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Hanif U, Cairns A, Mysliwiec V, Bettinardi RG, Elbaz M, Gimenez U, Mignot EJM. Associations between self-reported parasomnias and psychiatric illness in 370,000 patients with sleep disorders. Psychiatry Clin Neurosci 2024. [PMID: 39210704 DOI: 10.1111/pcn.13723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/03/2024] [Accepted: 07/18/2024] [Indexed: 09/04/2024]
Abstract
AIM To assess self-reported parasomnias in patients with sleep disorders and explore relationships with psychiatric illness, comorbidities, subjective sleep assessments, and polysomnographic study results. METHODS Results from intake questionnaires and polysomnographic assessments, collected from 240 sleep centers across 30 US states between 2004 and 2019, were analyzed retrospectively. Of 540,000 total patients, 371,889 who answered parasomnia-specific questions were included. Patients responding "often" or "always" to parasomnia-specific questions were considered "symptom-positive," whereas a "few times" or "never" were considered "symptom-negative" (controls). RESULTS The study sample was 54.5% male with mean age 54 years (range, 2-107 years). Frequencies for the different parasomnias were 16.0% for any parasomnia, 8.8% for somniloquy, 6.0% for hypnagogic hallucinations, 4.8% for sleep-related eating disorder, 2.1% for sleep paralysis, and 1.7% for somnambulism. Frequent parasomnias were highly associated with diagnosed depression (odds ratio = 2.72). All parasomnias were associated with being younger and female and with symptoms of depression, anxiety, insomnia, restless legs, pain, medical conditions, fatigue, and sleepiness. Associations with objective sleep metrics showed characteristics of consolidated sleep and differentiated weakly between nonrapid eye movement sleep and rapid eye movement sleep parasomnias. Machine learning accurately classified patients with parasomnia versus controls (balanced accuracies between 71% and 79%). Benzodiazepines, antipsychotics, and opioids increased the odds of experiencing parasomnias, while antihistamines and melatonin reduced the odds. Z-drugs were found to increase the likelihood of a sleep-related eating disorder. CONCLUSION Our findings suggest that parasomnias may be clinically relevant, yet understudied, symptoms of depression and anxiety. Further investigation is needed to quantify the nature of multimorbidity, including causality and implications for diagnosis and treatment.
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Affiliation(s)
- Umaer Hanif
- Data Science, BioSerenity, Paris, France
- BioSerenity Research Group, BioSerenity, Danvers, Massachusetts, USA
| | - Alyssa Cairns
- BioSerenity Research Group, BioSerenity, Danvers, Massachusetts, USA
| | - Vincent Mysliwiec
- BioSerenity Research Group, BioSerenity, Danvers, Massachusetts, USA
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | | | | | - Emmanuel J M Mignot
- Stanford University Center for Sleep and Circadian Sciences, Stanford University, Palo Alto, California, USA
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Colombo C, Cellini N. Lifetime prevalence and characteristics of sleep paralysis in Italian university students population. Sleep Med 2024; 122:106-112. [PMID: 39154571 DOI: 10.1016/j.sleep.2024.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 08/11/2024] [Accepted: 08/13/2024] [Indexed: 08/20/2024]
Abstract
Sleep paralysis (SP) is a REM-related parasomnia, characterized by the inability to perform voluntary movements. It is a relatively widespread phenomenon in the general population and, although usually not dangerous, it is experienced with intense fear. The current study aims to evaluate the lifetime prevalence and characteristics of SP in the Italian student population. The study was conducted online, through an online battery of questionnaires. We used the Unusual Sleep Experience Questionnaire to investigate the prevalence of the disorder and the typical characteristics, metacognitive beliefs on the episodes, and previous distress factors. We also collected information about anxiety and depression symptomatology, sleep quality, and circadian preferences. Four hundred and thirty-two participants (333 F, 22.8 ± 2.57 y) took part in the study and 37.5 % of them reported having experienced at least one SP episode in their lifetime. On a physiological level, the most common features were the inability to speak followed by a tingling sensation and the inability to open the eyes, consistent with REM muscle atonia. Cognitive features during episodes include the perception of a presence in the room, followed by the fear of dying. Participants who reported SP had higher anxiety and worse sleep quality, and were more associated with evening chronotypes compared to non-SP responders. Our results show that SP is generally widespread in Italian students, in line with the prevalence reported in previous studies. Further studies could investigate the effects of suggested therapies to decrease the number of episodes of the disorder, especially in those who experience it recurrently.
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Affiliation(s)
- Costanza Colombo
- Department of General Psychology, University of Padova, Padova, Italy.
| | - Nicola Cellini
- Department of General Psychology, University of Padova, Padova, Italy.
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Campillo-Ferrer T, Alcaraz-Sánchez A, Demšar E, Wu HP, Dresler M, Windt J, Blanke O. Out-of-body experiences in relation to lucid dreaming and sleep paralysis: A theoretical review and conceptual model. Neurosci Biobehav Rev 2024; 163:105770. [PMID: 38880408 DOI: 10.1016/j.neubiorev.2024.105770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/31/2024] [Accepted: 06/11/2024] [Indexed: 06/18/2024]
Abstract
Out-of-body experiences (OBEs) are characterized by the subjective experience of being located outside the physical body. Little is known about the neurophysiology of spontaneous OBEs, which are often reported by healthy individuals as occurring during states of reduced vigilance, particularly in proximity to or during sleep (sleep-related OBEs). In this paper, we review the current state of research on sleep-related OBEs and hypothesize that maintaining consciousness during transitions from wakefulness to REM sleep (sleep-onset REM periods) may facilitate sleep-related OBEs. Based on this hypothesis, we propose a new conceptual model that potentially describes the relationship between OBEs and sleep states. The model sheds light on the phenomenological differences between sleep-related OBEs and similar states of consciousness, such as lucid dreaming (the realization of being in a dream state) and sleep paralysis (feeling paralyzed while falling asleep or waking up), and explores the potential polysomnographic features underlying sleep-related OBEs. Additionally, we apply the predictive coding framework and suggest a connecting link between sleep-related OBEs and OBEs reported during wakefulness.
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Affiliation(s)
- Teresa Campillo-Ferrer
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Neuropsychology, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany.
| | - Adriana Alcaraz-Sánchez
- Centre for Philosophical Psychology, Department of Philosophy, University of Antwerp, Antwerp, Belgium
| | - Ema Demšar
- Monash Centre for Consciousness and Contemplative Studies, Melbourne, Australia; Monash University, Department of Philosophy, Melbourne, Australia
| | - Hsin-Ping Wu
- Laboratory of Cognitive Neuroscience, Neuro-X Institute & Brain Mind Institute, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland; Department of Clinical Neuroscience, Geneva University Hospital, Geneva, Switzerland
| | - Martin Dresler
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jennifer Windt
- Monash Centre for Consciousness and Contemplative Studies, Melbourne, Australia; Monash University, Department of Philosophy, Melbourne, Australia
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Neuro-X Institute & Brain Mind Institute, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland; Department of Clinical Neuroscience, Geneva University Hospital, Geneva, Switzerland
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Bhalerao V, Gotarkar S, Vishwakarma D, Kanchan S. Recent Insights Into Sleep Paralysis: Mechanisms and Management. Cureus 2024; 16:e65413. [PMID: 39184697 PMCID: PMC11344621 DOI: 10.7759/cureus.65413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/26/2024] [Indexed: 08/27/2024] Open
Abstract
Sleep paralysis (SP) is a phenomenon wherein individuals awaken from deep sleep but are unable to move or speak, often experiencing vivid hallucinations. This condition, attributed to the persistence of muscle atonia from rapid eye movement (REM) sleep into wakefulness, is associated with factors like sleep deprivation and irregular sleep patterns. While isolated episodes of SP are generally benign, recurrent episodes may warrant clinical attention, particularly when accompanied by distressing symptoms. Despite its prevalence across cultures and its documented association with various medical conditions, SP remains poorly understood by many. This review explores the clinical characteristics, epidemiology, and associated risk factors of SP, drawing from a comprehensive analysis of the existing literature. Additionally, the review discusses potential treatment modalities, including pharmacological interventions and cognitive-behavioral therapy, highlighting the need for further research to enhance our understanding and management of this intriguing phenomenon.
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Affiliation(s)
- Vijay Bhalerao
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shashank Gotarkar
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Deepak Vishwakarma
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sushim Kanchan
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Miletínová E, Kliková M, Dostalíková A, Bušková J. Morphological characteristics of cerebellum, pons and thalamus in Reccurent isolated sleep paralysis - A pilot study. Front Neuroanat 2024; 18:1396829. [PMID: 38962392 PMCID: PMC11219576 DOI: 10.3389/fnana.2024.1396829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/27/2024] [Indexed: 07/05/2024] Open
Abstract
Introduction Recurrent isolated sleep paralysis (RISP) is a rapid eye movement sleep (REM) parasomnia, characterized by the loss of voluntary movements upon sleep onset and/or awakening with preserved consciousness. Evidence suggests microstructural changes of sleep in RISP, although the mechanism of this difference has not been clarified yet. Our research aims to identify potential morphological changes in the brain that can reflect these regulations. Materials and methods We recruited 10 participants with RISP (8 women; mean age 24.7 years; SD 2.4) and 10 healthy control subjects (w/o RISP; 3 women; mean age 26.3 years; SD 3.7). They underwent video-polysomnography (vPSG) and sleep macrostructure was analyzed. After that participants underwent magnetic resonance imaging (MRI) of the brain. We focused on 2-dimensional measurements of cerebellum, pons and thalamus. Statistical analysis was done in SPSS program. After analysis for normality we performed Mann-Whitney U test to compare our data. Results We did not find any statistically significant difference in sleep macrostructure between patients with and w/o RISP. No evidence of other sleep disturbances was found. 2-dimensional MRI measurements revealed statistically significant increase in cerebellar vermis height (p = 0.044) and antero-posterior diameter of midbrain-pons junction (p = 0.018) in RISP compared to w/o RISP. Discussion Our results suggest increase in size of cerebellum and midbrain-pons junction in RISP. This enlargement could be a sign of an over-compensatory mechanism to otherwise dysfunctional regulatory pathways. Further research should be done to measure these differences in time and with closer respect to the frequency of RISP episodes.
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Affiliation(s)
- Eva Miletínová
- National Institute of Mental Health, Klecany, Czechia
- Third Faculty of Medicine, Charles University, Praha, Czechia
| | | | | | - Jitka Bušková
- National Institute of Mental Health, Klecany, Czechia
- Third Faculty of Medicine, Charles University, Praha, Czechia
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6
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Stefani A, Tang Q. Recurrent Isolated Sleep Paralysis. Sleep Med Clin 2024; 19:101-109. [PMID: 38368058 DOI: 10.1016/j.jsmc.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Recurrent isolated sleep paralysis has a 7.6% lifetime prevalence of at least one episode in the general population. Episodes resolve spontaneously and are benign. Sleep paralysis represents a dissociate state, with persistence of the rapid eye movement (REM)-sleep muscle atonia in the waking state. The intrusion of alpha electroencephalogram into REM sleep is followed by an arousal response and then by persistence of REM atonia into wakefulness. Predisposing factors include irregular sleep-wake schedules, sleep deprivation, and jetlag. No drug treatment is required. Patients should be informed about sleep hygiene. Cognitive behavioral therapy may be useful in cases accompanied by anxiety and frightening hallucinations.
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Affiliation(s)
- Ambra Stefani
- Department of Neurology, Sleep Disorders Clinic, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Qi Tang
- Department of Neurology, Sleep Disorders Clinic, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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7
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Černý F, Piorecká V, Kliková M, Kopřivová J, Bušková J, Piorecký M. All-night spectral and microstate EEG analysis in patients with recurrent isolated sleep paralysis. Front Neurosci 2024; 18:1321001. [PMID: 38389790 PMCID: PMC10882627 DOI: 10.3389/fnins.2024.1321001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
The pathophysiology of recurrent isolated sleep paralysis (RISP) has yet to be fully clarified. Very little research has been performed on electroencephalographic (EEG) signatures outside RISP episodes. This study aimed to investigate whether sleep is disturbed even without the occurrence of a RISP episode and in a stage different than conventional REM sleep. 17 RISP patients and 17 control subjects underwent two consecutive full-night video-polysomnography recordings. Spectral analysis was performed on all sleep stages in the delta, theta, and alpha band. EEG microstate (MS) analysis was performed on the NREM 3 phase due to the overall high correlation of subject template maps with canonical templates. Spectral analysis showed a significantly higher power of theta band activity in REM and NREM 2 sleep stages in RISP patients. The observed rise was also apparent in other sleep stages. Conversely, alpha power showed a downward trend in RISP patients' deep sleep. MS maps similar to canonical topographies were obtained indicating the preservation of prototypical EEG generators in RISP patients. RISP patients showed significant differences in the temporal dynamics of MS, expressed by different transitions between MS C and D and between MS A and B. Both spectral analysis and MS characteristics showed abnormalities in the sleep of non-episodic RISP subjects. Our findings suggest that in order to understand the neurobiological background of RISP, there is a need to extend the analyzes beyond REM-related processes and highlight the value of EEG microstate dynamics as promising functional biomarkers of RISP.
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Affiliation(s)
- Filip Černý
- Faculty of Biomedical Engineering, Czech Technical University, Prague, Czechia
- Sleep and Chronobiology Research Center, National Institute of Mental Health, Klecany, Czechia
| | - Václava Piorecká
- Faculty of Biomedical Engineering, Czech Technical University, Prague, Czechia
- Sleep and Chronobiology Research Center, National Institute of Mental Health, Klecany, Czechia
| | - Monika Kliková
- Sleep and Chronobiology Research Center, National Institute of Mental Health, Klecany, Czechia
| | - Jana Kopřivová
- Sleep and Chronobiology Research Center, National Institute of Mental Health, Klecany, Czechia
- Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Jitka Bušková
- Sleep and Chronobiology Research Center, National Institute of Mental Health, Klecany, Czechia
- Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Marek Piorecký
- Faculty of Biomedical Engineering, Czech Technical University, Prague, Czechia
- Sleep and Chronobiology Research Center, National Institute of Mental Health, Klecany, Czechia
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8
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Hefnawy MT, Amer BE, Amer SA, Moghib K, Khlidj Y, Elfakharany B, Mouffokes A, Alazzeh ZJ, Soni NP, Wael M, Elsayed ME. Prevalence and Clinical Characteristics of Sleeping Paralysis: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e53212. [PMID: 38425633 PMCID: PMC10902800 DOI: 10.7759/cureus.53212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Sleep paralysis (SP) is a mixed state of consciousness and sleep, combining features of rapid eye movement (REM) sleep with those of wakefulness. The exact cause of SP is unknown, and its prevalence varies among the studies. We aim to identify SP's global prevalence, the affected population's characteristics, and the SP's clinical picture. We searched three databases (PubMed, Scopus, and Web of Science (WoS)) using a unique search strategy to identify eligible studies. All observational studies identifying the prevalence or frequency of sleeping paralysis were included. No exclusions are made based on country, race, or questionnaire. The analysis was performed using the latest version of R software (R Core Team, Vienna, Austria). The analysis included 76 studies from 25 countries with 167,133 participants. The global prevalence of SP was 30% (95% CI (22%, 39%)). There were similar frequencies of isolated SP and SP (33%, 95% CI (26%, 42%), I2 = 97%, P <0.01; 31%, 95% CI (21%, 43%), I2 = 100%, P = 0, respectively). A subgroup analysis showed that the majority of those who experienced SP were psychiatric patients (35%, 95% CI (20%, 55%), I2 = 96%, P <0.01). The prevalence among non-psychiatric patients was among students (34%, 95% CI (23%, 47%), I2 = 100%, P = 0). Auditory and visual hallucinations were reported in 24.25% of patients. Around 4% had only visual hallucinations. Meta-regression showed no association between the frequency of SP and sex. Publication bias was detected among the included studies through visual inspection of funnel plot asymmetry. Our findings revealed that 30% of the population suffered from SP, especially psychiatric patients and students. The majority of SP cases lacked associated hallucinations, while a noteworthy proportion experienced combined visual and auditory hallucinations.
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Affiliation(s)
- Mahmoud T Hefnawy
- Faculty of Medicine, Zagazig University, Zagazig, EGY
- Medical Research Group of Egypt Branch, Negida Academy, Arlington, USA
| | - Basma E Amer
- Faculty of Medicine, Banha University, Banha, EGY
- Medical Research Group of Egypt Branch, Negida Academy, Arlington, USA
| | - Samar A Amer
- Family Medicine, Royal College of General Practice, London, GBR
- Faculty of Public Health and Community Medicine, Zagazig University, Zagazig, EGY
| | | | - Yehya Khlidj
- Faculty of Medicine, University of Algiers Benyoucef Benkhedda, Algiers, DZA
| | - Bahaa Elfakharany
- Faculty of Allied Medical Sciences, Pharos University, Alexandria, EGY
- Medical Research Group of Egypt Branch, Negida Academy, Arlington, USA
| | - Adel Mouffokes
- Internal Medicine, Faculty of Medicine, University of Oran 1 Ahmed Ben Bella, Oran, DZA
| | - Zainab J Alazzeh
- Faculty of Medicine, Jordanian University of Science and Technology, Ar-Ramtha, JOR
| | - Nishant P Soni
- Medicine, Gujarat Medical Education and Research Society Medical College and Hospital, Ahmedabad, IND
| | - Muhannad Wael
- Urology, Saint Joseph Hospital, Jerusalem, PSE
- Faculty of Medicine, An-Najah National University, Nablus, PSE
| | - Mohamed E Elsayed
- Department of Psychiatry, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Oldenburg, DEU
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Muzammil MA, Syed AR, Farooq MH, Ahmed S, Qazi MH, Patel T, Khatri M, Zaman MU, Nadeem T, Tanveer F, Kumar U, Varrassi G, Shah AA. Frequency and Factors of Sleep Paralysis Among Medical Students of Karachi. Cureus 2023; 15:e41722. [PMID: 37575779 PMCID: PMC10414800 DOI: 10.7759/cureus.41722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION Sleep paralysis is a prevalent phenomenon characterized by suffocation, immobility, and hallucinations. Its causes remain unknown, although the neurotransmitter imbalance is suggested as a potential factor. This condition is closely associated with hallucinations and a sense of intrusion, often observed in patients with narcolepsy, hypertension, and seizures. METHODS A cross-sectional study was conducted in various medical colleges in Karachi, involving 297 participants aged 18 to 30 years. The participants were divided into groups based on gender and year of study. They were surveyed about the frequency of sleep paralysis episodes, their beliefs about the phenomenon, sleep routines, and academic impacts. RESULTS Among the respondents, a significant number of females (n=209, 70.3%) reported experiencing sleep paralysis. The overall mean age was 20±2.0 years. Correlation analysis revealed an insignificant relationship between depression and mental anxiety (p=0.147). Similarly, no significant association was found when comparing the occurrence of sleep paralysis (p=0.16). However, a notable finding was the significant link between sleep paralysis and its impact on academics (p=0.043). CONCLUSION This study highlighted the frequency of sleep paralysis among medical students, particularly among females. Furthermore, it emphasizes the diverse beliefs held by individuals regarding these frightening episodes. To address this neglected issue, it is essential to conduct awareness sessions aimed at understanding and alleviating sleep paralysis in individuals' lives.
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Affiliation(s)
| | | | | | - Shaheer Ahmed
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Tirath Patel
- Medicine, American University of Antigua, St. John, ATG
| | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
| | | | - Taha Nadeem
- Medicine, Allama Iqbal Medical College, Lahore, PAK
| | | | - Umesh Kumar
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
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Ableidinger S, Holzinger B. Sleep Paralysis and Lucid Dreaming-Between Waking and Dreaming: A Review about Two Extraordinary States. J Clin Med 2023; 12:jcm12103437. [PMID: 37240545 DOI: 10.3390/jcm12103437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Sleep paralysis and lucid dreams are two states of consciousness that are connected to REM sleep but are defined by higher awareness in contrast to regular REM sleep. Despite these similarities, the two states differ widely in their emotional tone and their perceived controllability. This review aims to summarize the current research containing sleep paralysis and lucid dreams. However, given the sparsity of the research, one single topic cannot be chosen. METHODS Articles containing both lucid dreams as well as sleep paralysis were searched for in the following databanks: MEDLINE, Scopus, Web of Science, PsycInfo, PsycArticles, and PSYNDEX. Further, citations of the found papers were examined. RESULTS 10 studies were included in the review. Most of the studies were surveys, but there was also a case study, a randomized trial, and an observational EEG study. The numbers of participants ranged from a single participant in the case study to 1928 participants in a survey. The main findings were that correlations between sleep paralysis and lucid dreaming were positive and significant in most of the studies. CONCLUSIONS There is a connection between lucid dreaming and sleep paralysis. However, research is still very limited and diverse in the methodologies used. Future research should build standardized methods for examining the two phenomena.
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Affiliation(s)
| | - Brigitte Holzinger
- Institute for Consciousness and Dream Research, 1180 Vienna, Austria
- Sleep Coaching, Medical University Vienna, 1090 Vienna, Austria
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11
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Duarte JM, Lisi GR, Carroll BT, Garro MF, Appiani FJ. The prevalence of sleep paralysis in medical students in Buenos Aires, Argentina. J Neurosci Rural Pract 2023; 14:272-275. [PMID: 37181188 PMCID: PMC10174134 DOI: 10.25259/jnrp_16_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Objectives The objectives of this study were to determine the prevalence of sleep paralysis (SP) in medical students from the University of Buenos Aires (UBA). Materials and Methods An ad hoc questionnaire based on the diagnosis of SP and a demographic survey was electronically presented to students of Internal Medicine at the School of Medicine of the UBA. The respondents answered both questionnaires using Google Forms®. Results The prevalence of SP was 40.7% (95% CI 33.5-47.8). A higher percentage of the respondents (76%) reported experiencing SP-related anxiety. An association between self-perceived quality of sleep and the incidence of SP was found (χ2: 12.712, P = 0.002). The highest frequency was hypnopompic SP (55.55%), and the highest percentage (55.4%) suffered from SP less than once every 6 months. Most respondents (59.5%) reported having started with SP symptoms after 18 years of age, and the highest percentage (66.2%) had exacerbated their symptoms at college. The frequency of the Incubus phenomenon was 14.5% (95% CI 6.2-23). Most respondents (70.8%) denied the association of SP with religious or paranormal beliefs. Conclusion SP is highly prevalent in medical students and is associated with poor sleep habits and perceived poor sleep quality. Clinicians should be aware of this parasomnia to avoid a misdiagnosis of psychosis and inform sufferers of the nature of SP.
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Affiliation(s)
- Juan Manuel Duarte
- Department of Mental Health, División Neuropsicofarmacología, Hospital de Clínicas “José de San Martín,”Buenos Aires, Argentina, United States
| | - Gisela Roxana Lisi
- Department of Mental Health, División Neuropsicofarmacología, Hospital de Clínicas “José de San Martín,”Buenos Aires, Argentina, United States
| | | | - Marcelo Fabián Garro
- Department of Mental Health, División Neuropsicofarmacología, Hospital de Clínicas “José de San Martín,”Buenos Aires, Argentina, United States
| | - Francisco José Appiani
- Department of Mental Health, División Neuropsicofarmacología, Hospital de Clínicas “José de San Martín,”Buenos Aires, Argentina, United States
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Rauf B, Sharpless BA, Denis D, Perach R, Madrid-Valero JJ, French CC, Gregory AM. Isolated sleep paralysis: Clinical features, perception of aetiology, prevention and disruption strategies in a large international sample. Sleep Med 2023; 104:105-112. [PMID: 36934464 DOI: 10.1016/j.sleep.2023.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/17/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023]
Abstract
STUDY OBJECTIVES Isolated sleep paralysis is a benign but frightening condition characterised by a temporary inability to move at sleep onset or upon awakening. Despite the prevalence of this condition, little is known concerning its clinical features, associated demographic characteristics, and prevention as well as disruption strategies. METHODS An online cross-sectional study was conducted. The sample comprised 3523 participants who had reported at least one lifetime episode of ISP and 3288 participants without a lifetime episode. Participants answered a survey including questions about sleep quality, sleep paralysis, and sleep paralysis prevention/disruption techniques. RESULTS A total of 6811 participants were investigated (mean age = 46.9, SD = 15.4, age range = 18-89, 66.1% female). Those who reported experiencing ISP at least once during their lives reported longer sleep onset latencies, shorter sleep duration, and greater insomnia symptoms. Females (vs. male) and younger (vs. older) participants were more likely to experience ISP. Significant fear during episodes was reported by 76.0% of the participants. Most people (63.3%) who experienced ISP believed it to be caused by 'something in the brain'. A minority endorsed supernatural causes (7.1%). Five prevention strategies (e.g., changing sleep position, adjusting sleep patterns) with at least 60.0% effectiveness, and five disruption strategies (e.g., physical/bodily action, making noise) with varying degrees of effectiveness (ranging from 29.5 to 61.8) were identified through open-ended responses. CONCLUSIONS ISP is associated with shorter sleep duration, longer sleep onset latency, and greater insomnia symptoms. The multiple prevention and disruption techniques identified in this study support existing treatment approaches and may inform subsequent treatment development. Implications for current diagnostic criteria are discussed.
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Affiliation(s)
- Betul Rauf
- Department of Psychology, Goldsmiths, University of London, London, United Kingdom.
| | - Brian A Sharpless
- Department of Psychology, Goldsmiths, University of London, London, United Kingdom; Department of Psychology, Pennsylvania State University, State College, PA, USA
| | - Dan Denis
- Department of Psychology, University of York, United Kingdom
| | - Rotem Perach
- Department of Psychology, Goldsmiths, University of London, London, United Kingdom; School of Social Sciences, University of Westminster, United Kingdom
| | - Juan J Madrid-Valero
- Department of Health Psychology, Faculty of Health Sciences, University of Alicante, Spain
| | - Christopher C French
- Department of Psychology, Goldsmiths, University of London, London, United Kingdom
| | - Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, London, United Kingdom.
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Akhtar MS, Feng T. Detection of Sleep Paralysis by using IoT Based Device and Its Relationship Between Sleep Paralysis And Sleep Quality. EAI ENDORSED TRANSACTIONS ON INTERNET OF THINGS 2022. [DOI: 10.4108/eetiot.v8i30.2688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
When a person wakes up in the middle of the night, they are paralyzed. Despite the fact that most episodes are associated with extreme terror and some might cause clinically significant suffering, little is understood about the experience. This study will analyze existing research on the relationship between sleep paralyses and sleep in general. Many studies have connected poor sleep quality to an increased risk of sleep paralysis. Awake yet unable to act, sleep paralysis occurs. This might happen between awake and sleeping. The problem is approached in three steps: Data collection, data storage, calculation and machine learning prediction of sleep paralysis. The data came from the Smart Device. The dataset has several (independent) and dependent variables (Outcome). This device has been put to the test. Each exam has its own set of features and predicted outcomes. To assess the system's validity, we executed a posture recognition accuracy test. The device was hidden on top of the bed. The controller is in charge of measurement and data collection. Experiments were conducted by collecting pressure data from a patient lying down. The person acted out his sleeping positions on a mat for a while. Machine learning has been used to predict sleep paralysis. By comparing sleep postures to the outcome, we were able to show the link between sleep qualities and sleep paralysis. Machine learning approaches have been used to predict sleep paralysis. Comparing sleeping positions with the results showed the link between sleep quality and sleep paralysis. Sleep paralysis correlates with poor sleep quality. The Random Forest model has the highest accuracy of 91.9 percent in predicting sleep paralysis in the given dataset. SVM with Linear Kernel was 80.49 percent accurate, RBF was 42.68 percent, and Polynomial was 47.56 percent. The accuracy of logistic regression was 76.83 percent. KNN had a dismal performance of 60.98%. Decision Trees and Gradient Boosting both fared well at 85.37 percent.
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Benham G. Sleep paralysis in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1286-1291. [PMID: 32813623 DOI: 10.1080/07448481.2020.1799807] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/22/2020] [Accepted: 07/17/2020] [Indexed: 06/11/2023]
Abstract
Objective: We examined the prevalence of sleep paralysis (SP), its association with stress and sleep, and associated subjective experiences and beliefs. Participants: 1,115 college students from a large university in the southwestern United States. The sample was predominantly Hispanic (94%) and female (70%). Methods: Validated measures of life-events stress, self-perceived stress, sleep quality and insomnia were administered to participants online. Results: 35% of students had previously experienced SP and reported greater stress and poorer sleep than those who had never experienced it. Effect sizes were larger when comparing those who had/had not experienced SP within the prior year. Conclusions: Based on our predominantly Hispanic and majority female sample, we found that SP is experienced by approximately one-third of undergraduate students and associated with both higher stress and poorer sleep. We therefore recommend that college health practitioners seek ways to integrate relevant assessment and education into campus health practices.
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Affiliation(s)
- Grant Benham
- Department of Psychological Science, The University of Texas Rio Grande Valley, Edinburg, Texas, USA
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15
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Characteristics of Sleep Paralysis and Its Association with Anxiety Symptoms, Perceived Stress, PTSD, and Other Variables Related to Lifestyle in Selected High Stress Exposed Professions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137821. [PMID: 35805480 PMCID: PMC9265794 DOI: 10.3390/ijerph19137821] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 11/18/2022]
Abstract
Sleep paralysis (SP) is a hypnagogic or hypnopompic state associated with the inability to move while conscious. Recurrent isolated sleep paralysis (RISP) is a type of REM parasomnia. Individuals experiencing anxiety disorders, PTSD, exposure to chronic stress, or shift work are at risk of developing this sleep disorder. This study aimed to assess: (1) the prevalence, frequency, and symptomatology of SP, and (2) the impact of the severity of anxiety symptoms, perceived stress, and lifestyle mode variables on the frequency and severity of SP in four professional groups at high risk of SP (n = 844): nurses and midwives (n = 172), policemen (n = 174), teachers (n = 107), and a group of mixed professions—“other professions” (n = 391). The study used a battery of online questionnaires: the Sociodemographic and Health Status Questionnaire, the SP-EPQ, the PCL -5, the STAI-T, the PSWQ and the PSS-10. The prevalence of SP was the lowest among policemen (15.5%) and the highest in the group of “other professions” (39.4%). The association of SP with symptoms of PTSD and anxiety was confirmed in the group of nurses and “other professions”. Among other factors modulating the incidence and severity of SP were: age, BMI, smoking, alcohol consumption, sleep duration, and perceived stress. This study indicates that there exist links between SP and psychological and lifestyle factors, suggesting a complex etiology for this sleep disorder. Due to the high prevalence of SP in the studied groups of occupations, further research is necessary to develop preventive and therapeutic methods for SP.
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Wróbel-Knybel P, Flis M, Rog J, Jalal B, Karakuła-Juchnowicz H. Risk factors of sleep paralysis in a population of Polish students. BMC Psychiatry 2022; 22:383. [PMID: 35672736 PMCID: PMC9171979 DOI: 10.1186/s12888-022-04003-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/17/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Sleep paralysis (SP) is a transitional dissociative state associated with the REM sleep phase that affects approximately 28.3% of the student population during their lifetime. The reasons for the high prevalence of SP in the student population are not entirely clear. Research indicates possible influencing factors such as the intensification of anxiety symptoms, a tendency to worry, the presence of PTSD symptoms, and behavioral factors such as the consumption of psychoactive substances (caffeine, alcohol, nicotine), sleep deprivations and poor sleep hygiene. The study aimed to assess the prevalence of SP and determine the risk factors for the occurrence of SP in the population of Polish students. METHODS The study used a battery online consisting of a set of questionnaires 1) a personal questionnaire, 2) the SP-EPQ, 3) the PCL -5, 4) the STAI-T, 5) the PSWQ. The questionnaire was sent via Facebook to 4500 randomly selected students from different universities in Poland. The questionnaire was completed by 2598 students. To unify the participant sample, people over 35 were excluded from the study (45 students). Ultimately, data from 2553 students were analyzed. RESULTS A total of 33.14% of individuals experienced at least one episode of SP in their lives. The highest odds ratio for SP was associated with: the presence of three or more health problems (OR: 2.3; p = 0.002), the presence of any mental disorder (OR: 1.77; p = 0.002), including mood disorders (OR: 2.07; p = 0.002), suffering from at least one somatic disease (OR: 1.34; p = 0.002), a high level of anxiety as a constant personality trait (OR: 1.20; p = 0.035) and smoking (OR: 1.48; p = 0.0002), alcohol consumption (OR: 1.52; p < 0.0001), physical activity (OR: 1.31; p = 0.001). CONCLUSIONS The results of our research indicate that a large proportion of students experienced isolated sleep paralysis. Mental and somatic health problems and lifestyle factors were found to predispose individuals to this disorder. Due to the numerous risk factors for SP, it is necessary to conduct additional research to confirm the impact of these factors and to investigate the mechanisms of their influence on SP.
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Affiliation(s)
- Paulina Wróbel-Knybel
- I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Głuska 1 Street, 20-439, Lublin, Poland.
| | - Michał Flis
- grid.411484.c0000 0001 1033 7158I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Głuska 1 Street, 20-439 Lublin, Poland
| | - Joanna Rog
- grid.411484.c0000 0001 1033 7158I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Głuska 1 Street, 20-439 Lublin, Poland
| | - Baland Jalal
- grid.38142.3c000000041936754XDepartment of Psychology, Harvard University, 33 Kirkland St, Cambridge, MA 02138 USA ,grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Downing Street, Cambridge, CB2 3EB UK
| | - Hanna Karakuła-Juchnowicz
- grid.411484.c0000 0001 1033 7158I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Głuska 1 Street, 20-439 Lublin, Poland
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Um YH, Oh J, Kim SM, Kim TW, Seo HJ, Jeong JH, Hong SC. Differential characteristics of repeated polysomnography and multiple sleep latency test parameters in narcolepsy type 1 and type 2 patients: a longitudinal retrospective study. Sleep Breath 2021; 26:1939-1946. [PMID: 34820763 DOI: 10.1007/s11325-021-02525-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/27/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Narcolepsy is a chronic disorder and its phenotype is dichotomized into narcolepsy type 1 (NT1) and narcolepsy type 2 (NT2). The clinical course and pathophysiological mechanisms of these two clinical entities and their differences are not adequately defined. This study aimed to explore the differential longitudinal patterns of polysomnography (PSG) and multiple sleep latency test (MSLT) in NT1 and NT2. METHODS In this retrospective study demographic characteristics, PSG, and MSLT parameters at baseline and follow-up were compared between NT1 and NT2 patients. Patients with both follow-up MSLT and PSG were selected for sub-group analysis. Baseline and follow-up MSLT and PSG parameters were compared. RESULTS Of 55 patients with narcolepsy, mean follow-up periods were 7.4 ± 3.5 years for NT1 and 5.5 ± 2.9 for NT2. Demographic data showed increased body mass index and prevalence of sleep paralysis in NT1. Baseline PSG characteristics between NT1 and NT2 showed decreased sleep latency (p = 0.016) and REM latency (p = 0.046) in NT1 group when compared with NT2. Nocturnal SOREMP on PSG was more prevalent in NT1 (p = 0.017), and half of NT2 patients with nocturnal SOREMP on PSG changed their diagnoses to NT1. On follow-up PSG, NT1 displayed reductions in sleep stage N2 (p = 0.006) and N3 (p = 0.048), while wake after sleep onset (WASO) (p = 0.023) and apnea-hypopnea index (AHI) (p = 0.007) were significantly increased. CONCLUSION Differential MSLT and PSG characteristics of NT1 and NT2 in at baseline and follow-up indicate that NT1 and NT2 are distinct disease phenotypes, and that they present with a contrasting course of disease.
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Affiliation(s)
- Yoo Hyun Um
- Department of Psychiatry, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbu-daero, Paldal-guGyeonggi-do, Suwon-si, 16247, Republic of Korea
| | - Jihye Oh
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Min Kim
- Department of Psychiatry, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbu-daero, Paldal-guGyeonggi-do, Suwon-si, 16247, Republic of Korea
| | - Tae-Won Kim
- Department of Psychiatry, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbu-daero, Paldal-guGyeonggi-do, Suwon-si, 16247, Republic of Korea
| | - Ho-Jun Seo
- Department of Psychiatry, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbu-daero, Paldal-guGyeonggi-do, Suwon-si, 16247, Republic of Korea
| | - Jong-Hyun Jeong
- Department of Psychiatry, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbu-daero, Paldal-guGyeonggi-do, Suwon-si, 16247, Republic of Korea
| | - Seung-Chul Hong
- Department of Psychiatry, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93, Jungbu-daero, Paldal-guGyeonggi-do, Suwon-si, 16247, Republic of Korea.
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18
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Kliková M, Piorecký M, Miletínová E, Janků K, Dudysová DU, Bušková J. Objective REM sleep characteristics of recurrent isolated sleep paralysis: a case-control study. Sleep 2021; 44:6305144. [PMID: 34145456 DOI: 10.1093/sleep/zsab153] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/05/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Recurrent isolated sleep paralysis (RISP) is a rapid eye movement (REM) parasomnia characterized by a dissociative state with characteristics of REM sleep and wakefulness. Pathophysiology has not yet been clarified and very little research has been performed using objective polysomnographic measures with inconsistent results. The main aim of our study was to find whether higher REM sleep fragmentation is consistent with the theory of state dissociation or whether signs of dissociation can be detected by spectral analysis. METHODS Nineteen participants in the RISP group and 19 age- and gender-matched participants in the control group underwent two consecutive full-night video-polysomnography recordings with 19-channel electroencephalography. Apart from sleep macrostructure, other REM sleep characteristics such as REM arousal index, percentage of wakefulness and stage shifts within REM sleep period were analyzed, as well as power spectral analysis during REM sleep. RESULTS No difference was found in the macrostructural parameters of REM sleep (percentage of REM sleep and REM latency). Similarly, no significant difference was detected in REM sleep fragmentation (assessed by REM sleep arousal index, percentage of wakefulness and stage shifts within REM sleep). Power spectral analysis showed higher bifrontal beta activity in the RISP group during REM sleep. CONCLUSIONS The results showed an underlying persistent trait of higher cortical activity that may predispose patients with SP to be more likely to experience recurrent episodes, without any apparent macrostructural features including higher REM sleep fragmentation.
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Affiliation(s)
- Monika Kliková
- National Institute of Mental Health, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marek Piorecký
- National Institute of Mental Health, Klecany, Czech Republic.,Faculty of Biomedical Engineering, Czech Technical University, Prague, Czech Republic
| | - Eva Miletínová
- National Institute of Mental Health, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karolina Janků
- National Institute of Mental Health, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Daniela Urbaczka Dudysová
- National Institute of Mental Health, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jitka Bušková
- National Institute of Mental Health, Klecany, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Abstract
Nightmare disorder and recurrent isolated sleep paralysis are rapid eye movement (REM) parasomnias that cause significant distress to those who suffer from them. Nightmare disorder can cause insomnia due to fear of falling asleep through dread of nightmare occurrence. Hyperarousal and impaired fear extinction are involved in nightmare generation, as well as brain areas involved in emotion regulation. Nightmare disorder is particularly frequent in psychiatric disorders and posttraumatic stress disorder. Nonmedication treatment, in particular imagery rehearsal therapy, is especially effective. Isolated sleep paralysis is experienced at least once by up to 40% of the general population, whereas recurrence is less frequent. Isolated sleep paralysis can be accompanied by very intense and vivid hallucinations. Sleep paralysis represents a dissociated state, with persistence of REM atonia into wakefulness. Variations in circadian rhythm genes might be involved in their pathogenesis. Predisposing factors include sleep deprivation, irregular sleep-wake schedules, and jetlag. The most effective therapy consists of avoiding those factors.
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Affiliation(s)
- Ambra Stefani
- Department of Neurology, Medical University of Innsbruck (MUI), Anichstrasse 35, 6020, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck (MUI), Anichstrasse 35, 6020, Innsbruck, Austria.
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20
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Denis D, Poerio GL, Derveeuw S, Badini I, Gregory AM. Associations between exploding head syndrome and measures of sleep quality and experiences, dissociation, and well-being. Sleep 2018; 42:5245405. [DOI: 10.1093/sleep/zsy216] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Indexed: 02/07/2023] Open
Affiliation(s)
- Dan Denis
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Giulia L Poerio
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Sarah Derveeuw
- King’s College London, MRC Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Isabella Badini
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, London, UK
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