Relationship between Personality and Insomnia in Panic Disorder Patients

Personality and insomnia: A systematic review and narrative synthesis

The inherent nature of personality serves as a predisposing, and possible maintaining, factor of insomnia. However, methodological differences limit the ability to draw causal conclusions regarding the specific traits involved in the aetiology of the disorder. This systematic review of the relationship between insomnia and personality provides a narrative synthesis of the literature to date. Here, we identified N = 76 studies meeting the inclusion/exclusion criteria. The outcomes reliably evidenced the experience of insomnia to be associated with personality traits that are typically considered to be negative or maladaptive in nature. More specifically, insomnia was related to neuroticism, introversion, perfectionistic doubts and concerns, elevated personal standards, negative affect, social inhibition and avoidance, hysteria, hypochondriasis, psychasthenia, impulsive behaviour, anger, hostility, and psychopathic tendencies, schizotypal and borderline traits, reduced conscientiousness and self-directedness, and negatively perceived perception of the self. Several studies examined the role that personality plays in predicting the treatment efficacy and adherence of CBTi. Moving forward, longitudinal research, methodological consistency, the mediating role of treatment outcomes and adherence, and clinical and population representative samples should be prioritised. Methodological strengths and limitations of the literature are discussed alongside the next steps that should be taken to advance our understanding of the literature.

Effect of Personality Type on the Occurrence of Temporomandibular Disorders-A Cross-Sectional Study

BACKGROUND

Personality traits are one of the major factors influencing the behavior and functioning of an individual, and they play a crucial role in the development of psychosomatic disorders and diseases. This paper aimed to evaluate the importance of personality traits in temporomandibular disorder (TMDs) development using the NEO-FFI Personality Inventory by Paul Costa and Robert McCrae (the Five-Factor Model of Personality, known as the Big Five). Moreover, the relationship between personality type and the intensity of dysfunctional changes in the stomatognathic system was assessed using the NEO-FFI Personality Inventory by Paul Costa and Robert McCrae (the Five-Factor Model of Personality, known as the Big Five).

MATERIAL AND METHODS

The study included a group of 75 adult participants (aged 19-52) with TMD diagnosed according to DC/TMD criteria and a control group of 75 participants without symptoms of dysfunction. The study consisted of a questionnaire and clinical study; the questionnaire included the NEO-FFI psychological questionnaire and a self-authored one. The clinical part consisted of extra- and intraoral dental examinations.

RESULTS

Participants who clenched their teeth showed a greater degree of conscientiousness than those who did not exhibit this symptom (p = 0.048). Presence of headaches was correlated with greater severity of neuroticism (p = 0.001). Moreover, participants with enamel cracks showed a lower intensity of extraversion (p = 0.039), and those with worn hard dental tissues showed a higher intensity of neuroticism (p = 0.03), a lower intensity of conscientiousness (p = 0.01), and a lower intensity of extroversion (p = 0.046). Acoustic symptoms during mandibular movements were found to be linked with a higher level of neuroticism (p = 0.020), a lower level of extraversion (p = 0.035), and a lower level of conscientiousness, whereas pain upon mandibular movements were linked to a lower level of conscientiousness (p = 0.025). Participants with pain upon palpation of the masticatory muscles showed a lower level of conscientiousness (p = 0.01) compared to those without pain symptoms. Episodes of mandibular blockage or problems with its adduction depend on the intensity of conscientiousness (p = 0.007). Moreover, people from the study group with high levels of neuroticism showed lower protrusion values (p = 0.016).

CONCLUSION

The intensity of individual personality traits was found to be associated with some TMDs in comparison to healthy controls.

Bilateral repetitive transcranial magnetic stimulation ameliorated sleep disorder and hypothalamic-pituitary-adrenal axis dysfunction in subjects with major depression

OBJECTIVE

In this study, we sought to explore the effectiveness of bilateral repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) on depressive symptoms and dysfunction of hypothalamic-pituitary-adrenal (HPA) axis in patients with major depressive disorder (MDD).

MATERIALS AND METHODS

One hundred and thirty-six adults with MDD were administrated drugs combined with 3 weeks of active rTMS (n = 68) or sham (n = 68) treatment. The 17-item Hamilton Depression Rating Scale for Depression (HAMD-17) was to elevate depression severity at baseline and weeks 4. To test the influence of rTMS on the HPA axis, plasma adrenocorticotropic hormone (ACTH) and serum cortisol (COR) were detected in pre- and post-treatment.

RESULTS

No statistical significance was found for the baseline of sociodemographic, characteristics of depression, and psychopharmaceutical dosages between sham and rTMS groups (p > 0.05). There was a significant difference in the HAMD-17 total score between the two groups at end of 4 weeks after treatment (p < 0.05). Compared to the sham group, the rTMS group demonstrated a more significant score reduction of HAMD-17 and sleep disorder factor (HAMD-SLD) including sleep onset latency, middle awakening, and early awakening items at end of 4-week after treatment (p < 0.05). Furthermore, total score reduction of HAMD-17 was correlated with a decrease in plasma ACTH, not in COR, by rTMS stimulation (p < 0.05).

CONCLUSION

Bilateral rTMS for 3 weeks palliated depression via improvement of sleep disorder, and plasma ACTH is a predictor for the efficacy of rTMS, especially in male patients with MDD.

A Way to Increase the Sensitivity and Specificity of the Hamilton Depression and Anxiety Scales

Objective

The Hamilton Depression Rating Scale (HDRS-17) and the Hamilton Anxiety Rating Scale (HARS-14) have been acknowledged as gold standards in evaluating the severity of depression and anxiety. The specificity and sensitivity of these scales in predicting somatic complaints of depression and anxiety are issues in both clinical and research areas. The present study proposes a new model to enhance the sensitivity and specificity of HDRS-17 and HARS-14 for predicting symptoms of insomnia, inappetence, and loss of libido in psychiatric patients.

Methods

This study included 1507 patients diagnosed withbipolar disorder, depression, panic disorder, obsessive-compulsive disorder, and generalized anxiety disorder. The HDRS-17 and the HARS-14 were utilized as predictive scales for the prediction of patients' sleep, appetite, and libido. The sensitivity and specificity were computed using the receiver operating characteristic (ROC). Logistic regression was performed to enhance the predictive values. The predictive value of the logistic regression model was not satisfactory, and a conversion table was therefore designed for each symptom-diagnosis subgroup. The new joint ROC model was then used to recalculate the sensitivity and specificity of the 2 scales for each symptom-diagnosis subgroup. The outcome is a prediction table, presented for use by clinicians.

Results

It was observed that the new statistical model, the joint ROC, increased the sensitivity and specificity of the HDRS-17 and the HARS-14.

Conclusion

: Based on the results of the evaluations with the HDRS and the HARS, the joint ROC method was developed to better predict the presence of symptoms.

Relationship between Personality and Biological Reactivity to Stress: A Review

Objective Personality traits can be the basis for individual differences in the biological response of stress. To date, many psychobiological studies have been conducted to clarify the relationship between personality and biological reactivity to stress. This review summarizes the most important findings in this area of research. Results Key findings related to the relationship between personality factors and stress-sensitive biological systems in four research models have been summarized; model of psychosocial characteristics, model based on Rumination and Emotional Inhibition, Eysenck's biopsychological model, and Five-Factor Approach of Personality. Conclusion According to the results of this review, it can be concluded that personality typology of individuals influenced their biological reactivity to stressful events. Understanding the biological basis of personality can help to better understand vulnerability to stress. Future research can be continuing based on framework of the four models.

Temperament characteristics in patients with panic disorder and their first-degree relatives

AIM

Panic disorder is one of the highly heritable anxiety disorders; and temperament characteristics are considered predicting liability to panic disorder. Accumulating evidence suggests temperament characteristics are intermediate phenotypes for clinical conditions. Given this background, we aimed to investigate temperament characteristics in patients with panic disorder, their first-degree relatives, and healthy controls.

METHOD

Study sample consisted of 60 patients with panic disorder, 37 first-degree relatives of these patients, and 37 age, gender, and education level matched healthy controls (HC). SCID-I, the Panic Agoraphobia Scale, and the State and Trait Anxiety Inventory were applied to assess clinical characteristics of the patient group. Temperament characteristics were assessed using the Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionnaire (TEMPS-A).

RESULTS

Anxious, depressive, cyclothymic, and irritable temperament scores of patients were higher than those of HC. There was no difference between the patients and the relatives, with the exception of higher anxious temperament scores in patients.

CONCLUSION

Overall, our findings suggest that anxious temperament characteristic might be a trait marker for liability to panic disorder. Further research with a prospective design in a larger sample is required to confirm our findings.

Association between morningness-eveningness and temperament and character in community-dwelling Korean adults

INTRODUCTION

Previous studies have reported an association between biogenetic temperament/character and circadian preference in Spanish or French college students. Our aim is to investigate the association between temperament/character and circadian preference in psychiatrically healthy, community-dwelling Korean adults of a wide age range.

METHODS

Subjects free of Axis I disorders (n = 342) completed the Morningness-Eveningness Questionnaire and the Temperament and Character Inventory.

RESULTS

High Novelty Seeking and low Self-Directedness was associated with eveningness. In contrast to prior studies on college students, eveningness was associated with high (not low) Harm Avoidance. Eveningness-Novelty Seeking association and Eveningness-Harm Avoidance association were prominent in females. Eveningness-Novelty Seeking was prominent in the older group (age ≥40), while Eveningness-Harm Avoidance was prominent in the younger group (age ≤40).

DISCUSSION

Despite the limitation of the small sample size, the present study suggests that eveningness is associated with high Novelty Seeking/Harm Avoidance and low Self-Directedness in community-dwelling adults, and that this association may be related to age, gender, and other sociocultural factors.

Total sleep deprivation decreases flow experience and mood status

BACKGROUND

The purpose of this study was to examine the effect of sleep deprivation on flow experience.

METHODS

Sixteen healthy male volunteers of mean age 21.4±1.59 (21-24) years participated in two experimental conditions, ie, sleep-deprivation and normal sleep. In the sleep-deprived condition, participants stayed awake at home for 36 hours (from 8 am until 10 pm the next day) beginning on the day prior to an experimental day. In both conditions, participants carried out a simple reaction time (psychomotor vigilance) task and responded to a questionnaire measuring flow experience and mood status.

RESULTS

Flow experience was reduced after one night of total sleep deprivation. Sleep loss also decreased positive mood, increased negative mood, and decreased psychomotor performance.

CONCLUSION

Sleep deprivation has a strong impact on mental and behavioral states associated with the maintenance of flow, namely subjective well-being.

Prevalence and Clinical Correlates of Insomnia in Depressive Disorders: The CRESCEND Study

OBJECTIVE

To investigate the prevalence, clinical manifestations, and clinical correlates of insomnia in a large cohort of Korean patients with depressive disorders.

METHODS

We recruited 944 patients with depressive disorders from the Clinical Research Center for Depression of South Korea (CRESCEND) study. Psychometric scales were used to assess depression (HAMD), anxiety (HAMA), psychotic symptoms (BPRS), global severity (CGI-S), and functioning (SOFAS). Insomnia levels were determined by adding the scores for all items on the HAMD insomnia subscale. The clinical characteristics of the patients with 'low insomnia' (summed score ≤3 on the HAMD subscale) and 'high insomnia' (score ≥4) were compared using statistical analyses. A logistic regression model was constructed to identify factors associated with 'high insomnia' status.

RESULTS

Symptoms of insomnia were present in 93% of patients, while simultaneous early, middle, and late insomnia affected 64.1%. The high insomnia patients were characterized by significantly greater age, higher symptom levels (including core, gastrointestinal somatic and anxiety symptoms, and suicidal ideation), higher global severity and incidence of physical disorders, and greater insight. Explanatory factors of 'high insomnia' status were older age, higher gastrointestinal somatic and anxiety symptom levels, higher global severity, and greater insight.

CONCLUSION

In clinical psychiatry, insomnia has been significantly underdiagnosed and undertreated. It affects most patients with depressive disorders, and is indicative of the global severity of depression. Active efforts to diagnose and treat insomnia in patients with depressive disorders should be strongly encouraged. Further research is needed to improve the diagnosis and treatment of insomnia in depressive patients.

Biogenetic temperament and character in insomnia and depression

OBJECTIVE

We compared the biogenetic temperaments and characters of primary insomnia patients, major depressive disorder (MDD) patients with insomnia, MDD patients without insomnia, and normal controls.

METHODS

A total of 417 participants were recruited from a community and a psychiatric clinic in South Korea. Subjects were divided into 4 groups based on the Structured Clinical Interview for DSM-IV axis I disorder (SCID-IV) and sleep questionnaire: 1) normal controls (n=314), 2) primary insomnia (n=33), 3) MDD without insomnia (n=30), and 4) MDD with insomnia (n=40). All participants were requested to complete the Temperament and Character Inventory.

RESULTS

There were significant between-group differences in harm avoidance (HA)(F=32.96, p<0.001), reward dependence (RD)(F=5.21, p<0.01), self-directedness (SD)(F=24.72, p<0.001) and cooperativeness (CO)(F=15.75, p<0.001), after controlling for age and gender. Subjects with primary insomnia showed higher HA and lower SD than normal control, but lower HA and higher SD than MDD patients with insomnia. CO was lower in MDD patients, but not in subjects with primary insomnia. Lower RD was found only in MDD patients with insomnia.

CONCLUSION

The current study suggests that high HA and low SD were related to primary insomnia, although these patterns were more prominent in patients with MDD.