1
|
Kishi TT, Andersen ML, Luciano YM, Kakazu VA, Tufik S, Pires GN. Methods for REM Sleep Density Analysis: A Scoping Review. Clocks Sleep 2023; 5:793-805. [PMID: 38131750 PMCID: PMC10742531 DOI: 10.3390/clockssleep5040051] [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: 10/11/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
Rapid eye movements (REM) sleep density is the parameter proposed to explain the variability in the amount of eye movements during REM sleep. Alterations in REM sleep density have been proposed as a screening criterion for individuals with depression and other mental health conditions, but its accuracy has not been properly evaluated. The lack of consensus and the variability of the methods used to score it reduces the external validity of the results, hindering an adequate analysis of its diagnostic accuracy and clinical applicability. This scoping review aimed to identify and quantify the methods used to score REM sleep density, describing their main characteristics. A literature search was conducted in PubMed, Scopus, PsycInfo, and Web of Science. Only studies with objective measures for REM sleep density analysis in individuals with depression were considered eligible. The final sample comprised 57 articles, covering 64 analyses of REM sleep density. The relative frequency methods were the predominant measurement parameter for analyzing REM sleep density across studies. The most frequently adopted REM estimation unit was the number of REM events followed by mini-epochs containing REM. The most common unit of measurement were frequency/time measures. The results demonstrate that there is no consistency in the methods used to calculate REM sleep density in the literature, and a high percentage of studies do not describe their methods in sufficient detail. The most used method was the number of REM episodes per minute of REM sleep, but its use is neither unanimous nor consensual. The methodological inconsistencies and omissions among studies limit the replicability, comparability, and clinical applicability of REM sleep density. Future guidelines should discuss and include a specific methodology for the scoring of REM sleep density, so it can be consensually implemented in clinical services and research.
Collapse
Affiliation(s)
- Tamires Tiemi Kishi
- Departamento de Psicobiologia, Federal University of São Paulo, São Paulo 04024-002, Brazil; (T.T.K.)
| | - Monica Levy Andersen
- Departamento de Psicobiologia, Federal University of São Paulo, São Paulo 04024-002, Brazil; (T.T.K.)
- Sleep Institute, São Paulo, 04020-060, Brazil
| | - Ygor Matos Luciano
- Departamento de Psicobiologia, Federal University of São Paulo, São Paulo 04024-002, Brazil; (T.T.K.)
| | - Viviane Akemi Kakazu
- Departamento de Psicobiologia, Federal University of São Paulo, São Paulo 04024-002, Brazil; (T.T.K.)
| | - Sergio Tufik
- Departamento de Psicobiologia, Federal University of São Paulo, São Paulo 04024-002, Brazil; (T.T.K.)
- Sleep Institute, São Paulo, 04020-060, Brazil
| | - Gabriel Natan Pires
- Departamento de Psicobiologia, Federal University of São Paulo, São Paulo 04024-002, Brazil; (T.T.K.)
- Sleep Institute, São Paulo, 04020-060, Brazil
| |
Collapse
|
2
|
Taji W, Pierson R, Ujma PP. Protocol of the Budapest sleep, experiences, and traits study: An accessible resource for understanding associations between daily experiences, individual differences, and objectively measured sleep. PLoS One 2023; 18:e0288909. [PMID: 37856524 PMCID: PMC10586695 DOI: 10.1371/journal.pone.0288909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/07/2023] [Indexed: 10/21/2023] Open
Abstract
Sleep is both a neurophysiological state and a biologically necessary behavior that performs a variety of indispensable roles for human health, development, and cognitive functioning. Despite this, comparatively little is known about the relationships between daily experiences and sleep features. Importantly, these relationships are bidirectional in nature, may be differently associated with subjectively and objectively assessed sleep, and may also be modulated by individual differences To address this challenge, we created the Budapest Sleep, Experiences, and Traits Study (BSETS), a multidisciplinary observational sleep study utilizing novel remote EEG devices. BSETS was designed to establish a dataset for future use in investigating the relationships between sleep features and daily experiences. In this paper we describe the protocol of the currently ongoing BSETS, which examines a community-dwelling sample of over 250 healthy participants who are studied in a naturalistic setting using a large questionnaire assessing psychological, demographic, and anthropometric information, as well as evening/morning diaries of sleep and daily experiences, and mobile EEG recordings over a period of 7 days. This dataset will become an accessible resource to the wider scientific community and can be utilized to investigate the complex multidirectional relationships between objectively and subjectively measured sleep, daily experiences, and individual differences, bestowing it with significant value for sleep researchers as well as practitioners working in clinical settings with patients suffering from disordered sleep.
Collapse
Affiliation(s)
- Wael Taji
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Róbert Pierson
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | | |
Collapse
|
3
|
Shorub E, Omar AN, Elshahawi H, Naoum D, Elsahrawy T, Elhawary Y. Impulsivity and psychiatric comorbidity as risk factors for suicide attempts in borderline personality disorder. S Afr J Psychiatr 2022; 28:1544. [PMID: 35747342 PMCID: PMC9210139 DOI: 10.4102/sajpsychiatry.v28i0.1544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/08/2021] [Indexed: 11/01/2022] Open
Abstract
Background: Addressing the risk of suicidality in borderline personality disorder (BPD) is a crucial issue. The notion that impulsive individuals are more likely to plan for suicide attempts is important for many reasons in both theoretical and clinical decision-making.Aim: The aim of this study was to investigate potential risks of suicidality in BPD and to correlate it to impulsivity.Setting: The study was conducted at the Institute of Psychiatry, Ain Shams University and Al Mashfa Private Hospital.Methods: Ninety-one participants were included in the study: 30 patients were diagnosed as BPD without axis I comorbidities, 31 BPD patients had psychiatric comorbidities and 30 healthy subjects were assessed by using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), Suicide Behavior Questionnaire-Revised (SBQ-R), the Arabic version of Barratt’s Impulsiveness Scale-11 (BIS-11) and Global Assessment of Functioning scale.Results: There was a significant difference in suicidality using the SBQ-R between the healthy controls and BPDs without and with comorbidities. Healthy controls showed low suicidality in only 3.3%, while it was higher in both groups of BPD. The total score of BIS was as follows: 62.5 (±10.1 SD) in group A, 79.4 (±12 SD) in group B and 80.3 (±12.5 SD) in group C, which denote mild, moderate and moderate-to-severe degree of impulsivity in group A, B and C, respectively. Suicidality was positively correlated with (AI item: lack of span Attention in Attentional Facet) (r = 0.489, p = 0.006), (PI item: lack of self-control in planning facet) (r = 0.401, p = 0.028), as well as (MII item: lack perseverance in holding off impulsive acts in motor facet) (r = 0.471, p = 0.009).Conclusion: Proper assessment of associated psychiatric comorbidities and impulsivity among BPD patients will help preventing of future suicidal attempts.
Collapse
Affiliation(s)
- Eman Shorub
- Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Abdel Nasser Omar
- Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Heba Elshahawi
- Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Tarek Elsahrawy
- Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Yomna Elhawary
- Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
4
|
Boland C, Jalihal V, Organ C, Oak K, McLean B, Laugharne R, Woldman W, Beck R, Shankar R. EEG Markers in Emotionally Unstable Personality Disorder-A Possible Outcome Measure for Neurofeedback: A Narrative Review. Clin EEG Neurosci 2021; 52:254-273. [PMID: 32635758 DOI: 10.1177/1550059420937948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objectives. There is growing evidence for the use of biofeedback (BF) in affective disorders, dissocial personality disorder, and in children with histories of abuse. Electroencephalogram (EEG) markers could be used as neurofeedback in emotionally unstable personality disorder (EUPD) management especially for those at high risk of suicide when emotionally aroused. This narrative review investigates the evidence for EEG markers in EUPD. Methods. PRISMA guidelines were used to conduct a narrative review. A structured search method was developed and implemented in collaboration with an information specialist. Studies were identified via 3 electronic database searches of MEDLINE, Embase, and PsycINFO. A predesigned inclusion/exclusion criterion was applied to selected papers. A thematic analysis approach with 5 criteria was used. Results. From an initial long list of 5250 papers, 229 studies were identified and screened, of which 44 met at least 3 of the predesigned inclusion criteria. No research to date investigates EEG-based neurofeedback in EUPD. A number of different EEG biomarkers are identified but there is poor consistency between studies. Conclusions. The findings heterogeneity may be due to the disorder complexity and the variable EEG related parameters studied. An alternative explanation may be that there are a number of different neuromarkers, which could be clustered together with clinical symptomatology, to give new subdomains. Quantitative EEGs in particular may be helpful to identify more specific abnormalities. EEG standardization of neurofeedback protocols based on specific EEG abnormalities detected may facilitate targeted use of neurofeedback as an intervention in EUPD.
Collapse
Affiliation(s)
- Cailín Boland
- Saint James's Hospital, Dublin, Ireland.,8809Trinity College Dublin, Dublin, Ireland
| | | | | | - Katy Oak
- 8028Royal Cornwall Hospitals Trust, Truro, UK
| | | | - Richard Laugharne
- 7491Cornwall Partnership NHS Foundation Trust, Truro, UK.,151756Exeter Medical School, Exeter, UK
| | | | - Randy Beck
- Institute of Functional Neuroscience, Perth, Western Australia, Australia
| | - Rohit Shankar
- 7491Cornwall Partnership NHS Foundation Trust, Truro, UK.,151756Exeter Medical School, Exeter, UK
| |
Collapse
|
5
|
Vanek J, Prasko J, Ociskova M, Hodny F, Holubova M, Minarikova K, Slepecky M, Nesnidal V. Insomnia in Patients with Borderline Personality Disorder. Nat Sci Sleep 2021; 13:239-250. [PMID: 33654445 PMCID: PMC7910080 DOI: 10.2147/nss.s295030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/20/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Both sleep disorders and BPD are prevalent in the population, and one is often a comorbidity of the other. This narrative review aims to assess contemporary literature and scientific databases to provide the current state of knowledge about sleep disorders in patients with borderline personality disorder (BPD) and clinical suggestions for managing sleep disorders in BPD patients and future research direction. METHODS Articles were acquired via PubMed and Web of Science, and papers published between January 1980 and October 2020 were extracted. Authors made a series of literature searches using the keywords: Sleep problems, Insomnia, Nightmares, Obstructive sleep apnea, Borderline personality disorder. The inclusion criteria were: published in peer-reviewed journals; studies in humans; or reviews on the related topic; English language. The exclusion criteria were: abstracts from conferences; commentaries; subjects younger than 18 years. After an inspection of the full texts, 42 papers from 101 were selected. Secondary documents from the reference lists of the primary designated papers were searched, assessed for suitability, and included. In total, 71 papers were included in the review process. RESULTS Sleep disturbance is common among patients with BPD. Nevertheless, the number of investigations is limited, and the prevalence differs between 5-45%. Studies assessing objective changes in sleep architecture in BPD show inconsistent results. Some of them identify REM sleep changes and a decrease in slow-wave sleep, while other studies found no objective sleep architecture changes. There is also a higher prevalence of nightmares in patients with BPD. Untreated insomnia can worsen BPD symptoms via interference with emotional regulation. BPD itself seems to influence the subjective quality of sleep significantly. Proper diagnosis and treatment of sleep disorders in patients with BPD could lead to better results in therapy. Psychotherapeutic approaches can improve both sleep disorders and BPD symptoms. CONCLUSION Recognising and managing sleep disorders in patients with BPD may help alleviate the disorder's symptoms. Treatment of people with BPD may be more effective if the treatment plan explicitly addresses sleep problems. Further research is needed to reach reliable conclusions.
Collapse
Affiliation(s)
- Jakub Vanek
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic.,Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic.,Institute for Postgraduate Education in Health Care, Prague, The Czech Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Frantisek Hodny
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Michaela Holubova
- Department of Psychiatry, Hospital Liberec, Liberec, The Czech Republic
| | - Kamila Minarikova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic
| | - Vlastimil Nesnidal
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| |
Collapse
|
6
|
McGowan N, Goodwin G, Bilderbeck A, Saunders K. Actigraphic patterns, impulsivity and mood instability in bipolar disorder, borderline personality disorder and healthy controls. Acta Psychiatr Scand 2020; 141:374-384. [PMID: 31916240 PMCID: PMC7216871 DOI: 10.1111/acps.13148] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/02/2020] [Accepted: 01/05/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To differentiate the relation between the structure and timing of rest-activity patterns and symptoms of impulsivity and mood instability in bipolar disorder (BD), borderline personality disorder (BPD) and healthy controls (HC). METHODS Eighty-seven participants (31 BD, 21 BPD and 35 HC) underwent actigraph monitoring for 28 days as part of the Automated Monitoring of Symptom Severity (AMoSS) study. Impulsivity was assessed at study entry using the BIS-11. Mood instability was subsequently longitudinally monitored using the digital Mood Zoom questionnaire. RESULTS BPD participants show several robust and significant correlations between non-parametric circadian rest-activity variables and worsened symptoms. Impulsivity was associated with low interdaily stability (r = -0.663) and weak amplitude (r = -0.616). Mood instability was associated with low interdaily stability (r = -0.773), greater rhythm fragmentation (r = 0.662), weak amplitude (r = -0.694) and later onset of daily activity (r = 0.553). These associations were not present for BD or HCs. Classification analysis using actigraphic measures determined that later L5 onset reliably distinguished BPD from BD and HC but did not sufficiently discriminate between BD and HC. CONCLUSIONS Rest-activity pattern disturbance indicative of perturbed sleep and circadian function is an important predictor of symptom severity in BPD. This appears to validate the greater subjective complaints of BPD individuals that are sometimes regarded as exaggerated by clinicians. We suggest that treatment strategies directed towards improving sleep and circadian entrainment may in the future be investigated in BPD.
Collapse
Affiliation(s)
- N.M. McGowan
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - G.M. Goodwin
- Department of PsychiatryUniversity of OxfordOxfordUK,Oxford Health NHS Foundation TrustWarneford HospitalOxfordUK
| | | | - K.E.A. Saunders
- Department of PsychiatryUniversity of OxfordOxfordUK,Oxford Health NHS Foundation TrustWarneford HospitalOxfordUK,NIHR Oxford Health Biomedical Research CentreOxfordUK
| |
Collapse
|
7
|
Dixon-Gordon KL, Conkey LC, Whalen DJ. Recent advances in understanding physical health problems in personality disorders. Curr Opin Psychol 2017; 21:1-5. [PMID: 28915400 DOI: 10.1016/j.copsyc.2017.08.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 11/16/2022]
Abstract
Personality disorders are associated with a range of adverse health outcomes, contributing to the high healthcare utilization seen in patients with these disorders. A growing literature supports a robust association of personality disorders and health problems. The primary aim of this article is to summarize the most recent research documenting the associations between personality disorders and health conditions. Extending past reviews, we discuss the association of personality disorders with chronic physical illnesses, sleep disturbances, pain conditions, and obesity. We provide recommendations for future research in this area.
Collapse
Affiliation(s)
- Katherine L Dixon-Gordon
- University of Massachusetts Amherst, Department of Psychological and Brain Sciences, 135 Hicks Way, Amherst, MA 01003, USA.
| | - Lindsey C Conkey
- University of Massachusetts Amherst, Department of Psychological and Brain Sciences, 135 Hicks Way, Amherst, MA 01003, USA
| | - Diana J Whalen
- Washington University School of Medicine, Department of Psychiatry, Box 8511, St. Louis, MO 63110, USA
| |
Collapse
|
8
|
Weibel S, Jermann F, Weiner L, Nicastro R, Ardu S, Pham E, Hasler R, Dayer A, Prada P, Perroud N. Insomnia in adult attention-deficit/hyperactivity disorder: A comparison with borderline personality disorder population in a clinical setting and control participants. Compr Psychiatry 2017; 76:119-128. [PMID: 28501733 DOI: 10.1016/j.comppsych.2017.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/29/2017] [Accepted: 04/28/2017] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Many adults with attention-deficit/hyperactivity disorder (ADHD) report sleeping difficulties. The relationship between sleep and ADHD is poorly understood, and shows discrepancies between subjective and objective measures. In order to determine the specificity of sleep-associated symptoms in ADHD, subjective sleep assessments among ADHD adult patients were compared with control subjects and with individuals suffering from borderline personality disorder (BPD). METHODS 129 outpatients with ADHD, 70 with BPD (including 17 patients with BPD and ADHD comorbidity), and 65 control participants were assessed for sleep quality, insomnia, and sleepiness, using the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS). RESULTS ADHD- and BPD-sufferers achieved higher insomnia and lower sleep quality scores than control subjects. Clinical groups did not differ in terms of sleep quality, although insomnia was more severe among BPD patients. Depression scores explained most of sleep symptoms, but even when controlling for depression, ADHD sufferers showed higher sleep latency. Inattentive symptoms were associated with somnolence, while hyperactive/impulsive symptoms were associated with insomnia and lower sleep efficiency. CONCLUSION Sleep-related symptoms associated with ADHD were partly explained by non-specific factors, especially depression symptoms. In a dimensional perspective, hyperactive and inattentive symptoms were associated with specific sleep symptoms.
Collapse
Affiliation(s)
- Sébastien Weibel
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland.
| | - Françoise Jermann
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Luisa Weiner
- Department of Psychiatry, Mental Health and Addictology, University Hospital of Strasbourg, Strasbourg, France
| | - Rosetta Nicastro
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Stefano Ardu
- Department of Cariology and Endodontology, Treatment Plan Unit and Division of Operative Dentistry, Dental School, University of Geneva, Geneva, Switzerland
| | - Eleonore Pham
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Alexandre Dayer
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Paco Prada
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| |
Collapse
|
9
|
The sleep phenotype of Borderline Personality Disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev 2017; 73:48-67. [DOI: 10.1016/j.neubiorev.2016.12.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 11/22/2016] [Accepted: 12/09/2016] [Indexed: 12/30/2022]
|
10
|
Baglioni C, Nanovska S, Regen W, Spiegelhalder K, Feige B, Nissen C, Reynolds CF, Riemann D. Sleep and mental disorders: A meta-analysis of polysomnographic research. Psychol Bull 2016; 142:969-990. [PMID: 27416139 PMCID: PMC5110386 DOI: 10.1037/bul0000053] [Citation(s) in RCA: 535] [Impact Index Per Article: 66.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Investigating sleep in mental disorders has the potential to reveal both disorder-specific and transdiagnostic psychophysiological mechanisms. This meta-analysis aimed at determining the polysomnographic (PSG) characteristics of several mental disorders. Relevant studies were searched through standard strategies. Controlled PSG studies evaluating sleep in affective, anxiety, eating, pervasive developmental, borderline and antisocial personality disorders, attention-deficit-hyperactivity disorder (ADHD), and schizophrenia were included. PSG variables of sleep continuity, depth, and architecture, as well as rapid-eye movement (REM) sleep were considered. Calculations were performed with the "Comprehensive Meta-Analysis" and "R" software. Using random effects modeling, for each disorder and each variable, a separate meta-analysis was conducted if at least 3 studies were available for calculation of effect sizes as standardized means (Hedges' g). Sources of variability, that is, sex, age, and mental disorders comorbidity, were evaluated in subgroup analyses. Sleep alterations were evidenced in all disorders, with the exception of ADHD and seasonal affective disorders. Sleep continuity problems were observed in most mental disorders. Sleep depth and REM pressure alterations were associated with affective, anxiety, autism and schizophrenia disorders. Comorbidity was associated with enhanced REM sleep pressure and more inhibition of sleep depth. No sleep parameter was exclusively altered in 1 condition; however, no 2 conditions shared the same PSG profile. Sleep continuity disturbances imply a transdiagnostic imbalance in the arousal system likely representing a basic dimension of mental health. Sleep depth and REM variables might play a key role in psychiatric comorbidity processes. Constellations of sleep alterations may define distinct disorders better than alterations in 1 single variable. (PsycINFO Database Record
Collapse
Affiliation(s)
- Chiara Baglioni
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Svetoslava Nanovska
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Wolfram Regen
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Bernd Feige
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Christoph Nissen
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | | | - Dieter Riemann
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| |
Collapse
|
11
|
Weinhold SL, Göder R, Pabst A, Scharff AL, Schauer M, Baier PC, Aldenhoff J, Elbert T, Seeck-Hirschner M. Sleep recordings in individuals with borderline personality disorder before and after trauma therapy. J Neural Transm (Vienna) 2016; 124:99-107. [PMID: 26970970 DOI: 10.1007/s00702-016-1536-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
Most individuals diagnosed with borderline personality disorder (BPD) have been exposed to severe and traumatic stressors and thus frequently present with symptoms of a posttraumatic stress disorder (PTSD). Severe sleep disturbances often accompany these complex cases, but changes of sleep parameters during therapy and the impact of sleep on treatment response have barely been studied. Narrative Exposure Therapy (NET) is an evidence-based approach for the treatment of trauma-related psychological disorders. To investigate the effect of NET on sleep in patients with BPD and comorbid PTSD, we screened 45 inpatients and outpatients who met the inclusion criteria of both diagnoses according to DSM-IV and who had a minimum of 2 weeks' stable medication. Patients were allocated to NET (N = 13) or treatment as usual (TAU; N = 8) in blocks. Polysomnographies and psychological questionares were performed before, directly and 6 months after the last therapy session. The aim of this pilot study was to investigate the effectiveness of trauma therapy by NET on sleep quantity (total sleep time) and sleep continuity (sleep efficiency and awakenings) in patients with comorbid BPD and PTSD. Participants of the NET group compared with those who received TAU showed an increased reduction in sleep latency from baseline to the end of therapy and a reduction in arousals over time. Patients with longer pre-treatment total sleep time and pre-treatment REM sleep duration showed a better outcome of NET with respect to PTSD symptoms. NET seems not lead to a change in sleep for the worse during therapy and seems to improve sleep as good as treatment as usual. Furthermore, our results provide evidence of an influence of sleep structure at baseline on treatment success later on.
Collapse
Affiliation(s)
- Sara Lena Weinhold
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Niemannsweg 147, 24105, Kiel, Germany
| | - Robert Göder
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Niemannsweg 147, 24105, Kiel, Germany.
| | - Astrid Pabst
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Niemannsweg 147, 24105, Kiel, Germany
| | - Anna-Lena Scharff
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Niemannsweg 147, 24105, Kiel, Germany
| | - Maggie Schauer
- Department of Psychology, University of Konstanz, Constance, Germany
| | - Paul Christian Baier
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Niemannsweg 147, 24105, Kiel, Germany
| | - Josef Aldenhoff
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Niemannsweg 147, 24105, Kiel, Germany
| | - Thomas Elbert
- Department of Psychology, University of Konstanz, Constance, Germany
| | | |
Collapse
|
12
|
Asaad T, Sabry W, Rabie M, El-Rassas H. Polysomnographic characteristics of bipolar hypomanic patients: Comparison with unipolar depressed patients. J Affect Disord 2016; 191:274-9. [PMID: 26688496 DOI: 10.1016/j.jad.2015.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/24/2015] [Accepted: 12/04/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sleep profile in bipolar disorder has received little attention in comparison to sleep studies in major depressive disorders. Specific sleep abnormalities especially in REM sleep parameters have been detected in depression. The current study aimed at investigating whether bipolar disorder shares the same polysomnographic (PSG) changes or not. METHODS All night polysomnographic assessments were made for 20 patients diagnosed to have hypomania, in addition to 20 patients with major depression and 20 healthy matched controls. All participants were examined using Standardized Sleep Questionnaire, SCID-I for psychiatric diagnosis, based on DSM-IV criteria, YMRS (for hypomanic patients), HAMD (for major depression patients), and all-night polysomnography (for all subjects). RESULTS The two patient groups differed significantly from controls in their sleep profile, especially regarding sleep continuity measures, Short REML (Rapid Eye Movement Latency), with increased REMD (Rapid Eye Movement sleep density). High similarity was found in EEG sleep profile of the two patient groups, though the changes were more robust in patients with depression LIMITATIONS A relatively small sample size, the absence of follow up assessment, lack of consideration of other variables like body mass index, nicotine and caffeine intake. CONCLUSION Similarity in EEG sleep profile between Bipolar disorder patients and patients with major depression suggests a common biological origin for both conditions, with the difference being "quantitative" rather than "qualitative". This quantitative difference in sleep efficiency and SWS (Slow wave sleep), being higher in hypomania, might explain the rather "refreshing" nature of sleep in hypomanic patients, compared to depression.
Collapse
Affiliation(s)
- Tarek Asaad
- Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Egypt
| | - Walaa Sabry
- Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Egypt
| | - Menan Rabie
- Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Egypt
| | - Hanan El-Rassas
- Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Egypt
| |
Collapse
|
13
|
Dixon-Gordon KL, Whalen DJ, Layden BK, Chapman AL. A Systematic Review of Personality Disorders and Health Outcomes. ACTA ACUST UNITED AC 2015; 56:168-190. [PMID: 26456998 DOI: 10.1037/cap0000024] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Personality disorders have been associated with a wide swath of adverse health outcomes and correspondingly high costs to healthcare systems. To date, however, there has not been a systematic review of the literature on health conditions among individuals with personality disorders. The primary aim of this article is to review research documenting the associations between personality disorders and health conditions. A systematic review of the literature revealed 78 unique empirical English-language peer-reviewed articles examining the association of personality disorders and health outcomes over the past 15 years. Specifically, we reviewed research examining the association of personality disorders with sleep disturbance, obesity, pain conditions, and other chronic health conditions. In addition, we evaluated research on candidate mechanisms underlying health problems in personality disorders and potential treatments for such disorders. Results underscore numerous deleterious health outcomes associated with PD features and PD diagnoses, and suggest potential biological and behavioural factors that may account for these relations. Guidelines for future research in this area are discussed.
Collapse
Affiliation(s)
- Katherine L Dixon-Gordon
- University of Massachusetts Amherst, Department of Psychological and Brain Sciences, Amherst MA 01003; Tel: 413-545-0226;
| | - Diana J Whalen
- Washington University School of Medicine, Department of Psychiatry, Box 8511, St. Louis MO 63110; Tel: 314-286-2730;
| | - Brianne K Layden
- Simon Fraser University, Department of Psychology, 8888 University Drive, Burnaby BC V5A 1S6; Tel: 604-314-2762; ;
| | - Alexander L Chapman
- Simon Fraser University, Department of Psychology, 8888 University Drive, Burnaby BC V5A 1S6; Tel: 604-314-2762; ;
| |
Collapse
|
14
|
Skrzypińska D, Szmigielska B. Dream-reality confusion in borderline personality disorder: a theoretical analysis. Front Psychol 2015; 6:1393. [PMID: 26441768 PMCID: PMC4569816 DOI: 10.3389/fpsyg.2015.01393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022] Open
Abstract
This paper presents an analysis of dream-reality confusion (DRC) in relation to the characteristics of borderline personality disorder (BPD), based on research findings and theoretical considerations. It is hypothesized that people with BPD are more likely to experience DRC compared to people in non-clinical population. Several variables related to this hypothesis were identified through a theoretical analysis of the scientific literature. Sleep disturbances: problems with sleep are found in 15–95.5% of people with BPD (Hafizi, 2013), and unstable sleep and wake cycles, which occur in BPD (Fleischer et al., 2012), are linked to DRC. Dissociation: nearly two-thirds of people with BPD experience dissociative symptoms (Korzekwa and Pain, 2009) and dissociative symptoms are correlated with a fantasy proneness; both dissociative symptoms and fantasy proneness are related to DRC (Giesbrecht and Merckelbach, 2006). Negative dream content: People with BPD have nightmares more often than other people (Semiz et al., 2008); dreams that are more likely to be confused with reality tend to be more realistic and unpleasant, and are reflected in waking behavior (Rassin et al., 2001). Cognitive disturbances: Many BPD patients experience various cognitive disturbances, including problems with reality testing (Fiqueierdo, 2006; Mosquera et al., 2011), which can foster DRC. Thin boundaries: People with thin boundaries are more prone to DRC than people with thick boundaries, and people with BPD tend to have thin boundaries (Hartmann, 2011). The theoretical analysis on the basis of these findings suggests that people who suffer from BPD may be more susceptible to confusing dream content with actual waking events.
Collapse
Affiliation(s)
- Dagna Skrzypińska
- Unit of Sleep Psychology, Institute of Psychology, Jagiellonian University Krakow, Poland
| | - Barbara Szmigielska
- Unit of Sleep Psychology, Institute of Psychology, Jagiellonian University Krakow, Poland
| |
Collapse
|
15
|
Oltmanns JR, Oltmanns TF. Borderline Personality Pathology, Polysomnography, and Self-Reported Sleep Problems: A Review. CURRENT SLEEP MEDICINE REPORTS 2015. [DOI: 10.1007/s40675-015-0011-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
16
|
Oltmanns JR, Weinstein Y, Oltmanns TF. Borderline personality pathology and insomnia symptoms in community-dwelling older adults. Personal Ment Health 2014; 8:178-87. [PMID: 24574136 PMCID: PMC4365934 DOI: 10.1002/pmh.1259] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 01/28/2014] [Accepted: 01/29/2014] [Indexed: 11/09/2022]
Abstract
Prior research has associated BPD with sleep problems, but the relationship has been explored primarily in small clinical samples of younger adults. Findings from our lab have demonstrated that borderline symptoms remain present in later middle age and are associated with several negative life outcomes. A representative community sample of older adults (N = 633, Mage = 62.3) was obtained from the St Louis area, and interviewer-reports, self-reports, and informant-reports of personality pathology were completed along with an insomnia symptoms questionnaire. Cross-sectional analyses revealed that symptoms from all 10 DSM-IV personality disorders were significantly correlated with insomnia symptoms. However, after statistically controlling for major depression, body-mass index, race and gender, only borderline personality pathology remained significantly associated with insomnia symptoms. Our results demonstrate that in addition to other negative health outcomes, borderline personality pathology is uniquely associated with sleep problems in later middle-aged adults in the community.
Collapse
Affiliation(s)
- Joshua R Oltmanns
- Department of Psychology, Washington University in St. Louis, St. Louis, MO, United States
| | | | | |
Collapse
|
17
|
Hafizi S. Sleep and borderline personality disorder: a review. Asian J Psychiatr 2013; 6:452-9. [PMID: 24309854 DOI: 10.1016/j.ajp.2013.06.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 06/24/2013] [Accepted: 06/28/2013] [Indexed: 12/17/2022]
Abstract
Sleep problems are very common among psychiatric patients. Borderline personality disorder, as a common and severe mental disorder, is associated with different types of sleep disturbances, such as disturbances of sleep continuity, altered REM sleep regulation and nightmares. These disturbances are the result of interaction of the personality traits, concomitant and comorbid diseases and environmental factors. Despite the high prevalence of sleep related disorders in BPD patients, this aspect of BPD is still neglected in clinical and research settings. To date there has been little agreement on sleep characteristics of BPD among different studies, and presence of some uncontrolled confounding factors, make interpretation of the results difficult. However, it seems that appropriate diagnosis and treatment of sleep disorders in BPD patients might lead to better outcome. This article aimed to review the current literature of sleep studies in BPD. Some recommendations and suggestions were made for future researches in this field.
Collapse
Affiliation(s)
- Sina Hafizi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
18
|
Selby EA. Chronic sleep disturbances and borderline personality disorder symptoms. J Consult Clin Psychol 2013; 81:941-7. [PMID: 23731205 DOI: 10.1037/a0033201] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Few studies have examined the experience of chronic sleep disturbances in those with borderline personality disorder (BPD), and further establishing this association may be pertinent to enhancing current treatments, given the relevance of sleep to emotion regulation and stress management. METHOD Data were analyzed (N = 5,692) from Part II of the National Comorbidity Survey-Replication (NCS-R) sample (Kessler & Merikangas, 2004), which assessed personality disorders and sleep problems. Rates of chronic sleep disturbances (difficulty initiating sleep, difficulty maintaining sleep, and waking earlier than desired), as well as the consequences of poor sleep, were examined. Indices for BPD diagnosis and symptoms were used in logistic and linear regression analyses to predict sleep and associated problems after accounting for chronic health problems, Axis I comorbidity, suicidal ideation over the last year, and key sociodemographic variables. RESULTS BPD was significantly associated with all 3 chronic sleep problems assessed, as well as with the consequences of poor sleep. The magnitude of the association between BPD and sleep problems was comparable to that for Axis I disorders traditionally associated with sleep problems. BPD symptoms interacted with chronic sleep problems to predict elevated social/emotional, cognitive, and self-care impairment. CONCLUSIONS Sleep disturbances are consistently associated with BPD symptoms, as are the daytime consequences of poor sleep. There may also be a synergistic effect where BPD symptoms are aggravated by poor sleep and lead to higher levels of functional impairment. Sleep in patients with BPD should be routinely assessed, and ameliorating chronic sleep problems may enhance treatment by improving emotion regulation and implementation of therapeutic skills. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Collapse
|
19
|
Simor P, Horváth K. Altered sleep in Borderline Personality Disorder in relation to the core dimensions of psychopathology. Scand J Psychol 2013; 54:300-12. [PMID: 23574575 DOI: 10.1111/sjop.12048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 01/19/2013] [Indexed: 11/29/2022]
Abstract
The aim of the study was to review the literature regarding sleep disturbances in Borderline Personality Disorder (BPD) and to relate the reported sleep alterations to the underlying core dimensions of BPD pathology. We present a qualitative and theoretical review regarding the empirical studies that investigated objective and subjective sleep quality in BPD and in different psychiatric conditions showing high co-morbidity with this disorder. We show that disturbed sleep including sleep fragmentation, alterations in Slow Wave Sleep and REM sleep, and dysphoric dreaming are prevalent symptoms in BPD. We provide a framework relating the specific sleep alterations to the core dimensions of BPD pathology in order to clarify the inconsistencies of the different findings. The specific sleep disturbances in BPD seem to be related to different dimensions of psychopathological functioning and may have detrimental consequences on waking affect and cognition. Investigating disturbed sleep in BPD in relation to waking symptoms and underlying neural functioning would shed more light on the nature of this complex disorder. Moreover, a stronger emphasis on sleep disturbances would enrich the treatment protocols of BPD.
Collapse
Affiliation(s)
- Péter Simor
- Department of Cognitive Sciences, Budapest University of Technology and Economics, Budapest, Hungary.
| | | |
Collapse
|
20
|
Schredl M, Paul F, Reinhard I, Ebner-Priemer UW, Schmahl C, Bohus M. Sleep and dreaming in patients with borderline personality disorder: a polysomnographic study. Psychiatry Res 2012; 200:430-6. [PMID: 22657954 DOI: 10.1016/j.psychres.2012.04.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 04/26/2012] [Accepted: 04/29/2012] [Indexed: 10/28/2022]
Abstract
Previous research has demonstrated disturbances in sleep continuity in subjects with borderline personality disorders (BPD). Moreover, depression-like sleep abnormalities like reduced REM latency have been found in BPD subjects, even without comorbid major depression disorder. Yet it is still unknown what the effect is of co-morbid posttraumatic stress disorder on sleep continuity and dream content in BPD patients group. The present study compared 27 unmedicated female BPD subjects and healthy controls. The patients exhibited increased sleep fragmentation, increased REM density, and reduced REM latency. The findings were independent from co-morbid posttraumatic stress response (PTSD), which was present in 33% of the patient sample. Negatively toned dreams obtained by REM awakenings and nightmares were also reported more often by the patients-also irrespective of co-morbid PTSD-whereas dreams of specific BPD behavior, like self-mutilation, were rare. Taking these finding into account, one might productively investigate whether the sleep abnormalities improve during successful treatment of BPD and whether efficient methods for treating nightmares can be beneficial for this patient group.
Collapse
|
21
|
Sleep disturbances and circadian CLOCK genes in borderline personality disorder. J Neural Transm (Vienna) 2012; 119:1105-10. [DOI: 10.1007/s00702-012-0860-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 06/29/2012] [Indexed: 01/03/2023]
|
22
|
Huynh C, Guilé JM, Godbout R. Études polysomnographiques du sommeil dans le trouble de personnalité limite chez l’adulte. Presse Med 2012; 41:e63-75. [DOI: 10.1016/j.lpm.2011.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 06/10/2011] [Indexed: 10/17/2022] Open
|
23
|
Sansone RA, Edwards HC, Forbis JS. Sleep quality in borderline personality disorder: a cross-sectional study. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 12. [PMID: 21274357 DOI: 10.4088/pcc.09m00919bro] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 12/28/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE In this study, relationships between sleep quality and borderline personality disorder were examined using 2 self-report measures. METHOD Using a cross-sectional design in a sample of convenience of internal medicine outpatients, we surveyed men and women (N=76), aged 18 years or older, who were seeking nonemergent medical care during the period January 2009 to September 2009. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and borderline personality was assessed with 2 measures: the borderline personality scale of the Personality Diagnostic Questionnaire-4 (PDQ-4) and the Self-Harm Inventory (SHI). RESULTS The global PSQI score was statistically significantly associated with scores on the PDQ-4 (P < .01), the SHI (P < .01), and the combination PDQ-4 and SHI (P < .01). With regard to the components of the PSQI, subjective sleep quality (P < .05), sleep duration (P < .05), and daytime dysfunction (P < .01) were all statistically significantly associated with scores on the PDQ-4, and sleep latency was statistically significantly associated with the combined PDQ-4 and SHI (P < .05). CONCLUSIONS Individuals with borderline personality symptomatology demonstrate a poorer overall quality of sleep than those without these symptoms.
Collapse
Affiliation(s)
- Randy A Sansone
- Department of Psychiatry and Internal Medicine, Wright State University School of Medicine, Dayton.
| | | | | |
Collapse
|
24
|
De la Fuente JM, Bengoetxea E, Navarro F, Bobes J, Alarcón RD. Interconnection between biological abnormalities in borderline personality disorder: use of the Bayesian networks model. Psychiatry Res 2011; 186:315-9. [PMID: 20858567 DOI: 10.1016/j.psychres.2010.08.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 08/24/2010] [Accepted: 08/26/2010] [Indexed: 11/26/2022]
Abstract
There is agreement in that strengthening the sets of neurobiological data would reinforce the diagnostic objectivity of many psychiatric entities. This article attempts to use this approach in borderline personality disorder (BPD). Assuming that most of the biological findings in BPD reflect common underlying pathophysiological processes we hypothesized that most of the data involved in the findings would be statistically interconnected and interdependent, indicating biological consistency for this diagnosis. Prospectively obtained data on scalp and sleep electroencephalography (EEG), clinical neurologic soft signs, the dexamethasone suppression and thyrotropin-releasing hormone stimulation tests of 20 consecutive BPD patients were used to generate a Bayesian network model, an artificial intelligence paradigm that visually illustrates eventual associations (or inter-dependencies) between otherwise seemingly unrelated variables. The Bayesian network model identified relationships among most of the variables. EEG and TSH were the variables that influence most of the others, especially sleep parameters. Neurological soft signs were linked with EEG, TSH, and sleep parameters. The results suggest the possibility of using objective neurobiological variables to strengthen the validity of future diagnostic criteria and nosological characterization of BPD.
Collapse
|
25
|
Doerr JP, Hirscher V, Riemann D, Voderholzer U. [Disturbances of slow-wave sleep and psychiatric disorders]. DER NERVENARZT 2010; 81:347-54. [PMID: 20012932 DOI: 10.1007/s00115-009-2897-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Slow-wave sleep is defined as sleep stages 3 and 4 that characteristically show slow delta EEG activity during polysomnography. The percentage of slow-wave sleep normally declines with age. Sleep disorders are a common symptom of many psychiatric disorders. In polysomnographic recordings they mostly manifest as disturbances of sleep continuity. In some disorders changes in REM sleep are also found. A reduction of slow-wave sleep has most often been described in patients with depression and addictive disorders. More recent research implicates slow-wave sleep as an important factor in memory consolidation, especially the contents of declarative memory. Psychotropic drugs influence sleep in different ways. Hypnotic substances can reduce the deep sleep stages (e.g. benzodiazepines), whereas 5-HT2C antagonists increase the percentage of slow-wave sleep. Whether a selective impairment/alteration of slow-wave sleep is clinically relevant has not yet been proved.
Collapse
Affiliation(s)
- J P Doerr
- Abteilung für Psychiatrie und Psychotherapie, Universitätsklinikum, Hauptstrasse 5, 79104, Freiburg.
| | | | | | | |
Collapse
|
26
|
Marissen MAE, Meuleman L, Franken IHA. Altered emotional information processing in borderline personality disorder: an electrophysiological study. Psychiatry Res 2010; 181:226-32. [PMID: 20153144 DOI: 10.1016/j.pscychresns.2009.10.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 08/05/2009] [Accepted: 10/16/2009] [Indexed: 10/19/2022]
Abstract
Emotional dysregulation is one of the key symptoms of patients with borderline personality disorder (BPD). In the present study it is hypothesized that borderline patients display a cortical hyper-responsivity to emotional stimuli compared with a healthy control group. Further, we aimed to examine whether BPD patients were able to suppress stimuli with negative emotional valence as well as healthy control participants could. This is the first study addressing the electrophysiological processing of emotional stimuli in BPD. The electrophysiological response to emotional information was studied among 30 BPD patients and compared with the response in 30 normal controls using event-related potentials (ERPs). Participants were shown pictures selected from the International Affective Picture System with neutral, positive, and negative valence. After performing an attentional task, the participants were asked to perform a reappraisal task. The assignment was to consciously suppress emotions that might occur after viewing pictures with an unpleasant content. Borderline patients displayed larger late positive potentials (LPP) to pictures with an unpleasant valence as compared with the control group, indicating an enhanced elaborative processing of unpleasant stimuli. However, they did not differ on the reappraisal task. Borderline patients show an enhanced emotional cortical reactivity to unpleasant stimuli as compared with a control group. This suggests an emotional dysfunctioning in BPD patients. This feature might be an important focus in the treatment of BPD.
Collapse
Affiliation(s)
- Marlies A E Marissen
- Centre for Personality Disorders, PsyQ, The Hague, The Netherlands; Erasmus University Rotterdam, Institute of Psychology, Rotterdam, The Netherlands.
| | | | | |
Collapse
|
27
|
Harty L, Duckworth R, Thompson A, Stuewig J, Tangney JP. Are inmates' subjective sleep problems associated with borderline personality, psychopathy, and antisocial personality independent of depression and substance dependence? THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 2010; 21:23-39. [PMID: 20198127 PMCID: PMC2830015 DOI: 10.1080/14789940903194095] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Previous research investigating the relationship between Borderline Personality Disorder (BPD) and sleep problems, independent of depression, has been conducted on small atypical samples with mixed results. This study extends the literature by utilizing a much larger sample and by statistically controlling for depression and substance dependence. Subjective reports of sleep problems were obtained from 513 jail inmates (70% male) incarcerated on felony charges. Symptoms of BPD were significantly associated with sleep problems even when controlling for depression. Thus, sleep problems associated with BPD cannot be attributed simply to co-morbid symptoms of depression and substance dependence was ruled out as proximal causes for this relationship. Symptoms of depression, but not Antisocial Personality features, were related to sleep problems independent of substance dependence. Treatment of individuals with BPD may be more effective if sleep problems are explicitly addressed in the treatment plan.
Collapse
|
28
|
Plante DT, Zanarini MC, Frankenburg FR, Fitzmaurice GM. Sedative-hypnotic use in patients with borderline personality disorder and axis II comparison subjects. J Pers Disord 2009; 23:563-71. [PMID: 20001175 PMCID: PMC3222941 DOI: 10.1521/pedi.2009.23.6.563] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sleep disturbance is a common, yet poorly understood, phenomenon in borderline personality disorder (BPD). We examined the use of sedative-hypnotic medication in BPD, as part of a larger naturalistic study. In comparison to other personality disorder (OPD) comparison subjects, a significantly higher percentage of BPD subjects than OPD subjects used both as needed (prn) and standing medications to help them sleep. Specifically, over the course of the study, BPD subjects were approximately 4 times more likely to have used prn (OR = 4.27, 95% CI: 2.22-8.22) and standing sleeping medications (OR = 3.81, 95% CI: 1.88-7.72). When adjusted for differences in depression, anxiety, and age among BPD and OPD subjects, BPD subjects were approximately 3 times more likely to have used prn (adjusted OR = 3.38, 95% CI: 1.73-6.61) and standing sleeping medications (adjusted OR = 2.81, 95% CI: 1.33-5.95). These results indicate that sedative-hypnotic use is greater among BPD than OPD subjects. They also confirm clinical observations that subjective sleep disturbance is a significant problem in BPD.
Collapse
Affiliation(s)
- David T. Plante
- Division of Sleep Medicine, Harvard Medicial School, Boston, MA,Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Mary C. Zanarini
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Frances R. Frankenburg
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,Edith Nourse Rogers Memorial Veterans Hospital Bedford, Massachusetts
| | - Garrett M. Fitzmaurice
- Department of Psychiatry, Harvard Medical School, Boston, MA,Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA,Department of Biostatistics, Harvard School of Public Health, Boston, MA
| |
Collapse
|
29
|
Hornung OP, Regen F, Warnstedt C, Anghelescu I, Danker-Hopfe H, Heuser I, Lammers CH. Declarative and procedural memory consolidation during sleep in patients with borderline personality disorder. J Psychiatr Res 2008; 42:653-8. [PMID: 17706671 DOI: 10.1016/j.jpsychires.2007.07.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Revised: 07/05/2007] [Accepted: 07/05/2007] [Indexed: 11/28/2022]
Abstract
Borderline personality disorder (BPD) is characterized by changes in subjective and objective measures of sleep quality. As recent findings point to the importance of sleep in memory consolidation, sleep-related memory consolidation was investigated in 15 female BPD patients (mean age 26.1+/-6.1 years) and 15 female healthy controls (mean age 25.6+/-6.8 years). Before and after the study night, declarative and procedural memory performance was tested by a paired associate list and a mirror tracing task. Subjective sleep quality was assessed by a sleep questionnaire, objective sleep quality was measured by a portable sleep recording device. During the study night the restorative value of sleep was significantly reduced in BPD patients (p<0.001), while objective sleep quality showed a trend for longer REM sleep duration (p=0.054). No significant differences were found regarding overnight performance improvement in the declarative and procedural memory tasks. Present findings suggest that declarative and procedural memory consolidation during sleep is intact in BPD patients.
Collapse
Affiliation(s)
- Orla P Hornung
- Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany.
| | | | | | | | | | | | | |
Collapse
|
30
|
Semiz UB, Basoglu C, Ebrinc S, Cetin M. Nightmare disorder, dream anxiety, and subjective sleep quality in patients with borderline personality disorder. Psychiatry Clin Neurosci 2008; 62:48-55. [PMID: 18289141 DOI: 10.1111/j.1440-1819.2007.01789.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The aims of the present study were to examine the rate of nightmare disorder (ND) and to determine the levels of dream anxiety and subjective sleep quality in patients with borderline personality disorder (BPD). Another aim was to determine whether dream anxiety was associated with childhood trauma, dissociative experiences, and subjective sleep disturbance in BPD patients. Finally, the hypothesis as to whether BPD patients with ND exhibited a more severe clinical profile than those without ND, was also tested. METHODS A total of 88 borderline patients and 100 age- and sex-matched healthy control subjects were assessed using the Structured Clinical Interview for DSM-III-R Personality Disorders, Structured Clinical Interview for DSM-IV Axis I Disorders, Van Dream Anxiety Scale, Pittsburgh Sleep Quality Index, Dissociative Experiences Scale, and Traumatic Experiences Checklist. Subjects with codiagnoses that could affect sleep were not included. RESULTS BPD patients suffered a significantly greater rate of nightmares, elevated levels of dream anxiety, and disturbed sleep quality than did controls. In the borderline group, heightened dream anxiety was correlated with higher rates of early traumatic experiences and dissociative symptoms, and impaired sleep quality. Furthermore, borderline patients with ND exhibited greater psychopathology as compared to those without ND in terms of several clinical characteristics. CONCLUSIONS The present study provides support for a strong association between BPD, distressing nightmares, and subjective sleep quality. Recognition and management of dream and sleep disturbances in BPD patients might lead to improvements in their global clinical picture.
Collapse
Affiliation(s)
- Umit B Semiz
- GATA Haydarpasa Training Hospital, Department of Psychiatry, Istanbul, Turkey.
| | | | | | | |
Collapse
|
31
|
Clark LA. Temperament as a unifying basis for personality and psychopathology. JOURNAL OF ABNORMAL PSYCHOLOGY 2006; 114:505-21. [PMID: 16351374 DOI: 10.1037/0021-843x.114.4.505] [Citation(s) in RCA: 374] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Personality and psychopathology long have been viewed as related domains, but the precise nature of their relations remains unclear. Through most of the 20th century, they were studied as separate fields; within psychopathology, clinical syndromes were separated from personality disorders in 1980. This division led to the revelation of substantial overlap among disorders both within and across axes and to the joint study of normal and abnormal personality. The author reviews these literatures and proposes an integrative framework to explain personality-psychopathology relations: Three broad, innate temperament dimensions--negative affectivity, positive affectivity, and disinhibition--differentiate through both biologically and environmentally based developmental processes into a hierarchical personality trait structure and, at their extremes, are risk factors (diatheses) for psychopathology, especially given adverse life experiences (stress).
Collapse
Affiliation(s)
- Lee Anna Clark
- Department of Psychology, University of Iowa, Iowa City, IA 52242-1316, USA.
| |
Collapse
|
32
|
Abstract
Macrostructure describes the temporal organization of sleep based on successive epochs of conventional length, while microstructure, which is analyzed on the basis of the scoring of phasic events, provides additional important dynamic characteristics in the evaluation of both normal and pathological sleep processes. Relationships between sleep, sleep disorders, and psychiatric disorders are quite complex, and it clearly appears that both the macrostructure and the microstructure of sleep are valuable physiologically and clinically. Psychiatric patients often complain about their sleep, and they may show sleep abnormalities that increase with the severity of their illness. Changes in the occurrence and frequency of phasic events during sleep may be associated with specific psychiatric disorders, and may provide valuable information for both diagnosis and prognosis of these disorders.
Collapse
Affiliation(s)
- Alain Muzet
- Centre National de la Recherche Scientifique, CNRS-CEPA, Strasbourg, France.
| |
Collapse
|
33
|
Abstract
Objective. To study the frequency, socio-demography and comorbidity of ICD-10 personality disorders (PD), especially of emotionally unstable PD, in psychiatric inpatients. To test the subdivision of emotionally unstable PD in impulsive and borderline subtypes. Methods. Data on all psychiatric hospital stays in the Canton of Zurich in the years 1998-2002, routinely collected at the time of each patient's hospitalization, were analysed. Results. PD was diagnosed in 10.2% of all inpatients, and the proportion of emotionally unstable PD diagnosis was 54.5%. There are considerable differences between impulsive and borderline personality disorders with respect to sex, age, employment status and comorbidity. Conclusion. Emotionally unstable PD is the most frequent PD in clinical settings. Its differentiation into impulsive and borderline subtypes is justified.
Collapse
Affiliation(s)
- Jiri Modestin
- Department of Psychiatry, Burghölzli Hospital, University of Zurich, Switzerland
| | | | | |
Collapse
|
34
|
De la Fuente JM, Bobes J, Morlán I, Bascarán MT, Vizuete C, Linkowski P, Mendlewicz J. Is the biological nature of depressive symptoms in borderline patients without concomitant Axis I pathology idiosyncratic? Sleep EEG comparison with recurrent brief, major depression and control subjects. Psychiatry Res 2004; 129:65-73. [PMID: 15572186 DOI: 10.1016/j.psychres.2004.05.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2003] [Revised: 01/19/2004] [Accepted: 05/17/2004] [Indexed: 10/26/2022]
Abstract
The relationship between borderline personality disorder (BPD) and the affective disorders is controversial, and we have previously compared BPD and major depression (MD) with endocrinological measures and sleep electroencephalography (S-EEG). We have also compared BPD, MD and recurrent brief depression (RBD) using endocrine tests. We have proposed that depressive symptoms in BPD might have a biological substrate that is distinct from those in depressive illness without comorbid BPD. BPD has been proposed to overlap with RBD, which has been found to share perturbed biological substrates with MD, but we have not found the same biological pattern in BPD. When endocrinological data in BPD, MD and RBD were compared, we did not find evidence of biological linkage between BPD and RBD. To clarify the biological nature of depressive symptoms in BPD, we examined S-EEG characteristics in BPD, RBD, MD and controls. Among 20 BPD patients, 12 were also diagnosed as having clinical RBD. BPD patients showed differences in sleep continuity and especially in sleep architecture compared with RBD, MD and controls. BPD with or without clinical RBD did not show significant differences in any parameter. BPD with or without clinical RBD had less slow sleep activity not only than MD but also than non-borderline RBD patients. We propose that although BPD patients can have concomitant MD, they often exhibit a specific BPD-associated affective syndrome that is different from both MD and non-borderline RBD in the quality and duration of symptoms and the biological substrate.
Collapse
Affiliation(s)
- José Manuel De la Fuente
- Department of Psychiatry, Erasme Hospital, Free University of Brussels, 808 route de Lennik, B-1070 Brussels, Belgium.
| | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
Research into the relationship between depression and personality disorder is compromised by a number of methodologic factors, including differing concepts of personality disorder, the validity of a personality disorder diagnosis, the effect of mood on diagnosis, and the overlap between some personality disorder symptoms and mood symptoms. Personality pathology is common in patients with personality disorder. Reasons for this include a "scar" effect of chronic low mood on attitudes and behaviors, as well as possible risk factors via certain personality traits. The negative effect of comorbid personality disorder on treatment outcome in depressed patients may be less than previously believed. Possible reasons include treatment bias in non-controlled trials and the increasing use of selective serotonin reuptake inhibitors rather than tricyclic antidepressants. Many personality traits and disorders may be part of the psychopathology of depression and share a common origin.
Collapse
Affiliation(s)
- Roger T Mulder
- Department of Psychological Medicine, Christchurch School of Medicine, PO Box 4345, Christchurch, New Zealand.
| |
Collapse
|