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Bernstein EE, Klare D, Weingarden H, Greenberg JL, Snorrason I, Hoeppner SS, Vanderkruik R, Harrison O, Wilhelm S. Impact of sleep disruption on BDD symptoms and treatment response. J Affect Disord 2024; 346:206-213. [PMID: 37952909 PMCID: PMC10842714 DOI: 10.1016/j.jad.2023.11.028] [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: 01/23/2023] [Revised: 08/08/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is severe, undertreated, and relatively common. Although gold-standard cognitive behavioral therapy (CBT) for BDD has strong empirical support, a significant number of patients do not respond. More work is needed to understand BDD's etiology and modifiable barriers to treatment response. Given its high prevalence and impact on the development, maintenance, and treatment of related, frequently comorbid disorders, sleep disruption is a compelling, but not-yet studied factor. METHODS Data were drawn from a randomized controlled trial of guided smartphone app-based CBT for BDD. Included participants were offered 12-weeks of treatment, immediately (n = 40) or after a 12-week waitlist (n = 37). Sleep disruption and BDD symptom severity were assessed at baseline, week-6, and week-12. RESULTS Hypotheses and analysis plan were pre-registered. Two-thirds of patients reported significant insomnia symptoms at baseline. Baseline severity of sleep disruption and BDD symptoms were not related (r = 0.02). Pre-treatment sleep disruption did not predict BDD symptom reduction across treatment, nor did early sleep improvements predict greater BDD symptom improvement. Early BDD symptom improvement also did not predict later improvements in sleep. LIMITATIONS Limitations include the small sample, restricted ranges of BDD symptom severity and treatment response, and few metrics of sleep disruption. CONCLUSIONS Although insomnia was disproportionately high in this sample and both BDD symptoms and sleep improved in treatment, results suggest sleep and BDD symptoms may function largely independent of one another. More work is encouraged to replicate and better understand findings as well as potential challenges and benefits of addressing sleep in BDD.
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Affiliation(s)
- Emily E Bernstein
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America.
| | - Dalton Klare
- Massachusetts General Hospital, United States of America
| | - Hilary Weingarden
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | - Jennifer L Greenberg
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | - Ivar Snorrason
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | - Susanne S Hoeppner
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | - Rachel Vanderkruik
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | | | - Sabine Wilhelm
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
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Naftalovich H, Anholt GE, Keren R, Ben Arush O, Kalanthroff E. Waxing and waning: The roles of chronotype and time of day in predicting symptom fluctuations in obsessive-compulsive disorder using a daily-monitoring design. J Psychiatr Res 2021; 143:91-97. [PMID: 34461354 DOI: 10.1016/j.jpsychires.2021.08.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/23/2021] [Accepted: 08/19/2021] [Indexed: 02/01/2023]
Abstract
Obsessive-compulsive disorder (OCD) symptoms fluctuate throughout the day, but scientists are not sure what underlies these fluctuations. One factor which may explain how OCD symptoms wax and wane throughout the day is alertness. Increased alertness is associated with greater inhibitory control, a factor which plays a significant role in patients' ability to overcome their OCD symptoms. The current study examined the relationship between chronotype (morningness/eveningness preference, a measure of alertness) and within-day OCD symptom severity fluctuations. We hypothesized that increased alertness leads to better inhibitory abilities and, therefore, reduced OCD symptoms. OCD Symptoms were measured through 7-days of monitoring in which participants were asked to retrospectively rate their symptoms at several timepoints throughout the day. Chronotype was measured using the Morningness/Eveningness Questionnaire (MEQ). Consistent with our hypotheses, results revealed an interaction between chronotype and time of day, such that those with an eveningness preference tended to have worse symptoms in the morning, and vice versa. In addition, we also report novel findings regarding the effect of bedtime, sleep duration, and sleep quality on symptom severity the next day. Taken together, these findings suggest that alertness may modulate OCD symptom severity throughout the day such that individuals experience more severe symptoms during times of low alertness. The clinical and theoretical implications of these findings are discussed.
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Affiliation(s)
- Hadar Naftalovich
- Department of Psychology, The Hebrew University of Jerusalem, Israel.
| | - Gideon E Anholt
- Department of Psychology, Ben-Gurion University of the Negev, Israel
| | - Rotem Keren
- Functional Neurosurgery Department, Tel-Aviv Sourasky Medical Center, Israel
| | - Oded Ben Arush
- The Obsessive and Compulsive Related Disorders Center, Modi'in, Israel
| | - Eyal Kalanthroff
- Department of Psychology, The Hebrew University of Jerusalem, Israel
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Delayed Sleep Timing in Obsessive-Compulsive Disorder Is Associated With Diminished Response to Exposure and Ritual Prevention. Behav Ther 2021; 52:1277-1285. [PMID: 34452679 DOI: 10.1016/j.beth.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 12/12/2022]
Abstract
Exposure and ritual prevention (ERP) and pharmacotherapy are typically associated with significant symptom reductions for individuals with obsessive-compulsive disorder (OCD). However, many patients are left with residual symptoms and other patients do not respond. There is increasing evidence that delays in sleep timing/circadian rhythms are associated with OCD but the potential effects of delays in sleep timing on ERP warrant attention. This paper presents data from 31 outpatients with OCD who participated in ERP. Results showed that delayed sleep timing was common and that individuals with delayed bedtimes benefited significantly less from treatment and were significantly more likely to be nonresponders compared to individuals with earlier bedtimes. Further, the effects of sleep timing remained statistically significant even after controlling for global sleep quality, negative affect, and several other variables. These findings add to a growing literature suggesting the utility of better understanding the role of disruptions in the timing of sleep in OCD.
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Examining subjective sleep quality in adults with hoarding disorder. J Psychiatr Res 2021; 137:597-602. [PMID: 33309063 PMCID: PMC8091966 DOI: 10.1016/j.jpsychires.2020.10.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/24/2020] [Accepted: 10/28/2020] [Indexed: 02/07/2023]
Abstract
Hoarding disorder (HD), characterized by difficulty parting with possessions and functionally impairing clutter, affects 2-6% of the population. Originally considered part of Obsessive-Compulsive Disorder (OCD), HD became a distinct diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. While sleep impacts OCD, little is known about sleep in HD. As HD patients often report poor sleep in clinical settings, understanding global subjective sleep quality and disturbances may lead to novel therapeutic targets. To address this gap, the authors used a sample of convenience: an existing data set designed to screen research study eligibility and explore the psychopathology and phenomenology of OCD and HD. The data set included information collected from individuals with HD (n = 38), OCD (n = 26), and healthy participants (n = 22) about insomnia, sleep quality, and mood using interviews and structured instruments including the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Depression Anxiety Stress Scales (DASS). In this data set, HD and OCD groups reported significantly greater insomnia symptoms and poorer sleep quality compared with healthy controls while controlling for depression, age, and gender. A sizable minority of HD and OCD individuals met criteria for comorbid sleep disorders. OCD and HD groups differed in delayed sleep phase prevalence. To our knowledge, this is the first study examining subjective sleep quality and insomnia in HD as compared to healthy individuals and those with OCD, while controlling for relevant clinical characteristics. Given that there are evidence-based treatments for insomnia and other sleep disorders, our study raises the possibility that treatment interventions targeting sleep may improve HD outcomes.
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Segalàs C, Labad J, Salvat-Pujol N, Real E, Alonso P, Bertolín S, Jiménez-Murcia S, Soriano-Mas C, Monasterio C, Menchón JM, Soria V. Sleep disturbances in obsessive-compulsive disorder: influence of depression symptoms and trait anxiety. BMC Psychiatry 2021; 21:42. [PMID: 33446149 PMCID: PMC7809865 DOI: 10.1186/s12888-021-03038-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/28/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Sleep disturbances have been reported in obsessive-compulsive disorder (OCD) patients, with heterogeneous results. The aim of our study was to assess sleep function in OCD and to investigate the relationship between sleep and the severity of obsessive-compulsive (OC) symptoms, depressive symptoms and trait anxiety. METHODS Sleep quality was measured in 61 OCD patients and 100 healthy controls (HCs) using the Pittsburgh Sleep Quality Index (PSQI). Multiple linear regression was conducted to explore the association between sleep and psychopathological measures; a mediation analysis was also performed. RESULTS OCD patients showed poor sleep quality and more sleep disturbances compared to HCs. The severity of depression, trait anxiety and OC symptomatology were correlated with poor sleep quality. Multiple linear regression analyses controlling for potential confounders revealed that the severity of depression and trait anxiety were independently related to poor sleep quality in OCD. A mediation analysis showed that both the severity of trait anxiety and depression mediate the relationship between the severity of OC symptoms and poor sleep quality among patients with OCD. CONCLUSIONS Our findings support the existence of sleep disturbances in OCD. Trait anxiety and depression play a key role in sleep quality among OCD patients.
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Affiliation(s)
- Cinto Segalàs
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.469673.90000 0004 5901 7501Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Javier Labad
- grid.469673.90000 0004 5901 7501Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain ,Department of Mental Health, Consorci Sanitari del Maresme. Institut d’Investigació i Innovació Parc Taulí(I3PT), Barcelona, Spain
| | - Neus Salvat-Pujol
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.469673.90000 0004 5901 7501Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain ,Department of Mental Health, Consorci Sanitari del Maresme. Institut d’Investigació i Innovació Parc Taulí(I3PT), Barcelona, Spain
| | - Eva Real
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.469673.90000 0004 5901 7501Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain
| | - Pino Alonso
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.469673.90000 0004 5901 7501Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Sara Bertolín
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Susana Jiménez-Murcia
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Fisiopatología Obesidad y Nutrición (CIBEROBN), Carlos III Health Institute, Madrid, Spain
| | - Carles Soriano-Mas
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.469673.90000 0004 5901 7501Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain ,grid.7080.fDepartment of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Carmen Monasterio
- grid.417656.7Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Section of Respiratory Medicine, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Carlos III Health Institute, Madrid, Spain
| | - José M. Menchón
- grid.411129.e0000 0000 8836 0780Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L’Hospitalet de Llobregat, Barcelona, Spain ,grid.469673.90000 0004 5901 7501Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain ,grid.5841.80000 0004 1937 0247Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Virginia Soria
- Department of Psychiatry, Bellvitge University Hospital. Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health, Feixa Llarga s/n. 08907, L'Hospitalet de Llobregat, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain. .,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain.
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Kaczkurkin AN, Tyler J, Turk-Karan E, Belli G, Asnaani A. The Association between Insomnia and Anxiety Symptoms in a Naturalistic Anxiety Treatment Setting. Behav Sleep Med 2021; 19:110-125. [PMID: 31955594 PMCID: PMC7369215 DOI: 10.1080/15402002.2020.1714624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective/Background: Few studies have examined the relationship between insomnia and anxiety treatment outcomes in naturalistic settings. Furthermore, prior studies typically examine insomnia within a single anxiety diagnosis without accounting for the high overlap between disorders. Here we investigate the association between insomnia and multiple anxiety disorders over a course of cognitive behavioral treatment (CBT) in a naturalistic treatment setting. Participants: Insomnia was assessed in 326 patients seeking treatment at a clinic specializing in CBT for anxiety. Methods: Multilevel modeling was used to investigate whether insomnia moderated reductions in anxiety symptoms. A cross-lagged analysis tested for bidirectional effects between insomnia and anxiety. Multiple regression was used to investigate the relationship between insomnia and anxiety while controlling for the other anxiety disorders and depression. Results: While there was a significant reduction in insomnia during treatment in all anxiety disorders, the majority of the most severe patients remained in the clinical range at post-treatment. Baseline insomnia did not significantly moderate anxiety outcomes, suggesting that patients with high or low levels of insomnia will do equally well in CBT for anxiety. The bidirectional effect between insomnia and anxiety did not reach significance. Additionally, posttraumatic stress disorder, generalized anxiety disorder, and panic disorder were associated with the greatest endorsement of insomnia, after controlling for the overlap between disorders. Conclusions: Sleep problems may persist after anxiety treatment, suggesting that CBT for insomnia may be warranted during or after a course of CBT for anxiety. Importantly, baseline insomnia does not impede anxiety reduction during CBT.
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Affiliation(s)
| | - Jeremy Tyler
- University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, Philadelphia, PA, USA 19104
| | - Elizabeth Turk-Karan
- University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, Philadelphia, PA, USA 19104
| | - Gina Belli
- University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, Philadelphia, PA, USA 19104
| | - Anu Asnaani
- University of Utah, Department of Psychology, Salt Lake City, UT 84112
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Nota JA, Potluri S, Kelley KN, Elias JA, Krompinger JW. Delayed Bedtimes Are Associated With More Severe Obsessive-Compulsive Symptoms in Intensive Residential Treatment. Behav Ther 2020; 51:559-571. [PMID: 32586430 DOI: 10.1016/j.beth.2019.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 12/27/2022]
Abstract
Delays in behavioral and biological circadian rhythms (e.g., sleep timing, melatonin secretion) are found more frequently in individuals with severe and treatment-resistant obsessive-compulsive disorder (OCD). In recent years, it has been documented that these delays in behavioral and biological circadian rhythms are associated with more severe OCD symptoms and poorer response to some OCD treatments. This study examined self-reported sleep behaviors in individuals taking part in an intensive treatment for OCD and the relations between these and OCD symptoms (both at admission to and discharge from the treatment program). Replicating previous findings in less severe populations, delayed sleep phases were relatively common in this group and later bedtimes were associated with more severe OCD symptoms at admission. Sleep onset latency and sleep duration were not associated with OCD symptom severity at admission. Later bedtimes were not associated with self-reported depression or worry symptom severity. There was no evidence of sleep behaviors affecting change in OCD symptoms from admission to discharge from treatment-however, later bedtimes at admission were associated with more severe OCD symptoms at admission and discharge from treatment. There was no evidence of sleep onset latency or sleep duration having a similar predictive effect. More severe OCD symptoms at admission were also associated with later bedtimes at admission and discharge from treatment. These bidirectional predictive relations between late bedtimes and OCD symptoms were of small effect size but support the potential value of evaluating sleep timing in individuals with severe and/or treatment-resistant OCD.
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8
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Schubert JR, Stewart E, Coles ME. Later Bedtimes Predict Prospective Increases in Symptom Severity in Individuals with Obsessive Compulsive Disorder (OCD): An Initial Study. Behav Sleep Med 2020; 18:500-512. [PMID: 31151357 DOI: 10.1080/15402002.2019.1615490] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Prior studies of sleep in individuals with OCD have often focused on sleep duration. Several studies have found that individuals with OCD sleep less than healthy controls while others have failed to find significant group differences. Addressing sleep timing has been much more rare, but have consistently shown that many individuals with severe OCD in inpatient facilities had markedly elevated rates of disruptions in sleep timing. We extend prior work by testing prospective relations between sleep and OC symptoms in individuals representing a range of OC symptom severity. Twenty-six individuals diagnosed with OCD, 18 healthy controls, and 10 with subthreshold OC symptoms, completed seven days of sleep diaries and OCD symptom ratings. Results showed that sleep timing (later bedtimes) predicted prospective increases in both obsessions and compulsions in individuals with OCD but not the other two groups. In contrast, there were no significant effects of sleep duration. The significant effects of sleep timing in the OCD group were maintained controlling for depressive symptoms and OCD symptoms did not predict prospective changes in sleep timing. In conclusion, there is increasing evidence that sleep timing may play an important role in OCD and additional work in this area is encouraged.
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Affiliation(s)
- Jessica R Schubert
- Veteran's Affairs Ann Arbor Healthcare System , Ann Arbor, Michigan.,University of Michigan Medical School , Ann Arbor, Michigan
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Sleep duration and timing in obsessive-compulsive disorder (OCD): evidence for circadian phase delay. Sleep Med 2020; 72:111-117. [PMID: 32575000 DOI: 10.1016/j.sleep.2020.03.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/04/2020] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate potential delays in endogenous melatonin in individuals with obsessive-compulsive disorder (OCD). METHODS First, data are presented for 15 individuals with OCD and matched healthy controls. Next, nine additional participants with OCD who did not have matched controls were added, resulting in a sample of 24 individuals with OCD. All participants were assessed for sleep and circadian rhythm disturbance. Dim light melatonin onset (DLMO) was derived from salivary melatonin and was used in conjunction with sleep diaries, interview measures, and questionnaires. A subset of the OCD group (n = 16) also used actigraphy. RESULTS In sum, 42% percent (10/24) of the patients with OCD met the criteria for delayed sleep-wake phase disorder (DSWPD) in comparison to 0% in the control sample. DLMO was significantly later in individuals with OCD compared to controls. DLMO and bedtime were not significantly associated with the severity of obsessive-compulsive symptoms or negative affect. CONCLUSIONS Replication of the findings presented herein, particularly the DLMO results, is warranted. Further, there are now three studies showing that nearly ½ of individuals with OCD meet criteria for a DSWPD. Future studies can explore the mechanisms underlying these connections and the implications of this comorbidity. These findings may increase our understanding of OCD and inform future interventions.
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10
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Richards A, Kanady JC, Neylan TC. Sleep disturbance in PTSD and other anxiety-related disorders: an updated review of clinical features, physiological characteristics, and psychological and neurobiological mechanisms. Neuropsychopharmacology 2020; 45:55-73. [PMID: 31443103 PMCID: PMC6879567 DOI: 10.1038/s41386-019-0486-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 02/08/2023]
Abstract
The current report provides an updated review of sleep disturbance in posttraumatic stress disorder and anxiety-related disorders. First, this review provides a summary description of the unique and overlapping clinical characteristics and physiological features of sleep disturbance in specific DSM anxiety-related disorders. Second, this review presents evidence of a bidirectional relationship between sleep disturbance and anxiety-related disorders, and provides a model to explain this relationship by integrating research on psychological and neurocognitive processes with a current understanding of neurobiological pathways. A heuristic neurobiological framework for understanding the bidirectional relationship between abnormalities in sleep and anxiety-related brain pathways is presented. Directions for future research are suggested.
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Affiliation(s)
- Anne Richards
- The San Francisco VA Health Care System, San Francisco, CA, USA.
- The University of California, San Francisco, San Francisco, CA, USA.
| | - Jennifer C Kanady
- The San Francisco VA Health Care System, San Francisco, CA, USA
- The University of California, San Francisco, San Francisco, CA, USA
| | - Thomas C Neylan
- The San Francisco VA Health Care System, San Francisco, CA, USA
- The University of California, San Francisco, San Francisco, CA, USA
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11
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Coles ME, Goodman MH. A systematic review of case studies testing a melatonergic agonist/ 5HT 2c antagonist for individuals with obsessive compulsive disorder. J Anxiety Disord 2020; 69:102173. [PMID: 31877423 DOI: 10.1016/j.janxdis.2019.102173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/02/2019] [Accepted: 12/08/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Treatments for Obsessive-Compulsive Disorder (OCD) have greatly improved over time. However, some patients do not respond to current interventions and many are left with residual symptoms even if they are 'responders'. There is increasing evidence that individuals with OCD frequently report delayed bedtimes and are at elevated risk for Delayed Sleep Phase Disorder (DSPD). Therefore, it is logical to ask whether interventions addressing disruptions in sleep timing and circadian rhythms would lead to reductions in OCD symptoms. A prior study from our group showed that behaviorally shifting sleep timing resulted in significant symptom reduction in a treatment resistant OCD patient. OBJECTIVES Extending prior findings, this manuscript presents quantitative data from case studies which tested the use of a pharmacological intervention that targets melatonin receptors. Specifically, the case studies reviewed herein utilized the melatonin analog and melatonergic MT1 and MT2 receptor agonist, Agomelatine. METHODS A literature review revealed 10 cases which have used Agomelatine for OCD. RESULTS Seven of the cases were reported to have sleep and/or circadian disruptions prior to treatment. These cases OCD symptom reductions between 46%-90%. In contrast, three additional cases without pre-treatment sleep and/or circadian disruptions did not respond to the intervention. DISCUSSION There is growing evidence that disruptions in sleep and circadian rhythms may contribute to the maintenance of OCD. Further work is warranted.
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Affiliation(s)
- Meredith E Coles
- Department of Psychology, State University of New York Binghamton, Binghamton, NY, United States.
| | - Matthew H Goodman
- Department of Psychology, State University of New York Binghamton, Binghamton, NY, United States
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12
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Role of sleep deprivation in the causation of postpartum obsessive-compulsive disorder. Med Hypotheses 2019; 122:58-61. [DOI: 10.1016/j.mehy.2018.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/15/2018] [Accepted: 10/20/2018] [Indexed: 12/19/2022]
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Abstract
The primary aim of this study was to evaluate activity rhythms in fibromyalgia syndrome (FMS) and their association with FMS-related symptoms. We hypothesized that stronger and more consistent activity rhythms would be associated with reduced symptom severity and presentation in FMS. Two hundred ninety-two patients with FMS (mean age = 45.1 ± 11.1; 272 women) provided a 7-day actigraphy recording and responses to questionnaires addressing degree of pain, fatigue, mood, and physical impairment. Using a simple cosine model, we extracted Amplitude (activity range), Phi (time at maximum), Mesor (mean activity), and their variabilities (across days) from each participant's actigraphy. The clinical and actigraphic measures were operationally independent. There was a significant canonical relationship between activity rhythm parameters and clinical FMS measures (r = 0.376, R = 0.14, P < 0.001). The set of Mesor, Amplitude, and Phi activity parameters remained associated with clinical measures when controlled statistically for both demographics and activity variability (P < 0.001). Each activity parameter provided unique discrimination of the clinical set by multivariate test (P = 0.003, 0.018, and 0.007 for Amplitude, Phi, and Mesor, respectively). These results revealed that better pain, fatigue, mood, physical impairment, and sleep outcomes were associated with higher activity range and more rhythmicity (Amplitude), increased mean activity (Mesor), and with earlier timing of peak activity (Phi). Exploratory analyses revealed significantly worse sleep for individuals with low Amplitude and more delayed Phi.
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Simor P, Harsányi A, Csigó K, Miklós G, Lázár AS, Demeter G. Eveningness is associated with poor sleep quality and negative affect in obsessive-compulsive disorder. J Behav Addict 2018; 7:10-20. [PMID: 29415552 PMCID: PMC6035014 DOI: 10.1556/2006.7.2018.07] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/18/2018] [Accepted: 01/21/2018] [Indexed: 11/19/2022] Open
Abstract
Background Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts and repetitive behaviors that severely encumber daily functioning. OCD patients seem to exhibit sleep disturbances, especially delayed bedtimes that reflect disrupted circadian rhythmicity. Morningness-eveningness is a fundamental factor reflecting individual variations in diurnal preferences related to sleep and waking activities. Eveningness reflecting a delayed sleep-wake timing has repeatedly been associated with sleep problems and negative affect (NA). Therefore, the aim of this study was to examine the associations between morningness-eveningness, sleep complaints, and symptom severity in OCD patients and compared with a mixed psychiatric control group. Materials and methods The data of 49 OCD and 49 mixed psychiatric inpatients (with unipolar depression and anxiety disorders) were analyzed. Patients completed questionnaires regarding morningness-eveningness, sleep quality, nightmare frequency, depression, anxiety, and affective states. Obsessive and compulsive symptom severity was also assessed within the OCD group by clinician-rated scales. Results Eveningness preference was associated with impaired sleep quality and higher NA in OCD patients. In addition, impaired sleep quality showed a moderate correlation with anxiety and strong correlations with depressive symptoms and NA. Interestingly, in the mixed psychiatric group, eveningness was not linked to NA, and sleep quality also showed weaker associations with depressive symptoms and NA. Within the OCD group, eveningness preference was predictive of poorer sleep quality regardless the influence of depressive symptoms. Conclusion Our findings suggest that eveningness and sleep complaints are predictive of affective dysfunctions, and should be carefully considered in the evaluation and treatment of OCD patients.
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Affiliation(s)
- Péter Simor
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Nyírő Gyula Hospital, National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - András Harsányi
- Nyírő Gyula Hospital, National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Kata Csigó
- Nyírő Gyula Hospital, National Institute of Psychiatry and Addictions, Budapest, Hungary
| | | | - Alpár Sándor Lázár
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Gyula Demeter
- Department of Cognitive Sciences, Budapest University of Technology and Economics, Budapest, Hungary
- Rehabilitation Department of Brain Injuries, National Institute of Medical Rehabilitation, Budapest, Hungary
- Learning and Memory Disorders Research Group, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
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Sakalli Kani A, Aksoy Poyraz C, Poyraz BC, Bayar MR, Akin E, Kose S. The role of affective temperaments and chronotype in pharmacotherapy response in patients with obsessive-compulsive disorder. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1391157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Ayse Sakalli Kani
- Department of Psychiatry, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Cana Aksoy Poyraz
- Department of Psychiatry, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - B. Cağrı Poyraz
- Department of Psychiatry, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - M. Reha Bayar
- Department of Psychiatry, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Ercan Akin
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Samet Kose
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
- Department of Psychiatry, University of Texas Medical School of Houston, Houston, TX, USA
- Center for Neurobehavioral Research on Addictions, Houston, TX, USA
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Dohrmann AL, Stengler K, Jahn I, Olbrich S. EEG-arousal regulation as predictor of treatment response in patients suffering from obsessive compulsive disorder. Clin Neurophysiol 2017; 128:1906-1914. [PMID: 28826021 DOI: 10.1016/j.clinph.2017.07.406] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/09/2017] [Accepted: 07/15/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Aim of this study was to analyze whether electroencephalogram (EEG)-based CNS-arousal markers differ for patients suffering from obsessive compulsive disorder (OCD) that either respond or do not respond to cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs) or their combination. Further the study aimed to identify specific response-predictors for the different therapy approaches. METHODS CNS-arousal from 51 unmedicated patients during fifteen-minute resting state was assessed using VIGALL (Vigilance Algorithm Leipzig). Clinical Global Impression (CGI) scores were used to assess response or non-response after three to six months following therapy (CBT, n=18; SSRI, n=11 or combination, n=22). Differences between Responders (R) and Non-Responders (NR) were identified using multivariate analysis of covariance (MANCOVA) models. RESULTS MANCOVA revealed that Responders spent significant less time at the highest CNS-arousal stage 0. Further, low amounts of the highest CNS-arousal stages were specifically predictive for a response to a combined treatment approach. CONCLUSIONS The fact that CNS-arousal markers allowed discrimination between Responders and Non-Responders and also between Responders of different treatment arms underlines a possible clinical value of EEG-based markers. SIGNIFICANCE These results encourage further research on EEG-arousal regulation for determining pathophysiological subgroups for treatment response.
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Affiliation(s)
- Anna-Lena Dohrmann
- Department for Psychiatry and Psychotherapy, University Leipzig, Germany.
| | - Katarina Stengler
- Department for Psychiatry and Psychotherapy, University Leipzig, Germany
| | - Ina Jahn
- Department for Psychiatry and Psychotherapy, University Leipzig, Germany
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17
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Donse L, Sack AT, Fitzgerald PB, Arns M. Sleep disturbances in obsessive-compulsive disorder: Association with non-response to repetitive transcranial magnetic stimulation (rTMS). J Anxiety Disord 2017; 49:31-39. [PMID: 28388457 DOI: 10.1016/j.janxdis.2017.03.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 03/14/2017] [Accepted: 03/29/2017] [Indexed: 01/22/2023]
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) is a promising augmentation strategy for treatment-refractory OCD. However, a substantial group still fails to respond. Sleep disorders, e.g. circadian rhythm sleep disorders (CRSD), are highly prevalent in OCD and might mediate treatment response. The aims of the current study were to compare sleep disturbances between OCD patients and healthy subjects as well as between rTMS responders and non-responders, and most importantly to determine sleep-related predictors of rTMS non-response. Methods 22 OCD patients received at least 10 sessions rTMS combined with psychotherapy. Sleep disturbances were measured using questionnaires and actigraphy. Sleep in patients was compared to healthy subjects. Treatment response was defined as >35% reduction on YBOCS. Treatment response prediction models were based on measures of CRSD and insomnia. Results Sleep disturbances were more prevalent in OCD patients than healthy subjects. The OCD group consisted of 12 responders and 10 non-responders. The CRSD model could accurately predict non-response with 83% sensitivity and 63% specificity, whereas the insomnia model could not. Conclusions CRSD is more prevalent in OCD patients than healthy subjects, specifically in rTMS non-responders. Therefore, CRSD may serve as a biomarker for different subtypes of OCD corresponding with response to specific treatment approaches.
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Affiliation(s)
- Lana Donse
- Research Institute Brainclinics, Nijmegen, The Netherlands; Dept of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Alexander T Sack
- Dept of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands; Maastricht Brain Imaging Center, Maastricht, The Netherlands
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, the Alfred and Monash University, Central Clinical School, Victoria, Australia
| | - Martijn Arns
- Research Institute Brainclinics, Nijmegen, The Netherlands; Dept of Experimental Psychology, Utrecht University, Utrecht, The Netherlands; neuroCare Group, Munich, Germany.
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Nota JA, Schubert JR, Coles ME. Sleep disruption is related to poor response inhibition in individuals with obsessive-compulsive and repetitive negative thought symptoms. J Behav Ther Exp Psychiatry 2016; 50:23-32. [PMID: 25989071 DOI: 10.1016/j.jbtep.2015.04.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/22/2015] [Accepted: 04/25/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Obsessive-compulsive (OC) symptoms and repetitive negative thinking (RNT) are associated with poor inhibitory control. Sleep disruptions may partially mediate these relations and/or act as a "second hit" to individuals with OC symptoms and RNT. Models including habitual (past month) hours slept and bedtimes were tested. METHODS We employed a go/no-go task that allowed us to examine the relation between sleep and inhibition with various task contingencies. Sixty-seven unselected individuals were recruited from the participant pool at a public university. RESULTS Bias-corrected bootstrap estimates did not show that sleep disruption mediated the relation between OC symptoms and response inhibition nor the relation between RNT and response inhibition. Multiple linear regression analyses found significant interactions between hours slept and OC symptom severity and between RNT and hours slept to predict poor response inhibition. Hours slept significantly negatively predicted commission errors when OC symptoms and RNT levels were relatively heightened but not when OC symptoms and RNT levels were relatively low. These effects were present in blocks where task contingencies were designed to shape a no-go bias. No significant relations were found with habitual bedtimes. LIMITATIONS The cross-sectional study design precludes testing the temporal precedence of symptoms in the "second hit" model. The unselected sample also limits generalization to clinical samples. CONCLUSIONS These findings support a "second hit" model of interaction between sleep disruption and perseverative thoughts and behaviors. Further research on the mechanisms of the relation between sleep disruption and perseverative thought symptoms (OC and RNT) is warranted.
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Affiliation(s)
- Jacob A Nota
- Binghamton University, Department of Psychology, USA.
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19
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Cox RC, Olatunji BO. A systematic review of sleep disturbance in anxiety and related disorders. J Anxiety Disord 2016; 37:104-29. [PMID: 26745517 DOI: 10.1016/j.janxdis.2015.12.001] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/20/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
Recent research suggests that sleep disturbance may be a transdiagnostic process, and there is increasing interest in examining how sleep disturbance may contribute to anxiety and related disorders. The current review summarizes and synthesizes the extant research assessing sleep in anxiety and related disorders. The findings suggest that sleep disturbance exacerbates symptom severity in the majority of anxiety and related disorders. However, the nature of sleep disturbance often varies as a function of objective versus subjective assessment. Although sleep disturbance is a correlate of most anxiety and related disorders, a causal role for sleep disturbance is less clear. A model of potential mechanisms by which sleep disturbance may confer risk for the development of anxiety and related disorders is discussed. Future research integrating findings from basic sleep research with current knowledge of anxiety and related disorders may facilitate the development of novel treatments for comorbid sleep disturbance and clinical anxiety.
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20
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Boland EM, Ross RJ. Recent Advances in the Study of Sleep in the Anxiety Disorders, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder. Psychiatr Clin North Am 2015; 38:761-76. [PMID: 26600107 DOI: 10.1016/j.psc.2015.07.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sleep disturbance is frequently associated with generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. This article reviews recent advances in understanding the mechanisms of the sleep disturbances in these disorders and discusses the implications for developing improved treatments.
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Affiliation(s)
- Elaine M Boland
- Behavioral Health, Mental Illness Research Education and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA.
| | - Richard J Ross
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
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21
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Reynolds KC, Gradisar M, Alfano CA. Sleep in Children and Adolescents with Obsessive-Compulsive Disorder. Sleep Med Clin 2015; 10:133-41. [DOI: 10.1016/j.jsmc.2015.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Perugi G, Quaranta G, Bucci N. The use of agomelatine in OCD: effects on the motivational aspects and dysregulated circadian rhythms. Expert Opin Investig Drugs 2015; 24:705-13. [DOI: 10.1517/13543784.2015.1021918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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23
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Nota JA, Sharkey KM, Coles ME. Sleep, arousal, and circadian rhythms in adults with obsessive-compulsive disorder: a meta-analysis. Neurosci Biobehav Rev 2015; 51:100-7. [PMID: 25603315 DOI: 10.1016/j.neubiorev.2015.01.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 10/18/2014] [Accepted: 01/05/2015] [Indexed: 11/19/2022]
Abstract
Findings of this meta-analysis show that obsessive-compulsive disorder (OCD) is related to disruptions in both the duration and timing of sleep. PsycINFO and Google Scholar database searches identified 12 relevant studies that compared measures of sleep in individuals with OCD to those of either a healthy control group or published norms. Sleep measures included sleep onset latency, sleep duration, awakening after sleep onset, percentage of rapid eye movement (REM) sleep, percentage of slow wave sleep, and prevalence of delayed sleep phase disorder (DSPD). Individual effect sizes were pooled using a random effects model. Sleep duration was found to be shorter, and the prevalence of DSPD higher, in individuals with OCD compared to controls. Further, excluding samples with comorbid depression did not meaningfully reduce the magnitude of these effects (although the results were no longer statistically significant) and medication use by participants is unlikely to have systematically altered sleep timing. Overall, available data suggest that sleep disruption is associated with OCD but further research on both sleep duration and sleep timing in individuals with OCD is needed.
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Affiliation(s)
- Jacob A Nota
- Department of Psychology, Binghamton University, PO Box 6000, Binghamton, NY 13902-6000, United States.
| | - Katherine M Sharkey
- Departments of Medicine and Psychiatry & Human Behavior, Rhode Island Hospital/Brown University, 300 Duncan Drive, Providence, RI 02906, United States
| | - Meredith E Coles
- Department of Psychology, Binghamton University, PO Box 6000, Binghamton, NY 13902-6000, United States
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24
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Nota JA, Coles ME. Duration and Timing of Sleep are Associated with Repetitive Negative Thinking. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9651-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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25
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Abstract
Sleep issues are common in people with psychiatric disorders, and the interaction is complex. Sleep disorders, particularly insomnia, can precede and predispose to psychiatric disorders, can be comorbid with and exacerbate psychiatric disorders, and can occur as part of psychiatric disorders. Sleep disorders can mimic psychiatric disorders or result from medication given for psychiatric disorders. Impairment of sleep and of mental health may be different manifestations of the same underlying neurobiological processes. For the primary care physician, key tools include recognition of potential sleep effects of psychiatric medications and familiarity with treatment approaches for insomnia in depression and anxiety.
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Affiliation(s)
- Eliza L Sutton
- Department of Medicine, University of Washington, 4245 Roosevelt Way Northeast, Box 354765, Seattle, WA 98105, USA.
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26
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Schubert JR, Coles ME. The experience and impact of intrusive thoughts in individuals with late bedtimes. BIOL RHYTHM RES 2014. [DOI: 10.1080/09291016.2014.948741] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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27
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Schubert JR, Coles ME. Obsessive-compulsive symptoms and characteristics in individuals with delayed sleep phase disorder. J Nerv Ment Dis 2013; 201:877-84. [PMID: 24080675 DOI: 10.1097/nmd.0b013e3182a5eb13] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research has demonstrated a relationship between circadian disruption and severe obsessive-compulsive disorder (OCD). Misalignment of sleep timing/endogenous biological rhythms with the 24-hour light/dark cycle may result in difficulty dismissing intrusive thoughts, thus increasing vulnerability to disorders characterized by intrusive thoughts, such as OCD. Deficits in inhibition of intrusive thoughts are posited to play a role in OCD. The current study investigated whether individuals with delayed sleep phase disorder (DSPD) report elevated symptoms of OCD and have greater difficulty inhibiting intrusive thoughts than do individuals without DSPD. Community participants with and without DSPD completed questionnaires and performed behavioral tasks designed to elicit intrusive thoughts. The participants with DSPD (n = 27) had elevated OCD symptoms and greater rates of disorders characterized by intrusive thoughts on a structured interview, as compared with the participants without DSPD (n = 19). These results support a link between the timing of sleep and symptoms of OCD. Implications and future directions are discussed.
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Paterson JL, Reynolds AC, Ferguson SA, Dawson D. Sleep and obsessive-compulsive disorder (OCD). Sleep Med Rev 2013; 17:465-74. [PMID: 23499210 DOI: 10.1016/j.smrv.2012.12.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 10/24/2012] [Accepted: 12/12/2012] [Indexed: 11/18/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a chronic mental illness that can have a debilitating effect on daily functioning. A body of research reveals altered sleep behaviour in OCD sufferers; however, findings are inconsistent and there is no consensus on the nature of this relationship. Understanding sleep disturbance in OCD is of critical importance given the known negative consequences of disturbed sleep for mood and emotional wellbeing. A systematic literature search was conducted of five databases for studies assessing sleep in adults diagnosed with OCD. Fourteen studies met inclusion criteria and qualitative data analysis methods were used to identify common themes. There was some evidence of reduced total sleep time and sleep efficiency in OCD patients. Many of the sleep disturbances noted were characteristic of depression. However, some OCD sufferers displayed delayed sleep onset and offset and an increased prevalence of delayed sleep phase disorder (DSPD). Severe OCD symptoms were consistently associated with greater sleep disturbance. While the sleep of OCD patients has not been a major focus to date, the existing literature suggests that addressing sleep disturbance in OCD patients may ensure a holistic approach to treatment, enhance treatment efficacy, mitigate relapse and protect against the onset of co-morbid psychiatric illnesses.
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Affiliation(s)
- Jessica L Paterson
- Central Queensland University, Appleton Institute, PO Box 42, Goodwood SA 5034, Australia.
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29
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EEG-vigilance regulation during the resting state in obsessive–compulsive disorder. Clin Neurophysiol 2013; 124:497-502. [DOI: 10.1016/j.clinph.2012.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/28/2012] [Accepted: 08/30/2012] [Indexed: 11/20/2022]
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Agomelatine augmentation of escitalopram therapy in treatment-resistant obsessive-compulsive disorder: a case report. Case Rep Psychiatry 2012; 2012:642752. [PMID: 23094178 PMCID: PMC3474211 DOI: 10.1155/2012/642752] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 09/18/2012] [Indexed: 11/18/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a chronic condition characterized by obsessions or compulsions that cause distress or interfere with functioning. Selective serotonin reuptake inhibitors are the first-line strategy in the treatment of OCD, but approximately 40% to 60% of patients with OCD fail to respond to them. Several augmentation strategies have been proposed, including the use of atypical antipsychotics and antidepressant combinations. In the present paper we describe the case of a young female patient suffering from severe treatment-resistant OCD who remitted as a result of agomelatine augmentation of escitalopram therapy.
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31
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Drummond LM, Wulff K, Rani RS, White S, Mbanga-Sibanda J, Ghodse H, Fineberg NA. How should we measure delayed sleep phase shift in severe, refractory obsessive-compulsive disorder? Int J Psychiatry Clin Pract 2012; 16:268-76. [PMID: 22809128 DOI: 10.3109/13651501.2012.709866] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE A previous study, based upon direct nursing observations, showed almost half of a cohort of inpatients with severe, enduring OCD also suffered from delayed sleep phase shift. Males, younger patients and those with more severe symptoms were most likely to be affected. However, the ward environment may have had a direct effect on sleeping patterns. In this study we compared the accuracy of actigraphic measurements with that of the "gold standard" of direct nursing observation, and other clinical sleep scales. We postulated that actigraphy would prove a reliable, acceptable, and valid alternative. METHODS All patients admitted over 29 months to a specialized treatment unit for severe, chronic refractory OCD were invited to participate. We collected demographic data, clinical measures of OCD and depressive symptom severity, self-rated measures of social and occupational disability and sleep, nursing records based upon direct observation of sleep onset and duration, and actigraphy records. RESULTS Evaluable data was obtained from 36 patients (22 males) with an average age of 37 years and profound OCD symptoms measured by the Yale-Brown Obsessive-Compulsive Scale. According to direct nursing observation, 12 patients (33%) showed delayed sleep phase shift. Actigraphic recordings demonstrated good agreement (kappa = 0.63) with nursing observation as did the St George's Insomnia Questionnaire (kappa = 0.66). CONCLUSION This study demonstrates that actigraphy is a reliable method of recording sleep/activity cycles in severe, enduring OCD.
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Affiliation(s)
- Lynne M Drummond
- National OCD/BDD Service, Springfield University Hospital, South West London and St George's NHS Trust, London.
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Abstract
There is increasing recognition of an important interplay between psychiatric disorders and sleep. Clinical observations and several empirical studies have shown that later bedtimes are associated with obsessive-compulsive disorder (OCD). This study examined the relation of delayed bedtimes (DBs) and symptoms of OCD. Two hundred and sixty-six undergraduates completed a battery of questionnaires assessing sleep patterns, mood, and obsessive-compulsive (OC) symptoms. Results showed that participants with DBs reported increased rates of OC symptoms, as compared with non-DB participants. Further, this relation remained significant when controlling for negative affect. Additional work examining the interplay between sleep and OC symptoms is warranted.
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Affiliation(s)
- Meredith E Coles
- Department of Psychology, Binghamton University, Binghamton, NY 13902-6000, USA.
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33
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Circadian rhythms in obsessive–compulsive disorder. J Neural Transm (Vienna) 2012; 119:1077-83. [DOI: 10.1007/s00702-012-0805-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 04/12/2012] [Indexed: 11/25/2022]
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35
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Coles ME, Sharkey KM. Compulsion or chronobiology? A case of severe obsessive-compulsive disorder treated with cognitive-behavioral therapy augmented with chronotherapy. J Clin Sleep Med 2011; 7:307-9. [PMID: 21677902 DOI: 10.5664/jcsm.1080] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Individuals with treatment-resistant obsessive compulsive disorder (OCD) have elevated rates of delayed sleep phase. This report describes a patient with severe OCD who had failed prior trials of pharmacotherapy and psychotherapy, and whose symptoms were associated with delayed bedtimes and delays in the time she initiated her nighttime compulsions. METHODS Case report. RESULTS A 54 year-old woman with OCD kept sleep/symptom logs as an adjunct to traditional cognitive-behavioral therapy for OCD. At presentation, she reported habitual bedtime = 06:00, wake time = 13:00, sleep latency ' 5 min, and total sleep time = 6.5-7.5 h. Later time of initiating her compulsions was associated with longer time performing the compulsions (r = 0.86, p < 0.001). Cognitive-behavioral therapy with adjunctive chronotherapy was associated with substantial improvement. CONCLUSIONS OCD patients with nighttime compulsions may receive light exposure that results in delayed sleep times/circadian phase. Chronotherapy may enhance outcomes for refractory OCD patients, particularly those who perform compulsions at night.
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Affiliation(s)
- Meredith E Coles
- Department of Psychology, Binghamton University, Binghamton, NY 13902-6000, USA.
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Brand S, Kirov R. Sleep and its importance in adolescence and in common adolescent somatic and psychiatric conditions. Int J Gen Med 2011; 4:425-42. [PMID: 21731894 PMCID: PMC3119585 DOI: 10.2147/ijgm.s11557] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Indexed: 02/05/2023] Open
Abstract
Restoring sleep is strongly associated with a better physical, cognitive, and psychological well-being. By contrast, poor or disordered sleep is related to impairment of cognitive and psychological functioning and worsened physical health. These associations are well documented not only in adults but also in children and adolescents. Importantly, adolescence is hallmarked by dramatic maturational changes in sleep and its neurobiological regulation, hormonal status, and many psychosocial and physical processes. Thus, the role of sleep in mental and physical health during adolescence and in adolescent patients is complex. However, it has so far received little attention. This review first presents contemporary views about the complex neurobiology of sleep and its functions with important implications for adolescence. Second, existing complex relationships between common adolescent somatic/organic, sleep-related, and psychiatric disorders and certain sleep alterations are discussed. It is concluded that poor or altered sleep in adolescent patients may trigger and maintain many psychiatric and physical disorders or combinations of these conditions, which presumably hinder recovery and may cross into later stages of life. Therefore, timely diagnosis and management of sleep problems appear critical for growth and development in adolescent patients.
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Affiliation(s)
- Serge Brand
- Depression and Sleep Research Unit, Psychiatric Hospital of the University of Basel, Basel, Switzerland
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Fornaro M. Switching from serotonin reuptake inhibitors to agomelatine in patients with refractory obsessive-compulsive disorder: a 3 month follow-up case series. Ann Gen Psychiatry 2011; 10:5. [PMID: 21356085 PMCID: PMC3058071 DOI: 10.1186/1744-859x-10-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 02/28/2011] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Serotonin reuptake inhibitors (SRIs) currently represent the cornerstone of obsessive-compulsive disorder (OCD) pharmacotherapy. However, OCD is characterized by high rates of partial and/or absent response to standard, recommended treatments, often prompting pharmacological and non-pharmacological augmentation or switching of strategies. Agomelatine, a novel melatonin agonist and selective serotonin antagonist (MASSA) antidepressant approved for major depressive disorder (MDD) has recently been additionally proposed as a treatment for anxiety disorders such as social anxiety disorder (SAD) and panic disorder (PD), but not yet OCD. Nonetheless, agomelatine may have a role in the management of OCD, essentially due to its anxiolytic 5-hydroxytryptamine (HT)2C blockade action, while melatonin (MT)1 and MT2 modulation might contribute to circadian rhythm restoration if impaired. METHODS This case series reports the outcome of six patients with or without comorbid mood and/or other anxiety disorders who were treated with SRIs at adequate doses for at least 8 weeks, showing partial or no response. Patients were then switched to agomelatine 50 mg/day, and followed up for 12 weeks. RESULTS Three out of six patients, in particular those with relevant circadian rhythm subjective impairment, showed a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score reduction of ≥35%. No relevant side effects were observed, but initial, transient, self-remitting dizziness in one patient and weight gain in another were seen. CONCLUSIONS Although clinical confounding factors (subthreshold bipolarity and eventually the presence of impaired circadian rhythms) and methodological boundaries (lack of control and neurophysiological recording, tiny sample size and short follow-up) limit the validity of this preliminary observation, it does indicate agomelatine may have a role in some SRI-refractory OCD cases, thus prompting the validity of investigation by further controlled studies, even for drug-naïve OCD patients.
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Affiliation(s)
- Michele Fornaro
- University of Genova, Department of Psychiatry, Genoa, Italy.
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Wirz-Justice A, Bromundt V, Cajochen C. Circadian Disruption and Psychiatric Disorders: The Importance of Entrainment. Sleep Med Clin 2009. [DOI: 10.1016/j.jsmc.2009.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Sleep and circadian rhythm disturbances: multiple genes and multiple phenotypes. Curr Opin Genet Dev 2009; 19:237-46. [PMID: 19423332 DOI: 10.1016/j.gde.2009.03.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Revised: 03/16/2009] [Accepted: 03/20/2009] [Indexed: 11/23/2022]
Abstract
Sleep is regulated by two broad mechanisms: the circadian system, which generates 24-h rhythms of sleep propensity and a wake-dependent homeostatic sleep process whereby sleep pressure increases during wake and dissipates during sleep. These, in turn, regulate multiple brain structures and neurotransmitter systems. In view of the complexity of sleep it is not surprising that there is considerable variation between individuals in both sleep timing and propensity. Furthermore, marked abnormalities in sleep are commonly encountered in psychiatric and neurodegenerative disorders. Teasing apart the genetic versus environmental contributions to normal and abnormal sleep is complex. Here we attempt to summarise what recent progress has been made, and what will be needed in the future to gain a more complete understanding of this fundamental aspect of physiology.
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Zee PC, Lu BS. Insomnia and Circadian Rhythm Sleep Disorders. Psychiatr Ann 2008. [DOI: 10.3928/00485713-20080901-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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