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Aboaja AM, Dewa LH, Perry AE, Carey JF, Steele R, Abdelsamie A, Alhasan GTA, Sharma IS, Watson F, Cairney SA. Sleep interventions for adults admitted to psychiatric inpatient settings: A systematic scoping review. Sleep Med Rev 2024; 76:101950. [PMID: 38788520 DOI: 10.1016/j.smrv.2024.101950] [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: 12/15/2022] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024]
Abstract
Sleep disturbances are common, affecting over half of adults with a mental disorder. For those admitted to a psychiatric ward, difficulties with sleep, particularly insomnia, are compounded by factors relating to the inpatient setting. We conducted a scoping review of sleep intervention studies involving adults admitted to psychiatric settings. We categorised the different types of sleep interventions and identified the effects on sleep and other mental and physical health outcomes. Instruments used to measure sleep were also examined. The search strategy yielded 4780 studies, of which 28 met the inclusion criteria. There was evidence of more non-pharmacological than pharmacological interventions having been tested in inpatient settings. Results indicated that non-pharmacological interventions based on cognitive behaviour therapy for insomnia improve sleep and may improve mental and physical health. Several distinct sleep measures were used in the studies. Gaps in the literature were identified, highlighting the importance of research into a wider range of sleep interventions tested against robust controls, using validated measures of sleep with evaluation of additional mental and physical health outcomes among a large sample size of adults in the psychiatric inpatient settings.
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Affiliation(s)
- Anne M Aboaja
- Forensic Service, Tees, Esk and Wear Valleys NHS Foundation Trust, UK; Mental Health and Addictions Research Group, University of York, York, UK.
| | - Lindsay H Dewa
- School of Public Health, Imperial College London, London, UK; NIHR Imperial Biomedical Research Centre, London, UK
| | - Amanda E Perry
- Mental Health and Addictions Research Group, University of York, York, UK
| | - Jon F Carey
- Forensic Service, Tees, Esk and Wear Valleys NHS Foundation Trust, UK
| | - Rachel Steele
- Library and Information Services, Tees, Esk and Wear Valleys, NHS Foundation Trust, UK
| | - Ahmed Abdelsamie
- Forensic Service, Tees, Esk and Wear Valleys NHS Foundation Trust, UK
| | - Gies T A Alhasan
- Forensic Service, Tees, Esk and Wear Valleys NHS Foundation Trust, UK
| | - Ishwari S Sharma
- Forensic Service, Tees, Esk and Wear Valleys NHS Foundation Trust, UK
| | - Florence Watson
- Forensic Service, Tees, Esk and Wear Valleys NHS Foundation Trust, UK
| | - Scott A Cairney
- Department of Psychology, University of York, UK; York Biomedical Research Institute (YBRI), University of York, UK
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Lopes-Silva LB, Cunha DMG, Lima AC, Bioni VS, Gonçalves N, Kurita JPF, Wuo-Silva R, Silva RH. Sleep deprivation induces late deleterious effects in a pharmacological model of Parkinsonism. Exp Brain Res 2024:10.1007/s00221-024-06811-0. [PMID: 38499659 DOI: 10.1007/s00221-024-06811-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/18/2024] [Indexed: 03/20/2024]
Abstract
Parkinson's disease is a degenerative, chronic and progressive disease, characterized by motor dysfunctions. Patients also exhibit non-motor symptoms, such as affective and sleep disorders. Sleep disorders can potentiate clinical and neuropathological features and lead to worse prognosis. The goal of this study was to evaluate the effects of sleep deprivation (SD) in mice submitted to a progressive pharmacological model of Parkinsonism (chronic administration with a low dose of reserpine). Male Swiss mice received 20 injections of reserpine (0.1 mg/kg) or vehicle, on alternate days. SD was applied before or during reserpine treatment and was performed by gentle handling for 6 h per day for 10 consecutive days. Animals were submitted to motor and non-motor behavioral assessments and neurochemical evaluations. Locomotion was increased by SD and decreased by reserpine treatment. SD during treatment delayed the onset of catalepsy, but SD prior to treatment potentiated reserpine-induced catalepsy. Thus, although SD induced an apparent beneficial effect on motor parameters, a delayed deleterious effect on alterations induced by reserpine was found. In the object recognition test, both SD and reserpine treatment produced cognitive deficits. In addition, the association between SD and reserpine induced anhedonic-like behavior. Finally, an increase in oxidative stress was found in hippocampus of mice subjected to SD, and tyrosine hydroxylase immunoreactivity was reduced in substantia nigra of reserpine-treated animals. Results point to a possible late effect of SD, aggravating the deficits in mice submitted to the reserpine progressive model of PD.
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Affiliation(s)
- L B Lopes-Silva
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Universidade Federal de São Paulo (EPM/UNIFESP), Rua Botucatu, 862, Ed. Leal Prado, São Paulo, Brazil
| | - D M G Cunha
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Universidade Federal de São Paulo (EPM/UNIFESP), Rua Botucatu, 862, Ed. Leal Prado, São Paulo, Brazil
| | - A C Lima
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Universidade Federal de São Paulo (EPM/UNIFESP), Rua Botucatu, 862, Ed. Leal Prado, São Paulo, Brazil
| | - V S Bioni
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Universidade Federal de São Paulo (EPM/UNIFESP), Rua Botucatu, 862, Ed. Leal Prado, São Paulo, Brazil
| | - N Gonçalves
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Universidade Federal de São Paulo (EPM/UNIFESP), Rua Botucatu, 862, Ed. Leal Prado, São Paulo, Brazil
| | - J P F Kurita
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Universidade Federal de São Paulo (EPM/UNIFESP), Rua Botucatu, 862, Ed. Leal Prado, São Paulo, Brazil
| | - R Wuo-Silva
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Universidade Federal de São Paulo (EPM/UNIFESP), Rua Botucatu, 862, Ed. Leal Prado, São Paulo, Brazil
| | - R H Silva
- Behavioral Neuroscience Laboratory, Department of Pharmacology, Universidade Federal de São Paulo (EPM/UNIFESP), Rua Botucatu, 862, Ed. Leal Prado, São Paulo, Brazil.
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Wu Y, Li Z, Chen X, Wu S, Zhong X, Zheng A, Li L, Chen H, Li J, Lu Y, Chen J, Gan K. Assessing the causal associations of sleep apnea with mental health and socioeconomic status: a bidirectional two-sample Mendelian randomization. BMC Med Genomics 2024; 17:27. [PMID: 38254193 PMCID: PMC10804749 DOI: 10.1186/s12920-023-01783-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE Traditional observational research has suggested a connection between socioeconomic position, mental health, and sleep apnea (SA), but the specifics of this connection are still unclear. Using the Mendelian randomization approach, we intended to evaluate the potential causal link between mental health, socioeconomic status, and SA. METHODS Our research employed summary statistics data from large-scale genome-wide association studies (GWAS) on mental health, socioeconomic status, and SA. In the main study, the connection between mental health, socioeconomic status, and SA was examined using the inverse variance weighted approach. In addition, as a supplement, we also used other Mendelian randomization methods, including MR Egger, weighted median, simple mode, and weighted mode. RESULTS The primary analysis showed that educational attainment, including longer years of schooling, college or university degree, and higher intelligence was associated with a lower risk of SA (OR = 0.750, 95%CI = 0.653-0.862; OR = 0.558, 95%CI = 0.423-0.735; OR = 0.871, 95%CI = 0.760-0.999, respectively), while social deprivation was associated with a higher risk of SA (OR = 1.821, 95%CI = 1.075-3.085). And the income was not associated with the risk of sleep apnea (OR = 0.877, 95%CI = 0.682-1.129). In mental health exposure, major depressive disorder was associated with a higher risk of sleep apnea (OR = 1.196, 95%CI = 1.015-1.409), while attention-deficit hyperactivity disorder, bipolar disorder, and schizophrenia were not associated with the risk of sleep apnea (OR = 1.064, 95%CI = 0.958-1.181; OR = 1.030, 95%CI = 0.942-1.127; OR = 0.990, 95%CI = 0.957-1.025, respectively). Reverse MR analysis failed to find a causal effect from SA on mental health and socioeconomic status. CONCLUSIONS This MR investigation offers proof of a possible causal relationship between SA, socioeconomic level, and mental health.
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Affiliation(s)
- Yuan Wu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zuming Li
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xueru Chen
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Siyi Wu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xuemei Zhong
- Kashgar First People's Hospital, The Xinjiang Uygur Autonomous Region, Kashgar, China
| | - Aifang Zheng
- Kashgar First People's Hospital, The Xinjiang Uygur Autonomous Region, Kashgar, China
| | - Li Li
- Kashgar First People's Hospital, The Xinjiang Uygur Autonomous Region, Kashgar, China.
| | - Hai Chen
- The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.
| | - Jiqiang Li
- The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.
| | - Yue Lu
- The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.
| | - Jiankun Chen
- The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.
| | - Kao Gan
- The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.
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Wang Q, Hu S, Qi L, Wang X, Jin G, Wu D, Wang Y, Ren L. Causal associations between sleep traits and brain structure: a bidirectional Mendelian randomization study. BEHAVIORAL AND BRAIN FUNCTIONS : BBF 2023; 19:17. [PMID: 37784181 PMCID: PMC10544625 DOI: 10.1186/s12993-023-00220-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/28/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Emerging evidence suggests bidirectional causal relationships between sleep disturbance and psychiatric disorders, but the underlying mechanisms remain unclear. Understanding the bidirectional causality between sleep traits and brain imaging-derived phenotypes (IDPs) will help elucidate the mechanisms. Although previous studies have identified a range of structural differences in the brains of individuals with sleep disorders, it is still uncertain whether grey matter (GM) volume alterations precede or rather follow from the development of sleep disorders. RESULTS After Bonferroni correction, the forward MR analysis showed that insomnia complaint remained positively associated with the surface area (SA) of medial orbitofrontal cortex (β, 0.26; 95% CI, 0.15-0.37; P = 5.27 × 10-6). In the inverse MR analysis, higher global cortical SA predisposed individuals less prone to suffering insomnia complaint (OR, 0.89; 95%CI, 0.85-0.94; P = 1.51 × 10-5) and short sleep (≤ 6 h; OR, 0.98; 95%CI, 0.97-0.99; P = 1.51 × 10-5), while higher SA in posterior cingulate cortex resulted in a vulnerability to shorter sleep durations (β, - 0.09; 95%CI, - 0.13 to - 0.05; P = 1.21 × 10-5). CONCLUSIONS Sleep habits not only result from but also contribute to alterations in brain structure, which may shed light on the possible mechanisms linking sleep behaviours with neuropsychiatric disorders, and offer new strategies for prevention and intervention in psychiatric disorders and sleep disturbance.
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Affiliation(s)
- Qiao Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, NO.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Shimin Hu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, NO.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Neurological Disorders, Beijing, China
- Beijing Key Laboratory of Neuromodulation, Beijing, China
- Institute of Sleep and Consciousness Disorders, Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
| | - Lei Qi
- Department of Neurology, Xuanwu Hospital, Capital Medical University, NO.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Xiaopeng Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, NO.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Guangyuan Jin
- Department of Neurology, Xuanwu Hospital, Capital Medical University, NO.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Di Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, NO.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Yuke Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, NO.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Liankun Ren
- Department of Neurology, Xuanwu Hospital, Capital Medical University, NO.45 Changchun Street, Xicheng District, Beijing, China.
- National Center for Neurological Disorders, Beijing, China.
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Bonfils KA, Longenecker JM, Soreca I, Hammer LA, Tighe CA, Haas GL, Bramoweth AD. Sleep disorders in veterans with serious mental illnesses: prevalence in Veterans Affairs health record data. J Clin Sleep Med 2023; 19:1651-1660. [PMID: 37141001 PMCID: PMC10476039 DOI: 10.5664/jcsm.10630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/05/2023]
Abstract
STUDY OBJECTIVES This study aimed to estimate the 12-month prevalence of diagnosed sleep disorders among veterans with and without serious mental illnesses (SMI) in Veterans Affairs health record data in 2019. We also examined diagnosed sleep disorders across a 9-year period and explored associations with demographic and health factors. METHODS This study used health record data from VISN 4 of the Veterans Health Administration from 2011 to 2019. SMI diagnoses included schizophrenia and bipolar spectrum diagnoses as well as major depression with psychosis. Sleep diagnoses included insomnias, hypersomnias, sleep-related breathing disorders, circadian rhythm sleep-wake disorders, and sleep-related movement disorders. Demographic and health-related factors were also collected from the record. RESULTS In 2019, 21.8% of veterans with SMI were diagnosed with a sleep disorder. This is a significantly higher proportion than for veterans without SMI, 15.1% of whom were diagnosed with a sleep disorder. Sleep disorder rates were highest in veterans with a chart diagnosis of major depression with psychosis. From 2011 to 2019, the overall prevalence of sleep disorders in veterans with SMI more than doubled (10.2%-21.8%), suggesting improvements in the detection and diagnosis of sleep concerns for this group. CONCLUSIONS Our findings suggest that identification and diagnosis of sleep disorders for veterans with SMI has improved over the past decade, though diagnoses still likely underrepresent actual prevalence of clinically relevant sleep concerns. Sleep concerns may be at particularly high risk of going untreated in veterans with schizophrenia-spectrum disorders. CITATION Bonfils KA, Longenecker JM, Soreca I, et al. Sleep disorders in veterans with serious mental illnesses: prevalence in Veterans Affairs health record data. J Clin Sleep Med. 2023;19(9):1651-1660.
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Affiliation(s)
- Kelsey A. Bonfils
- School of Psychology, The University of Southern Mississippi, Hattiesburg, Mississippi
| | - Julia M. Longenecker
- VISN 4 Mental Illness Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Isabella Soreca
- VISN 4 Mental Illness Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Lillian A. Hammer
- School of Psychology, The University of Southern Mississippi, Hattiesburg, Mississippi
| | - Caitlan A. Tighe
- VISN 4 Mental Illness Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Gretchen L. Haas
- VISN 4 Mental Illness Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania and Department of Psychology, Dietrich School of Arts and Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adam D. Bramoweth
- VISN 4 Mental Illness Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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Wright CJ, Milosavljevic S, Pocivavsek A. The stress of losing sleep: Sex-specific neurobiological outcomes. Neurobiol Stress 2023; 24:100543. [PMID: 37252645 PMCID: PMC10209346 DOI: 10.1016/j.ynstr.2023.100543] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/20/2023] [Accepted: 05/06/2023] [Indexed: 05/31/2023] Open
Abstract
Sleep is a vital and evolutionarily conserved process, critical to daily functioning and homeostatic balance. Losing sleep is inherently stressful and leads to numerous detrimental physiological outcomes. Despite sleep disturbances affecting everyone, women and female rodents are often excluded or underrepresented in clinical and pre-clinical studies. Advancing our understanding of the role of biological sex in the responses to sleep loss stands to greatly improve our ability to understand and treat health consequences of insufficient sleep. As such, this review discusses sex differences in response to sleep deprivation, with a focus on the sympathetic nervous system stress response and activation of the hypothalamic-pituitary-adrenal (HPA) axis. We review sex differences in several stress-related consequences of sleep loss, including inflammation, learning and memory deficits, and mood related changes. Focusing on women's health, we discuss the effects of sleep deprivation during the peripartum period. In closing, we present neurobiological mechanisms, including the contribution of sex hormones, orexins, circadian timing systems, and astrocytic neuromodulation, that may underlie potential sex differences in sleep deprivation responses.
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Affiliation(s)
| | | | - Ana Pocivavsek
- Corresponding author. Pharmacology, Physiology, and Neuroscience, USC School of Medicine, Columbia, SC, 29208, USA.
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Marin L, Guàrdia A, González-Rodríguez A, Haba-Rubio J, Natividad M, Bosch E, Domínguez N, Monreal JA. Sleep Disturbances in At-Risk Mental States and First Episode of Psychosis: A Narrative Review on Interventions. Clocks Sleep 2023; 5:249-259. [PMID: 37218866 DOI: 10.3390/clockssleep5020020] [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: 11/17/2022] [Revised: 02/17/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023] Open
Abstract
Sleep disturbances are a common yet often overlooked symptom of psychosis that can drastically affect the quality of life and well-being of those living with the condition. Sleep disorders are common in people diagnosed with schizophrenia and have significant negative effects on the clinical course of the illness and the functional outcomes and quality of life of patients. There is a limited number of studies addressing this question in first-episode psychosis (FEP). In this narrative review, we aimed to provide an overview of sleep disorders in populations with FEP and at-risk mental states (ARMS). The review was focused on the various treatments currently used for sleep disorders, including both non-pharmacological and pharmacological treatments. A total of 48 studies were included. We found that sleep disturbances are associated with attenuated psychotic symptoms and other psychopathological symptoms in ARMSs. The association of sleep disturbances with the transition to psychosis has been poorly investigated. Sleep disturbances have an impact on the quality of life and the psychopathological symptoms of people suffering from FEP. The non-pharmacological treatments include cognitive behavioral therapy for insomnia, bright light therapy, cognitive restructuring techniques, sleep restriction therapy, basic sleep hygiene education, and the provision of portable sleep trackers. Other treatments include antipsychotics in acute phases and melatonin. The early intervention in sleep disturbances may improve overall prognosis in emerging psychosis populations.
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Affiliation(s)
- Lorena Marin
- Department of Mental Health, Mútua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, 08221 Terrassa, Spain
| | - Armand Guàrdia
- Department of Mental Health, Mútua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, 08221 Terrassa, Spain
| | - Alexandre González-Rodríguez
- Department of Mental Health, Mútua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, 08221 Terrassa, Spain
| | - José Haba-Rubio
- Centre for Investigation and Research in Sleep (CIRS), Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
| | - Mentxu Natividad
- Department of Mental Health, Mútua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, 08221 Terrassa, Spain
| | - Elena Bosch
- Department of Mental Health, Mútua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, 08221 Terrassa, Spain
| | - Noelia Domínguez
- Department of Mental Health, Mútua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, 08221 Terrassa, Spain
| | - José Antonio Monreal
- Department of Mental Health, Mútua Terrassa University Hospital, Fundació Docència I Recerca Mutua Terrassa, 08221 Terrassa, Spain
- Institut de Neurociències, UAB, CIBERSAM, 08221 Terrassa, Spain
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Brown NK, Roche JK, Farmer CB, Roberts RC. Evidence for upregulation of excitatory synaptic transmission in the substantia nigra in Schizophrenia: a postmortem ultrastructural study. J Neural Transm (Vienna) 2023; 130:561-573. [PMID: 36735096 DOI: 10.1007/s00702-023-02593-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/14/2023] [Indexed: 02/04/2023]
Abstract
The dopamine hypothesis of schizophrenia suggests that psychotic symptoms originate from dysregulation of dopaminergic activity, which may be controlled by upstream innervation. We hypothesized that we would find anatomical evidence for the hyperexcitability seen in the SN. We examined and quantified synaptic morphology, which correlates with function, in the postmortem substantia nigra (SN) from 15 schizophrenia and 12 normal subjects. Synapses were counted using stereological techniques and classified based on the morphology of the post-synaptic density (PSD) and the presence or absence of a presynaptic density. The density and proportion of excitatory synapses was higher in the schizophrenia group than in controls, while the proportion (but not density) of inhibitory synapses was lower. We also detected in the schizophrenia group an increase in density of synapses with a PSD of intermediate thickness, which may represent excitatory synapses. The density of synapses with presynaptic densities was similar in both groups. The density of synapses with mixed morphologies was higher in the schizophrenia group than in controls. The human SN contains atypical synaptic morphology. We found an excess amount and proportion of excitatory synapses in the SN in schizophrenia that could result in hyperactivity and drive the psychotic symptoms of schizophrenia. The sources of afferent excitatory inputs to the SN arise from the subthalamic nucleus, the pedunculopontine nucleus, and the ventral tegmental area (VTA), areas that could be the source of excess excitation. Synapses with mixed morphologies may represent inputs from the VTA, which release multiple transmitters.
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Affiliation(s)
- Nicole K Brown
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Sparks Center 835C, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Joy K Roche
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Sparks Center 835C, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Charlene B Farmer
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Sparks Center 835C, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Rosalinda C Roberts
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Sparks Center 835C, 1720 2nd Avenue South, Birmingham, AL, 35294, USA.
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Circadian functioning and quality of life in substance use disorder patients with and without comorbid schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2023; 120:110623. [PMID: 36029929 DOI: 10.1016/j.pnpbp.2022.110623] [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: 05/23/2022] [Revised: 08/10/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022]
Abstract
Sleep disturbances are strongly linked with mental diseases such as substance use disorder (SUD) or schizophrenia (SZ) which can have a detrimental impact on quality of life (QOL), especially when both disorders are comorbid (dual disorder). In absence of studies about both circadian characteristics and QOL in patients with SUD and comorbid SZ (SUD + SZ), we examined a sample of 155 male under treatment, 75 with SUD + SZ and 80 only with SUD. Circadian functioning was evaluated by chronotype, social jet-lag and sleep quality (using the Pittsburgh Sleep Quality Index, PSQI), while the QOL was obtained by the World Health Organization's Quality of Life Questionnaire (WHOQOL)-BREF. SUD + SZ patients were more evening type than SUD, and this chronotype was linked to polydrug use in total sample and SUD + SZ group. We observed that the comorbidity did not lead to worse sleep quality in the SUD and SUD + SZ patients. QOL was poorer in SUD + SZ patients, who showed a negative association of Physical health, Psychological health and Social relationship with suicide attempts and severity of SZ. Lastly, patients with worse QOL also reported poorer sleep quality suggesting that treatment could include circadian adjustments along with a focused approach to lifestyle improvement.
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Mijnster T, Boersma GJ, Meijer E, Lancel M. Effectivity of (Personalized) Cognitive Behavioral Therapy for Insomnia in Mental Health Populations and the Elderly: An Overview. J Pers Med 2022; 12:jpm12071070. [PMID: 35887566 PMCID: PMC9319701 DOI: 10.3390/jpm12071070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Insomnia is very prevalent in psychiatry and is considered a transdiagnostic symptom of mental disorders. Yet, it is not only a consequence of a mental condition but may also exert detrimental effects on psychiatric symptom severity and therapeutic response; thus, adequate insomnia treatment is particularly important in psychiatric populations. The first choice of intervention is cognitive behavioral therapy for insomnia (CBT-I) as it is rather effective, also in the long run without side effects. It is offered in various forms, ranging from in-person therapy to internet-delivered applications. CBT-I protocols are typically developed for individuals with insomnia disorder without co-occurring conditions. For an optimal therapeutic outcome of CBT-I in individuals with comorbid mental disorders, adaptations of the protocol to tailor the treatment might be beneficial. Based on a literature search using major search engines (Embase; Medline; APA Psych Info; and Cochrane Reviews), this paper provides an overview of the effectiveness of the different CBT-I applications in individuals with diverse comorbid mental conditions and older adults and describes the functionality of CBT-I protocols that have been personalized to specific psychiatric populations, such as depression, substance abuse, and schizophrenia spectrum disorder. Finally, we discuss urgent needs for insomnia therapy targeted to improve both sleep and psychopathologies.
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Affiliation(s)
- Teus Mijnster
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands; (T.M.); (G.J.B.); (E.M.)
| | - Gretha J. Boersma
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands; (T.M.); (G.J.B.); (E.M.)
- Forensic Psychiatric Hospital, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands
| | - Esther Meijer
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands; (T.M.); (G.J.B.); (E.M.)
| | - Marike Lancel
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands; (T.M.); (G.J.B.); (E.M.)
- Forensic Psychiatric Hospital, GGZ Drenthe, Mental Health Institute, 9404 LA Assen, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, 9712 TS Groningen, The Netherlands
- Correspondence:
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Klingaman EA, Lucksted A, Crosby ES, Hack SM, Peeples AD, Blank Y, Schwartz E. How do US military veterans with serious mental illness manage insomnia? A phenomenological analysis. J Sleep Res 2022; 31:e13570. [PMID: 35319123 DOI: 10.1111/jsr.13570] [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: 11/07/2021] [Revised: 01/20/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022]
Abstract
Insomnia is a prevalent experience for individuals with serious mental illness, and is one of the most common reasons for mental health referrals in the Veterans Health Administration. Insomnia also critically impacts psychiatric, cognitive and somatic outcomes. However, there is limited information about how people with serious mental illness (i.e. schizophrenia spectrum, bipolar, or major depressive disorders, with serious functional impairments) understand and respond to problems with their own sleep. Bringing this information to light will yield novel methods of research and treatment. The purpose of this study was to examine reactions to insomnia among veterans with serious mental illness and insomnia. An inductive phenomenological approach was used to collect data from 20 veterans with serious mental illness and insomnia using semi-structured interviews. Six themes were identified: Becoming Aware that Insomnia is a Problem; Response to and Dissatisfaction with Medications; Strategies to Get Better Sleep: Contrary to Usual Guidelines; Personal Responsibility for Getting Sleep; Resigned and Giving Up; and Acceptance and Persistence. These results provide insight into the process of identifying insomnia and the subsequent cognitive and behavioural responses that are used to manage sleep disturbances among veterans with serious mental illness, a group often excluded from gold-standard treatments for chronic insomnia. Clinical implications and recommendations for improving treatment efficacy are discussed.
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Affiliation(s)
- Elizabeth A Klingaman
- VA Capitol Health Care Network Mental Illness Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA.,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alicia Lucksted
- VA Capitol Health Care Network Mental Illness Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA.,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Eric S Crosby
- VA Capitol Health Care Network Mental Illness Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA
| | - Samantha M Hack
- VA Capitol Health Care Network Mental Illness Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA.,School of Social Work, University of Maryland, Baltimore, Maryland, USA
| | - Amanda D Peeples
- VA Capitol Health Care Network Mental Illness Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA.,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Yelena Blank
- Palo Alto VA Healthcare System, Palo Alto, California, USA
| | - Elana Schwartz
- VA Capitol Health Care Network Mental Illness Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA
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12
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Fekih-Romdhane F, Hallit S, Cheour M, Jahrami H. The nature, consequences, mechanisms, and management of sleep disturbances in individuals at-risk for psychosis. Front Psychiatry 2022; 13:1011963. [PMID: 36203842 PMCID: PMC9530454 DOI: 10.3389/fpsyt.2022.1011963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/05/2022] [Indexed: 11/26/2022] Open
Abstract
There is strong evidence that sleep disturbances are commonly experienced by people with psychosis. Evidence has also shown that sleep disturbances are present since the very early stages of the disease, even during the pre-diagnostic phase. More recently, research involving young individuals at ultra-high risk (UHR) for psychosis documented frequent occurrence of sleep disturbances in this group. The very early onset of sleep disturbances in the course of psychosis has drawn attention to the possible links between sleep parameters and the risk of psychosis. To date, the nature of sleep disturbances characterizing the UHR stage remains unclear, with available studies having yielded mixed findings. In this regard, we performed this review to update the body of literature on the nature of sleep disturbances, their underlying mechanisms, their clinical and functional consequences, the prevention and intervention strategies in the at-risk for psychosis population. Our findings provided further support to the presence of disturbed sleep in UHR individuals as evidenced by subjective and objective sleep measures such as polysomnography, sleep electroencephalograms, and actigraphy. Reviewing the possible mechanisms underlying the relationship between sleep and psychosis emphasized its complex and multifactorial nature which is yet to be determined and understood. Further research is warranted to determine which facets of sleep disturbances are most detrimental to this specific population, and to what extent they can be causal factors or markers of psychosis.
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Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry Ibn Omrane, Razi Hospital, Tunis, Tunisia
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon.,Psychology Department, College of Humanities, Effat University, Jeddah, Saudi Arabia.,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Majda Cheour
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry Ibn Omrane, Razi Hospital, Tunis, Tunisia
| | - Haitham Jahrami
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.,Department of Psychiatry, Ministry of Health, Manama, Bahrain
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13
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The Impact of Sleep on Neurocognition and Functioning in Schizophrenia—Is It Time to Wake-Up? JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2022; 7. [PMID: 35224206 PMCID: PMC8880843 DOI: 10.20900/jpbs.20220001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
People with schizophrenia (SZ) display substantial neurocognitive deficits that have been implicated as major contributors to poor daily functioning and disability. Previous reports have identified a number of predictors of poor neurocognition in SZ including demographics, symptoms, and treatment adherence, as well as body mass index, aerobic fitness, and exercise activity. However, the putative impact of sleep has received relatively limited consideration, despite sleep disturbances, which are pervasive in this population, resulting in symptoms that are strikingly similar to the neurocognitive deficits commonly observed in SZ. Here we argue for the consideration of the impact of sleep on neurocognition in people with SZ and propose recommendations for future research to elucidate the links between sleep parameters, neurocognition and daily functioning.
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14
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Griffiths C, Hina F. Prisoner's insomnia prevalence, insomnia associated factors and interventions with sleep as an outcome: a review and narrative analysis. Int J Prison Health 2021; 18:27-42. [PMID: 34219430 DOI: 10.1108/ijph-01-2021-0014] [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: 11/17/2022]
Abstract
PURPOSE Insomnia is highly prevalent in prisoners. The purpose of this paper is a review of research evidence on interventions with sleep as an outcome (2000 to 2020) and rates of insomnia prevalence and associated factors in prisons (2015 to 2020). DESIGN/METHODOLOGY/APPROACH An internet-based search used Medline, PubMed, PsycINFO (EBSCOhost), Embase, Web of Science and Scopus. Seven interventions and eight sleep prevalence or sleep-associated factor papers were identified. FINDINGS Intervention research was very limited and the quality of the research design was generally poor. Interventions such as cognitive behavioural therapy for insomnia (CBT-I), yoga and mindfulness can be beneficial in a prison setting. This review identified a high prevalence of insomnia in prisons across the world, which was supported by recent evidence. Factors associated with insomnia include anxiety, depression, post-traumatic stress disorder, personality disorder and pain. RESEARCH LIMITATIONS/IMPLICATIONS There is a need for appropriately powered randomised control trials of CBT-I in prisons and a need to use objective measures of sleep quality. ORIGINALITY/VALUE Due to a lack of an up-to-date review, this paper fulfils the need for a review of the evidence on interventions in prison settings with sleep as an outcome, rates of insomnia prevalence and associated factors in prisons.
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Affiliation(s)
- Chris Griffiths
- Department of Innovation and Research, Northamptonshire Healthcare NHS Foundation Trust, Northampton, UK
| | - Farah Hina
- Department of Innovation and Research, Northamptonshire Healthcare NHS Foundation Trust, Northampton, UK
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15
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Zhang W, Sun Q, Chen B, Basta M, Xu C, Li Y. Insomnia symptoms are associated with metabolic syndrome in patients with severe psychiatric disorders. Sleep Med 2021; 83:168-174. [PMID: 34022493 DOI: 10.1016/j.sleep.2021.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/17/2021] [Accepted: 03/26/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine the relationship between insomnia symptoms and metabolic syndrome in patients with severe psychiatric disorders. METHODS We conducted a cross-sectional study including 272 inpatients (mean age: 34.06 ± 11.52 years, 67.3% males) with severe psychiatric disorders consecutively admitted in Shantou University Mental Health Center Inpatient Department. All patients underwent a psychiatric evaluation. Insomnia symptoms were assessed by the Pittsburgh Sleep Quality Index (PSQI) and defined present if PSQI>7. The diagnosis of metabolic syndrome was defined using the new International Diabetes Federation definition based on clinical and laboratory evaluation. RESULTS Among the 272 patients, 94 (34.6%) presented insomnia symptoms. Overall, patients with insomnia symptoms had significantly higher percentage of metabolic syndrome (23.4% vs. 12.4%, p = 0.019) and hypertriglyceridemia (30.9% vs. 19.1%, p = 0.029), and marginally significantly higher levels of fasting insulin (58.75 ± 37.22 pmol/L vs. 51.72 ± 34.09 pmol/L, p = 0.050), homeostasis model assessment of insulin resistance (1.83 ± 1.31 vs. 1.62 ± 1.25, p = 0.055) and percentage of insulin resistance (55.3% vs. 44.4%, p = 0.086) compared to those without insomnia symptoms. Multiple logistic regressions showed that patients with insomnia symptoms had significantly higher odds for metabolic syndrome [odds ratio (OR) = 2.99, 95% confidence interval (CI) = 1.25-7.14], central obesity (OR = 3.02, 95% CI = 1.18-7.76), hypertriglyceridemia (OR = 2.46, 95% CI = 1.28-4.76) and marginally significantly higher odds for insulin resistance (OR = 1.68, 95% CI = 0.93-3.02) after controlling for potential confounders. CONCLUSIONS Within severely mentally ill patients, insomnia symptoms are associated with metabolic syndrome and insulin resistance. It appears that insomnia symptoms are independent clinical indicators of underlying metabolic syndrome in patients with severe psychiatric disorders.
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Affiliation(s)
- Wenjuan Zhang
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou, Guangdong, China; Sleep Medicine Center, Shantou University Medical College, Shantou, Guangdong, China
| | - Qimeng Sun
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou, Guangdong, China; Sleep Medicine Center, Shantou University Medical College, Shantou, Guangdong, China
| | - Baixin Chen
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou, Guangdong, China; Sleep Medicine Center, Shantou University Medical College, Shantou, Guangdong, China
| | - Maria Basta
- Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Chongtao Xu
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou, Guangdong, China; Sleep Medicine Center, Shantou University Medical College, Shantou, Guangdong, China
| | - Yun Li
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou, Guangdong, China; Sleep Medicine Center, Shantou University Medical College, Shantou, Guangdong, China.
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16
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Savage CLG, Orth RD, Jacome AM, Bennett ME, Blanchard JJ. "Assessing the Psychometric Properties of the PROMIS Sleep Measures in Persons with Psychosis.". Sleep 2021; 44:6292152. [PMID: 34086964 DOI: 10.1093/sleep/zsab140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/28/2021] [Indexed: 11/14/2022] Open
Abstract
An accumulation of research has indicated that persons with psychotic disorders experience a variety of sleep disturbances. However, few studies have examined the psychometric properties of sleep assessments that are utilized in this population. We conducted two studies to examine the reliability and validity of the PROMISTM Sleep Disturbance and Sleep-Related Impairment scales in outpatient samples of persons with psychosis. In Study 1, we examined the internal consistency and convergent validity of the PROMIS sleep scales in individuals with various psychotic disorders (N = 98) and healthy controls (N = 22). The PROMIS sleep scales showed acceptable internal consistency and convergent validity in both healthy controls and individuals with psychotic disorders. In addition, replicating prior research, the PROMIS scales identified greater sleep disturbance and sleep-related impairment in participants with psychotic disorders compared to healthy controls. In Study 2, we examined the test-retest reliability (M = 358 days) of the PROMIS sleep scales in a subset (N = 37) of persons with psychotic disorders who previously participated in Study 1. We also assessed the relation between these self-report measures and actigraph sleep parameters. The results showed that PROMIS sleep measures demonstrated modest temporal stability in the current sample. Contrary to our hypothesis, there was a lack of correspondence between these scales and actigraph sleep parameters. Overall, these findings indicate that the PROMIS sleep scales are psychometrically sound measures for populations with psychosis and highlight the importance of utilizing a multi-method approach to assess sleep.
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Affiliation(s)
| | - Ryan D Orth
- Department of Psychology, University of Maryland, College Park, Maryland, USA
| | - Anyela M Jacome
- Department of Psychology, University of Maryland, College Park, Maryland, USA
| | - Melanie E Bennett
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jack J Blanchard
- Department of Psychology, University of Maryland, College Park, Maryland, USA
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17
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Rentschler KM, Baratta AM, Ditty AL, Wagner NTJ, Wright CJ, Milosavljevic S, Mong JA, Pocivavsek A. Prenatal Kynurenine Elevation Elicits Sex-Dependent Changes in Sleep and Arousal During Adulthood: Implications for Psychotic Disorders. Schizophr Bull 2021; 47:1320-1330. [PMID: 33823027 PMCID: PMC8379538 DOI: 10.1093/schbul/sbab029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Dysregulation of the kynurenine pathway (KP) of tryptophan catabolism has been implicated in psychotic disorders, including schizophrenia and bipolar disorder. Kynurenic acid (KYNA) is a KP metabolite synthesized by kynurenine aminotransferases (KATs) from its biological precursor kynurenine and acts as an endogenous antagonist of N-methyl-D-aspartate and α7-nicotinic acetylcholine receptors. Elevated KYNA levels found in postmortem brain tissue and cerebrospinal fluid of patients are hypothesized to play a key role in the etiology of cognitive symptoms observed in psychotic disorders. Sleep plays an important role in memory consolidation, and sleep disturbances are common among patients. Yet, little is known about the effect of altered KP metabolism on sleep-wake behavior. We presently utilized a well-established experimental paradigm of embryonic kynurenine (EKyn) exposure wherein pregnant dams are fed a diet laced with kynurenine the last week of gestation and hypothesized disrupted sleep-wake behavior in adult offspring. We examined sleep behavior in adult male and female offspring using electroencephalogram and electromyogram telemetry and determined sex differences in sleep and arousal in EKyn offspring. EKyn males displayed reduced rapid eye movement sleep, while female EKyn offspring were hyperaroused compared to controls. We determined that EKyn males maintain elevated brain KYNA levels, while KYNA levels were unchanged in EKyn females, yet the activity levels of KAT I and KAT II were reduced. Our findings indicate that elevated prenatal kynurenine exposure elicits sex-specific changes in sleep-wake behavior, arousal, and KP metabolism.
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Affiliation(s)
- Katherine M Rentschler
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | | | - Audrey L Ditty
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Nathan T J Wagner
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Courtney J Wright
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Snezana Milosavljevic
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Jessica A Mong
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ana Pocivavsek
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, SC, USA,To whom correspondence should be addressed; tel: (803) 216–3509, fax: 803-216-3538, e-mail:
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18
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Maiti R, Mishra BR, Jena M, Mishra A, Nath S. Effect of Haloperidol and Risperidone on Serum Melatonin and GAP-43 in Patients with Schizophrenia: A Prospective Cohort Study. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2021; 19:125-134. [PMID: 33508796 PMCID: PMC7851459 DOI: 10.9758/cpn.2021.19.1.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/06/2020] [Accepted: 09/07/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Serum melatonin, a biomarker of circadian rhythm, can upregulate Growth-associated protein 43 (GAP-43) which is involved in neural regeneration and plasticity. The present study was conducted to investigate the adequacy of the first-line antipsychotic drugs to improve sleep and circadian rhythm disruptions by assessing the effect of haloperidol and risperidone on serum melatonin and GAP-43 in schizophrenia. METHODS In this cohort study, 100 schizophrenic patients were recruited, and clinical evaluations were done using the Positive and Negative Syndrome Scale (PANSS) and the Pittsburgh sleep quality index (PSQI). The patients with predominantly positive symptoms taking haloperidol (Group I) and patients with predominantly negative symptoms taking risperidone (Group II) were admitted and serum melatonin, arylalkylamine N-acetyltransferase, GAP-43 and urinary melatonin were estimated. After 8 weeks, all clinical and biochemical parameters were repeated. RESULTS Serum melatonin (2:00 hours) was significantly decreased in both haloperidol (2.42; 95% confidence interval [95% CI]: 0.67-4.17; p = 0.008) and risperidone group (3.40; 95% CI: 0.54-6.25; p = 0.021). Urinary melatonin was significantly decreased in both haloperidol (p = 0.005) and risperidone group (p = 0.014). PSQI score was significantly increased in both haloperidol (p = 0.001) and risperidone group (p = 0.003). Serum GAP-43 was significantly decreased in both haloperidol and risperidone group (p < 0.001). PANSS decreased significantly in both the groups and there was a significant negative correlation between serum melatonin at 2:00 hours and PANSS (r = -0.5) at baseline. CONCLUSION Monotherapy with haloperidol and risperidone can achieve symptomatic improvement but cannot improve sleep and circadian rhythm disturbances in schizophrenia.
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Affiliation(s)
- Rituparna Maiti
- Departments of Pharmacology, All India Institute of Medical Sciences (AIIMS), Odisha, India
| | - Biswa Ranjan Mishra
- Departments of Psychiatry, All India Institute of Medical Sciences (AIIMS), Odisha, India
| | - Monalisa Jena
- Departments of Pharmacology, All India Institute of Medical Sciences (AIIMS), Odisha, India
| | - Archana Mishra
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Santanu Nath
- Departments of Psychiatry, All India Institute of Medical Sciences (AIIMS), Odisha, India
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19
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Szaulińska K, Wichniak A. BMI-NECK: A simple assessment of risk of obstructive sleep apnea in schizophrenia. J Psychiatr Res 2020; 125:33-37. [PMID: 32203737 DOI: 10.1016/j.jpsychires.2020.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION A high risk of obstructive sleep apnea (OSA) has been reported in patients with schizophrenia. However, existing screening questionnaires for OSA haven't been validated in this population and the impact of OSA on schizophrenia symptoms has rarely been studied. This study aimed to investigate the prevalence and impact of OSA in patients with schizophrenia and validate the existing OSA screening scales. METHOD Patients with schizophrenia consecutively admitted to hospital (n = 51) and patients with schizophrenia and obesity (n = 31) were compared to healthy controls (n = 51). Apnea risk was measured with STOP-BANG, NoSAS, No-Apnea, and the Berlin Questionnaire; psychiatric symptoms were measured with the PANSS and Calgary scales and B-CATS battery. Daytime sleepiness was measured with the Epworth sleepiness scale. OSA was diagnosed using the Embletta system. RESULTS OSA was found more frequently in obese schizophrenia patients than in those consecutively admitted to hospital (45% vs. 22%, p < 0.05). Significant differences between patients with and without OSA were found on the PANSS negative symptoms subscale, B-CATS digit symbol test, and in daytime sleepiness. None of the used screening scales showed satisfactory sensitivity and specificity. Obesity with coexisting neck circumference ≥41 cm in women or ≥43 cm in men (BMI-NECK model) predicted OSA in 57% of cases. CONCLUSIONS OSA should be screened in patients with schizophrenia as it has a negative influence on psychiatric symptoms and may contribute to the higher mortality of these patients. Assessment of BMI and neck circumference proves a good screening test in ambulatory contexts.
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Affiliation(s)
- Katarzyna Szaulińska
- Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Prevention and Treatment of Addictions, Institute of Psychiatry and Neurology, Warsaw, Poland.
| | - Adam Wichniak
- Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland; Sleep Medicine Center, Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland.
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20
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Solomonova E, MacKinnon AL, Gold I, Robins S, Wunderlich S, Feeley N, Hayton B, Libman E, Zelkowitz P. Disordered sleep is related to delusional ideation and depression during the perinatal period. Sleep Health 2020; 6:179-184. [DOI: 10.1016/j.sleh.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/13/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
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21
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Blanchard JJ, Andrea A, Orth RD, Savage C, Bennett ME. Sleep disturbance and sleep-related impairment in psychotic disorders are related to both positive and negative symptoms. Psychiatry Res 2020; 286:112857. [PMID: 32087449 PMCID: PMC7416463 DOI: 10.1016/j.psychres.2020.112857] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 02/06/2020] [Indexed: 12/17/2022]
Abstract
A large literature indicates that sleep disturbances are associated with paranoia and other positive symptoms in psychotic disorders. However, few studies have examined the potential association between sleep disturbances and negative symptoms and the results have been inconsistent. The current study examined the hypothesis that sleep problems would be associated with more severe positive and negative symptoms in a transdiagnostic sample of individuals with psychosis (N = 90). Further, we examined whether sleep would be related to negative symptoms above and beyond the contribution of paranoia, other positive symptoms, and depression-anxiety. Results replicated prior research in finding that both sleep disturbance and sleep-related impairment were related to more severe paranoia, other positive symptoms and depression-anxiety. Consistent with our hypothesis, more severe sleep disturbance and sleep-related impairment were related to greater negative symptoms; this was evident across both motivation-pleasure deficits and diminished expression. Sleep variables remained significantly related to motivation-pleasure deficits even after controlling for other non-negative symptoms. These results indicate the broad symptom impact of sleep disturbances and may suggest a novel treatment target to improve negative symptoms.
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Affiliation(s)
- Jack J Blanchard
- Department of Psychology, University of Maryland, College Park, MD 20742, USA.
| | - Alexandra Andrea
- Department of Psychology, University of Maryland, College Park, MD 20742, USA
| | - Ryan D Orth
- Department of Psychology, University of Maryland, College Park, MD 20742, USA
| | - Christina Savage
- Department of Psychology, University of Maryland, College Park, MD 20742, USA
| | - Melanie E Bennett
- Department of Psychiatry, University of Maryland School of Medicine, 737 W. Lombard Street, Suite 551 Baltimore, MD 21201, USA; Department of Psychiatry, Baltimore VA Medical Center, 10 North Greene Street, Baltimore, MD 21201, USA
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22
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Chen MH, Korenic SA, Wickwire EM, Wijtenburg SA, Hong LE, Rowland LM. Sex Differences in Subjective Sleep Quality Patterns in Schizophrenia. Behav Sleep Med 2020; 18:668-679. [PMID: 31462084 PMCID: PMC7047560 DOI: 10.1080/15402002.2019.1660168] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE/BACKGROUND Sleep dysfunction is prevalent among patients with schizophrenia. Although sex differences have been identified in schizophrenia, sex differences in sleep patterns among patients with schizophrenia are not established. Therefore, the current study examined sex differences in subjective sleep quality patterns in people with schizophrenia utilizing a standardized inventory. PARTICIPANTS Study sample consisted of 75 patients with schizophrenia and 82 healthy controls (HC). METHODS Participants completed the Pittsburgh Sleep Quality Index (PSQI). RESULTS Compared to HC, patients with schizophrenia were more likely to report being poor sleepers (PSQI global score > 5), longer sleep duration, more sleep disturbances, longer sleep onset latency, increased daytime dysfunction due to poor sleep, and more frequent use of sleep medications. Regarding sex differences, female patients were more likely to report being poor sleepers and endorsed more sleep disturbances than female HC, while male patients reported longer sleep duration, more daytime dysfunction, and poorer overall sleep quality relative to male HC. Additionally, higher level of sleep dysfunction was linked to higher symptom severity in male patients only. CONCLUSIONS Patients with schizophrenia endorsed a range of sleep difficulties, and male and female patients with schizophrenia differ compared to their HC counterparts. Implications for treatment of sleep complaints among patients with schizophrenia are discussed.
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Affiliation(s)
- Michelle H. Chen
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, , Catonsville, MD, USA
| | - Stephanie A. Korenic
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, , Catonsville, MD, USA
| | - Emerson M. Wickwire
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA,Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S. Andrea Wijtenburg
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, , Catonsville, MD, USA
| | - L. Elliot Hong
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, , Catonsville, MD, USA
| | - Laura M. Rowland
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, , Catonsville, MD, USA,Corresponding Author: Laura M. Rowland. Address: Maryland Psychiatric Research Center, Tawes Building, Catonsville, MD 21228, USA. Phone: 410-402-6803.
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23
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Blanchard JJ, Savage CLG, Orth RD, Jacome AM, Bennett ME. Sleep Problems and Social Impairment in Psychosis: A Transdiagnostic Study Examining Multiple Social Domains. Front Psychiatry 2020; 11:486. [PMID: 32547433 PMCID: PMC7270336 DOI: 10.3389/fpsyt.2020.00486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/12/2020] [Indexed: 12/11/2022] Open
Abstract
Psychotic disorders are characterized by profound social impairment. An accumulation of research has explored the contribution of symptoms, cognitive functioning, and behavioral skills deficits to this social dysfunction. Recent research indicates that sleep disturbance has significant social implications in nonclinical populations-this research suggests that sleep problems may also be relevant to understanding social impairment in psychosis. This study adopted a symptom-oriented dimensional approach to examine how sleep disturbance and sleep-related impairment are related to multiple social domains within a transdiagnostic sample (N = 90). This sample included individuals with a variety of psychotic disorders (n = 75) along with healthy non-clinical participants (n = 15) to ensure sampling across the full range of sleep problems and social functioning. Social domains spanned self-reported perceptions of social relationships, social functioning in the community, and behavioral assessments of social competence. We hypothesized that greater sleep disturbance and sleep-related impairment would be associated with more negative or problematic perceptions of social relationships (i.e., less social support, less companionship, and greater distress), poorer social functioning in the community, smaller social networks, and poorer behavioral ratings of social competency. Results supported these hypotheses indicating that sleep disturbance and sleep-related impairment have widespread deleterious impacts on perceptions of social relationships, social functioning, and competence. Sleep disturbance retained associations with perceptions of social relationships, social functioning, and social competence even after controlling for total symptoms or cognitive functioning. These findings indicate that sleep problems may have important implications for fully understanding the causes of social impairment in psychosis.
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Affiliation(s)
- Jack J Blanchard
- Department of Psychology, University of Maryland, College Park, College Park, MD, United States
| | - Christina L G Savage
- Department of Psychology, University of Maryland, College Park, College Park, MD, United States
| | - Ryan D Orth
- Department of Psychology, University of Maryland, College Park, College Park, MD, United States
| | - Anyela M Jacome
- Department of Psychology, University of Maryland, College Park, College Park, MD, United States
| | - Melanie E Bennett
- Department of Psychiatry, University of Maryland, Baltimore, Baltimore, MD, United States.,Department of Psychiatry, Baltimore VA Medical Center, Baltimore, MD, United States
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Sleep therapeutics and neuropsychiatric illness. Neuropsychopharmacology 2020; 45:166-175. [PMID: 31376815 PMCID: PMC6879486 DOI: 10.1038/s41386-019-0474-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/23/2019] [Accepted: 07/30/2019] [Indexed: 11/08/2022]
Abstract
Alterations in sleep are extremely common in patients with neuropsychiatric illness. In addition, sleep disorders such as insomnia, obstructive sleep apnea, rapid eye movement sleep behavior disorder, and circadian rhythm disorders commonly occur at a rate greater than the general population in neuropsychiatric conditions. Historically, sleep problems have been viewed as symptoms of associated neuropsychiatric disorders. However, there is increasing evidence suggesting a complex inter-relationship with possible bidirectional causality. The inter-relatedness of these conditions represents an opportunity for understanding mechanisms and improving clinical treatment. To the extent that sleep problems affect neuropsychiatric conditions, it may be possible to address sleep problems and have a positive impact on the course of neuropsychiatric illnesses. Further, some treatments for sleep disorders have direct effects on neuropsychiatric illnesses that may be unrelated to their effects on sleep disorders. Similarly, neuropsychiatric conditions and their treatments can affect sleep and sleep disorders. This article reviews available evidence on the effects of therapies for sleep disorders on neuropsychiatric conditions and also secondarily considers the impacts of therapies for neuropsychiatric conditions on sleep. Primary goals of this review are to identify gaps in current research, to determine the extent to which the cross-therapeutic effects of these treatments help to elucidate therapeutic or pathological mechanisms, and to assist clinicians in optimizing therapeutic choice in patients with sleep disorders and neuropsychiatric conditions.
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Korenic SA, Klingaman EA, Wickwire EM, Gaston FE, Chen H, Wijtenburg SA, Rowland LM. Sleep quality is related to brain glutamate and symptom severity in schizophrenia. J Psychiatr Res 2020; 120:14-20. [PMID: 31610406 DOI: 10.1016/j.jpsychires.2019.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 12/29/2022]
Abstract
Up to 80% of patients with schizophrenia experience sleep disturbances, which negatively impact daytime functioning. Given that the glutamatergic system is involved in the pathophysiology of schizophrenia as well as normal sleep-wake neurobiology, the current project aimed to determine whether sleep quality was related to brain glutamate levels in schizophrenia. The Pittsburgh Sleep Quality Index (PSQI) was used to assess subjective sleep quality and proton magnetic resonance spectroscopy (MRS) was used to quantify glutamate in the bilateral anterior cingulate, left parietal cortex, and left hippocampus. Results indicate that global PSQI scores were negatively correlated with the anterior cingulate and parietal glutamate levels. In patients with schizophrenia, poorer sleep quality correlated with greater positive symptom severity. Our findings suggest that poor sleep quality is related to greater positive symptom severity and lower levels of anterior cingulate glutamate in individuals with schizophrenia. Interventions to enhance sleep quality may prove beneficial for patients. Future studies will examine whether glutamate relates to objective measures of sleep quality, and whether glutamate may mediate the relationship between sleep quality and symptom severity across the schizophrenia-spectrum.
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Affiliation(s)
- Stephanie A Korenic
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Elizabeth A Klingaman
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA; VISN 5 Mental Illness Research, Education, and Clinical Center (MIRECC), VA Capitol Health Care Network (VISN 5), Baltimore, MD, USA
| | - Emerson M Wickwire
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA; Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Frank E Gaston
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hongji Chen
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Andrea Wijtenburg
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laura M Rowland
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
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Klingaman EA, Lucksted A, Crosby ES, Blank Y, Schwartz E. A phenomenological inquiry into the experience of sleep: Perspectives of US military veterans with insomnia and serious mental illness. J Sleep Res 2019; 28:e12833. [PMID: 30891868 DOI: 10.1111/jsr.12833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/27/2018] [Accepted: 01/10/2019] [Indexed: 12/20/2022]
Abstract
The majority of people with serious mental illness experience insomnia, and insomnia is one of the most frequent reasons for mental health referrals in the Veterans Health Administration. Insomnia also represents a critical obstacle to mental health recovery. Little is known about how military veterans with mental health problems conceptualize their sleep and sleep problems; such information may uncover new avenues for research and treatment. Therefore, the purpose of this study was to explore how veterans with serious mental illness and insomnia experience and understand their sleep, towards the aim of identifying these new avenues. Participants included 20 veterans with insomnia and serious mental illness (i.e. schizophrenia spectrum, bipolar or major depressive disorders, with serious functional impairments). Data were collected via an inductive phenomenological approach using semi-structured interviews. We identified five themes: Sleep to Recharge; Sleep as a Fight; Sleep as Safety or Escape; Sleep as Dangerous; and Military Influence. Participants' relationship with sleep was complex; many associated it with intrusive and troubling hallucinations, paranoia and military experiences, yet at the same time desired sleep for its potential to liberate them from distress. Military mindsets both helped and hindered sleep. These results extend existing models of insomnia development and maintenance, and illuminate phenomena previously unidentified in this underserved veteran population. Clinical and theoretical implications are discussed, as well as new research directions for enhancing therapeutic efficacy.
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Affiliation(s)
- Elizabeth A Klingaman
- VA Capitol Health Care Network Mental Illness Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA.,Department of Psychiatry, School of Medicine, University of Maryland, College Park, Maryland, USA
| | - Alicia Lucksted
- VA Capitol Health Care Network Mental Illness Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA.,Department of Psychiatry, School of Medicine, University of Maryland, College Park, Maryland, USA
| | - Eric S Crosby
- VA Capitol Health Care Network Mental Illness Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA
| | - Yelena Blank
- Palo Alto VA Health Care System, Palo Alto, California, USA
| | - Elana Schwartz
- VA Capitol Health Care Network Mental Illness Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA
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Rowland LM, Wickwire EM. A Wake-up Call: Assess and Treat Sleep Disorders in Early Psychosis. Schizophr Bull 2019; 45:265-266. [PMID: 30561739 PMCID: PMC6403060 DOI: 10.1093/schbul/sby187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Laura M Rowland
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD,To whom correspondence should be addressed; Maryland Psychiatric Research Center, PO Box 21247, Baltimore, MD 21228; tel: 410-402-6803, fax: 410-402-6077, e-mail:
| | - Emerson M Wickwire
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD,Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
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Corona CC, Zhang M, Wadhawan A, Daue ML, Groer MW, Dagdag A, Lowry CA, Hoisington AJ, Ryan KA, Stiller JW, Fuchs D, Mitchell BD, Postolache TT. Toxoplasma gondii IgG associations with sleep-wake problems, sleep duration and timing. Pteridines 2019; 30:1-9. [PMID: 30918422 PMCID: PMC6433149 DOI: 10.1515/pteridines-2019-0001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Evidence links Toxoplasmagondii (T. gondii), a neurotropic parasite, with schizophrenia, mood disorders and suicidal behavior, all of which are associated and exacerbated by disrupted sleep. Moreover, low-grade immune activation and dopaminergic overstimulation, which are consequences of T. gondii infection, could alter sleep patterns and duration. Methods: Sleep data on 833 Amish participants [mean age (SD) = 44.28 (16.99) years; 59.06% women] were obtained via self-reported questionnaires that assessed sleep problems, duration and timing. T. gondii IgG was measured with ELISA. Data were analyzed using multivariable logistic regressions and linear mixed models, with adjustment for age, sex and family structure. Results: T. gondii seropositives reported less sleep problems (p < 0.005) and less daytime problems due to poor sleep (p < 0.005). Higher T. gondii titers were associated with longer sleep duration (p < 0.05), earlier bedtime (p< 0.005) earlier mid-sleep time (p < 0.05). Conclusions: It seems unlikely that sleep mediates the previously reported associations between T. gondii and mental illness. Future longitudinal studies with objective measures are necessary to replicate our findings.
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Affiliation(s)
- Celine C Corona
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Man Zhang
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimers, MD 21201, USA
| | - Abhishek Wadhawan
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA, Saint Elizabeths Hospital, Psychiatry Residency Program, Washington, DC 20032, USA
| | - Melanie L Daue
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimers, MD 21201, USA, Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA, Geriatrics Research and Education Clinical Center, Veteran Affairs Medical Center, Baltimore, MD 21201, USA
| | - Maureen W Groer
- College of Nursing, University of South Florida College of Nursing, Tampa, FL 33612, USA
| | - Aline Dagdag
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA, Psychiatry Adult Inpatient & Behavioral Health, University of Maryland Medical Center, Baltimore, MD 21201, USA
| | - Christopher A Lowry
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA; Department of Physical Medicine and Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO80045, USA, Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran. Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO80 045, USA
| | - Andrew J Hoisington
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran. Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO80 045, USA, Department of Systems Engineering and Management, Air Force Institute of Technology, Wright-Patterson AFB, OH 45433, USA
| | - Kathleen A Ryan
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimers, Md 21201, USA, Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - John W Stiller
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA, Saint Elizabeths Hospital, Department of Neurology, Washington DC 20032, USA; Maryland State Athletic Commission, Baltimore, MD 21202, USA
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter, Innsbruck Medical University, Innsbruck, Austria
| | - Braxton D Mitchell
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimers, MD 21201, USA, Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA, Geriatrics Research and Education Clinical Center, Veteran Affairs Medical Center, Baltimore, MD 21201, USA
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Winsky-Sommerer R, de Oliveira P, Loomis S, Wafford K, Dijk DJ, Gilmour G. Disturbances of sleep quality, timing and structure and their relationship with other neuropsychiatric symptoms in Alzheimer’s disease and schizophrenia: Insights from studies in patient populations and animal models. Neurosci Biobehav Rev 2019; 97:112-137. [DOI: 10.1016/j.neubiorev.2018.09.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 08/31/2018] [Accepted: 09/30/2018] [Indexed: 02/06/2023]
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Boksa P, Joober R. Who should be "controls" in studies on the neurobiology of psychiatric disorders? J Psychiatry Neurosci 2018; 43. [PMID: 30125246 PMCID: PMC6158024 DOI: 10.1503/jpn.180128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Patricia Boksa
- From the Douglas Mental Health University Institute, Dept. of Psychiatry, McGill University, Montreal, Que., Canada
| | - Ridha Joober
- From the Douglas Mental Health University Institute, Dept. of Psychiatry, McGill University, Montreal, Que., Canada
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Hennig T, Lincoln TM. Sleeping Paranoia Away? An Actigraphy and Experience-Sampling Study with Adolescents. Child Psychiatry Hum Dev 2018; 49:63-72. [PMID: 28451897 DOI: 10.1007/s10578-017-0729-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Paranoid symptoms co-occur with distress and poor functioning and constitute a risk for psychosis and other mental disorders. Poor sleep is known to be associated with paranoid symptoms, but the direction of the effect and the mediating factors have not been studied thoroughly. In an experience-sampling study, 61 adolescents wore an actigraph over eight nights and also rated their sleep, symptoms of paranoia, and potentially mediating factors. Shorter sleep time and more dreaming predicted paranoid symptoms in multilevel regression models. Paranoid symptoms did not significantly predict sleep parameters. Positive and negative affect partially mediated the effect of sleep time on paranoid symptoms. The effects were small, but encourage further research that might then be used to improve the prevention of paranoid symptoms.
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Affiliation(s)
- Timo Hennig
- Faculty of Psychology and Human Movement Science, Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany.
| | - Tania M Lincoln
- Faculty of Psychology and Human Movement Science, Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany
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Meng Q, Li R, Hou F, Zhang Q. Effects of chlorpromazine on sleep quality, clinical and emotional measures among patients with schizophrenia. Clin Neurol Neurosurg 2018; 165:134-138. [DOI: 10.1016/j.clineuro.2018.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 12/14/2017] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
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Pocivavsek A, Rowland LM. Basic Neuroscience Illuminates Causal Relationship Between Sleep and Memory: Translating to Schizophrenia. Schizophr Bull 2018; 44:7-14. [PMID: 29136236 PMCID: PMC5768044 DOI: 10.1093/schbul/sbx151] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with schizophrenia are often plagued by sleep disturbances that can exacerbate the illness, including potentiating psychosis and cognitive impairments. Cognitive dysfunction is a core feature of schizophrenia with learning and memory being particularly impaired. Sleep disruptions often accompanying the illness and may be key mechanism that contribute to these core dysfunctions. In this special translational neuroscience feature, we highlight the role of sleep in mediating cognitive function, with a special focus on learning and memory. By defining dysfunctional sleep architecture and rhythms in schizophrenia, we focus on the disarray of mechanisms critical to learning and memory and postulate an association between sleep disturbances and cognitive impairments in the disorder. Lastly, we review preclinical models of schizophrenia and highlight exciting translational research that may lead to new therapeutic approaches to alleviating sleep disturbances and effectively improving cognitive function in schizophrenia.
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Affiliation(s)
- Ana Pocivavsek
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Laura M Rowland
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
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Izuhara M, Matsuda H, Saito A, Hayashida M, Miura S, Oh-Nishi A, Azis IA, Abdullah RA, Tsuchie K, Araki T, Ryousuke A, Kanayama M, Hashioka S, Wake R, Miyaoka T, Horiguchi J. Cognitive Behavioral Therapy for Insomnia as Adjunctive Therapy to Antipsychotics in Schizophrenia: A Case Report. Front Psychiatry 2018; 9:260. [PMID: 29946274 PMCID: PMC6005892 DOI: 10.3389/fpsyt.2018.00260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/25/2018] [Indexed: 11/13/2022] Open
Abstract
The authors present the case of a 38-year-old man with schizophrenia and with severe insomnia, who attempted suicide twice during oral drug therapy with risperidone. The patient slept barely 2 or 3 h per night, and he frequently took half days off from work due to excessive daytime sleepiness. As a maladaptive behavior to insomnia, he progressively spent more time lying in bed without sleeping, and he repeatedly thought about his memories, which were reconstructed from his hallucinations. His relatives and friends frequently noticed that his memories were not correct. Consequently, the patient did not trust his memory, and he began to think that the hallucinations controlled his life. During his insomniac state, he did not take antipsychotic drugs regularly because of his irregular meal schedule due to his excessive daytime sleepiness. The authors started cognitive behavioral therapy for insomnia (CBT-i) with aripiprazole long acting injection (LAI). CBT-i is needed to be tailored to the patient's specific problems, as this case showed that the patient maladaptively use chlorpromazine as a painkiller, and he exercised in the middle of the night because he believed he can fall asleep soon after the exercise. During his CBT-i course, he learned how to evaluate and control his sleep. The patient, who originally wanted to be short sleeper, began to understand that adequate amounts of sleep would contribute to his quality of life. He finally stopped taking chlorpromazine and benzodiazepine as sleeping drugs while taking suvorexant 20 mg. Through CBT-i, he came to understand that poor sleep worsened his hallucinations, and consequently made his life miserable. He understood that good sleep eased his hallucinations, ameliorated his daytime sleepiness and improved his concentration during working hours. Thus, he was able to improve his self-esteem and self-efficacy by controlling his sleep. In this case report, the authors suggest that CBT-i can be an effective therapy for schizophrenia patients with insomnia to the same extent of other psychiatric and non-psychiatric patients.
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Affiliation(s)
- Muneto Izuhara
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Hiroyuki Matsuda
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Ami Saito
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Maiko Hayashida
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Syoko Miura
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Arata Oh-Nishi
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | | | | | - Keiko Tsuchie
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Tomoko Araki
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Arauchi Ryousuke
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Misako Kanayama
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Sadayuki Hashioka
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Rei Wake
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Tsuyoshi Miyaoka
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Jun Horiguchi
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
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Ma XR, Song GR, Xu XB, Tian T, Chang SH. The Prevalence of Sleep Disturbance and Its Socio-demographic and Clinical Correlates in First-episode Individuals With Schizophrenia in Rural China. Perspect Psychiatr Care 2018; 54:31-38. [PMID: 27861956 DOI: 10.1111/ppc.12197] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/13/2016] [Accepted: 10/12/2016] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study aimed to determine the prevalence and the socio-demographic and clinical correlates of sleep disturbance in first-episode individuals with schizophrenia in rural China and the factors that impact sleep among individuals with schizophrenia. DESIGN AND METHODS A total of 104 first-episode individuals with schizophrenia were randomly selected in rural areas in Ningxia, China, in 2015 as the study sample. FINDINGS In first-episode individuals with schizophrenia, the prevalence of sleep disturbance was 78.8% (82/104). Sleep disturbance was significantly associated with economic status, living situation, educational level, depressive symptoms, and anxiety symptoms. PRACTICE IMPLICATIONS Sleep disturbance is common in first-episode individuals with schizophrenia in rural China and more attention should be paid in clinical practice to improve the sleep quality for individuals with schizophrenia.
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Affiliation(s)
- Xin-Rong Ma
- Xin-Rong Ma, MD, is an Associate Consultant Psychiatrist, Ningxia Mental Health Center, Ningxia Ning-An Hospital, Yinchuan, Ningxia Province, China
| | - Guang-Rong Song
- Guang-Rong Song, MD, is a Consultant Physician, Ningxia Mental Health Center, Ningxia Ning-An Hospital, Yinchuan, Ningxia Province, China
| | - Xue-Bing Xu
- Xue-Bing Xu, MD, is a Consultant Psychiatrist, Ningxia Mental Health Center, Ningxia Ning-An Hospital, Yinchuan, Ningxia Province, China
| | - Tao Tian
- Tao Tian, MD, is an Associate Consultant Psychiatrist, Ningxia Mental Health Center, Ningxia Ning-An Hospital, Yinchuan, Ningxia Province, China
| | - Shao-Hua Chang
- Shao-Hua Chang, MD, is an Associate Consultant Psychiatrist, Ningxia Mental Health Center, Ningxia Ning-An Hospital, Yinchuan, Ningxia Province, China
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Kang SG, Lee YJ, Park YM, Kim L, Lee HJ. Haplotype Association of the MAP2K5 Gene with Antipsychotics-Induced Symptoms of Restless Legs Syndrome among Patients with Schizophrenia. Psychiatry Investig 2018; 15:84-89. [PMID: 29422930 PMCID: PMC5795036 DOI: 10.4306/pi.2018.15.1.84] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/21/2017] [Accepted: 04/09/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Restless legs syndrome (RLS) is considered a genetic disease and, following a genome-wide association study conducted in 2007, the mitogen-activated protein kinase 5 (MAP2K5) gene has been regarded as the promising candidate gene for RLS. The present study investigated whether polymorphisms of MAP2K5 are associated with antipsychotics-induced RLS in schizophrenia. METHODS We assessed antipsychotics-induced RLS symptoms in 190 Korean schizophrenic patients using the diagnostic criteria of the International Restless Legs Syndrome Study Group. Five single-nucleotide polymorphisms (SNPs) of MAP2K5 were genotyped. We investigated genetic and haplotypic associations of these five SNPs with the risk of antipsychotics-induced RLS symptoms. RESULTS We divided the 190 subjects into 2 groups: 1) those with RLS symptoms (n=96) and 2) those without RLS symptoms (n=94). There were no significant intergroup differences in the distributions of the genotypes and alleles of the rs1026732, rs11635424, rs12593813, rs4489954, and rs3784709 SNPs. However, the haplotype analysis showed that the G-G-G-G-T (rs1026732-rs11635424-rs12593813-rs4489954-rs3784709) haplotype was associated with RLS symptoms (permutation p=0.033). CONCLUSION These data suggest that a haplotype of MAP2K5 polymorphisms confers increased susceptibility to antipsychotics-induced RLS symptoms in schizophrenic patients.
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Affiliation(s)
- Seung-Gul Kang
- Department of Psychiatry, Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Min Park
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Leen Kim
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
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Ahmad Z, Moustafa YW, Stiller JW, Pavlovich MA, Raheja UK, Gragnoli C, Snitker S, Nazem S, Dagdag A, Fang B, Fuchs D, Lowry CA, Postolache TT. Sleep onset insomnia, daytime sleepiness and sleep duration in relationship to Toxoplasma gondii IgG seropositivity and serointensity. Pteridines 2017; 28:195-204. [PMID: 29657364 PMCID: PMC5894504 DOI: 10.1515/pterid-2017-0010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Toxoplasma gondii (T. gondii) infects central nervous tissue and is kept in relative dormancy by a healthy immune system. Sleep disturbances have been found to precipitate mental illness, suicidal behavior and car accidents, which have been previously linked to T. gondii as well. We speculated that if sleep disruption, particularly insomnia, would mediate, at least partly, the link between T. gondii infection and related behavioral dysregulation, then we would be able to identify significant associations between sleep disruption and T. gondii. The mechanisms for such an association may involve dopamine (DA) production by T. gondii, or collateral effects of immune activation necessary to keep T. gondii in check. Sleep questionnaires from 2031 Old Order Amish were analyzed in relationship to T. gondii-IgG antibodies measured by enzyme-linked immunosorbent assay (ELISA). Toxoplasma gondii seropositivity and serointensity were not associated with any of the sleep latency variables or Epworth Sleepiness Scale (ESS). A secondary analysis identified, after adjustment for age group, a statistical trend toward shorter sleep duration in seropositive men (p = 0.07). In conclusion, it is unlikely that sleep disruption mediates links between T. gondii and mental illness or behavioral dysregulation. Trending gender differences in associations between T. gondii and shorter sleep need further investigation.
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Affiliation(s)
- Zaki Ahmad
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Yara W. Moustafa
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA; and Saint Elizabeths’ Hospital, Psychiatry Residency Training Program, Washington, DC, USA
| | - John W. Stiller
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA; Saint Elizabeths’ Hospital, Department of Neurology, Washington, DC, USA; and Maryland State Athletic Commission, Baltimore, MD, USA
| | - Mary A. Pavlovich
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Uttam K. Raheja
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA; and Child and Adolescent Psychiatry Residency Program, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Claudia Gragnoli
- Division of Endocrinology, Translational Medicine, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA; Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; and Molecular Biology Laboratory, Bios Biotech Multi Diagnostic Health Center, Rome, Italy
| | - Soren Snitker
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sarra Nazem
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, USA; Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; and Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Aline Dagdag
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Beverly Fang
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter, Innsbruck Medical University, Innsbruck, Austria
| | - Christopher A. Lowry
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA; Department of Physical Medicine and Rehabilitation and Center for Neuroscience, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; and Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Denver, CO, USA
| | - Teodor T. Postolache
- Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA; Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Denver, CO, USA; and Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, MD, USA
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Sundararajan T, Manzardo AM, Butler MG. Functional analysis of schizophrenia genes using GeneAnalytics program and integrated databases. Gene 2017; 641:25-34. [PMID: 29032150 DOI: 10.1016/j.gene.2017.10.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/06/2017] [Accepted: 10/11/2017] [Indexed: 12/14/2022]
Abstract
Schizophrenia (SCZ) is a chronic debilitating neuropsychiatric disorder with multiple risk factors involving numerous complex genetic influences. We examined and updated a master list of clinically relevant and susceptibility genes associated with SCZ reported in the literature and genomic databases dedicated to gene discovery for characterization of SCZ genes. We used the commercially available GeneAnalytics computer-based gene analysis program and integrated genomic databases to create a molecular profile of the updated list of 608 SCZ genes to model their impact in select categories (tissues and cells, diseases, pathways, biological processes, molecular functions, phenotypes and compounds) using specialized GeneAnalytics algorithms. Genes for schizophrenia were predominantly expressed in the cerebellum, cerebral cortex, medulla oblongata, thalamus and hypothalamus. Psychiatric/behavioral disorders incorporating SCZ genes included ADHD, bipolar disorder, autism spectrum disorder and alcohol dependence as well as cancer, Alzheimer's and Parkinson's disease, sleep disturbances and inflammation. Function based analysis of major biological pathways and mechanisms associated with SCZ genes identified glutaminergic receptors (e.g., GRIA1, GRIN2, GRIK4, GRM5), serotonergic receptors (e.g., HTR2A, HTR2C), GABAergic receptors (e.g., GABRA1, GABRB2), dopaminergic receptors (e.g., DRD1, DRD2), calcium-related channels (e.g., CACNA1H, CACNA1B), solute transporters (e.g., SLC1A1, SLC6A2) and for neurodevelopment (e.g., ADCY1, MEF2C, NOTCH2, SHANK3). Biological mechanisms involving synaptic transmission, regulation of membrane potential and transmembrane ion transport were identified as leading molecular functions associated with SCZ genes. Our approach to interrogate SCZ genes and their interactions at various levels has increased our knowledge and insight into the disease process possibly opening new avenues for therapeutic intervention.
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Affiliation(s)
- Tharani Sundararajan
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS, United States
| | - Ann M Manzardo
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS, United States
| | - Merlin G Butler
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS, United States; Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, United States.
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Kantojärvi K, Liuhanen J, Saarenpää-Heikkilä O, Satomaa AL, Kylliäinen A, Pölkki P, Jaatela J, Toivola A, Milani L, Himanen SL, Porkka-Heiskanen T, Paavonen J, Paunio T. Variants in calcium voltage-gated channel subunit Alpha1 C-gene (CACNA1C) are associated with sleep latency in infants. PLoS One 2017; 12:e0180652. [PMID: 28792954 PMCID: PMC5549883 DOI: 10.1371/journal.pone.0180652] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/19/2017] [Indexed: 12/12/2022] Open
Abstract
Genetic variants in CACNA1C (calcium voltage-gated channel subunit alpha1 C) are associated with bipolar disorder and schizophrenia where sleep disturbances are common. In an experimental model, Cacna1c has been found to modulate the electrophysiological architecture of sleep. There are strong genetic influences for consolidation of sleep in infancy, but only a few studies have thus far researched the genetic factors underlying the process. We hypothesized that genetic variants in CACNA1C affect the regulation of sleep in early development. Seven variants that were earlier associated (genome-wide significantly) with psychiatric disorders at CACNA1C were selected for analyses. The study sample consists of 1086 infants (520 girls and 566 boys) from the Finnish CHILD-SLEEP birth cohort (genotyped by Illumina Infinium PsychArray BeadChip). Sleep length, latency, and nightly awakenings were reported by the parents of the infants with a home-delivered questionnaire at 8 months of age. The genetic influence of CACNA1C variants on sleep in infants was examined by using PLINK software. Three of the examined CACNA1C variants, rs4765913, rs4765914, and rs2239063, were associated with sleep latency (permuted P<0.05). There was no significant association between studied variants and night awakenings or sleep duration. CACNA1C variants for psychiatric disorders were found to be associated with long sleep latency among 8-month-old infants. It remains to be clarified whether the findings refer to defective regulation of sleep, or to distractibility of sleep under external influences.
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Affiliation(s)
- Katri Kantojärvi
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Johanna Liuhanen
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | | | - Anna-Liisa Satomaa
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland
| | - Anneli Kylliäinen
- School of Social Sciences and Humanities/Psychology, University of Tampere, Tampere, Finland
| | - Pirjo Pölkki
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| | - Julia Jaatela
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Auli Toivola
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Lili Milani
- The Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Sari-Leena Himanen
- Department of Clinical Neurophysiology, Tampere University Hospital, Medical Imaging Centre and Hospital Pharmacy, Pirkanmaa Hospital District, Tampere, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | | | - Juulia Paavonen
- Child and Adolescent Mental Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Tiina Paunio
- Genomics and Biomarkers Unit, National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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Abstract
STUDY OBJECTIVES Insomnia is pervasive among people with serious mental illnesses (SMI) and has a profound negative impact on their psychiatric symptom management and recovery. However, little is known about the factors that affect severity of insomnia in those with SMI. In addition, very few studies have explored whether evidence-based interventions developed for those without SMI are appropriate for or applicable to individuals with SMI. The purpose of this study was to test the role of arousal, dysfunctional cognitions about sleep, and sleep-related behaviors in predicting severity of insomnia in a sample of 60 Veterans who were receiving care in Veterans Health Administration mental health and psychosocial rehabilitation programs and who reported subjective insomnia. In addition, information was collected regarding the types of insomnia treatments provided to these Veterans. METHODS Participants completed assessments of insomnia severity and sleep-related arousal, behaviors, and cognitions. Medical records were reviewed to determine whether participants had been screened/assessed for insomnia and whether treatments for insomnia were provided before the date of referral to the study. Multiple regression was used to predict insomnia severity on the basis of these factors. RESULTS Most participants (81.7%) reported moderate to severe insomnia, although only 3.3% had a diagnosis of insomnia in their medical records. Worry and helplessness about sleep were predictive of insomnia severity; better self-reported sleep hygiene and higher levels of arousal were also associated with greater severity of insomnia. Education about sleep hygiene and medication were the only types of insomnia treatment received. CONCLUSIONS Similar to insomnia among individuals without SMI, insomnia in Veterans with SMI is associated with dysfunctional sleep-related behaviors and cognitions. Many of the Veterans also lacked access to settings and resources conducive to healthy sleep. Veterans with SMI should be regularly assessed for insomnia. Research is needed concerning optimal evidence-based insomnia interventions for addressing behaviors and cognitions in this population in the context of these challenges.
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Rodriguez ML, Messer LS. Patterns of Bedtime Preparation for In-patients with Schizophrenia: A Pilot Study. Arch Psychiatr Nurs 2017; 31:231-232. [PMID: 28359438 DOI: 10.1016/j.apnu.2016.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/16/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Mercedes L Rodriguez
- Jackson Health System, 1500 N.W. 12th Avenue, Suite 715A, Miami, Florida, 33138, United States.
| | - Linda S Messer
- Jackson Health System, 1500 N.W. 12th Avenue, Suite 715A, Miami, Florida, 33138, United States
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The Relationship between Body Weight Change and Body Constitutions of Traditional Chinese Medicine in Patients with Schizophrenia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:9585968. [PMID: 27818703 PMCID: PMC5081436 DOI: 10.1155/2016/9585968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/16/2016] [Accepted: 09/21/2016] [Indexed: 01/09/2023]
Abstract
Objective. To explore the relationship between body constitution (BC) types and weight change in patients with schizophrenia and who underwent second-generation antipsychotics (SGAs) treatment. Method. Body weight and waist circumference of eighty-five participants were measured for 6 consecutive weeks. Constitutions of Yin-Xu, Yang-Xu, and Stasis were assessed using the Body Constitution Questionnaire (BCQ). Results. Participants with body constitutions Yin-Xu (50.6%), Yang-Xu (49.4%), or Stasis (38.8%) exhibited worse physical condition and unhealthy daily habits, particularly in Stasis constitution. Moreover, Stasis constitution was significantly associated with several factors, including BMI, body weight, waist circumference, perception of stress, perception of health, staying up late, and less physical exercise. However, perception of stress showed significant difference in Yin-Xu, Yang-Xu, and Stasis. Generalized estimating equation (GEE) analysis revealed that significant time effects in body weight increase in the imbalanced BC types and gentleness BC type. SGAs induced weight gain in imbalanced BC type as well as gentleness BC type, especially treated with olanzapine. Conclusions. This is the first study to explore the longitudinal relationship between BC and weight gain in schizophrenia patients undergoing SGAs treatment. Health care providers should focus on weight gain problems in schizophrenia patients who underwent SGAs treatment.
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Pinacho R, Villalmanzo N, Meana JJ, Ferrer I, Berengueras A, Haro JM, Villén J, Ramos B. Altered CSNK1E, FABP4 and NEFH protein levels in the dorsolateral prefrontal cortex in schizophrenia. Schizophr Res 2016; 177:88-97. [PMID: 27236410 DOI: 10.1016/j.schres.2016.04.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 03/15/2016] [Accepted: 04/27/2016] [Indexed: 11/28/2022]
Abstract
Schizophrenia constitutes a complex disease. Negative and cognitive symptoms are enduring and debilitating components of the disorder, highly associated to disability and burden. Disrupted neurotransmission circuits in dorsolateral prefrontal cortex (DLPFC) have been related to these symptoms. To identify candidates altered in schizophrenia, we performed a pilot proteomic analysis on postmortem human DLPFC tissue from patients with schizophrenia (n=4) and control (n=4) subjects in a pool design using differential isotope peptide labelling followed by liquid chromatography tandem mass spectrometry (LC-MS/MS). We quantified 1315 proteins with two or more unique peptides, 116 of which showed altered changes. Of these altered proteins, we selected four with potential roles on cell signaling, neuronal development and synapse functioning for further validation: casein kinase I isoform epsilon (CSNK1E), fatty acid-binding protein 4 (FABP4), neurofilament triplet H protein (NEFH), and retinal dehydrogenase 1 (ALDH1A1). Immunoblot validation confirmed our proteomic findings of these proteins being decreased in abundance in the schizophrenia samples. Additionally, we conducted immunoblot validation of these candidates on an independent sample cohort comprising 23 patients with chronic schizophrenia and 23 matched controls. In this second cohort, CSNK1E, FABP4 and NEFH were reduced in the schizophrenia group while ALDH1A1 did not significantly change. This study provides evidence indicating these proteins are decreased in schizophrenia: CSNK1E, involved in circadian molecular clock signaling, FABP4 with possible implication in synapse functioning, and NEFH, important for cytoarchitecture organization. Hence, these findings suggest the possible implication of these proteins in the cognitive and/or negative symptoms in schizophrenia.
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Affiliation(s)
- Raquel Pinacho
- Unitat de recerca, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Universitat de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM. Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830 Barcelona, Spain
| | - Núria Villalmanzo
- Unitat de recerca, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Universitat de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM. Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830 Barcelona, Spain
| | - J Javier Meana
- Departamento de Farmacología, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Instituto BioCruces, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Bº Sarriena s/n, 48940 Leioa, Bizkaia, Spain
| | - Isidre Ferrer
- Instituto de Neuropatología, IDIBELL-Hospital Universitari de Bellvitge, Universitat de Barcelona, Centro de Investigación Biomédica en Red para enfermedades neurodegenerativas, CIBERNED, Feixa Llarga s/n, Hospitalet de LLobregat, 08907 Barcelona, Spain
| | - Adriana Berengueras
- Banc de Teixits Neurologics, Parc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830 Barcelona, Spain
| | - Josep M Haro
- Unitat de recerca, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Universitat de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM. Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830 Barcelona, Spain
| | - Judit Villén
- Genome Sciences Department, School of Medicine, University of Washington, 3720 15th Ave NE, Seattle 98195, WA, USA
| | - Belén Ramos
- Unitat de recerca, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Universitat de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM. Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830 Barcelona, Spain.
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Müller MJ, Olschinski C, Kundermann B, Cabanel N. Subjective sleep quality and sleep duration of patients in a psychiatric hospital. ACTA ACUST UNITED AC 2016; 9:202-206. [PMID: 28123661 PMCID: PMC5241614 DOI: 10.1016/j.slsci.2016.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 08/13/2016] [Accepted: 08/29/2016] [Indexed: 01/24/2023]
Abstract
Sleep complaints and sleep disturbances are highly prevalent in patients with psychiatric disorders. During hospitalization the patients’ condition may be even worse but little is known about the subjective sleep quality in psychiatric hospitals. Thus, we have investigated subjective sleep quality and mean sleep duration in patients with different psychiatric disorders at the end of hospitalization. For a period of one year, inpatients of a psychiatric hospital with diagnosis of substance use disorder (SUD), schizophrenia (SCZ), or anxiety/depressive disorders (AND) were routinely asked to fill in an easily comprehensible sleep quality questionnaire at the end of their hospitalization. Age, gender, subjective sleep quality, and sleep duration were analyzed; sleep duration was classified according to age-specific recommendations. Data of n=309 patients (age 52.1±17.9y, 56.1% women) were analyzed (n=63 SUD, n=50 SCZ, n=196 AND). Mean sleep duration was 7.0±2.0 h; 20.7% of patients had sleep durations below and 4.5% above age-specific recommendations. Non-restorative sleep during hospitalization was reported “almost always” in 38.2% (n=118), and “occasionally” in 30.1% (n=93). Subjective sleep quality was significantly associated with sleep duration (rs=−0.31, P<0.0005), but not with age, gender or diagnostic subgroup. The study showed that a great proportion of patients reported poor subjective sleep quality during hospitalization, regardless of age, gender and psychiatric diagnosis. As sleep quality was significantly associated with short sleep duration, a first step could be to take care to achieve recommended age-specific sleep durations in psychiatric hospitals.
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Affiliation(s)
- Matthias J Müller
- Vitos Clinical Centre for Psychiatry and Psychotherapy Giessen-Marburg, Germany; Justus-Liebig University of Giessen, Giessen, Germany
| | | | - Bernd Kundermann
- Vitos Clinical Centre for Psychiatry and Psychotherapy Giessen-Marburg, Germany
| | - Nicole Cabanel
- Vitos Clinical Centre for Psychiatry and Psychotherapy Giessen-Marburg, Germany
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