nonpharmacological approaches in people with schizophrenia spectrum disorders; (2) documentation of guidelines to assist providers in clinically tailoring such interventions when their clients experience positive, negative, and/or cognitive symptoms; (3) research on the best ways providers can capitalize on clients' self-identified needs and motivation to engage in sleep treatments through shared decision making; and (4) the importance of investigating whether and how mental health and sleep treatment services should be better connected to facilitate access for people with schizophrenia spectrum disorders. Assessment and tailored treatment of sleep disorders within mental health treatment settings has the potential to reduce sleep problems and improve functioning, quality of life, and recovery of this population.
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Affiliation(s)
- Elizabeth A Klingaman
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Capitol Health Care Network (VISN 5), 10 North Greene Street (Annex Suite 720), Baltimore, MD, 21201, USA,
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Kishi T, Matsunaga S, Iwata N. Suvorexant for Primary Insomnia: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. PLoS One 2015; 10:e0136910. [PMID: 26317363 PMCID: PMC4552781 DOI: 10.1371/journal.pone.0136910] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 08/09/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We performed a systematic review and meta-analysis of double-blind, randomized, placebo-controlled trials evaluating suvorexant for primary insomnia. METHODS Relevant studies were identified through searches of PubMed, databases of the Cochrane Library, and PsycINFO citations through June 27, 2015. We performed a systematic review and meta-analysis of suvorexant trial efficacy and safety outcomes. The primary efficacy outcomes were either subjective total sleep time (sTST) or subjective time-to-sleep onset (sTSO) at 1 month. The secondary outcomes were other efficacy outcomes, discontinuation rate, and individual adverse events. The risk ratio, number-needed-to-treat/harm, and weighted mean difference (WMD) and 95% confidence intervals (CI) based on a random effects model were calculated. RESULTS The computerized literature database search initially yielded 48 results, from which 37 articles were excluded following a review of titles and abstracts and another eight review articles after full-text review. Thus, we identified 4 trials that included a total of 3,076 patients. Suvorexant was superior to placebo with regard to the two primary efficacy outcomes (sTST: WMD = -20.16, 95% CI = -25.01 to -15.30, 1889 patients, 3 trials, sTSO: WMD = -7.62, 95% CI = -11.03 to -4.21, 1889 patients, 3 trials) and was not different from placebo in trial discontinuations. Suvorexant caused a higher incidence than placebo of at least one side effects, abnormal dreams, somnolence, excessive daytime sleepiness/sedation, fatigue, dry mouth, and rebound insomnia. CONCLUSIONS Our analysis of published trial results suggests that suvorexant is effective in treating primary insomnia and is well-tolerated.
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Affiliation(s)
- Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- * E-mail:
| | - Shinji Matsunaga
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Saunders EF, Fernandez-Mendoza J, Kamali M, Assari S, McInnis MG. The effect of poor sleep quality on mood outcome differs between men and women: A longitudinal study of bipolar disorder. J Affect Disord 2015; 180:90-6. [PMID: 25885066 PMCID: PMC4448970 DOI: 10.1016/j.jad.2015.03.048] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Sleep disturbance is bi-directionally related to mood de-stabilization in bipolar disorder (BD), and sleep quality differs in men and women. We aimed to determine whether perception of poor sleep quality would have a different effect on mood outcome in men versus women. METHODS We assessed association between sleep quality (Pittsburgh Sleep Quality Index (PSQI)) at study intake and mood outcome over 2 years in subjects from the Prechter Longitudinal Study of Bipolar Disorder (N=216; 29.6% males). The main outcome measure was the severity, variability, and frequency of mood episodes measured by self-report over 2 years of follow-up. Multivariable linear regression models stratified by sex examined the relationship between PSQI with mood outcomes, while age, stressful life events, mood state and neuroticism at baseline were controlled. RESULTS In women, poor sleep quality at baseline predicted increased severity (B=0.28, p<0.001) and frequency of episodes (B=0.32, p<0.001) of depression, and poor sleep quality was a stronger predictor than baseline depression; poor sleep quality predicted increased severity (B=0.19, p<0.05) and variability (B=0.20, p<0.05) of mania, and frequency of mixed episodes (B=0.27, p<0.01). In men, baseline depression and neuroticism were stronger predictors of mood outcome compared to poor sleep quality. LIMITATIONS We measured perception of sleep quality, but not objective changes in sleep. CONCLUSIONS In a longitudinal study of BD, women reported poorer perceived sleep quality than men, and poor sleep quality predicted worse mood outcome in BD. Clinicians should be sensitive to addressing sleep complaints in women with BD early in treatment to improve outcome in BD.
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Affiliation(s)
- Erika F.H. Saunders
- Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA,University of Michigan Medical School, Department of Psychiatry, Ann Arbor, MI,University of Michigan Depression Center, Ann Arbor, MI
| | - Julio Fernandez-Mendoza
- Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, P.O. Box 850, Mail Code: HO73, Hershey, PA, USA; Sleep Research & Treatment Center, Department of Psychiatry, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
| | - Masoud Kamali
- University of Michigan Medical School, Department of Psychiatry, Ann Arbor, MI, USA; University of Michigan Depression Center, Ann Arbor, MI, USA.
| | - Shervin Assari
- University of Michigan Medical School, Department of Psychiatry, Ann Arbor, MI, USA; University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Melvin G. McInnis
- University of Michigan Medical School, Department of Psychiatry, Ann Arbor, MI,University of Michigan Depression Center, Ann Arbor, MI
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