Are there gender differences in objective and subjective sleep measures? A study of insomniacs and healthy controls

It is well known that insomnia is more frequent in women than in men throughout all age groups. In this respect insomnia resembles other psychiatric disorders that occur more frequently in women such as anxiety and depressive disorders. Since insomnia is frequently a symptom of anxiety and depression, it remains an open question whether the comorbidity with psychiatric disorders fully explains the gender differences in the prevalence of insomnia or whether gender influences sleep independently from psychiatric conditions. We analyzed sleep measures of patients diagnosed with a primary insomnia (n=86) and of an age- and sex-matched healthy control group (n=86) by polysomnography; additionally, subjective rating scales were available for 70 patients and 54 controls matched for mean age and sex ratio. Surprisingly, none of the sleep continuity measures (sleep duration, sleep efficiency, arousal index, and wake%), nor slow wave or REM sleep % showed significant gender differences in both insomniacs and healthy controls. Also, subjective estimates of sleep quality were comparable in both sexes. As expected, insomniacs strongly differed from the control group in all subjective measures of sleep. Polysomnography showed significantly reduced sleep duration and efficiency, increased arousal index, and slightly, but significantly, less REM sleep in the insomniacs as compared to the healthy controls. These studies indicate that gender seems to have, if any, relatively little influence on sleep per se. We hypothesize that the clear gender differences in the prevalence of insomnia are caused predominantly by gender differences in the prevalence of anxiety and depression. Primary insomnia may be, at least in a part of the cases, a subclinical or subthreshold form of anxiety or depression.     

Is alexithymia related to negative symptoms of schizophrenia? A preliminary longitudinal study

BACKGROUND: Alexithymic features are close to anhedonia, blunted affect, and alogia that are also characteristics of the negative symptoms of schizophrenia. This study aimed to evaluate whether alexithymia is associated with negative symptoms and is related to the change of schizophrenic symptoms over time. SAMPLING AND METHODS: A consecutive sample of 29 schizophrenic outpatients was evaluated at baseline and at 3, 6, and 12 months during appropriate treatment. They completed the Positive and Negative Syndrome Scale, the Montgomery and Asberg Depression Rating Scale, the Global Assessment of Functioning Scale, and the 20-item Toronto Alexithymia Scale at any time points. RESULTS: The psychiatric scale scores showed significant symptom improvement over time but were unrelated to the alexithymia score that was instead stable over time. Hierarchical regression showed that the 20-item Toronto Alexithymia Scale at baseline was the sole predictor of alexithymia at 12 months, after controlling for psychopathology and psychological functioning. CONCLUSIONS: Alexithymia was unrelated to negative symptoms, suggesting it is an independent and separate construct from schizophrenia. As expected, the negative symptoms were associated instead with illness-related aspects of depression and psychosocial functioning. Caution should be expressed in generalization mainly because this study is limited by the small sample size.     

Do periodic arm movements during sleep exist in healthy subjects? A polysomnographic study

BackgroundDespite several polysomnographic studies on periodic leg movements (PLM) in healthy sleep, data on the prevalence and characteristics of periodic arm movements (PAM) in normal subjects are lacking. We aimed to investigate PAM and their association with PLM during wakefulness and sleep in healthy subjects.MethodsNinety-one participants underwent video-polysomnography according to American Academy of Sleep Medicine 2007 criteria. In addition to standard electromyographic registration, data for both flexor digitorum superficialis muscles were recorded.ResultsSixty-two subjects (68.1%) had a PAM index during wakefulness >5/h (median PAM index during wakefulness, 8.8/h; range, 0–77). Seven subjects (7.7%) had a PAM index >5/h during sleep (median PAM index during sleep, 0.7/h; range, 0–47.4). In 14% of cases, PAM during wakefulness were coincident with PLM during wakefulness. During sleep, this coincidence was not evident. The correlation between PAM and PLM was weak to moderate (during wakefulness: Spearman's ρ = 0.576, P < 0.001; during sleep: Spearman's ρ = 0.222, P = 0.036).ConclusionIn healthy subjects, PAM occur predominantly during wakefulness with no apparent true periodicity. In contrast to classical PLM, some PAM may not present a true periodic phenomenon, but rather random voluntary movements meeting the wide range of periodicity criteria for PLM.     

Are visual measures of mood superior to questionnaire measures in non–Western settings?

OBJECTIVE: We hypothesised that, in a non-Western setting where literacy was not universal, a visual measure (the FACES test) would be more valid than a traditional psychiatric questionnaire [the General Health Questionnaire (GHQ)] as a screening test for mood disorders. METHODS: The study was nested within a randomised controlled trial of 450 patients with a common mental disorder (CMD). Subjects were evaluated at 2, 6 and 12 months after enrolment with the Clinical Interview Standardised-Revised (CISR) (the gold standard), the GHQ5 (the shortened version of the GHQ-12) and the FACES test. RESULTS: Correlation coefficients and Receiver Operating Characteristic (ROC) curves show superiority of the GHQ5 in the detection of CMD based on the CISR, compared with the visual FACES test. Less-educated subjects had particular difficulty completing the FACES. The kappa coefficient of agreement between the two instruments, using the cut-off point for the GHQ5 estimated by the ROC curves, was between 0.70 and 0.75. CONCLUSIONS: Contrary to our hypothesis, the questionnaire-based measure was significantly superior to a visual measure of mood, especially for less-educated subjects. A short five-item version of the GHQ has a good discriminatory ability for CMD and may be used as a brief alternative to standardised interviews in clinical and survey settings.     

Are dyslexics' visual deficits limited to measures of dorsal stream function?

We tested the hypothesis that the differences in performance between developmental dyslexics and controls on visual tasks are specific for the detection of dynamic stimuli. We found that dyslexics were less sensitive than controls to coherent motion in dynamic random dot displays. However, their sensitivity to control measures of static visual form coherence was not significantly different from that of controls. This dissociation of dyslexics' performance on measures that are suggested to tap the sensitivity of different extrastriate visual areas provides evidence for an impairment specific to the detection of dynamic properties of global stimuli, perhaps resulting from selective deficits in dorsal stream functions.     

Are quantitative functional measures more sensitive to worsening MS than traditional measures?

The authors used data collected prospectively during a multicenter trial in 133 patients with secondary progressive MS to assess the relative sensitivity of quantitative functional tests and traditional measures, including the Expanded Disability Status Scale (EDSS) and Ambulation Index. Quantitative functional measures worsened in 69% of patients during an average of 6 months of observation, whereas the Clinical Global Impression of Change worsened in 33% and the EDSS worsened in 25% of patients. These changes should be interpreted in the context of the test-retest reliability for each measure.     

Does alexithymia expose to mental disorder symptoms in late adolescence? A 4-year follow-up study

ObjectiveTo investigate the possible causal link between alexithymia and the emergence of anxiety and depression symptoms, as well as alcohol consumption in a sample of late adolescents.MethodThe nonclinical sample comprised late adolescents (n= 315), including both females (n= 256) and males (n= 59). The follow-up period was 4 years, and at baseline, the mean age of the subjects was 19 years (range 17−21 years). Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20), depression symptoms with the short form of the Beck Depression Inventory (RBDI), anxiety with the State-Trait Anxiety Inventory (STAI) and alcohol consumption with the Alcohol Use Disorders Identification Test (AUDIT). The three TAS-20 subscales were assessed separately. Linear and cumulative logistic regression analyses were used for the evaluation of associations, and the analyses were adjusted with the corresponding baseline scores.ResultsThe TAS-20 total and subscale scores did not predict the RBDI or AUDIT scores at follow-up. However, the TAS-20 subscale “difficulty identifying feelings” was significantly associated with both STAI-State (P= .007) and STAI-Trait (P= .004) scores at follow-up.ConclusionsAlexithymic features may be individual predictors of later anxiety symptoms. The significant differences between the various dimensions of alexithymia should be considered in future studies.     

Are there subtypes of suicidal schizophrenia? A prospective study

BACKGROUND: Tragically, suicide is not uncommon in schizophrenia. The principal objective of this study was to examine possible subtypes of suicidal schizophrenic patients and identify their clinical and psychopathological profiles at long-term follow-up. METHOD: The study involved 62 patients diagnosed with schizophrenia according to ICD-10 criteria, who were consecutively admitted following a suicide attempt. Of these subjects, 47 (75.8%) could be re-evaluated after 1 year. Sociodemographic, general clinical, and psychopathological variables were evaluated. RESULTS: Two predominant subgroups were identified according to suicidal motivation: psychotic motivation and depressive motivation. At re-evaluation after 1 year, the depressive motivation subgroup showed higher depression and hopelessness scores. This subgroup also had greater educational level, age, and duration of illness, and more frequent existence of previous suicide attempts compared to the psychotic motivation subgroup. Of note in the psychotic motivation subgroup was the presence of hopelessness. The variables of educational level, duration of illness, and previous suicide attempts were the ones that best distinguished these subgroups. CONCLUSION: These findings reinforce the notion that meaningful subgroups occur among suicidal schizophrenic patients. The different psychopathological profiles of the two prominent subgroups suggest the need for a different management approach in each case. The identification of these profiles in both subtypes at long-term follow-up may facilitate their detection by clinicians and, therefore, foster the adoption of appropriate preventive measures against subsequent suicidal behavior.     

Does rapid eye movement sleep behavior disorder exist in psychiatric populations? A clinical and polysomnographic case–control study

ObjectivesRapid eye movement (REM) sleep behavior disorder (RBD) has been increasingly reported in patients with psychiatric disorders (pRBD). Although a close association with the usage of psychotropics has been postulated, it remains elusive whether psychotropics are the only causative factor of RBD symptoms in psychiatric populations. Moreover, there is limited literature documenting and quantifying the clinical and polysomnographic features in this population.MethodsA case–control study comparing the clinical and polysomnographic features of 31 pRBD patients with: (1) Age-, sex-, and psychiatric diagnoses-matched controls; and (2) Typical idiopathic RBD (tRBD) patients.ResultsDespite being prescribed with similar psychotropics, pRBD patients had more dream-enacting behaviors (p < 0.01), sleep-related injuries (p < 0.01), and nightmares (p < 0.01) than the psychiatric controls. pRBD patients were younger with more females, but they had comparable sleep-related injuries to tRBD. Both tRBD and pRBD had more REM-related muscle activity than controls (p < 0.01) and the effect remained significant after adjusting for age, gender, and use of antidepressants.ConclusionsOur study suggests that pRBD had comparable clinical features and consequences to those of tRBD. The occurrence of RBD symptoms in these patients may be related to a constellation of factors, including individual predisposition, depressive illness, antidepressants, and other clinical factors. Given the association of RBD and neurodegeneration in tRBD, further prospective follow-up of these patients is warranted.     

Is alexithymia linked with marital satisfaction or attachment to the partner? A study in a pregnancy cohort of parents-to-be

Objective

To investigate possible associations of alexithymia with marital satisfaction and mutual attachment between the partners in a group of parents-to-be during pregnancy.

Methods

The present study was conducted in a pregnancy cohort. Cross-sectional data were available for 151 mothers and 106 fathers, and altogether 102 couples. The 20-item Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia, the Index of Marital Satisfaction (IMS) to assess romantic relationship satisfaction and the Experiences in Close Relationships Scale (ECR) to evaluate attachment-related anxiety and avoidance. Kruskal–Wallis test was used for categorized variable comparisons. For continuous variables, Spearman correlation analyses and linear regression analyses were conducted.

Results

The TAS-20 total score, as well as, two of its dimensions, difficulties in identifying and describing feelings, were significantly correlated (p < 0.01) with both the IMS scores and the ECR anxiety and avoidance scores. In the regression analyses, the most significant predictive factor for the subjects' IMS scores was their partners' corresponding scores, although among fathers the IMS scores were partly explained by their own TAS-20 factor 1 scores (p = 0.004). The subjects' own TAS-20 scores explained the ECR anxiety and avoidance scores to a significant extent, but the fathers' TAS-20 factor 3 scores were also associated with the mothers' avoidance scores (p = 0.037).

Conclusion

Alexithymia was not directly related to marital satisfaction. However, alexithymia appears to have a significant effect on relationship-related anxiety and avoidance. This association should be further studied in parents and their offspring in a longitudinal setting.     

Effects of asthma on stability of Wisconsin card sorting test measures*☆ A twin study

BACKGROUND： The four measures used to assess the stability of the Wisconsin card sorting test （WCST）, that is, the number of preservative errors, percentage of preservative errors, number of categories completed, and the number of trials to complete the first category, reflect the function of the frontal lobe.
OBJECTIVE： This study was designed to investigate the effects of asthma on the stability of WCST measurements through the use of a twin study, and to analyze whether egg-type difference exists.
DESIGN： A cohort study.
SETTING： Mental Health Center, the First Affiliated Hospital of Chongqing Medical University.
PARTICIPANTS： Fifty-nine pairs of twins, aged 6-16 years, were primarily selected from schools between August 2005 and February 2007 and the WCST and Zygosity identification test was applied. Twins with achromatopsia, severe upper limb diseases, somatic diseases, or mental disorders were excluded. According to disease history of asthmatic attack, children were assigned into asthma （n = 16） and non-asthma （n = 43） groups.
METHODS： Four WCST measurements were determined in the 59 pairs of twins, and egg-type differences were identified in conjunction.
RESULTS： All 59 pairs of twins were included in the final analysis. Among the pairs of twins, 28 （48.5 %） were monozygotic twins, and 31 （52%） were dizygotic twins. Among the monozygotic and dizygotic twins, the number of preservative errors and percentage of preservative errors were significantly higher in the asthma group than in the non-asthma group （P 〈 0.05）. However, there was no significant difference of each corresponding measure between the monozygotic and dizygotic twins （P 〉 0.05）.
CONCLUSION： Asthma may affect the stability of WCST measures, but egg-type differences do not exist.     

Are nonpharmacological induced rewards related to anhedonia? A study among skydivers

It is well-known that persons with a drug addiction experience feelings of anhedonia during "normal" daily activities. It has been proposed that these symptoms of anhedonia are the result of direct pharmacological influences of drugs on the dopamine system. To test the assumption that nonpharmacological processes are also involved in anhedonia, we studied anhedonic symptoms in skydivers who regularly expose themselves to thrillful extreme sport activity and then experience intense hedonic feelings. A group of skydivers completed anhedonia scales and their scores were compared to a control group (a group of rowers). The main finding of the present study was that subjects who engage in the high-risk activity of skydiving, experienced more anhedonic symptoms than subjects who do not engage in such an extreme sport, but rather prefer a low-risk activity like rowing. This finding supports the notion that skydiving has similarities with addictive behaviors and that frequent exposure to "natural high" experiences is related to anhedonia. This suggests that the negative emotional state as observed in drug users may not be exclusively the results of exogenous psychopharmacological effects, but might also result from psychological mechanisms that are partly responsible for these anhedonic feelings.     

Are NREM sleep characteristics associated to subjective sleep complaints after mild traumatic brain injury?

IntroductionSleep complaints are common after mild traumatic brain injury (mTBI). While recent findings suggest that sleep macro-architecture is preserved in mTBI, features of non-rapid eye movement (NREM) sleep micro-architecture including electroencephalography (EEG) spectral power, slow waves (SW), and sleep spindles could be affected. This study aimed to compare NREM sleep in mTBI and healthy controls, and explore whether NREM sleep characteristics correlate with sleep complaints in these groups.MethodsThirty-four mTBI participants (mean age: 34.2 ± 11.9 yrs; post-injury delay: 10.5 ± 10.4 weeks) and 29 age-matched controls (mean age: 32.4 ± 8.2 yrs) were recruited for two consecutive nights of polysomnographic (PSG) recording. Spectral power was computed and SW and spindles were automatically detected in three derivations (F3, C3, O1) for the first three sleep cycles. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI).ResultsmTBI participants reported significant poorer sleep quality than controls on the PSQI and showed significant increases in beta power during NREM sleep at the occipital derivation only. Conversely, no group differences were found in SW and spindle characteristics. Interestingly, changes in NREM sleep characteristics were not associated with mTBI estimation of sleep quality.ConclusionsCompared to controls, mTBI were found to have enhanced NREM beta power. However, these changes were not found to be associated with the subjective evaluation of sleep. While increases in beta bands during NREM sleep may be attributable to the occurrence of a brain injury, they could also be related to the presence of pain and anxiety as suggested in one prior study.     

Do we really want more sleep? A population-based study evaluating the strength of desire for more sleep

OBJECTIVE: The sleep literature increasingly points to an apparent chronic sleep debt in the general population. We investigated this by examining perceived shortfalls in daily sleep, using more indirect questioning methods. METHODS: To determine perceived sleep deficits, 10,810 adults completed a simple questionnaire, which avoided leading questions and provided information on sleep length, daytime sleepiness, desired sleep length, a choice of attractive daytime activities in a "free hour", and "stressful lifestyle". From this we assessed whether deficits were reflected by increased daytime sleepiness or opting for more sleep when given attractive waking alternatives. Respondents were divided according to age and sex. RESULTS: Half of men and women seemed to desire more sleep, but this apparent sleep deficit was not correlated with daytime sleepiness, for any age or sex group. Irrespective of deficit, few people opted for sleep when given waking alternatives. "Stressful lifestyle" was independently related to this sleep deficit. CONCLUSION: Desiring more sleep may also be synonymous with a need for more "time out", as sleep deficit was unrelated to daytime sleepiness but rather related to "stressful lifestyle." Extra sleep may not be the only anodyne for sleep deficit.     

Are physicians aware of obstructive sleep apnea in children?

BACKGROUND AND PURPOSE: Childhood obstructive sleep apnea (OSA) affects 1-3% of preschool children. If left untreated, it can result in serious morbidity including growth retardation, cor pulmonale, and neurocognitive deficits, such as poor learning and behavioral problems. Early recognition and treatment is important to prevent morbidity and sequela and to provide better quality of life both for the child and his or her family members. The purpose of this study was to elucidate the knowledge and attitude physicians have about pediatric OSA, using the Obstructive Sleep Apnea Knowledge and Attitudes in Children (OSAKA-KIDS) questionnaire. PATIENTS AND METHODS: The first section of the OSAKA-KIDS questionnaire, which includes 18 items presented in a true-or-false format, was developed to assess the knowledge physicians have about pediatric OSA. The second section, including five items, was developed to assess attitudes and was measured on a five-point Likert scale ranging from 1 to 5. RESULTS: A total of 230 questionnaires were completed by physicians: 138 (60.3%) pediatricians, 70 (30.5%) general practitioners and 21 (9.2%) pulmonologists. The mean total knowledge score was 66.7%. The knowledge score positively correlated with having sub-specialty training (r=0.205, P=0.002) and negatively correlated with having a higher degree (r=-0.283, P<0.001). The mean total attitude score was 3.4. The knowledge score positively correlated with the attitude score (r=0.27, P<0.001). CONCLUSIONS: This study shows that among physicians there are deficits in knowledge about childhood OSA and its treatment. More focused educational programs are needed within medical schools and within pediatric residency and post-graduate training programs.     

Are alexithymia and depression distinct or overlapping constructs?: a study in a general population

The aim of this study was to investigate the relationship between alexithymia and depression in a general population sample (N = 1,888), as measured by the 20-item Toronto Alexithymia Scale (TAS-20) and the 21-item Beck Depression Inventory (BDI-21), using factor analysis. The items of the TAS-20 and the BDI-21 loaded on separate factors with only a minor overlap concerning physical worries. However, in a subset of subjects, who were both alexithymic and depressed, loadings were highly overlapping. These findings suggest that alexithymia and depression may be highly associated. Another conclusion might be that psychometric properties of the TAS should be further developed to make differentiation between alexithymia and depression possible.     

Are personality traits of juvenile myoclonic epilepsy related to frontal lobe dysfunctions? A proton MRS study

Purpose:   Personality traits characterized by emotional instability and immaturity, unsteadiness, lack of discipline, hedonism, frequent and rapid mood changes, and indifference toward one's disease have been associated with patients who have juvenile myoclonic epilepsy (JME). Literature data demonstrate worse seizure control and more psychosocial dysfunctions among patients with JME who have those traits. In this controlled study we performed a correlation analysis of psychiatric scores with magnetic resonance spectroscopy (MRS) values across JME patients, aiming to verify the existence of a possible relation between frontal lobe dysfunction and the prevalence of personality disorders (PDs) in JME.
Methods:   Sixteen JME patients with cluster B PDs, 41 JME patients without any psychiatric disorder, and 30 healthy controls were submitted to a psychiatric evaluation and to a quantitative multivoxel MRS of thalamus; insula; cingulate gyrus; striatum; and frontal, parietal, and occipital lobes. Groups were homogeneous according to age, gender, and manual dominance. Psychiatric evaluation was performed through the Scheduled Clinical Interview for DSM-IV, Axis I and II (SCID I and II, respectively).
Results:   A significant reduction of N -acetyl-aspartate over creatinine (NAA/Cr) ratio was observed mainly in the left frontal lobe in the JME and PD group. In addition, a significant increase in the glutamate–glutamine over creatinine GLX/Cr ratio was also observed in this referred region in the same group.
Discussion:   These data support the hypothesis that PDs in JME could represent neuronal dysfunction and possibly a more severe form of this epileptic syndrome.